Delivery of index-linked HIV testing for children: learnings from a qualitative process evaluation of the B-GAP study in Zimbabwe.

BACKGROUND: Index-linked HIV testing for children, whereby HIV testing is offered to children of individuals living with HIV, has the potential to identify children living with undiagnosed HIV. The "Bridging the Gap in HIV Testing and Care for Children in Zimbabwe" (B-GAP) study implemented and evaluated the provision of index-linked HIV testing for children aged 2-18 years in Zimbabwe. We conducted a process evaluation to understand the considerations for programmatic delivery and scale-up of this strategy. METHODS: We used implementation documentation to explore experiences of the field teams and project manager who delivered the index-linked testing program, and to describe barriers and facilitators to index-linked testing from their perspectives. Qualitative data were drawn from weekly logs maintained by the field teams, monthly project meeting minutes, the project coordinator's incident reports and WhatsApp group chats between the study team and the coordinator. Data from each of the sources was analysed thematically and synthesised to inform the scale-up of this intervention. RESULTS: Five main themes were identified related to the implementation of the intervention: (1) there was reduced clinic attendance of potentially eligible indexes due to community-based differentiated HIV care delivery and collection of HIV treatment by proxy individuals; (2) some indexes reported that they did not live in the same household as their children, reflecting the high levels of community mobility; (3) there were also thought to be some instances of 'soft refusal'; (4) further, delivery of HIV testing was limited by difficulties faced by indexes in attending health facilities with their children for clinic-based testing, stigma around community-based testing, and the lack of familiarity of indexes with caregiver provided oral HIV testing; (5) and finally, test kit stockouts and inadequate staffing also constrained delivery of index-linked HIV testing. CONCLUSIONS: There was attrition along the index-linked HIV testing cascade of children. While challenges remain at all levels of implementation, programmatic adaptations of index-linked HIV testing approaches to suit patterns of clinic attendance and household structures may strengthen implementation of this strategy. Our findings highlight the need to tailor index-linked HIV testing to subpopulations and contexts to maximise its effectiveness.

HIV testing in termination of pregnancy and colposcopy services: a scoping review.

BACKGROUND: Women and girls are relatively under-represented across the HIV treatment cascade. Two conditions unique to women, pregnancy and cervical cancer/dysplasia, share a common acquisition mode with HIV. This scoping review aimed to explore HIV testing practices in voluntary termination of pregnancy (TOP) and colposcopy services. METHODS: The scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We searched articles published up to 20 December 2020 using three electronic databases (PubMed/Medline, Embase, Google Scholar) and including the keywords "HIV Testing", "Abortion, Induced", "Colposcopy", "HIV screen*" and "termination of pregnancy". RESULTS: A total of 1496 articles were identified, of which 55 met the inclusion criteria. We included studies providing background HIV prevalence in addition to prevalence in the study population and studies of women seeking TOP rather than presenting with TOP complications. This limited our review to high-income, low HIV prevalence settings. We observed two study phases: studies pre-antiretroviral therapy (ART) using unlinked anonymous testing data and examining HIV risk factors associated with positive HIV tests and studies post-ART using routine testing data and exploring HIV testing uptake. HIV prevalence was estimated at >0.2% in most TOP settings and >1% (range 1.7%-11.4%) in colposcopy services. Many TOP providers did not have local HIV testing policies and HIV testing was not mentioned in many specialist guidelines. Testing uptake was 49%-96% in TOP and 23%-75% in colposcopy services. CONCLUSION: Given the estimated HIV prevalence of >0.1% among women attending TOP and colposcopy services, HIV testing would be economically feasible to perform in high-income settings. Explicit testing policies are frequently lacking in these two settings, both at the local level and in specialist guidelines. Offering HIV testing regardless of risk factors could normalise testing, reduce late HIV presentation and create an opportunity for preventive counselling.

Tracking missed opportunities for an early HIV diagnosis in a population of people living with HIV with known time of infection.

PURPOSE: The goal of 90-90-90 first requires the expansion of access to HIV testing. Our aim was to record frequencies of HIV indicator conditions (ICs) and identify missed opportunities for an early HIV diagnosis. METHODS: We retrospectively identified ICs in a population of 231 people living with HIV with known infection dates who attended our clinic. The study population was divided into four groups: (1) those self-tested pre-emptively (47/231, 20.3%), (2) those offered targeted testing based on risk factors (67/231, 29%), (3) those tested after an IC (73/231, 31.6%) and (4) those who were not offered testing after an IC (44/231, 19%). HIV acquisition dates were estimated by molecular clock analysis. RESULTS: A total of 169 healthcare contacts (HCCs) were recorded. The most frequent HCC was mononucleosis-like syndrome (20.1%), unexplained weight loss (10.7%) and STIs (10.1%). AIDS-defining conditions were detected in 11.8%. Only 62.4% (73/117) of those with an IC were offered testing after their first HCC. Patients in group 4 had statistically significant delay in diagnosis compared with group 3 (109.1 weeks (IQR 56.4-238.6) vs 71.6 weeks (IQR 32.3-124.6)). The proportion of patients diagnosed as late presenters in each group was: (1) 16/47 (34%), (2) 37/67 (55.2%), (3) 43/73 (58.9%) and (4) 27/44 (61.4%) (p=0.027). CONCLUSIONS: Our study uses a combination of molecular and clinical data and shows evidence that late presentation occurs in a high proportion of patients even in the presence of an IC. Given that risk-based targeted testing has low coverage, IC-guided testing provides a reasonable alternative to facilitate earlier HIV diagnosis and to improve late diagnosis across Europe and globally.

HIV-testimise ravijuhend / HIV testing treatment guide

In 2019, 178 new HIV cases were diagnosed in Estonia (13.5 cases per 100,000 people). Among the new cases, the proportion of women was 37%. 53% of the new cases were discovered in Tallinn and 25% in Ida-Virumaa. Between 2010 and 2019, the number of new cases per year has decreased twice, but remains very high ( 2 ) . In the European Union, Estonia has been at the forefront in terms of the number of HIV cases per 100,000 people for twenty years ( 3 ). The share of heterosexual transmission of infection has increased (69% of known transmission routes of infection in 2019 were heterosexual), especially among women and over 29-year-olds. The proportion of cases spread through homosexual means has also increased (14% of the known ways of spreading the infection in 2019 were homosexual) ( 2 ) . In Estonia, nearly 200,000 people are examined for HIV infection every year, including blood donors and prisoners ( 2 ) . This is nearly 15% of the total population. If we compare the level of HIV testing in Estonia with other European Union countries where testing data are collected, our testing level is higher than average. In 2018, 85 people per 1,000 people were tested for HIV in Estonia (excluding anonymously tested persons and blood donors). At the same time, for example, 87 people per 1,000 people were tested in France, 64 in Belgium, 50 in Ireland, 47 in Latvia and 39 in Lithuania. 278 people were tested in Russia, 47 in Georgia and 44 in Ukraine per 1000 people ( 3 ) . Representatives of all professions come into contact with people infected with HIV. 2014-2015 2010 data on newly infected people with HIV showed that 82% of them had used health services in the two years before their HIV diagnosis (the average number of visits was nine). Only 16% of them had been tested for HIV at least once. At the same time, only 5% had been tested for HIV indicator conditions. 75% had visited a family doctor, but only 0.8% of visits had an HIV test ( 4 ) . In 2019, 7% of people who received health services were tested for HIV ( 5 ) . GPs tested 2% of their patients. In 2019, family doctors performed an average of 26 HIV tests per list. Less than 4% of the patients aged 16­49 in Harju County and Ida-Viru County had been tested by family doctors ( 5 ) . Women were tested significantly more than men (10% vs. 5%), mainly related to pregnancy monitoring (30% of all tests and 40% of HIV tests performed on women were related to pregnancy monitoring). The largest number of women (22%) and men (10%) aged 16­49 from Ida-Virumaa were tested. If you look at the number of people tested in health care in relation to the population, in Harjumaa and Ida-Virumaa, one tenth of women and about 5% of men were tested in 2019. 3% of medical bills with HIV indicator conditions had HIV tests ( 5 ) . Among the main risk groups, people who inject drugs (IDUs) and women involved in prostitution, levels of HIV testing and awareness of HIV infection are quite good, but lower among men who have sex with men (MSM) ( 2 ) . General practitioners tested 1% of their patients and specialists 8%. The highest proportion of HIV-tested patients was in Ida-Virumaa (9%) and among 16-49-year-olds (13%), while 16% among 16-49-year-olds in Ida-Virumaa. Women were tested significantly more than men (9% vs. 4%) and this was mainly related to pregnancy monitoring (30% of all tests and 40% of HIV tests performed on women were related to pregnancy monitoring). 3% of medical bills with HIV indicator conditions had HIV tests ( 5 ) . Among the main risk groups, people who inject drugs (IDUs) and women involved in prostitution, the level of HIV testing and awareness of HIV infection is quite good, but it is lower among men who have sex with men (MSM) ( 2 ) . Despite the good general level of testing, it is estimated that nearly a thousand people live in Estonia who have not yet been diagnosed with HIV infection ( 6 ) . On average, 6% of newly infected people with HIV are diagnosed with AIDS after three months, the proportion of which has increased over the last ten years ( 2 ) . Based on the 2019 data, late diagnoses were more common among heterosexually infected and older age groups ( 2 ) . Due to late diagnosis, treatment is delayed, quality of life deteriorates and treatment costs increase ( 7 ) . Furthermore, people who are unaware of their infection are much more likely to spread HIV than those who are aware (1 ) ( 8 ) . In Estonia, HIV testing guidelines have been in line with international recommendations for many years. HIV testing has always been possible in all medical specialties. Since 2016, based on current guidelines, it is also possible to test uninsured patients, and since 2017, family doctors have unlimited resources for HIV testing. Despite this, there are significant gaps in the early diagnosis of HIV. For testing to fulfill its purpose, guidelines and effective health management measures are needed. In this way, HIV infection can be diagnosed as early as possible and contribute to the prevention of its further spread.

2019. aastal diagnoositi Eestis 178 uut HIV-i juhtu (13,5 juhtu 100 000 inimese kohta). Uute juhtude seas oli naiste osakaal 37%. Uutest juhtudest 53% avastati Tallinnas ja 25% Ida-Virumaal. Vahemikus 2010­2019 on uute juhtude arv aastas langenud kaks korda, kuid on jätkuvalt väga suur (2). Euroopa Liidus on Eesti HIV-i juhtude arvu poolest 100 000 inimese kohta esireas juba kakskümmend aastat (3). Nakkuse heteroseksuaalsel teel levimise osakaal on kasvanud (69% teadaolevatest nakkuse levikuteedest 2019. aastal olid heteroseksuaalsed), eriti naiste ja üle 29-aastaste seas. Suurenenud on ka homoseksuaalsel teel levinud juhtude osakaal (14% teadaolevatest nakkuse levikuteedest 2019. aastal olid homoseksuaalsed) (2). Eestis uuritakse aastas HIV-nakkuse suhtes ligi 200 000 inimest, nende seas veredoonorid ja kinnipeetavad (2). See moodustab ligi 15% kogu rahvastikust. Kui võrrelda Eesti HIV-testimise taset teiste Euroopa Liidu riikidega, kus testimise andmeid kogutakse, on meil testimise tase keskmisest kõrgem. 2018. aastal uuriti Eestis HIV-i suhtes 85 inimest 1000 inimese kohta (ilma anonüümselt testitute ja veredoonoriteta). Samal ajal testiti näiteks Prantsusmaal 87, Belgias 64, Iirimaal 50, Lätis 47 ja Leedus 39 inimest 1000 inimese kohta. Venemaal testiti 278, Georgias 47 ja Ukrainas 44 inimest 1000 inimese kohta (3). HIV-i nakatunutega puutuvad kokku kõigi erialade esindajad. 2014.­2015. aasta uute HIV-i nakatunute andmed näitasid, et 82% neist oli kahe aasta jooksul enne HIV-i diagnoosimist kasutanud tervishoiuteenuseid (keskmine visiitide arv oli üheksa). Vaid 16% nendest oli vähemalt korra HIV-testitud. Seejuures oli HIV-i indikaatorseisundite puhul testitud vaid 5%. Perearsti oli külastanud 75%, kuid HIV-testi olid tehtud vaid 0,8% visiitide raames (4). 2019. aastal HIV-testiti 7% tervishoiuteenuseid saanud inimestest (5). Perearstid testisid 2% oma patsientidest. Ühe nimistu kohta tegid perearstid 2019. aastal keskmiselt 26 HIV-testi. Harjumaa ja Ida-Virumaa 16­49-aastastest patsientidest olid perearstid testinud vähem kui 4% (5). Naisi testiti oluliselt enam kui mehi (10% vs. 5%), peamiselt oli see seotud raseduse jälgimisega (30% kõigist testidest ja 40% naistele tehtud HIV-testidest olid seotud raseduse jälgimisega). Kõige rohkem oli testitud Ida-Virumaa 16­49-aastaseid naisi (22%) ja mehi (10%). Kui vaadata tervishoius testitute arvu rahvaarvu suhtes, siis olid Harjumaa ja Ida-Virumaa naistest 2019. aastal testitud kümnendik ja meestest umbes 5%. HIV-i indikaatorseisunditega raviarvetest oli 3%-l HIV-test (5). Peamiste riskirühmade ­ narkootikume süstivate inimeste (NSI) ja prostitutsiooni kaasatud naiste ­ seas on HIV-testimise tase ja teadlikkus HIV-i nakatumisest üsna hea, kuid meestega seksivate meeste (MSM) seas madalam (2). Perearstid testisid 1% oma patsientidest ja eriarstid 8%. Kõige suurem HIV-testitud patsientide osakaal oli Ida-Virumaal (9%) ja 16­49-aastaste seas (13%), seejuures Ida-Virumaa 16­49-aastase seas 16%. Naisi oli testitud oluliselt enam kui mehi (9% vs 4%) ja see oli peamiselt seotud raseduse jälgimisega (30% kõigist testidest ja 40% naistele tehtud HIV-testidest oli seotud raseduse jälgimisega). HIV-i indikaatorseisunditega raviarvetest oli 3%-l HIV-test (5). Peamiste riskirühmade ­ narkootikume süstivate inimeste (NSI) ja prostitutsiooni kaasatud naiste seas on HIV-testimise tase ja teadlikkus HIV-nakatumisest üsna hea, kuid meestega seksivate meeste (MSM) seas madalam (2). Heast üldisest testimise tasemest hoolimata elab Eestis hinnanguliselt ligi tuhat inimest, kellel ei ole HIV-nakkus veel diagnoositud (6). Keskmiselt 6%-l uutest HIV-i nakatunutest diagnoositakse kolme kuu möödudes AIDS, mille osakaal on viimase kümne aasta jooksul kasvanud (2). 2019. aasta andmete põhjal oli hiliseid diagnoose enam heteroseksuaalsel teel nakatunute ja vanemate vanuserühmade seas (2). Hilise diagnoosimise tõttu hilineb ravile pöördumine, halveneb elukvaliteet ja suurenevad ravikulud (7). Peale selle levitavad inimesed, kes oma nakkusest ei tea, HIV-i palju suurema tõenäosusega kui teadlikud nakatunud (1) (8). Eestis on HIV-testimise suunised aastaid olnud kooskõlas rahvusvaheliste soovitustega. HIV-testimine on alati olnud võimalik kõikide arstlike erialade raames. Aastast 2016 on kehtivate juhiste alusel võimalik testida ka ravikindlustamata patsiente ja aastast 2017 on perearstidel piiramatud vahendid HIV-testimiseks. Sellest hoolimata on HIV-i varases diagnoosimises olulisi puudujääke. Et testimine täidaks oma eesmärki, on vaja juhiseid ja tõhusaid tervishoiukorralduslikke meetmed. Nii saab HIV-nakkuse diagnoosida võimalikult varakult ja panustada selle edasise leviku ennetamisse.

Developing and Validating an Effective Pediatric and Adolescent HIV Testing Eligibility Screening Tool for High-Volume Entry Points in Uganda.

INTRODUCTION: Because of low pediatric HIV prevalence, more tests are needed to find 1 HIV-positive child compared with adults. In Uganda, the number needed to test (NNT) to find 1 new HIV-positive child was 64 in outpatient departments (OPDs) and 31 through index testing. We aimed to develop and validate a pediatric (1.5-14 years) screening tool to optimize testing approaches. METHODS: Phase 1 evaluated the performance of 10 screening questions in 14 OPDs using a variable selection algorithm to evaluate combinations of screening questions. Using logistic regression, we identified the number of screening questions with the best predictive accuracy using the receiver operation characteristic curve. Phase 2 validated the proposed tool in 15 OPDs and 7 orphan and vulnerable children programs. We estimated sensitivity, specificity, and NNT accounting for intercluster correlations. RESULTS: A total of 3482 children were enrolled. The optimal model included reported HIV-positive maternal status or 2/5 symptoms (sickly in the last 3 months, recurring skin problems, weight loss, not growing well, and history of tuberculosis). The proposed tool had sensitivity of 83.6% [95% confidence interval (CI): 68.1 to 92.4] and specificity of 62.5% (95% CI: 55.0 to 69.4). The tool was validated in a sample of 11,342 children; sensitivity was 87.8% (95% CI: 80.9 to 92.5) and specificity 62.6% (95% CI: 54.8 to 69.7) across OPDs and community sites. In OPDs, sensitivity was 88.1% (95% CI: 80.8 to 92.8) and specificity 69.0% (95% CI: 61.9 to 75.3). The NNT was 43 (95% CI: 28 to 67) across settings and 28 (95% CI: 20 to 38) for OPD. CONCLUSIONS: This HIV screening tool has high sensitivity and reasonable specificity, increasing testing efficiency and yield for children and adolescents.

HIV testing in patients who are HCV positive: Compliance with CDC guidelines in a large healthcare system.

BACKGROUND: There are approximately 300,000 people in the United States who are co-infected with HIV and HCV. Several organizations recommend that individuals who are HCV infected, as well as persons over the age of 13, should be HIV tested. Comorbidities associated with HCV can be reduced with early identification of HIV. Our objective was to determine whether providers routinely followed HIV testing guidelines for patients who tested HCV positive (HCV+). METHODS: A retrospective chart review was conducted of all patients in primary care at an academic health system from 7/2015-3/2017 who tested HCV+. As part of a primary database, HCV testing data was collected; HIV testing data was abstracted manually. We collected and described the intervals between HCV and HIV tests. To determine associations with HIV testing univariable and multivariable analyses were performed. RESULTS: We identified 445 patients who tested HCV+: 56.6% were tested for HIV, the mean age was 57 ± 10.9 years, 77% were from the Birth Cohort born 1945-1965 (BC); 61% were male; and 51% were Black/AA. Patients in the BC were more likely to be HIV tested if they were: male (p = 0.019), Black/AA (p<0.001), and had Medicaid (p = 0.005). These differences were not found in the non-BC. Six patients who were tested for both HIV and HCV were found to be newly HIV positive at the time of testing. CONCLUSION: As demonstrated, providers did not routinely follow CDC recommendations as almost half of the HCV+ patients were not correctly tested for HIV. It is important to emphasize that six persons were tested HIV positive simultaneously with their HCV+ diagnosis. If providers did not follow the CDC guidelines, then these patients may not have been identified. Improvements in EHR clinical decision support tools and provider education can help improve the HIV testing rate among individuals who are HCV+.

Direct single-molecule imaging for diagnostic and blood screening assays.

Every year, over 100 million units of donated blood undergo mandatory screening for HIV, hepatitis B, hepatitis C, and syphilis worldwide. Often, donated blood is also screened for human T cell leukemia-lymphoma virus, Chagas, dengue, Babesia, cytomegalovirus, malaria, and other infections. Several billion diagnostic tests are performed annually around the world to measure more than 400 biomarkers for cardiac, cancer, infectious, and other diseases. Considering such volumes, every improvement in assay performance and/or throughput has a major impact. Here, we show that medically relevant assay sensitivities and specificities can be fundamentally improved by direct single-molecule imaging using regular epifluorescence microscopes. In current microparticle-based assays, an ensemble of bound signal-generating molecules is measured as a whole. By contrast, we acquire intensity profiles to identify and then count individual fluorescent complexes bound to targets on antibody-coated microparticles. This increases the signal-to-noise ratio and provides better discrimination over nonspecific effects. It brings the detection sensitivity down to the attomolar (10-18 M) for model assay systems and to the low femtomolar (10-16 M) for measuring analyte in human plasma. Transitioning from counting single-molecule peaks to averaging pixel intensities at higher analyte concentrations enables a continuous linear response from 10-18 to 10-5 M. Additionally, our assays are insensitive to microparticle number and volume variations during the binding reaction, eliminating the main source of uncertainties in standard assays. Altogether, these features allow for increased assay sensitivity, wide linear detection ranges, shorter incubation times, simpler assay protocols, and minimal reagent consumption.

Comprehensive investigation of sources of misclassification errors in routine HIV testing in Zimbabwe.

INTRODUCTION: Misclassification errors have been reported in rapid diagnostic HIV tests (RDTs) in sub-Saharan African countries. These errors can lead to missed opportunities for prevention-of-mother-to-child-transmission (PMTCT), early infant diagnosis and adult HIV-prevention, unnecessary lifelong antiretroviral treatment (ART) and wasted resources. Few national estimates or systematic quantifications of sources of errors have been produced. We conducted a comprehensive assessment of possible sources of misclassification errors in routine HIV testing in Zimbabwe. METHODS: RDT-based HIV test results were extracted from routine PMTCT programme records at 62 sites during national antenatal HIV surveillance in 2017. Positive- (PPA) and negative-percent agreement (NPA) for HIV RDT results and the false-HIV-positivity rate for people with previous HIV-positive results ("known-positives") were calculated using results from external quality assurance testing done for HIV surveillance purposes. Data on indicators of quality management systems, RDT kit performance under local climatic conditions and user/clerical errors were collected using HIV surveillance forms, data-loggers and a Smartphone camera application (7 sites). Proportions of cases with errors were compared for tests done in the presence/absence of potential sources of errors. RESULTS: NPA was 99.9% for both pregnant women (N = 17224) and male partners (N = 2173). PPA was 90.0% (N = 1187) and 93.4% (N = 136) for women and men respectively. 3.5% (N = 1921) of known-positive individuals on ART were HIV negative. Humidity and temperature exceeding manufacturers' recommendations, particularly in storerooms (88.6% and 97.3% respectively), and premature readings of RDT output (56.0%) were common. False-HIV-negative cases, including interpretation errors, occurred despite staff training and good algorithm compliance, and were not reduced by existing external or internal quality assurance procedures. PPA was lower when testing room humidity exceeded 60% (88.0% vs. 93.3%; p = 0.007). CONCLUSIONS: False-HIV-negative results were still common in Zimbabwe in 2017 and could be reduced with HIV testing algorithms that use RDTs with higher sensitivity under real-world conditions and greater practicality under busy clinic conditions, and by strengthening proficiency testing procedures in external quality assurance systems. New false-HIV-positive RDT results were infrequent but earlier errors in testing may have resulted in large numbers of uninfected individuals being on ART.

The Role of Targeted HIV Screening in the Emergency Department: A Scoping Review.

BACKGROUND: Human immunodeficiency virus (HIV) infection continues to expand worldwide, and a significant proportion of infection is still undiagnosed. Recent studies have addressed the impact and feasibility of 'opt-out' HIV screening in Emergency Departments (EDs) in urban settings at high HIV prevalence, whereas little is known about the yield of implementing 'targeted' HIV testing, especially in low-prevalence areas. OBJECTIVE: The present study undertakes a scoping review of research carried out on the implementation of targeted HIV screening of adult in EDs to determine the impact, feasibility and acceptability of HIV testing in different HIV prevalence settings. DESIGN: Online databases (EMBASE, MEDLINE) were used to identify papers published between 2000 to 2020. A three-concept search was employed with HIV (HIV, Human immunodeficiency virus infection, HIV infections), targeted testing (Target, screening or testing) and emergency medicine (Emergency Service, emergency ward, A&E, accident and emergency or Emergency Department) (28th February 2020). Only full-text articles written in English, French, Spanish or Italian and using impact and/or feasibility and/or acceptability of the program as primary or secondary outcomes were analysed. RESULTS: The search provided 416 articles. Of these, 12 met inclusion criteria and were included in the final review. Most of the included studies were carried out in the United States (n=8; 67%) and in areas of high HIV prevalence (n=11; 92%). Three (20%) were randomized control studies. While the rate of newly diagnosed HIV cases varied widely (0.03-2.2%), likely due to methodological heterogeneity between studies, the linkage of new HIV diagnosis was often high (80-100%) and median CD4+ cell count was always greater than 200 cells per microliter. Targeted HIV screening was found to be cost-effective (out of 2 studies) and well accepted by participants (out 2 studies). CONCLUSIONS: Targeted HIV screening at the ED can be impactful, feasible and well accepted, but often requires extra funding and staff. Most previous work has focused on areas of high disease prevalence.

Willingness of Adults in the United States to Receive HIV Testing in Dental Care Settings: Cross-Sectional Web-Based Study.

BACKGROUND: The Centers for Disease Control and Prevention estimates that 1.1 million people in the United States are living with HIV and 1 in 8 are estimated to be unaware of their serostatus. Little is known about whether individuals would consider being tested for HIV in nontraditional health care settings such as a dentist's office. Studies in selected US cities have indicated high acceptability of receiving an HIV test among people attending dental clinics. However, we are not aware of studies that have assessed willingness to receive HIV testing in dental care settings at a national level. OBJECTIVE: Using a web-based sample of adult residents of the United States, we sought to assess the self-reported willingness to receive any type of HIV testing (ie, oral fluid rapid testing, finger-stick blood rapid testing, or venipuncture blood testing) in a dental care setting and evaluate independent associations of willingness with the extent to which dental care providers were perceived as knowledgeable about HIV and how comfortable participants felt discussing HIV with their dental care providers. METHODS: Participants were recruited using banner advertisements featured on social networking platforms (Facebook and Instagram) from December 2018 to February 2019. Demographic and behavioral data including information on sexual behaviors in the past 6 months, HIV testing history, and dental/health care-seeking history were collected using an anonymous web-based survey. Willingness to receive any type of HIV testing in a dental care setting was assessed on 4-point scale from very willing to very unwilling. Factors independently associated with participants' willingness were identified using a multivariable logistic regression model. RESULTS: Of the 421 participants in our study aged 18 to 73 years, 271 (64.4%) reported having oral sex, 197 (46.8%) reported having vaginal sex, and 136 (32.3%) reported having anal sex in the past 6 months. Approximately one-third had never been tested for HIV (137/421, 32.5%), and the same proportion had not been tested in the past year (137/421, 32.5%). Most participants had dental insurance coverage (356/421, 84.6%), and more than three-fourths reported being very or somewhat willing (326/421, 77.4%) to receive any type of HIV testing in a dental care setting. Higher levels of willingness were associated with being 18 to 24 years versus ≥35 years (aOR 3.22, 95% CI 1.48-6.98), 25 to 34 years versus ≥35 years (aOR 5.26, 95% CI 2.52-10.98), believing that one's dental care provider is knowledgeable about HIV (aOR 2.04, 95% CI 1.06-3.92), and feeling comfortable discussing HIV with one's dental care provider (aOR 9.84, 95% CI 3.99-24.27). CONCLUSIONS: Our data indicate high acceptability of receiving HIV testing in a dental care setting, especially among those who report having a positive patient-provider relationship. Future research should focus on assessing dental care providers' attitudes, self-efficacy, and beliefs about whether HIV testing fits into the scope of dentistry.

Facilitators of Self-Initiated HIV Testing Among Youths: A Qualitative Study.

BACKGROUND: Youth experience disparities in HIV infection but have significantly low rates of HIV testing that lead to late diagnoses, increased transmission rates, and adverse health outcomes. There is limited knowledge regarding self-initiated HIV testing, which is a promising strategy for improving testing rates among youth. PURPOSE: This study aimed to identify the facilitators of self-initiated HIV testing among youth. METHOD: Thirty youths aged 18-24 years were recruited to participate in a qualitative descriptive study. Potential participants were recruited from a combination of HIV testing sites, including community testing events, a community-based organization, an adolescent health clinic, and a college campus. A demographic and sexual history questionnaire and audio-recorded interviews were used to collect data. Transcribed interviews were analyzed using qualitative content analysis. RESULTS: Salient themes and subthemes that explain the study findings are as follows: testing within the context of a sexual relationship (e.g., infidelity), support and influence from social relationships (e.g., family support), taking the initiative for health (e.g., signs and symptoms of infection), HIV testing preferences (e.g., free testing), and HIV testing experiences (e.g., provision of other health services). CONCLUSIONS: The findings of this study advance scholarly understanding regarding the predictors of self-initiated testing and provide critical information necessary to further improve evidence-based nursing clinical practice and develop public health nursing interventions that target self-initiated HIV testing. Encouraging self-initiated HIV testing is an effective approach to increasing testing rates and, consequently, preventing new HIV transmissions in this vulnerable population.

Consolidated guidelines on HIV testing services, 2019

These consolidated guidelines on HIV testing services (HTS) bring together existing and new guidance on HTS across different settings and populations. The World Health Organization (WHO) first released consolidated guidelines on HTS in 2015, in response to requests from Member States, national programme managers and health workers for support to achieve the United Nations (UN) 90­90­90 global HIV targets ­ and specifically the first target of diagnosing 90% of all people with HIV. In 2016, based on new evidence, WHO released a supplement to address important new HIV testing approaches ­ HIV self-testing (HIVST) and provider-assisted referral. Since the release of 2015 and 2016 HTS guidelines, new issues and more evidence have emerged. To address this, WHO has updated guidance on HIV testing services. In this guideline, WHO updates recommendation on HIVST and provides new recommendations on social network-based HIV testing approaches and western blotting (see box, next page). This guideline seeks to provide support to Member States, programme managers, health workers and other stakeholders seeking to achieve national and international goals to end the HIV epidemic as a public health threat by 2030. These guidelines also provide operational guidance on HTS demand creation and messaging; implementation considerations for priority populations; HIV testing strategies for diagnosis HIV; optimizing the use of dual HIV/syphilis rapid diagnostic tests; and considerations for strategic planning and rationalizing resources such as optimal time points for maternal retesting (see box, next page).