Uptake Of Testing Research Articles

Interest in and Experience with Genetic Testing for Late-Onset Medical Conditions: Results from the National Poll on Healthy Aging.

The increasing availability of genetic testing for late-onset diseases such as Alzheimer's disease necessitates understanding public perceptions and experiences of such testing among at-risk populations. To assess (a) prior uptake of genetic testing (both in medical and direct-to-consumer settings), (b) future interest in genetic testing for late-onset conditions (e.g., Alzheimer's disease, Parkinson's disease), and (c) perceptions of testing pros and cons among middle-to-older aged adults. Online, cross-sectional survey study. The National Poll on Healthy Aging at the University of Michigan is a recurring biannual survey of a nationally representative sample of adults aged 50-80. This study reports on a March 2018 fielding of the survey that included a genetic testing module administered to adults aged 50-64. Study participants were 991 community-dwelling adults aged 50-64. Survey measures assessed (a) prior use of genetic testing, (b) reasons for engaging in genetic testing, (c) interest in different types of genetic testing, including for Alzheimer's disease, Parkinson's disease, and macular degeneration, and (d) perceived benefits, risks, and limitations of testing. Previous uptake of genetic testing was limited (medical use: 5.1%; direct-to-consumer: 10.8%), with direct-to-consumer test uptake higher among respondents with household incomes of $100,000 or more. Over half of adults endorsed interest in genetic testing for estimation of disease risk (58.9%), ancestry knowledge (58%), and informing medical care (53.8%). Interest in genetic testing for specific late-onset conditions was even higher, including Alzheimer's disease (70%), Parkinson's disease (65.3%), and macular degeneration (64.3%). Multivariable logistic regression models showed that older adults more likely to be interested in genetic testing for medical or disease risk purposes were those with higher levels of education (college degree or higher) and who endorsed the benefits of genetic testing, whereas respondents who endorsed testing risks and limitations were less likely to express interest. While prior use of genetic testing among the middle-to-older age population was low, interest in testing for Alzheimer's disease and other late-onset conditions was high. This high interest may translate into increased uptake given expanded access to testing and recent treatment advances for Alzheimer's disease.

Association between mass media exposure and HIV testing uptake in Cameroon.

In sub-Saharan African countries, mass media is critical in disseminating health information, including the need for HIV testing. Yet, in Cameroon, there is a dearth of studies examining how exposure to mass media is effective in the uptake of HIV testing. Using the 2018 Cameroon Demographic and Health Survey, we examined the association between exposure to mass media and HIV testing among sexually active women (n = 12,619) and men (n = 5,607). Our findings revealed a generally low uptake of HIV testing although more women (78%) have ever tested for HIV compared to men (67%). Adjusting for demographic, socioeconomic, and psychosocial factors, we found for both women and men their exposure at least once a week to the Internet (aOR = 1.57, p<0.001 for women; aOR = 1.76, p<0.001 for men), print media (aOR = 1.59, p<0.05 for women; aOR = 2.04, p<0.001 for men), radio (aOR = 1.34, p<0.01 for women; aOR = 1.57, p<0.001 for men), and television (aOR = 1.74, p<0.001 for women; aOR = 1.94, p<0.001 for men) was significantly associated with a higher likelihood of testing for HIV compared to their counterparts with no exposure at all. Our findings underscore the importance of further integrating mass media in HIV messaging in Cameroon as the country aims to achieve UNAIDS target 95-95-95 by 2023.

Primary Human Papillomavirus Test Uptake and Cervical Cancer Screening Trends in the Midwest, United States.

Despite U.S. Preventive Services Task Force and American Cancer Society endorsement of primary HPV screening, limited published data shows low uptake. Assess cervical cancer screening rates over time, particularly primary HPV test uptake, among patients in a midwestern practice. Evaluate associations between sociodemographics and screening adherence. Cross-sectional study. Qualifying subjects and type of screening test used were identified by applying ICD-9, ICD-10, lab test, and CPT codes to the Unified Data Platform. Sociodemographics were found through the electronic health record. Primary HPV uptake represented <1% of annual screening from 1/2017 to 1/2022. On 1/1/2022, only 55% of 21 to 29 year old and 63% of 30 to 65 year old were up to date with screening among the studied population. For 21 to 29 year old, compared with White women, Black women were 28% less likely to be screened [RR = 0.72 (0.66-0.79)]. Compared with never-smokers, current smokers were 9% less likely to be screened [RR = 0.91 (0.87-0.96)], past smokers were 14% more likely [RR = 1.14 (1.09-1.2)]. Among 30 to 65 year old, compared with White women, Black women were 14% less likely to be screened [RR = 0.86 (0.81-0.9)]. Compared with never-smokers, current smokers were 21% less likely to be screened [RR = 0.79 (0.77-0.81)], past smokers were 6% less likely [RR = 0.94 (0.92-0.95)]. Jointly considering race, ethnicity, smoking status, Charlson score, and rurality, findings were similar for 21 to 29 year old; Black women were screened less than White women [RR = 0.73 (0.67-0.79)]; current smokers [RR = 0.9 (0.85-0.94)] and past smokers [RR = 1.12 (1.06-1.17)] were screened less than never smokers. For 30 to 65 year old, Black women were screened less than White women [RR = 0.83 (0.79-0.88)]; current smokers [RR = 0.8 (0.78-0.81)] and past smokers [RR = 0.95 (0.93-0.96)] were screened less than never smokers. Screening rates remained below the Healthy People 2030 goal of 79.2% over time, particularly for younger Black women and current smokers, with minimal use of primary HPV screening.

Streamlined Genetic Education and Cascade Testing in Men from Hereditary Breast Ovarian Cancer Families: A Randomized Trial.

When a pathogenic BRCA1 or BRCA2 mutation is identified in a family, cascade genetic testing of family members is recommended since the results may inform screening or treatment decisions in men and women. However, rates of cascade testing are low, and men are considerably less likely than women to pursue cascade testing. To facilitate cascade testing in men, we designed a Web-based genetic education tool that addressed barriers to cascade testing, was individually tailored, delivered proactively, and could be used in lieu of pretest genetic counseling to streamline the cascade testing process. We randomized 63 untested men from hereditary cancer families to Web-based genetic education (WGE) versus enhanced usual care (EUC). WGE participants were provided access to a genetic education website after which they could accept or decline genetic testing or opt for pretest genetic counseling. EUC participants received an informational brochure and a letter informing them of their eligibility for genetic testing and recommending they schedule genetic counseling. The primary outcome was the uptake of genetic testing. Men in the WGE group were more likely to complete genetic counseling and/or genetic testing (43% vs. 12.1%; χ2 [n = 63, df = 1] = 7.77, p = 0.005). WGE participants were also more likely to complete genetic testing compared to men in the EUC group (30% vs. 9.1%; χ2 [n = 63, df = 1] = 4.46, p = 0.03). This preliminary trial suggests that a streamlined approach to genetic testing using proactively delivered genetic education may reduce barriers to cascade testing for at-risk men, leading to increased uptake. These results should be interpreted cautiously given the select sample and high rate of non-response.

Understanding HIV Prevalence among Teenagers in Western Kenya: Risk Factors, Challenges, and Intervention Strategies

Sub-Saharan Africa remains the epicentre of the global HIV epidemic, with the region accounting for 67% of the 39 million HIV-positive individuals worldwide in 2021. Kenya ranks among the top fifteen countries with the highest HIV prevalence, with approximately 3.7% of adults aged 15 to 49 affected. The prevalence among women is notably double that of men. This review focuses on the HIV prevalence among teenagers in Western Kenya, examining the sociocultural, economic, and environmental factors that contribute to HIV transmission in this demographic. It analyses current data on prevalence rates, risk behaviours, and the uptake of HIV testing and treatment among teenagers in the region. Additionally, the narrative review identifies key challenges in addressing HIV in this group and evaluates effective intervention strategies. By highlighting gaps in knowledge and synthesizing existing research, this review aims to guide targeted public health initiatives to reduce HIV incidence and improve outcomes for teenagers in Western Kenya.

Index Case HIV Testing Uptake and its Associated Factors at Oromia, Ethiopia.

Lack of index case testing increased the risk of contracting HIV among the families of index clients, partners, and biological children. The aim of this study was to determine the prevalence of index case HIV testing uptake and its associated factors at Oromia, Ethiopia. An institutional-based cross-sectional study was conducted. A face-to-face interviewer administered structured questionnaire and chart review checklist were used to collect data. The data were analyzed using SPSS version 25. Logistic regressions were executed and statistical significance was declared at P < .05. The prevalence of index case testing was 80.2%. Factors associated with index case HIV testing uptake included HIV status disclosure (AOR = 5.4, 95% CI: 2.1, 14.0), discussed about HIV with family (AOR = 3.1, 95% CI: 1.2, 7.5), counseling of the index case (AOR = 3.3, 95% CI: 1.7, 10.6), perceived benefit of the index case tested (AOR = 3.2, 95% CI: 1.5, 8.7), being on ART 12 months or more (AOR = 2.6, 95% CI: 1.1, 6.1), and maintained privacy (AOR = 3.1, 95% CI: 1.3, 7.1). The uptake of index case HIV testing was moderately high. Additionally, factors such as HIV status disclosure, discussion of HIV with family, counseling of the index case, perception of the benefits of HIV testing for the index case, duration of clients on ART, and privacy maintenance during service delivery were significantly associated with index case HIV testing. To enhance index case testing, it is crucial to raise awareness and ensure client privacy during the initial HTC visit. Encouraging HIV status disclosure through discussion and promoting adherence to HIV medication is also recommended.

Expanded and intensified population-based screening and diagnosis of hypertension and diabetes mellitus among rural adults in Northern India: An implementation research in routine programmatic setting

ABSTRACT Background: The National Noncommunicable Disease Program of India currently recommends population-based NCD screening (PBS) among people aged ≥30 years. The low turnaround for diagnosis confirmation is a consistent issue the program has faced since its launch. The current study assessed an expanded PBS (including people 18–29 years) and intensified (home-based) diagnosis confirmation strategy for hypertension (HT) and diabetes mellitus (DM) in a routine programmatic setting. Materials and Methods: This implementation research was conducted among all people aged ≥18 years in a rural health block in northern India. The eligible population was screened for HT and DM (using random blood sugar), and the screen positives were asked to visit a nearby public health facility (preferably) for diagnosis. An intensified home-based diagnosis confirmation was offered to screen positives who did not visit the health facility for diagnosis confirmation. Results: Of the 2004 participants screened, 1149 (57.3%) were female and 586 (28.2%) were aged 18–29 years. A total of 353 (20.2%) and 200 (10.9%) were found newly screened positive for HT and DM, respectively. The turnout rate for facility-based confirmation ranged from 69.6% to 91.2%. The prevalence of HT and DM in people aged 18–29 years and ≥30 years was 6.1% and 2.9% and 30.0% and 26.2%, respectively. The expanded screening and intensified home-based diagnosis confirmation strategies yielded an additional 12.8% HT and 24.1% DM among the total new cases detected. Conclusion: An expanded PBS and intensified diagnosis confirmation is feasible in a programmatic setting and has yielded additional new cases. Cost effectiveness of the above strategy must be assessed in future studies. Further, in-depth understanding of the risk perception, and potential cultural, social, and health system factors for improving the uptake of confirmatory tests is the need of the hour.

Understanding the uptake and determinants of prevention of mother-to-child transmission of HIV services in East Africa: Mixed methods systematic review and meta-analysis.

Prevention of mother-to-child transmission (PMTCT) of HIV service is conceptualized as a series of cascades that begins with all pregnant women and ends with the detection of a final HIV status in HIV-exposed infants (HEIs). A low rate of cascade completion by mothers' results in an increased risk of HIV transmission to their infants. Therefore, this review aimed to understand the uptake and determinants of key PMTCT services cascades in East Africa. We searched CINAHL, EMBASE, MEDLINE, Scopus, and AIM databases using a predetermined search strategy to identify studies published from January 2012 through to March 2022 on the uptake and determinants of PMTCT of HIV services. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. A random-effects model was used to obtain pooled estimates of (i) maternal HIV testing (ii) maternal ART initiation, (iii) infant ARV prophylaxis and (iv) early infant diagnosis (EID). Factors from quantitative studies were reviewed using a coding template based on the domains of the Andersen model (i.e., environmental, predisposing, enabling and need factors) and qualitative studies were reviewed using a thematic synthesis approach. The searches yielded 2231 articles and we systematically reduced to 52 included studies. Forty quantitative, eight qualitative, and four mixed methods papers were located containing evidence on the uptake and determinants of PMTCT services. The pooled proportions of maternal HIV test and ART uptake in East Africa were 82.6% (95% CI: 75.6-88.0%) and 88.3% (95% CI: 78.5-93.9%). Similarly, the pooled estimates of infant ARV prophylaxis and EID uptake were 84.9% (95% CI: 80.7-88.3%) and 68.7% (95% CI: 57.6-78.0) respectively. Key factors identified were the place of residence, stigma, the age of women, the educational status of both parents, marital status, socioeconomic status, Knowledge about HIV/PMTCT, access to healthcare facilities, attitudes/perceived benefits towards PMTCT services, prior use of maternal and child health (MCH) services, and healthcare-related factors like resource scarcity and insufficient follow-up supervision. Most of the identified factors were modifiable and should be considered when formulating policies and planning interventions. Hence, promoting women's education and economic empowerment, strengthening staff supervision, improving access to and integration with MCH services, and actively involving the community to reduce stigma are suggested. Engaging community health workers and expert mothers can also help to share the workload of healthcare providers because of the human resource shortage.

Patients' and Care Providers' Reported Barriers and Suggestions for Improving HIV Viral Load Testing in Tanzania: A Qualitative Study in Dar es Salaam.

The study explores barriers and suggestions for improving viral load testing (VLT) uptake in Tanzania, revealing that only 58% of patients receive VLT annually, contrary to the Tanzanian National Guidelines toward the 95-95-95 UNAIDS targets. Twelve individual interviews and three patient-focus groups were conducted as part of a qualitative study conducted in six human immunodeficiency virus (HIV) clinics in Dar es Salaam to identify potential suggestions for access enhancement, as well as barriers to VLT uptake. Using King's theory of goal attainment, we found that missing appointments was the primary individual barrier to VLT uptake, along with limited knowledge among individuals living with HIV. Participants also face system-level barriers, such as a lack of integrated care and evening service availability. The study suggests that, despite challenges, there is potential for improvement in the uptake and quality of VLT services in Tanzanian public health facilities through a holistic approach.

MAGENTA: a Multinational patient survey assessing the Awareness, perceptions and unmet needs in GENetic Testing and counselling among patients with breAst cancer.

Genetic testing and counselling are critical in assessing breast cancer risk and tailoring treatment strategies. However, several barriers hinder patients from opting for genetic testing/counselling, leading to fewer than one-third of patients undergoing testing and even fewer being offered counselling. A granular understanding of these barriers is essential in overcoming them. A multinational survey developed by patient authors was conducted in 9 countries, to identify the specific local/regional barriers. The survey question pathway was individualized, based on responses to prior questions. Percentage responses to a response option were calculated based on the total number of respondents to that question. Chi-square tests were used to assess the significance of the results, if applicable. The final analysis set (FAS) included 1,176 respondents, with a subset of this responding to all questions. In the FAS, 63% of respondents had undergone testing. Among those who got tested, 70% were offered testing. Among untested respondents, only 40% were offered the test but eventually did not get tested. In the tested population, 44% received counselling, which was significantly higher than 7% (p<0.00001) in the untested group. Among those reporting on awareness, 71% reported awareness level between 'very low' and 'moderate' prior to cancer diagnosis. Most respondents (71%) agreed that all breast cancer patients should undergo testing before treatment initiation. However, Asian patients were less likely to endorse this view compared to respondents from other regions (25% vs ≥50%; p<0.00001). A higher proportion of tested respondents were 'very willing' to get their family members tested (44%) versus untested respondents (11%), with relatively higher willingness among Australian (77%) and Russian respondents (56%), the regional variation being statistically significant (p<0.00001). Critical gaps remain in the access, awareness and perceived value of genetic testing and counselling, with regional variance or difference between the tested and untested groups. Most patients are not offered counselling, which may be associated with the low uptake of testing. Strategic action is needed to drive policy-shaping and improve access to testing and counselling, including raising patient awareness and improving patient experience for better treatment outcomes.

Factors Associated with Utilization of COVID-19 Preventive Measures by Patients Attending Private Healthcare Facilities in Southwest Nigeria

Background: Understanding disease risk is important for prevention. Identifying high-risk COVID-19 patients helps healthcare professionals implement precautions. This study examined factors related to COVID-19 prevention in patients at private healthcare facilities in Southwest Nigeria, during the early stages of the pandemic. Methods: A descriptive cross-sectional survey was conducted in two hospitals using multi-stage sampling. 400 respondents were selected two out of 78 private healthcare facilities in in Southwest Nigeria. Trained interviewers administered a questionnaire to collect information on risk profile, symptoms, perception of COVID-19 risk, and preventive practices. Data was analyzed using descriptive statistics, chi-square test, and binary logistic regression at a significance level of 0.05. Results: The average age of participants was 27.83 + 10.46 years. 52.8% of respondents were female. 70.5% were single, 75.8% belonged to the Yoruba ethnic group, and 72% identified as Christians. None had a history of international travel or contact with a confirmed COVID-19 case in the past 14 days, but 12.75% had been in contact with suspected cases. 47% reported having a fever. The majority had a low risk score for COVID-19. Most did not smoke (98.5%), consume alcohol (83.75%), or visit club houses (85.75%). Only 9.5% underwent COVID-19 testing, and 16.0% of those tested were positive. The main reason for test refusal was a lack of perception of susceptibility to COVID-19. Adherence to preventive practices was poor in all investigated circumstances. Conclusion: Patients presenting in hospitals during the early phase of the COVID-19 pandemic had a low risk of COVID-19. However, their poor compliance with preventive protocols and low testing uptake make them a potential source of transmission. Strategies to promote adoption of preventive measures are needed, especially among patients at private healthcare facilities.

Dynamics of HIV self-testing uptake among sexual and gender minorities: pre and during COVID-19.

To identify the factors associated with HIV self-testing (HIVST) uptake among adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW) before and during the COVID-19 pandemic. A cross-sectional HIVST uptake study was conducted among AMSM and ATGW. Peer educators and health professionals began providing HIVST in February 2019. The outcome was the HIVST uptake before and during the COVID-19 pandemic. The association between each predictor and outcome in each period was analyzed using simple and multiple logistic regressions, estimating odds ratios, and their respective 95% confidence intervals. The uptake was 229/510 (44.9%) and 382/1,075 (35.5%) before and during the pandemic. During the pre-pandemic period, HIVST uptake was higher in participants who reported receptive anal sex. During the pandemic, uptake was lower in participants with a steady sexual partner and higher in those with frequent oral sex with a steady partner in the previous three months. Before and during the pandemic, HIVST uptake was lower in ATGW and higher in those aged 18-19 years and in participants who lived alone. Uptake decreased during the pandemic. Sexual behavioral factors associated with HIVST uptake changed during the COVID-19 pandemic, showing the fluid dynamics of sexuality in AMSM and ATGW during this period. HIV programs can optimize the implementation of HIVST among adolescents and young people by incorporating effective and differentiated service delivery models to increase HIV testing uptake and to reach undiagnosed individuals effectively.

Determinants and acceptability of HIV self-testing among vulnerable groups in sub-Saharan Africa: A scoping review protocol

IntroductionHIV self-testing (HIVST) is where individuals collect their specimens and perform the HIV test privately. HIVST has improved testing uptake and coverage, especially among vulnerable groups of sub-Saharan Africa (SSA)....

Trend, spatial distribution, and factors associated with HIV testing uptake among pregnant women in Ethiopia, based on 2005-2016 Ethiopia demographic and health survey: A multivariate decomposition analysis and geographically weighted regression.

HIV testing during pregnancy is an integral component and first step of prevention for mother to child transmission, initiation of antiretroviral treatment and diagnosis of HIV/AIDS. However, Ethiopia and other sub-Saharan African countries face challenges in meeting the first target of the 95-95-95 global initiatives. This study examines trends, spatial distribution, and factors influencing HIV testing among pregnant women in Ethiopia from 2005 to 2016, using data from the Ethiopia Demographic and Health Surveys. The study was based on three consecutive demographic and health survey in Ethiopia. A total weighted sample of 13,020 women who gave birth within 2 year proceeding each survey year was included in each survey. Logit based decomposition analysis technique was employed to identify factors contributing to the change in HIV testing uptake among pregnant women overtime. ArcGIS version 10.7.1 and SaT Scan version 10.1software were used for the spatial analysis and geographically weighted regression. HIV testing uptake among pregnant women has significantly increased from 0.51% in 2005 to 32.4% in 2016 with 2.9% annual rate of increment in Ethiopia. About 75.9% of the overall increase in HIV testing uptake among pregnant from 2005-2016 was due to increases in women's composition with knowledge of Mother to child transmission of HIV (3.2%), HIV counseling (10.3%), 4 or more antenatal care visits (31.4%), health facility delivery (6.3%), not perceiving distance from the health facility as a big problem (1.1%), and urban residence (0.6%). Spatial variation of low proportion of HIV testing was non-random in all three surveys (Moran index, p-value<0.05). Hot spot clusters exhibited in all the three waves includes Tigray and SNNPRs in 2005 and consistent hotspot areas in Benishangul-Gumuz, Somali, SNNPR, and Gambella in 2011 and 2016 EDHS. Lack of knowledge of Mother to child transmission of HIV, lack of antenatal care visit, lack of media exposure, and health facility delivery were significant predictors for the spatial variation of low proportion of HIV testing uptake across regions in Ethiopia in 2016. Over all, there has been a substantial increase in HIV testing uptake among pregnant women overtime in Ethiopia, but it still far away from achieving the 2025 HIV testing targets. Knowledge of Mother to child transmission of HIV, HIV counseling, Number of Antenatal care visit, previous place of delivery, residence and distance to health facility were significant contributing factors for the change in HIV testing uptake. There was geographical disparity in HIV testing uptake across regions in all three EDHS. Lack of knowledge of Mother to child transmission of HIV, lack of ANC visit, lack media exposure, and health facility delivery were significant predictors. Geographic-based interventions, together with broader public health strategies, are essential for advancing HIV testing uptake.

Factors Associated with Poor Uptake of HIV Counselling and Testing amongst Adult Men at Health Facilities in Rustenburg Sub-district, South Africa

Background: HIV counselling and testing (HCT) is one of the ways of reducing the prevalence of HIV infection and ensuring that infected individuals receive appropriate care. Unfortunately, the uptake of HCT amongst males, aged 15 to 49 years remains low. Aim: The aim of the study was to identify factors influencing low uptake of HCT amongst males between the ages of 15 and 49 in the health care facilities of Rustenburg. Methods: It is a cross-sectional descriptive study among 15- and 49-years males who visited 19 health facilities within Rustenburg using a self-administered questionnaire. Results: Four hundred and forty (440) males (15-49 years) took part in the study with a response rate of 98%. Of this total, 39 (9%) had never been tested for HIV. Most (79.1%) of participants undertook HIV testing for health reasons. The results indicated that differences in age (males aged between 40 and 49 years) and employment status (employed men) translated to differences in the likelihood of one being tested and these two variables (age and employment status) were associated with knowledge as a factor in the acceptance and usage of HCT services. Knowledge about HCT services was significantly associated with acceptability and usage of HCT services (P&lt;0.05). Conclusion: Participants aged between 15 and 29 years were less likely to undergo HIV testing than other age groups. There is a need to encourage young people to undertake HIV testing since they are the most vulnerable age group.

Medical Male Circumcision and HIV Testing Practices among Men Aged 15 to 59 Years Old: Evidence from Zambia Demographics and Health Survey

Medical male circumcision (MMC) and HIV testing have been recommended by the World Health Organization (WHO) as part of a comprehensive approach to HIV prevention. Zambia has integrated MMC with HIV testing interventions. This study examined the syndemic relationship between MMC and HIV testing, as well as sociodemographic characteristics influencing both MMC and HIV testing in Zambia. Data were derived from the 2018 Zambia Demographic and Health Survey (ZDHS), a nationally representative cross-sectional survey conducted among 12,123 men aged 15 to 59 years. Descriptive characteristics were summarized using frequencies and proportions. Two multivariate logistic regression models examined the relationship between independent and dependent variables (HIV testing and MMC alternatively). The results showed that 76.8% of men reported having ever tested for HIV, and 26% performed MMC. The logistic regression results showed that MMC was significantly associated with ever being tested for HIV and vice versa. Sociodemographic characteristics, including province, resident type, age, marital status, education, wealth status, and religion, were also significantly associated with MMC and having tested for HIV among men in Zambia. By and large, this study has identified that both MMC and HIV have an intricate relationship with health benefits to reduce the risk of HIV infections for men in Zambia. There is a need for continuous scaling up the perceived benefits of MMC and HIV testing uptake. In addition, more robust awareness is needed in specific provinces, rural areas, and other sociodemographic variables with lower incidences of MMC and HIV testing practices among men in Zambia. Keywords: HIV testing, Men, Medical male circumcision, Sociodemographic characteristics, Zambia.

The Role of Preprocedure Genetic Counseling in Pregnancies Interrupted for Fetal Abnormalities.

Congenital birth defects affect 3 to 5% of pregnancies. Genetic counseling can help patients navigate the testing process and understand results. The study objective was to identify predictors and utility of genetic counseling at the time of pregnancy termination. Additionally, we aimed to see what proportion of patients would benefit from additional testing based on the results of the genetic testing. This was a retrospective cohort review of all terminations performed for fetal anomalies by an academic center from July 2016 to May 2020. Indications were stratified by abnormal serum screening or types of abnormal ultrasound findings. Data were abstracted regarding uptake of genetic counseling and testing results. Abnormal results that warranted additional testing regarding recurrence risks were noted. Multivariable logistic regression was performed to identify predictors of receipt of genetic counseling and testing. Of 387 patients, 57% (n = 220) received preprocedure genetic counseling and 43% (n = 167) did not. Among patients who received diagnostic testing, 62% (n = 194) had genetic counseling compared with 38% (n = 121) without counseling (adjusted odds ratio 2.46, 95% confidence interval [1.41-4.29], p < 0.001). Among the entire cohort, 38% (n = 148) had suspected aneuploidy based on serum screening. Of these, 89% (n = 132/148) had definitive testing, 92% (n = 122/132) confirming the aneuploidy. Among the other 68% (n = 239) with structural anomalies, 76% (n = 183) had diagnostic testing with 29% (n = 53) yielding an abnormal result. Among those fetuses with structural anomalies, 36% (n = 19/53) of genetic diagnoses warranted additional parental testing because of risk of recurrence compared with only 2% (n = 2/122) of patients with abnormal serum screening results alone. Genetic counseling was associated with increased uptake of diagnostic testing, which yielded useful information and prompted additional testing. This is important for determining etiology and recurrence risk and should be offered to patients presenting for termination for fetal indications, as well as providing diagnostic closure for patients. · Genetic counseling increases the uptake of diagnostic testing in patients with fetal anomalies.. · Patients with ultrasound anomalies received less diagnostic testing despite actionable results 36% of the time.. · Genetic testing is invaluable for recurrence risk counseling even if patients chose to terminate..

Implementation of the advanced HIV disease care package with point-of-care CD4 testing during tuberculosis case finding: A mixed-methods evaluation.

During TB-case finding, we assessed the feasibility of implementing the advanced HIV disease (AHD) care package, including VISITECT CD4 Advanced Disease (VISITECT), a semiquantitative test to identify a CD4≤200cells/μl. Adult participants with tuberculosis symptoms, recruited near-facility in Lesotho and South-Africa between 2021-2022, were offered HIV testing (capillary blood), Xpert MTB/RIF and Ultra, and MGIT culture (sputum). People living with HIV (PLHIV) were offered VISITECT (venous blood) and Alere tuberculosis-lipoarabinomannan (AlereLAM, urine) testing. AHD was defined as a CD4≤200cells/μl on VISITECT or a positive tuberculosis test. A CD4≤200cells/μl on VISITECT triggered Immy cryptococcal antigen (Immy CrAg, plasma) testing. Participants were referred with test results. To evaluate feasibility, we assessed i) acceptability and ii) intervention delivery of point-of-care diagnostics among study staff using questionnaires and group discussions, iii) process compliance, and iv) early effectiveness (12-week survival and treatment status) in PLHIV. Predictors for 12-week survival were assessed with logistic regression. Thematic content analysis and triangulation were performed. Among PLHIV (N = 676, 48.6% of 1392 participants), 7.8% were newly diagnosed, 81.8% on ART, and 10.4% knew their HIV status but were not on ART. Among 676 PLHIV, 41.7% had AHD, 29.9% a CD4≤200cells/μl and 20.6% a tuberculosis diagnosis. Among 200 PLHIV tested with Immy CrAg, 4.0% were positive. The procedures were acceptable for study staff, despite intervention delivery challenges related to supply and the long procedural duration (median: 73 minutes). At 12 weeks, among 276 PLHIV with AHD and 328 without, 3.3% and 0.9% had died, 84.8% and 92.1% were alive and 12.0% and 7.0% had an unknown status, respectively. Neither AHD nor tuberculosis status were associated with survival. Implementing AHD care package diagnostics was feasible during tuberculosis-case finding. AHD was prevalent, and not associated with survival, which is likely explained by the low specificity of VISITECT. Challenges with CD4 testing and preventive treatment uptake require addressing.

Novel embryo selection strategies-finding the right balance.

The use of novel technologies in the selection of embryos during in vitro fertilisation (IVF) has the potential to improve the chances of pregnancy and birth of a healthy child. However, it is important to be aware of the potential risks and unintended consequences that may arise from the premature implementation of these technologies. This article discusses the ethical considerations surrounding the use of novel embryo selection technologies in IVF, including the growing uptake of genetic testing and others, and argues that prioritising embryos for transfer using these technologies is acceptable, but discarding embryos based on unproven advances is not. Several historical examples are provided, which demonstrate possible harms, where the overall chance of pregnancy may have been reduced, and some patients may have missed out on biological parenthood altogether. We emphasise the need for caution and a balanced approach to ensure that the benefits of these technologies outweigh any potential harm. We also highlight the primacy of patients' autonomy in reproductive decision-making, especially when information gained by utilising novel technologies is imprecise.

Hepatitis C Knowledge and Self-Reported Testing Behavior in the General Population in China: Online Cross-Sectional Survey.

The World Health Organization has proposed a worldwide target of eliminating hepatitis C virus (HCV) by 2030. A better understanding of HCV, testing behaviors, and associated factors in the general population is essential. This study aimed to assess HCV knowledge, self-reported HCV testing behavior, and willingness to undergo HCV screening in the general Chinese population. A cross-sectional online survey of the general Chinese population aged ≥15 years was conducted from November 2021 to May 2023. Participant characteristics were assessed based on their knowledge level and uptake of HCV testing. Participants ever having heard of HCV were recognized as being aware of HCV and asked additional HCV knowledge questions using a brief, validated 9-item scale. Participants with 0-3 points and who were unaware of HCV were categorized as having poor knowledge, and those with 4-6 points and 7 points were categorized as having fair and good knowledge, respectively. Participant uptake of HCV testing, testing results, reasons for undergoing or not undergoing HCV testing, and willingness to undergo HCV screening were collected through self-reports. Ordinal and binary logistic regression analyses were used to assess factors associated with the HCV knowledge level and the uptake of HCV testing, respectively. A total of 1491 valid participants' questionnaires were included. Of these, 714 (47.6%) participants were aware of HCV. The proportion of participants with poor, fair, and good HCV knowledge was 63.4% (945/1491), 9.3% (139/1491), and 27.3% (407/1491), respectively. A total of 465 (31.2%) participants reported ever undergoing HCV testing, and 4 (0.9%) were anti-HCV antibody positive. Most participants were tested for HCV following blood donation (353/465, 75.9%). The most common reasons for not undergoing HCV screening were a lack of HCV awareness (665/1026, 64.8%), followed by a low self-perceived risk of infection (176/1026, 17.2%). Of 1026 participants who had never undergone HCV testing, 937 (91.3%) were willing to undergo HCV screening if universal screening was provided at no cost. The HCV knowledge level was positively associated with the HCV testing rate. Participants who were less educated, lived in rural areas, resided in West China, and were currently alcohol drinkers had lower HCV knowledge and reduced odds of having undergone HCV testing. In contrast, participants with a blood donation history and a family history of hepatitis B virus or HCV infection had higher HCV knowledge and increased odds of prior testing. Participants aged ≥60 years had lower knowledge, and women had reduced odds of having undergone previous HCV testing. The general population of China has low HCV knowledge and testing rate. There is an urgent need for enhanced HCV awareness and scaled-up HCV screening and treatment. Individuals who are less well educated, reside in less-developed areas, currently drink alcohol, and are female should be prioritized for health education and interventions.