HIV Testing Rates Research Articles

Associations Between HIV-Related Stigma, Trust, and Testing Behaviors Among the General U.S. Adult Population.

HIV testing is essential to achieving the 95-95-95 targets, yet lifetime HIV testing rates in the United States fall below established guidelines. Building on similar healthcare contexts where stigma hinders access and trust mitigates its negative effect, this exploratory study examined the relationship between HIV-related stigma (HRS) and testing behavior, focusing on the role of trust in healthcare providers (HCPs). We used data from the 2022 General Social Survey, a nationally representative sample of the general population. HRS was evaluated across three domains: perceived social discrimination towards people living with HIV (PLWH), avoidance due to unfounded fear of transmission, and moral judgement. Weighted stratified logistic regression was employed to examine how the relationship between HRS and testing behavior varied across different levels of trust in HCPs. Among participants with low trust in HCPs, the avoidance of PLWH due to unfounded fears was associated with lower odds of undergoing HIV testing. In the high trust group, none of the HRS domains were associated with HIV testing; instead, testing was linked to the individual's engagement in HIV-risk behaviors. Our findings reveal a complex interplay between HRS, trust, and testing behavior, highlighting the need for collective action to address misconceptions about HIV transmission and promote awareness of risk behaviors, with concurrent efforts to foster trust in HCPs.

Implementing HIV teams sustainably improves HIV indicator condition testing rates in hospitals in the Netherlands: the #aware.hiv clinical trial.

Develop and validate a strategy to improve HIV testing rates using HIV teams. A prospective clinical trial was conducted from January 2020 to July 2023 in two Dutch university hospitals. The intervention involved implementing HIV teams to provide peer awareness, education, and feedback to physicians treating patients ≥18 years newly diagnosed with HIV indicator conditions. The primary outcome was the HIV testing rate. Secondary outcomes included testing rates by specialty, HIV prevalence, and reasons for withholding testing. Of the 313,666 newly registered diagnoses, 2,395 involved indicator conditions. The overall HIV testing rate of newly diagnosed HIV indicator conditions increased from 50.1% (222/443) pre-implementation to 80.7% (1,575/1,952) post-implementation of HIV teams (p < 0.001) with sustained improvement during the observation period (range 72.4-90.4%). The intervention was effective across physicians from all medical specialties. HIV prevalence among those tested was 0.6% (95%CI 0.3-1.1%). Peer feedback for 411 untested indicator conditions, resulted in 69 (16.3%) additional HIV tests. Failure to test frequently remained without reason (50.6%) or due to patient loss of follow-up (18.4%). Multivariate analysis indicated that women with indicator conditions were tested less often (aOR 0.59, 95%CI 0.45-0.79, p < 0.01), and indicator conditions without HIV testing recommendations in national guidelines were also less likely to be tested for HIV (aOR 0.36, 95%CI 0.27-0.48, p < 0.01). For external validation, we implemented this intervention in a second hospital, where it also significantly increased the testing rate post-implementation of HIV teams. Implementing HIV teams in hospitals is feasible, effective and leads to a sustained increase in HIV indicator condition-guided testing, supporting its broader adoption.

Effectiveness of the smart program: Stepped-care HIV prevention for gay and bisexual adolescent boys.

Adolescent men who have sex with men (AMSM) have high HIV incidence and low rates of HIV testing and pre-exposure prophylaxis (PrEP) use. There are few evidence-based HIV prevention programs that meet the unique needs of AMSM. The sequential, multiple assignment, randomized trial (SMART) program is a stepped care package of increasingly intensive eHealth interventions that were developed specifically for English- and Spanish-speaking AMSM. The sequence included universal sexuality education (SMART Sex Ed), an automated motivation and behavioral skills focused intervention (SMART Squad), and motivational interviewing via videoconferencing (SMART Sessions). This SMART compared HIV testing, PrEP use, condomless anal sex (CAS), condom use intentions, and condom use self-efficacy outcomes for different embedded treatment sequences in the SMART program among a large sample of English- and Spanish-speaking AMSM (ages 13-18) in the U.S. states and territories (N = 1,306). In most of the embedded treatment sequences, there were significant improvements across 12 months for most of the outcomes, including CAS with casual partners, HIV testing, PrEP use, and condom use self-efficacy. There were largely no changes in CAS inclusive of serious partnerships and condom use intentions declined in some regimes. Findings from 12 months of follow-up provide evidence of the SMART program's long-term effectiveness, with particular benefits for the important outcomes of HIV testing and PrEP use. Given the lack of effective interventions for this high HIV-incidence population coupled with the potential for high reach given the eHealth modality, funders should put in place the resources to enable rapid implementation. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

HIV/AIDS knowledge, attitudes, high-risk sexual behaviour and HIV testing among university students in Henan, China

ABSTRACT The number of young Chinese students infected with HIV continues to rise, and young students have become an important group in HIV infection and transmission. This study aims to explore HIV/AIDS knowledge, attitudes, high-risk sexual behaviour and HIV testing among university students in Henan Province, China, to provide a reference for more targeted health education in universities. We conducted a cross-sectional survey of university students in Henan Province using stratified sampling. A validated self-administered questionnaire was used as the research instrument. Logistic regression analysis was used in data analysis. A total of 897 valid questionnaires were collected. The awareness rate of HIV/AIDS knowledge was 71.35%, the positive attitude rate of HIV/AIDS was 57.19%, the incidence of sexual behaviour was 16.16%, the incidence of high-risk sexual behaviour was 3.90%, and the HIV testing rate after high-risk sexual behaviour was 11.43%. Medical students (AOR = 1.67) and students who had attended AIDS health education (AOR = 1.41) were protective factors for knowledge of HIV/AIDS. Female students (AOR = 1.66) and knowledge of HIV/AIDS (AOR = 1.58) were protective factors for attitudes towards HIV/AIDS, and higher grades students (AOR = 0.74) was a risk factor for attitudes towards HIV/AIDS. Higher grades students (AOR = 2.21) and bisexual and homosexual students (AOR = 4.02) were risk factors for high-risk sexual behaviour, students who had attended AIDS health education (AOR = 0.36) and positive attitudes towards HIV/AIDS (AOR = 0.34) were protective factors for high-risk sexual behaviour. Homosexuality and bisexuality (AOR = 3.06) and sexual orientation uncertainty (AOR = 2.98) were protective factors for HIV testing. University students do not have a comprehensive understanding of HIV/AIDS, so it is necessary to strengthen AIDS education, guide students to establish positive attitudes towards HIV/AIDS, and raise their awareness of self-protection and the rate of HIV testing after high-risk sexual behaviour. Focus on male students, higher grades students, non-medical students and homosexual and bisexual students.

P-479. The Impact of the COVID-19 Pandemic on HIV Testing in Peru: An Interrupted Time Series Analysis from 2014 to 2022

Abstract Background HIV testing is crucial for early treatment and mortality reduction. In Latin America and the Caribbean, 18% of individuals are unaware of their HIV status, which leads to a late diagnosis. Furthermore, COVID-19 lockdowns had a negative impact on HIV testing rates. This study focused on comparing pre-pandemic (January 2014-February 2020) and post-lockdown (August 2020-December 2022) testing rates to support effective HIV screening and public health strategies.Figure 1.Interrupted time series analysis for the frequency of HIV testing per quarter. Methods We performed an interrupted time series analysis with cross-sectional data from Peru's National Demographic and Health Survey (ENDES), covering 2014 to 2022. ENDES follows a complex, three-stage sampling method: proportional cluster selection, random household selection within clusters, and individual selection aged 15 or older for the health survey. A segmented regression analysis adjusted for age and gender evaluated changes in testing rates, with an ARIMA model providing counterfactual predictions against actual pandemic-period rates.Figure 2.Interrupted time series analysis for HIV testing. Results The study included 211,359 participants aged 15 to 49 years. There was a significant drop in HIV testing by 8.33% (95% CI: -10.73% to -5.93%, p&amp;lt; 0.001) post-lockdown. Before the lockdown, HIV testing rates trend was increasing by 0.30% per quarter (95% CI: 0.21% to 0.40%, p&amp;lt; 0.001); however, after the lockdown, they declined by -0.24% per quarter (95% CI: -0.56% to 0.09%, p=0.125) (Figure 1), with the most pronounced decrease among adolescents (15-17 years), the economically disadvantaged, those who lived in rural areas, and non-capital residents. The ARIMA model indicated a potential non-pandemic decline of -9.20% in testing proportions (95% CI: -13.70% to -4.80%) in comparison with the forecasted values (Figure 2). Conclusion COVID-19 lockdown policies markedly decreased HIV testing in Peru, especially affecting high-risk groups. Although limited by potential recall bias and self-reporting, this research, focusing primarily on individuals aged 15 to 49, provides essential data for targeted interventions to restore and ensure HIV testing accessibility post-pandemic. Disclosures All Authors: No reported disclosures

P-509. Impact of an Innovative Educational Initiative Using Community-Based Organization Partnerships to Reach Young Adults at Risk for HIV

Abstract Background Young adults (YA) are particularly vulnerable to acquiring HIV due to low self-perceived risk, low rates of HIV testing, and lack of knowledge/awareness about pre-exposure prophylaxis (PrEP). Methods Between 3/23 – 8/23, six education sessions for YAs were conducted in the Southeastern U.S. by local healthcare professionals (HCPs) along with community-based organizations (CBOs) in non-clinical settings (e.g. college campuses, breweries). Pre- and post-surveys were administered, with follow-up surveys 3 weeks later. A scale-up education toolkit was disseminated to HCPs nationwide. Results A total of 264 YAs participated in the education sessions (mean age: 24 years; 85% female; 54% Caucasian; 87% heterosexual) with 29% previously tested for HIV and 21% who previously discussed PrEP with a HCP. YA’s knowledge of different forms of PrEP improved significantly (38% pre- vs. 96% post-activity; p &amp;lt; 0.001) as did their confidence in protecting themselves from acquiring HIV (55% pre vs. 93% post; p &amp;lt; 0.001). In addition, awareness of local resources for HIV testing improved from 60% to 93% (p &amp;lt; 0.001) with a significant increase in YAs who stated they were likely to get tested for HIV (26% pre vs. 63% post, p &amp;lt; 0.001). Seventy-five HCPs and CBO leaders also participated. Interestingly, there was a disconnect between CBO/HCPs’ perceptions of barriers to HIV/STI testing compared to YAs’ reported challenges (Fig 1). All providers stated they were likely/very likely to organize another session. A follow-up survey of HCPs (N = 10) found they helped 58 YAs access HIV testing and 33 access PrEP since the education, with 70% of HCPs using the materials during 1:1 counseling with YAs, suggesting sustainability of the resources. HCPs (N = 867) who reviewed the toolkit had improvements in their confidence in differentiating between PrEP options and identifying who would benefit from each approach (p &amp;lt; 0.001) and counseling YAs about PrEP (p &amp;lt; 0.001). Conclusion Providing HIV prevention education to YAs in informal, community settings increases reach to those who may not have these discussions with their HCPs during regular visits. This type of educational initiative, which includes partnering with CBOs, is scalable and sustainable. Disclosures Meredith E. Clement, MD, Gilead Sciences: Grant/Research Support|Viiv Pharmaceuticals: Advisor/Consultant Kelly E. Pillinger, PharmD, AHFS: Contractor

P-514. Enhancing the Pediatric Primary Care Provider’s Role in Adolescent HIV Prevention

Abstract Background Youth with a history of bacterial sexually transmitted infections (STIs) are at increased risk of HIV acquisition and should be counseled on HIV Pre-Exposure Prophylaxis (PrEP). PrEP counseling has been associated with high acceptability rates in primary care, but most pediatric providers do not discuss PrEP during clinic visits. We conducted a quality improvement project at primary care clinics affiliated with a tertiary not-for-profit children’s hospital serving the city of Milwaukee. The objective of this project is to increase rates of counseling on HIV testing and PrEP during primary care visits around an STI diagnosis, as part of a larger institutional initiative to increase PrEP utilization in at-risk youth. Methods Rates of HIV testing and PrEP counseling were monitored monthly during baseline (July 2022-June 2023) and post-intervention periods (July 2023-June 2024) using Plan-Do-Study-Act (PDSA) cycles tracked via a statistical process control chart. We included well child and sexual health-related office visits in youth aged 12 and older that occurred within 3 months of a bacterial STI diagnosis (gonorrhea, chlamydia, or syphilis). Interventions consisted of a clinician educational session, a prompt in the electronic health record (EHR) for missing HIV tests and a communication to the primary care provider containing internal PrEP resources following a patient’s STI diagnosis. Results From July 2022 to December 2023, we identified 255 primary care visits around an STI diagnosis (90.59% chlamydia, 25.49% gonorrhea, 0.39% syphilis and 16.47% co-infections). Patient characteristics are summarized in Table 1. Interim analysis showed counseling rates on HIV testing increased from 50% to 63% (Figure 1) and PrEP counseling from 5% to 15% (Figure 2) through December 2023. Data will continue to be measured through June 2024. Conclusion For the first 6 months of our project, clinician education combined with an EHR prompt and provider communications containing PrEP resources have resulted in a modest increase in counseling rates on HIV testing and PrEP for at-risk youth during primary care visits. These initial interventions demonstrate a promising start towards enhancing HIV prevention discussions in pediatric primary care. Disclosures All Authors: No reported disclosures

P-489. Opt-Out HIV Testing, Trends in a Community Healthcare System–A Longitudinal Analysis from 2018 to 2024

Abstract Background Emergency department (ED)-based “Opt-Out” HIV testing is critical to access HIV prevention and care services. Due to the COVID-19 pandemic, disruptions in medical services might have affected HIV testing uptake. The number of HIV tests per month in ED-based settings in the Memorial Healthcare System between July 2018 and February 2024. A, Pre-COVID-19 phase; B, The COVID-19 pandemic phase; C, Post-pandemic phase. MPC, monthly percent changeFigure 1.Multiple joinpoint models showing the temporal trends in the number of HIV tests per month in ED-based settings in the MHealthcare System between July 2018 and February 2024. A, Pre-COVID-19 phase; B, The COVID-19 pandemic phase; C, Post-pandemic phase. MPC, monthly percent change. Methods We collected data on ED-based HIV testing from the Memorial Healthcare System in Hollywood, Florida. Data from July 2018 to February 2024 were divided into three phases: pre-pandemic (July 2018 – Feb 2020), pandemic (March 2020 − April 2022), and post-pandemic (May 2022 – February 2024) phases. Joinpoint regression models were used for analysis. The actual observed numbers of HIV testing that occurred from months beginning March 2020 to April 2022 were compared with the number of HIV tests predicted by the models. Trends in positivity rates of HIV testing from July 2018 to February 2024, stratified by the COVID-19 pandemic.Figure 2.Multiple joinpoint models showing the temporal trends in the positivity rates of HIV tests per month in ED-based settings in the Memorial Healthcare System between July 2018 and February 2024. A, Pre-COVID-19 phase; B, The COVID-19 pandemic phase; C, Post-pandemic phase. MPC, monthly percent change Results The monthly HIV tests remained stable during the pre-pandemic phase, with an average monthly percentage change (AMPC) of 0.88% (95% confidence interval [CI]: -0.38 to 1.98; p &amp;gt; 0.05). However, there was an increasing trend in monthly HIV tests during the pandemic phase, with an AMPC of 3.30% (95% CI, 2.98 to 4.49; p &amp;lt; 0.05).In the post-pandemic phase, monthly HIV tests remained increased, with an AMPC of 2.79% (95% CI, 1.86 to 4.22; p &amp;lt; 0.05). In the absence of the COVID-19 pandemic, the model projected 38,742 tests from March 2020 to April 2022 and 40,428 tests from May 2022 to February 2024. However, we observed 27,270 and 49,582 tests respectively, representing a 29.6% reduction for the pandemic phase (p &amp;lt; 0.001) and a 22.6% increase for the post-pandemic phase (p &amp;lt; 0.001). In the absence of the COVID-19 pandemic, the model projected 38,742 tests from March 2020 to April 2022 and 40,428 tests from May 2022 to February 2024. However, we observed 27,270 and 49,582 tests respectively, representing a 29.6% reduction for the pandemic phase (p &amp;lt; 0.001) and a 22.6% increase for the post-pandemic phase (p &amp;lt; 0.001). Conclusion The number of HIV tests decreased substantially during the COVID-19 pandemic period. However, there was an increasing trend for HIV tests during the pandemic and the post-pandemic phases, with a MPCs of 3.30% and 2.79%, respectively. Our findings correlate with other reports on decreased HIV diagnosis from 2019 to 2020. These findings have epidemiological significance and can inform health providers in implementing appropriate measures for HIV prevention. In conformance to CDC recommendations, all health care systems should increase access to HIV testing services to mitigate the missed diagnoses during the COVID-19 pandemic, these strategies include self-testing and routine opt out screening in health care settings. Disclosures All Authors: No reported disclosures

Awareness of Sexual Partner's HIV Status Among Men Who Have Sex With Men in China: Cross-Sec. tional Survey Study.

Men who have sex with men (MSM) constitute a significant proportion of individuals living with human immunodeficiency virus. Over the past few years, China has implemented various strategies aimed at increasing the rate of HIV testing and reducing HIV transmission among MSM. Among these, the disclosure of HIV serostatus is an effective prevention strategy. This study aimed to assess HIV serostatus disclosure and identify factors associated with awareness of sexual partners' HIV status among MSM to provide a scientific basis for promoting HIV testing and reducing HIV transmission. A cross-sectional study based on a large-scale web-based survey was conducted among MSM in Zhejiang province, China, between July and December 2023. MSM who were HIV-negative or had an unknown HIV status were recruited from the Sunshine Test, a web-based platform that uses location-based services to provide HIV prevention services. Participants were required to complete a questionnaire on demographic characteristics, sexual behavior, rush popper use, awareness of sexual partners' HIV status, and knowledge of pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP). A multinomial regression model was used to identify the factors associated with awareness of sexual partners' HIV status. A total of 7629 MSM participated in the study, with 45.2% (n=3451) being aware, 35.4% (n=2701) being partially aware, and 19.4% (n=1477) being unaware of their sexual partner's HIV status. The multinomial logistic regression analysis revealed the following results. Compared to those who were unaware of their sexual partner's HIV status, participants who were students (adjusted odds ratio [aOR] 1.43, 95% CI 1.09-1.86), had a monthly income of more than US $1400 (aOR 1.36, 95% CI 1.03-1.80), had insertive anal sex (aOR 1.35, 95% CI 1.12-1.63), had only male sexual partners (aOR 1.53, 95% CI 1.28-1.82), had 1 sexual partner in the past 3 months (aOR 2.36, 95% CI 2.01-2.77), had used condoms for the past 3 months (aOR 1.72, 95% CI 1.33-2.22), had frequently used rush poppers in the past 3 months (aOR 2.27, 95% CI 1.81-2.86), were aware of HIV PrEP (aOR 2.04, 95% CI 1.68-2.48), were aware of HIV PEP (aOR 1.69, 95% CI 1.39-2.06), used mail reagent self-testing (aOR 1.19, 95% CI 1.04-1.36), and had previously undergone HIV testing (aOR 1.40, 95% CI 1.16-1.69) were associated with increased odds of being aware of their sexual partner's HIV status. Overall, 45.2% of MSM who were HIV-negative or had an unknown status were aware of their sexual partners' HIV status in China. We suggest strengthening targeted interventions through web-based platforms and gay apps to promote the disclosure of HIV serostatus and reduce HIV transmission among MSM.

A prospective multi-site study to evaluate the performance and usability of an oral fluid-based HIV self-test in Canada

BackgroundBlood and oral fluid-based HIV self-tests are important for reaching the undiagnosed living with HIV. The study objectives were to evaluate the oral fluid-based OraQuick® HIV Self-Test (HIV-ST) performance in comparison to laboratory reference testing; determine if laypersons can correctly perform the HIV-ST; document if intended users can successfully interpret pre-made contrived positive, negative, and invalid results; and document if intended users can understand the key messages in the product labeling.MethodsThis prospective study enrolled consenting adult intended users of HIV self-testing from six community health centres in four Canadian provinces between June 2022 and January 2024. Positive and negative agreement was determined by comparing the results of the HIV self-tests with the results of the laboratory-based “gold standard” Abbott Alinity HIV Antigen/Antibody Combo test. Descriptive statistics were used to summarize usability self-test procedure steps.ResultsOverall, 951 participants were recruited and consented with 911 available for all analyses. With respect to sociodemographics: 84% of participants were between 18–45 years of age, 73% had at least a college education, 48% were Cis-male, 45% were employed; and 26% identified as White, 23% as African, Caribbean or Black, 5% as Indigenous [First Nations, Métis or Inuit], 33% as Asian, and 6% as LatinX. Primary efficacy analysis on the 911 who completed HIV-ST revealed a single confirmed positive participant and a negative percent agreement of 100% (880/880, 95% CI: 99.9–100%) with the comparator method. For usability determination, the average success rate for “critical” steps for completing the test was 94.1%. Approximately 97% of participants found the instructions easy to follow and 98% of participants reported they would use the test again. Of the 465 participants who interpreted the strong positive, weak positive, negative, and invalid pre-made contrived results, the average of correct interpretations ranged from 59–97%ConclusionsA licensed oral fluid-based HIV self-test in Canada can present an accurate, easy-to-use, and less invasive alternative to blood-based HIV testing. The addition of an oral-fluid self-test along with the current licensed blood-based HIV self-test could help reach the undiagnosed with HIV in Canada and positively impact HIV testing rates overall by offering individuals a choice of self-testing devices.

Factors associated with HIV testing among young women in Tanzania: Insights from the 2022 Tanzanian Demographic and Health Survey using Anderson's Behavioral Model.

HIV continues to be a significant global health issue, particularly affecting sub-Saharan Africa, including Tanzania. Knowing one's HIV status is a crucial first step in combating HIV/AIDS and achieving the targets set for the Sustainable Development Goals (SDGs) by 2030. However, despite ongoing efforts, HIV testing coverage remains low in developing countries, including Tanzania, where testing among young people poses particular challenges. Therefore, this study, based on the 2022 Tanzanian Demographic and Health Survey, aims to identify the factors influencing HIV testing among young women through the lens of Anderson's Behavioral Model. In this study, we analyzed a weighted sample of 5,810 young women from the 2022 Tanzania Demographic and Health Survey (TDHS). Given the hierarchical structure of the DHS data and the binary nature of the outcome variable 'ever tested for HIV,' we employed a multilevel mixed-effect logistic regression model. The best-fitting model was identified using the deviance value. In the multivariable analysis, we calculated adjusted odds ratios (AORs) along with their 95% confidence intervals (CIs) to assess the strength of associations between various predictors and HIV testing. Statistical significance was determined at a p-value of less than 0.05. In our study, the prevalence of HIV testing among young women was 60.18% (95% CI: 58.91 to 61.43%). Significant factors associated with HIV testing included age (AOR = 4.33, 95% CI [3.43, 5.45]), marital status (AOR = 2.31, 95% CI [1.76, 3.04]), knowledge of HIV prevention (AOR = 1.59, 95% CI [1.23, 2.04]), discriminatory attitudes towards HIV (AOR = 0.74, 95% CI [0.58, 0.95]), visiting healthcare facilities (AOR = 4.80, 95% CI [3.75, 6.14]), media exposure (AOR = 1.44, 95% CI [1.09, 1.90]), internet use (AOR = 1.56, 95% CI [1.02, 2.38]), and ever heard of STIs (AOR = 2.12, 95% CI [1.63, 2.77]). Our study found that 60.18% of young women in Tanzania have been tested for HIV. Addressing barriers like stigma and improving access to healthcare and information through media and the internet can significantly boost HIV testing rates among young women, aiding the global effort to end the AIDS epidemic by 2030.The Anderson Behavioral Model emphasizes the importance of predisposing, enabling, and need factors in healthcare utilization, which aligns with our findings and underscores the necessity of a multifaceted approach to improve HIV testing rates.

Factors Associated with HIV Testing Uptake in Cameroon: Data from the 2018 Cameroon Demographic and Health Survey.

HIV represents a significant public health challenge, contributing to increased mortality and morbidity within the population. Despite the implementation of various HIV testing strategies, the uptake rate of HIV testing remains low. This study aims to assess the factors associated with HIV testing uptake among women and men in Cameroon. A secondary analysis of the 2018 Cameroon demographic and health survey (DHS) was conducted using data of sexually active men and women aged 15-64. Multivariate logistic regression was employed to identify the key factors associated with HIV testing in Cameroon. We included a total of 18,112 participants (12563 women and 5549 men). The study found that 47.8% (95% CI 46.9-48.7) of women and 45% (95% CI 43.7-46.3) of men were tested for HIV in the past 12 months. Among women and men, age above 20-24 years (AOR= 1.3, p<0.01 vs AOR= 2.3, p<0.001), a high level of education (AOR= 2.1, p<0.001 vs AOR= 2.3, p<0.001) and high wealth (AOR= 1.9, p<0.001 AOR= 2.0, p<0.001) were positively associated with HIV testing uptake. Conversely,residing in the northern regions (AOR= 0.5, p<0.001 vs AOR= 0.4, p<0.001), was negatively associated. Among men, no independent significant association was found between HIV testing uptake and never being married. This study, utilizing data from the Cameroon DHS, provides valuable insights into HIV testing in Cameroon. To achieve UNAIDS targets of "zero new infections and zero deaths" by 2030, interventions must prioritize less educated individuals, younger age groups and low income earners. The findings from this research can inform recommendations for decision-makers and contribute to the development of effective public health interventions to combat HIV in Cameroon.

Implementing HIV teams to improve HIV indicator condition-guided testing in general practitioner centers in the Netherlands

BackgroundHIV indicator condition-guided testing is recommended by guidelines to identify undiagnosed HIV infections. However, general practitioners (GPs) frequently see patients for indicator conditions without testing them for HIV. The aim of this study was to evaluate whether implementing HIV teams, using trained GP ambassadors, promoted local HIV indicator condition-guided testing practices in urban GP centers in the Netherlands.MethodsWe conducted a prospective implementation study between May 2021 and March 2023. Patients ≥ 18 years newly diagnosed with HIV indicator conditions in three GP centers were included. The intervention consisted of HIV expert led education for GPs with a stepwise implementation of point-of-care testing (phase 1), followed by adding peer-to-peer case feedback by trained GP ambassadors (phase 2). Questionnaires were used to assess the experiences and beliefs of HIV indicator condition-driven testing in patients and GPs. The primary outcome was the overall HIV testing rate in patients diagnosed with indicator conditions compared to pre-implementation. Secondary outcomes were HIV testing rate per phase and per indicator condition, HIV positivity rate, and patients’ and GPs’ experiences with this testing strategy.ResultsIn 132,338 patient visits, 846 (0.6%, 95%CI 0.6–0.7%) HIV indicator conditions were diagnosed, including 485 sexually transmitted infections (57.3%). Overall, 215 (25.4%) indicator conditions were tested for HIV after the implementation of HIV teams. The testing rate was comparable between the two phases (25.2% versus 25.9%, p = 0.83). The testing rates pre- and post-implementation were comparable (21.3% versus 25.4%, p = 0.33). The most frequently tested HIV indicator conditions were unexplained weight loss (n = 13, 41.9%), unexplained lymphadenopathy (n = 8, 38.1%), and sexually transmitted infections (n = 161, 33.2%). Three patients (1.4%, 95%CI 0.3–4.0%) tested positive for HIV. Test acceptance in patients was high as was the self-perceived knowledge of GPs on HIV indicator conditions.ConclusionsImplementing HIV teams did not enhance HIV indicator condition-guided testing in urban GP centers from a low HIV prevalence setting. The high patients acceptance rate and self-perceived knowledge among GPs regarding HIV indicator conditions did not manifest in high HIV testing rates. Patients accepted testing, but a gap was found between the self-perceived knowledge of GPs regarding HIV indicator conditions and testing, and the actual HIV testing rate.Trial registrationClinicalTrials.gov NCT05225493 (registration date: 17-01-2022).

Effect of a multimodal continuing professional development initiative on HIV testing in primary care in British Columbia, Canada

IntroductionMany persons are unaware of HIV infection until they present in an advanced stage of the disease. Diagnosing HIV infection in its earliest stages reduces morbidity and mortality and contributes to improved public health. Increased testing for HIV is critical for prevention, and primary care providers play an essential role in early HIV screening. However, lack of knowledge and confidence are barriers to the adoption of screening practices. Continuing professional development (CPD) may enhance greater HIV testing uptake amongst primary care providers by improving awareness and comfort. This paper aims to report on the impact of a multimodal CPD initiative to increase HIV screening and test ordering across primary care settings in British Columbia, Canada.MethodsThe ‘HIV Testing Initiative in Family Practice’ was designed as a multimodal education strategy to encourage family physicians to adopt routine HIV testing in their practices. The initiative encompassed a variety of core and supplementary educational activities, including interactive in-person CPD workshops, practice resources, and patient education materials. An interrupted time series study was undertaken to evaluate the effect on HIV test ordering before and after workshop participation. Participants also completed post-workshop surveys to assess satisfaction.ResultsIn total, 316 individuals participated in the core educational activities of the initiative. The number of HIV tests ordered increased significantly amongst participants following workshop participation (p < .001). HIV test ordering increased for both rural and urban providers with no significant difference (p = .075) on the number of tests ordered between these groups. Participants were very satisfied with workshop participation, with an overall mean satisfaction rating of 4.78 (out of 5) and reported high satisfaction with the format (4.64 out of 5) and interactivity (4.76 out of 5) features across the workshops.DiscussionThe findings suggest that the introduction of a multimodal CPD intervention may have effected change in family physicians’ HIV testing practices. The HIV testing rates of physicians who had participated in CPD workshops increased significantly, and participant evaluation data indicated a greater understanding of the rationale for routine HIV testing, as well as an increase in comfort with recommending HIV tests to patients.

Determinants of non-testing for HIV among women during antenatal care follow up in sub-saharan Africa: a hierarchical analysis of recent Demographic and Health Survey datasets

IntroductionHIV/AIDS is a global public health concern that is closely related to other sociocultural problems. The prevention of mother to child transmission cascade often begins with and is integrated into antenatal care in order to ensure a high rate of case detection and optimal treatment coverage. Although guidelines suggest that all pregnant women should have HIV testing as part of their regular screening checks during antenatal care, a significant proportion of pregnant women were not tested for HIV during antenatal care follow-up in sub-Saharan Africa. Hence, this study was aimed at assessing the determinants of women not tested for HIV during antenatal care follow-up in sub-Saharan Africa.MethodA cross-sectional study was conducted to assess the determinants of non-testing for HIV among women as part of antenatal care in sub-Saharan Africa, utilizing secondary data from the 2015–2022 Demographic and Health Surveys. The study included a weighted sample of 788,421 women who had antenatal care follow-up during their most recent pregnancy within five years preceding the survey. A multilevel mixed effect logistic regression analysis was employed to identify the determinants of non-testing for HIV among these women. The adjusted odds ratios with 95% confidence intervals were calculated to determine the associations between the outcome and explanatory variables. Statistical significance was determined using a p-value of less than 0.05.ResultThe hierarchical analysis of this study identified several significant factors associated with women not being tested for HIV during antenatal care in sub-Saharan Africa. These factors include young age, low or no education, not being in a union, unemployment, and low household wealth index. Additionally, limited media exposure, stigmatizing attitudes towards people living with HIV, male-headed households, and rural residence were significant at the individual and household levels. At the community level, low media exposure and high illiteracy rates were significant, while at the country level, high fertility rates and low literacy rates were also associated with lower rates of HIV testing during antenatal care.ConclusionThis study identified significant individual, community, and country-level factors associated with women not testing for HIV during antenatal care in sub-Saharan Africa. Key factors include young age, low education, unemployment, not being in a union, low household wealth, limited media exposure, stigmatizing attitudes towards people living with HIV, male household head, rural residence, low community media exposure, high community illiteracy, high fertility rates, and low literacy rates. These findings highlight the need for targeted, context-specific interventions to improve HIV testing rates and enhance maternal and child health outcomes in the region.

Factors associated with uptake of HIV testing among clients diagnosed with sexually transmitted infections in Chegutu District, Zimbabwe, 2021

HIV testing services (HTS) enable early linkage to HIV prevention, treatment and care. A review of Chegutu District Health Information System 2 sexually transmitted infection (STI)/HIV data revealed HIV testing rates among those infected with STIs were 41%, 48%, 50%, 51% and 68%, respectively, for the period 2016–2020 against a target of 100%. We investigated factors associated with the uptake of HTS among STI clients. Methods: We conducted a 1:1 unmatched case–control study. We randomly selected cases from STI registers and controls from HTS registers. We defined a case as an individual 18–49 years old diagnosed with STI, unknown HIV status and no documented HIV test result from 01 August 2020 through 31 August 2021. We recruited 115 cases and 115 controls. We used questionnaires to collect data from cases and controls after obtaining written consent. Epi Info7 generated frequencies, proportions, odds ratios and confidence intervals (CIs) at a 0.05 significance level. We applied forward stepwise logistic regression to determine independent factors for HIV testing uptake. Results: Independent factors for uptake of HIV testing among STI clients were: being employed [aOR 0.23; 95% CI(0.09–0.50)], having no stigma towards people living with HIV [aOR 0.19;95% CI(0.06–0.61)], preferring health facility for HIV testing [aOR 0.30;95% CI(0.13–0.65)], male head of family [aOR 2.95. 95% CI(1.25–6.95)], and confidence in clinic staff’s commitment to confidentiality [aOR 0.19; 95% CI(0.06–0.63)]. Conclusion: Male decision-makers may deter partner involvement in HTS. We recommended strengthening male involvement in HIV programming through community dialogues that address gender inequalities.

Trajectories of medication for opioid use disorder and their impact on HIV testing among people who inject drugs in India: A longitudinal assessment of clinic-based data.

The aim of this study was to identify longitudinal trajectories of medication for opioid use disorder (MOUD) use throughout 1year following MOUD initiation and to examine the association of trajectory membership with HIV testing among people who inject drugs in India. The study comprised group-based trajectory modeling using longitudinal clinic-based MOUD use data, set in seven Indian cities with integrated care centers (ICC) delivering MOUD, predominantly buprenorphine, in 2018-2019. A total of 1562 people who inject drugs who initiated MOUD for the first time at an ICC between 1 January 2018 and 31 December 2018 were included in this study. Median age was 26 years, 98% were male and 22% were living with HIV. Daily directly observed MOUD visits were biometrically verified and entered into an electronic database. A dichotomous variable for MOUD use each day throughout 1year following initiation was created for the trajectory models. Client socio-demographics, HIV status and testing at the ICC and dose were extracted from the clinical database. We found five MOUD trajectory groups: (1) early dropout (41%), (2) late dropout (18%), (3) delayed dropout (10%), (4) intermittent use (12%) and (5) persistent use (19%). Differences between the dropout groups were characterized by the rate of decline in MOUD use over time. The late dropout group had an 18% higher rate of HIV testing [adjusted rate ratio (aRR) = 1.18, 95% confidence interval (CI) = 1.10-1.27] and those with persistent MOUD use had a 91% higher rate of testing (aRR = 1.91, 95% CI = 1.77-2.05) compared with the early dropout group. Nearly 70% of clients initiating medication for opioid use disorder (MOUD) at integrated care centers (ICCs) in India stop MOUD use within 1year, with trajectories characterized by the rate of decline in engagement. Clients with better MOUD adherence appear to return more frequently for HIV testing at the ICCs, underscoring the value of integrated care models.

Efficacy of the mLab App: a randomized clinical trial for increasing HIV testing uptake using mobile technology.

Efficacy of the mLab App: a randomized clinical trial for increasing HIV testing uptake using mobile technology.

Impact of Mobile Health Interventions on HIV Testing Rates among At-Risk Youths: A Review

HIV remains a significant global public health challenge, particularly among at-risk youths aged 15–24, who accounted for over 30% of new infections in 2022. Barriers such as stigma, socioeconomic disparities, and limited access to healthcare contribute to low HIV testing rates within this demographic. Mobile health (mHealth) interventions, which leverage the widespread use of mobile devices, offer innovative solutions to address these barriers by providing confidential, accessible platforms for HIV testing and care. This review explored the impact of various mHealth interventions, such as SMS-based reminders, mobile apps, and telehealth platforms, on HIV testing rates among at-risk youths in different regions. Several studies demonstrate significant increases in testing rates, with mHealth tools reducing barriers related to confidentiality, stigma, and geographical access. However, challenges remain, including digital access disparities, privacy concerns, and the sustainability of interventions. A comprehensive literature review of studies on mHealth interventions targeting at-risk youth populations were utilized in compiling this educating paper. Future research should focus on refining mHealth strategies, incorporating emerging technologies like AI, and ensuring interventions are tailored to specific cultural and geographical contexts. mHealth has the potential to play a crucial role in combating the HIV epidemic by empowering at-risk youths to access testing and care. Keywords: Mobile health (mHealth), HIV testing, At-risk youths, Digital health interventions. HIV prevention.

Effectiveness of Peer-Led Education in Reducing HIV Transmission among Youths in Urban Areas: A Comprehensive Review

HIV transmission among urban youths remains a significant public health concern, driven by factors such as risky sexual behaviors, limited access to healthcare, and high social connectivity. Peer-led education has emerged as a promising intervention to reduce HIV transmission by utilizing the influence of social networks and delivering relatable, accessible information on HIV prevention. This review assessed the effectiveness of peer-led education programs in urban areas by examining their impact on HIV-related knowledge, behavior change, and HIV testing rates. Studies revealed that peer-led education significantly improves HIV knowledge, promotes condom use, and encourages HIV testing among urban youths, contributing to a reduction in high-risk behaviors. Additionally, the social and emotional benefits of peer-led education create supportive environments for discussing sexual health, reducing stigma, and fostering empowerment among participants. However, challenges such as variability in program quality, sociocultural barriers, and sustainability issues limit the long-term success of these interventions. To address these challenges, future strategies should focus on integrating digital health platforms, personalizing peer education, and employing rigorous program evaluation methods. The methodology for this review included a comprehensive analysis of existing literature, including randomized controlled trials, systematic reviews, and observational studies, to provide a holistic understanding of peer-led education’s effectiveness in reducing HIV transmission among urban youths. Keywords: Peer-led education, HIV prevention, Urban youths, Behavioral change, HIV transmission.