HIV Counseling And Testing Uptake Research Articles

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.

HIV testing and counselling among women in Benin: a cross-sectional analysis of prevalence and predictors from demographic and health survey data

ObjectiveTo examine the uptake of HIV testing and counselling (HTC) and its associated factors among women in Benin.DesignWe performed a cross-sectional analysis of data from the 2017–2018 Benin Demographic and...

HIV Counseling and Testing Uptake, Knowledge and Attitude and Influencing Factors among Student Nurses and Midwives in The Gambia: An Institutional-based Cross-sectional Study

HIV counseling and testing (HCT) has become paramount in the prevention and control of HIV/AIDS worldwide. However, the uptake of HCT has been very slow globally, especially in sub-Saharan Africa. Student nurses formed the largest group undergoing health care training in the country compared to doctors and other health cadres. According to WHO, they are part of the most vulnerable group to HIV infection, judging by the fact that they interact more with patients/clients than other healthcare professionals. This study aimed to determine the prevalence of HCT uptake, knowledge, and attitude and evaluate influencing factors among student nurses and midwives in public nursing schools. An institutional-based cross-sectional study design was employed to collect data from 305 randomly selected nursing students and midwives using a validated and reliable self-administered questionnaire. Descriptive statistics (percentages, mean and standard deviation) and inferential statistics (chi square, logistics regression, one-way ANOVA and independent samples t-test) were used for data analysis using SPSS version 25.0. A p-value < 0.05 was considered for statistical significance. Out of the 305 students recruited for the study, 60.98% were females, with a mean age of 25.5 years old. About 58.4% of the participants had tested for HIV in the past. About 95.7% acknowledged the importance of HCT in the prevention and control of HIV/AIDS. HCT uptake among student nurses and midwives was influenced by factors ranging from an individual that are interpersonal challenges (such as concerns of friends), perceived susceptibility to the disease, lack of confidentiality, stigma and discrimination from health service providers. Therefore, these barriers can be addressed through an organized targeted health education intervention and advocacy programs across health training institutions in the Gambia and beyond.

Preliminary effectiveness and implementation outcomes of the IMARA-South Africa sexual health intervention on adolescent girls and young women: A pilot randomized trial.

Family-based interventions may help reduce the risk of HIV and other sexually transmitted infections (STI) among adolescent girls and young women (AGYW) in sub-Saharan Africa but few have been tested. We examined the preliminary effectiveness and implementation outcomes of Informed, Motivated, Aware, and Responsible Adolescents and Adults-South Africa (IMARA-SA), an evidence-based intervention for South African AGYW (15-19 years) and their female caregivers. We piloted IMARA-SA in the Western Cape using an individually randomized experimental design and average follow-up at 11 months. Primary outcomes were HIV Testing and Counselling (HTC) uptake, STI incidence (gonorrhea, chlamydia), and pre-exposure prophylaxis (PrEP) uptake. Secondary outcomes were self-reported sexual risk behavior (condom use at last sex, consistency of condom use, substance use during sex, and number of sexual partners) and PrEP adherence. We examined four implementation outcomes: reach, feasibility, acceptability, and fidelity. Data from 59 AGYW (mean = 17.2 years) were analyzed at baseline (n = 29 from IMARA-SA, 30 from a health promotion control group). At follow-up, 51 (86%) completed surveys and 39 (66%) presented for HTC, STI testing, and/or PrEP. Compared to controls, fewer IMARA-SA participants tested positive for an STI (22% versus 38%), more IMARA-SA participants took up PrEP (68% versus 45%), and four of five secondary outcomes favored the IMARA-SA group at follow-up. These differences did not reach statistical significance. HTC uptake at follow-up was 100% in both groups. All AGYW-FC dyads agreed to participate in the study (reach). In the IMARA-SA group, 76% of dyads completed the intervention (feasibility), and over 76% of acceptability ratings from AGYW and their FC had the highest Likert rating. Fidelity of intervention delivery was 95%. IMARA-SA is a promising strategy for reducing HIV/STI risk among South African AGYW. We found strong evidence of reach, feasibility, acceptability, and fidelity. A fully powered randomized controlled trial is warranted. Trial registration: Clinical trials.gov registration number: NCT05504954.

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.

Assessing the sustainability of the Systems Analysis and Improvement Approach to increase HIV testing in family planning clinics in Mombasa, Kenya: results of a cluster randomized trial

BackgroundIn Kenya, HIV incidence is highest among reproductive-age women. A key HIV mitigation strategy is the integration of HIV testing and counseling (HTC) into family planning services, but successful integration remains problematic. We conducted a cluster-randomized trial using the Systems Analysis and Improvement Approach (SAIA) to identify and address bottlenecks in HTC integration in family planning clinics in Mombasa County, Kenya. This trial (1) assessed the efficacy of this approach and (2) examined if SAIA could be sustainably incorporated into the Department of Health Services (DOHS) programmatic activities. In Stage 1, SAIA was effective at increasing HTC uptake. Here, we present Stage 2, which assessed if SAIA delivery would be sustained when implemented by the Mombasa County DOHS and if high HTC performance would continue to be observed.MethodsTwenty-four family planning clinics in Mombasa County were randomized to either the SAIA implementation strategy or standard care. In Stage 1, the study staff conducted all study activities. In Stage 2, we transitioned SAIA implementation to DOHS staff and compared HTC in the intervention versus control clinics 1-year post-transition. Study staff provided training and minimal support to DOHS implementers and collected quarterly HTC outcome data. Interviews were conducted with family planning clinic staff to assess barriers and facilitators to sustaining HTC delivery.ResultsOnly 39% (56/144) of planned SAIA visits were completed, largely due to the COVID-19 pandemic and a prolonged healthcare worker strike. In the final study quarter, 81.6% (160/196) of new clients at intervention facilities received HIV counseling, compared to 22.4% (55/245) in control facilities (prevalence rate ratio [PRR]=3.64, 95% confidence interval [CI]=2.68–4.94). HIV testing was conducted with 60.5% (118/195) of new family planning clients in intervention clinics, compared to 18.8% (45/240) in control clinics (PRR=3.23, 95% CI=2.29–4.55). Interviews with family planning clinic staff suggested institutionalization contributed to sustained HTC delivery, facilitated by low implementation strategy complexity and continued oversight.ConclusionsIntervention clinics demonstrated sustained improvement in HTC after SAIA was transitioned to DOHS leadership despite wide-scale healthcare disruptions and incomplete delivery of the implementation strategy. These findings suggest that system interventions may be sustained when integrated into DOHS programmatic activities.Trial registrationClinicalTrials.gov (NCT02994355) registered on 16 December 2016.

An individually randomized controlled trial of a mother-daughter HIV/STI prevention program for adolescent girls and young women in South Africa: IMARA-SA study protocol

BackgroundSouth Africa has the world’s largest HIV epidemic, but South African adolescent girls and young women (AGYW) acquire HIV at twice the rate of and seroconvert on average 5–7 years earlier than their male peers. Female caregivers (FC) are an untapped resource for HIV/STI prevention in South Africa and offer a novel opportunity to strengthen AGYW prevention efforts. This study will evaluate the effectiveness and cost-effectiveness of an evidence-based mother-daughter HIV/STI prevention program tested in the United States and adapted for South Africa, Informed Motivated Aware and Responsible Adolescents and Adults (IMARA), to decrease STI incident infections and increase HIV testing and counseling (HTC) and PrEP uptake in AGYW.MethodsThis is a 2-arm individually randomized controlled trial comparing IMARA to a family-based control program matched in time and intensity with 525 15–19-year-old Black South African AGYW and their FC-dyads in Cape Town’s informal communities. AGYW will complete baseline, 6-, and 12-month assessments. Following randomization, AGYW-FC dyads will participate in a 2-day group workshop (total 10 h) that includes joint and separate mother and daughter activities. Primary outcomes are AGYW STI incidence, HTC uptake, and PrEP uptake at 6 months. Secondary outcomes are AGYW STI incidence, HTC uptake, and PrEP uptake at 12 months, sexual behavior (e.g., condom use, number of partners), HIV incidence, and ART/PrEP adherence and intervention cost-effectiveness. AGYW who test positive for a STI will receive free treatment at the study site. HIV positive participants will be referred to ART clinics.DiscussionPrimary prevention remains the most viable strategy to stem new STI and HIV transmissions. HIV and STI disparities go beyond individual level factors, and prevention packages that include supportive relationships (e.g., FC) may produce greater reductions in HIV-risk, improve HTC and PrEP uptake, and increase linkage, retention, and adherence to care. Reducing new HIV and STI infections among South African AGYW is global public health priority.Trial registrationClinicalTrials.gov Number NCT04758390, accepted 02/16/2021.

Sex Differences in HIV Testing among Older Adults in Sub-Saharan Africa: A Systematic Review.

Background Despite being sexually active and engaging in risky sexual behaviours similar to young adults, older adults (50 years or older) are less likely to receive HIV testing, and disaggregated data are still scarce about HIV prevention and treatment in this vulnerable population in sub-Saharan Africa (SSA). This systematic review is aimed at examining sex differences in HIV testing and counseling (HTC) among older adults in SSA. Methods A systematic search of four databases, namely, MEDLINE (Ovid), EMBASE (Ovid), Web of Science, and Global Health, was conducted from 2000 to January 2020. The primary outcome of interest for this study was gender differences in HTC among older adults in SSA. Observational studies including cross-sectional, retrospective, and prospective cohort studies were included. Eligible studies must have reported sex differences in HIV testing uptake in a standard HTC service among older adults in SSA. Results From the database search, 4143 articles were identified. Five studies were ultimately included in the final review. Of the 1189 participants, 606 (51.1%) and 580 (48.9%) were female and male, respectively. The review findings suggested that both men and women preferred HTC providers that are the same sex as them with women additionally preferring a provider who is also of a similar age. Men and women differed in their pathways to getting tested for HIV. The review documented mixed results with regard to the associations between sex of older adults and uptake of HTC. Older adult HTC uptake data are limited in scope and coverage in sub-Saharan Africa. Conclusion This review revealed shortage of evidence to evaluate optimum HTC utilization among older adults. Few studies examined sex differences in HIV testing among older adults in the region. There is a need for stakeholders working in the area of HIV prevention and treatment to focus on older adult health utilization evidence organization, disaggregated by age and sex. Hence, high-quality research designs are needed on the topic in order to generate good quality evidence for targeted interventions to improve HTC among older adults in sub-Saharan Africa.

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.

Changes over time in HIV testing and counselling uptake and associated factors among youth in Zambia: a cross-sectional analysis of demographic and health surveys from 2007 to 2018

IntroductionZambia is among the countries with the highest HIV burden and where youth remain disproportionally affected. Access to HIV testing and counselling (HTC) is a crucial step to ensure the reduction of HIV transmission. This study examines the changes that occurred between 2007 and 2018 in access to HTC, inequities in testing uptake, and determinants of HTC uptake among youth.MethodsWe carried out repeated cross-sectional analyses using three Zambian Demographic and Health Surveys (2007, 2013–14, and 2018). We calculated the percentage of women and men ages 15–24 years old who were tested for HIV in the last 12 months. We analysed inequity in HTC coverage using indicators of absolute inequality. We performed bivariate and multivariate logistic regression analyses to identify predictors of HTC uptake in the last 12 months.ResultsHIV testing uptake increased between 2007 and 2018, from 45 to 92% among pregnant women, 10 to 58% among non-pregnant women, and from 10 to 49% among men. By 2018 roughly 60% of youth tested in the past 12 months used a government health centre. Mobile clinics were the second most common source reaching up to 32% among adolescent boys by 2018. Multivariate analysis conducted among men and non-pregnant women showed higher odds of testing among 20–24 year-olds than adolescents (aOR = 1.55 [95%CI:1.30–1.84], among men; and aOR = 1.74 [1.40–2.15] among women). Among men, being circumcised (aOR = 1.57 [1.32–1.88]) and in a union (aOR = 2.44 [1.83–3.25]) were associated with increased odds of testing. For women greater odds of testing were associated with higher levels of education (aOR = 6.97 [2.82–17.19]). Education-based inequity was considerably widened among women than men by 2018.ConclusionHTC uptake among Zambian youth improved considerably by 2018 and reached 65 and 49% tested in the last 12 months for women and men, respectively. However, achieving the goal of 95% envisioned by 2020 will require sustaining the success gained through government health centres, and scaling up the community-led approaches that have proven acceptable and effective in reaching young men and adolescent girls who are less easy to reach through the government facilities.

Acceptability and correlates of HIV self-testing among university students in northern Nigeria.

Concerns about stigma and confidentiality limit the uptake of HIV testing and counseling (HTC) among young adults. HIV self-testing has been offered as a youth-friendly alternative to conventional HTC. We conducted a cross-sectional study to assess HTC uptake, willingness to self-test, and their predictors among university students (n = 399) in Kano, Nigeria. Anonymous self-administered questionnaires were provided to participants. Adjusted odd ratios were generated for predictors with logistic regression models. The results showed that only 35.8% (n = 143) of participants had previous HTC.Most respondents (70.4%, n = 281) were willing to self-test. HTC was associated with year of college (500 Level vs. 100 Level), adjusted odds ratio (AOR, [95% Confidence Interval (CI)] = 0.44 (0.19-0.97), campus residence (off- vs. on-campus, AOR = 0.45; 95%CI: 0.28-0.73), sexual activity in the past six months (AOR = 0.39; 95%CI: 0.24-0.64), willingness to self-test (AOR = 0.38; 95%CI: 0.22-0.66), and consistent condom use (AOR = 4.45; 95%CI: 1.41-14.08). Students who were older (≥ 30 vs. <20 years, AOR = 0.20; 95%CI: 0.05-0.90) and female (AOR = 0.56; 95%CI: 0.32-0.98) were less likely to be willing to self-test, whereas students who were more senior (500 Level vs. 100 Level, AOR = 5.24; 95%CI: 1.85-14.84), enrolled in clinical science programs (vs. agriculture, AOR = 4.92; 95%CI: 1.51-16.05) or belonging to "other" ethnic groups (vs. Hausa-Fulani, AOR = 2.40; 95%CI: 1.11-5.19) were more willing to self-test. Overall HTC uptake was low, but acceptability of self-testing was high. College seniority, age, ethnicity, and program of study were associated with willingness to self-test. Our findings support the feasibility of scaling up HIV self-testing among university students in Nigeria.

Uptake of HIV testing and counseling among tertiary institution students in the Hohoe Municipality, Ghana.

HIV Testing and Counselling (HTC) is a critical strategy to reduce the rate of new HIV infections and the key entry point to HIV treatment, care and support services. This study aimed to determine the uptake of HTC among students of tertiary institutions in the Hohoe Municipality of Ghana. This was a quantitative cross-sectional study. A structured questionnaire was used to collect data among a proportionate stratified sample of students from tertiary institutions. Chi-square and Logistic regression analyses were performed using Stata version 12.0 at the 0.05 level of significance. Only 30.6% of the total respondents had ever tested for HIV/AIDS of which, only 22.9% tested less than 6 months before the current study. Students above twenty-four years of age were 3 times more likely to go for HTC than those below 20 years [OR=2.56 (95% CI: 1.07-6.11; p=0.034)]; those in the fourth year of study were 3 times more likely get HTC than those in the first year [OR=3.05 (95%CI: 1.10-8.49; p=0.033)]; and those attending THERESCO, the Midwifery training college and UHAS were more than 2 times more likely to get tested for HIV than those attending FRANCO [OR =2.67 (95% CI: 1.14-6.15; p=0.024)], [OR=2.40 (95% CI: 1.04-5.54; p=0.040)] and [OR=2.63 (95% CI: 1.13-6.13; p=0.026)] respectively. The uptake of HTC among tertiary institution students in Hohoe municipality was considerably low. Policymakers should design programs and interventions that would increase uptake of HTC among tertiary students, with focus on those aged less than 20 years, those at the lower level of study and those in the non-health related institutions.

Individual and partner characteristics associated with HIV testing and counseling uptake among individuals 50 years or older in Tanzania.

HIV prevention efforts have historically focused on people aged 15–49 years, despite mounting evidence of risk behavior and increased disease burden among older adults. We analyzed survey data from 600 adults aged ≥50 years in the Rombo District of Tanzania. Logistic regression models were performed to evaluate individual and partner-level factors associated with HIV testing and counseling (HTC) uptake. In this sample, more than half of participants were sexually active and condom use was rare, but only 57% had ever been tested for HIV. Ten were HIV infected (1.7%); this prevalence was approximately one-third that observed among the general population in Tanzania (4.7%). Individual factors associated with increased HTC uptake included younger age, female gender, greater educational attainment, and having health insurance. Partner factors associated with increased HTC uptake included lower partner age and higher partner education. This population demonstrated substantial HIV risk, warranting tailored interventions to raise awareness and increase HTC uptake.

The effectiveness of national HIV prevention education program on behavioral changes for men who have sex with men and transgender women in Thailand

Purpose The purpose of this paper is to investigate the effectiveness of the national HIV prevention outreach program for men who have sex with men (MSM) and transgender women (TGW). Design/methodology/approach It examined changes in condom use, lubricant use, HIV testing and counseling (HTC) uptake and sexually transmitted infection (STI) screening uptake, as well as how and why changes did or did not occur. The study applied mixed methods of both quantitative and qualitative approaches. Findings There were 16,539 MSM, and TGW reached at least three times in the program during October 2011‒September 2012. The program was found to affect changes in condom use with steady partners (p&lt;0.000), condom use with casual partners (p&lt;0.000), water-based lubricant use (p&lt;0.000), HTC uptake (p&lt;0.000) and STIs screening uptake (p&lt;0.000). Age and province of outreach are associated with HTC uptake and STI screening (p&lt;0.000), slightly as well as gender identity (p&lt;0.1). Gender identity and province of outreach are associated with condom use with steady partners (p&lt;0.000). Gender identity (p&lt;0.000) and sex work (p&lt;0.05) are associated with the use of lubricant. The qualitative results showed that the program had an immediate effect on HTC and STIs screening due to successful bond between the outreach workers and their clients, leading to trust and influencing behavior change. Originality/value HIV prevention by peer educators continues to be proved the most effective method, assuming its program consistency. TGW are more vulnerable to MSM to protect themselves, and they have steady partners. Future program for MSM can be replicated and scaled up, but more empowerment component and self-esteem building should be integrated to target TGW.

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.

HIV risk, risk perception and uptake of HIV testing and counseling among youth men who have sex with men attending a gay sauna

BackgroundMen who have sex with men (MSM) are amongst populations at-risk for HIV acquisition in Thailand. In youth MSM (aged 15–24 years), the incidence of HIV infection has substantially increased. However, data on HIV risk, risk perception and HIV testing and counseling (HTC) uptake among youth MSM in hotspots are limited.MethodsA subanalysis of a prospective study among Thai MSM attending a gay sauna was conducted. HIV risk and risk perception were assessed by an anonymous survey. The MSM were categorized as having actual “low-risk”, “moderate-risk” and “high-risk” for HIV acquisition based on the validated study risk categorization tool. HTC was provided on-site with result notification within 1 h. HIV care establishment appointment was arranged by the counselors for HIV-infected participants. Care engagement within 1 year of diagnosis was subsequently assessed.ResultsThere were 358 MSM participants; 87 (24%) were youth MSM. Comparing to other MSM, youth MSM had significantly higher median number of lifetime sexual partners [2 (IQR 1–9) vs. 1 (IQR 0–1); P < 0.001), were more-likely to ever exchange sex for money (44% vs. 9%; P < 0.001) and have sexual partner who exchanged sex for money (8% vs. 1%; P < 0.001). Rates of consistent condom use in the past 3 months for anal, oral and vaginal sexes were low and not significantly different between youth and other MSM (51% vs. 61%, 26% vs. 35% and 72% vs. 61%, respectively). By using the study risk categorization tool, there were 68 youth MSM with moderate or high-risk for HIV acquisition, of which 43 (63%) had false perception of low HIV risk. Youth MSM were more likely than other MSM to accept HTC [68% vs. 33%, P < 0.001)] and to be first-time testers (42% vs. 28%, P = 0.07). By HTC, the rates of HIV infection tended to be higher among youth MSM comparing to other MSM [14/59 (24%) vs. 11/89 (12%); P = 0.07]. Among the 14 youth MSM newly-diagnosed with HIV infection, only 6 (43%) showed-up for continuity care after 1-year follow-up.ConclusionsYouth MSM had substantial high HIV risk, false perception of low HIV risk and low rate of care engagement but demonstrated considerable rate of HTC uptake. Strategies to improve access to HTC, risk perception and linkage to care are needed for HIV prevention and management among the youth MSM.

Uptake Pattern of HIV Counseling and Testing Services: A 4-Year Review in Plateau State, Nigeria

Plateau state is one of the HIV high-burden states in Nigeria with few people knowing their HIV status as a result of challenges with access to HIV Counseling and Testing (HCT) services. This study was aimed at determining the HCT uptake among the general population as well as the pattern by age and sex in Plateau state. The study was a 4-year descriptive analysis of HCT services in the general population of Plateau state, Nigeria based on data generated between January 2012 and December 2015. The data on HCT services were managed through the electronic Nigerian National HIV/AIDS Response Information Management System (eNNRIMS) which was web-based software. The data was disaggregated by year, age and sex in the software and analysis was done using excel to obtained the proportions and trend of HCT uptake in the general population and by year, age and sex. Out of a total of 495,718 tested for HIV, 400,699 people received their test results giving an 80.8% HCT uptake in Plateau state. The highest (99.7%) HCT uptake was in 2014 and the least (67.7%) was in 2012. The age group 25 – 49 years accounted for nearly two-thirds of HCT uptake. The female population had higher percentages of between 7.2% and 17.6% HCT uptake across the years compared to their male counterparts. The HCT uptake was relatively high, and it was even higher among the female population compared to the HCT uptake among male population in Plateau state Nigeria.

The impacts of community-based HIV testing and counselling on testing uptake

Purpose Community-based HIV testing and counselling (HTC) has been recommended for improving access to prevention, care, and treatment services in at-risk populations. Earlier systematic reviews and meta-analyses have been undertaken, but due to some methodological limitations, their findings do not yet provide a practical significance. The purpose of this paper is to re-examine the recent evidence of the efficacy of community-based HTC approaches on the uptake of HTC in at-risk populations. Design/methodology/approach The database of PubMed online, Science Direct, the Lancet Global Health, the Cochrane Central Register of Controlled Trials, and Google Scholar were systematically searched using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to obtain empirical papers published between March 2013 and December 2015. Findings Of 600 collected papers, there were 6 cluster randomized trials papers which met the inclusion criteria. Compared to the health facilities-based HTC, community-based HTC approaches have been shown to improve the uptake of HIV testing from 5.8 to 37 per cent, and improve HIV testing in men and their partners together from 6.8 to 34 per cent. The community approaches also detected lower HIV-positive cases (0.29 per cent as compared to 4 per cent), improved access to treatment services from 0.3 to 25 per cent, demonstrated higher cluster differentiation 4 count in newly diagnosed patients (median of 400-438 cells/µl), and increased the rate of first-time HIV testing from 9 to 11.8 per cent. With respect to social and behavioural outcomes, community-based HTC increased social norms for HIV testing by 6 per cent (95 per cent CI 3-9), decreased multiple sex partners by 55 per cent (95 per cent CI 42-73), lowered casual sex by 45 per cent (95 per cent CI 33-62), increased knowledge about HIV (83.2 vs 28.9 per cent), improved positive attitudes towards HIV patients (73.0 vs 34.3 per cent), and increased the use of condoms (28.0 vs 12.3 per cent). Originality/value Community-based HTC combined with behavioural interventions have been found to be more effective in increasing the uptake of HIV testing as well as other outcomes as compared to the conventional health facilities-based testing and counselling approaches.

Sexual risk behavior and uptake of HIV counseling and testing among youth in Metropolitan Kumasi, Ghana

ABSTRACTResearch on HIV counselling and testing (HCT) has proliferated in Ghana but limited evidence exists about the uptake of HCT among a large population that has been shown to engage in HIV risk-related behavior in Metropolitan Kumasi. With retrospective cross-sectional data from a representative sample of sexually active young people, multivariate logistic regression models examine the variables associated with HCT uptake in Kumasi. Among 906 participants (male 51% and female 49%, with a mean age ±SD, 25 ± 6), 22% had utilized HCT in the last six months despite the higher knowledge of HCT (84%) mainly through mass media (65%) and health providers (27%). Besides, less than 20% of the sample intended to undergo HCT services. Multivariate logistic regression analysis showed that female gender (adjusted odds ratio [aOR] = 1.830; 95% CI: 1.280–47.831; p < 0.001), being single (aOR = 3.032; 95% CI: 1.413–6.485; p = 0.040), having sexual intercourse with irregular partner (aOR = 5.597; 95% CI: 1.776–17.638; p = 0.018), practiced unprotected sex (aOR = 2.614; 95% CI: 1.821–6.472; p = 0.002), having multiple sex partners (aOR = 2.902; 95% CI: 1.405–7.226; p < 0.001) and being aware of HCT services (OR = 3.488; 95% CI: 1.256–5.929; p < 0.005) were associated with HCT uptake. These findings are germane for health policy and planning interventions seeking to address the barriers to HCT uptake among youth who are at greater risk of HIV infection.

Toward 90-90-90: identifying those who have never been tested for HIV and differences by sex in Lesotho

ABSTRACTTo reach HIV epidemic control it is important to ensure that those who have never been tested access HIV testing and counseling (HTC) particularly in the context of a generalized HIV epidemic. Using data from the 2014 Lesotho Demographic Health Survey bivariate and multivariate logistic regressions were conducted to determine the associations between never tested for HIV and key socio-cognitive characteristics by sex. Marginal probabilities at the means were calculated for the socio-cognitive variables for men and women to ascertain the magnitude of the differences in the likelihood of never being tested by sex. We stratified by gender and controlled for age, education, religion, marital status, place of residence, and years circumcised (for men only). Results indicate that more men than women have never been tested (χ2 = 461.16, p < 0.001); and, among men, acceptance of gender based violence (Odds ratio [OR]: 1.44, p < 0.001), holding discriminatory attitudes (OR: 1.50, p < 0.001), and not having basic HIV prevention knowledge (OR: 1.53, p < 0.001) were significantly associated with never being tested. The likelihood of never being tested among those who had these three socio-cognitive characteristics was much higher among men (0.56, p < 0.001) than women (0.20, p < 0.001). Given the strong sex differential, there is an urgent need for strategies specifically targeting men in order to effectively promote HTC uptake among them. Additionally, results suggest that those strategies should integrate strategies to address GBV acceptance, HIV prevention knowledge, and HIV discrimination or link men to programs addressing these.