scholarly journals Current allocations and target apportionment for HIV testing and treatment services for marginalized populations: characterizing PEPFAR investment and strategy

2021 ◽  
Vol 24 (S3) ◽  
Author(s):  
Austin Jones ◽  
Brian Honermann ◽  
Elise Lankiewicz ◽  
Jennifer Sherwood ◽  
Greg Millett
Keyword(s):  
Hiv Testing ◽  
Marginalized Populations ◽  
Treatment Services

scholarly journals An urgent need for a paradigm shift in HIV testing for older children: A sine qua non condition to achieve an AIDS-free generation

2020 ◽  
Author(s):  
H.A. Yumo ◽  
J.J.N. Ndenkeh ◽  
I. Sieleunou ◽  
D.N. Nsame ◽  
P.B. Kuwoh ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Pediatric Hiv ◽  
Hiv Care ◽  
Older Children ◽  
Chi Square ◽  
Treatment Services ◽  
Art Initiation ◽  
Testing Technology ◽  
Chi Square Test ◽  
Free Generation

AbstractBackgroundAchieving an AIDS-free generation requires effective pediatric testing and treatment services. While pediatric HIV testing has been more focused on children below 18 months through PMTCT, the yield of this approach remains unclear comparatively to testing children above 18 months through routine PITC. This study aimed at bridging this evidence gap and provide knowledge to guide pediatric HIV testing investments.Materials and MethodsParents visiting or receiving HIV care in three hospitals in Cameroon were invited to test their children for HIV. HIV testing was done using PCR and antibody rapid tests for children < 18 months and those ≥18 months, respectively. We compared HIV case detection and ART initiation between the two subgroups of children and this using Chi-square test at 5% significant level.ResultsA total of 4079 children aged 6 weeks-15 years were included in the analysis. Compared to children < 18 months, children group ≥18 months was 4-fold higher among those who enrolled in the study (80.3% vs 19.7%, p<0.001); 3.5-fold higher among those who tested for HIV (77.6% vs 22.4%, p<0.001); 6-fold higher among those who tested HIV+ (85.7% vs 14.3%, p=0.241) and 11-fold higher among those who enrolled on ART (91.7% vs 8.3%, p< 0.028).ConclusionsOur results show that 4 out of 5 children who tested HIV+ and over 90% of ART enrolled cases were children ≥ 18 months. Thus, while rolling out PCR HIV testing technology for neonates and infants, committing adequate and proportionate resources in antibody rapid testing for older children is a sine quo none condition to achieve an AIDS-free generation.

scholarly journals Ethical Challenges of HIV Partner Notification in Prisons

2019 ◽  
Vol 18 ◽  
pp. 232595821988058 ◽  
Author(s):  
Gabriel J. Culbert ◽  
Valerie A. Earnshaw ◽  
Judith A. Levy
Keyword(s):  
Hiv Testing ◽  
Partner Notification ◽  
Index Patient ◽  
Standards Of Care ◽  
People Living With Hiv ◽  
Ethical Challenges ◽  
Treatment Services ◽  
Undiagnosed Hiv ◽  
Hiv Exposure ◽  
Health Illiteracy

Partner services provide a safe and humane way for people living with HIV (PLWH) to alert their sex and/or drug-injecting partners to the possibility of HIV exposure and the need for HIV testing, yet little is known about the ethical challenges of delivering partner services in prisons. In this article, we consider 7 key ethical and methodological questions that should be considered when developing, testing, or implementing partner services in prison settings. These questions relate to the ethics of: (1) mandatory HIV testing, (2) health illiteracy, (3) level of prison staff involvement, (4) protecting confidentiality, (5) minimizing harm, (6) achieving equivalency with community standards of care, and (7) providing HIV prevention and treatment services to index patient and their partners. By assisting PLWH in prison to inform partners with whom they may have shared HIV exposure either before or during incarceration, partner services can help to identify cases of undiagnosed HIV infection for testing and linkage to medical care. The acceptability and effectiveness of a future partner services model for PLWH in prison depends critically on answering these 7 questions to assure the highest ethical standards of research and practice.

scholarly journals An Internet-Based Self-Testing Model (Easy Test): Cross-Sectional Survey Targeting Men Who Have Sex With Men Who Never Tested for HIV in 14 Provinces of China (Preprint)

2018 ◽  
Author(s):  
Xia Jin ◽  
Junjie Xu ◽  
M. Kumi Smith ◽  
Dong Xiao ◽  
Erica R Rapheal ◽  
...  
Keyword(s):  
Positive Result ◽  
Hiv Testing ◽  
Sexual Partners ◽  
Hiv Prevalence ◽  
Hiv Positive ◽  
Test Model ◽  
Test Results ◽  
Treatment Services ◽  
Sex With Men ◽  
First Time

BACKGROUND With China’s explosive internet growth, activities such as socializing and partner seeking among men who have sex with men (MSM) has also become Web based through popular services such as Blued. This creates a new mode of health promotion with the potential to instantly reach large numbers of MSM, including those who rarely access traditional offline testing facilities. OBJECTIVE This study aimed to assess the feasibility of the Easy Test in increasing access and uptake of HIV testing and treatment services among MSM and to identify demographic and behavioral predictors of program uptake to inform future implementation. METHODS A feasibility study of the Easy Test model was conducted from October 2017 to December 2017 in 14 Chinese provinces. Applicants who provided informed consent completed a self-administered questionnaire and submitted a US $5 deposit to have the free test kit delivered to their homes. Orders were then received, processed, and posted by volunteers from local community-based organizations. Once applicants submitted images of their test results, the deposit was refunded to the applicant. Those whose test results were deemed to be HIV-positive were then connected to a peer navigator to accompany the individual to follow-up medical services. A chi-squared trend test was used to assess the relationship between lifetime HIV testing volume and HIV prevalence. Logistic regression models were used to identify independent risk factors associated with two outcomes: (1) never having tested for HIV and (2) receiving an HIV-positive result. RESULTS A total of 879 individuals submitted Web-based requests for test kits. Their median age was 28 (interquartile range 24-34 years); 69.3% (609/879) had at least a college education, and 51.5% (453/879) had a monthly income between US $450 to $750; 77.7% (683/879) of the applicants submitted images of their test results, among whom 14.3% (98/683) had an HIV-positive result. Among the 42.9% (293/683) who were first-time testers, the HIV prevalence was 18.8% (55/293). Nearly three-quarters (71/98, 72.4%) of those with a positive test result were connected with a peer navigator and enrolled in treatment. Among the first-time testers, having multiple sexual partners (2-3 sexual partners: adjusted odds ratio [aOR] 2.44, 95% CI 1.08-5.50; 4 or above sexual partners: aOR 3.55, 95% CI 1.18-10.68) and reporting inconsistent condom use in the previous 3 months (aOR 7.95, 95% CI 3.66-17.26) were both associated with an HIV-positive result. An inverse dose response relationship between lifetime HIV testing volume and HIV prevalence was also observed in this study (χ23=55.0; P<.001). CONCLUSIONS The Easy Test model reached a larger portion of first-time testers, many who reported higher risk sexual behaviors. This highlights the potential for an internet-based self-test model to increase access to HIV treatment services for HIV-positive MSM in China.

scholarly journals Understanding the pathways leading to socioeconomic inequalities in HIV testing uptake in 18 sub-Saharan African countries: a mediation analysis

2021 ◽  
Author(s):  
Pearl Anne Ante-Testard ◽  
Mohamed Hamidouche ◽  
Benedicte Apouey ◽  
Rachel Baggaley ◽  
Joseph Larmarange ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Indirect Effects ◽  
Socioeconomic Inequalities ◽  
Demographic And Health Surveys ◽  
People Living With Hiv ◽  
African Countries ◽  
Treatment Services ◽  
Positive Attitudes ◽  
Testing Uptake ◽  
Sub Saharan

Introduction: Although socioeconomic inequalities in HIV prevention, testing and treatment services have been well documented, their drivers remain poorly understood. Understanding the different pathways between socioeconomic position and HIV testing across different countries could help designing tailored programs aimed at reducing such inequalities. Methods: We analysed data from Demographic and Health Surveys conducted between 2010 and 2018 in 18 sub-Saharan African countries (Burkina Faso, Cameroon, Cote d Ivoire, Congo DR, Ethiopia, Guinea, Kenya, Lesotho, Liberia, Malawi, Mali, Niger, Rwanda, Senegal, Sierra Leone, Tanzania, Zambia and Zimbabwe). Using a potential outcomes framework and the product method, we decomposed the total effect linking wealth and recent (< 12 months) HIV testing into i) direct effects, and ii) indirect effects, via demand-related (related to individual s ability to perceive need for care and inclination to seek care) or supply-related (related to individual s ability to reach, pay for and engage in health care) mediators. Multivariable gender-specific modified Poisson models were fitted to estimate proportions mediated, while accounting for exposure-mediator interaction when present. Results: A total of 392,044 participants were included in the analysis. Pro-rich wealth-related inequalities were observed in a majority of countries, with nine countries with high levels of inequalities among women and 15 countries among men. The indirect effects of each mediator varied greatly across countries. The proportion mediated tended to be higher for demand-related than for supply-related mediators. For instance, among women, HIV-related knowledge was estimated to mediate up to 12.1% of inequalities in Cote d Ivoire; this proportion was up to 31.5% for positive attitudes toward people living with HIV (PLHIV) in Senegal. For the four supply-related mediators, the proportion mediated was systematically below 7%. Similar conclusions were found when repeating analyses on men for the demand-related mediators, with higher proportions mediated by positive attitudes toward PLHIV (up to 39.9% in Senegal). Conclusions: Our findings suggest that socioeconomic inequalities in HIV testing may be mediated by the demand-side more than supply-side characteristics, with important variability across countries. Overall, the important inter-country heterogeneity in pathways of socioeconomic inequalities in HIV testing illustrates that addressing inequalities requires tailored efforts as well as upstream interventions. A French version of the abstract is available upon request from the corresponding author.

scholarly journals The impacts of community-based HIV testing and counselling on testing uptake

2018 ◽  
Vol 32 (2) ◽  
pp. 152-163 ◽  
Author(s):  
Jaelan Sumo Sulat ◽  
Yayi Suryo Prabandari ◽  
Rossi Sanusi ◽  
Elsi Dwi Hapsari ◽  
Budiono Santoso
Keyword(s):  
At Risk ◽  
Hiv Testing ◽  
Systematic Reviews ◽  
Health Facilities ◽  
Community Based ◽  
Content Type ◽  
Treatment Services ◽  
Hiv Testing And Counselling ◽  
At Risk Populations ◽  
Meta Analyses

Purpose Community-based HIV testing and counselling (HTC) has been recommended for improving access to prevention, care, and treatment services in at-risk populations. Earlier systematic reviews and meta-analyses have been undertaken, but due to some methodological limitations, their findings do not yet provide a practical significance. The purpose of this paper is to re-examine the recent evidence of the efficacy of community-based HTC approaches on the uptake of HTC in at-risk populations. Design/methodology/approach The database of PubMed online, Science Direct, the Lancet Global Health, the Cochrane Central Register of Controlled Trials, and Google Scholar were systematically searched using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to obtain empirical papers published between March 2013 and December 2015. Findings Of 600 collected papers, there were 6 cluster randomized trials papers which met the inclusion criteria. Compared to the health facilities-based HTC, community-based HTC approaches have been shown to improve the uptake of HIV testing from 5.8 to 37 per cent, and improve HIV testing in men and their partners together from 6.8 to 34 per cent. The community approaches also detected lower HIV-positive cases (0.29 per cent as compared to 4 per cent), improved access to treatment services from 0.3 to 25 per cent, demonstrated higher cluster differentiation 4 count in newly diagnosed patients (median of 400-438 cells/µl), and increased the rate of first-time HIV testing from 9 to 11.8 per cent. With respect to social and behavioural outcomes, community-based HTC increased social norms for HIV testing by 6 per cent (95 per cent CI 3-9), decreased multiple sex partners by 55 per cent (95 per cent CI 42-73), lowered casual sex by 45 per cent (95 per cent CI 33-62), increased knowledge about HIV (83.2 vs 28.9 per cent), improved positive attitudes towards HIV patients (73.0 vs 34.3 per cent), and increased the use of condoms (28.0 vs 12.3 per cent). Originality/value Community-based HTC combined with behavioural interventions have been found to be more effective in increasing the uptake of HIV testing as well as other outcomes as compared to the conventional health facilities-based testing and counselling approaches.

HIV Testing and HIV/AIDS Treatment Services in Rural Counties in 10 Southern States: Service Provider Perspectives

2010 ◽  
Vol 26 (3) ◽  
pp. 240-247 ◽  
Author(s):  
Madeline Sutton ◽  
Monique-Nicole Anthony ◽  
Christie Vila ◽  
Eleanor McLellan-Lemal ◽  
Paul J. Weidle
Keyword(s):  
Hiv Testing ◽  
Service Provider ◽  
Southern States ◽  
Treatment Services ◽  
Provider Perspectives ◽  
Rural Counties ◽  
Hiv Aids
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