HIV-negative Test Results Research Articles

Brief Report: Self-Reported HIV-Positive Status but Subsequent HIV-Negative Test Results in Population-Based HIV Impact Assessment Survey Participants-11 Sub-Saharan African Countries, 2015-2018.

HIV testing is a critical step to accessing antiretroviral therapy (ART) because early diagnosis can facilitate earlier initiation of ART. This study presents aggregated data of individuals who self-reported being HIV-positive but subsequently tested HIV-negative during nationally representative Population-Based HIV Impact Assessment surveys conducted in 11 countries from 2015 to 2018. Survey participants aged 15 years or older were interviewed by trained personnel using a standard questionnaire to determine HIV testing history and self-reported HIV status. Home-based HIV testing and counseling using rapid diagnostic tests with return of results were performed by survey staff according to the respective national HIV testing services algorithms on venous blood samples. Laboratory-based confirmatory HIV testing for all participants identified as HIV-positives and self-reported positives, irrespective of HIV testing results, was conducted and included Geenius HIV-1/2 and DNA polymerase chain reaction if Geenius was negative or indeterminate. Of the 16,630 participants who self-reported as HIV-positive, 16,432 (98.6%) were confirmed as HIV-positive and 198 (1.4%) were HIV-negative by subsequent laboratory-based testing. Participants who self-reported as HIV-positive but tested HIV-negative were significantly younger than 30 years, less likely to have received ART, and less likely to have received a CD4 test compared with participants who self-reported as HIV-positive with laboratory-confirmed infection. A small proportion of self-reported HIV-positive individuals could not be confirmed as positive, which could be due to initial misdiagnosis, deliberate wrong self-report, or misunderstanding of the questionnaire. As universal ART access is expanding, it is increasingly important to ensure quality of HIV testing and confirmation of HIV diagnosis before ART initiation.

Diagnostic challenge of Pneumocystis jirovecii pneumonia infection mimicking interstitial lung disease in initially HIV negative patient

Background: Pneumocystis jirovecii pneumonia (PJP) infections are common in immunocompromised patients and are rarely found in immunocompetent patients. Lung radiology in PJP patients could mimic the appearance of interstitial lung disease (ILD) and could be used to diagnose HIV-negative patients. Clinicians should rule out false negatives in patients with patterns suggestive of opportunistic infections and risk factors for HIV infection. Case illustration: A 34-year-old man presented with a chief complaint of shortness of breath, had history of 15 years of smoking, and daily chlorine exposure. The radiology pattern and initial HIV-negative test results suggested an ILD diagnosis. Owing to persistent symptoms despite initial management and the presence of risk factors, repeat HIV testing was initiated and was positive. The patient was treated with cotrimoxazole and showed rapid clinical improvement. Discussion: The diagnosis of PJP in our patient was based on radiology and an HIV-positive status. In patients who are not immunocompromised, the diagnosis of PJP is unlikely, and other diagnoses, such as ILD, should be considered. However, in the HIV testing window period of infection, a poor advanced state of HIV could cause a false negative result. Therefore, clinical judgement is essential in suspecting such a result. The empirical treatment course of cotrimoxazole has been shown to provide better clinical outcomes in PJP. Conclusion: The possibility of PJP must be considered in patients with initially HIV-negative results, especially in patients with risk factors and clinical symptoms suggestive of immunocompromise. While some ILD showed similar PJP, the risk factors for ILD and PCP could be distinguishing factors. Retesting for HIV infection can confirm the diagnosis and rule out false-negative results.

Examining Chinese Users' Feedback Comments on HIV Self-testing Kits From e-Commerce Platforms: Thematic and Content Analysis.

HIV self-testing is preferred by many Chinese people for its convenience and confidentiality. However, most studies on HIV self-testing (HIVST) uptake in China overfocused on men who have sex with men and overrelied on obtrusive methods such as surveys and interviews to collect data. We aimed to explore Chinese HIVST kit users' authentic experience via their feedback comments posted on e-commerce platforms using an unobtrusive approach. In total, 21,018 feedback comments about buying and using HIVST kits posted on Chinese e-commerce platforms (Tmall and Pinduoduo) were collected. An inductive thematic analysis based on a random sample of 367 comments yielded several thematic features. These thematic features were developed into coding categories for a quantitative content analysis of another random sample of 1857 comments. Four themes were identified in the first study, including the expression of positive and negative emotions after and before getting the test, respectively, calling for living a clean and moral life in the future, comments on the sellers and HIVST kits, and the reasons for buying HIVST kits. The results from the second study suggested that there were significant associations between different platforms and several thematic features. Nearly 50% of the comments were related to the product itself and the disclosures of HIV-negative test results. More than 25% of the comments showed users' feelings of gratefulness after receiving negative test results such as "thank heavens for sparing my life." The results suggested that Chinese users relied on HIVST kits to reduce and prevent HIV infection, while they also considered HIV infection a punishment related to moral violation such as being sexually promiscuous. The traditional Chinese health belief that health is influenced by one's morality still persists among some Chinese users. Many users also lacked appropriate knowledge about HIV transmission and self-testing kits.

Receipt of infant HIV DNA PCR test results is associated with a reduction in retention of HIV-exposed infants in integrated HIV care and healthcare services: a quantitative sub-study nested within a cluster randomised trial in rural Malawi

BackgroundRetention of HIV-infected mothers in integrated HIV and healthcare facilities is effective at reducing mother-to-child-transmission (MTCT) of HIV. In the context of Option B+, we examined maternal and HIV-exposed infant retention across three study arms to 18 months postpartum: mother-and-infant clinics (MIP), MIP with short-messaging service (MIP + SMS) and standard of care (SOC). In particular, we focused on the impact of mothers receiving an infant’s HIV PCR test result on maternal and infant study retention.MethodsA quantitative sub-study nested within a cluster randomised trial undertaken between May 2013 and August 2016 across 30 healthcare facilities in rural Malawi enrolling HIV-infected pregnant mothers and HIV-exposed infants on delivery, was performed. Survival probabilities of maternal and HIV-exposed infant study retention was estimated using Kaplan-Meier curves. Associations between mother’s receiving an infant’s HIV test result and in particular, an infant’s HIV-positive result on maternal and infant study retention were modelled using time-varying multivariate Cox regression.ResultsFour hundred sixty-one, 493, and 396 HIV-infected women and 386, 399, and 300 HIV-exposed infants were enrolled across study arms; MIP, MIP + SMS and SOC, respectively. A total of 47.5% of mothers received their infant’s HIV test results < 5 months postpartum. Receiving an infant’s HIV result by mothers was associated with a 70% increase in infant non-retention in the study compared with not receiving an infant’s result (HR = 1.70; P-value< 0.001). Receiving a HIV-positive result was associated with 3.12 times reduced infant retention compared with a HIV-negative result (P-value< 0.001). Of the infants with a HIV-negative test result, 87% were breastfed at their final study follow-up.ConclusionsReceiving an infant’s HIV test result was a driving factor for reduced infant study retention, especially an infant’s HIV-positive test result. As most HIV-negative infants were still breastfed at their last follow-up, this indicates a large proportion of HIV-exposed infants were potentially at future risk of MTCT of HIV via breastfeeding but were unlikely to undergo follow-up HIV testing after breastfeeding cessation. Future studies to identify and address underlying factors associated with infant HIV testing and reduced infant retention could potentially improve infant retention in HIV/healthcare facilities.Trial registrationPan African Clinical Trial Registry: PACTR201312000678196.

Attitudes and Preferences Regarding the Use of Rapid Self-Testing for Sexually Transmitted Infections and HIV in San Diego Area Men Who Have Sex With Men.

BackgroundSexually transmitted infections (STIs) increase the risk of HIV transmission and are present at high rates among men who have sex with men (MSM). Adherence to HIV/STI testing guidelines is low in the United States. Testing programs that utilize rapid self-administered HIV/STI tests improve testing rates, though multiple factors influence their uptake.MethodsMSM were recruited at an HIV/STI testing and treatment program in 2014 and provided consent, demographics, risk behaviors, HIV/STI test preferences, and perceived testing barriers via an online questionnaire. Comparisons of testing preferences and barriers were made based on age, risk group, and HIV serostatus using the Fisher exact test.ResultsHIV testing preferences included rapid oral test (71.1%), home test location (78.5%), electronic delivery of HIV-negative test results (76.4%), and direct provider notification for HIV-positive test results (70%), with respondents age >45 years being significantly more likely to prefer home testing (P = .033). STI testing preferences included self-collection of specimens (73.2%), home test location (61%), electronic delivery of negative STI test results (76.4%), and direct provider notification for positive STI test results (56.6%) with no significant differences between age, HIV serostatus, or risk groups. The most frequently reported HIV and STI testing barrier was lack of known prior HIV/STI exposure (57.3% for HIV, 62.9% for STI) with respondents age <45 years more frequently citing inconvenience as a barrier to testing (HIV: 50.9% vs 17.4%, P = .010; STI: 58.3% vs 31.8%, P = .070).ConclusionsAlthough additional research is needed, increasing resources directed specifically toward home testing has the potential to translate into improved uptake of rapid HIV/STI testing. Efforts to improve convenience in testing programs must be balanced with the need for continued educational outreach.

Evaluation of antenatal rapid human immunodeficiency virus testing in rural South Africa.

South African guidelines recommend two rapid tests for diagnosing human immunodeficiency virus (HIV) using the serial HIV testing algorithm, but the accuracy and compliance to this algorithm is unknown in rural clinics. We evaluated the accuracy of HIV rapid testing and the time to receiving test results among pregnant women in rural KwaZulu-Natal (KZN). We observed the accuracy of rapid HIV testing algorithms for 208 consenting antenatal patients accessing voluntary HIV testing services in nine rural primary healthcare (PHC) clinics in KZN. A PHC-based HIV counsellor obtained finger-prick whole blood from each participant to perform rapid testing using the Advanced Quality™ One Step anti-HIV (1&2) and/or ABON™ HIV 1/2/O Tri-Line HIV test. A research nurse obtained venous blood for an enzyme-linked immunosorbent assay (ELISA) HIV test, which is the gold standard diagnostic test. We recorded the time of receipt of HIV test results for each test. Among 208 pregnant women with a mean age of 26 years, 72 women from nine rural PHC clinics were identified as HIV-positive by two rapid tests with an HIV-prevalence of 35% (95% Bayesian credibility intervals [BCI]: 28% - 41%). Of the 208 patients, 135 patients from six clinics were tested with the serial HIV testing algorithm. The estimated sensitivity and specificity for the 135 participants were 100% (95% confidence interval [CI]: 93% - 100%) and 99% (CI: 95% - 100%), respectively. The positive predictive value and negative predictive value were estimated at 98% (CI: 94% - 100%) and 95% (CI: 88% - 99%), respectively. All women received their HIV rapid test results within 20 min of testing. Test stock-out resulted in poor test availability at point-of-care, preventing performance of a second HIV test in three out of nine PHC clinics in rural KZN. Despite the poor compliance with national guidelines for HIV rapid testing services, HIV rapid test results provided to pregnant women in rural PHC clinics in KZN were generally accurate and timely. Test stock-out was shown to be one of the barriers to test availability in rural PHC clinics, resulting in poor compliance with guidelines. We recommend a compulsory confirmation HIV rapid test for all HIV-negative test results obtained from pregnant patients in rural and resource-limited settings.

HIV post-test practices: an online survey examining perceived delivery of HIV test results, post-test discussion and referral in healthcare settings across the WHO European Region.

Background The aim of this study was to assess perceptions of health professionals involved in HIV testing policy and practice in national settings across the WHO European Region regarding the delivery of HIV test results, post-test discussion and referral to specialist HIV services as recommended in authoritative guidelines. An online self-report survey was completed by a convenience sample of 338 respondents (response rate 34.1%) from 55 countries. Respondents worked with non-government organisations (49.4%), health services (32.8%), non-health service government agencies (6.2%) or other organisations (11.5%; e.g. prisons, education and research, international development). Experts' perceptions indicate that delivery of HIV-positive test results and related post-test discussion in their country generally corresponded to recommendations. However, results pointed to a significant gap perceived by experts between recommendations and the practice of delivering HIV-negative test results. Fewer respondents thought that suitable time is taken to deliver a negative HIV-test result (54.1%) than a positive result (73.1%). Also, fewer respondents thought there was a procedure for referral to specialist treatment, care and support services for people receiving a HIV-negative test result (34.9%) than for people receiving an HIV-positive test result (86.2%). Experts also reported low perceived use of communication technologies (i.e. telephone, email, text messaging, a secure website) for delivering HIV test results. This expert survey offers new insight into perceived HIV post-test practices in almost all national settings across the WHO European Region. The findings provide valuable guidance for future HIV testing guidelines for the WHO European Region.

"You Know You Are Sick, Why Do You Carry A Pregnancy Again?" Applying the Socio-Ecological Model to Understand Barriers to PMTCT Service Utilization in Western Kenya.

ObjectiveThroughout most of sub-Saharan Africa (SSA), prevention of mother-to-child transmission (PMTCT) services are readily available. However, PMTCT programs in SSA have had suboptimal performance compared to other regions of the world. The main objective of this study is to explore the socio-ecological and individual factors influencing the utilization of PMTCT services among HIV-positive pregnant women in western Kenya using a social ecological model as our analytical lens.MethodsData were collected using in-depth interviews with 33 HIV-infected women attending government health facilities in rural western Kenya. Women with HIV-infected infants aged between 6 weeks to 6 months with a definitive diagnosis of HIV in the infant, as well as those with an HIV-negative test result in the infant were interviewed between November 2012 and June 2013. Coding and analysis of the transcripts followed grounded theory tenets. Coding reports were discussed in a series of meetings held among the authors. We then employed constant comparative analysis to discover dominant individual, family, society and structural determinants of PMTCT use.ResultsBarriers to women’s utilization of PMTCT services fell within the broad constructs of the socio-ecological model of individual, family, society and structural determinants. Several themes cut across the different steps of PMTCT cascade and relate to different constructs of the socio-ecological model. These themes include: self-motivation, confidence and resilience, family support, absence or reduced stigma, right provider attitude and quality of health services provided. We also found out that these factors ensured enhanced maternal health and HIV negative children.ConclusionThe findings of this study suggest that a woman’s social environment is an important determinant of MTCT. PMTCT Interventions must comprehensively address multiple factors across the different ecological levels. More research is however required for the development of multi-component interventions that combine strategies at different ecological levels.

The heterogeneous effects of HIV testing

An extensive multi-disciplinary literature examines the effects of learning one's HIV status on subsequent risky sexual behaviors. However, many of these studies rely on non-experimental designs; use self-reported outcome measures; or both. In this study, we investigate the effects of a randomly assigned home based HIV testing and counseling (HTC) intervention on risky sexual behaviors and schooling investments among school-age females in Malawi. We find no overall effects on HIV, Herpes Simplex Virus (HSV-2), or achievement test scores at follow-up. However, among the small group of individuals who tested positive for HIV, we find a large increase in the probability of HSV-2 infection, with this effect being stronger among those surprised by their test results. Similarly, those surprised by HIV-negative test results have significantly higher achievement test scores at follow-up, consistent with increased returns to investments in human capital.

Mutual HIV Disclosure among HIV-Negative Men Who have Sex with Men in Beijing, China, 2010

HIV is rising rapidly among Chinese men who have sex with men (MSM). Discussion of HIV status between sexual partners is potentially a key prevention behavior. It is unclear if HIV-negative Chinese MSM talk about HIV and disclose their HIV status with sexual partners. Understanding the correlates of disclosure among this population could provide insight into developing disclosure-based interventions. We conducted a respondent driven sampling based study of 500 MSM in Beijing. A total of 332 men had a previous HIV-negative test result and thus considered themselves to be HIV-negative and were included in our analysis of disclosure. Equal numbers of these men reported talking about HIV and disclosing their HIV status to at least one sexual partner. MSM who disclosed were more likely to be living with a main partner. No other demographic characteristics were associated with disclosure in bivariate analysis. We also used data on up to three sexual partners per participant to examine disclosure on the partnership level. Main partnerships, meeting partners at bars/clubs, sometimes using alcohol before sex in a partnership, and usually having sex at home compared to other venues were associated with disclosure. Using generalized estimating equation analysis to characterize individuals from their partnership data, we found only having at least one main partnership and knowing people who were infected with HIV to be associated with a participant being a discloser. Interventions that wish to harness discussion of HIV and HIV status among Chinese MSM will need to focus on moving these discussions towards having them with casual partners.

Providing HIV-negative results to low-risk clients by telephone

In Australia, Health Department policies differ on the recommended method of providing HIV results. Traditionally, all results have been provided in person. Our aim was to trial provision of HIV-negative test results by telephone to low-risk clients attending sexual health services and to assess clients' preferences for delivery method. During 4 months in 2009 at two sexual health services in Sydney, all clients assessed as low-risk for HIV infection were invited to receive their HIV result by telephone. Non-receipt of results was defined as failure to receive results within 30 days of the test being performed. Of 763 clients tested, 328 (43%) were excluded following risk assessment, 30 (4%) declined to participate and 405 (53%) were enrolled. Among enrolled clients, 86% received their HIV result by telephone within 30 days, 97% were satisfied with delivery of the result by telephone and 93% preferred telephone delivery for their next HIV result. Only one enrolled client returned a positive HIV result. Independent predictors of receiving results within the 30-day timeframe were clinic attendance for sexually transmissible infection screening (P=0.021), lack of anogenital symptoms (P=0.015) and not being a sex worker (P=0.001). In this study of telephone provision of HIV results to low HIV-risk clients, there were no adverse events and clients expressed satisfaction with the process plus a strong preference for telephone delivery of future results. There was a decreased rate of failure to receive HIV results compared with other Australian studies.

Staff Strategies for Improving HIV Detection Using Mobile HIV Rapid Testing

This paper examines the performance of 13 mobile testing units (MTUs) and rapid HIV testing technology in Los Angeles County as reflected in the relationship between the cognitive strategies used by MTU staff regarding instructions to clients about picking up their test results and returning for test results, and following up with those clients who did not return, and the spatial distribution of MTUs and AIDS rates in 2003. Maps were created using geographic information systems (GIS) data on 93 MTU testing locations and 2003 AIDS cases data. MTU staff (N = 45) were interviewed and several themes were identified. MTU testing locations were clustered near high AIDS rate areas. Staff reports were obtained on 24 clients in the past 6 months who received HIV-negative test results and 24 clients during the same time period who received HIV-positive test results. Staff strategies that were used included keeping clients with them while rapid test results were being processed and adjusting to clients' schedules when arranging for picking up test results. Some staff used tangible incentives such as vouchers for area businesses to encourage preliminary HIV-positive clients to return for confirmatory test results. Staff also sought to convince clients who preliminarily tested HIV-positive to convert from anonymous to confidential testing in order to facilitate clients' linkage to treatment. The GIS findings and client risk data support the Centers for Disease Control and Prevention policy of implementing MTUs and rapid testing in large urban communities with high AIDS rates.

MDMA (‘ecstasy’) use, and its association with high risk behaviors, mental health, and other factors among gay/bisexual men in New York City

This study assesses patterns of use of methylenedioxymethamphetamine (MDMA or ‘ecstasy’), and the characteristics of users, in a sample of 733 men who have sex with men (MSM) in New York City. Among respondents, 13.7% reported using MDMA in the past 6 months, with mean frequency of use of 6.24 times in that period. MDMA users were found to be younger, less educated, to have had more male partners, more one night stands with men, more visits to bars or clubs and sex clubs or bathhouses, to have unprotected anal sex with a male, to be likely to have been the victim of physical domestic violence, to have more gay/bisexual friends, to have disclosed their sexual orientation to more friends, family members, and coworkers, and to have higher levels of gay community participation and affiliation. Among MDMA users, higher frequency of MDMA use was associated with being younger, having more visits to bars or clubs, more gay/bisexual friends, and having an HIV negative test result or never having been tested. MDMA users thus constitute a group at risk for sexually transmitted diseases, including HIV, and other problems. The data suggest that MDMA use is associated with being more ‘out’, which may be advantageous in helping gay men deal with harmful psychological effects of stigma, but may place individuals in settings that expose them to MDMA. These men have also presumably already been well exposed to safer sex messages within the gay community, thus raising challenges for interventions aimed at prevention, as well as opportunities (e.g. MSM and community specific interventions) that need to be further explored.

Reliability in Testing: Clinical and Research Applications

Reliability of an instrument is described as its accuracy and dependability. Reliability is thought of in terms of the consistency, stability, and/or equivalence of measurements (Nieswiadomy, 1998, p. 199; Young, Taylor, & McLaughlin-Renpenning, 2001, p. 30). Reliability should be thought of in terms of the current study—the current sample at the time it is being studied. It is not a characteristic that necessarily transcends the specific circumstance of data collection. Although the reliability of an instrument in a prior study is important to know, ideally it should be assessed in each study (Nieswiadomy, 1998, p. 199). The concept of reliability may be clearer in a clinical context than in a research context. Clinically, for example, we need to know that the various tests to determine one’s HIV status and the progression of HIV disease do not provide results in a random fashion. Rather, they need to provide consistent meaning for everyone who is tested because the test results imply behavioral choices and treatment options. Clients and staff make major decisions based on test results. Nurses understand the concept of false negative and false positive. In the case of HIV testing, a false positive occurs when a person gets an HIVpositive test result but is not HIV infected. Conversely, a false-negative result occurs when a person gets an HIV-negative test result but is HIV-positive. We understand as clinicians that the lowest possible occurrence of fluke test results is essential if test results are to be meaningful or useful. Likewise, in a research context, the data must be stable and consistent so that we can make interpretations that are useful for understanding the phenomenon under investigation or for testing the outcomes of interventions. Equipment used in diagnostic assessment may need frequent calibration for accurate results, and the Joint Commission on Accreditation of Healthcare Organizations and federal standards require that periodically all equipment be inspected and maintained by the biomedical engineering staff. On-paper instruments that are administered and interpreted by people provide reliable results only when all users are trained and certified to collect and interpret the data consistently. For example, the annual performance evaluation may or may not be applied and interpreted equitably throughout an institution by all raters, and for staff, salary increments or promotions may be at stake. Froman (1999) described a process of ensuring that a clinical ladder review system is objective, replicable, and fair—in other words, that it is consistently applied throughout a health care system. As another example, when people are subjected to performance testing, as in the case of CPR certification, it is crucial that all raters apply the criteria in the same way for certification to have meaning, or for it to be true that certified people “know” CPR.

The Behavioral Consequences of HIV Testing

This paper focuses on the impact of HIV testing for the willingness of at-risk heterosexual young adults to engage in risky sexual behavior based on the awareness of their own and their potential partners HIV status. The key prediction of the utility-based model of risky sexual behavior was investigated. The findings revealed that an individual who has very low probability of being infected with HIV is more willing to engage in risky sex with casual partner who has HIV-negative test results than with a partner who has extremely low appraisal of the likelihood of infections. However no parallel prediction was noted for the willingness of an individual tested as HIV-positive to engage in risky sex with a high-risk casual partner and the willingness to engage in such behavior when both sex partners had a very high probability of being infected. Hence the testing- induced shifts in sexual risk taking at low probability of HIV infection were not affected with the subjects likelihood of engaging in casual sex behavior and having taken an HIV test. Furthermore the study demonstrated the consideration of costs of infection in making risky sex behavior.