Areas Of High HIV Prevalence Research Articles

Getting to Zero: A Demonstration Project of Partner HIV Testing in the Prenatal Setting in Chicago, Illinois.

Women who experience HIV seroconversion during pregnancy are missed during early routine pregnancy HIV screening and are at high risk of perinatal HIV transmission. Male partner HIV testing during routine prenatal care may be an effective primary prevention strategy by identifying women at risk of seroconversion and mitigating their risk. Our objective was to assess interest in and uptake of male partner HIV testing services offered during prenatal care. This demonstration project included all pregnant, English-speaking, HIV-negative women receiving publicly funded prenatal care in an urban hospital-based practice located in a high HIV prevalence area. Women were offered free HIV screening for their male sexual partners. From April 2017 to June 2018, enrolled women completed surveys on social demographics, medical access characteristics, and HIV testing history. Women were invited to bring their partners to a prenatal visit where HIV testing was offered to their male partners. Factors associated with women's interest in testing and completion of partner testing were assessed using bivariable and multivariable analyses. Of 392 women approached, 70% (N = 274) completed study surveys. Although the majority (76%, N = 200 of 264 respondents) of women desired their partner undergo HIV testing, testing was underutilized as only 18 (7%) male partners completed testing. While neither maternal characteristics nor male social or attitudinal factors were associated with interest in or completion of partner HIV testing, sensitivity analyses, performed with multiple imputation, demonstrated some association between interest and completion of partner testing and partner medical care access and utilization. In conclusion, although the majority of low-income women in an urban prenatal clinic expressed interest in having their partners undergo HIV testing, uptake of free partner HIV testing services was uncommon. A focused assessment of implementation and uptake barriers is needed to optimize partner testing and eliminate HIV transmission to mothers and their babies.

Rotavirus disease burden pre-vaccine introduction in young children in Rural Southern Mozambique, an area of high HIV prevalence.

BackgroundRotavirus vaccines have been adopted in African countries since 2009, including Mozambique (2015). Disease burden data are needed to evaluate the impact of rotavirus vaccine. We report the burden of rotavirus-associated diarrhea in Mozambique from the Global Enteric Multicenter Study (GEMS) before vaccine introduction.MethodsA case-control study (GEMS), was conducted in Manhiça district, recruiting children aged 0–59 months with moderate-to-severe diarrhea (MSD) and less-severe-diarrhea (LSD) between December 2007 and November 2012; including 1–3 matched (age, sex and neighborhood) healthy community controls. Clinical and epidemiological data and stool samples (for laboratory investigation) were collected. Association of rotavirus with MSD or LSD was determined by conditional logistic regression and adjusted attributable fractions (AF) calculated, and risk factors for rotavirus diarrhea assessed.ResultsOverall 915 cases and 1,977 controls for MSD, and 431 cases and 430 controls for LSD were enrolled. Rotavirus positivity was 44% (217/495) for cases and 15% (160/1046) of controls, with AF = 34.9% (95% CI: 32.85–37.06) and adjusted Odds Ratio (aOR) of 6.4 p< 0.0001 in infants with MSD compared to 30% (46/155) in cases and 14% (22/154) in controls yielding AF = 18.7%, (95% CI: 12.02–25.39) and aOR = 2.8, p = 0.0011 in infants with LSD. The proportion of children with rotavirus was 32% (21/66) among HIV-positive children and 23% (128/566) among HIV-negative ones for MSD. Presence of animals in the compound (OR = 1.9; p = 0.0151) and giving stored water to the child (OR = 2.0, p = 0.0483) were risk factors for MSD; while animals in the compound (OR = 2.37, p = 0.007); not having routine access to water on a daily basis (OR = 1.53, p = 0.015) and washing hands before cooking (OR = 1.76, p = 0.0197) were risk factors for LSD.ConclusionThe implementation of vaccination against rotavirus may likely result in a significant reduction of rotavirus-associated diarrhea, suggesting the need for monitoring of vaccine impact.

Did sexual behaviour differences between HIV infection and treatment groups offset the preventative biological effects of ART roll-out in Zimbabwe?

Declines in HIV incidence have been slower than expected during the roll-out of antiretroviral treatment (ART) services in sub-Saharan African populations suffering generalized epidemics. Using data from a population-based, open cohort HIV sero-survey (2004–13), we found evidence for initial reductions in sexual activity and multiple sexual partnerships, followed by increases during the period of ART scale-up in areas of high HIV prevalence in Manicaland, east Zimbabwe. Recent population-level increases in condom use were also recorded, but largely reflected high use by the rapidly growing proportion of HIV-infected individuals on treatment. Sexual risk behaviour increased in susceptible uninfected individuals and in untreated (and therefore more infectious) HIV-infected men, which may have slowed the decline in HIV incidence in this area. Intensified primary HIV prevention programmes, together with strengthened risk screening, referral, and support services following HIV testing, could help to maximize the impact of ‘test-and-treat’ programmes in reducing new infections.

Targeted HIV screening in the emergency department.

Despite considerable improvement in human immunodeficiency virus (HIV) knowledge and treatment in the last 3 decades, the overall number of people living with HIV (PLHIV) is still rising with up to one quarter being unaware of their HIV status. Early HIV diagnosis and treatment prolongs life, reduces transmission, improves quality of life, and is a cost-effective public health intervention. The emergency department (ED) sees a large number of patients from marginalized and traditionally underserved populations in whom HIV is known to be more prevalent and who may notattend traditional services because of either cultural reasons or because of a chaotic lifestyle. This article discusses the two main approaches to screening; 'Opt-out' screening offers testing routinely in all clinical settings, and 'Targeted' screening offers testing to individuals presenting with indicator conditions. There are many studies of 'Opt-out' ED HIV screening in urban areas of high-HIV prevalence. However, little is known about the effectiveness of 'targeted' HIV screening, especially in areas of low prevalence. This review discusses the background to HIV screening in the ED and reviews the evidence around 'targeted' HIV screening in adult EDs in different HIV prevalence settings, concluding that targeted HIV screening at the ED can be impactful, cost-effective, and well accepted in the ED population, but its long-term implementation requires extra funding and increased staffing resource limiting its application in low resource setting. Despite most evidence being from areas of high-HIV prevalence, targeted screening might also be appropriate in low-HIV prevalence areas.

Evaluation of an Electronic Algorithm for Identifying Cisgender Female Pre-Exposure Prophylaxis Candidates.

We previously developed an electronic medical record-based algorithm for identifying patients at risk for HIV in the emergency department (ED). The aim of this study was to evaluate the performance of the HIV risk algorithm for identifying cisgender women with a pre-exposure prophylaxis (PrEP) indication. To retrospectively evaluate the HIV risk algorithm, we identified cisgender women with HIV diagnosed in the ED and retrospectively calculated the HIV risk algorithm output. To prospectively validate the algorithm, we surveyed cisgender women seeking care in the ED regarding behavioral risks for HIV. We prospectively determined whether the algorithm identified them as PrEP candidates. In the retrospective evaluation, 9.4% (2/21) of women with incident HIV infection were identified as at risk for HIV by the algorithm. In the prospective evaluation, 24% (59/245) of women who completed the survey had a PrEP indication based on self-report of behavioral risk factors for HIV. The sensitivity of the algorithm for identifying cisgender female PrEP candidates was 10%, and the specificity was 96%. PrEP indications missed by the electronic algorithm included condomless sex in a high HIV prevalence area, multiple sex partners, male partners who have sex with men, and recent bacterial sexually transmitted infections diagnosed at outside clinics. An electronic algorithm to identify PrEP candidates in the ED has low sensitivity for identifying cisgender women with PrEP indications. More research is needed to identify electronic data that can improve the algorithm sensitivity among cisgender women.

Prevention of Perinatal HIV Transmission in an Area of High HIV Prevalence in the United States

To evaluate the uptake of perinatal HIV preventive interventions by the risk of perinatal HIV transmission in mother-infant pairs in a high-HIV prevalence area in the US. This was a retrospective cohort study of mother-infant pairs with perinatal HIV exposure during 2013-2017 managed at a subspecialty pediatric HIV program in Washington, DC. We collected demographic data, maternal HIV history, delivery mode, maternal and infant antiretroviral drug (ARV) use, and infant HIV test results. We compared the uptake of recommended preventive interventions in low-risk (ie, mothers on antiretroviral therapy [ART] with viral suppression) and high-risk (mothers without ART or viral suppression) mother-infant pairs using the Pearson chi-square, Fisher exact, and Wilcoxon rank-sum tests and logistic regression. We analyzed 551 HIV-exposed infants (HEIs) and 542 mothers living with HIV. The majority of mothers received ARVs (95.5%), had HIV RNA ≤1000 copies/mL before delivery (81.9%), and received intrapartum zidovudine (ZDV; 65.5%). The majority of all HEIs were low risk (82.6%) and received postpartum ARVs (98.9%). Among the low-risk infants, 53.2% were delivered via cesarean delivery (CD), and 62.9% and 96.5% were administered intrapartum and postpartum ZDV, respectively. Among high-risk infants, 84.4% were delivered via CD, 78.1% received intrapartum ZDV, and 62.5% received combination ART. Nine high-risk infants acquired HIV perinatally. In an area of high HIV prevalence in the US, a large proportion of low-risk HEIs received intrapartum ZDV and were delivered via CD. We also observed missed opportunities for the prevention of perinatal HIV transmission.

Depressive symptoms among children attending community based support in South Africa - pathways for disrupting risk factors.

Children in Southern Africa are exposed to high rates of structural and family adversities. This study tests whether services from Community Based Organisations (CBOs) in South Africa can promote children’s resilience against depression exposed to such adversities. Two linked longitudinal studies were conducted, comprising n = 1848 children aged 9 to 13 years. One group received CBO services, whilst the other (quasi-control) did not. Analyses used interaction terms in regression models to test for potential moderation effects of CBO attendance, and marginal effects models to interpret significant interactions. Two interaction effects were shown, demonstrating moderation effects of CBO attendance on common structural disadvantages. First, children exposed to community violence showed increased depression (contrast = 0.62 [95%CI 0.43, 0.82], p < .001), but this association was removed by CBO access (contrast = 0.07 [95%CI −0.28, 0.43], p = .682). Second, children living in informal housing showed increased depression (contrast = 0.63 [95%CI 0.42, 0.85], p < .001), however, this association was removed by CBO access (contrast = 0.01 [95%CI −0.55, 0.56], p = .977). CBO attendance is associated with fewer depressive symptoms, and can buffer against important structural adversities of poor housing and violence that are common in high HIV-prevalence areas. However, CBO attendance was not able to remove the increased psychosocial distress associated with some family-level vulnerabilities such as orphanhood and abuse. These findings highlight the centrality of CBO-provided psychosocial support for children in Southern Africa, and suggest areas for bolstering provision.

A mathematical model to estimate the state-specific impact of the Health Resources and Services Administration's Ryan White HIV/AIDS Program.

BackgroundAccess to and engagement in high-quality HIV medical care and treatment is essential for ending the HIV epidemic. The Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program (RWHAP) plays a critical role in ensuring that people living with diagnosed HIV (PLWH) are linked to and consistently engaged in high quality care and receive HIV medication in a timely manner. State variation in HIV prevalence, the proportion of PLWH served by the RWHAP, and local health care environments could influence the state-specific impact of the RWHAP. This analysis sought to measure the state-specific impact of the RWHAP on the HIV service delivery system and health outcomes for PLWH, and presents template language to communicate this impact for state planning and stakeholder engagement.Methods and findingsThe HRSA’s HIV/AIDS Bureau (HAB) and the Centers for Disease Control and Prevention‘s Division of HIV/AIDS Prevention (CDC DHAP) have developed a mathematical model to estimate the state-specific impact of the RWHAP. This model was parameterized using RWHAP data, HIV surveillance data, an existing CDC model of HIV transmission and disease progression, and parameters from the literature. In this study, the model was used to analyze the hypothetical scenario of an absence of the RWHAP and to calculate the projected impact of this scenario on RWHAP clients, RWHAP-funded providers, mortality, new HIV cases, and costs compared with the current state inclusive of the RWHAP. To demonstrate the results of the model, we selected two states, representing high HIV prevalence and low HIV prevalence areas. These states serve to demonstrate the functionality of the model and how state-specific results can be translated into a state-specific impact statement using template language.ConclusionsIn the example states presented, the RWHAP provides HIV care, treatment, and support services to a large proportion of PLWH in each state. The absence of the RWHAP in these states could result in substantially more deaths and HIV cases than currently observed, resulting in considerable lifetime HIV care and treatment costs associated with additional HIV cases. State-specific impact statements may be valuable in the development of state-level HIV prevention and care plans or for communications with planning bodies, state health department leadership, and other stakeholders. State-specific impact statements will be available to RWHAP Part B recipients upon request from HRSA’s HIV/AIDS Bureau.

"It's Like Plan B but for HIV!" Design and Evaluation of a Media Campaign to Drive Demand for PEP.

Post-exposure Prophylaxis (PEP) is an effective yet underutilized HIV prevention tool. PEPTALK developed and evaluated a media campaign to drive demand for PEP among men who have sex with men (MSM) and transgender women (TW) living in high HIV prevalence areas in New York City. Formative qualitative research (38 in-depth interviews and five focus groups [N = 48]) with Black or African-American MSM or TW who reported condomless sex with a HIV-positive/unknown status man was conducted to inform campaign design. We assessed the impact of the campaign, 15 bus shelter ads and low or no-cost social media, by assessing change in the proportions of new PEP patient visits, to the clinical site where the campaign directed consumers, using one-sided z-test for proportions, before and after the media campaign. The proportion of new PEP patients increased significantly after the media campaign in the periods examined, suggesting that such campaigns may increase PEP demand.

Attitudes towards male partner HIV testing among low-income, minority pregnant women and their partners

ObjectivePrimary prevention of maternal HIV seroconversion requires knowledge of the HIV status of sexual partners, but testing rates, particularly among urban minority heterosexual males, remain low. This study was initiated to understand the attitudes of pregnant women and their partners surrounding partner HIV testing. MethodsThis was a qualitative study of pregnant women receiving publicly-funded prenatal care in a large urban hospital located in a high HIV prevalence area and their partners. Participants underwent in-depth individual interviews about HIV testing. Semi-structured interview guides were used to elicit participant attitudes. Transcripts were analyzed using the constant comparative method to determine themes and subthemes; analysis was organized by whether participants desired or declined partner testing. ResultsOf 51 participants, 29 were pregnant women and 22 were male partners of female participants. Reasons for desiring or declining HIV testing aligned within three major themes: risk perception, logistical considerations, and testing history. An individual’s perception of risk included evaluations of fetal safety as well as partner autonomy and fidelity. Logistical considerations included cost, test availability, and male partner geographic location. Individuals’ recent testing histories also influenced testing preferences. One cross-cutting theme was of the pregnant woman taking responsibility for family health, which could serve as a motivator to test or reason to decline. ConclusionPregnant women are often the linchpin of prevention of HIV transmission in the family unit. These data inform strategies to engage pregnant women and their partners to improve implementation of partner HIV testing in the prenatal setting.

Perceptions of Patient HIV Risk by Primary Care Providers in High-HIV Prevalence Areas in the Southern United States.

The southern United States accounted for 52% of new HIV diagnoses in 2015. Visits to primary care providers (PCPs) offer opportunities for routine HIV screening. However, of at-risk persons in the United States who visited a health care provider within the previous year, >75% were not offered a test for HIV. Perceptions of patient population risk by PCPs could offer insight into these missed opportunities, and inform development of HIV testing interventions for PCPs to increase routine screening. During April-October 2017, we conducted online surveys regarding PCP's perceptions of patient HIV risk in six areas of the South with high-HIV prevalence. Surveys queried HIV-related knowledge, beliefs, attitudes, and practices. Free-text responses to the question "Are there any unique or special risk factors relating to HIV infection in your patient population?" were analyzed using NVivo for applied thematic analysis. Of 526 respondents, the mean age was 47 years with 65% white, 13% Asian/other, 13% black, 6% Hispanic/Latino; 71% female; 93% straight/heterosexual; and 35% offered HIV screening correctly based on standard of care. Main themes revealed were as follows: (1) provider perceptions of patient risk factors (e.g., "injection drug use is rampant"), (2) provider perceptions of patient barriers to access and care (e.g., "concern for parental notification and cost for treatment"), and (3) provider misconceptions of HIV risk and patient stigmatization (e.g., "I have a low-risk population"). Our findings suggest that PCPs in the South may warrant education regarding local HIV prevalence and routine HIV screening and prevention practices.

Measuring HIV Risk Perception and Behavior: Results from Round 1 of the Cognitive Interviewing Project with young women and men who have sex with men in South Africa.

Self-reported HIV risk perception and behaviors are used in a variety of settings for diverse purposes, such as HIV prevention program planning and screening. Careful consideration of how youth in high HIV prevalence areas interpret these kinds of questions warrants attention. The Cognitive Interviewing Project (CIP) conducted cognitive interviews on common risk survey items with 30 cis-female and 20 MSM youth (18 to 24), who had recent sex with a male partner, in Cape Town and Vulindlela, South Africa. Results identified a number of potential issues including (1) confusing text; (2) mismatches of terms with local usage; (3) confusion with items requiring self-tailoring; (4) presentation concerns limiting selection of full range of answers; and (5) challenges reporting on information dependent on partner (eg., HIV risk, HIV status of partner). Self-report Items used to identify those at elevated risk for HIV should be evaluated with local populations to optimize shared understanding.

Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai, Uganda

SummaryBackgroundInternational and global organisations advocate targeting interventions to areas of high HIV prevalence (ie, hotspots). To better understand the potential benefits of geo-targeted control, we assessed the extent to which HIV hotspots along Lake Victoria sustain transmission in neighbouring populations in south-central Uganda.MethodsWe did a population-based survey in Rakai, Uganda, using data from the Rakai Community Cohort Study. The study surveyed all individuals aged 15–49 years in four high-prevalence Lake Victoria fishing communities and 36 neighbouring inland communities. Viral RNA was deep sequenced from participants infected with HIV who were antiretroviral therapy-naive during the observation period. Phylogenetic analysis was used to infer partial HIV transmission networks, including direction of transmission. Reconstructed networks were interpreted through data for current residence and migration history. HIV transmission flows within and between high-prevalence and low-prevalence areas were quantified adjusting for incomplete sampling of the population.FindingsBetween Aug 10, 2011, and Jan 30, 2015, data were collected for the Rakai Community Cohort Study. 25 882 individuals participated, including an estimated 75·7% of the lakeside population and 16·2% of the inland population in the Rakai region of Uganda. 5142 participants were HIV-positive (2703 [13·7%] in inland and 2439 [40·1%] in fishing communities). 3878 (75·4%) people who were HIV-positive did not report antiretroviral therapy use, of whom 2652 (68·4%) had virus deep-sequenced at sufficient quality for phylogenetic analysis. 446 transmission networks were reconstructed, including 293 linked pairs with inferred direction of transmission. Adjusting for incomplete sampling, an estimated 5·7% (95% credibility interval 4·4–7·3) of transmissions occurred within lakeside areas, 89·2% (86·0–91·8) within inland areas, 1·3% (0·6–2·6) from lakeside to inland areas, and 3·7% (2·3–5·8) from inland to lakeside areas.InterpretationCross-community HIV transmissions between Lake Victoria hotspots and surrounding inland populations are infrequent and when they occur, virus more commonly flows into rather than out of hotspots. This result suggests that targeted interventions to these hotspots will not alone control the epidemic in inland populations, where most transmissions occur. Thus, geographical targeting of high prevalence areas might not be effective for broader epidemic control depending on underlying epidemic dynamics.FundingThe Bill & Melinda Gates Foundation, the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, the National Institute of Child Health and Development, the Division of Intramural Research of the National Institute for Allergy and Infectious Diseases, the World Bank, the Doris Duke Charitable Foundation, the Johns Hopkins University Center for AIDS Research, and the President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention.

Cervical cancer screening - The challenges of complete pathways of care in low-income countries: Focus on Malawi.

Cervical cancer is the fourth most common cancer among women globally, with approximately 580,000 new diagnoses in 2018. Approximately, 90% of deaths from this disease occur in low- and middle-income countries, especially in areas of high HIV prevalence, and largely due to limited prevention and screening opportunities and scarce treatment options. In this overview, we describe the opportunities and challenges faced in many low- and middle-income countries in delivery of cervical cancer detection, treatment and complete pathways of care. In particular, drawing on our experience and that of colleagues, we describe cervical screening and pathways of care provision in Malawi, as a case study of a low-resource country with high incidence and mortality rates of cervical cancer. Screening methods such as cytology – although widely used in high-income countries – have limited relevance in many low-resource settings. The World Health Organization recommends screening using human papillomavirus testing wherever possible; however, although human papillomavirus primary testing is more sensitive and detects precancers and cancers earlier than cytology, there are currently costs, infrastructure considerations and specificity issues that limit its use in low- and middle-income countries. The World Health Organization accepts the alternative screening approach of visual inspection with acetic acid as part of ‘screen and treat’ programmes as a simple and inexpensive test that can be undertaken by trained health workers and hence give wider screening coverage; however, subjectivity and variability in interpretation of findings between providers raise issues of false positives and overtreatment. Cryotherapy using either nitrous oxide or carbon dioxide is an established treatment for precancerous lesions within ‘screen and treat’ programmes; more recently, thermal ablation has been recognized as suitable to low-resource settings due to lightweight equipment, short treatment times, and hand-held battery-operated and solar-powered models. For larger lesions and cancers, complete clinical pathways (including loop excision, surgery, radiotherapy, chemotherapy and palliative care) are required for optimal care of women. However, provision of each of these components of cancer control is often limited due to limited infrastructure and lack of trained personnel. Hence, global initiatives to reduce cervical mortality need to adopt a holistic approach to health systems strengthening.

Current social support and social adaptation of HIV/AIDS patients in Henan province

Objective: To understand the status quo of social support for and social adaptation of HIV/AIDS patients in Henan province, analyze the relationship between social support and social adaptation, and provide reference for improving the quality of life of HIV/AIDS patients. Methods: A multi-stage stratified random sampling method was adopted to select HIV/AIDS patients in high HIV prevalence areas (Shangcai, Shenqiu), middle epidemic areas (Queshan, Yongcheng), low prevalence areas (Jiyuan, Sanmenxia) in Henan province. A social support scale was used to investigate the three dimensions of objective support, subjective support and support utilization. A social adaptation scale was used to investigate the three dimensions of patient cognitive willingness, social interaction and role adaptation. Finally, the characteristics of the social support, social adaptation and their relationships were analyzed. Results: The overall score of 506 HIV/AIDS patients' social support was 36.30±9.34, the score of objective support was 7.48±3.01, the score of subjective support was 22.35±5.79, and the score of support utilization was 6.28±2.38, the overall score and the scores of three dimensions of social support of HIV/AIDS patients were lower than the national levels, and the differences were statistically significant (P<0.05). The overall score of patients' social adaptation was39.10±7.10, the score of cognitive willingness was 9.96±3.23, the score of social interaction was 18.57±3.25, and the score of role adaptation was 10.57±2.52. The average score of social adaptation of patients was less than 2/3 of the overall score, and the average cognitive willingness score was less than 1/2 of the overall score. The differences in social support score and social adaptation score among patients with different gender, age, marital status, occupation, transmission route, number of symptoms were statistically significant (P<0.05). For the HIV/AIDS patients, there was a correlation between the social support and the social adaptation (r=0.14, P<0.05). Conclusion: HIV/AIDS patients had a low level of social support and social adaptation, and social support might be a contributing factor to the social adaptation of HIV/AIDS patients.

Limited Knowledge and Lack of Screening for Acute HIV Infection at Primary Care Clinics in High-Prevalence Communities of New York City.

Diagnosis and treatment of acute HIV infection (AHI) is crucial for ending the HIV epidemic. Individuals with AHI, who have high viral loads and often are unaware of their infection, are more likely to transmit HIV to others than those with chronic infection. In preparation for an educational intervention on AHI in primary health care settings in high HIV-prevalence areas of New York City, 22 clinic directors, 313 clinic providers, and 220 patients were surveyed on their knowledge and awareness of the topic from 2012-2015. Basic HIV knowledge was high among all groups while knowledge of AHI was partial among providers and virtually absent among patients. Inadequate knowledge about this crucial phase of HIV may be impeding timely identification of cases in the primary care setting.

Thirty-Five Years Later

Stigma has negatively influenced the lives of people living with HIV since the beginning of the epidemic. It affects every facet of their lives and can cause mental health problems, loss of human rights, and barriers to care. Studies in developing countries have shown a high prevalence of HIV stigma among health care workers. Few studies have been conducted in the United States. We used a validated instrument to survey 330 health care workers in Washington, DC, a high HIV prevalence area. The goal was to obtain data to assess the severity of the problem. We found that stigmatizing beliefs and attitudes were prevalent as reflected in responses from 66% of the participants. Of clinicians surveyed, 31% reported using double gloves. Participants with stigma training had lower stigma levels, whereas older individuals and support staff were more stigmatizing. Negative attitudes affect access to care and have major public health implications.

PREVALENCE AND CORRELATES OF CONDOM ERRORS AMONG SEXUALLY ACTIVE RESIDENTS OF GEM SUB-COUNTY, SIAYA, COUNTY WESTERN KENYA, 2012-2014

Condom effectiveness is compromised by user errors. We set out to examine the rates of condom use and condom errors among sexually active persons living within a Health Demographic Surveillance this high HIV prevalence area in Western Kenya. We analyzed data from the second round of a longitudinal bio-behavioral survey that was conducted in Gem, Siaya County between November 2012 and February 2014.Logistic regression analysis was done to identify predictors of condom use among all sexually active persons and condom errors among participants reporting condom use in the past 3 months. Of 7815 persons interviewed minority (39%) reported having used male condoms with at least one sexual partner in the past 3 months of whom 459 (15%) reported condom errors. Majority of those reporting condom errors had experienced ‘incomplete use’ (i.e. (a combination of early removal, late application or both early removal and late application). Participants who had experienced condom errors were significantly more likely to be aged <25 years and 25-34 years compared to those who were aged 35 years and older (OR 1.5; 95% CI 1.1-1.9 and OR 1.3; 95% CI 1.0-1.8 respectively to have had 3 or more and 2 sexual partners in the past 12 months compared to those who had one (OR 2.4; 95CI 1.7-3.5 and OR 1.6;95%CI 1.2-2.1 respectively),to have reported their sex partners to have ever been drunk during sex (OR 1.7; 95% CI 1.1-2.7), to have used mind altering substances in the past 12 months compared to those who had never used mind altering substances in the past 12 months (OR 1.9; 95% CI 1.2-3.1), and to report that their sex partner had ever used mind altering substances in the past 12 months (OR 1.7; 95% CI 1.0-2.8). Limited experience with condom use and the use mind-altering substances may partly be responsible for condom errors. Sexual and reproductive health programs should provide health education to promote condom use and HIV risk awareness. Additional strategies to mitigate effects of drug abuse as a harm reduction strategy should be considered for HIV prevention.

Cost of Community-Based HIV Testing Activities to Reach Saturation in Botswana.

In Botswana, 85% of persons living with HIV are aware of their status. We performed an economic analysis of HIV testing activities implemented during intensive campaigns, in 11 communities, between April 2015 and March 2016, through the Botswana Combination Prevention Project. The total cost was $1,098,312, or $99,847 per community, with 60% attributable to home-based testing and 40% attributable to mobile testing. The cost per person tested was $44, and $671 per person testing positive (2017 USD). Labor costs comprised 64% of total costs. In areas of high HIV prevalence and treatment coverage, the cost of untargeted home-based testing may be inflated by the efforts required to assess the testing eligibility of clients who are HIV-positive and on ART. Home-based and mobile testing delivered though an intensive community-based campaign allowed the identification of HIV positive persons, who may not access health facilities, at a cost comparable to other studies.

Demographic factors associated with HIV infection between low and high prevalence areas in Nigeria, 2015.

IntroductionSub-Saharan Africa accounts for 66% of 36.7 million individuals living with HIV in 2015 with Nigeria having the second highest prevalence in Africa. The study aimed to find the prevalence and socio-demographic factors associated with HIV infection and compare these findings between high and low prevalence areas.MethodsWe conducted a cross-sectional study among adults aged 15 to 49 years from March to April 2015. We administered a questionnaire to collect linked anonymous data on socio-demographic and socio-cultural characteristics and screened all respondents for HIV infection. We defined a high HIV prevalence area as area with prevalence consistently above 5% and an area with prevalence consistently below 2% as low prevalence area. We performed univariate, bivariate and logistic regration analysis to assess factors associated with HIV infection.ResultsWe screened and interviewed all 480 respondents. Majority 344 (71.7%) were females, mean age was 30.1 years (±7.4 years), high proportion were employed 246 (51.2%). In high HIV prevalence area, aged <30 years (Adjusted Odd Ratio (AOR) = 4.2, 95% Confidence Interval (CI) = 1.1-20.4) and being employed (AOR= 3.7, 95% CI=1.0-58.8) increased the likelihood of HIV infection. In low HIV prevalence area, lack of education (AOR=7.1, 95% CI= 0.9-32) was the only predictor of HIV infection.ConclusionInterplay of socio-demographic factors was responsible for differences in HIV prevalence. To further decrease prevalence in low prevalence areas (below 1%), government should make universal basic education mandatory and in high prevalence areas, interventions should target the young and the employed.