Human Immunodeficiency Virus Testing Research Articles

Racial HIV Testing Inequalities in Adolescent Men who have Sex with Men and Transgender Women in Three Brazilian Cities.

Many barriers to human immunodeficiency virus (HIV) testing among Black people exist. This study analysed the association between race/skin colour and lifetime HIV testing among adolescent men who have sex with men (AMSM) and transgender women (ATGW) in three Brazilian cities. This cross-sectional study was nested within the PrEP1519 cohort, a multicentre study of AMSM and ATGW aged 15-19 years in Belo Horizonte, Salvador, and São Paulo, Brazil. The outcome variable was the lifetime HIV testing (no or yes). The main exposure variable was self-reported race/skin colour as White and a unique Black group (composed of Pardo-mixed colour and Black, according to the Brazilian classification). Descriptive statistics and bivariate and multiple logistic regression analyses were conducted to estimate the adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) to determine the association between the main exposure and outcome, adjusted for covariates. White adolescents were tested more frequently than the unique Black group (64.0% vs. 53.7%, respectively; Ρ = 0.001). Multiple logistic regression analysis showed that the unique Black group of AMSM and ATGW had 26% (adjusted OR [aOR], 0.74; 95% CI, 0.55-0.98) and 38% (aOR, 0.62; 95% CI, 0.45-0.87) lower odds of being tested for HIV in a lifetime than Whites in model 1 and 2, respectively. Our findings highlight the role of racism in lifetime HIV testing among AMSM and ATGW. Therefore, an urgent need for advances exists in public policies to combat racism in Brazil.

Abstract 120: A closer Look at colorectal cancer risk: Insights from the complex relationship of HIV, helminths, and immune responses

Abstract The advent of antiretroviral therapy has markedly increased the survival rates of individuals with human immunodeficiency virus (HIV). However, this demographic, particularly in low-middle-income countries (LMICs) where HIV-helminth co-infections are prevalent, remains susceptible to infections. The intricate interplay between helminth infections and HIV susceptibility, often inducing immunological phenotypes that heighten vulnerability, remains poorly understood. Studies have shown the association between HIV-helminth co-infections and elevated susceptibility to colorectal cancer (CRC), introducing an additional layer of health concerns for this already vulnerable population. This retrospective observational study delves into the profound effects of HIV-helminth co-infections on immune responses, with a specific focus on type 2 T helper (Th2) cell immunomodulation and susceptibility to CRC. Utilizing samples from a master project (n=414), 80 systematically randomized individuals were categorized into uninfected control, HIV-infected only, helminth-infected only, and HIV-helminth co-infected groups. Parasite detection employed the Kato-Katz technique, and serum testing was conducted for helminth-specific antibodies. Serological HIV testing, viral load categorization, white blood cell counts, and differential analyses were performed. Human ProcartaPlex Panel 1 was used for cytokine profiling of immune stimulatory and inhibitory soluble proteins. A significant reduction in B and T lymphocyte attenuator (BTLA) (p=0.049) in helminth infections compared to the control. The association of BTLA with its ligand, herpesvirus entry mediator (HVEM), establishes a direct link between the CD28 and tumor necrosis factor receptor (TNFR) families, triggering wide-ranging and robust immune responses. Subsequently, a notable reduction in CD28 was observed in HIV-infected subjects (p=0.003), followed by helminth-infected and HIV-helminth co-infected individuals (p=0.03) compared to the control. Furthermore, programmed death ligand-2 (PD-L2) expression, a major contributor to alternatively activated macrophage polarization during helminth infections, was significantly increased in the HIV-helminth co-infected group (p = 0.05), favoring a shift towards Th2 immune responses. These observed alterations underscore the complexity of the immunological interplay in co-infected individuals, emphasizing an additional risk factor for colorectal cancer development. This necessitates a comprehensive understanding, providing valuable insights for the development of therapeutic strategies in LMICs and similar settings, addressing the heightened risk of CRC within this population. Citation Format: Botle P. Damane, Thanyani V. Mulaudzi, Sayed S. Kader, Ropo E. Ogunsakin, Pragalathan Naidoo, Zodwa Dlamini, Zilungile L. Mkhize-Kwitshana. A closer Look at colorectal cancer risk: Insights from the complex relationship of HIV, helminths, and immune responses [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 120.

Knowledge, acceptance, and uptake of voluntary counseling and testing for human immunodeficiency virus/acquired immunodeficiency syndrome among undergraduates of a public university in Southwestern Nigeria

Objectives: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a global public health problem, and Nigeria has about 1.9 million people living with the virus. HIV testing and counseling services serve as a very important entry point to HIV/AIDS care and treatment. Voluntary counseling and testing (VCT) is one of the interventions developed to tackle the HIV/AIDS epidemic in Africa. This study determined the knowledge, acceptance, and utilization of VCT for HIV/AIDS among undergraduates in a public University in Southwestern Nigeria. Material and Methods: The study adopted a descriptive cross-sectional design, using the multistage sampling technique to select 425 respondents. A self-administered questionnaire was used for data collection. Data analysis was done using Statistical package for the social sciences (SPSS), version 25. Descriptive statistics were presented in tables and figures, and inferential statistics were analyzed at a level of significance of 0.05. Results: Over half of the respondents, 226 (53.2%) were within the age range of 18–25 years. The majority were female, 345 (81.2%), single 403 (94.8%), and had never had sexual intercourse 300 (70.6%). Over half of the respondents’ 240 (57%), had above average knowledge of VCT for HIV/AIDs, had above average levels of acceptance 254 (59%), and the majority 326 (76.2%) of the respondents had very low level of utilization of VCT for HIV/AIDS. There was a significant association between respondents’ age (χ2 = 55.599a, P = 0.000), gender (χ2 = 19.094a, P = 0.000), religion (χ2 = 8.990a, P = 0,038), marital status (χ2 = 8.411a, P = 0.038), age at first sex (χ2 = 61.847a, P = 0.000), knowledge of VCT (χ2 = 5.297a, P = 0.021), acceptance of VCT (χ2 = 80.235a, P = 0.000), and their uptake of VCT for HIV/AIDs. Furthermore, selected socio-demographic characteristics, knowledge, and acceptance of VCT significantly predicted the uptake of VCT among respondents (F [8,416] = 20.163, P < 0.05). Conclusion: The study concluded that respondents had an above average knowledge and acceptance of VCT but a low level of utilization. To increase the utilization of VCT for HIV/AIDS among undergraduates, public health programs should focus on educating undergraduates and significant others on the importance of VCT in the context of HIV prevention, care, and treatment.

Factors Associated with Utilization of Sexual and Reproductive Health Services among Married Adolescent Girls in Kano, Northern Nigeria.

Married adolescents face significant obstacles in making informed reproductive health decisions and accessing sexual and reproductive health (SRH) services. It is important to identify barriers hindering these adolescents from accessing SRH services. The aim of this study was to identify factors associated with the utilization of SRH services among married adolescent girls in northern Nigeria. We used a cross-sectional study design. The study population comprised of married female adolescents aged 14-19 years who were residents in the study areas for at least six months. The outcome measure was SRH service utilization, defined as the use of any of the conventional SRH services (ante/postnatal care, human immunodeficiency virus (HIV) testing and counseling, sexually transmitted infections (STI) treatment, family planning, and post-abortion care). Predictor variables included the sociodemographic, obstetric, and gynecological characteristics of the respondents. An adapted, pretested, interviewer-administered, and semi-structured questionnaire was employed for data collection. Multivariable logistic regression was used to explore the independent association between selected variables and utilization of SRH services. A total of 200 respondents were surveyed (100 each from an urban and a rural community in Kano, Nigeria), survey response rate: 94.5%. The age of respondents ranged from 14 to 19 years, with mean age (± standard deviation) of 18.5 (±1.1) years and 17.5 (±1.3) years for urban and rural respondents, respectively. All respondents were aware of the available SRH facilities and preferred public facilities (92.6% urban respondents and 67.0% rural respondents). Ever-use of SRH services was higher among urban than rural respondents (86% vs. 56%, respectively). Geographic proximity was a key factor for urban respondents (64.2%), while affordability was considered important by rural respondents (47.9%). Respondent's age and partner's occupation were independently associated with utilization of SRH services. Urban respondents whose husbands were businessmen were seven times more likely to use SRH services than those whose partners were civil servants (adjusted odds ratio [aOR] = 6.80, 95% confidence interval [CI]: 1.29-35.84, P = 0.02). Rural respondents 18 years of age and older were approximately six times more likely to utilize SRH services than those <18 years (aOR = 5.71, 95% CI: 1.56-12.78, P = 0.01). Awareness of available SRH services was high in the study population, and service utilization was influenced by the respondent's age and partner's occupation. Findings from this study can help inform the development of age-appropriate and accessible SRH services tailored to married adolescents in similar settings.

The current state and outlook of HIV infection and AIDS in South Korea

Background: Over the past decade, approximately 1,100 newly diagnosed cases of human immunodeficiency virus (HIV) infection have been reported annually in South Korea, with 1,066 newly diagnosed cases reported in 2022. A decrease in HIV infection rate can be achieved only through coordinated prevention, diagnosis, and treatment. South Korea is lagging in the worldwide decreasing trend of HIV infection, and a brief review of this situation may suggest improvements necessary for progress.Current Concepts: In South Korea, the proportion of patients with CD4 cell count below 200 cells/mm&lt;sup&gt;3&lt;/sup&gt; at initial diagnosis of HIV infection remains high, suggesting that a significant population is diagnosed at the late stage of the disease. Since 2019, the Korean National Health Insurance Service began to cover the cost of preexposure prophylaxis for sexual partners of patients living with HIV, but few have started the regimen due to several barriers. Insurance criteria for a prophylaxis regimen should be modified, and accessibility to the regimen should be made available through multiple pathways. Proactive use of rapid HIV testing kits in community health centers and clinics should be expanded. Legal and administrative environments encouraging voluntary testing, early diagnosis, and treatment should be fostered. Medical personnel must be able to offer medical care without discrimination regardless of HIV infection status.Discussion and Conclusion: The HIV epidemic in South Korea has not yet decreased. To end it, efforts should be required across broad areas, including voluntary HIV testing, early diagnosis, active pre-exposure prophylaxis, a stigma- and discrimination-free social environment, and changes in legal and medical environments.

Partner notification service utilization and associated factors among clients attending anti-retroviral therapy clinics of public health facilities in Gimbi Town, West Ethiopia, 2023: a facility-based mixed-method cross-sectional study

BackgroundPartner Notification Service is among the strategies used to conduct targeted Human Immunodeficiency Virus Testing Service by obtaining information about sexual contacts of index clients to refer for testing. But most people living with Human Immunodeficiency Virus are still unaware of their status, including Ethiopia. Limited studies are available on the magnitude of partner notification service utilization and associated factors in Ethiopia.ObjectiveThe aim of this study was to assess the magnitude of partner notification service utilization and associated factors among people living with Human Immunodeficiency Virus attending anti-retroviral therapy clinics of public health facilities in Gimbi town, West Ethiopia.MethodsA facility-based mixed-method cross-sectional study design was used. Total of 455 study participants were selected by systematic random sampling for quantitative data and health workers were purposively selected for qualitative data until saturation of ideas was reached. The study was conducted from December 1, 2022 to January 30, 2023. Structured questionnaires and key informant interview guides were used for data collection. Quantitative data were analyzed using Statistical Package for Social Science version 25. Open code 4.02 software was used for qualitative data analysis. Frequencies and proportions were used to summarize descriptive statistics. Bivariable and multivariable logistic regression was used to identify associated factors then variables with a p value < 0.05 were declared to have an association with the dependent variable.ResultExactly 298 (65.5%) of the study participants were notified their HIV status to their sexual partners. Factors associated with Partner Notification Service Utilization were depression AOR: 0.12 (95% CI: 0.07, 0.20), urban settlers AOR: 2.21 (95% CI: 1.2, 3.83), fear of support loss AOR: 0.24 (95% CI: 0.14, 0.40) and intimate partner violence AOR: 0.55 (95% CI: 0.31, 0.97). From qualitative part of this study, factors associated to Partner Notification service utilization were fear of stigma, discrimination and fear of divorce.ConclusionTwo-third of the study participants were utilized partner notification service, and efforts are important to prevent depression and intimate partner violence. Local government bodies and stakeholders should implement economic strengthening and strategies to address the rural community for HIV/AIDS prevention. Promotion of supportive and inclusive environment for PLHIV should also considered as way to increase PNS utilization.

Using adult care visits to diagnose HIV infection in children, Burkina Faso.

To estimate the feasibility, positivity rate and cost of offering child testing for human immunodeficiency virus (HIV) to mothers living with HIV attending outpatient clinics in Burkina Faso. We conducted this implementation study in nine outpatient clinics between October 2021 and June 2022. We identified all women ≤ 45 years who were attending these clinics for their routine HIV care and who had at least one living child aged between 18months and 5years whose HIV status was not known. We offered these mothers an HIV test for their child at their next outpatient visit. We calculated intervention uptake, HIV positivity rate and costs. Of 799 eligible children, we tested 663 (83.0%) and identified 16 new HIV infections: 2.5% (95% confidence interval, CI: 1.5-4.1). Compared with HIV-negative children, significantly more HIV-infected children were breastfed beyond 12 months (P-value: 0.003) and they had not been tested before (P-value: 0.003). A significantly greater proportion of mothers of HIV-infected children were unaware of the availability of child testing at 18 months (P-value: < 0.001) and had more recently learnt their HIV status (P-value: 0.01) than mothers of HIV-negative children. The intervention cost 98.1 United States dollars for one child testing HIV-positive. Barriers to implementing this strategy included shortages of HIV tests, increased workload for health-care workers and difficulty accessing children not living with their mothers. Testing HIV-exposed children through their mothers in outpatient clinics is feasible and effective in a low HIV-prevalence setting such as Burkina Faso. Implementation of this strategy to detect undiagnosed HIV-infected children is recommended.

Safeguarding strategies and current HIV treatment in the UK

Objectives: This study aims to illuminate contemporary strategies and treatment approaches employed in the United Kingdom (UK) to safeguard against Human Immunodeficiency Virus (HIV) transmission and enhance the well-being of those grappling with Acquired Immune Deficiency Syndrome (AIDS). The review contributes to a comprehensive understanding of the nation's ongoing efforts in managing the impact of HIV on public health. Material and Methods: Research, reports, guidelines, and official websites from 2005 to 2024 were searched from the Pubmed database and Bournemouth University's database. English resources were searched using keywords related to HIV risk measures, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and anti-retroviral therapy (ART). Results: HIV prevention efforts in the UK emphasize education, widespread testing, and targeted interventions. Strategies include promoting safe sex practices, regular testing, and condom use. HIV testing, PrEP, PEP and ART play crucial roles in prevention and treatment, with initiatives focusing on high-risk populations such as men who have sex with men (MSM) and transgender individuals. Challenges include regional variations, financial constraints, and social stigma. Conclusions: A holistic and adaptable approach is essential in HIV prevention and treatment in the UK. Education, widespread testing, and tailored interventions for diverse populations are key components. Challenges such as financial constraints and social stigma require sustained efforts and global collaboration. Advancements in PrEP, PEP, and ART offer promising avenues for mitigating the impact of HIV, emphasizing the importance of accessibility and adherence.

Development of a Machine Learning Modeling Tool for Predicting HIV Incidence Using Public Health Data From a County in the Southern United States.

Advancements in machine learning (ML) have improved the accuracy of models that predict human immunodeficiency virus (HIV) incidence. These models have used electronic medical records and registries. We aim to broaden the application of these tools by using deidentified public health datasets for notifiable sexually transmitted infections (STIs) from a southern US county known for high HIV incidence. The goal is to assess the feasibility and accuracy of ML in predicting HIV incidence, which could inform and enhance public health interventions. We analyzed 2 deidentified public health datasets from January 2010 to December 2021, focusing on notifiable STIs. Our process involved data processing and feature extraction, including sociodemographic factors, STI cases, and social vulnerability index (SVI) metrics. Various ML models were trained and evaluated for predicting HIV incidence using metrics such as accuracy, precision, recall, and F1 score. We included 85 224 individuals; 2027 (2.37%) were newly diagnosed with HIV during the study period. The ML models demonstrated high performance in predicting HIV incidence among males and females. Influential features for males included age at STI diagnosis, previous STI information, provider type, and SVI. For females, predictive features included age, ethnicity, previous STI information, overall SVI, and race. The high accuracy of our ML models in predicting HIV incidence highlights the potential of using public health datasets for public health interventions such as tailored HIV testing and prevention. While these findings are promising, further research is needed to translate these models into practical public health applications.

Chapitre 3. Inégalités dans le dépistage et la prévention du VIH/SIDA

Despite progress in the detection and treatment of the Human Immunodeficiency Virus (HIV), major challenges remain in developing countries due to insufficient resources and infrastructure. The number of people living with HIV who do not know their serostatus has fallen worldwide. However, a number of existing obstacles stand in the way of better results. The socio-cultural context in Africa hampers knowledge and understanding of the disease, leading to stigmatizing attitudes, reluctance to undergo screening and poor access to treatment.Inequalities also exist within the countries of the North, as in the case of the French West Indies, which benefit from a policy to combat HIV/AIDS, with results that fall short of those in mainland France. For this reason, we have chosen to compare the situation in the West Indies with that in Benin, in the context of African culture.Our analysis takes stock of the issues and prospects linked to the accessibility and use of screening care in sub-Saharan Africa and the French Departments of America (DFA).In both cases, fear of the disease, stigmatization, fear of a positive HIV test result and fear of disclosing the test result limit preventive and treatment actions for an effective fight against HIV.In sub-Saharan Africa, women are more likely to accept a screening test than men. Certain populations, including adolescents and homosexuals, are in a vulnerable position. The comparison reveals similar attitudes and suggests actions or recommendations in both countries that have produced results.Innovative strategies and specific programs must be implemented to turn the tide in the fight against the HIV epidemic.

Provider and female client economic costs of integrated sexual and reproductive health and HIV services in Zimbabwe.

A retrospective facility-based costing study was undertaken to estimate the comparative cost per visit of five integrated sexual and reproductive health and HIV (human immuno-deficiency virus) services (provider perspective) within five clinic sites. These five clinics were part of four service delivery models: Non-governmental-organisation (NGO) directly managed model (Chitungwiza and New Africa House sites), NGO partner managed site (Mutare site), private-public-partnership (PPP) model (Chitungwiza Profam Clinic), and NGO directly managed outreach (operating from New Africa House site. In addition client cost exit interviews (client perspective) were conducted among 856 female clients exiting integrated services at three of the sites. Our costing approach involved first a facility bottom-up costing exercise (February to April 2015), conducted to quantify and value each resource input required to provide individual SRH and HIV services. Secondly overhead financial expenditures were allocated top-down from central office to sites and then respective integrated service based on pre-defined allocation factors derived from both the site facility observations and programme data for the prior 12 months. Costs were assessed in 2015 United States dollars (USD). Costs were assessed for HIV testing and counselling, screening and treatment of sexually transmitted infections, tuberculosis screening with smear microscopy, family planning, and cervical cancer screening and treatment employing visual inspection with acetic acid and cervicography and cryotherapy. Variability in costs per visit was evident across the models being highest for cervical cancer screening and cryotherapy (range: US$6.98-US$49.66). HIV testing and counselling showed least variability (range; US$10.96-US$16.28). In general the PPP model offered integrated services at the lowest unit costs whereas the partner managed site was highest. Significant client costs remain despite availability of integrated sexual and reproductive health and HIV services free of charge in our Zimbabwe study setting. Situating services closer to communities, incentives, transport reimbursements, reducing waiting times and co-location of sexual and reproductive health and HIV services may help minimise impact of client costs.

Pneumocystis jirovecii pneumonia: a case report

Introduction and importancePneumocystis jirovecii (PJP) pneumonia is a serious life-threatening condition in immunocompromised individuals and is often associated with human immunodeficiency virus (HIV) + patients. We describe a case of PJP pneumonia which provided a diagnostic challenge in a patient who presented with no known risk factors leading to a delay in initiation of appropriate antibiotic therapy.Case presentationA 71-year-old previously healthy white/Caucasian male presented with subacute hypoxic respiratory failure due to multifocal pneumonia with diffuse bilateral ground glass opacities with consolidations despite prior treatment with antibiotics and steroids. He was admitted and started on intravenous broad-spectrum antibiotics but continued to deteriorate, eventually requiring intubation and transfer to the ICU. Bronchoscopy revealed PJP and treatment was initiated, but the patient developed refractory shock and multiorgan failure, and ultimately died. It was later discovered that he was HIV-1 positive.Clinical discussionPJP, as a potential cause of his presentation, was not considered given that our patient lacked any overt risk factors for PJP pneumonia. He continued to worsen despite broad spectrum antibiotic therapy and hence bronchoscopy was pursued. His clinical profile, in hindsight, was suspicious for PJP pneumonia and early PJP-directed antibiotic therapy may have prevented a fatal outcome, as in this case. There was an element of cognitive bias across multiple providers which may have contributed to the delay in treatment despite his rapid clinical decline while on conventional pneumonia treatment protocol. His diagnosis was later evident when his BAL-DFA grew PJP in addition to his low levels of CD4 and CD8 cells. He was found to be HIV-1 positive five days after his death; there was a delay in this diagnosis since all positive HIV tests from the hospital are reported as ‘pending’ until the presumptive positive sample goes to the Connecticut Department of Public Health State laboratory for the confirmatory test. PJP-targeted therapies were initiated later in our patient’s hospital course when the infection had progressed to refractory septic shock with multiorgan failure and eventual death.ConclusionPJP pneumonia is a fatal disease if not recognized early in the course of illness, and the patient usually undergoes multiple antibiotic regimens before they are diagnosed and receive appropriate clinical care. The gold standard of diagnostic testing for PJP is by obtaining bronchial washings through a flexible bronchoscopy and the turnaround time for such results may take a few days to result. A significant proportion of patients may not have any overt risk factors of immunosuppression and early empiric treatment for PJP may be clinically appropriate as the delay in diagnosis may be associated with significant morbidity and mortality risk.

HIV counseling, testing, and test result receipt among East African women of reproductive age using recent national health surveys.

One of the most important public health concerns is still the Human Immunodeficiency Virus (HIV) and acquired immunodeficiency syndrome (AIDS), particularly in developing countries. Although HIV testing is an important step in both prevention and treatment, its uptake remains low, and no study has looked into the scale of HIV counseling, testing, and test result receipt among East African women all at the same time. Therefore, this study aimed to investigate HIV counseling, testing, and test result receipt, as well as the factors that influence them, among East African women. This analysis used Demographic and Health Survey data collected from 10 East African countries between 2011 and 2022. We examined the coverage of HIV counseling, testing, and test result receipt among East African women, as well as other characteristics. To select candidate factors and identify significant explanatory variables related to the outcome variable, binary and multiple logistic regression analyses were conducted, and the results were presented using adjusted odds ratios (AORs) with 95% confidence intervals. In the binary and multiple logistic regression analyses, P values of less than or equal to 0.2 and <0.05 were used to assess significant variables, respectively. A total of 41,627 weighted women included to this study. HIV counseling, testing, and test result receipt among East African women were found to be 77.86% (95% CI = 77.46, 78.26). Being 25-34 years old (AOR = 1.13, 95% CI, 1.06, 1.21), 35-49 years old (AOR = 1.15, 95% CI, 1.05, 1.26) as compared to 15-24 years old women, primary education (AOR = 1.75, 95% CI, 1.64, 1.86), secondary/higher education level (AOR = 1.96, 95% CI, 1.82, 2.13) as compared to not educated women, poor, (AOR = 1.22, 95% CI, 1.14, 1.29), middle wealth (AOR = 1.12, 95% CI, 1.04, 1.21) as compared to rich wealth index, mass media exposure (AOR = 1.29, 95% CI, 1.22, 1.35), 3-5 parity (AOR = 1.29, 95% CI, 1.21, 1.37), more than 5 parity (AOR = 1.46, 95% CI, 1.33, 1.61) as compared to <3 parity, health institution delivery (AOR = 1.65, 95% CI, 1.53, 1.76), were associated positively with the outcome variable respectively. However, being married (AOR = 0.79, 95% CI, 0.72, 0.87), not using contraceptive (AOR = 0.58, 95% CI, 0.51, 0.61), and traditional contraceptive method user (AOR = 0.47, 95% CI, 0.41, 0.54) as compared to modern users were associated negatively with outcome variable respectively. This study found that HIV counseling, testing, and test result receipt are still unsatisfactory. Strengthening maternal health services such as institutional delivery, family planning, and women's empowerment, as well as changing mass media and taking advantage of these opportunities, will boost the region's coverage of HIV counseling, testing, and obtaining results.

HIV Voluntary Counselling and Testing Utilisation among School of Healthcare Sciences Undergraduate Students at the University of Limpopo.

Existing evidence indicates that South African university students have low utilisation of Human Immunodeficiency Virus (HIV) Voluntary Counselling and Testing (VCT). A cross-sectional survey was conducted to determine the utilisation of HIV VCT among undergraduate students in the School of Healthcare Sciences. Structured questionnaires were used to collect data through Google Forms. The results are presented through descriptions and percentages and illustrated in tables. Out of 389 undergraduate students, only 324 completed the questionnaire. The majority (97.2%) were aware of the health centre on campus, while only (74.7%) knew about the HIV VCT services offered on campus. Despite the awareness, many (36.7%) do not utilise the campus HIV VCT services, and some (9.6%) have never tested for HIV. There was an association between awareness of Voluntary Counselling and Testing of HIV services offered at the campus health and wellness centre and utilisation of HIV Voluntary Counselling and Testing at (<0.001). Therefore, it is imperative to urgently escalate the level of HIV/AIDS education in higher institutions of learning and emphasise the mounting danger of HIV infection and the immense importance of regular HIV testing. The findings of this study could serve as a foundation for creating HIV prevention and control programmes for youth, particularly in higher education institutions.

Associations Between Negative Body Image and Sexual Health Practices in Emerging Adults from Malaysia

Past findings on the association between negative body image and sexual health behaviors have been mixed and mostly derived from Western samples. The aim of the current study was to examine associations between indices of negative body image and sexual health practices that reduce the risk of disease transmission in emerging adults, and whether these associations are moderated by gender. Using an online survey, a convenience sample of 584 Malaysian adults aged 18–30 years (230 men, 354 women) completed measures of satisfaction with overall appearance, body size dissatisfaction, weight satisfaction, height satisfaction, and genital image evaluation. They also reported if they ever had partnered sex, condomless sex, and been screened for human immunodeficiency virus (HIV), as well as their lifetime number of penetrative sex partners. Hierarchical logistic and ordinal regression analyses indicated that more positive genital image evaluation, but not the other body image indices, was significantly associated with having had partnered sex and fewer lifetime penetrative sex partners. None of the body image indices were significantly associated with condomless sex. All associations were consistent across men and women. For HIV testing, a significant interaction between genital image evaluation and gender emerged. However, this was reduced to non-significance after controlling for the number of penetrative sex partners. Overall, our findings underline the importance of promoting improved genital image in interventions aimed at increasing positive sexual health behaviors.

National Hospitalization Rates and In-Hospital Mortality Rates of HIV-Related Opportunistic Infections in the United States, 2011-2018.

Human immunodeficiency virus (HIV)-related opportunistic infections (OIs) cause substantial morbidity and mortality among people with HIV (PWH). US hospitalization and in-hospital mortality rates associated with OIs have not been published using data from the past decade. We analyzed the National Inpatient Sample for the years 2011 through 2018. We used sociodemographic, financial, and hospital-level variables and identified hospitalizations for PWH and OI diagnoses. Using survey-weighted methods, we estimated all OI-related US hospitalization rates and in-hospital mortality per 100 000 PWH and modeled associated factors using survey-based multivariable logistic regression techniques. From 2011 to 2018, there were an estimated 1 710 164 (95% confidence interval [CI], 1 659 566-1 760 762) hospital discharges for PWH with 154 430 (95% CI, 148 669-159 717 [9.2%]) associated with an OI, of which 9336 (95% CI, 8813-9857; 6.0%) resulted in in-hospital mortality. Variables associated with higher odds of OI-related hospitalizations (compared to without an OI) included younger age, male sex, non-White race/ethnicity, and being uninsured (all likelihood ratio [LR] P < .001). Higher OI-related mortality was associated with older age (LR P < .001), male sex (LR P = .001), Hispanic race/ethnicity (LR P < .001), and being uninsured (LR P = .009). The OI-related hospitalization rate fell from 2725.3 (95% CI, 2266.9-3183.7) per 100 000 PWH in 2011 to 1647.3 (95% CI, 1492.5-1802.1) in 2018 (P < .001), but the proportion of hospitalizations with mortality was stable (5.9% in 2011 and 2018). Our findings indicate an ongoing need for continued funding of HIV testing, health insurance for all PWH, OI screening initiatives, review of current prophylaxis guidelines, and recruitment of more HIV clinicians.

Predictors of never testing for HIV among sexually active individuals aged 15–56 years in Rwanda

Human Immunodeficiency Virus (HIV) testing services are known as the primary step in preventing the spread of HIV. However, access to these crucial services varies across regions within continents due to disparities in healthcare infrastructure, resources, and awareness. Approximately one in every five people living with HIV (PLWH) encounters obstacles in accessing HIV testing, notably in Eastern and Southern Africa, where geographical, resource, awareness, and infrastructure limitations prevail. Consequently, HIV remains a significant public health concern in these regions, necessitating expanded testing efforts to combat the HIV/AIDS disaster. Despite these challenges, there is a lack of scientific evidence on the prevalence of HIV testing and its determining factors in Rwanda. This study determined the prevalence of never being tested for HIV and its associated factors among sexually active individuals aged 15–56 who participated in the Rwanda AIDS Indicators and HIV Incidence Survey (RAIHIS). This cross-sectional study enrolled 1846 participants. The variables were extracted from the RAIHIS dataset and statistically analyzed using STATA software version 13. Bivariate and multivariate logistic regression models were employed to identify predictors of never having undergone HIV testing, with a 95% confidence interval and a 5% statistical significance level applied. The prevalence of non-testing for HIV was 17.37%. Being aged 15–30 years (aOR 2.57, 95%CI 1.49–4.43, p < 0.001) and male (aOR 2.44, 95%CI 1.77–3.36, p < 0.001) was associated with an increase in the odds of never testing for HIV. Further, those from urban area were less likely than those living in rural areas to have never tested for HIV (aOR 0.31; 95% CI 0.38–0.67; p < 0.001). Participants who were not aware of HIV test facilitates were more likely to have never undergone HIV testing (aOR 1.75; 95% CI 1.25–2.47; p = 0.031) than their counterparts. While the prevalence of HIV non-testing remains modest, the significance of youth, male gender, lack of awareness, and rural residence as influential factors prompts a call for inventive strategies to tackle the reasons behind never having undergone HIV testing. Further exploration using mixed methodologies is advocated to better comprehend socio-cultural impacts and causation relating to these identified factors.

Impact de la COVID-19 sur les services de prévention du VIH et de prise en charge des personnes vivant avec le VIH dans la ville de Bukavu : une étude mixte séquentielle explicative

Introduction : Depuis son apparition fin 2019 en Chine, les mesures de riposte contre l’infection à COVID-19 ont perturbé la prestation des services de santé primaires dont ceux liés au virus de l’immunodéficience humaine (VIH). En République démocratique du Congo, l’effet des mesures anti-COVID-19 (confinement) sur l’utilisation des services de prévention du VIH et de prise en charge des personnes vivant avec le VIH (PVVIH) reste peu décrit à ce jour. Objectif : Comparer et comprendre l’effet des mesures anti-COVID-19 sur l’utilisation des services préventifs du VIH et de prise en charge des PVVIH dans les Centres de traitement ambulatoire (CTA) de Bukavu avant (octobre 2019 à février 2020) et pendant (mars à juillet 2020) la période des mesures anti-COVID-19. Méthodes : Étude mixte multisite avec un devis séquentiel explicatif réalisée à Bukavu entre juillet et septembre 2021. La phase quantitative est observationnelle, descriptive, rétrospective et basée sur des données programmatiques issues des CTA. La phase qualitative, guidée par les résultats quantitatifs, est basée sur 31 entretiens semi-structurés avec les soignants et les PVVIH. Résultats : Par comparaison avec la période pré-COVID-19, les mesures anti-COVID-19 ont entrainé une baisse de 11 à 20% des services de prévention du VIH et de prise en charge des PVVIH. Elles ont également induit les ruptures de stock d’antirétroviraux et de tests VIH, la réorganisation des services VIH, la contamination de certains soignants à la COVID-19 et le décès d’autres, ainsi qu’une baisse de l’utilisation des services VIH. Discussion et conclusion : À Bukavu, les mesures anti-COVID-19 ont eu un impact négatif sur le parcours de soins des personnes à risque et infectées par le VIH. Elles ont entravé les progrès vers les objectifs : 95% des personnes dépistées au VIH, 95% des PVVIH sous traitement et 95% des PVVIH avec une charge virale supprimée.

Partying in Thailand: Never Testing Among Men Who Have Sex With Men Who Attend Sexualized (Drug) Parties.

Human immunodeficiency virus (HIV) testing for Thai men who have sex with men (MSM) is suboptimal, which undermines their linkage to care and subsequent HIV preexposure prophylaxis (PrEP) uptake. We analyzed a cross-sectional survey conducted in 2021 among Thai MSM who attended any private sex parties or circuit parties in the past 3 years ("sexualized parties"). Of the 424 men included in our analysis, 47.6% had been recently tested for HIV in the past 1 year, 30.2% had not recently been tested, and 22.2% had never been tested. In our multivariable analysis, relative to participants who had recently tested for HIV, those who have never tested were more likely to have lower education or to live outside of Bangkok, and to have attended both circuit and private sex parties (vs. private sex party only) but were less likely to report any sexually transmitted infection diagnosis or to have heard of PrEP. Participants who had an HIV test more than a year ago were more likely to have attended both circuit and private sex parties (vs. private sex parties only) but were less likely to have any sexually transmitted infection diagnosis, meet sexual partners online, or have heard of PrEP. Rates of condomless anal sex and willingness to use PrEP were similar across groups. Despite the high rates of sexual risk-taking, sexualized party attendees reported suboptimal HIV testing uptake. The joint promotion of HIV testing and PrEP is warranted-especially on-premise HIV testing at circuit parties and outreach at online platforms to reach sexualized party attendees.

Accuracy of C-Reactive Protein for Tuberculosis Detection in General-Population Screening and Ambulatory-Care Triage in Uganda.

Rationale: C-reactive protein (CRP) has demonstrated utility as a point-of-care triage test for tuberculosis (TB) in clinical settings, particularly among people with human immunodeficiency virus (HIV), but its performance for general-population TB screening is not well characterized. Objective: To assess the accuracy of CRP for detecting pulmonary TB disease among individuals undergoing community-based screening or presenting for evaluation of TB symptoms in Kampala, Uganda. Methods: We pooled data from two case-control studies conducted between May 2018 and December 2022 among adolescents and adults (⩾15 yr) in Kampala, Uganda. We conducted community-based screening for TB, regardless of symptoms. We enrolled people with Xpert MTB/RIF Ultra-positive (including trace) sputum results and a sample of people with Ultra-negative results. We also enrolled symptomatic patients diagnosed with TB and controls with negative TB evaluations from ambulatory care settings. Participants underwent further evaluation, including sputum culture, CRP, and HIV testing. We assessed the accuracy of CRP alone or with symptom screening against a bacteriologic reference standard. Our primary analysis evaluated the sensitivity and specificity of CRP at a cutoff of 5 mg/L. Diagnostic performance was summarized by calculating the area under the receiver operating curve (AUC). Results: In the community setting (n = 544), CRP ⩾ 5 mg/L had a sensitivity of 55.3% (95% confidence interval, 47.0-63.4%) and specificity of 84.7% (79.7-88.8%) for confirmed TB; AUC was 0.75 (0.70-0.79). Screening for CRP ⩾ 5 mg/L or positive symptoms increased sensitivity to 92.0% (86.4-95.8%) at the expense of specificity (57.1% [50.8-63.2%]). In the ambulatory care setting (n = 944), sensitivity of CRP ⩾ 5 mg/L was 86.7% (81.8-90.7%), specificity was 68.6% (64.8-72.2%), and AUC (0.84 [0.81-0.87]) did not differ significantly by HIV status. CRP ⩾ 5 mg/L was >90% sensitive among individuals with a medium or high semiquantitative Xpert result in both settings. Conclusions: Although CRP did not meet World Health Organization (WHO) TB screening benchmarks in the community, it demonstrated high specificity, and sensitivity was high among individuals with high sputum bacillary burden who are likely to be most infectious. In ambulatory care, estimated sensitivity and specificity were each within 4 percentage points of WHO benchmarks, with no meaningful difference in performance by HIV status.