The effect of a mobile-learning curriculum on improving compliance to quality management guidelines for HIV rapid testing services in rural primary healthcare clinics, KwaZulu-Natal, South Africa: a quasi-experimental study.

BACKGROUND: Despite significant achievements made towards HIV testing, linkage to antiretroviral therapy treatment and viral load suppression, the Sub-Saharan region of Africa continues to be reported to have the highest prevalence of HIV/AIDS, with over 26 million people living with the disease. In light of the added burden on already overwhelmed health systems due to the Covid-19 pandemic, maintaining the reliability and accuracy of point-of-care diagnostics (POC) results is crucial to ensure the sustainability of quality service delivery. The integration of technology-based interventions into nurse education curricula is growing, to help prepare students for the current practice environment which requires access to large amounts of information. The aim of this study was to determine the effect of a Mobile Learning (mLearning) Curriculum on improving the quality of HIV rapid testing services in rural clinics of KwaZulu-Natal (KZN), South Africa. METHODS: To achieve the aim of this study, pre-test and post-test audits were conducted in a quasi-experimental design. Eleven clinics of KZN, with the highest availability and usage of POC diagnostics were selected from a cross-sectional study survey to constitute the sample of this study. The World Health Organization On-site Monitoring Checklist-Assessment of Quality System was adapted and used as an audit tool to evaluate four key quality components. The effect of the mLearning curriculum on HIV testing quality improvement was determined through statistically comparing pre-audit and post-audit results. The independent samples t-test and the Levene's test were employed to evaluate the equality of measured variables for the two groups. The relationships between variables were estimated using the Pearson pair wise correlation coefficient (p) and correlations were reported as significant at p < 0.05. RESULTS: A total of 11 clinics was audited at the pretest and 7 clinics were audited post-piloting of the mLearning curriculum. The estimated level of compliance of the participating clinics to quality HIV rapid testing guidelines ranged between poor and moderate quality. The mLearning curriculum was shown to have no statistically significant effect on the quality of POC diagnostic services provided in rural clinics of KZN. CONCLUSION: The mLearning curriculum was shown to have no statistically significant effect on the quality of HIV rapid testing services provided in participating clinics; however, multiple barriers to the full adoption of the piloted curriculum were identified. The provision of reliable technology devices and improved internet connection were recommended to enhance the adoption of technology-based interventions necessary to improve access to relevant learning material and updated information.

Acceptability of on-site rapid HIV/HBV/HCV testing and HBV vaccination among three at-risk populations in distinct community-healthcare outreach centres: the ANRS-SHS 154 CUBE study.

BACKGROUND: HIV, HBV and HCV infections continue to represent major health concerns, especially among key at-risk populations such as men who have sex with men (MSM), people who inject drugs (PWIDs), transgender women (TGW) and sex workers (SW). The objective of the ANRS-CUBE study was to evaluate the acceptability of a healthcare, community-based strategy offering a triple rapid HIV-HBV-HCV testing, and HBV vaccination, targeted at three priority groups (MSM, PWIDs and TGW/SWs), in three community centers, in the Paris area. METHODS: This longitudinal multicentric non-randomized study included all adult volunteers attending one of the three specialized community centers in Paris, between July 2014 and December 2015. HIV, HBV and HCV status and acceptability of HBV vaccination were evaluated. RESULTS: A total of 3662, MSM, 80 PWIDs and 72 TGW/SW were recruited in the three centers respectively. Acceptability of rapid tests was 98.5% in MSM and 14.9% in TGW/SWs, but could not be estimated in PWIDs since the number of users attending and the number of proposals were not recorded. User acceptability of HBV vaccination was weak, only 17.9% of the eligible MSM (neither vaccinated, nor infected) agreed to receive the first dose, 12.2% two doses, 5.9% had a complete vaccination. User acceptability of HBV vaccination was greater in PWIDs and TGW/SWs, but decreased for the last doses (66.7 and 53.3% respectively received a first dose, 24.4 and 26.7% a second dose and 6.7 and 0% a third dose). Fifty-three participants (49 MSM and 4 PWIDs) were discovered HIV positive, more than half with a recent infection. All but two HIV positive participants were linked to appropriate care in less than one month. CONCLUSIONS: Rapid HIV-HCV-HBV screening showed a very high level of acceptability among MSM. Efforts need to be made to improve immediate acceptability for HBV vaccination, especially among MSM, and follow-up doses compliance. Our results show the important role of community centers in reaching targets, often fragile, populations, while also suggesting the need to reinforce on-site human support in terms of testing and vaccination, especially when addressing PWIDs.

Expanding access to HIV testing through Canadian community pharmacies: findings from the APPROACH study.

BACKGROUND: There is a need for acceptable and feasible HIV testing options to ensure people living with HIV know their status so they can access care. Pharmacist-provided HIV point-of-care testing (POCT) may overcome testing barriers, including privacy concerns, testing wait times, and improve accessibility. In the APPROACH study, we aimed to develop and assess an HIV POCT program in community pharmacies for future scale up and evaluation. This paper describes the program uptake, participant and pharmacist experiences, and implementation factors. METHODS: A pharmacist-provided HIV POCT program was offered in 4 pharmacies in two Canadian provinces. A mixed methods design incorporated self-report questionnaire data, participant telephone interviews, pharmacist focus groups, workload analysis, and situational analysis to assess the uptake, acceptability and feasibility of the HIV POCT program. RESULTS: Over the 6-month pilot, 123 HIV tests were performed. One new case of HIV was identified; this participant was linked with confirmatory testing and HIV care. Participants were predominantly male (76%), with a mean age of 35 years. This was the first HIV test for 27% participants, and 75% were at moderate to very high risk of undiagnosed HIV infection, by Denver HIV Risk Score. Questionnaires and telephone interviews showed participants were very satisfied with the program; 99% agreed HIV POCT should be routinely offered in pharmacies and 78% were willing to pay for the service. Participants felt the pharmacy was convenient, discreet, and that the pharmacist was supportive and provided education about how to reduce their future risk. Pharmacists felt prepared, confident, and expressed professional satisfaction with offering HIV POCT. Community and public health supports, clear linkage to care plans to refer participants with positive HIV POCT results, and provision of counselling tools were important enabling factors for the program. Pharmacist remuneration, integration with existing healthcare systems, and support for ongoing promotion of HIV POCT availability in pharmacies were identified as needs for future scale-up and sustainability. CONCLUSIONS: A successful model of pharmacy-based POCT, including linkage to care, was developed. Further research is needed to determine the effectiveness and cost-effectiveness of this approach in finding new diagnoses and linking them with care. TRIAL REGISTRATION: Retrospectively registered with clinicaltrials.gov (NCT03210701) on July 6, 2017.

Field performance of the INSTI HIV-1/-2 antibody test in two South African antenatal clinics.

This was a prospective study that assessed field performance of the INSTI HIV-1/-2 antibody test (INSTI test) in two antenatal clinics in South Africa (SA). INSTI test was evaluated against rapid tests used at these clinics, and pooled nucleic acid amplification testing (NAAT) performed for individuals with negative rapid tests. Three hundred and eighty-six pregnant women were enrolled; 334 (86.5%) with negative results on the screening rapid test, and 52 (13.5%; 95% confidence interval [CI]: 10.2-17.3%) with positive results on screening and confirmatory rapid tests. INSTI test yielded the same results as other rapid tests in all participants, thus showing a 100% sensitivity (95% CI: 93.2-100.0%) and specificity (95% CI: 98.9-100.0%). Pooled NAAT was performed for 290 participants who had negative rapid tests, and yielded negative results in all pools. These data show excellent field performance of the INSTI test, and highlight that this test can be implementedat SA clinics.

An Evaluation of Introduction of Rapid HIV Testing in a Perinatal Program.

OBJECTIVE: This study was conducted to evaluate the roll-out of rapid HIV testing as part of an emergency Prevention of Perinatal HIV Transmission Program. Specifically, HIV prevalence in this population, the reason(s) for performing the rapid HIV test, and compliance with recommendations for antiretroviral prophylaxis were assessed. METHODS: Since November 2011, all women presenting to a tertiary labour and delivery unit with unknown HIV status or with ongoing risk of HIV infection since their last HIV test were offered rapid HIV testing. Through retrospective chart review, demographic data, HIV risk and prior testing history, and antiretroviral prophylaxis, data were collected and descriptive statistics were performed. RESULTS: One hundred fourteen rapid HIV tests were conducted and there were two preliminary reactive rapid results (one true positive, one false positive). None of the infants was HIV infected. Sixty-three percent of women had multiple risk factors for HIV acquisition, most commonly intravenous drug use (54%). Forty-four percent of women were within the 4-week seroconversion window at the time of delivery; 25% of these women and 52% of their infants received prophylactic drug therapy. CONCLUSION: Rapid HIV testing identified a high-risk cohort and enabled aggressive management of a newly diagnosed HIV-positive pregnancy, successfully preventing perinatal HIV transmission. Risk factors for HIV acquisition were ongoing within the seroconversion window for over half of the women, impacting the utility of the test in eliminating unnecessary antiretroviral prophylaxis in this population because prophylaxis is recommended despite a negative rapid HIV test in these cases.

Effect of testing experience and profession on provider acceptability of rapid HIV testing after implementation in public sexual health clinics in Sydney.

OBJECTIVES: Rapid HIV testing (RHT) is well established in many countries, but it is new in Australia since a policy change in 2011. We assessed service provider acceptability of RHT before and after its implementation in four Sydney public sexual health clinics. METHODS: Service providers were surveyed immediately after training in RHT and again 6-12 months later. Differences in mean scores between survey rounds were assessed via t-tests, with stratification by profession and the number of tests performed. RESULTS: RHT was rated as highly acceptable among staff at baseline and acceptability scores improved between survey rounds. Belief in being sufficiently skilled and experienced to perform RHT (P = 0.004) and confidence in the delivery of nonreactive results increased (P = 0.007), while the belief that RHT was disruptive declined (P = 0.001). Acceptability was higher for staff who had performed a greater number of tests regarding comfort with their role in RHT (P = 0.004) and belief that patients were satisfied with RHT (P = 0.007). Compared with nurses, doctors had a stronger preference for a faster rapid test (P = 0.027) and were more likely to agree that RHT interfered with consultations (P = 0.014). CONCLUSIONS: Differences in responses between professions may reflect differences in staff roles, the type of patients seen by staff and the model of testing used, all of which may affect the number of tests performed by staff. These findings may inform planning for how best to implement RHT in clinical services.

Utilization of Rapid Diagnostic Testing in sub-Saharan Africa: Challenges and Effects on HIV Prevention.

The human immunodeficiency virus (HIV) remains a global threat to health. To prevent and control the disease caused by the virus, developed and developing countries continue to invest heavily in research and equipment so as to accurately detect the virus. The utilization of highly sensitive and effective rapid diagnostic tests (RDTs) have the potential to detect HIV in high-burden countries, especially those in sub-Saharan Africa (SSA). Yet, in SSA, challenges associated with HIV-RDT result inaccuracy, HIV misdiagnosis, poor tester capacity, and the improper storage of HIV-RDT kits have negatively impacted the benefits, and threaten to undermine HIV prevention. This paper focuses on the utilization of RDTs in HIV diagnosis in SSA, HIV-RDT challenges, and the effects of HIV-RDT challenges on HIV prevention. Subsequent to reviewing available literature, the authors found that although HIV-RDTs can negatively impact HIV-prevention efforts in SSA due to the likelihood of false positive HIV diagnoses, they generally provide quick results for people in resource poor settings, and do not require them to return to the testing sites to obtain their results. Obtaining accurate rapid HIV results means people who test positive can immediately seek care and take steps to prevent future transmission of the virus.

Chilean Health Care Providers' Perceived Comfort in Performing Oral Rapid Testing for HIV: A Cross-Sectional Study.

OBJECTIVES: To understand key factors influencing Chilean health care providers' perceived comfort performing oral rapid HIV testing. DESIGN: One hundred and fifty health care providers completed a self-administered questionnaire that included a five-item scale measuring self-perceived comfort in conducting HIV pretest counseling, oral rapid testing, finger-prick testing, and delivering test results. RESULTS: Most participants (60%) envisioned good overall comfort performing oral rapid HIV testing (mean score of 16.21; range 0-20), including doing at least four of the five steps. They perceived least comfort delivering HIV-positive test results during posttest counseling. HIV stigmatizing attitudes reduced self-perceived comfort. CONCLUSIONS: Providing training to counter HIV stigmatization while increasing comfort in performing oral rapid testing would help facilitate its successful implementation.

Oral Rapid HIV Testing: Implementation experiences of dental hygiene faculty and students.

Purpose: The goal of oral rapid HIV testing (ORHT) in the dental setting is to identify persons who are unaware of their positive HIV status. The purpose of this study was to describe the experiences of dental hygiene faculty and students who implemented ORHT in university-based dental hygiene clinics and to assess the facilitators and barriers to implementation of ORHT in the dental setting.Methods: Data were collected via semi-structured interviews with dental hygiene faculty and students who conducted ORHT in three dental clinics located in academic institutions. All interview sessions were audio-recorded and transcribed. An inductive approach informed by grounded theory methodology was used to code data and inform theme development. The interview sessions were completed when conceptual saturation was reached.Results: Five themes were identified by the study participants consisting of dental hygiene faculty (n= 8) and dental hygiene students (n=14). Participants felt dental hygienists are qualified to administer ORHT, which fits within their scope of practice; dental hygienists have the skills to feel comfortable offering ORHT without judgement; training is needed with ORHT administration, reading/discussing test results, and counseling for those who receive reactive results; most patients were receptive to being offered the ORHT; and patients accepted the ORHT because it was free, quick to administer and receive results, and convenient since they were already in the dental setting.Conclusion: Results from this study indicate that dental hygienists can play a key role in public health efforts to identify persons who are unaware of their HIV status.

Study of the possibility of introduction of Kazakhstan NGO-based rapid HIV testing procedures.

INTRODUCTION: New initiatives presented by the World Health Organization (WHO) and the Joint United Nations Program on HIV and AIDS , such as 90-90-90, test and treat, preventive treatment, and best international practices related to the introduction of rapid human immunodeficiency virus (HIV) testing in clinics, and field conditions, including self-testing, predetermined the introduction of NGO-based rapid HIV testing in the Republic of Kazakhstan nongovernmental organizations (NGOs). This work presents the results of a comprehensive study conducted about the possible introduction of NGO-based rapid HIV testing in the country. It should be noted that 32,573 HIV infections have been diagnosed in Kazakhstan (prevalence of 117.7 per 100,000 people) from 1987 to 2018. Most of these new cases are diagnosed among "key" population groups, such as people who use injectable drugs, sex workers, men who have sex with men, those who rely mainly on NGOs, and those who prefer to deal with an organization such as an NGO, which makes it possible to introduce NGO-based rapid HIV testing in Kazakhstan. METHODS: In this work, we used the following rapid HIV tests: Alere DetermineTM HIV ½ Ag/Ab Combo, Hexagon HIV 1+2, Abon HIV ½, HIV 1,2 Han Medtest, and Geenius HIV1/2 Confirmatory. RESULTS: The study of the rapid tests, including their diagnostic patterns, conducted in Kazakhstan shows that five rapid HIV tests completely meet the WHO's requirements (sensitivity>99%; specificity>98%). These are Alere DetermineTM HIV ½ Ag/Ab Combo, Hexagon HIV 1+2, Abon HIV ½, HIV 1,2 Han Medtest, and Geenius HIV1/2 Confirmatory. The study of legal and social problems associated with rapid HIV testing in NGOs shows that HIV-related medical examination and counseling carried out in Kazakhstan, including those by rapid methods, are governed by corresponding laws and normative legal documents. CONCLUSION: It has been established that there are social barriers that interfere with rapid HIV testing. In view of this, services associated with NGO-based rapid HIV testing shall be rendered with the use of a social and legal protection mechanism for those under examination.

A prospective multicentre study of healthcare provider preference in rapid HIV testing kits: Determine versus INSTI.

Rapid HIV testing may circumvent the practical barriers to HIV testing in several settings. User preference of the testing kits available has been relatively underexplored. We examined healthcare provider (HCP) ratings of two validated rapid testing kits in clinical practice. From 1 July to 1 December 2012 we prospectively recruited HCPs (clinic nurses) from three outpatient clinics linked to Lausanne University Hospital, Lausanne, Switzerland. The HCPs had experience in taking blood samples but varying experience in rapid HIV testing. Participating HCPs performed rapid HIV testing using Determine™ Combo (DETE) or INSTI™ (INSTI), according to a predefined randomization sequence, and rated practical aspects of each test using a Likert scale. Seventeen HCPs of 23 approached (74%) were eligible and agreed to participate, performing a total of 336 HIV tests. Globally, the testing procedure was rated as easy or very easy by 97% (DETE) to 99% (INSTI) of tests performed. Among experienced HCPs, DETE was rated easier than INSTI for kit storage (p < 0.001) and blood collection ( P = 0.012) while INSTI was rated easier than DETE for blood application ( P = 0.001) and test interpretation ( P = 0.005). Among less experienced HCPs, both tests performed equally with the exception of test interpretation ( P < 0.001) and overall ease of use ( P = 0.05) in favour of INSTI. Of all HCPs, 94% stated they would recommend INSTI over DETE based on the time to result, ease of test interpretation and overall ease of use. Rapid HIV testing was considered easy to perform, even by inexperienced nursing staff. Whilst both tests were considered easy to use, the HCPs in this study preferred INSTI to DETE overall, due to rapid time to result, ease of test interpretation and general ease of use.

Integrating Pregnancy Prevention Into an HIV Counseling and Testing Program in Pediatric Primary Care.

PURPOSE: Certified health educator (CHE)-based HIV counseling and testing typically focus on HIV and sexually transmitted infection (STI) prevention only. A quality improvement initiative examined integrating assessment of reproductive life plans, counseling about pregnancy prevention, and contraception referral into a CHE-based HIV testing program. METHODS: Between February 2014 and January 2017, in one urban pediatric primary care clinic serving patients aged 0-25, CHEs assessed sexual history, HIV risk, short-term (i.e., the next 6-12 months) pregnancy desire, and current contraception method and satisfaction among patients aged 13-25 who had ever had vaginal sex, using a standardized questionnaire. Data were analyzed using a de-identified administrative dataset that also tracked referrals to initiate contraception and actual method initiation. RESULTS: Of 1,211 patients, most (96%) reported no short-term pregnancy or partner pregnancy desire. Use of less effective or no contraception, as well as method dissatisfaction, was common. A high proportion of female patients referred to new methods opted for more effective methods (62%) and initiated these methods (76%); a high proportion of male patients opted for receipt of condoms (67%). Patients reporting short-term pregnancy desire reported higher rates of previous pregnancy and STIs. CONCLUSIONS: Program findings highlight the potential benefit of integrating assessment for and counseling about pregnancy prevention in a CHE-based HIV testing program. This can more effectively address the needs of patients with concomitant risks of STI/HIV and unintended pregnancy, and link patients who do not desire pregnancy to more effective methods.

Low Rates of Adoption and Implementation of Rapid HIV Testing in Substance Use Disorder Treatment Programs.

INTRODUCTION: Rapid HIV testing (RHT) greatly increases the proportion of clients who learn their test results. However, existing studies have not examined the adoption and implementation of RHT in programs treating persons with substance use disorders, one of the population groups at higher risk for HIV infection. METHODS: We examined 196 opioid treatment programs (OTPs) using data from the 2011 National Drug Abuse Treatment System Survey (NDATSS). We used logistic regressions to identify client and organizational characteristics of OTPs associated with availability of on-site RHT. We then used zero-inflated negative binomial regressions to measure the association between the availability of RHT on-site and the number of clients tested for HIV. RESULTS: Only 31.6% of OTPs offered on-site rapid HIV testing to their clients. Rapid HIV testing was more commonly available on-site in larger, publicly owned and better-staffed OTPs. On the other hand, on-site rapid HIV testing was less common in OTPs that prescribed only buprenorphine as a method of opioid dependence treatment. The availability of rapid HIV testing on-site reduced the likelihood that an OTP did not test any of its clients during the prior year. But on-site availability rapid HIV testing was not otherwise associated with an increased number of clients tested for HIV at an OTP. CONCLUSIONS: New strategies are needed to a) promote the adoption of rapid HIV testing on-site in substance use disorder treatment programs and b) encourage substance use disorder treatment providers to offer rapid HIV testing to their clients when it is available.

In-Country Migration and Risk Factors for HIV Acquisition among Pregnant Women in Tijuana, Mexico.

OBJECTIVE: To compare HIV prevalence and HIV acquisition risk behaviors between pregnant women residents and migrants. DESIGN: A cross-sectional study of pregnant women of unknown HIV status seeking care at Tijuana General Hospital, Mexico. METHODS: Pregnant women attending the labor and delivery unit or the prenatal clinic had a rapid HIV test drawn, with positive results confirmed by Western blot. Migrants were defined as women who had resided in Tijuana for less than 5 years. RESULTS: Between 2007 and 2008, a total of 3331 pregnant women consented to participate. The HIV seroprevalence did not differ between Tijuana residents (18 of 2502, 0.72%) and migrants (3 of 829, 0.36%, P = .32). In multivariate regression analyses, HIV acquisition risk behaviors included methamphetamine use (adjusted odds ratio [OR]: 6.03, 95% confidence interval [CI]: 2.3-15.8, P < .001) and first presentation at labor (adjusted OR: 5.0, 95% CI: 1.6-15.3, P = .005), adjusted for migrant status, age, and history of sexually transmitted infections. CONCLUSION: The overall HIV seroprevalence was 0.63% and did not differ between Tijuana residents and migrants.

A cross sectional survey of the barriers for implementing rapid HIV testing among French general practitioners.

In France, almost 30,000 people are unaware of their HIV-positive status. Innovative screening strategies are essential to reach this population. The aim of this study was to describe the acceptability of rapid HIV testing (RHT) among French general practitioners (GPs) working in the south of France and barriers for implementing this strategy. We analysed an anonymous questionnaire sent by mail to GPs about demographic data, routine practice, knowledge of RHT and barriers to its use. Between 1 April and 30 September 2013, out of the 165 GPs contacted, 78 returned the questionnaires. The GPs' mean age was 52 years; 49 were men. Fifty-one GPs reported that their registered patients included at least one HIV-infected person and 70 GPs reported taking care of high-risk patients. Sixty-three percent of GPs reported being interested in using RHT in their daily practice. The main reasons reported by uninterested GPs were: greater confidence in standard HIV testing, difficulties including RHT during the routine consultation, difficulties to screen for other sexually transmitted infections simultaneously, and difficulties to deliver a positive result. French National Authorities for Health propose to screen the population at least once in their lifetime and high-risk people at least once a year. In order to achieve this aim, RHT should be included in the GPs' arsenal for HIV testing. We showed a high acceptability of RHT by GPs. If specific and adapted training is developed, and if solutions to barriers reported by GPs are found, RHT could be implemented in to their routine activity.

Cost-effectiveness of rapid hepatitis C virus (HCV) testing and simultaneous rapid HCV and HIV testing in substance abuse treatment programs.

AIMS: To evaluate the cost-effectiveness of rapid hepatitis C virus (HCV) and simultaneous HCV/HIV antibody testing in substance abuse treatment programs. DESIGN: We used a decision analytic model to compare the cost-effectiveness of no HCV testing referral or offer, off-site HCV testing referral, on-site rapid HCV testing offer and on-site rapid HCV and HIV testing offer. Base case inputs included 11% undetected chronic HCV, 0.4% undetected HIV, 35% HCV co-infection among HIV-infected, 53% linked to HCV care after testing antibody-positive and 67% linked to HIV care. Disease outcomes were estimated from established computer simulation models of HCV [Hepatitis C Cost-Effectiveness (HEP-CE)] and HIV [Cost-Effectiveness of Preventing AIDS Complications (CEPAC)]. SETTING AND PARTICIPANTS: Data on test acceptance and costs were from a national randomized trial of HIV testing strategies conducted at 12 substance abuse treatment programs in the United States. MEASUREMENTS: Lifetime costs (2011 US$) and quality-adjusted life years (QALYs) discounted at 3% annually; incremental cost-effectiveness ratios (ICERs). FINDINGS: On-site rapid HCV testing had an ICER of $18,300/QALY compared with no testing, and was more efficient than (dominated) off-site HCV testing referral. On-site rapid HCV and HIV testing had an ICER of $64,500/QALY compared with on-site rapid HCV testing alone. In one- and two-way sensitivity analyses, the ICER of on-site rapid HCV and HIV testing remained <$100,000/QALY, except when undetected HIV prevalence was <0.1% or when we assumed frequent HIV testing elsewhere. The ICER remained <$100,000/QALY in 91% of probabilistic sensitivity analyses. CONCLUSIONS: On-site rapid hepatitis C virus and HIV testing in substance abuse treatment programs is cost-effective at a <$100,000/quality-adjusted life year threshold.

Long-term highly suppressed HIV-infected children and adolescents with negative rapid HIV tests due to significant antibody loss.

BACKGROUND: Rapid HIV test devices are widely used throughout the world and are important as diagnostic tools with relatively high sensitivity and specificity. Loss of HIV specific antibodies in late-stage AIDS patients has previously been reported in patients with advanced disease (i.e., AIDS). OBJECTIVE: To study rate of antibody loss that may lead to false negative HIV-antibodies results in children and adolescents who received long term antiretroviral (ARV) treatment with persistently undetectable viral loads. STUDY DESIGN: Five FDA approved rapid HIV test kits including Trinity Uni-Gold Recombigen HIV-1, OraQuick Advance HIV-1/2, Reveal G3 HIV-1, Clearview STAT-PAK HIV-1/2, and Clearview COMPLETE HIV-1/2 were used to test 98 stored samples from 27 patients. Samples were tested at baseline and at least twice in 6-14 years post initiation of ARV treatment and full viral load suppression. RESULTS: Of the 403 tests, 43 (10.7%) were found to be false-negative using rapid HIV kits. Loss of positivity was correlated with decrease of HIV antibody titer. CONCLUSIONS: There is a slow but persistent loss of HIV specific antibodies in highly suppressed HIV infected children and adolescents that may lead to false-negative results in rapid HIV antibody tests. The temporal loss of signal is dependent on the baseline level of antibodies and the type of HIV rapid test kit used.

Rapid HIV Testing on the College Campus: Comparing Traditional and Outreach Models.

The purpose of this study was to compare rapid HIV testing services on a college campus between a clinic-based testing group and an outreach-based testing group. Study participants were 1,233 individuals who underwent HIV counseling and testing. Questionnaires assessed demographics and HIV transmission risk behaviors. Results indicate that outreach-based testers were more likely to be younger, female, and African American relative to clinic-based testers. Overall, 100% of clinic-based testers and 99.5% of outreach-based testers receiving their test results. All individuals with positive rapid test results received confirmatory blood testing and entered medical care within one week of preliminary diagnosis. College campuses may provide a unique setting to deliver HIV testing and may help increase the percentage of young people who are aware of their serostatus, particularly younger, female, and African American students who may be less likely to undergo testing in traditional clinic settings.

Acceptance of HIV Antibody Testing Among Women in Domestic Violence Shelters.

The purpose of this study was to examine which factors derived from an adapted version of the Health Belief Model are associated with HIV testing among women at domestic violence shelters in the rural south (N = 112). Participants were administered self-report questionnaires to assess for test acceptance and were offered private and free HIV rapid testing. A logistic regression analysis was performed. Results indicated that higher perceived susceptibility and higher PTSD symptoms predicted a greater likelihood of HIV test acceptance. The most common reason given for not testing was a lack of time. Implications are discussed.

Aconselhamento na testagem anti-HIV no ciclo gravídico-puerperal: o olhar da integralidade / Counseling in HIV testing in the pre and post labor periods: the look of the integrality

A sorologia para HIV em mulheres no pré-natal e os testes rápidos anti-HIV em maternidade devem ser realizados com aconselhamento pré e pós-teste. Na prática, observa-se que esse nem sempre é realizado, predominando o cumprimento de procedimentos técnicos destinados a prevenir a transmissão vertical. O objetivo deste estudo foi analisar o cuidado profissional a mulheres que tomaram conhecimento da positividade para o HIV durante o trabalho de parto ou puerpério. Trata-se de estudo exploratório de natureza qualitativa, utilizando como categorias analíticas gênero e integralidade. Participaram do estudo doze puérperas usuárias de um centro de referência para HIV/aids, em Salvador (BA). Foi recortado para este artigo o olhar das mulheres sobre o aconselhamento no processo de testagem para o HIV. Os resultados foram produzidos a partir de entrevista semiestruturada e analisados pela técnica de análise de discurso segundo Fiorin. A análise revelou que a testagem anti-HIV foi incorporada à prática clínica sem aconselhamento em nenhuma das etapas da atenção ao ciclo gravídico-puerperal, na realidade investigada. As relações entre profissionais e usuárias refletem mecanismos de poder que comprometem a autonomia das mulheres, distanciando o cuidado da perspectiva da integralidade.

The sorology for HIV in woman and rapid HIV testing in maternity hospitals must be carried with pre and pos-test counseling. However, it has been observed that the counseling has not been accomplished by many health professionals, who give more importance to the prophylactic measures which intend to prevent vertical transmission. The objective of this qualitative study is to investigate how women evaluate the health care received during the HIV testing at pre and post-labor periods. For this paper the look of woman about counseling in the process of HIV testing was cut. We used gender and integrality as analytic categories. The technique used to collect data was the semi-structured interview, carried out in women seen at the CTA for diagnostic conclusion. The testing lost its specificity through its inclusion in the clinical practice as a routine without a counseling in any stages of the care during pre and post labor periods. The relationship between users and professionals reflect power mechanisms that compromise the autonomy of women, distancing the care from the perspective of the integrality.