scholarly journals Evaluation of Kenya’s readiness to transition from sentinel surveillance to routine HIV testing for antenatal clinic-based HIV surveillance

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Martin Sirengo ◽  
George W. Rutherford ◽  
Boaz Otieno-Nyunya ◽  
Timothy A. Kellogg ◽  
Davies Kimanga ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Antenatal Clinic ◽  
Sentinel Surveillance ◽  
Hiv Surveillance ◽  
Routine Hiv Testing

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 Return of test results in Vietnam HIV sentinel surveillance: Implementation and preliminary results

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Giang T. Le ◽  
Duc H. Bui ◽  
Diep T. Vu ◽  
Duong C. Thanh ◽  
Nghia V. Khuu ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sentinel Surveillance ◽  
Confirmatory Test ◽  
Hiv Positive ◽  
Test Results ◽  
Hiv Surveillance ◽  
Hiv Test ◽  
Hiv Serostatus ◽  
To Receive ◽  
Test Result

ObjectiveTo describe the implementation and preliminary results of returning HIV test results to participants in Vietnam HIV sentinel surveillance.IntroductionKnowledge of one’s HIV serostatus helps improve quality of life for those who test positive and decreases the risk of HIV transmission. WHO recommends that all participants in HIV prevalence surveys be provided access to their test results, especially those who test HIV positive [1]. Anonymous Vietnam HIV sentinel surveillance (HSS), implemented since 1994, focuses on people who inject drugs (PWID), female sex workers (FSW), and men who have sex with men (MSM) [2]. According to national guidelines, the HIV testing algorithm for surveillance purposes was based on two tests whereas the diagnostic algorithm for individuals was based on three tests. Thus, surveillance test results could not be returned to participants [3] who were instead encouraged to learn their HIV serostatus by testing at public confirmatory testing sites.In 2015, a three-test strategy was applied as part of HSS so that test results could be returned to participants.MethodsIn 2015, return of HIV test results was implemented as a pilot in 16 HSS provinces. HSS participants were asked to identify which of the designated HIV testing and counselling centers (HTC) in the province was most convenient for them. Participants were then given appointment cards with an assigned survey ID to receive their test results at the chosen venue at a specific date and time. Specimens, with assigned survey IDs, were transferred to the respective HIV laboratory at the Province AIDS Center (PAC) for confirmatory testing. The same three-test algorithm was used for surveillance purposes as well as to return confirmatory test results to participants [3]. Final test results were classified as “positive”, “negative” or “indeterminate”. HIV confirmatory test results were made available at all designated HTC in the provinces within 10 days after blood collection; thus, if a participant presented at a location, date or time that differed from the appointment card, s/he could still receive the test result. In some settings in which provinces integrated HSS with either static or mobile HTC, three rapid tests were used at point-of-care so that same-day test results were available. In this case, participants received test results at the end of the specified time regardless of their infection status.At the HTC, individuals showed their appointment cards. The IDs were used to identify the correct test results which were then given verbally to participants by HTC counsellors. Test results were not returned by phone or email. Individuals who tested positive were immediately referred to HIV treatment and other available health/social services in the province.The proportion of participants who received their test results was calculated for each survey group and province.ResultsThe number of provinces that reported returning of HIV test results in 2015 and 2016 were 14 and 15, respectively. Overall, among 15,530 persons tested through HSS in 2015 and 2016, 7,354 persons returned to receive their test results. The proportion of participants who returned for test results varied by province and survey population (table 1). In some provinces where HSS was integrated with HTC, such as Hai Phong and Dong Thap, 100% of participants received their test results within a day [4].ConclusionsReturning HIV test results to HIV surveillance participants is feasible and beneficial in low-income countries like Vietnam. This enhancement facilitates participants learning their serostatus and contributes toward Vietnam’s achievement of HIV control [4]. Based on the pilot experiences, Vietnam Ministry of Health decided to extend test result notifications to all 20 HSS provinces in 2017.Key factors that contributed to the success of the activity were fast turnaround time, roles and level of commitment of PAC, and coordination between the survey and HTC. The returning rate in HSS 2015 and 2016 are promising but these could be improved further. Better coordination and commitment between the survey and HIV testing service are needed to further increase return rates so that HIV-positive individuals can learn their serostatus and be better linked to care and treatment services.References1. WHO, Guidelines for second generation HIV surveillance: An update: Know your epidemic, 2013.2. VAAC, Guidance for epidemiological surveillance of HIV/AIDS & sexually transmitted infections, 2012.3. MOH, National guideline on HIV serology testing, in Decision 1098/QD-BYT, 2013.4. VAAC, Primarily results of HSS, 2016. 

scholarly journals Statistical models for incorporating data from routine HIV testing of pregnant women at antenatal clinics into HIV/AIDS epidemic estimates

AIDS ◽  
2017 ◽  
Vol 31 ◽  
pp. S87-S94 ◽  
Author(s):  
Ben Sheng ◽  
Kimberly Marsh ◽  
Aleksandra B. Slavkovic ◽  
Simon Gregson ◽  
Jeffrey W. Eaton ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Hiv Testing ◽  
Statistical Models ◽  
Aids Epidemic ◽  
Antenatal Clinics ◽  
Routine Hiv Testing ◽  
Hiv Aids

Feasibility of voluntary counselling and testing services for HIV among pregnant women presenting in labour in Pune, India

2005 ◽  
Vol 16 (8) ◽  
pp. 553-555 ◽  
Author(s):  
K E Bharucha ◽  
J Sastry ◽  
A Shrotri ◽  
S Sutar ◽  
A Joshi ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Hiv Testing ◽  
Post Partum ◽  
Antenatal Clinic ◽  
Delivery Room ◽  
Normal Delivery ◽  
Factors Affecting ◽  
Voluntary Counselling ◽  
Early Labour ◽  
Voluntary Counselling And Testing

Factors affecting the eligibility and acceptability of voluntary counselling and rapid HIV testing (VCT) were examined among pregnant women presenting in labour in Pune, India. Of the 6702 total women appearing at the delivery room from April 2001 to March 2002, 4638 (69%) were admitted for normal delivery. The remaining women presented with obstetrical complications, delivered immediately or were detected to be in false labour. Overall, 2818 (61%) of the admitted women had been previously tested for HIV during their pregnancy. If previously seen in the hospital's affiliated antenatal clinic, the likelihood of being previously tested was 89%, in contrast to 27% of women having prenatal care elsewhere. Of the admitted women, 3436 (74.3%) were assessed for their eligibility for rapid HIV VCT in the delivery room. Only 1322 (38%) of these women were found to be in early labour and without severe pain or complications, and therefore eligible for rapid HIV screening in the delivery room (DR). Of those 1322 eligible women, only 582 (44%) consented and were tested for HIV, of whom nine (1.6%) were found to be HIV-infected. Of the 1674 women arriving in the DR with no evidence of previous HIV testing, through this DR screening programme, we identified four women with HIV who could now benefit from treatment with ART. Given the high rates of HIV testing in the antenatal clinic at this site and the challenges inherent to conducting DR screening, alternatives such as post-partum testing should be considered to help reduce maternal to infant transmission in this population.

Stigma, Structural Vulnerability, and “What Matters Most” Among Women Living With HIV in Botswana, 2017

2021 ◽  
pp. e1-e9
Author(s):  
Lawrence H. Yang ◽  
Ohemaa B. Poku ◽  
Supriya Misra ◽  
Haitisha T. Mehta ◽  
Shathani Rampa ◽  
...  
Keyword(s):  
Health Care ◽  
Hiv Testing ◽  
Structural Level ◽  
Structural Vulnerability ◽  
Women Living With Hiv ◽  
Care Policies ◽  
Health Care Policies ◽  
Women With Hiv ◽  
Routine Hiv Testing ◽  
What Matters

Objectives. To explore whether beneficial health care policies, when implemented in the context of gender inequality, yield unintended structural consequences that stigmatize and ostracize women with HIV from “what matters most” in local culture. Methods. We conducted 46 in-depth interviews and 5 focus groups (38 individuals) with men and women living with and without HIV in Gaborone, Botswana, in 2017. Results. Cultural imperatives to bear children bring pregnant women into contact with free antenatal services including routine HIV testing, where their HIV status is discovered before their male partners’. National HIV policies have therefore unintentionally reinforced disadvantage among women with HIV, whereby men delay or avoid testing by using their partner’s status as a proxy for their own, thus facilitating blame toward women diagnosed with HIV. Gossip then defines these women as “promiscuous” and as violating the essence of womanhood. We identified cultural and structural ways to resist stigma for these women. Conclusions. Necessary HIV testing during antenatal care has inadvertently perpetuated a structural vulnerability that propagates stigma toward women. Individual- and structural-level interventions can address stigma unintentionally reinforced by health care policies. (Am J Public Health. Published online ahead of print June 10, 2021: e1–e9. https://doi.org/10.2105/AJPH.2021.306274 )

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