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Chen S, Fang Y, Chan PSF, Kawuki J, Mo P, Wang Z. Counseling Supporting HIV Self-Testing and Linkage to Care Among Men Who Have Sex With Men: Systematic Review and Meta-Analysis. JMIR Public Health Surveill 2024; 10:e45647. [PMID: 38265866 PMCID: PMC10851126 DOI: 10.2196/45647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 10/06/2023] [Accepted: 12/14/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Counseling supporting HIV self-testing (HIVST) is helpful in facilitating linkage to care and promoting behavior changes among men who have sex with men (MSM). Different levels of counseling support for MSM HIVST users may lead to variance in the linkage to care. OBJECTIVE This study aims to synthesize evidence on counseling supporting MSM HIVST users and to conduct a meta-analysis to quantify the proportion of MSM HIVST users who were linked to care. METHODS A systematic search was conducted using predefined eligibility criteria and relevant keywords to retrieve studies from the MEDLINE, Global Health, Web of Science, Embase, APA PsycINFO, and Scopus databases. This search encompassed papers and preprints published between July 3, 2012, and June 30, 2022. Studies were eligible if they reported counseling supporting HIVST or quantitative outcomes for linkage to care among MSM and were published in English. The screening process and data extraction followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The quality of the included studies was assessed by the National Institutes of Health quality assessment tool. Data were extracted using random effects models to combine the proportion of HIVST users who were linked to care. Subgroup analyses and metaregression were conducted to assess whether linkage to care varied according to study characteristics. All analyses were performed with R (version 4.2.1; R Foundation for Statistical Computing) using the metafor package. RESULTS A total of 55 studies published between 2014 and 2021, including 43 observational studies and 12 randomized controlled trials, were identified. Among these studies, 50 (91%) provided active counseling support and 5 (9%) provided passive counseling support. In studies providing active counseling support, most MSM HIVST users were linked to various forms of care, including reporting test results (97.2%, 95% CI 74.3%-99.8%), laboratory confirmation (92.6%, 95% CI 86.1%-96.2%), antiretroviral therapy initiation (90.8%, 95% CI 86.7%-93.7%), and referral to physicians (96.3%, 95% CI 85%-99.2%). In studies providing passive counseling support, fewer MSM HIVST users were linked to laboratory confirmation (78.7%, 95% CI 17.8%-98.4%), antiretroviral therapy initiation (79.1%, 95% CI 48.8%-93.7%), and referral to physicians (79.1%, 95% CI 0%-100%). Multivariate metaregression indicated that a higher number of essential counseling components, a smaller sample size (<300), and the use of mobile health technology to deliver counseling support were associated with better linkage to care. The quality of the studies varied from fair to good with a low to high risk of bias. CONCLUSIONS Proactively providing counseling support for all users, involving a higher number of essential components in the counseling support, and using mobile health technology could increase the linkage to care among MSM HIVST users. TRIAL REGISTRATION PROSPERO CRD42022346247; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346247.
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Affiliation(s)
- Siyu Chen
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Paul Shing-Fong Chan
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Joseph Kawuki
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Phoenix Mo
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Zixin Wang
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
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Robles G, Lee JJ, Reynolds A, Rodríguez-Díaz CE, Rendina HJ. Reactions to Testing HIV Negative: An Assessment of Measurement Invariance and Associations with Condomless Anal Sex among English and Spanish-speaking Latinx Sexual Minority Men in the United States. AIDS Behav 2023; 27:3661-3668. [PMID: 37195473 PMCID: PMC10777537 DOI: 10.1007/s10461-023-04081-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 05/18/2023]
Abstract
Among the many effective prevention strategies, frequent HIV testing continues to be promoted to reduce the risk of HIV transmission among sexual minority men (SMM). Testing negative for HIV can result in varied reactions that influence subsequent HIV transmission behaviors, yet the extant research has primarily been conducted in English. The current study examined measurement invariance of a Spanish-translated Inventory of Reactions to Testing HIV Negative (IRTHN). The study also examined whether the IRTHN was associated with subsequent condomless anal sex. Data were drawn from 2,170 Latinx SMM subsample of the UNITE Cohort Study. We conducted a multigroup confirmatory factor analysis to test for measurement invariance between participants who opted to take the survey in English (n = 2,024) and those who opted to take it in Spanish (n = 128). We also examined if the IRTHN is associated with subsequent CAS. The results were suggestive of partial invariance. The subscales of Luck and Invulernability were associated with CAS at the 12-month follow-up. Practice and research-based implications are discussed.
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Affiliation(s)
- Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, NJ, USA.
| | - Jane J Lee
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Addam Reynolds
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Carlos E Rodríguez-Díaz
- The George Washington University-Milken Institute School of Public Health, Washington, DC, USA
| | - H Jonathon Rendina
- The George Washington University-Milken Institute School of Public Health, Washington, DC, USA
- Whitman-Walker Institute, Washington, DC, USA
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Schnall R, Liu J, Kuhns LM, Pearson C, Scott Batey D, Bruce J, Radix A, Belkind U, Hidalgo MA, Hirshfield S, Ganzhorn S, Garofalo R. A feasibility study of the use of HIV self-tests in young men who have sex with men. AIDS Care 2023; 35:1279-1284. [PMID: 36608217 PMCID: PMC11177622 DOI: 10.1080/09540121.2022.2160864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
Studies on HIV self-testing (HIV-ST) have been limited to adults (age 18+). The study assessed use of HIV-ST among a diverse group of young men who have sex with men (YMSM) in the United States (US) and assessed differences in uptake by demographic characteristics and requirements for parental consent. This study demonstrated feasibility of HIV-ST for YMSM as young as 14 years of age, which suggests potential for increasing HIV testing in this young age group and promoting health equity.
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Affiliation(s)
- Rebecca Schnall
- School of Nursing, Columbia University, New York, NY, USA
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jianfang Liu
- School of Nursing, Columbia University, New York, NY, USA
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cynthia Pearson
- Indigenous Wellness Research Institute, School of Social Work, University of Washington, Seattle, Washington, USA
| | - D Scott Batey
- School of Social Work, Tulane University, New Orleans, LA, USA
| | - Josh Bruce
- Birmingham AIDS Outreach, Birmingham, Alabama, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Uri Belkind
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Marco A Hidalgo
- Division of General Internal Medicine and Health Services Research, Medicine Pediatrics Section, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sabina Hirshfield
- STAR Program, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Sarah Ganzhorn
- School of Nursing, Columbia University, New York, NY, USA
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Schünemann J, Strulik H, Trimborn T. Anticipation of deteriorating health and information avoidance. JOURNAL OF HEALTH ECONOMICS 2023; 89:102755. [PMID: 37004358 DOI: 10.1016/j.jhealeco.2023.102755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/15/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
We integrate anticipatory utility and endogenous beliefs about future negative health shocks into a life-cycle model of physiological aging. Individuals care about their future utility derived from their health status and form endogenous beliefs about the probability of a negative health shock. We calibrate the model with data from gerontology and use the model to predict medical testing decisions of individuals. We find that anticipation in combination with endogenous beliefs provides a quantitatively strong motive to avoid medical testing for Huntington's disease, which explains the low testing rates found empirically. We also study the case of breast and ovarian cancer and provide an explanation for why testing rates depend on the individual's income when treatment is available.
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Affiliation(s)
- Johannes Schünemann
- University of Fribourg, Department of Economics, Bd. de Perolles 90, 1700 Fribourg, Switzerland.
| | - Holger Strulik
- University of Goettingen, Department of Economics, Platz der Goettinger Sieben 3, 37073 Goettingen, Germany.
| | - Timo Trimborn
- Aarhus University, Department of Economics and Business Economics, Fuglesangs Allé 4, 8210 Aarhus V, Denmark.
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Costa AB, Viscardi LH, Feijo M, Fontanari AMV. HIV Voluntary Counseling and Testing (VCT-HIV) effectiveness for sexual risk-reduction among key populations: A systematic review and meta-analysis. EClinicalMedicine 2022; 52:101612. [PMID: 36034408 PMCID: PMC9399159 DOI: 10.1016/j.eclinm.2022.101612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND HIV disproportionately affects people who inject drugs, transgender people, sex workers, men who have sex with men, and incarcerated people. Recognized as key populations (KP), these groups face increased impact of HIV infection and reduced access to health assistance. In 1990, the Center for Disease Control and Prevention organized technical guidance on HIV Voluntary Counseling and Testing (VCT-HIV), with subsequent trials comparing intervention methodologies, no longer recommending this strategy. However, KP needs have not been explicitly considered. METHODS We assessed VCT-HIV effectiveness for sexual risk-reduction among KP (PROSPERO 2020 CRD42020088816). We searched Pubmed, EMBASE, Global Health, Scopus, PsycINFO, and Web of Science for peer-reviewed, controlled trials from February, 2020, to April, 2022. We screened the references list and contacted the main authors, extracted data through Covidence, applied the Cochrane Risk-of-Bias tool, and performed the meta-analysis using Review Manager. FINDINGS We identified 17 eligible trials, including 10,916 participants and evaluated HIV risk behaviors. When compared to baseline, VCT-HIV reduced unsafe sex frequency (Z=5.40; p<0.00001, I²=0%). INTERPRETATION While our meta-analysis identified VCT-HIV as protective for sexual risk behaviors for among KP, the results are limited to MSM and PWID, demonstrating the paucity of data on the other KP. Also, it highlights the importance of applying a clear VCT-HIV guideline as well as properly training the counselors. FUNDING Research funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ/MS-DIAHV N° 24/2019), and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.
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Affiliation(s)
- Angelo Brandelli Costa
- Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil
- Medicine Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucas Henriques Viscardi
- Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil
- Medicine Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Marina Feijo
- Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Anna Martha Vaitses Fontanari
- Psychology Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil
- Medicine Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil
- Correspondence to: Medicine and Health Sciences Graduate Program, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul 90619-900, Brazil.
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Diress G, Adane S, Linger M, Merchaw A, Mengist B. Individual and community-level determinates of risky sexual behaviors among sexually active unmarried men: A multilevel analysis of 2016 Ethiopian Demographic and Health Survey. PLoS One 2022; 17:e0270083. [PMID: 35862425 PMCID: PMC9302804 DOI: 10.1371/journal.pone.0270083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background In Ethiopia, HIV/AIDS continues to be a major public health problem mostly due to the high prevalence of risky sexual behaviors. However, research on risky sexual behavior and its determinants among unmarried men (never married, widowed, and divorced) who are highly vulnerable to risky sexual behavior was limited. Therefore, this study aimed to assess the magnitude of risky sexual behavior and its determinants among non-married men using a nationally representative sample. Methods The analysis was done on 5680 sexually active unmarried men aged 15–59 years using data from the 2016 Ethiopia Demographic Health Survey (EDHS). The main outcome variable was risky sexual behavior which defined as having at least one of the following: multiple sexual partners; initiation of sex before the age of 18 years; inconsistent condom use in the last 12 months; alcohol consumption at last sex. Multivariable generalized linear mixed-effects regression was employed to identify variables associated with risky sexual behavior. Result The overall magnitude of risky sexual behavior was 26.9% (95% CI; 25.7, 28.0). Currently employed (AOR = 2.49, 95% CI = 1.64–3.77), history of HIV testing (AOR = 2.51, 95% C = 1.95–3.23), drinking alcohol almost every day (AOR = 5.49, 95 CI = 2.73–11.02), and using Internet daily (AOR = 1.99, 95% CI = 1.06–3.74) increase the odds of risky sexual behavior. Whereas, primary education (AOR = 0.44, 95% CI = 0.32–0.61), secondary education level (AOR = 0.46, 95% CI = 0.29–0.72) and a high proportion of community-level media exposure (AOR = 0.42, 95% CI = 0.12–0.75) decrease the odds of risky sexual behavior. Conclusion In general, a significant proportion of sexually active unmarried men in Ethiopia have practiced risky sexual behavior. An intervention should be designed which are against the factors found to increase the odds of risky sexual behavior to reduce the incidence of HIV and other sexually transmitted infections.
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Affiliation(s)
- Gedefaw Diress
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Seteamlak Adane
- School of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Melese Linger
- Department of Human Nutrition, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Abebe Merchaw
- School of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Belayneh Mengist
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Johnson LF, Meyer-Rath G, Dorrington RE, Puren A, Seathlodi T, Zuma K, Feizzadeh A. The Effect of HIV Programs in South Africa on National HIV Incidence Trends, 2000-2019. J Acquir Immune Defic Syndr 2022; 90:115-123. [PMID: 35125471 DOI: 10.1097/qai.0000000000002927] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies have shown HIV incidence declines at a population level in several African countries. However, these studies have not directly quantified the extent to which incidence declines are attributable to different HIV programs. METHODS We calibrated a mathematical model of the South African HIV epidemic to age- and sex-specific data from antenatal surveys, household surveys, and death registration, using a Bayesian approach. The model was also parameterized using data on self-reported condom use, voluntary medical male circumcision (VMMC), HIV testing, and antiretroviral treatment (ART). Model estimates of HIV incidence were compared against the incidence rates that would have been expected had each program not been implemented. RESULTS The model estimated incidence in 15-49 year olds of 0.84% (95% CI: 0.75% to 0.96%) at the start of 2019. This represents a 62% reduction (95% CI: 55% to 66%) relative to 2000, a 47% reduction (95% CI: 42% to 51%) relative to 2010, and a 73% reduction (95% CI: 68% to 77%) relative to the incidence that would have been expected in 2019 in the absence of any interventions. The reduction in incidence in 2019 because of interventions was greatest for ART and condom promotion, with VMMC and behavior change after HIV testing having relatively modest impacts. HIV program impacts differed significantly by age and sex, with condoms and VMMC having greatest impact in youth, and overall incidence reductions being greater in men than in women. CONCLUSIONS HIV incidence in South Africa has declined substantially since 2000, with ART and condom promotion contributing most significantly to this decline.
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Affiliation(s)
- Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine University of Cape Town, Cape Town, South Africa
| | - Gesine Meyer-Rath
- Health Economics and Epidemiology Research Office, Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Rob E Dorrington
- Centre for Actuarial Research, School of Management Studies, University of Cape Town, Cape Town, South Africa
| | - Adrian Puren
- Division of Virology, School of Pathology, University of Witwatersrand, Johannesburg, South Africa
| | - Thapelo Seathlodi
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine University of Cape Town, Cape Town, South Africa
| | - Khangelani Zuma
- Human Sciences Research Council, Pretoria, South Africa ; and
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Gebremeskel AT, Omonaiye O, Yaya S. Sex differences in HIV testing among elders in Sub-Saharan Africa: a systematic review protocol. Syst Rev 2022; 11:95. [PMID: 35578357 PMCID: PMC9109370 DOI: 10.1186/s13643-022-01968-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elders (age 50+) HIV demographic (age and sex) data are essential to better understand their HIV service utilization and develop appropriate evidence-based responses and policies. Despite a significant prevalence rate of HIV and growing numbers of this population group, data are still scarce, and studies have neglected them in Sub-Saharan Africa. The aim of this protocol is to outline the methodological process of a systematic review that will gather qualitative and quantitative data to critically examine sex differences in HIV testing among elders (age 50+) in Sub-Saharan Africa. METHODS This protocol adheres to the PRISMA-P reporting guidelines. We will conduct a systematic database search to retrieve all observational and qualitative studies. Electronic search strategies will be developed for MEDLINE, EMBASE, Web of Science, Global Health, and CINAHL for studies reporting HIV data. Two reviewers will independently screen all citations, full-text articles, and abstract data. The search strategy will consist of free-text and Medical Subject Headings (MeSH) terms. Search terms for elders (50+) will include the following: "elders", "older adults", "aged", "geriatric" and "seniors". The primary outcome of interest is sex differences in the uptake of HIV counselling and testing (HCT). The study methodological quality (or bias) will be appraised using appropriate tools. Screening, data extraction, and assessments of risk of bias will be performed independently by two reviewers. Narrative synthesis will be conducted with studies that are compatible based on population and outcome. As it will be a systematic review, without human participants' involvement, there will be no requirement for ethical approval. DISCUSSION The systematic review will present key evidence on sex differences in HIV testing among elders in Sub-Saharan Africa. The findings will be used to inform program developers, policymakers, and other stakeholders to enhance sex disaggregated HIV data to improve access to HIV counselling and testing service for elders in Sub-Saharan Africa. The final manuscript will be disseminated through a peer-reviewed journal and scientific conferences. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42020172737 .
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Affiliation(s)
- Akalewold T Gebremeskel
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.,School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Olumuyiwa Omonaiye
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Burwood, Melbourne, Victoria, Australia.,Centre for Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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Hareru HE, Kaso AW, Ashuro Z, Mareg M. Risky sexual practice and associated factors among people living with HIV/AIDS receiving antiretroviral therapy in Ethiopia: Systematic review and meta-analysis. PLoS One 2022; 17:e0266884. [PMID: 35421163 PMCID: PMC9009662 DOI: 10.1371/journal.pone.0266884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background The risky sexual behavior of people living with HIV/AIDS (PLWHA) may impose a risk of transmitting the disease to their partners and increase Human Immunodeficiency Virus (HIV) co-infection. This systematic review and meta-analysis aimed to determine the pooled prevalence of risky sexual behavior and associated factors among PLWHA receiving [Antiretroviral Therapy (ART)] in Ethiopia. Methods To identify both published and unpublished research articles, systematic searches were performed in PubMed, HINARI, Medline, Science Direct, and Google Scholar databases. The review was carried out following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. Cross-sectional studies reporting the prevalence of risky sexual practice and its associated factors among PLWHA receiving ART in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format prepared in Microsoft Excel and exported to STATA version 14 statistical software for further analyses. The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of the studies. Since the included studies exhibited considerable heterogeneity, the random-effects meta-analysis model was computed to estimate the pooled prevalence of risky sexual practice which was determined by dividing the total number of PLWHA with risky sexual practice practices by the total number of PLWHA on ART in the study and multiplied by 100. Furthermore, pooled odds ratio (OR) with 95% confidence interval (CI) was determined for the association between determinant factors and risky sexual practice. Result In this study, 2351 articles were identified from different databases, and fifteen articles were selected for final systematic review and meta-analysis. In Ethiopia, the pooled prevalence of risky sexual practices was 43.56% (95% confidence interval (CI):35.51, 51.62). Discussion about safe sex with sexual partner/s [AOR = 0.26, 95% CI: 0.08, 0.92] and having multiple sexual partners [AOR = 1.90, 95% CI: 0.53, 6.84] were factors significantly associated with risky sexual practice in Ethiopia. Conclusion A significant proportion of respondents engaged in risky sexual practices. Multiple sexual partners and a lack of discussion about safe sex are linked to a higher prevalence of the risky sexual practice in Ethiopia. It is critical to raise awareness about safe sexual practices during health education and counselling services and to encourage clients to freely discuss safer sex practices with their sexual partner/s at their antiretroviral therapy (ART) appointments as part of their follow-up care. Protocol registration The protocol for this systematic review and meta-analysis was registered at PROSPERO (record ID = CRD42021274600, 25 September 2021).
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Affiliation(s)
- Habtamu Endashaw Hareru
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
- * E-mail:
| | - Abdene Weya Kaso
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Zemachu Ashuro
- Department of Environmental Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Moges Mareg
- Department of Reproductive Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
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Wilbourn B, Howard-Howell T, Castel A, D'Angelo L, Trexler C, Carr R, Greenberg D. Barriers and Facilitators to HIV Testing Among Adolescents and Young Adults in Washington, District of Columbia: Formative Research to Inform the Development of an mHealth Intervention. JMIR Form Res 2022; 6:e29196. [PMID: 35275083 PMCID: PMC8956991 DOI: 10.2196/29196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/20/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adolescents and young adults (AYA) in the United States, and in Washington, District of Columbia (DC), specifically, are disproportionately affected by HIV. Both the national Ending the HIV Epidemic initiative and DC-specific plans emphasize HIV testing, and innovative strategies to encourage testing among AYA are needed. OBJECTIVE The purpose of this study is to identify sexual behaviors, HIV knowledge, HIV perceptions (eg, susceptibility and severity), and perceived barriers and facilitators to HIV testing among AYA at risk for HIV in DC. METHODS This study was part of a larger study to determine the acceptability of using a life-and-dating simulation game to increase HIV testing among AYA. Focus groups and surveys stratified by self-reported sexual orientation were conducted among, and administered to, AYA aged 13-24 years in DC. HIV knowledge was explored during focus groups and measured using an adapted version of the Brief HIV Knowledge Questionnaire. Survey data were summarized using descriptive statistics and compared by self-reported sexual orientation. Transcripts were thematically analyzed. RESULTS Of the 46 AYA who participated in the focus groups, 30 (65%) identified as heterosexual and 16 (35%) as lesbian, gay, bisexual, transgender, or queer. A higher proportion of lesbian, gay, bisexual, transgender, or queer AYA reported sexual activity (12/16, 75%, vs 18/30, 60%), condomless sex (11/12, 92%, vs 15/18, 83%), and HIV testing (13/16, 81%, vs 17/29, 58%) than heterosexual AYA. HIV prevention ("condoms" and "...PrEP") and transmission ("exchange of fluids") knowledge was high, and most (34/44, 77%) of the AYA perceived HIV testing as beneficial. However, the AYA also demonstrated some misinformation concerning HIV: an average of 67% (31/46; SD 0.474) of the participants believed that an HIV test could deliver accurate results 1 week after a potential exposure and an average of 72% (33/46; SD 0.455) believed that an HIV vaccine exists. The AYA also identified individual ("...people...are scared"), interpersonal ("it's an awkward conversation"), and structural ("...people don't...know where they can go") barriers to testing. Most of the AYA indicated that they were very likely to use the demonstrated game prototype to help with getting tested for HIV (median 3.0, IQR 2.0-3.0, using a scale ranging from 0 to 3, with 3 indicating high likelihood) and strongly agreed that the game was interesting (median 5.0, IQR 5.0-5.0), fun (median 5.0, IQR 4.0-5.0), and easy to learn (median 5.0, IQR 5.0-5.0, using a scale ranging from 1 to 5, with 5 indicating strong agreement). CONCLUSIONS These results suggest a need for multilevel HIV testing interventions and informed the development of a mobile health intervention aiming to increase HIV knowledge and risk perception among AYA, while reducing barriers to testing at the individual and structural levels, supporting efforts to end the domestic HIV epidemic.
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Affiliation(s)
- Brittany Wilbourn
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | | | - Amanda Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | | | | | - Rashida Carr
- Children's National Hospital, Washington, DC, United States
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11
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Hsu KK, Rakhmanina NY. Adolescents and Young Adults: The Pediatrician's Role in HIV Testing and Pre- and Postexposure HIV Prophylaxis. Pediatrics 2022; 149:183848. [PMID: 34972226 PMCID: PMC9645702 DOI: 10.1542/peds.2021-055207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Most sexually active youth in the United States do not believe that they are at risk for contracting HIV and have never been tested. Creating safe environments that promote confidentiality and respect, obtaining an accurate sexual and reproductive health assessment, and providing nonstigmatizing risk counseling are key components of any youth encounters. Pediatricians can play a key role in preventing and controlling HIV infection by promoting risk-reduction counseling and offering routine HIV testing and prophylaxis to adolescent and young adult (youth) patients. In light of persistently high numbers of people living with HIV in the United States and documented missed opportunities for HIV testing, the Centers for Disease Control and Prevention and the US Preventive Services Task Force recommend universal and routine HIV screening among US populations, including youth. Recent advances in HIV diagnostics, treatment, and prevention help support this recommendation. This clinical report reviews epidemiological data and recommends that routine HIV screening be offered to all youth 15 years or older, at least once, in health care settings. After initial screening, youth at increased risk, including those who are sexually active, should be rescreened at least annually, and potentially as frequently as every 3 to 6 months if at high risk (male youth reporting male sexual contact, active injection drug users, transgender youth; youth having sexual partners who are HIV-infected, of both genders, or injection drug users; youth exchanging sex for drugs or money; or youth who have had a diagnosis of or have requested testing for other sexually transmitted infections). Youth at substantial risk for HIV acquisition should be routinely offered HIV preexposure prophylaxis, and HIV postexposure prophylaxis is also indicated after high-risk exposures. This clinical report also addresses consent, confidentiality, and coverage issues that pediatricians face in promoting routine HIV testing and HIV prophylaxis for their patients.
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Affiliation(s)
- Katherine K Hsu
- Division of STD Prevention and HIV/AIDS Surveillance, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts,Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, Massachusetts,Address correspondence to Katherine K. Hsu, MD, MPH, FAAP. E-mail:
| | - Natella Yurievna Rakhmanina
- Children’s National Hospital, School of Medicine and Health Sciences, The George Washington University, Washington, DC,Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC
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12
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Koris AL, Stewart KA, Ritchwood TD, Mususa D, Ncube G, Ferrand RA, McHugh G. Youth-friendly HIV self-testing: Acceptability of campus-based oral HIV self-testing among young adult students in Zimbabwe. PLoS One 2021; 16:e0253745. [PMID: 34185815 PMCID: PMC8241036 DOI: 10.1371/journal.pone.0253745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/12/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Targeted HIV testing strategies are needed to reach remaining undiagnosed people living with HIV and achieve the UNAIDS' 95-95-95 goals for 2030. HIV self-testing (HIVST) can increase uptake of HIV testing among young people, but user perspectives on novel distribution methods are uncertain. We assess the acceptability, perceived challenges, and recommendations of young adult lay counselor-led campus-based HIVST delivery among tertiary school students aged 18-24 years in Zimbabwe. METHODS We purposively sampled participants from an intervention involving campus-based HIVST using lay workers for distribution. We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) among young adults from 10 universities and colleges in Zimbabwe who: (1) self-tested on campus; (2) self-tested off campus; and (3) opted not to self-test. We audio recorded and transcribed all interviews. Using applied thematic analysis, two investigators identified emergent themes and independently coded transcripts, achieving high inter-coder agreement. RESULTS Of the 52 young adults (53.8% male, 46.1% female) interviewed through 26 IDIs and four FGDs, most IDI participants (19/26, 73%) favored campus-based HIVST, describing it as a more autonomous, convenient, and socially acceptable experience than other facility or community-based HIV testing services. Despite general acceptability, participants identified challenges with this delivery model, including: perceived social coercion, insufficient privacy and access to post-test counseling. These challenges influenced some participants to opt against self-testing (6/52, 11.5%). Recommendations for improved implementation included integrating secondary distribution of test kits and increased HIV counseling options into campus-based programs. CONCLUSIONS Barriers to HIV testing among young people are numerous and complex. As the number of new HIV infections among youth continue to grow worldwide, targeted strategies and youth friendly approaches that increase access to testing are needed to close the diagnostic coverage gap. This is the first study to describe young adult acceptance of campus-based delivery of HIVST by lay counselors in Zimbabwe.
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Affiliation(s)
- Andrea L. Koris
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Kearsley A. Stewart
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Tiarney D. Ritchwood
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Family Medicine and Community Health, Duke University, Durham, NC, United States of America
| | - Daniel Mususa
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Rashida A. Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
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13
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Schwartz KL, McGeer AJ, Bogoch II. Le dépistage des personnes asymptomatiques au moyen de tests antigéniques rapides: un outil de santé publique pour lutter contre la COVID-19. CMAJ 2021; 193:E888-E891. [PMID: 34099478 PMCID: PMC8203254 DOI: 10.1503/cmaj.210100-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Kevin L Schwartz
- Unity Health Toronto (Schwartz); Départements de médecine (Bogoch) et de médecine de laboratoire et pathobiologie (McGeer), et École de santé publique Dalla Lana (Schwartz, McGeer), Université de Toronto; Hôpital Mount Sinai (McGeer); Réseau universitaire de santé (Bogoch), Toronto, Ont.
| | - Allison J McGeer
- Unity Health Toronto (Schwartz); Départements de médecine (Bogoch) et de médecine de laboratoire et pathobiologie (McGeer), et École de santé publique Dalla Lana (Schwartz, McGeer), Université de Toronto; Hôpital Mount Sinai (McGeer); Réseau universitaire de santé (Bogoch), Toronto, Ont
| | - Isaac I Bogoch
- Unity Health Toronto (Schwartz); Départements de médecine (Bogoch) et de médecine de laboratoire et pathobiologie (McGeer), et École de santé publique Dalla Lana (Schwartz, McGeer), Université de Toronto; Hôpital Mount Sinai (McGeer); Réseau universitaire de santé (Bogoch), Toronto, Ont
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14
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Is HIV Post-test Counselling Aligned with Universal Test and Treat Goals? A Qualitative Analysis of Counselling Session Content and Delivery in South Africa. AIDS Behav 2021; 25:1583-1596. [PMID: 33241450 DOI: 10.1007/s10461-020-03075-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 11/27/2022]
Abstract
Early identification of people living with HIV (PLHIV) and subsequent engagement into HIV treatment is a key to reducing HIV-related illness, HIV-related deaths, and HIV transmission through universal test and treat approaches. With the scale-up of antiretroviral therapy (ART) programmes, counselling that is provided immediately after the diagnosis of HIV (post-test counselling) is well placed to facilitate linkage to care and ART initiation. We sought to assess whether the current delivery of post-test counselling in a routine HIV programme was aligned with the goals of universal test and treat as articulated in local and international HIV testing service guidelines. We analysed transcripts of 40 post-test counselling sessions for HIV-positive clients, performed by 34 counsellors in ten public sector health facilities in the Ekurhuleni District of South Africa. We used thematic analysis to identify key aspects of counselling techniques and content provided to the client. We identified five key themes of counselling messages: (1) specific behaviour changes that are required to maintain or improve health when living with HIV, (2) the benefits of ART, (3) behaviour changes required for ART to be effective, (4) the need for clients to disclose their HIV status, and (5) a need for caution with ART due to a wide range of severe side effects. The counselling sessions were highly didactic, which limited the opportunities for clients to express concerns or counsellors to address client's needs during the counselling session. Based on our observations, a substantial re-adjustment is needed to deliver best-practice counselling. This may include a combination of digital media-based counselling, counselling scripts, and truly client-centred counselling for a sub-set of individuals who are at risk of not linking to care, or not initiated ART within a specified period.
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15
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Schwartz KL, McGeer AJ, Bogoch II. Rapid antigen screening of asymptomatic people as a public health tool to combat COVID-19. CMAJ 2021; 193:E449-E452. [PMID: 33658247 PMCID: PMC8099167 DOI: 10.1503/cmaj.210100] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Kevin L Schwartz
- Unity Health Toronto (Schwartz); Departments of Medicine (Bogoch), and Laboratory Medicine and Pathobiology (McGeer), and Dalla Lana School of Public Health (Schwartz, McGeer), University of Toronto; Sinai Health System (McGeer); University Health Network (Bogoch), Toronto, Ont.
| | - Allison J McGeer
- Unity Health Toronto (Schwartz); Departments of Medicine (Bogoch), and Laboratory Medicine and Pathobiology (McGeer), and Dalla Lana School of Public Health (Schwartz, McGeer), University of Toronto; Sinai Health System (McGeer); University Health Network (Bogoch), Toronto, Ont
| | - Isaac I Bogoch
- Unity Health Toronto (Schwartz); Departments of Medicine (Bogoch), and Laboratory Medicine and Pathobiology (McGeer), and Dalla Lana School of Public Health (Schwartz, McGeer), University of Toronto; Sinai Health System (McGeer); University Health Network (Bogoch), Toronto, Ont
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16
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Experiences Receiving HIV-Positive Results by Phone: Acceptability and Implications for Clinical and Behavioral Research. AIDS Behav 2021; 25:709-720. [PMID: 32915328 PMCID: PMC7483487 DOI: 10.1007/s10461-020-03027-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Improving HIV testing rates and increasing early detection among men who have sex with men (MSM) are critical strategies for enhancing overall health and decreasing HIV transmission. Remote testing and phone delivery of HIV test results may reduce barriers such as geographic isolation or HIV-related stigma. In 2018–19, 50 MSM completed qualitative interviews about their experience receiving a positive HIV test result via phone through their participation in a research study that included remote HIV testing. Interview topics included the acceptability of, and concerns about, phone delivery of HIV results, as well as suggestions for improvement. Interviews were transcribed, coded, and analysed using an inductive thematic approach. Overall, participants reported high acceptability of phone delivery of HIV-positive results. Participants praised the support and information provided by study staff. Benefits identified included increased convenience compared to in-person medical visits, allowing participants to emotionally process their test results privately, as well as receiving the results from supportive and responsive staff members. A few participants indicated drawbacks to phone-based HIV test result delivery, such as logistical concerns about receiving a phone call during the day (e.g., while at work), reduced confidentiality, and the lack of in-person emotional support. Overall, participants described phone delivery of positive HIV-results as acceptable. At-home testing with phone delivery has the potential to increase HIV testing access, especially to geographically isolated or medically underserved patients.
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Tiwari R, Wang J, Han H, Kalu N, Sims LB, Katz DA, Burke B, Tsegaye AT, Carter KA, Freije S, Guo B, Albirair M, Barr‐DiChiara M, Baggaley R, Jamil MS, Senya K, Johnson C, Khosropour CM. Sexual behaviour change following HIV testing services: a systematic review and meta-analysis. J Int AIDS Soc 2020; 23:e25635. [PMID: 33161636 PMCID: PMC7649006 DOI: 10.1002/jia2.25635] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Learning one's HIV status through HIV testing services (HTS) is an essential step toward accessing treatment and linking to preventive services for those at high HIV risk. HTS may impact subsequent sexual behaviour, but the degree to which this varies by population or is true in the setting of contemporary HIV prevention activities is largely unknown. As part of the 2019 World Health Organization Consolidated Guidelines on HTS, we undertook a systematic review and meta-analysis to determine the effect of HTS on sexual behaviour. METHODS We searched nine electronic databases for studies published between July 2010 and December 2019. We included studies that reported on at least one outcome (condom use [defined as the frequency of condom use or condom-protected sex], number of sex partners, HIV incidence, STI incidence/prevalence). We included studies that prospectively assessed outcomes and that fit into one of three categories: (1) those evaluating more versus less-intensive HTS, (2) those of populations receiving HTS versus not and (3) those evaluating outcomes after versus before HTS. We conducted meta-analyses using random-effects models. RESULTS AND DISCUSSION Of 29 980 studies screened, 76 studies were included. Thirty-eight studies were randomized controlled trials, 36 were cohort studies, one was quasi-experimental and one was a serial cross-sectional study. There was no significant difference in condom use among individuals receiving more-intensive HTS compared to less-intensive HTS (relative risk [RR]=1.03; 95% CI: 0.99 to 1.07). Condom use was significantly higher after receiving HTS compared to before HTS for individuals newly diagnosed with HIV (RR = 1.65; 95% CI: 1.36 to 1.99) and marginally significantly higher for individuals receiving an HIV-negative diagnosis (RR = 1.63; 95% CI: 1.01 to 2.62). Individuals receiving more-intensive HTS reported fewer sex partners at follow-up than those receiving less-intensive HTS, but the finding was not statistically significant (mean difference = -0.28; 95% CI: -3.66, 3.10). CONCLUSIONS Our findings highlight the importance of using limited resources towards HTS strategies that focus on early HIV diagnosis, treatment and prevention services rather than resources dedicated to supplementing or enhancing HTS with additional counselling or other interventions.
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Affiliation(s)
- Ruchi Tiwari
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Jiayu Wang
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Hannah Han
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Ngozi Kalu
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Lee B Sims
- School of Public HealthImperial College LondonLondonUnited Kingdom
| | - David A Katz
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Barbara Burke
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Adino T Tsegaye
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Kayla A Carter
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Sophie Freije
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Boya Guo
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | | | | | - Rachel Baggaley
- Global HIV, Hepatitis and STIs programmeWorld Health OrganizationGenevaSwitzerland
| | - Muhammad S Jamil
- Global HIV, Hepatitis and STIs programmeWorld Health OrganizationGenevaSwitzerland
| | - Kafui Senya
- Communicable Diseases ClusterWorld Health OrganizationAccraGhana
| | - Cheryl Johnson
- Global HIV, Hepatitis and STIs programmeWorld Health OrganizationGenevaSwitzerland
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18
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Nakalema HS, Rajan SS, Morgan RO, Lee M, Gillespie SL, Kekitiinwa A. The effect of antiretroviral therapy guideline change on health outcomes among youth living with HIV in Uganda. AIDS Care 2020; 33:904-913. [PMID: 33021095 DOI: 10.1080/09540121.2020.1829533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ABSTRACTOpportunistic infections (OIs) are the primary cause of HIV-related morbidity and mortality. To reduce the risk, the ART eligibility criteria were revised to start treatment before advanced disease onset. We evaluated the effect of 2014 HIV clinical guideline changes in Uganda on opportunistic infections and survival among Youth Living with HIV (YLWH). This retrospective cohort analysis used administrative data from the District Health Information System (DHIS2) and the national referral hospital, to compare YLWH, 15-24 years old, who started ART pre-guideline (January 2012-June 2014) and post-guideline (July 2014-December 2016). We assessed the effect using multivariable logistic and Cox Proportional Hazards regression models, respectively. Post-guideline youth had 18% and 30% lower adjusted odds of having an OI at 6 (aOR: 0.82, 95%CI: 0.67, 0.99), and 12 months (aOR: 0.70, 95%CI: 0.58, 0.85) after ART initiation, compared to pre-guideline youth. No significant differences were observed in survival probabilities (Z = 2.56, P-value = 0.11) and adjusted hazard ratios (aHR: 1.55, 95%CI: 0.46, 5.28). Early ART initiation reduced the risk of OIs among YLWH. However, given the existence of geographical and clinical variations in the endemicity, morbidity and mortality associated with different OIs, additional research is still needed.
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Affiliation(s)
- Hilda Sekabira Nakalema
- Department of Management, Policy and Community Health, University of Texas Health Science Center, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda.,Department of Retrovirology, Baylor College of Medicine, Houston, TX, USA
| | - Suja S Rajan
- Department of Management, Policy and Community Health, University of Texas Health Science Center, Houston, TX, USA.,Department of Biostatistics & Data Science, University of Texas Health Science Center, Houston, TX, USA
| | - Robert O Morgan
- Department of Management, Policy and Community Health, University of Texas Health Science Center, Houston, TX, USA
| | - Minjae Lee
- Department of Epidemiology, Human Genetics & Environmental Health, University of Texas Health Science Center, Houston, TX, USA.,Department of Biostatistics & Data Science, University of Texas Health Science Center, Houston, TX, USA
| | - Susan L Gillespie
- Department of Retrovirology, Baylor College of Medicine, Houston, TX, USA
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Ortblad KF, Chanda MM, Mwale M, Haberer JE, McConnell M, Oldenburg CE, Bärnighausen T. Perceived Knowledge of HIV-Negative Status Increases Condom Use Among Female Sex Workers in Zambian Transit Towns. AIDS Patient Care STDS 2020; 34:184-192. [PMID: 32324483 PMCID: PMC7194317 DOI: 10.1089/apc.2019.0266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Knowledge of HIV status is a necessary pre-condition for most HIV interventions, including treatment as well as biomedical and behavioral prevention interventions. We used data from a female sex worker (FSW) cohort in three Zambian transit towns to understand the effect that knowledge of HIV status has on FSWs' HIV risk-related sexual behaviors with clients. The cohort was formed from an HIV self-testing trial that followed participants for 4 months. Participants completed three rounds of data collection at baseline, 1 month, and 4 months where they reported their perceived knowledge of HIV status, number of clients on an average working night, and consistent condom use with clients. We measured the effect of knowledge of HIV status on participants' sexual behaviors by using linear regression models with individual fixed effects. The majority of the 965 participants tested for HIV at least once during the observation period (96%) and changed their knowledge of HIV status (79%). Knowledge of HIV status did not affect participants' number of clients, but it did affect their consistency of condom use. Compared with unknown HIV status, knowledge of HIV-negative status significantly increased participants' consistent condom use by 8.1% points [95% confidence interval (CI): 2.7–13.4, p = 0.003] and knowledge of HIV-positive status increased participants' consistent condom use by 6.1% points (95% CI: −0.1 to 12.9, p = 0.08); however, this latter effect was not statistically significant. FSWs in Zambia engaged in safer sex with clients when they learned their HIV status. The expansion of HIV testing programs may serve as a behavioral HIV prevention measure among FSWs.
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Affiliation(s)
- Katrina F. Ortblad
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | - Jessica E. Haberer
- Department of General Internal Medicine, Massachusetts General Hospital Global Health, Boston, Massachusetts, USA
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Catherine E. Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Africa Health Research Institute (AHRI), Somkhele and Durban, South Africa
- Heidelberg Institute of Public Health (HIGH), University of Heidelberg, Heidelberg, Germany
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20
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Ortblad KF, Musoke DK, Chanda MM, Ngabirano T, Velloza J, Haberer JE, McConnell M, Oldenburg CE, Bärnighausen T. Knowledge of HIV Status Is Associated With a Decrease in the Severity of Depressive Symptoms Among Female Sex Workers in Uganda and Zambia. J Acquir Immune Defic Syndr 2020; 83:37-46. [PMID: 31633611 PMCID: PMC6898780 DOI: 10.1097/qai.0000000000002224] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/25/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Knowledge of HIV-positive status may result in depressive symptoms, which may be a concern to scaling novel HIV testing interventions that move testing outside the health system and away from counselor support. SETTING Uganda and Zambia. METHODS We used longitudinal data from 2 female sex worker (FSW) cohorts in Uganda (n = 960) and Zambia (n = 965). Over 4 months, participants had ample opportunity to HIV testing using standard-of-care services or self-tests. At baseline and 4 months, we measured participants' perceived knowledge of HIV status, severity of depressive symptoms (continuous PHQ-9 scale, 0-27 points), and prevalence of likely depression (PHQ-9 scores ≥10). We estimated associations using individual fixed-effects estimation. RESULTS Compared with unknown HIV status, knowledge of HIV-negative status was significantly associated with a decrease in depressive symptoms of 1.06 points in Uganda (95% CI -1.79 to -0.34) and 1.68 points in Zambia (95% CI -2.70 to -0.62). Knowledge of HIV-positive status was significantly associated with a decrease in depressive symptoms of 1.01 points in Uganda (95% CI -1.82 to -0.20) and 1.98 points in Zambia (95% CI -3.09 to -0.88). The prevalence of likely depression was not associated with knowledge of HIV status in Uganda but was associated with a 14.1% decrease with knowledge of HIV-negative status (95% CI -22.1% to -6.0%) and a 14.3% decrease with knowledge of HIV-positive status (95% CI -23.9% to -4.5%) in Zambia. CONCLUSIONS Knowledge of HIV status, be it positive or negative, was significantly associated with a decrease in depressive symptoms in 2 FSW populations. The expansion of HIV testing programs may have mental health benefits for FSWs.
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Affiliation(s)
| | | | | | | | - Jennifer Velloza
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Catherine E. Oldenburg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
| | - Till Bärnighausen
- Department of Global Health, University of Washington, Seattle, WA
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa; and
- Heidelberg Institute of Public Health, Heidelberg University, Heidelberg, Germany
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Wekesa E. HIV testing experiences in Nairobi slums: the good, the bad and the ugly. BMC Public Health 2019; 19:1600. [PMID: 31783749 PMCID: PMC6884792 DOI: 10.1186/s12889-019-7975-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background HIV testing is an integral component of HIV prevention, treatment and care and, therefore, is crucial in achieving UNAIDS 90–90-90 targets. HIV testing in Kenya follows both the voluntary counselling and testing (VCT) and provider initiated testing and counselling (PITC) models. However, little is known about the individual experiences of undergoing an HIV test in the two testing models. This study provides experiential evidence of undergoing an HIV test in a resource poor urban slum setting. Methods The study explored testing experiences and challenges faced in respect to ensuring the 3 Cs (consent, counselling and confidentiality), using in-depth interviews (N = 41) with HIV-infected men and women in two slum settlements of Nairobi City. The in-depth interview respondents were aged above 18 years with 56% being females. All interviews were audio-recorded, transcribed and then translated into English. The transcribed data were analysed using thematic analysis method. Results The respondent HIV-testing experiences were varied and greatly shaped by circumstances and motivation for HIV testing. The findings show both positive and negative experiences, with sporadic adherence to the 3Cs principle in both HIV testing models. Although some respondents were satisfied with the HIV testing process, a number of them raised a number of concerns, with instances of coercion and testing without consent being reported. Conclusion The 3Cs (consent, counselling and confidentiality) principle must underlie HIV testing and counselling practices in order to achieve positive testing outcomes. The study concludes that adherence to the 3Cs during HIV testing contributes to both the individual and public health good – irrespective of whether testing is initiated by the individual or by the health provider.
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Affiliation(s)
- Eliud Wekesa
- Department of Sociology, Anthropology and Community Development, South Eastern Kenya University, P.O Box 170-90200, Kitui, Kenya.
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Zang X, Krebs E, Wang L, Marshall BDL, Granich R, Schackman BR, Montaner JSG, Nosyk B. Structural Design and Data Requirements for Simulation Modelling in HIV/AIDS: A Narrative Review. PHARMACOECONOMICS 2019; 37:1219-1239. [PMID: 31222521 PMCID: PMC6711792 DOI: 10.1007/s40273-019-00817-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Born out of a necessity for fiscal sustainability, simulation modeling is playing an increasingly prominent role in setting priorities for combination implementation strategies for HIV treatment and prevention globally. The design of a model and the data inputted into it are central factors in ensuring credible inferences. We executed a narrative review of a set of dynamic HIV transmission models to comprehensively synthesize and compare the structural design and the quality of evidence used to support each model. We included 19 models representing both generalized and concentrated epidemics, classified as compartmental, agent-based, individual-based microsimulation or hybrid in our review. We focused on four structural components (population construction; model entry, exit and HIV care engagement; HIV disease progression; and the force of HIV infection), and two analytical components (model calibration/validation; and health economic evaluation, including uncertainty analysis). While the models we reviewed focused on a variety of individual interventions and their combinations, their structural designs were relatively homogenous across three of the four focal components, with key structural elements influenced by model type and epidemiological context. In contrast, model entry, exit and HIV care engagement tended to differ most across models, with some health system interactions-particularly HIV testing-not modeled explicitly in many contexts. The quality of data used in the models and the transparency with which the data was presented differed substantially across model components. Representative and high-quality data on health service delivery were most commonly not accessed or were unavailable. The structure of an HIV model should ideally fit its epidemiological context and be able to capture all efficacious treatment and prevention services relevant to a robust combination implementation strategy. Developing standardized guidelines on evidence syntheses for health economic evaluation would improve transparency and help prioritize data collection to reduce decision uncertainty.
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Affiliation(s)
- Xiao Zang
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Emanuel Krebs
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Linwei Wang
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | | | - Reuben Granich
- Independent Public Health Consultant, Washington, DC, USA
| | | | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
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Flowers P, Estcourt C, Sonnenberg P, Burns F. HIV testing intervention development among men who have sex with men in the developed world. Sex Health 2019; 14:80-88. [PMID: 28080947 DOI: 10.1071/sh16081] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 10/19/2016] [Indexed: 11/23/2022]
Abstract
HIV testing is a 'gateway' technology, enabling access to treatment and HIV prevention. Biomedical approaches to prevention, such as pre-exposure prophylaxis and treatment as prevention, require accurate and regular HIV test results. HIV testing also represents a powerful 'teachable moment' for behavioural prevention. An increasing range of HIV tests and the emergence of self-managed diagnostic technologies (e.g. self-testing) means there is now considerable diversification of when, where and how results are available to those who test. These changes have profound implications for intervention development and, indeed, health service redesign. This paper highlights the need for better ways of conceptualising testing in order to capitalise on the health benefits that diverse HIV testing interventions will bring. A multidimensional framework is proposed to capture ongoing developments in HIV testing among men who have sex with men and focus on the intersection of: (1) the growing variety of HIV testing technologies and the associated diversification of their pathways into care; (2) psychosocial insights into the behavioural domain of HIV testing; and (3) better appreciation of population factors associated with heterogeneity and concomitant inequities. By considering these three aspects of HIV testing in parallel, it is possible to identify gaps, limitations and opportunities in future HIV testing-related interventions. Moreover, it is possible to explore and map how diverse interventions may work together having additive effects. Only a holistic and dynamic framework that captures the increasing complexity of HIV testing is fit for purpose to deliver the maximum public health benefit of HIV testing.
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Affiliation(s)
- Paul Flowers
- Institute for Applied Health Research, Glasgow Caledonian University, Scotland G4 OBA, UK
| | - Claudia Estcourt
- Institute for Applied Health Research, Glasgow Caledonian University, Scotland G4 OBA, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, WC1E 6JB, UK
| | - Fiona Burns
- Research Department of Infection and Population Health, University College London, WC1E 6JB, UK
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Ortblad KF, Musoke DK, Ngabirano T, Salomon JA, Haberer JE, McConnell M, Oldenburg CE, Bärnighausen T. Is knowledge of HIV status associated with sexual behaviours? A fixed effects analysis of a female sex worker cohort in urban Uganda. J Int AIDS Soc 2019; 22:e25336. [PMID: 31287625 PMCID: PMC6615530 DOI: 10.1002/jia2.25336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/05/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Female sex workers (FSWs) have strong economic incentives for sexual risk-taking behaviour. We test whether knowledge of HIV status affects such behaviours among FSWs. METHODS We used longitudinal data from a FSW cohort in urban Uganda, which was formed as part of an HIV self-testing trial with four months of follow-up. Participants reported perceived knowledge of HIV status, number of clients per average working night, and consistent condom use with clients at baseline, one month, and four months. We measured the association between knowledge of HIV status and FSWs' sexual behaviours using linear panel regressions with individual fixed effects, controlling for study round and calendar time. RESULTS Most of the 960 participants tested for HIV during the observation period (95%) and experienced a change in knowledge of HIV status (71%). Knowledge of HIV status did not affect participants' number of clients but did affect their consistent condom use. After controlling for individual fixed effects, study round and calendar month, knowledge of HIV-negative status was associated with a significant increase in consistent condom use by 9.5 percentage points (95% CI 5.2 to 13.5, p < 0.001), while knowledge of HIV-positive status was not associated with a significant change in consistent condom use (2.5 percentage points, 95% CI -8.0 to 3.1, p = 0.38). CONCLUSIONS In urban Uganda, FSWs engaged in safer sex with clients when they perceived that they themselves were not living with HIV. Even in communities with very high HIV prevalence, the majority of the population will test HIV-negative. Our results thus imply that expansion of HIV testing programmes may serve as a behavioural HIV prevention measure among FSWs.
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Affiliation(s)
| | | | | | - Joshua A Salomon
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
- Department of MedicineStanford UniversityStanfordCAUSA
| | - Jessica E Haberer
- Department of General Internal MedicineMassachusetts General Hospital Global HealthBostonMAUSA
| | - Margaret McConnell
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Catherine E Oldenburg
- Francis I. Proctor FoundationUniversity of California San FranciscoSan FranciscoCAUSA
- Department of OphthalmologyUniversity of CaliforniaSan FranciscoSan FranciscoCAUSA
- Department of Epidemiology & BiostatisticsUniversity of CaliforniaSan FranciscoCAUSA
| | - Till Bärnighausen
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Heidelberg Institute of Public HealthUniversity of HeidelbergHeidelbergGermany
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The Effect of HIV Self-Testing Delivery Models on Female Sex Workers' Sexual Behaviors: A Randomized Controlled Trial in Urban Uganda. AIDS Behav 2019; 23:1225-1239. [PMID: 30652205 PMCID: PMC6510910 DOI: 10.1007/s10461-019-02393-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
HIV self-testing increases recent and frequent HIV testing among female sex workers (FSWs) in urban Uganda. Using results from a randomized controlled trial, we aim to establish the effect of HIV self-testing delivery models on FSWs’ sexual behaviors in this setting. Clusters of one peer educator and eight participants were 1:1:1 randomized to: (1) direct provision of an HIV self-test, (2) provision of a coupon for facility collection of an HIV self-test, or (3) referral to standard-of-care HIV testing services. Sexual behaviors were self-reported at 1 and 4 months. From October to November 2016, 960 participants were enrolled and randomized. At 4 months, there were no statistically significant differences in participants’ sexual behaviors, including inconsistent condom use, across study arms. We do not find any changes in sexual risk-taking among FSWs in response to the delivery of HIV self-tests. Routine policies for HIV self-testing are likely a behaviorally safe component of comprehensive HIV prevention strategies.
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Salway T, Thomson K, Taylor D, Haag D, Elliot E, Wong T, Fairley CK, Grennan T, Shoveller J, Ogilvie G, Gilbert M. Post-test comparison of HIV test knowledge and changes in sexual risk behaviour between clients accessing HIV testing online versus in-clinic. Sex Transm Infect 2019; 95:102-107. [PMID: 30636706 PMCID: PMC6580762 DOI: 10.1136/sextrans-2018-053652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/19/2018] [Accepted: 11/01/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Internet-based HIV testing offers the potential to address privacy-related barriers to testing and increase frequency of testing but may result in missed opportunities related to sexual health education and prevention that typically occur in face-to-face encounters. In this study, we assessed the HIV test knowledge and sexual risk behaviour of clients testing for HIV through GetCheckedOnline, an internet-based sexually transmitted and bloodborne infection testing platform inclusive of HIV testing, in comparison to clients testing through a large sexual health clinic. METHODS We concurrently recruited GetCheckedOnline clients and clinic clients from Vancouver, Canada, over the course of a 10-month period during 2015-2016. Participants completed baseline and 3-month questionnaires, anonymous and online. A six-item score was used to estimate knowledge of HIV test concepts typically conveyed during an HIV pretest encounter in a clinic. We used multiple regression to estimate associations between testing modality (online vs clinic based) and two outcomes-HIV test knowledge and change in condom use pre/post-test-with adjustment for relevant background factors. RESULTS Among 352 participants, online testers demonstrated higher HIV post-test knowledge than clinic-based testers (mean score 4.65/6 vs 4.09/6; p<0.05); this difference was reduced in adjusted analysis (p>0.05). Men who have sex with men, clients with a university degree, those who have lived in Canada >10 years and English speakers had higher HIV post-test knowledge (p<0.05). Eighteen per cent of online testers and 10% of clinic-based testers increased condom use during the 3 months post-test (p>0.05). CONCLUSIONS In this comparative study between online and clinic-based testers, we found no evidence of decreased HIV test knowledge or decreased condom use following HIV testing through GetCheckedOnline. Our findings suggest that with careful design and attention to educational content, online testing services may not lead to missed opportunities for HIV education and counselling.
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Affiliation(s)
- Travis Salway
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberly Thomson
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darlene Taylor
- School of Nursing, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Devon Haag
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Elizabeth Elliot
- College of Registered Nurses of British Columbia, Vancouver, British Columbia, Canada
| | - Tom Wong
- Indigenous Services Canada, Ottawa, Ontario, Canada
| | | | - Troy Grennan
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Nnko S, Kuringe E, Nyato D, Drake M, Casalini C, Shao A, Komba A, Baral S, Wambura M, Changalucha J. Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review. BMC Public Health 2019; 19:15. [PMID: 30611219 PMCID: PMC6321716 DOI: 10.1186/s12889-018-6362-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 12/21/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND HIV testing and counselling (HTC) is an essential component for HIV prevention and a critical entry point into the HIV continuum of care and treatment. Despite the importance of HTC for HIV control, access to HTC services among female sex workers (FSWs) in sub-Saharan Africa (SSA) remains suboptimal and little is known about factors influencing FSWs' access to HTC. Guided by the client-centred conceptual framework, we conducted a systematic review to understand the facilitators and barriers influencing FSWs in SSA to access HTC services. METHODS A systematic search was conducted in MEDLINE, POPLINE and Web of Science databases for literature published between January 2000 and July 2017. References of relevant articles were also searched. We included primary studies of any design, conducted in SSA and published in the English language. Studies conducted in multi-sites inclusive of SSA were included only if data from sites in SSA were separately analysed and reported. Similarly, studies that included other subpopulations were only eligible if a separate analysis was done for FSWs. This review excluded papers published as systematic reviews, editorial comments and mathematical modelling. The protocol for this review is registered in the Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017062203. RESULTS This review shows that factors related to approachability, acceptability, availability, affordability and appropriateness of the services are crucial in influencing access to HTC services among FSWs in SSA. These factors were mediated by individual attributes such as HIV risk perceptions, awareness of the availability of HTC, and perceptions of the importance and quality of HTC services. The decision to utilise HTC was predominantly hampered by discriminatory social norms such as HIV stigma and criminalisation of sex work. CONCLUSIONS FSWs' access to HTC is facilitated by multiple factors, including individual awareness of the availability of HTC services, and perceived quality of HTC especially with regard to assured confidentiality. Concerns about HIV stigma and fear about discrimination due to community intolerance of sex work acted as major barriers for FSWs to seek HTC services from the facilities offering health services to the general population.
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Affiliation(s)
- Soori Nnko
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, P.O Box 1462, Mwanza, Tanzania
| | - Evodius Kuringe
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, P.O Box 1462, Mwanza, Tanzania
| | - Daniel Nyato
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, P.O Box 1462, Mwanza, Tanzania
| | - Mary Drake
- Sauti Program, Jhpiego Tanzania - an affiliate of Johns Hopkins University, P.O Box 9170, Dar es Salaam, Tanzania
| | - Caterina Casalini
- Sauti Program, Jhpiego Tanzania - an affiliate of Johns Hopkins University, P.O Box 9170, Dar es Salaam, Tanzania
| | - Amani Shao
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, P.O Box 1462, Mwanza, Tanzania
| | - Albert Komba
- Sauti Program, Jhpiego Tanzania - an affiliate of Johns Hopkins University, P.O Box 9170, Dar es Salaam, Tanzania
| | - Stefan Baral
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, E7146, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Mwita Wambura
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, P.O Box 1462, Mwanza, Tanzania
| | - John Changalucha
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, P.O Box 1462, Mwanza, Tanzania
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Reddy N, Khan SD. How to Take a Sexual History. Sex Med 2019. [DOI: 10.1007/978-981-13-1226-7_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
Here we wanted to assess whether sexual risk behaviour differs dependent by human immunodeficiency virus (HIV) status by following 100 HIV− and 137 HIV+ women recruited at two university teaching hospitals in Rwanda. Women were tested for sexually transmitted infections (STIs; trichomoniasis, syphilis, hepatitis B and C) and for reproductive tract infections (RTIs; candidiasis, bacterial vaginosis (BV)) and were interviewed at baseline and 9 months later. BV was the most prevalent infection, while syphilis was the most common STI with a 9-month incidence of 10.9% in HIV+ women. Only 24.5% of women positive for any RTI/STI contacted their health facility and got treatment. More HIV− women than HIV+ women had had more than one sexual partner and never used condoms during the follow-up period. The use of condoms was affected neither by marital status nor by concomitant STIs besides HIV. Our data highlight the importance of public education regarding condom use to protect against STIs in an era when HIV no longer is a death sentence.
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Watson RJ, Fish JN, Allen A, Eaton L. Sexual Identity Disclosure and Awareness of HIV Prevention Methods Among Black Men Who Have Sex With Men. JOURNAL OF SEX RESEARCH 2018; 55:975-983. [PMID: 29023141 PMCID: PMC5897190 DOI: 10.1080/00224499.2017.1375452] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Black men who have sex with men (BMSM) are disproportionately affected by the human immunodeficiency virus (HIV) epidemic, yet we know little about how HIV-negative BMSM of different sexual orientations access HIV prevention strategies. Identity development, minority stress, and disclosure theories suggest that for people of different sexual orientations, disclosure of sexual identity may be related to health behaviors. We performed a latent class analysis on a sample of 650 BMSM (Mage = 33.78, SD = 11.44) from Atlanta, Georgia, to explore whether sexual orientation, disclosure of sexual identity, and relationship status were related to HIV prevention strategies, including awareness of PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) and frequency of HIV testing. We found three distinct BMSM classes referred to as (1) closeted bisexuals, (2) sexual identity managers, and (3) gay, out, and open; all classes primarily engaged in casual sex. Classes differed in their awareness and access to HIV prevention strategies. The closeted bisexual class was least aware of and least likely to access HIV prevention. Findings have important implications for future research, namely the consideration of sexual identity and disclosure among BMSM. With this knowledge, we may be able to engage BMSM in HIV/sexually transmitted infection (STI) prevention services.
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Affiliation(s)
- Ryan J Watson
- c Department of Human Development and Family Studies , University of Connecticut
| | - Jessica N Fish
- b Population Research Center , University of Texas at Austin
| | | | - Lisa Eaton
- c Department of Human Development and Family Studies , University of Connecticut
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Li MJ, Huang JH. Healthcare Seeking Intention if Diagnosed with HIV Among Young MSM in Taiwan: A Theory-Based Comparison by Voluntary Counseling and Testing Experience. AIDS Behav 2018; 22:2480-2490. [PMID: 29808258 DOI: 10.1007/s10461-018-2169-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The number of HIV cases in Taiwan exceeded 30,000 in 2016. Per the UNAIDS 90-90-90 target, 81% of people living with HIV should receive medication. However, numerous previous studies focused on adherence rather than the initial healthcare seeking intention if diagnosed with HIV (HIV HSI). Based on the Theory of Planned Behavior (TPB), anonymous online survey data were collected from December 2016 through February 2017 from 2709 young MSM (YMSM) ages 15-39. Multivariate logistic regression found the significant factors and strengths of associations with HIV HSI varied by their HIV voluntary counseling and testing (VCT) experience. YMSM without VCT experience perceiving high support from salient others (AOR = 1.28) and high control under facilitating conditions (AOR = 2.73) had higher HIV HSI. YMSM with VCT experience perceiving high control under facilitating (AOR = 1.79) and constraining (AOR = 1.54) conditions had higher HIV HSI. Regardless of VCT experience, YMSM with positive attitudes toward positive healthcare seeking outcomes (AOR = 3.72-3.95) had highest HIV HSI, highlighting the importance of increasing positive outcome expectations in YMSM.
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Feinstein BA, Dellucci TV, Graham S, Parsons JT, Mustanski B. Sexually transmitted infections among young men who have sex with men: Experiences with diagnosis, treatment, and reinfection. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2018; 15:172-182. [PMID: 30505356 PMCID: PMC6261487 DOI: 10.1007/s13178-017-0312-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Despite high rates of sexually transmitted infections (STIs) among young men who have sex with men (YMSM), little is known about their experiences with diagnosis, treatment, and reinfection. To fill this gap, we interviewed 17 YMSM ages 18-29 who participated in an online HIV prevention trial and tested positive for STIs at both the baseline and three-month follow-up assessments. Participants were asked about their reactions to testing positive, experiences with treatment, disclosure to partners, and changes in thinking and behavior. Reactions were diverse, the most common being surprise and concern. Most participants sought treatment, although type of provider varied (e.g., primary care physician, clinic that specialized in gay/bisexual men's health). Providers tended to re-test participants, but some did so at the incorrect anatomical site. Participants who felt comfortable talking to providers about STIs tended to use their regular provider or one who specialized in gay/bisexual men's health. Most participants described changes in their thinking and behavior (e.g., increased condom use, decreased sex partners, questioning their partners' trust). Most participants disclosed to at least one partner, but some did not remember or were not in contact with partners. Experiences were similar the first and second time participants tested positive for STIs during the study with a few exceptions (e.g., more self-blame and comfort talking to providers the second time). In sum, YMSM have diverse experiences with STI diagnosis and treatment. Implications for public policy and STI prevention are discussed.
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Affiliation(s)
- Brian A. Feinstein
- Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, IL
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
| | - Trey V. Dellucci
- Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, IL
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
- Center for HIV Educational Studies & Training (CHEST), Hunter College of the City University of New York, New York, NY
- Health Psychology and Clinical Science Doctoral Training Program, Graduate Center of the City University of New York, New York, NY
| | - Simon Graham
- Center for HIV Educational Studies & Training (CHEST), Hunter College of the City University of New York, New York, NY
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, 3052, Australia
| | - Jeffrey T. Parsons
- Center for HIV Educational Studies & Training (CHEST), Hunter College of the City University of New York, New York, NY
- Hunter College of the City University of New York, Department of Psychology, New York, NY
- Health Psychology and Clinical Science Doctoral Training Program, Graduate Center of the City University of New York, New York, NY
| | - Brian Mustanski
- Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, IL
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
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Sagherian MJ, Huedo-Medina TB, Pellowski JA, Eaton LA, Johnson BT. Single-Session Behavioral Interventions for Sexual Risk Reduction: A Meta-Analysis. Ann Behav Med 2017; 50:920-934. [PMID: 27510956 DOI: 10.1007/s12160-016-9818-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Evidence-based, single-session STI/HIV interventions to reduce sexual risk taking are potentially effective options for implementation in resource-limited settings and may solve problems associated with poor participant retention. PURPOSE The purpose of the study is to estimate the efficacy of single-session, behavioral interventions in reducing unprotected sex or increasing condom use. METHODS Data sources were searched through April 2013 producing 67 single-session interventions (52 unique reports; N = 20,039) that included outcomes on condom use and/or unprotected sex. RESULTS Overall, participants in single-session interventions reduced sexual risk taking relative to control groups (d + = 0.19, 95 % CI = 0.11, 0.27). Within-group effects of the interventions were larger than the between-groups effects when compared to controls. CONCLUSIONS Brief, targeted single-session sexual risk reduction interventions demonstrate a small but significant effect and should be prioritized.
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Moodley A, Kagee A. Experiences of social support among persons seeking HIV testing. J Health Psychol 2017; 24:777-786. [PMID: 29250998 DOI: 10.1177/1359105316685900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We interviewed 15 HIV test seekers to understand how social support acted either as a facilitator or barrier to HIV testing. Participants were recruited at community outreach testing sites in South Africa and participated in qualitative interviews which were then analysed using thematic analysis. We identified three main themes, namely, the social phenomenon of perceived risk as a facilitator to HIV testing, social support as a way of managing distress and the public health service as a supportive environment, which all played a role in test-seeking among participants. The results are integrated with the current debates on HIV testing in South Africa.
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Affiliation(s)
- Athena Moodley
- Department of Psychology, Stellenbosch University, South Africa
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, South Africa
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Tetteh RA, Yankey BA, Nartey ET, Lartey M, Leufkens HGM, Dodoo ANO. Pre-Exposure Prophylaxis for HIV Prevention: Safety Concerns. Drug Saf 2017; 40:273-283. [PMID: 28130774 PMCID: PMC5362649 DOI: 10.1007/s40264-017-0505-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Available evidence supports the efficacy of pre-exposure prophylaxis (PrEP) in decreasing the incidence of human immunodeficiency virus (HIV) infection among high-risk individuals, especially when used in combination with other behavioural preventive methods. Safety concerns about PrEP present challenges in the implementation and use of PrEP. The aim of this review is to discuss safety concerns observed in completed clinical trials on the use of PrEP. We performed a literature search on PrEP in PubMed, global advocacy for HIV prevention (Aids Vaccine Advocacy Coalition) database, clinical trials registry " http://www.clinicaltrials.gov " and scholar.google, using combination search terms 'pre-exposure prophylaxis', 'safety concerns in the use of pre-exposure prophylaxis', 'truvada use as PrEP', 'guidelines for PrEP use', 'HIV pre-exposure prophylaxis' and 'tenofovir' to identify clinical trials and literature on PrEP. We present findings associated with safety issues on the use of PrEP based on a review of 11 clinical trials on PrEP with results on safety and efficacy as at April 2016. We also reviewed findings from routine real-life practice reports. The pharmacological intervention for PrEP was tenofovir disoproxil fumarate/emtricitabine in a combined form as Truvada® or tenofovir as a single entity. Both products are efficacious for PrEP and seem to have a good safety profile. Regular monitoring is recommended to prevent long-term toxic effects. The main adverse effects observed with PrEP are gastrointestinal related; basically mild to moderate nausea, vomiting and diarrhea. Other adverse drug effects worth monitoring are liver enzymes, renal function and bone mineral density. PrEP as an intervention to reduce HIV transmission appears to have a safe benefit-risk profile in clinical trials. It is recommended for widespread use but adherence monitoring and real-world safety surveillance are critical in the post-marketing phase to ensure that the benefits observed in clinical trials are maintained in real-world use.
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Affiliation(s)
- Raymond A Tetteh
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands. .,Pharmacy Department, Korle-Bu Teaching Hospital, Korle-Bu, Mamprobi, MP 2362, Accra, Ghana.
| | - Barbara A Yankey
- School of Public Heath, Georgia State University, Atlanta, GA, USA
| | - Edmund T Nartey
- World Health Organization Collaborating Centre for Advocacy and Training in Pharmacovigilance, Centre for Tropical Clinical Pharmacology and Therapeutics, School of Medicine and Dentistry, University of Ghana, Legon, Accra, Ghana.,Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Margaret Lartey
- Department of Medicine, School of Medicine and Dentistry, University of Ghana, Legon, Accra, Ghana
| | - Hubert G M Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Medicines Evaluation Board, Utrecht, The Netherlands
| | - Alexander N O Dodoo
- World Health Organization Collaborating Centre for Advocacy and Training in Pharmacovigilance, Centre for Tropical Clinical Pharmacology and Therapeutics, School of Medicine and Dentistry, University of Ghana, Legon, Accra, Ghana
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DiNenno EA, Prejean J, Delaney KP, Bowles K, Martin T, Tailor A, Dumitru G, Mullins MM, Hutchinson A, Lansky A. Evaluating the Evidence for More Frequent Than Annual HIV Screening of Gay, Bisexual, and Other Men Who Have Sex With Men in the United States: Results From a Systematic Review and CDC Expert Consultation. Public Health Rep 2017; 133:3-21. [PMID: 29182894 PMCID: PMC5805092 DOI: 10.1177/0033354917738769] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The Centers for Disease Control and Prevention (CDC) recommended in 2006 that sexually active gay, bisexual, and other men who have sex with men (MSM) be screened for human immunodeficiency virus (HIV) at least annually. A workgroup comprising CDC and external experts conducted a systematic review of the literature, including benefits, harms, acceptability, and feasibility of annual versus more frequent screening among MSM, to determine whether evidence was sufficient to change the current recommendation. Four consultations with managers of public and nonprofit HIV testing programs, clinics, and mathematical modeling experts were conducted to provide input on the programmatic and scientific evidence. Mathematical models predicted that more frequent than annual screening of MSM could prevent some new HIV infections and would be more cost-effective than annual screening, but this evidence was considered insufficient due to study design. Evidence supports CDC's current recommendation that sexually active MSM be screened at least annually. However, some MSM might benefit from more frequent screening. Future research should evaluate which MSM subpopulations would benefit most from more frequent HIV screening.
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Affiliation(s)
- Elizabeth A. DiNenno
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph Prejean
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kevin P. Delaney
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristina Bowles
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tricia Martin
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amrita Tailor
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gema Dumitru
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary M. Mullins
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angela Hutchinson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy Lansky
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Matovu JKB, Bukuluki PW, Mafigiri DK, Mudondo H. HIV counseling and testing practices among clients presenting at a market HIV clinic in Kampala, Uganda: a cross-sectional study. Afr Health Sci 2017; 17:729-737. [PMID: 29085400 PMCID: PMC5656195 DOI: 10.4314/ahs.v17i3.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Uptake of HIV counseling and testing (HCT) among informal sector workers is not well documented. OBJECTIVE To assess HCT practices among clients presenting for HIV services at a market HIV clinic in Kampala, Uganda. METHODS Between August 1 and September 15, 2009, clients presenting for HIV services at a market HIV clinic were invited to participate in the study. Socio-demographic and HCT data were collected from consenting adults aged 16+ years. Descriptive statistics were performed using STATA version 14.1. RESULTS Of 224 individuals who consented to the interview, n=139 62 % were market vendors while n=85 38 % were engaged in other market-related activities. Majority of the respondents, n=165, 73.7 %, had ever tested for HIV; of these, n=148,89.7 % had ever tested for 2+ times. The main reasons for repeat testing were the need to confirm previous HIV test results, n=126, 85.1% and the belief that the previous HIV test results were false, n=35, 23.6 %. Uptake of couples' HCT was low, n=63, 38.2 %, despite the fact that n=200, 89 % had ever heard of couples' HCT. CONCLUSION These findings indicate high rates of repeat testing but low rates of couples' HCT uptake in this population.
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Affiliation(s)
- Joseph KB Matovu
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Paul W Bukuluki
- Department of Social Work & Social Administration, School of Social Sciences, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
| | - David K Mafigiri
- Department of Social Work & Social Administration, School of Social Sciences, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
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Frequent HIV Testing: Impact on HIV Risk Among Chinese Men Who Have Sex with Men. J Acquir Immune Defic Syndr 2017; 72:452-61. [PMID: 27003496 DOI: 10.1097/qai.0000000000001001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The HIV epidemic continues to expand among men who have sex with men (MSM) in China. The NIMH Project Accept/HPTN 043 trial suggested a borderline significant trend toward HIV incidence reduction among persons with higher testing rates. METHODS We assessed HIV testing histories and infection status among a community-based Beijing MSM. HIV serostatus was lab confirmed. We ascertained demographic/behavioral factors through questionnaire-based interviews. Associations of previous HIV testing with odds of current HIV infection were assessed, seeking improved like-with-like risk comparisons through multivariable logistic regression analysis with propensity score adjustment and restricted cubic spline modeling. RESULTS Among 3588 participants, 12.7% were HIV infected; 70.8% reported having ever tested for HIV. Compared with MSM who never tested, those ever testing had a 41% reduction in the odds of being HIV positive [adjusted odds ratio (aOR): 0.59; 95% confidence interval (CI): 0.48 to 0.74. Higher HIV testing frequencies were associated with a decreasing trend in the odds of being infected with HIV vs. a referent group with no previous testing [>6 tests (aOR: 0.27; 95% CI: 0.18 to 0.41); 4-6 (aOR: 0.55; 95% CI: 0.39 to 0.78); 2-3 (aOR: 0.61; 95% CI: 0.45 to 0.82); P for trend <0.001]. The multivariable-adjusted model with restricted cubic spline of HIV testing frequency showed a higher frequency of previous HIV testing associated with lower odds of HIV infection, particularly among men with ≥10 lifetime male sexual partners. CONCLUSIONS Using risk probability adjustments to enable less biased comparisons, frequent HIV testing was associated with a lower HIV odds among Chinese MSM.
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Mejia CM, Acland D, Buzdugan R, Grimball R, Natoli L, McGrath MR, Klausner JD, McCoy SI. An Intervention Using Gamification to Increase Human Immunodeficiency Virus and Sexually Transmitted Infection Screening Among Young Men Who Have Sex With Men in California: Rationale and Design of Stick To It. JMIR Res Protoc 2017; 6:e140. [PMID: 28716771 PMCID: PMC5537559 DOI: 10.2196/resprot.8064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In the United States, young men who have sex with men (YMSM) remain disproportionately affected by human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). Although routine HIV/STI screening is pivotal to the timely diagnosis of HIV and STIs, initiation of appropriate treatment, and reduced onward disease transmission, repeat screening is underused. Novel interventions that incorporate elements of games, an approach known as gamification, have the potential to increase routinization of HIV/STI screening among YMSM. OBJECTIVE The study aims to test the hypothesis that an incentive-based intervention that incorporates elements of gamification can increase routine HIV/STI screening among YMSM in California. METHODS The study consists of a formative research phase to develop the intervention and an implementation phase where the intervention is piloted in a controlled research setting. In the formative research phase, we use an iterative development process to design the intervention, including gathering information about the feasibility, acceptability, and expected effectiveness of potential game elements (eg, points, leaderboards, rewards). These activities include staff interviews, focus group discussions with members of the target population, and team meetings to strategize and develop the intervention. The final intervention is called Stick To It and consists of 3 components: (1) online enrollment, (2) Web-based activities consisting primarily of quizzes and a countdown "timer" to facilitate screening reminders, and (3) in-person activities that occur at 2 sexual health clinics. Participants earn points through the Web-based activities that are then redeemed for chances to win various prizes during clinic visits. The pilot study is a quasi-experimental study with a minimum of 60 intervention group participants recruited at the clinics, at community-based events, and online. We will compare outcomes in the intervention group with a historical control group consisting of individuals meeting the inclusion criteria who attended study clinics in the 12 months prior to intervention implementation. Eligible participants in the pilot study (1) are 18 to 26 years old, (2) were born or identify as male, 3) report male sexual partners, and 4) have a zip code of residence within defined areas in the vicinity of 1 of the 2 implementation sites. The primary outcome is repeat HIV/STI screening within 6 months. RESULTS This is an ongoing research study with initial results expected in the fourth quarter of 2017. CONCLUSIONS We will develop and pilot test a gamification intervention to encourage YMSM to be regularly screened for HIV/STIs. The results from this research will provide preliminary evidence about the potential effectiveness of using gamification to amplify health-related behavioral change interventions. Further, the research aims to determine the processes that are essential to developing and implementing future health-related gamification interventions. TRIAL REGISTRATION Clinicaltrials.gov NCT02946164; https://clinicaltrials.gov/ct2/show/NCT02946164 (Archived by WebCite at http://www.webcitation.org/6ri3G4HwD).
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Affiliation(s)
- Christopher M Mejia
- Public Health Division, AIDS Healthcare Foundation, Los Angeles, CA, United States
| | - Daniel Acland
- Goldman School of Public Policy, University of California, Berkeley, CA, United States
| | - Raluca Buzdugan
- School of Public Health, University of California, Berkeley, CA, United States
| | - Reva Grimball
- School of Public Health, University of California, Berkeley, CA, United States
| | - Lauren Natoli
- Public Health Division, AIDS Healthcare Foundation, Los Angeles, CA, United States
| | - Mark R McGrath
- Public Health Division, AIDS Healthcare Foundation, Los Angeles, CA, United States
| | - Jeffrey D Klausner
- David Geffen School of Medicine, University of California, Los Angeles, CA, United States
- Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Sandra I McCoy
- School of Public Health, University of California, Berkeley, CA, United States
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Changes in Condomless Sex and Serosorting Among Men Who Have Sex With Men After HIV Diagnosis. J Acquir Immune Defic Syndr 2017; 73:475-481. [PMID: 27792685 DOI: 10.1097/qai.0000000000001128] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Among men who have sex with men (MSM) diagnosed with HIV, high-risk sexual behaviors may decline in the year after diagnosis. The sustainability of these changes is unknown. METHODS We created a retrospective cohort (Seroconversion Cohort) of MSM attending an STD clinic in Seattle, Washington who tested HIV positive between 2001 and 2013 and had a negative HIV test <2 years before diagnosis. We randomly selected 1000 HIV-negative controls (men who always tested HIV negative) who were frequency-matched to the Seroconversion Cohort based on HIV diagnosis year. 12-month sexual behavior data were collected at each clinic visit. We examined condomless anal intercourse (CAI) with HIV-negative, HIV-positive, and HIV unknown-status partners before diagnosis and up to 4 years thereafter. RESULTS Of the 26,144 clinic visits where MSM tested for HIV, there were 655 (2.5%) new HIV diagnoses. Of these, 186 (28%) men had previously tested HIV negative and were included in the Seroconversion Cohort. The proportion (of the 186) reporting CAI with HIV-negative partners declined from 73% at diagnosis to 12% after diagnosis (P < 0.001), whereas CAI with HIV-positive partners increased (11%-67%; P < 0.001). The proportion who serosorted (ie, CAI only with HIV-concordant partners) did not change before or after diagnosis (34%-40%; P = 0.65). These 3 behaviors remained stable for up to 4 years after diagnosis. Among HIV-negative controls, serosorting and CAI with HIV-positive and HIV-negative partners was constant. CONCLUSIONS MSM substantially modify their sexual behavior after HIV diagnosis. These changes are sustained for several years and may reduce HIV transmission to HIV-uninfected men.
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Feinstein BA, Johnson BA, Parsons JT, Mustanski B. Reactions to Testing HIV Negative: Measurement and Associations with Sexual Risk Behaviour Among Young MSM Who Recently Tested HIV Negative. AIDS Behav 2017; 21:1467-1477. [PMID: 27557984 DOI: 10.1007/s10461-016-1525-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Receiving an HIV-positive test result is associated with reduced condomless anal sex (CAS), but little is known about negative test results. The recent development of the Inventory of Reactions to Testing HIV Negative confirmed that there are diverse reactions to receiving a negative test result, which have implications for risk behaviour. The goals of the current study were to validate the measure in a sample of young men who have sex with men who recently tested HIV-negative (N = 1113) and to examine its associations with CAS. Factor analysis identified four factors, three of which were the same as the original factors (Reinforced Safety, Luck, and Invulnerability) and one that was novel (Reinforced Risk). Construct validity was demonstrated with associations between subscales and constructs from the IMB model of HIV prevention. Lower Reinforced Safety and higher Luck and Reinforced Risk were associated with more CAS. Associations between Reinforced Safety and Luck with CAS were stronger for those who reported more lifetime HIV tests. Findings highlight the importance of reactions to testing HIV-negative and suggest that they become more important with repeated testing.
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Routine Inpatient Human Immunodeficiency Virus Screening: Missed Prevention Opportunities. CLIN NURSE SPEC 2017; 31:45-51. [PMID: 27906733 DOI: 10.1097/nur.0000000000000265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/OBJECTIVES This article reviews the current guidelines for human immunodeficiency virus (HIV) screening among inpatients and explores adherence to the guidelines and barriers to their implementation. BACKGROUND In 2006, the Centers for Disease Control and Prevention released updated recommendations suggesting HIV screening for all patients in all healthcare settings. DESCRIPTION A nonsystematic review of current HIV screening guidelines, as well as research and nonresearch literature, addressing rates of inpatient screening was performed. RESULTS Between 2000 and 2010, there was a significant increase in testing in healthcare settings. Despite these advances, 10 years after the updated Centers for Disease Control and Prevention guidelines were released, many hospitals still have not fully implemented the recommendations. Barriers to implementation of the guidelines include provider misconceptions and lack of time and reimbursement. CONCLUSIONS Screening for HIV identifies new infections, reduces transmission, prevents complications, and encourages a discussion about prevention. Increasing adherence to screening recommendations can help prevent new cases and disease progression. The nursing focus on prevention makes clinical nurse specialists and other advanced practice registered nurses uniquely positioned to increase screening. Clinical nurse specialists should implement research projects to understand adherence in their facilities and identify and address site-specific barriers. Quality improvement programs can then be implemented to improve screening rates.
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Weinhardt LS, Galvao LW, Yan AF, Stevens P, Mwenyekonde TN, Ngui E, Emer L, Grande KM, Mkandawire-Valhmu L, Watkins SC. Mixed-Method Quasi-Experimental Study of Outcomes of a Large-Scale Multilevel Economic and Food Security Intervention on HIV Vulnerability in Rural Malawi. AIDS Behav 2017; 21:712-723. [PMID: 27350305 PMCID: PMC5306183 DOI: 10.1007/s10461-016-1455-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of the Savings, Agriculture, Governance, and Empowerment for Health (SAGE4Health) study was to evaluate the impact of a large-scale multi-level economic and food security intervention on health outcomes and HIV vulnerability in rural Malawi. The study employed a quasi-experimental non-equivalent control group design to compare intervention participants (n = 598) with people participating in unrelated programs in distinct but similar geographical areas (control, n = 301). We conducted participant interviews at baseline, 18–, and 36–months on HIV vulnerability and related health outcomes, food security, and economic vulnerability. Randomly selected households (n = 1002) were interviewed in the intervention and control areas at baseline and 36 months. Compared to the control group, the intervention led to increased HIV testing (OR 1.90; 95 % CI 1.29–2.78) and HIV case finding (OR = 2.13; 95 % CI 1.07–4.22); decreased food insecurity (OR = 0.74; 95 % CI 0.63–0.87), increased nutritional diversity, and improved economic resilience to shocks. Most effects were sustained over a 3-year period. Further, no significant differences in change were found over the 3-year study period on surveys of randomly selected households in the intervention and control areas. Although there were general trends toward improvement in the study area, only intervention participants’ outcomes were significantly better. Results indicate the intervention can improve economic and food security and HIV vulnerability through increased testing and case finding. Leveraging the resources of economic development NGOs to deliver locally-developed programs with scientific funding to conduct controlled evaluations has the potential to accelerate the scientific evidence base for the effects of economic development programs on health.
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Affiliation(s)
- Lance S Weinhardt
- Joseph J Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201 USA
| | - Loren W Galvao
- Center for Global Health Equity, College of Nursing, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201-0413 USA
| | - Alice F Yan
- Joseph J Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201 USA
| | - Patricia Stevens
- College of Nursing, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201-0413 USA
| | | | - Emmanuel Ngui
- Joseph J Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201 USA
| | - Lindsay Emer
- Joseph J Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201 USA
| | - Katarina M Grande
- Joseph J Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI 53201 USA
| | - Lucy Mkandawire-Valhmu
- Department of Economics, Chancellor College, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Susan C Watkins
- Professor Emeritus of Sociology, University of Pennsylvania and Visiting Scholar, California Center for Population Research, University of California-Los Angeles, 4284 Public Affairs Bldg, PO Box 957236, Los Angeles, CA 90095-7236 USA
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Witzel TC, Lora W, Lees S, Desmond N. Uptake contexts and perceived impacts of HIV testing and counselling among adults in East and Southern Africa: A meta-ethnographic review. PLoS One 2017; 12:e0170588. [PMID: 28207802 PMCID: PMC5313213 DOI: 10.1371/journal.pone.0170588] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/06/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION HIV testing and counselling (HTC) interventions are key to controlling the HIV epidemic in East and Southern Africa where HTC is primarily delivered through voluntary counselling and testing (VCT), provider initiated testing and counselling (PITC), and home-based counselling and testing (HBVCT). Decision making processes around uptake of HTC models must be taken into account when designing new interventions. Counselling in HTC aims to reduce post-test risk taking behaviour and to link individuals to care but its efficacy is unclear. This meta-ethnography aims to understand the contexts of HTC uptake in East and Southern Africa and to analyse the perceived impacts of counselling-based interventions in relation to sexual behaviour and linkage to care. METHODS We conducted a systematic literature review of studies investigating HTC in East and Southern Africa from 2003 -April 2014. The search and additional snowballing identified 20 studies that fit our selection criteria. These studies were synthesised through a thematic framework analysis. RESULTS Twenty qualitative and mixed-methods studies examining impacts of HTC models in East and Southern Africa were meta-synthesised. VCT decisions were made individually while HBVCT decisions were located in family and community units. PITC was associated with coercion from healthcare providers. Low quality counselling components and multiple-intersecting barriers faced by individuals mean that counselling in HTC was not perceived to be effective in reducing post-test risk behaviour and had limited perceived effect in facilitating linkage to care. CONCLUSION HBVCT is associated with minimal stigma and should be considered as an area of priority. Counselling components in HTC interventions were effective in transmitting information about HIV and sexual risk, but were perceived as ineffective in addressing the broader personal circumstances preventing sexual behaviour change and modulating access to care.
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Affiliation(s)
- T. Charles Witzel
- Sigma Research, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine. London, United Kingdom
| | - Wezzie Lora
- Malawi-Liverpool Wellcome Trust Clinical Research Programme. Liverpool School of Tropical Medicine. Blantyre, Malawi
| | - Shelley Lees
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine. London, United Kingdom
| | - Nicola Desmond
- Malawi-Liverpool Wellcome Trust Clinical Research Programme. Liverpool School of Tropical Medicine. Blantyre, Malawi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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The Impact of Healthcare Access on Knowledge and Willingness for HIV Testing in Chinese Female Entertainment Workers. J Immigr Minor Health 2017; 17:1322-9. [PMID: 25115291 DOI: 10.1007/s10903-014-0087-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Chinese female entertainment workers are at high risk for HIV. We assessed the impact of healthcare access on HIV knowledge, condom use, and their willingness to receive HIV testing. We surveyed 257 entertainment workers in a cross-sectional study. Demographic, knowledge, and behavioral risk factors were examined. Of 257 women, 107 (42.1%) reported inconsistent condom use. Only 9% had prior HIV testing. Their HIV knowledge was generally poor. Having access to healthcare, being able to obtain condoms, and managers providing health information were associated with consistent condom use (all P < 0.01). Having access to healthcare was related to previous HIV testing (P < 0.01). Our study showed that having a doctor and access to healthcare had positive effects on HIV knowledge and likelihood of condom use and previous HIV testing. Chinese medical providers can play a significant role in encouraging HIV testing and outreach in migrant women employed at entertainment venues.
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Pathmanathan I, Lederer P, Shiraishi RW, Wadonda-Kabondo N, Date A, Matatiyo B, Dokubo EK. Knowledge of Human Immunodeficiency Virus Status and Seropositivity After a Recently Negative Test in Malawi. Open Forum Infect Dis 2016; 4:ofw231. [PMID: 28480233 DOI: 10.1093/ofid/ofw231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/26/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Awareness of human immunodeficiency virus (HIV) status among all people with HIV is critical for epidemic control. We aimed to assess accurate knowledge of HIV status, defined as concordance with serosurvey test results from the 2010 Malawi Demographic Health Survey (MDHS), and to identify risk factors for seropositivity among adults (aged 15-49) reporting a most recently negative test within 12 months. METHODS Data were analyzed from the 2010 MDHS. A logistic regression model was constructed to determine factors independently associated with HIV seropositivity after a recently negative test. All analyses controlled for the survey's complex design. RESULTS A total of 11 649 adults tested for HIV during this MDHS reported ever being sexually active. Among these, HIV seroprevalence was 12.0%, but only 61.7% had accurate knowledge of their status. Forty percent (40.3%; 95% confidence interval [CI], 36.8-43.8) of seropositive respondents reported a most recently negative test. Of those reporting that this negative test was within 12 months (n = 3630), seroprevalence was 7.2% for women (95% CI, 5.7-9.2), 5.2% for men (95% CI, 3.9-6.9), higher in the South, and higher in rural areas for men. Women with higher education and men in the richest quintile were at higher risk. More than 1 lifetime union was significantly associated with recent HIV infection, whereas never being married was significantly protective. CONCLUSIONS Self-reported HIV status based on prior test results can underestimate seroprevalence. These results highlight the need for posttest risk assessment and support for people who test negative for HIV and repeat testing in people at high risk for HIV infection.
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Affiliation(s)
- Ishani Pathmanathan
- Division of Global HIV and TB (DGHT), US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Division of Global HIV and TB (DGHT), US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Philip Lederer
- Division of Global HIV and TB (DGHT), US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Division of Global HIV and TB (DGHT), US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Ray W Shiraishi
- Division of Global HIV and TB (DGHT), US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | - Anand Date
- Division of Global HIV and TB (DGHT), US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | - E Kainne Dokubo
- Division of Global HIV and TB (DGHT), US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Johnson BA, McKenney J, Ricca AV, Rosenberg ES, Liu C, Sharma A, Sullivan PS. Risk Factors Associated With Repeated HIV Testing Among Internet-Using Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:511-523. [PMID: 27925484 PMCID: PMC5726263 DOI: 10.1521/aeap.2016.28.6.511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Men who have sex with men (MSM) represent a disproportionately impacted risk group for HIV incidence among at-risk U.S. POPULATIONS Few studies have identified risk factors associated with HIV testing frequency both within and outside of traditional health care settings. MSM enrolled in a prospective cohort were mailed at-home specimen collection kits and followed for a year. Incidence density rate ratios (IDRR) of testing were calculated, and generalized estimating equations were used to analyze the association between HIV testing and behavioral factors. The incidence rate of testing was higher among Black MSM than White MSM (IDRR: 1.3, 95% confidence interval CI [1.1, 1.5]) and higher among MSM who reported 3+ condomless anal intercourse partners (CAI) than MSM who reported no CAI (IDRR: 1.6, 95% CI [1.3, 2.0]). Increasing availability of HIV testing outside traditional health care settings, including at-home testing kits, in conjunction with targeted behavioral interventions and biomedical treatment preventions is needed.
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Affiliation(s)
- Brent A. Johnson
- University of Rochester, Rochester, New York, USA, Department of Biostatistics and Computational Biology, School of Medicine and Dentistry
| | - Jennie McKenney
- Emory University, Atlanta, Georgia, USA, Department of Epidemiology, Rollins School of Public Health
| | - Alexandra V. Ricca
- Emory University, Atlanta, Georgia, USA, Department of Epidemiology, Rollins School of Public Health
| | - Eli S. Rosenberg
- Emory University, Atlanta, Georgia, USA, Department of Epidemiology, Rollins School of Public Health
| | - Chang Liu
- University of Rochester, Rochester, New York, USA, Department of Biostatistics and Computational Biology, School of Medicine and Dentistry
| | - Akshay Sharma
- Emory University, Atlanta, Georgia, USA, Department of Epidemiology, Rollins School of Public Health
| | - Patrick S. Sullivan
- Emory University, Atlanta, Georgia, USA, Department of Epidemiology, Rollins School of Public Health
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49
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HIV transmission risk behaviors among people living with HIV/AIDS: the need to integrate HIV prevention interventions and public health strategies into HIV care. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 21:E1-E10. [PMID: 24335609 DOI: 10.1097/phh.0000000000000038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT People living with human immunodeficiency virus (HIV)/AIDS (PLWHA) who continue high-risk behaviors may represent an important source for transmitting HIV infections. OBJECTIVE To identify factors associated with high-risk behaviors among PLWHA and to plan better HIV prevention intervention strategies in HIV care. DESIGN A cross-sectional survey to assess HIV transmission risk behaviors including sexual practices, disclosure of HIV infection status to sexual partner(s), and injection drug use. SETTING Five HIV outpatient clinics serving diverse PLWHA in south central Pennsylvania. PARTICIPANTS A total of 519 HIV-infected patients. MAIN OUTCOME MEASURES Two high-risk behaviors that may increase HIV transmission risk: (1) any unsafe sexual behavior and (2) nondisclosure of HIV infection status to sexual partner(s). An unsafe sexual behavior was defined as inconsistent condom use, sex under the influence of alcohol or drugs, or exchange of sex for money. A subgroup analysis was performed to examine factors related to unprotected anal intercourse among sexually active men who have sex with men. RESULTS About two-thirds of 519 HIV patients (65.7%) were sexually active, and nearly 50% of sexually active patients reported at least 1 unsafe sexual behavior. Nondisclosure of HIV infection status was reported by about 15% of the patients. Partners' characteristics including HIV infection status and the perceived partner behavior (ie, partner may have sex with other people) were significantly associated with unsafe sexual behaviors and with nondisclosure of HIV infection status. Non-Hispanic black males were more likely to withhold their HIV infection status from their sexual partner(s) (adjusted odds ratio = 4.51) than their white counterparts. In addition, the perceived partner sexual behavior was significantly related to unprotected anal intercourse among men who have sex with men (adjusted odds ratio = 2.00). CONCLUSIONS High-risk sexual behaviors are commonly reported by PLWHA, and these behaviors may be influenced by their partners' characteristics. HIV prevention interventions and public health strategies need to be incorporated into HIV care.
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50
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Gooden L, Metsch LR, Pereyra MR, Malotte CK, Haynes LF, Douaihy A, Chally J, Mandler RN, Feaster DJ. Examining the Efficacy of HIV Risk-Reduction Counseling on the Sexual Risk Behaviors of a National Sample of Drug Abuse Treatment Clients: Analysis of Subgroups. AIDS Behav 2016; 20:1893-906. [PMID: 26837631 PMCID: PMC4970956 DOI: 10.1007/s10461-016-1300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV counseling with testing has been part of HIV prevention in the U.S. since the 1980s. Despite the long-standing history of HIV testing with prevention counseling, the CDC released HIV testing recommendations for health care settings contesting benefits of prevention counseling with testing in reducing sexual risk behaviors among HIV-negatives in 2006. Efficacy of brief HIV risk-reduction counseling (RRC) in decreasing sexual risk among subgroups of substance use treatment clients was examined using multi-site RCT data. Interaction tests between RRC and subgroups were performed; multivariable regression evaluated the relationship between RRC (with rapid testing) and sex risk. Subgroups were defined by demographics, risk type and level, attitudes/perceptions, and behavioral history. There was an effect (p < .0028) of counseling on number of sex partners among some subgroups. Certain subgroups may benefit from HIV RRC; this should be examined in studies with larger sample sizes, designed to assess the specific subgroup(s).
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Affiliation(s)
- Lauren Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
- Department of Sociomedical Sciences, Mailman School of Public Health, Miami Research Center, Columbia University, 1120 NW 14th Street, Room 1030, Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Margaret R Pereyra
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Miami Research Center, Columbia University, 1120 NW 14th Street, Room 1030, Miami, FL, 33136, USA
| | - C Kevin Malotte
- Department of Health Science, California State University, Long Beach, CA, USA
| | - Louise F Haynes
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA
| | - Antoine Douaihy
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jack Chally
- Johns Hopkins University, Baltimore, MD, USA
- EMMES Corporation, Inc., Rockville, MD, USA
| | - Raul N Mandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
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