HCT Services Research Articles

Busulfan, fludarabine, and melphalan are effective conditioning for pediatric and young adult patients with myeloid malignancies underdoing matched sibling or alternative donor transplantation.

Allogeneic hematopoietic cell transplantation (allo-HCT) remains a curative option for patients with high-risk myeloid malignancies. We present our 10-year experience (October 2012 to October 2021) of consecutive allo-HCT in patients with myeloid malignancies treated on the pediatric HCT service and conditioned with myeloablative targeted dose-busulfan (BU), fludarabine (FLU), and melphalan (MEL). Twenty-three children, adolescents, and young adult patients (CAYA) (median age 15.4years) with acute myeloid leukemia (AML, n = 17), myelodysplastic syndrome (MDS, n = 4), or chronic myeloid leukemia (CML, n = 2) underwent allo-HCT post-BU-FLU-MEL. Four patients had treatment-related AML/MDS. Donor/stem cell source was matched sibling donor (MSD) PBSC (n = 7), matched unrelated donor (MUD) PBSC (n = 2), umbilical cord blood (UCB) (n = 3), or haploidentical-BMT (n = 11). Risk stratification was low (n = 2), intermediate (n = 15), high (n = 3), and very high risk (n = 1). The two patients with CML had failed tyrosine kinase inhibitor therapies. With a median follow-up of 41.6months, the relapse rate is only 4.5% with an overall survival (OS) 100%, progression-free survival (PFS) 95.5%, and graft-versus-host-free-relapse-free survival (GRFS) 67.8%. The donor source and the acute graft-versus-host disease (GvHD) prophylaxis regimen significantly impacted grade II-IV aGvHD 66.7% versus 19.2% (p = .039) and chronic graft-versus-host-disease (cGvHD) 66.7% versus 0% (p = .002) in the patients receiving MSD or MUD PBSC compared to haplo-BMT, respectively, resulting in improved GRFS in haplo-BMT, 83.3% compared to 40% matched donor peripheral blood stem cell transplant (PBSCT) (p = .025). Our results demonstrate that BU-FLU-MEL is efficacious conditioning for disease control in young patients with myeloid malignancies undergoing MSD or alternative donor allo-HCT, but in the setting of PBSC grafts with cyclosporine A-methotrexate (CSA-MTX) GvHD prophylaxis, it results in an unacceptably high incidence of GvHD.

Inequities in the utilization of HIV counseling and testing services among undergraduates in mainland China

BackgroundHIV counseling and testing (HCT) is provided free of charge on college campuses, but very few studies have examined whether HCT uptake is equitably distributed. This cross-sectional study aimed to compare the relative importance of various determinants of HCT uptake among undergraduates in mainland China so as to assess and subsequently to suggest ways to eliminate inequities in its use, guided by the Andersen’s behavioral model.MethodsA total of 10,665 eligible undergraduates were conveniently selected to complete an online survey. Hierarchical logistic regression analyses were performed to identify the factors associated with HCT utilization.ResultsOnly 7.7% of undergraduates had utilized HCT services. HCT uptake was inequitably distributed, since it was mainly determined by predisposing and enabling factors rather than by need factors. Further analysis indicated that HCT uptake was significantly related to two need factors, one enabling factor and six predisposing factors. Those with a higher need [i.e., perceiving themselves to be at higher risk of acquiring HIV infection (AOR = 2.76, 95% CI:2.02–3.78) and engaging in condomless sex (AOR = 1.29, 95% CI:1.00–1.67)] and those with more resources [i.e., being knowledgeable of local AIDS service organization (AOR = 1.59, 95% CI:1.37–1.85)] were more likely to utilize HCT services. Compared to non-heterosexual men, non-heterosexual women (AOR = 0.51, 95% CI:0.37–0.72), heterosexual men (AOR = 0.44, 95% CI:0.33–0.57) and women (AOR = 0.31, 95%CI: 0.24–0.41) were less likely to utilize HCT service. Furthermore, those with more knowledge (AOR = 0.80, 95% CI:0.69–0.94) and taking a positive attitude towards HCT services [i.e, expressing their willingness to utilize HCT services (AOR = 0.68, 95% CI:0.56–0.81) and having recognized the necessity to provide HTC services in the local university (AOR = 0.46, 95% CI:0.36–0.57)] were less likely to utilize HCT services. However, medical students (AOR = 1.34, 95% CI: 1.15–1.56) and non-freshmen (AOR = 1.22, 95% CI:1.03–1.45) were more likely to utilize HCT services.ConclusionsTo increase HCT uptake and simultaneously reduce the remaining inequities, a comprehensive intervention should be continued to target non-heterosexual men and non- freshmen and those with a higher need for HCT services, conduct health education, improve the availability and accessibility of HIV testing services.

Factors associated with high HIV-related stigma among commuter populations in Johannesburg, South Africa

ABSTRACT Stigma remains an important barrier to seeking and staying in care among individuals infected with Human Immunodeficiency Virus (HIV). Despite continued widespread information, education and communication campaigns to raise awareness about the infection. The aim of the study was to identify factors related to HIV stigma among a commuter population in the inner-city Johannesburg. A self-administered closed-ended questionnaire was loaded onto personal tablet computers during a community outreach campaign. The outcome was measured by asking the respondents to rate their perceptions of stigma as ‘high or low’. About 1146 participants were enrolled in the study of which 585 (51.0%) reported high stigma levels. Overall, being married/cohabiting (Adjusted Prevalence Ratio (APR): 1.14 95%CI: 1.02–1.28), divorced (APR: 1.38 95%CI: 1.07–1.78), were associated with high levels of stigma; while being aware of HCT services (APR: 0.85 95%CI: 0.75–0.97) and employment status (APR: 0.78 95%CI: 0.71–0.87) were less likely associated with a high level of stigma. High HIV stigma still exists among those affected in our communities. Enhancement of health promotion intervention and reinforcing the benefits of knowing HIV status is essential to mitigate factors shown to influence stigma in the commuter population. Such an approach would help overcome stigma, an obstacle for expanding access to HIV testing and counselling.

Knowledge, attitude, and utilization of HIV counseling and testing by female sex workers in Lagos State, Nigeria

Objectives: The Human Immunodeficiency Virus (HIV) epidemic continues to expand among female sex workers (FSWs) who have limited access to and utilization of HIV counseling and testing services (HCT). HCT plays a pivotal role in increasing knowledge and awareness to prevent, treat, and control HIV/AIDS. The study objective was to determine the knowledge, attitude, utilization of HCT among brothel-based FSWs (BBFSWs). Method: This was a descriptive cross-sectional study among 300 BBFSWs in Lagos State. The respondents were recruited by snowballing after a multistage sampling method was used in the selection of the brothels. The data was collected using an adapted interviewer-administered questionnaire and analyzed using IBM SPSS Statistics version 23. The level of statistical significance was set at p<0.05. Results: Majority (63.0%) of the respondents were between the ages of 21-30 years and 67.4% had good knowledge of HIV and HCT. About 75.0% had a positive attitude towards HCT and 55.6% of FSWs in this study had utilized an HCT center in the past. The main reason for not taking HIV test was the fear of a positive result (90.6%) while the main reasons given for not visiting any HCT center were lack of confidentiality (13.3%), stigmatization (14.8%), and distance to the HCT center (67.2%). Conclusion: There was a good knowledge of HCT and a positive attitude towards HCT services by the respondents. The main reasons for not taking the HIV test as indicated by respondents were fear of a positive result. HIV-stigma related issues should be adequately addressed.

Utilization rate and factors influencing the use of HIV counseling and testing services among young females: a community-based study from Nigeria.

This study aims to explore the utilization rate and factors influencing the use of HCT services among young females in Ikorodu, Lagos State, Nigeria. This study was a descriptive cross-sectional survey of 404 females, aged 15-24 years, residing in Ikorodu, Nigeria. Study tool was a questionnaire. Collected data was analyzed using the SPSS version 16 software. The mean age (±SD) of the respondents was 19.3 (±2.6) years and 90.1% were single. Only 148 (36.6%) respondents had ever utilized the HCT service, of which only 40.5% of them were adolescents. Amongst those that had ever utilized HCT services (n=148), only 60.1% of them did so within 12 months prior to the study while only 33.8% of them initiated the demand for testing themselves. According to the respondents, the top two barriers to the utilization of HCT services were: fear of discrimination (82.9%); and fear of unavailability of access to treatment (68.0%), while the top two factors that facilitates its use were: the adoption of counseling-before-testing approach in the HCT service centers (85.9%); and peoples' need for HIV status declaration prior to getting a job employment/marriage partner (85.1%). The study shows that utilization of HCT service remains low among the respondents. There is an urgent need to encourage the utilization of HCT services among young females in Ikorodu, Nigeria.

107. PATHWAYS INITIATIVE TO IMPROVE TRANSITION CARE IN A MED-PEDS RESIDENCY PROGRAM

Background Approximately 750,000 adolescents with special health care needs graduate to adulthood annually, often with their health suffering. Less than half receive the services needed for a successful transition. In Illinois the Division of Specialized Care for Children Family Survey revealed that only 18.2% of youth ages 14-21 received transition services. A recent review demonstrated that almost two thirds of HCT evaluation studies had statistically significant positive outcomes. Another study demonstrated that providing HCT services resulted in a 28% reduction in per member per month total cost driven by reductions in hospitalization and ED visits. Aim Statement 1. Increase HCT services for youth and young adults with special health care needs (YASHCN) in a Med-Peds residency practice (10% per year). 2. Increase HCT consultations for YASHCN (10% per year). 3. Improve HCT knowledge, attitudes and practices among Med-Peds residents. (improve annually). 4. Provide Med-Peds residents with a longitudinal QI project aligned with ACGME requirements. Interventions PATHways is a residency-based HCT consultative service founded to improve health for YASHCN and provide HCT education to residents. PATHways’ QI initiatives are modeled after Gottransition's Six Core Elements. A HCT policy was disseminated. EMR tools were developed to assess HCT skills and create portable health summaries. A registry of over 200 YASHCN aged 14-26 in the practice was created. Formal HCT education was provided to residents through HCT consultations. Measures 1. Baseline and annual follow up HCT knowledge, attitude, and practices survey of residents 2. Baseline and annual follow up audits of patients in the HCT registry addressing key elements (readiness assessment, HCT planning, creation of portable health summaries) 3. Tracking of consultations: Requesting services, diagnoses, HCT services provided. Results 33 consultations were provided over 18 months and were received from 9 different services with Pediatrics comprising 70%. Autonomy planning and completion of portable healthcare summaries comprised the majority of consults (80%). Consultations also aided in guardianship (43%), insurance and income support planning (67%), and identifying adult providers (20%). Residents surveys demonstrated increased HCT knowledge. Residents correctly identified the ages to introduce HCT, begin HCT planning, and prepare for transfer (scores increased by 8%, 21%, and 8%, respectively). They were able to identify specific tools for HCT including the clinic's policy and registry. After one year, 42% of residents stated that they addressed HCT readiness often in their practice, increased from 18%, and no residents reported not ever addressing HCT, improved from 38%. Residents reported providing more frequent guidance on education, insurance planning, registering for adult services, guardianship assessment, and identifying adult providers. Residents reported feeling more empowered and engaged in caring for YASCHN. Baseline and follow up chart audits demonstrated that readiness assessment improved from 10 to 50%, transition planning improved from 20 to 60% and creation of portable health summaries improved from 5 to 45%. Conclusions and Next Steps The PATHways initiative is a feasible way to improve HCT for YASHCN and resident HCT knowledge, attitudes and practices. Next Steps: 1. Utilize the EMR's new feature, Slicer Dicer for transition registry management and chart audits. 2. Mailers and EMR messages will be sent to all patients in the transition registry directing them to schedule a HCT appointment. 3. Continue to raise awareness about the PATHways consultation services.

Effect of Peer Education and Provision of On-Site HCT Services on the Uptake of HCT Among Public Secondary School Students in Ebonyi State, South East Nigeria

Effect of Peer Education and Provision of On-Site HCT Services on the Uptake of HCT Among Public Secondary School Students in Ebonyi State, South East Nigeria

Factors Affecting the Attitude of Young People towards HIV Testing Uptake in Rural Ghana

Background: Voluntary Counseling and Testing (VCT) is an integral component of HIV prevention and care strategies worldwide. Attitude of young people towards HIV testing in Techiman Municipality has negative outcome of testing uptake; leading to missed opportunities among this group. Previous studies have confirmed that factors that influence such attitudes include counselors’ attitude, level of awareness, perception about people living with HIV/AIDS and respondent’s socio-demographics such as age, gender, study level and location of residents. Objective: To determine the factors affecting the willingness of people to be tested for HIV among young people in rural Ghana. Design: Cross-sectional study • Setting: Government owned Senior High Schools of Techiman North district. • Participants: Students in Senior High Schools (15-24 years) were included. • Response rate: Response rate of 386 (76.1%). Results: Analysis showed that the prevalence of use of HCT services was the difference between socio-demographic characteristics, knowledge about HTC centre for testing, knowledge of HIV status and ever visited any HCT centre. Logistic regression analysis showed that variables significantly related with the use of HCT services by providers in Techiman district were perception, attitude and no desire for testing. The results may help health providers to plan for young people’s desires for HCT services in Techiman Municipality and Ghana as a whole. Future research should address behaviour change of the young people for testing. Methodology: Self-administered questionnaire was used to assess the factors that affect HIV testing among the representative sample of 386 young students selected by stratified random sampling from September to October, 2015. Conclusions: Participants desire for HIV testing is influenced by knowledge about HIV and own health status, Visit to HCT centre and knowledge about the HCT Centre.

Prevalence and predictors of unknown HIV status among women delivering in Mulago National Referral Hospital, Kampala, Uganda.

Knowledge of a person's HIV status during pregnancy is critical for prevention of mother to child transmission of HIV. To determine the prevalence and factors associated with unknown HIV status among women delivering in Mulago Hospital. This was a cross-sectional study of women that had just delivered. The women's demographic characteristics, health seeking behaviour, health system-related factors and knowledge on PMTCT were collected. Fisher's exact test, Wilcoxon rank sum test and logistic regression were used to test associations. The prevalence of unknown HIV status was 2.6% (10/382). Attending ANC at higher level facilities (OR =0.1 95% CI 0.0 - 0.4) and having been counselled for HIV testing during ANC (OR=0.1, 95% CI 0.0 - 0.4) were associated with likelihood of having a known HIV status. Out of the ten women with unknown HIV status, 4/6 who attended ANC in public/government accredited health facilities "opted out" of HIV testing due to personal reasons. Among the four who attended ANC in private clinics, two were not offered HIV testing and one "opted out". Most participants had a known HIV status at labour (97%). Private clinics need to be supported to provide free quality HCT services in ANC.

I don’t know what I am doing because I am doing everything: perceptions and experiences of nurses about HIV counselling and testing among children in Free State Province, South Africa

ABSTRACTAlthough HIV/AIDS constitute a significant health burden among children in South Africa, testing and counselling of exposed children are inadequate. It is therefore imperative that factors relating to paediatric HCT services offered by health workers are examined. This study was conducted to explore and describe the perceptions and experiences of trained professional nurses regarding HIV counselling and testing among children. We conducted six focus group discussions among trained professional nurses in health facilities in a district in Free State Province, South Africa. All verbatim transcripts were analysed with a thematic approach and emergent codes were applied. Forty-seven trained professional nurses participated in the study and two of them were males. The age of the participants ranges from 38 to 60 years while the median age was 50 years. Most participants in the focus groups explained how HCT occurs during regular health talks and that lay counsellors are doing most of the counselling. While a few participants thought that children should not be bothered with HCT, most of them seek consent from caregivers for HIV test for children. While children whose parents are negative are usually not tested, most children are tested only when they become ill. Identified barriers to HCT among children include refusal of consent, work overload, lack of encouragement, and poor record keeping. Participants recommended improvement of issues relating to community mobilization and increasing trained staff strength for optimal paediatric HCT service delivery. Developing guidance and policies with respect to obtaining consent, recruiting more health providers, and addressing structural issues in the society to reduce stigma and discrimination were identified as key priority issues by majority of the participants. The perspectives of these participants who provide paediatric HCT services offer vital insight which may be useful to inform policy interventions.

Strategies for Scaling up HIV prevention among Adolescents: TASO Masaka Safe Male Circumcision Experience

Issue: Uganda has HIV prevelance of 7.3%; however HIV prevalence in Masaka is at 10%. TASO Masaka has 383 active adolescents in care. Men’s uptake of Safe Male Circumcision is at 34% in the central area of Uganda including Masaka. Safe male circumcision (SMC) is one intervention for HIV prevention that targets male adolescents directly. SMC was conducted at the facility with one mobilizer doing mobilization. There was also limited community leadership involvement in the program. To improve adolescents’ uptake of SMC services, TASO Masaka came up with strategies like training community linkage facilitators to mobilize adolescents for SMC, targeting schools, conducting dialogue meetings and setting up circumcision camps. Description: 6 dialogue meetings were conducted in 6 districts to allow community participation. 2 linkage facilitators were trained in SMC and community mobilization. Targeting schools for sensitization and encouraging adolescents seek consent from their parents. Offering free transport to facility and camping sites, Provided IEC through videos, flipcharts, fliers complemented by health talks and one to one counseling. Circumcised Peers were encouraged to do mobilization of their fellow peers. HCT and safe male circumcision services are provided to all eligible clients. Follow ups are done after 48 h, 7 days and 6 weeks. SMC telephone hotline was established for follow ups. Lessons learnt: Dialogue meetings help program implementers to work in a coordinated manner with meaningful involvement of community leadership. A total of 20786 adolescents received HCT and circumcision (6/1/2014 to 17/12/2015 contributing to 85% of the total men circumcised. Peer to peer mobilization has worked more with adolescents as compared to men. A school approach (221 schools) targeted many adolescents for mobilization and follow up services, 16628) adolescents were followed up in the review period. SMC camps bring services nearer to the community a, total of 1883 adolescents were circumcised in camps. 20786 Adolescents have tested for HIV, 100 treated sexually transmitted infections and receive risk reduction messages. The SMC hotline improved follow-ups, linkages and mobilization. Interventions that target a particular group for HIV prevention need a multidisciplinary approach.

Correlates of previous couples’ HIV counseling and testing uptake among married individuals in three HIV prevalence strata in Rakai, Uganda

BackgroundStudies show that uptake of couples’ HIV counseling and testing (couples’ HCT) can be affected by individual, relationship, and socioeconomic factors. However, while couples’ HCT uptake can also be affected by background HIV prevalence and awareness of the existence of couples’ HCT services, this is yet to be documented. We explored the correlates of previous couples’ HCT uptake among married individuals in a rural Ugandan district with differing HIV prevalence levels.DesignThis was a cross-sectional study conducted among 2,135 married individuals resident in the three HIV prevalence strata (low HIV prevalence: 9.7–11.2%; middle HIV prevalence: 11.4–16.4%; and high HIV prevalence: 20.5–43%) in Rakai district, southwestern Uganda, between November 2013 and February 2014. Data were collected on sociodemographic and behavioral characteristics, including previous receipt of couples’ HCT. HIV testing data were obtained from the Rakai Community Cohort Study. We conducted multivariable logistic regression analysis to identify correlates that are independently associated with previous receipt of couples’ HCT. Data analysis was conducted using STATA (statistical software, version 11.2).ResultsOf the 2,135 married individuals enrolled, the majority (n=1,783, 83.5%) had been married for five or more years while (n=1,460, 66%) were in the first-order of marriage. Ever receipt of HCT was almost universal (n=2,020, 95%); of those ever tested, (n=846, 41.9%) reported that they had ever received couples’ HCT. There was no significant difference in previous receipt of couples’ HCT between low (n=309, 43.9%), middle (n=295, 41.7%), and high (n=242, 39.7%) HIV prevalence settings (p=0.61). Marital order was not significantly associated with previous receipt of couples’ HCT. However, marital duration [five or more years vis-à-vis 1–2 years: adjusted odds ratio (aOR): 1.06; 95% confidence interval (95% CI): 1.04–1.08] and awareness about the existence of couples’ HCT services within the Rakai community cohort (aOR: 7.58; 95% CI: 5.63–10.20) were significantly associated with previous receipt of couples’ HCT.ConclusionsPrevious couples’ HCT uptake did not significantly differ by HIV prevalence setting. Longer marital duration and awareness of the existence of couples’ HCT services in the community were significantly correlated with previous receipt of couples’ HCT. These findings suggest a need for innovative demand–creation interventions to raise awareness about couples’ HCT service availability to improve couples’ HCT uptake among married individuals.

HIV-related knowledge, perceptions, attitudes, and utilisation of HIV counselling and testing: a venue-based intercept commuter population survey in the inner city of Johannesburg, South Africa

BackgroundHIV counselling and testing (HCT) and knowledge about HIV have been key strategies utilised in the prevention and control of HIV/AIDS worldwide. HIV knowledge and uptake of HCT services in sub-Saharan Africa are still low. This study was conducted to determine factors associated with HCT and HIV/AIDS knowledge levels among a commuter population in Johannesburg, South Africa.ObjectiveTo identify the factors associated with HCT uptake among the commuter population.DesignA simple random sampling method was used to select participants in a venue-based intercept survey at a taxi rank in the Johannesburg Central Business District. Data were collected using an electronic questionnaire. Logistic regression analysis assessed factors associated with HIV testing stratified by gender.Results1,146 respondents were interviewed, the maority (n=579, 50.5%) were females and (n=780, 68.1%) were over 25 years of age. Overall HCT knowledge was high (n=951, 83%) with more females utilising HCT facilities. There was a significant difference in HIV testing for respondents living closer to and further away from health facilities. Slightly more than half of the respondents indicated stigma as one of the barriers for testing (n=594, 52%, p-value=0.001). For males, living with a partner (aOR: 1.68, 95% CI: 1.02–2.78, p-value: 0.041) and possessing a post-primary education were positively associated with testing (aOR: 2.00, 95% CI: 1.15–3.47, p-value: 0.014), whereas stigma and discrimination reduced the likelihood of testing (aOR: 0.40, 95% CI: 0.31–0.62, p-value: <0.001). For females, having one sexual partner (aOR: 2.65, 95% CI: 1.19–5.90, p-value: 0.017) and a low perceived benefit for HIV testing (aOR: 0.54, 95% CI: 0.30–0.96, p-value: 0.035) were associated with HIV testing.ConclusionThe overall HIV/AIDS knowledge was generally high. Gender-specific health education and HIV intervention programmes are needed for improved access to HCT services. One favourable intervention would be the use of home-based HCT programmes.

Analysis of Health Facility Based Barriers And Facilitators To Use Of Sexual And Reproductive Health Care Services Among Most At Risk Populations (MARPS): Evidence From A Mystery Client Survey In Nigeria

Background: Access to sexual and reproductive health care services for most at risk population (MARPs) is a very important step in stemming the spread of HIV; as HCT and early diagnosis and treatment of STIs can contribute to reduction of the spread of HIV. Within Nigeria and most Sub Saharan African countries, MARPs are highly stigmatized both in the general society and in health care centres. It is important health care facility based facilitators and barriers to MARPs’ access to use of sexual and reproductive health care services by MARPs are identified to guide project design and implementation as well as policy formulation. Methods: Mystery client survey was conducted in thirty three (33) healthcare facilities in Nigeria. For the purpose of the survey, the mystery clients (MARPs) sought only STI consultation and HIV counselling and testing services. Twelve (12) mystery clients visited each facility seeking either STI or HCT service in the facility. Ethical approval was obtained from the Nigeria Institute of Medical Research (NIMR). SPSS version 20 was used for the Bi-variate and multivariate logistic regression analysis. Results: While positive attitude of health care workers was found to be a facilitator of access to health care services, this study shows that perceived quality of services is a very significant variable in MARPs’ use of a health care facility. We also found that MARPs were more willing to refer their community members to facilities that have educational materials promoting non-stigmatizing attitude towards PLWHAs and MARPs. Amazingly, privacy of services provided was not significant. Conclusion: It is recommended that standard of health care practices should be enforced. Training and re training of health care workers on provision of MARP friendly services should be formalized and scaled up. Investment in educational materials (posters) in health facility settings should be promoted.

Pilot study of home-based delivery of HIV testing and counseling and contraceptive services to couples in Malawi.

BackgroundHIV counseling and testing for couples is an important component of HIV prevention strategies, particularly in Sub Saharan Africa. The purpose of this pilot study is to estimate the uptake of couple HIV counseling and testing (CHCT) and couple family planning (CFP) services in a single home visit in peri-urban Malawi and to assess related factors.MethodsThis study involved offering CHCT and CFP services to couples in their homes; 180 couples were sampled from households in a peri-urban area of Blantyre. Baseline data were collected from both partners and follow-up data were collected one week later. A pair of male and female counselors approached each partner separately about HIV testing and counseling and contraceptive services and then, if both consented, CHCT and CFP services (pills, condoms and referrals for other methods) were given. Bivariate and multivariate logistic regression analyses were done to examine the relationship between individual partner characteristics and acceptance of the services. Selected behaviors reported pre- and post-intervention, particularly couple reports on contraceptive use and condom use at last sex, were also tested for differences.Results89% of couples accepted at least one of the services (58% CHCT-only, 29% CHCT + CFP, 2% CFP-only). Among women, prior testing experience (p < 0.05), parity (p < 0.01), and emotional closeness to partner (p < 0.01) had significant bivariate associations with acceptance of at least one service. Reported condom use at last sex increased from 6% to 25% among couples receiving any intervention. First-ever HIV testing was delivered to 25 women and 69 men, resulting, respectively, in 4 and 11 newly detected infections.ConclusionsHome-based CHCT and CFP were very successful in this pilot study with high proportions of previously untested husbands and wives accepting CHCT and there were virtually no negative outcomes within one week. This study supports the need for further research and testing of home- and couple-based approaches to expand access to HCT and contraceptive services to prevent the undesired consequences of sexually transmitted infection and unintended pregnancy via unprotected sex.

Providing a gateway to prevention and care for the most at-risk populations in Bhutan: is this being achieved?

Two free-standing urban human immunodeficiency virus (HIV) testing and counselling (HCT) centres in Bhutan offering services to the general population and targeting the most at-risk populations (MARPs). To assess the trend in testing for HIV, hepatitis B and syphilis in both the general population and MARPs, and to determine if sociodemographic and risk behaviour characteristics are associated with HIV, hepatitis B and syphilis seropositivity. Cross-sectional study using client records, 2009 - 2012. Of 7894 clients, 3009 (38%) were from the general population, while 4885 (62%) were from MARPs. Over the 4-year period, testing declined progressively among the general population, while it increased or remained static for MARPs. Of 4885 MARPs, seropositivity was respectively 0.7%, 1.3% and 1.2% for HIV, hepatitis B and syphilis. Female sex workers (FSWs) (relative risk [RR] 4.4, P = 0.03) and partners of person living with HIV (RR 25.9, P < 0.001) had a higher risk of being HIV-positive. FSWs had also a greater risk of being syphilis-positive (RR 9.1, P < 0.001). The increase in uptake of HCT services by MARPs is a welcome finding; however, the relatively static trends call for the introduction of community outreach approaches. The critical gateway being provided to MARPs is an 'opportunity' for the expansion of the current service package.

P6.049 PHC Coordinators’ STI and HIV - AIDS Technical Assistance

PHC Coordinators’ STI and HIV – AIDS Technical AssistanceBackgroundTechnical teams (TA) from Indonesia FHI 360 visits to 25 health centres in four provinces in the Indonesian capital. In order to...

Characteristics of HIV/AIDS Patients Presenting Late at a Teaching Hospital in Nigeria

Background: The introduction of highly active antiretroviral therapy (HAART) has significantly reduced the morbidity and mortality associated with HIV/AIDS. This benefit that HAART confers can only be maximized if patients present early. This study was embarked upon to describe the characteristics of patients presenting late at a teaching hospital in north central Nigeria. Methodology: This was a cross sectional study of patients who presented late with HIV/AIDS admitted into the medical wards of the Jos University Teaching Hospital over a one year period. Late presentation was defined as patients presenting in CDC class B or C Results: 56.7% of patients who were admitted with HIV /AIDS presented late with the majority (79%) being in CDC class C. The median CD4+ cell count was 88 cells/mm3 with a range of 12 -552 cells/mm3. Reasons for late presentation included fear of stigma 35 (46.7%), financial constraints 23 (30.7%), faith in herbal / spiritual healing 8 (10.7%) and not believing in HIV treatment 5 (6.7%). No one came to hospital in late stage because of distance from hospital. Similarly HCT services were not accessed early because of fear of stigma 37 (50.7 %), not wanting to know about status 29 (39.2 %), absence of symptoms 51(68%) and seeing partner as faithful 28 (38.9%). Tuberculosis was the commonest reason for hospitalization Conclusions: Stigma was the major reason for delayed HIV testing and late presentation.. Public education and enlightenment on the need for routine HCT and early presentation for care and treatment is advocated.Key Words HIV/AIDS, Late presentation, Stigma, Tuberculosis

Self–reported reasons for seeking HIV testing by people living with HIV/AIDS(PLWHA) in a tertiary hospital in Nigeria

Objective To assess the reasons for HIV testing among people living with HIV and AIDS (PLWHA) that were receiving care/treatment in the University of Ilorin Teaching Hospital(UITH), Ilorin. Methods The study was a descriptive cross-sectional survey conducted on 300 people living with HIV and AIDS receiving care at the antiretroviral therapy (ART) clinics of the hospital. All the patients who came to the clinic during the period of data collection and met the inclusion criteria were recruited into the study consecutively. Data were analyzed using the EPI-INFO 2005 software package. Results The mean age of the respondents was 39 years (SD=9.32), ranging between 19 and 65 years. About two thirds (64.7%) were females, among which 62.7% were married. Slightly less than half (47.3%) of the respondents were not informed before they were tested for HIV while 11% did not receive post-test counselling. The main reason for HIV test was because client was sick and not responding to the treatment for other illnesses and during routine medical test when spouse tested positive. Conclusions The findings from this study reveal that the majority of respondents were tested for HIV/AIDS when they had protracted illness or lost their partners to AIDS. To achieve the WHO goal of universal access to HIV prevention, care, treatment and support, there is an urgent need to rapidly scale up HCT services at all levels of the health care system, while pursuing innovative human right approaches to provider-initiated testing and counselling (PITC).