RESUMO
To help diagnose and initiate antiretroviral therapy (ART) for ≥95% of all persons living with HIV (PLHIV), the World Health Organization (WHO) recommends offering HIV testing to biological children, and sexual and needle-sharing partners of all PLHIV (index-client testing, ICT). Many index clients, however, do not identify or have contactable partners, and often substantially fewer than 95% of HIV-positive partners initiate ART soon after index testing. To help improve early HIV diagnosis and ART initiation in Eswatini (formerly Swaziland), we implemented a community-based HIV testing and peer-delivered, linkage case management program (CommLink) that provided ICT as part of a comprehensive package of WHO recommended linkage services. CommLink was implemented June 2015 -March 2017 (Phase I), and April 2017 -September 2018 (Phase II). In addition to biological children and partners, HIV testing was offered to adult family members (Phases I and II) and high-risk associates including friends and acquaintances (Phase II) of CommLink index clients. Compared with Phase I, in Phase II proportionally more CommLink clients disclosed their HIV-infection status to a partner or family member [94% (562/598) vs. 75% (486/652)], and had ≥1 partners, family members, or high-risk associates (contacts) tested through CommLink [41% (245/598) vs. 18% (117/652)]. Of 537 contacts tested, 253 (47%) were HIV-positive and not currently in HIV care, including 17% (17/100) of family members aged <15 years, 42% (78/187) of non-partner family members aged ≥15 years, 60% (73/121) of sexual partners, and 66% (85/129) of high-risk associates. Among 210 HIV-positive contacts aged ≥15 years who participated in CommLink, nearly all received recommended linkage services including treatment navigation (95%), weekly telephone follow-up (93%), and ≥3 counseling sessions (94%); peer counselors resolved 76% (306/404) of identified barriers to care (e.g., perceived wellness); and 200 (95%) initiated ART at a healthcare facility, of whom 196 (98%) received at least one antiretroviral refill before case-management services ended. To help countries achieve ≥90% ART coverage among all PLHIV, expanding ICT for adult family members and high-risk associates of index clients, and providing peer-delivered linkage case management for all identified PLHIV, should be considered.
Assuntos
Sorodiagnóstico da AIDS , Fármacos Anti-HIV/uso terapêutico , Cônjuges/estatística & dados numéricos , Sorodiagnóstico da AIDS/estatística & dados numéricos , Adolescente , Adulto , Continuidade da Assistência ao Paciente , Essuatíni/epidemiologia , Família , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Acessibilidade aos Serviços de Saúde , Humanos , Armazenamento e Recuperação da Informação , Masculino , Adulto JovemRESUMO
Systems serology provides a broad view of humoral immunity by profiling both the antigen-binding and Fc properties of antibodies. These studies contain structured biophysical profiling across disease-relevant antigen targets, alongside additional measurements made for single antigens or in an antigen-generic manner. Identifying patterns in these measurements helps guide vaccine and therapeutic antibody development, improve our understanding of diseases, and discover conserved regulatory mechanisms. Here, we report that coupled matrix-tensor factorization (CMTF) can reduce these data into consistent patterns by recognizing the intrinsic structure of these data. We use measurements from two previous studies of HIV- and SARS-CoV-2-infected subjects as examples. CMTF outperforms standard methods like principal components analysis in the extent of data reduction while maintaining equivalent prediction of immune functional responses and disease status. Under CMTF, model interpretation improves through effective data reduction, separation of the Fc and antigen-binding effects, and recognition of consistent patterns across individual measurements. Data reduction also helps make prediction models more replicable. Therefore, we propose that CMTF is an effective general strategy for data exploration in systems serology.
Assuntos
Sorodiagnóstico da AIDS , Teste Sorológico para COVID-19 , COVID-19/imunologia , Interpretação Estatística de Dados , Infecções por HIV/imunologia , Sorodiagnóstico da AIDS/métodos , Sorodiagnóstico da AIDS/estatística & dados numéricos , Anticorpos Antivirais/sangue , Anticorpos Antivirais/metabolismo , Teste Sorológico para COVID-19/métodos , Teste Sorológico para COVID-19/estatística & dados numéricos , Humanos , Imunidade Humoral , Células Matadoras Naturais/imunologia , Modelos Logísticos , Receptores Fc/imunologia , Receptores de IgG/imunologiaRESUMO
ABSTRACT: While pediatric human immunodeficiency virus (HIV) testing has been more focused on children below 18âmonths through prevention of mother to child transmission of HIV (PMTCT), the yield of this approach remains unclear comparatively to testing children above 18âmonths through routine provider-initiated testing and counselling (PITC). This study aimed at assessing and comparing the HIV case detection and antiretroviral therapy (ART) enrolment among children below and above 18âmonths of age in Cameroon. This information is required to guide the investments in HIV testing among children and adolescents.We conducted a cross-sectional study where we invited parents visiting or receiving HIV care in 3 hospitals to have their children tested for HIV. HIV testing was done using polymerase chain reaction (PCR) and antibody rapid tests for children <18âmonths and those ≥18âmonths, respectively. We compared HIV case detection and ART initiation between the 2 subgroups of children and this using Chi-square test at 5% significant level.A total of 4079 children aged 6 weeks to 15âyears were included in the analysis. Compared with children <18âmonths, children group ≥18âmonths was 4-fold higher among those who enrolled in the study (80.3% vs 19.7%, Pâ<â.001); 3.5-fold higher among those who tested for HIV (77.6% vs 22.4%, Pâ<â.001); 6-fold higher among those who tested HIV+ (85.7% vs 14.3%, Pâ=â.24), and 11-fold higher among those who enrolled on ART (91.7% vs 8.3%, Pâ=â.02).Our results show that 4 out of 5 children who tested HIV+ and over 90% of ART enrolled cases were children ≥18âmonths. Thus, while rolling out PCR HIV testing technology for neonates and infants, committing adequate and proportionate resources in antibody rapid testing for older children is a sine quo none condition to achieve an acquired immunodeficiency syndrome (AIDS)-free generation.
Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Programas de Rastreamento/estatística & dados numéricos , Adolescente , Fatores Etários , Camarões/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , HIV/imunologia , Infecções por HIV/epidemiologia , Humanos , Lactente , Masculino , Programas de Rastreamento/métodosRESUMO
To explore the effects of urea dissociation on reducing false-positive results of the Elecsys HIV combi PT assay. A retrospective analysis was used to evaluate the false-positive rate of the Elecsys HIV combi PT assay. Six false-positive sera, six positive sera and six sera from patients with early HIV infection were collected. Dissociation was performed using 1 mol/L, 2 mol/L, 4 mol/L, 6 mol/L, or 8 mol/L urea, and HIV screening assay were then detected to select the appropriate concentration of urea dissociation. Next, 55 false-positive sera and 15 sera from early HIV infection were used to verify the best concentration of urea to achieve dissociation. Retrospective analysis showed that the COI of the Elecsys HIV combi PT assay in false-positive sera ranged from 1.0 to 200.0, and approximately 97.01%(227/234) of false-positive sera were in the range of 1.0-15.0. The avidity index (AI) in positive and false-positive sera decreased as the urea dissociation concentration increased. When the dissociation concentration was 6 mol/L, the AI of false-positive serum was between 0.0234 and 0.2567, and the AI of early HIV infection sera was between 0.4325 and 0.5017. The difference in AI between false-positive and positive samples was significant. When negativity was defined as an AI of less than 0.3970, the sensitivity and specificity were 100.0% and 100.0%, respectively. Urea-mediated dissociation could significantly reduce the false-positive rate of the Elecsys HIV combi PT assay with a low COI. Our findings provided a reference for distinguishing positive and false-positive of the Elecsys HIV combi PT assay.
Assuntos
Sorodiagnóstico da AIDS/métodos , Infecções por HIV/diagnóstico , Sorodiagnóstico da AIDS/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Western Blotting , Criança , Pré-Escolar , China , Diagnóstico Precoce , Técnicas Eletroquímicas , Reações Falso-Positivas , Feminino , Anticorpos Anti-HIV/sangue , Infecções por HIV/sangue , Infecções por HIV/imunologia , Humanos , Indicadores e Reagentes , Lactente , Recém-Nascido , Luminescência , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Ureia , Adulto JovemRESUMO
Early antiretroviral therapy (ART) initiation is essential, but linkage to care following community-based services is often poor, and inadequately understood. This study examined factors influencing linkage to care following home-based HIV-testing services (HBHTS) in a hyper-endemic setting in South Africa. HBHTS was offered to participants (N = 10,236) enrolled in the second HIV Incidence Provincial Surveillance System survey (2015-2016), KwaZulu-Natal. Follow-up telephone surveys with 196 of the 313 individuals diagnosed HIV-positive through HBHTS were used to measure linkage to care (i.e., a clinic visit within 12 weeks) and ART-initiation. Among newly diagnosed individuals (N = 183), 55% linked to care, and 21% of those who were ART-eligible started treatment within 12 weeks. Linkage to care was less likely among participants who had doubted their HIV-diagnosis (aOR:0.46, 95%CI: 0.23-0.93) and more likely among participants who had disclosed their HIV-status (aOR:2.31, 95%CI: 1.07-4.97). Reasons for not linking to care included no time (61%), only wanting to start treatment when sick (48%), fear of side-effects (33%), and not believing the HIV-diagnosis (16%). Results indicate that HBHTS needs to be paired with targeted interventions to facilitate early linkage to care. Interventions are required to counter denial of HIV status and facilitate early linkage to care among healthier individuals.
Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade , Serviços de Saúde Comunitária , Escolaridade , Feminino , Insegurança Alimentar , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Serviços de Assistência Domiciliar , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , África do Sul/epidemiologia , Resultado do Tratamento , Adulto JovemRESUMO
Growing demand for use of Health Facility (HF) HIV testing data, in addition to other testing data to obtain district level HIV prevalence requires understanding the comparability of these various sources. We analysed the 2011 Uganda AIDS indicator survey data to assess: the proportion of people tested for HIV across Uganda by venue of testing; HIV prevalence ratio for those tested in a HF compared to those tested in community setting; [Katz, D., Baptista, J., Azen, S. P., & Pike, M. C. (1978). Obtaining confidence intervals for the risk ratio in cohort studies. International Biometric Society, 34(3), 469-474. https://doi.org/10.2307/2530610] and factors associated with HIV positivity in each subgroup. Of the 11,685 individuals, 8978 (77.1%) had ever tested for HIV in a HF. Fifty nine per cent tested in a HF in the 12 months preceding the survey (female: 5507, 72.7% versus male: 1413, 34.9%). HIV prevalence ratio was 1.8 times among those tested in a HF compared to those tested at community setting (10.9% [95% CI: 10.0-11.7] versus 6.2% [95% CI: 5.4-7.0]). Among HF testers, older age group, previously married and having no sexual partner was associated with significantly higher HIV prevalence. Using facility testing data for planning and decisions should take into consideration the elevated and varying HIV prevalence among individuals accessing HIV testing services at HFs as well as differences in their social-demographic characteristics.
Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Teste de HIV/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Sorodiagnóstico da AIDS/métodos , Adolescente , Adulto , Estudos de Coortes , Feminino , Infecções por HIV/prevenção & controle , Sistemas de Informação em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Parceiros Sexuais , Fatores Socioeconômicos , Uganda/epidemiologia , Adulto JovemRESUMO
Before 2014, the only test used for anonymous voluntary human immunodeficiency virus (HIV) screening at public health centers (PHCs) in the Republic of Korea was an enzyme-linked immunosorbent assay (ELISA), which takes around 3 days to obtain results. In 2014, to encourage voluntary anonymous HIV screening tests, the Seoul Metropolitan Government adopted a rapid HIV screening test at PHCs. The rapid HIV screening test was introduced at four PHCs in 2014 and all 25 PHCs after 2015. We compared the numbers of HIV screening tests and confirmed positive individuals before and after introduction of the rapid HIV screening test. In 2012-2013, before the introduction of rapid HIV screening test, an average of 330 HIV screening tests were performed monthly (355 in 2012 and 305 in 2013) and 69 individuals were confirmed to have HIV in 2012 and 93 in 2013. After the introduction of the rapid HIV screening test, anonymous voluntary HIV screening increased to a monthly average of 447 tests in 2014, 2099 in 2015, and 2409 in 2016. These identified 38 new cases in 2014, 116 in 2015, and 143 in 2016. Adoption of the rapid HIV screening test has increased the number of HIV screening tests and confirmed cases.
Assuntos
Sorodiagnóstico da AIDS/métodos , Ensaio de Imunoadsorção Enzimática/métodos , Teste de HIV/métodos , Programas de Rastreamento/estatística & dados numéricos , Sorodiagnóstico da AIDS/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Teste de HIV/estatística & dados numéricos , Humanos , Projetos Piloto , Saúde Pública , República da Coreia , SeulRESUMO
Novel viral load monitoring strategies are needed to help individuals maintain an undetectable viral load (UVL). In 2018, U.S. MSM living with HIV with a past detectable VL received a dried blood spot (DBS) kit at baseline and 3-month follow-up and returned specimens to a research laboratory. Of 56 consenting participants, 91% returned specimens at baseline and 77% at 3-month follow-up; 74% who returned two specimens had UVL at both time points. At-home DBS collection and longitudinal VL monitoring is feasible among U.S. MSM with fluctuating viral load. This complementary approach to clinical care could improve viral suppression maintenance.
RESUMEN: Se necesitan nuevas estrategias para evaluar los niveles de la carga viral para ayudar a las personas viviendo con VIH a mantener una carga viral indetectable (CVI). En 2018, hombres viviendo con VIH, que reportaron sexo con hombres y una carga viral detectable, recibieron dos paquetes de materiales para colectar muestras de sangre seca después de completar una evaluación basal y después de tres meses de seguimiento. Participantes devolvieron las muestras de sangre seca a un laboratorio. De 56 participantes que dieron su consentimiento a participar en el estudio, el 91% devolvió una muestra de sangre seca al inicio del estudio y el 77% a los 3 meses de seguimiento. Además, el 74% que devolvió dos muestras de sangre seca tenían CVI en ambos puntos de tiempo. La colección de sangre seca en el hogar y el monitoreo longitudinal de la carga viral de VIH es factible entre los hombres viviendo con el VIH y que tienen sexo con hombres. Los resultados de este estudio pueden proporcionar un enfoque complementario a la atención clínica para mejorar la supresión viral del VIH.
Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Teste em Amostras de Sangue Seco/métodos , Infecções por HIV/virologia , HIV-1/imunologia , Homossexualidade Masculina , Manejo de Espécimes/métodos , Carga Viral/métodos , Sorodiagnóstico da AIDS/métodos , Adulto , Fármacos Anti-HIV/administração & dosagem , Terapia Antirretroviral de Alta Atividade , Estudos de Viabilidade , Infecções por HIV/tratamento farmacológico , HIV-1/genética , Humanos , Masculino , Projetos Piloto , RNA Viral/sangue , Kit de Reagentes para Diagnóstico/estatística & dados numéricos , Autocuidado , Sensibilidade e EspecificidadeRESUMO
Offering people living with HIV the opportunity to refer partners for HIV testing is an efficient way of identifying new HIV diagnoses. This report describes the outcomes of physician-led partner services at an urban academic center. Patients with HIV VL > 1000 copies/mL in both inpatient and outpatient settings were offered partner notification services (PNS). Of referred partners, 8.7% had a new diagnosis of HIV. New HIV+ partners were as likely to be referred by patients with existing HIV diagnoses as new diagnoses (p = 0.61), and as likely to be referred by patients interviewed while hospitalized as those in the clinic (p = 0.61).
Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Busca de Comunicante/métodos , Infecções por HIV/diagnóstico , Encaminhamento e Consulta/estatística & dados numéricos , Parceiros Sexuais/psicologia , Sorodiagnóstico da AIDS/métodos , Adulto , Instituições de Assistência Ambulatorial , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Uso Comum de Agulhas e Seringas , Carga ViralRESUMO
INTRODUCTION: Neurosyphilis can occur at any stage of syphilis. After treatment, 30%-40% of syphilis patients remained serofast. But the prevalence of asymptomatic neurosyphilis (ANS) among serofast syphilis patients remains unclear. Untimely treatment or improper management for ANS may result in neurological complications. So we perform the meta-analysis to evaluate the prevalence of ANS cases among HIV-negative serofast syphilis patients for exploring their relationship and addressing their clinical management. METHODS: We searched CNKI, Wan Fang, VIP, CBMdisc, PubMed, Embase and Medline from January 1st 1990 to September 22nd 2020 for both English and Chinese records. We strictly restrict the eligibility criteria. STROBE was used for reporting quality assessment. We examined forest plots and conducted both fix-effects and random-effects to estimate prevalence by R version 3.6.2/R studio 1.2.1335 statistical software packages META version 4.9-9. If appropriate, between-study heterogeneity was examined using the I2 statistic and subgroup analysis. RESULTS: Of 77 screened records, 5 were included. The pooled prevalence of ANS among HIV-negative serofast syphilis patients was 13% (95% CI 3%-23%; I2 = 93% P<0.01, 417 people). The prevalence of ANS for the verified ANS classification definition was 3% (95% CI 0%-7%; I2 = 67% P = 0.08, two studies, 189 people), and 21% (95% CI 6%-36%; I2 = 86% P<0.01, three studies, 228 people) for the likely ANS classification. The prevalence of ANS among the serofast syphilis patients who were followed up for one year was 29% (95% CI 22%-36%; I2 = 0% P = 0.5, two studies, 167 people) and 5% (95% CI 0%-13%; I2 = 79% P = 0.03, two studies, 144 people) for two years. The prevalence in the studies from different geographical subgroups was as follows: 9% (95% CI 0%-19%; I2 = 82% P<0.01, three studies, 169 people) in South-central China, 6% (95% CI 1%-10%; one study, 106 people) in East China, and 30% (95% CI 23%-38%; one study, 142 people) in North China. CONCLUSION: This meta-analysis showed a high estimated prevalence of ANS in HIV-negative serofast syphilis patients, the prevalence of ANS among patients diagnosed with the verified ANS case definition is much lower than that for the likely ANS classification. It may be necessary to carry out nontreponemal test, protein test and leukocyte count for cerebrospinal fluid (CSF) in treated serofast patients for better clinical management to avoid neurological complications. The case classification definition of ANS is a key factor to evaluate the prevalence. Geographical heterogeneity needs more studies to detect. In future we need better-design studies to explore relationship between ANS and serofast status.
Assuntos
Infecções Assintomáticas/epidemiologia , Infecções por HIV/diagnóstico , Neurossífilis/epidemiologia , Sorodiagnóstico da AIDS/estatística & dados numéricos , China/epidemiologia , Infecções por HIV/sangue , Humanos , Neurossífilis/sangue , Neurossífilis/diagnóstico , Prevalência , Fatores de Risco , Sorodiagnóstico da Sífilis/estatística & dados numéricosRESUMO
Sri Lanka has a low-level HIV epidemic. This study aims to provide evidence on HIV, syphilis and hepatitis B (HBV) prevalence, sexual risk behaviours and utilisation of HIV prevention interventions among female sex workers (FSW) in the cities Colombo, Galle, and Kandy. Using respondent-driven sampling (RDS), we recruited a total of 458 FSW in Colombo, 360 in Galle and 362 in Kandy from November 2017 to March 2018. Participants provided biological specimens for testing for infections and completed a behavioural questionnaire. We found no HIV nor HBV infections in Galle and Kandy, and low HIV (0.4%) and HBV surface antigen (0.6%) prevalence in Colombo. FSW in Colombo had higher positivity on Treponema pallidum-particle agglutination test (8.4%) compared to Galle (2.0%) and Kandy (2.5%). About two thirds of FSW heard of HIV in each of the cities. Around 90% of FSW used condom at last sex with a client in both Colombo and Galle, but considerably less in Kandy (57.1%). However, lower proportion of FSW used condoms every time during sex with clients in the past 30 day: 22.9% of FSW in Colombo, 26.6% in Kandy and 68.4% in Galle. Across cities, 17.5%-39.5% of FSW reported being tested for HIV in the past 12 months or knowing HIV positive status. The commonest reasons for never testing for HIV was not knowing where to test (54.2% in Colombo, 41.8% in Galle, 48.1% in Kandy) followed by inconvenient testing location (23.7% in Colombo and 31.1% in Kandy). HIV has not yet been firmly established among FSW in three cities in Sri Lanka, but the vulnerability towards HIV and STIs is substantial. HIV interventions should be intensified by expanding community-based HIV testing approaches, increasingawareness of HIV risks and addressing socio-structural vulnerabilities of FSW to HIV.
Assuntos
Soropositividade para HIV/epidemiologia , Hepatite B/epidemiologia , Profissionais do Sexo/estatística & dados numéricos , Sífilis/epidemiologia , Sorodiagnóstico da AIDS/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Sri Lanka , Sorodiagnóstico da Sífilis/estatística & dados numéricos , Sexo sem Proteção/estatística & dados numéricosRESUMO
BACKGROUND: HIV self-testing (HIVST) is an additional approach to increasing uptake of HIV testing services. The practicability and accuracy of and the preference for the capillary blood self-test (Exacto Test HIV) versus the oral fluid self-test (OraQuick HIV self-test) were compared among untrained individuals in the Democratic Republic of the Congo (DRC). METHODS: This multicenter cross-sectional study (2019) used face-to-face, tablet-based, structured questionnaires in a facility-based HIVST approach. Volunteers from the general public who were at high risk of HIV infection, who were between 18 and 49 years of age, and who had signed an informed consent form were eligible for the study. The successful performance and correct interpretation of the self-test results were the main outcomes of the practicability evaluation. The successful performance of the HIV self-test was conditioned by the presence of the control band. The sensitivity and specificity of the participant-interpreted results compared to the laboratory results were estimated for accuracy. Preference for either type of self-test was assessed. Logistic regression models were used to examine factors associated with participants' preference. RESULTS: A total of 528 participants were included in this survey. The rate of successful performance of the HIV self-tests was high, with the blood test (99.6%) and the oral-fluid test (99.4%) yielding an absolute difference of 0.2% (95% CI: -1.8 to 1.1; P = 0.568). The rate of correct interpretation of the HIV self-test results was 84.4% with the blood test versus 83.8% with the oral-fluid test (difference = 0.6; 95% CI: -0.2 to 1.7; P = 0.425). Misinterpretation (25.4% for the blood test and 25.6% for the oral-fluid test) and inability to interpret (20.4% for the blood test and 21.1% for the oral-fluid test) test results were significantly more prevalent with invalid tests. The Exacto Test HIV self-test and the OraQuick HIV self-test showed 100% and 99.2% sensitivity, and 98.9% and 98.1% specificity, respectively. Preference for oral-fluid-based HIVST was greater than that for blood-based HIVST (85.6% versus 78.6%; P = 0.008). Preference for the blood test was greater among participants with a university education (86.1%; aOR = 2.4 [95% CI: 1.1 to 4.9]; P = 0.016), a higher risk of HIV infection (88.1%; aOR = 2.3 [95% CI: 1.0 to 5.3]; P = 0.047), and knowledge about the existence of HIVST (89.3%; aOR = 2.2 [95% CI: 1.0 to 5.0]; P = 0.05). CONCLUSION: Our field observations demonstrate that blood-based and oral-fluid-based HIVST are both practicable approaches with a high and comparable rate of accuracy in the study setting. Although preference for the oral-fluid test was generally greater, preference for the blood test was greater among participants with a university education, a high risk of HIV infection, and knowledge about the existence of HIVST. Both approaches seem complementary in the sense that users can choose the type of self-test that best suits them for a similar result. Taken together, our observations support the use of the two HIV self-test kits in the DRC.
Assuntos
Sorodiagnóstico da AIDS/métodos , Infecções por HIV/diagnóstico , Sorodiagnóstico da AIDS/estatística & dados numéricos , Adolescente , Adulto , Líquidos Corporais/imunologia , Estudos Transversais , República Democrática do Congo , Feminino , Anticorpos Anti-HIV/análise , Anticorpos Anti-HIV/sangue , Infecções por HIV/sangue , Infecções por HIV/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Boca/imunologia , Participação do Paciente , Autocuidado , Inquéritos e Questionários , Adulto JovemRESUMO
Latinxs in the United States are disproportionately affected by HIV and present with more advanced disease than their non-Latinx peers, due to numerous barriers to care including HIV stigma. We describe the adaptation, implementation, and reach of Sólo Se Vive Una Vez (You Only Live Once), Baltimore's first social marketing campaign promoting HIV screening among Spanish-speaking Latinxs. The 6-month campaign promoted free HIV testing by addressing HIV stigma. The campaign included a website, a social marketing campaign, community outreach events, and advertisements via radio, billboards, local partners, and buses. During the campaign, there were 9,784 unique website users, and ads were served to over 84,592 people on social media platforms. Among Latinx HIV testers at the Baltimore City Health Department, 31.6% reported having seen or heard of Sólo Se Vive Una Vez and 25.3% of Latinx HIV testers reported that the campaign influenced them to get tested.
Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Relações Comunidade-Instituição , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Promoção da Saúde/métodos , Hispânico ou Latino/educação , Marketing Social , Estigma Social , Migrantes/educação , Baltimore , Infecções por HIV/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Hispânico ou Latino/psicologia , Humanos , Masculino , Programas de Rastreamento/métodos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Mídias Sociais , Migrantes/psicologia , Estados UnidosRESUMO
In-depth interviews were conducted with 42 HIV-positive fisherfolk and 15 health care providers to identify experiences of social support and its influence on access to and use of HIV testing, treatment, and care. Fisherfolk participants reported receiving support at some point. Prior to HIV diagnosis, this usually took the form of advice on what illness they were dealing with and remedies to use. After HIV diagnosis and disclosure to friends or family, emotional support enabled fisherfolk to come to terms with an HIV diagnosis, informational support offered guidance on how best to live with HIV, while instrumental support enabled access to relevant HIV services. Finally, affiliative support, in the form of new friends met through HIV clinic visits, provided a sense of belonging. Each of these different kinds of support assisted fisherfolk to respond positively to HIV with important consequences for secondary and tertiary prevention.
Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Antirretrovirais/uso terapêutico , Pesqueiros , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Pessoal de Saúde/psicologia , Acessibilidade aos Serviços de Saúde , Apoio Social , Adulto , Aconselhamento , Emprego , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Humanos , Entrevistas como Assunto , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Pesquisa Qualitativa , UgandaRESUMO
INTRODUCTION: Men who have sex with men and transgender individuals (MSM/TG) carry a disproportionately high burden of HIV, including in South Africa. However, there are few empirical population-representative estimates of viral suppression and the HIV care cascade including HIV testing among this population, nor of factors associated with these outcomes. METHODS: We conducted a respondent driven sampling (RDS) survey among 301 MSM/TG in Johannesburg in 2017. Participants gave blood samples for HIV testing and viral load. Participants self-completed a survey including sociodemographics, HIV testing history, and engagement in care. We calculated RDS-II weighted estimates of the percentage of HIV-negative MSM/TG reporting HIV testing in the previous 6 months, their testing experience and preferences. Among those HIV-positive, we estimated the percentage status-aware, on ART, and virally suppressed (<50 viral copies/ml plasma). We conducted RDS-weighted robust Poisson regression to obtain weighted prevalence ratios of factors associated with 1) HIV testing among those HIV-negative; and 2) viral suppression among those HIV-positive. RESULTS: There were 118/300 HIV-positive MSM/TG, (37.5%). Of the HIV-negative MSM/TG, 61.5% reported that they had tested for HIV in the previous 6 months, which was associated with selling sex to men (Prevalence Ratio = 1.67, 95% CI 1.36-2.05). There were 76/118 HIV-positive MSM/TG (56.5%) who reported having previously tested positive for HIV and 39/118 (30.0%) who reported current ART. There were 58/118 HIV-positive MSM/TG with viral loads <50 copies/ml plasma (46.9%). Viral suppression was associated with older age (adjusted PR = 1.03, 95% CI 1.00-1.06 for each year), neighbourhood, and having bought sex from men (adjusted PR = 1.53, 95% CI 1.12-2.08). CONCLUSIONS: HIV prevalence was very high. Viral suppression among those HIV-positive was similar to the general male population in South Africa, but remains far short of national and international targets. A majority of HIV-negative MSM/TG had HIV tested in the previous 6 months, though there is room for improvement.
Assuntos
Infecções por HIV/epidemiologia , Homossexualidade Masculina , Pessoas Transgênero , Sorodiagnóstico da AIDS/estatística & dados numéricos , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/virologia , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Prevalência , Fatores Socioeconômicos , África do Sul/epidemiologia , Inquéritos e Questionários , Carga Viral , Adulto JovemRESUMO
Most of the information on clinical factors related to HIV infection is focused on key populations and young people. Therefore, there is little information on clinical factors related to HIV infection in older persons (>45 years old). In this study, data on CD4 lymphocyte counts were analyzed on adults who are linked to care and have their first CD4 cell count done from different regions of the Republic of Panama from 2012 to 2017. Samples were grouped according to late presentation status, region of origin in the country, year, gender, and age groups. Factors associated with late presentation to care and advanced HIV were assessed on each group by multivariable logistic regression. Late presentation to care was observed in 71.6% of the evaluated subjects, and advanced HIV in 54.5%. Late presentation was associated with males (adjusted odds ratio [AOR] = 1.3, 95% confidence interval [CI]=1.1-1.6, p = 0.03), age greater than 45 years old (AOR = 2.3 CI= 1.8-2.9, p < 0.001), and being from regions where antiretroviral clinics are not well instituted (AOR = 2.1, CI = 1.6-2.7, p < 0.001). Despite an increase in subjects linked to care with a CD4 test performed over the years, late presentation remained constant. Therefore, prevention policies must be reformulated. Promotion of routine HIV testing, accessibility among all population groups, installation of antiretroviral clinics, and implementation of programs as rapid initiation of antiretroviral therapy should be rolled out nationally.
Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Panamá/epidemiologia , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Fatores de Tempo , Tempo para o Tratamento , Adulto JovemRESUMO
BACKGROUND: There is a growing body of evidence positioning targeted provider-initiated testing and counselling (tPITC, also known as index case testing) as a promising HIV case-finding and linkage strategy among children and adolescents. However, the effectiveness and efficiency of this strategy is limited by low HIV testing uptake and case detection rates. Despite this fact, there is very little literature on factors associated with HIV testing uptake, HIV seropositivity and ART-enrolment in tPITC implementation among African children. This study aims to bridge this information gap and contribute in improving the effectiveness and efficiency of tPITC among children and adolescents in Cameroon and beyond. METHODS: In three ART clinics where tPITC was previously inexistent, we introduced the routine implementation of this strategy by inviting parents living with HIV/AIDS in care to have their biological children (6 weeks-19 years) HIV-tested. Children of consenting parents were HIV-tested; those testing positive were enrolled on ART. Parental and child-level characteristics associated with HIV testing uptake, seropositivity and ART-enrollment were assessed using bivariate and multivariate regression analysis at 5% significance level. RESULTS: We enrolled 1,236 parents, through whom 1,990 children/adolescents were recruited for HIV testing. Among enrolled parents, 46.2% (571/1,236) had at least one child tested, and 6.8% (39/571) of these parents had at least one HIV-positive child. Among enrolled children/adolescents, 56.7% (1,129/1,990) tested for HIV and 3.5% (40/1129) tested HIV-positive. Parental predictors of HIV testing uptake among children/adolescents were sex, occupation and duration on ART: female [aOR = 1.6 (1.1-2.5)], office workers/students [aOR = 2.0 (1.2-3.3)], and parents with ART duration > 5 years [aOR = 2.0 (1.3-2.9)] had significantly higher odds to test a child than male, farmers/traders, and parents with ART duration < 5 years respectively. The only child-level predictor of testing uptake was age: children < 18 months [aOR = 5(2-10)] had significantly higher odds to test for HIV than adolescents > 15 years. Parents of children identified as HIV-positive were more likely to be female, aged 40-60 years, farmers/traders, widows/divorcees and not on ART. Children found HIV-positive and who were ART-enrolled were more likely to be female and aged 5-9 years. However, none of the above-mentioned associations was statistically significant. CONCLUSIONS: Parents who were male, farmers/traders, and on ART for ≤ 5 years were less likely to test their children for HIV. Also, adolescents 10-19 years old were less likely to be tested. Therefore, these groups should be targeted with intensive counseling and follow-up to facilitate optimal testing uptake. No association was found between parental or child-level characteristics and HIV seropositivity among tested children. This finding prompts for further research to investigate approaches to better identify and target HIV testing to children/adolescents with the highest likelihood of HIV seropositivity. CLINICAL TRIAL REGISTRATION: Reg: CinicalTrials.gov # NCT03024762.
Assuntos
Infecções por HIV/diagnóstico , Sorodiagnóstico da AIDS/estatística & dados numéricos , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Camarões/epidemiologia , Criança , Pré-Escolar , Aconselhamento , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Soropositividade para HIV/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Relações Pais-Filho , Pais , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: Serological tests can distinguish recent (in the prior 12 months) from long-term HIV infection. Integrating recency testing into routine HIV testing services (HTS) can provide important information on transmission clusters and prioritize clients for partner testing. This study assessed the feasibility and use of integrating HIV recency into routine testing. METHODS: We conducted a multi-method study at 14 facilities in Kenya, and key informant interviews with health care providers. We abstracted clinical record data, collected specimens, tested specimens for recent infection, returned results to participants, and conducted a follow-up survey for those recently infected. RESULTS: From March to October 2018, we enrolled 532 clients who were diagnosed HIV-positive for the first time. Of these, 46 (8.6%) were recently infected. Women aged 15-24 years had 2.9 (95% confidence interval: 1.46 to 5.78) times higher adjusted odds of recent infection compared with 15-24-year-old men and those tested within the past 12 months having 2.55 (95% confidence interval: 0.38 to 4.70) times higher adjusted odds compared with those tested ≥12 months previously. Fourteen of 17 providers interviewed found the integration of recency testing into routine HTS services acceptable and feasible. Among clients who completed the follow-up interview, most (92%) felt that the recency results were useful. CONCLUSIONS: Integrating recent infection testing into routine HTS services in Kenya is feasible and largely acceptable to clients and providers. More studies should be done on possible physical and social harms related to returning results, and the best uses of the recent infection data at an individual and population level.
Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Infecções por HIV/epidemiologia , Adolescente , Adulto , Estudos de Viabilidade , Feminino , Infecções por HIV/diagnóstico , Humanos , Quênia/epidemiologia , Masculino , Parceiros Sexuais , Adulto JovemRESUMO
BACKGROUND: A prior randomized control trial showed financial incentives increase HIV testing rates for children of unknown HIV status. Translating evidence-based interventions such as these to scale requires an implementation science approach. METHODS: A qualitative study evaluating health care providers' perceptions of barriers and facilitators of a previously completed financial incentives intervention for pediatric HIV testing was conducted at health care facilities in Kisumu, Kenya. Six focus group discussions with 52 providers explored determinants of acceptability, feasibility, and sustainability of financial incentive scale-up for pediatric HIV testing using the Consolidated Framework for Implementation Research to inform question guides and thematic analysis. RESULTS: Providers found the use of financial incentive interventions for pediatric HIV testing to be highly acceptable. First, providers believed financial incentives had a relative advantage over existing strategies, because they overcame cost barriers and provided additional motivation to test; however, concerns about how financial incentives would be implemented influenced perceptions of feasibility and sustainability. Second, providers expressed concern that already overburdened staff and high costs of financial incentive programs would limit sustainability. Third, providers feared that financial incentives may negatively affect further care because of expectations of repeated financial support and program manipulation. CONCLUSIONS: Providers viewed financial incentives as an acceptable intervention to scale programmatically to increase uptake of pediatric testing. To ensure feasibility and sustainability of financial incentives in pediatric HIV testing programs, it will be important to clearly define target populations, manage expectations of continued financial support, and establish systems to track testing.
Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Financiamento Pessoal , Infecções por HIV/economia , Pessoal de Saúde/psicologia , Motivação , Criança , Humanos , Quênia , Pesquisa QualitativaRESUMO
OBJECTIVE: The aim of this study was to evaluate HIV testing yield under several candidate strategies for outreach testing at venues (i.e. places where people socialize and meet new sex partners) in East Africa cross-border areas. DESIGN: Population-based cross-sectional biobehavioural survey of people who had not been previously diagnosed with HIV found in venues. METHODS: We identified participants who would have been tested for HIV under each of 10 hypothetical outreach testing strategies and calculated the proportion who would have newly tested positive for HIV under each strategy. On the basis of this proportion, we calculated the 'number needed to test' (NNT) to identify one new case of HIV under each strategy. All estimates were obtained by applying survey sampling weights to account for the complex sampling design. RESULTS: If testing was performed at a random sample of venues, 35 people would need to be tested to identify one new case of HIV, but higher yield could be found by limiting testing to venues with specific characteristics. Strategies focusing on women had higher testing yield. Testing women employed by venues would result in highest yield of all strategies examined (NNTâ=â15), while testing men under age 24 would result in the lowest yield (NNTâ=â99). CONCLUSION: Quantitatively evaluating HIV testing strategies prior to implementation using survey data presents a new opportunity to refine and prioritize outreach testing strategies for the people and places most likely to result in high HIV testing yield.