Rapid HIV Testing Research Articles

759. Where can we find active TB? Case finding at community sites and alcohol based venues (ABVs) in rural South Africa

BackgroundCommunity-based intensive case finding (CBICF) is an effective strategy for infectious disease case detection, particularly for hard-to-reach populations. Alcohol use is increasingly recognized as a risk factor for tuberculosis. We report on the association of alcohol use with tuberculosis case detection as part of a CBICF in a rural resource limited setting.MethodsIn rural KwaZuluNatal, South Africa, community health workers stationed outside ABVs, community centers, and public events conducted health education and voluntary confidential screening in a mobile clinic. A WHO endorsed TB symptom screen (with sputum collection for GeneXpert if ≥1 symptom), HIV rapid test, random glucose (elevated >7mmol/L), and blood pressure (elevated >140 or >90mmHg) were offered. Community members with positive results were referred to their primary care clinic. Alcohol Use Disorder Identification Test (AUDIT) was used to identify hazardous drinking (score ≥8for men, ≥6for women). Here we report on TB screening results only.ResultsAmong 1438 participants, 91.2% were screened at ABV, 72.3% were male, median age was 30 (IQR 22-46), 25.9% were employed, 92.0% had electricity but only 29.4% had running water. Among those screened at all sites, 43.1% reported hazardous alcohol use, 39.3% tobacco use, and 13.9% cannabis use. Overall, 5 people with active TB were identified representing a number needed to screen of 288 to identify one case of TB. Bivariate analysis showed TB cases were more likely to be associated with older age (p=0.03), cigarette use (p=0.06), and hazardous alcohol use (p=0.01). Among only men who were screened, older age (p=0.01) and hazardous alcohol use (p=0.04) were associated with active TB disease. The mean AUDIT score among TB cases was 13.8 (SD 4.09) compared to non-TB cases 6.8 (SD 7.5) (p=0.04).ConclusionCBICF is a useful way to detect people with active TB, especially for hard-to-reach rural populations. Focusing screening efforts among those at ABVs is high yield and can be a useful adjunctive strategy for TB case finding efforts. These findings highlight a need for comprehensive substance abuse services to assist those at high risk for TB acquisition.Disclosures All Authors: No reported disclosures

978. Barriers to Recruitment of Latino Men who Have Sex with Men and Transgender Women to Behavioral HIV Seroprevalence Studies

BackgroundChicago’s HIV epidemic disproportionally affects people of color. Almost a quarter (23%) of these infections occur in Hispanics. It is important to understand sexual behaviors and HIV risk in Latino MSM and transgender women (TGW) to create targeted culturally sensitive harm reduction interventions. However, participation of minority MSM and TGW in survey-based studies is low. The main objective of the study was to understand the sexual health and of Latino MSM and TGW residing in Chicago, Illinois, United States. We herein report subject’s attitudes towards participating in the study and qualitative observations about perceived barriers to enrollment of this population.MethodsThis study was a cross sectional analysis of a behavioral/HIV seroprevalence survey administered during 2017-2020 to presumed HIV negative, Latino identifying, MSM and TGW individuals. The survey included questions on sexual risk, HIV knowledge and depression scores. We categorized recurrent themes of the most common reasons participants provided for declining to participate in the study. We generated descriptive statistics.ResultsA total of 48 community organizations assisted with recruitment. Of 149 participants screened, only 18 (12%) agreed to complete the survey. Among those who declined to complete the survey (n=131), the most common reasons given were: participants were uncomfortable answering some questions (n=59, 45.0%), participant’s did not have the time to initiate or complete the survey (n=41, 31.3%) and survey was deemed long (n=16, 12.2%).We categorized barriers to successful recruitment into the following general themes: 1) Participants were unwilling to discuss their sexual history; 2) Participant’s felt uncomfortable taking a rapid oral HIV test; 3) Participant’s lacked transportation; and 3) Participants didn’t have time to complete the survey or thought it was too long.ConclusionDespite extensive community networking, we found barriers to recruitment of high-risk Latino MSM and TGW into an HIV seroprevalence study. Further research is needed to better understand and address these barriers, and thus, increase representation of this key population in prevention studies.Disclosures All Authors: No reported disclosures

1039. Real World Community-Based HIV Rapid Start Antiretroviral with BFTAF Versus Conventional HIV Antiretroviral Therapy Start – The RoCHaCHa Study, a Pilot Study

BackgroundTrillium Health (TH) is a FQHC in Rochester, NY providing primary and specialty care, including HIV prevention and treatment. Rapid Start ART (RSA) has been shown to decrease time to virologic suppression while increasing linkage to and retention in care. However, data on BFTAF with these benefits is limited. We aim to prove RSA with BFTAF is advantageous in time to viral load suppression, linkage to and retention in care, and patient satisfaction and acceptance.MethodsWe included data from ART-naive newly diagnosed PLWH enrolled between October 2018 and March 2020 with baseline assessment and started BFTAF. Follow up visits were done per protocol though 48 weeks. The primary study endpoints include median times from: diagnosis to clinic presentation, clinic presentation to ART, and ART to undetectable viral load (VL), < 200 copies/mL and < 50 copies/mL. Linkage to and retention in care were measured at 3 months. Study results were compared with non-RSA historical control data. Patient reported outcomes were evaluated at study completion.ResultsOf the 27 eligible, 25 participants enrolled. Thirteen received their diagnosis at TH: screening for PrEP (6), community-based HIV/STI/HCV testing (3), community outreach (1), or routine patient screening in primary care (3). Twelve were diagnosed externally: university health centers (2), other health clinic (9), or at-home rapid HIV test (1). All accepted the RSA treatment with BFTAF; two eligible patients declined the study, but accepted RSA. 73.9% of participants were seen within 14 days of Day 84, compared with 50% of historical control group. 12 of 25 completed the primary endpoint of which 100% were highly satisfied with RSA. There were no regimen changes or virologic failures through 48 weeks.RoCHaCHa Study Results ConclusionRSA with BFTAF reduced time to virologic suppression in all participants newly diagnosed with HIV-1 compared with historical non-RSA model.DisclosuresAshley R. Zuppelli, PHARMD, BCACP, AAHIVP, Gilead Sciences, Inc. (Grant/Research Support)Gilead Sciences, Inc. (Advisor or Review Panel member, Research Grant or Support) Michael Mancenido, DO, AAHIVS, Gilead Sciences, Inc. (Grant/Research Support) Jacob Scutaru, MD, Gilead Sciences, Inc. (Grant/Research Support) Alexandra Danforth, PHARMD, BCACP, AAHIVP, Gilead Sciences, Inc. (Grant/Research Support) Robert Biernbaum, DO, MS, FAAEM, AAHIVS, Gilead Sciences, Inc. (Grant/Research Support, Advisor or Review Panel member, Speaker’s Bureau) Roberto Corales, DO, AAHIVS, Gilead Sciences (Employee) William M. Valenti, MD, FIDSA, Gilead Sciences, Inc. (Grant/Research Support, Speaker’s Bureau)

Leveraging Non-Communicable Diseases for Rapid Community-Based HIV Testing Mechanism in Sri Lanka

Leveraging Non-Communicable Diseases for Rapid Community-Based HIV Testing Mechanism in Sri Lanka

False reactive HIV rapid antibody test in pregnancy

Background: Universal screening of HIV infection in pregnant women is recommended by CDC as well as Indonesia Ministry of Health to prevent mother-to-child HIV transmission. Algorithm of HIV testing in pregnant women in Indonesia is similar to that in Integrated Counseling and Testing Centre (ICTC) which refes to WHO HIV Testing Strategy III. Pregnancy has been observed to be associated with false positive HIV testing that can cause serious emotional distress and unnecessary follow-up. Case Description: A 21 y old pregnant woman was referred to a tertiary hospital with premature rupture of the membranes. Before C-section, preoperative laboratory test panels were ordered, including for HIV to which she consented. A rapid HIV test (A1) was performed and tested reactive for antibodies against HIV. The second (A2) and third (A3) rapid tests were then performed and yielded non-reactive results, concluding the final result as negative. Reassessment of the patients showed no risk factors for HIV infection. This was the third case of reactive A1 with non-reactive A2 and A3 within the last year in the hospital. After confirmatory tests, which came back non-reactive and negative for fourth-generation HIV test and Western Blot, respectively, the A1 test was considered as false positive. Discussion: Based on several reports, there are alloantibodies in pregnancy, transfusions, transplantations, and autoimmune diseases that account for the increased false positive rate. Positive HIV antibody test results can occur in the absence of infection due to cross-reactivity between viral proteins and tested specimens, but such cross-reactivity is less common using current peptide-based EIAs which contain fewer antigens than previous viral lysate-based EIAs. However, clinicians should be aware that when HIV prevalence is low, as is often the case among pregnant women, a reactive EIA result is more likely to be false positive. Conclusion: Counselling and HIV test should be integrated in antenatal care. Diagnostic procedure of HIV test in pregnant women refers to WHO Testing Strategy III. Because the positive predictive value of HIV test in obstetric population is low, positive screening results should be handled carefully and appropriate confirmatory testing should always be pursued.

Prevalence of HIV among Transgenders in Nigeria

Background: Despite the growing awareness on the need to provide HIV/AIDS services specific to key populations (Female Sex Workers (FSWs), Men who have sex with Men (MSM), People Who Inject Drugs (PWID), and Transgenders (TG)) in Nigeria, the interventions for the Transgender group has not gained the needed attention. To the best of our knowledge, no data has been published on the prevalence of HIV among this sub-group of key Populations in Nigeria. Thus, this study aimed to investigate the prevalence of HIV among Transgenders in Nigeria. Methods and materials: We conducted a cross-sectional study in five states of Nigeria (Akwa Ibom, Benue, Cross River, Lagos, and the Federal Capital Territory (FCT)) using purposeful sampling techniques, from November 2018 to July 2019. HIV Testing Services was provided to identified transgender in Heartland Alliance International Nigeria (HAI-N) supported HIV/Sexually Transmitted Infections (STIs) clinics, located in the fives states where the study was conducted. HIV Rapid Test Kits (Determine, Unigold, and Stat Pack) were used for study. Data on the results of the test were analyzed using the Statistical Package for Social Sciences (SPSS) version 23 to obtain frequencies and percentages. Results: We analyzed program records from 1,007 Transgenders. The mean age of participants was 31.1 ± 3 years, and the modal age 20–24. The majority, 44.3% (446/1007) of the participants were Transgenders resident in Akwa Ibom state. The overall prevalence of HIV among all the participants was 10.0%. The highest prevalence (22.7%) was among transgender aged 35–39 years. Geographically, Cross River State had the highest prevalence rate (23.8%), followed by Lagos (9.1%), Benue (8.0%), Akwa Ibom (6.7%) and the least was in FCT (3.3%). Conclusion: The prevalence of HIV among Transgender in Nigeria was high when compared to the general population, with wide variance in geographical boundaries. However, this prevalence is slightly lower than the prevalence noted among other key population groups in Nigeria. Therefore, there is high need for the government of Nigeria to prioritize and scale up HIV prevention and treatment services among the transgender group in Nigeria.

The availability, use and disposal of malaria and HIV rapid diagnostic test kits in health facilities in the greater Accra region of Ghana

Background: The Malaria and HIV rapid diagnostic tests (RDTs) are some of the commonest tests that are used in Ghana to support malaria and HIV management/care respectively. When these devices are used, they are categorized as potentially infectious. This paper aims to highlight the availability and management of used malaria and HIV RDTs in various healthcare facilities and by health service providers in the greater Accra region of Ghana.Methods: Data was obtained from 400 health facilities including hospitals, clinics, health centres, and pharmacies and over the counter medicine seller’s shops using purposive sampling technique with the aid of structured questionnaires and observation of practices.Results: Seventy percent of the facilities (n=280) used only malaria RDTs, 29% (n=116) used both malaria and HIV RDTs and 1% (n=4) reported using HIV RDTs only. 81.7% (n=326) which formed the majority used less than 10 RDTs daily. There was poor waste segregation, storage, transportation, treatment and disposal of waste. Facilities that had some sort of on-site treatment of waste used single chambered incinerators.Conclusions: Each of the categories of health facilities had a common practice of poor hazardous waste management. We therefore recommend that there should be enhancement of education and training of practitioners in the health facilities and the general public on the optimal use of the RDTs and disposal or the management of healthcare waste in general. The environmental protection agency and ministry of health should collaborate and enforce all the regulations on healthcare waste management in the various facilities.

Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study

SummaryBackgroundDual HIV and syphilis testing might help to prevent mother-to-child transmission (MTCT) of HIV and syphilis through increased case detection and treatment. We aimed to model and assess the cost-effectiveness of dual testing during antenatal care in four countries with varying HIV and syphilis prevalence.MethodsIn this modelling study, we developed Markov models of HIV and syphilis in pregnant women to estimate costs and infant health outcomes of maternal testing at the first antenatal care visit with individual HIV and syphilis tests (base case) and at the first antenatal care visit with a dual rapid diagnostic test (scenario one). We additionally evaluated retesting during late antenatal care and at delivery with either individual tests (scenario two) or a dual rapid diagnosis test (scenario three). We modelled four countries: South Africa, Kenya, Colombia, and Ukraine. Strategies with an incremental cost-effectiveness ratio (ICER) less than the country-specific cost-effectiveness threshold (US$500 in Kenya, $750 in South Africa, $3000 in Colombia, and $1000 in Ukraine) per disability-adjusted life-year averted were considered cost-effective.FindingsRoutinely offering testing at the first antenatal care visit with a dual rapid diagnosis test was cost-saving compared with the base case in all four countries (ICER: –$26 in Kenya,–$559 in South Africa, –$844 in Colombia, and –$454 in Ukraine). Retesting during late antenatal care with a dual rapid diagnostic test (scenario three) was cost-effective compared with scenario one in all four countries (ICER: $270 in Kenya, $260 in South Africa, $2207 in Colombia, and $205 in Ukraine).InterpretationIncorporating dual rapid diagnostic tests in antenatal care can be cost-saving across countries with varying HIV prevalence. Countries should consider incorporating dual HIV and syphilis rapid diagnostic tests as the first test in antenatal care to support efforts to eliminate MTCT of HIV and syphilis.FundingWHO, US Agency for International Development, and the Bill & Melinda Gates Foundation.

The Role of Health Education Specialists in Conducting Rapid HIV Testing

There are over one million people living with HIV in the United States; an estimated 16% are unaware of their status. More innovative testing strategies are needed, as evidence suggests that persons most at risk for HIV, or who may present with early infections, are not being reached. Expanding the role of health education specialists can make HIV testing routine and more accessible, and help achieve the national goals of decreasing HIV infection and increasing knowledge of HIV status. This paper focuses on the role of Certified Health Education Specialists (CHES)/Master CHES as being professionally prepared to conduct HIV testing.

National-level effectiveness of ART to prevent early mother to child transmission of HIV in Namibia.

BackgroundNamibia introduced the prevention of mother to child HIV transmission (MTCT) program in 2002 and lifelong antiretroviral therapy (ART) for pregnant women (option B-plus) in 2013. We sought to quantify MTCT measured at 4–12 weeks post-delivery.MethodsDuring Aug 2014-Feb 2015, we recruited a nationally representative sample of 1040 pairs of mother and infant aged 4–12 weeks at routine immunizations in 60 public health clinics using two stage sampling approach. Of these, 864 HIV exposed infants had DNA-PCR HIV test results available. We defined an HIV exposed infant if born to an HIV-positive mother with documented status or diagnosed at enrollment using rapid HIV tests. Dried Blood Spots samples from HIV exposed infants were tested for HIV. Interview data and laboratory results were collected on smartphones and uploaded to a central database. We measured MTCT prevalence at 4–12 weeks post-delivery and evaluated associations between infant HIV infection and maternal and infant characteristics including maternal treatment and infant prophylaxis. All statistical analyses accounted for the survey design.ResultsBased on the 864 HIV exposed infants with test results available, nationally weighted early MTCT measured at 4–12 weeks post-delivery was 1.74% (95% confidence interval (CI): 1.00%-3.01%). Overall, 62% of mothers started ART pre-conception, 33.6% during pregnancy, 1.2% post-delivery and 3.2% never received ART. Mothers who started ART before pregnancy and during pregnancy had low MTCT prevalence, 0.78% (95% CI: 0.31%-1.96%) and 0.98% (95% CI: 0.33%-2.91%), respectively. MTCT rose to 4.13% (95% CI: 0.54%-25.68%) when the mother started ART after delivery and to 11.62% (95% CI: 4.07%-28.96%) when she never received ART. The lowest MTCT of 0.76% (95% CI: 0.36% - 1.61%) was achieved when mother received ART and ARV prophylaxis within 72hrs for infant and highest 22.32% (95%CI: 2.78% -74.25%) when neither mother nor infant received ARVs. After adjusting for mother’s age, maternal ART (Prevalence Ratio (PR) = 0.10, 95% CI: 0.03–0.29) and infant ARV prophylaxis (PR = 0.32, 95% CI: 0.10–0.998) remained strong predictors of HIV transmission.ConclusionAs of 2015, Namibia achieved MTCT of 1.74%, measured at 4–12 weeks post-delivery. Women already on ART pre-conception had the lowest prevalence of MTCT emphasizing the importance of early HIV diagnosis and treatment initiation before pregnancy. Studies are needed to measure MTCT and maternal HIV seroconversion during breastfeeding.

Weight Loss

Key Points When considering weight loss, consider the possibility of an error in recorded weights.Obtain a thorough dietary history. Consider inaccuracy, especially if an eating disorder is possible.A basic workup should be performed before attributing the loss to mental health. Consider the following assessments: complete blood cell count, comprehensive metabolic panel, C-reactive protein, erythrocyte sedimentation rate, tuberculin test, rapid plasma reagin test, HIV test, tissue transglutaminase plus immunoglobulin A, thyrotropin plus free thyroxine, stool guaiac test/culture/ova/parasites, and urinalysis.Close follow-up is mandatory. Admission criteria if an eating disorder is considered can include less than 75% of the ideal body weight, a supine heart rate less than 50 beats/min, a temperature less than 35.6°C, a systolic blood pressure less than 90 mm Hg, arrhythmia, and orthostatic vital signs.If findings from the workup are negative, attempts to increase caloric intake are insufficient, and an eating disorder is not suspected, refer the patient to a registered dietitian and/or a gastroenterologist.

An Assessment of Emergency Nurses’ Perspectives on Nurse-Driven Human Immunodeficiency Virus Testing in the Emergency Department

IntroductionEngaging emergency clinicians in universal human immunodeficiency virus screening is paramount to achieving goals of reengaging human immunodeficiency virus–positive persons into care, identifying new human immunodeficiency virus cases, and linking them to care. The study aim was to identify beliefs and barriers towards opt-out human immunodeficiency virus testing among emergency nurses. MethodsA cross-sectional study used Qualtrics software to deliver a survey on a tablet device to emergency nurses in a private Level 1 trauma hospital in Houston, Texas during downtimes of their clinical shifts. The survey evaluated perspectives on human immunodeficiency virus screening and knowledge relative to rapid screening and human immunodeficiency virus prevalence rates locally and nationally. ResultsFifty emergency nurses were enrolled. Few nurses accurately identified human immunodeficiency virus prevalence rates at the local hospital and city level (10% and 42%, respectively). Most (54%) of nurses correctly estimated human immunodeficiency virus prevalence rates nationally. Nearly half of the nurses (42.0%) correctly predicted the cost of a rapid human immunodeficiency virus test with accuracy and most were willing to offer rapid human immunodeficiency virus testing all the time (60.0%). Eighty-eight percent of nurses were supportive of facilitating universal human immunodeficiency virus screening. However, 92.0% strongly supported human immunodeficiency virus testing for high risk patients only when compared to 80.0% support of testing for all eligible patients. Qualitative data revealed time constraints and follow-up concerns as barriers. DiscussionEmergency nurses reported barriers that sometimes prevented application of Centers for Disease Control and Prevention recommendations to human immunodeficiency virus screening. Strategies to overcome these barriers are instrumental to programmatic success. Solutions can corroborate the importance of emergency nurses to the nation’s Ending the HIV Epidemic plan.

Does peer-navigated linkage to care work? A cross-sectional study of active linkage to care within an integrated non-communicable disease-HIV testing centre for adults in Soweto, South Africa.

IntroductionSouth Africa is the HIV epidemic epicentre; however, non-communicable diseases (NCDs) will be the most common cause of death by 2030. To improve identification and initiation of care for HIV and NCDs, we assessed proportion of clients referred and linked to care (LTC) for abnormal/positive screening results and time to LTC and treatment initiation from a HIV Testing Services (HTS) Centre before and after integrated testing for NCDs with optional peer-navigated linkage to care.Materials and methodsThis two-phase prospective study was conducted at an adult HTS Centre in Soweto, South Africa. Phase 1 (February-June 2018) utilised standard of care (SOC) HTS services (blood pressure [BP], HIV rapid diagnostic testing (RDT), sexually transmitted infections [STI]/Tuberculosis [TB] symptom screening) with passive referral for abnormal/positive results. Phase 2 (June 2018-March 2019) further integrated blood glucose/cholesterol/chlamydia RDT, with optional peer-navigated referral. Enrolled referred clients completed telephonic follow-up surveys confirming LTC/treatment initiation ≤3 months post-screening. Socio-demographics, screening results, time to LTC/treatment initiation, peer-navigated referral uptake were reported. Analysis included Fisher’s exact, chi-squared, Kruskal Wallis, and Student’s T-tests. Thematic analysis was conducted for open-ended survey responses.ResultsOf all 320 referrals, 40.0% were HIV-infections, 11.9% STIs, 6.6% TB, and 28.8% high/low BP. Of Phase 2-only referrals, 29.4% were for glucose and 23.5% cholesterol. Integrated NCD-HTS had significantly more clients LTC for HIV (76.7%[n = 66/86] vs 52.4%[n = 22/42], p = 0.0052) and within a shorter average time (6–8 days [Interquartile range (IQR):1–18.5] vs 8–13 days [IQR:2–32]) as compared to SOC HTS. Integrated NCD-HTS clients initiated HIV/STIs/BP treatment on average more quickly as compared to SOC HTS (5 days for STIs [IQR:1–21], 8 days for HIV/BP [IQR:5–17 and 2–13, respectively] vs 10 days for STIs [IQR: 4–32], 19.5 days for HIV [IQR:6.5–26.5], 8 days for BP [IQR:2–29)]. Participants chose passive over active referral (89.1% vs 10.9%; p<0.0001). Participants rejecting peer-navigated referral preferred to go alone (55.7% [n = 39/70]). Non-LTC was due to being busy (41.1% [n = 39/95]) and not being ready/refusing treatment (31.6% [n = 30/95]). Normalised results assessed at referral clinic (49.7% [n = 98/196]), prescribed lifestyle modification/monitoring (30.9% [n = 61/196]), and poor clinic flow/congestion and/or further testing required (10.7% [n = 21/196]) were associated with non-treatment initiation.ConclusionSame-day treatment initiation is not achieved across diseases, despite peer-navigated referral. There are psychosocial and health systems barriers at entry to care/treatment initiation. Additional research may identify best strategies for rapid treatment initiation.

Outcomes of HIV Self-Testing Implementation in Zimbabwe, 2018-2020 and Its Relevance to the COVID-19 Period and Beyond

Background: HIV self-testing (HIV-ST) is an innovative strategy to increase HIV case identification and can be implemented while maintaining physical distancing. This analysis shares the outcomes of HIV-ST implementation within the Zimbabwe HIV Care and Treatment (ZHCT) project and demonstrate the relevance of the results in bridging the HIV testing gap during the COVID-19 period and beyond.Methods: We extracted HIV-ST data for the period October 2018 to March 2020 from the project database and assessed 1)the proportion of reactive HIV-ST results; 2) the concordance between reactive HIV-ST results against rapid confirmatory HIV tests using Determine™ and Chembio™ in parallel; and 3) the monthly contribution of HIV-ST to total HIV positive cases identified within project. The Chi-square test was used to assess for differences in proportion of cases identified through HIV-ST and through index and mobile testing by age group, gender, and month.Findings: Between October 2018 and March 2020, the ZHCT project distributed 11,983 HIV-ST kits, where 11,924 (99·8%) were used and 2,616 (21·9%) were reactive. Of the reactive tests, 2,610 were confirmed HIV positive, a concordance rate of 99·8% between the HIV-ST results and the confirmatory tests. Proportion of reactive results differed by age-groups; with the 30-34, 35-39- and 40-44-year age groups having the highest proportions above 25% (pInterpretation: The ZHCT project has successfully scaled up HIV self-testing which is contributing significantly to HIV case finding. Given the current COVID-19 challenges these results demonstrate the potential of HIV-ST in closing the HIV testing gap because it can be implemented while maintaining physical distancing.Funding Statement: The ZHCT project is a six-year Presidential Emergency Plan for AIDS Relief (PEPFAR) funded project through the United States Agency for International Development (USAID).Declaration of Interests: The authors declare that they have no competing interests.Ethics Approval Statement: The study was reviewed and approved for non-research determination by the Medical Research Council of Zimbabwe (MRCZ/E/159).

Brief Report: Proportion and Predictors of Adult TB Contacts Accepting HIV Testing During an Active TB Case Finding Intervention in South Africa.

Many individuals at risk for HIV may be reached through active TB case finding interventions in areas with highly prevalent co-epidemics of TB/HIV. We analyzed data from a cluster-randomized trial of 2 TB case finding strategies: facility-based screening and contact investigation of newly identified TB cases. In both arms, on-site rapid HIV testing was offered to all contacts older than 18 months who did not self-report HIV-positive status. Those who were HIV infected were referred appropriately. All contacts 15 years and older were included in this analysis. Among 2179 contacts identified, 50% (1092) accepted HIV testing and counselling, of whom 6.3% (68) tested HIV-positive. Contacts who were unemployed [adjusted prevalence ratio (aPR) 1.14, 95% confidence interval (CI): 1.04 to 1.25], had not been to a clinic (aPR 1.09, 95% CI: 1.02 to 1.18) or HIV tested (aPR 1.25, 95% CI: 1.14 to 1.39) 6 months before, and those reporting gastrointestinal symptoms (aPR 1.22, 95% CI: 0.98 to 1.52) and genitourinary symptoms (aPR 1.30, 95% CI: 1.17 to 1.45) were significantly associated with accepting HIV testing. Women [adjusted odds ratio (aOR) 2.19, 95% CI: 1.26 to 3.81], individuals with a past history of tuberculosis (aOR 1.96, 95% CI: 0.93 to 4.14), and those not HIV tested 6 months before (aOR 2.20, 95% CI: 1.28 to 3.79) were significantly associated with testing HIV-positive. Offering HIV testing in the context of active tuberculosis case finding represents an opportunity to identify a large proportion of previously undiagnosed individuals with HIV in a population that might otherwise not seek testing.

378 Expanding HIV Testing to Regional Emergency Departments Identifies Community HIV Cases

In the United States, the Centers for Disease Control and Prevention (CDC) estimates that 1.1 million people aged 13 and older are currently living with an HIV infection, and approximately 14% of these were undiagnosed and unaware of their HIV infection (2016 estimate). Expanded testing programs, including those provided in the emergency department (ED), may lead to earlier detection and further reduction in the transmission of HIV. CDC and United States Preventative Services Task Force (USPSTF) 2013 guidelines recommend screening for HIV in adolescents and adults aged 15-65 as well as younger adolescents and older adults at high risk. The ED is a frequent health care access point for underserved, at-risk populations at high risk for HIV infection, and these populations utilize ED services for evaluation of sexually transmitted diseases. Our aim was to see whether increasing system-wide access to efficient HIV testing in the ED would improve detection of HIV in the community setting. Starting in January 2020, our health system in northeast Ohio expanded availability of rapid lab-based HIV testing from beyond the urban main campus to 11 community hospital EDs. Collaboration with laboratory medicine and infectious disease permitted these EDs to offer rapid lab-based HIV testing patients presenting with STIs or other clear HIV risk factors. For each preliminary positive test, a confirmatory test was reflexively run using blood samples obtained from the initial draw. Data was collected through an EMR query using a series of EPIC lab order codes for all ED encounters in the health system between January 1 and May 2, 2020 for which a rapid HIV test was ordered in the ED. Data query included test results, patient demographic information, ED location, and time of patient arrival to ED. Proportions and p values (Chi Square) are reported. There were a total of 326 distinct ED encounters in which a rapid HIV test was performed across the 12 health system EDs. The mean age of patients was 29.9 years (SD = 11.7), and 172 (52.8%) were male. Overall, there were 11 reactive tests (3.4%). 234/326 (71.8%) of encounters with a rapid HIV test occurred at community EDs, with a median of 18 tests (SD: 11.8) being performed over the study period at each location. There was no difference in the prevalence of HIV positive tests between community and urban settings (7/234; 3.0% positive tests community vs. 4/92; 4.3% positive Main Campus urban tertiary care center, X2 (1, N = 326) = 0.36, p = .54). Expanding rapid HIV testing to community EDs in a regional health system identified additional previously unrecognized patients who tested positive for HIV, with a similar proportion of positive tests at the urban main campus ED as community EDs.Tabled 1EDDistinct ED EncountersRapid Test Reactive Results1 (community)1212 (community)303 (community)3634 (community)2315 (community -pediatric ED)1206 (community)907 (community - pediatric ED)1418 (community)2309 (community)42010 (urban tertiary care center)92411 (community)22012 (community)3013 (community)24114 (community)110Total32611 Open table in a new tab

Providing Unique Support for Health Study Among Young Black and Latinx Men Who Have Sex With Men and Young Black and Latinx Transgender Women Living in 3 Urban Cities in the United States: Protocol for a Coach-Based Mobile-Enhanced Randomized Control Trial.

BackgroundThe US National HIV/AIDS Strategy 2020 calls for increasing access to care, improving outcomes of people living with HIV, and targeting biomedical prevention efforts, including access to pre-exposure prophylaxis (PrEP) in communities where HIV is most heavily concentrated. The cities of Baltimore, Maryland (MD); Washington, DC; and Philadelphia, Pennsylvania (PA) are disproportionately burdened by high rates of new cases of HIV infection, with high prevalence among young Black and Latinx men who have sex with men (YBLMSM) and young Black and Latinx transgender women (YBLTW) aged 15-24 years.ObjectiveThis study aims (1) to identify and recruit YBLMSM and YBLTW who are at risk or living with HIV in Baltimore, MD; Philadelphia, PA; and Washington, DC, using respondent-driven sampling (RDS) with targeted seed selection, and (2) to assess the efficacy of a coach-based mobile-enhanced intervention (MEI) compared with standard of care (SOC) to increase successful engagement and retention into HIV, PrEP, and substance use treatment care across the HIV care and prevention continua in 3 Mid-Atlantic cities. This paper describes the protocol and progress as of October 20, 2019.MethodsThis study uses a multiphase mixed methods design. The first phase is a formative, qualitative research with focus group discussions and key informant interviews. The second phase consists of evaluating the ability of RDS with targeted seed selection. The third phase includes 2 embedded randomized controlled trials (RCTs), where participants complete a baseline sociobehavioral survey, rapid HIV testing, and eligible youth enroll in parallel status-dependent RCTs that randomize the participant to 1 of 2 study arms: MEI with coach or SOC. Participants are asked to complete a web-based survey and provide biologic specimens—HIV-1 RNA (viral load) or HIV-1 antibody test and urine drug screen—at baseline and at 3, 6, and 12 months, and an exit interview at 18 months.ResultsA formative qualitative research was conducted in February 2017 and May 2018, and this led to further refinement of recruitment and study methods. Aim 1 recruitment began in September 2017 with subsequent enrollment into the RCTs. Recruitment is ongoing with 520 participants screened and 402 (77.3%) enrolled in aim 1 by October 2020. Of these, 159 are enrolled in the 2 randomized trials: 36 (22.6%) HIV-positive not virally suppressed (aim 2) and 123 (77.4%) high-risk HIV-negative (aim 3).ConclusionsThis study has the potential to significantly impact the medical and substance use services provided to YBLMSM and YBLTW in the United States by providing rigorous scientific evidence outlining approaches and strategies that improve the uptake and engagement of YBLMSM and YBLTW in the HIV treatment and prevention continuum.Trial RegistrationClinicalTrials.gov NCT03194477; https://clinicaltrials.gov/ct2/show/NCT03194477International Registered Report Identifier (IRRID)DERR1-10.2196/17269

Planejamento estratégico situacional como ferramenta para promoção da saúde do homem: relato de experiência

Objetivo: descrever a experiência de acadêmicos de enfermagem na realização de ações de promoção da saúde do homem como parte de uma equipe multidisciplinar de saúde a partir da implementação do planejamento estratégico situacional. Metodologia: trata-se de um estudo descritivo, do tipo relato de experiência por meio de atividades práticas desenvolvidas em uma estratégia de saúde da família localizada em um município do Rio Grande do Sul. Resultados e Discussões: implementação do plano de ação ocorreu no do dia 11 de junho de 2019, e obteve a participação de 320 homens trabalhadores da secretaria de infraestrutura urbana e rural. As atividades prestadas abrangeram ações de promoção da saúde, como aferição da pressão arterial; hemoglicoteste; testes rápidos de HIV/AIDS, sífilis, hepatite, consulta odontológica, consulta médica e orientações referente à saúde do homem. Considerações Finais: trabalhar com o planejamento estratégico situacional permitiu a realização do diagnóstico situacional, a estruturação e a organização das atividades com diferentes setores da rede de atenção à saúde e a integração entre ensino-serviço, mostrando a relevância da realização de atividades semelhantes para a formação em saúde.

Correlates of HIV, STI and TB among sub-Saharan African migrants in Lisbon: a biobehavioral study

Abstract Sub-Saharan African migrants (SAMs) have been disproportionately affected by infectious diseases such as HIV, other sexually transmitted infections (STIs) and Tuberculosis infection (TB). Research on infectious diseases and related factors among migrant populations is critical to further understand these populations' health needs and inform prevention strategies. However, migrants are often underrepresented in national statistics and research. This study aimed to examine correlates of HIV, past STI and past TB among SAMs. A venue-based sample of 790 SSAMs completed a cross-sectional biobehavioral survey on sexual practices, HIV testing and self-reported infectious diseases; an HIV rapid test was offered. Uni- and multivariable logistic regression analyses were performed to examine factors associated with HIV, past STI and past TB. Overall, 5.4% of participants were HIV-positive and 16.7% reported a past STI. Odds of being HIV positive increased by age (OR 1.07, 95%CI 1.03-1.11) and were higher among those who experienced violence from a partner (OR 2.77, 95%CI 1.08-7.10). Increased odds of having a past STI were found among migrants with low income (OR 2.86, 95%CI 1.48-5.56), long-term migrants (&amp;gt;25 years residing in Portugal: OR 2.16, 95%CI 1.06-4.38) and those who reported sexual risk behaviors (≥3 sexual partners: OR 2.06, 95%CI 1.14-3.70; inconsistent condom use: OR 2.61, 95%CI 1.32-5.17). In total, 4.1% of participants had TB in the past; these were more likely male (OR 3.42, 95%CI 1.29-9.06) and HIV positive (OR 11.48, 95%CI 4.55-28.94). Half of the participants had never been tested for HIV before, including over a third of those who had STI or TB in the past. Efforts are needed to reduce missed opportunities for HIV/STIs prevention and uptake of HIV testing among SSAMs through more integrated care, while addressing social determinants of infectious diseases. Key messages High levels of HIV, STI and TB infection among SAMs were found to be strongly associated with socioeconomic disadvantage and poor living conditions in the host country. Social inequalities are persistently a major factor affecting risk for HIV, STIs and TB, and thus addressing social determinants of infectious diseases must remain a public health priority.

Uncertainties, work conditions and testing biases: Potential pathways to misdiagnosis in point-of-care rapid HIV testing in Zimbabwe.

Disconcerting levels of misdiagnosis are common in point-of-care rapid HIV testing programmes in sub-Saharan Africa. To investigate potential pathways to misdiagnosis, we interviewed 28 HIV testers in Zimbabwe and conducted weeklong observations at four testing facilities. Approaching adherence to national HIV testing algorithms as a social and scripted practice, dependent on the integration of certain competences, materials and meanings, our thematic analysis revealed three underlying causes of misdiagnosis: One, a lack of confidence in using certain test-kits, coupled with changes in testing algorithms and inadequate training, fed uncertainties with some testing practices. Two, difficult work conditions, including high workloads and resource-depleted facilities, compounded these uncertainties, and meant testers got distracted or resorted to testing short-cuts. Three, power struggles between HIV testers, and specific client-tester encounters created social interactions that challenged the testing process. We conclude that these contexts contribute to deviances from official and recommended testing procedures, as well as testing and interpretation biases, which may explain cases of misdiagnoses. We caution against user-error explanations to misdiagnosis in the absence of a broader recognition of how broader structural determinants affect HIV testing practices.