Testing Services Research Articles

Preferences for oral-fluid-based or blood-based HIV self-testing and provider-delivered testing: an observational study among different populations in Zimbabwe

BackgroundThere is limited data on client preferences for different HIV self-testing (HIVST) and provider-delivered testing options and associated factors. We explored client preferences for oral-fluid-based self-testing (OFBST), blood-based self-testing (BBST) and provider-delivered blood-based testing (PDBBT) among different populations.MethodsAt clinics providing HIV testing services to general populations (1 urban, 1 rural clinic), men seeking voluntary medical male circumcision (VMMC, 1 clinic), and female sex workers (FSW, 1 clinic), clients had the option to test using OFBST, BBST or PDBBT. A pre-test questionnaire collected information on demographics and testing history. Two weeks after collecting a self-test kit, participants responded to a questionnaire. We used logistic regression to determine predictors of choices. We also conducted 20 in-depth interviews to contextualise quantitative findings.ResultsMay to June 2019, we recruited 1244 participants of whom 249 (20%), 251 (20%), 244 (20%) and 500 (40%) were attending urban general, rural, VMMC and FSW clinics, respectively. Half (n = 619, 50%) chose OFBST, 440 (35%) and 185 (15%) chose BBST and PDBBT, respectively. In multivariable analysis comparing those choosing HIVST (OFBST and BBST combined) versus not, those who had never married aOR 0.57 (95% CI 0.34–0.93) and those previously married aOR0.56 (0.34–0.93) were less likely versus married participants to choose HIVST. HIVST preference increased with education, aOR 2.00 (1.28–3.13), 2.55 (1.28–5.07), 2.76 (1.48–5.14) for ordinary, advanced and tertiary education, respectively versus none/primary education. HIVST preference decreased with age aOR 0.97 (0.96–0.99). Urban participants were more likely than rural ones to choose HIVST, aOR 9.77 (5.47–17.41), 3.38 (2.03–5.62) and 2.23 (1.38–3.61) for FSW, urban general and VMMC clients, respectively. Comparing those choosing OFBST with those choosing BBST, less literate participants were less likely to choose oral fluid tests, aOR 0.29 (0.09–0.92).ConclusionsMost testing clients opted for OFBST, followed by BBST and lastly, PDBBT. Those who self-assessed as less healthy were more likely to opt for PDBBT which likely facilitated linkage. Results show importance of continued provision of all strategies in order to meet needs of different populations, and may be useful to inform both HIVST kit stock projections and tailoring of HIVST programs to meet the needs of different populations.

A service for teaching medical decision-making using an ophthalmoscopy hardware and software simulator

Modern methods of teaching medical skills involve their development on simulation equipment. The further development of such devices, in addition to the maximum identity of a living person, is the creation of intelligent services for an objective and individual approach to a particular student. A service for teaching medical decision-making using a hardwaresoftware ophthalmoscopy simulator has been developed. The service for ophthalmoscopy training performs the functions of entering the student’s identification data, lecture material in the form of presentations, studying descriptions and images of various eye diseases on an additional monitor, illustrative material for the formation of an individual training program. The testing service is designed to test the knowledge and diagnostic skills acquired during training. The exam consists in the creation by the teacher of a set of clinical cases with a gradation of typical cases, complex cases and comorbidities for diagnosis by the examinee. It is possible to determine the time and accuracy of diagnostics. Based on the results of the exam, a reporting form is generated, which is stored in the archive. The service can work remotely using Internet channels.

The Availability and Readiness of Primary Health Care Facilities to Provide HIV Testing and Counseling Services in Indonesia.

The Availability and Readiness of Primary Health Care Facilities to Provide HIV Testing and Counseling Services in Indonesia.

Sexually Transmitted Infection Risks and Symptoms Heightened Among Female Sex Workers who Started Selling Sex Before the Age of 18 in Five Cities in Cameroon

Many adolescents under 18 years old who sell sex are at elevated risk for sexually transmitted infection (STI) acquisition, which may persist into adulthood. There has been limited study of the burden of the risks and vulnerabilities among women who started selling sex as adolescents across Sub-Saharan Africa. In this study, a Adult female sex workers (FSW) recruited through respondent-driven sampling in five cities in Cameroon from December 2015 to October 2016 completed a questionnaire and human immunodeficiency virus (HIV) and syphilis testing. Multivariable logistic regression analysis controlling for age was used to identify factors associated with reporting selling sex before age 18. Selling sex before age 18 was reported by 11.5% (256/2,220) of FSW. Initiation of selling sex as an adolescent was positively associated with experiencing dysuria (adjusted odds ratio [aOR]:1.50, 95% confidence interval [CI]:1.08–2.10) or genital warts (aOR:1.78, 95% CI:1.08–2.94) and negatively associated with prior recent testing for HIV (aOR:0.71, 95% CI:0.53–0.96) or STIs (aOR:0.65, 95% CI:0.44–0.96). Consistent condom use with clients was negatively associated with early initiation of selling sex (aOR:0.58, 95% CI:0.42–0.80), while experience of recent sexual violence was positively associated with early initiation (aOR:1.74, 95% CI:1.15–2.63). There were no independent significant differences in HIV (24.5%) or syphilis (8.3%) prevalence. Given the limited use of HIV and STI testing services by women who sold sex as adolescents, the prevalence of forced sex, condomless sex, and STI symptoms were high. Programs serving FSW should more vigorously aim to serve adolescents and adults who began selling sex early.

Pengaruh Kualitas Pelayanan dan Keragaman Produk Tabungan terhadap Minat Menabung Masyarakat Bondowoso pada Bank Muamalat

The aim of this research is to find and examine the relationship between service quality and the diversity of savings products in attracting Bondowoso people's interest in saving at Bank Muamalat. Quantitative research is the type now used. The Bondowoso community was the target of this research, which included a sample of 100 respondents from each of the five sub-districts of Sukosari, Tapen, Wonosari, Tenggarang and Bondowoso. Multiple linear regression is the analysis tool used. The following are the findings from the multiple linear regression analysis coefficient assessment: 1) With a beta test coefficient of 0.249, service quality has a good and significant effect on the Bondowoso people's desire to save at Muamalat Bank; 2) With a beta test coefficient of 0.446, the diversity of savings products has a good and significant effect on the Bondowoso people's desire to save at Bank Muamalat; 3) With the beta test coefficient, service quality and diversity of savings products have a good and significant effect on the Bondowoso people's desire to save at Bank Muamalat.

User perceptions of COVID-19 telemedicine testing services, disease risk, and pandemic preparedness: findings from a private clinic in Hong Kong.

During the coronavirus disease 2019 (COVID-19) pandemic, telemedicine has been regarded as a method for providing safe access to healthcare. Here, we explored the experiences of individuals using telemedicine in Hong Kong during the COVID-19 pandemic to understand their risk perceptions and preparedness measures. We conducted a cross-sectional online survey of telemedicine users of private clinic-based COVID-19 testing services from 6 April to 11 May 2020. All users were invited to complete an anonymous online survey regarding COVID-19 risk perception and preparedness measures. The results of the survey were compared with the findings of a previous territory-wide survey. In total, 141 of 187 telemedicine users agreed to participate; the response rate was 75.4%. Of the participants, 95.1% (116/122) believed that telemedicine consultations were useful. Nearly half of the participants (49.0%) agreed or strongly agreed that telemedicine consultations were appropriate during the COVID-19 pandemic. Most participants believed that telemedicine consultations could perform the functions of 'health protection, promotion and disease prevention' (73.6%) and 'diagnosis' (64.0%). Concerning the choice of telemedicine provider, almost all participants (99.2%) were willing to consult medical doctors; more than half of the participants (54.1%) were willing to consult registered nurses, but only 13.1% were willing to consult non-clinical staff who had been trained to provide telemedicine services. The use of telemedicine for screening and patient education can be encouraged during the COVID-19 pandemic in Hong Kong.

Adherence to national malaria treatment guidelines in private drug outlets: a cross-sectional survey in the malaria-endemic Kisumu County, Kenya

BackgroundMalaria prevalence in Kenya is 6%, with a three-fold higher prevalence in western Kenya. Adherence to malaria treatment guidelines improves care for suspected malaria cases and can reduce unnecessary anti-malarial use. Data on adherence to guidelines in retail drug outlets (DOs) is limited, yet approximately 50% of people with fever access treatment first in these outlets. This study assessed adherence to the national malaria treatment guidelines among DOs in a high transmission area of Western Kenya.MethodsIn a cross-sectional survey of DOs in Kisumu Central and Seme sub-counties in 2021, DO staff were interviewed using structured questionnaires to assess outlet characteristics (location, testing services), staff demographics (age, sex, training), and health system context (supervision, inspection). Mystery shoppers (research assistants disguised as clients) observed malaria management practices and recorded observations on a standardized tool. Adherence was defined as dispensing artemether-lumefantrine (AL) to patients with a confirmed positive test, accompanied by appropriate medication counseling. Logistic regression was used to test for association between adherence to guidelines and DO-related factors.ResultsNone of the 70 DOs assessed had a copy of the guidelines, and 60 (85.7%) were in an urban setting. Staff adhered to the guidelines in 14 (20%) outlets. The odds of adherence were higher among staff who had a bachelor’s degree {odds ratio (OR) 6.0, 95% confidence interval (95% CI) 1.66–21.74}, those trained on malaria rapid diagnostic test (RDT) {OR 4.4, 95% CI 1.29–15.04}, and those who asked about patient’s symptoms {OR 3.6, 95% CI 1.08–12.25}. DOs that had higher odds of adherence included those with functional thermometers {OR 5.3, 95% CI 1.46–19.14}, those recently inspected (within three months) by Pharmacy and Poisons Board (PPB) {OR 9.4, 95% CI 2.55–34.67}, and those with all basic infrastructure {OR 3.9, 95% CI 1.01–15.00}. On logistic regression analysis, recent PPB inspection {adjusted OR (AOR) 4.6, 95% CI 1.03–20.77} and malaria RDT-trained staff (aOR 4.5, 95% CI 1.02–19.84) were independently associated with adherence.ConclusionMost outlets didn’t adhere to malaria guidelines. Regular interaction with regulatory bodies could improve adherence. Ministry of Health should enhance private sector engagement and train DOs on RDT use.

A piecewise spline approach for modeling of ECG signals

This paper presents a new spline-based modeling method of electrocardiogram (ECG) signal that can reproduce normal as well as abnormal ECG beats. Large volume ECG data is required for automatic machine learning diagnostic systems, medical education, research and testing purposes but due to privacy issues, access to this medical data is very difficult. Given this, modeling an ECG signal is a very challenging task in the field of biomedical signal processing. Spline-based modeling is the latest and one of the most efficient methods with very low computational complexity in the domain of ECG signal generation. In this paper, healthy ECG and arrhythmia conditions have been considered for the synthetic generation, (namely Atrial fibrillation and Congestive heart failure ECG beats) because these are the leading causes of death globally. To validate the performance of the presented modeling method, it is tested on 100 signals, also the percentage root mean square difference (PRD) and the root mean square error (RMSE) have been determined. These calculated values are analyzed and the results are found to be very promising and show that the presented method is one of the best methods in the field of synthetic ECG signal generation. A comparison amongst relevant existing techniques and the proposed method is also presented. The performance merit values PRD and RMSE, for the proposed method obtained are 38.99 and 0.10092, respectively, which are lower than the values obtained in other compared methods. To ensure fidelity of the proposed modeling technique with respect to IEC60601 standard, few Conformance Testing Services (CTS)database signals have also been modelled with a very close resemblance with the standard signals.

Mapping evidence on health promotion in HIV testing among men who have sex with men and transgender women using the social-ecological model and the vulnerability theoretical framework: a scoping review

This study aimed to map the scientific evidence on health promotion in human immunodeficiency virus) HIV testing among men who have sex with men (MSM) and transgender women (TGW) based on the social-ecological model (i.e., individual, organizational and social levels) and the theoretical framework of vulnerability (i.e., individual, social, and programmatic levels). The reviewed studies indicated several barriers to accessing HIV testing (e.g., economic, structural, and bureaucratic) and demonstrated the potential for community approaches to promote greater access to HIV testing and minimize the stigma and discrimination associated with HIV testing, primarily through community leadership and social support networks. The socio-ecological model of health promotion and the vulnerability approach have the potential to contribute to improving HIV testing services by balancing the technical and political power of health services and providers with community participation while considering the social contexts. Therefore, there is a need for reflection on health promotion policies and programs aimed at expanding access to HIV testing among MSM and TGW through interventions that consider the social contexts and cultural perspectives. Moreover, inter-sectoral strategies aimed at improving living conditions and access to fundamental resources for maintaining health and well-being should be considered.

Further development and testing of a rainfall test rig

Changes made recently by The Ministry of Health New Zealand, to the internal noise design requirements for Preschools, has required that the design of the roof reduces rainfall noise to Ministry of Education, Design Quality Learning Spaces Acoustics (DQLS) Version 3.0, for rainfall noise. Previously Canterbury Acoustic Testing Services (CATS) had developed a rainfall noise test rig, in accordance with ISO 10140-1: 2016 [3] and ISO 10140-5:2010/Amd 1:2014 and carried out testing on a series of warm roof/ceiling constructions. Preschools tend to use cold roof systems where the thermal insulation sits on the ceiling, rather than in a warm roof, where the insulation is part of the roof structure. So there has been no tested performance data for rainfall noise acoustic design purpose, using a cold roof construction. As part of the testing program, there was a need to recommission the rig, to verify rain drop size and rainfall rate. A testing program was established, to include the base roof structure (roofing iron only) to a full buildup of roof and ceiling, to get a better understanding of how each component in the system contributes to the control of the rainfall noise.

Measuring the performance of HIV self-testing at private pharmacies in Kenya: a cross-sectional study.

HIV self-testing (HIVST) has the potential to support daily oral pre-exposure prophylaxis (PrEP) delivery in private pharmacies, but many national guidelines have not approved HIVST for PrEP dispensing. In Kenya, pharmacy providers are permitted to deliver HIVST, but often do not have the required certification to deliver rapid diagnostic testing (RDT). We estimated the performance of provider-delivered HIVST compared to RDT, the standard of care for PrEP delivery, at private pharmacies in Kenya to inform decisions on the use of HIVST for PrEP scale-up. At 20 pharmacies in Kisumu County, we trained pharmacy providers (pharmacists and pharmaceutical technologists) on blood-based HIVST use and client assistance (if requested). We recruited pharmacy clients purchasing sexual and reproductive health-related products (e.g. condoms) and enrolled those ≥18 years with self-reported behaviours associated with HIV risk. Enrolled clients received HIVST with associated provider counselling, followed by RDT by a certified HIV testing services (HTS) counsellor. Pharmacy providers and clients independently interpreted HIVST results prior to RDT (results interpreted only by the HTS counsellor). We calculated the sensitivity and specificity of pharmacy provider-delivered HIVST compared to HTS counsellor-administered RDT. Between March and June 2022, we screened 1691 clients and enrolled 1500; 64% (954/1500) were female and the median age was 26 years (IQR 22-31). We additionally enrolled 40 providers; 42% (17/40) were pharmacy owners and their median years of experience was 6 (IQR 4-10). The majority (79%, 1190/1500) of clients requested provider assistance with HIVST and providers spent a median of 20 minutes (IQR 15-43) with each HIVST client. The sensitivity of provider-delivered HIVST at the pharmacy was high when interpreted by providers (98.5%, 95% CI 97.8%, 99.1%) and clients (98.8%, 95% CI 98.0%, 99.3%), as was the specificity of HIVST in this setting (provider-interpretation: 96.9%, 95% CI 89.2%, 99.6%; client-interpretation: 93.8%, 95% CI 84.8%, 98.3%). When compared to the national HIV testing algorithm, provider-delivered blood-based HIVST at private pharmacies in Kenya performed well. These findings suggest that blood-based HIVST may be a useful tool to support PrEP initiation and continuation at private pharmacies and potentially other community-based delivery settings.

RANCANG BANGUN SISTEM INFORMASI PEMETAAN FLORA DAN FAUNA TAMAN HUTAN RAYA NURAKSA DENGAN MODEL ARSITEKTUR MICROSERVICES

The Great Forest Park (Tahura) Nuraksa has a lot of flora and fauna in it. Currently, Tahura Nuraksa does not yet have a mapping system for its flora and fauna. In the Long-Term Management Plan of Tahura Nuraksa for 2019-2029, one of which is the acceleration of completion of the mapping of Tahura Nuraksa, an indicator of success is that the making of maps supporting the management of the area can be completed. The solution is to build a Geographic Information System of flora and fauna based on microservices architecture. The system uses the Extreme Programming method. The system is built using the React JS framework for websites and React Native for mobile, and the MongoDB database. Testing services using Postman tools, testing website features using Selenium tools, and testing mobile applications using black boxes. equivalence partition and Mean Opinion Score to measure the feasibility of the system based on the point of view of the officers and the point of view of the tourists. The assessment from the officers got the results of 71% Strongly Agree, and 29% Agree. Based on the point of view of tourists, the results obtained are 47.9% Strongly Agree, 43% Agree, and 3.8% Neutral

Estimating prevalence and modelling correlates of HIV test positivity among female sex workers, men who have sex with men, people who inject drugs, transgender people and prison inmates in Sierra Leone, 2021

Key populations (KPs) are particularly vulnerable to HIV infection and efforts to prevent HIV infections among KPs have been less successful, largely due to existing laws and legislation that classify the groups as illegal. Understanding the HIV infection pathway and the burden of HIV infection among Female Sex Workers (FSWs), Transgender people (TG), Men who have sex with Men (MSM), People who Inject Drugs (PWID), and Prison Inmates (PIs) is critical to combatting the HIV epidemic globally. This study aims to estimate HIV prevalence and model the risk factors of HIV positivity rate among the aforementioned KPs in Sierra Leone. This study used Time Location Sampling, Respondent Driven Sampling (RDS), and Conventional cluster Sampling designs to generate a representative sample of FSWs, MSM, TG, PI, and PWID. HIV prevalence and the corresponding 95% confidence intervals among each KP were estimated by adjusting for sampling weight using the logit-transformed confidence intervals. To determine correlates of HIV test positivity among KPs, a multivariable modified Poisson regression model that adjusts for RDS survey weights was used and sensitivity analysis was conducted using a multivariable logistic regression model with cluster robust standard errors. The prevalence of HIV among FSWs in the six regional headquarter towns was estimated to be 11.8% (95% CI: 7.9–17.1); MSM was 3.4% [95% CI: 1.9–5.8]; TGs was 4.2% (95% CI: 2.9–6.1); PWIDs was 4.2% (95% CI: 2.7–6.4) and PI was 3.7% (95% CI: 1.4–9.6). The correlates of HIV test positivity among KPs and PIs include HIV-related knowledge, marital status, district, income, age and sex of KP, level of education, alcohol intake, injecting drugs, and use of lubricants. HIV prevalence is relatively high among FSWs, MSMs, PWID, and TGs as compared to the previous estimate of the general population. There is a need to scale up and strengthen evidence-based HIV prevention interventions such Pre-Exposure Prophylaxis and needle and syringe exchange programmes targeting KPs, including prison inmates. Government must scale up both non-clinical and clinical routine HIV and STI testing and counseling services at the correctional center and drop-in centers for KPs screening/testing, and ensure that services are responsive to the needs of KP.

Implementation of Universal Newborn Hearing Screening in the Philippines: A Survey of Registered Newborn Hearing Centers.

Universal newborn hearing screening is mandated in the Philippines through the Universal Newborn Hearing Screening and Intervention Act of 2009 (RA 9709). Newborn hearing screening (NBHS) centers are required to perform screening tests, compile and submit data on screened newborns, and advise parents on the subsequent steps after NBHS. The study aimed to conduct a survey of the implementation of the Universal Newborn Hearing Screening and Intervention Program (UNHSIP) in the different regions of the country; and assess the information technology (IT) capabilities of hearing centers. Fifty-one NBHS centers across twelve regions were surveyed through on-site inspections in 2016. Data was gathered on the centers' testing capability, staffing, access to specialists, use of local protocols, connectivity, and IT capabilities. All surveyed centers followed the recommended protocols of the Manual of Operations of the Universal Newborn Hearing Screening and Intervention Act of 2009 (RA 9709). Among the 12 regions visited, only five (41.67%) had Category C centers with confirmatory testing and early amplification services as recommended. Majority of facilities (96.1%) were staffed by trained and certified personnel. A small percentage had access to subspecialists such as clinical audiologists (39.2%) and speech-language pathologists (23.5%). All facilities had computer access, but only 58.8% had internet access. Majority (94.1%) of the centers visited were not using the recommended data submission methods, specifically the use of registry cards and the online registry. Only 27.5% of centers had data on newborns who underwent confirmatory testing or early intervention. Facilities were found to be compliant to NBHS screening protocols and majority complied with certification requirements for staff; but were found to be non-compliant with use of registry cards or the online registry. Majority of centers were able to contact the parents of neonates who did not pass newborn screening, but had no system to track outcomes. Lack of confirmatory and early intervention services in identified areas emphasize the need for development of regional centers. It is recommended that measures to improve the utilization of the online registry are taken.

A-182 The journey From Conceptualizing, Designing, and Implementing Our Integrated Smart Core Lab at Kokilaben Dhirubhai Ambani Hospital (KDAH) & Medical Research Institute, Mumbai, India

Abstract Background KDAH established in 2009, is a 550 bedded tertiary care, multispecialty hospital in Mumbai, India. Annually the hospital manages about 300 000 patients, the clinical lab delivers >1 750 000 results with Compound Annual Growth Rate of 18 %. In the last 14 years, the clinical lab has expanded; increasing the test services, adding equipment, recruiting staff, and requesting for more space. There is increasing pressure to improve speed of service to impact early patient outcomes keeping an awareness on cost, non-availability of space for expansion. There is also demand to bring in new clinical tests and increase outreach beyond the hospital. In October 2018, the laboratory and hospital management decided to apply principles of Lean and design thinking to laboratory processes. The Smart Core Laboratory conceptualized was an outcome of this work and is focused on delivering results in the most efficient way, in terms of quality, cost, and speed. Methods The team of experts from various lab disciplines and lean consultants, started evaluating the end-to-end process from sample received at the central station to results review, reporting and sample disposal 1. Process Map: The process steps are classified and evaluated by the core team as value added (VA) and non-value added (NVA) & business-value added or necessary waste. Process Maps charts were generated for the following sample flow. a. Central Sample Receipt to Section. Verification, Registration & Distribution Process.b.In Lab preanalytical, analytical, post analytical processes: Clinical Chemistry, Immunoassay, Infectious Serology. (Serum, Plasma Fluoride / Heparin)Hematology (EDTA Whole Blood)Hemostasis (Citrate Plasma) 1. Value Stream Map A detailed Value Stream Map of all the actions for the above processes was generated to determine VA and NVA process steps 3. Spaghetti Mapping: Motion Study Observation and analysis of the Spaghetti mapping diagrams exposed inefficient layouts and identified areas with a lot of unnecessary movement. This helped to decide optimization of the flow and re-organization of the entire lab section Results & Discussion Based on the analysis of the data generated from the lean tools and identifying process waste and non-value added steps the following immediate improvements were implemented a. Combining steps extra-processing at centrifugation at each lab sectionb.Decreasing sample vacutainers by reducing number of sample drawsc.Eliminating Overproduction by removing extra barcode printing and registersd.Using Staff Creatively: Reorganize IQC, Calibration and maintenance to off peak hourse.Space Optimization. Conclusion This consolidation approach has enabled us to free up at least 341 sq ft prime lab space (≈14 % reduction), decrease staff motion & sample transportation. Approximately 50% simplification in overall processes is achieved. It also allowed reduction in additional patient sample draws by at least 40 %. The team could use this lean analysis to conceptualize and design a multidisciplinary Automation solution that would consolidate 5 sections namely Clinical Chemistry, Immunoassay, Infectious Serology, Hematology and Hemostasis in the Smart Core Laboratory.

Correlation between climate testing methods and service life prediction for paint systems

Correlation between climate testing methods and service life prediction for paint systems

Challenges and Solutions to STI Control in the Era of HIV and STI Prophylaxis.

This article reviews current efforts to control bacterial sexually transmitted infections (STIs) among HIV pre-exposure prophylaxis (PrEP) users and outlines the opportunities and challenges to controlling STIs within HIV PrEP programs. The incidence of STIs continues to rise globally especially among HIV PrEP users, with an estimated 1 in 4 PrEP users having a curable bacterial STI. STIs and HIV comprise a syndemic needing dual interventions. The majority of STIs are asymptomatic, and when testing is available, many STIs occur in extragenital sites that are missed when relying on urine testing or genital swabs. Optimal testing and treatment, including testing for antimicrobial resistance, pose difficulties in high income countries and is essentially non-existent in most low- and middle-income countries. Novel STI primary prevention strategies, like doxycycline post-exposure prophylaxis (PEP) for STI prevention, have proven to be highly efficacious in some populations. A few jurisdictions have issued normative guidelines and position statements for doxycycline PEP; however, clinical standards for implementation and data on public health impact are limited. STI incidence rates are high and rising in sexually active populations. Sexual health programs should leverage the expansion of HIV PrEP delivery services to integrate STI testing, surveillance, and novel STI prevention services.

Mini review: Molecular pathology of personalized medicine in cancer susceptibility syndromes

In current times, medical oncology is increasingly incorporating cancer genetics and genetic testing into its practice. About 5–10% of all cancers are caused due to inherited genetic mutation that increases susceptibility to a particular malignancy. There is an increasing practice of incorporation of genetic testing and results with potential benefits that have been seen in current-day oncology practice. The American College of Medical Genetics and Genomics highly advises conducting clinical molecular genetic testing within a laboratory that has received CLIA approval with results accurately interpreted by molecular geneticists. The patient is highly recommended to talk to a genetic specialist to explain about the risk, document the family history, and also explain the limitations and outcomes of the genetic testing. Nonetheless, significant discussions and ambiguity persist regarding the optimal approach for providing genetic testing services. These include considerations such as which tests should be employed, which patients should undergo testing, the order and timing of the tests, who should administer them, and the appropriate course of action for follow-up.

Can HIV self-testing reach first-time testers? A telephone survey among self-test end users in Côte d’Ivoire, Mali, and Senegal

BackgroundCoverage of HIV testing remains sub-optimal in West Africa. Between 2019 and 2022, the ATLAS program distributed ~400 000 oral HIV self-tests (HIVST) in Côte d’Ivoire, Mali, and Senegal, prioritising female sex workers (FSW) and men having sex with men (MSM), and relying on secondary redistribution of HIVST to partners, peers and clients to reach individuals not tested through conventional testing. This study assesses the proportion of first-time testers among HIVST users and the associated factors.MethodsA phone-based survey was implemented among HIVST users recruited using dedicated leaflets inviting them to anonymously call a free phone number. We collected socio-demographics, sexual behaviours, HIV testing history, HIVST use, and satisfaction with HIVST. We reported the proportion of first-time testers and computed associated factors using logistic regression.ResultsBetween March and June 2021, 2 615 participants were recruited for 50 940 distributed HIVST (participation rate: 5.1%). Among participants, 30% received their HIVST kit through secondary distribution (from a friend, sexual partner, family member, or colleague).The proportion who had never tested for HIV before HIVST (first-time testers) was 41%. The main factors associated with being a first-time tester were sex, age group, education level, condom use, and secondary distribution. A higher proportion was observed among those aged 24 years or less (55% vs 32% for 25–34, aOR: 0.37 [95%CI: 0.30–0.44], and 26% for 35 years or more, aOR: 0.28 [0.21–0.37]); those less educated (48% for none/primary education vs 45% for secondary education, aOR: 0.60 [0.47–0.77], and 29% for higher education, aOR: 0.33 [0.25–0.44]). A lower proportion was observed among women (37% vs 43%, aOR: 0.49 [0.40–0.60]); those reporting always using a condom over the last year (36% vs 51% for those reporting never using them, aOR: 2.02 [1.59–2.56]); and those who received their HISVST kit through primary distribution (39% vs 46% for secondary distribution, aOR: 1.32 [1.08–1.60]).ConclusionATLAS HIVST strategy, including secondary distribution, successfully reached a significant proportion of first-time testers. HIVST has the potential to reach underserved populations and contribute to the expansion of HIV testing services in West Africa.

Distribution of Hepatitis B prevention services in Wakiso District, Central Uganda.

Hepatitis B Virus (HBV) infection remains a significant global public health challenge especially in low-and-middle income countries. Although there are significant global and national efforts to control Hepatitis B, equitable distribution and access to prevention services such as testing and vaccination remains a challenge. Efforts to increase access are hindered by inadequate evidence on the availability and distribution of HBV services. This cross-sectional study aimed at generating evidence of the distribution of HBV prevention services in Wakiso District, Uganda. A total of 55 healthcare facilities (HCFs) including 4 hospitals, and 51 primary care facilities were surveyed. Data were collected using an electronic structured questionnaire and analysed using STATA 14.0. A chi-square test was performed to establish the relationship between HCF characteristics and the availability of hepatitis B services. ArcGIS (version 10.1) was used to generate maps to illustrate the distribution of hepatitis B prevention services. We found out that the hepatitis B vaccine was available in only 27.3% (15) of the HCF, and 60% (33) had testing services. Receipt of the hepatitis B vaccine doses in the last 12 months was associated with the level (p = ≤0.001) and location (p = 0.030) of HCF. Availability of the hepatitis B vaccine at the time of the survey was associated with the level (p = 0.002) and location (p = 0.010) of HCF. The availability of hepatitis B testing services was associated with the level (p = 0.031), ownership (p≤0.001) and location (p = 0.010) of HCF. HCFs offering vaccination and testing services were mostly in urban areas, and close to Kampala, Uganda's capital. Based on this study, hepatitis B prevention services were sub-optimal across all HCF levels, locations, and ownership. There is a need to extend hepatitis B prevention services to rural, public and private-not-for-profit HCFs.