HIV Testing Research Articles

Combined interventions for the testing and treatment of HIV and schistosomiasis among fishermen in Malawi: a three-arm, cluster-randomised trial

Undiagnosed HIV and schistosomiasis are highly prevalent among fishermen in the African Great Lakes region. We aimed to evaluate the efficacy of lakeside interventions integrating services for HIV and male genital schistosomiasis on the prevalence of schistosomiasis, uptake of antiretroviral therapy (ART) for HIV, and voluntary male medical circumcision (VMMC) among fishermen in Malawi. We conducted a three-arm, cluster-randomised trial in 45 lakeshore fishing communities (clusters) in Mangochi, Malawi. Clusters were defined geographically by their home community as the place where fishermen leave their boats (ie, a landing site). Eligible participants were male fishermen (aged ≥18 years) who resided in a cluster. Clusters were randomly allocated (1:1:1) through computer-generated random numbers to either enhanced standard of care (SOC), which offered invitation with information leaflets to a beach clinic offering HIV testing and referral, and presumptive treatment for schistosomiasis with praziquantel; peer education (PE), in which a nominated fisherman was responsible for explaining the study leaflet to promote services to his boat crew; or peer distribution education (PDE), in which the peer educator explained the leaflet and distributed HIV self-test kits to his boat crew. The beach clinic team and fishermen were not masked to intervention allocation; however, investigators were masked until the final analysis. Coprimary composite outcomes were the proportion of participants who had at least one Schistosoma haematobium egg observed on light microscopy from 10 mL of urine filtrate and the proportion who had self-reported initiating ART or scheduling VMMC by day 28. Outcomes were analysed by intention to treat; multiple imputation for missing outcomes was done; random-effect binomial models adjusting for baseline imbalance and clustering were used to compute unadjusted and adjusted risk differences, risk ratios (RRs) and 95% CIs, and intracluster correlation coefficients for each outcome. This trial is registered with ISRCTN, ISRCTN14354324. Between March 1, 2022, and Jan 29, 2023, 45 (65·2%) of 69 clusters assessed for eligibility were enrolled in the trial, with 15 clusters per arm. Of the 6036 fishermen screened at baseline, 5207 (86·3%) were eligible for participation: 1745 (87·6%) of 1991 in the enhanced SOC group, 1687 (81·9%) of 2061 in the PE group, and 1775 (89·5%) of 1984 in the PDE group. Compared with the prevalence of active schistosomiasis in the enhanced SOC group (292 [16·7%] of 1745), 241 (13·6%) of 1775 fishermen in the PDE group (adjusted RR 0·80 [95% CI 0·69-0·94]; p=0·0054) and 263 (15·6%) of 1687 fishermen in the PE group (0·92 [0·79-1·07]; p=0·28) had schistosomiasis at day 28. 230 (13·2%) in the enhanced SOC group, 281 (16·7%) in the PE group, and 215 (12·1%) in the PDE group initiated ART or were scheduled for VMMC. ART initiation or VMMC scheduling was not significantly increased with the PDE intervention (0·88 [0·74-1·05); p=0·15) and was marginally increased with the PE intervention (1·16 [0·99-1·37]; p=0·069) when compared with the enhanced SOC group. No serious adverse events were reported in this trial. We found weak evidence for the use of peer education to increase uptake of ART and VMMC, but strong evidence for the added distribution of HIV self-test kits to promote high engagement with services and reduce the prevalence of active schistosomiasis, suggesting a high potential for scale-up in hard-to-reach communities across Malawi. Wellcome Trust and the UK National Institute for Health Research.

384 Predictive Factors in Emergency Department-Based HIV Testing Refusal

384 Predictive Factors in Emergency Department-Based HIV Testing Refusal

Opt-out HIV screening in adults attending the Emergency Department of a London teaching hospital

BackgroundOpt-out Emergency Department blood borne virus (EDBBV) screening was introduced at the Royal Free Hospital under the NHSEI (NHS England and NHS Improvement) programme to expand opt-out testing in local authority areas with high HIV prevalence. This initiative was part of the “Toward Zero” policy towards ending HIV transmission in England by 2030. MethodsAll patients attending the Royal Free Hospital Emergency Department (ED) aged 16 and over were screened for blood borne viruses (HIV/HBV/HCV) unless they opted out. We looked at HIV data from patients seen in ED between the initiation of EDBBV testing on the 12th of April and 12th of August 2022. Hepatitis B and C data was reviewed in a separate study. OutcomeA total of 12,208 samples from 10,641 patients were screened for HIV. Amongst these samples there were 88 which were positive, giving a seroprevalence of 0.84%. There were 48 patients who were already known to local HIV services, 35 were known to HIV services outside of our trust and 5 were new diagnoses. ConclusionOur results confirmed our local HIV prevalence to be very high as per the UK Health Security Agency and supports the need for HIV testing. Opt-out ED BBV screening has been a highly effective method for identifying people living with HIV who are unaware of their status.

A Statistical Model for Inference of Recent and Incident HIV Infection Using Surveillance Data on Individuals Newly Diagnosed With HIV Infection in Scotland

Background: To inform global ambitions to end AIDS, evaluation of progress toward HIV incidence reduction requires robust methods to measure incidence. Although HIV diagnosis date in routine HIV/AIDS surveillance systems are often used as a surrogate marker for incidence, it can be misleading if acquisition of transmission occurred years before testing. Other information present in data such as antibody testing dates, avidity testing result, and CD4 counts can assist, but the degree of missing data is often prohibitive. Methods: We constructed a Bayesian statistical model to estimate the annual proportion of first ever HIV diagnoses in Scotland (period 2015–2019) that represent recent HIV infection (ie, occurring within the previous 3–4 months) and incident HIV infection (ie, infection within the previous 12 months), by synthesizing avidity testing results and surveillance data on the interval since last negative HIV test. Results: Over the 5-year analysis period, the model-estimated proportion of incident infection was 43.9% (95% CI: 40.9 to 47.0), and the proportion of recent HIV infection was 21.6% (95% CI: 19.1 to 24.1). Among the mode of HIV acquisition categories, the highest proportion of recent infection was estimated for people who inject drugs: 27.4% (95% CI: 20.4 to 34.4). Conclusions: The Bayesian approach is appropriate for the high prevalence of missing data that can occur in routine surveillance data sets. The proposed model will aid countries in improving their understanding of the number of people who have recently acquired their infection, which is needed to progress toward the goal of HIV transmission elimination.

Preferences for Delivery of HIV Prevention Services Among Healthcare Users in South Africa: A Discrete Choice Experiment.

Progress has been made to scale oral pre-exposure prophylaxis (PrEP) as part of combination HIV prevention, with the WHO recommending differentiated, simplified and demedicalized approaches. This study explored user preferences for components of a PrEP service delivery package, through a discrete choice experiment (DCE) among 307 people accessing primary healthcare services in South Africa between November 2022 and February 2023. Attributes included were: Source of information about HIV prevention and PrEP; Site for PrEP initiation and follow-up; Frequency of follow-up; PrEP pick-up point; HIV testing whilst using PrEP; Contact between appointments. A D-efficient DCE design was created with 16 choice sets in 2 blocks. DCE data were analysed using generalised multinomial logistic models. Compared to printed materials, participants preferred getting information about PrEP online (aOR = 7.73, 95% CI = 5.13-11.66) and through WhatsApp (aOR = 2.23, 95% CI = 0.98-5.55). PrEP initiation at a pharmacy or mobile clinic was valued equally to initiating PrEP at a clinic, but a community pop-up site was less preferred (aOR = 0.46, 95% CI = 0.33-0.64). There was a preference for 6-monthly over 3-monthly follow-up (aOR = 11.88, 95% CI = 5.44-25.94). Participants preferred collecting PrEP from a pharmacy (aOR = 5.02, 95% CI = 3.45-7.31), through home delivery (aOR = 2.18, 95% CI = 1.26-3.78) and from a vending machine (aOR = 1.43, 95% CI = 1.02-1.99) relative to where they initiated PrEP. Participants also preferred HIV self-testing over a healthcare provider test (aOR = 5.57, 95% CI = 3.72, 8.36). WhatsApp or Facebook groups (aOR = 4.12, 95% CI = 3.00-5.67), monthly phone calls (aOR = 2.84, 95% CI = 1.73-4.67) and weekly messages (aOR = 1.47, 95% CI = 1.10-1.97) were preferred contact between appointments, relative to no contact. To meet users' preferences, there is a need to expand decentralised and self-led HIV prevention services.

Peer-Delivered HIV Self-Testing, Sexually Transmitted Infection Self-Sampling, and Pre-exposure Prophylaxis for Transgender Women in Uganda: A Randomized Trial.

Peer-delivered HIV self-testing (HIVST) and sexually transmitted infection self-sampling (STISS) may promote adherence to oral pre-exposure prophylaxis (PrEP), but no studies have analyzed this approach among transgender women (TGW) in sub-Saharan Africa. The Peer study was a cluster randomized trial in Uganda (October 2020-July 2022; NCT04328025). Ten TGW peer groups, each with 1 TGW peer and 8 TGW, were randomized 1:1 to receive quarterly in-clinic HIV testing with PrEP refills as standard-of-care (SOC) or SOC plus monthly peer delivery of oral-fluid HIVST, STISS, and PrEP refills (intervention). Participants were followed for 12 months. The primary outcome was PrEP adherence. We screened 85 TGW and enrolled 82 (41 per arm). The median age was 22 years (interquartile range [IQR] 20-24). Twelve-month retention was 88% (72/82). At the 3, 6, 9, and 12-month clinic visits, 10%, 5%, 5%, and 0% of TGW in the intervention arm had TFV-DP levels ≥700 fmol/punch, versus 7%, 15%, 7%, and 2% in the SOC arm, respectively (P = 0.18). At all visits, any detectable TFV-DP levels were significantly higher in SOC than the peer delivery group (P < 0.04). PrEP adherence was associated with sex work (incidence rate ratio 6.93; 95% CI: 2.33 to 20.60) and >10 years of schooling (incidence rate ratio 2.35; 95% CI: 1.14 to 4.84). There was a strong correlation between tenofovir detection in dried blood spots and urine (P < 0.001). No HIV seroconversions occurred. Peer-delivered HIVST and STISS did not increase low levels of oral PrEP adherence among TGW in Uganda. Long-acting PrEP formulations should be considered for this population.

Assessing the impact of COVID-19 on HIV care cascade for people living with HIV in Ethiopia: a retrospective longitudinal study.

The study aimed to investigate the impact of COVID-19 on the cascade of HIV care for people living with HIV (PLHIV) in Ethiopia. A retrospective longitudinal study. The study was conducted in North Showa Zone, Ethiopia, from pre-COVID-19 (January 2018-December 2019) and during COVID-19 (January 2020-December 2021). We identified 61901 records from 3925 PLHIV, of which 23 848 were recorded during the pandemic. We investigated indicators from four stages of the HIV care cascade, including HIV screening and diagnosis, HIV care, HIV treatment and HIV disease progression, according to a WHO framework. The indicator changes were assessed with incidence rate ratios (IRRs). For HIV screening and diagnosis, the monthly number of HIV tests experienced a 46% decline from 2520 to 1361 since the pandemic (IRR 0.553; 95% CI 0.546 to 0.561). For HIV care, the monthly number of consultations was reduced by 49.6% (from 1582 to 798) since the pandemic (IRR 0.591; 95% CI 0.581 to 0.601). Similarly, the monthly number of viral load tests was reduced by 42.8% (IRR 0.614; 95% CI 0.581 to 0.650). For HIV treatment, the number of antiretroviral therapy (ART) initiations was reduced by 27.8% and the number of ART adherence by 52.5% since the pandemic. For HIV disease progression, the monthly number of PLHIV achieving viral suppression was reduced by 61.6%, while HIV-related deaths doubled during the pandemic. The study highlights pandemic-induced disruptions in the cascade of care for PLHIV. Targeted interventions are necessary to protect PLHIV in public health emergencies.

Impact of Awareness of Sexual Partners' HIV Serostatus on the HIV Acquisition among Men Who Have Sex with Men in Guangzhou, China: A Nested Case-Control Study.

This study aimed to investigate the impact of sexual partners' HIV serostatus awareness on theHIV acquisition among men who have sex with men (MSM) in Guangzhou, China. A nested case-control study was conducted based on a prospective cohort of MSM in Guangzhou. Within the cohort, individuals who underwent HIV seroconversion were identified as the case group, and each case was matched with four controls from the non-seroconverted participants. Information regarding the awareness of sexual partners' HIV serostatus over the preceding 6months was gathered. Of the 161 participants, 36.0% were aware of the HIV serostatus of all their sexual partners. The practice of engaging in condomless anal sex with partners of unknown HIV serostatus and being aware of the HIV serostatus of only some casual partners were positively correlated with an elevated risk of acquiring HIV. Conversely, being fully aware of the HIV serostatus of all sexual partners, including regular ones, was associated with a diminished risk of HIV incidence.Regular communication with sexual partners regarding HIV testing outcomes, honest disclosure of one's own HIV serostatus, and refusal of sexual contact with partners of unknown HIV serostatus can potentially mitigate the risk of acquiring HIV among MSM.

Rekonstruksi Kalimat pada Teks Berita di Laman CNN Indonesia Edisi Desember 2023 sebagai Bahan Ajar Membaca Kritis Siswa Kelas 12 SMA

News is a text that has an important role in disseminating information. News text is so useful that it has become a literacy material for students due to the development of advanced technology. Although it has become one of the sources of student literacy, online news texts are still classified as having syntactic errors such as a lack of understanding of the language used in compiling a sentence in the news. The purpose of this study is to describe sentence errors in the news contained in the old CNN Indonesia news, such as "December Sky Phenomena: Geminid Meteor Shower to Solstice", "Mandalika Circuit's Important Role in Bringing Indonesian Drivers to Success in Asia", "Solar Storms Raining on Earth, RI Safe?", "The First Candidate Debate will be Held at the KPU Office on December 12", and "When HIV Tests Become a Scary Scourge Because of People's Scorn". This research uses a descriptive method with a qualitative approach. The results of this study found several findings such as effective sentences, ineffective sentences, spelling errors according to EYD, errors in the use of diction, and sentences that are not clear to the reader. The most common error found in the five news articles is ineffective sentences. The benefit of this research is to provide knowledge insights in the form of understanding sentence writing systematically, which will be useful in improving understanding of authorship in news texts and preventing errors from occurring again in the same news so that it is worthy of being a literacy material for 12th grade high school students.

Comparative acceptability of saliva-based self-testing versus blood-based self-testing for HIV screening among key populations in Kisangani

IntroductionHIV self-testing represents a convenient and confidential option for HIV testing—the present study aimed to assess the acceptability of blood versus saliva self-tests among key populations in Kisangani.MethodsThis study was an analytical cross-sectional study. Our sample size was 363 subjects. After obtaining their consent, we administered a questionnaire to participants. We asked participants to choose between blood and saliva self-testing. We defined the acceptability of the self-test (saliva or blood) as the intention to use the self-test using a 5-point Likert scale. Descriptive statistics were described by estimating proportions for categorical variables and means with standard deviations for symmetrically distributed quantitative variables. The variable of interest was the acceptability of self-testing, which was dichotomized (Very Likely/Unlikely). The corresponding endpoint was the proportion of participants accepting the self-test in HIV screening. A bivariate analysis was performed to determine factors related to the acceptability of the self-test, using Pearson’s Chi-square (χ2) and ANOVA followed by 2-to-2 multiple comparisons (Bonferroni) for comparison of means and proportions. A progressive stepwise logistic regression model at the 5% threshold included variables with a bi-variate association.ResultsThe acceptability of the blood self-test was 71.6% compared to 28.4% for the saliva self-test. Factors associated with acceptability of the self-test were higher level of education aOR CI95%: 1.5(0.4–5.5) p = 0.006; non-use of condoms with casual partners aOR CI95%: 2.8(1.4-5) p = 0.003; knowledge of the type of self-test aOR CI95%:2.4(1.02–5.65) p = 0.043 and the obstacle to acceptability of the self-test was non-availability of the self-test aOR CI 95%: 18.9(6.5–54.9) p < 0.0001.ConclusionOur study showed that key populations in Kisangani preferred blood self-testing over saliva self-testing. Blood self-tests must be made available to key population groups, as this would improve access to testing for these populations, thus boosting the first UNAIDS target 95.

Evaluation of Nurses’ Attitudes toward Human Immuno Deficiency

Background: HIV nursing protocols, including rapid HIV testing, face weaknesses such as improper data collection and ambiguity. To reduce stigmatization, interventions should promote the adoption of nursing practices that influence stigmatization experiences. The International Nursing Network for HIV Research recommends collaboration, global partnerships, and scientific work to increase nurses' impact in HIV research. Nurses' experiences with HIV/AIDS patients can impact their health and the spread of the virus. Barriers to HIV treatment include lack of knowledge, demotivation, resistance, and lack of adherence to treatment guidelines. Nurse involvement in HIV prevention is crucial for improving patient outcomes. Objective(s): This study aims to evaluate nurses' attitudes toward human Immuno deficiency. Methodology: A quasi-experimental design was conducted in 7 January 2024 to 7 May 2024, The study at Al Musayyib General Hospital in Babylon, Iraq, involved 100 nursing professionals in a health education program. The program aimed to improve nurses' understanding and attitudes towards HIV/AIDS. The program's effectiveness was assessed through questionnaires. Results: The study found that nurses aged 23-less than 30 years, predominantly female, had moderate attitudes towards the human immunodeficiency virus. However, there was no significant relationship between nurses' attitudes and sociodemographic variables or professional variables such as education, years of experience, knowledge development, or participation in training courses. The majority of nurses were urban residents. Conclusion: Healthcare professionals should therefore follow national infection prevention guidelines when working in hospitals. To increase nurses' understanding and proficiency in this area, policy designers ought to train them in infection prevention. Further research should include a qualitative study in order to obtain more detailed information. Recommendation: Institutions may enhance their knowledge of HIV care practices by conducting frequent training sessions for nursing staff, personalizing instructional materials, gauging and reviewing attitude levels, encouraging peer learning, and expanding the scope of research. In order to provide effective HIV care, this will assist nurses in expanding their knowledge and adjusting their attitude.

Evaluation of Nurses’ Attitudes toward Human Immuno Deficiency

Background: HIV nursing protocols, including rapid HIV testing, face weaknesses such as improper data collection and ambiguity. To reduce stigmatization, interventions should promote the adoption of nursing practices that influence stigmatization experiences. The International Nursing Network for HIV Research recommends collaboration, global partnerships, and scientific work to increase nurses' impact in HIV research. Nurses' experiences with HIV/AIDS patients can impact their health and the spread of the virus. Barriers to HIV treatment include lack of knowledge, demotivation, resistance, and lack of adherence to treatment guidelines. Nurse involvement in HIV prevention is crucial for improving patient outcomes. Objective(s): This study aims to evaluate nurses' attitudes toward human Immuno deficiency. Methodology: A quasi-experimental design was conducted in 7 January 2024 to 7 May 2024, The study at Al Musayyib General Hospital in Babylon, Iraq, involved 100 nursing professionals in a health education program. The program aimed to improve nurses' understanding and attitudes towards HIV/AIDS. The program's effectiveness was assessed through questionnaires. Results: The study found that nurses aged 23-less than 30 years, predominantly female, had moderate attitudes towards the human immunodeficiency virus. However, there was no significant relationship between nurses' attitudes and sociodemographic variables or professional variables such as education, years of experience, knowledge development, or participation in training courses. The majority of nurses were urban residents. Conclusion: Healthcare professionals should therefore follow national infection prevention guidelines when working in hospitals. To increase nurses' understanding and proficiency in this area, policy designers ought to train them in infection prevention. Further research should include a qualitative study in order to obtain more detailed information. Recommendation: Institutions may enhance their knowledge of HIV care practices by conducting frequent training sessions for nursing staff, personalizing instructional materials, gauging and reviewing attitude levels, encouraging peer learning, and expanding the scope of research. In order to provide effective HIV care, this will assist nurses in expanding their knowledge and adjusting their attitude.

Religious Mandatory Premarital HIV Testing; Assessment of Perceptions on Ethical Concerns Among Healthcare Workers in Kwaebibirem

Objective: This cross-sectional survey describes healthcare workers’ (HCWs’) perceptions on religious mandatory premarital HIV testing- (RMPmHT) associated ethical concerns. Methodology: An online survey was completed with an e-questionnaire, circulated via WhatsApp, (a freeware, centralized instant messaging cross-platform). This involved 530 participants and data were descriptively analyzed using Epi info 3.5.1. Results: The findings illustrate that HCWs, mostly aged 30 or younger with a mean age of 30.4 (±7.2), were largely familiar with RMPmHT, (58.5%). Despite general acceptance, disclosing positive results to RO leadership was widely discouraged. HCWs considered RMPmHT non-intrusive, yet paradoxically believed it increased the risk of stigmatization. Despite an unclear ethical paradigm and state silence on RMPmHT, HCWs didn't see knowledge of a positive result as a 'right' for RO leadership. Policy frameworks for 'medico-legal' permission and result disclosure were seen as ambiguous. Concerns about fragile confidentiality structures persist, and the prohibition of marriages for HIV-positive or RMPmHT-dissenting couples was widely deprecated. Conclusion: RMPmHT, tenably, infringes upon the right to marry and found a family, bodily integrity, privacy, and information as negative results may subtly be a precondition for marriage. Advocacy for the need to situate RMPmHT in a clear ethical paradigm remains imperative. Policy frameworks guiding documentation of consent processes, HIV couple discordancy, counselling, information, disclosure, data management and linking RMPmHT services to public health institutions should be engendered.

Characterizing syndemic HIV risk profiles and mHealth intervention acceptability among patients in the emergency department

ABSTRACT Syndemic theory proposes that co-occurring, mutually reinforcing psychosocial challenges (mental health, substance use, minority stress [discrimination/stigma], abuse, unmet basic needs) drive HIV risk behavior and create barriers to care for marginalized populations. It is thus necessary to address this holistic, complex picture in HIV prevention. Emergency department (ED) visits are a prime opportunity to engage key risk groups, given their low engagement in regular clinic-based care and high utilization of drop-in care via EDs. Yet, EDs are overburdened and under-resourced; mHealth may be a vehicle for intervention delivery in this context. This study aimed to 1) characterize demographics, syndemic profiles, and HIV risk behavior among ED patients and 2) assess the acceptability of addressing syndemic issues, particularly via an mHealth approach, in the ED. A sample of N = 198 ED patients with an indication of HIV risk completed a cross-sectional psychosocial assessment. Descriptive statistics and bivariate correlations between syndemic issues were examined. Patients presenting to the ED reported marginalized identities and complex syndemic profiles including mental health issues (77%), at risk substance use (30%), childhood abuse (35%), adult abuse (31%), minority stress (63%), and unmet basic needs (37%). Over half the sample reported at least three syndemic issues (54%). All syndemic issues were significantly correlated with each other, supporting a synergistic nature. The sample reported indicators of HIV risk including lack of PrEP awareness (33%)/uptake (94%), condomless sex (37%), and not testing for HIV (41%). Majority reported syndemic profiles have never been addressed in the ED (71%), think it would be helpful (88%), and willing to utilize mHealth during an ED visit (76%). The current study provides information to guide next steps for ED-based point-of-care HIV prevention, and more broadly, working towards equitable HIV prevention services reaching those missed by existing interventions.

Contextualizing HIV testing experiences within the HIV prevention cascade: qualitative insights from refugee youth in Bidi Bidi refugee settlement, Uganda

BackgroundThere remain key knowledge gaps regarding HIV testing needs and priorities among refugee youth in low and middle-income country (LMIC) humanitarian settings. The HIV prevention cascade framework focuses on three domains (motivation, access, effective use) central to prevention uptake, yet is understudied in relationship to HIV testing, particularly among refugee youth. Uganda is an exemplar context to explore refugee youth HIV testing needs and priorities as it hosts 1.5 million refugees and is Africa’s largest refugee hosting nation. In this study, we explored perceptions and experiences regarding HIV testing among refugee youth living in Bidi Bidi refugee settlement, Uganda.MethodsWe conducted a community-based research study in Bidi Bidi Refugee Settlement, one of the world’s largest refugee settlements with over 195,000 residents. This qualitative study involved four focus groups (2 with young women, 2 with young men) with refugee youth aged 16–24 living in Bidi Bidi refugee settlement. We applied thematic analysis informed by the HIV prevention cascade to understand domains of motivation, access, and effective use that emerged as salient for HIV testing engagement.ResultsParticipants (n = 40; mean age: 20 years, standard deviation: 2.2) included refugee young women (n = 20) and young men (n = 20), of whom 88% had a lifetime HIV test and 58% had ever heard of HIV self-testing. Participant discussions described HIV testing motivation was influenced by dimensions of: HIV treatment and testing knowledge; risk perception; positive and negative consequences of use; and social norms regarding gender and age. Access to HIV testing was shaped by: limited availability; distance and language barriers; confidentiality concerns; and affordability. Effective use of and engagement with HIV testing was related to HIV serostatus knowledge self-efficacy and in/equitable partner dynamics.ConclusionsComplex, multi-level factors shape motivation for, access to, and effective use of HIV testing among refugee youth in Bidi Bidi. Findings align with the HIV prevention cascade framework that helps to identify gaps to inform intervention development with youth in humanitarian settings. HIV testing approaches tailored for refugee youth in contexts such as Bidi Bidi can foster HIV prevention and treatment literacy, gender equity, gender-based violence prevention, and intersectional stigma reduction.

Detection of antiretroviral drug-resistant mutations and HIV-1 subtypes in circulation among men who have sex with men, SEM females and female sex workers: results of Vietnam's HIV Sentinel Surveillance Plus (HSS+) system, 2018 - 2020.

HIV drug resistance (HIVDR) can reduce the effectiveness of antiretroviral (ARV) drugs in preventing morbidity and mortality, limit options for treatment, and prevention. Our study aimed to assess HIV-1 subtypes and HIVDR among key populations in HIV Sentinel Surveillance Plus Behavior (HSS+) in 2018 and 2020. One-stage venue-based cluster sampling was used to recruit participants at hotspots identified for Men who have sex with men (MSM) in 7 provinces and SEM females and female sex worker (FSW) in 13 provinces. Participants completed a standard questionnaire about risk and preventive behaviors, and ART history, and provided intravenous blood for HIV testing. HIVDR testing was conducted on HIV-positive samples with VL >1,000 copies/ml. A total of 185/435 (42.5%) HIV-positive samples had viral load ≥1,000 copies/ml, of which 130/136 from MSM and 26/49 from FSW, were successfully sequenced. Six HIV-1 subtypes were detected (CRF01_AE, A, CRF07/08_BC, B, C, CRF25_cpx), with CRF01_AE (82.7%, 129/156) the most common. Drug resistance mutations were detected in 16.7% of participants overall (26/156), in 15.4% (20/130) of MSM, and in 23.1% (6/26) of FSW. Mutations associated with resistance to NNRTI were the most frequently detected (73.1%, 19/26). The high level of resistance was presented in NNRTI and NRTI classes. There are 10 major resistance mutations detected with NRTI (M184VI-25.0%, K65KR-50.0%, Y115F-25%), NNRTI (K103N-21.1%, E138A-10.5%, V106M-5.3%, K101E-5.3%, G190A-5.3%) PI (L33F-40.0%, M46L-20.0%). Vietnam's HSS+ system identified an emerging strain of HIV-1 and mutations associated with resistance to multiple drug classes among MSM and FSW.

Associations of Minority Stressors, Alcohol Use Disorder, Resilience, and HIV Testing Self-Efficacy Among Community-Based Black Men Who Have Sex with Men in a Southern U.S. City: A Causal Mediation and Moderation Analysis

Background: Black men who have sex with men (BMSM) face multiple minority stressors (e.g., homophobia, racism, and presumed HIV status) that may indirectly erode their confidence in pursuing HIV testing uptake through exacerbating alcohol use disorder (AUD). Objectives: Using cross-sectional data from 203 community-based BMSM (71.4% as homosexual with a mean age of 26 years) living in a Southern US city, we conducted a causal mediation and moderation analysis to investigate in/direct pathways linking minority stressors, AUD risk, and self-efficacy of HIV testing, including how resilience may moderate these associations. Results: Our mediation analysis revealed that AUD risk accounted for 32.1% of the total effect of internalized homonegativity (βtotal effect = -0.424; SE=0.071; p<0.001), 28.6% of the total effect of experienced homophobia (βtotal effect = -0.684; SE=0.122; p<0.001), and 15.3% of the total effect of perceived HIV stigma (βtotal effect = -0.361; SE=0.164; p<0.05) on HIV testing self-efficacy. Resilience significantly moderated the associations of experienced homophobia (β = -0.049; SE=0.011; p<0.001), internalized homonegativity (β = -0.065; SE=0.027; p<0.01), and perceived HIV stigma (β = -0.034; SE=0.013; p<0.05) with AUD risk. Resilience also significantly moderated the associations of experienced homophobia (β = -0.073; SE=0.021; p<0.01), internalized homonegativity (β = -0.082; SE=0.012; p<0.001), perceived HIV stigma (β = -0.037; SE=0.039; p<0.05), and AUD risk (β = -0.021; SE=0.015; p<0.05) with HIV testing self-efficacy. Conclusions: Our study provides important implications in identifying multilevel sources for building resilience among BMSM to buffer the effects of minority stress on AUD risk and improve HIV testing outcomes.

Uptake of HIV Testing Services among Refugee Men in Kiryandongo Refugee Settlement Camp, Mid-western Uganda

Aims: HIV testing is a critical checkpoint to late diagnosis and delayed treatment. However, utilization of HIV testing services has not yet reached the desired target, especially for men. This study aimed to determine the level of uptake of HIV testing services and the associated factors among refugee men in the Kiryandongo Refuge Settlement Camp. Study Design: Cross-sectional by mixed methods. Methodology: The study was conducted by mixed methods. A total of 422 men &gt;18 years were selected using systematic random sampling. Interview administered semi-structured - questionnaires and informant interview guides were used to collect quantitative and qualitative data respectively. Results: The level of uptake of HIV testing services was 32%. Key factors negatively associated with the testing included social-cultural status (P=0.006, AOR=3.80) disclosure of positive results and awareness (P=0.002, AOR=0.14 and P=0.000, AOD=0.08) respectively, unemployment (P=0.015, AOR=0.17), religion (P=0.043, AOD=0.37) and multiple sexual partners (P=0.033, AOR=0.23). Conclusion: The level of uptake of HIV testing services among refugee men in the Kiryandongo refugee settlement camp is significantly lower than the national mark. Targeted testing strategies and sensitization are critical to address the negatively associated factors and inform public health policies.

Index-linked Assisted HIV Self-Testing for Children 2-14 Years: Results of a Pilot Evaluation in Ethiopia.

Case identification remains a challenge to reaching the United Nations 95-95-95 targets for children with HIV. While the World Health Organization approved oral mucosal HIV self-testing (HIVST) for children over 2 years in 2019, there is little information on HIVST for pediatric case identification in Ethiopia. Nine health facilities across Ethiopia. We implemented a pilot program from November 2021-April 2022 to assess acceptability and feasibility of using HIVST to screen children 2-14 years of adult index clients, (i.e., parents/caregivers living with HIV and on antiretroviral therapy). HIV-positive adults who had children with unknown HIV status were given HIVST kits (OraQuick®) to screen their children at home. Parents/caregivers were asked to report results telephonically and bring children screening positive to the health facility for confirmatory HIV testing. We defined HIVST acceptability as ≥50% of parents/caregivers accepting testing and ≥50% reporting results within seven days of receiving a test kit. Feasibility was defined as ≥60% of children with a reactive HIVST receiving confirmatory testing and <5 serious social harms reported per 1000 kits distributed. Overall, 1496 of 1651 (91%) parents/caregivers accepted HIVST kits to test their children at home and 1204 (71%) reported results within seven days. Of 17 children (1%) with reactive results, 13 (76%) received confirmatory testing; of which 7 (54%) were confirmed to be HIV-positive. One serious social harm was reported. Providing adult parents/caregivers with HIVST kits to screen their children at home is an acceptable and feasible strategy to reach untested children and improve pediatric case finding in a low prevalence setting.

Cost and Cost-Effectiveness of Distributing HIV Self-Tests within Assisted Partner Services in Western Kenya

Background: Assisted partner services (APS) is a recommended public health approach to promote HIV testing for sexual partners of individuals diagnosed with HIV. We evaluated the cost and cost-effectiveness of integrating oral HIV self-testing (HIVST) into existing APS programs. Methods: Within the APS-HIVST study conducted in western Kenya (2021–2022), we conducted micro-costing, time-and-motion, and provider surveys to determine incremental HIVST distribution cost (2022 USD). Using a decision tree model, we estimated the incremental cost per new diagnosis (ICND) for HIVST incorporated into APS, compared to APS with provider-delivered testing only. Scenario, parameter and probabilistic sensitivity analyses were conducted to explore influential assumptions. Results: The cost per HIVST distributed within APS was USD 8.97, largest component costs were testing supplies (38%) and personnel (30%). Under conditions of a facility-based testing uptake of &lt;91%, or HIVST utilization rates of &lt;27%, HIVST integration into APS is potentially cost-effective. At a willing-to-pay threshold of USD 1000, the net monetary benefit was sensitive to the effectiveness of HIVST in increasing testing rates, phone call rates, HIVST sensitivity, HIV prevalence, cost of HIVST, space allocation at facilities, and personnel time during facility-based testing. In a best-case scenario, the HIVST option was cheaper by USD 3037 and diagnosed 11 more cases (ICND = 265.82). Conclusions: Implementers and policy makers should ensure that HIVST programs are implemented under conditions that guarantee efficiency by focusing on facilities with low uptake for provider-delivered facility-based testing, while deliberately targeting HIVST utilization among the few likely to benefit from remote testing. Additional measures should focus on minimizing costs relating to personnel and testing supplies.