Implementation Of HIV Testing Research Articles

Factors associated with retention of mother-baby pairs in the elimination of mother-to-child transmission of HIV program in Kaberamaido district: A longitudinal analysis.

Retention along the elimination of Mother to Child Transmission (eMTCT) cascade in Uganda remains poor as only 62.7%-69.5% are followed up to 18months. The objective of this study was to determine the rates of retention of mother-baby pairs at two levels of the eMTCT cascade (12 and 18 months) and associated factors. This was a longitudinal analysis of 368 mother-baby pairs who were enrolled into the eMTCT program in Kaberamaido district from January 2013 to December 2018. Data was extracted from early infant diagnosis (EID) and mothers' ART registers, entered into Microsoft Excel and then exported to Stata statistical software package version 14.0 for management and analysis. Descriptive statistics such as mean and frequencies were computed at univariate level. At the bivariate level, Cox proportional hazard regression was performed to assess the level of association between the primary outcome and each independent variable, while Cox proportional hazard regression model was built at multivariate level to determine the factors independently associated with retention of mother-baby pairs in the eMTCT program. Of the 368 mothers enrolled into the study, their average age was 29.7years (SD = 6.6). Nearly two-thirds of the mothers were married/cohabiting, (n = 232, 63.0%). The 368 mother baby pairs were observed for a total time of 6340 person months, with majority, 349 (94.8%, 95%CI = 92.0-96.7) still active in eMTCT care, while 19(5.2%, 95%CI = 3.3-8.0) were lost to follow up at 12months. At 18 months, 323 (87.8%, 95%CI = 84.0-90.8) were active in eMTCT program while 45(12.2%, 95 CI = 9.2-16.0) were lost to follow up. At bivariate level, marital status, health facility level of enrolment, mothers' ART treatment supporter, and mothers' ART enrolment time were significantly associated with survival/lost to follow up (LTFU) of mother-baby pairs along the eMTCT cascade. At multivariable level, the mothers' time of ART initiation was significantly associated with survival/lost to follow up (LTFU) of mother-baby pairs at along the eMTCT cascade, with mothers-baby pairs who were initiated during the antenatal/post-natal periods having higher hazards of LTFU compared to those who initiated ART before Antenatal period (before pregnancy), aHR = 4.37(95%CI, 1.62-11.76, P = 0.003). Mother-baby pairs who were enrolled into the eMTCT program after the implementation of HIV test and treat policy (year 2017 and 2018) had higher hazards of LTFU as compared to those enrolled before the implementation of test and treat policy in Uganda (year 2013-2016), aHR = 2.22(95% CI, 1.15-4.30, P = 0.017). All the other factors had no significant association with lost to follow up and cascade completion at multivariate level. There was high level of retention of mother-baby pairs in the eMTCT program in Kaberamaido at 12 months, but it was suboptimal at 18months. ART initiation during the antenatal and/or post-natal period was significantly associated with suboptimal retention of mother-baby pairs along the eMTCT cascade.

Monkeypox vaccination—an opportunity for HIV prevention

Monkeypox vaccination—an opportunity for HIV prevention

A Systematic Review of HIV Testing Implementation Strategies in Sub-Saharan African Countries.

HIV/AIDS remains a looming presence in public health across the world, particularly in Sub-Saharan Africa. The HIV Care Cascade hinges on testing and knowledge of HIV status. Though significant advances have been made in diagnosing people living with HIV (PLHIV), limitations in understanding which strategies are best suited to certain regions or populations have contributed to the uneven distribution in the success of various HIV testing strategies. Here, we present a conceptual framework that outlines effective HIV testing strategies for four target groups. This framework is based on a systematic literature review of articles published from January 1st, 2008, to December 31st, 2019. The effectiveness of HIV testing strategies depends on various factors including the setting, type of test and service providers. Multiple strategies are needed to reach the UNAIDS target of 95% of individuals knowing their HIV status. Expansion of community-based approaches, self-testing and HIV testing services in antenatal care will further improve the state of HIV testing in Sub-Saharan Africa.

The Prevention of Mother-to-Child HIV/AIDS Transmission at Public Health Centers: A Phenomenology Study

Objective: Mothers with HIV are likely to transmit the virus to their babies during pregnancy, delivery, or through breastfeeding. According to studies, the risk of mother-to-child HIV transmission among mothers that do not receive any form of treatment during pregnancy is approximately 15-45%. In Indonesia, the lack of a prevention program for HIV led to the provision of antiretroviral therapy (ART) for the prevention of mother-to-child transmission (PMTCT). The policies, financial facilities, the healthcare system, and human resources, including health workers, are factors that influence the PMTCT. This research discusses the perceptions of several doctors and midwives regarding the prevention of mother-to-child transmission at public health centers. Furthermore, information regarding policies and implementation of the PMTCT program at public health centers in Yogyakarta was qualitatively collected through semi-structured interviews. Methods: This research involved 6 participants, comprising of 3 heads of public health centers and 3 midwives as the HIV/AIDS program managers. A total of 5 themes were selected for the interview, namely policies of mandatory HIV testing for pregnant mothers, inadequate knowledge of the virus, need for PMTCT training, infrastructure and facilities, and HIV retesting. Results: Pregnant mothers are at potential risk of exposing health workers to HIV. They are also prone to contracting the virus due to poor educational background and less exposure to health information. Therefore, midwives need Prongs 3 and 4 to avoid contracting the virus while assisting pregnant mothers. Presently, there is a shortage of health promotion media for PMTCT, which include both electronic and print educational media. Therefore, the implementation of HIV testing in Indonesia is mandatory for pregnant mothers at their first antenatal care (ANC). However, despite the importance of conducting this test before labor, there is no regulation to ensure its implementation. Conclusion: The success of HIV mitigation is closely associated with the participation of academicians, policymakers, and community networks in providing collaborative planning strategies for the reduction of its spread, and evaluation of the mitigation result.

Using Assisted Partner Services for HIV Testing and the Treatment of Males and Their Female Sexual Partners: Protocol for an Implementation Science Study.

BackgroundDespite the effective scale-up of HIV testing and treatment programs, only 75% of people living with HIV (PLWH) globally know their status, and this rate is lower among men. This highlights the importance of implementing HIV testing and linkage interventions with a high uptake in this population. In a cluster randomized controlled trial conducted in Kenya between 2013 and 2015, we found that assisted partner services (APS) for HIV-exposed partners of newly diagnosed PLWH safely reached more HIV-exposed individuals with HIV testing compared with client referral alone. However, more data are needed to evaluate APS implementation in a real-world setting.ObjectiveThis study aims to evaluate the effectiveness, acceptability, fidelity, and cost of APS when integrated into existing HIV testing services (HTS) in Western Kenya.MethodsOur study team from the University of Washington and PATH is integrating APS into 31 health facilities in Western Kenya. We are enrolling females newly diagnosed with HIV (index clients) who consent to receiving APS, their male sexual partners, and female sexual partners of male sexual partners who tested HIV positive. Female index clients and sexual partners testing HIV positive will be followed up at 6 weeks, 6 months, and 12 months postenrollment to assess linkage to care, antiretroviral therapy initiation, and HIV viral load suppression. We will evaluate the acceptability, fidelity, and cost of real-world implementation of APS via in-depth interviews conducted with national, county, and subcounty-level policy makers responsible for HTS. Facility health staff providing HTS and APS, in addition to staff working with the study project team, will also be interviewed. We will also conduct direct observations of facility infrastructure and clinical procedures and extract data from the facilities and county and national databases.ResultsAs of March 2020, we have recruited 1724 female index clients, 3201 male partners, and 1585 female partners. We have completed study recruitment as well as 6-week (2936/2973, 98.75%), 6-month (1596/1641, 97.25%), and 12-month (725/797, 90.9%) follow-up visits. Preliminary analyses show that facilities scaling up APS identify approximately 12-18 new HIV-positive males for every 100 men contacted and tested. We are currently completing the remaining follow-up interviews and incorporating an HIV self-testing component into the study in response to the COVID-19 pandemic.ConclusionsThe results will help bridge the gap between clinical research findings and real-world practice and provide guidance regarding optimal strategies for APS integration into routine HIV service delivery.International Registered Report Identifier (IRRID)DERR1-10.2196/27262

Life Experiences in Parenting: The Perspective of Women with HIV-AIDS

BACKGROUND: The role of mother with HIV/AIDS in caring for their children has its own complexities. The mother plays a role in taking care of the family as well as being the caregiver for her children. Mothers with HIV-AIDS need to take care of themselves and their children who are either infected or not. Mothers can do multiple roles if their partner leaves them.
 AIM: The purpose of this study was to determine the life experiences of mothers with HIV-AIDS in childcare.
 METHODS: A phenomenological study was chosen as a design to explore the phenomenon of mothers with HIV-AIDS in parenting their children using in-depth interviews. Participants were drawn based on a purposive sample of seven people. The participant’s considerations were the wife who was diagnosed with HIV-AIDS positive and was registered as a patient managed by the HIV-AIDS program at the Serang City Health Center; the participants received ARV treatment, good general condition, able to communicate well, and cooperatively. The data analysis used was Colaizzi.
 RESULTS: The results of the study generate four new themes: Expectation of negative status of the loved ones, lamentations of wives with People Living With HIV/AIDS (PLWHA) status, management of sick child care and HIV testing, tendencies of authoritarian, and permissive parenting in children.
 CONCLUSION: Therefore, it is important to increase peer group counseling on the process of disease acceptance, management of sick children management, and implementation of HIV testing that can be accessed by family members of PLWHA.

Mobile Health–Supported HIV Self-Testing Strategy Among Urban Refugee and Displaced Youth in Kampala, Uganda: Protocol for a Cluster Randomized Trial (Tushirikiane, Supporting Each Other)

BackgroundHIV is the leading cause of mortality among youth in sub-Saharan Africa. Uganda hosts over 1.43 million refugees, and more than 83,000 live in Kampala, largely in informal settlements. There is limited information about HIV testing uptake and preferences among urban refugee and displaced youth. HIV self-testing is a promising method for increasing testing uptake. Further, mobile health (mHealth) interventions have been effective in increasing HIV testing uptake and could be particularly useful among youth.ObjectiveThis study aims to evaluate the feasibility and effectiveness of two HIV self-testing implementation strategies (HIV self-testing intervention alone and HIV self-testing combined with an mHealth intervention) in comparison with the HIV testing standard of care in terms of HIV testing outcomes among refugee/displaced youth aged 16 to 24 years in Kampala, Uganda.MethodsA three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomization will be performed with a 1:1:1 method. Approximately 450 adolescents (150 per cluster) will be enrolled and followed for 12 months. Data will be collected at the following three time points: baseline enrollment, 8 months after enrollment, and 12 months after enrollment. Primary outcomes (HIV testing frequency, HIV status knowledge, linkage to confirmatory testing, and linkage to HIV care) and secondary outcomes (depression, condom use efficacy, consistent condom use, sexual relationship power, HIV stigma, and adolescent sexual and reproductive health stigma) will be evaluated.ResultsThe study has been conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (June 14, 2019), Mildmay Uganda (November 11, 2019), and the Uganda National Council for Science and Technology (August 3, 2020). The Tushirikiane trial launched in February 2020, recruiting a total of 452 participants. Data collection was paused for 8 months due to COVID-19. Data collection for wave 2 resumed in November 2020, and as of December 10, 2020, a total of 295 participants have been followed-up. The third, and final, wave of data collection will be conducted between February and March 2021.ConclusionsThis study will contribute to the knowledge of differentiated HIV testing implementation strategies for urban refugee and displaced youth living in informal settlements. We will share the findings in peer-reviewed manuscripts and conference presentations.Trial RegistrationClinicalTrials.gov NCT04504097; https://clinicaltrials.gov/ct2/show/NCT04504097.International Registered Report Identifier (IRRID)DERR1-10.2196/26192

The effect of implementing HIV testing on healthcare services: a literature review

People Living with HIV (PLWH) in Indonesia continue to increase in number. Government is needed to know objectively about the number of PLWH. One way is by HIV testing. HIV testing is an important strategy for preventing the spread of HIV. This paper reviews the effectiveness of HIV testing in other countries in order to reduce HIV transmission, so hopefully the result can be adapted to be done in Indonesia for making health policy, especially on urban healthcare services. The publications reviewed comes from Science Direct, PubMed, as well as Google Scholar database covering the period 2016 - 2020 using the keywords “HIV” or “AIDS” and “HIV Testing” and “Healthcare Services” and ‘Urban Healthcare”. Five articles were reviewed in this study. Based on this review, the implementation of HIV testing can be done on several strategies, such as community-based, home-based as well as provider-based testing. Respondents who were given HIV test also varied, from neonates to adults. All of the strategy can succeed for implemented. HIV testing is a promising intervention strategy on healthcare services to reduce HIV transmission that can be adapted in Indonesia.

Treatment outcome of the implementation of HIV test and treat policy at The AIDs Support Organization (TASO) Tororo clinic, Eastern Uganda: A retrospective cohort study

BackgroundUganda has been making progress towards universal HIV test and treat since 2013 and the 2016 test and treat policy was expanded from the 2013 guidelines. The expanded policy was rolled out in 2017 across the country. The treatment outcomes of this new policy have not yet been assessed at program level. The objective of this study was to determine the treatment outcome of the HIV test and treat policy in TASO Tororo Clinic, Eastern Uganda.MethodologyThis was a retrospective cohort study using secondary data. The study involved 580 clients who were newly diagnosed HIV positive in TASO Tororo clinic between June 2017 and May 2018, who were then followed up for ART initiation, retention in care, viral load monitoring and viral load suppression. The data was analyzed using Stat 14.0 version statistical software application.ResultsOf the 580 clients, 93.1%(540) were adults aged ≥20 years. The uptake of test and treat was at 92.4%(536) and 12 months retention was at 78.7% (422). The factors associated with retention in care were a) being counselled before ART initiation, AOR 2.41 (95%CI, 1.56–3.71), b) having a treatment supporter, AOR 1.57 (95%CI, 1.02–2.43) and having an opportunistic infection, AOR 2.99 (95%CI:1.21–7.41). The viral load coverage was 52.4% (221) and viral load suppression rate was 89.1% (197) of clients monitored. Age <20 years was the only identified factor associated with vial load non suppression, AOR 7.35 (95% CI = 2.23–24.24).ConclusionThis study found high uptake of ART under test and treat policy, with very low viral load coverage, and a high viral load suppression rate among those monitored. The study therefore highlights a need to differentiate viral load testing based on the population needs and ensure each client testing positive receives pre-ART initiation counselling so as to improve retention in care.

HIV testing: What, where and how?

Globally, one in four people living with HIV are unaware of their status. Current HIV testing services' strategies are falling short of reaching all, and thus, HIV testing should be offered in more decentralized and non-traditional settings such as the dental and community settings. The workshop titled "HIV Testing: What, Where, and How?" provided an overview of concepts and advances in HIV point of care and self-testing diagnostics and a discussion on the implementation of HIV self-test interventions in different healthcare settings and its impact thereof. We also described how to build layperson capacity to deliver HIV testing in community settings. Additionally, we discussed what we have learned from expanding HIV testing beyond the specialist setting. We also noted considerations (i.e. provider willingness, test selection, training and preparing testing environment) dentists and other non-specialist providers need to account for if they are planning to conduct HIV testing. Finally, we highlighted facilitators and barriers to implementing HIV testing in the dental setting on a global scale. These considerations are critical to meeting the UNAIDS 90-90-90 target to help end the HIV/AIDS epidemic.

Antenatal testing for anaemia, HIV and syphilis in Indonesia \u2013 a health systems analysis of low coverage

BackgroundAdverse pregnancy outcomes can be prevented through the early detection and treatment of anaemia, HIV and syphilis during the antenatal period. Rates of testing for anaemia, HIV and syphilis among women attending antenatal services in Indonesia are low, despite its mandate in national guidelines and international policy.MethodsMidwife-held antenatal care records for 2015 from 8 villages in 2 sub-districts within Cianjur district were reviewed, alongside the available sub-district Puskesmas (Community Health Centre) maternity and laboratory records. We conducted four focus group discussions with kaders (community health workers) (n = 16) and midwives (n = 9), and 13 semi-structured interviews with laboratory and counselling, public sector maternity and HIV management and relevant non-governmental organisation staff. Participants were recruited from village, sub-district, district and national level as relevant to role.ResultsWe were unable to find a single recorded result of antenatal testing for HIV, syphilis or anaemia in the village (566 women) or Puskesmas records (2816 women) for 2015. Laboratory records did not specifically identify antenatal women. Participants described conducting and reporting testing in a largely ad hoc manner; relying on referral to health facilities based on clinical suspicion or separate non-maternity voluntary counselling and testing programs. Participants recognized significant systematic challenges with key differences between the more acceptable (and reportedly more often implemented) haemoglobin testing and the less acceptable (and barely implemented) HIV and syphilis testing. However, a clear need for leadership and accountability emerged as an important factor for prioritizing antenatal testing and addressing these testing gaps.ConclusionsPractical solutions such as revised registers, availability of point-of-care tests and capacity building of field staff will therefore need to be accompanied by both funding and political will to coordinate, prioritize and be accountable for testing in pregnancy.

RELATIONSHIP OF PREGNANT WOMEN'S PERCEPTION ABOUT HIV / AIDS WITH THE IMPLEMENTATION OF HIV TESTS

One of the infectious diseases that is being talked about is HIV / AIDS, an infectious disease caused by infection with the Human Immunodeficiency Virus. The number of new cases of HIV / AIDS in Indonesia tends to fluctuate. The purpose of this study was to determine the relationship between perceptions of pregnant women about HIV / AIDS with the implementation of the HIV test. The design of this study was questionnaire based survey with cross sectional approach, to determine the factors that influence the implementation of HIV test in pregnant women. The population in this study were all pregnant women in the working area of Puskesmas II Denpasar Barat, amounting to 573 people and a sample of 82 people. The sampling technique used was consecutive sampling. Chi Square statistical test and Logistic Regression were applied for bivariate and multivariate analysis respectively. The results showed that there was a relationship between the perception of vulnerability of pregnant women about HIV / AIDS and the implementation of the HIV test (p = 0.002), there was a relationship between the perception of the severity of pregnant women and the HIV test (p = 0.019), HIV test (p = 0.006), there was a relationship between the perception of obstacle for pregnant women and the implementation of the HIV test (p = 0.009), the most dominant variable associated with the implementation of the HIV test was perception of vulnerability (p = 0.004, OR: 5.885, 95% CI 1,776-19,493). There is significant relationship between perception with HIV testing and vulnerability perception is the most dominant variable affecting HIV testing. The results of this study it is recommended to increase health promotion related to the implementation of HIV testing and its benefits so that pregnant women are willing to carry out HIV testing.

1294. Long-Term Impact of an HIV Testing Program on High-Risk HIV Screening in the Emergency Department

BackgroundEmergency Departments (EDs) are important sites for HIV testing. However, there is little guidance on how best to implement HIV testing in the ED. The purpose of this study was to evaluate HIV screening practices of high-risk individuals presenting to an ED in the absence (ED1) and in the presence (ED2) of an established HIV testing program within the same academic hospital.MethodsWe performed a retrospective chart review of all individuals 18 years or older presenting to either ED between January 1, 2016 and December 31, 2018. High-risk of HIV infection was determined by receipt of bacterial sexually transmitted infection (STI) testing for Neisseria gonorrhoeae or Chlamydia trachomatis. The primary outcome was receipt of any HIV test in the ED. Overall proportions of patients tested for HIV at the same time of STI testing were compared between sites by chi-square test. Predictors of HIV testing were analyzed by logistic regression.ResultsDuring the study period, 7,956 individuals received STI testing at ED1 and 10,815 received STI testing at ED2. The majority of individuals receiving STI testing at both sites were female, 81.2% at ED1 and 66.4% at ED2 (P <0.001). Only 4.0% of individuals received HIV testing at ED1 compared with 47.4% at ED2 (P <0.001). Individuals were significantly more likely to receive HIV testing at the time of STI testing in the ED with an HIV testing program (aOR 19.66, 95% CI 17.28–22.37). In the ED without an HIV testing program, individuals were more likely to receive HIV testing if they were male (aOR 3.57, 95% CI 2.78–4.55) and less likely if they were black (aOR 0.57, 95% CI 0.50–0.97). In the ED with an HIV testing program, individuals were more likely to receive HIV testing if they were male (aOR 2.17, 95% CI 1.92–2.44) and more likely if they were black (aOR 1.74, 95% CI 1.37–2.20).ConclusionOverall, the presence of an HIV testing program in the ED significantly increased the probability that individuals would receive an HIV test at the time of bacterial STI testing and mitigated disparities in care. The results of this study will help guide ongoing interventions to improve HIV screening among high-risk individuals in the emergency department.Disclosures All authors: No reported disclosures.

1297. Examining the Successes and Challenges of Implementing HIV Testing Clinical Decision Support in the Emergency Department

BackgroundIn 2016, MetroHealth System (MHS) launched the FOCUS (Frontlines of Communities in the United States) project to routinize HIV testing in the emergency department (ED). Before 2016, clinical decision support (CDS) for HIV testing was not in place, nor was there a policy to support the importance of opt-out, nontargeted screening. The purpose of this study was to outline the progress of HIV testing after the integration of CDS, as well as describe the implementation challenges, and how certain events impacted HIV testing.MethodsHIV testing data from MHS EDs were collected from October 1, 2015 to March 31, 2019 and graphed into a run chart. The dataset was mapped with the following events: project start date, ED testing begins (without CDS), CDS implementation, the staffing of the ED Testing Coordinator (EDTC), and optimization of CDS (Figure 1). To determine whether observed variation in the dataset is due to random or special cause variation, these run chart rules were applied: Run, Shift (Figure 2), and Trend.ResultsThere were 42 data points and 4 runs. With 42 points, the lower limit of runs was 16 and the upper limit of runs was 28. This signals that one or more special cause variations were present. A total of three distinct shifts were observed indicating special cause variation. The run chart did not include any downward or upward trends. Testing increased as much as 3971% (7 tests in October 2015 vs. 285 tests in March 2018).ConclusionHIV testing increased from 7 tests to 86 tests (Shift 1). This coincided with establishment of an ED testing policy in April 2016. Testing increased to 266 tests in October 2016 (Shift 2). This directly related to implementation of CDS in the ED. December 2017 displayed the lowest testing with 117 tests. This was due to lack of policy awareness, and to the rarely-visited location of the HIV screening tool during the triage process. Staff was re-educated and the HIV screening tool was moved to a more visible location. This resulted in 227 tests in February 2018, and was followed by the highest testing month with 285 tests (Shift 3). Continued challenges prohibit sustained upward trends in ED testing. A control chart may be the appropriate next step to identify new control limits Disclosures All authors: No reported disclosures.

Health Workers Perspectives on the Outcomes Enablers and Barriers to the Implementation of HIV Test and Treat Guidelines in Abuja Nigeria

We evaluated health workers' perspectives on the implementation of the 2016 HIV "Test and Treat" guidelines in Nigeria. Using semi-structured interviews, qualitative data was collected from twenty health workers meeting inclusion criteria in six study sites. Data exploration was conducted using thematic content analysis. Participants perceived that the "Test and Treat" guidelines improved care for PLHIV, though they also perceived possible congested clinics. Perceived key factors enabling guidelines use were perceived patient benefits, availability of policy document and trainings. Perceived key barriers to guidelines use were poverty among patients, inadequate human resources and stock-outs of HIV testing kits. Further improvements in uptake of guidelines could be achieved by effecting an efficient supply chain system for HIV testing kits, and improved guidelines distribution and capacity building prior to implementation. Additionally, implementing differentiated approaches that decongest clinics, and programs that economically empower patients, could improve guidelines use, as Nigeria scales "Test and Treat" nationwide.

Fortalezas y fragilidades en la implantación de la prueba rápida para VIH en un centro especializado en Brasil

To analyze how health professionals and health service users assess counseling on Rapid HIV test, as well as its implementation, which started in Brazil in 2010, focusing on positive aspects, barriers, and limitations, and analyzing possible meanings that are given to STD and HIV/AIDS. Qualitative, exploratory, and descriptive research. Semi-structured interviews were administered to 27 service users and 14 health care professionals; a thematic analysis of the interviews was performed. The study was carried out in one of the first Counseling and Testing Centers (CTC) designed to implement Rapid HIV tests in Porto Alegre, Brazil. Positive aspects of Rapid HIV testing implementation included a reduced waiting time for obtaining the test results, better assistance provision, an increase in the number of service hours, personalized pre- and post-tests, and better prepared health care professionals regarding health care during counseling. Limitations included beliefs about the effectiveness of Rapid HIV testing, physical structure, bad publicity on this technology, and poor health care capacity. Likewise, there are some who oppose this type of test, since they believe rapid tests may not be effective. Integrating the perspectives of health care professionals and users on this policy will favor future rapid test implementations in other CTCs, and increase health care access possibilities.

Why do HIV-positive pregnant women discontinue with comprehensive PMTCT services? A qualitative study

AbstractBackground and purpose: Prevention of mother to child transmission (PMTCT) is a government program aimed at preventing mother-to-child transmission of HIV. A comprehensive PMTCT program involves the implementation of HIV testing up to antiretroviral (ARV) treatment for mothers with positive HIV test results. Coverage of comprehensive PMTCT remains low, with many HIV-positive pregnant women who discontinued ARV treatment. This study aims to explore the reasons of HIV-positive pregnant women to discontinue with the comprehensive PMTCT program.Methods: A qualitative study was carried out in Badung District, Bali Province, with seven respondents: one HIV-positive pregnant woman who did not continue the ARV treatment, two HIV-positive women who gave birth the previous year and did not take ARV, three public health centre (PHC) providers, and one head of PHC. Respondents were selected using a purposive sampling technique. Data were collected through in-depth interviews and analyzed thematically. The results presented narratively to illustrate the reasons why HIV-positive pregnant women discontinued with the comprehensive PMTCT program.Results: The emerging themes related to the reasons of HIV-positive pregnant women discontinued with the comprehensive PMTCT program included the lack of comprehensive PMTCT-related information, the lack of health provider assistance, and the high stigma towards people living with HIV (PLHIV). These barriers were affecting the willingness of HIV-positive pregnant women to continue with the program.Conclusions: Lack of comprehensive PMTCT-related information, lack of assistance by health care providers, and high public stigma impacts upon HIV-positive pregnant women’s willingness to continue with comprehensive PMTCT program. There is a need for a minimum service standard in the implementation of comprehensive PMTCT services and comprehensive information on HIV infection in order to reduce the stigma towards PLHIV.

Why do HIV-positive pregnant women discontinue with comprehensive PMTCT services? A qualitative study

AbstractBackground and purpose: Prevention of mother to child transmission (PMTCT) is a government program aimed at preventing mother-to-child transmission of HIV. A comprehensive PMTCT program involves the implementation of HIV testing up to antiretroviral (ARV) treatment for mothers with positive HIV test results. Coverage of comprehensive PMTCT remains low, with many HIV-positive pregnant women who discontinued ARV treatment. This study aims to explore the reasons of HIV-positive pregnant women to discontinue with the comprehensive PMTCT program.Methods: A qualitative study was carried out in Badung District, Bali Province, with seven respondents: one HIV-positive pregnant woman who did not continue the ARV treatment, two HIV-positive women who gave birth the previous year and did not take ARV, three public health centre (PHC) providers, and one head of PHC. Respondents were selected using a purposive sampling technique. Data were collected through in-depth interviews and analyzed thematically. The results presented narratively to illustrate the reasons why HIV-positive pregnant women discontinued with the comprehensive PMTCT program.Results: The emerging themes related to the reasons of HIV-positive pregnant women discontinued with the comprehensive PMTCT program included the lack of comprehensive PMTCT-related information, the lack of health provider assistance, and the high stigma towards people living with HIV (PLHIV). These barriers were affecting the willingness of HIV-positive pregnant women to continue with the program.Conclusions: Lack of comprehensive PMTCT-related information, lack of assistance by health care providers, and high public stigma impacts upon HIV-positive pregnant women’s willingness to continue with comprehensive PMTCT program. There is a need for a minimum service standard in the implementation of comprehensive PMTCT services and comprehensive information on HIV infection in order to reduce the stigma towards PLHIV.

Acceptance of Routine HIV Testing by Hospitalized Adolescents and Young Adults.

Youth carry a disproportionate burden of new HIV infections. With our study, we aimed to characterize HIV testing experiences among adolescents and young adults admitted to a children's hospital that is located in a high HIV-prevalent community and implemented routine HIV testing for all patients ≥13 years of age. A total of 120 patients aged 13 to 24 years old who were admitted to our hospital and had a documented offer of routine HIV testing on admission were invited to complete a self-administered survey that asked about sex, race and/or ethnicity, HIV risk behaviors, and attitudes toward routine HIV testing in the hospital. Date of birth, admission diagnosis, and verification of HIV testing and results were collected by chart review. Study participants (N = 99) were 17.4 ± 2.3 years old, 52% female, 47% Hispanic, and 29% African American. Additional characteristics include the following: 65% had previous sexual activity, 11% had a history of sexually transmitted infections, and 12% were worried about their risk for HIV. Forty-seven percent of participants accepted HIV testing, with older patients (P < .01) and those reporting previous sexual activity (P < .01) and a previous HIV test (P < .01) being more likely to accept testing. A total of 96% of participants agreed that the hospital is a good place to offer HIV testing. Our findings support offering routine HIV testing to youth admitted to children's hospital. Given the high incidence of new and undiagnosed HIV infections among youth, additional venues for HIV testing are essential.

Effectiveness and cost-effectiveness of implementing HIV testing in primary care in East London: protocol for an interrupted time series analysis

IntroductionHIV remains underdiagnosed. Guidelines recommend routine HIV testing in primary care, but evidence on implementing testing is lacking. In a previous study, the Rapid HIV Assessment 2 (RHIVA2) cluster randomised...