Improving Underestimation of HIV Prevalence in Surveys Using Time-Location Sampling.

We sought to find a method that improves HIV estimates obtained through time-location sampling (TLS) used to recruit most-at-risk populations (MARPs). The calibration on residuals (CARES) method attributes weights to TLS sampled individuals depending on the percentile to which their logistic regression residues belong. Using a real country database, provided by EMIS-2010, with 9591 men who have sex with men (MSM) and an HIV prevalence of 12.1%, we simulated three populations (termed "pseudo-populations") with different levels of HIV. From each pseudo-population, 1000 TLS samples were drawn, and the HIV prevalence estimated by the TLS method and by the CARES method were recorded and compared with the HIV prevalence of the 9591 men. Results showed that the CARES method improves estimates given by the TLS method by getting closer to the real HIV prevalence.

Utilization of safe male circumcision among adult men in a fishing community in rural Uganda.

BACKGROUND: In Uganda, most-at-riskpopulations(MARPs) such as fishing communities remain vulnerable to preventable HIV acquisition. Safe Male Circumcision (SMC) has been incorporated into Uganda's HIV prevention strategies. This study aimed at determining SMC utilization and associated factors among adult men in a rural fishing community in Uganda. METHODS: A cross-sectional study was conducted in a rural fishing village in central Uganda. Stratified random sampling of 369 fishermen aged 18-54 yearswas used according to their occupational category; fish monger, boat crew and general merchandise. The dependent variable wasutilization of SMC.A forward fitting multivariable logistic regression model was fitted with variables significant at p≤0.05 controlling for confounding and effect modification. RESULTS: Respondents'mean(SD) age was 30.0(9.3) years. Only8.4%hadSMC and among non-circumcised men, 84.9% had adequate knowledge of SMC benefits while 79.3% did not know were SMC services were offered. Peer support(AOR0.17;95%-CI0.05-0.60) and perceived procedural safety (AOR6.8;95%CI2.16-21.17) were independently associated with SMC utilization. CONCLUSION: In this rural fishing community, SMC utilization was low. These findings underscore the need to inform HIV preventionstrategies inthecontextof peer support and perceptionsheld by rural dwelling men.

A review of the atomoRapid HIV self-testing device: an acceptable and easy alternative to facilitate HIV testing.

Introduction:HIV testing is the gateway to both HIV prevention and treatment, and increased HIV testing and linkage to services is vital for an effective HIV response. HIV testing has progressed significantly from a lengthy laboratory process conducted by specialist medical staff to rapid point of care testing performed by trained lay staff. Despite HIV testing services being widely available, testing rates remain suboptimal among young people and men. Alternative delivery strategies that complement conventional testing services are needed to reach these priority groups. Areas covered:This article reviewed the AtomoRapid HIV self-testing (HIVST) device as an innovative alternative to conventional testing. Expert commentary:HIVST complements traditional HIV testing options and can be used to overcome major barriers to testing by catering for testing outside of conventional settings and by allowing individuals to test themselves privately, and at their own discretion and frequency. We conclude that the high sensitivity, specificity, acceptability, usability, and fidelity of this device makes it an appropriate option for the enhancement of HIV testing strategies for harder to reach populations, such as young people and men.

Population Size Estimation of Men Who Have Sex with Men in Ho Chi Minh City and Nghe An Using Social App Multiplier Method.

This study aims to estimate the number of men who have sex with men (MSM) in Ho Chi Minh City (HCMC) and Nghe An province, Viet Nam, using a novel method of population size estimation, and to assess the feasibility of the method in implementation. An innovative approach to population size estimation grounded on the principles of the multiplier method, and using social app technology and internet-based surveys was undertaken among MSM in two regions of Viet Nam in 2015. Enumeration of active users of popular social apps for MSM in Viet Nam was conducted over 4 weeks. Subsequently, an independent online survey was done using respondent driven sampling. We also conducted interviews with key informants in Nghe An and HCMC on their experience and perceptions of this method and other methods of size estimation. The population of MSM in Nghe An province was estimated to be 1765 [90% CI 1251-3150]. The population of MSM in HCMC was estimated to be 37,238 [90% CI 24,146-81,422]. These estimates correspond to 0.17% of the adult male population in Nghe An province [90% CI 0.12-0.30], and 1.35% of the adult male population in HCMC [90% CI 0.87-2.95]. Our size estimates of the MSM population (1.35% [90% CI 0.87%-2.95%] of the adult male population in HCMC) fall within current standard practice of estimating 1-3% of adult male population in big cities. Our size estimates of the MSM population (0.17% [90% CI 0.12-0.30] of the adult male population in Nghe An province) are lower than the current standard practice of estimating 0.5-1.5% of adult male population in rural provinces. These estimates can provide valuable information for sub-national level HIV prevention program planning and evaluation. Furthermore, we believe that our results help to improve application of this population size estimation method in other regions of Viet Nam.

Attracting female sex workers to HIV testing and counselling in Ethiopia: a qualitative study with sex workers in Addis Ababa.

Despite growing efforts to increase HIV testing and counselling (HTC) services for most at risk populations in Ethiopia, the use of these services by female sex workers (FSWs) remains low. With rising numbers of FSWs in Addis Ketema and concerns about their high risk behaviours, exploring and addressing the barriers to uptake is crucial. This qualitative study explores the barriers to utilising HTC facilities and identifies the motives and motivations of FSWs who seek HTC through in-depth and semi-structured interviews with female sex workers, healthcare workers and key informants. Results indicate that FSWs face numerous barriers including inability to seek treatment if found to be positive due to the requirement of an identity (ID) card many do not own. Many FSWs reported discriminatory behaviour from healthcare workers and a lack of dedicated services. What is clear from the findings is that distinct strategies, which differ from those of the broader population, are required to attract FSWs--strategies which take into account the barriers and maximise the reported motives and motivations for testing.

Sex, drugs and prisons: HIV prevention strategies for over 190 000 clients in Ukraine.

SETTING: One hundred and forty non-governmental organisations implementing human immunodeficiency virus (HIV) prevention programmes among clients, including people who inject drugs, prisoners, female sex workers, men who have sex with men and street children in Ukraine, 2010-2011. OBJECTIVE: Among enrolled clients, to assess factors associated with HIV testing, HIV retesting within a year of initial testing and HIV seroconversion. DESIGN: Retrospective cohort study involving record reviews. RESULTS: Of 192 487 clients, 42 109 (22%) underwent an initial HIV test (22% were positive). Among HIV-negative clients at baseline, 10 858 (27%) were retested within a year: 317 (3%) of these were HIV-positive. HIV testing and retesting rates were lower among prisoners (0.3%) and others (street children and partners of those in risk groups, 6%), and those who did not receive counselling or services such as condom and needle distribution. Individuals who were not counselled were more likely to seroconvert. CONCLUSIONS: In this large cohort of high-risk groups from Eastern Europe, HIV testing was low and HIV sero-conversion was high. This is of public health concern, bringing into question the overall quality of counselling and how well it is tailored to the specific needs of various risk groups. Qualitative studies to understand the reasons for non-testing are urgently required for designing client-specific interventions.

Contexte : Cent quarante organisations non gouvernementales impliquées dans la mise en œuvre de programmes de prévention du virus de l'immunodéficience humaine (VIH) pour des clients comprenant des utilisateurs de drogues injectables, des détenus, des travailleuses du sexe, des homosexuels masculins et des enfants des rues en Ukraine de 2010 à 2011.Objectif : Evaluer les facteurs associés au dépistage du VIH, à un second dépistage dans l'année qui suit et à une séroconversion parmi les clients enrôlés.Schéma : Etude rétrospective de cohorte par revue de dossiers.Résultats : Sur 192 487 clients, 42 109 (22%) ont eu un test VIH initial (22% étaient positifs). Parmi les clients négatifs au départ, 10 858 (27%) ont eu un deuxième test dans l'année, dont 317 (3%) se sont révélés VIH positifs. Les taux de dépistage initial et subséquent étaient plus faibles parmi les prisonniers (0,3%) et d'autres groupes comme les enfants des rues et les partenaires de groupes à risque (6%), ainsi que ceux qui n'avaient pas bénéficié de conseil ni de services comme la distribution de préservatifs et d'aiguilles. Les sujets qui n'avaient pas bénéficié de conseil étaient plus enclins à la séroconversion.Conclusions: Dans cette vaste cohorte de groupes à risque élevé d'Europe de l'Est, le taux de dépistage était faible et le taux de séroconversion élevé. Cette situation est préoccupante en termes de santé publique et met en doute la qualité d'ensemble du conseil et la manière dont il est adapté aux besoins spécifiques de divers groupes à risque. Il est urgent de réaliser des études qualitatives afin de comprendre les raisons du non dépistage et d'élaborer des interventions spécifiques des clients.

Marco de referencia: Las 140 organizaciones no gubernamentales que aplican programas de prevención de la infección por el virus de la inmunodeficiencia humana (VIH) a usuarios como los consumidores de drogas inyectables, los reclusos, las trabajadoras del sexo, los hombres que tienen relaciones sexuales con hombres y los niños de la calle en Ucrania entre el 2010 y el 2011.Objetivo: Evaluar los factores que se asocian con la práctica de la prueba diagnóstica del VIH, la repetición de la prueba un año después de la primera y la seroconversión en los usuarios inscritos.Método: Fue este un estudio retrospectivo de cohortes con análisis de las historias clínicas.Resultados: De los 192 487 usuarios del programa, 42 109 recibieron una primera prueba del VIH (22%); 22% fueron positivos. De las personas con un resultado negativo inicial, 10 858 repitieron la prueba un año después (27%) y 317 de ellas obtuvieron un resultado positivo (3%). Las tasas de práctica de la prueba del VIH y de repetición de la misma fueron inferiores en los reclusos (0,3%), en el grupo de otros (los niños de la calle y las parejas de personas de los grupos de riesgo, 6%) y en las personas que no recibieron asesoramiento ni servicios como la distribución de agujas o preservativos. La seroconversión fue más frecuente en las personas que no recibieron orientación.Conclusión: En este amplio estudio de cohortes de grupos de riesgo en Europa oriental, la tasa de pruebas diagnósticas del VIH fue baja y los índices de seroconversión fueron altos. Esta situación representa un problema de salud pública y pone en tela de juicio la calidad general de los programas de asesoramiento y la forma como estos se adaptan a las necesidades específicas de los diversos grupos de riesgo. Se precisan con urgencia estudios cualitativos que analicen las razones de la falta de la prueba diagnóstica, con el fin de elaborar intervenciones que sean específicas para determinados usuarios.

Providing a gateway to prevention and care for the most at-risk populations in Bhutan: is this being achieved?

SETTING: Two free-standing urban human immunodeficiency virus (HIV) testing and counselling (HCT) centres in Bhutan offering services to the general population and targeting the most at-risk populations (MARPs). OBJECTIVES: To assess the trend in testing for HIV, hepatitis B and syphilis in both the general population and MARPs, and to determine if sociodemographic and risk behaviour characteristics are associated with HIV, hepatitis B and syphilis seropositivity. DESIGN: Cross-sectional study using client records, 2009 - 2012. RESULTS: Of 7894 clients, 3009 (38%) were from the general population, while 4885 (62%) were from MARPs. Over the 4-year period, testing declined progressively among the general population, while it increased or remained static for MARPs. Of 4885 MARPs, seropositivity was respectively 0.7%, 1.3% and 1.2% for HIV, hepatitis B and syphilis. Female sex workers (FSWs) (relative risk [RR] 4.4, P = 0.03) and partners of person living with HIV (RR 25.9, P < 0.001) had a higher risk of being HIV-positive. FSWs had also a greater risk of being syphilis-positive (RR 9.1, P < 0.001). CONCLUSION: The increase in uptake of HCT services by MARPs is a welcome finding; however, the relatively static trends call for the introduction of community outreach approaches. The critical gateway being provided to MARPs is an 'opportunity' for the expansion of the current service package.

Contexte : Deux centres indépendants de dépistage et conseil pour le VIH (HCT) au Bhoutan proposant leurs services à la population générale et ciblent les plus à risque (MARP).Objectifs : Evaluer la tendance des tests VIH, hépatite et syphilis dans la population générale et chez les MARP et déterminer si les caractéristiques sociodémographiques et les conduites à risque sont associées à la séropositivité pour le VIH, l'hépatite et la syphilis.Schéma : Etude transversale sur les dossiers des clients, de 2009 à 2012.Résultats :Sur 7894 clients, 3009 (38%) appartenaient à la population générale et 4885 (62%) aux MARP. Au cours des 4 années, les examens ont diminué pour la population générale tandis qu'ils augmentaient ou restaient stables pour les MARP. Sur 4885 MARP, la séropositivité était de 0,7% pour le VIH, 1,3% pour l'hépatite B et 1,2% pour la syphilis. Les professionnelles du sexe (risque relatif [RR] 4,4 ; P = 0,03) et les partenaires de personnes vivant avec le VIH (RR 25,9 ; P < 0,001) avaient davantage de risques d'être VIH positif. Les professionnelles du sexe aveint également un risque plus élevé d'être positives pour la syphilis (RR 9,1 ; P < 0,001).Conclusion : L'augmentation de l'utilisation des services de HCT par les MARP est un résultat bienvenu, mais la tendance relativement stationnaire demande l'introduction d'approches de stratégie avancées dans les communautés. La porte d'entrée critique offerte aux MARP est une « opportunité ¼ d'accroitre le paquet de services actuels.

Marco de referencia: Dos centros independientes de diagnóstico y orientación de la infección por el virus de la inmunodeficiencia humana (VIH) en Bután, que prestan servicios a la población general, con una orientación especial hacia la población de más alto riesgo (MARP).Objetivos: Evaluar la tendencia en la práctica de las pruebas diagnósticas del VIH, la hepatitis B y la sífilis en la población general y en los MARP y analizar si existen factores sociodemográficos y comportamentales que se asocien con la positividad del examen serológico de estas infecciones.Métodos: Fue este un estudio transversal a partir de los registros de los usuarios de los centros entre el 2009 y el 2012.Resultados: De los 7894 usuarios, 3009 (38%) formaban parte de la población general y 4885 (62%) pertenecían a los MARP. Durante el período de 4 años, la práctica de las pruebas diagnósticas disminuyó de manera progresiva en la población general, pero aumentó o permaneció estable en los MARP. En las 4885 personas del grupo con mayor riesgo, la seropositividad fue 0,7% frente al VIH, 1,3% a la hepatitis B y 1,2% a la sífilis. Se observó un riesgo más alto de obtener un resultado positivo al VIH en las mujeres profesionales del sexo (riesgo relativo [RR] 4,4; P = 0,03) y en las parejas de las personas resultados positivos a la serología del VIH (RR 25,9; P < 0,001). Las profesionales del sexo exhibieron un mayor riesgo de obtener una serología positiva de la sífilis (RR 9,1; P < 0,001).Conclusión: El aumento de la utilización de los servicios de diagnóstico y orientación del VIH por parte de las poblaciones con más alto riesgo constituye una observación afortunada, pero la estabilización de las tendencias invita a introducir estrategias de extensión a la comunidad. La pasarela crucial que se está ofreciendo a la población en mayor riesgo de contraer estas enfermedades representa una 'oportunidad' de difusión del conjunto de servicios que se prestan en la actualidad.

HIV/AIDS-Related Knowledge and Behaviors Among Most-at-Risk Populations in Vietnam.

The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has supported the Vietnamese Ministry of Health (MOH) in implementing behavior change strategies to slow the HIV epidemic. These programs target commercial sex workers (CSW), injection drug users (IDU), and men who have sex with men (MSM). Using data from a program evaluation to assess effectiveness of the PEPFAR intervention, we conducted a sub-analysis of HIV/AIDS knowledge, sexual behaviors, and injection drug risk behaviors among 2,199 Vietnamese respondents, including those reporting recent contact with an outreach worker and those who did not report contact. We found overall high levels of HIV/AIDS knowledge, low rates of needle sharing, and moderate to high rates of inconsistent condom use. Average knowledge scores of IDU were significantly higher than non-IDU for antiretroviral treatment knowledge, while MSM had significantly less knowledge of treatment compared to non-MSM. HIV/AIDS-related knowledge was not significantly associated with needle-sharing practices. Knowledge was modestly but significantly associated with more consistent use of condoms with primary and commercial sex partners, even after controlling for contact with an outreach worker. Contact with an outreach worker was also an independent predictor of more consistent condom use. Outreach programs appear to play a meaningful role in changing sexual behavior, though the effect of outreach on IDU risk behaviors was less clear. More research is needed to understand the relationship between outreach programs and skill development, motivation, and use of referral services by most-at-risk populations in Vietnam.