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Ruderman LW, Ochwal P, Marcus N, Napierala S, Thirumurthy H, Agot K, Maman S. 'When I have these kits … I have confidence' - HIV self-testing provides agency for women in their sexual decision-making. Glob Public Health 2022; 17:3735-3746. [PMID: 35770697 PMCID: PMC9800639 DOI: 10.1080/17441692.2022.2092176] [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: 10/12/2021] [Accepted: 05/10/2022] [Indexed: 02/06/2023]
Abstract
Oral fluid-based HIV self-testing (HIVST) has emerged as a promising approach to increasing HIV testing coverage, particularly among high-risk populations. Understanding the experiences of women using self-tests and offering them to their sexual partners (secondary distribution) is crucial for determining the potential of HIVST. Qualitative in-depth interviews were conducted among 32 women at high risk of HIV infection, including women who engage in transactional sex, who participated in a cluster randomised trial of a secondary distribution strategy in western Kenya. Interviews explored how women used self-tests within relationships and how this affected their sexual decision-making. Three key themes emerged: women used HIVST to assess risk prior to engaging in sex with partners; HIVST provided women with increased agency to engage in or end relationships; and women appreciated these benefits and urged expanded access to self-tests. HIVST has the potential to support HIV prevention objectives in settings with high prevalence of HIV.Trial registration: ClinicalTrials.gov identifier: NCT03135067.
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Affiliation(s)
- Lucy W. Ruderman
- Gillings School of Global Public Health Department of Health Behaviour, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Perez Ochwal
- Impact Research and Development Organization, Kisumu, Kenya
| | - Noora Marcus
- Perelman School of Medicine, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Sue Napierala
- Women’s Global Health Imperative, RTI International, Berkeley, CA, USA
| | - Harsha Thirumurthy
- Perelman School of Medicine, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Suzanne Maman
- Gillings School of Global Public Health Department of Health Behaviour, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hamill MM, Onzia A, Wang TH, Kiragga AN, Hsieh YH, Parkes-Ratanshi R, Gough E, Kyambadde P, Melendez JH, Manabe YC. High burden of untreated syphilis, drug resistant Neisseria gonorrhoeae, and other sexually transmitted infections in men with urethral discharge syndrome in Kampala, Uganda. BMC Infect Dis 2022; 22:440. [PMID: 35525934 PMCID: PMC9077641 DOI: 10.1186/s12879-022-07431-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Prompt diagnosis and treatment of sexually transmitted infections (STIs) are essential to combat the STI epidemic in resource-limited settings. We characterized the burden of 5 curable STIs chlamydia, gonorrhea, trichomoniasis, Mycoplasma genitalium, syphilis, and HIV infection in Ugandan men with urethritis. METHODS Participants were recruited from a gonococcal surveillance program in Kampala, Uganda. Questionnaires, penile swabs were collected and tested by nucleic acid amplification. Gonococcal isolates were tested for antimicrobial sensitivity. Sequential point-of-care tests on blood samples were used to screen for syphilis and HIV. Bivariable and multivariable multinomial logistic regression models were used to estimate odds ratios for preselected factors likely to be associated with STIs. Adherence to STI treatment guidelines were analyzed. RESULTS From October 2019 to November 2020, positivity (95% CI) for gonorrhea, chlamydia, trichomoniasis, and Mycoplasma genitalium, were 66.4% (60.1%, 72.2%), 21.7% (16.8%, 27.4%), 2.0% (0.7%, 4.9%), and 12.4% (8.7%, 17.3%) respectively. All Neisseria gonorrhoeae isolates were resistant to ciprofloxacin, penicillin, and tetracycline, but susceptible to extended spectrum cephalosporins and azithromycin. HIV and syphilis prevalence was 20.0% (50/250) and 10.0% (25/250), and the proportion unaware of their infection was 4.0% and 80.0% respectively. Most participants were treated per national guidelines. Multivariable analysis demonstrated significant associations between curable STI coinfections and younger age, transactional sex, but not HIV status, nor condom or alcohol use. CONCLUSIONS STI coinfections including HIV their associated risk factors, and gonococcal AMR were common in this population. The majority with syphilis were unaware of their infection and were untreated. Transactional sex was associated with STI coinfections, and > 80% of participants received appropriate treatment.
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Affiliation(s)
- Matthew M Hamill
- Division of Infectious Disease, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Mason F. Lord Center Tower, Suite 381, Baltimore, MD, 21224, USA.
| | - Annet Onzia
- Infectious Disease Institute, Kampala, Uganda
| | | | | | - Yu-Hsiang Hsieh
- Division of Infectious Disease, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Mason F. Lord Center Tower, Suite 381, Baltimore, MD, 21224, USA
| | | | - Ethan Gough
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peter Kyambadde
- Ministry of Health, National Sexually Transmitted Infections Control Program, Kampala, Uganda
| | - Johan H Melendez
- Division of Infectious Disease, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Mason F. Lord Center Tower, Suite 381, Baltimore, MD, 21224, USA
| | - Yukari C Manabe
- Division of Infectious Disease, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Mason F. Lord Center Tower, Suite 381, Baltimore, MD, 21224, USA.,Infectious Disease Institute, Kampala, Uganda
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