Peer mobilisation and HIV partner notification services among gay, bisexual, other men who have sex with men and transgender women in coastal Kenya identified a high number of undiagnosed HIV infections

Abstract Introduction HIV partner notification services (HPN), peer mobilisation with HIV self-testing and acute and early HIV infection (AEHI) screening among gay, bisexual, other men who have sex with men (GBMSM) and transgender women (TGW) were assessed for acceptability, feasibility and linkage to antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) services. Methods Between April-August 2019, peer mobilisers mobilised clients by offering HIV oral self-tests and immediate clinic referral for clients with AEHI symptoms. Mobilised participants received clinic-based rapid antibody testing and point-of-care HIV-RNA testing. Newly diagnosed participants including those derived from HIV testing services were offered immediate ART and HPN. Partners were recruited through HPN. . Results Of 772 mobilised clients, 452 (58.5%) enrolled in the study as mobilised participants. Of these, 16 (3.5%) were HIV newly diagnosed, including 2 (0.4%) with AEHI. All but two (14/16, 87.5%) initiated ART. 35 GBMSM and TGW were offered HPN and 27 (77.1%) accepted it. Provider referral identified a higher proportion of partners tested (39/64; 60.9% vs. 5/14; 35.7%) and partners with HIV (27/39; 69.2% vs. 2/5; 40.0%) than index referral. Of 44 enrolled partners, 10 (22.7%) were newly diagnosed, including 3 (6.8%) with AEHI. All 10 (100%) initiated ART. PrEP was initiated among 24.0% (103/429) mobilised participants and 28.6% (4/14) partners without HIV. Conclusions HPN, combined with a peer mobilisation-led self-testing strategy and AEHI screening for GBMSM and TGW, appears acceptable and feasible. These strategies, especially HPN provider referral, effectively identified undiagnosed HIV infections and linked individuals to ART and PrEP-services.

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Individual and partnership factors associated with anticipated versus actual partner notification following STI diagnosis among men who have sex with men and/or with transgender women in Lima, Peru

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053292 ◽

2017 ◽

Vol 94 (8) ◽

pp. 607-610 ◽

Cited By ~ 5

Author(s):

Hannan M Braun ◽

Eddy R Segura ◽

Jordan E Lake ◽

Monica Gandhi ◽

Jessica Rios ◽

...

Keyword(s):

Control Strategies ◽

Partner Notification ◽

Prevalence Ratio ◽

Estimating Equation ◽

Transgender Women ◽

Oral Sex ◽

Newly Diagnosed ◽

Regression Analyses ◽

Factors Associated ◽

Sex With Men

ObjectivesA detailed understanding of intentions and practices related to partner notification (PN) following STI diagnosis can improve control strategies. We assessed participant-level and partner-level factors guiding notification behaviour among men who have sex with men and/or with transgender women (MSM-TW) in Lima, Peru, including discordances between anticipated and actual notification.MethodsMen newly diagnosed with gonorrhoea, chlamydia and/or syphilis between 2012 and 2014 reported recent partners’ characteristics, anticipated PN practices, and actual PN outcomes following diagnosis. Generalised estimating equation Poisson regression analyses assessed factors guiding PN outcomes.ResultsParticipants (n=150) predominantly identified as homosexual (70%) and moderno (versatile sexual role, 55%); 55% of partners (n=402) were casual. Among all sexual partners, 35% were notified of the STI diagnosis, though only 51% of predicted PN occurred and 26% of actual notifications were unanticipated. 47% of participants notified no partners, while 24% notified all partners. PN was more common with stable versus casual (adjusted prevalence ratio (aPR), 95% CI: 0.53, 0.39 to 0.73) or commercial (aPR, 95% CI: 0.38, 0.12 to 1.21) partners, and among participants who perceived PN as normative among their peers (aPR, 95% CI: 1.96, 1.37 to 2.82). A trend towards greater notification following condom-protected intercourse was observed (aPR, 95% CI: 1.33, 0.98 to 1.81). PN frequency did not differ by type of STI diagnosed.Anticipated notification predicted actual notification (aPR, 95% CI: 1.67, 1.19 to 2.33) only imperfectly: 81 (54%) participants’ PN practices did not match their anticipated behaviour. Successful notification despite anticipated silence (40 participants, 63 partners) was associated with stable partnerships and a normative perception of PN. Non-notification despite intention (43 participants, 73 partners) frequently occurred among participants reporting exclusively oral sex with the partner or with partners identified as activo (insertive role).ConclusionsAnticipated notification imperfectly reflects actual PN behaviour. Future interventions to improve PN among MSM-TW in Peru need to acknowledge partnership contexts.

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Recent HIV Infection among men who have sex with men and transgender women in Tijuana

Revista de Saúde Pública ◽

10.11606/s1518-8787.2020054002179 ◽

2020 ◽

Vol 54 ◽

pp. 82

Author(s):

Britt Skaathun ◽

Heather A. Pines ◽

Thomas L Patterson ◽

Shirley J Semple ◽

Jonathan Pekar ◽

...

Keyword(s):

Hiv Infection ◽

Disease Transmission ◽

Hiv Infections ◽

Genetic Distances ◽

Transgender Women ◽

Newly Diagnosed ◽

Recent Infection ◽

Transgender Persons ◽

Sex With Men ◽

Recent Hiv Infection

OBJECTIVE: To characterize recent HIV infections among newly diagnosed men who have sex with men and transgender women in Tijuana. METHODS: Limiting Antigen (LAg)-Avidity testing was performed to detect recent HIV infection within a cohort of newly-diagnosed men who have sex with men and transgender women in Tijuana. Logistic regression was used to determine characteristics associated with recent infection. A partial transmission network was inferred using HIV-1 pol sequences. Tamura-Nei 93 genetic distances were measured between all pairs of sequences, and the network was constructed by inferring putative transmission links (genetic distances ≤ 1.5%). We assessed whether recent infection was associated with clustering within the inferred network. RESULTS: Recent infection was detected in 11% (22/194) of newly-diagnosed participants. Out of the participants with sequence data, 60% (9/15) with recent infection clustered compared with 31% (43/139) with chronic infection. Two recent infections belonged to the same cluster. In adjusted analyses, recent infection was associated with years of residence in Tijuana (OR = 1.5; 95%CI 1.01–1.09), cocaine use (past month) (OR = 8.50; 95%CI 1.99–28.17), and ever experiencing sexual abuse (OR = 2.85; 95%CI 1.03–7.85). DISCUSSION: A total of 11% of men newly diagnosed with HIV who have sex with men and transgender women in Tijuana were recently infected. The general lack of clustering between participants with recent infection suggests continued onward HIV transmission rather than an outbreak within a particular cluster. DESCRIPTORS: HIV Infections, epidemiology. Sexual and Gender Minorities. Transgender Persons. Disease Transmission, Infectious.

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Economic evaluation of alternative testing regimes and settings to detect undiagnosed HIV in Australia

BMC Health Services Research ◽

10.1186/s12913-020-06040-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Owain D. Williams ◽

Judith A. Dean ◽

Anna Crothers ◽

Charles F. Gilks ◽

Jeff Gow

Keyword(s):

Point Of Care ◽

Cost Model ◽

Cost Effective ◽

Positive Diagnosis ◽

Trade Offs ◽

Self Testing ◽

Undiagnosed Hiv ◽

Sex With Men ◽

The Individual ◽

The Cost

Abstract Background The study aimed to estimate the comparative costs per positive diagnosis of previously undetected HIV in three testing regimes: conventional; parallel and point of care (POC) testing. The regimes are analysed in six testing settings in Australia where infection is concentrated but with low prevalence. Methods A cost model was developed to highlight the trade-offs between test and economic efficiency from a provider perspective. First, an estimate of the number of tests needed to find a true (previously undiagnosed) positive diagnosis was made. Second, estimates of the average cost per positive diagnosis in whole of population (WoP) and men who have sex with men (MSM) was made, then third, aggregated to the total cost for diagnosis of all undetected infections. Results Parallel testing is as effective as conventional testing, but more economically efficient. POC testing provide two significant advantages over conventional testing: they screen out negatives effectively at comparatively lower cost and, with confirmatory testing of reactive results, there is no loss in efficiency. The average and total costs per detection in WoP are prohibitive, except for Home Self Testing. The diagnosis in MSM is cost effective in all settings, but especially using Home Self Testing when the individual assumes the cost of testing. Conclusions This study illustrates the trade-offs between economic and test efficiency and their interactions with population(s) prevalence. The efficient testing regimes and settings are presently under or not funded in Australia. Home Self Testing has the potential to dramatically increase testing rates at very little cost.

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Increase in Newly Diagnosed HIV Infections Among Young Black Men Who Have Sex with Men - Milwaukee County, Wisconsin, 1999-2008

PsycEXTRA Dataset ◽

10.1037/e595152011-003 ◽

2011 ◽

Keyword(s):

Black Men ◽

Hiv Infections ◽

Newly Diagnosed ◽

Milwaukee County ◽

Sex With Men

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The Laboratory Diagnosis of HIV Infections

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2005/515063 ◽

2005 ◽

Vol 16 (1) ◽

pp. 26-30 ◽

Cited By ~ 18

Author(s):

Margaret Fearon

Keyword(s):

Point Of Care ◽

Diagnostic Testing ◽

Clinical Information ◽

Hiv Infections ◽

Laboratory Diagnosis ◽

The United States ◽

Specific Information ◽

Antibody Testing ◽

Diagnostic Laboratory ◽

Laboratory Results

HIV diagnostic testing has come a long way since its inception in the early 1980s. Current enzyme immunoassays are sensitive enough to detect antibody as early as one to two weeks after infection. A variety of other assays are essential to confirm positive antibody screens (Western blot, polymerase chain reaction [PCR]), provide an adjunct to antibody testing (p24 antigen, PCR), or provide additional information for the clinician treating HIV-positive patients (qualitative and quantitative PCR, and genotyping). Most diagnostic laboratories have complex testing algorithms to ensure accuracy of results and optimal use of laboratory resources. The choice of assays is guided by the initial screening results and the clinical information provided by the physician; both are integral to the laboratory's ability to provide an accurate laboratory diagnosis. Laboratories should also provide specific information on specimen collection, storage and transport so that specimen integrity is not compromised, thereby preserving the accuracy of laboratory results. Point of Care tests have become increasingly popular in the United States and some places in Canada over the past several years. These tests provide rapid, on-site HIV results in a format that is relatively easy for clinic staff to perform. However, the performance of these tests requires adherence to good laboratory quality control practices, as well as the backup of a licensed diagnostic laboratory to provide confirmation and resolution of positive or indeterminate results. Laboratory quality assurance programs and the participation in HIV proficiency testing programs are essential to ensure that diagnostic laboratories provide accurate, timely and clinically relevant laboratory results.

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Limited awareness of pre-exposure prophylaxis among black men who have sex with men and transgender women in New York city

AIDS Care ◽

10.1080/09540121.2017.1363364 ◽

2017 ◽

Vol 30 (1) ◽

pp. 9-17 ◽

Cited By ~ 42

Author(s):

Matthew Garnett ◽

Yael Hirsch-Moverman ◽

Julie Franks ◽

Eleanor Hayes-Larson ◽

Wafaa M. El-Sadr ◽

...

Keyword(s):

New York ◽

New York City ◽

Black Men ◽

York City ◽

Transgender Women ◽

Sex With Men ◽

Exposure Prophylaxis

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HAV infection in Brazilian men who have sex with men: The importance of surveillance to avoid outbreaks

PLoS ONE ◽

10.1371/journal.pone.0256818 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0256818

Author(s):

Lisie Souza Castro ◽

Grazielli Rocha de Rezende ◽

Fernanda Rodas Pires Fernandes ◽

Larissa Melo Bandeira ◽

Gabriela Alves Cesar ◽

...

Keyword(s):

Risk Factors ◽

Sexual Behaviors ◽

Household Income ◽

Hepatitis A ◽

Hepatitis A Virus ◽

Transgender Women ◽

Antibody Testing ◽

Cross Sectional ◽

Monthly Household Income ◽

Sex With Men

Background Hepatitis A is a fecal-oral infection caused by hepatitis A virus (HAV). Men who have sex with men (MSM) and transgender women (TW) have been reported as target groups for HAV infection. This study aimed to determine the seroprevalence, risk factors, and circulating strains associated with HAV infection among MSM and TW in Central Brazil. Methods A cross-sectional study was conducted from November 2011 to September 2013. Serum samples were collected from 425 individuals for anti-HAV antibody testing and HAV molecular characterization. Of them, 149 (35.1%) participants were self-identified as transgender women. Statistical analysis was performed to evaluate the risk factors of HAV seropositivity. Results The seroprevalence of HAV exposure was 69.7% (95% Confidence Interval: 65.3–74.0%). Serological evidence of HAV was significantly higher in participants who self-identified as transgender women (83.2%) than MSM (62.3%). Increasing age, non-white race, and lower monthly household income were independently associated with HAV exposure among MSM. Only lower monthly household income was independently associated with HAV exposure among TW. One anti-HAV IgM positive sample, from a transgender woman (0.2%), was detected and classified as subgenotype IA. Conclusions High HAV prevalence was observed, markedly among TW. Considering the risky sexual behaviors this population is exposed to, HAV vaccination and prevention programs targeting this population should be considered to prevent outbreaks and the burden of the disease.

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Cost-Effectiveness Analysis of the Daily HIV Pre-Exposure Prophylaxis in Men who Have Sex with Men in Barcelona

10.20944/preprints202111.0295.v1 ◽

2021 ◽

Author(s):

Francesc López Seguí ◽

Unai Oyon Lerga ◽

Laura Laguna Marmol ◽

Pep Coll ◽

Angels Andreu ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Time Horizon ◽

Cost Savings ◽

Health Indicators ◽

Hiv Infections ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Oral Prep

Introduction: Pre-Exposure Prophylaxis (PrEP) for HIV prevention has been implemented in several countries. Previous literature has shown that its cost-effectiveness (and, under some specifications, cost-saving character) is dependent on the reduction in price due to generics, the time-horizon and its effectiveness. The intervention has never been studied in Catalonia, a territory with extensive implementation. Methods: Economic evaluation of the implementation of HIV pre-exposition prophylaxis using administrative data from Men who have Sex with Men (MSM) who receive the treatment (at the generic price). A deterministic compartmental model and a social perspective with a micro-costing approach over the time horizon 2022-2062 are used. A baseline 86% effectiveness of PrEP is assumed. Results: Daily oral PrEP is found to be cost-saving: discounted savings in costs are attained after 16 years, and after 40 years they reach 81 million euros. In terms of health indicators, 10,322 additional discounted QALYs are generated by the intervention. Results are sensitive to sexual behavioral patterns among MSM, the price of PrEP (reduced if offered on-demand), its effectiveness and the discount rate. Conclusions: The use and promotion of PrEP in Catalonia is predicted to result in substantial health and monetary benefits because of reductions in HIV infections. Short-term investments in the promotion of PrEP will result in important cost-savings in the long term.

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