HIV Prevention Programs Research Articles

Can We Leverage HIV Prevention Programs for Breast Cancer Interventions? Preliminary Findings From a Study in Nigerian Women Working in the Informal Work Sector

PURPOSE Breast cancer (BC) is the leading cause of cancer-related deaths in Nigerian women. A large proportion of Nigerian women work as artisans in the informal work sector. As a population, they are unreached and underserved with poor access to BC information and screening services. Studies have demonstrated the feasibility of implementing HIV prevention programs through artisan groups. Integrating BC programs to existing HIV prevention programs may offer potentials to tap synergies and could lead to sustainable integrated interventions. This study assessed BC screening practices and the feasibility of implementing integrated HIV and BC programs among artisans. METHODS A cross-sectional study was carried out in 3 local government areas in Ibadan, Nigeria. Data were collected using an electronic data capture tool from 400 consenting respondents selected through a multistage sampling technique. Knowledge of BC and HIV were measured on 14- and 8-item scales. Data were analyzed using descriptive statistics and inferential tests at P < .05. RESULTS A quarter of the 400 respondents were age ≥ 40 years, a third were Muslims, and 64.8% had secondary level education or less. One third (32.8%) of the respondents had adequate knowledge of BC signs and symptoms. Of the respondents, 11.3% of the women received clinical breast examination, while the mammography rate for women age ≥ 40 years was 9.0%. In contrast, the proportion of artisans with adequate knowledge of HIV’s modes of transmission was 92.7% and HIV screening was 74%. Educational level, religion, and knowledge of BC signs and symptoms were significantly associated with BC screening ( P < .05). Rate of willingness to participate in an integrated HIV and BC intervention was 95.5%. CONCLUSION BC knowledge and screening practices are low. Findings will inform the development of an integrated intervention that can serve as a model with the potential to expand coverage, and reduce missed opportunities for early detection and treatment of BC and other noncommunicable diseases.

Learning About HIV: Predicting the Sources of Knowledge That Matter Regarding HIV Testing Among a National Sample of Black and Latinx Adolescents and Young Adults in the United States.

This study investigated the knowledge and beliefs of a nationally representative sample of youth and young adults about HIV based on the microsystems and mesosystems of the ecodevelopmental theory. We used a stratified sample (n = 538) of Black and Latinx adolescents and young adults in the United States, 15-24 years of age, at risk of becoming infected with HIV to assess the source of their HIV knowledge and its association with HIV testing to identify modifiable factors that can support the development of interventions addressing HIV-related risks. Using a logistic regression analysis, findings suggest that identifying protective health behaviors, such as providing adolescents and young adults with sexual health information that is accurate, trustworthy, and safe, could be one way to reduce their risk of HIV infection. Expanding knowledge about the important role and influence of sources of HIV-related knowledge on testing behaviors can inform HIV prevention and intervention programs specific to this population.

HIV Knowledge of Middle Eastern and North Africans 18-35 Residing in the U.S.: A Cross Sectional Study

ABSTRACT The current body of literature on the HIV knowledge related to young adult Middle Eastern and North African (MENA) individuals residing in the United States is substantially underdeveloped. As the number of MENA individuals residing in the US continues to rise, there remains a need for research investigating the levels of general HIV knowledge for this unique group. An exploratory cross-sectional design was used for an anonymous online survey of MENA adults ages 18–35 (n = 198) residing in the United States concerning their levels of HIV knowledge. Results showed that less than fifty percent (46.40%) of the sample reported adequate knowledge of HIV transmission and prevention methods. Multiple regression analyses indicate that prior sexual health education, prior HIV testing, a four-year college degree and identification as a Muslim predicted higher HIV knowledge. These findings may assist with the development of MENA specific HIV prevention and education programs.

Longitudinal relations of classroom goal structures to students’ motivation and learning outcomes in health education.

Little attention has been paid to goal structures in health education, despite their well-established roles in motivation and learning. The primary goal of this study was to examine the longitudinal relations of classroom goal structures to high school students’ (N = 636) motivation and learning outcomes in health education. We incorporated two aspects of motivation: self-efficacy for negotiating condom use and task values for learning new information about HIV and pregnancy prevention. Results revealed that students’ perceptions of a mastery goal structure were positively related to their self-efficacy and task values, and also their knowledge and behavioral intentions one year after the health education curriculum had been delivered. In contrast, students’ perceptions of an extrinsic goal structure were not related to their motivation and learning outcomes. Our findings suggest that the implementation of instructional practices focusing on mastery may enhance the efficacy of HIV and pregnancy prevention programs. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

The de-implementation and persistence of low-value HIV prevention interventions in the United States: a cross-sectional study

BackgroundAs more effective or efficient interventions emerge out of scientific advancement to address a particular public health issue, it may be appropriate to de-implement low-value interventions, or interventions that are less effective or efficient. Furthermore, factors that contribute to appropriate de-implementation are not well identified. We examined the extent to which low-value interventions were de-implemented among public health organizations providing HIV prevention services, as well as explored socio-economic, organizational, and intervention characteristics associated with de-implementation.MethodsWe conducted an online cross-sectional survey from the fall of 2017 to the spring of 2019 with organizations (N = 188) providing HIV prevention services in the USA. Organizations were recruited from the Center for Disease Control and Prevention’s (CDC) website gettested.org from 20 metropolitan statistical areas with the highest HIV incidence. An organization was eligible to participate if the organization had provided at least one of the HIV prevention interventions identified as inefficient by the CDC in the last ten years, and one administrator familiar with HIV prevention programming at the organization was recruited to respond. Complete responses were analyzed to describe intervention de-implementation and identify organizational and intervention characteristics associated with de-implementation using logistic regression.ResultsOrganizations reported 359 instances of implementing low-value interventions. Out of the low-value interventions implemented, approximately 57% were group, 34% were individual, and 5% were community interventions. Of interventions implemented, 46% had been de-implemented. Although we examined a number of intervention and organizational factors thought to be associated with de-implementation, the only factor statistically associated with de-implementation was organization size, with larger organizations—those with 50+ FTEs—being 3.1 times more likely to de-implement than smaller organizations (95% CI 1.3–7.5).ConclusionsWhile low-value interventions are frequently de-implemented among HIV prevention organizations, many persisted representing substantial inefficiency in HIV prevention service delivery. Further exploration is needed to understand why organizations may opt to continue low-value interventions and the factors that lead to de-implementation.

Sexual Health of Rural and Urban Young Male Couples in the United States: Differences in HIV Testing, Pre-exposure Prophylaxis Use, and Condom Use.

Young men who have sex with men (YMSM) are disproportionally affected by HIV, and main partnerships account for a large proportion of new HIV infections. HIV prevention is largely focused on urban YMSM, and less is known about sexual health of rural male couples. The present study used data from a randomized controlled trial of a relationship education and HIV prevention program for male couples to test associations of rurality with HIV/STI testing, PrEP use, number of sexual partners, and condomless anal sex (CAS) acts. Participants were 430 YMSM in relationships. Rural YMSM were less likely to have been tested for HIV/STIs, and to have used PrEP, compared to urban YMSM. Although higher rurality was associated with fewer CAS acts, CAS was not infrequent among rural YMSM, highlighting the need for increased HIV prevention geared toward young male couples living in rural, less resourced areas.

Understanding of personal agency among youth to curtail HIV rates

We aimed to discover which social factors influence protective health behaviors among Black youth. We measured study variables based on data from the National Survey of Teens and Young Adults on HIV/AIDS. Participants include youth aged 15 to 24 who completed a 40-question, web-based survey. The analytical sample of participants (n = 270) only comprised African American youth, mean age 20 years (SD: 0.28). Using multiple regression analysis, study findings suggest that focusing on protective health behaviors, such as personal agency among youth, with variables like personal perception and concern and HIV testing could be one way to reduce their risk of HIV transmission. Enhancing the role and influence of personal agency given their testing behaviors can inform HIV prevention and intervention programs that are specific to Black youth. Our findings identify targets for intervention to enhance personal agency in this population, including enhancing HIV risk prevention.

Application of the "syndemics" theory to explain unprotected sex and transactional sex: A crosssectional study in men who have sex with men (MSM), transgender women, and non-MSM in Colombia.

Introduction: Men who have sex with men (MSM) and transgender women (TW) in Colombia are highly affected by HIV. To improve understanding of the role of HIV risk behaviors in HIV acquisition, we used the syndemic framework, a useful concept to inform prevention efforts.Objective: To examine the effect of four psychosocial conditions, namely, forced sex, history of childhood sexual abuse, frequent alcohol use, and illicit drug use on unprotected sex and the synergistic effects (“syndemic” effects) of these conditions on HIV risk behavior.Materials and methods: We enrolled a total of 812 males (54.7% men who have sex with men, MSM; 7.3% transgender women, and 38% non-MSM). The participants were recruited from neighborhoods of low socioeconomic status through free HIV-counseling and-testing campaigns. We performed Poisson regression analysis to test the associations and interactions between the four psychosocial conditions and unprotected sex with regular, occasional, and transactional partners. To test the “syndemic” model, we assessed additive and multiplicative interactions.Results: The prevalence of any psychosocial condition was 94.9% in transgender women, 60.1% in MSM, and 72.2% in non-MSM. A higher likelihood of transactional sex was associated in MSM (prevalence ratio (PR)=7.41, p<0.001) and non-MSM (PR=2.18, p< 0.001) with three or all four conditions compared to those with one condition. Additive interactions were present for all combinations of psychosocial problems on transactional sex in MSM. No cumulative effect or additive interaction was observed in transgender women. Conclusions: Our study highlights the need for bundled mental health programs addressing childhood sexual abuse, illicit drug use, and frequent alcohol use with other HIV prevention programs.

Understanding the costs and the cost structure of a community-based HIV and gender-based violence (GBV) prevention program: the Woza Asibonisane Community Responses Program in South Africa

BackgroundThe Woza Asibonisane Community Responses (CR) Programme was developed to prevent HIV infections and gender-based violence (GBV) within four provinces in South Africa. The Centre for Communication Impact (CCI) in collaboration with six partner non-governmental organizations (NGOs) implemented the programme, which was comprised of multiple types of group discussion and education activities organized and facilitated by each NGO. To date, little information exists on the cost of implementing such multi-objective, multi-activity, community-based programmes. To address this information gap, we estimated the annual cost of implementing the CR Programme for each NGO.MethodsWe used standard methods to estimate the costs for each NGO, which involved a package of multiple activities targeted to distinct subpopulations in specific locations. The primary sources of information came from the implementing organizations. Costs (US dollars, 2017) are reported for each partner for one implementation year (the U.S. Government fiscal year (10/2016–09/2017). In addition to total costs disaggregated by main input categories, a common metric--cost per participant intervention hour--is used to summarize costs across partners.ResultsEach activity included in the CR program involve organizing and bringing together a group of people from the target population to a location and then completing the curriculum for that activity. Activities were held in community settings (meeting hall, community center, sports grounds, schools, etc.). The annual cost per NGO varied substantially, from $260,302 to $740,413, as did scale based on estimated total participant hours, from 101,703 to 187,792 participant hours. The cost per participant hour varied from $2.8–$4.6, with NGO labor disaggregated into salaries for management and salaries for service delivery (providing the activity curriculum) contributing to the largest share of costs per participant hour.ConclusionsThe cost of implementing any community-based program depends on: (1) what the program implements; (2) the resources used; and (3) unit costs for such resources. Reporting on costs alone, however, does not provide enough information to evaluate if the costs are ‘too high’ or ‘too low’ without a clearer understanding of the benefits produced by the program, and if the benefits would change if resources (and therefore costs) were changed.

Roles of role players in the implementation of school-based human immunodeficiency virus and acquired immunodeficiency syndrome prevention programmes in local high school settings.

BackgroundWorldwide, a large proportion of all new HIV infections occur in people under the age of 25. HIV and AIDS remain the leading cause of deaths among adolescents in sub-Saharan Africa and second leading cause of death globally. Preventing new HIV infections and AIDS-related deaths are at the heart of South Africa’s National Strategic Plan on HIV and AIDS, STIs and TB 2017-2022.AimsExplore and describe the roles of the local role players in the implementation of the school-based HIV and AIDS prevention programmes in local high school settings.SettingsThe study was conducted in the Bushbuckridge local municipal area in Mpumalanga Province.MethodsA qualitative, explorative, descriptive design and contextual study was used. Individual interviews and focus group interviews were conducted with the purposively selected participants from the clinic, health centre, high schools and community members. Data was analysed using Tesch’s method of data analysis.ResultsAlthough all the local role players were found to have important roles to play in the implementation of the school-based HIV and AIDS prevention programme, gaps exist in the rendering of youth friendly services (YFS); accessible clinic times; HIV and AIDS education; life skills education; Life Orientation (LO) and health education; information sessions; counselling; school health programmes; campaigns as well as collaborative working strategy.ConclusionSuccessful development and collaborative implementation of the school-based HIV and AIDS prevention programme can result in significant changes in knowledge and attitudes that affect sexual behaviour of young people, leading to significant decrease in HIV infection among young people.

Creating HIV risk profiles for men in South Africa: a latent class approach using cross-sectional survey data.

IntroductionEngaging at‐risk men in HIV prevention programs and services is a current priority, yet there are few effective ways to identify which men are at highest risk or how to best reach them. In this study we generated multi‐factor profiles of HIV acquisition/transmission risk for men in Durban, South Africa, to help inform targeted programming and service delivery.MethodsData come from surveys with 947 men ages 20 to 40 conducted in two informal settlements from May to September 2017. Using latent class analysis (LCA), which detects a small set of underlying groups based on multiple dimensions, we identified classes based on nine HIV risk factors and socio‐demographic characteristics. We then compared HIV service use between the classes.ResultsWe identified four latent classes, with good model fit statistics. The older high‐risk class (20% of the sample; mean age 36) were more likely married/cohabiting and employed, with multiple sexual partners, substantial age‐disparity with partners (eight years younger on‐average), transactional relationships (including more resource‐intensive forms like paying for partner’s rent), and hazardous drinking. The younger high‐risk class (24%; mean age 27) were likely unmarried and employed, with the highest probability of multiple partners in the last year (including 42% with 5+ partners), transactional relationships (less resource‐intensive, e.g., clothes/transportation), hazardous drinking, and inequitable gender views. The younger moderate‐risk class (36%; mean age 23) were most likely unmarried, unemployed technical college/university students/graduates. They had a relatively high probability of multiple partners and transactional relationships (less resource‐intensive), and moderate hazardous drinking. Finally, the older low‐risk class (20%; mean age 29) were more likely married/cohabiting, employed, and highly gender‐equitable, with few partners and limited transactional relationships. Circumcision (status) was higher among the younger moderate‐risk class than either high‐risk class (p < 0.001). HIV testing and treatment literacy score were suboptimal and did not differ across classes.ConclusionsDistinct HIV risk profiles among men were identified. Interventions should focus on reaching the highest‐risk profiles who, despite their elevated risk, were less or no more likely than the lower‐risk to use HIV services. By enabling a more synergistic understanding of subgroups, LCA has potential to enable more strategic, data‐driven programming and evaluation.

Condom use among young women who sell sex in Zimbabwe: a prevention cascade analysis to identify gaps in HIV prevention programming.

IntroductionAdolescent girls and young women (AGYW), including those who sell sex in sub‐Saharan Africa, are especially vulnerable to HIV. Reaching them with effective prevention is a programmatic priority. The HIV prevention cascade can be used to track intervention coverage, and identify gaps and opportunities for programme strengthening. The aim of this study was to characterise gaps in condom use and identify reasons underlying these gaps among young women who sell sex (YWSS) in Zimbabwe using data from enrolment into an impact evaluation of the DREAMS programme. DREAMS provided a package of biomedical, social and economic interventions to AGYW aged 10 to 24 with the aim of reducing HIV incidence.MethodsIn 2017, we recruited YWSS aged 18 to 24 using respondent‐driven sampling in six sites across Zimbabwe. We measured knowledge about efficacy of, access to, and effective (consistent) use of condoms with the most recent three sexual partners, separately by whether YWSS self‐identified as female sex workers (FSW) or not. Among YWSS without knowledge about efficacy of, not having access to, and not effectively using condoms, we described the potential reasons underlying the gaps in the condom cascade. To identify socio‐demographic characteristics associated with effective condom use, we used logistic regression modelling. All analyses were RDS‐II weighted and restricted to YWSS testing HIV‐negative at enrolment.ResultsWe enrolled 2431 YWSS. Among 1842 (76%) YWSS testing HIV‐negative, 66% (n = 1221) self‐identified as FSW. 89% of HIV‐negative YWSS demonstrated knowledge about efficacy of condoms, 80% reported access to condoms and 58% reported using condoms consistently with the three most recent sexual partners. Knowledge about efficacy of and effective use of condoms was similar regardless of whether or not YWSS self‐identified as FSW, but YWSS self‐identifying as FSW reported better access to condoms compared to those who did not (87% vs 68%; age‐ and site‐adjusted (adjOR) = 2.69; 95% CI: 2.01 to 3.60; p < 0.001). Women who reported experiencing sexual violence in the past year and common mental disorder in the past week were less likely to use condoms consistently (43% vs. 60%; adjOR = 0.49; 95% CI: 0.35 to 0.68; p < 0.001) and (51% vs. 61%; adjOR = 0.76; 95% CI: 0.60 to 0.97; p = 0.029), respectively.ConclusionsDespite high knowledge about efficacy of and access to condoms, there remain large gaps in self‐reported consistent condom use among YWSS. Addressing the structural determinants of YWSS’ inconsistent condom use, including violence, could reduce this gap. YWSS who do not self‐identify as FSW have less access to condoms and may require additional programmatic intervention.

A tale of two cascades: promoting a standardized tool for monitoring progress in HIV prevention.

IntroductionTo achieve significant progress in global HIV prevention from 2020 onward, it is essential to ensure that appropriate programmes are being delivered with high quality and sufficient intensity and scale and then taken up by the people who most need and want them in order to have both individual and public health impact. Yet, currently, there is no standard way of assessing this. Available HIV prevention indicators do not provide a logical set of measures that combine to show reduction in HIV incidence and allow for comparison of success (or failure) of HIV prevention programmes and for monitoring progress in meeting global targets. To redress this, attention increasingly has turned to the prospects of devising an HIV prevention cascade, similar to the now‐standard HIV treatment cascade; but this has proven to be a controversial enterprise, chiefly due to the complexity of primary prevention.DiscussionWe address a number of core issues attendant with devising prevention cascades, including: determining the population of interest and accounting for the variability and fluidity of HIV‐related risk within it; the fact that there are multiple HIV prevention methods, and many people are exposed to a package of them, rather than a single method; and choosing the final step (outcome) in the cascade. We propose two unifying models of prevention cascades‐one more appropriate for programme managers and monitors and the other for researchers and programme developers‐and note their relationship. We also provide some considerations related to cascade data quality and improvement.ConclusionsThe HIV prevention field has been grappling for years with the idea of developing a standardised way to regularly assess progress and to monitor and improve programmes accordingly. The cascade provides the potential to do this, but it is complicated and highly nuanced. We believe the two models proposed here reflect emerging consensus among the range of stakeholders who have been engaging in this discussion and who are dedicated to achieving global HIV prevention goals by ensuring the most appropriate and effective programmes and methods are supported.

Low program access despite high burden of sexual, structural, and reproductive health vulnerabilities among young women who sell sex in Mombasa, Kenya

BackgroundAcross Sub-Saharan Africa, young women who sell sex (YSW) face institutional barriers in accessing sexual health and HIV prevention programs designed for female sex workers. In 2018, Kenya developed a national framework to guide service provision for YSW aged 14–24 years. To help inform the implementation of the framework, we estimated the burden of vulnerabilities related to the Sustainable Development Goals (SDGs related to health and gender equality) and program contact among YSW.MethodsWe used data from Transitions, a 2015 bio-behavioural cross-sectional survey of 408 YSW aged 14–24 years in Mombasa, Kenya. We estimated the prevalence of sexual (inconsistent condom use), structural (financial, violence), and reproductive health vulnerabilities; and characterized engagement with local HIV programs tailored to sex workers. We then compared the prevalence of vulnerabilities by age group (14–18 years, N = 117; 19–24 years, N = 291) and by program contact (ever contacted by local program for sex workers).Results47.3% reported inconsistent condom use with any partner in the previous week (no difference by age-group, p = 1.00). Structural vulnerabilities were common and did not vary by age: 83.6% did not have a regular source of income; 29.9 and 29.2% had experienced physical and sexual violence, respectively. 26.5% reported at least one pregnancy before age 18, and 18.5% used a non-reliable form of contraception with little variability by age. 25.7% were aware of at least one program, and only 13.7% of YSW had ever been contacted by a program (8.5% of those aged 14–18 years; and 15.8% of those aged 19–24 years, p = 0.06). Sexual, structural, and reproductive health vulnerabilities did not vary by program contact.ConclusionsSDG-related vulnerabilities begin early in the lives of YSW who are not currently reached by programs designed for female sex workers.

Attributes of HIV infection over decades (1982-2018): A systematic review and meta-analysis.

Understanding the risk factors for HIV infection is the foundation of successful preventive strategies, which must bundle sociocultural, behavioural and biomedical interventions to halt disease transmission. We aimed in this study to provide a pooled estimation of HIV risk factors and trace changes across decades in order to drive consensus and accurate assessment of disease transmission risk. We comprehensively searched PubMed, ISI Web of Knowledge, Medline, EMBASE, ScienceDirect, Ovid, EBSCO, Google Scholar and the Egyptian Universities Library Consortium from October to December 2018. Two independent reviewers extracted data from eligible studies. Funnel plots were inspected to identify publication bias. Heterogeneity across studies was checked using the Q and I2 statistics. The results were reported based on the pooled odds ratio (pOR) with 95% CI using a random-effects model. Meta-analysis of HIV risk factors revealed a superior role for risky sexual practices (unprotected vaginal/anal sex), injecting drug use (IDU), sharing needles, sexually transmitted infections (STIs), child sexual abuse and vertical transmissions. Trends across decades (1982-1999 and 2000-2018, respectively) showed rising evidence for prostitution [pOR (95% CI)= 2.3 (1.12-4.68) versus 2.69 (1.67-4.32)] and men who have sex with men (MSM) [pOR (95% CI)= 2.28 (1.64-3.17) versus 3.67 (1.88-7.17)], while transmission through IDU [pOR (95% CI)= 3.42 (2.28-5.12) versus 2.16 (1.74-2.70)], alcoholism [pOR (95% CI)= 2.35 (0.73-7.59) versus 1.71(1.08-2.72)], and sharing syringes [pOR (95% CI)= 6.10 (2.57-14.5) versus 2.70 (2.01-6.35)] showed notable decline. Harm reduction programs and condom use have been recognized as chief HIV prevention strategies, while male circumcision contributed a partial role. Collectively, sexual risk factors continue to be a key driver of the global HIV epidemic. Persistent and emerging risk factors identified in our analysis should constitute the forefront targets of HIV prevention programmes to accelerate efforts towards HIV elimination.

Views about HIV and sexual health among gay and bisexual Filipino men living in New Zealand

ABSTRACT HIV infection is an issue for all gay and bisexual men in New Zealand, including men of Asian ethnicity among whom HIV infection is increasing. This study identifies the ways Filipino gay and bisexual men living in New Zealand talk about and understand issues related to HIV and HIV health-promoting behaviours. A qualitative descriptive methodology was used. Individual face-to-face interviews were analysed using a general inductive analytic approach. Three themes are evident across the men’s talk in relation to knowledge and practices around HIV and HIV health-promoting behaviours: (a) safe-sex is about condom use, (b) low levels of engagement with HIV testing, and (c) barriers to engagement with HIV-health promotion. The study results have implications for HIV health promotion and prevention programmes. Specifically, improved health literacy around HIV and prevention technologies is required. Culturally appropriate services and health promotion interventions need to be developed. Improved support and advocacy for gay and bisexual men in the broader Filipino community to counter stigma appear warranted.

Social Capital and HIV Testing Uptake among Indirect Female Sex Workers in Bali, Indonesia.

Indirect female sex workers (FSWs), a type of FSW working under the cover of entertainment enterprises (e.g., karaoke lounge, bar, etc.), remain as an important key population for HIV transmission, signaling the need of appropriate interventions targeting HIV-related behaviors. This study aimed to investigate the association between social capital and HIV testing uptake. A cross-sectional study was conducted among 200 indirect FSWs in Denpasar, Bali. The dependent variable was HIV testing uptake in the last six months preceding the survey. The main independent variables were social capital constructs: social cohesion (perceived peer support and trust) and social participation. Variables of socio-demographic characteristics were controlled in this study to adjust the influence of social capital. Binary logistic regression was performed. The prevalence of HIV testing in the last six months was 72.50%. The multivariate analysis showed that only peer support from the social capital constructs was associated with HIV testing uptake. Indirect FSWs who perceived a high level of support within FSWs networks were 2.98-times (95% CI = 1.43–6.24) more likely to report for HIV testing. Meanwhile, perceived trust and social participation did not show significant associations in relation to HIV testing uptake. As social cohesion (support) within FSWs’ relationships can play an important role in HIV testing uptake, existing HIV prevention programs should consider support enhancement to develop a sense of belonging and solidarity.

Linkage of voluntary medical male circumcision clients to adolescent sexual and reproductive health (ASRH) services through Smart-LyncAges project in Zimbabwe: a cohort study

ObjectivesWHO recommended strengthening the linkages between various HIV prevention programmes and adolescent sexual reproductive health (ASRH) services. The Smart-LyncAges project piloted in Bulawayo city and Mt Darwin district of Zimbabwe...

Cohort profile: the LHIV-Manitoba clinical cohort of people living with HIV in Manitoba, Canada

PurposeThe LHIV-Manitoba cohort was developed as a way to provide a comprehensive source of HIV-related health information in the central Canadian Prairie province of Manitoba. The cohort will provide important...

PNS35 A POLICY TOOL TO ESTIMATE DISABILITY-ADJUSTED LIFE YEARS

The evidence base that allows comparisons of various interventions across different disease areas is key for informing resource allocation decisions. Converting disease-specific metrics (e.g., cases averted) to disability-adjusted life years (DALYs), a standardized metric that captures both longevity and morbidity, is a necessary step for prioritizing health interventions and making comparisons in similar terms. We developed a Web-based, user-friendly DALY calculator (https://cevr.shinyapps.io/DALYcalculation/) and provided a case study to illustrate the conversion process. With user-specified inputs for disease type, age at onset, and age at death, the DALY calculator estimates years of life lost, years lived with disease, and total DALYs at the individual level. Disease incidence and mortality information can be input for population-level estimates. As a case study, we extracted relevant information from a published cost-effectiveness study that estimated the impact of an HIV prevention program in India using both HIV cases and DALYs averted. Modifying the underlying R code to reflect customized disability weights and other data used in the study, we estimated DALYs per HIV case using our calculator and compared our results to the published estimates. To estimate country-specific DALYs, we updated the standard life expectancy table with country-specific life expectancy. The original paper reported approximately 62,000 HIV cases and 1.06 million DALYs averted due to the program, or 17.2 DALYs averted per case. Our online calculator estimate with country-specific life expectancy data was 20.58. Using the customized R code that included additional study data yielded an estimate of 19.42. Residual differences from the published estimates are likely due to disease transmission parameters that our standard calculator does not reflect. The online DALY calculator provides an intuitive and efficient way to convert health outcomes expressed as non-DALY metrics into estimated DALYs. Further validation efforts should focus on additional disease areas and interventions.