A randomized group antenatal care pilot showed increased partner communication and partner HIV testing during pregnancy in Malawi and Tanzania

Abstract Background HIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa. Although most women are tested at ANC, they remain at risk for HIV exposure and transmission to their infant when their partners are not tested. This study evaluates how an HIV-enhanced and Centering-based group ANC model-Group ANC+ that uses interactive learning to practice partner communication is associated with improvements in partner HIV testing during pregnancy. Methods A randomized pilot study conducted in Malawi and Tanzania found multiple positive outcomes for pregnant women (n = 218) assigned to Group ANC+ versus individual ANC. This analysis adds previously unpublished results for two late pregnancy outcomes: communication with partner about three reproductive health topics (safer sex, HIV testing, and family planning) and partner HIV testing since the first antenatal care visit. Multivariate logistic regression models were used to assess the effect of type of ANC on partner communication and partner testing. We also conducted a mediation analysis to assess whether partner communication mediated the effect of type of care on partner HIV testing. Results Nearly 70% of women in Group ANC+ reported communicating about reproductive health with their partner, compared to 45% of women in individual ANC. After controlling for significant covariates, women in group ANC were twice as likely as those in individual ANC to report that their partner got an HIV test (OR 1.99; 95% CI: 1.08, 3.66). The positive effect of the Group ANC + model on partner HIV testing was fully mediated by increased partner communication. Conclusions HIV prevention was included in group ANC health promotion without compromising services and coverage of standard ANC topics, demonstrating that local high-priority health promotion needs can be integrated into ANC using a Group ANC+. These findings provide evidence that greater partner communication can promote healthy reproductive behaviors, including HIV prevention. Additional research is needed to understand the processes by which group ANC allowed women to discuss sensitive topics with partners and how these communications led to partner HIV testing.

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Test@Work Texts: Mobile Phone Messaging to Increase Awareness of HIV and HIV Testing in UK Construction Employees during the COVID-19 Pandemic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17217819 ◽

2020 ◽

Vol 17 (21) ◽

pp. 7819

Author(s):

Matthew Middleton ◽

Sarah Somerset ◽

Catrin Evans ◽

Holly Blake

Keyword(s):

Health Promotion ◽

Hiv Prevention ◽

Hiv Testing ◽

Construction Industry ◽

Text Messaging ◽

Participatory Design ◽

Workplace Health Promotion ◽

Treatment Options ◽

Perceived Usefulness ◽

Hiv Test

Background: HIV poses a threat to global health. With effective treatment options available, education and testing strategies are essential in preventing transmission. Text messaging is an effective tool for health promotion and can be used to target higher risk populations. This study reports on the design, delivery and testing of a mobile text messaging SMS intervention for HIV prevention and awareness, aimed at adults in the construction industry and delivered during the COVID-19 pandemic. Method: Participants were recruited at Test@Work workplace health promotion events (21 sites, n = 464 employees), including health checks with HIV testing. Message development was based on a participatory design and included a focus group (n = 9) and message fidelity testing (n = 291) with assessment of intervention uptake, reach, acceptability, and engagement. Barriers to HIV testing were identified and mapped to the COM-B behavioural model. 23 one-way push SMS messages (19 included short web links) were generated and fidelity tested, then sent via automated SMS to two employee cohorts over a 10-week period during the COVID-19 pandemic. Engagement metrics measured were: opt-outs, SMS delivered/read, number of clicks per web link, four two-way pull messages exploring repeat HIV testing, learning new information, perceived usefulness and behaviour change. Results: 291 people participated (68.3% of eligible attendees). A total of 7726 messages were sent between March and June 2020, with 91.6% successfully delivered (100% read). 12.4% of participants opted out over 10 weeks. Of delivered messages, links were clicked an average of 14.4% times, max 24.1% for HIV related links. The number of clicks on web links declined over time (r = −6.24, p = 0.01). Response rate for two-way pull messages was 13.7% of participants. Since the workplace HIV test offer at recruitment, 21.6% reported having taken a further HIV test. Qualitative replies indicated behavioural influence of messaging on exercise, lifestyle behaviours and intention to HIV test. Conclusions: SMS messaging for HIV prevention and awareness is acceptable to adults in the construction industry, has high uptake, low attrition and good engagement with message content, when delivered during a global pandemic. Data collection methods may need refinement for audience, and effect of COVID-19 on results is yet to be understood.

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Test@Work Texts: Mobile Phone Messaging to Increase Awareness of HIV and HIV Testing in UK Construction Employees During the COVID-19 Pandemic

10.20944/preprints202009.0657.v1 ◽

2020 ◽

Author(s):

Matthew Middleton ◽

Sarah Somerset ◽

Catrin Evans ◽

Holly Blake

Keyword(s):

Health Promotion ◽

Hiv Prevention ◽

Hiv Testing ◽

Construction Industry ◽

Text Messaging ◽

Participatory Design ◽

Workplace Health Promotion ◽

Treatment Options ◽

Perceived Usefulness ◽

Hiv Test

Background: HIV poses a threat to global health. With effective treatment options available, education and testing strategies are essential in preventing transmission. Text messaging is an effective tool for health promotion and can be used to target higher risk populations. This study reports on the design, delivery and testing of a mobile text messaging SMS intervention for HIV prevention and awareness, aimed at adults in the construction industry and delivered during the COVID-19 pandemic. Method: Participants were recruited at Test@Work workplace health promotion events (21 sites, n=464 employees), including health checks with HIV testing. Message development was based on a participatory design and included a focus group (n=9) and message fidelity testing (n=291) with assessment of intervention uptake, reach, acceptability, and engagement. Barriers to HIV testing were identified and mapped to the COM-B behavioural model. 23 one-way push SMS messages (19 included short web links) were generated and fidelity tested, then sent via automated SMS to two employee cohorts over a 10-week period during the COVID-19 pandemic. Engagement metrics measured were; opt-outs, SMS delivered/read, number of clicks per web link, and four two-way pull messages exploring repeat HIV testing, learning new information, perceived usefulness and behaviour change. Results: 291 people participated (68.3% of eligible attendees). A total of 7,726 messages were sent between March and June 2020, with 91.6% successfully delivered (100% read). 12.4% of participants opted out over 10 weeks. Of delivered messages, links were clicked an average of 14.4%, max 24.1% for HIV related links. The number of clicks on web links declined over time (r= -6.24, p=0.01). Response rate for two-way pull messages was 13.7% of participants. Since the workplace HIV test offer at recruitment, 21.6% reported having taken a further HIV test. Qualitative replies indicated behavioural influence of messaging on exercise, lifestyle behaviours and intention to HIV test. Conclusion: SMS messaging for HIV prevention and awareness is acceptable to adults in the construction industry, has high uptake, low attrition and good engagement with message content, when delivered during a global pandemic. Data collection methods may need refinement for audience and effect of COVID-19 on results is yet to be understood.

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What happens after HIV self-testing? Results from a longitudinal cohort of Chinese men who have sex with men

BMC Infectious Diseases ◽

10.1186/s12879-019-4455-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Weiming Tang ◽

Wenting Huang ◽

Haidong Lu ◽

Bolin Cao ◽

Dan Wu ◽

...

Keyword(s):

Hiv Prevention ◽

Condom Use ◽

Hiv Testing ◽

Consistent Condom ◽

Consistent Condom Use ◽

Longitudinal Cohort ◽

Prevention Services ◽

Self Testing ◽

Hiv Test ◽

Sex With Men

Abstract Background HIV self-testing (HIVST) is a promising approach to expand HIV testing. HIVST is a process in which a person performs an HIV test and interprets the result. Negative HIVST results may encourage men who have sex with men (MSM) to use HIV prevention services. The objective of this study was to examine behaviors (e.g., facility-based HIV testing, condom use) after a negative HIVST test result among Chinese MSM. Methods We collected data from MSM in eight Chinese cities over a 12-month period. This is a secondary analysis of longitudinal cohort data collected as part of an intervention trial to increase HIV testing. Men completed a survey that described sociodemographic information, sexual behaviors, HIV self-testing, and facility-based HIV testing. Men who completed at least one follow-up survey were included in this analysis. Generalized linear mixed models were used to evaluate whether HIVST increased subsequent facility-based HIV testing and consistent condom use. Results We included 1219 men. Most men (78.7%) were under 30 years old and had never been married (87.0%). 755 (61.9%) men tested for HIV and 593 (49.3%) men self-tested during the study period. At baseline, among men who had never been tested for HIV, 44.9% (314/699) initiated HIVST during the study period. HIVST was associated with subsequent facility-based testing (aOR of 1.87, 95% CI: 1.47–2.37). HIVST was also associated with subsequent consistent condom use (aOR = 1.53, 95% CI: 1.13–2.06). Conclusion HIVST was associated with subsequent facility-based HIV testing and consistent condom use. HIVST may enhance uptake of related HIV prevention services at facilities, suggesting the need for more implementation research.

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Stigma, sexual risk and desire for HIV tests in Ghana

Sexual Health ◽

10.1071/sh09095 ◽

2011 ◽

Vol 8 (1) ◽

pp. 110 ◽

Cited By ~ 7

Author(s):

Emmanuel F. Koku

Keyword(s):

Hiv Prevention ◽

Hiv Testing ◽

Treatment Programs ◽

Negative Interaction ◽

Sexual Behaviours ◽

Hiv Test ◽

Related Stigma ◽

Risky Sexual Behaviours ◽

Positive Effect

Background: Although various HIV prevention and treatment programs have been implemented in Ghana since 2003, desire for and uptake of HIV testing is still low, owing largely to HIV-related stigma. This study examined the effect of stigma on desire for HIV testing, while controlling for socio-demographic and other influences. Method: The study used data from the 2003 Ghana Demographic and Health Survey to regress desire for an HIV test on levels of stigma while controlling for selected socio-demographic, socio-cognitive and socio-behavioural covariates. Results: The study revealed significant associations between several socio-demographic and socio-cognitive variables and the desire for an HIV test. For example, both male (adjusted odds ratio (AOR) = 0.41; 95% confidence interval (CI) = 0.24–0.72) and female (AOR = 0.62; 95% CI = 0.41–0.93) respondents in the wealthiest households, and those who know someone infected with HIV (AOR = 0.65; 95% CI = 0.43–1.00) have lower odds of desiring an HIV test. The study showed a significant but negative interaction between risky sexual behaviours and community stigma (AOR = 0.44; 95% CI = 0.19–0.67), indicating that the positive effect of risky sex on HIV testing is attenuated among females who live in communities with high levels of stigma. Conclusion: Since community-level education and risk reduction programs have demonstrable influences on reducing HIV stigma, it is imperative that the Ghana government’s ongoing anti-stigma campaigns and other HIV prevention programs recognise the role of community stigma in influencing HIV testing decisions, especially in the context of risky sexual behaviours.

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Rates and Correlates of HIV Incidence in Namibia’s Zambezi Region From 2014 to 2016: Sentinel, Community-Based Cohort Study

JMIR Public Health and Surveillance ◽

10.2196/17107 ◽

2020 ◽

Vol 6 (2) ◽

pp. e17107

Author(s):

Andrew D Maher ◽

Tuli Nakanyala ◽

Nicholus Mutenda ◽

Karen M Banda ◽

Dimitri Prybylski ◽

...

Keyword(s):

Hiv Testing ◽

Rural Areas ◽

Sub Saharan Africa ◽

Hiv Incidence ◽

Community Based ◽

Home Based ◽

Hiv Test ◽

Hiv Acquisition ◽

Hiv Negative

Background Direct measures of HIV incidence are needed to assess the population-level impact of prevention programs but are scarcely available in the subnational epidemic hotspots of sub-Saharan Africa. We created a sentinel HIV incidence cohort within a community-based program that provided home-based HIV testing to all residents of Namibia’s Zambezi region, where approximately 24% of the adult population was estimated to be living with HIV. Objective The aim of this study was to estimate HIV incidence, detect correlates of HIV acquisition, and assess the feasibility of the sentinel, community-based approach to HIV incidence surveillance in a subnational epidemic hotspot. Methods Following the program’s initial home-based testing (December 2014-July 2015), we purposefully selected 10 clusters of 60 to 70 households each and invited residents who were HIV negative and aged ≥15 years to participate in the cohort. Consenting participants completed behavioral interviews and a second HIV test approximately 1 year later (March-September 2016). We used Poisson models to calculate HIV incidence rates between baseline and follow-up and multivariable Cox proportional hazard models to assess the correlates of seroconversion. Results Among 1742 HIV-negative participants, 1624 (93.23%) completed follow-up. We observed 26 seroconversions in 1954 person-years (PY) of follow-up, equating to an overall incidence rate of 1.33 per 100 PY (95% CI 0.91-1.95). Among women, the incidence was 1.55 per 100 PY (95% CI 1.12-2.17) and significantly higher among those aged 15 to 24 years and residing in rural areas (adjusted hazard ratio [aHR] 4.26, 95% CI 1.39-13.13; P=.01), residing in the Ngweze suburb of Katima Mulilo city (aHR 2.34, 95% CI 1.25-4.40; P=.01), who had no prior HIV testing in the year before cohort enrollment (aHR 3.38, 95% CI 1.04-10.95; P=.05), and who had engaged in transactional sex (aHR 17.64, 95% CI 2.88-108.14; P=.02). Among men, HIV incidence was 1.05 per 100 PY (95% CI 0.54-2.31) and significantly higher among those aged 40 to 44 years (aHR 13.04, 95% CI 5.98-28.41; P<.001) and had sought HIV testing outside the study between baseline and follow-up (aHR 8.28, 95% CI 1.39-49.38; P=.02). No seroconversions occurred among persons with HIV-positive partners on antiretroviral treatment. Conclusions Nearly three decades into Namibia’s generalized HIV epidemic, these are the first estimates of HIV incidence for its highest prevalence region. By creating a sentinel incidence cohort from the infrastructure of an existing community-based testing program, we were able to characterize current transmission patterns, corroborate known risk factors for HIV acquisition, and provide insight into the efficacy of prevention interventions in a subnational epidemic hotspot. This study demonstrates an efficient and scalable framework for longitudinal HIV incidence surveillance that can be implemented in diverse sentinel sites and populations.

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Socio-cultural and economic barriers, and facilitators influencing men’s involvement in antenatal care including HIV testing: A qualitative study from urban Blantyre, Malawi

10.21203/rs.3.rs-18743/v5 ◽

2020 ◽

Author(s):

Doreen Sakala ◽

Moses K. Kumwenda ◽

Donaldson F. Conserve ◽

Bassey Ebenso ◽

Augustine Talumba Choko

Keyword(s):

Qualitative Study ◽

Antenatal Care ◽

Hiv Testing ◽

Randomised Trial ◽

Male Partner ◽

Peer Pressure ◽

Barriers And Facilitators ◽

Cluster Randomised Trial ◽

Hiv Test ◽

Economic Barriers

Abstract Background Male partner involvement in antenatal care (ANC) is associated with positive maternal and neonatal outcomes. However, only a handful of men attend ANC with their partners. This study aimed to understand the underlying barriers and facilitators influencing men’s ANC attendance including HIV testing in Blantyre, Malawi.Methods Data were collected during a formative qualitative study of a cluster-randomised trial. Six focus group discussions (FGDs) with 42 men and women and 20 in-depth interviews (IDIs) were conducted at three primary health centres in urban Blantyre, Malawi. FGD participants were purposively sampled with IDI participants subsequently sampled after FGD participation. Thematic analysis was used to analyse the data.Results The economic requirement to provide for their families exerted pressure on men and often negatively affected their decision to attend ANC together with their pregnant partners despite obvious benefits. Peer pressure and the fear to be seen by peers queueing for services at ANC, an environment traditionally viewed as a space for women and children made men feel treated as trespassers and with some level of hostility rendering them feeling emasculated when they attend ANC. Health system problems associated with overall organization of the ANC services, which favours women created resistance among men to be involved. An association between ANC and HIV testing services discouraged men from attending ANC because of their fear of testing HIV-positive in the presence of their partners. The availability of a male friendly clinic offering a private, quick, supportive/sensitive and flexible service was considered to be an important incentive that would facilitate male men’s ANC attendance. Men described compensation to cover transport and opportunity cost for attending the clinic as a motivator to attending ANC services and accepting an HIV test. Conclusion Peer and economic influences were the most influential barriers of men attending ANC and testing for HIV with their pregnant partners. Addressing these socio-economic barriers and having a male friendly clinic are promising interventions to promote male ANC attendance in this setting.

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From HIV prevention to non-communicable disease health promotion efforts in sub-Saharan Africa

AIDS ◽

10.1097/qad.0000000000001879 ◽

2018 ◽

Vol 32 ◽

pp. S63-S73 ◽

Cited By ~ 11

Author(s):

Kenneth Juma ◽

Michael Reid ◽

Monika Roy ◽

Susan Vorkoper ◽

Tecla M. Temu ◽

...

Keyword(s):

Health Promotion ◽

Hiv Prevention ◽

Communicable Disease ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Non Communicable Disease

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HIV testing in an urgent-care clinic

Sexual Health ◽

10.1071/sh05026 ◽

2005 ◽

Vol 2 (4) ◽

pp. 245 ◽

Cited By ~ 4

Author(s):

Keith Murphy ◽

Oscar Grusky ◽

Kathleen Johnston Roberts ◽

Aimee-Noelle Swanson

Keyword(s):

Hiv Prevention ◽

Hiv Testing ◽

Urgent Care ◽

Medical Setting ◽

Structured Interviews ◽

Care Clinic ◽

Health Maintenance ◽

Hiv Test ◽

Study Results ◽

Urgent Care Clinic

Background: Early detection of HIV is increasingly important in light of advances in HIV research and treatment. Although treatment advances offer the potential to curtail HIV incidence and seroprevalence, the full benefits remain unrealised because many infected individuals remain unaware of their serostatus. An intensive observational study of HIV testing and counselling was undertaken in a large health maintenance organisation’s urgent-care clinic (UCC) for non-threatening illnesses and non-traumatic injuries in order to better understand the HIV testing process in a medical setting. Methods: Multiple data collection strategies, including observation, semi-structured interviews and document and policy analyses, were used in order to identify key factors influencing HIV testing. The study examined physicians’, nurses’ and physician’s assistants’ relationships with patients in the UCC. Results: It was found that HIV testing in the UCC is highly variable because some patients are asked about their sexual risk histories and given HIV prevention education materials and others are not. Moreover, for those patients who do receive these components of testing, the content of both the risk assessments and HIV prevention counselling varies from patient to patient. Findings also highlight the problematic nature of providing HIV test results in an UCC. Conclusions: A number of implementation issues were found to be relevant to the new US Centers for Disease Control and Prevention (CDC) policy of making HIV testing a routine feature of medical care. The study results suggest the need for organisationally fine-tuned interventions designed to improve the process of testing patients for HIV in medical settings.

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The Intersection between Sex Work and Reproductive Health in Northern Karnataka, India: Identifying Gaps and Opportunities in the Context of HIV Prevention

AIDS Research and Treatment ◽

10.1155/2012/842576 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 11

Author(s):

Marissa Becker ◽

Satyanarayana Ramanaik ◽

Shiva Halli ◽

James F. Blanchard ◽

T. Raghavendra ◽

...

Keyword(s):

Hiv Prevention ◽

Reproductive Health ◽

Hiv Testing ◽

Sex Work ◽

Sex Workers ◽

Prevention Program ◽

Hiv Transmission ◽

Health Indicators ◽

Hiv Interventions ◽

To Receive

Objective. To examine the reproductive health practices of female sex workers (FSWs) in the context of an HIV prevention program in Karnataka, India.Methods. Data obtained from a survey of 1,011 FSWs registered with an HIV prevention program. We examined reproductive health indicators, and performed multivariate logistic regression among primiparous FSWs to assess sex work during pregnancy and antenatal HIV testing.Results. Among primiparous FSWs (N=251), 92.0% continued sex work during pregnancy, and 55.4% received antenatal HIV testing. A longer duration in sex work (AOR 2.7, 95% CI: 1.0–7.5), rural residence (AOR 3.3, 95% CI: 1.2–8.9), and antenatal HIV testing (AOR 6.3, 95% CI: 2.0–20.1) were associated with continued sex work during pregnancy. Older FSWs (age >25 years, AOR 0.12, 95% CI: 0.05–0.33), who delivered at home (AOR 0.14, 95% CI: 0.09–0.34), were least likely to receive antenatal HIV testing. Antenatal HIV testing was associated with awareness of methods to prevent vertical HIV transmission (AOR 3.9, 95% CI: 1.9–14.1).Conclusions. Antenatal HIV testing remains low in the context of ongoing sex work during pregnancy. Existing HIV prevention programs are well positioned to immediately integrate reproductive health care with HIV interventions targeted to FSWs.

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The Drive to Take an HIV Test in Rural Uganda: A Risk to Prevention for Young People?

Social Aspects of HIV - Remaking HIV Prevention in the 21st Century ◽

10.1007/978-3-030-69819-5_19 ◽

2021 ◽

pp. 265-276

Author(s):

Sarah Bernays ◽

Allen Asiimwe ◽

Edward Tumwesige ◽

Janet Seeley

Keyword(s):

Young People ◽

Hiv Prevention ◽

Hiv Testing ◽

Daily Lives ◽

Hiv Test ◽

The Social ◽

Hiv Acquisition ◽

Prevention Methods ◽

Biomedical Interventions

AbstractA key component of current global HIV prevention efforts is widespread HIV testing. This strategy in part reflects the focus on the broader global targets to eliminate AIDS by achieving high rates of viral suppression. In this chapter we look at young people’s engagement with HIV prevention options in South-West Uganda. Taking a qualitative approach, using repeat in-depth interviews and participatory workshops with 50 young people aged 16–24 years old, we reflect on their accounts of how they navigate risks and opportunities within their daily lives. These risks include HIV-acquisition, but also the harms of economic precarity. Within a context in which using HIV prevention methods, such as condoms or abstinence, were for various reasons severely compromised by their contextual realities, some young people reported relying on irregular HIV testing as their singular method. The young people’s accounts demonstrate that an unintended consequence of the ‘push’ for HIV testing may be the justification of its replacement of other behavioural prevention strategies. This case study illustrates what impact such biomedical interventions may have if implemented as a priority and in isolation from the structural drivers of vulnerability: the social context of young people’s lives.

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