Early HIV Testing Research Articles

Mother-child dyads living with HIV in the Western Cape, South Africa: Undetectable = Undetectable?

Globally, children living with HIV continue to lag behind UNAIDS targets for viral suppression (VS). Because studies with linked mother-child data are limited, we describe VS and associated factors among young children in a setting with early infant HIV testing (at birth, age 10 weeks and 6 months) and early protease inhibitor-based first-line antiretroviral therapy (ART). We analysed routinely collected mother-child data for children living with HIV born 2018-2022 in Western Cape province, South Africa (followed through mid-2023). We assessed associations between child and maternal viral load (VL) results at 12 and 24 months after child ART start using logistic regression, adjusted for child sex, birthyear, severity of child immunodeficiency at ART start, maternal age and timing of maternal HIV diagnosis. Among 2219 children living with HIV; 30% were diagnosed at birth (≤7 days), 41% before age 1 year (8-365 days) and 29% at age >1 year. Overall, 5% (n = 112/2219) of children died, a third of whom had not started ART; 90% of children (n = 1990) started ART, at median age 5 months (IQR 1-16). Median follow-up from ART start was 26 months (IQR 14-40). Among children with available VL at 12 months (n = 853/1582), 24 months (n = 614/1129) and 36 months (n = 350/658) after ART start, 36%, 43% and 48% were virally suppressed, respectively (VL<100 copies/ml). VS among children at 12 and 24 months was more likely if maternal VL was <100 versus ≥100 copies/ml at 12 months (adjusted odds ratio [aOR] = 3.5; 95% CI 1.9-6.5) and 24 months (aOR = 6.1; 95% CI 2.8-13.1) after child ART start. Children with no/mild versus advanced/severe immunodeficiency at ART start were more likely to achieve VS at 12 months (aOR = 2.3; 95% CI 1.3-4.2) but not at 24 months. Eligible children with missing VL at 24 months (39%) were more likely to have gaps in care of >6 months than those with VL≥100 or VL<100 copies/ml (84% vs. 28% vs. 14%, respectively; p<0.001). Less than half of children on ART achieved VS, and children were more likely to achieve VS if their mothers were also virally suppressed. Significant efforts are needed to support mother-child dyads to achieve optimal VS.

Using drones to improve care for HIV-exposed children in Conakry, Republic of Guinea: Anthropological perspectives.

In Conakry, Guinea, like many other African capitals, traffic congestion is a major obstacle to transporting blood samples from peripheral health centres to laboratories where tests are centralised. This situation complicates early HIV testing of HIV-exposed children (i.e., born to HIV-positive mothers), even though the World Health Organization recommends treating HIV-positive children before the age of two months to reduce mortality. The use of drones, which has proved effective in many countries for rapidly transporting healthcare products and reaching isolated areas, could help to resolve these difficulties and improve early detection. A pilot study was conducted from 2020-2021 to assess the feasibility, cost-effectiveness and acceptability of such a strategy. The pilot study had an anthropological component and this article presents the results on the acceptability and perception of using drones to optimise the transport of blood samples in Conakry. Interviews and observations were conducted across six health facilities in Conakry and in various national and international institutions, with 62 people: mothers living with HIV, health professionals and community workers, the local population, health authorities and development workers. The theoretical framework is based on the concepts of innovation and acceptability from an anthropological perspective. The analyses focus on perceptions and conditions of acceptance of a technological innovation such as drones in the healthcare sector. The results show that perceptions of drones are generally positive, despite concerns about their potential misuse. However, this consensus is fragile, knowledge on the subject is sometimes limited and public opinion can vary depending on policy changes in the political and health contexts. Future drone programmes will need to be adapted to the priority health needs identified by local stakeholders, to meet the technical and ethical challenges of this emerging technology and to develop appropriate communication to ensure an optimum level of public support.

Advanced HIV disease and associated factors among young people aged 15—24 years at a tertiary hospital in Sierra Leone: a cross-sectional study

BackgroundAdvanced HIV disease (AHD) in young people living with HIV (PLHIV) is an increasingly pressing public health issue in sub-Saharan Africa. Despite global progress in early HIV testing and reducing HIV-related deaths, many youths experience increased rates of HIV disease progression in sub-Saharan Africa. This study describes the burden, clinical manifestations, and factors for disease progression among young PLHIV aged 15 – 24 years seeking medical services at a major public hospital in Sierra Leone.MethodsWe performed a cross-sectional analysis of routinely collected data for PLHIV patients aged 15 to 24 seen at Connaught Hospital in Sierra Leone between September 2022 and March 2023. We estimated the proportion of AHD in young PLHIV and performed logistic regression modelling to explore predictors of AHD. The statistical significance level was set at 0.05 for all statistical tests.ResultsOf the 581 PLHIV that were reported, 238 (40.9%) were between the ages of 15 and 24 years, with a median age of 22 (20—24), and 151 (63.5%) were females. On review, 178 (74.8%) has initiated antiretroviral therapy regimen (ART); 117 (65.7%) were actively on ART for ≤ 6 months, while 114 (64%) had interruptions with their ART treatment. The overall prevalence of AHD was 41.6% (99/238); 46.7% (35/68) of young PLHIV at the HIV clinic, and 39.3% (64/163) of admission. Sex—Female (OR, 0.51; 95% CI, 0.28–0.94; p = 0.030), and Tertiary Education level (OR, 0.27; 95% CI, 0.10 – 0.78; p = 0.015) have significantly lower odds of AHD in the entire study population. While for inpatients, Age (young Adults) of PLHIV (OR, 1.23; 95% CI, 1.00–1.52; p = 0.047) had 1.23 times the odds of AHD compared to adolescents, and being female (OR, 0.27; 95% CI, 0.08–0.84; p = 0.024), Overweight—Body mass index (OR, 0.10; 95% CI, 0.01–0.77; p = 0.028), Tertiary Education level (OR, 0.08; 95% CI, 0.01–0.52; p = 0.008) have significantly lower odds of AHD. Common conditions reported for the AHD group in the medical wards are tuberculosis (13.58%), hepatitis B (6.13%), Kaposi sarcoma (3.07%), and oesophagal candidiasis (2.45%).ConclusionWe reported a high prevalence of advanced HIV among young patients in a tertiary Hospital in Sierra Leone. One in two young PLHIV aged 15 to 24 years reported AHD, emphasizing the need to strengthen public health measures that address access to and retention of HIV services.

Effects of the COVID-19 pandemic on early infant diagnosis of HIV in Cape Town, South Africa.

In South Africa, infants who are HIV-exposed are tested for HIV at birth and 10 weeks of age. The COVID-19 pandemic lockdown restrictions resulted in reduced access to healthcare services and uncertain impact on early infant HIV testing. To describe the effects of the COVID-19 pandemic lockdown restrictions on early infant HIV testing and diagnosis in Cape Town, South Africa. This retrospective cohort study compares HIV-exposed infants born during the first COVID-19 pandemic lockdown (2020) to those born in the same period the year before (2019). Laboratory and other data were abstracted from the Provincial Health Data Centre. A total of 2888 infants were included: 1474 born in 2020 and 1413 in 2019. Compared to 2019, there was an increase in the 10-week HIV polymerase chain reaction (PCR) uptake in 2020 (71% vs. 60%, P < 0.001). There was also an increase in the proportion of infants who demised without 10-week testing or were lost to follow-up in 2020 compared to 2019 (8% vs. 5%, P = 0.017). Differences detected in birth HIV PCR positivity rates between the two groups (1.1% vs. 0.5%, P = 0.17) did not reach statistical significance; however, a significant increase in vertical transmission of HIV by 10 weeks old was found in the 2020 cohort (1.2% vs. 0.5%. P = 0.046). Vertical transmission of HIV at 10 weeks increased in the Cape Town Metropolitan during the initial COVID-19 lockdown. There was also an increase in the proportion of deaths without testing by 10 weeks in the 2020 group.

Statewide Implementation of Universal Third-Trimester Repeat HIV Testing in Illinois.

This article aims to assess statewide uptake of HIV repeat testing in the first 2 years after the implementation of an amendment to the Illinois Perinatal HIV Prevention Act (IPHPA) mandating universal repeat HIV testing in the third trimester. This is a retrospective, population-based study of all birthing individuals in Illinois (2018-2019). Data were collected using the state-mandated closed system of perinatal HIV test reporting. We evaluated the incidence of mother-infant pairs with negative early tests and repeat third-trimester tests (RTTTs) performed in adherence with the law, as well as the timing of the performance of the RTTTs (outpatient vs. inpatient). Chi-square tests of trend by quarter were performed to ascertain sustainability. Of 138,805 individuals delivered in 2018, 80.6% presented with early test and RTTTs. In 2018, outpatient RTTTs improved from 71.8% (quarter 1) to 85.1% (quarter 4; p < 0.001). In 2018, the proportion of mother-infant dyads who received testing that was adherent to the IPHPA Amendment was 92.1, 95.5, 96.7, and 96.4% in quarters 1 through 4, respectively (p < 0.001). In 2019, outpatient RTTTs performance remained high (87.4%) and stable (p = 0.06). In 2019, 99.9% of mother-infant dyads had testing adherent to the mandate in quarters 1 through 4 (p = 0.39). Of individuals who presented without RTTTs, 93.5% (2018) and 98.8% (2019) underwent inpatient testing before delivery. Implementation of RTTTs in Illinois was rapid, successful, and sustained in its first 2 years. Public health methodologies from Illinois may benefit other states implementing RTTT programs. · In 2018, Illinois enacted statewide RTTT for HIV among all parturients.. · In 2019, over 99% of mother-infant dyads had documentation of both early and repeat HIV testing before hospital discharge.. · Implementation of repeat third-trimester HIV testing in Illinois was rapid, successful, and sustained in its first 2 years.. · Public health methodologies from Illinois may benefit other states implementing similar programs..

Motivational interviewing retention counseling and adherence to early infant diagnostic HIV testing schedule in South Africa: The PAEDLINK randomized trial: Erratum.

Motivational interviewing retention counseling and adherence to early infant diagnostic HIV testing schedule in South Africa: The PAEDLINK randomized trial: Erratum.

The effect of weekly interactive text-messaging on early infant HIV testing in Kenya: a randomised controlled trial (WelTel PMTCT)

Mother-to-child transmission of HIV remains a significant concern in Africa despite earlier progress. Early infant diagnosis (EID) of HIV is crucial to reduce mortality among infected infants through early treatment initiation. However, a large proportion of HIV-exposed infants are still not tested in Kenya. Our objective was to investigate whether weekly interactive text-messages improved prevention of mother-to-child transmission (PMTCT) of HIV care outcomes including EID HIV testing. This multicentre, parallel-group, randomised, open-label trial included six antenatal care clinics across western Kenya. Pregnant women living with HIV, aged 18 years or older, with mobile phone access, were randomised in a 1:1 ratio to weekly text messages that continued until 24 months postpartum, asking “How are you?” (“Mambo?”) to which they were asked to respond within 48 h, or a control group. Healthcare workers contacted participants reporting problems and non-responders by phone. Participants in both groups received routine PMTCT care. The prespecified secondary outcome reported in this paper is EID HIV testing by eight weeks of age (blinded outcome assessment). Final 24-months trial results will be published separately. We estimated risk ratios using Poisson regression with robust standard errors. Between June 2015–July 2016, we screened 735 pregnant women, of whom 600 were enrolled: 299 were allocated to the intervention and 301 to the control group. By eight weeks of age, the uptake of EID HIV testing out of recorded live births was 85.5% in the intervention and 84.7% in the control group (71.2% vs. 71.8% of participants randomised, including miscarriages, stillbirths, etc.). The intention-to-treat risk ratio was 0.99; 95% CI: 0.90–1.10; p = 0.89. The proportion of infants diagnosed with HIV was 0.8% in the intervention and 1.2% in the control group. No adverse events were reported. We found no evidence to support that the WelTel intervention improved EID HIV testing. A higher uptake of EID testing than expected in both groups may be a result of lower barriers to EID testing and improved PMTCT care in western Kenya, including the broader standard use of mobile phone communication between healthcare workers and patients. (ISRCTN No. 98818734. Funded by the European-Developing Countries Clinical Trial Partnership and others).

Association Between Perceived Community HIV-AIDS Stigma and HIV Testing Behaviors Among High-Risk Heterosexuals in Dallas and Houston, Texas: An Analysis of the National HIV Behavioral Surveillance System

Background: Stigma-related behaviors place a great burden on people with HIV (PWH) or at risk of infection. For high-risk populations, perceived community HIV/AIDS stigma (PCHAS) may prevent early HIV testing, treatment, and care. The objective of this study was to assess the prevalence of PCHAS and its association with sociodemographic characteristics and HIV testing behaviors among high-risk heterosexuals in Dallas and Houston, Texas. Methods: Data from 1,003 high-risk heterosexuals recruited using respondent-driven sampling in 2013 and obtained from the National HIV Behavioral Surveillance system in Dallas and Houston, Texas were used for this study. Data procured were subjected to descriptive and inferential statistics that included frequency run, chi-square test and univariate logistic regression models to explore the associations between perceived community HIV/AIDS stigma index (PCHASi) and HIV testing behaviors, and sociodemographic characteristics. Results: Participants in both cities were primarily Black/African American, of low income, under poverty level, and uninsured. PCHAS was prevalent in Dallas (58.2%) and Houston (57.5%). The majority of participants in Dallas (76.7%) and Houston (86.6%) indicated ever getting tested for HIV, and about a third had tested at least once in the past 2 years. PCHAS was more common among Hispanics/Latinos (p=0.013) in Houston, and annual income (p=0.032), and homelessness (p=0.016) in the past 12 months were associated with PCHAS in Dallas. Participants in Dallas who were afraid of finding out if they had HIV (PR: 4.41, 95% CI: 1.40-13.9) and those who gave other reasons (PR: 2.64, 95%CI: 1.17-5.95) for not testing for HIV in the past year were more likely to perceive community-level support for the rights of PWH. In Houston, participants who had ever tested for HIV (PR: 2.26, 95% CI: 1.27-3.99) and those who tested 3 times (PR: 3.11, 95% CI: 1.18-8.19) in the past 2 years perceived community-level unfriendliness to PWH. Conclusion: Our study did not establish any clear relationship between PCHAS and HIV testing behaviors. However, perceived community-level fears and unfriendliness to PWH were associated with selected HIV testing behaviors suggesting that HIV knowledge and education at individual- and community-level may be important targets for intervention. Future research should consider the role of social and cultural norms in influencing the relationship between PCHAS and HIV testing behaviors.

Harambee! 2.0: The Impact of HIV-Related and Intersectional Stigmas on HIV Testing Behaviors Among African Immigrant Communities in Seattle, Washington.

African immigrants are disproportionately affected by HIV compared to U.S.-born individuals, and early HIV testing is the key challenge in ending the HIV epidemic in these communities. HIV-related stigma appears to be the most significant barrier to testing for HIV among African communities in King County, WA. In this formative study, we conducted thirty key informant interviews and five focus group discussions (n = total 72 participants) with Ethiopian, Somali, and Eritrean people living with HIV, health professionals, religious and other community leaders, and lay community members in King County to better understand HIV-related and intersectional stigmas’ impact on HIV testing behaviors. We used inductive coding and thematic analysis. Participants from all communities reported similar themes for HIV-related and intersectional stigmas’ influences on HIV testing behaviors. Misconceptions or poor messaging, e.g., regarding treatability of HIV, as well as normative or religious/moral beliefs around pre/extramarital sex contributed to HIV-related stigma. Intersecting identities such as immigrant status, race/ethnicity, and having a non-English language preference, all intermingle to further influence access to the U.S. healthcare system, including for HIV testing. These findings can be used to inform future research on community-led approaches to addressing early HIV testing amongst African immigrant communities.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10461-021-03396-5.

Efficacy of Mobile phone use on adherence to Nevirapine prophylaxis and retention in care among the HIV-exposed infants in prevention of mother to child transmission of HIV: a randomized controlled trial

BackgroundHIV is a major contributor to infant mortality. A significant gap remains between the uptake of infant and maternal antiretroviral regimens and only a minority of HIV-exposed infants receives prophylaxis and safe infant feeding. Losses to follow-up of HIV-exposed infants are associated with shortcomings of facility-based PMTCT models with weak community support of linkages. Use of mobile phones offers an opportunity for improving care and promoting retention assessed by timely attendance of scheduled appointments for the mother-baby pairs and achievement of an HIV-free generation. The objective of this study was to compare self-reported adherence to infant Nevirapine (NVP) prophylaxis and retention in care assessed by timely attendance of scheduled appointments over 10 weeks in HIV exposed infants randomized to 2-weekly mobile phone calls (intervention) versus no phone calls (control).MethodsIn this open label randomized controlled study, one hundred and fifty HIV infected women drawn from 3 health facilities in Western Kenya and their infants were randomly assigned to receive either phone-based reminders on PMTCT messages or standard health care messages (no calls) within 24 h of delivery. Women in the intervention arm continued to receive fortnightly phone calls. At 6- and 10-weeks following randomization we collected data on infant adherence to Nevirapine, mode of infant feeding, early HIV testing and retention in care in both study arms. All analyses were intention to treat.ResultsAt 6 weeks follow-up, 90.7% (n = 68) of participants receiving phone calls reported adherence to infant NVP prophylaxis, compared with 72% (n = 54) of participants in the control group (p = 0.005). Participants in the intervention arm were also significantly more likely to remain in care than participants in the control group [78.7% (n = 59) vs. 58.7% (n = 44), p = 0.009 at 6 weeks and 69.3% (n = 52) vs. 37.3% (n = 28), p < 0.001 at 10 weeks].ConclusionsThese results suggest that phone calls are potentially an important tool to improve adherence to infant NVP prophylaxis and retention in care for HIV-exposed infants.Trial registrationPACTR202007654729602. Registered 6 June 2018 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3449

Self-reported motivators for HIV testing in the treat-all era among HIV positive patients in Johannesburg, South Africa.

To explore associations between self-reported ill-health as a primary motivator for HIV-testing and socio-demographic factors.Four local primary healthcare clinics in Johannesburg, South Africa.A total of 529 newly HIV diagnosed adults (≥18 years) enrolled from October 2017 to August 2018, participated in the survey on the same day of diagnosis.Testing out of own initiative or perceived HIV exposure was categorized as asymptomatic. Reporting ill-health as the main reason for testing was categorized as symptomatic. Modified Poisson regression was used to evaluate predictors of motivators for HIV testing.Overall, 327/520 (62.9%) participants reported symptoms as the main motivator for testing. Among the asymptomatic, 17.1% reported potential HIV exposure as a reason for testing, while 20.0% just wanted to know their HIV status. Baseline predictors of symptom-related motivators for HIV testing include disclosing intention to test (aPR 1.4 for family/friend/others vs partners/spouse, 95% CI: 1.1–1.8; aPR 1.4 for not disclosing vs partners/spouse, 95% CI: 1.1–1.7), and HIV testing history (aPR 1.2 for last HIV test >12-months ago vs last test 12-months prior, 95% CI: 1.0–1.5; aPR 1.3 for never tested for HIV before vs last test 12-months prior, 95%CI:1.0–1.6).Findings indicate that newly diagnosed HIV positive patients still enter care because of ill-health, not prevention purposes. Increasing early HIV testing remains essential to maximize the benefits of expanded ART access.

Associations of Sociodemographic and Clinical Factors with Late Presentation for Early Infant HIV Diagnosis (EID) Services in Kenya.

Background:Understanding the missed opportunities in early infant HIV testing within the PMTCT program is essential to address any gaps. The study set out to describe the clinical and sociodemographic characteristics of the infants presenting late for early infant diagnosis in Kenya.Methods:We abstracted routinely collected clinical and sociodemographic characteristics, in a cross-sectional study, on all HIV-infected infants with a positive polymerase chain reaction (PCR) test from 1,346 President’s Emergency Plan for AIDS Relief (PEPFAR) supported health facilities for the period October 2016 to September 2018. We used multivariate logistic regression to examine the association of sociodemographic and clinical characteristics with late (>2 months after birth) presentation for infant HIV testing.Results:Of the 4,011 HIV-infected infants identified, the median infant age at HIV diagnosis was 3 months [interquartile range (IQR), 1-16 months], and two-thirds [2,669 (66.5%)] presented late for infant HIV testing. Factors that were associated with late presentation for infant testing were: maternal ANC non-attendance, adjusted odds ratio (aOR) 1.41 (95% confidence interval (CI) 1.18 -1.69); new maternal HIV diagnosis, aOR 1.45, (95%CI 1.24 -1.7); and lack of maternal antiretroviral therapy(ART), aOR 1.94, (95% CI 1.64 - 2.30). There was a high likelihood of identifying HIV-infected infants among infants who presented for medical services in the outpatient setting (aOR 18.9; 95% CI 10.2 - 34.9) and inpatient setting (aOR 12.2; 95% CI 6.23-23.9) compared to the infants who presented late in maternity.Conclusion and Global Health Implications:Gaps in early infant HIV testing suggest the need to increase maternal pre-pregnancy HIV diagnosis, timely antenatal care, early infant diagnosis services, early identification of mothers who seroconvert during pregnancy or breastfeeding and improved HIV screening in outpatient and inpatient settings. Early referral from the community and access to health facilities should be strengthened by the implementation of national PMTCT guidelines.

The magnitude of opportunistic infections and associated factors in HIV-infected adults on antiretroviral therapy in southern zone Tigray, Ethiopia: a cross-sectional study.

IntroductionGreater than twenty known opportunistic infections have been associated with HIV infection and usually patients experience co-infections during the stage of illness, HIV-related opportunistic infections are associated with significant morbidity and mortality.MethodsA hospital-based retrospective study was conducted in HIV-infected adult patients on antiretroviral (ART) from April to June 2017; secondary data were collected from review of clinical records. A total of 400 study participants selected through a systematic sampling technique and a pre-tested checklist was used to collect data from records of study subjects. The data was entered and analyzed using SPSS version 22.ResultsA total of 400 patients included in the study, in which more than half (51.0%) were females. The mean age of patients was 34 (standard deviation [SD] ±1.96) years. The overall of opportunistic infections (OIs) among HIV/AIDS patients on ART was 55.3%. The highest rates of OIs observed were oral candidacies 11.0%, followed by herpes zoster (10.8%) and tuberculosis (TB) (9.5%). The odds of having college and above educational levels were less likely to developed OIs compared to illiterate (AOR=0.007; 95% CI=0.053, 0.634). The odds of having OIs in WHO clinical stage I were less likely to have OIs compared to WHO clinical stage III and V (AOR=0.001; 95% CI=0.000, 0.015 and AOR=0.00; 95%CI=0.00 respectively).ConclusionThere was a high prevalence of OIs observed in this study. Illiterate educational level and advanced WHO clinical stages were found to be predictors of OIs. Interventions were aimed at promoting early HIV testing and ART enrollment of HIV-infected.

Acceptability of a tablet-based application to support early HIV testing among men in rural KwaZulu-Natal, South Africa: a mixed method study

ABSTRACT Uptake of HIV testing remains low among men in South Africa. As part of a trial, we assessed the acceptability of a theoretically derived and adapted tablet-based-application (EPIC-HIV1) in rural South Africa. We conducted 20 in-depth interviews with men aged ≥18 years and offered a tablet-based survey to all men aged ≥15 years who received EPIC-HIV1 (Sep-Dec 2018). We conducted a descriptive analysis of the survey and used Self-Determination Theory (SDT) to guide our thematic analysis. A total of 232/307 (75%) completed the survey, 55% of whom were aged 15–24 years. 96%[ CI: 92.8–98.2%; n = 223] found EPIC-HIV1 acceptable and 77% [95% CI: 71.8–82.6%; n = 179] found it user-friendly. 222 [96%] reported that EPIC-HIV1 motivated them to test; 83% (192/232) tested for HIV, of which 33% (64/192) were first time testers. Those who did not consent (n = 40) were more likely to have had an HIV-positive test result. Participants reported that the app boosted their confidence to test. However, they were unsure that the app would help them overcome barriers to test in local clinics. Given reach and usability, an adapted SDT male-tailored app was found to be acceptable and could encourage positive health-seeking behavioural change among men.

Opportunistic Infections in Patients Living with HIV at Brazzaville University Hospital: Prevalence and Associated Factors

Objectives: To determine the prevalence of opportunistic infections in the Infectious Diseases Department and to look for associated factors. Patients and Methods: A descriptive and analytical retrospective study of patients living with HIV, diagnosed in pre- or per-hospitalization, receiving or not receiving highly active antiretroviral therapy, in which an opportunistic infection related to AIDS has been documented. Results: A total of 548 patients included (22.7% of admissions) of average age of 39.9±11.2 years (17-82 years), mostly female (n-339; 61.9%), singles (n-403;73.5%), with a primary education level (n-218;39.8%). The majority (n=403; 73,5%) came from an urban area, with a primary education level (n-218;39.8%), residing in cities (n-403;73).77 Patients working in the informal sector were overwhelmingly represented (n-357;65.1) followed by the unemployed (n-51; 9.3%). The average consultation time was 29 ±3.5 (6-42) days. Type 1 HIV was the most found (419; 78.1%) and Lower CD4< 200/mm3 in 93 patients. The most common opportunistic infections found were Tuberculosis (n-231;42.2%), Toxoplasmosis (n-85;15.5%) and Neuromeningeal Cryptococcosis (n-58; 10.6%). Only 381 patients were on ARTV (69.5%), first-line (n-124; 74.3%). The average length of hospital stay was 20.4-11.8 (5-60) days. The overall lethality was 68%. Conclusion: Opportunistic infections remain common at the Brazzaville University Hospital in an HIV-depressed population1. Tuberculosis affects lethality, which is high as a result of therapeutic non-compliance. This is to say the importance of early HIV testing and management to minimize the emergence of opportunistic diseases in this area.

Late ART Initiation among adult HIV patients at university of Gondar Hospital, NorthWest Ethiopia.

Late initiation of anti-retroviral therapy (ART) is associated with low immunologic response, increase morbidity, mortality and hospitalization. Therefore, this study aimed to assess the prevalence and factors associated with late ART initiation among adult HIV patients in NorthWest Ethiopia. Retrospective cross-sectional study was conducted among 412 HIV patients who started ART between January/2009 and December/2014. Simple random sampling technique was used to select patient records. Data were collected by using pretested and structured extraction tool. Binary logistic regression model was fitted to identify factors associated with late ART initiation. A total of 410 participants were included for analysis after excluding 2 participants with incomplete data. The prevalence of late ART initiation was 67.3%. Age between 35-44 years(AOR=3.85; 95%CI:1.68-8.82), duration between testing and enrollment to care<1year (AOR=2.19;95%CI:1.30-3.69), secondary education (AOR=2.59; 95%CI 1.36-4.94), teritary education(AOR=3.28; 95%CI 1.25-8.64), being unmarried(AOR=1.88; 95%CI 1.13-3.03), bedridden and ambulatory patients (AOR=4.68 95%CI:1.49-14.68), other medication use before ART initiation(AOR=2.18; 95%CI 1.07-4.44), starting ART between 2009-2010 (AOR=5.94; 95%CI 2.74-12.87) and 2011-2012(AOR=2.80; 95%CI 1.31-5.96) were significantly associated with late ART initation at p-value <0.05. The prevalence of late ART initiation was high. Strengthening the mechanisms of early HIV testing and linkage to care are recommended to initiate treatment earlier.

HIV-related stigma, knowledge about HIV, HIV risk behavior and HIV testing motivation among women in Lampung, Indonesia

This study aims to identify factors that influence HIV testing motivation among women at the Dr. H. Abdul Moeloek General Hospitalin Lampung, Indonesia. A cross-sectional method was used in this study that employed a consecutive sampling technique involving 120 women with HIV. The participants were outpatients at the Voluntary Counseling and Testing (VCT) Dr. H. Abdul Moeloek General Hospital. This study utilized three instruments: the Berger HIV Stigma Scale, HIV Knowledge Questionnaire (HIV-KQ-18) and Safe Sex Behavior Questionnaire (SSBQ). The study examined factors that influence HIV testing motivation among women: HIV-related stigma, knowledge about HIV and HIV risk behavior. The results of the analysis showed that there is a significant relationship among the HIV-related stigma variable (p=0.019, OR=2.727), knowledge about HIV variable (p=0.011, OR=3.750) and HIV risk behavior variable (p=0.041, OR=2.381). The most dominant factor influencing HIV testing motivation is HIV risk behavior (p=0.016, ά=0.05 at 95% CI and OR=3.217). This indicates that Women Living With HIV (WLWH) who engage in risk HIV behavior demonstrate 3.2 times to HIV testing motivation. HIV-related stigma, knowledge about HIV and HIV risk behavior influence HIV testing motivation for women. Our findings have implications for nursing and healthcare practice as well as research, especially in supporting HIV testing for women who are at risk for HIV. Nurses should focus their attention on motivating women with a high risk of HIV to undergo early HIV testing.

An Early Infant HIV Risk Score for Targeted HIV Testing at Birth.

Early HIV testing is needed for treatment success in young infants, but universal testing is expensive. In this study, we examined the feasibility of early infant HIV risk scores for targeted polymerase chain reaction (PCR) testing and early HIV diagnosis. A cross-sectional cohort of newborns exposed to HIV was enrolled and PCR tested within 72 hours. We quantified associations between HIV infection and clinical and laboratory maternal-infant parameters by logistic regression models and determined sensitivity and specificity for derived risk scores. From August 2014 to December 2016, 1759 participants were enrolled. Mothers without antenatal care (5.7% [97 of 1688]) were more likely to deliver newborns who are PCR-positive (P = .0005). A total of 1 in 5 mothers (217 of 990; 21.9%) had HIV viral load (VL) >1000 copies per µL. A total of 432 of 1655 (26.1%) infants were preterm. Low birth weight was documented in 398 of 1598 (24.55%) and 13 of 31 (40.63%) newborns who are PCR-negative and -positive, respectively (P = .0329). A total of 204 of 1689 (12.08%) were growth restricted or small for gestational age, and 6 of 37 (16.22%) were PCR-positive. Symptomatic newborns frequently tested positive (P = .0042). The HIV PCR positivity rate was 2.2% (37 of 1703). Two-risk (combined 3-drug antiretroviral therapy [cART] duration, VL), 3-risk (cART duration, VL, symptomatic newborn), and 4-risk (cART duration, VL, symptomatic, small for gestational age newborn) models for HIV acquisition had predictive probability of 0.28, 0.498, and 0.57, respectively; this could guide targeted birth testing. However, using the 3- and 4-risk scores (probability 0.02 and 0.04), 20% and 24% will be missed compared with universal testing. Targeted newborn testing requires access to maternal VL. Even if risk models include parameters such as maternal cART history, birth weight, weeks' gestation, and symptoms, 1 in 5 newborns who are infected will not be targeted. At present, we support universal PCR testing at birth within the South African prevention of mother-to-child transmission of HIV context.

Centering female agency while investigating contraceptive use: a case study in Agincourt, South Africa

BackgroundRural areas of South Africa face persistently high teenage and premarital childbearing rates, reflecting a lack of or inconsistent use of modern contraception. In attempting to understand this behavior, much of the literature has denied agency to young women, portraying them solely as victims of their environments. This study moved beyond these approaches to understanding adolescent contraceptive use, to reframe the investigation to focus on the tension around exercising agency within specific structural constraints.MethodsFindings are based on a qualitative study in Agincourt, South Africa. Data were collected through six focus group discussions with 63 women aged 18–44. A grounded theory approach utilizing emergent coding was performed focusing on the decision-making processes around family planning. The focus group participants discussed attitudes and norms around: early first births, contraceptive use, unplanned pregnancy, abortion, and HIV testing. When possible, differences that emerged around these topics according to the age groups (18–24, 25–34, and 35–44) and/or nationality of village (South African or Mozambican) are highlighted.ResultsParticipants of all focus groups agreed that early first birth were common and undesirable. Younger participants described pregnancy prevention as a key rationale for contraceptive usage, while older participants were more inclined to cite HIV prevention. Women of all focus groups discussed the importance of women taking the initiative with family planning. Participants expressed a range of opinions about the acceptability of abortion, and all focus groups discussed concerns about the safety of abortion. Finally, all of the focus group participants stressed the importance of HIV testing, both to protect themselves and to protect their families.ConclusionThis study found many locations of agency for young women in rural South Africa. The decision-making surrounding contraceptive use consists of a series of decision junctures at which women must assign values to certain factors and then select their behavior on the basis of those values. Young women weigh the costs and benefits of contraception and of pregnancy, while also taking into account the chances of actually becoming pregnant along with the costs and benefits of abortion. Furthermore, the women explicitly viewed contraception as within their own realm of decision-making and action (as opposed to within the realm of their male partners).

Predictors of early childhood HIV testing among children of sex workers living with HIV in Cameroon

BackgroundDespite recent progress, there exist gaps in the prevention of vertical HIV transmission program access and uptake in Cameroon. Female sex workers (FSW), many of whom are mothers, are disproportionately affected by HIV and have specific barriers to HIV testing and treatment access. Testing for HIV-exposed infants is crucial in monitoring for incident infection and timely intervention. This study explores the level of early childhood testing and also associations between antenatal care (ANC) attendance and other factors and early childhood HIV testing among FSW in Cameroon.MethodsFSW were recruited to participate in an integrated biobehavioral survey in Cameroon between December 2015 and October 2016. Women were included in these analyses if they were living with HIV and had at least one living child. Both univariate and multivariable logistic regression were used to look at predictors of a child being tested for HIV before age five.ResultsA total of 481/2255 FSW were eligible for these analyses as they were HIV seropositive and had at least one living child at the time of the study. Women included in these analyses had a median age of 35(IQR 30–41). Nearly 70% reported none of their children had been tested for HIV before age five (326/481), and 3.5%(17/481) reported one or more of their children had been diagnosed with HIV. ANC attendance (adjusted OR 2.12, 95% CI: [1.02, 4.55]), awareness of HIV status (aOR 3.70[2.30, 5.93]), pregnancy intentions (aOR 1.89[1.16, 3.08]), and higher education (aOR 2.17[1.01, 4.71]) were all independently associated with increased odds of women having a greater proportion of children tested for HIV before age five. Regional differences in early childhood testing were also observed.ConclusionVertical transmission of HIV remains a challenge in Cameroon, and HIV testing among children of FSW living with HIV was very low. ANC attendance and promotion of the mother’s health were associated with increased child HIV testing. For women at high risk of HIV and for whom engagement in the health system is low, strategies to promote and ensure ANC attendance are essential for their health and the health of their children.