Pediatric HIV Case Identification Across 22 PEPFAR-Supported Countries During the COVID-19 Pandemic, October 2019-September 2020.

During 2020, an estimated 150,000 persons aged 0-14 years acquired HIV globally (1). Case identification is the first step to ensure children living with HIV are linked to life-saving treatment, achieve viral suppression, and live long, healthy lives. Successful interventions to optimize pediatric HIV testing during the COVID-19 pandemic are needed to sustain progress toward achieving Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets.* Changes in HIV testing and diagnoses among persons aged 1-14 years (children) were assessed in 22 U.S. President's Emergency Plan for AIDS Relief (PEPFAR)-supported countries during October 1, 2019-September 30, 2020. This period corresponds to the two fiscal quarters before the COVID-19 pandemic (i.e., Q1 and Q2) and the two quarters after the pandemic began (i.e., Q3 and Q4). Testing was disaggregated by age group, testing strategy, and fiscal year quarter. During October 2019-September 2020, PEPFAR supported 4,312,343 HIV tests and identified 74,658 children living with HIV (CLHIV). The number of HIV tests performed was similar during Q1 and Q2, decreased 40.1% from Q2 to Q3, and increased 19.7% from Q3 to Q4. The number of HIV cases identified among children aged 1-14 years (cases identified) increased 7.4% from Q1 to Q2, decreased 29.4% from Q2 to Q3, and increased 3.3% from Q3 to Q4. Although testing in outpatient departments decreased 21% from Q1 to Q4, testing from other strategies increased during the same period, including mobile testing by 38%, facility-based index testing (offering an HIV test to partners and biological children of persons living with HIV) by 8%, and testing children with signs or symptoms of malnutrition within health facilities by 7%. In addition, most tests (61.3%) and cases identified (60.9%) were among children aged 5-14 years (school-aged children), highlighting the need to continue offering HIV testing to older children. These findings provide important information on the most effective strategies for identifying CLHIV during the COVID-19 pandemic. HIV testing programs should continue to use programmatic, surveillance, and financial data at both national and subnational levels to determine the optimal mix of testing strategies to minimize disruptions in pediatric case identification during the COVID-19 pandemic.

Self-reported HIV-positive status but subsequent HIV-negative test result using rapid diagnostic testing algorithms among seven sub-Saharan African military populations.

HIV rapid diagnostic tests (RDTs) combined in an algorithm are the current standard for HIV diagnosis in many sub-Saharan African countries, and extensive laboratory testing has confirmed HIV RDTs have excellent sensitivity and specificity. However, false-positive RDT algorithm results have been reported due to a variety of factors, such as suboptimal quality assurance procedures and inaccurate interpretation of results. We conducted HIV serosurveys in seven sub-Saharan African military populations and recorded the frequency of personnel self-reporting HIV positivity, but subsequently testing HIV-negative during the serosurvey. The frequency of individuals who reported they were HIV-positive but subsequently tested HIV-negative using RDT algorithms ranged from 3.3 to 91.1%, suggesting significant rates of prior false-positive HIV RDT algorithm results, which should be confirmed using biological testing across time in future studies. Simple measures could substantially reduce false-positive results, such as greater adherence to quality assurance guidelines and prevalence-specific HIV testing algorithms as described in the World Health Organization's HIV testing guidelines. Other measures to improve RDT algorithm specificity include classifying individuals with weakly positive test lines as HIV indeterminate and retesting. While expansion of HIV testing in resource-limited countries is critical to identifying HIV-infected individuals for appropriate care and treatment, careful attention to potential causes of false HIV-positive results are needed to prevent the significant medical, psychological, and fiscal costs resulting from individuals receiving a false-positive HIV diagnosis.

Global HIV Prevention, Testing, and Counseling in Military Populations.

BACKGROUND: Compared with the general population in low- and middle-income countries, military members tend to be male, young, travel more frequently away from their main sexual partners, drink more alcohol and have a consistent source of income. All of these factors may lead to an increased risk of contracting HIV. OBJECTIVE: In response, the Department of Defense HIV/AIDS Prevention Program advocates for the integration of HIV prevention "building blocks" into military health services to reduce the risk of acquiring HIV among foreign uniformed services. METHOD: The building blocks include basic HIV education including outreach, condom promotion, enabling HIV policies, HIV testing services, screening for sexually transmitted infections, voluntary medical male circumcision where appropriate, prevention of mother-to-child transmission, and other supportive services. CONCLUSION: The Department of Defense HIV/AIDS Prevention Programs supports implementation of these building blocks though partnerships with foreign militaries. This comprehensive prevention package, when closely linked with HIV treatment services, is the cornerstone of creating an HIVfree generation in military and surrounding communities worldwide.

Voluntary Medical Male Circumcision among Rwanda Defense Force Members.

INTRODUCTION: Strong scientific evidence supports voluntary medical male circumcision as part of an overall HIV prevention strategy, but self-report information on circumcision status may be inaccurate. The study objectives were to obtain estimates of male circumcision within the Rwanda Defense Force (RDF), to assess the ability of soldiers to correctly report their own circumcision status, and to document the uptake of voluntary medical male circumcision (VMMC) in the RDF. METHODS: Data were collected from members of the Rwandan military during their annual physical examination. A self-administered questionnaire collected demographic and circumcision characteristics. Self-reported circumcision status was compared with the medical exam evaluation. RESULTS: Using questionnaires with complete data (n = 579), 69% of the study participants were circumcised by physical examination and there was a strong agreement with self-reported circumcision status (κ = 0.97). Almost half (44%) of all circumcisions had been performed within the past 2 years. DISCUSSION: These results suggest that self-report is an appropriate method to collect information on circumcision status in the Rwandan military. Many of the circumcisions occurred within the last 2 years, possibly as an effect of the successful scale-up of voluntary medical male circumcision in the Rwandan military utilizing effective messaging, demand creation, and positive news reported by the media.

Prevention Interventions for People Living with HIV in Military Settings.

BACKGROUND: Military HIV prevention programs and healthy living programs were developed in the mid-1980s to manage and support newly HIV-positive military personnel in the US military. Since then, a program developed by the Centers for Disease Control and Prevention with support from the Department of Defense HIV/AIDS Prevention Program (DHAPP), called Positive Health, Dignity and Prevention (PHDP), is currently being rolled out by DHAPP in partner militaries. The program, designed to reduce HIV transmission, is a package of interventions for people living with HIV (PLHIV), including risk reduction counseling, condom provision, disclosure counseling, testing of sexual partner(s) and children, adherence counseling, diagnosis and treatment of sexually transmitted infections, and provision of family planning services. METHODS: DHAPP has trained military and civilian personnel caring for military personnel, their families, and the civilians seen at military installations in sub-Saharan Africa, such as Rwanda, Democratic Republic of the Congo, Malawi, and Zambia. These programs have varying degrees of implementing the program with innovative ways of engaging PLHIV. RESULTS/CONCLUSIONS: Many successes are being achieved through the training of military and civilian personnel working for or at military health care settings. In 2015, one of DHAPP's goals for the PHDP program is to enhance the monitoring, evaluation, and reporting of PHDP to demonstrate PHDP service provision to at least 90% of HIV-positive patients over the next 5 years.

Evaluation of PIMATM CD4 System for Decentralization of Immunological Monitoring of HIV-Infected Patients in Senegal.

BACKGROUND: HIV infection is a concern in the army troupes because of the risk behaviour of the military population. In order to allow regular access to CD4+ T cell enumeration of military personnel as well as their dependents and civilians living with HIV, the Senegalese Army AIDS program is implementing PIMATM Alere technology in urban and semi-urban military medical centres. Validation such device is therefore required prior their wide implementation. The purpose of this study was to compare CD4+ T cell count measurements between the PIMATM Alere to the BD FACSCountTM. METHODOLOGY: We selected a total of 200 subjects including 50 patients with CD4+ T-cells below 200/mm3, 50 between 200 and 350/mm3, 50 between 351 and 500/mm3, and 50 above 500/mm3. CD4+ T-cell count was performed on venous blood using the BD FASCountTM as reference method and the PIMATM Point of Care technology. The mean biases and limits of agreement between the PIMATM Alere and BD FACSCountTM were assessed with the Bland-Altman analysis, the linear regression performed using the Passing-Bablok regression analysis, and the percent similarity calculated using the Scott method. RESULTS: Our data have shown a mean difference of 22.3 cells/mm3 [95%CI:9.1-35.5] between the BD FACSCountTM and PIMATM Alere CD4 measurements. However, the mean differences of the two methods was not significantly different to zero when CD4+ T-cell count was below 350/mm3 (P = 0.76). The Passing-Bablok regression in categorized CD4 counts has also showed concordance correlation coefficient of 0.89 for CD4+ T cell counts below 350/mm3 whilst it was 0.5 when CD4 was above 350/mm3. CONCLUSION: Overall, our data have shown that for low CD4 counts, the results from the PIMATM Alere provided accurate CD4+ T cell counts with a good agreement compared to the FACSCountTM.

Sexually transmitted infections and sexual behaviour of deploying shipboard US military personnel: a cross-sectional analysis.

OBJECTIVES: Sexually transmitted infection (STI) prevalence and risk behaviour may differ at different phases of deployment. We examined STI prevalence and sexual behaviour in the predeployment time period (12 months prior) among recently deployed shipboard US Navy and Marine Corps military personnel. METHODS: Data were collected from 1938 male and 515 female service members through an anonymous, self-completed survey assessing sexual behaviours and STI acquisition characteristics in the past 12 months. Cross-sectional sex-stratified descriptive statistics are reported. RESULTS: Overall, 67% (n=1262/1896) reported last sex with a military beneficiary (spouse, n=931, non-spouse service member, n=331). Among those with a sexual partner outside their primary partnership, 24% (n=90/373) reported using a condom the last time they had sex and 30% (n=72/243) reported their outside partner was a service member. In total, 90% (n=210/233) reported acquiring their most recent STI in the USA (88%, n=126/143 among those reporting ≥1 deployments and an STI ≥1 year ago) and a significantly higher proportion (p<0.01) of women than men acquired the STI from their regular partner (54% vs 21%) and/or a service member (50% vs 26%). CONCLUSIONS: Findings suggest a complex sexual network among service members and military beneficiaries. Findings may extend to other mobile civilian and military populations. Data suggest most STI transmission within the shipboard community may occur in local versus foreign ports but analyses from later time points in deployment are needed. These data may inform more effective STI prevention interventions.

The impact of an educational film on promoting knowledge and attitudes toward HIV in soldiers of the Serbian Armed Forces.

BACKGROUND/AIM: Millions of soldiers around the world represent one of the most vulnerable populations regarding exposure to human immunodeficiency virus (HIV) infection. The programs for HIV prevention remain the most viable approach to reducing the spread of HIV infection. Very few studies have tested the effectiveness of HIV preventive interventions undertaken in military population. The aim of this study was to determine the effectiveness of educational film to transfer knowledge about HIV infection to soldiers. METHODS: We performed a quasi-experimental study among 102 soldiers of the Serbian Armed Forces. The experimental intervention consisted of the HIV knowledge pre-questionnaire, watching a film on HIV knowledge, then the post-HIV knowledge questionnaire. The results of pre- and post-HIV knowledge questionnaires were compared. RESULTS: There were 23 questions in the test. The average total score on the questionnaire before watching the film was 18.23 and after watching it was 20.14, which was statistically significant difference (p < 0.001). CONCLU- SIONS: The results of the study show that viewing a film on HIV infection is an effective method of transferring knowledge about HIV to the Serbian military population.

Military HIV policy assessment in sub-Saharan Africa.

While HIV/AIDS continues to inflict a heavy toll on African militaries, the military commitment and leadership response has been inconsistent, as reflected by variable presence of a written HIV policy. The Department of Defense HIV/AIDS Prevention Program collaborates with most sub-Saharan military HIV/AIDS programs. In 2010, 28 invited countries (80%) completed a self-administered survey describing their program, including policy. Descriptive and nonparametric measures were calculated. The majority (57%) of respondents reported having a written military HIV policy. Of these, 86% included HIV testing, 88% required recruit testing, and 96% denied entry for those testing HIV-positive. Mandatory HIV testing was reported by 71%, occurring before deployments, peacekeeping missions, foreign training, and when clinically indicated. Southern African militaries were most likely to require HIV testing. The majority of militaries allowed deployment of HIV-positive personnel in-country, whereas few allowed foreign deployment. Most sub-Saharan militaries screen applicants for HIV and other diseases to determine duty fitness, resulting in near universal HIV negative recruit cohorts. No militaries discharge personnel from service if they acquire HIV. Legal challenges to military HIV policies may hinder finalization and dissemination of policies. Lack of HIV policies impedes routine testing and earlier care and treatment for HIV-infected personnel.

HIV type 1 pol gene diversity and genotypic antiretroviral drug resistance mutations in Malabo, Equatorial Guinea.

In this study, HIV strains circulating among military personnel were characterized, in Malabo, the capital city of Equatorial Guinea. One sample was found to be HIV-2 group A while a high degree of genetic diversity was recorded in the pol region of 41 HIV-1-positive samples. CRF02_AG accounted for 53.7% of the strains, and 11 different variants were obtained in the remaining 19 samples: subtype G (n = 3), A3 (n = 2), C (n = 2), CRF26_A5U (n = 2), F2 (n = 1), CRF06 (n = 1), CRF09 (n = 1), CRF11 (n = 1), CRF22 (n = 1), and divergent subtype A (n = 1) and F (n = 1). One strain could not be classified and three were unique recombinants. Analysis of antiretroviral drug resistance mutations revealed two patients each harboring one major mutation, M46I in protease and D67N in reverse transcriptase sequences, respectively. The high genetic diversity and emerging ARV resistance mutations call for frequent surveys and appropriate monitoring of ARV considering the increasing access to ARV in the country.