A costing analysis of B-GAP: index-linked HIV testing for children and adolescents in Zimbabwe

Abstract Background By testing children and adolescents of HIV positive caretakers, index-linked HIV testing, a targeted HIV testing strategy, has the ability to identify high risk children and adolescents earlier and more efficiently, compared to blanket testing. We evaluated the incremental cost of integrating index-linked HIV testing via three modalities into HIV services in Zimbabwe. Methods A mixture of bottom-up and top-down costing was employed to estimate the provider cost per test and per HIV diagnosis for 2–18 year olds, through standard of care testing, and the incremental cost of index-linked HIV testing via three modalities: facility-based testing, home-based testing by a healthcare worker, and testing at home by the caregiver using an oral mucosal transudate test. In addition to interviews, direct observation and study process data, facility registries were abstracted to extract outcome data and resource use. Costs were converted to 2019 constant US$. Results The average cost per standard of care test in urban facilities was US$5.91 and US$7.15 at the rural facility. Incremental cost of an index-linked HIV test was driven by the uptake and number of participants tested. The lowest cost approach in the urban setting was home-based testing (US$6.69) and facility-based testing at the rural clinic (US$5.36). Testing by caregivers was almost always the most expensive option (rural US$62.49, urban US$17.49). Conclusions This is the first costing analysis of index-linked HIV testing strategies. Unit costs varied across sites and with uptake. When scaling up, alternative testing solutions that increase efficiency such as index-linked HIV testing of the entire household, as opposed to solely targeting children/adolescents, need to be explored.

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

Frontiers in Public Health ◽

10.3389/fpubh.2021.651325 ◽

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.

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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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Barriers to HIV Testing and Opportunities for Expansion Using Home-Based HIV Self-Testing: Results of a National Study of Higher HIV Risk Young Men Who Have Sex With Men

SAGE Open ◽

10.1177/21582440211016835 ◽

2021 ◽

Vol 11 (2) ◽

pp. 215824402110168

Author(s):

Sarah J. Marks ◽

Roland C. Merchant ◽

Melissa A. Clark ◽

Tao Liu ◽

Joshua G. Rosenberger ◽

...

Keyword(s):

Hiv Testing ◽

The United States ◽

National Study ◽

National Guidelines ◽

The Past ◽

Home Based ◽

Self Testing ◽

Hiv Test ◽

Condomless Anal Intercourse ◽

Sex With Men

HIV incidence among young adult men-who-have-sex-with-men (YMSM) is among the highest in the United States (US), yet YMSM have lower rates of HIV testing than most other MSM. Among 1,835 U.S. Black, Hispanic, and White YMSM who reported condomless anal intercourse (CAI) in the prior year, 30% (95% confidence interval [CI]: [28%, 32%]) had not been tested for HIV in the past year as recommended by national guidelines, and 19% (95% CI: [17%, 21%]) had never been tested. Factors associated with not being tested in the past year included not having a primary care provider (PCP)) (odds ratio [OR]: 2.00, 95% CI: [1.53, 2.60]), discomfort with asking a PCP for an HIV test (OR: 2.66, 95% CI: [2.05, 3.44]), living in a smaller community (OR: 1.71, 95% CI: [1.35, 2.18]), younger age (OR: 2.00, 95% CI: [1.53, 2.60]), and greater self-perception of having an undiagnosed HIV infection (OR: 1.46, 95% CI: [1.07, 1.99]). YMSM who had not been tested in the prior year were less likely to know where to get tested, yet were interested in trying home-based HIV self-testing. This study shows that knowledge, clinician-relationship, geographic, and perceptional barriers must be overcome to improve HIV testing among YMSM. Home-based HIV self-testing may address some of these barriers, particularly for YMSM living in smaller communities.

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

10.2196/preprints.17107 ◽

2019 ◽

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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Improving Pregnant Mothers’ Intention toward HIV Testing through Home-based HIV Test and Education (HOPE) in Jember, Indonesia

NurseLine Journal ◽

10.19184/nlj.v6i1.18521 ◽

2021 ◽

Vol 6 (1) ◽

pp. 18

Author(s):

Azkiel Fikrie ◽

Ahmad Rifai ◽

Dicky Endrian Kurniawan

Keyword(s):

Experimental Design ◽

Hiv Testing ◽

Significant Influence ◽

Sampling Technique ◽

Decision Makers ◽

Wilcoxon Test ◽

Home Based ◽

Hiv Test ◽

Hope Intervention ◽

Pregnant Mothers

The HIV testing program's implementation among pregnant mothers is still not going well due to their intention. Their intention is needed because it can affect pregnant mothers' behavior toward HIV testing. New interventions are needed to solve this problem, such as Home-based HIV Test and Education (HOPE). This study aimed to analyze the influence of HOPE to improve HIV testing intention among pregnant mothers. The pre-experimental design was used with one group pretest-posttest approach—thirty pregnant mothers in Jember following this study and involved by using a purposive sampling technique. The data were collected by using the intention questionnaire and analyzed with the Wilcoxon test. The result showed that pregnant mothers' intention of HIV testing numbers increased from 20 to 27. The results indicate that there is a significant influence of HOPE on the intention of HIV testing in pregnant women (p = 0.033). The Home-based HIV Test and Education (HOPE) intervention can improve pregnant mothers' intention toward HIV testing. The HOPE intervention can reach all pregnant mothers (and their husbands) to discover HIV testing information. Involving their husbands on HOPE intervention encouraged pregnant mothers' intention of HIV testing because their husbands were decision-makers in their family, and pregnant mothers will take HIV testing.

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The tactics of managing children and adolescents when twisting the uterine appendages from the position of international standards

GYNECOLOGY ◽

10.26442/20795696.2020.3.200148 ◽

2020 ◽

Vol 22 (3) ◽

pp. 39-41

Author(s):

Zalina K. Batyrova ◽

Zaira K. Kumykova ◽

Elena V. Uvarova ◽

Vladimir D. Chuprynin ◽

Natalya A. Buralkina ◽

...

Keyword(s):

Children And Adolescents ◽

Ovarian Tissue ◽

Standard Of Care ◽

Lymphatic Drainage ◽

International Standards ◽

Delivery Of Care ◽

National Medical ◽

Treatment Standard ◽

Common Causes ◽

Adolescent Gynecology

Background. Adnexal torsion (AT) takes fifth place among all emergency gynecological conditions. Suspicion of AT requires immediate diagnosis and urgent surgical treatment. The most common causes of AT are various volumetric formations, such as functional or dermoid ovarian cysts, contributing to an increase in its volume and/or anomalies in the development of the ligamentous apparatus. Timely diagnosis and detorsion contributes to the full restoration of impaired venous outflow and lymphatic drainage of the ovarian tissue, preventing the development of severe ischemia and necrosis. Over the past few decades, a surgical organ-preserving approach in managing patients with AT has been the gold standard of care. Materials and methods. The article describes the results of a retrospective study of cases of AT in children and adolescents treated at the Department of Pediatric and adolescent gynecology Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology with an assessment of the clinical and anamnestic features of this cohort of patients and the choice of therapeutic tactics. Conclusion. A multidisciplinary approach is critical to optimizing the delivery of care in cases of AT, including minimally invasive detorsion and preserving the functionality of the ovary as a treatment standard that should be used in the management of children and adolescents.

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Promoting HIV indicator condition-guided testing in hospital settings (PROTEST 2.0): study protocol for a multicentre interventional study

BMC Infectious Diseases ◽

10.1186/s12879-021-06183-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Saskia J. Bogers ◽

Maarten F. Schim van der Loeff ◽

Udi Davidovich ◽

Anders Boyd ◽

Marc van der Valk ◽

...

Keyword(s):

The Netherlands ◽

Hiv Testing ◽

Quantitative Methods ◽

Hospital Setting ◽

Audit And Feedback ◽

Interventional Study ◽

Hiv Diagnosis ◽

Post Intervention ◽

Hiv Test ◽

Undiagnosed Hiv

Abstract Background Late presentation remains a key barrier towards controlling the HIV epidemic. Indicator conditions (ICs) are those that are AIDS-defining, associated with a prevalence of undiagnosed HIV > 0.1%, or whose clinical management would be impeded if an HIV infection were undiagnosed. IC-guided HIV testing is an effective strategy in identifying undiagnosed HIV, but opportunities for earlier HIV diagnosis through IC-guided testing are being missed. We present a protocol for an interventional study to improve awareness of IC-guided testing and increase HIV testing in patients presenting with ICs in a hospital setting. Methods We designed a multicentre interventional study to be implemented at five hospitals in the region of Amsterdam, the Netherlands. Seven ICs were selected for which HIV test ratios (proportion of patients with an IC tested for HIV) will be measured: tuberculosis, cervical/vulvar cancer or high-grade cervical/vulvar dysplasia, malignant lymphoma, hepatitis B and C, and peripheral neuropathy. Prior to the intervention, a baseline assessment of HIV test ratios across ICs will be performed in eligible patients (IC diagnosed January 2015 through May 2020, ≥18 years, not known HIV positive) and an assessment of barriers and facilitators for HIV testing amongst relevant specialties will be conducted using qualitative (interviews) and quantitative methods (questionnaires). The intervention phase will consist of an educational intervention, including presentation of baseline results as competitive graphical audit and feedback combined with discussion on implementation and opportunities for improvement. The effect of the intervention will be assessed by comparing HIV test ratios of the pre-intervention and post-intervention periods. The primary endpoint is the HIV test ratio within ±3 months of IC diagnosis. Secondary endpoints are the HIV test ratio within ±6 months of diagnosis, ratio ever tested for HIV, HIV positivity percentage, proportion of late presenters and proportion with known HIV status prior to initiating treatment for their IC. Discussion This protocol presents a strategy aimed at increasing awareness of the benefits of IC-guided testing and increasing HIV testing in patients presenting with ICs in hospital settings to identify undiagnosed HIV in Amsterdam, the Netherlands. Trial registration Dutch trial registry: NL7521. Registered 14 February 2019.

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Supporting Older Adults and Caregivers Through Integrative Service Learning During COVID

Innovation in Aging ◽

10.1093/geroni/igaa057.3503 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 958-958

Author(s):

Keith Chan ◽

Sarah LaFave ◽

Maggie Ratnayake ◽

Christina Marsack-Topolewski ◽

Jillian Graves ◽

...

Keyword(s):

Older Adults ◽

Service Learning ◽

Community Resources ◽

Learning Models ◽

Process Data ◽

Community Based ◽

Age In Place ◽

Home Based ◽

Hands On ◽

Hands On Learning

Abstract There is a growing population of older adults who are living longer and acquiring chronic illness and disabilities, making it difficult for them to complete everyday activities and age in place. More than 2 million of these older adults are homebound and 5 million need help leaving their homes. They experience social isolation, food insecurity, and lack of connection to community resources which has intensified since the pandemic. Integrative service learning models can provide home-based support to older adults while offering valuable, hands-on learning experiences for students. This study examined findings for a community-based program which trained university students to provide practical home-based support for older adults and their caregivers. Data was collected for 109 older adults who were connected with student trainees. Students provided services with groceries, companionship, and help accessing needed services. Findings from t-test results using the UCLA Loneliness Scale indicated that older adults reported less loneliness after engagement with students (mean difference = 6.15, t = 3.14, df = 82, p < 0.01). Qualitative process data suggested that older adults benefited from services and a connection to their assigned students prior to and during the pandemic. Student trainees reported that the experience enriched their learning and reaffirmed their commitment to working with older adults. Community-based service learning can address home-based needs of older adults and their caregivers and enhance learning opportunities for students. Policies and practice can support a pipeline of geriatric health professionals through innovative service learning models to benefit older adults, caregivers and students.

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Characteristics and Outcomes Among Hospitalized COVID-19-Positive Patients in a Nonurban Environment

Military Medicine ◽

10.1093/milmed/usab044 ◽

2021 ◽

Author(s):

Robert P Lennon ◽

Theodore J Demetriou ◽

M Fahad Khalid ◽

Lauren Jodi Van Scoy ◽

Erin L Miller ◽

...

Keyword(s):

New York ◽

Medical Center ◽

Academic Medical Center ◽

Military Medicine ◽

Case Series ◽

Outcome Data ◽

Urban Environments ◽

Urban Setting ◽

Published Data ◽

Retrospective Case

ABSTRACT Introduction Virtually all hospitalized coronavirus disease-2019 (COVID-19) outcome data come from urban environments. The extent to which these findings are generalizable to other settings is unknown. Coronavirus disease-2019 data from large, urban settings may be particularly difficult to apply in military medicine, where practice environments are often semi-urban, rural, or austere. The purpose of this study is compare presenting characteristics and outcomes of U.S. patients with COVID-19 in a nonurban setting to similar patients in an urban setting. Materials and Methods This is a retrospective case series of adults with laboratory-confirmed COVID-19 infection who were admitted to Hershey Medical Center (HMC), a 548-bed tertiary academic medical center in central Pennsylvania serving semi-urban and rural populations, from March 23, 2020, to April 20, 2020 (the first month of COVID-19 admissions at HMC). Patients and outcomes of this cohort were compared to published data on a cohort of similar patients from the New York City (NYC) area. Results The cohorts had similar age, gender, comorbidities, need for intensive care or mechanical ventilation, and most vital sign and laboratory studies. The NYC’s cohort had shorter hospital stays (4.1 versus 7.2 days, P < .001) but more African American patients (23% versus 12%, P = .02) and higher prevalence of abnormal alanine (>60U/L; 39.0% versus 5.9%, P < .001) and aspartate (>40U/L; 58.4% versus 42.4%, P = .012) aminotransferase, oxygen saturation <90% (20.4% versus 7.2%, P = .004), and mortality (21% versus 1.4%, P < .001). Conclusions Hospitalists in nonurban environments would be prudent to use caution when considering the generalizability of results from dissimilar regions. Further investigation is needed to explore the possibility of reproducible causative systemic elements that may help improve COVID-19-related outcomes. Broader reports of these relationships across many settings will offer military medical planners greater ability to consider outcomes most relevant to their unique settings when considering COVID-19 planning.

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