scholarly journals Facility-based HIV self-testing strategies may substantially increase number of men and youth tested for HIV in Malawi: results from a data-driven individual-based model

2021 ◽  
Author(s):  
Brooke E Nichols ◽  
Alexandra de Nooy ◽  
Mariet Benade ◽  
Kelvin Balakasi ◽  
Misheck Mphande ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Hiv Testing ◽  
Human Resource ◽  
Data Driven ◽  
People Living With Hiv ◽  
Individual Based Model ◽  
Eligibility Criteria ◽  
Self Testing ◽  
Resource Requirements

AbstractBackgroundMalawi is rapidly closing the gap in achieving the UNAIDS 95-95-95 targets, with 90% of people living with HIV in Malawi aware of their status. As we approach epidemic control, interventions to improve coverage will become more costly. There is therefore an urgent need to identify innovative and low-cost strategies to maintain and increase testing coverage without diverting resources from other HIV services.MethodsA data-driven individual-based model was parameterized with data from a community-representative survey (sociodemographic, health service utilization, HIV testing history) of men and youth in Malawi (data collected 08/2019). 79 different strategies for the implementation of HIV self-testing (HIVST) and provider-initiated-testing-and-counselling at the outpatient department (OPD) were evaluated. Outcomes included percent of men/youth tested for HIV in a 12-month period, cost-effectiveness, and human resource requirements. Testing yield was assumed to be constant across the scenarios.FindingsFacility-based HIVST offered year-round resulted in the greatest increase in proportion of men and youth tested in the OPD (from 45% to 72%-83%), was considered cost-saving for HIVST kit priced at $1.00, and generally reduced required personnel as compared to the status quo. At higher HIVST kit prices, and more relaxed eligibility criteria, all scenarios that considered year-round HIVST in the OPD remained on the cost-effectiveness frontier.InterpretationFacility-based HIVST is a cost-effective strategy to increase the proportion of men/youth tested for HIV and decreases the human resource requirements for HIV testing in the OPD-providing additional health care worker time for other priority health care activities.FundingFCDO; USAID

scholarly journals Mandatory HIV testing in China: the perception of health-care providers

2007 ◽  
Vol 18 (7) ◽  
pp. 476-481 ◽  
Author(s):  
Li Li ◽  
Zunyou Wu ◽  
Sheng Wu ◽  
Sung-Jae Lee ◽  
Mary Jane Rotheram-Borus ◽  
...  
Keyword(s):  
Health Care ◽  
Hiv Testing ◽  
Health Care Providers ◽  
Perceived Risk ◽  
Ethical Issues ◽  
Service Providers ◽  
Risk Behaviour ◽  
People Living With Hiv ◽  
Care Providers ◽  
Hiv Aids

Health-care providers in China are facing an exponential increase in HIV testing and HIV-positive patients. A total of 1101 service providers were recruited to examine attitudes toward people living with HIV/AIDS (PLWHA) in China. Logistic regression models were used to assess factors associated with providers' attitudes toward mandatory HIV testing. Providers were most likely to endorse mandatory HIV testing for patients with high-risk behaviour and for all patients before surgery. Over 43% of providers endorsed mandatory testing for anyone admitted to hospital. Controlling for demographics, multivariate analyses indicated that providers with higher perceived risk of HIV infection at work, higher general prejudicial attitudes toward PLWHA, and previous contact with HIV patients were more likely to endorse mandatory HIV testing for anyone admitted to hospital. Results underscore the importance of implementing universal precautions in health-care settings and call attention to social and ethical issues associated with HIV/AIDS control and treatment in China.

scholarly journals Cost-Effectiveness of Peer-Delivered HIV Self-Tests for MSM in Uganda

2021 ◽  
Vol 9 ◽  
Author(s):  
Stephen Okoboi ◽  
Barbara Castelnuovo ◽  
Jean-Pierre Van Geertruyden ◽  
Oucul Lazarus ◽  
Lung Vu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Hiv Testing ◽  
Cost Effective ◽  
Hiv Infections ◽  
Standard Of Care ◽  
Sub Saharan Africa ◽  
High Risk Population ◽  
Self Testing ◽  
The Cost

Introduction: Distribution of HIV self-testing (HIVST) kits through MSM peer networks is a novel and effective strategy to increase HIV testing coverage in this high-risk population. No study has evaluated the cost or cost effectiveness of peer distribution of HIVST strategies among MSM in sub-Saharan Africa.Methods: From June to August 2018, we conducted a pilot study of secondary MSM peer HIVST kit distribution at The AIDS Support Organization at Entebbe and Masaka. We used an ingredients approach to estimate the cost of MSM peer HIVST kit distribution relative to standard-of-care (SOC) hotspot testing using programme expenditure data reported in US dollars. The provider perspective was used to estimate incremental cost-effective ratios per HIV infection averted using the difference in HIV annual transmission rates between MSM with HIV who knew their status and were not virologically suppressed and MSM with HIV who did not know their status.Results: We enrolled 297 participants of whom 150 received MSM peer HIVST kit distribution (intervention group) and 147 received TASO standard of care HIV testing (control group). Provider cost for the intervention was $2,276 compared with $1,827 for SOC during the 3-month study period. Overall, the intervention resulted in higher HIV positivity yield (4.9 vs. 1.4%) and averted more HIV infections per quarter (0.364 vs. 0.104) compared with SOC. The cost per person tested was higher for the intervention compared to SOC ($15.90 vs. $12.40). Importantly, the cost per new HIV diagnosis ($325 vs. $914) and cost per transmission averted ($6,253 vs. $ 17,567) were lower for the intervention approach relative to SOC. The incremental cost per HIV transmission averted by the self-testing program was $1,727. The incremental cost to providers per additional HIV-positive person identified by the intervention was $147.30.Conclusion: The intervention strategy was cost-effective, and identified more undiagnosed HIV infections than SOC hotspot testing at a cost-effectiveness threshold of US $2,129. Secondary distribution of HIVST kits through peers should further be evaluated with longer duration aimed at diagnosing 95% of all persons with HIV by 2030; the first UNAIDS 95-95-95 target.

An Economic Evaluation of a Community-Based Organization Led HIV Self-Testing Program Among Men Who Have Sex With Men in China

2020 ◽  
Author(s):  
Shanzi Huang ◽  
Jason Ong ◽  
Wencan Dai ◽  
Xi He ◽  
Yi Zhou ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hiv Testing ◽  
Variable Cost ◽  
Community Based ◽  
Self Testing ◽  
Hiv Test ◽  
Community Based Organization ◽  
The Mean ◽  
The Cost ◽  
Mean Cost

Abstract Introduction: HIV self-testing (HIVST) is effective in improving the uptake of HIV testing among key populations. Complementary data on the cost-effectiveness of HIVST is critical for planning and scaling up HIVST. This study aimed to evaluate the cost-effectiveness of a community-based organization (CBO)-led HIVST model implemented in China. Method: A cost-effectiveness analysis (CEA) was conducted by comparing a CBO-led HIVST model with a CBO-led facility-based HIV rapid diagnostics testing (HIV-RDT) model. The full economic cost, including fixed and variable cost, from a health provider perspective using a micro costing approach was estimated. We determined the cost-effectiveness of these two HIV testing models over a two year time horizon (i.e. duration of the programs), and reported costs using US dollars (2020). Results: From January 2017 to December 2018, a total of 4,633 men tested in the HIVST model, and 1,780 men tested in the HIV-RDT model. The total number of new diagnosis was 155 for HIVST and 126 for the HIV-RDT model; the HIV test positivity was 3.3% (95% confidence interval (CI): 2.8-3.9) for the HIVST model and 7.1% (95% CI: 5.9-8.4) for the HIV-RDT model. The mean cost per person tested was $14.57 for HIVST and $24.74 for HIV-RDT. However, the mean cost per diagnosed was higher for HIVST ($435.52) compared with $349.44 for HIV-RDT.Conclusion: Our study confirms that compared to facility-based HIV-RDT, a community-based organization led HIVST program could have a cheaper mean cost per MSM tested for HIV in China. Better targeting of high-risk individuals would further improve the cost-effectiveness of HIVST.

scholarly journals Co-creation of HIVST Delivery Approaches for Improving Urban Men’s Engagement with HIV Services in eThekwini District, KwaZulu-Natal: Nominal Group Technique

2021 ◽  
Author(s):  
Tivani Phosa Mashamba-Thompson ◽  
Richard Lessells ◽  
Tafadzwa Dzinamarira ◽  
Paul Drain ◽  
Lehana Thabane
Keyword(s):  
Health Care ◽  
Hiv Testing ◽  
Nominal Group Technique ◽  
Nominal Group ◽  
Delivery Strategy ◽  
Hiv Services ◽  
Urban Men ◽  
Key Stakeholders ◽  
Self Testing ◽  
Hiv Testing Services

Background: HIV self-testing (HIVST) is one of the recommended approaches for HIV testing services, particularly for helping reach populations who would not normally access facility-based HIV testing. HIVST must be tailored to different populations to ensure uptake. Objective: The main objective of this study was to develop an acceptable HIVST delivery strategy to help improve urban men’s engagement with HIV services. Methods: We invited key stakeholders for urban men’s HIV services to participate in a co-creation workshop aimed at developing HIVST delivery approaches for urban men, using eThekwini municipality as a study setting. We conducted purposive sampling to include health care users and health care providers, representing a range of views across the public sector and voluntary sector. We employed the Nominal Group Technique (NGT) method for data collection. The NGT workshop was conducted in two consecutive phases: phase one was focused on determining barriers for men’s engagement with the current/facility-based HIV testing services; phase two was aimed at determining HIVST delivery strategies. We used the results of the NGT to design a tailored HIVST strategy for urban men in eThekwini District. Results: Participants identified the following psychological factors as the most important barriers to uptake of HIV testing services by urban men: stigma, ignorance about the importance of testing and testing process as well as fear of positive test results. Key stakeholders suggested internal motivation strategies as a potentially effective approach to support HIVST delivery strategy. Guided by the NGT results, we designed a HIVST delivery strategy that is supported by a risk communication approach Conclusion: We designed an evidence-based risk communication mobile health (mHealth) strategy coupled with SARS COV-2 self-testing tailored to improve men’s uptake of HIVST. A follow-up study to evaluate the feasibility of implementing these approaches is recommended.

scholarly journals Venues and methods to improve professional men’s access to HIV self-testing and linkage to HIV prevention or treatment: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Patience A. Muwanguzi ◽  
Esther M. Nasuuna ◽  
Florence Namimbi ◽  
Charles Peter Osingada ◽  
Tom Denis Ngabirano
Keyword(s):  
Qualitative Study ◽  
Hiv Testing ◽  
Underserved Populations ◽  
Linkage To Care ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Eligibility Criteria ◽  
Prevention Services ◽  
Self Testing ◽  
Engaging Men

Abstract Background HIV testing among men in sub-Saharan Africa is sub-optimal. Despite several strategies to improve access to underserved populations, evidence regarding engaging men in professional and formal occupations in HIV testing is limited. This study explored employed professional men’s preferences for uptake of HIV self-testing, and linkage to HIV care, or prevention services. Methods This was an explorative-descriptive qualitative study where a sample of 33 men from six Ugandan urban centres. Participants were purposively selected guided by the International Standard Classification of Occupations to participate in in-depth interviews. The data were collected using an interview guide and the sample size was determined by data saturation. Eligibility criteria included fulltime formal employment for over a year at that organization. The data were analyzed manually using thematic content analysis. Results Three categories emerged: uptake of HIV self-tests, process of HIV self-testing and linkage to post-test services. The different modes of distribution of HIV self-test kits included secondary distribution, self-tests at typically male dominated spaces, delivery to workplaces and technology-based delivery. The process of HIV self-testing may be optimized by providing collection bins, and mHealth or mobile phone applications. Linkage to further care or prevention services may be enhanced using medical insurance providers, giving incentives and tele counselling. Conclusion We recommend utilization of several channels for the uptake of HIV self-tests. These include distribution of test kits both to offices and men’s leisure and recreation ‘hot spots’, Additionally, female partners, peers and established men’s group including social media groups can play a role in improving the uptake of HIV self-testing. Mobile phones and digital technology can be applied in innovative ways for the return of test results and to strengthen linkage to care or prevention services. Partnership with medical insurers may be critical in engaging men in professional employment in HIV services.

scholarly journals HOSENG trial – Effect of the provision of oral self-testing for absent and refusing individuals during a door-to-door HIV testing campaign on testing coverage: protocol of a cluster randomized clinical trial in rural Lesotho

2019 ◽  
Author(s):  
Alain Amstutz ◽  
Thabo Ishmael Lejone ◽  
Lefu Khesa ◽  
Josephine Muhairwe ◽  
Bienvenu Lengo Nsakala ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Health Facility ◽  
World Health ◽  
Eligibility Criteria ◽  
High Coverage ◽  
Home Based ◽  
Self Testing ◽  
Household Members ◽  
Cluster Randomized ◽  
Testing Coverage

Abstract BACKGROUND HIV testing coverage remains below the targeted 90% despite efforts and resources invested. Home-based HIV testing is a key approach endorsed by the World Health Organization (WHO), especially to reach individuals who might not seek testing otherwise. Although acceptance of test-ing during such campaigns is high, coverage remains low due to absent household members. This cluster-randomized trial aims to assess increase in testing coverage using oral HIV self-testing (HIVST) among individuals who are absent or decline testing during home-based HIV testing. METHODS The HOSENG (HOme-based SElf-testiNG) trial is a cluster-randomized, parallel group, superiority trial in two districts of Lesotho, Southern Africa. Clusters are stratified by district, village size, and village access to the nearest health facility. Cluster eligibility criteria include: village is in catchment area of one of the study facilities, village authority provides consent, and village has a registered, capable and consenting village health worker (VHW). In intervention clusters, HIV self-tests are provided for eligible household members who are absent or decline HIV testing in presence of the campaign team. In control clusters, standard of care for absent and refusing individuals applies, i.e. referral to health facility. The primary outcome is HIV testing coverage among individuals 12 years and older within 120 days after enrolment. Secondary objectives include HIV testing coverage among other age groups, and uptake of the different testing modalities. Statistical analyses will be conducted and reported in line with CONSORT guidelines. HOSENG trial is linked to VIBRA (Village-Based Refill of ART) trial. Together, they constitute the GET ON (GETting tOwards Ninety) research project. DISCUSSION The HOSENG trial tests if oral HIVST may be an add-on during door-to-door testing campaigns towards achieving optimal testing coverage. The provision of oral self-test kits, followed up by VHWs, requires little additional human resources, finances and logistics. If cost-effective, this approach will inform home-based HIV testing policies not only in Lesotho, but in similar high-prevalence settings. TRIAL REGISTRATION This trial has been registered at clinicaltrials.gov (NCT03598686) on July 25, 2018. More information under www.getonproject.wordpress.com.

scholarly journals Co-Creation of HIVST Delivery Approaches for Improving Urban Men’s Engagement with HIV Services in eThekwini District, KwaZulu-Natal: Nominal Group Technique

2021 ◽  
Author(s):  
Tivani Mashamba-Thompson ◽  
Richard Lessells ◽  
Tafadzwa Dzinamarira ◽  
Paul Drain ◽  
Lehana Thabane
Keyword(s):  
Health Care ◽  
Hiv Testing ◽  
Nominal Group Technique ◽  
Nominal Group ◽  
Delivery Strategy ◽  
Hiv Services ◽  
Urban Men ◽  
Key Stakeholders ◽  
Self Testing ◽  
Hiv Testing Services

Abstract Background: HIV self-testing (HIVST) is one of the recommended approaches for HIV testing services, particularly for helping reach populations who would not normally access facility-based HIV testing. HIVST must be tailored to different populations to ensure uptake. Objective: The main objective of this study was to develop an acceptable HIVST delivery strategy to help improve urban men’s engagement with HIV services. Methods: We invited key stakeholders for urban men’s HIV services to participate in a co-creation workshop aimed at developing HIVST delivery approaches for urban men, using eThekwini municipality as a study setting. We conducted purposive sampling to include health care users and health care providers, representing a range of views across the public sector and voluntary sector. We employed the Nominal Group Technique (NGT) method for data collection. The NGT workshop was conducted in two consecutive phases: phase one was focused on determining barriers for men’s engagement with the current/facility-based HIV testing services; phase two was aimed at determining HIVST delivery strategies. We used the results of the NGT to design a tailored HIVST strategy for urban men in eThekwini District. Results: Participants identified the following psychological factors as the most important barriers to uptake of HIV testing services by urban men: stigma, ignorance about the importance of testing and testing process as well as fear of positive test results. Key stakeholders suggested internal motivation strategies as a potentially effective approach to support HIVST delivery strategy. Guided by the NGT results, we designed a HIVST delivery strategy that is supported by a risk communication approach. Conclusion: We designed an evidence-based risk communication mobile health (mHealth) strategy coupled with SARS COV-2 self-testing tailored to improve men’s uptake of HIVST. A follow-up study to evaluate the feasibility of implementing these approaches is recommended.

Sign in / Sign up

Export Citation Format

Share Document