HIV Positive Rate Research Articles

Incentivization of Sexually Transmitted Infection Testing at a Large Public University

Abstract Background According to the United States (U.S.) Centers for Disease Control and Prevention, more than 2.5 million cases of syphilis, gonorrhea, and chlamydia were reported in 2022, with notable increases in gonorrhea and chlamydia. The highest rates of chlamydia, gonorrhea, and syphilis were found in men and women of college age. This study compared free STI testing events to usual care with regard to patient socio-economic factors and testing positivity rates. Methods The Department of Student Health & Wellness at a large, public university offers routine testing at a low cost, flat rate, including chlamydia, gonorrhea, hepatitis C Ab, syphilis and HIV testing. Two weeks of free testing were held during calendar year 2023. Utilization and positivity rates between free testing and regular testing weeks were compared using Pearson’s chi squared and Fisher Exact tests. Results A total of 8705 tests were performed during routine testing weeks with associated cost averaging 174 tests per week as compared to 1177 tests for the free testing weeks averaging 589 tests per week. Testing uptake during free testing weeks was higher among females (65.6% (n = 772) vs. 55.1% (n = 4797); p < 0.001) and minorities such as, Black or African American [11.3% (n = 133) vs. 9.4% (n = 813); p = 0.02], Hispanic [11.4% (n = 134) vs. 9.2% (n = 798); p = 0.02] and Asian [13.1% (n = 154) vs. 8.8% (n = 763); p < 0.001] when compared to testing during regular weeks. Chlamydial infection positivity rate was lower during the free testing weeks [1.8% (n = 7)] vs. [3.9% (n = 123); p = 0.04]. Gonorrhea, hepatitis C, HIV, and Syphilis positivity rates did not differ between the two testing periods. Conclusions Free STI testing in the context of a large, public university Student Health Department shows increased utilization. The establishment of free testing weeks was associated with an increase in female students and minorities use of testing services at a large public university. Key messages • Incentivization can improve STI testing utilization among university students. • The establishment of STI free testing periods can increase the use of testing services among minority students and females.

Intimate Partner Violence Among Three Key Populations at Risk of HIV in Panama

This study aims to estimate the prevalence of interpersonal personal violence (IPV) among three key populations at an increased risk of HIV in Panama (namely, transgender women, sex workers, and men who have sex with men [MSM]) and to estimate the positivity rate of four sexually transmitted infections (STIs), including HIV. Participants from the 2018 PEMAR study with a stable primary partner completed a 31-item survey with demographic data, the Spanish version of the four-item HITS questionnaire (being physically Hurt, Insulted, Threatened, or Screamed at; Cronbach’s α = .816), and an optional blood draw for STI testing. Prevalence rates of IPV were estimated with their respective 95% CIs after imputing 3.93% of missing values. The analytic sample (N= 356) included 76.0% MSM, 15.5% sex workers, and 9.3% transgender women, most of whom were in their 30s, married, and Latinx; completed some college; and worked full time. The most frequent forms of IPV were screams and insults. The IPV prevalence rates were estimated for transgender women (19.05%), sex workers (10.53%), and MSM (2.36%). Among participants who consented to blood samples (n= 291), transgender women who experienced IPV had a significantly (P= .03) higher syphilis positivity rate and MSM who did not experience IPV had a significantly (P< .001) higher HIV positivity rate. Among key populations, transgender women experienced the highest rate of IPV and significantly higher syphilis rates. Paradoxically, HIV rates were higher among MSM who do not experience IPV. While societal roles and other contextual factors play a partial role in these syndemic findings, more studies are warranted.

Characteristics of and Factors Associated With Partner Service Uptake Cascade Among People With Newly Reported HIV/AIDS Diagnoses in Southeastern China in 2022: Cross-Sectional Survey.

HIV notification and testing integrated into partner service (PS) practices among HIV-positive individuals have been proven to be an efficient approach for case finding, although it remains a weak link in China. Although nonmarital sexual activities accounted for a large proportion of newly diagnosed HIV-positive cases in China, little is known about PS uptake and associated factors within nonmarital partnerships. This study aimed to describe HIV PS utilization and its associated factors among HIV-positive individuals with nonmarital sexual partners. We recruited newly diagnosed HIV-positive individuals who had nonmarital sexual partners in 2022 in Zhejiang Province and offered them PS. We described the PS uptake cascade within sexual partner categories and analyzed the associated factors with 3 primary outcomes from the participants' perspective: nonmarital partner enumeration, HIV testing, and HIV positivity. In this study, 3509 HIV-positive individuals were recruited as participants, and they enumerated 2507 nonmarital sex partners (2507/14,556, 17.2% of all nonmarital sex partners) with contact information. Among these, 43.1% (1090/2507) underwent an HIV test, with an HIV-positive rate of 28.3% (309/1090). Heterosexual commercial partners were the least likely of being enumerated (441/4292, 10.3%) and had the highest HIV-positive rate (40/107, 37.4%). At the participant level, 48.1% (1688/3509) of the participants enumerated at least one nonmarital sex partner with contact information, 52.7% (890/1688) had a sex partner tested for HIV, and 31% (276/890) had at least one nonmarital sex partner who tested positive. Multivariate analysis indicated that gender and transmission route were associated with both nonmarital sex partner enumeration and HIV testing. Age and occupation were associated with nonmarital sex partner enumeration and HIV positivity. Compared with participants who had no regular nonmarital sex partner, those who had a regular nonmarital sex partner were more likely to enumerate nonmarital sex partners (adjusted odds ratio [aOR] 3.017, 95% CI 2.560-3.554), have them get tested for HIV (aOR 1.725, 95% CI 1.403-2.122), and have an HIV-positive nonmarital sex partner (aOR 1.962, 95% CI 1.454-2.647). The percentage of partner enumeration was low, and HIV testing rate was moderate among nonmarital partnerships of HIV-positive individuals. More efforts should be made to improve PS practices among HIV-positive individuals and address the gap in partner enumeration, especially for heterosexual commercial nonmarital partnerships. Additionally, enhancing PS operational skills among health care personnel could increase the overall efficiency of PS uptake in China.

Application of ‘CDC- Public Security Bureau-NGO’ Joint Prevention and Control Mechanism Allied AIDS prevention and control in Guigang, Guangxi

BackgroundHIV/AIDS has emerged as a nationwide epidemic and has taken the forefront position as the primary infectious killer of adults in China. The control and prevention of the disease have been hampered by a weak link in the form of heterosexual transmission. However, conventional intervention measures have demonstrated suboptimal efficacy in reducing the incidence of new HIV infections. In light of the current epidemiological characteristics, we have developed and executed an innovative intervention model known as the Joint Prevention and Control Mechanism of the ‘CDC-Public Security Bureau-NGO’. The purpose of this research is to assess the impact of this model on the AIDS awareness, HIV infection rates, sexual behavior, and associated factors among female sex workers and elderly clients. Through the provision of robust evidence of the efficacy of this innovative model, we seek to advocate for its implementation in future interventions.MethodsThe research design of this study incorporates both a serial cross-sectional study and time-series analysis from 2014 to 2021, including a 4-year traditional intervention (2014–2017) and the 4-year ‘CDC-Public Security Bureau-NGO’ innovative intervention (2018–2021), was conducted to evaluate the effects of the new intervention. The GM(1, 1) model was performed to predict the proportion of HIV infection without implementing the innovative intervention in 2018–2021; P and C values were used to evaluate the performance of the model. Mann-Kendall test and descriptive methods were used to analyzed the trend of traditional and innovative interventions models on HIV positive detection rate in FSWs and elderly clients.ResultsThe condom usage rates during the last commercial sexual encounter for FSWs and elderly clients improved from 74.9% and 9.1%, respectively, to 96.9% and 28.1%. (P < 0.05), newly reported cases of HIV have decreased by 15.56% yearly and the HIV positive detection rate among middle-aged and elderly people has dropped by 14.47%. The innovative intervention model has significantly reduced the HIV infection rates.ConclusionsThe ‘CDC-Public Security Bureau-NGO’ innovative intervention has achieved beneficial effects on HIV/AIDS prevention and control and provides a good reference for Guangxi, China.

Prevalence of and Factors Associated With Adverse Maternal Obstetrical Events Among Teenage Mothers Delivering in a Tertiary Referral Hospital in Southwestern Uganda.

Many female teenagersin low-resource settings conceive, of which half are unplannedand end in many deaths in sub-Saharan Africa, accounting for the majority of the cases. Teenage pregnancy is associated sometimes with poor maternal, newborn, and child deaths. The aim of the study was to determine the prevalence, maternal obstetric outcomes, and factors associated with poor maternal obstetric outcomes among teenage mothers delivering at Mbarara Regional Referral Hospital. This was a cross-sectional study carried out in a maternity ward at Mbarara Regional Referral Hospital, where 9,200 mothers deliver annually. All the women coming in for the delivery of their babies were consecutively approached for inclusion in the study. The women were enrolled in the post-delivery ward after delivery and interviewed with pretested questionnaires to capture the sociodemographic, obstetric, and medical profiles of the mothers. Factors were significant if the p-value was <0.05. Results:Out of the 327 participants, the majority were rural dwellers (68.5%), married (75.8%), attained primary education (69.4%), had not used contraception (89%), and had had a planned pregnancy (63.3%). The prevalence of adverse maternal obstetrical events was 59.9%. The HIV-positive rate was 4.9%, and about half of the participants had delivered by cesarean section (41.6%). The participants' mean age was 18.4 yearsand SD 1.1. The mean number of antenatal care contacts attended was 4.59 and SD 1.9. The adverse maternal outcomes includedepisiotomy (30.9%), perineal tear (18.7%), premature rupture of membranes (10.1%), placenta abruption (5.2%), and pre-eclampsia/eclampsia (4%). Having a cesarean delivery was found to significantly reduce the occurrence of adverse maternal obstetric events among the participants by 97% (adjusted odds ratio (aOR) (95% CI) of 0.03 (0.02-0.06), p-value<0.001). Having a prior history of a miscarriage was significantly associated with the occurrence of adverse maternal obstetrical events among the participants (aOR (95% CI) of 6.55 (1.46-29.42), p-value0.014). Slightly more than half of the teenage mothers had adverse maternal obstetrical outcomes, and a history of a miscarriage in previous pregnancieswas significantly associated with adverse maternal obstetrical outcomes. Having a cesarean delivery was found to significantly reduce the occurrence of adverse maternal obstetric events among the participants. Teenage mothers are at a high risk of adverse maternal obstetrical outcomes, and close antepartum and intrapartum surveillance is recommended.

Rapid antiretroviral therapy initiation following rollout of point-of-care early infant diagnosis testing, Uganda, 2018–2021

BackgroundUganda Ministry of Health (MOH) recommends a first HIV DNA-PCR test at 4–6 weeks for early infant diagnosis (EID) of HIV-exposed infants (HEI) and immediate return of results. WHO recommends initiating antiretroviral therapy (ART) ≤ 7 days from HIV diagnosis. In 2019, MOH introduced point-of-care (POC) whole-blood EID testing in 33 health facilities and scaled up to 130 facilities in 2020. We assessed results turnaround time and ART linkage pre-POC and during POC testing.MethodsWe evaluated EID register data for HEI at 10 health facilities with POC and EID testing volume of ≥ 12 infants/month from 2018 to 2021. We abstracted data for 12 months before and after POC testing rollout and compared time to sample collection, results receipt, and ART initiation between periods using medians, Wilcoxon, and log-rank tests.ResultsData for 4.004 HEI were abstracted, of which 1.685 (42%) were from the pre-POC period and 2.319 (58%) were from the period during POC; 3.773 (94%) had a first EID test (pre-POC: 1.649 [44%]; during POC: 2.124 [56%]). Median age at sample collection was 44 (IQR 38–51) days pre-POC and 42 (IQR 33–50) days during POC (p < 0.001). Among 3.773 HEI tested, 3.678 (97%) had test results. HIV-positive infants’ (n = 69) median age at sample collection was 94 (IQR 43–124) days pre-POC and 125 (IQR 74–206) days during POC (p = 0.04). HIV positivity rate was 1.6% (27/1.617) pre-POC and 2.0% (42/2.061) during POC (p = 0.43). For all infants, median days from sample collection to results receipt by infants’ caregivers was 28 (IQR 14–52) pre-POC and 1 (IQR 0–25) during POC (p < 0.001); among HIV-positive infants, median days were 23 (IQR 7–30) pre-POC and 0 (0–3) during POC (p < 0.001). Pre-POC, 4% (1/23) HIV-positive infants started ART on the sample collection day compared to 33% (12/37) during POC (p < 0.001); ART linkage ≤ 7 days from HIV diagnosis was 74% (17/23) pre-POC and 95% (35/37) during POC (p < 0.001).ConclusionPOC testing improved EID results turnaround time and ART initiation for HIV-positive infants. While POC testing expansion could further improve ART linkage and loss to follow-up, there is need to explore barriers around same-day ART initiation for infants receiving POC testing.

Strategic HIV Case Findings among Infants at Different Entry Points of Health Facilities in Cameroon: Optimizing the Elimination of Mother-To-Child Transmission in Low- and- Middle-Income Countries

Background: HIV case finding is an essential component for ending AIDS, but there is limited evidence on the effectiveness of such a strategy in the pediatric population. We sought to determine HIV positivity rates among children according to entry points in Cameroon. Methods: A facility-based survey was conducted from January 2015 to December 2019 among mother–child couples at various entry points of health facilities in six regions of Cameroon. A questionnaire was administered to parents/guardians. Children were tested by polymerase chain reaction (PCR). Positivity rates were compared between entry points. Associations were quantified using the unadjusted positivity ratio (PR) for univariate analyses and the adjusted positivity ratio (aPR) for multiple Poisson regression analyses with 95% confidence intervals (CIs). p-values &lt; 0.05 were considered significant. Results: Overall, 24,097 children were enrolled. Among them, 75.91% were tested through the HIV prevention of mother-to-child transmission (PMTCT) program, followed by outpatient (13.27%) and immunization (6.27%) services. In total, PMTCT, immunization, and outpatient services accounted for 95.39% of children. The overall positivity was 5.71%, with significant differences (p &lt; 0.001) between entry points. Univariate analysis showed that inpatient service (PR = 1.45; 95% CI: [1.08, 1.94]; p = 0.014), infant welfare (PR = 0.43; 95% CI: [0.28, 0.66]; p &lt; 0.001), immunization (PR = 0.56; 95% CI: [0.45, 0.70]; p &lt; 0.001), and PMTCT (PR = 0.41; 95% CI: [0.37, 0.46]; p &lt; 0.001) were associated with HIV transmission. After adjusting for other covariates, only PMTCT was associated with transmission (aPR = 0.66; 95% CI: [0.51, 0.86]; p = 0.002). Conclusions: While PMTCT accounts for most tested children, high HIV positivity rates were found among children presenting at inpatient, nutrition, and outpatient services and HIV care units. Thus, systematic HIV testing should be proposed for all sick children presenting at the hospital who have escaped the PMTCT cascade.

Impact of Covid-19 Pandemic on HIV/AIDS Testing and Treatment

Objective: This study aimed to assess the impact of the COVID-19 pandemic on HIV testing, diagnosis, treatment, and care in Nagpur, India by analyzing trends across patient data from 2017-2021. The goal was to outline challenges and future policy measures to mitigate disruptions and improve engagement of individuals living with HIV/AIDS. Materials and Methods: Data were analyzed for 971 diagnosed HIV/AIDS patients undergoing antiretroviral therapy at the Government Medical College's Integrated Counseling and Testing Centre and Antiretroviral Therapy Centre in Nagpur, spanning 2017-2021. Descriptive statistics were used to evaluate trends in key parameters - HIV screening, positivity rates, patient characteristics, ICTC-ART linkages, treatment outcomes. Appropriate ethical guidelines were adhered to. Results: Notable declines in HIV testing and positivity rates were observed during the COVID-19 period. Changes in patient demographic distribution and service gaps (drop in eligible spouse testing; ICTC-ART linkage gaps) indicated likely challenges in care access and engagement during the pandemic. Issues also emerged in critical areas including ART adherence, loss to follow-ups, and cessation of treatment over 2019-2021. Discussion: The results underscore pandemic-related disruptions faced by HIV care systems, potentially stemming from lockdowns, restrictions, and healthcare service limitations. Addressing detriments through multi-faceted approaches is imperative - improved ICTC-ART linkages, adoption of telemedicine/multi-month ART models and decentralized care can aid optimization of HIV care delivery during outbreaks. The learnings can inform the development of resilient health systems equipped to support vulnerable groups through co-occurring epidemics. Keywords: COVID-19, healthcare utilization, ICTCs (Integrated counseling and testing centers), linkage, pandemic, patient retention, service gaps, HIV/AIDS, vulnerable populations.

Provision of HIV testing services and its impact on the HIV positivity rate in the public health sector in KwaZulu-Natal: a ten-year review

ABSTRACT South Africa has been rated as having the most severe HIV epidemic in the world since it has one of the largest populations of people living with HIV (PLHIV). KwaZulu-Natal (KZN) is the epicentre of the HIV epidemic. The HIV test and treat services in the public health sector are critical to managing the epidemic and responding to the increase in HIV infections. The KwaZulu-Natal Department of Health (DOH) commissioned a review of the provision of HIV testing services in the province and aimed to investigate its impact on the HIV positivity rate over a ten-year period. The study was an ecological study design using data extracted from the Department’s District Health Information System (DHIS). Descriptive analysis was conducted in addition to ANOVA and multiple regression analysis. The results of this study have shown that the total number of HIV tests conducted over the ten-year period in the province has increased with the highest number of HIV tests being conducted in the 2018/2019 MTEF year. ANOVA analysis indicates that there was a statistically significant difference in the total number of HIV tests conducted and the number of HIV tests per 100 000 population across the province’s 11 districts (p < 0.001). Statistically significant differences were observed in the HIV testing rate and in the HIV positivity rate over the period (p < 0.001). Results from multiple regression analysis showed that the HIV testing rate per 100 000 population was the strongest predictor of the HIV positivity rate. HIV positivity among clients correlated negatively with the number of HIV tests conducted per 100 000 population (r = −0.823; p < 0.001) and the HIV testing rate (r = −0.324; p < 0.01). This study has found that HIV testing could have an impact on reducing the positivity rate of HIV in the province and is therefore an effective strategy in curbing the HIV epidemic. The KwaZulu-Natal Department of Health should ensure that strategies for implementing and maintaining HIV testing and treating services should continue at an accelerated rate in order to achieve the first 95 of the UNAIDS 2025 SDG target.

Progress towards 90-90-90 and 95-95-95 strategy implementations and HIV positivity trends in the City of Johannesburg.

The 95-95-95 strategy implementation is a positive initiative for moving the HIV tide towards elimination, with a focus on addressing the huge inequalities in existence in access to HIV services. To establish performance towards the 90-90-90 and 95-95-95 targets and trends in HIV positivity rates since strategy implementation rollout in the City of Johannesburg (CoJ), South Africa. This was a descriptive study, part of the bigger quasi-experimental study using the monthly District Health Information System during the implementation and rollout of the 90-90-90 strategy. HIV access trends were tracked and compared with the set strategy implementation targets. In addition, the HIV positivity rate was analysed to observe trends. A time trend analysis for aggregated data was performed on all the measured indicators to determine whether the decrease or increase was statistically significant. P<0.05 was used to indicate statistical significance. The study has shown that by March 2022, 15 months after December 2020, CoJ had reached 91-65-88. There were significant steady increases in the number of people who knew their HIV status (slope = 0.044, p<0.001) and initiating on antiretroviral therapy (ART) (slope = 0.001, p<0.001), and significant decreases for overall HIV positivity rate (slope = -0.016, p<0.001), adolescent positivity rate (slope = -0.0087, p<0.001) and antenatal care HIV positivity rate (slope = -0.013, p<0.001). This study has established positive progress made by the CoJ towards HIV testing, ART initiation, viral load suppression and HIV positivity rate. On the other hand, gaps in linkage to care after testing positive have been highlighted. It is therefore critical in the 95-95-95 strategy implementation era to focus on finding those missed during the 90-90-90 phase through revised and renewed innovative approaches.

1529. Factors Associated With HIV-positive Test Results in People Who Inject Drugs

Abstract Background Syringe Services Programs (SSP) are essential for harm reduction among persons who inject drugs (PWID). The Kentucky Income Reinvestment Program (KIRP), a statewide program funded through the Ryan White HIV/AIDS Program, provides comprehensive early intervention services targeting those at highest risk for HIV infection. As KIRP provides testing at SSPs and at other venues serving PWID, we sought to compare factors associated with a positive HIV test result between SSP sites and community testing sites. Methods We conducted a cross-sectional study across the state of Kentucky from January 2022 to March 2023. We compared the demographic characteristics of PWID tested across 54 SSPs versus PWID tested at KIRP outreach events (substance abuse treatment centers, correctional facilities, shelters, etc.); and factors associated with an HIV-positive test result. Study data were collected and managed using a REDCap database. The statistical analyses, including logistic regression, were performed with Stata 17 (College Station, TX: Stata Corp LLC). Results In the study period, 20,397 PWID were tested for HIV, 10,058 in the outreach events, and 10,339 at SSPs. The median age was 39 (IQR 32 – 46) years; 11,075 (54.3%) were male, 18,905 (92.7%) were white, and 550 (6.7%) reported MSM behavior. Outreach events were superior in reaching racial and ethnic minority groups. (Table 1). The HIV-positive rate was higher in the outreach group (0.37% vs. 0.15%; p=0.003). In a multivariate model, PWID not engaged with an SSP were significantly associated with higher HIV incidence when adjusted by gender, race, and sexual risk factors for HIV acquisition.Table 1.Demographic characteristics of the PWID tested for HIV by test location.Table 2.Factors associated with an HIV-positive test in PWID. Conclusion SSPs provide comprehensive harm reduction services, and, in our study, reduced HIV incidence amongst participants. We were able to reach more underrepresented populations with testing at outreach sites, which also serve PWID. To end the HIV epidemic, and increase prevention services, enrollment of underrepresented populations into SSP services is paramount. Disclosures All Authors: No reported disclosures

A comparative study of transgender women accessing HIV testing via face-to-face and telemedicine services in Chiang Mai, Thailand during the COVID-19 pandemic and their risk of being HIV-positive

BackgroundDue to the restricted availability of health services in Thailand, there are still some transgender women (TGW) who do not have access to HIV counseling and testing. Telehealth, which is accessible to individuals who are reluctant to undergo face-to-face interviewing, played an especially important role during the COVID-19 epidemic. The objectives of this study are to compare the characteristics, pattern of accessing HIV testing, and the HIV-positive rates of TGW between the face-to-face and telemedicine services.MethodsWe conducted a cross-sectional study to compare the access to HIV testing and the HIV-positive rates among TGW via face-to-face service and telemedicine services and examined the influence of potential associated factors on the risk of being HIV-positive.ResultsOf the 637 TGW participants, 26 (4.1%) were HIV-positive. Accessing the telemedicine service increased in the third and fourth COVID-19 waves (28.1% in the first and second vs. 71.9% in the third and fourth). There was no difference in the risk of being HIV-positive between the types of service. Having sex work experience (adjusted odds ratio (aOR) = 5.92; 95% confidence interval (CI): 1.57–22.30) and either never having been or tested more than 1 year ago were independently significantly associated with a higher risk of being HIV-positive (aOR = 4.05; 95% CI: 1.11–14.77).ConclusionThe telemedicine service became more popular among TGW during the COVID-19 pandemic and was not related to a higher risk of being HIV-positive. Moreover, it proved to be an effective alternative channel to access HIV testing, especially for intravenous drug users. Sex work experience and irregular HIV testing are key risk factors for HIV infection in TGW seeking either the telemedicine or face-to-face service.

Estimating prevalence and modelling correlates of HIV test positivity among female sex workers, men who have sex with men, people who inject drugs, transgender people and prison inmates in Sierra Leone, 2021

Key populations (KPs) are particularly vulnerable to HIV infection and efforts to prevent HIV infections among KPs have been less successful, largely due to existing laws and legislation that classify the groups as illegal. Understanding the HIV infection pathway and the burden of HIV infection among Female Sex Workers (FSWs), Transgender people (TG), Men who have sex with Men (MSM), People who Inject Drugs (PWID), and Prison Inmates (PIs) is critical to combatting the HIV epidemic globally. This study aims to estimate HIV prevalence and model the risk factors of HIV positivity rate among the aforementioned KPs in Sierra Leone. This study used Time Location Sampling, Respondent Driven Sampling (RDS), and Conventional cluster Sampling designs to generate a representative sample of FSWs, MSM, TG, PI, and PWID. HIV prevalence and the corresponding 95% confidence intervals among each KP were estimated by adjusting for sampling weight using the logit-transformed confidence intervals. To determine correlates of HIV test positivity among KPs, a multivariable modified Poisson regression model that adjusts for RDS survey weights was used and sensitivity analysis was conducted using a multivariable logistic regression model with cluster robust standard errors. The prevalence of HIV among FSWs in the six regional headquarter towns was estimated to be 11.8% (95% CI: 7.9–17.1); MSM was 3.4% [95% CI: 1.9–5.8]; TGs was 4.2% (95% CI: 2.9–6.1); PWIDs was 4.2% (95% CI: 2.7–6.4) and PI was 3.7% (95% CI: 1.4–9.6). The correlates of HIV test positivity among KPs and PIs include HIV-related knowledge, marital status, district, income, age and sex of KP, level of education, alcohol intake, injecting drugs, and use of lubricants. HIV prevalence is relatively high among FSWs, MSMs, PWID, and TGs as compared to the previous estimate of the general population. There is a need to scale up and strengthen evidence-based HIV prevention interventions such Pre-Exposure Prophylaxis and needle and syringe exchange programmes targeting KPs, including prison inmates. Government must scale up both non-clinical and clinical routine HIV and STI testing and counseling services at the correctional center and drop-in centers for KPs screening/testing, and ensure that services are responsive to the needs of KP.

Lost to follow up: the (non)psychosocial barriers to HIV/AIDS care in southeast Nigeria

ABSTRACT Medication withdrawal remains a problem in Nigeria’s HIV care. The Enugu state of southeast Nigeria has 3,736 people living with HIV/AIDS (PLHIV), with a 1.9% HIV-positive prevalence rate among the age band of 15–49 years, higher than 1.3%, the national average for the same cohort. Despite the disease burden, many cases are “lost to follow-up” in this region. Through four focus groups of patients (20 participants in total) and in-depth interviews with four clinicians from four public hospitals, this study aimed to understand the barriers to attending healthcare appointments faced by young adults. The participants were recruited through flyers, posters, and snowballs at clinics; both data sets were first analysed separately yet used to triangulate each other. We found that clinical interruptions are mainly attributable to factors such as stigma, suicidal ideation, loss of means of livelihood due to PLHIV’s “new identities”, and thus poverty and malnutrition. These barriers, complicated by the COVID-19 pandemic and armed conflicts in the region, have made medication adherence further challenging. Therefore, we recommend the Nigerian government integrate non-biomedical support for PLHIV into people-centred HIV care.

Improved access to HIV diagnosis and linkage to antiretroviral therapy among children in Southern Nigeria: a before-after study

BackgroundGlobally, two out of five children living with HIV (CLHIV) are unaware of their HIV status, and a little more than 50% are receiving antiretroviral therapy (ART). This paper describes case-finding strategies and their contribution to identifying CLHIV and linking them to ART in Nigeria.MethodsThis before-after study used program data abstracted during the implementation of different paediatric-focused strategies (provider-initiated testing and counselling, orphans and vulnerable children testing, family-based index testing, early infant diagnosis (EID), community-driven EID, and community-based testing) delivered in health facilities and in communities to improve HIV case identification. Data were abstracted for children (0 to 14 years) who received HIV testing services and were initiated on ART in Akwa Ibom State, Nigeria during the pre-implementation period (April–June 2021) and during the implementation period (July–September 2021). Descriptive statistics were used to describe the testing coverage, positivity rate (proportion of tests that were positive for HIV), linkage to ART, and ART coverage, by age, sex, and testing modality. Interrupted time series analysis (ITSA) on STATA 14 was used to estimate the effect of the implementation of these strategies on HIV testing uptake and positivity rate at a 0.05 significance level.ResultsA total of 70,210 children were tested for HIV within the six-month period, and 1,012 CLHIV were identified. A total of 78% (n = 54,821) of the tests and 83.4% (n = 844) CLHIV were diagnosed during the implementation period. During implementation, the HIV positivity rate increased from 1.09% (168/15,389) to 1.54% (844/54,821), while linkage to ART increased from 99.4% (167/168) to 99.8% (842/844). The contribution from community-based modalities to CLHIV identified increased from 63% (106/168) to 84% (709/844) during the implementation, with the majority, 60.8% (431/709), from community-based index testing. Overall, ART coverage increased from 39.7 to 55.6% at the end of the intervention period.ConclusionThe findings show that expanding differentiated HIV testing approaches provided mostly in the community significantly increased pediatric case identification. However, ART coverage remains low, especially for younger age groups, and requires further efforts.

Impact of COVID-19 on Sexually Transmitted Infection and HIV Screening at an Urban Safety-Net Hospital

HIV and other sexually transmitted infections (STIs) are on the rise nationally and internationally. The coronavirus 2019 (COVID-19) pandemic drove a shift toward telemedicine and prioritization of symptomatic treatment over asymptomatic screening. The impact in safety-net settings, which faced disproportionate baseline STI/HIV rates rooted in structural inequities, and where many patients lack telemedicine resources, is not yet known. This study describes the impact of COVID-19 on STI/HIV testing at an urban safety-net hospital. We used descriptive statistics to compare hospital-wide chlamydia, gonorrhea, syphilis, and HIV testing volume and positivity rates in the following periods: prepandemic (July 1, 2019-February 29, 2020), peak-pandemic (March 1, 2020-May 31, 2020), and postpeak (June 1, 2020-August 31, 2021). STI and HIV test volume dropped sharply in March 2020. STI testing during the peak-pandemic period was 42% of prepandemic baseline (mean 1145 vs. 2738 tests/month) and nadired in April 2020 (766 tests/month). Similarly, peak-pandemic HIV testing was 43% of prepandemic baseline (mean 711 vs. 1635 tests/month) and nadired in April 2020 with 438 tests/month, concentrated in emergency department and inpatient settings. STI and HIV testing rates did not return to baseline for a full year. STI and HIV test positivity rates were higher in the peak-pandemic period compared with the prepandemic baseline. Given the precipitous decline in STI and HIV testing during the pandemic, safety-net settings should develop low-barrier alternatives to traditional office-based testing to mitigate testing gaps, high positivity rates, and associated morbidity.

Maintaining HIV testing and treatment services in Zambia during COVID-19: a story of success and resilience

ABSTRACT Background Coronavirus disease 2019 (COVID-19) is caused by a virus called severe acute respiratory syndrome coronavirus. As countries struggled to control the spread of the virus through among other measures closure of health facilities, repurposing of health care workers, and restrictions on people’s movement, HIV service delivery was affected. Objectives To assess the impact of COVID-19 on HIV service delivery in Zambia by comparing uptake of HIV services before and during COVID-19. Methods We used repeated cross-sectional quarterly and monthly data on HIV testing, HIV positivity rate, people living with HIV initiating ART and use of essential hospital services from July 2018 to December 2020. We assessed quarterly trends and measured proportionate changes comparing periods before and during COVID-19 divided into three different comparison time frames: (1) annual comparison 2019 versus 2020; (2) April to December 2019 versus same period in 2020; and (3) Quarter 1 of 2020 as base period versus each of the other quarters of year 2020. Results Annual HIV testing dropped by 43.7% (95%CI 43.6–43.7) in 2020 compared to 2019 and was similar by sex. Overall, annual recorded number of newly diagnosed PLHIV fell by 26.5% (95% CI 26.37–26.73) in 2020 compared to 2019, but HIV positivity rate was higher in 2020, 6.44% (95%CI 6.41–6.47) compared to 4.94% (95% CI 4.92–4.96) in 2019. Annual ART initiation dropped by 19.9% (95%CI 19.7–20.0) in 2020 compared to 2019 while use of essential hospital services dropped during the early months of COVID-19 April to August 2020 but picked up later in the year. Conclusion While COVID-19 had a negative impact on health service delivery, its impact on HIV service delivery was not huge. HIV policies that were implemented before COVID-19 on testing made it easier to adopt COVID-19 control measures and to continue providing HIV testing services without much disruption.

Risk and Protective Profile of Men Who Have Sex With Men Using Mobile Voluntary HIV Counseling and Testing: Latent Class Analysis.

Mobile voluntary counseling and testing (VCT) for HIV has been carried out to improve the targeting of at-risk populations and HIV case detection for men who have sex with men (MSM). However, the HIV-positive detection rate using this screening strategy has declined in recent years. This may imply unknown changes in risk-taking and protective features jointly influencing the testing results. These changing patterns in this key population remain unexplored. The aim of this study was to identify the nuanced group classification of MSM who underwent mobile VCT using latent class analysis (LCA), and to compare the difference in characteristics and testing results between subgroups. A cross-sectional research design and purposive sampling were applied between May 21, 2019, and December 31, 2019. Participants were recruited by a well-trained research assistant through social networking platforms, including the most popular instant messenger app Line, geosocial network apps dedicated to MSM, and online communities. Mobile VCT was provided to participants at an assigned time and place. Demographic characteristics and risk-taking and protective features of the MSM were collected via online questionnaires. LCA was used to identify discrete subgroups based on four risk-taking indicators-multiple sexual partners (MSP), unprotected anal intercourse (UAI), recreational drug use within the past 3 months, and history of sexually transmitted diseases-and three protective indicators-experience of postexposure prophylaxis, preexposure prophylaxis use, and regular HIV testing. Overall, 1018 participants (mean age 30.17, SD 7.29 years) were included. A three-class model provided the best fit. Classes 1, 2, and 3 corresponded to the highest risk (n=175, 17.19%), highest protection (n=121, 11.89%), and low risk and low protection (n=722, 70.92%), respectively. Compared to those of class 3, class 1 participants were more likely to have MSP and UAI within the past 3 months, to be ≥40 years of age (odds ratio [OR] 2.197, 95% CI 1.357-3.558; P=.001), to have HIV-positive results (OR 6.47, 95% CI 2.272-18.482; P<.001), and a CD4 count ≤349/μL (OR 17.50, 95% CI 1.223-250.357; P=.04). Class 2 participants were more likely to adopt biomedical preventions and have marital experience (OR 2.55, 95% CI 1.033-6.277; P=.04). LCA helped derive a classification of risk-taking and protection subgroups among MSM who underwent mobile VCT. These results may inform policies for simplifying the prescreening assessment and more precisely recognizing those who have higher probabilities of risk-taking features but remain undiagnosed targets, including MSM engaging in MSP and UAI within the past 3 months and those ≥40 years old. These results could be applied to tailor HIV prevention and testing programs.

Reaching Populations at Risk for HIV Through Targeted Facebook Advertisements: Cost-Consequence Analysis

An undiagnosed HIV infection remains a public health challenge. In the digital era, social media and digital health communication have been widely used to accelerate research, improve consumer health, and facilitate public health interventions including HIV prevention. We aimed to evaluate and compare the projected cost and efficacy of different simulated Facebook (FB) advertisement (ad) approaches targeting at-risk populations for HIV based on new HIV diagnosis rates by age group and geographic region in the United States. We used the FB ad platform to simulate (without actually launching) an automatically placed video ad for a 10-day duration targeting at-risk populations for HIV. We compared the estimated total ad audience, daily reach, daily clicks, and cost. We tested ads for the age group of 13 to 24 years (in which undiagnosed HIV is most prevalent), other age groups, US geographic regions and states, and different campaign budgets. We then estimated the ad cost per new HIV diagnosis based on HIV positivity rates and the average health care industry conversion rate. On April 20, 2021, the potential reach of targeted ads to at-risk populations for HIV in the United States was approximately 16 million for all age groups and 3.3 million for age group 13 to 24 years, with the highest potential reach in California, Texas, Florida, and New York. When using different FB ad budgets, the daily reach and daily clicks per US dollar followed a cumulative distribution curve of an exponential function. Using multiple US $10 ten-day ads, the cost per every new HIV diagnosis ranged from US $13.09 to US $37.82, with an average cost of US $19.45. In contrast, a 1-time national ad had a cost of US $72.76 to US $452.25 per new HIV diagnosis (mean US $166.79). The estimated cost per new HIV diagnosis ranged from US $13.96 to US $55.10 for all age groups (highest potential reach and lowest cost in the age groups 20-29 and 30-39 years) and from US $12.55 to US $24.67 for all US regions (with the highest potential reach of 6.2 million and the lowest cost per new HIV diagnosis at US $12.55 in the US South). Targeted personalized FB ads are a potential means to encourage at-risk populations for HIV to be tested, especially those aged 20 to 39 years in the US South, where the disease burden and potential reach on FB are high and the ad cost per new HIV diagnosis is low. Considering the cost efficiency of ads, the combined cost of multiple low-cost ads may be more economical than a single high-cost ad, suggesting that local FB ads could be more cost-effective than a single large-budget national FB ad.

Analysis of the current status of needle and syringe exchange programmes for injecting drug users in China

Objective: To analyze the needle and syringe exchange programme (NSEP) implementation among injecting drug users (IDUs) in China and provide data support and a scientific reference for intervention among IDUs. Methods: All the statistical reports of high-risk behavior interventions during 2007-2021 were collected from the HIV/AIDS Comprehensive Response Information Management System. Descriptive analysis was used to analyze the changes in the number of NSEP points, regional distribution of NSEP points, the number of people covered, and the HIV detection rate in China from 2007 to 2021. Excel 2016 software was used to plot the variation trend. SAS 9.4 software was used for the needle recovery and HIV-positive detection rate to do the χ2 trend test. Results: There were 578 NSEP sites in 11 provinces (autonomous regions and municipalities) by the end of 2021, covering 21 215 IDUs. 2014-2021, the number of NSEP sites and the number of IDUs covered decreased year by year. Each injecting drug user participating in NSEP received more than 200 clean needles annually. The needle recovery rate showed an increasing trend(Z=170.26, P<0.001) from 2009 to 2016 but showed a decreasing trend (Z=-91.96, P<0.001) from 2016 to 2021. The rate of HIV-positive in IDUs participating in NSEP showed a downward trend (Z=-66.53, P<0.001), which decreased from 5.8% (2 709/46 591) in 2011 to 0.1% (19/21 215) in 2021, decreasing 98.3%. Conclusions: NSEP is a vital intervention to prevent HIV transmission through injecting drugs. There were still many difficulties. It is necessary to strengthen further communication and coordination with government and public security departments to understand and support for NSEP. Targeted publicity and education are needed to be carried out for local IDUs to encourage them to participate in NSEP and reduce their dropout. Meanwhile, peer educators supervision and management also need to be strengthened.