HIV Counseling And Testing Services Research Articles

Improvement of laboratory testing services by implementation of quality assurance scheme

Introduction: The National AIDS Control Organization (NACO), Government of India and the Uttar Pradesh State AIDS Control Society (UPSACS) established the State Referral Laboratory (SRL) in the Department of Microbiology, Motilal Nehru Medical College, Prayagraj for HIV testing and monitoring of linked HIV Counselling and Testing Services (HCTS) in Uttar Pradesh.Methods: This is a retrospective study conducted from 2008 to 2021. In this evaluation period 10144 serum samples (9580 HIV negative, 555 HIV positive and 9 discordant) were received for retesting at SRL. The Quality Control serum samples received from testing sites consisted of 5% negative and 20% positive from all tested samples collected in the first seven days in the External Quality Assurance Scheme (EQAS) quarter month i.e. January, April, July and October. All samples were tested using rapid diagnostic kits procured by NACO/UPSACS with NACO testing strategy. All linked centres with SRL received 4 coded serum samples for proficiency testing (PT) which were tested similarly.Results: Of 10144 serum samples, 99.92% reported correct results and 0.08% reported discrepancy due to various issues. Similarly in the proficiency testing programme, of 4072 samples tested between 2010 to 2021 by testing sites, 4061 (99.07%) reported concordant results and the remaining14 (0.34%) samples reported indeterminate results. Of the 4072 samples, 14 shows discordant results by three different rapid tests based on different principles. Hands on training were provided for technicians who reported indeterminate results in PT or retesting.Conclusion: The tremendous increase in quality testing at peripheral centrally linked centres increase the reliability of HIV diagnosis at ground level. The study also concluded that continuous monitoring and mentoring of technicians of the diagnostic laboratories under EQAS improves their quality for HIV diagnosis.

Factors Associated with Poor Uptake of HIV Counselling and Testing amongst Adult Men at Health Facilities in Rustenburg Sub-district, South Africa

Background: HIV counselling and testing (HCT) is one of the ways of reducing the prevalence of HIV infection and ensuring that infected individuals receive appropriate care. Unfortunately, the uptake of HCT amongst males, aged 15 to 49 years remains low. Aim: The aim of the study was to identify factors influencing low uptake of HCT amongst males between the ages of 15 and 49 in the health care facilities of Rustenburg. Methods: It is a cross-sectional descriptive study among 15- and 49-years males who visited 19 health facilities within Rustenburg using a self-administered questionnaire. Results: Four hundred and forty (440) males (15-49 years) took part in the study with a response rate of 98%. Of this total, 39 (9%) had never been tested for HIV. Most (79.1%) of participants undertook HIV testing for health reasons. The results indicated that differences in age (males aged between 40 and 49 years) and employment status (employed men) translated to differences in the likelihood of one being tested and these two variables (age and employment status) were associated with knowledge as a factor in the acceptance and usage of HCT services. Knowledge about HCT services was significantly associated with acceptability and usage of HCT services (P<0.05). Conclusion: Participants aged between 15 and 29 years were less likely to undergo HIV testing than other age groups. There is a need to encourage young people to undertake HIV testing since they are the most vulnerable age group.

Costs of HIV prevention services provided by community-based organizations to female sex workers in Nigeria.

Nigeria has been consistently targeted in sub-Saharan Africa as an HIV-priority country. Its main mode of transmission is heterosexual, and consequently, a key population of interest is female sex workers (FSWs). While HIV prevention services are increasingly implemented by community-based organizations (CBOs) in Nigeria, there is a paucity of evidence on the implementation costs of these organizations. This study seeks to fill this gap by providing new evidence about service delivery unit cost for HIV education (HIVE), HIV counseling and testing (HCT), and sexually transmitted infection (STI) referral services. In a sample of 31 CBOs across Nigeria, we calculated the costs of HIV prevention services for FSWs taking a provider-based perspective. We collected 2016 fiscal year data on tablet computers during a central data training in Abuja, Nigeria, in August 2017. Data collection was part of a cluster-randomized trial examining the effects of management practices in CBOs on HIV prevention service delivery. Staff costs, recurrent inputs, utilities, and training costs were aggregated and allocated to each intervention to produce total cost calculations, and then divided by the number of FSWs served to produce unit costs. Where costs were shared across interventions, a weight proportional to intervention outputs was applied. All cost data were converted to US dollars using the mid-year 2016 exchange rate. We also explored the cost variation across the CBOs, particularly the roles of service scale, geographic location, and time. The average annual number of services provided per CBO was 11,294 for HIVE, 3,326 for HCT, and 473 for STI referrals. The unit cost per FSW tested for HIV was 22 USD, the unit cost per FSW reached with HIV education services was 19 USD, and the unit cost per FSW reached by STI referrals was 3 USD. We found heterogeneity in total and unit costs across CBOs and geographic location. Results from the regression models show that total cost and service scale were positively correlated, while unit costs and scale were consistently negatively correlated; this indicates the presence of economies of scale. By increasing the annual number of services by 100 percent, the unit cost decreases by 50 percent for HIVE, 40 percent for HCT, and 10 percent for STI. There was also evidence that indicates that the level of service provision was not constant over time across the fiscal year. We also found unit costs and management to be negatively correlated, though results were not statistically significant. Estimates for HCT services are relatively similar to previous studies. There is substantial variation in unit costs across facilities, and evidence of a negative relationship between unit costs and scale for all services. This is one of the few studies to measure HIV prevention service delivery costs to female sex workers through CBOs. Furthermore, this study also looked at the relationship between costs and management practices-the first of its kind to do so in Nigeria. Results can be leveraged to strategically plan for future service delivery across similar settings.

Hiv testing and counseling services in Kassala State, Sudan: what are the relevant beliefs of private healthcare providers?

ABSTRACT HIV testing and counseling (HTC) services are essential for all HIV prevention and treatment interventions. Evidence is limited on the role of private healthcare providers in providing HTC services. This study assessed the relevant beliefs for intervention to enhance the intention to offer HTC services among private healthcare providers. A cross-sectional study included 387 private healthcare providers who completed a questionnaire about beliefs and intentions regarding offering HTC services. A Confidence Interval Based Estimation of Relevance (CIBER) approach was used to identify the most relevant beliefs. The behavioral belief “Offering HTC services would cause patients to feel worries” and the normative belief “My managers believe that I should offer HTC services to patients” were relevant beliefs for intervention. The control beliefs “If I offer HTC services, I spend more time with the patients” and “Patients are at low risk of HIV, and they would not need HTC services” were significantly associated with intention and important intervention candidates. The belief “If I offer HTC services, I would be concerned about HIV test results confidentiality” was a relevant belief to target with intervention. The beliefs of private service providers differ in their association with relevance to their intention to offer HTC services. More relevant beliefs need to be selected to increase the potential effectiveness of the interventions to promote the private healthcare providers’ intentions to offer HTC services.

Trends and Factors Associated with HIV Testing among Adolescent Girls and Young Women in Lesotho: Results from 2004 to 2014 Lesotho Demographic and Health Surveys

HIV/AIDS is prevalent among adolescent girls and young women (AGYW) in Lesotho, and among the top five infectious diseases causing a high mortality rate in Africa. The paramount management of HIV is based on screening, prevention, and therapeutic interventions, of which HIV testing and counselling (HTC) is the gateway. The utilization of HTC services among AGYW is limited owing to numerous barriers encountered by this population group. The aim of this study was to assess trends and factors associated with HTC among AGYW in Lesotho. A secondary data analysis was used to analyze data sets extracted from the 2004, 2009, and 2014 Lesotho Demographic Health Surveys (LDHS). The LDHS was conducted using a cross-sectional study design and samples drawn were representative of the whole population of Lesotho. We used descriptive analysis to determine trends in HTC. In determining factors associated with the uptake of HTC, univariate and multivariable logistic regression models were applied on the 2014 LDHS. All analyses were adjusted for unequal sampling probabilities using survey weights. The number of AGYWs analyzed were 2743 in 2004, 2393 in 2009, and 2842 in 2014. The overall prevalence estimates of HTC uptake were 12%, 62.2%, and 72.5%, respectively. For the 15–19 years AGYW, HTC uptake rose from 6.2% (2004), 46.3% (2009), to 57.9% (2014), while for the 20–24 years age group, the rates were 18.7%, 80.2%, and 88.3%, respectively. For the 2842 AGYW in 2014, the odds of ever having an HIV test were significantly higher for those aged 20–24 years (aOR 2.15, 95% CI 1.61 to 2.87, p < 0.001), in a union (aOR 3.21, 95%CI 2.25 to 4.58, p < 0.001), with Mother-to-child transmission of HIV (MTCT) knowledge (aOR 1.53, 95%CI: 1.21 to 1.94, p < 0.001), with HIV non-discriminatory attitudes (aOR 2.50, 95%CI 1.87 to 3.34, p < 0.001), and those who had ever been pregnant (aOR 11.53, 95%CI 7.46 to 17.84, p < 0.001). HTC uptake among AGYW in Lesotho is below expected targets, hence we recommend optimizing access to HTC services, especially for AGYW aged 15–19 years.

Psychosocial beliefs of health providers' intention and behavior of offering HIV testing and counseling services: Estimating their relevance for intervention.

Diagnosis of people with HIV is vital in achieving the 95-95-95 global targets. The proportion of people with HIV who know they have HIV in Sudan is low. Promoting engagement of healthcare providers (HCPs) in offering HIV Testing and Counseling (HTC) services would improve the percentage of diagnosed people with HIV in the country. This study aims to assess the psychosocial beliefs associated with HCPs' intention and behavior to offer HTC services and their relevance for intervention. This institutional cross-sectional study was conducted in Kassala State, from July 2019 to February 2020, among 438 healthcare providers from public health facilities. A self-administered questionnaire was used to assess behavior and intention to offer HTC services and related behavioral, normative, and control beliefs. Data were analyzed using R software. Confidence Interval Based Estimation of Relevance (CIBER) was used to estimate the relevance of the beliefs to interventions. The CIBER analysis showed that the belief "It causes many worries for patients if I offer or counsel them about HIV test" was negatively associated with HCPs' intention and behavior to offer HTC services and a highly relevant belief for intervention. The belief "My manager thinks I should offer or counsel patients about HIV test" was positively associated with the behavior and intention to offer HTC services and was a relatively highly relevant belief. The control belief "Patients are at low risk of HIV and do not need offering or counseling about HIV test" was negatively associated with HCPs' intention and behavior and was relevant for intervention. The control belief "If I offered or counseled patients about HIV test, I would spend more time with them" was negatively associated with the intention and behavior of HCPs toward HTC services, with high relevance to target with intervention. The belief "My colleagues think I should offer or counsel patients about HIV test" was weakly associated with behavior and intention, and it is a low relevant belief for intervention. Different psychosocial beliefs among healthcare providers can influence their intention and behavior to offer HTC services to patients. More relevant beliefs are required to be targeted with interventions to promote the intention and behavior of providing HTC services among health care providers.

Non-uptake of HIV testing among trans men and trans women: cross-sectional study of client records from 2017 to 2019 in a community-based transgender health center in Metro Manila, Philippines

BackgroundTransgender individuals are considered at high risk of contracting HIV infection. Integrating HIV testing and counseling (HTC) services into current transgender health programs is necessary to increase its uptake. Our study aimed to describe the characteristics of trans men (TM) and trans women (TW) who accessed HTC services in a community-based transgender health center in Metro Manila, Philippines, and to examine the relationship between gender identity and their non-uptake of HIV testing. MethodsWe conducted a cross-sectional study of TM and TW seeking care from 2017 to 2019. Medical records of clients were reviewed to ascertain their age, gender identity, year and frequency of clinic visits, lifestyle factors, and non-uptake of HIV testing. The effect of gender identity on the non-uptake of HIV testing was estimated using a generalized linear model with Poisson distribution, log link function, and a robust variance, adjusted for confounding variables. ResultsFive hundred twenty-five clients were included in the study, of which about 82.3% (432/525) of the clients declined the HTC services being offered. In addition, the prevalence of non-uptake of HIV testing was 48% higher (Adjusted Prevalence Ratio: 1.48; 95% Confidence Interval: 1.31–1.67) among TM compared to TW. Approximately 3.7% (1/27) and 10.6% (7/66) of the TM and TW, respectively, who accessed the HTC services were reactive. Moreover, most reactive clients were on treatment 87.5% (7/8); three were already virally suppressed, four were on ART but not yet virally suppressed, and one TW client was lost to follow up.ConclusionThe non-uptake of HTC service of TM and TW is high. HIV program implementers should strategize solutions to reach this vulnerable population for increased and better HTC service uptake and linkage to care.

Utilization of HIV testing and counselling services by women with disabilities during antenatal care in Uganda: analysis of 2016 demographic and health survey

BackgroundHIV testing and counselling during antenatal care (ANC) is critical for eliminating mother-to-child transmission of HIV. We investigated disparity in utilization of HIV testing and counselling services (HTC) between women with and without disabilities in Uganda.MethodsWe conducted a retrospective study using the nationally representative 2016 Uganda Demographic and Health Survey. The study sampled 10,073 women between age 15–49 who had a live birth in the last 5 years. We estimated unadjusted and adjusted odds ratio for receiving pre-test HIV counselling, obtaining an HIV test result, and post-test HIV counselling by disability status using logistic regressions.ResultsWe found that women with disabilities were less likely to receive pre-test HIV counselling (59.6 vs 52.4), obtain an HIV test result (68.2 vs 61.4), receive post-test HIV counselling (55.5 vs 51.6), and all HTC services (49.2 vs 43.5). From the regression analysis, women with disabilities were less likely to receive pre-test counselling [AOR = 0.83; CI = 0.74, 0.93] and obtain an HIV test result [AOR = 0.88; CI = 0.78, 0.99].ConclusionsOur findings revealed that women with disabilities are less likely to receive HTC service during ANC and highlighted the need for disability-inclusive HIV and reproductive health services. Government, non-governmental organizations, and other stakeholders should consider funding inclusive campaigns and identifying other mechanisms for disseminating health information and behavioral interventions to women with disabilities.

Social-Cognitive Determinants of HIV Testing Among Tuberculosis Infected Patients in Kassala State, Sudan.

Background: Use of HIV testing and counselling (HTC) services remains low among TB patients in Sudan. Identifying the social-cognitive (sub) determinants associated with HTC uptake is essential before developing interventions to promote uptake. This study aims to assess the sub-determinants of intention to use and actual behaviour of using HTC services among TB patients in Sudan and to ascertain the most relevant beliefs to inform future interventions.Methods: A cross-sectional study was carried out in five health facilities selected randomly in Kassala State. First, a small elicitation study (N = 25) was conducted to inform the Reasoned Action Approach (RAA) based questionnaire. A total of 411 TB patients completed the survey questionnaire. Confidence Interval Based Estimation of Relevance analysis (CIBER) was employed to establish the sub-determinants' relevance.Result: The studied beliefs explained 38–52% of the variance in the intention and 20–35% in the behaviour variance. The beliefs that “Using HTC services increases my fear of being tested positive for HIV” and “Using HTC services increases my fear of losing my partner if I have a positive test result” were negatively associated with intentions and use of HTC services; and both were highly relevant for intervention. The belief “If I use HTC services, I would know my HIV status” was positively associated with intentions and use of HTC services. However, it was less relevant for intervention. Perceived susceptibility to HIV infection was not associated with intention and only weakly associated with use of HTC services. Its relevance was low for intervention.Conclusions: The study showed that the social-cognitive beliefs (sub-determinants) vary in their relationship with the intention and use of HTC services among TB patients; with variable relevance for intervention. Interventions to enhance the use of HTC services should address the most relevant beliefs to maximise the effectiveness of interventions. Further studies are needed to identify other relevant sub-determinants of HTC use behaviour.

Psychosocial beliefs related to intention to use HIV testing and counselling services among suspected tuberculosis patients in Kassala state, Sudan

BackgroundThere is limited information about the psychosocial sub-determinants regarding the use of HIV Testing and Counselling (HTC) services among suspected Tuberculosis (TB) patients in Sudan. This study aimed to assess the association between psychosocial beliefs and the intention to use HTC services and to establish the relevance of these beliefs for developing behaviour change interventions among suspected TB patients.MethodsSuspected TB patients (N = 383) from four separate TB facilities completed a cross-sectional questionnaire which was based on the Reasoned Action Approach theory. Eligibility criteria included attending Tuberculosis Management Units in Kassala State as suspected TB patients and aged 18–64 years. A Confidence Interval Based Estimation of Relevance (CIBER) analysis approach was employed to investigate the association of the beliefs with the intention to use HTC services and to establish their relevance to be targeted in behaviour change interventions.ResultsThe CIBER results showed the beliefs included in the study accounted for 59 to 70% of the variance in intention to use HTC services. The belief “My friends think I have to use HTC services” was positively associated with the intent to use HTC, and it is highly relevant for intervention development. The belief “I would fear to be stigmatized if I get a HIV positive result” was negatively related to the intention to use HTC services and was considered a highly relevant belief. The belief “If I use HTC services, health care providers will keep my HIV test result confidential” was strongly associated with the intention to use HTC services. However, the relevance of this belief as a target for future interventions development was relatively low. Past experience with HTC services was weakly associated with the intention to use HTC services.ConclusionThe intention to use HTC was a function of psychosocial beliefs. The beliefs investigated varied in their relevance for interventions designed to encourage the use of HTC services. Interventions to promote intention to use HIV testing and counselling services should address the most relevant beliefs (sub-determinants). Further study is needed to establish the relevance of sub-determinants of the intention to use HTC services for interventions development.

Availability and readiness to provide sexually transmitted infections and HIV testing and counselling services in Nepal: evidence from comprehensive health facility survey

ObjectiveWe assessed the availability and readiness of health facilities to provide sexually transmitted infections (STI) and HIV testing and counselling (HTC) services in Nepal.DesignThis was a cross-sectional study.SettingWe used data...

Assessing the willingness to pay for HIV counselling and testing service: a contingent valuation study in Lagos State, Nigeria

HIV/AIDS is a major health issue faced by the world, generally, but particularly sub-Saharan Africa. Nigeria ranked third in the world by number of people living with HIV/AIDS in 2019. Despite prominent HIV counselling and testing (HCT) intervention programmes, Nigeria faces serious challenges, such as inadequate funding and low utilisation rates. Paucity of research into such a critical topic has restricted the capacity of policy makers to address the problem adequately. Consequently, a cross-sectional study was carried out using the contingent valuation method to assess the economic quantum of payment and determining factors associated with people’s willingness to pay for HCT services. Data were collected from 768 people selected by convenience sampling of three local government areas — Alimosho, Ikorodu and Surulere in Lagos State, Nigeria. Data were analysed using descriptive statistics, chi-square, Mann–Whitney, and general linear regression model analysis. Findings show that 75% of respondents were willing to pay an average fee of N1 291 ($4.22) for HCT services. Significant determinants of willingness to pay were: income; knowledge of someone living with HIV or died of AIDS; worry about HIV infection; and fear of HIV-related stigma. The findings offer vital information germane to co-payment schemes aimed at financial sustainability of HCT and HIV/AIDS programmes in Nigeria.

HIV-targeted health promotion: Can we learn from the experience in Tanzania?

Abstract The overall rise in deaths from preventable communicable diseases in the African Region is of utmost concern from a public health perspective. Sub-Saharan Africa (SSA) is home to a severe generalized HIV epidemic with the value of targeted health promotion only recently gaining momentum. The transport sector and transport corridors represent a major transmission route for HIV, fueled by unemployment, multiple sexual partnerships, gender-based violence (GBV), migrant workers and poor access to quality health information and services. In Tanzania, targeted sensitization and health promotion interventions spanning two major road corridors and their large-scale construction projects led to improved knowledge and behavior change among the road construction workers, community leaders and local residents in the communities along the road project as measured during a baseline and end line survey. Taking a comprehensive approach to health promotion the road project in Tanzania focused on: Educational and behavioral change campaigns, aimed via road shows at creating awareness on HIV and AIDS, STI, TB and GBV and encouraged people to know their sero status at mobile outlets of the HIV Counselling and Testing Services (HTS) during community bonanzas, featuring edutainment.Training peer educators from communities and road construction workers on basic knowledge and communication skills to transfer information along the roads, within the communities and in the nearby schools.Establishing village multi-sectoral HIV/AIDS committees.Development of SBCC materials with targeted messages to road construction workers and community members, developed jointly with multiple stakeholders.HIV Testing Services in collaboration with districts and health facilities along the roads.Capacity development of health workers and relevant stakeholders. Lessons learnt can provide guidance for similar settings in SSA and stimulate also a fresh view on promotive activities in Europe.

Links between unit costs for HIV services, perceived service quality and client satisfaction in Ukraine

Ukraine’s HIV prevention and management efforts focus on continuous and sustained scale-up of services. To reach UNAIDS 90–90-90 targets by 2020, Ukraine should increase investments in diagnosing, enrolling and retaining people living with HIV in treatment and care. We evaluated the relationship between expenditure on HIV services and client perception of service quality, as client satisfaction has been linked to retention in the HIV care continuum. We interviewed 617 clients who received HIV services at 43 healthcare facilities. Perceived service quality was measured across five domains: comprehensiveness of services, accessibility, user-friendliness, confidentiality and privacy, and overall satisfaction. Annual unit costs were estimated for HIV counseling and testing (HCT), antiretroviral treatment (ART), opioid substitution therapy (OST) and the needle and syringe program (NSP). Linkages between perceived service quality scores that were dichotomized at median and unit costs were measured using logistic regressions among subsets of clients who received respective HIV services. Median annual unit costs for HIV services varied from $7.94 to $661.84. Odds of HCT comprehensiveness increased linearly with the unit cost for HCT services (OR = 3.54, 95% CI 1.43–10.27). ART comprehensiveness was not linked to ART costs (OR = 0.46, 95% CI: 0.04–4.53). There was a negative relationship between confidentiality and privacy and OST costs (OR = 0.61, 95% CI: 0.38–0.96). Overall satisfaction was positively linked only to HCT costs (OR = 2.54, 95% CI 1.12–6.29), and no association was found for NSP costs (OR = 2.28, 95% CI 0.47–12.56). Unit costs for HCT services were associated with better perception of service quality and overall satisfaction, whereas other unit costs were negatively linked (OST) or were not associated (ART, NSP). Mixed results suggest that higher unit costs for some HIV services do not necessarily translate into better quality and consequently into improved retention in care. The lack of positive associations between unit costs and perceived quality of some services highlights the need to explore how HIV resource allocations can be improved in Ukraine to achieve better outcomes.

Young people's willingness to go for HIV/acquired immunodeficiency syndrome counseling and testing in oluku community in South Nigeria

Background: Young people are vulnerable to HIV/acquired immunodeficiency syndrome (AIDS) as they significantly contribute to new HIV infections in Nigeria and sub-Saharan Africa. HIV counseling and testing (HCT) provides an opportunity for increased awareness, prevention, treatment, care, and support for HIV/AIDS and contributes to the prevention and control of HIV/AIDS. Objective: This study aims to determine the HIV/AIDS awareness, knowledge of methods of prevention and transmission of HIV/AIDS, HIV status of sexual partner, and willingness to go for HIV/AIDS counseling and testing (HCT) among young people in Oluku Community, Ovia North East, local government, Edo State, South South, Nigeria. Materials and Methods: This was a descriptive cross-sectional study conducted between January and June, 2013, using multistage sampling method. Data were collected using interviewer-administered questionnaire adapted from the 2007 National HIV/AIDS and Reproductive Health Survey (NARHS) plus. Results: A total of 400 young people participated in this study; their mean age was 17.8 years (3.9 years). There were more females (211 [52.8%]) than males (189 [47.3%]). Majority (92.3%) of the young people were aware of HIV/AIDS; most heard of it via electronic media (81%), peers (63.5%), and parents (55.5%). Majority knew the methods of transmission of HIV/AIDS as having multiple sexual partners (80.0%), sharing sharps (78.3%), blood transmission (71.5%), and having unprotected sex (69.8%). Abstinence (50.1%) and condom use (37.8%) and faithfulness to partner (5.3%) were the methods practiced by most young people to prevent disease transmission and pregnancy. Most (61.9%) of the young people did not know the HIV/AIDS status of their partners before sexual intercourse. More than two-thirds (68.0%) had never gone for HCT, however majority (73.0%) of them were willing to go for HCT. Conclusion and Recommendations: Most young people were aware of HIV/AIDS and the methods of transmission, whereas more than two-thirds had never gone for HCT. However, majority of them were willing to go for HCT. Efforts should be geared toward improving access to HCT services by using stand-alone, mobile/outreach, and health facility-based HCT centers and community enlightenment on the importance of avoiding premarital sex and their roles in reducing HIV/AIDS and other sexually transmitted infection transmission.

Preference and uptake of different community-based HIV testing service delivery models among female sex workers along Malaba-Kampala highway, Uganda, 2017

IntroductionFemale Sex workers (FSW) and their clients accounted for 18% of the new HIV infections in 2015/2016. Special community-based HIV testing service delivery models (static facilities, outreaches, and peer to peer mechanism) were designed in 2012 under the Most At Risk Populations Frame work and implemented to increase access and utilization of HIV care services for key populations like female sex workers. However, to date there is no study that has been done to access the preference and uptake of different community-based HIV testing service delivery models used to reach FSW. We assessed preference and uptake of the current community-based HIV testing services delivery models that are used to reach FSW and identified challenges faced during the implementation of the models.MethodsWe conducted a cross-sectional study design using quantitative (interview with the health workers in facilities providing services to female sex workers and interviews with FSWs) and qualitative (interviews with Ministry of Health staff, health workers, district health team members, program staff at different levels involved in delivery of HIV care services, FSWs and political leaders to assess for the enabling environment created to deliver the different community-based HIV testing services to FSWs along the Malaba-Kampala highway. Malaba – Kampala high way is one of the major high ways with many different hot spots where the actual buying and selling of sex takes place. We defined FSWs as any female, who undertakes sexual activity after consenting with a man for money or other items/benefits as an occupation or as a primary source of livelihood irrespective of site of operation within the past six months.We assessed the preference and uptake of different community based HIV testing services delivery model among FSWs based on two indicators, i.e., the proportion of FSWs who had an HIV Counseling and Testing (HCT) in the last 12 months and the proportion of FSWs who were positive and linked to care.ResultsOverall, 86% (390/456) of the FSWs had taken an HIV test in the last 12 months. Of the 390 FSWs, 72% (279/390) had used static facilities, 25% (98/390) had used outreaches, and 3.3% (13/390) used peer to peer mechanisms to have an HIV test. Overall, 35% (159/390) of the FSWs who had taken an HIV test were HIV positive. Of the 159, 83% (132/159) were successfully linked into care. Ninety one percent (120/132) reported to have been linked into care by static facilities. Challenges experienced included; lack of trust in the results given during outreaches, failure to offer other testing services including hepatitis B and syphilis during outreaches, inconsistent supply of testing kits, condoms, STI drugs, and unfriendly health services due to the infrastructure and non-trained health workers delivering KP HIV testing services.ConclusionsMost of the FSWs had HCT services and were linked to care through static facilities. Community-based HIV testing service delivery models are challenged with inconsistent supply of HIV testing commodities and unfriendly services.. We recommended strengthening of all HIV testing community-based HIV testing service deliverymodels by ensuring constant supply of HIV testing/AIDS care commoditiesoffering FSW friendly services, and provision of comprehensive HIV/AIDS health care package.

English

Nigeria has high burden of HIV/AIDS; antiretroviral therapy (ART) availability, a blessing to HIV patients. Unfortunately, most people do not know their HIV status. Association for Reproductive and Family Health (ARFH), Nigeria introduced mobile free HIV Counseling and Testing (HCT) services to complement its clinic services for HCT uptake. The characteristics of clients patronizing ARFH’s HCT services are assessed. A retrospective review of ARFH’s clinics’ data on HCT services between 2005 and 2011 was undertaken and demographic characteristics of HCT clients were abstracted from the HIV intake register. Descriptive statistics of data were obtained using SPSS version 20.0. Significance of association between socio-demographic characteristics and reasons for HCT uptake were investigated using Chi-square test. The mean age of 6,684 clients was 29.5±9.4 years and 76% were females while 20% positive to HIV. Two-thirds in monogamous marriage and 25% had university/polytechnic education while 41% were artisans and apprentices. Nearness of HCT to patient’s residence and referral from ANC were the major reasons for HCT uptake. Mobile HCT clinic enhanced HCT uptake especially in sexually active age-group. Availability of mobile HCT services will fast-track achieving the first 90 of the 90-90-90-PEPFAR target for the control of HIV/AIDS. Proportion positive to HIV is high. Key words: HIV counseling and testing (HCT), Nigeria, HIV/AIDS, demographic characteristics, mobile, stand-alone.

Effect of multiple intervention models on uptake of HIV testing services and sexual behaviour among residents of military cantonments in south-east Nigeria

Background: HIV testing and counselling (HTC) has been a viable tool in controlling the spread of HIV/AIDS, and serves as the entry point in the HIV care and treatment cascade. In Africa, HIV-related morbidity and mortality are high with thousands still unaware of their HIV status. This study assessed the effect of on-site multiple HIV control interventions on the uptake of HTC services, knowledge and sexual behaviour among residents of two military cantonments [barracks] in south-east Nigeria.Methods: A quasi-experimental study was conducted among residents of cantonments in two states in Nigeria. A multistage sampling technique was used to select 350 respondents each at intervention and control sites. A pre-tested interviewer-administered questionnaire was used to collect information. On-site HTC services were established, with the training of HTC counsellors and peer educators. HIV awareness carnivals, with information, education and communication activities were conducted. Data were analysed with SPSS software and statistical tests carried out at 5% level of significance.Results: There was a statistically significant increase in the uptake of HTC services from 41.1% pre-intervention to 81.1% post-intervention (χ2 = 113.8, p < 0.001). Also, knowledge about HIV improved significantly from 35.4% to 98.8% (p < 0.001) in the intervention group, together with avoidance of risky sexual behaviour.Conclusion: The study demonstrated the effectiveness of multiple on-site intervention models in improving HIV knowledge, uptake of HTC services, and sexual behaviour among diverse cantonment residents. Establishing on-site HTC services and a constellation of awareness events will contribute significantly towards HIV prevention and control among high-risk populations.

51. Unmet Need For Risk Reduction Counseling And Prep Among Young Women At Risk For HIV

Pre-exposure prophylaxis (PrEP) for HIV can reduce acquisition up to 96%. Women currently account for 20% of new HIV infections in the United States. The Centers for Disease Control and Prevention (CDC) recommends HIV counseling and testing services (CTS) for sexually active women diagnosed with a bacterial sexually transmitted infection (STI), and that PrEP be offered to women who have an HIV-positive sexual partner, engage in injection drug use (IDU), or who inconsistently use condoms with a partner of unknown HIV status. The purpose of this study is to evaluate provider sexual risk reduction counseling behaviors and adherence to HIV CTS and PrEP education/prescription guidelines. Data was extracted from the Women’s BioHealth Study, a longitudinal study of young women aged 13-29 years seeking routine gynecologic or obstetric care in pediatric, adolescent medicine, and obstetrics/gynecology clinics within a large academic medical center in Baltimore, Maryland. The STIs considered were Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), Mycoplasma genitalium (MG), and Trichomonas vaginalis (TV). Patients provided demographic and sexual risk data at baseline through a self-reported questionnaire and were notified of results. Eligibility criteria for inclusion in this analysis was: 1) a prior negative HIV test and 2) diagnosis of a bacterial STI, self-reported injection drug use, having an HIV seropositive partner, or inconsistent condom use with a partner of unknown HIV status. Assessment of documented provider HIV and STI risk reduction counseling behaviors were gathered from the Electronic Medical Record (EMR) using a standardized data extraction form. Descriptive statistics and logistic regression analyses were performed. Of the 688 patients enrolled, 23% (N=159) were positive for an STI (CT 10%, NG 5%, TV 38%, MG 62%). Among HIV-seronegative patients, 145 were eligible for PrEP counseling based on diagnosis of a bacterial STI (N=145) and/or self-reported injection drug use (N=3). Of the women eligible for PrEP intervention (N=145), the mean age was 21.5 years (SD 3.6), 92% were African American, 90% reported having one male partner, 6.9% reported consistent condom use, and 41% (N=60) were pregnant. STI treatment was documented for 55% of pregnant women and 80% of non-pregnant women. Non-pregnant women had 84.4 times the odds of receiving general risk reduction counseling compared to pregnant women (OR 84.4; 95% CI: 27.9, 255; p<0.001). Non-pregnant women under the age of 25 had 136 times the odds of receiving risk reduction counseling as compared to pregnant women over the age of 25 (OR 136; 95% CI: 34.08, 542.41; p<0.001). Only one woman (0.69%) eligible for PrEP counseling was offered PrEP. Young women seeking routine gynecologic and obstetric care have an unmet need for STI and HIV CTS and are rarely offered PrEP counseling. Pregnant women are particularly vulnerable for non-receipt of sexual risk reduction counseling and HIV CTS services and should be a targeted for intervention given the potential impact of recurrent or untreated STI diagnosis (including HIV) on maternal-child health outcomes.

Financial and Behavioral Economic Factors Associated With HIV Testing In AIDS-Affected Adolescents in Uganda: A Cross-Sectional Analysis.

Provision of free HIV counseling and testing services (HCTS) helps remove financial barriers to care. Little is known on whether uptake of free HCTS by households impoverished by AIDS is influenced by financial and behavioral economic factors. We examined use of free HCTS by employment status, cash savings, food/income security, and present-bias preferences among 346 adolescent AIDS orphans and their household members in Uganda. HIV testing was low for all. Adolescents cared for by present-biased guardians (those who disproportionately weighted the present while discounting the future) were more likely to be HIV tested (OR=2.64, 95%CI:1.04-6.70) than adolescents cared for by guardians who weighted future gains. Guardians (OR=2.02; 95% CI:1.19-3.41) and non-guardian adults (OR=2.38; 95% CI:1.30-4.34) in households with savings were more likely to have been tested. Financially-insecure households (OR=0.59, 95%CI:0.35-0.97) were less likely to have been tested. Interventions addressing would-be HIV testers' economic needs may prove beneficial.