scholarly journals National HIV testing and diagnosis coverage in sub-Saharan Africa: a new modeling tool for estimating the “first 90” from program and survey data

2019 ◽  
Author(s):  
M Maheu-Giroux ◽  
K Marsh ◽  
C Doyle ◽  
A Godin ◽  
C Lanièce Delaunay ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Critical Role ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Hiv Diagnosis ◽  
Hiv Knowledge ◽  
Out Of Sample ◽  
Living With Hiv ◽  
Program Data

AbstractObjectiveHIV testing services (HTS) are a crucial component of national HIV responses. Learning one’s HIV diagnosis is the entry point to accessing life-saving antiretroviral treatment and care. Recognizing the critical role of HTS, theJoint United Nations Programme on HIV/AIDS(UNAIDS) launched the 90-90-90 targets stipulating that by 2020, 90% of people living with HIV know their status, 90% of those who know their status receive antiretroviral therapy, and 90% of those on treatment have a suppressed viral load. Countries will need to regularly monitor progress on these three indicators. Estimating the proportion of people living with HIV who know their status (i.e., the “first 90”), however, is difficult.MethodsWe developed a mathematical model (henceforth referred to as “F90”) that formally synthesizes population-based survey and HTS program data to estimate HIV status awareness over time. The proposed model uses country-specific HIV epidemic parameters from the standard UNAIDS Spectrum model to produce outputs that are consistent with other national HIV estimates. The F90 model provides estimates of HIV testing history, diagnosis rates, and knowledge of HIV status by age and sex. We validate the F90 model using both in-sample comparisons and out-of-sample predictions using data from three countries: Côte d’Ivoire, Malawi, and Mozambique.ResultsIn-sample comparisons suggest that the F90 model can accurately reproduce longitudinal sex-specific trends in HIV testing. Out-of-sample predictions of the fraction of PLHIV ever tested over a 4-to-6-year time horizon are also in good agreement with empirical survey estimates. Importantly, out-of-sample predictions of HIV knowledge are consistent (i.e., within 4% points) with those of the fully calibrated model in the three countries, when HTS program data are included. The F90 model’s predictions of knowledge of status are higher than available self-reported HIV awareness estimates, however, suggesting –in line with previous studies– that these self-reports are affected by non-disclosure of HIV status awareness.ConclusionKnowledge of HIV status is a key indicator to monitor progress, identify bottlenecks, and target HIV responses. The F90 model can help countries track progress towards their “first 90” by leveraging surveys of HIV testing behaviors and annual HTS program data.

scholarly journals Accuracy of self-reported HIV testing history and awareness of HIV-positive status among people living with HIV in four Sub-Saharan African countries

2020 ◽  
Author(s):  
Yiqing Xia ◽  
Rachael M. Milwid ◽  
Arnaud Godin ◽  
Mare-Claude Boily ◽  
Leigh F. Johnson ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Latent Class ◽  
Latent Class Models ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Hiv Status ◽  
African Countries ◽  
Sub Saharan ◽  
Living With Hiv

Background: In many countries in Sub-Saharan Africa, self-reported HIV testing history and awareness of HIV-positive status from household surveys are used to estimate the percentage of people living with HIV (PLHIV) who know their HIV status. Despite widespread use, there is limited empirical information on the sensitivity of those self-reports, which can be affected by non-disclosure. Methods: Bayesian latent class models were used to estimate the sensitivity of self-reported HIV testing history and awareness of HIV-positive status in four Population-based HIV Impact Assessment surveys in Eswatini, Malawi, Tanzania, and Zambia. Antiretroviral (ARV) metabolites biomarkers were used to identify persons on treatment who did not accurately report their status. For those without ARV biomarkers, the pooled estimate of non-disclosure among untreated persons was 1.48 higher than those on treatment. Results: Among PLHIV, the sensitivity of self-reported HIV testing history ranged 96% to 99% across surveys. Sensitivity of self-reported awareness of HIV status varied from 91% to 97%. Non-disclosure was generally higher among men and those aged 15-24 years. Adjustments for imperfect sensitivity did not substantially influence estimates of of PLHIV ever tested (difference <4%) but the proportion of PLHIV aware of their HIV-positive status was higher than the unadjusted proportion (difference <8%). Conclusions: Self-reported HIV testing histories in four Eastern and Southern African countries are generally robust although adjustment for non-disclosure increases estimated awareness of status. These findings can contribute to further refinements in methods for monitoring progress along the HIV testing and treatment cascade.

scholarly journals An Integrated Approach to HIV Disclosure for HIV-Affected Families in Thailand

2019 ◽  
Vol 18 ◽  
pp. 232595821983102 ◽  
Author(s):  
Jureeporn Jantarapakde ◽  
Chitsanu Pancharoen ◽  
Somsong Teeratakulpisarn ◽  
Pornpen Mathajittiphan ◽  
Rosalin Kriengsinyot ◽  
...  
Keyword(s):  
Family Relationship ◽  
Integrated Approach ◽  
Hiv Disclosure ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Hiv Knowledge ◽  
Group Education ◽  
Living With Hiv ◽  
Hiv Programs ◽  
The Impact

Disclosure of HIV status to family members could improve communication, relationship, and cohesion. We evaluated the impact of a family-centered program designed to increase the readiness/willingness of parents to disclose HIV status to their children. People living with HIV (PLWH) with children ≥8 years were surveyed regarding HIV knowledge, family relationship, attitudes, willingness/readiness to disclose, and they were then invited to participate in group education and family camps. Of 367 PLWH surveyed, 0.8% had disclosed, 14.7% had not yet disclosed but were willing/ready to disclose, 50.4% were willing but not ready, and 33.2% did not wish to disclose. The educational sessions and camps led to significant improvements of HIV knowledge and disclosure techniques, and readiness/willingness to disclose. Given the benefits of group education and family camps in supporting PLWH to improve their communication with their families and disclose their HIV status, these supporting activities should be included in HIV programs.

scholarly journals Trends in knowledge of HIV status and efficiency of HIV testing services in Sub-Saharan Africa (2000-2020): a modelling study of survey and HIV testing program data

2020 ◽  
Author(s):  
Katia Giguère ◽  
Jeffrey W. Eaton ◽  
Kimberly Marsh ◽  
Leigh F. Johnson ◽  
Cheryl C. Johnson ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Median Time ◽  
Credible Interval ◽  
Population Based ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Hiv Testing Services ◽  
Sub Saharan ◽  
First Time

AbstractBackgroundKnowledge of HIV status (KOS) among people living with HIV (PLHIV) is essential for an effective national HIV response. This study estimates progress and gaps in reaching the UNAIDS 2020 target of 90% KOS, and the efficiency of HIV testing services (HTS) in sub-Saharan Africa (SSA), where two thirds of all PLHIV live.MethodsWe used data from 183 population-based surveys (N=2.7 million participants) and national HTS programs (N=315 country-years) from 40 countries as inputs into a mathematical model to examine trends in KOS among PLHIV, median time from HIV infection to diagnosis, HIV testing positivity, and proportion of new diagnoses among all positive tests, adjusting for retesting.FindingsAcross SSA, KOS steadily increased from 6% (95% credible interval [95%CrI]: 5% to 7%) in 2000 to 84% (95%CrI: 82% to 86%) in 2020. Twelve countries and one region, Southern Africa, reached the 90% target. In 2020, KOS was lower among men (79%) than women (87%) across SSA. PLHIV aged 15-24 years were the least likely to know their status (65%), but the largest gap in terms of absolute numbers was among men aged 35-49 years, with over 700,000 left undiagnosed. As KOS increased from 2000 to 2020, the median time to diagnosis decreased from 10 to 3 years, HIV testing positivity declined from 9% to 3%, and the proportion of first-time diagnoses among all positive tests dropped from 89% to 42%.InterpretationOn the path towards the next UNAIDS target of 95% diagnostic coverage by 2030, and in a context of declining positivity and yield of first-time diagnoses, we need to focus on addressing disparities in KOS. Increasing KOS and treatment coverage among older men could be critical to reduce HIV incidence among women in SSA, and by extension, reducing mother-to-child transmission.

scholarly journals How early is too early? Challenges in ART initiation and engaging in HIV care under Treat All in Rwanda—A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251645
Author(s):  
Jonathan Ross ◽  
Charles Ingabire ◽  
Francine Umwiza ◽  
Josephine Gasana ◽  
Athanase Munyaneza ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Qualitative Interviews ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Hiv Diagnosis ◽  
Art Initiation ◽  
Treat All

Introduction HIV treatment guidelines recommend that all people living with HIV (PLWH) initiate antiretroviral therapy (ART) as soon as possible after diagnosis (Treat All). As Treat All is more widely implemented, an increasing proportion of PLWH are likely to initiate ART when they are asymptomatic, and they may view the relative benefits and risks of ART differently than those initiating at more advanced disease stages. To date, patient perspectives of initiating care under Treat All in sub-Saharan Africa have not been well described. Methods From September 2018 to March 2019, we conducted individual, semi-structured, qualitative interviews with 37 patients receiving HIV care in two health centers in Kigali, Rwanda. Data were analyzed using a mixed deductive and inductive thematic analysis approach to describe perceived barriers to, facilitators of and acceptability of initiating and adhering to ART rapidly under Treat All. Results Of 37 participants, 27 were women and the median age was 31 years. Participants described feeling traumatized and overwhelmed by their HIV diagnosis, resulting in difficulty accepting their HIV status. Most were prescribed ART soon after diagnosis, yet fear of lifelong medication and severe side effects in the immediate period after initiating ART led to challenges adhering to therapy. Moreover, because many PLWH initiated ART while healthy, taking medications and attending appointments were visible signals of HIV status and highly stigmatizing. Nonetheless, many participants expressed enthusiasm for Treat All as a program that improved health as well as health equity. Conclusion For newly-diagnosed PLWH in Rwanda, initiating ART rapidly under Treat All presents logistical and emotional challenges despite the perceived benefits. Our findings suggest that optimizing early engagement in HIV care under Treat All requires early and ongoing intervention to reduce trauma and stigma, and promote both individual and community benefits of ART.

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.

scholarly journals Resisting Public Health Surveillance: Anonymous HIV Testing and the Imperative of Health

2013 ◽  
Vol 11 (1/2) ◽  
pp. 35-54 ◽  
Author(s):  
Patrick O'Byrne ◽  
Alyssa Bryan
Keyword(s):  
Public Health ◽  
Hiv Testing ◽  
Public Health Surveillance ◽  
Health Surveillance ◽  
People Living With Hiv ◽  
Health Law ◽  
Hiv Status ◽  
Public Health Law ◽  
Living With Hiv ◽  
Anonymous Hiv Testing

To date, there has been little research published about public health surveillance and HIV testing/prevention. Accordingly, an exploratory project was undertaken, involving a detailed review of local public health law, and the distribution of surveys about self-reported STI testing/diagnosis, HIV testing practices, and sexual behaviours among gay, bisexual, and other men who have sex with men. A review of the public health law indicated that, in the local context, there is a pervasive public health surveillance apparatus that requires mandatory reporting of identified communicable diseases, including HIV. Results of the survey indicated that individuals who reported a preference for, or use of, anonymous HIV testing were more likely to have reported having (a) been tested for, and diagnosed with, STIs, (b) a self-reported history of anal sex, (c) more sexual partners, and (d) been aware of criminal prosecutions against people living with HIV for not disclosing their HIV status. At first glance, it appeared as though anonymous HIV testing represented a form of resistance to public health surveillance; a strategy by which individuals who are likely to test positive for HIV circumvent surveillance. However, when these results were examined using Lupton’s “Imperative of Health” framework, it became clear that one must appreciate the two-pronged nature of anonymous HIV testing. On the one hand, knowing one’s HIV status can be beneficial; for example, it corresponds with decreased HIV transmission and improved quantity / quality of life for people living with HIV. On the other hand, anonymous testing represents a complicit acceptance of the imperative of health, and an internalization of public health surveillance. From this perspective, true resistance to public health surveillance would manifest as an absolute rejection of HIV testing.

scholarly journals Dating, Marriage, and Parenthood for HIV-Positive Heterosexual Puerto Rican Men

2014 ◽  
Vol 9 (2) ◽  
pp. 139-149 ◽  
Author(s):  
Francisco Sastre ◽  
Diana M. Sheehan ◽  
Arnaldo Gonzalez
Keyword(s):  
Puerto Rican ◽  
Hiv Transmission ◽  
Sexual Life ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Hiv Diagnosis ◽  
Latino Men ◽  
Hiv Positive Women ◽  
Living With Hiv

HIV-positive men are living long and healthier lives while managing HIV as a chronic illness. Although research has extensively documented the experiences of illness of people living with HIV, dating, marriage, and fatherhood among heterosexual Latino men has not been examined. To address this gap, this study used a qualitative study design to examine patterns and strategies for dating, marriage, and parenthood among 24 HIV-positive heterosexual Puerto Rican men living in Boston. The findings in our study indicate that an HIV diagnosis does not necessarily deter men from having an active sexual life, marrying, or having children. In fact, for some of the men, engaging in these social and life-changing events is part of moving on and normalizing life with HIV; these men planned for, achieved, and interpreted these events in the context of establishing normalcy with HIV. Although the HIV diagnosis discouraged some men from engaging in sexual relations, getting married, or having children, others fulfilled these desires with strategies aimed to reconciling their HIV status in their personal life, including dating or marrying HIV-positive women only. Additional important themes identified in this study include the decision to disclose HIV status to new sexual partners as well as the decision to accept the risk of HIV transmission to a child or partner in order to fulfill desires of fatherhood. Understanding the personal struggles, decision-making patterns, and needs of HIV-positive heterosexual men can aid in designing interventions that support healthy living with HIV.

scholarly journals Sex, HIV Status, and Measures of Cardiac Stress and Fibrosis in Uganda

2021 ◽  
Author(s):  
Jasmine Kipke ◽  
Seunghee Margevicius ◽  
Cissy Kityo ◽  
Grace Mirembe ◽  
Jonathan Buggey ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cystatin C ◽  
Sub Saharan Africa ◽  
Cardiac Biomarkers ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Growth Differentiation Factor 15 ◽  
Differentiation Factor ◽  
Sub Saharan ◽  
Living With Hiv

Background Biomarkers of myocardial stress and fibrosis are elevated in people living with HIV and are associated with cardiac dysfunction. It is unknown whether sex influences these markers of heart failure risk in sub‐Saharan Africa, where HIV burden is high and where the vast majority of women with HIV live. Methods and Results Echocardiograms and 6 plasma biomarkers (suppression of tumorigenicity‐2, growth differentiation factor 15, galectin 3, soluble fms‐like tyrosine kinase‐1, NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide], and cystatin C) were obtained from 100 people living with HIV on antiretroviral therapy and 100 HIV‐negative controls in Uganda. All participants were ≥45 years old with ≥1 major cardiovascular risk factor. Multivariable linear and logistic regression models were used to assess associations between biomarkers, echocardiographic variables, HIV status, and sex, and to assess whether sex modified these associations. Overall, mean age was 56 years and 62% were women. Suppression of tumorigenicity‐2 was higher in men versus women ( P <0.001), and growth differentiation factor 15 was higher in people living with HIV versus controls ( P <0.001). Sex modified the HIV effect on cystatin C and NT‐proBNP (both P for interaction <0.025). Women had more diastolic dysfunction than men ( P= 0.02), but there was no evidence of sex‐modifying HIV effects on cardiac structure and function. Cardiac biomarkers were more strongly associated with left ventricular mass index in men compared with women. Conclusions There are prominent differences in biomarkers of cardiac fibrosis and stress by sex and HIV status in Uganda. The predictive value of cardiac biomarkers for heart failure in people living with HIV in sub‐Saharan Africa should be examined, and novel risk markers for women should be further explored.

scholarly journals The Lived Experiences of Stigmatization in the Process of HIV Status Disclosure among People Living with HIV in Taiwan

2021 ◽  
Vol 18 (10) ◽  
pp. 5089
Author(s):  
Chia-Hui Yu ◽  
Chu-Yu Huang ◽  
Nai-Ying Ko ◽  
Heng-Hsin Tung ◽  
Hui-Man Huang ◽  
...  
Keyword(s):  
Lived Experiences ◽  
Healthcare Professionals ◽  
Social Stigma ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Structured Interviews ◽  
Two Phases ◽  
Hiv Status Disclosure ◽  
Living With Hiv ◽  
Status Disclosure

People living with HIV (PLWH) face social stigma which makes disclosure of HIV status difficult. The purpose of this descriptive qualitative study was to understand the lived experiences of stigmatization in the process of disease disclosure among PLWH in Taiwan. Analysis of the semi-structured interviews from 19 PLWH in Taiwan revealed two phases and six themes. Phase one “experiences before disclosure” involved three themes: “Struggles under the pressure of concealing the HIV Status,” “Torn between fear of unemployment/isolation and desire to protect closed ones,” and “Being forced to disclose the HIV status.” Phase two “experiences after disclosure” included three themes: “Receiving special considerations and requirements from school or work,” “Receiving differential treatments in life and when seeking medical care,” and “Stress relief and restart.” Healthcare professionals need to assess stigmatization in PLWH and develop individualized approaches to assist with the disease disclosure process.

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