1
|
Lee JE, Murchison K, Hassanein L, Peters D, Jacomino M, Luck G. Trends in HIV-Related Services Offered by Substance Abuse Treatment Facilities. Cureus 2024; 16:e57400. [PMID: 38694649 PMCID: PMC11062491 DOI: 10.7759/cureus.57400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/27/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction In the United States, persons who inject drugs (PWID) represent an increasingly vulnerable population, with a high risk of HIV transmission related to needle sharing. This paper aims to investigate the availability of HIV-related services within substance abuse treatment facilities while emphasizing the need for implementing comprehensive harm-reduction strategies in such facilities. Methods This study explores the prevalence and trends regarding HIV-related services within substance abuse treatment facilities in the United States including testing, counseling, early intervention, and medication provision. Data from the National Survey of Substance Abuse Treatment Services (N-SSATS) were analyzed in order to assess trends in HIV-related services from 2013 to 2020. Results Facility response rates revealed an increase in the availability of HIV testing and specialized programs for individuals with HIV. However, there was a contrasting trend with the decline in early intervention and counseling services, only with a slight increase in 2020. Additionally, government-owned facilities demonstrated superior performance in delivering HIV services compared to private facilities. Conclusion This study highlights the dire need for implementing routine opt-out HIV testing within substance abuse treatment facilities in order to identify new cases. Additionally emphasized is the importance of early intervention for this at-risk population. To effectively address these challenges, we suggest considering the adoption of the "Seek, Test, Treat, Retain" model as a potential solution. Increasing access to HIV-related services within substance abuse facilities requires enhanced resource allocation as well as integrated programs. Identifying deficiencies in HIV service integration is crucial to enhancing care and reducing HIV transmission among PWID.
Collapse
Affiliation(s)
- Jordyn E Lee
- Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Kyle Murchison
- Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Lillian Hassanein
- Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Darian Peters
- Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Mario Jacomino
- Women's and Children's Health, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - George Luck
- Integrated Medical Science, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| |
Collapse
|
2
|
Mohamed H, Hedriana HD, Holbrook EA, Henderson H, Wilson JW. HIV False-Positive Test in the Setting of CD4 Lymphocytopenia. Cureus 2024; 16:e51515. [PMID: 38304642 PMCID: PMC10831196 DOI: 10.7759/cureus.51515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 02/03/2024] Open
Abstract
In 2016, we implemented a non-targeted Emergency Department (ED)-based HIV screening program at our academic medical center following revised CDC guidelines utilizing the Abbott Alinity 4th generation HIV-1/2 antigen (Ag)/antibody (Ab) immunoassay (Abbott Laboratories, Abbott Park, IL). Following the CDC algorithm, after reactive fourth-generation testing, HIV-1/2 Ab testing is conducted. Patients undergoing acute seroconversion (acutes) may express p24 Ag but have a negative confirmatory Ab test. Acutes have the same laboratory signature during the ED encounter as those that are false positive (False +), and the two patient groups are denoted as "equivocals" until viral load testing specifies a definitive HIV status. Among False + patients (Ab/Ag positive, Ab negative, viral load undetectable), there have been limited studies on those also demonstrating a reduction in CD4+ count, an uncommon phenomenon known as "idiopathic CD4 lymphocytopenia." We review a patient with a reactive fourth-generation HIV Ab/p24 Ag test on two separate occasions. Despite lymphopenia with a reduced CD4 count, his symptoms resolved, and an RNA PCR test did not detect any presence of HIV (False +). This patient was unique as False + patient with p24 Ag reactive, as well as a coincidental low CD4 count in the absence of HIV infection. A low CD4 count is often a sign of significant HIV infection.
Collapse
Affiliation(s)
| | | | | | - Heather Henderson
- Emergency Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Jason W Wilson
- Emergency Medicine, University of South Florida Health Morsani College of Medicine, Tampa, USA
| |
Collapse
|
3
|
Allorant A, Muset P, Hodgins C, Kirakoya-Samadoulougou F, Namachapa K, Mbofana F, Panagiotoglou D, Johnson LF, Imai-Eaton JW, Maheu-Giroux M. Temporal Trends and Determinants of HIV Testing at Antenatal Care in Sub-Saharan Africa: A Pooled Analysis of Population-Based Surveys (2005-2021). J Acquir Immune Defic Syndr 2024; 95:e97-e105. [PMID: 38180847 PMCID: PMC10769174 DOI: 10.1097/qai.0000000000003329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
BACKGROUND In sub-Saharan Africa (SSA), integrating HIV testing into antenatal care (ANC) has been crucial toward reducing mother-to-child transmission of HIV. With the introduction of new testing modalities, we explored temporal trends in HIV testing within and outside of ANC and identified sociodemographic determinants of testing during ANC. METHODS We analyzed data from 139 nationally representative household surveys conducted between 2005 and 2021, including more than 2.2 million women aged 15-49 years in 41 SSA countries. We extracted data on women's recent HIV testing history (<24 months), by modality (ie, at ANC versus outside of ANC) and sociodemographic variables (ie, age, socioeconomic status, education level, number of births, urban/rural). We used Bayesian generalized linear mixed models to estimate HIV testing coverage and the proportion of those that tested as part of ANC. RESULTS HIV testing coverage (<24 months) increased substantially between 2005 and 2021 from 8% to 38%, with significant variations between countries and subregions. Two percent of women received an HIV test in the 24 months preceding the survey interview as part of ANC in 2005 and 11% in 2021. Among women who received an HIV test in the 24 months preceding the survey, the probability of testing at ANC was significantly greater for multiparous, adolescent girls, rural women, women in the poorest wealth quintile, and women in West and Central Africa. CONCLUSION ANC testing remains an important component to achieving high levels of HIV testing coverage and benefits otherwise underserved women, which could prove instrumental to progress toward universal knowledge of HIV status in SSA.
Collapse
Affiliation(s)
- Adrien Allorant
- Department of Epidemiology and Biostatistics, School of Global and Population Health, McGill University, Montréal, Canada
| | - Paul Muset
- Department of Epidemiology and Biostatistics, School of Global and Population Health, McGill University, Montréal, Canada
| | - Caroline Hodgins
- Department of Epidemiology and Biostatistics, School of Global and Population Health, McGill University, Montréal, Canada
| | - Fati Kirakoya-Samadoulougou
- Research Center in Epidemiology, Biostatistics, and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Khumbo Namachapa
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Francisco Mbofana
- Conselho Nacional de Combate ao SIDA, Ministry of Health, Maputo, Mozambique
| | - Dimitra Panagiotoglou
- Department of Epidemiology and Biostatistics, School of Global and Population Health, McGill University, Montréal, Canada
| | - Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, City of Cape Town, WC, South Africa
| | - Jeffrey W. Imai-Eaton
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA; and
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Global and Population Health, McGill University, Montréal, Canada
| |
Collapse
|
4
|
Johnson AL, Butts SA, Rodriguez E, Craker L, Kanamori M, Doblecki-Lewis S. "Test-To-PrEP": Assessing Reach and Adoption of a New Approach to Increase HIV Testing and PrEP Knowledge Using HIV Self-Test Kit Distribution Through PrEP Clients' Social Networks. J Acquir Immune Defic Syndr 2023; 94:421-428. [PMID: 37949445 PMCID: PMC10651164 DOI: 10.1097/qai.0000000000003294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/15/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND HIV self-testing (HIVST) can increase the reach of HIV testing. Preexposure prophylaxis (PrEP) clients may be ideal distributors of HIVST kits and PrEP information within their social networks. This study uses the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to evaluate the distribution of HIVST bundled with PrEP information ("Test-to-PrEP" kits) among egocentric friendship networks of PrEP users. METHODS The study was conducted in Miami from November 2021 to March 2022. Enrolled PrEP clients (egos; n = 100) were offered Test-to-PrEP kits for distribution. Egos and Test-to-PrEP kit users completed brief online surveys. Descriptive statistics are reported for participants, their reported network members, and users of the Test-to-PrEP kits. Logistic and Poisson regression assessed the relationship between characteristics of egos, alters, and the distribution of Test-to-PrEP kits. RESULTS The 100 enrolled egos reported a total of 414 alters. Participants received 293 Test-to-PrEP kits for distribution with 47 of the 100 participants distributing at least 1 kit. Of those who scanned the quick-response code and responded to the survey, 16.2% reported no previous HIV test and 38.5% reported no prior knowledge of PrEP; 32.5% reported interest in distributing Test-to-PrEP kits, 3 successfully distributed kits, and 2 initiated PrEP. CONCLUSIONS An approach using PrEP clients' social networks can disseminate HIVST bundled with PrEP information to critical populations including individuals lacking knowledge of PrEP or who have never been tested for HIV. Future studies will assess whether this use of network effects can increase reach and efficiency of HIV testing and PrEP information distribution.
Collapse
Affiliation(s)
- Ariana L. Johnson
- Department of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stefani A. Butts
- Department of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Edda Rodriguez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lacey Craker
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mariano Kanamori
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Susanne Doblecki-Lewis
- Department of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
5
|
Alsaeed A, AlKhalaf A, Al Matar F, AlRamadan S, Al Muhaif A, Marzooq Z, Alaali Z. Unveiling Monkeypox: A Rare Case of Sexual Transmission in Saudi Arabia. Cureus 2023; 15:e47785. [PMID: 38022203 PMCID: PMC10676519 DOI: 10.7759/cureus.47785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
This case report describes the presentation, management, and clinical course of monkeypox in a 30-year-old female with multiple sexual partners admitted to Dammam Medical Complex, a major hospital in eastern Saudi Arabia. The patient presented with a rash on her inner thighs and vagina, accompanied by subjective fever and itching. A biopsy confirmed the diagnosis of monkeypox. Despite the absence of complications, the patient was isolated and received conservative therapy under the care of the infectious disease team. This case report highlights the effectiveness of conservative therapy in managing monkeypox, testing another possibility of sexually transmitted disease, and emphasizes the role of the infectious disease team in providing comprehensive care to patients with infectious diseases.
Collapse
Affiliation(s)
- Ali Alsaeed
- Infectious Disease Division, Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Abdullah AlKhalaf
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Fatimah Al Matar
- Internal Medicine Residency Program, Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Saleh AlRamadan
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Ali Al Muhaif
- Internal Medicine Residency Program, Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Zahra Marzooq
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Zainab Alaali
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| |
Collapse
|
6
|
Sousa LRM, de Mesquita RF, Wiklander M, Eriksson LE, Gir E, Reis RK. Cultural Adaptation and Validation of the Barriers to HIV Testing Scale-Karolinska Version for Brazilian Men Who Have Sex With Men. J Assoc Nurses AIDS Care 2023; 34:481-498. [PMID: 37561660 PMCID: PMC10481927 DOI: 10.1097/jnc.0000000000000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
ABSTRACT The aim of this study was to perform the cultural adaptation and validation of the Barriers to HIV testing scale-Karolinska version for Brazilian men who have sex with men. A methodological study was conducted for cultural adaptation and validation of the scale. Reliability analyses, exploratory factor analysis, confirmatory factor analysis, and convergent and discriminant validity tests were performed. Four factors were extracted: F1, personal consequences; F2, structural barriers; F3, confidentiality; F4, economic consequences and individual concerns. Good fit indexes were obtained: (χ 2 )/GL (2.71); goodness of fit index (0.94); root-mean-square error of approximation (0.052; 90% CI [0.045-0.059]); Tucker-Lewis index (0.94); normed fit index (0.93); IFI (0.95); comparative fit index (0.95). Convergent validity results were greater than 0.7 for the four factors. The adapted version of the scale showed satisfactory reliability and validity for assessing barriers to HIV testing among men who have sex with men.
Collapse
Affiliation(s)
- Laelson Rochelle Milanês Sousa
- Laelson Rochelle Milanês Sousa, PhD, is a Postdoctoral Researcher, Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Rafael Fernandes de Mesquita, PhD, is a Professor, Federal Institute of Education, Science and Technology of Piauí, Teresina, Brazil. Maria Wiklander, PhD, is a Psychologist, Associate Senior Lecturer, Division of Nursing, Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Huddinge, Sweden. Lars E. Eriksson, RN, is an Associate Professor, Senior Lecturer, Department Director of Doctoral Education, Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden. Elucir Gir, PhD, MNSc.RN, is a Full Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, Vice Dean of University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil. Renata Karina Reis, PhD, MNSc.RN, is a Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Rafael Fernandes de Mesquita
- Laelson Rochelle Milanês Sousa, PhD, is a Postdoctoral Researcher, Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Rafael Fernandes de Mesquita, PhD, is a Professor, Federal Institute of Education, Science and Technology of Piauí, Teresina, Brazil. Maria Wiklander, PhD, is a Psychologist, Associate Senior Lecturer, Division of Nursing, Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Huddinge, Sweden. Lars E. Eriksson, RN, is an Associate Professor, Senior Lecturer, Department Director of Doctoral Education, Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden. Elucir Gir, PhD, MNSc.RN, is a Full Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, Vice Dean of University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil. Renata Karina Reis, PhD, MNSc.RN, is a Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Maria Wiklander
- Laelson Rochelle Milanês Sousa, PhD, is a Postdoctoral Researcher, Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Rafael Fernandes de Mesquita, PhD, is a Professor, Federal Institute of Education, Science and Technology of Piauí, Teresina, Brazil. Maria Wiklander, PhD, is a Psychologist, Associate Senior Lecturer, Division of Nursing, Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Huddinge, Sweden. Lars E. Eriksson, RN, is an Associate Professor, Senior Lecturer, Department Director of Doctoral Education, Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden. Elucir Gir, PhD, MNSc.RN, is a Full Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, Vice Dean of University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil. Renata Karina Reis, PhD, MNSc.RN, is a Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Lars E. Eriksson
- Laelson Rochelle Milanês Sousa, PhD, is a Postdoctoral Researcher, Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Rafael Fernandes de Mesquita, PhD, is a Professor, Federal Institute of Education, Science and Technology of Piauí, Teresina, Brazil. Maria Wiklander, PhD, is a Psychologist, Associate Senior Lecturer, Division of Nursing, Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Huddinge, Sweden. Lars E. Eriksson, RN, is an Associate Professor, Senior Lecturer, Department Director of Doctoral Education, Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden. Elucir Gir, PhD, MNSc.RN, is a Full Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, Vice Dean of University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil. Renata Karina Reis, PhD, MNSc.RN, is a Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Elucir Gir
- Laelson Rochelle Milanês Sousa, PhD, is a Postdoctoral Researcher, Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Rafael Fernandes de Mesquita, PhD, is a Professor, Federal Institute of Education, Science and Technology of Piauí, Teresina, Brazil. Maria Wiklander, PhD, is a Psychologist, Associate Senior Lecturer, Division of Nursing, Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Huddinge, Sweden. Lars E. Eriksson, RN, is an Associate Professor, Senior Lecturer, Department Director of Doctoral Education, Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden. Elucir Gir, PhD, MNSc.RN, is a Full Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, Vice Dean of University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil. Renata Karina Reis, PhD, MNSc.RN, is a Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Renata Karina Reis
- Laelson Rochelle Milanês Sousa, PhD, is a Postdoctoral Researcher, Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Rafael Fernandes de Mesquita, PhD, is a Professor, Federal Institute of Education, Science and Technology of Piauí, Teresina, Brazil. Maria Wiklander, PhD, is a Psychologist, Associate Senior Lecturer, Division of Nursing, Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Huddinge, Sweden. Lars E. Eriksson, RN, is an Associate Professor, Senior Lecturer, Department Director of Doctoral Education, Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden. Elucir Gir, PhD, MNSc.RN, is a Full Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, Vice Dean of University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil. Renata Karina Reis, PhD, MNSc.RN, is a Professor, General and Specialized Nursing Department, Graduate Program in Fundamental Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
7
|
Thomas MD, Vittinghoff E, Koester KA, Dahiya P, Riano NS, Cournos F, Dawson L, Olfson M, Pinals DA, Crystal S, Walkup J, Shade S, Mangurian C, Arnold EA. Examining the Impact of State-Level Factors on HIV Testing for Medicaid Enrollees With Schizophrenia. J Acquir Immune Defic Syndr 2023; 94:18-27. [PMID: 37229531 PMCID: PMC10524352 DOI: 10.1097/qai.0000000000003225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/22/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND People with schizophrenia experience unique barriers to routine HIV testing, despite increased risk of HIV compared with the general US population. Little is known about how health care delivery system factors affect testing rates or whether there are testing differences for people with schizophrenia. SETTING Nationally representative sample of Medicaid enrollees with and without schizophrenia. METHODS Using retrospective longitudinal data, we examined whether state-level factors were associated with differences in HIV testing among Medicaid enrollees with schizophrenia compared with frequency-matched controls during 2002-2012. Multivariable logistic regression estimated testing rate differences between and within cohorts. RESULTS Higher HIV testing rates for enrollees with schizophrenia were associated with higher state-level Medicaid spending per enrollee, efforts to reduce Medicaid fragmentation, and higher federal prevention funding. State-level AIDS epidemiology predicted more frequent HIV testing for enrollees with schizophrenia versus controls. Living in rural settings predicted lower HIV testing, especially for people with schizophrenia. CONCLUSION Overall, state-level predictors of HIV testing rates varied among Medicaid enrollees, although rates were generally higher for those with schizophrenia than controls. Increased HIV testing for people with schizophrenia was associated with coverage of HIV testing when medically necessary, higher Centers for Disease Control and Prevention prevention funding, and higher AIDS incidence, prevalence, and mortality when compared with controls. This analysis suggests that state policymaking has an important role to play in advancing that effort. Overcoming fragmented care systems, sustaining robust prevention funding, and consolidating funding streams in innovative and flexible ways to support more comprehensive systems of care delivery deserve attention.
Collapse
Affiliation(s)
- Marilyn D. Thomas
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine 550 16th St 2 floor, San Francisco, CA 94158
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine 675 18th St, San Francisco, CA 94107
| | - Eric Vittinghoff
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine 550 16th St 2 floor, San Francisco, CA 94158
| | - Kimberly A. Koester
- Department of Medicine, University of California San Francisco, School of Medicine 533 Parnassus Ave, San Francisco, CA 94143
| | - Priya Dahiya
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine 675 18th St, San Francisco, CA 94107
| | - Nicholas S. Riano
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine 675 18th St, San Francisco, CA 94107
- Department of Psychological Science, School of Social Ecology, University of California Irvine, 2220 Social and Behavioral Sciences Gateway, 214 Pereira Dr, Irvine, CA 92617
| | - Francine Cournos
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons 630 W 168th St, New York, NY 10032
- Department of Epidemiology, Columbia University Mailman School of Public Health 722 W 168th St, New York, NY 10032
| | - Lindsey Dawson
- KFF (Kaiser Family Foundation) 185 Berry St #2000, San Francisco, CA 94107
| | - Mark Olfson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons 630 W 168th St, New York, NY 10032
- Department of Epidemiology, Columbia University Mailman School of Public Health 722 W 168th St, New York, NY 10032
- New York State Psychiatric Institute 1051 Riverside Dr, New York, NY 10032
| | - Debra A. Pinals
- Department of Psychiatry, University of Michigan Medical School 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Steven Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University 112 Paterson St, New Brunswick, NJ 08901
| | - James Walkup
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University 112 Paterson St, New Brunswick, NJ 08901
- Graduate School of Applied and Professional Psychology, Rutgers University 152 Frelinghuysen Rd, Piscataway, NJ 08854
| | - Starley Shade
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine 550 16th St 2 floor, San Francisco, CA 94158
| | - Christina Mangurian
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine 550 16th St 2 floor, San Francisco, CA 94158
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine 675 18th St, San Francisco, CA 94107
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital 2789 25th St, San Francisco, CA 94110
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco 490 Illinois Street 7 Floor, San Francisco, CA 94158
| | - Emily A. Arnold
- Department of Medicine, University of California San Francisco, School of Medicine 533 Parnassus Ave, San Francisco, CA 94143
- Center for AIDS Prevention Studies, University of California San Francisco 550 16th St 3rd floor, San Francisco, CA 94158
| |
Collapse
|
8
|
Yang B, Sloot R, Floyd S, Awoniyi D, Griffith S, Ayles H, Fidler S, Hayes R, Vermund SH, Bock P. Brief Report: How Do We Reach Men? Offering HIV Testing in Evenings and Weekends in the HPTN 071 (PopART) Community-Based Trial in South Africa. J Acquir Immune Defic Syndr 2023; 93:300-304. [PMID: 37001128 PMCID: PMC10313787 DOI: 10.1097/qai.0000000000003197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/06/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Unknown HIV status and consequent low antiretroviral treatment coverage among men living with HIV combined with high-risk behavior is a key driver of the HIV epidemic in high-burden settings. We investigated whether conducting household visits during nontraditional shifts increased the number of men recruited for community-based HIV testing, compared with traditional weekday shifts in the HPTN 071 (PopART) trial in South Africa. METHODS We used data captured during household visits among individuals aged 15 years or older in 6 communities in South Africa from September 2016 to September 2017. Successful recruitment required community HIV care providers (CHiPs) accessing a household member and completing the study questionnaire. Linear regression analysis compared mean successful recruitments between the different shift types stratified by sex. RESULTS During 187 days, 62,455 successful household visits were completed. Recruitment of men and women was higher in weekends, for men highest on Sundays (Coef: 11.2, 95% CI: 8.7 to 13.7), for women highest on Saturdays (Coef: 11.3, 95% CI: 7.6 to 15.1), indicating a mean of 11.2 more men recruited on Sunday shifts, compared with traditional weekday shifts was similar when comparing traditional weekday shifts with nontraditional weekday shifts for both men and women. CONCLUSION Conducting household visits during the weekends led to increased recruitment for participation in the PopART intervention among both men and women. This suggests that targeting households during the weekend can be an effective and easy-to-implement strategy to increase the number of men accessed for HIV testing that can be integrated into a wide range of community-based services.
Collapse
Affiliation(s)
- Blia Yang
- Desmond Tutu TB Centre, Stellenbosch University, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Rosa Sloot
- Desmond Tutu TB Centre, Stellenbosch University, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Sian Floyd
- London School of Hygiene and Tropical Medicine, Department of Infectious Disease Epidemiology, London, United Kingdom
| | - Dolapo Awoniyi
- Desmond Tutu TB Centre, Stellenbosch University, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Sam Griffith
- FHI360, Durham, North Carolina, United States of America
| | - Helen Ayles
- Zambia AIDS Related Tuberculosis Project, University of Zambia, Lusaka, Zambia
- London School of Hygiene and Tropical Medicine, Department of Clinical Research, London, United Kingdom
| | - Sarah Fidler
- Imperial College London, Department of Infectious Disease Epidemiology, London, United Kingdom
| | - Richard Hayes
- London School of Hygiene and Tropical Medicine, Department of Infectious Disease Epidemiology, London, United Kingdom
| | - Sten H. Vermund
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Peter Bock
- Desmond Tutu TB Centre, Stellenbosch University, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | | |
Collapse
|
9
|
Viguerie A, Song R, Johnson AS, Lyles CM, Hernandez A, Farnham PG. Isolating the Effect of COVID-19-Related Disruptions on HIV Diagnoses in the United States in 2020. J Acquir Immune Defic Syndr 2023; 92:293-299. [PMID: 36515707 PMCID: PMC10111242 DOI: 10.1097/qai.0000000000003140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diagnoses of HIV in the United States decreased by 17% in 2020 due to COVID-related disruptions. The extent to which this decrease is attributable to changes in HIV testing versus HIV transmission is unclear. We seek to better understand this issue by analyzing the discrepancy in expected versus observed HIV diagnoses in 2020 among persons who acquired HIV between 2010 and 2019 because changes in diagnosis patterns in this cohort cannot be attributed to changes in transmission. METHODS We developed 3 methods based on the CD4-depletion model to estimate excess missed diagnoses in 2020 among persons with HIV (PWH) infected from 2010 to 2019. We stratified the results by transmission group, sex assigned at birth, race/ethnicity, and region to examine differences by group and confirm the reliability of our estimates. We performed similar analyses projecting diagnoses in 2019 among PWH infected from 2010 to 2018 to evaluate the accuracy of our methods against surveillance data. RESULTS There were approximately 3100-3300 (approximately 18%) fewer diagnoses than expected in 2020 among PWH infected from 2010 to 2019. Females (at birth), heterosexuals, persons who inject drugs, and Hispanic/Latino PWH missed diagnoses at higher levels than the overall population. Validation and stratification analyses confirmed the accuracy and reliability of our estimates. CONCLUSIONS The substantial drop in number of previously infected PWH diagnosed in 2020 suggests that changes in testing played a substantial role in the observed decrease. Levels of missed diagnoses differed substantially across population subgroups. Increasing testing efforts and innovative strategies to reach undiagnosed PWH are needed to offset this diagnosis gap. These analyses may be used to inform future estimates of HIV transmission during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Alex Viguerie
- Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Division of HIV Prevention (DHP), Quantitative Sciences Branch (QSB)
| | - Ruiguang Song
- Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Division of HIV Prevention (DHP), Quantitative Sciences Branch (QSB)
| | - Anna Satcher Johnson
- Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Division of HIV Prevention (DHP), HIV Surveillance Branch (HSB)
| | - Cynthia M. Lyles
- Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Division of HIV Prevention (DHP), Quantitative Sciences Branch (QSB)
| | - Angela Hernandez
- Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Division of HIV Prevention (DHP), HIV Surveillance Branch (HSB)
| | - Paul G. Farnham
- Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Division of HIV Prevention (DHP), Quantitative Sciences Branch (QSB)
| |
Collapse
|
10
|
Gurley SA, Stupp PW, Fellows IE, Parekh BS, Young PW, Shiraishi RW, Sullivan PS, Voetsch AC. Estimation of HIV-1 Incidence Using a Testing History-Based Method; Analysis From the Population-Based HIV Impact Assessment Survey Data in 12 African Countries. J Acquir Immune Defic Syndr 2023; 92:189-196. [PMID: 36730779 PMCID: PMC9911103 DOI: 10.1097/qai.0000000000003123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Estimating HIV incidence is essential to monitoring progress in sub-Saharan African nations toward global epidemic control. One method for incidence estimation is to test nationally representative samples using laboratory-based incidence assays. An alternative method based on reported HIV testing history and the proportion of undiagnosed infections has recently been described. METHODS We applied an HIV incidence estimation method which uses history of testing to nationally representative cross-sectional survey data from 12 sub-Saharan African nations with varying country-specific HIV prevalence. We compared these estimates with those derived from laboratory-based incidence assays. Participants were tested for HIV using the national rapid test algorithm and asked about prior HIV testing, date and result of their most recent test, and date of antiretroviral therapy initiation. RESULTS The testing history-based method consistently produced results that are comparable and strongly correlated with estimates produced using a laboratory-based HIV incidence assay (ρ = 0.85). The testing history-based method produced incidence estimates that were more precise compared with the biomarker-based method. The testing history-based method identified sex-, age-, and geographic location-specific differences in incidence that were not detected using the biomarker-based method. CONCLUSIONS The testing history-based method estimates are more precise and can produce age-specific and sex-specific incidence estimates that are informative for programmatic decisions. The method also allows for comparisons of the HIV transmission rate and other components of HIV incidence among and within countries. The testing history-based method is a useful tool for estimating and validating HIV incidence from cross-sectional survey data.
Collapse
Affiliation(s)
- Stephen A. Gurley
- Rollins School of Public Health, Emory University, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
| | - Paul W. Stupp
- Division of Global HIV&TB, United States Centers for Disease Control and Prevention, Atlanta, GA
| | - Ian E. Fellows
- Division of Global HIV&TB, United States Centers for Disease Control and Prevention, Atlanta, GA
- Fellows Statistics Inc., San Diego, CA; and
| | - Bharat S. Parekh
- Division of Global HIV&TB, United States Centers for Disease Control and Prevention, Atlanta, GA
| | - Peter W. Young
- Division of Global HIV&TB, United States Centers for Disease Control and Prevention, Atlanta, GA
- Division of Global HIV & TB, United States Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Ray W. Shiraishi
- Division of Global HIV&TB, United States Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Andrew C. Voetsch
- Rollins School of Public Health, Emory University, Atlanta, GA
- Division of Global HIV&TB, United States Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
11
|
Williams WO, Song W, Huang T, Mulatu MS, Uhl G, Rorie M. HIV Diagnoses Through Partner Services in the United States in 2019 and Opportunities for Improvement. Sex Transm Dis 2023; 50:74-78. [PMID: 36630414 PMCID: PMC9839312 DOI: 10.1097/olq.0000000000001738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: HIV Partner Services (HIV PS) is an effective strategy for diagnosing HIV infection. Sex/needle-sharing partners of individuals diagnosed with HIV are notified about potential exposure and offered HIV testing and other services. We assessed the HIV PS contribution to HIV diagnoses in the U.S. and assessed priority areas for improvements. Methods: National HIV Monitoring and Evaluation Partner Services and case surveillance data reported to the Centers for Disease Control and Prevention for 2019 were used for this analysis. The percentage of all new diagnoses that HIV PS programs reported are described nationally and by state. Linkage to HIV medical care among newly diagnosed partners is described. Potential increases in diagnosing HIV infection are assessed by HIV PS step to identify priority areas for improvement. Results: HIV PS contributed 1,214/35,164 (3.5%) of all diagnoses nationally in 2019, and contributions ranged 0-31.8% by state. Of partners tested with non-missing data, 22.7% were newly diagnosed. An estimated 1,692 new partner diagnoses were lost during HIV PS steps. Steps resulting in the highest losses included index patients not being interviewed, partners not being tested for HIV, and index patients not being located. Seventy-two percent of partners newly diagnosed with HIV were linked to HIV medical care. Conclusions: HIV PS is an effective strategy for diagnosing HIV, and a high percent of sex/needle-sharing partners were newly diagnosed with HIV. Expanded HIV PS in some states and targeted improvements in HIV PS steps can enhance the contribution of HIV PS toward achieving national goals. HIV Partner Services in 2019 resulted in 1,214 diagnoses (3.5% of diagnoses in the United States) with 22.7% new positivity among partners without prior diagnosis. Areas for improvement are identified.
Collapse
Affiliation(s)
- Weston O. Williams
- Public Health Analytic Consulting Services, Inc., Hillsborough, NC
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Wei Song
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Taoying Huang
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mesfin S. Mulatu
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gary Uhl
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michele Rorie
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
12
|
Wang G, Song W, Rao S, Heitgerd J, Mulatu MS, Karch D, Belcher L. HIV Positivity, Linkage to Medical Care, Interview for Partner Services, and Pre-Exposure Prophylaxis Awareness and Referral Among Men Who Have Sex With Men Tested in Non-healthcare Settings in the United States, 2019. J Acquir Immune Defic Syndr 2023; 92:34-41. [PMID: 36166309 PMCID: PMC10959101 DOI: 10.1097/qai.0000000000003106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/23/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. This study reports data on HIV testing program outcomes among MSM tested for HIV in non-healthcare settings in the United States. METHODS We analyzed Centers for Disease Control and Prevention's National HIV Prevention Program Monitoring and Evaluation data collected in 2019. Descriptive and multivariate robust Poisson regression analyses were conducted to summarize the patterns of HIV testing program outcomes [ie, positivity, linkage to HIV medical care within 30 days of diagnosis, interview for partner services (PS), and pre-exposure prophylaxis (PrEP) awareness and referral] by demographic characteristics, HIV prevalence, and testing site type. RESULTS A total of 123,251 HIV tests were conducted among MSM; of these, 1773 (1.4%) were newly diagnosed with HIV. Among MSM newly diagnosed with HIV, 75% were linked to HIV medical care and 80% were interviewed for PS. Among MSM who tested HIV-negative, 63% were aware of PrEP and 47% of those who were eligible for PrEP were referred to PrEP providers. Referral or linkage to services varied by demographic characteristics or other factors. CONCLUSIONS Linkage to HIV medical care and interview for PS among MSM newly diagnosed with HIV in non-healthcare settings were below national or funding program targets. Most MSM with risk factors for HIV infection were not referred to PrEP providers. Expanded efforts to address barriers to equitable access to services may help improve HIV-related outcomes among MSM and contribute to ending the HIV epidemic in the United States.
Collapse
Affiliation(s)
- Guoshen Wang
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wei Song
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shubha Rao
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet Heitgerd
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mesfin S. Mulatu
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Debra Karch
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Belcher
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
13
|
O'Grady TJ, Yuan Y, Harris JM, Massaroni RJ, Fuller JA, Tesoriero JM. Impact of COVID-19 on HIV Testing Among AIDS Institute-Funded Providers in New York State-A Time Series Analysis. J Acquir Immune Defic Syndr 2023; 92:27-33. [PMID: 36215975 PMCID: PMC9722363 DOI: 10.1097/qai.0000000000003109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/23/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND New York State (NYS) was at the intersection of the HIV epidemic and coronavirus disease 2019 (COVID-19) pandemic leading to a disruption in HIV-preventive services. This study sought to determine the impact of the COVID-19 pandemic and mitigation efforts on HIV-testing trends in NYS among AIDS Institute (AI)-funded providers. METHODS We analyzed weekly testing data from the AI Reporting System from January 1, 2017, to June 27, 2021, to fit an interrupted time series model that predicted the expected number of HIV tests among AI-funded providers in NYS had the COVID-19 pandemic not occurred. The actual observed numbers of HIV testing that occurred from weeks beginning March 15, 2020, to June 30, 2021, were compared with the number of HIV tests predicted by the model. RESULTS In the absence of the COVID-19 pandemic, our model predicted that there would have been 45,605 HIV tests among AI-funded providers between the weeks beginning March 15, 2020, to June 27, 2021. We observed 20,742 HIV tests, representing a 54.5% reduction. We observed percent decreases of greater than 50% for HIV testing among AI-funded providers for New York City (52.9%) and rest of state (59.8%) regions, male (50.6%) and female (66.8%) genders, as well as Black (59.2%), Hispanic (52.8%), mixed race (57.5%), other (50.3%), and White (50.1%) race and ethnicities. CONCLUSION HIV testing among AI-funded providers in NYS has declined substantially following the COVID-19 pandemic, reflecting decreased access to, and/or demand for, testing among persons at elevated risk for HIV. Initiatives to increase HIV testing and maintain access to HIV prevention services need to be explored following COVID-19.
Collapse
Affiliation(s)
| | - Yingchao Yuan
- New York State Department of Health, AIDS Institute, Albany, NY
| | - Julie M. Harris
- New York State Department of Health, AIDS Institute, Albany, NY
| | | | - John A. Fuller
- New York State Department of Health, AIDS Institute, Albany, NY
| | | |
Collapse
|
14
|
Ostermann J, Njau B, Masaki M, Mtuy T, Itemba D, Hobbie A, Yelverton V, Moore S, Yamanis T, Thielman NM. Feasibility, Acceptability, and Potential Cost-Effectiveness of a Novel Mobile Phone Intervention to Promote Human Immunodeficiency Virus Testing Within Social Networks in Tanzania. Sex Transm Dis 2022; 49:778-781. [PMID: 35093981 PMCID: PMC9329485 DOI: 10.1097/olq.0000000000001611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Among 145 individuals surveyed in Tanzania, 42% indicated willingness to test for human immunodeficiency virus in response to a confidential, phone-based text message. On average, participants were likely to provide contact information for 1.5 members of their social networks, suggesting high feasibility and moderate acceptability of a novel mHealth human immunodeficiency virus testing intervention.
Collapse
Affiliation(s)
| | - Bernard Njau
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Martha Masaki
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | | | - Amy Hobbie
- Center for Health Policy & Inequalities Research, Duke University, Durham, NC
| | | | - Spencer Moore
- Department of Social Sciences, Wageningen University, Wageningen, The Netherlands
| | - Thespina Yamanis
- School of International Service, American University, Washington, DC
| | | |
Collapse
|
15
|
Tseng AS, Sambai B, Monroe-Wise A, Mbogo LW, Ludwig-Barron NT, Masyuko SJ, Chohan BH, Scott JD, Sinkele W, Herbeck JT, Farquhar C, Guthrie BL. Assisted Partner Services for People Who Inject Drugs: Index Characteristics Associated With Untreated HIV in Partners. J Acquir Immune Defic Syndr 2022; 91:269-275. [PMID: 35969466 PMCID: PMC9588565 DOI: 10.1097/qai.0000000000003062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Assisted partner services (APSs) is a feasible, acceptable, and effective strategy that increases uptake of HIV testing; however, it has not been used widely among people who inject drugs (PWID) in Africa to notify sexual and injecting partners of potential exposures to HIV and provide testing services. SETTING Nairobi, Kilifi, and Mombasa counties in Kenya. METHODS PWID living with HIV (indexes) were enrolled and asked to provide contact information for sexual and injecting partners who were traced and offered HIV testing. APS efficiency was assessed by the number of indexes needed to interview (NNTI) to find 1 additional partner who was unaware of their HIV status or not on antiretroviral therapy (ART). We defined index participant characteristics associated with greater efficiency, defined as lower NNTIs. RESULTS Among 783 indexes, the NNTI to identify one partner unaware of their HIV status was 7.1 and to identify one HIV-positive partner not on ART (regardless of status awareness) was 4.1. APS was provided to 977 partners and was more efficient in identifying partners who were not on ART (n = 201) among indexes who were female (NNTI = 2.9 vs. 5.7, P < 0.001), unaware of their HIV status (NNTI = 2.2 vs. 4.2, P = 0.009), not on ART (NNTI = 2.1 vs. 4.9; P < 0.001), not enrolled in a methadone program (NNTI = 3.3 vs. 10.4, P < 0.001), reported injecting <5 years (NNTI = 3.3 vs. 5.0; P = 0.005), or from Nairobi (NNTI = 3.2 vs. 5.6, P < 0.001). CONCLUSION Scaling up APS among PWID living with HIV with certain characteristics could result in more efficient APS and greater partner engagement in HIV care.
Collapse
Affiliation(s)
- Ashley S Tseng
- Departments of Epidemiology, and
- Global Health, University of Washington, Seattle, WA
| | | | | | | | | | - Sarah J Masyuko
- Global Health, University of Washington, Seattle, WA
- National AIDS and STI Control Program, Kenya Ministry of Health, Nairobi, Kenya
| | - Bhavna H Chohan
- Global Health, University of Washington, Seattle, WA
- Center for Virology, Kenya Medical Research Institute, Nairobi, Kenya
| | - John D Scott
- Department of Medicine, University of Washington, Seattle, WA; and
| | - William Sinkele
- Support for Addiction Prevention and Treatment in Africa, Nairobi, Kenya
| | | | - Carey Farquhar
- Departments of Epidemiology, and
- Global Health, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA; and
| | - Brandon L Guthrie
- Departments of Epidemiology, and
- Global Health, University of Washington, Seattle, WA
| |
Collapse
|
16
|
Patel D, Williams WO, Wright C, Taylor-Aidoo N, Song W, Marandet A, DiNenno EA. HIV Testing Services Outcomes in CDC-Funded Health Departments During COVID-19. J Acquir Immune Defic Syndr 2022; 91:117-121. [PMID: 36094476 PMCID: PMC9714773 DOI: 10.1097/qai.0000000000003049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Organizations offering HIV prevention services have reported interruptions during the COVID-19 pandemic. The national extent of these interruptions and their public health impact remain largely unexplored. METHODS Using data from 60 state and local health departments, we compared HIV testing services outcomes in calendar years 2019 and 2020, including the number of Centers for Disease Control and Prevention (CDC)-funded HIV tests conducted, the percentage of persons with newly diagnosed HIV infection (ie, HIV positivity), and the percentage linked to HIV medical care within 30 days after new diagnoses (ie, linkage to care) using χ2 and robust Poisson models. We also assessed the independent associations between the pandemic period (ie, March-December 2020) and the number of COVID-19 cases with monthly HIV testing services outcomes using multivariable robust Poisson models. RESULTS There was a 46.0% (P < 0.001) reduction in the number of CDC-funded HIV tests conducted in 2020 (n = 1,255,895) compared with 2019 (n = 2,324,421). Although there were fewer persons with newly diagnosed HIV in 2020 (n = 5581 vs. n = 7739 in 2019), HIV positivity was greater in 2020 (0.4% vs. 0.3% in 2019; adjusted prevalence ratio [aPR] = 1.33, 95% confidence interval [CI]: 1.05 to 1.69). When adjusting for the monthly number of COVID-19 cases, the pandemic period was associated with a 56% reduction in the number of monthly CDC-funded HIV tests (adjusted rate ratio = 0.44, 95% CI: 0.37 to 0.52) but 28% higher monthly HIV positivity (aPR = 1.28 95% CI: 1.16 to 1.41) and 10% higher linkage to care (aPR = 1.10, 95% CI: 1.02 to 1.18). DISCUSSION Despite increased HIV positivity, a drastic reduction in the number of CDC-funded HIV tests was observed in 2020, affecting the ability to identify persons with newly diagnosed HIV. CDC and health departments will need to expand testing strategies to cover tests not conducted in 2020 while adapting to the continuing pandemic.A visual abstract is available for this article at: http://links.lww.com/QAI/B941.
Collapse
Affiliation(s)
- Deesha Patel
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Carolyn Wright
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Wei Song
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Angele Marandet
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth A. DiNenno
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
17
|
Ante-Testard PA, Hamidouche M, Apouey B, Baggaley R, Larmarange J, Benmarhnia T, Temime L, Jean K. Understanding the pathways leading to socioeconomic inequalities in HIV testing uptake in 18 sub-Saharan African countries. AIDS 2022; 36:1707-16. [PMID: 35848589 DOI: 10.1097/QAD.0000000000003316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To better understand the different pathways linking socioeconomic position and HIV testing uptake in 18 sub-Saharan African countries. DESIGN We used cross-sectional population-based surveys between 2010 and 2018. METHODS Using a potential outcomes framework and the product method, we decomposed the total effect linking wealth and recent (<12 months) HIV testing into direct effects, and indirect effects, via internal (related to individual's ability to perceive need for and to seek care) or external (ability to reach, pay for and engage in healthcare) mediators to calculate the proportion mediated (PM) by each mediator. RESULTS High levels of inequalities were observed in nine and 15 countries among women and men, respectively. The mediator indirect effect varied greatly across countries. The PM tended to be higher for internal than for external mediators. For instance, among women, HIV-related knowledge was estimated to mediate up to 12.1% of inequalities in Côte d'Ivoire; and up to 31.5% for positive attitudes towards people with HIV (PWH) in Senegal. For the four external mediators, the PM was systematically below 7%. Similar findings were found when repeating analyses on men for the internal mediators, with higher PM by attitudes towards PWH (up to 39.9% in Senegal). CONCLUSIONS Our findings suggest that wealth-related inequalities in HIV testing may be mediated by internal more than external characteristics, with important variability across countries. Overall, the important heterogeneities in the pathways of wealth-related inequalities in HIV testing illustrate that addressing inequalities requires tailored efforts and upstream interventions.
Collapse
|
18
|
King K, Balan S, Kanamori M, Shrader CH, Arroyo-Flores J, Johnson A, Whiteside P, Michniewicz M, Doblecki-Lewis S. Feasibility and Acceptability of HIV Self-Test Kit Distribution Through PrEP Clients' Social and Sexual Networks to Increase HIV Testing and PrEP Information. J Acquir Immune Defic Syndr 2022; 90:S105-S113. [PMID: 35703762 PMCID: PMC9204857 DOI: 10.1097/qai.0000000000002970] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the feasibility, acceptability, and implementation of a HIV self-test (HIVST) program through PrEP clients' social and sexual networks. BACKGROUND HIV testing is critical for treatment and prevention engagement. HIVST kits can overcome barriers to testing. A negative result is an opportunity to provide PrEP information. We describe implementation factors associated with engaging current Mobile PrEP (MP) clients to distribute HIVST kits and PrEP information through their networks. SETTING Community venues in Miami-Dade County, Florida. METHODS A baseline survey collected network information and explored distribution plans for offering HIVST kits. A follow-up survey evaluated use and distribution. A logic model describes the process of implementation and evaluation. Up to 4 Ora-Quick HIV ST kits were offered to 81 MP clients. A brief training included resources for posttest engagement. RESULTS Forty-four percent of the kits were reported as distributed. Of 81 MP clients offered kits, 50 (62%) accepted. In a follow-up survey, 77% of MP clients distributed at least 1 kit. Fifty-six (86%) social network members were Latino, and 9 (14%) were Black. Three of 4 MP clients engaged in PrEP discussions (77%) with SN members. Reported reasons for HIVST kit use included convenience, confidentiality, privacy concerns, and discomfort with going to a testing site. MP clients reported that kit distribution was affected by the COVID-19 pandemic. CONCLUSION HIV ST kits allowed PrEP users to engage others in their social and sexual networks for HIV testing and information regarding PrEP. Work to scale-up this intervention is underway.
Collapse
Affiliation(s)
- Katherine King
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL
| | - Shuba Balan
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL
| | - Mariano Kanamori
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Cho-Hee Shrader
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | | | - Ariana Johnson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | | | - Mara Michniewicz
- Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, HIV/AIDS Section, HIV Prevention Program, Tallahassee, FL; and
| | - Susanne Doblecki-Lewis
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL
| |
Collapse
|
19
|
MANGURIAN C, DAHIYA P, GOLDMAN ML, CORBEIL T, WALL MM, ESSOCK SM, DIXON LB, TANG F, FRIMPONG E, MASCAYANO F, RADIGAN M, WANG R, OLFSON M, SMITH TE. Underdetection of pre-existing HIV/AIDS during psychiatric hospitalizations. AIDS 2022; 36:1031-1037. [PMID: 35142705 PMCID: PMC9167207 DOI: 10.1097/qad.0000000000003190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES People with severe mental illness are 10 times more likely to have HIV/ AIDS than the general population, yet little is known about the characteristics and frequency of recognition of pre-existing HIV/AIDS diagnoses among inpatients with severe mental illness. This study examines documentation rates of pre-existing HIV/ AIDS among inpatients within psychiatric hospitals in New York State. DESIGN Retrospective cohort study to examine recognition of pre-existing HIV/AIDS among psychiatric inpatients. METHODS Patient-level Medicaid claims records were linked with hospital and regional data for people admitted to psychiatric inpatient units in New York State. Presence of HIV/AIDS diagnoses prior to psychiatric hospitalization was coded for each inpatient (n = 14 602). Adjusted odds ratios of undocumented HIV/AIDS diagnoses at the time of discharge were calculated using logistic regression analyses. RESULTS About 5.1% (741/14 602) of unique psychiatric inpatients had pre-existing HIV/AIDS diagnoses. Of these inpatients, 58.3% (432/741) were not coded as having HIV/AIDS upon discharge. Higher rates of missed detection were associated with younger age, non-Hispanic white race/ethnicity, shorter length of stay, more distal coding of an HIV/AIDS diagnosis, and fewer HIV/AIDS-related Medicaid claims in the past year. Hospitals with higher readmission rates also had higher rates of undetected HIV/AIDS diagnoses. CONCLUSION Over half of inpatients previously diagnosed with HIV/AIDS did not have their HIV-positive status noted upon discharge from psychiatric hospitalization. This finding underscores how frequently clinically significant medical comorbidities fail to be incorporated into psychiatric treatment and treatment planning. Inpatient clinicians are missing important opportunities to optimize HIV/AIDS treatment and reduce morbidity and mortality.
Collapse
Affiliation(s)
- Christina MANGURIAN
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
- Department of Epidemiology & Biostatistics, University of California San Francisco
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital
| | - Priya DAHIYA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Matthew L. GOLDMAN
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | | | - Melanie M. WALL
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Susan M. ESSOCK
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Lisa B. DIXON
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Fei TANG
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Eric FRIMPONG
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | | | - Marleen RADIGAN
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Rui WANG
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Mark OLFSON
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Thomas E. SMITH
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| |
Collapse
|
20
|
Long JE, Sanchez H, Dasgupta S, Huerta L, Garcia DC, Lama JR, Duerr A. Brief Report: Self-Reported Knowledge of HIV Status Among Cisgender Male Sex Partners of Transgender Women in Lima, Peru. J Acquir Immune Defic Syndr 2022; 90:1-5. [PMID: 35044990 PMCID: PMC8986569 DOI: 10.1097/qai.0000000000002920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Knowledge of HIV status is a critical first step in the HIV care cascade. Cisgender male sex partners of transgender women (MSTW) are at a disproportionately high risk of HIV, but little is known about their access to HIV testing or knowledge of HIV status. METHODS We used cross-sectional data from a respondent-driven sampling study to analyze self-reported HIV status and predictors of knowledge of HIV status among MSTW in Lima, Peru. Mixed-effects models were used to generate crude and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for the association between knowledge of HIV status and predictors of interest, including sociodemographics and recent sexual behavior. RESULTS From February to July 2018, 196 eligible MSTW enrolled, of which 90 (46%) reported not knowing their HIV status. Recent casual or 1-time partners were reported by 84% of MSTW and 54% reported purchasing sex. In adjusted analyses, MSTW participants were less likely to know their HIV status if they reported buying sex (aPR 0.43, 95% CI: 0.32 to 0.59) or reported ≥16 recent sex partners compared with ≤5 partners [aPR 0.32, (0.20 to 0.50)]. Those who reported male sex partners were 80% more likely to know their status [aPR 1.80, (1.33 to 2.44)]. CONCLUSIONS Reported knowledge of HIV status was low among MSTW in Lima, and unknown HIV status was associated with behaviors linked to HIV acquisition. MSTW who reported male partners were more likely to know their status, potentially indicating that HIV testing is more accessible to men who have sex with men.
Collapse
Affiliation(s)
- Jessica E Long
- Department of Epidemiology, University of Washington, Seattle, USA
| | | | - Sayan Dasgupta
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | - Ann Duerr
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| |
Collapse
|
21
|
Violette LR, Cornelius-Hudson A, Snidarich M, Niemann LA, Assennato SM, Ritchie A, Goel N, Chavez PR, Ethridge SF, Katz DA, Lee H, Delaney KP, Stekler JD. Evaluation of SAMBA II: A Qualitative and Semiquantitative HIV Point-of-Care Nucleic Acid Test. J Acquir Immune Defic Syndr 2022; 89:537-545. [PMID: 34974473 PMCID: PMC9058199 DOI: 10.1097/qai.0000000000002902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Point-of-care (POC) nucleic acid tests (NATs) have potential to diagnose acute HIV infection and monitor persons taking pre-exposure prophylaxis or antiretroviral therapy (ART). POC NATs have not yet been evaluated in the US. METHODS From June 2018-March 2019, we conducted a cross-sectional evaluation of the Simple Amplification-Based Assay version II (SAMBA II) POC NAT. People with HIV (PWH) and persons testing for HIV were tested with the SAMBA II qualitative (Qual) whole blood (WB) test. From April-September 2019, the Qual test was used on persons who were ART-naive, and SAMBA II Semi-quantitative (Semi-Q) WB was used with ART-experienced PWH. Both were performed on unprocessed venipuncture (VP) and, when indicated by protocol, fingerstick (FS) WB and plasma. SAMBA results were compared with Abbott RealTime HIV-1 polymerase chain reaction results on plasma. We calculated sensitivity, specificity, and concordance between tests. RESULTS SAMBA was used in 330 visits among 280 participants: 202 (61.2%) visits from PWH, and 128 (38.8%) from HIV-negative persons. Qual test sensitivity with ART-naive participants was 91.4% [32/35, 95% confidence interval (CI): 77.6% to 97.0%] using VP WB and 100% (27/27, 95% CI: 87.5% to 100%) using FS WB. Specificity was 100% using both specimen types. Concordance between the gold standard and Semi-Q at 1000 copies/mL among PWH on ART was 97.7% (86/88, 95% CI: 92.1% to 99.4%) and 100% (30/30, 95% CI: 88.7% to 100%) using VP and FS WB, respectively. CONCLUSIONS The SAMBA II POC NATs showed high sensitivity, specificity, and concordance with the gold standard assay, indicating its potential use in diagnostics and monitoring. Future work will evaluate POC NAT implementation in the US.
Collapse
Affiliation(s)
- Lauren R Violette
- Department of Medicine, University of Washington, Seattle, WA, US
- Department of Epidemiology, University of Washington, Seattle, WA, US
| | | | | | - Lisa A Niemann
- Department of Medicine, University of Washington, Seattle, WA, US
| | | | | | - Neha Goel
- Diagnostics for the Real World Ltd, Cambridge, UK
| | - Pollyanna R Chavez
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, US
| | - Steven F Ethridge
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, US
| | - David A. Katz
- Department of Global Health, University of Washington, Seattle, WA, US
| | - Helen Lee
- Diagnostics for the Real World Ltd, Cambridge, UK
| | - Kevin P Delaney
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, US
| | - Joanne D Stekler
- Department of Medicine, University of Washington, Seattle, WA, US
- Department of Epidemiology, University of Washington, Seattle, WA, US
- Department of Global Health, University of Washington, Seattle, WA, US
| |
Collapse
|
22
|
Tordoff DM, Zangeneh S, Khosropour CM, Glick SN, McClelland RS, Dimitrov D, Reisner S, Duerr A. Geographic Variation in HIV Testing Among Transgender and Nonbinary Adults in the United States. J Acquir Immune Defic Syndr 2022; 89:489-497. [PMID: 35001041 PMCID: PMC9058176 DOI: 10.1097/qai.0000000000002909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transgender and nonbinary (TNB) populations are disproportionately affected by HIV and few local health departments or HIV surveillance systems collect/report data on TNB identities. Our objective was to estimate the prevalence of HIV testing among TNB adults by US county and state, with a focus on the Ending the HIV Epidemic (EHE) geographies. METHODS We applied a Bayesian hierarchical spatial small area estimation model to data from the 2015 US Transgender Survey, a large national cross-sectional Internet-based survey. We estimated the county- and state-level proportion of TNB adults who ever tested or tested for HIV in the last year by gender identity, race/ethnicity, and age. RESULTS Our analysis included 26,100 TNB participants with valid zip codes who resided in 1688 counties (54% of all 3141 counties that cover 92% of the US population). The median county-level proportion of TNB adults who ever tested for HIV was 44% (range 10%-80%) and who tested in the last year was 17% (range 4%-44%). Within most counties, testing was highest among transgender women, black respondents, and people aged ≥25 years. HIV testing was lowest among nonbinary people and young adults aged <25 years. The proportion of TNB adults who tested within the last year was very low in most EHE counties and in all 7 rural states. CONCLUSIONS HIV testing among TNB adults is likely below national recommendations in the majority of EHE geographies. Geographic variation in HIV testing patterns among TNB adults indicates that testing strategies need to be tailored to local settings.
Collapse
Affiliation(s)
- Diana M. Tordoff
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Sahar Zangeneh
- RTI International, Seattle WA
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Sara N. Glick
- School of Medicine, University of Washington, Seattle, WA
| | - R. Scott McClelland
- Department of Epidemiology, University of Washington, Seattle, WA
- School of Medicine, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Sari Reisner
- Departments of Medicine and Epidemiology, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
| | - Ann Duerr
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Global Health, University of Washington, Seattle, WA
| |
Collapse
|
23
|
van Empel E, De Vlieg RA, Harling G, Marcus ME, Kahn K, Bärnighausen TW, Montana L, Choko AT, Manne-Goehler J. Reaching for the 'first 95': a cross-country analysis of HIV self-testing in nine countries in sub-Saharan Africa. AIDS 2022; 36:297-304. [PMID: 34934021 PMCID: PMC7612158 DOI: 10.1097/qad.0000000000003106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES HIV self-testing (HIVST) offers a promising approach to increase HIV diagnosis and advance progress towards the UNAIDS 95-95-95 targets. We aimed to understand patterns of HIVST awareness and utilization in nine sub-Saharan African (SSA) countries, with the goal of identifying populations to target in disseminating this technology. DESIGN A cross-sectional study. METHODS We pooled individual-level population-based data from nine Demographic and Health Surveys (DHS) in SSA conducted 2015-2019 (Burundi, Cameroon, Guinea, Malawi, Senegal, Sierra Leone, South Africa, Zambia, Zimbabwe). Primary outcomes were HIVST awareness and utilization. We used logistic regression with survey fixed effects to explore the relationship between sociodemographic characteristics and these outcomes. Models were adjusted for sex, age, rural/urban residence, education, wealth, and marital status. We accounted for complex survey design. RESULTS The study sample included 177 572 people (66.0% women, mean age 29 ± 10 years), of whom 86.6% [95% confidence interval (95% CI) 86.4-86.7] were unaware of HIVST, 11.7% (95% CI 11.6-11.9) were aware of but never used HIVST, and 1.7% (95% CI 1.6-1.8) had used HIVST. In adjusted models, women were less likely to be aware of HIVST [odds ratio (OR) 0.75, 95% CI 0.71-0.79], but more likely to have used HIVST (OR 1.17, 95% CI 1.03-1.32) compared with men. Rural residents, those who were least educated, and poorest were less likely to have heard of or used HIVST. CONCLUSION HIVST awareness and uptake were low. Rural, less educated, and lower income populations were least likely to have heard of or used HIVST. Efforts to scale-up HIVST in these settings should aim to reach these less advantaged groups.
Collapse
Affiliation(s)
- Eva van Empel
- Maastricht University, Maastricht, the Netherlands
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Rebecca A De Vlieg
- Maastricht University, Maastricht, the Netherlands
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Guy Harling
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
- Institute for Global Health, University College London, London, UK
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Africa Health Research Institute, KwaZulu-Natal
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Maja E Marcus
- University of Goettingen, Department of Economics and Centre for Modern Indian Studies, Goettingen, Germany
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, East Legon, Ghana
| | - Till W Bärnighausen
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Heidelberg University, Heidelberg Institute of Global Health (HIGH), Heidelberg, Germany
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts
| | - Livia Montana
- The Demographic and Health Surveys Program, Rockville, Maryland, USA
| | - Augustine T Choko
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Jennifer Manne-Goehler
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, Massachusetts, USA
| |
Collapse
|
24
|
Katureebe C, Ashburn K, Machekano R, Gill MM, Gross J, Kazooba P, Kiyonga A, Taasi G, Adler M, Nazziwa E, Rivadeneira ED, Kekitiinwa A, Magongo E, Matovu JB, Nantume S, Bitarakwate E. Developing and Validating an Effective Pediatric and Adolescent HIV Testing Eligibility Screening Tool for High-Volume Entry Points in Uganda. J Acquir Immune Defic Syndr 2021; 88:290-298. [PMID: 34651604 PMCID: PMC10203979 DOI: 10.1097/qai.0000000000002775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Because of low pediatric HIV prevalence, more tests are needed to find 1 HIV-positive child compared with adults. In Uganda, the number needed to test (NNT) to find 1 new HIV-positive child was 64 in outpatient departments (OPDs) and 31 through index testing. We aimed to develop and validate a pediatric (1.5-14 years) screening tool to optimize testing approaches. METHODS Phase 1 evaluated the performance of 10 screening questions in 14 OPDs using a variable selection algorithm to evaluate combinations of screening questions. Using logistic regression, we identified the number of screening questions with the best predictive accuracy using the receiver operation characteristic curve. Phase 2 validated the proposed tool in 15 OPDs and 7 orphan and vulnerable children programs. We estimated sensitivity, specificity, and NNT accounting for intercluster correlations. RESULTS A total of 3482 children were enrolled. The optimal model included reported HIV-positive maternal status or 2/5 symptoms (sickly in the last 3 months, recurring skin problems, weight loss, not growing well, and history of tuberculosis). The proposed tool had sensitivity of 83.6% [95% confidence interval (CI): 68.1 to 92.4] and specificity of 62.5% (95% CI: 55.0 to 69.4). The tool was validated in a sample of 11,342 children; sensitivity was 87.8% (95% CI: 80.9 to 92.5) and specificity 62.6% (95% CI: 54.8 to 69.7) across OPDs and community sites. In OPDs, sensitivity was 88.1% (95% CI: 80.8 to 92.8) and specificity 69.0% (95% CI: 61.9 to 75.3). The NNT was 43 (95% CI: 28 to 67) across settings and 28 (95% CI: 20 to 38) for OPD. CONCLUSIONS This HIV screening tool has high sensitivity and reasonable specificity, increasing testing efficiency and yield for children and adolescents.
Collapse
Affiliation(s)
| | - Kim Ashburn
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, D.C., U.S.A
| | | | - Michelle M. Gill
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, D.C., U.S.A
| | - Jessica Gross
- Maternal and Child Health Branch, Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, U.S.A
| | | | | | | | - Michelle Adler
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Esther Nazziwa
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Emilia D. Rivadeneira
- Maternal and Child Health Branch, Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, U.S.A
| | | | | | | | - Sophie Nantume
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | | |
Collapse
|
25
|
Hlatshwako T, Conserve D, Day S, Reynolds Z, Weir S, Tucker JD. Increasing Men's Engagement in HIV Testing and Treatment Programs Through Crowdsourcing: A Mixed-Methods Analysis in Eswatini. Sex Transm Dis 2021; 48:789-797. [PMID: 33675595 PMCID: PMC8418618 DOI: 10.1097/olq.0000000000001408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sub-Saharan African HIV programs have had limited success in engaging men. Crowdsourcing contests may be a useful method to spur men's engagement in HIV services. We evaluated contributions and social media response to a crowdsourcing contest focused on increasing men's engagement in Eswatini HIV services. METHODS We conducted a crowdsourcing contest to gain insight from the public on how HIV campaigns can more effectively engage young (20-40 years old) men in HIV services. Eligible submissions included images, songs, videos, and Internet memes. We used standard qualitative methods to examine textual themes from submissions. We examined social media response using Facebook analytics, comparing the number of people reached through crowdsourced HIV messages and the number of people reached through conventional HIV messages. RESULTS We received 144 submissions from 83 participants. They represented 55 towns and all 4 regions of Eswatini. The contest page gained 461 followers on Facebook. Emergent themes included appealing to men's roles as protectors by suggesting that they need to take care of their own health to continue safeguarding their families. Crowdsourced messages reached a mean of 88 individuals across 4 posts; conventional messages reached a mean of 75 individuals across 4 posts. CONCLUSIONS Crowdsourcing contest submissions provided insight on how to encourage men to engage in Eswatini HIV services. Crowdsourcing contests can be effective in collecting messages from men to create more locally relevant communication materials for HIV programs.
Collapse
Affiliation(s)
| | - Donaldson Conserve
- Department of Health Promotion, Education, and Behavior, University of South Carolina, SC
| | - Suzanne Day
- Institute for Global Health and Infectious Diseases
| | - Zahra Reynolds
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | |
Collapse
|
26
|
Rowlinson E, Mawandia S, Ledikwe J, Bakae O, Tau L, Grande M, Seckel L, Mogomotsi GP, Mmatli E, Ngombo M, Norman T, Golden MR. HIV testing criteria to reduce testing volume and increase positivity in Botswana. AIDS 2021; 35:2007-2015. [PMID: 34138770 PMCID: PMC8416793 DOI: 10.1097/qad.0000000000002997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We used data from a routine HIV testing program to develop risk scores to identify patients with undiagnosed HIV infection while reducing the number of total tests performed. DESIGN Multivariate logistic regression. METHODS We included demographic factors from HIV testing data collected in 134 Botswana Ministry of Health & Wellness facilities during two periods (1 October 2018- 19 August 2019 and 1 December 2019 to 30 March 2020). In period 2, the program collected additional demographic and risk factors. We randomly split each period into prediction/validation datasets and used multivariate logistic regression to identify factors associated with positivity; factors with adjusted odds ratios at least 1.5 were included in the risk score with weights equal to their coefficient. We applied a range of risk score cutoffs to validation datasets to determine tests averted, test positivity, positives missed, and costs averted. RESULTS In period 1, three factors were significantly associated with HIV positivity (coefficients range 0.44-0.87). In period 2, 12 such factors were identified (coefficients range 0.44-1.37). In period 1, application of risk score cutoff at least 1.0 would result in 50% fewer tests performed and capture 61% of positives. In period 2, a cutoff at least 1.0 would result in 13% fewer tests and capture 96% of positives; a cutoff at least 2.0 would result in 40% fewer tests and capture 83% of positives. Costs averted ranged from 12.1 to 52.3%. CONCLUSION Botswana's testing program could decrease testing volume but may delay diagnosis of some positive patients. Whether this trade-off is worthwhile depends on operational considerations, impact of testing volume on program costs, and implications of delayed diagnoses.
Collapse
Affiliation(s)
| | - Shreshth Mawandia
- Department of Global Health, University of Washington, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH)
| | - Jenny Ledikwe
- Department of Global Health, University of Washington, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH)
| | - Odirile Bakae
- International Training and Education Center for Health (I-TECH)
| | - Lenna Tau
- International Training and Education Center for Health (I-TECH)
| | - Matias Grande
- International Training and Education Center for Health (I-TECH)
| | - Laura Seckel
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Esther Mmatli
- Botswana Ministry of Health and Wellness, HIV Testing Services Unit, Gaborone, Botswana
| | - Modise Ngombo
- Botswana Ministry of Health and Wellness, HIV Testing Services Unit, Gaborone, Botswana
| | - Tebogo Norman
- Botswana Ministry of Health and Wellness, HIV Testing Services Unit, Gaborone, Botswana
| | - Matthew R Golden
- Center for AIDS and STD and Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| |
Collapse
|
27
|
West CA, Chang GC, W Currie D, Bray R, Kinchen S, Behel S, McCullough-Sanden R, Low A, Bissek A, Shang JD, Ndongmo CB, Dokubo EK, Balachandra S, Lobognon LR, Dube L, Nuwagaba-Biribonwoha H, Li M, Pasipamire M, Getaneh Y, Lulseged S, Eshetu F, Kingwara L, Zielinski-Gutierrez E, Tlhomola M, Ramphalla P, Kalua T, F Auld A, B Williams D, Remera E, Rwibasira GN, Mugisha V, Malamba SS, Mushi J, Jalloh MF, Mgomella GS, Kirungi WL, Biraro S, C Awor A, Barradas DT, Mugurungi O, H Rogers J, Bronson M, M Bodika S, Ajiboye A, Gaffga N, Moore C, Patel HK, C Voetsch A. Unawareness of HIV Infection Among Men Aged 15-59 Years in 13 Sub-Saharan African Countries: Findings From the Population-Based HIV Impact Assessments, 2015-2019. J Acquir Immune Defic Syndr 2021; 87:S97-S106. [PMID: 34166316 PMCID: PMC8711576 DOI: 10.1097/qai.0000000000002708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Identifying men living with HIV in sub-Saharan Africa (SSA) is critical to end the epidemic. We describe the underlying factors of unawareness among men aged 15-59 years who ever tested for HIV in 13 SSA countries. METHODS Using pooled data from the nationally representative Population-based HIV Impact Assessments, we fit a log-binomial regression model to identify characteristics related to HIV positivity among HIV-positive unaware and HIV-negative men ever tested for HIV. RESULTS A total of 114,776 men were interviewed and tested for HIV; 4.4% were HIV-positive. Of those, 33.7% were unaware of their HIV-positive status, (range: 20.2%-58.7%, in Rwanda and Cote d'Ivoire). Most unaware men reported they had ever received an HIV test (63.0%). Age, region, marital status, and education were significantly associated with HIV positivity. Men who had HIV-positive sexual partners (adjusted prevalence ratio [aPR]: 5.73; confidence interval [95% CI]: 4.13 to 7.95) or sexual partners with unknown HIV status (aPR: 2.32; 95% CI: 1.89 to 2.84) were more likely to be HIV-positive unaware, as were men who tested more than 12 months compared with HIV-negative men who tested within 12 months before the interview (aPR: 1.58; 95% CI: 1.31 to 1.91). Tuberculosis diagnosis and not being circumcised were also associated with HIV positivity. CONCLUSION Targeting subgroups of men at risk for infection who once tested negative could improve yield of testing programs. Interventions include improving partner testing, frequency of testing, outreach and educational strategies, and availability of HIV testing where men are accessing routine health services.
Collapse
Affiliation(s)
| | - Gregory C Chang
- Division of Global HIV and TB, Center for Global Health, CDC
- ASPPH/PHI/CDC HIV Surveillance Fellowship
| | - Dustin W Currie
- Division of Global HIV and TB, Center for Global Health, CDC
| | | | - Steve Kinchen
- Division of Global HIV and TB, Center for Global Health, CDC
| | - Stephanie Behel
- Division of Global HIV and TB, Center for Global Health, CDC
| | - Rachel McCullough-Sanden
- ASPPH/PHI/CDC HIV Surveillance Fellowship
- Division of Global HIV and TB, Center for Global Health, CDC Cameroon
| | - Andrea Low
- ICAP at Columbia University, New York, NY
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | | | - Judith D Shang
- Division of Global HIV and TB, Center for Global Health, CDC Cameroon
| | - Clement B Ndongmo
- Division of Global HIV and TB, Center for Global Health, CDC Cameroon
- Division of Global HIV and TB, Center for Global Health, CDC Zambia
| | - Emily K Dokubo
- Division of Global HIV and TB, Center for Global Health, CDC Cameroon
| | | | - Legre R Lobognon
- Division of Global HIV and TB, Center for Global Health, CDC Cote d'Ivoire
| | - Lenhle Dube
- National AIDS Program/Ministry of Health, Eswatini
| | | | - Michelle Li
- Division of Global HIV and TB, Center for Global Health, CDC Eswatini
| | | | | | | | - Frehywot Eshetu
- Division of Global HIV and TB, Center for Global Health, CDC Ethiopia
| | - Leonard Kingwara
- National AIDS and STI Control Programme, Ministry of Health, Kenya
| | | | | | - Puleng Ramphalla
- Division of Global HIV and TB, Center for Global Health, CDC Lesotho
| | | | - Andrew F Auld
- Division of Global HIV and TB, Center for Global Health, CDC Malawi
| | - Daniel B Williams
- Division of Global HIV and TB, Center for Global Health, CDC Namibia
| | | | | | - Veronicah Mugisha
- ICAP at Columbia University, Rwanda
- ICAP at Columbia University, Tanzania
| | - Samuel S Malamba
- Division of Global HIV and TB, Center for Global Health, CDC Rwanda
| | - Jeremiah Mushi
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Tanzania
| | - Mohamed F Jalloh
- Division of Global HIV and TB, Center for Global Health, CDC Tanzania
| | - George S Mgomella
- Division of Global HIV and TB, Center for Global Health, CDC Tanzania
| | | | | | - Anna C Awor
- Division of Global HIV and TB, Center for Global Health, CDC Uganda
| | | | | | - John H Rogers
- Division of Global HIV and TB, Center for Global Health, CDC Zimbabwe
| | - Megan Bronson
- Division of Global HIV and TB, Center for Global Health, CDC
| | | | | | - Nicholas Gaffga
- Division of Global HIV and TB, Center for Global Health, CDC
| | - Carole Moore
- Division of Global HIV and TB, Center for Global Health, CDC
| | - Hetal K Patel
- Division of Global HIV and TB, Center for Global Health, CDC
| | | |
Collapse
|
28
|
Neary J, Wagner AD, Omondi V, Otieno V, Mugo C, Wamalwa DC, Maleche-Obimbo E, John-Stewart GC, Slyker JA, Njuguna IN. Male Caregiver Barriers to HIV Index Case Testing of Untested Children. J Acquir Immune Defic Syndr 2021; 87:e229-e231. [PMID: 33633034 PMCID: PMC8500355 DOI: 10.1097/qai.0000000000002669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Index case testing (ICT) for children—testing children of HIV-positive index adults—reveals a high prevalence of undiagnosed pediatric HIV; however, uptake of ICT is sub-optimal. Methods: During recruitment for a randomized trial (NCT03049917 ), data were collected from sequential clients attending HIV care regarding whether they had children ages 0–12 years of unknown HIV status. We assessed male caregiver barriers to ICT and identified reasons children could not be tested for HIV through ICT. Results: A higher proportion of males receiving HIV care reported untested children ≤12 years of age (7% [483/7,267]) compared to females (2% [358/15,008]; p<0.001). Among caregivers with untested children ≤12 years, 34% (166/483) of males and 89% (320/358) of females were eligible for ICT (p<0.001). Among caregivers who were ineligible for ICT, 29% (141/483) of male and 9% (31/358) of female caregivers were ineligible for ICT due to inability to physically access their children (p<0.001). A higher proportion of males than females did not have access to their children due to separation or divorce (82% [116/141] vs. 52% [16/31]). Overall, a higher proportion of male caregivers declined participation in the trial compared to females (11% [19/166] vs. 5% [15/320]; p=0.006), with 47% (9/19) of those males declining participation because they wanted to consult with their partner compared to 7% (1/15) of female caregivers (p=0.010). Conclusion: As programs scale up ICT, male caregiver barriers to ICT must be addressed to effectively reach untested children.
Collapse
Affiliation(s)
| | | | - Vincent Omondi
- Kenya Pediatric Research Consortium, Kenya Pediatric Association, Nairobi, Kenya
| | - Verlinda Otieno
- Kenya Pediatric Research Consortium, Kenya Pediatric Association, Nairobi, Kenya
| | - Cyrus Mugo
- Departments of Epidemiology
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Dalton C Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | | | - Grace C John-Stewart
- Departments of Epidemiology
- Global Health, University of Washington, Seattle, WA
- Departments of Pediatrics and Medicine, University of Washington, Seattle, WA
| | - Jennifer A Slyker
- Departments of Epidemiology
- Global Health, University of Washington, Seattle, WA
| | - Irene N Njuguna
- Global Health, University of Washington, Seattle, WA
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| |
Collapse
|
29
|
Behrends CN, Kapadia SN, Schackman BR, Frimpong JA. Addressing Barriers to On-site HIV and HCV Testing Services in Methadone Maintenance Treatment Programs in the United States: Findings From a National Multisite Qualitative Study. J Public Health Manag Pract 2021; 27:393-402. [PMID: 33346582 PMCID: PMC8137509 DOI: 10.1097/phh.0000000000001262] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Few substance use disorder (SUD) treatment programs provide on-site human immunodeficiency virus (HIV) and/or hepatitis C virus (HCV) testing, despite evidence that these tests are cost-effective. OBJECTIVE To understand how methadone maintenance treatment (MMT) programs that offer on-site HIV/HCV testing have integrated testing services, and the challenges related to offering on-site HIV/HCV testing. DESIGN We used the 2014 National Drug Abuse Treatment System Survey to identify outpatient SUD treatment programs that reported offering on-site HIV/HCV testing to 75% or more of their clients. We stratified the sample to identify programs based on combinations of funding source, type of drug treatment offered, and Medicaid-managed care arrangements. We conducted semi-structured qualitative interviews with leadership and staff in 2017-2018 using a directed content analysis approach to identify dominant themes. SETTING Seven MMT programs located in 6 states in the United States. PARTICIPANTS Fifteen leadership and staff from 7 MMT programs with on-site HIV/HCV testing. MAIN OUTCOME MEASURE Themes related to integration of on-site HIV/HCV testing. RESULTS Methadone maintenance treatment programs identified 3 domains related to the integration of HIV/HCV testing on-site at MMT programs: (1) payment and billing, (2) internal and external stakeholders, and (3) medical and SUD treatment coordination. Programs identified the absence of state policies that facilitate medical billing and inconsistent grant funding as major barriers. Testing availability was limited by the frequency at which external organizations could provide services on-site, the reliability of those external relationships, and MMT staffing. Poor electronic health record systems and privacy policies that prevent medical information sharing between medical and SUD treatment providers also limited effective care coordination. CONCLUSION Effective and sustainable integration of on-site HIV/HCV testing by MMT programs in the United States will require more consistent funding, improved billing options, technical assistance, electronic health record system enhancement and coordination, and policy changes related to privacy.
Collapse
Affiliation(s)
- Czarina N Behrends
- Departments of Population Health Sciences (Drs Behrends, Schackman, and Kapadia) and Medicine (Dr Kapadia), Weill Cornell Medical College, New York, New York; and Carey Business School, John Hopkins University, Baltimore, Maryland (Dr Frimpong)
| | | | | | | |
Collapse
|
30
|
Harhay R, Alexander NJ, Gomez G, Jacobs ME. Psychosis and Rectal Bleeding as the Presenting Symptoms of AIDS in an Adolescent Male. Cureus 2021; 13:e15272. [PMID: 34194876 PMCID: PMC8234560 DOI: 10.7759/cureus.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Socioeconomic status, racial health disparities, and age are some of the many barriers that may confound and delay the diagnosis of human immunodeficiency virus (HIV). Despite the new and highly effective advancements in the treatment of HIV, in the United States, there is a disparity in the rate of timely diagnosis and treatment among Black/African Americans, men who have sex with men, those who suffer from homelessness, and transgendered youth. While there are existing recommendations in place to guide the testing of adolescents for HIV, the rate of testing is highly variable, which can lead to missed diagnoses. We present the case of a previously healthy 17-year-old African American male with psychosis who was initially diagnosed with a primary psychiatric disorder. Three weeks later, the patient presented with rectal bleeding. Further evaluation revealed that the patient was positive for HIV. The psychiatric symptoms were attributed to HIV dementia and rectal bleeding to HIV colitis. To our knowledge, this is the first case report of a patient with HIV dementia and rectal bleeding as the initial presenting symptoms of AIDS. This case demonstrated the potential consequences of variable testing practices for HIV and the devastating sequela that can follow the lack of timely diagnosis.
Collapse
Affiliation(s)
- Rana Harhay
- Pediatrics, University at Buffalo Jacobs School of Medicine & Biomedical Sciences, Buffalo, USA
| | - Nicholas J Alexander
- Pediatrics, University at Buffalo Jacobs School of Medicine & Biomedical Sciences, Buffalo, USA
| | - Gretell Gomez
- Pediatrics, University at Buffalo Jacobs School of Medicine & Biomedical Sciences, Buffalo, USA
| | - Meghan E Jacobs
- Pediatrics, University at Buffalo Jacobs School of Medicine & Biomedical Sciences, Buffalo, USA
| |
Collapse
|
31
|
Ye R, Liu C, Tan S, Li J, Simoni JM, Turner D, Nelson LE, Vermund SH, Wang N, Qian HZ. Factors associated with past HIV testing among men who have sex with men attending university in China: a cross-sectional study. Sex Health 2021; 18:58-63. [PMID: 33639685 PMCID: PMC10767712 DOI: 10.1071/sh20088] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/31/2020] [Indexed: 01/19/2023]
Abstract
Background HIV prevalence has been rapidly increasing among men who have sex with men (MSM) attending university in China, but HIV testing rates remain suboptimal. The factors associated with past HIV testing in this population in Beijing, China, were investigated. METHODS This study used data from the baseline survey of an HIV intervention clinical trial among MSM who did not have a history of a positive HIV diagnosis. This analysis focused on the HIV testing experience in a subgroup of university student MSM participants. Log-binomial models were used to evaluate factors associated with past HIV testing. RESULTS Of 375 university student MSM, the median age was 22 years; 89.3% were Han ethnic. Approximately half (50.4%, n = 189) had ever taken an HIV test before the survey. In a multivariable log-binomial model, older age (adjusted prevalence ratio (APR), 1.04; 95% confidence interval (CI), 1.02-1.06), had first sexual intercourse at age <18 years (APR, 1.35; 95% CI, 1.08-1.45) and knew someone living with HIV (APR, 1.33; 95% CI, 1.07-1.61) were associated with a higher likelihood of past testing. Self-reported barriers to taking a test included perceived low HIV risk, fear of a positive diagnosis, did not know where to get tested and fear of discrimination. Facilitators included anonymity in taking a test, confidentiality of testing results and availability of home-based and rapid testing. CONCLUSIONS The HIV testing rate among university student MSM was low. Interventions should be implemented to address structural, institutional and individual barriers to HIV testing in this vulnerable population.
Collapse
Affiliation(s)
- Rongyi Ye
- School of Public Health, Guilin Medical University, Guilin, China
| | - Chunfang Liu
- School of Public Health, Baotou Medical University, Baotou, China
| | - Shengkui Tan
- School of Public Health, Guilin Medical University, Guilin, China
| | - Juntong Li
- School of Public Health, Guilin Medical University, Guilin, China
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - DeAnne Turner
- School of Public Health, Yale University, New Haven, CT, USA
| | | | - Sten H Vermund
- School of Public Health, Yale University, New Haven, CT, USA
| | - Na Wang
- School of Public Health, Guilin Medical University, Guilin, China; and Corresponding authors. ;
| | - Han-Zhu Qian
- School of Public Health, Yale University, New Haven, CT, USA; and Xiangya Nursing School, Central South University, Changsha, China; and Corresponding authors. ;
| |
Collapse
|
32
|
Bukhari S, Dirweesh A, Amodu A, Nadeem M, Wallach SL. A Case of False-Positive HIV Test in a Patient With Newly Diagnosed Hodgkin Lymphoma and Literature Review. Cureus 2020; 12:e10884. [PMID: 33178536 PMCID: PMC7652365 DOI: 10.7759/cureus.10884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hodgkin lymphoma (HL) is one of the non-acquired immunodeficiency syndrome (AIDS)-defining cancers (NADCs). HIV testing has become a part of routine testing in HL because of commonly anticipated association. Here we report an unusual case where the need for HIV screening in a newly diagnosed case of HL raised an ethical dilemma and a medical challenge due to false-positive HIV test results. In literature, pregnancy, autoimmune disorders, some viral infections, and the presence of hypergammopathy of hematologic malignancy have all been linked with false-positive HIV screening. The reactive results require additional testing with an HIV-1/HIV-2 antibody differentiation assay. The specimens show reactivity on the initial screening immunoassay, but negative or indeterminate antibody differentiation assay should undergo nucleic acid testing.
Nevertheless, several instances of discordance between screening and confirmatory techniques have been described. It is speculated that this might be due to coincidental cross-reaction of subtypes of polyclonal gamma globulin with the HIV p24 antigen. In conclusion, this case signifies the understanding of the HIV testing algorithm and the use of reflex testing in the context of a positive HIV test before disclosing such preliminary results to patients and/or physicians.
Collapse
Affiliation(s)
- Sumera Bukhari
- Internal Medicine/Hospital Medicine/Palliative Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, USA
| | - Ahmed Dirweesh
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, USA
| | - Afolarin Amodu
- Internal Medicine: Nephrology, Boston University Medical Center, Boston, USA
| | - Muhammad Nadeem
- Internal Medicine, Seton Hall University, Saint Francis Medical Center, Trenton, USA
| | - Sara L Wallach
- Internal Medicine, Seton Hall University, Saint Francis Medical Center, Trenton, USA
| |
Collapse
|
33
|
Teasdale CA, Tsiouris F, Mafukidze A, Shongwe S, Choy M, Nhlengetfwa H, Simelane S, Mthethwa S, Ao T, Ryan C, Dale H, Rivadeneira E, Abrams EJ. Birth Testing for Infant HIV Diagnosis in Eswatini: Implementation Experience and Uptake Among Women Living With HIV in Manzini Region. Pediatr Infect Dis J 2020; 39:e235-41. [PMID: 32453193 DOI: 10.1097/INF.0000000000002734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION HIV testing at birth of HIV-exposed infants (HEIs) may improve the identification of infants infected with HIV in utero and accelerate antiretroviral treatment (ART) initiation. METHODS ICAP at Columbia University supported implementation of a national pilot of HIV testing at birth (0-7 days) in Eswatini at 2 maternity facilities. Dried blood spot (DBS) samples from neonates of women living with HIV (WLHIV) were collected and processed at the National Molecular Reference Laboratory using polymerase chain reaction (PCR). Mothers received birth test results at community health clinics. We report data on HIV birth testing uptake and outcomes for HIV-positive infants from the initial intensive phase (October 2017-March 2018) and routine support phase (April-December 2018). RESULTS During the initial intensive pilot phase, 1669 WLHIV delivered 1697 live-born HEI at 2 health facilities and 1480 (90.3%) HEI received birth testing. During the routine support phase, 2546 WLHIV delivered and 2277 (93.5%) HEI received birth testing. Overall October 2017-December 2018, 22 (0.6%) infants of 3757 receiving birth testing had a positive PCR test, 15 (68.2%) of whom were successfully traced and linked for confirmatory testing (2 infants were reported by caregivers to have negative follow-up HIV tests). Median time from birth test to receipt of results by the caregiver was 13 days (range: 8-23). Twelve (60.0%) of 20 infants confirmed to be HIV-positive started ART at median age of 17.5 days (12-43). One mother of an HIV-positive infant who was successfully traced refused ART following linkage to care and another child died after ART initiation. Three infants (15.0%) had died by the time their mothers were reached and 4 (15.0%) infants were never located. CONCLUSION This pilot of universal birth testing in Eswatini demonstrates the feasibility of using a standard of care approach in a low resource and high burden setting. We document high uptake of testing for newborns among HIV-positive mothers and very few infants were found to be infected through birth testing.
Collapse
|
34
|
Johnson LF, Patrick M, Stephen C, Patten G, Dorrington RE, Maskew M, Jamieson L, Davies MA. Steep Declines in Pediatric AIDS Mortality in South Africa, Despite Poor Progress Toward Pediatric Diagnosis and Treatment Targets. Pediatr Infect Dis J 2020; 39:843-8. [PMID: 32433224 DOI: 10.1097/INF.0000000000002680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few attempts have been made to monitor progress toward HIV diagnosis and antiretroviral treatment (ART) coverage targets in children, and the impact that ART and prevention of mother-to-child transmission (PMTCT) programs have had on pediatric HIV incidence and mortality. METHODS A multiparameter evidence synthesis approach was adopted to integrate South African pediatric HIV data sources. A previously developed model of HIV in South Africa was calibrated to household survey HIV prevalence data, routine antibody testing data, data on numbers and ages of children on ART, vital registration data and data on HIV diagnosis at death. The impact of ART and PMTCT was estimated by comparing validated model outputs against model predictions of the trends that would have been expected in the absence of ART and PMTCT. RESULTS By mid-2018, the model estimated that 75.2% (95% CI: 73.9%-76.8%) of HIV-positive children were diagnosed, substantially lower than the corresponding estimates in HIV-positive adults (91.0%). ART coverage in children in 2018 (51.2%, 95% CI: 49.4%-52.7%) was also lower than that in adults (62.0%). In 2017-2018, the numbers of new cases of mother-to-child transmission and pediatric AIDS deaths were reduced by 84% and 94%, respectively, relative to what would have been expected in the absence of interventions, but reductions in mortality were driven largely by PMTCT. CONCLUSIONS Although levels of AIDS mortality in children have declined dramatically in South Africa, this has mostly been due to successful PMTCT programs, and progress toward the 90-90-90 targets appears relatively poor when compared with that in adults.
Collapse
|
35
|
Sevelius JM, Poteat T, Luhur WE, Reisner SL, Meyer IH. HIV Testing and PrEP Use in a National Probability Sample of Sexually Active Transgender People in the United States. J Acquir Immune Defic Syndr 2020; 84:437-442. [PMID: 32692101 PMCID: PMC7340231 DOI: 10.1097/qai.0000000000002403] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND HIV testing and pre-exposure prophylaxis (PrEP) are effective HIV prevention strategies often underused by transgender people. METHODS Recruitment occurred in 2 phases to identify transgender respondents in a probability sample of adults in the United States. Transgender respondents completed a self-administered paper or web-based survey designed to assess transgender population health. Sexually active respondents (HIV-negative and had sex in the 5 years previously, N = 190) and a subsample of those at risk for sexual HIV acquisition (sex with cisgender men or transgender women, n = 120) were included in analyses. RESULTS Of the full sample of sexually active respondents, those who were transfeminine were less likely to be familiar with PrEP; most (72%) reported favorable attitudes toward PrEP. Of those at risk for HIV acquisition, 23% had never tested for HIV. Respondents of color were more likely than white respondents to meet Centers for Disease Control and Prevention recommendations for HIV testing. Respondents who met Centers for Disease Control and Prevention recommendations for HIV testing were more likely to report looking online for lesbian, gay, bisexual, and transgender or transgender-specific health information. Few respondents reported currently taking PrEP (3%); those who reported higher levels of nonaffirmation of their gender identity were less likely to currently use PrEP. DISCUSSION These findings may indicate some success of HIV testing outreach programs that prioritize people at higher risk for acquiring HIV, focusing on those who are vulnerable to structural marginalization. Ongoing public health efforts are needed to increase HIV testing and PrEP awareness among transgender adults, who are disproportionately impacted by HIV.
Collapse
|
36
|
Hensen B, Schaap AJ, Mulubwa C, Floyd S, Shanaube K, Phiri MM, Bond V, Bwalya C, Simwinga M, Fidler S, Hayes R, Mwinga A, Ayles H. Who Accepts and Who Uses Community-Based Secondary Distribution HIV Self-Testing (HIVST) Kits? Findings From the Intervention Arm of a Cluster-Randomized Trial of HIVST Distribution Nested in Four HPTN 071 (PopART) Communities in Zambia. J Acquir Immune Defic Syndr 2020; 84:355-364. [PMID: 32195749 PMCID: PMC7340225 DOI: 10.1097/qai.0000000000002344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND HPTN 071 (PopART) was a community-randomized trial of a universal testing-and-treatment intervention on HIV incidence at population level in Zambia and South Africa. In Zambia, a trial of community-based distribution of HIV self-testing (HIVST) kits, including secondary distribution, as an option for HIV-testing was nested within 4 PopART intervention communities. We used data from the intervention arm of the nested trial to measure levels of and factors associated with acceptance and use of secondary distribution HIVST kits. METHODS Community HIV care providers offered the PopART combination HIV-prevention intervention door-to-door, systematically visiting all households and enumerating all household members. From 1 February to 30 April 2017, individuals aged 16 years and older consenting to PopART were offered the option to HIV self-test, if eligible for HIV-testing services. Individuals aged 18 years and older who reported a partner absent during household visits were offered an HIVST kit for secondary distribution to this partner. We used two data sources to measure acceptance and use of secondary distribution HIVST kits. RESULTS Among 9105 individuals aged 18 years and older consenting to PopART, 9.1% (n = 825) accepted an HIVST kit for secondary distribution. Approximately 55.8% reported that the kit had been used. Women were more likely to accept, and men more likely to use, secondary distribution HIVST kits. Kits were more likely to be used by individuals aged 30+ and who had not participated in a previous round of PopART. Approximately 6.8% had a reactive result. CONCLUSIONS Community-based secondary distribution of HIVST kits reached men absent during community HIV care provider household visits and is a complement to facility- and community-based HIV-testing services, which often miss men.
Collapse
Affiliation(s)
- Bernadette Hensen
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Albertus J Schaap
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, Lusaka, Zambia
| | | | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Virginia Bond
- Zambart, Lusaka, Zambia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom; and
| | | | | | - Sarah Fidler
- Imperial College, London, United Kingdom and Imperial College NIHR BRC
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Helen Ayles
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, Lusaka, Zambia
| |
Collapse
|
37
|
Yan F, Shi CX, Zhang Y, Chen J, Williams AB, Li X. "I'll Change His Sexual Orientation, I Don't Think About HIV": A Qualitative Study to Explore Attitudes, Behaviors, and Experiences Among Wives of Men Who Have Sex With Men in Mainland China. J Assoc Nurses AIDS Care 2020; 31:428-438. [PMID: 32205501 PMCID: PMC7478852 DOI: 10.1097/jnc.0000000000000168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In mainland China, HIV prevalence among men who have sex with men (MSM) has risen sharply in the past decade. However, few HIV studies have directly addressed the female spouses' (tongqi) experiences, a population estimated at 14 million [Cheng, F. K. (2016). I want to come forward: Voices from Chinese tongqi. Cogent Social Sciences, 2(1), 1158343. doi:10.1080/23311886.2016.1158343; Zhu, J. (2018). "Unqueer" kinship? Critical reflections on "marriage fraud" in mainland China. Sexualities, 21(7), 1075-1091. doi:10.1177/1363460717719240]. We conducted this exploratory qualitative study to understand tongqi's attitudes toward same-sex sexuality and HIV risk as well as their sexual history. Semistructured interviews were conducted with 24 tongqi between October 2015 and September 2016. Data were coded and analyzed using thematic analysis. We identified four primary themes: (a) surprise, initial disbelief, and negative attitudes toward their husbands' same-sex sexuality; (b) maintenance of regular sexual contact, particularly before pregnancy; (c) unprotected sex with marital and extramarital partners; and (d) low perception of HIV risk. Strategies to increase HIV knowledge and testing uptake are urgently needed among these vulnerable women but must be implemented with caution to avoid exacerbating high levels of homophobia.
Collapse
Affiliation(s)
- Fang Yan
- Xiangya Nursing School, Central South University, Changsha, Hunan, Mainland China
| | - Cynthia X. Shi
- Department of Epidemiology of Microbial Diseases, Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
| | - Ye Zhang
- Zhuhai Maternal and Child Health Hospital, Zhuhai, Guangzhou, Mainland China
| | - Jia Chen
- Xiangya Nursing School, Central South University, Changsha, Hunan, China, Mainland China
| | - Ann Bartley Williams
- Rory Meyers College of Nursing, New York University, New York City, New York, USA
| | - Xianhong Li
- Xiangya Nursing School, Central South University, Changsha, Hunan, Mainland China
| |
Collapse
|
38
|
Aronson ID, Freeman R, Taylor T, Bennett AS. Developing Digital Media to Destigmatize Emergency Department Human Immunodeficiency Virus Testing Among Sexual and Racial Minority Youth: A Hyper-iterative Methodology. Cureus 2020; 12:e7209. [PMID: 32269887 PMCID: PMC7138468 DOI: 10.7759/cureus.7209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/07/2020] [Indexed: 11/10/2022] Open
Abstract
Rates of undiagnosed youth human immunodeficiency virus (HIV) remain problematically high across the United States and internationally. In addition, youth HIV test rates remain consistently low, and youth with HIV remain undiagnosed for longer periods of time as compared with older populations. Youth HIV remains especially persistent among African American adolescents and emerging adults, who are less likely to have consistent access to primary care and thus to HIV testing and prevention education. Therefore, increasing youth HIV test rates has become an important priority in emergency departments and other settings. At the same time, many young patients may not disclose risk behaviors or even engage in discussions of HIV testing when they interact with healthcare providers because they may fear being stigmatized. Technology-based interventions present valuable opportunities to reframe risk reporting and discussions of testing by designing computer-mediated interactions that young sexual and racial minority participants find non-judgmental and less threatening. If designed in accordance with empirically tested theories of instructional design/multimedia learning and established models of behavior change, technology-based interventions can increase the number of HIV tests offered to young people and offer testing in nonthreatening ways that more young people will accept. The current paper describes a hyper-iterative methodology used to develop the Mobile Augmented Screening (MAS) tool, a technology-based intervention designed to destigmatize HIV and increase HIV test rates among youth.
Collapse
Affiliation(s)
- Ian D Aronson
- Research, Digital Health Empowerment, Brooklyn, USA
- Health Communication, New York University School of Global Public Health, New York, USA
| | | | - Tonya Taylor
- Medicine: Infectious Disease, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | - Alex S Bennett
- Research, New York University School of Global Public Health, New York, USA
| |
Collapse
|
39
|
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: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
40
|
Olatosi B, Siddiqi KA, Conserve DF. Towards ending the human immunodeficiency virus epidemic in the US: State of human immunodeficiency virus screening during physician and emergency department visits, 2009 to 2014. Medicine (Baltimore) 2020; 99:e18525. [PMID: 31914025 PMCID: PMC6959905 DOI: 10.1097/md.0000000000018525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/07/2019] [Accepted: 11/28/2019] [Indexed: 11/01/2022] Open
Abstract
Human immunodeficiency virus (HIV) testing is important for prevention and treatment. Ending the HIV epidemic is unattainable if significant proportions of people living with HIV remain undiagnosed, making HIV testing critical for prevention and treatment. The Centers for Disease Control and Prevention (CDC) recommends routine HIV testing for persons aged 13 to 64 years in all health care settings. This study builds on prior research by estimating the extent to which HIV testing occurs during physician office and emergency department (ED) post 2006 CDC recommendations.We performed an unweighted and weighted cross-sectional analysis using pooled data from 2 nationally representative surveys namely National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2009 to 2014. We assessed routine HIV testing trends and predictive factors in physician offices and ED using multi-stage statistical survey procedures in SAS 9.4.HIV testing rates in physician offices increased by 105% (5.6-11.5 per 1000) over the study period. A steeper increase was observed in ED with a 191% (2.3-6.7 per 1000) increase. Odds ratio (OR) for HIV testing in physician offices were highest among ages 20 to 29 ([OR] 7.20, 99% confidence interval [CI: 4.37-11.85]), males (OR 1.34, [CI: 0.91-0.93]), African-Americans (OR 2.97, [CI: 2.05-4.31]), Hispanics (OR 1.80, [CI: 1.17-2.78]), and among visits occurring in the South (OR 2.06, [CI: 1.23-3.44]). In the ED, similar trends of higher testing odds persisted for African Americans (OR 3.44, 99% CI 2.50-4.73), Hispanics (OR 2.23, 99% CI 1.65-3.01), and Northeast (OR 2.24, 99% CI 1.10-4.54).While progress has been made in screening, HIV testing rates remains sub-optimal for ED visits. Populations visiting the ED for routine care may suffer missed opportunities for HIV testing, which delays their entry into HIV medical care. To end the epidemic, new approaches for increasing targeted routine HIV testing for populations attending health care settings is recommended.
Collapse
Affiliation(s)
| | | | - Donaldson Fadael Conserve
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| |
Collapse
|
41
|
Abstract
OBJECTIVES To investigate whether adverse childhood experiences are important determinants of sexual debut and HIV testing. DESIGN Adolescents (age 10-16; N = 2089) from rural Malawi were interviewed in 2017-2018 for the baseline wave of a longitudinal study of childhood adversity and HIV risk. METHODS Respondents were interviewed in their local language. Surveys captured 13 lifetime childhood adversities (using the Adverse Childhood Experience - International Questionnaire); sexual debut; and previous HIV testing. We used multivariate regression models to test whether adversity, measured both cumulatively and separately, predicted HIV risk. RESULTS For each additional adversity, there was a significant rise in the odds of sexual debut (odds ratio 1.13, confidence interval 1.07-1.20) and HIV testing (odds ratio 1.10, confidence interval 1.04-1.16). CONCLUSION Preventing HIV among all young people necessitates a paradigm shift that recognizes the importance of early life social determinants in structuring HIV risk.
Collapse
Affiliation(s)
- Rachel Kidman
- Program in Public Health and Department of Family, Population and Preventive Medicine, Stony Brook University (State University of New York), Stony Brook, NY 11794
| | - Hans-Peter Kohler
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA 19104-6298
| |
Collapse
|
42
|
Enane LA, Lowenthal ED, Arscott-Mills T, Eby J, Caiphus C, Kgwaadira B, Coffin SE, Steenhoff AP. Investigating Outcomes of Adolescents and Young Adults (10-24 Years of Age) Lost to Follow-up from Tuberculosis Treatment in Gaborone, Botswana. Pediatr Infect Dis J 2019; 38:e271-4. [PMID: 31220045 DOI: 10.1097/INF.0000000000002369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This retrospective study investigated outcomes among lost to follow-up (LTFU) adolescents and young adults (AYAs: 10-24 years of age) with tuberculosis (TB) registered from 2008 to 2014 in Gaborone, using surveillance data. Of 68 LTFU AYAs, 16 repeated treatment; 8 completed and 6 were again LTFU. Of 4 confirmed deaths, 3 had TB/HIV coinfection. Approaches to improve AYA retention in TB care are needed.
Collapse
|
43
|
Pintye J, Drake AL, Begnel E, Kinuthia J, Abuna F, Lagat H, Dettinger J, Wagner AD, Thirumurthy H, Mugwanya K, Baeten JM, John-Stewart G. Acceptability and outcomes of distributing HIV self-tests for male partner testing in Kenyan maternal and child health and family planning clinics. AIDS 2019; 33:1369-1378. [PMID: 30932954 PMCID: PMC6546533 DOI: 10.1097/qad.0000000000002211] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Providing HIV self-tests to women for distribution to male partners may provide a unique opportunity to increase male partner and couples testing among women in HIV high-burden settings. METHODS Between November 2017 and June 2018, we offered self-tests for at-home couples or partner HIV testing to HIV-uninfected women seeking routine maternal and child health and family planning services at eight facilities in Kisumu, Kenya. Women accepting self-tests were offered at least two self-tests (OraQuick) to take to their partner(s) with instructions on use. HIV self-testing (HIVST) outcomes were evaluated using available programmatic data. RESULTS Overall, 3620 women were offered self-tests for at-home male partner HIV testing. The median age was 24 years (interquartile range 21-28) and 81% were in monogamous marriages. Overall, 1422 (39%) women reported having a partner of unknown HIV status, of whom 755 (53%) accepted self-tests. Among women with partners of unknown HIV status who declined self-tests (n = 667), 49% reported needing to consult their partner. Pregnant women were more likely to accept HIVST than nonpregnant women (prevalence ratio = 1.2, 95% confidence interval 1.0-1.4, P = 0.013). Self-testing outcomes were ascertained for 389 (44%) women who accepted self-tests. Among these women, 93% offered HIVSTs to their male partner; of these, 95% reported their male partners used the self-test and 99% used a self-test with their partner. CONCLUSION Among women attending routine maternal and child health and family planning services who had male partners of unknown HIV status, over half accepted self-tests for partner testing. Most women with outcomes ascertained reported that male partners accepted and used self-tests and that couples testing occurred.
Collapse
Affiliation(s)
- Jillian Pintye
- Department of Global Health, University of Washington, Seattle, Washington
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, Washington
| | - Emily Begnel
- Department of Global Health, University of Washington, Seattle, Washington
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Obstetrics/Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | - Felix Abuna
- University of Washington—Kenya, Nairobi, Kenya
| | | | - Julia Dettinger
- Department of Global Health, University of Washington, Seattle, Washington
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, Washington
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth Mugwanya
- Department of Global Health, University of Washington, Seattle, Washington
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Pediatric, University of Washington, Seattle, Washington
| |
Collapse
|
44
|
Dalrymple J, McAloney-Kocaman K, Flowers P, McDaid LM, Frankis JS. Age-related factors influence HIV testing within subpopulations: a cross-sectional survey of MSM within the Celtic nations. Sex Transm Infect 2019; 95:351-357. [PMID: 31201278 DOI: 10.1136/sextrans-2018-053935] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/02/2019] [Accepted: 05/18/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Despite a recent fall in the incidence of HIV within the UK, men who have sex with men (MSM) continue to be disproportionately affected. As biomedical prevention technologies including pre-exposure prophylaxis are increasingly taken up to reduce transmission, the role of HIV testing has become central to the management of risk. Against a background of lower testing rates among older MSM, this study aimed to identify age-related factors influencing recent (≤12 months) HIV testing. METHODS Cross-sectional subpopulation data from an online survey of sexually active MSM in the Celtic nations-Scotland, Wales, Northern Ireland and Ireland (n=2436)-were analysed to compare demographic, behavioural and sociocultural factors influencing HIV testing between MSM aged 16-25 (n=447), 26-45 (n=1092) and ≥46 (n=897). RESULTS Multivariate logistic regression demonstrated that for men aged ≥46, not identifying as gay (OR 0.62, CI 0.41 to 0.95), location (Wales) (OR 0.49, CI 0.32 to 0.76) and scoring higher on the personalised Stigma Scale (OR 0.97, CI 0.94 to 1.00) significantly reduced the odds for HIV testing in the preceding year. Men aged 26-45 who did not identify as gay (OR 0.61, CI 0.41 to 0.92) were also significantly less likely to have recently tested for HIV. For men aged 16-25, not having a degree (OR 0.48, CI 0.29 to 0.79), location (Republic of Ireland) (OR 0.55, CI 0.30 to 1.00) and scoring higher on emotional competence (OR 0.57, CI 0.42 to 0.77) were also significantly associated with not having recently tested for HIV. CONCLUSION Key differences in age-related factors influencing HIV testing suggest health improvement interventions should accommodate the wide diversities among MSM populations across the life course. Future research should seek to identify barriers and enablers to HIV testing among the oldest and youngest MSM, with specific focus on education and stigma.
Collapse
Affiliation(s)
- Jenny Dalrymple
- Nursing and Community Health, Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK .,Sandyford Sexual Health Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Paul Flowers
- Social Relationships and Health Improvement, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Lisa M McDaid
- Social Relationships and Health Improvement, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.,Social Relationships and Health Improvement, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jamie Scott Frankis
- Nursing and Community Health, Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK
| |
Collapse
|
45
|
Hakim AJ, Badman SG, Weikum D, Amos A, Willie B, Narokobi R, Gabuzzi J, Pekon S, Kupul M, Hou P, Aeno H, Neo Boli R, Nembari J, Ase S, Kaldor JM, Vallely AJ, Kelly-Hanku A. Considerable distance to reach 90-90-90 targets among female sex workers, men who have sex with men and transgender women in Port Moresby, Papua New Guinea: findings from a cross-sectional respondent-driven sampling survey. Sex Transm Infect 2019; 96:143-150. [PMID: 31182653 DOI: 10.1136/sextrans-2019-053961] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/15/2019] [Accepted: 05/20/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To characterise the Joint United Nations Programme on HIV/AIDS 90-90-90 cascade among female sex workers (FSW) and men who have sex with men (MSM)/transgender women (TGW) in Port Moresby, Papua New Guinea (PNG). METHODS We conducted respondent-driven sampling surveys among FSW and MSM/TGW in Port Moresby, PNG from June to October 2016. All participants spoke English or Tok Pisin and were aged >12 years. FSW had to be born female and sell/exchange sex with a male in the past 6 months. MSM/TGW had to be born male and have oral/anal sex with another male-born person in the past 6 months. Participants were interviewed and offered rapid HIV diagnostic and viral load testing. HIV viral suppression (VS) was defined as <1000 copies/mL. RESULTS We recruited 674 FSW and 400 MSM/TGW; HIV prevalence was 15.2% (95% CI 11.7 to 18.8) and 8.5% (95% CI 5.0 to 11.9), respectively. Among FSW living with HIV, 39.0% (95% CI 26.6 to 51.4) self-reported having been diagnosed; of them 79.6% (95% CI 62.7 to 96.5) self-reported being on antiretroviral therapy (ART), and 54.1% (95% CI 31.8 to 76.4) achieved VS. Among MSM/TGW living with HIV, 24.4% (95% CI 4.7 to 44.1) self-reported having been diagnosed; of them 43.9% (95% CI 33.6 to 54.8) self-reported being on ART, and 86.1% (95% CI 71.1 to 93.9) achieved VS. CONCLUSIONS ART use among those aware of their HIV status is encouraging. However, the generally low awareness of infection status among FSW and MSM/TGW with HIV and the low VS among FSW on ART indicate an urgent need for innovative strategies to increase testing uptake and ART adherence among these populations. Monitoring drug resistance may be warranted.
Collapse
Affiliation(s)
- Avi J Hakim
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Steven G Badman
- Kirby Institute for Infection and Immunity, UNSW Sydney, New South Wales, Australia
| | - Damian Weikum
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angelyne Amos
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Barne Willie
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Rebecca Narokobi
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Josephine Gabuzzi
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Simon Pekon
- Papua New Guinea National Department of Health, Port Moresby, Papua New Guinea
| | - Martha Kupul
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Parker Hou
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Herick Aeno
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ruthy Neo Boli
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Joshua Nembari
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Sophie Ase
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - John M Kaldor
- Kirby Institute for Infection and Immunity, UNSW Sydney, New South Wales, Australia
| | - Andrew J Vallely
- Kirby Institute for Infection and Immunity, UNSW Sydney, New South Wales, Australia.,Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Angela Kelly-Hanku
- Kirby Institute for Infection and Immunity, UNSW Sydney, New South Wales, Australia.,Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | | |
Collapse
|
46
|
Liu Y, Silenzio VMB, Nash R, Luther P, Bauermeister J, Vermund SH, Zhang C. Suboptimal Recent and Regular HIV Testing Among Black Men Who Have Sex With Men in the United States: Implications From a Meta-Analysis. J Acquir Immune Defic Syndr 2019; 81:125-133. [PMID: 30844996 PMCID: PMC6956840 DOI: 10.1097/qai.0000000000002013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The continuum of HIV care among black men who have sex with men (BMSM) continues to be the least favorable in the United States. BMSM are disproportionally HIV-infected-but-unaware, despite expanded HIV testing efforts among this subgroup. METHODS We meta-analytically analyzed various HIV testing patterns [lifetime, after 24 months, after 12 months, after 6 months, and frequent (every 3-6 months) testing] among BMSM using the PRISMA guideline. PubMed, MEDLINE, Web of Science, and PsycINFO were searched for relevant articles, reports, conference proceedings, and dissertations published between January 1, 1996, and April 25, 2018. Two independent investigators reviewed and abstracted data into a standardized form. We used the DerSimonian-Laird random-effect model to pool the HIV testing prevalence and I-square statistics to measure heterogeneity. Funnel plots and Egger tests were used to assess for publication bias. We also performed subgroup and meta-regression analyses to explore aggregate-level characteristics that explain the heterogeneity across studies. RESULTS Our meta-analysis includes a total of 42,074 BMSM pooled from 67 studies. Lifetime HIV testing prevalence was high, 88.2% [95% confidence interval (CI): 86.2% to 90.1%], but recent (after 6 months = 63.4%; 95% CI: 59.3% to 67.4%) and frequent (42.2%, 95% CI: 34.1% to 50.3%) HIV testing prevalence was low. Meta-regression suggests that younger age (borderline significant), lower annual income, and homelessness were correlated with lower lifetime/recent HIV testing prevalence; while ever having condomless insertive/receptive sex, alcohol consumption, and illicit drug use were associated with higher lifetime/recent HIV testing prevalence. CONCLUSIONS Recent and frequent HIV testing remains suboptimal among BMSM. Future testing programs should prioritize strategies to enhance self-initiated, regular HIV testing among BMSM.
Collapse
Affiliation(s)
- Yu Liu
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | | | - Robertson Nash
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Patrick Luther
- Nashville Council on AIDS, Resources, Education and Support (CARES), Nashville, TN
| | | | - Sten H. Vermund
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, CT
| | - Chen Zhang
- School of Nursing, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
47
|
Darbes LA, McGrath NM, Hosegood V, Johnson MO, Fritz K, Ngubane T, van Rooyen H. Results of a Couples-Based Randomized Controlled Trial Aimed to Increase Testing for HIV. J Acquir Immune Defic Syndr 2019; 80:404-413. [PMID: 30730356 PMCID: PMC6524952 DOI: 10.1097/qai.0000000000001948] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although couples HIV testing and counseling (CHTC) is effective for facilitating mutual disclosure and linkage to HIV care, uptake remains low. Using a randomized controlled design, we tested the efficacy of a behavioral couples-based intervention aimed to increase CHTC. SETTING The Vulindlela district of KwaZulu-Natal, South Africa. METHODS Couples were recruited from the community (eg, markets and community events). Couples were excluded if mutual HIV serostatus disclosure had occurred. Both partners had to report being each other's primary partner and relationship length was at least 6 months. Assessments occurred at baseline, and 3, 6, and 9 months after intervention. Eligible couples attended a group session (3-4 hours) after which randomization occurred. Intervention couples additionally received: one couples-based group session followed by 4 couples' counseling sessions (1-2 hours). Intervention topics included communication skills, intimate partner violence, and HIV prevention. Our primary outcomes were CHTC and sexual risk behavior. RESULTS Overall, 334 couples were enrolled. Intervention couples were significantly more likely to have participated in CHTC [42% vs. 12% (P ≤ 0.001)]. In addition, their time to participate in CHTC was significantly shorter (logrank P ≤ 0.0001) (N = 332 couples). By group, 59% of those who tested HIV-positive in intervention and 40% of those who tested in control were new HIV diagnoses (P = 0.18). There were no group differences in unprotected sex. CONCLUSIONS Our intervention improved CHTC uptake-a vehicle for mutual serostatus disclosure and entrée into HIV treatment, both of which exert a significant public health impact on communities substantially burdened by HIV.
Collapse
Affiliation(s)
- Lynae A Darbes
- Center for AIDS Prevention Studies, Division of Prevention Sciences, University of California, San Francisco, San Francisco, CA
- Currently, Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI
| | - Nuala M McGrath
- Division of Primary Care and Population Sciences, Faculty of Medicine, Southampton, United Kingdom
- Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, United Kingdom
| | - Victoria Hosegood
- Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, United Kingdom
| | - Mallory O Johnson
- Center for AIDS Prevention Studies, Division of Prevention Sciences, University of California, San Francisco, San Francisco, CA
| | | | | | - Heidi van Rooyen
- Human Social Development, Human Sciences Research Council, Durban, South Africa
| |
Collapse
|
48
|
Njuguna IN, Wagner AD, Omondi VO, Otieno VA, Neary J, Bosire R, Babigumira JB, Levin C, Maleche-Obimbo E, Wamalwa DC, John-Stewart G, Slyker J. Financial Incentives for Pediatric HIV Testing in Kenya. Pediatr Infect Dis J 2018; 37:1142-4. [PMID: 29596217 DOI: 10.1097/INF.0000000000002035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The acceptability of financial incentives for pediatric HIV testing was evaluated in Kenya. Sixty HIV-positive women with children of unknown status were randomized to receive $5, $10 or $15 conditional upon HIV testing. Forty-four (73%) completed child testing, with similar rates across arms. Uptake was significantly higher than a cohort with similar procedures but no incentives (73% vs. 14%, P < 0.001).
Collapse
|
49
|
HU J, GELDSETZER P, STEELE SJ, MATTHEWS P, ORTBLAD K, SOLOMON T, SHROUFI A, VAN CUTSEM G, TANSER F, WYKE S, VOLLMER S, PILLAY D, MCCONNELL M, BÄRNIGHAUSEN T. The impact of lay counselors on HIV testing rates: quasi-experimental evidence from lay counselor redeployment in KwaZulu-Natal, South Africa. AIDS 2018; 32:2067-2073. [PMID: 29912066 PMCID: PMC6115282 DOI: 10.1097/qad.0000000000001924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to determine the causal effect of the number of lay counselors removed from a primary care clinic in rural South Africa on the number of clinic-based HIV tests performed. DESIGN Fixed-effects panel analysis. METHODS We collected monthly data on the number of lay counselors employed and HIV tests performed at nine primary care clinics in rural KwaZulu-Natal from January 2014 to December 2015. Using clinic-level and month-level fixed-effects regressions, we exploited the fact that lay counselors were removed from clinics at two quasi-random time points by a redeployment policy. RESULTS A total of 24 526 HIV tests were conducted over the study period. Twenty-one of 27 lay counselors were removed across the nine clinics in the two redeployment waves. A 10% reduction in the number of lay counselors at a clinic was associated with a 4.9% [95% confidence interval (CI) 2.8-7.0, P < 0.001] decrease in the number of HIV tests performed. In absolute terms, losing one lay counselor from a clinic was associated with a mean of 29.7 (95% CI 21.2-38.2, P < 0.001) fewer HIV tests carried out at the clinic per month. CONCLUSION This study provides some evidence that lay counselors play an important role in the HIV response in rural South Africa. More broadly, this analysis adds some empirical support to plans to increase the involvement of lay health workers in the HIV response.
Collapse
Affiliation(s)
- Janice HU
- School of Medicine, Duke University, Durham, North Carolina, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Pascal GELDSETZER
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Philippa MATTHEWS
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
| | - Katrina ORTBLAD
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Gilles VAN CUTSEM
- Southern African Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
| | - Frank TANSER
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Sally WYKE
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sebastian VOLLMER
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Economics & Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Deenan PILLAY
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, UK
| | - Margaret MCCONNELL
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Till BÄRNIGHAUSEN
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
50
|
Nosyk B, Min JE, Krebs E, Zang X, Compton M, Gustafson R, Barrios R, Montaner JSG. The Cost-Effectiveness of Human Immunodeficiency Virus Testing and Treatment Engagement Initiatives in British Columbia, Canada: 2011-2013. Clin Infect Dis 2018; 66:765-777. [PMID: 29028964 PMCID: PMC5850008 DOI: 10.1093/cid/cix832] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/22/2017] [Indexed: 01/03/2023] Open
Abstract
Background Recognition of the secondary preventive benefits of antiretroviral therapy (ART) has mobilized global efforts to "seek, test, treat, and retain" people living with human immunodeficiency virus [HIV]/AIDS (PLHIV) in HIV care. We aimed to determine the cost-effectiveness of a set of HIV testing and treatment engagement interventions initiated in British Columbia, Canada, in 2011-2013. Methods Using a previously validated dynamic HIV transmission model, linked individual-level health administrative data for PLHIV, and aggregate-level HIV testing data, we estimated the cost-effectiveness of primary care testing (hospital, emergency department [ED], outpatient), ART initiation, and ART retention initiatives vs a counterfactual scenario that approximated the status quo. HIV incidence, mortality, costs (in 2015$CDN), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios were estimated. Analyses were executed over 5- to 25-year time horizons from a government-payer perspective. Results ED testing was the best value at $30216 per QALY gained and had the greatest impact on incidence and mortality among PLHIV, while ART initiation provided the greatest QALY gains. The ART retention initiative was not cost-effective. Delivered in combination at the observed scale and sustained throughout the study period, we estimated a 12.8% reduction in cumulative HIV incidence and a 4.7% reduction in deaths among PLHIV at $55258 per QALY gained. Results were most sensitive to uncertainty in the number of undiagnosed PLHIV. Conclusions HIV testing and ART initiation interventions were cost-effective, while the ART retention intervention was not. Developing strategies to reengage PLHIV lost to care is a priority moving forward.
Collapse
Affiliation(s)
- Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, Vancouver
- Faculty of Health Sciences, Simon Fraser University, Burnaby
| | - Jeong E Min
- BC Centre for Excellence in HIV/AIDS, Vancouver
| | | | - Xiao Zang
- BC Centre for Excellence in HIV/AIDS, Vancouver
| | - Miranda Compton
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada
| | - Reka Gustafson
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, Vancouver
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julio S G Montaner
- BC Centre for Excellence in HIV/AIDS, Vancouver
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|