Individual- and contextual-level factors associated with client-initiated HIV testing

Predictors of never testing for HIV among sexually active individuals aged 15-56 years in Rwanda

Human Immunodeficiency Virus (HIV) testing services are known as the primary step in preventing the spread of HIV. However, access to these crucial services varies across regions within continents due to disparities in healthcare infrastructure, resources, and awareness. Approximately one in every five people living with HIV (PLWH) encounters obstacles in accessing HIV testing, notably in Eastern and Southern Africa, where geographical, resource, awareness, and infrastructure limitations prevail. Consequently, HIV remains a significant public health concern in these regions, necessitating expanded testing efforts to combat the HIV/AIDS disaster. Despite these challenges, there is a lack of scientific evidence on the prevalence of HIV testing and its determining factors in Rwanda. This study determined the prevalence of never being tested for HIV and its associated factors among sexually active individuals aged 15-56 who participated in the Rwanda AIDS Indicators and HIV Incidence Survey (RAIHIS). This cross-sectional study enrolled 1846 participants. The variables were extracted from the RAIHIS dataset and statistically analyzed using STATA software version 13. Bivariate and multivariate logistic regression models were employed to identify predictors of never having undergone HIV testing, with a 95% confidence interval and a 5% statistical significance level applied. The prevalence of non-testing for HIV was 17.37%. Being aged 15-30 years (aOR 2.57, 95%CI 1.49-4.43, p < 0.001) and male (aOR 2.44, 95%CI 1.77-3.36, p < 0.001) was associated with an increase in the odds of never testing for HIV. Further, those from urban area were less likely than those living in rural areas to have never tested for HIV (aOR 0.31; 95% CI 0.38-0.67; p < 0.001). Participants who were not aware of HIV test facilitates were more likely to have never undergone HIV testing (aOR 1.75; 95% CI 1.25-2.47; p = 0.031) than their counterparts. While the prevalence of HIV non-testing remains modest, the significance of youth, male gender, lack of awareness, and rural residence as influential factors prompts a call for inventive strategies to tackle the reasons behind never having undergone HIV testing. Further exploration using mixed methodologies is advocated to better comprehend socio-cultural impacts and causation relating to these identified factors.

Adolescents in situations of poverty: resilience and vulnerabilities to sexually transmitted infections

OBJECTIVE

To analyze the association between vulnerabilities to Sexually Transmitted Infections (STIs/HIV/AIDS) of adolescents in poverty and their level of resilience.

METHOD

Cross-sectional study with 287 students between 11 and 17 years old in a school in the outskirts of Fortaleza-Ce. The study was conducted from August to October 2016. Three instruments related to characterization, vulnerability to STIs/HIV/AIDS and resilience were used. The association between the instruments was calculated using the Mann-Whitney and Kruskal-Wallis tests. Association between vulnerability to STIs/HIV/AIDS and resilience was assessed through the Spearman's correlation coefficient. Statistical significance was set at p<0.05.

RESULTS

There was a significant association between the factors "housing" (p=0.022), "family income" (p=0.037) and vulnerability to STIs/HIV/AIDS. Adolescents whose father has completed high school (p=0.043) have moderately high resilience.

CONCLUSION

Adolescents with low socioeconomic status and who live on less than a minimum wage tends to be more susceptible to vulnerabilities to STIs/HIV/AIDS and to have low resilience.

HIV Care Continuum from diagnosis in a Counseling and Testing Center

OBJECTIVE

To analyze the HIV care continuum from the diagnosis in an HIV/AIDS Counseling and Testing Center (CTC), and the sociodemographic, clinical, and laboratory characteristics related to gender.

METHOD

Epidemiological study, conducted with data of individuals assisted at a Counseling and Testing Center, and followed in an outpatient clinic for HIV/AIDS. Pearson's Chi-square test and binary logistic regression were used to obtain odds ratios, considering alpha value <0.05.

RESULTS

The prevalence of HIV among 5,229 users was 5%. The highest chance of positive results was among men, aged 14 to 33 years old, who were not in a domestic partnership. In the analysis of TCD4+ lymphocytes and viral load (VL) of 238 cases, 56.1% had a late diagnosis. We have identified gaps in the care cascade, especially linkage to the care, retention in care, and viral load suppression.

CONCLUSION

The results suggest a late diagnosis for both genders, as well as difficulty in reaching the viral suppression goal.

"It is always better for a man to know his HIV status" - A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya

HIV testing services are an important component of HIV program and provide an entry point for clinical care for persons newly diagnosed with HIV. Although uptake of HIV testing has increased in Kenya, men are still less likely than women to get tested and access services. There is, however, limited understanding of the context, barriers and facilitators of HIV testing among men in the country. Data are from in-depth interviews with 30 men living with HIV and 8 HIV testing counsellors that were conducted to gain insights on motivations and drivers for HIV testing among men in the city of Nairobi. Men were identified retroactively by examining clinical CD4 registers on early and late diagnosis (e.g. CD4 of ≥500 cells/mm, early diagnosis and <500 cells/mm, late diagnosis). Analysis involved identifying broad themes and generating descriptive codes and categories. Timing for early testing is linked with strong social support systems and agency to test, while cost of testing, choice of facility to test and weak social support systems (especially poor inter-partner relations) resulted in late testing. Minimal discussions occurred prior to testing and whenever there was dialogue it happened with partners or other close relatives. Interrelated barriers at individual, health-care system, and interpersonal levels hindered access to testing services. Specifically, barriers to testing included perceived providers attitudes, facility location and set up, wait time/inconvenient clinic times, low perception of risk, limited HIV knowled ge, stigma, discrimination and fear of having a test. High risk perception, severe illness, awareness of partner's status, confidentiality, quality of services and supplies, flexible/extended opening hours, and pre-and post-test counselling were facilitators. Experiences between early and late testers overlapped though there were minor differences. In order to achieve the desired impact nationally and to attain the 90-90-90 targets, multiple interventions addressing both barriers and facilitators to testing are needed to increase uptake of testing and to link the positive to care.