HIV Testing Research Articles

Background: Those living with HIV are at an increased risk for cardiac dysfunction and clinical heart failure compared to people without HIV. Persons with HIV are also at an increased risk for cancer. There are limited data on the cardiotoxicity post anthracycline-based chemotherapy in cancer patients with HIV. Hypothesis: Cancer patients with HIV have a higher risk of cardiotoxicity post anthracycline-based chemotherapy than HIV negative controls. Methods: We included consecutive adult patients who underwent anthracycline-based chemotherapy from 2016 to 2019 for any type of cancer and who had a HIV testing. Patients with preexisting heart failure were excluded from the analysis. The endpoint was the development of cardiotoxicity (defined as clinical heart failure or a drop in left ventricular ejection fraction (LVEF)≥10% to LVEF<50%). Results: Among the 662 cancer patients who had a HIV testing (19% non-Hispanic White, 26% non-Hispanic Black, 34% Hispanic), 49 were positive (7.4%). More male (12% vs 5%) and non-Hispanic Black (15% vs 0-8% in other race and ethnicity) patients were HIV positive. The rate of cardiotoxicity was 13% overall during a median follow-up of 21 months and it was not different between patients with and without HIV (14% with HIV and 13% without HIV, p=0.75). Mean baseline CD4 count was 294±249 cells/mm3 and it was similar between patients with and without cardiotoxicity. Baseline HIV virus load was undetectable or <40/mL in 53% of patients and antiretroviral therapy was used in 88% of patients, and these rates were not different between patients with and without cardiotoxicity. In the unadjusted and adjusted (age, sex, race and ethnicity, baseline LVEF, anthracycline dose) Cox proportional hazards models, HIV status and HIV viral control (among those with HIV) were not associated with the development of cardiotoxicity. Conclusion: s Based on a small cohort of cancer patients, HIV status, and HIV viral control among those with HIV, were not associated with the development of short-term cardiotoxicity.

Indigenous Peoples in the United States experience disproportionate burdens of sexually transmitted infections (STIs), HIV, and viral hepatitis, but data about associated testing behaviors are limited. Given that substance use is a risk factor for STIs and viral hepatitis, there is a need for more research on testing behaviors among Indigenous people who use drugs. This research examines correlates of STI, HIV, and hepatitis C virus (HCV) testing among a sample of people who use drugs in a northern Midwest Indigenous community. This community based participatory research includes a survey among people who used drugs in a Northern Midwest reservation community (N = 227). We described when individuals were most recently tested for STIs, HIV, and HCV. We also examined correlates of past-year testing, including individual characteristics, drug use behaviors, sexual partners, and condom use. Most participants had been tested for STIs (63%), HIV (60%), and HCV (65%) in their lifetime, while a quarter had been tested STIs (33%), HIV (24%), and HCV (27%) in the past year. Recent testing for STI, HIV, and HCV was significantly associated with younger age, being a woman or gender minority, lifetime injection drug use, number of sex partners, and being willing to distribute HIV test kits. This study is among the few to examine STI, HIV, and HCV screening behaviors in an Indigenous community, and found that screening rates were suboptimal. Culturally relevant, Indigenous-led programs are essential to increase awareness and access to screening and ultimately address critical public health disparities.

HIV self-testing (HST) is a user-controlled approach to increasing HIV testing and status knowledge, the gateway to biomedical prevention and treatment. HST is a promising option for key populations facing stigma-related barriers to testing in primary and specialty (e.g., HIV, substance use) healthcare clinics. We conducted a pilot efficacy trial of AEGIDA, a 4-session intervention designed for women who exchange sex and use substances, in Kazakhstan, where there is a growing HIV epidemic. Between November 2022 and August 2023, we used community-engaged approaches to recruit and screen 305 HIV-negative cisgender and transgender women (47% eligible). Ninety participants were enrolled and randomized in a 2:1 assignment to the active (AEGIDA) or a time-attention control (didactic self-screening information) condition with 6 months of follow-up. AEGIDA's theoretically grounded sessions included evidence-based techniques to reduce internalized intersectional stigma and build HST skills to increase HIV testing (e.g., motivational interviewing, peer education, and cognitive restructuring). Sessions were delivered face-to-face and via videoconference, with a closed Instagram page for active condition participants to access content on demand. The intent-to-treat analysis found that participants randomized to AEGIDA were over 4 times more likely to complete a recent HIV test (1 + test in the prior three months; aOR = 4.08, 95% CI: 1.22,13.62) at 6-month follow-up compared to control participants. The intervention had no significant impact on consistent HIV testing (1 + test per three months over the six-month follow-up period; aOR = 2.02, 95%CI: 0.69-5.88). Overall, the AEGIDA intervention demonstrated feasibility and acceptability, and preliminary efficacy to increase recent HIV testing. NCT Information NCT06150937.

BackgroundDigital health interventions (DHIs) can broaden the reach of HIV prevention interventions and overcome barriers for young cisgender men who have sex with men (YMSM). Community-based organizations (CBOs) have delivered HIV prevention interventions for decades, but few studies have examined how CBOs implement DHIs, including recruitment and retention. Keep It Up! (KIU!) is a Centers for Disease Control and Prevention–designated best-evidence DHI that can promote risk reduction behaviors and reduce sexually transmitted infection incidence.ObjectiveWe sought to descriptively assess CBOs’ approaches to recruitment and retention, elucidate lessons learned, and provide examples of recruitment and retention for future implementers.MethodsTwenty-two CBOs in counties with high HIV rates and large proportions of YMSM were selected through a request for proposal process to implement KIU!. Data were extracted from request for proposal applications and notes from monthly calls with CBO staff. Twenty-five staff members across CBOs were interviewed in the middle of implementation. A descriptive thematic analysis of the lessons learned in recruiting and retaining participants was performed. The research team developed an application dashboard for CBO staff to register participants, track participant progress through the intervention, record and track participant contact, and export usage data. CBO logins to the KIU! dashboard were tracked across the implementation. To descriptively compare approaches to recruitment and retention, the study team divided CBOs according to annual HIV testing volume in the 3 years prior to implementation and years of HIV service provision to YMSM.ResultsThe most frequent modes of recruitment were outreach and community partnerships (21/22, 95%), and the least frequent modes were via hook-up apps (6/22, 27%) and participant referrals (5/22, 23%). CBOs with a low HIV testing volume used online recruitment slightly more frequently, while medium-volume CBOs most frequently used hook-up apps for recruitment. Low-volume CBOs more frequently used phone calls and emails to remind participants to complete intervention modules, while high- and medium-volume CBOs more frequently used text messages. CBOs with more years of HIV service provision to YMSM more frequently had a set reminder schedule for contact with participants. CBO staff identified a need to change how KIU! is pitched to clients by using personalized, recipient-centered language rather than technical jargon. CBOs changed intake forms to ensure that staff remembered to offer KIU! to participants. CBOs had a difficult time retaining participants despite holding in-person events for enrolled participants (eg, raffles and trivia nights) and altering the frequency with which they reminded participants to complete modules.ConclusionsAlthough CBOs had experience in implementing other evidence-based interventions with YMSM, there was no consensus on successful recruitment and retention strategies for this population. We have presented approaches that future CBOs may use in their own implementation of KIU!.

An overview of existing research on HIV testing among transgender and other gender-diverse (TGD) populations in the United States, critical for developing effective future interventions and research, is missing. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, 3 databases (CINAHL, PubMed/Medline, PsycINFO) were searched for studies reporting in English on HIV testing behavior that focused on or included TGD persons, published in the past decade (February 2, 2013 to February 2, 2023). Twenty-six studies were included and extracted using Covidence. Four themes regarding HIV testing among TGD persons were identified: prevalence of HIV testing compared with cisgender persons, testing frequency and associated factors among TGD persons, barriers and facilitators to HIV testing experienced by TGD persons, and testing modalities. TGD persons seemed more likely to have been tested for HIV than cisgender persons, but less frequent than cisgender men who have sex with men. Barriers to testing included availability, confidentiality concerns, and negative interactions with providers. Social support and gender-affirming care were seen as facilitators. Self-testing, although not common, was acceptable and preferred when available. The conceptualizations and operationalizations of the term transgender varied markedly across studies. Our understanding of HIV testing practices in TGD populations is limited and shows serious gaps. Research on repeat testing is needed to enhance HIV prevention and care among TGD populations. Future research might benefit from theory-driven approaches and from involving TGD persons in the design and implementation of studies to ensure relevance and efficacy.

Older adults (defined as adults who are 50 and over) accounted for 1 in 6 persons newly diagnosed with HIV in 2022. The objectives of this analysis were to present the most currently available data about older adults reached by the Centers for Disease Control and Prevention's (CDC) HIV programs. From 2019 through 2022, CDC funded 61 health departments and 160 community-based organizations in the United States and Puerto Rico and the US Virgin Islands to provide HIV testing, preexposure prophylaxis (PrEP) referrals, and linkage to HIV medical care and report on their program outcomes to CDC. We conducted descriptive analysis and multivariable robust Poisson regression analysis to assess the association between demographic characteristics and outcomes of HIV tests among older adults. Between 2019 and 2022, the percentage of CDC-funded HIV tests provided to older adults increased (16.9% in 2019, 17.3% in 2020, 18.3% in 2021, and 18.4% in 2022). In 2022, older adults accounted for 11% of new diagnoses. Among those (876), 779 people had linkage data, and of those, 579 (74.1%) were linked to HIV medical care within 30 days after diagnosis. Of those older adults with a negative test result and available data, 90,422 (41.3%) were eligible for a PrEP referral and 39,382 (44.3%) were referred to a PrEP provider. Continued efforts are needed to provide focused HIV prevention messaging specifically for older adults and to make available relevant information about HIV to health care providers.

ABSTRACT In the Netherlands, sub-Saharan African migrants (SSAM) are disproportionately affected by HIV, and late HIV diagnoses remain a significant challenge. Using a socioecological framework, we explored barriers and facilitators to HIV testing from the perspectives of a diverse group of 32 SSAM and 13 key informants (KI) through semi-structured interviews. Interview data were analyzed using inductive thematic analysis. Identified barriers to HIV testing included risk perception, limited availability of HIV-related information and awareness of testing possibilities and opportunities, loss of social capital concerns, HIV testing-related stigma, intersectional stigmas, cultural norms, and difficulties in accessing HIV testing services at the primary care level. Our analysis revealed the prominent overarching influence of HIV stigma operating both directly and indirectly across socioecological levels. Identified gaps in community collaboration, mobilization, and ownership regarding testing interventions acted as barriers but, conversely, also as facilitators to HIV testing when implemented in practice. SSAM and KI perspectives aligned, except for views regarding the availability of HIV-related information. Our findings indicate a critical need for integrated, multi-level, community-driven interventions, including healthcare strategies and policies that foster increased testing uptake among SSAM.

Innovations in the biomedical prevention, diagnosis, and service delivery of HIV and other sexually transmitted infections.

Challenges and opportunities in developing integrated sexual and reproductive health programmes.

The goal of this study was to implement and evaluate a traditional healer administered HIV rapid diagnostic testing and referral system in Senegal. Twenty traditional healers were enrolled. Traditional healers offered testing to 1284 individuals. There were no refusals. Of the 1284 individuals who underwent testing, 53 (4.1%) had a positive result. Of the 53 with a positive result, 53 (100%) were referred to clinic. Of the 53 referred to clinic, 38 (71.7%) presented to clinic. Of the 38 who presented to clinic, 31 (81.6%) were confirmed HIV-positive and received ART. This approach provides an acceptable and feasible strategy to increase HIV testing and linkage to care in the region.

Opt-in and opt-out strategies for HIV testing—author's reply

We report a man in his thirties living with advanced HIV presenting with Pneumocystis pneumonia, cytomegalovirus colitis and HIV retinopathy. Initial HIV screening was positive, and immunochromatographic testing demonstrated simultaneous p24 antigen and antibody bands, an exceptionally rare finding outside the acute seroconversion phase. Despite profound immunosuppression (CD4 3 cells/µL), initiation of antiretroviral therapy led to rapid disappearance of the p24 antigen, while antibody positivity persisted. This case illustrates how severe cellular immune deficiency can allow concurrent antigen/antibody positivity, likely due to high viremia and impaired antibody responses. Clinicians should be aware that point-of-care HIV test results may vary depending on the stage of infection and the timing of therapeutic intervention.

Acute HIV infection (AHI) is the most infectious stage of HIV, yet existing rapid tests cannot reliably detect HIV in this early phase and require up to 90 days post-exposure for accurate results. Laboratory-based nucleic acid tests can detect AHI but are often inaccessible to high-risk populations with limited healthcare access. Novel rapid AHI tests are in development to bridge this gap by enabling earlier, decentralized detection. This study aims to explore the acceptability and future implementation considerations of such a test through engagement with clients (n = 5) and staff (n = 14) of Indiana-based HIV service organizations. Guided by human-centered design frameworks, semi-structured interviews examined experiences with HIV testing, acceptability of a proposed novel rapid AHI test that could detect infection about one month earlier but would require longer time to results (~60 minutes), and preferences for potential end-users (self, community health workers (CHW) or peers). Transcripts were thematic analyzed. Participants strongly supported earlier detection despite longer wait times, describing the trade-off as worthwhile for reducing transmission, initiating treatment sooner, and alleviating anxiety following high-risk exposures. Clients emphasized the benefits of convenience and peace of mind, particularly for people who use drugs or experience stigma. Staff highlighted the potential to retain individuals who are often lost to follow-up and to strengthen linkage to care. Concerns focused on organizational feasibility of accommodating longer test times and client expectations shaped by existing “rapid” tests. CHW/peer-led testing was preferred due to their ability to build trust, provide education and navigation, while self-testing was viewed as useful for overcoming barriers such as stigma and access, though concerns about accuracy, interpretation, and lack of counseling were noted. Stakeholder insights underscore the importance of accuracy, usability, affordability, and integration of counseling and care navigation in designing and implementing AHI rapid tests to maximize their impact among high-risk populations.

HIV diagnostic testing in most African countries follows national algorithms that typically use two tests, with or without a tie-breaker. We assessed the accuracy of these algorithms using data from population-based surveys in 14 sub-Saharan African countries, where all HIV-positive results were further confirmed with the Geenius HIV-1/2 supplemental assay. Our findings show that inter-test concordance and positive predictive values (PPVs) varied by HIV prevalence, with higher PPVs observed in higher-prevalence settings. Overall, the PPV of HIV diagnosis was close to 99%, indicating that two-test algorithms can provide highly accurate results when testing is performed with strict adherence to quality standards and tester competency. These results underscore the importance of quality assurance (QA) and suggest that countries with lower HIV prevalence may benefit from adopting a three-test algorithm. However, such changes should be accompanied by careful attention to logistics, procurement, training, record keeping, and other QA measures.

A&E hepatitis and HIV testing programme identifies thousands of undiagnosed cases.

Adolescent girls are at disproportionately high-risk for HIV and unintended pregnancy. Effective interventions to increase uptake of HIV testing and contraceptives are urgently needed. Our cluster-randomized controlled trial in 46 schools in Lusaka, Zambia evaluated the SKILLZ intervention: (a) 12 after-school sessions of sexuality and sexual and reproductive health (SRH) education culminating in a community “graduation” soccer event where a pop-up clinic offered HIV testing and contraception; (b) for those HIV positive, coach-assisted linkage to HIV care, interpersonal group psychotherapy, or youth-friendly SRH services; and (c) community-based distribution of HIV self-testing and contraceptives. We surveyed randomly sampled Grade 11 girls at baseline, 6, and 12 months to measure self-reported uptake of HIV/SRH products and services. We estimated intention-to-treat modified poisson regressions on uptake of (a) HIV testing and any contraceptive method within the previous 6 months, (b) HIV testing by modality and contraceptive uptake by method, and (c) new adoption and discontinuation. Between March 2021 and June 2022, 1,019 girls were enrolled from 23 control schools and 1,134 enrolled from 23 intervention schools; 79% of surveyed girls in intervention schools participated in SKILLZ, 71% attended at least 8/12 sessions to “graduate”. At 6 months, 600 (59%) participants in intervention schools and 307 (37%) participants in control schools self-reported HIV testing within the previous 6 months (risk difference: 22%, 95% CI: 14, 29); 281 (37%) participants in intervention schools and 200 (30%) participants in control schools had reported using contraception within the previous 6 months (6%, 95% CI: -2, 14). Effects on HIV testing and contraception are sustained at 12 months. SKILLZ increased reported uptake of HIV testing and contraception among in-school adolescent girls. Further research is needed to understand treatment mechanisms and heterogeneity to tailor the intervention before implementation at scale. The trial is registered with ClinicalTrials.gov, NCT04429061.

BackgroundHIV incidence is increasing among Latino gay, bisexual, and other men who have sex with men (MSM) in the Atlanta metropolitan area. Mobile phone apps represent an innovative tool to promote pre-exposure prophylaxis (PrEP) use, HIV testing, and condom use.ObjectiveThis study aimed to assess the acceptability and usability of Saludfindr, an Android-based HIV prevention app tailored to the needs of Latino MSM in the Atlanta area.MethodsWe recruited adult Latino MSM to interact with the app for 4 months. Saludfindr included initial and periodic health assessments; provision of suggestions regarding PrEP, HIV testing, and condom use; in-app product ordering; customized motivational messages; a customized sexual health clinic list; and a “Contact Us” button. To assess acceptability, we measured use of each app feature, PrEP and HIV testing uptake, and participant ratings of the app’s usefulness. We assessed usability using the System Usability Scale.ResultsWe enrolled 31 participants; the median age was 27 (IQR 24.5-32) years, 97% (30/31) were cisgender men, 81% (25/31) identified as MSM, and 61% (19/31) used the app in Spanish. All participants completed the initial health screening, with 84% (26/31) and 77% (24/31) completing the 2- and 4-month health screenings, respectively. Of all participants, 52% (16/31) and 23% (7/31) ordered condoms and home HIV tests through the app at least once, respectively. During the study period, 71% (22/31) of the participants got tested for HIV, of whom 68% (15/22) accessed it through clinic-based HIV testing. Of the participants not on PrEP at baseline, 41% (7/17) initiated PrEP during the study, and all of them did so at one of the clinics listed on the app. Saludfindr reached a System Usability Scale score of 74.5/100 (excellent).ConclusionsSaludfindr was highly acceptable and usable among Latino MSM participants in the Atlanta area. In-app assistance to access PrEP and clinic-based HIV testing referrals was well received. Further efforts are needed to increase users’ self-efficacy with home HIV self-testing.

Background: HIV self-testing (HIVST) offers a discreet and empowering approach to increase HIV testing coverage, particularly among key populations such as men who have sex with men (MSM). This strategy can help overcome stigma and improve case detection rates.Objective: To assess the acceptability, barriers, and associated factors influencing HIVST among MSM attending the Central Sexually Transmitted Disease (STD) Clinic in Colombo, Sri Lanka.Methods: A cross-sectional analytical study was conducted from October 2022 to September 2024 among 233 systematically selected MSM. Data were collected using a pre-tested, assisted self-administered questionnaire. Statistical analysis included descriptive and inferential methods using SPSS software.Results: The mean age was 30.2 years; the majority were Sinhalese (91.4%) and single (82.8%). A significant proportion (98.3%) reported multiple sexual partners, with 29.2% engaging in unprotected anal sex and 87.6% in unprotected oral sex. Awareness of HIVST was high (83.7%), but only 34.3% had ever used it. Willingness to use HIVST in the future was 82.8%. Common barriers included limited kit availability (40%), lack of procedural knowledge (25.3%), confidentiality concerns, and absence of post-test support. Acceptability was significantly associated with higher education, multiple partners, alcohol use during sex, group sex, awareness of HIV risk, and prior knowledge of HIVST (p < 0.05).Conclusion: HIVST is a promising approach for expanding HIV testing among MSM in Sri Lanka. Addressing access, education, and confidentiality concerns through targeted community-based interventions can improve uptake and support national HIV prevention goals.

Although transgender, nonbinary, and intersex (TNI) people are at greater risk for HIV acquisition than their cisgender counterparts, the research on HIV testing frequencies and predictors in this population is limited. Research focused on identifying HIV testing differences by gender among TNI people is especially lacking. This secondary data analysis examined differences in HIV testing frequencies by gender and identified the factors significantly associated with lifetime and recent HIV testing in a statewide convenience sample of TNI adults in the Mountain West region of the United States. Although chi-square test results indicated no significant gender differences in lifetime HIV testing, a significantly smaller proportion of nonbinary individuals reported receiving an HIV test in the last year when compared with transmasculine, transfeminine, and intersex individuals (Fisher's exact p = 0.04). Multi-variable logistic regression results revealed that having to educate medical providers about transgender-related care was significantly associated with a higher likelihood of ever receiving an HIV testing (AOR = 2.82, 95% CI (confidence interval): [1.56-5.07], p < 0.01). Moreover, nonbinary individuals were significantly less likely to have received an HIV test in the last year (AOR = 0.30, 95% CI: [0.11-0.81], p < 0.05). These findings point to the potentially important role that provider factors may play in HIV testing for TNBI persons. Alongside recognition of the need for more empirical work to understand complex relationships identified in this study, the study results suggest that HIV testing efforts may need to focus more on expanding access to TNI individuals, including those who identify as nonbinary.

IntroductionGiven the critical perspective of intersectionality and its potential to identify the causes of inequalities, it has been employed increasingly in studies related to health. Despite the rich theoretical evidence about intersectionality, there is a need to consider this approach empirically. This study aimed to apply the intersectionality in practice for health policy makers and researchers seeking to reduce health inequalities. In this regard, we described the development of an intersectionality-based and context-specific intervention focusing on HIV testing uptake among Afghan immigrants in Iran.MethodsThis is an intervention development study. The intersectionality was used to design a peer-led intervention guided by the 2008 MRC framework. We undertook the following activities related to the three stages of the MRC framework: 1. Identifying the existing evidence (conducting a scoping review to investigate the application of intersectionality in designing and implementing health interventions; designing the checklist of applying the intersectionality in health interventions and programs); 2. Identifying and developing a program theory (conducting a realist review to identify why, how, and under what conditions peer interventions can improve HIV testing uptake among immigrants); and 3. Modeling process and outcomes (adapting the contextual factors identified by conducting a qualitative study and the realist review; extracting considerations regarding intersectionality principles using the checklist of applying the intersectionality in health interventions and programs; determining context specific, intersectionality-based and evidence-based intervention components for each of the intervention pathways).ResultsAccording to considerations regarding checklist of application of intersectionality principles, the intervention at the different individual, organizational, and policy levels with multiple strategies should be designed to respond to needs/conditions affecting HIV testing uptake among immigrants. We determined the peer-led intervention features to improve the use of HIV testing services in Afghan immigrants following the intersectionality principles, target group needs, and contextual conditions aiming to modify power structures. Intervention strategies included HIV information provision, support, community-based services, and structural interventions.ConclusionThis study provides a practical framework for health planners and researchers seeking to reduce inequalities by presenting how intersectionality can influence the design of a health intervention. Accordingly, it is necessary to revisit the social relationships and power structures, determine the intervention components based on evidence tailored to the target group’s needs, and apply changes at different levels.