Study designs fail to represent the intricate effects of HIV testing and counselling on condom use and HIV transmission in sub-Saharan Africa

Abstract Background In sub-Saharan Africa HIV transmission is a major challenge in adolescents, especially among girls and those living in urban settings. Major international efforts have aimed at reducing sexual transmission. This analysis aims to assess the trends in HIV prevalence by gender in adolescents, as well as urban-rural disparities. Methods HIV prevalence data were obtained for 30 countries with a national survey since 2010 and for 23 countries with one survey circa 2005 and a recent survey circa 2015. Countries were grouped into 2% or higher and lower than 2% HIV prevalence among girls 15–19 years in the first survey. Country medians and average annual rates of changes were used to summarize the trends. Data on HIV incidence at ages 15–24 and prevalence at 5–9 and 10–14 years were reviewed from 11 recent national surveys. Trends in urban-rural disparities in HIV prevalence and selected indicators of sexual and HIV testing behaviours were assessed for females and males 15–24 years, using the same surveys. Results HIV prevalence among girls 15–19 years declined in the higher HIV prevalence group from 5.7–2.6% during 2005–2015, corresponding with an average annual rate of reduction of 6.5% per year. Among boys, the median HIV prevalence declined from 2.1–1.2% in the higher prevalence group. Smaller changes were observed in the lower prevalence country group where median HIV prevalence among girls decreased from 0.7–0.4% (average annual rate of reduction 5.9%). Girl – boy differences at 10–14 years were small with a country median HIV of 1.0% and 1.3%, respectively. Urban females and males 15–24 had at least 1.5 times higher HIV prevalence than their rural counterparts, and all experienced similar declines during 2005–2015. Condom use and HIV testing increased among adolescents in both higher and lower prevalence countries, but indicators of sexual activity showed little change over time. Conclusions HIV prevalence declined in almost all countries during the last decade, in both urban and rural settings, for both sexes. The urban-rural gap persisted and HIV transmission to girls, but not boys, is still a major challenge in eastern and southern African countries.

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Uptake and yield of HIV testing and counselling among children and adolescents in sub-Saharan Africa: a systematic review

Journal of the International AIDS Society ◽

10.7448/ias.18.1.20182 ◽

2015 ◽

Vol 18 (1) ◽

pp. 20182 ◽

Cited By ~ 56

Author(s):

Darshini Govindasamy ◽

Rashida A Ferrand ◽

Stephanie MS Wilmore ◽

Nathan Ford ◽

Saeed Ahmed ◽

...

Keyword(s):

Systematic Review ◽

Hiv Testing ◽

Children And Adolescents ◽

Sub Saharan Africa ◽

Hiv Testing And Counselling ◽

Sub Saharan

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HIV testing experiences in Nairobi slums: The good, the bad and the ugly

10.21203/rs.2.13368/v2 ◽

2019 ◽

Author(s):

Eliud Wekesa

Keyword(s):

Hiv Testing ◽

Urban Slum ◽

Sub Saharan Africa ◽

Depth Interview ◽

Hiv Test ◽

Keywords Hiv ◽

Hiv Testing And Counselling ◽

Sub Saharan ◽

The Individual ◽

Voluntary Counselling And Testing

Abstract Background HIV testing is an integral component of HIV prevention, treatment and care and, therefore, is crucial in achieving UNAIDS 90-90-90 targets. HIV testing in Kenya follows both the voluntary counselling and testing (VCT) and provider initiated testing and counselling (PITC) models. However, little is known about the individual experiences of undergoing an HIV test in the two testing models. This study provides experiential evidence of undergoing an HIV test in a resource poor urban slum setting. Methods The study explored testing experiences and challenges faced in respect to ensuring the 3 Cs (consent, counselling and confidentiality), using in-depth interviews (N=41) with HIV-infected men and women in two slum settlements of Nairobi City. The in-depth interview respondents were aged above 18 years with 56% being females. All interviews were audio-recorded, transcribed and then translated into English. The transcribed data were analysed using thematic analysis method. Results The respondent HIV-testing experiences were varied and greatly shaped by circumstances and motivation for HIV testing. The findings show both positive and negative experiences, with sporadic adherence to the 3Cs principle in both HIV testing models. Although some respondents were satisfied with the HIV testing process, a number of them raised a number of concerns, with instances of coercion and testing without consent being reported. Conclusion The 3Cs (consent, counselling and confidentiality) principle must underlie HIV testing and counselling practices in order to achieve positive testing outcomes. The study concludes that adherence to the 3Cs during HIV testing contributes to both the individual and public health good – irrespective of whether testing is initiated by the individual or by the health provider. Keywords: HIV testing, VCT, PITC, PLWHA, Slums, Kenya, sub-Saharan Africa

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The costs of home-based HIV testing and counselling in sub-Saharan Africa and its association with testing yield: a literature review

African Journal of AIDS Research ◽

10.2989/16085906.2019.1680399 ◽

2019 ◽

Vol 18 (4) ◽

pp. 324-331 ◽

Cited By ~ 2

Author(s):

Katharina Hauck

Keyword(s):

Literature Review ◽

Hiv Testing ◽

Sub Saharan Africa ◽

Home Based ◽

Hiv Testing And Counselling ◽

Sub Saharan

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Determinants of Previous HIV Testing and Knowledge of Partner’s HIV Status Among Men Attending a Voluntary Counseling and Testing Clinic in Dar es Salaam, Tanzania

American Journal of Men s Health ◽

10.1177/1557988312468146 ◽

2012 ◽

Vol 7 (6) ◽

pp. 450-460 ◽

Cited By ~ 22

Author(s):

Donaldson Conserve ◽

Luis Sevilla ◽

Jessie Mbwambo ◽

Gary King

Keyword(s):

Condom Use ◽

Hiv Testing ◽

Dar Es Salaam ◽

Hiv Disclosure ◽

Sub Saharan Africa ◽

Hiv Status ◽

Voluntary Counseling ◽

Voluntary Counseling And Testing ◽

Counseling And Testing ◽

Sub Saharan

Voluntary Counseling and Testing (VCT) remains low among men in sub-Saharan Africa. The factors associated with previous HIV testing and knowledge of partner’s HIV status are described for 9,107 men who visited the Muhimbili University College of Health Sciences’ VCT site in Dar es Salaam, Tanzania, between 1997 and 2008. Data are from intake forms administered to clients seeking VCT services. Most of the men (64.5%) had not previously been tested and 75% were unaware of their partner’s HIV status. Multivariate logistic regression revealed that age, education, condom use, and knowledge of partner’s HIV status were significant predictors of previous HIV testing. Education, number of sexual partners, and condom use were also associated with knowledge of partner’s HIV status. The low rate of VCT use among men underscores the need for more intensive initiatives to target men and remove the barriers that prevent HIV disclosure.

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