Human Immunodeficiency Virus Testing Research Articles

Tools Needed to Support Same-Day Diagnosis and Treatment of Current Hepatitis C Virus Infection.

The current multiday diagnosis and treatment paradigm for hepatitis C virus (HCV) infection results in far fewer patients receiving treatment with direct-acting antiviral agents than those with diagnosed HCV infection. To achieve HCV elimination, a paradigm shift in access to HCV treatment is needed from multiday testing and treatment algorithms to same-day diagnosis and treatment. This shift will require new tools, such as point-of-care (POC) antigen tests or nucleic acid tests for HCV and hepatitis B virus (HBV) and nucleic acid tests for human immunodeficiency virus (HIV) that do not require venous blood. This shift will also require better use of existing resources, including expanded access to HCV treatment and available POC tests, novel monitoring approaches, and removal of barriers to approval. A same-day diagnosis and treatment paradigm will substantially contribute to HCV elimination by improving HCV treatment rates and expanding access to treatment in settings where patients have brief encounters with healthcare.

Impact of COVID-19 pandemic on Tuberculosis and HIV services in Ghana: An interrupted time series analysis.

The Coronavirus disease 2019 (COVID-19) burden, coupled with unprecedented control measures including physical distancing, travel bans, and lockdowns of cities, implemented to stop the spread of the virus, have undoubtedly far-reaching aftereffects on other diseases. In low and middle-income countries (LMICs), a particular worry is the potential impact on Human Immunodeficiency Virus (HIV) and Tuberculosis (TB), as a consequence of possible disruption to health services and limiting access to needed life-saving health care. In Ghana, there is a paucity of information regarding the impact of COVID-19 on disease control, particularly TB and HIV control. This study sought to contribute to bridging this knowledge gap. The study involved the analysis of secondary data obtained from the District Health Information Management System-2 (DHIMS-2) database of Ghana Health Service, from 2016 to 2020. Data were analysed using an interrupted time-series regression approach to estimate the impact of COVID-19 on TB case notification, HIV testing, and Antiretroviral Therapy (ART) initiations, using March 2020 as the event period. The study showed that during the COVID-19 pandemic period, there was an abrupt decline of 20.5% (955CI: 16.0%, 24.5%) in TB case notifications in April and 32.7% (95%CI: 28.8%, 39.1%) in May 2020, with a median monthly decline of 21.4% from April-December 2020. A cumulative loss of 2,128 (20%; 95%CI: 13.3%, 26.7%) TB cases was observed nationwide as of December 2020. There was also a 40.3% decrease in people presenting for HIV tests in the first month of COVID-19 (April 2020) and a cumulative loss of 262620 (26.5%) HIV tests as of December 2020 attributable to the COVID-19 pandemic. ART initiations increased by 39.2% in the first month and thereafter decreased by an average of 10% per month from May to September 2020. Cumulatively, 443 (1.9%) more of the people living with HIV initiated ART during the pandemic period, however, this was not statistically significant. This study demonstrated that the COVID-19 pandemic negatively impacted TB case notifications and HIV testing and counselling services, However, ART initiation was generally not impacted during the first year of the pandemic. Proactive approaches aimed at actively finding the thousands of individuals with TB who were missed in 2020 and increasing HIV testing and counselling and subsequent treatment initiations should be prioritised.

Modeling one-stop-shop integration of family planning and HIV services in Zimbabwe, 2021

Objectives: In October 2020, the Ministry of Health and Child-care Zimbabwe commenced integrating reproductive health with human immunodeficiency virus (HIV) services. Family planning (FP), sexually transmitted infection (STI) screening and treatment, HIV testing services (HTS), pre-exposure prophylaxis (PrEP), and antiretroviral therapy (ART) services were offered through an integrated one-stop-shop model. The project aimed to address unacceptably high incidences of HIV and STIs among FP clients and demonstrate improved access and uptake of integrated services at dedicated FP centers. Materials and Methods: We conducted an intervention study. A service package of STI symptom screening and HTS (including HIV self-test [HIVST] primary and secondary distribution) was offered to all FP clients by multi-skilled nurses. Service uptake was measured pre and post-introduction of the intervention, before which services were provided by different nurses, in different rooms. HIV-diagnosed clients were linked to ART and eligible negative testers were offered PrEP. Service uptake was measured at 1 year of implementation against the same period before. Results: A total of 20,947 clients were recruited between October 2019 and September 2021, 9386 pre-intervention and 11,561 post-intervention. We observed a 5.2% total increase in clients seen and a 27.1% increase in the average uptake of all integrated services (FP, STI, HTS, PrEP, and ART). Most (93.5%) clients received oral contraception (Progestogen-only pills and combined-oral-contraceptives), while fewer (4.8%) received injectables and implants (1.1%). Following the intervention, STI screening increased by 30.2% (2730 vs. 11,028). HTS delivery increased by 38.9% and PrEP by 44.1%. HIV positivity yield increased significantly (10.1%, 62/615 vs. 16.6%, 813/4910) and linkage to ART improved by 44.4%. HIVST distribution contributed to improved access to HIV testing with 3754 FP clients accepting distribution compared with 4910 receiving HTS by nurses, provider-delivered testing was accessed by reactive self-testers. The project increased (?) improved linkage to preventive and treatment services and reduced missed opportunities associated with fragmented services. Conclusion: The integrated one-stop-shop model demonstrated improved service uptake during the intervention period. This project shows the benefits of integrated FP/STI/HTS/PrEP in Zimbabwe’s high HIV burden settings.

Individual Difference Correlates of Being Sexually Unrestricted Yet Declining an HIV Test

Which individual differences accurately predict one’s decision to get tested for human immunodeficiency virus (HIV), and do individuals who have regular short-term sex get tested at higher rates? Two studies—one lab study (total valid N = 69, with n = 20 who were tested) and one involving a student health center (valid N = 250, n = 4 who were tested)—involved participants (total valid N = 319, with n = 24 who got tested) taking a number of personality and individual difference measures, including the dark triad (Machiavellianism, narcissism, and psychopathy). Then, in both studies, participants had the opportunity to actually get tested for HIV. After analyzing data from Study 1, for Study 2 we preregistered the prediction that narcissistic participants would tend to (a) show disinclination to get tested for HIV, and (b) show proclivity for unrestricted short-term sexual behavior, manifesting in (c) a significant difference between these two correlations. As predicted, such a difference in correlations was evident for narcissism as well as psychopathy (the latter, however, was not predicted), suggesting that such individuals are not likely to seek HIV diagnostic information, but are taking more sexual risks. A research synthesis was consistent with these ideas (although controlling for demographic factors diminished the effects). Narcissistic and psychopathic individuals may be undetected hubs in the network of sexually active individuals with HIV. These results are silent on whether the typical HIV patient is narcissistic or psychopathic; the results merely implicate narcissistic and psychopathic traits in the spread of the virus.

Uptake of HIV testing and its correlates among sexually experienced college students in Southwestern, China: a Web-Based online cross-sectional study

BackgroundThe prevalence of human immunodeficiency virus (HIV) is becoming more common among college students in China. However, latest data on the prevalence and correlates of HIV testing among sexually experienced college students is rarely.MethodsAn online survey was conducted among college students aged 18 years or older using multistage stratified cluster sampling from 16 colleges. Data on socio-demographic, HIV testing, HIV-related awareness, attitudes, sexual education and behaviors were collected. Propensity score matching (PSM) and logistic regression model were used to identify factors associated with HIV testing.ResultA total of 108,987 students participated the survey, of which 13,201 sexually experienced college students were included in this study. 1,939 (14.69%) college students with sexual experience reported uptake of HIV testing in the preceding year. The uptake of HIV testing increased for college students with a rising HIV knowledge score and sexual health knowledge. Being awareness of HIV-related knowledge (aOR = 1.15, 95%CI: 1.01–1.30), accepting one-night stands (aOR = 1.16, 95%CI:1.03–1.32), obtaining satisfactory sexual interpretation from parent(s) (aOR = 1.24, 95%CI: 1.07–1.43), ever had unintended pregnancy (aOR = 1.78, 95%CI: 1.32–2.38), ever had received HIV-related preventive service(s) (aOR = 1.37, 95%CI: 1.10–1.70), ever had participated HIV-related preventive services (aOR = 3.76, 95%CI: 2.99–4.75) and ever had anal sex (aOR = 2.66, 95%CI: 2.11–3.34) were positively associated with uptake of HIV testing. However, accepting premarital sex (aOR = 0.76, 95%CI: 0.66–0.88), accepting cohabitation (aOR = 0.75, 95%CI: 0.61–0.92), occasionally discussing sex with parent(s) (aOR = 0.68, 95%CI: 0.50–0.91), and being with moderate satisfaction of school sex courses (aOR = 0.74, 95%CI: 0.58–0.95) were negatively associated with uptake of HIV testing.ConclusionThe prevalence of HIV testing was relatively low. Participation in HIV-related services and high-risk sexual behaviors were important enablers for testing. Improving sex education for students, increasing HIV preventive services on campus, and improving family sex education are necessary to increase HIV testing among college sexually experienced students.

A structural equation modeling approach to investigate HIV testing willingness for men who have sex with men in China

BackgroundA substantial risk of contracting Human immunodeficiency virus (HIV) exists among men who have sex with men (MSM), and HIV infection rates have been rising. This study aimed to analyze the factors influencing the Chinese MSM population’s intention to test for HIV.MethodsNonprobability sampling techniques were employed in June 2022 to recruit MSM in Chongqing and Sichuan, China. The data were analyzed using structural equation modeling (SEM), which is based on the knowledge-attitude-behavior (KAB) theory.ResultsAmong 1687 participants, 964 (57.1%) of the MSM were willing to have an HIV test. The results of the structural equation modeling (SEM) showed that knowledge, attitude, and behavior all influenced the testing intention, with attitude having the greatest impact (total effect of 0.22).ConclusionHIV testing needs to be increased among MSM as they exhibit a moderate willingness to test. Improving education on HIV knowledge and risk behavior might enhance the willingness of MSM to test for HIV in China.

Improving access to test results for participants in bio-behavioural surveys of people who inject drugs.

Bio-behavioural surveys of people who inject drugs (PWID) evolved from unlinked anonymous monitoring (UAM) of human immunodeficiency virus (HIV) incidence and prevalence, which began in some high-income countries in the late 1980s. UAM was conducted purely for surveillance purposes and test results were not returned to participants. Later, the importance of collecting data on behavioural risk factors was recognised, leading to the development of bio-behavioural surveys of PWID, which today are conducted regularly in several countries. Typically, these surveys recruit participants from venues providing harm reduction services and involve behavioural questionnaires and dried blood spot (DBS) testing for HIV and hepatitis C (HCV). DBS test results are not returned to participants; instead, countries offer varied systems of on-site testing separate from the bio-behavioural testing or provide referrals to external testing services. In this commentary, we trace the history of bio-behavioural surveys of PWID from their origins to the present day to explain how the methodologies evolved, along with the ethical considerations underlying them. We highlight the dramatic improvements in treatments for HIV and HCV over the past thirty years and the corresponding need to ensure that bio-behavioural survey participants can access low-barrier and timely testing. We review the pros and cons of different strategies for providing test results to participants and argue that the return of DBS results collected as part of bio-behavioural surveys warrants consideration as an additional tool to improve testing access for participants. Any changes should be informed by the perspectives of participants, study site personnel and investigators.

Correlation Between HIV Rapid Test and HIV Viral Load in HIV Patients at Haji Hospital in Surabaya

HIV (Human Immunodeficiency Virus) is a virus that causes decreased immunity. Examinations that can be done for HIV testing include a rapid HIV test and HIV viral load. The rapid HIV test is a test that is used to find out the antibodies in the sample, while the viral load test is to find out the amount of HIV. The purpose of this study was to compare HIV using a rapid test with HIV viral load in people with HIV. This type of research is observational with a cross-sectional approach. The sample in this study were 30 samples from HIV sufferers who carried out an HIV viral load examination using the Molecular Rapid Test (TCM) method at the RSUD Haji Provinsi Jawa Timur, then a rapid HIV test was carried out using the immunochromatography method. The results of the HIV rapid test and HIV viral load were processed in the form of a bar chart and tested with the McNemar statistical test. The results of the McNemar test can be concluded that there is a significant difference between the results of the HIV viral load examination of HIV viral load by the Molecular Rapid Test (TCM) method is superior to the HIV rapid test. However, rapid tests can be used in diagnosing HIV infection.

Optimization of HIV testing services in Germany using HIV indicator diseases: study protocol of the HeLP study

BackgroundDespite the potentially accompanying negative clinical, epidemiologic, and health economic effects, a large proportion of persons living with the human immunodeficiency virus (HIV) are diagnosed late. Internationally, numerous diseases are known to be HIV indicator diseases. Adequate HIV testing in the presence of HIV indicator diseases could help to diagnose unknown HIV infections earlier. The objective of the HeLP study is to validate published HIV indicator diseases for the German setting and to identify guidelines in terms of these indicator diseases in order to reduce knowledge gaps and increase HIV testing when HIV indicator diseases are diagnosed.MethodsA mixed methods approach is used. In a first step, published HIV indicator diseases will be identified in a systematic literature review and subsequently discussed with clinical experts regarding their relevance for the German setting. For the validation of selected indicator diseases different data sets (two cohort studies, namely HIV-1 seroconverter study & ClinSurv-HIV, and statutory health insurance routine data) will be analyzed. Sensitivity analyses using different time periods will be performed. Guidelines of HIV indicator diseases validated in the HeLP study will be reviewed for mentioning HIV and for HIV testing recommendations. In addition, semi-standardized interviews (followed by a free discussion) with guideline creators will identify reasons why HIV testing recommendations were (not) included. Subsequently, a random sample of physicians in medical practices will be surveyed to identify how familiar physicians are with HIV testing recommendations in guidelines and, if so, which barriers are seen to perform the recommended tests in everyday care.DiscussionThe HeLP-study adopts the challenge to validate published HIV indicator diseases for the German setting and has the potential to close a knowledge gap regarding this objective. This has the potential to improve targeted HIV testing for patients with HIV indicator diseases and consequently lead to earlier HIV diagnosis.Trial registrationDRKS00028743

Predictive ability of the Health Belief Model in HIV prevention and management in sub-Saharan Africa: a systematic review

ABSTRACT Around 70% of global Human Immunodeficiency Virus (HIV) diagnoses are in sub-Saharan Africa (SSA), where sexual transmission remains the primary mode of HIV transmission. Poor outcomes among persons living with HIV (PLHIV) in SSA are linked to delayed diagnosis (HIV Testing and Counselling [HTC] uptake), poor linkage to HIV care and suboptimal adherence to antiretroviral therapy (ART). This study is a systematic review of published articles on the predictive ability of the Health Belief Model in HIV prevention (condom use and sexual abstinence, Pre-Exposure Prophylaxis [PrEP], Voluntary Medical Male circumcision [VMMC]) and management (HTC uptake, Post-Exposure Prophylaxis [PEP] and ART adherence) in SSA. A systematic search was conducted in PubMed, Science Direct, Google Scholar, Scopus and institutional library databases. The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The HBM as a holistic model was useful in predicting HIV prevention and management in SSA. Perceived benefit, susceptibility, self-efficacy, barrier and cues to action were important predictors of the likelihood of uptake of HIV prevention and management intervention. Overall, the perceived benefit was found by the majority of the studies and showed high variance to predict the likelihood of individuals taking up interventions to prevent and manage HIV in SSA. Interventions should, therefore, focus on increasing perceived benefits associated with preventing and managing HIV.

The Influence of HIV Status on Acute Appendicitis: A Retrospective Study from South Africa.

Despite the human immunodeficiency virus (HIV) being the most common comorbidity in South African surgical patients, its impact on appendicitis has not been well-described. We aimed to determineHIV status' influence on patients' presentation, assessment, management and outcomes with acute appendicitis. The retrospective chart review included all patients aged 12years and older who were HIV-positive or HIV-negative and presented with acute appendicitis between 1 January 2013 and 31 December 2019. The primary outcome measure was survival to discharge. Secondary outcomes included analysis of the presentation (vital signs), assessment (biochemical, inflammatory markers) and management (intraoperative anatomical severity grading, length of hospital stay). Of the 1096 patients with appendicitis, 196 (17.9%) were HIV-positive, and CD4 counts were available for 159. The median age was 23years, with the HIV-positive patients being older and HIV-negative group having more males (58.7%). While the HIV-positive patients had a longer median length of hospital stay, there was no statistically significant difference in the two groups' incidence of high-grade appendicitis (p=0.670). The HIV-positive patients had a higher median shock index (OR 7.65; 95% [CI 2.042-28.64]) than their HIV-negative counterparts. HIV-positivity had a significant association with mortality (OR 9.56; 95% CI [1.68-179.39]), and of the seven HIV-positive patients who died, 66.7% (n=4) had a CD4 < 200 cells/mm3 (OR 8.6; 95% CI [1.6-63.9]). HIV-positive patients, those with CD4 < 200 cells/mm3 or not on ART, have increased mortality risk and may benefit from increased perioperative surveillance. Patients with an unknown HIV status in a high-prevalence population should be offered HIV testing to risk stratify more accurately.

Measuring Socioeconomic Inequalities in HIV Testing During Antenatal Care: A Peruvian National Survey.

Although several Latin American countries have 70% antenatal care coverage, the proportion of human immunodeficiency virus (HIV) testing of Peruvianpregnant women and the socioeconomic inequalities of this preventive measure are unknown. This study aimed to determine socioeconomic inequalities and quantify the contribution of contextual and compositional factors on HIV testing during prenatal carein Peru. A cross-sectional study of the 2021 Demographic and Family Health Survey data was conducted. The outcome variable was HIV testing of pregnant women during prenatal care. An analysis of inequalities was performed including the determination of concentration curves and a decomposition analysis of concentration indices. Of a total of 17521 women aged 15 to 49 years, 91.4% had been tested for HIV during prenatal care. The concentration curves showed that prenatal HIV testing was concentrated among richer women, while the decomposition analysis determined that the main contributors to inequality were having a higher education, residing in an urban area, and in the highlands, belonging to the wealthy quintile, and being exposed to television and newspapers. Strategies focused on improving access, promotion and restructuring of prevention of mother-to-child transmission measures should be prioritized.

BARRIERS TO EARLY DETECTION OF HIV/AIDS IN PREGNANT WOMEN IN MEDAN HELVETIA SUB-DISTRICT MEDAN CITY 2023

Pregnant women are one of the populations at risk of contracting Human immunodeficiency Virus (HIV), Syphilis, and Hepatitis B diseases in children more than 90% are infected from their mothers. The risk of mother-to-child transmission for HIV/AIDS is 20%-45%, for Syphilis is 69-80%, and for Hepatitis B is more than 90%. All three have the same transmission routes in the form of sexual intercourse, blood, and this transmission mostly occurs through vertical transmission from mother to fetus during pregnancy. Triple elimination is a program that aims to achieve and sustain mother-to-infant elimination of HIV/AIDS, Hepatitis B, and Syphilis in order to achieve better health for women, children, and their families through a coordinated approach. Detection and prevention of HIV incidence during pregnancy or postpartum should be prioritized and is essential to reduce mother-to-child transmission of HIV. In line with the increasing cases of mother-to-child HIV transmission, the government has made various control efforts through the PPIA or PMTCT (Prevention of Mother-to-Child Transmission) program. This research used field research to obtain qualitative data. Researchers go to the field to make observations about a phenomenon in a natural situation and are closely related to participant-observation. The results of the research obtained ANC services have been running well. Barriers to ANC access are related to cultural aspects and organizational systems that have not made maximum efforts to improve services, especially STIs (HIV/AIDS). At Puskesmas Helvetia, every pregnant woman will be directed to do HIV testing. Integrated ANC services have been running well. Routine technical training to improve obstetric competence for midwives and other supporting training needed as well as laboratory examination training for laboratory analysts (including STI and HIV/AIDS testing training) has been running well and systematically.

Sero-prevalence and risk factors of HIV/AIDS among intra-city commercial drivers in Kano State, Nigeria

Human immunodeficiency virus (HIV), which is among the world's largest cause of adult mortality, is an excellent example of the link between population mobility and infectious disease. Migrants are at a higher risk of ill health in general and HIV infection in particular. Migrants may be particularly vulnerable to HIV infection, according to epidemiological data from different nations worldwide. The objective of the study was to determine the sero-prevalence and risk factors of HIV among intra-city commercial drivers. A cross-sectional descriptive study design was used. An interviewer-administered questionnaire was used to collect information and blood for HIV testing through multi-stage sampling technique among four hundred and thirty four study participants. The mean and standard deviation of age of the respondents were 42.0 ± 11.3 years. The Sero-prevalence of HIV was 6.7% (95% CI: 3.7-12.6%). On adjusting for confounding effects using logistic regression analysis, marital status of separated (AOR=3.00, 95%CI=1.26-16.33), working experience of 11 – 20 years (AOR=4.10, 95%CI= 1.19-18.25), sexual intercourse under the influence of drugs or alcohol (AOR=3.98, 95% CI= 2.04 – 12.43), and history of extra-marital sex (AOR=4.01, 95%CI=6.07 – 10.43) remained significant predictors of HIV/AIDs. Establishment of clinic for treatment of sexually transmitted diseases in a strategic location and effective behavioural change communication strategies were recommended in order to reduce the risk of acquiring HIV infection.

Burden of hepatitis B virus and syphilis co-infections and its impact on HIV treatment outcome in Ethiopia: nationwide community-based study

Background Hepatitis B virus (HBV) and syphilis have been the most common co-infections that hinder treatment outcomes and increase early mortality among people living with human immunodeficiency virus (PLHIV). In this study, we aimed to determine the burden of HBV and syphilis co-infections and its impact on treatment outcomes among PLHIV in Ethiopia. Methods We used data from the Ethiopian Population-based HIV Impact Assessment (EPHIA), which was a household-based national survey in 2017/2018. Human immunodeficiency virus (HIV) testing was done among 19,136 participants using the national testing algorithm and 662 participants (3.50%) were HIV positives who were further tested for viral hepatitis and syphilis co-infections using HBV surface antigen and Chembio DPP syphilis assay, respectively. Viral load, CD4 count and high-sensitivity C-reactive protein (hsCRP) were done to measure HIV treatment outcomes. Descriptive statistics were used to determine the burden of co-infections and a logistic regression model to evaluate the determinants of co-infections using STATA V17.0. Results Overall prevalence of HBV and syphilis co-infection was 5.5% and 2.2%, respectively. HBV and syphilis (double co-infection) was 5.9%. The highest prevalence of HBV co-infection was observed among 10–19 years age group (12.9%) and male participants (7.44%) while the highest syphilis co-infection was among people aged ≥50 years (3.5%) followed by age groups 40–49 (3.3%) and 10–19 years (3.2%). Syphilis co-infection was higher among males (5.2%) compared to females (1.1%). After adjusted regression analysis, HBV co-infected PLHIV had higher odds of virologic failure (AOR (95% confidence interval (CI)) = 6.3 (4.2–14.3)), immunosuppression (CD4 count < 500 cells/mm3) (AOR (95%CI) = 2.1(1.3–4.9)) and inflammation (hsCRP >10 mg/dL) (AOR (95%CI) = 9.2(4.3–14.6)). Immunosuppression was also significantly higher among syphilis co-infected PLHIV (AOR (95%CI) = 3.4 (1.3–5.2)). Conclusions Burden of HBV and syphilis co-infections is high particularly among male and adolescent PLHIV and these co-infections hinder virologic and immunologic outcome in Ethiopia. Hence, the program shall enhance HBV and syphilis testing and treatment.

Reducing perinatal infection risk in newborns of mothers who received inadequate prenatal care.

Inadequate prenatal care increases risk for maternal infections going undetected and untreated, putting both the mother's health and that of her infant at risk. When pregnant women present late to care, routine testing that impacts infant management should include: hepatitis B surface antigen (HBsAg); serology for hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis; and testing for Chlamydia trachomatis and Neisseria gonorrhoeae. If the mother was not tested before or after delivery and is not available for testing, the infant should undergo testing for HIV, HBV, HCV, and syphilis. Testing for C. trachomatis and N. gonorrhoeae should be undertaken if the infant develops compatible clinical manifestations. Rapid turnaround of test results for HIV, HBV, and syphilis is optimal because preventive treatment decisions are time-sensitive. Early and effective preventive interventions are available for newborns at risk for HIV, HBV, syphilis, or gonorrhea. Close clinical follow-up and follow-up testing of infants born to mothers with inadequate prenatal care are warranted, as not all infections can be fully excluded perinatally.

Barriers to Uptake of Oral Pre-exposure Prophylaxis for HIV among Adolescents’ Young boys and Girls an Assessment of Cross River North Nigeria

Antiretroviral pre-exposure prevention (PrEP) to stop HIV transmission was 1st approved by the USA Food and Drug Administration in 2012. Despite correlations of decreases in new HIV infections being greatest wherever PrE-exposure prophylaxis has been deployed, the uptake of PrE-exposure prophylaxis is insulant, significantly among populations with disproportionate HIV burden. This narrative review seeks to spot individual and general barriers to PrE-exposure prophylaxis usage in African country. A comprehensive search of recent literature uncovered a fancy array of structural, social, clinical, and behavioral barriers, as well as knowledge/awareness of PrE exposure prophylaxis, perception of HIV risk, stigma from care suppliers or family/partners/friends, distrust of care providers/systems, access to school assignment, prices of PrE exposure prophylaxis, and issues around school assignment facet effects/medication interactions. significantly, these barriers might have totally different effects on specific populations in danger. The complete potential of PrE-exposure prophylaxis for HIV interference won't be realized till these problems area unit self-addressed. Ways to realize this goal ought to embody academic interventions, innovative approaches to delivery of HIV care, resource, and DE stigmatization of PrE-exposure prophylaxis and PrE-exposure prophylaxis users. Until then, PrE-exposure prophylaxis `uptake can still be suboptimal, significantly among people who would like it most. Results: Stigma influences uptake of pre-exposure prophylaxis; HIV risk perception does not affect uptake of pre-exposure prophylaxis; and a significant negative relationship between stigma and pre-exposure prophylaxis uptake. Conclusion: This study was conducted to investigate barriers to oral pre-exposure prophylaxis. Significant findings of the study conclude: stigma influences uptake of oral pre-exposure prophylaxis for HIV. Keywords: Acquired immunodeficiency syndromes, Barriers, Adolescents, Human immunodeficiency virus, Human immunodeficiency virus testing, Young Boys, Young Girls, Pre-exposure Prophylaxis.

Increased PrEP uptake and PrEP-RN coincide with decreased HIV diagnoses in men who have sex with men in Ottawa, Canada.

We sought to evaluate if increased uptake of HIV pre-exposure prophylaxis (PrEP) correlated to population-level changes in human immunodeficiency virus (HIV) epidemiology, in a setting with an integrated PrEP delivery system centred on a public health nurse-led PrEP clinic and referral process. This study was conducted in Ottawa, Canada, where all positive HIV test results are reported to the public health units. Risk factor information is also collected by nurses and subsequently entered into a provincial database. We extracted these data for Ottawa from 2017 to 2021 and restricted our analyses to first-time diagnoses. We identified 154 persons with a new HIV diagnosis. Over this period, the number of new diagnoses among men who have sex with men, the group most targeted for PrEP, decreased by 50%-60%. We did not identify changes in the number of new diagnoses based on race, intravenous drug use or among women. Increasing PrEP uptake in Ottawa in 2017 to 2021 coincided with a significant decrease in new HIV diagnoses among men who have sex with men. PrEP uptake in Ottawa, particularly by those most at risk, is likely supported by an integrated approach via PrEP-RN, a nurse-led public health program where individuals diagnosed with syphilis or rectal gonorrhea or chlamydia receive an automatic offer of PrEP. While these findings cannot causally link PrEP-RN or PrEP with this reduction in new HIV diagnoses, these changes in HIV epidemiology in Ottawa occurred exclusively among the group targeted for PrEP. These data highlight the efficacy and importance of PrEP.

HIV and HCV screening by non-infectious diseases physicians: can we improve testing and hidden infection rates?

Missed opportunities for Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) testing remain high. We aimed to ascertain the knowledge of screening guidelines and attitudes of non-infectious disease (ID) hospital physicians and assess the impact of a 1-h session on screening rates and diagnoses. This interventional study consisted of a 1-h training session on HIV and HCV epidemiology and testing guidelines for non-ID physicians. Pre-and post-session questionnaires compared the knowledge of the guidelines and attitudes toward screening before and after the session. Rates of screening and diagnoses were compared in three 6 months periods: before, immediately after, and 24 months ±4 after the session. A total of 345 physicians from 31 departments participated in these sessions. Before the session, 19.9% (28% medical, 8% surgical) and 17.9% (30% medical, 2.7% surgical) were aware of HIV and HCV testing guidelines, respectively. The willingness to routinely test increased from 5.6 to 22%, whereas not ordering tests decreased from 34.1 to 2.4%. HIV screening rates significantly increased by 20% after the session (7.7 vs. 9.3 tests per 103 patients; p < 0.001), and the effect persisted until the long-term period. The HIV diagnosis rate increased globally (3.6 vs. 5.2 HIV diagnoses per 105 patients; p = 0.157), mainly because of medical services (4.7 vs. 7.7 per 105 patients; p = 0.082). The HCV screening rate increased significantly immediately and in the long term only in medical services (15.7 and 13.6%, respectively). The new active HCV infection rates increased immediately and declined steeply thereafter. A short session for non-ID physicians can improve HIV/HCV screening, increase diagnosis, and contribute to disease elimination.

Frequency of HIV serodifferent couples within TB-affected households in a setting with a high burden of HIV-associated TB

IntroductionStrong epidemiological links between human immunodeficiency virus (HIV) and tuberculosis (TB) may make household TB contact investigation an efficient strategy for HIV screening and finding individuals in serodifferent partnerships at risk of HIV and linking them to HIV prevention services. We aimed to compare the proportions of HIV serodifferent couples in TB-affected households and in the general population of Kampala, Uganda.MethodsWe included data from a cross-sectional trial of HIV counselling and testing (HCT) in the context of home-based TB evaluation in Kampala, Uganda in 2016–2017. After obtaining consent, community health workers visited the homes of participants with TB to screen contacts for TB and offer HCT to household members ≥ 15 years. We defined index participants and their spouses or parents as couples. Couples were classified as serodifferent if confirmed by self-reported HIV status or by HIV testing results. We used a two-sample test of proportions to compare the frequency of HIV serodifference among couples in the study to its prevalence among couples in Kampala in the 2011 Uganda AIDS Indicator Survey (UAIS).ResultsWe included 323 index TB participants and 507 household contacts aged ≥ 18 years. Most index participants (55%) were male, while most (68%) adult contacts were female. There was ≥ 1 couple in 115/323 (35.6%) households, with most couples (98/115, 85.2%) including the index participant and spouse. The proportion of households with HIV-serodifferent couples was 18/323 (5.6%), giving a number-needed-to-screen of 18 households. The proportion of HIV serodifference among couples identified in the trial was significantly higher than among couples in the UAIS (15.7% vs. 8%, p = 0.039). The 18 serodifferent couples included 14 (77.8%) where the index participant was living with HIV and the spouse was HIV-negative, and 4 (22.2%) where the index partner was HIV-negative, while the spouse was living with HIV.ConclusionsThe frequency of HIV serodifference among couples identified in TB-affected households was higher than in the general population. TB household contact investigation may be an efficient strategy for identifying people with substantial exposure to HIV and linking them to HIV prevention services.