Accurate Comparison of HIV Testing Strategies Requires Verification of Clients’ HIV Status Using HIV Surveillance Registry. A Commentary on Halkitis et al.

2011 ◽  
Vol 43 (1) ◽  
pp. 143-143 ◽  
Author(s):  
Tamar C. Renaud ◽  
Angelica Bocour ◽  
Chi-Chi Udeagu ◽  
Colin W. Shepard
Keyword(s):  
Hiv Testing ◽  
Hiv Status ◽  
Hiv Surveillance ◽  
Testing Strategies ◽  
Accurate Comparison

scholarly journals Suboptimal HIV status ascertainment at antenatal clinics and the impact on HIV prevalence estimates

2021 ◽  
Author(s):  
Fatihiyya Wangara ◽  
Janne Estill ◽  
Hillary Kipruto ◽  
Kara Wools-Kaloustian ◽  
Wendy Chege ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Routine Data ◽  
Hiv Prevalence ◽  
Sentinel Surveillance ◽  
List Type ◽  
Hiv Status ◽  
Hiv Surveillance ◽  
New Findings ◽  
Prevalence Estimates ◽  
Antenatal Clinics

AbstractIntroductionHIV prevalence estimates is a key indicator to inform the coverage and effectiveness of HIV prevention measures. Many countries including Kenya transitioned from sentinel surveillance to the use of routine antenatal care data to estimate the burden of HIV. Countries in Sub Saharan Africa reported several challenges of this transition, including low uptake of HIV testing and sub national / site-level differences in HIV prevalence estimates.MethodsWe examine routine data from Kwale County, Kenya, for the period January 2015 to December 2019 and predict HIV prevalence among women attending antenatal care (ANC) at 100% HIV status ascertainment. We estimate the bias in HIV prevalence estimates as a result of imperfect uptake of HIV testing and make recommendations to improve the utility of ANC routine data for HIV surveillance. We used a generalized estimating equation with binomial distribution to model the observed HIV prevalence as explained by HIV status ascertainment and region (Sub County). We then used marginal standardization to predict the HIV prevalence at 100% HIV status ascertainment.ResultsHIV testing at ANC was at 91.3%, slightly above the global target of 90%. If there was 100% HIV status ascertainment at ANC, the HIV prevalence would be 2.7% (95% CI 2.3-3.2). This was 0.3% lower than the observed prevalence. Similar trends were observed with yearly predictions except for 2018 where the HIV prevalence was underestimated with an absolute bias of -0.2%. This implies missed opportunities for identifying new HIV infections in the year 2018.ConclusionsImperfect HIV status ascertainment at ANC overestimates HIV prevalence among women attending ANC in Kwale County. However, the use of ANC routine data may underestimate the true population prevalence. There is need to address both community level and health facility level barriers to the uptake of ANC services.Key questionsWhat is already known?▪HIV surveillance estimates from antenatal clinics (ANC) can serve as a useful proxy for HIV prevalence trends in the general female population.▪Kenya has conducted multiple studies which have shown that national HIV prevalence estimates from sentinel surveillance and those from routine program data to be similar.▪However, these studies have also revealed ongoing challenges to the suitability of using routine data as compared to sentinel surveillance including sub optimal uptake of HIV testing and sub national/ site-level differences in HIV prevalence estimates.What are the new findings?▪HIV positive pregnant women are more likely to be tested at ANC as compared to HIV negative women, leading to higher HIV prevalence estimates among women attending ANC.▪Health facility level HIV prevalence estimates are lower than that of the general population.What do the new findings imply?▪HIV positive women are underrepresented in antenatal clinics.▪In Kwale County (and similar contexts), use of routine ANC data is still not a reliable method to estimate HIV prevalence, both at facility and community level.

scholarly journals The Role of Health Education Specialists in Conducting Rapid HIV Testing

2020 ◽  
Vol 29 (1) ◽  
Author(s):  
Anthony Santella ◽  
Jacquie Fraser ◽  
Angela Prehn
Keyword(s):  
United States ◽  
Health Education ◽  
Hiv Testing ◽  
The United States ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Rapid Hiv Testing ◽  
Testing Strategies ◽  
Living With Hiv

There are over one million people living with HIV in the United States; an estimated 16% are unaware of their status. More innovative testing strategies are needed, as evidence suggests that persons most at risk for HIV, or who may present with early infections, are not being reached. Expanding the role of health education specialists can make HIV testing routine and more accessible, and help achieve the national goals of decreasing HIV infection and increasing knowledge of HIV status. This paper focuses on the role of Certified Health Education Specialists (CHES)/Master CHES as being professionally prepared to conduct HIV testing.

Observational study of the populations accessing rapid point-of-care HIV testing in Winnipeg, Manitoba, Canada, through a retrospective chart review of site records

2017 ◽  
Vol 94 (3) ◽  
pp. 194-199 ◽  
Author(s):  
James Blain Johnston ◽  
Joss N Reimer ◽  
John L Wylie ◽  
Jared Bullard
Keyword(s):  
Viral Load ◽  
Hiv Testing ◽  
Clinical Outcomes ◽  
Point Of Care ◽  
Age Groups ◽  
Linkage To Care ◽  
Hiv Positive ◽  
Hiv Status ◽  
Viral Load Suppression ◽  
Hiv Test

ObjectivesHIV point-of-care testing (POCT) has been available in Manitoba since 2008. This study evaluated the effectiveness of POCT at identifying individuals with previously unknown HIV status, its effects on clinical outcomes and the characteristics of the populations reached.MethodsA retrospective database review was conducted for individuals who received HIV POCT from 2011 to 2014. Time to linkage to care and viral load suppression were compared between individuals who tested positive for HIV using POCT and controls identified as positive through standard screening. Testing outcomes for labouring women with undocumented HIV status accessing POCT during labour were also assessed.Results3204 individuals received POCT (1055 females (32.9%) and 2149 males (67.1%)), being the first recorded HIV test for 2205 (68.8%). Males were more likely to be targeted with POCT as their first recorded HIV test (adjusted OR (AOR) 1.40). Between the two main test sites (Main Street Project (MSP) and Nine Circles Community Health Centre), MSP tested relatively fewer males (AOR 0.79) but a higher proportion of members of all age groups over 30 years old (AOR 1.83, 2.51 and 3.64 for age groups 30–39, 40–49 and >50, respectively). There was no difference in time to linkage to care (p=0.345) or viral load suppression (p=0.405) between the POCT and standard screening cohorts. Of 215 women presenting in labour with unknown HIV status, one was identified as HIV positive.ConclusionsPOCT in Manitoba has been successful at identifying individuals with previously unknown HIV-positive status. Demographic differences between the two main testing sites support that this intervention is reaching unique populations. Given that we observed no significant difference in time to clinical outcomes, it is reasonable to continue using POCT as a targeted intervention.MeSH termsHIV infection; rapid HIV testing; vertical infectious disease transmission; community outreach; service delivery; marginalised populations.

scholarly journals The Cost-effectiveness of Human Immunodeficiency Virus (HIV) Preexposure Prophylaxis and HIV Testing Strategies in High-risk Groups in India

2019 ◽  
Vol 70 (4) ◽  
pp. 633-642 ◽  
Author(s):  
Pooyan Kazemian ◽  
Sydney Costantini ◽  
Nagalingeswaran Kumarasamy ◽  
A David Paltiel ◽  
Kenneth H Mayer ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hiv Testing ◽  
Scale Up ◽  
Cost Effective ◽  
Status Quo ◽  
Hiv Incidence ◽  
Testing Strategies ◽  
Preexposure Prophylaxis ◽  
Immunodeficiency Virus ◽  
The Cost

Abstract Background The human immunodeficiency virus (HIV) epidemic in India is concentrated among 3.1 million men who have sex with men (MSM) and 1.1 million people who inject drugs (PWID), with a mean incidence of 0.9–1.4 per 100 person-years. We examined the cost-effectiveness of both preexposure prophylaxis (PrEP) and HIV testing strategies for MSM and PWID in India. Methods We populated an HIV microsimulation model with India-specific data and projected clinical and economic outcomes of 7 strategies for MSM/PWID, including status quo; a 1-time HIV test; routine HIV testing every 3, 6, or 12 months; and PrEP with HIV testing every 3 or 6 months. We used a willingness-to-pay threshold of US$1950, the 2017 Indian per capita gross domestic product, to define cost-effectiveness. Results HIV testing alone increased life expectancy by 0.07–0.30 years in MSM; PrEP added approximately 0.90 life-years to status quo. Results were similar in PWID. PrEP with 6-month testing was cost-effective for both MSM (incremental cost-effectiveness ratio [ICER], $1000/year of life saved [YLS]) and PWID (ICER, $500/YLS). Results were most sensitive to HIV incidence. PrEP with 6-month testing would increase HIV-related expenditures by US$708 million (MSM) and US$218 million (PWID) over 5 years compared to status quo. Conclusions While the World Health Organization recommends PrEP with quarterly HIV testing, our analysis identifies PrEP with semiannual testing as the cost-effective HIV prevention strategy for Indian MSM and PWID. Since nationwide scale-up would require a substantial fiscal investment, areas of highest HIV incidence may be the appropriate initial targets for PrEP scale-up.

scholarly journals Failure to test children of HIV-infected mothers in South Africa: implications for HIV testing strategies for preschool children

2011 ◽  
Vol 16 (12) ◽  
pp. 1490-1494 ◽  
Author(s):  
Meera K. Chhagan ◽  
Shuaib Kauchali ◽  
Stephen M. Arpadi ◽  
Murray H. Craib ◽  
Fatimatou Bah ◽  
...  
Keyword(s):  
South Africa ◽  
Preschool Children ◽  
Hiv Testing ◽  
Testing Strategies

42. PILOT OF NON-INVASIVE (ORAL FLUID) TESTING FOR HIV WITHIN A COMMUNITY SETTING

Sexual Health ◽  
2007 ◽  
Vol 4 (4) ◽  
pp. 300
Author(s):  
S. Staunton ◽  
J. Debattista ◽  
N. Roudenko ◽  
C. Davis
Keyword(s):  
Oral Fluid ◽  
Community Setting ◽  
Risk Behaviour ◽  
Community Response ◽  
Numerical Code ◽  
Sexual Risk Behaviour ◽  
Hiv Status ◽  
Hiv Surveillance ◽  
Hiv Antibodies ◽  
Gay Bars

An anonymous HIV surveillance study was conducted to determine the prevalence of HIV amongst patrons attending gay recreational venues, the level of undiagnosed HIV infection and to identify sexual risk behaviour associated with HIV positive, HIV negative and unknown serostatus. 427 men who have sex with men were recruited over a period of one week in various sex on premises venues and gay bars within the inner city of Brisbane. Oral fluid testing for HIV antibodies was undertaken using the Orasure collection system and assay. Each participant was invited to complete a brief behaviour questionnaire and submit an oral fluid specimen. Participants were also asked their HIV status. Surveys and specimens were linked using an anonymous numerical code. Surveys were analysed using Epi-Info. Oral swabs were tested for the presence of HIV antibodies and any reactive specimens were confirmed using an Orasure western Blot. Confirmed serology results were linked to reported sexual behaviours, testing patterns and HIV status. The results of this study - sexual and testing behaviour correlated with serostatus- and implications for HIV prevention programs will be presented. As well as that, discussions will be held regarding the community response to the project.

HIV Testing and Prevalence in Pregnancy in Edinburgh

1994 ◽  
Vol 5 (2) ◽  
pp. 101-104 ◽  
Author(s):  
F D Johnstone ◽  
R P Brettle ◽  
S M Burns ◽  
J Peutherer ◽  
J Y Q Mok ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Injection Drug ◽  
Hiv Status ◽  
Multiple Sources ◽  
Time Data ◽  
Related Risk ◽  
Changes In Pregnancy ◽  
Testing Policies ◽  
Hiv Seropositive ◽  
In Pregnancy

The objective was to study the changes in pregnancy HIV prevalence with time. Data were collected from multiple sources to provide a comprehensive record of all HIV seropositive pregnant women identified in the Edinburgh area (Scotland) until December 1992. There were 177 pregnancies in 108 HIV seropositive identified women. Risk factors were injection drug use (79% of pregnancies) and a known HIV seropositive injection drug-using partner (16%). Prevalence has decreased for Edinburgh City women from 0.5% of all pregnancies in 1986 to 0.1% in 1992; It was higher for induced abortion (0.6%) than for delivery (0.2%). HIV testing in pregnancy has declined. Comparison with unlinked anonymized testing showed that in 1990–1991, 20/22 seropositive women were known. In 1992, only 3 of 10 seropositive pregnancies were identified. The cohort initially infected by exposure to a ‘drug related’ risk factor between 1983 and 1985 may have increasingly finished childbearing, deliberately decided against pregnancy because of HIV status, and declined because of death, illness and emigration from the area, There may not have been major early tertiary heterosexual spread; however, data from 1992 suggest that this could now be impacting on pregnancy prevalence. Local testing policies have not adapted to this possible change.

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