Uptake Of Human Immunodeficiency Virus Testing Research Articles

Disclosure of Sexual Orientation and Uptake of HIV Testing and Hepatitis Vaccination for Rural Men Who Have Sex With Men.

The decision and ability of primary care clinician to make recommendations for routine human immunodeficiency virus (HIV) testing and hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccines are shaped by knowledge of their patient's risk behaviors. For men who have sex with men, such knowledge requires disclosure of same-sex sexual behavior or sexual identity. Data were analyzed from a national survey of rural men who have sex with men (N = 319) to understand whether the disclosure of sexual identity to clinicians was associated with increased uptake of HIV testing and hepatitis vaccinations. We found that disclosure of sexual identity to clinicians was significantly associated (OR = 1.26; 95% CI, 1.08-1.47) with uptake of routine HIV testing and HAV/HBV vaccination. Our finding reinforces the need for safe, nonjudgmental settings for patients to discuss their sexual identities freely with their clinicians.

Overcoming Communication Barriers in HIV Prevention among In- School People with Disability (PWD) In Ekiti State - A Case of the Hearing Impaired and Visually Impaired Population

People with disability are at significant risk of becoming Human Immunodeficiency Virus (HIV) infected due to various factors including lack of education and resources to ensure safe sex, risk of violence and rape, stigma and lack of legal protection amongst others. Situation analysis of HIV prevention intervention amongst in-school PWD in the three specials schools in the state show that 48% of the total populations in these schools are hearing impaired, 16% visually impaired and 6% intellectually impaired. To this end, Ekiti State AIDS Control Agency with the funding of the World Bank and in collaboration with a Community Based Organizations (Eyelosun) carried out a two year intervention programme targeted at reaching the PWD population with HIV prevention services. The project community Entry phase activities included Issue Based Advocacy, Selection and Training of PWDs as peer educators, Community dialogue, Interpersonal Communication and Focused Group Discussions. Age peers’ education approach was used to build the capacity of PWDs on HIV prevention. Peer Education manual and IEC materials were produced in Braille and sign language (target group specific communication materials) to ease communication barriers. Thirty five able teachers with specialization in Braille and sign languages were selected and trained as Peer Educator Trainers (Training of Trainers TOT) and 25 PWDs (hearing and visually impaired) were selected and trained by the trained teachers to carry out peer education using the Braille and sign language manuals. The use of Braille and Sign language HIV prevention specific materials to communicate with PWD improved their understanding and knowledge of HIV/AIDS with 80% increase in HIV Counseling and Testing (HCT) uptake and other HIV services. There was active participation of PWD in all the structural interventions including Community dialogues and Anti-AIDS club. However, the intellectually impaired, who are highly sexually active and at risk of HIV remain a neglected population due to communication challenge.

Uptake of HIV, Hepatitis B and Hepatitis C testing among injection drug users in Thailand

Correction: Due to an error in the online publication of this journal, the publication date of this issue was recorded as 2014. The publication date was corrected to 2015 on 3 rd September 2015. The date on the cover is correct. Background: Behaviour related to injection drug use such as needle and sy­ringe sharing and unsafe sex contribute to the transmission of blood-borne viral infections such as Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV). Therefore, it is recommended that ongoing Injection Drug Users (IDUs) should receive screening for HIV, HBV and HCV at least once every 6 to 12 months. This study aims to esti­mate prevalence of HIV, HBV and HCV testing uptake among IDUs living in Songkhla Province, Thailand, and explore its associated factors. Methods: A cross-sectional study was conducted among 157 male IDUs liv­ing in Songkhla, in southern Thailand, between July 2013 and January 2014. Participants were recruited through a snowball technique where they were given a unique coded coupon. Face-to-face interviews were conducted using a structured questionnaire. Results: The most common test reported was HIV (72%), followed by HBV (44.6%) and HCV (39.5%) respectively. Over one quarter (26.1%) reported not having been tested in the past 12 months while 35.7% reported having been tested for all three viruses. IDUs who had visited an NGO-run drop-in centre, knew the risks of injection drug use, had completed secondary or higher education, had used heroin or amphetamine less than weekly, had re­ceived targeted information or education, or were married, and had a greater likelihood to report receiving all three tests. Discussion and conclusions: There is room for improvement in the utili­sation of testing for blood-borne viral infections. More attention must be given to those participants who have never visited a health facility or a drop-in centre, do not know the risks of injection drug use and do not receive targeted information or education. Particularly, IDUs who use drugs more frequently should be the first priority. International Journal of Prevention and Treatment of Substance Use Disorders 2015;1(3-4):38-54

Factors Affecting the Uptake of HIV Testing among Men: A Mixed-Methods Study in Rural Burkina Faso.

BackgroundThis study aimed to explore factors shaping the decision to undergo Human Immunodeficiency Virus (HIV) testing among men in rural Burkina Faso.MethodsThe study took place in 2009 in the Nouna Health District and adopted a triangulation mixed methods design. The quantitative component relied on data collected through a structured survey on a representative sample of 1130 households. The qualitative component relied on 38 in-depth interviews, with men purposely selected to represent variation in testing decision, age, and place of residence. A two-part model was conducted, with two distinct outcome variables, i.e. “being offered an HIV test” and “having done an HIV test”. The qualitative data analysis relied on inductive coding conducted by three independent analysts.ResultOf the 937 men, 357 had been offered an HIV test and 97 had taken the test. Younger age, household wealth, living in a village under demographic surveillance, and knowing that HIV testing is available at primary health facilities were all positively associated with the probability of being offered an HIV test. Household wealth and literacy were found to be positively associated, and distance was found to be negatively associated with the probability of having taken an HIV test. Qualitative findings indicated that the limited uptake of HIV testing was linked to poor knowledge on service availability and to low risk perceptions.ConclusionWith only 10% of the total sample ever having tested for HIV, our study confirmed that male HIV testing remains unacceptably low in Sub-Saharan Africa. This results from a combination of health system factors, indicating general barriers to access, and motivational factors, such as one’s own knowledge of service availability and risk perceptions. Our findings suggested that using antenatal care and curative services as the exclusive entry points into HIV testing may not be sufficient to reach large portions of the male population. Thus, additional strategies are urgently needed to increase service uptake.

Stakeholders' perceptions on factors influencing male involvement in prevention of mother to child transmission of HIV services in Blantyre, Malawi.

BackgroundMale Involvement (MI) in the Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) services is essential in a patriarchal society where men are decision makers of the household. Male partners have a role in the woman’s risk of acquiring HIV, uptake of HIV testing and participation in Mother to Child Transmission (MTCT) prevention programmes. Although MI is important for uptake of PMTCT interventions, it remains low in Africa. The purpose of this study was to identify factors that promote and hinder MI in PMTCT services in antenatal care (ANC) services in Blantyre, Malawi. Understanding of the factors that influence MI will assist in developing strategies that will involve men more in the programme thereby improving the uptake of PMTCT and HIV testing and counselling services by women and men respectively.MethodsAn exploratory qualitative study was conducted from December 2012 to January 2013 at South Lunzu Health Centre (SLHC) in Blantyre, Malawi. It consisted of six face to face Key Informant Interviews (KIIs) with health care workers and four Focus Group discussions (FGDs) with 18 men and 17 pregnant women attending antenatal care at the clinic. The FGDs were divided according to sex and age. All FGDs and KIIs were digitally recorded and simultaneously transcribed and translated verbatim into English. Data were analysed using thematic content analysis.ResultsParticipants in both FGDs and KIIs identified the following barriers: lack of knowledge of MI in PMTCT, socioeconomic factors, relationship issues, timidity to be seen in a woman’s domain, unplanned and or extramarital pregnancies, fear of knowing one's HIV status, unwillingness to be associated with the service, health facility based factors, peer influence and cultural factors. The factors that would potentially promote male involvement were categorized into community, health facility and personal or family level factors.ConclusionsThe factors that may hinder or promote MI arise from different sources. The success of MI lies on recognizing sources of barriers and averting them. Factors that promote MI need to be implemented at different levels of health care.

HIV testing and retention in care of infants born to HIV- infected women enrolled in 'Option B+', Thyolo, Malawi.

Prevention of mother-to-child transmission 'Option B+' originated in Malawi in 2011 to prevent new infections in infants exposed to the human immunodeficiency virus (HIV). We assessed 12-month programme retention and HIV testing uptake among infants born to HIV-infected mothers from September 2011 to June 2012 in Thyolo District Hospital. Of 513 infants, 368 (71.7%) remained in care at 12 months. Altogether, 412 (80.3%) underwent HIV DNA polymerase chain reaction testing, with 267 (52.0%) tested at 6-12 weeks, and 255 (49.7%) underwent rapid HIV testing, with 144 (28.1%) tested at 12 months. Eighty-eight (17.2%) infants had both tests as scheduled. Measures are needed to improve adherence to national testing protocols.

Healthcare workers' experiences of HIV testing in Tshwane, South Africa.

In an era when antiretroviral (ARV) therapy has become part of the Human Immunodeficiency Virus (HIV) prevention strategy, early testing and introduction to ARVs iscritical for improving public health outcomes in general and, in particular, the lives of people living with HIV. South Africa has the highest number of people living with HIV as compared with the rest of the world. Initiated voluntary HIV counselling and testing and provider initiated counselling and testing (PICT) are required in order to increase the uptake of HIV testing. To explore and describe the experiences of healthcare workers who are themselves in need of HIV testing. A descriptive, exploratory design was used. In-depth interviews were conducted with the 26 healthcare workers who were involved in HIV testing in the Tshwane district of South Africa. The participants were sampled purposively from two healthcare settings. A thematic framework was used for data analysis. There was a complication with regard to PICT as healthcare workers felt they could not initiate HIV testing for themselves and or their work colleagues without their confidentiality being compromised. This was complicated further by both the perceived and actual fear of stigmatisation and discrimination. It was difficult for qualified staff to support and encourage the uptake of HIV testing by students nurses as this was seen, albeit incorrectly, as targeting the students in a negative manner. There is a need for accessible HIV testing policies for healthcare workers in order to increase access to HIV testing and prevent the progression of the disease.

Use of community volunteers to improve knowledge and uptake of tuberculosis and human immunodeficiency virus screening services among community members in Qu′an Pan Local Government Area, Plateau State

Background: The global impact of the converging dual epidemics of tuberculosis (TB) and human immunodeficiency virus (HIV)/AIDS is one of the major public health challenges of our time. Ignorance, fear, stigma and poverty have promoted the course of TB and HIV infections, particularly among people residing in the rural areas despite the availability of free diagnostic and treatment services. Community volunteers (CV) have been used successfully to promote and sustain knowledge and utilization of health services in various parts of the world. This study sought to determine the impact of the use of CV on knowledge and uptake of TB/HIV screening services in the study population. Methodology: The study design was a community-based quasi-experimental study. A multistage sampling technique was used to select the study participants. The Primary Health Care (PHC centres offering TB and HIV screening services were the primary sampling units while the communities close to the PHCs were the secondary sampling units. The intervention involved a CV in each community providing education and services on TB and HIV/AIDS infections to the community members. Knowledge and uptake of TB and HIV screening services among the community members were assessed before and after the intervention. Results: A total of 1305 people were recruited into the study and five communities each were selected per PHC. Postintervention, there was an increase in the knowledge of the cause, mode of transmission, symptoms and treatment of TB among community members from a mean score of 2.23 ± 2.31 to 5.37 ± 2.64 (P < 0.0001). There was also an increase in the knowledge of the modes of transmission, symptoms and prevention of HIV/AIDS among community members from a mean score of 6.66 ± 2.92 to 8.36 ± 3.35 (P < 0.0001). Uptake of TB screening rose from 59.4% to 75.0% (P = 0.0161) among community members with a history of chronic cough and uptake of HIV counselling and testing (HCT) also rose from 53.8% to 64.1% (P = 0.0215) among the community members.Conclusion: Community Volunteers were found to improve the people's knowledge of TB and HIV/AIDS infections as well as uptake of HCT and TB screening services. Their use will help improve TB and HIV collaborative activities and also contribute to the reduction of morbidity and mortality associated with TB and HIV infections.

Human immunodeficiency virus/Acquired immune deficiency syndrome (HIV/AIDS), Related knowledge, risk perception and practice of confidential counseling and testing for HIV among patients in a tertiary health institution in North Western Nigeria

Acquired immune deficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV) is the leading cause of death in sub-Sahara Africa. A major focal point of the epidemiology and spread of HIV infection and AIDS is HIV/AIDS related knowledge, especially as these affect AIDS risk behaviors in vulnerable populations of Africa. While HIV testing serves as the gateway to treatment, care, and prevention of HIV/AIDS; uptake of HIV testing is very low in sub-Saharan Africa. This study was conducted to assess the HIV/AIDS related knowledge, risk perception and practice of HIV confidential counseling and testing among patients in Sokoto. A descriptive cross-sectional study among 184 randomly selected patients attending the medical outpatient clinic of Specialist Hospital Sokoto, Nigeria was conducted in September 2010. Informed consent was taken and information was collected by a pre-designed questionnaire, data analysis was done using computer software, SPSS version 17. Almost all the patients (97.8%) have heard about HIV/AIDS. Although only 18.3% knew the causative agent, majority had adequate knowledge of transmission (71.1%) and prevention (62.2%) of the disease, with a few among them having some misconceptions. Most (89.4%) perceived the disease to be a serious threat to them, but some still engaged in sharing needle with another person (12.2%), and casual sex (8.3%). Barely half (57.2%) knew where to do HIV test, and only 23.9% have been tested for HIV. Inadequate awareness and poor practice of HIV testing was demonstrated in this study despite adequate knowledge and perception of risk of HIV/AIDS. This suggests the need for all the stakeholders to intensify health education aimed at removing misconceptions about the disease and improving uptake of HIV testing. Key words: Acquired immune deficiency syndrome/human immunodeficiency virus (HIV/AIDS), knowledge, risk perception, confidential counseling and testing.

HIV infection in severely malnourished children in Kumasi, Ghana: a cross-sectional prospective study

BackgroundThe Human Immunodeficiency Virus (HIV) epidemic has adversely affected the nutritional status and mortality of children in Africa. This study assessed the disease burden, predictive clinical features and outcomes for children with severe acute malnutrition (SAM) and concomitant HIV infection.MethodsThis was a cross-sectional prospective study of children with SAM aged between 3 months and 13 years admitted to the nutritional rehabilitation unit (NRU) of Komfo Anokye Teaching Hospital. Socio-demographic, anthropometric and clinical data were documented and HIV serostatus established with 2 rapid HIV antibody tests and Enzyme-linked immunosorbent assay, if indicated. HIV viral polymerase chain reaction testing was not available at the time of the study. Logistic regression analyses were used to identify significant clinical predictors of HIV seropositivity.ResultsSixty-seven (27.2%, 95% CI = 21.8-33.3%) of the 246 study children had positive HIV antibody results. Uptake of provider-initiated HIV testing and counselling was 100%. Amongst children aged 18 months and over, the HIV seroprevalence was 28.3% (30/106). HIV seropositivity was strongly associated with prolonged fever, cough and diarrhoea; oral thrush, generalised lymphadenopathy and pulmonary tuberculosis (p value < 0.001 for all parameters). The presence of ≥ 3 of the first 5 aforementioned parameters was highly specific (98.3-100%) for HIV seropositivity in study children. HIV seropositivity was also significantly associated with cough, vomiting, lethargy/altered consciousness, skin rash and hepatomegaly (p value < 0.05 for all parameters). Overall mortality rate was 17.5%, with HIV seropositive children having a significantly higher mortality rate (37.8% versus 10.1%; p value < 0.001) and a lower rate of weight gain (2.4 g/kg/day versus 7.0 g/kg/day; p value < 0.001).ConclusionsHIV testing was well accepted by parents/carers and should be offered in all NRUs. There was a high HIV seroprevalence among children with SAM and a significantly poorer outcome in mortality and weight gain. Some clinical features were identified to be predictive of HIV seropositivity and could be useful as indicators to prompt further investigation and/or referral in resource limited settings where HIV test kits are unavailable. This would aid in the early detection and comprehensive management of the HIV seropositive child with SAM.

Community-based intervention to enhance provision of integrated TB-HIV and PMTCT services in South Africa

To conduct an impact assessment of an intervention to enhance the provision of community-based integrated services for tuberculosis (TB), human immunodeficiency virus (HIV) and prevention of mother-to-child transmission (PMTCT). The intervention consisted of a combination of training of community care workers (CCWs), structural adjustments, harmonisation of scope of practice and stipend of CCWs and enhanced supervision of CCWs to provide comprehensive TB-HIV/PMTCT services in a rural South African district. A before and after study design was used with a household survey to assess the operational effectiveness of the intervention. Six clusters were randomised into intervention and control arms. Quantitative data were analysed using logistic regression, adjusting for cluster design. Logistic regression analyses of the survey data show that CCWs from the intervention arm performed better in the provision of TB-HIV/PMTCT services, such as screening for TB and sexually transmitted infections, adherence to anti-tuberculosis treatment and antiretroviral therapy and counselling on infant feeding compared to the control CCWs (P < 0.05). However, intervention CCWs performed worse in the integrated management of childhood illnesses education and social welfare referrals (P < 0.05). The uptake of HIV testing increased significantly in the intervention arm, from 55% to 78% (P < 0.001). The intervention was effective in enhancing the provision of community-based TB-HIV and PMTCT services. However, attention to other primary health care services is required to ensure that all key services are provided.

Uptake of HIV testing and HIV positivity among presumptive tuberculosis patients at Puducherry, South India.

Puducherry, a district in South India with a low prevalence of human immunodeficiency virus (HIV) infection (<1% among antenatal women). 1) To estimate the proportion of patients with known HIV status who were HIV-positive, 2) to describe the demographic and clinical characteristics of patients with unknown HIV status among presumptive TB patients, and 3) to assess the additional workload at HIV testing centres. In this cross-sectional study, consecutive presumptive TB patients attending microscopy centres for diagnosis during March-May 2013 were asked if they knew their HIV status. Patients with unknown HIV status were offered voluntary counselling and HIV testing. Of 1886 presumptive TB patients, HIV status was ascertained for 842 (44.6%); 28 (3.3%) were HIV-positive. The uptake of HIV testing was significantly higher in younger age groups, males, residents of Puducherry and smear-positive TB patients. The median increase in the number of clients tested for HIV per day per testing centre was 1 (range 0-6). The uptake of HIV testing was low. HIV prevalence was higher among presumptive TB patients than in antenatal women, and as high as in TB patients. With minimal increase in workload at HIV testing centres, HIV testing could be implemented using existing resources.

The ethics of feedback of HIV test results in population-based surveys of HIV infection

Population-based disease prevalence surveys raise ethical questions, including whether participants should be routinely told their test results. Ethical guidelines call for informing survey participants of any clinically relevant finding to enable appropriate management. However, in anonymous surveys of human immunodeficiency virus (HIV) infection, participants can "opt out" of being given their test results or are offered the chance to undergo voluntary HIV testing in local counselling and testing services. This is aimed at minimizing survey participation bias. Those who opt out of being given their HIV test results and who do not seek their results miss the opportunity to receive life-saving antiretroviral therapy. The justification for HIV surveys without routine feedback of results to participants is based on a public health utility argument: that the benefits of more rigorous survey methods - reduced participation bias - outweigh the benefits to individuals of knowing their HIV status. However, people with HIV infection have a strong immediate interest in knowing their HIV status. In consideration of the ethical value of showing respect for people and thereby alleviating suffering, an argument based on public health utility is not an appropriate justification. In anonymous HIV surveys as well as other prevalence surveys of treatable conditions in any setting, participation should be on the basis of routine individual feedback of results as an integral part of fully informed participation. Ensuring that surveys are ethically sound may stimulate participation, increase a broader uptake of HIV testing and reduce stigmatization of people who are HIV-positive.

Stigma and underutilization of facility-based sexually transmitted infection services undermine human immunodeficiency virus testing in rural communities of Rivers State, Nigeria

Context: Human immunodeficiency virus (HIV) testing is a critical step in limiting the spread of the virus and ensuring access to prevention, treatment, care and support. Aims: The study examines the consequences of stigma and underutilization of facility-based sexually transmitted infection (STI) services on the uptake of HIV testing in rural communities of Rivers State, Nigeria, in other to provide information necessary to address the problem. Materials and Methods: A cross-sectional study was conducted between the 1 st and 30 th July 2011 among men and women of reproductive age living in rural communities of Rivers State, Nigeria, using a multistage sampling technique. Data were analyzed using the Epi-info version 6.04d, with confidence limit set at 95%. Results: A total of 596 participants: 270 men (45.3%) and 326 women (54.7%) were interviewed. Their mean age was 26.59 ± 7.77 years. Only 226 (37.9%) of them had ever tested for HIV. Most had stigmatizing attitudes towards HIV positive persons, 164 (71.6%) and had not tested for HIV (χ2 = 8.85, df = 1, P = 0.003). Of those who reported STIs, only 45.7% received treatment from a health facility, against 188 (54.3%) who did not. Consequently, only 90 (67.2%) of them were tested for HIV compared to 44 (32.8%) who received treatment from informal care providers (χ2 = 8.41, df = 1, P = 0.000). Conclusions: Stigma and low patronage of facility-based STI services undermine HIV testing. Anti-HIV campaigns must be consciously designed to prevent and correct stigmatization, emphasize the relationship between HIV and STIs and the significance of seeking appropriate care from health facilities.

Risk factors for excess mortality and death in adults with tuberculosis in Western Kenya

To evaluate excess mortality and risk factors for death during anti-tuberculosis treatment in Western Kenya. We abstracted surveillance data and compared mortality rates during anti-tuberculosis treatment with all-cause mortality from a health and demographic surveillance population to obtain standardised mortality ratios (SMRs). Risk factors for excess mortality were obtained using a relative survival model, and for death during treatment using a proportional hazards regression model. The crude mortality rate during anti-tuberculosis treatment was 18.0 (95%CI 16.8-19.2) per 100 person-years. The age and sex SMR was 8.8 (95%CI 8.2-9.4). Excess mortality was greater in human immunodeficiency virus (HIV) positive TB patients (excess hazard ratio [eHR] 2.1, 95%CI 1.5-3.1), and lower in patients who were female or started treatment in a later year. Mortality was high in patients with unknown HIV status (HR 2.9, 95%CI 2.2-3.8) or, if HIV-positive, not on antiretroviral treatment (ART; HR 3.3, 95%CI 2.5-4.5) or not known to be on ART (HR 2.8, 95%CI 2.1-3.7). The attributable fraction of incomplete uptake of HIV testing and ART on mortality was 31% (95%CI 15-45) compared to HIV-positive patients on ART. Increasing the uptake of HIV testing and ART would further reduce mortality during anti-tuberculosis treatment by an estimated 31%.

Treatment outcomes of new adult tuberculosis patients in relation to HIV status in Zimbabwe.

All public health facilities in Chitungwiza District, Zimbabwe. To determine, in new tuberculosis (TB) patients registered in 2009, 1) the proportion of persons human immunodeficiency virus (HIV) tested, stratified by age, sex and type of TB, and 2) treatment outcomes in relation to type of TB and HIV status. Retrospective cohort study. Of 1800 TB patients, 1100 (61%) were tested, of whom 877 (80%) were HIV-positive and 75 (9%) were documented as receiving antiretroviral treatment (ART). HIV testing and HIV positivity were similar between patients with different types of TB. Overall, the treatment success rate was 70%, and 17% had transferred out. Being HIV-positive on ART was associated with better treatment success and lower transfer out; age ≥55 years was associated with poor treatment success and higher death rates. Defaulting was more common in those who did not undergo smear testing or in extra-pulmonary TB patients, while deaths were higher in males. In a Zimbabwe district, less than two thirds of TB patients were tested. Better treatment success was observed in patients documented as HIV-positive and on ART. Important lessons for improved TB control include increasing HIV testing uptake for better access to ART, more comprehensive recording practices on ART and better reporting on true outcomes of transfer-out patients.

The Effects of Health Education on Sexual Behavior and Uptake of HIV Counseling and Testing Among out of School Youths in a Nigerian Border Market

Background: This intervention study assessed the effectiveness of health education and provision of free Human Immunodeficiency Virus (HIV) counseling and testing services on sexual behavior and uptake of HIV counseling and testing (HCT) among out of school youths (15 24yrs) in a Nigerian border town market using Seme border as the study group and IdiIroko border as the control group.Methodology: One in two systematic sampling techniques was used for selecting 120 respondents in each border town market. Data was collected using a standardized validated questionnaire.Result: Both groups had similar demographic pattern, mean age of the respondents was 19 years while mean age at sexual debut was 16 years. Condom use increased from 60% to 74%, consistency of use from 15% to 19% while multiple partners decreased from 26% to 19%. Relationship was demonstrated between sexual debut and regular attendance at religious activities, alcohol consumption, having sex and multiple sexual partners. Statistically significant increase in number of youths who had done HCT post intervention from 18%to 59% (P = 0.05) was also observed.Conclusion: Provision of accessible youth friendly voluntary counseling and testing VCT services at the border as well as health education for out of school youths will help in improving uptake of VCT services and condom use among those that are sexually active.

Acceptance and uptake of voluntary HIV testing among healthcare workers in a South African public hospital

AbstractBackground: Healthcare workers are seen as being at the centre of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) management. They are also at risk of HIV infection from occupational exposure to blood-borne pathogens during their daily work activities. Although many studies on HIV/AIDS and its management have been carried out globally, only a few address HIV counselling and testing among healthcare workers. The aim of this study is to determine factors associated with the acceptance and uptake of voluntary HIV testing among healthcare workers in a public hospital in KwaZulu-Natal.Method: A cross-sectional quantitative descriptive survey was conducted among healthcare workers in a public hospital, by means of self-administered questionnaires. Written informed consent was obtained from each participant prior to participation in the study.Results: A response rate of 239 (59.4%) was achieved from a targeted population of 402 healthcare workers. Of the 239 participants, 20...

Opt-out provider-initiated HIV testing and counselling in primary care outpatient clinics in Zambia

To increase case-finding of infection with human immunodeficiency virus (HIV) in Zambia and their referral to HIV care and treatment by supplementing existing client-initiated voluntary counselling and testing (VCT), the dominant mode of HIV testing in the country. Lay counsellors offered provider-initiated HIV testing and counselling (PITC) to all outpatients who attended primary clinics and did not know their HIV serostatus. Data on counselling and testing were collected in registers. Outcomes of interest included HIV testing coverage, the acceptability of testing, the proportion testing HIV-positive (HIV+), the proportion enrolling in HIV care and treatment and the time between testing and enrolment. After the addition of PITC to VCT, the number tested for HIV infection in the nine clinics was twice the number undergoing VCT alone. Over 30 months, 44,420 patients were counselled under PITC and 31,197 patients, 44% of them men, accepted testing. Of those tested, 21% (6572) were HIV+; 38% of these HIV+ patients (2515) enrolled in HIV care and treatment. The median time between testing and enrolment was 6 days. The acceptability of testing rose over time. The introduction of routine PITC using lay counsellors into health-care clinics in Lusaka, Zambia, dramatically increased the uptake and acceptability of HIV testing. Moreover, PITC was incorporated rapidly into primary care outpatient departments. Maximizing the number of patients who proceed to HIV care and treatment remains a challenge and warrants further research.

Changes in Human Immunodeficiency Virus Testing Rates Among Urban Adolescents After Introduction of Routine and Rapid Testing

To examine human immunodeficiency virus (HIV) testing rates among adolescents during a 3-year period to determine (1) if the rate of testing increased after publication of national recommendations for routine HIV testing in 2006, and again after the introduction of rapid testing in the clinic in 2007, and (2) factors associated with HIV testing. Retrospective medical record review. Urban hospital-based adolescent primary care clinic. Thirteen- to 22-year-old sexually experienced patients who had computerized billing data reflecting testing for sexually transmitted infections, including HIV. Rates of HIV testing for each of 3 one-year phases-phase 1 (pre-routine testing recommendations), phase 2 (post-routine testing recommendations but pre-rapid testing), and phase 3 (post-rapid testing)-and factors associated with HIV testing. In total, 9491 patients were included. The rate of HIV testing in phase 2 was significantly higher than the rate of testing in phase 1 (27.7% vs 12.6%, P < .001). The rate of testing in phase 3 was significantly higher than the rate of testing in phase 2 (44.6% vs 27.7%, P < .001) and phase 1 (P < .001). Factors independently associated with HIV testing included phase, older age, male sex, race, public insurance status, and having a genitourinary-related diagnosis during the same phase. The HIV testing rates increased significantly following publication of recommendations for routine testing and further increased following introduction of rapid testing. Combining routine and rapid testing strategies may increase uptake of HIV testing among adolescents in primary care settings.