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de Voux A, Mvududu R, Happel A, Jaspan HB, Nyemba DC, Mashele N, Myer L, Davey DLJ. Point-of-Care Sexually Transmitted Infection Testing Improves HIV Preexposure Prophylaxis Initiation in Pregnant Women in Antenatal Care in Cape Town, South Africa, 2019 to 2021. Sex Transm Dis 2023; 50:92-97. [PMID: 36630416 PMCID: PMC9906800 DOI: 10.1097/olq.0000000000001729] [Citation(s) in RCA: 3] [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: 01/12/2023]
Abstract
Background Pre-exposure prophylaxis (PrEP) programs present a platform for diagnostic STI testing in low- and middle-income countries, and availability of targeted STI testing has been hypothesized to influence PrEP use. We evaluated the association of STI testing modality and PrEP uptake among pregnant women in antenatal care. Methods We enrolled pregnant, HIV-uninfected women (≥16 years) at their first antenatal visit with follow-up through 12 months postpartum. Women were offered oral PrEP and tested for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) using a point-of-care (Cepheid, August 2019–November 2020) or laboratory-based (Thermofisher, December 2020–October 2021) test. We compared the proportion of women initiating and continuing PrEP by STI test adjusting for confounders. Results We evaluated 1194 women (median age=26 years [IQR:22–31]) with a STI result (46% POC and 54% laboratory-based). The prevalence of any STI was the same in POC-tested (28%) and laboratory-tested (28%) women — 25% versus 23% for CT (p-value=0.35) and 7% versus 9% for NG (p-value=0.11). Mean time from testing to result was 0 for POC and 26 days for laboratory testing and mean time from testing to treatment was 3 for POC and 38 days for laboratory testing. Receiving a POC STI test was associated with higher PrEP initiation compared to women receiving a laboratory-based test (90% versus 78%; adjusted odds ratio=2.1; 95% CI:1.5–2.9), controlling for age, gravidity, STI diagnosis, intimate partner violence, gestational age, employment, HIV risk perception, and cohabiting status. Conclusion POC STI testing, offering same-day results and treatment initiation, may increase PrEP initiation among pregnant women in antenatal care. A study of HIV-uninfected pregnant women in South Africa found that women offered point-of-care STI testing had a higher odds of initiating HIV pre-exposure prophylaxis than women offered laboratory-based testing.
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Affiliation(s)
- Alex de Voux
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rufaro Mvududu
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Anna Happel
- Division of Immunology, Department of Pathology, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Heather B Jaspan
- Division of Immunology, Department of Pathology, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Seattle Children’s Research Institute, Seattle, Washington, United States of America
- Department of Pediatrics and Global Health, University of Washington, Seattle, Washington, United States of America
| | - Dorothy Chiwoniso Nyemba
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nyiko Mashele
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Dvora Leah Joseph Davey
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
- Division of Infectious Diseases, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
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Marcus R, Tie Y, Dasgupta S, Crim SM, Beer L, Williams SP, Weiser J. Sexually Transmitted Infection Testing Among Unstably Housed, Sexually Active Persons With Human Immunodeficiency Virus in the United States, 2018-2019. Sex Transm Dis 2022; 49:841-843. [PMID: 35858476 PMCID: PMC10217791 DOI: 10.1097/olq.0000000000001680] [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 Unstably housed sexually active people with human immunodeficiency virus experience both a high incidence of sexually transmitted infections (STI) and barriers to annual STI screening recommended by Centers for Disease Control and Prevention guidelines. We used Medical Monitoring Project data to describe STI testing among unstably housed people with human immunodeficiency virus by attendance at Ryan White HIV/AIDS Program-funded facilities.
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Affiliation(s)
- Ruthanne Marcus
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yunfeng Tie
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sharoda Dasgupta
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Stacy M. Crim
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Linda Beer
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Samantha P. Williams
- Behavioral Science and Epidemiology Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - John Weiser
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Spicehandler R, Zucker J, Yumori C, Adan M, Carnevale C, Theodore D, Castor D, Meyers K, Whittier S, Yin MT, Cohall A, Olender S, Gordon P, Sobieszczyk ME. Get2PrEP: An Electronic Medical Record Laboratory Comment Increased Safe Sex Counseling But Not Preexposure Prophylaxis Services at a Large Urban Academic Medical Center in Northern Manhattan. Sex Transm Dis 2022; 49:713-718. [PMID: 35921642 PMCID: PMC9481682 DOI: 10.1097/olq.0000000000001682] [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
BACKGROUND HIV preexposure prophylaxis (PrEP) remains underutilized despite its efficacy and potential population impact. Achieving PrEP's full potential depends on providers who are knowledgeable and comfortable prescribing it to individuals at risk of acquiring HIV. Previous educational interventions targeting provider-related uptake barriers have had limited success. We designed and tested an electronic medical record (EMR) interpretative comment to improve the delivery of PrEP. METHODS An EMR comment provided information on PrEP eligibility and referral resources to providers delivering positive chlamydia and gonorrhea results. Positive test results for bacterial sexually transmitted infections before intervention (January 1, 2019-August 23, 2019) and after intervention (August 24, 2019-December 31, 2019) were identified. A retrospective chart review was conducted to ascertain provider documentation of PrEP discussions or provision, HIV prevention discussions, and HIV screening. Pretest-posttest analysis was performed to compare the provision of PrEP and HIV prevention services. RESULTS We reviewed 856 preintervention encounters spanning 8 months and 461 postencounters spanning 4 months. Patient demographics were comparable. We observed an increase in provider documentation of safe sex and condom counseling (odds ratios [ORs], 1.2 [95% confidence interval {CI}, 1.07-1.18] and 1.11 [95% CI, 1.05-1.17], respectively), and the absence of any HIV prevention discussion decreased (OR, 0.85; 95% CI, 0.80-0.90), but not HIV screening or PrEP documentation. CONCLUSIONS We demonstrated that an EMR laboratory comment had a modest effect on increasing risk reduction counseling, although not HIV screening or PrEP prescriptions. Future strategies to encourage provider delivery of sexual health services may benefit from more targeted strategies that combine behavioral and information technology approaches.
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Affiliation(s)
| | - Jason Zucker
- Department of Internal Medicine, Division of Infectious Diseases; Columbia University Irving Medical Center, University of California Los Angeles
| | - Caitlin Yumori
- Department of Internal Medicine; University of California Los Angeles
| | - Matthew Adan
- Department of Internal Medicine, Division of Infectious Diseases; Columbia University Irving Medical Center, University of California Los Angeles
| | | | - Deborah Theodore
- Department of Internal Medicine, Division of Infectious Diseases; Columbia University Irving Medical Center, University of California Los Angeles
| | - Delivette Castor
- Department of Internal Medicine, Division of Infectious Diseases; Columbia University Irving Medical Center, University of California Los Angeles
| | | | - Susan Whittier
- Clinical Microbiology Lab, Columbia University Irving Medical Center
| | - Michael T. Yin
- Department of Internal Medicine, Division of Infectious Diseases; Columbia University Irving Medical Center, University of California Los Angeles
| | - Alwyn Cohall
- Department of Pediatrics, Columbia University Irving Medical Center
- Mailman School of Public Health
| | - Susan Olender
- Department of Internal Medicine, Division of Infectious Diseases; Columbia University Irving Medical Center, University of California Los Angeles
| | - Peter Gordon
- Department of Internal Medicine, Division of Infectious Diseases; Columbia University Irving Medical Center, University of California Los Angeles
| | - Magdalena E. Sobieszczyk
- Department of Internal Medicine, Division of Infectious Diseases; Columbia University Irving Medical Center, University of California Los Angeles
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Kennedy AK, Kaushik G, Dubinsky EL, Huseynli A, Jonson-Reid M, Plax K. Direct and Indirect Cost Savings From Sexually Transmitted Infection Testing, Treatment, and Counseling Among Foster Youth. Sex Transm Dis 2022; 49:86-89. [PMID: 34264902 PMCID: PMC8665035 DOI: 10.1097/olq.0000000000001511] [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: 01/03/2023]
Abstract
BACKGROUND Sexually transmitted infection (STI) prevention programs can decrease the economic burden of STIs. Foster youth have higher rates of STIs compared with their peers; however, information on direct costs and indirect costs averted by STI testing, treatment, and counseling among foster youth is lacking. METHODS This study used data from a comprehensive medical center for foster youth over a 3-year study period from July 2017 to June 2020. Direct and indirect costs averted by testing and treatment of chlamydia, gonorrhea, and syphilis, as well as HIV testing and counseling, were calculated based on formulas developed by the Centers for Disease Control and Prevention and adjusted for inflation. RESULTS Among the 316 youth who received medical services during this time, 206 were sexually active and tested for STIs and/or HIV. Among 121 positive STI test results, 64.5% (n = 78) were positive for chlamydia, 30.6% (n = 37) were positive for gonorrhea, and 5.0% (n = 6) were positive for syphilis. Treatment was provided to all. Overall, $60,049.68 in direct medical costs and $73,956.36 in indirect costs were averted. CONCLUSIONS Given the rates of STIs among this population and the economic benefit of STI treatment, it is imperative to continue to provide intensive and comprehensive, individualized sexual health care for foster youth. Traditional care management may miss the opportunity to prevent, identify, and treat STIs that comprehensive wraparound care can achieve. This study suggests that comprehensive wraparound care is a cost-effective way to identify, treat, and prevent STIs among foster youth.
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Affiliation(s)
| | - Gaurav Kaushik
- Washington University in St. Louis; Supporting Positive Opportunities with Teens
| | - Emma L. Dubinsky
- Washington University in St. Louis; Supporting Positive Opportunities with Teens
| | | | | | - Katie Plax
- Washington University in St. Louis; Adolescent Medicine
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Bonett S, Petsis D, Dowshen N, Bauermeister J, Wood SM. The Impact of the COVID-19 Pandemic on Sexually Transmitted Infection/Human Immunodeficiency Virus Testing Among Adolescents in a Large Pediatric Primary Care Network. Sex Transm Dis 2021; 48:e91-e93. [PMID: 33783411 PMCID: PMC8500357 DOI: 10.1097/olq.0000000000001427] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/19/2022]
Abstract
ABSTRACT Disruptions in sexually transmitted infection (STI) testing infrastructure during the COVID-19 pandemic threaten to impact STI service delivery for adolescents. Within a large pediatric primary care network, we compared STI testing encounters between the pandemic period and an analogous prepandemic period. The STI test counts decreased and test positivity increased during the pandemic period.
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Affiliation(s)
- Stephen Bonett
- School of Nursing, University of Pennsylvania, Philadelphia
| | - Danielle Petsis
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia
| | - Nadia Dowshen
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia
- Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Sarah M. Wood
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia
- Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Ogale Y, Yeh PT, Kennedy CE, Toskin I, Narasimhan M. Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis. BMJ Glob Health 2019; 4:e001349. [PMID: 31139454 PMCID: PMC6509609 DOI: 10.1136/bmjgh-2018-001349] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [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] [Received: 12/06/2018] [Revised: 03/28/2019] [Accepted: 03/30/2019] [Indexed: 11/20/2022] Open
Abstract
Background Self-collection of samples for diagnostic testing offers the advantages of patient autonomy, confidentiality and convenience. Despite data showing their feasibility and accuracy, there is a need to better understand how to implement such interventions for sexually transmitted infections (STIs). To support WHO guidelines on self-care interventions, we conducted a systematic review to investigate whether self-collection of samples should be made available as an additional approach to deliver STI testing services. Methods Peer-reviewed studies were included if they compared individuals who self-collected samples for chlamydia, gonorrhoea, syphilis and/or trichomonas testing to individuals who had samples collected by clinicians on the following outcomes: uptake/frequency of STI testing, social harms/adverse events, positive yield (case finding), linkage to clinical assessment/treatment and reported sexual risk behaviour. We searched PubMed, CINAHL, LILACS and EMBASE for articles published through July 2018. Risk of bias was assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for non-RCTs. Meta-analysis was conducted using random effects models to generate pooled estimates of relative risk (RR). Results Eleven studies, including five RCTs and six observational studies with a total of 202 745 participants, met inclusion criteria. Studies were conducted in Australia, Denmark and the USA. Meta-analysis found that programmes offering self-collection of samples increased overall uptake of STI testing services (RR: 2.941, 95% CI 1.188 to 7.281) and case finding (RR: 2.166, 95% CI 1.043 to 4.498). No studies reported measuring STI testing frequency, social harms/adverse events, linkage to care or sexual risk behaviour. Discussion While greater diversity in study designs, outcomes and settings would strengthen the evidence base, findings from this review suggest that self-collection of STI samples could be an effective additional strategy to increase STI testing uptake. Prospero registration number PROSPERO CRD42018114866.
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Affiliation(s)
- Yasmin Ogale
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Igor Toskin
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Geneve, Switzerland
| | - Manjulaa Narasimhan
- Department of Reproductive Health and Research, Organisation mondiale de la Santé, Geneve, Switzerland
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Abstract
OBJECTIVE To assess the acceptability of sexually transmitted infection (STI) testing using self-collected vaginal swabs (SCVS) among college women. PARTICIPANTS First-year female students (N=483). METHODS Participants were offered free testing for 3 STIs using SCVS in April 2010 and later completed a survey regarding their testing decision and experiences. RESULTS Sixty-four percent (n=310) accepted testing; of these, 98% found it easy or very easy to understand the SCVS instructions, and 93% found it easy or very easy to collect the specimen. Among the 36% who did not participate in testing, most had scheduling conflicts or did not perceive a risk for STIs; only 26% felt uncomfortable about the SCVS procedure. Among all women, SCVS was preferred over other STI testing methods. CONCLUSIONS STI testing using SCVS was acceptable to the majority of college women and could increase the uptake of testing among sexually active college women.
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Affiliation(s)
- Robyn L Fielder
- Department of Psychology, Syracuse University, Syracuse, New York, USA.
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Westmaas AH, Kok G, Vriens P, Götz H, Richardus JH, Voeten H. Determinants of intention to get tested for STI/HIV among the Surinamese and Antilleans in the Netherlands: results of an online survey. BMC Public Health 2012; 12:961. [PMID: 23136830 PMCID: PMC3599572 DOI: 10.1186/1471-2458-12-961] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 10/31/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND High infection rates of STIs are found among the different ethnic communities living in the Netherlands, especially among the Surinamese and Dutch-Antilleans. Only limited effective interventions that promote STI/HIV testing among these communities are available in the Netherlands. In the present study we identified the determinants of the intention to get tested for STI/HIV of the sexually active Surinamese and Dutch-Antilleans living in the Netherlands. Secondly, this study assesses which determinants should be addressed when promoting STI/HIV testing among these communities. METHODS In total, 450 Surinamese and 303 Dutch-Antillean respondents were recruited through Dutch Internet panels and group activities. The questionnaire used in the online survey was based on the concepts of the Health Belief Model, the Social Cognitive Theory, and Theory of Planned behavior. To correct for multiple outcome testing, we considered differences as statistically significant at p<.01 for all analyses. For the multivariate linear regression analysis, variables that were significant were entered into the model block-wise. RESULTS Health motivation, cues to action, subjective norms, risk behavior, test history, open communication about sexuality, and marital status were important (univariate) predictors of the intention to get tested for STI/HIV for both the Surinamese and Dutch-Antillean respondents. For both the Surinamese and Dutch-Antilleans, subjective norms were the most salient predictor of the intention to get tested in multivariate analyses, explaining 10% and 13% of the variance respectively; subjective norms had a direct influence on the intention for both the Surinamese and the Dutch-Antilleans. CONCLUSIONS The strong correlation and predictive power of subjective norms on the intention to get tested for STI/HIV, endorses the importance of focusing on community-based intervention rather than focusing on personal determinants, to change the present perceptions and attitudes towards testing. Health promoting programs should be aimed at promoting open communication regarding sexuality and testing. Stimulating each other to get tested frequently could also help achieving the desired behavior.
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Affiliation(s)
- Alvin H Westmaas
- Municipal Public Health Service Rotterdam, P.O. Box 70032, 3000, LP, Rotterdam, The Netherlands
- Maastricht University, Department of Work & Social Psychology, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Gerjo Kok
- Maastricht University, Department of Work & Social Psychology, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Pjer Vriens
- Municipal Public Health Service Rotterdam, P.O. Box 70032, 3000, LP, Rotterdam, The Netherlands
| | - Hannelore Götz
- Municipal Public Health Service Rotterdam, P.O. Box 70032, 3000, LP, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Municipal Public Health Service Rotterdam, P.O. Box 70032, 3000, LP, Rotterdam, The Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Hélène Voeten
- Municipal Public Health Service Rotterdam, P.O. Box 70032, 3000, LP, Rotterdam, The Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
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Ober AJ, Martino SC, Ewing B, Tucker JS. If you provide the test, they will take it: factors associated with HIV/ STI Testing in a representative sample of homeless youth in Los Angeles. AIDS Educ Prev 2012; 24:350-362. [PMID: 22827904 PMCID: PMC3408628 DOI: 10.1521/aeap.2012.24.4.350] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Homeless youth are at high risk for human immunodeficiency virus (HIV) and other sexually transmitted infections (STI), yet those at greatest risk may never have been tested for HIV or STI. In a probability sample of sexually active homeless youth in Los Angeles (n = 305), this study identifies factors associated with HIV/STI testing status. Most youth (85%) had ever been tested and 47% had been tested in the past 3 months. Recent testing was significantly more likely among youth who self-identified as gay, were Hispanic, injected drugs, and used drop-in centers, and marginally more likely among youth with more depressive symptoms. Drop-in center use mediated the association of injection drug use with HIV/STI testing. HIV/STI testing was unrelated to sexual risk behavior. Drop-in centers can play an important role in facilitating testing, including among injection drug users, but more outreach is needed to encourage testing in other at-risk subgroups.
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Affiliation(s)
- Allison J Ober
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138, USA.
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