Operational feasibility of using whole blood in the rapid HIV testing algorithm of a resource-limited settings like Bangladesh.

BACKGROUND: Serum-based rapid HIV testing algorithm in Bangladesh constitutes operational challenge to scaleup HIV testing and counselling (HTC) in the country. This study explored the operational feasibility of using whole blood as alternative to serum for rapid HIV testing in Bangladesh. METHODS: Whole blood specimens were collected from two study groups. The groups included HIV-positive patients (n = 200) and HIV-negative individuals (n = 200) presenting at the reference laboratory in Dhaka, Bangladesh. The specimens were subjected to rapid HIV tests using the national algorithm with A1 = Alere Determine (United States), A2 = Uni-Gold (Ireland), and A3 = First Response (India). The sensitivity and specificity of the test results, and the operational cost were compared with current serum-based testing. RESULTS: The sensitivities [95% of confidence interval (CI)] for A1, A2, and A3 tests using whole blood were 100% (CI: 99.1-100%), 100% (CI: 99.1-100%), and 97% (CI: 96.4-98.2%), respectively, and specificities of all test kits were 100% (CI: 99.1-100%). Significant (P < 0.05) reduction in the cost of establishing HTC centre and consumables by 94 and 61%, respectively, were observed. The cost of administration and external quality assurance reduced by 39 and 43%, respectively. Overall, there was a 36% cost reduction in total operational cost of rapid HIV testing with blood when compared with serum. CONCLUSION: Considering the similar sensitivity and specificity of the two specimens, and significant cost reduction, rapid HIV testing with whole blood is feasible. A review of the national HIV rapid testing algorithm with whole blood will contribute toward improving HTC coverage in Bangladesh.

The use of vouchers in HIV prevention, referral treatment, and care for young MSM and young transgender people in Dhaka, Bangladesh: experience from 'HIM' initiative.

INTRODUCTION: The study described the effectiveness of a voucher scheme to access sexual and reproductive health and HIV services among young MSM and transgender people aged 15-24 years in Dhaka, Bangladesh, a country with HIV prevalence of less than 0.1%. METHODS: Descriptive and analytical methods were used to assess the net effects of biodemographic factors of the respondents on the voucher scheme. Effectiveness of the scheme was contextualized as target population coverage, and turnaround time of voucher redemption to access services. RESULTS AND DISCUSSION: A total of 210 (87.9%) out of the 239 vouchers distributed were redeemed. The mean age of the identified young people was 19.6 years (SD = +2.6 years). The coverage of the scheme against the target population of 200 young MSM and 936 young transgender people was 88% (n = 175) and 4% (n = 35) respectively, with P < 0.001. The median turnaround time for voucher redemption was 7 days. The predictors of voucher turnaround time were age, education, and population group (P < 0.001). HIV testing and counselling was accessed by 160 (76%) respondents, one was positive and linked to antiretroviral treatment and 110 (52%) were diagnosed and treated for sexually transmitted infections. CONCLUSION: The voucher scheme was effective in linking young MSM with sexual and reproductive health and HIV services in Dhaka, Bangladesh. The findings are consistent with the low HIV prevalence in the country. The scheme is, however, not optimal for linking young transgender people with services.

Socioeconomic factors contributing to exclusion of women from maternal health benefit in Abuja, Nigeria.

BACKGROUND: An understanding of the predictive effect of socioeconomic characteristics (SECs) of women on maternal healthcare service utilisation is essential in order to maximise maternal health benefits and outcomes for the newborn. OBJECTIVES: To describe how SECs of women contribute to their exclusion from maternal health benefits in Abuja Municipal Areas Council (AMAC) in Abuja, Nigeria. METHOD: A non-experimental, facility-based cross-sectional survey was done. Data were collected from 384 respondents using a structured interviewer-administered questionnaire. The participants were sampled randomly at antenatal care (ANC) clinics in the five district hospitals in AMAC. Data analysis included descriptive statistics, cross-tabulations and measures of inequality. Logistic regression analysis was used to test the relationship between SECs (predictors) and maternal healthcare service utilisation. RESULTS: There were differentials in the utilisation of maternal healthcare services (ANC, delivery care, post natal care [PNC] and contraceptive services) amongst women with different SECs; and the payment system for maternal healthcare services was regressive. There were inconsistencies in the predictive effect of the SECs of women included in this study (age,education, birth order, location of residence, income group and coverage by health insurance) on maternal healthcare service utilisation when considered independently (bivariate analysis) as opposed to when considered together (logistic regression), with the exception of birth order, which showed consistent effect. CONCLUSION: SECs of women were predictive factors of utilisation of maternal healthcare services. There is a need for targeted policy measures and programme actions toward multiple SECs of women in their natural co-existing state in order to optimise maternal health benefits.