Socio-economic Status and Associated Factors in the Uptake of HIV Testing: Findings from the South African Population-based National Household Survey Conducted in 2017

Abstract Background: Improved understanding of barriers to HIV testing is important for reaching the first of the UNAIDS 90-90-90 targets, which states that 90 percent of HIV positive individuals ought to know their HIV status. This study examined socioeconomic status (SES) factors and related covariates associated with HIV testing uptake in the general population in South Africa. Information on SES and HIV testing may impact the HIV treatment and care cascade and prevention of HIV transmission. Methods: This study used data obtained from a national cross-sectional, population-based household survey conducted in 2017 using a multi-stage stratified random cluster sampling design. A composite SES score was created using multiple correspondence analyses of household assets; households were classified into wealth quintiles and dichotomized into low SES/poorest (lowest 3 quintiles) and high SES/less-poor (highest 2 quintiles). Bivariate and multivariate logistic regression models were fitted to analyse associations between the uptake of HIV testing and a set of socio-demographic and HIV-related variables. Results: HIV testing uptake was 73.8% and 76.7% among low and high SES household, respectively, both of which were below the first 90 target. The findings showed increased uptake of HIV testing was associated with being female and having a higher educational level independent of SES. Decreased uptake of HIV testing was associated with being from White and Indian/Asian race groups, residing in rural formal areas, alcohol consumption, and high self-perceived risk of HIV infection.Conclusions: We found that HIV testing uptake was similar for people from both low and high SES. However, interventions aimed at improving HIV testing in order to reach the first 90 target, should target males, all race groups, those with low education attainment, and those residing in rural formal areas. Reaching the first target will require efforts to improve community knowledge, and awareness about the negative impact of alcohol use and address HIV risk perception.

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Socio-economic differences in the uptake of HIV testing and associated factors in South Africa

BMC Public Health ◽

10.1186/s12889-021-11583-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sean Jooste ◽

Musawenkosi Mabaso ◽

Myra Taylor ◽

Alicia North ◽

Yolande Shean ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Urban Areas ◽

Associated Factors ◽

Economic Status ◽

Household Survey ◽

Population Based ◽

Low Ses ◽

Cross Sectional ◽

Testing Uptake

Abstract Background Improved understanding of barriers to HIV testing is important for reaching the first of the UNAIDS 90–90-90 targets, which states that 90% of HIV positive individuals ought to know their HIV status. This study examined socio-economic status (SES) differences in HIV testing uptake and associated factors among youth and adults 15 years and older in South Africa. Methods This study used data from a national cross-sectional, population-based household survey conducted in 2017 using a multi-stage sampling design. A composite SES score was created using multiple correspondence analyses of household assets; households were classified into wealth quintiles and dichotomised into low SES/poorest (lowest 3 quintiles) and high SES/less-poor (highest 2 quintiles). Bivariate and multivariate logistic regression models were used to examine factors associated with the uptake of HIV testing in low and high SES households. Results HIV testing uptake was 73.8 and 76.7% among low and high SES households, respectively, both of which were below the first 90 targets. Among both low and high SES households, increased HIV testing uptake was significantly associated with females than males. The decreased likelihood was significantly associated with residing in rural formal areas than urban areas, those with no education or low levels of educational attainment and alcohol drinkers among low SES households. Whites and Indians/Asians had a decreased likelihood than Black Africans in high SES households. Conclusions HIV testing interventions should target males, residents in rural formal areas, those with no or low education and those that consume alcohol in low SES households, including Whites and Indians/Asians from high SES households in order to bridge socio-economic disparities in the uptake of HIV testing. This should entail expanding HIV testing beyond traditional centres for voluntary counselling and testing through outreach efforts, including mobile testing and home-based testing.

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Impacts of the COVID-19 pandemic on HIV testing utilization among men who have sex with men in China: a cross-sectional online survey (Preprint)

10.2196/preprints.30070 ◽

2021 ◽

Author(s):

Ke Chun Zhang ◽

Yuan Fang ◽

He Cao ◽

Hongbiao Chen ◽

Tian Hu ◽

...

Keyword(s):

Hiv Testing ◽

Perceived Risk ◽

Online Survey ◽

Service Providers ◽

Cross Sectional ◽

Factors Associated ◽

Testing Service ◽

Initial Control ◽

Testing Uptake ◽

Sex With Men

BACKGROUND The COVID-19 pandemic creates disruptions on HIV prevention and sexual health services for men who have sex with men (MSM). OBJECTIVE This study compared HIV testing utilization in three different reference periods (i.e., before COVID-19 outbreak, after the outbreak, and after the pandemic was under initial control). Factors associated with HIV testing utilization after COVID-19 outbreak were also investigated. METHODS Participants were Chinese-speaking MSM aged ≥18 years living in Shenzhen, China. Those self-reported as HIV positive were excluded. A total of 595 participants recruited through multiple sources completed a self-administered online survey during August to September 2020. HIV testing uptake between February and July 2020 was the dependent variable, and multivariate logistic regression models were fitted. RESULTS About half of the participants reported any HIV testing uptake between February and July 2020 (n=331, 55.6%). As compared to the time before COVID-19 outbreak (November 2019 to January 2020), HIV testing uptake was significantly lower during February and April 2020 (44.0% versus 61.0%, p<.001). However, HIV testing uptake did not increase significantly after the pandemic was under initial control (May to July 2020) (46.6% versus 44.0%, p=.21). After adjusting for significant background characteristics, factors associated with higher HIV testing uptake between February and July 2020 included: 1) HIV testing uptake prior to COVID-19 outbreak (AOR: 10.75, 95%CI: 7.22, 16.02, p<.001), 2) use of sexually transmitted infections (STI) testing (AOR: 7.02, 95%CI: 4.10, 12.02, p<.001), other HIV/STI prevention (AOR: 3.15, 95%CI: 2.16, 4.60, p<.001) and PrEP (AOR: 3.58, 95%CI: 1.54, 8.34, p=.002) between February and July 2020, 3) CAI with RP (AOR: 2.05, 95%CI: 1.34, 3.13, p=.001) and NRP (AOR: 2.49, 95%CI: 1.39, 4.47, p=.002), and SDU (AOR: 2.72, 95%CI: 1.50, 4.94, p=.001) between February and July 2020, 4) perceived risk of HIV infection at present was higher than the time before COVID-19 outbreak (AOR: 1.15, 95%CI: 1.01, 1.30, p=.03), 5) perceived COVID-19 preventive measures taken up by HIV testing service providers to be effective (AOR: 1.52, 95%CI: 1.29, 1.78, p<.001), and 6) perceived higher behavioral control to take up HIV testing after COVID-19 outbreak (AOR: 1.18, 95%CI: 1.00, 1.40, p=.048). Concerns about COVID-19 infection during HIV testing (AOR: 0.78, 95%CI: 0.68, 0.89, p<.001), avoiding crowed places (AOR: 0.68, 95%CI: 0.48, 0.98, p=0.04) and HIV testing service providers reduced their working hours (AOR: 0.59, 95%CI: 0.48, 0.98, p=0.046) were negatively associated with the dependent variable. CONCLUSIONS HIV testing utilization among Chinese MSM declined after COVID-19 outbreak and did not increase after the pandemic received initial control. Removing structural barriers to access HIV testing caused by COVID-19, modifying perceptions related to HIV testing, and making use of HIV self-testing might be useful strategies to improve HIV testing among MSM during the pandemic.

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Anaemia prevalence and determinants in under 5 years children: findings of a cross-sectional population-based study in Sudan

BMC Pediatrics ◽

10.1186/s12887-020-02434-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Khalid Abdelmutalab Elmardi ◽

Ishag Adam ◽

Elfatih Mohamed Malik ◽

Abdalla Ahmed Ibrahim ◽

Asma Hashim Elhassan ◽

...

Keyword(s):

Malaria Infection ◽

Economic Status ◽

Haemoglobin Concentration ◽

Household Survey ◽

Population Based ◽

Cross Sectional Study ◽

Severe Anaemia ◽

Outcome Variable ◽

Cross Sectional ◽

Maternal Anaemia

Abstract Background Early childhood is an age at risk of anaemia and its deleterious consequences. In Sudan, there is limited evidence on the prevalence and determinant of anaemia in under-five children. This study was conducted in Sudan to assess the prevalence of anaemia in children and to identify its determinants. Methods We conducted a household survey involving children aged 6 months to 5 years in November 2016. A representative population was sampled across rural, urban and camps settlements across 18 states in Sudan. We used a pre-designed questionnaire data collection. Haemoglobin (Hb) level and malaria infection were checked. In this cross-sectional study, we dichotomized the outcome variable and performed logistic regression analyses. Results A total of 3094 children under 5 years enrolled in the study, 1566 (50.6%) of them were female and 690 (22.3%) of them were under 2 years old. Anaemia prevalence in the whole cohort (6 months - < 5 years) was 49.4% and the mean haemoglobin concentration was 108.1 (standard deviation (SD): 15.4) g/L. The prevalence in younger (6 months - < 2 years) children (61.9%) was higher than in older (2 - < 5 years) children (45.6%) (p < 0.001). Severe anaemia (Hb < 70 g/L) prevalence in the whole population was 1.6%. Age (Odds ratio (OR) 2.25, 95% confidence interval (95%CI) 1.75–2.90, p < 0.001), type of place of residence (OR 0.37, 95%CI 0.18–0.74, p = 0.005), maternal anaemia (OR 1.74, 95%CI 1.39–2.17, p < 0.001), and malaria infection (OR 2.82, 95%CI 1.56–5.11, p < 0.001) were the identified predictors of anaemia in the whole cohort. In younger children, only the economic class was an anaemia predictor, with a lower anaemia risk among the rich wealth class (OR 2.70, 95%CI 1.29–5.62, p = 0.008). However, in older children, three anaemia predictors were identified. These are maternal anaemia (OR 1.79, 95%CI 1.40–2.28, < 0.001), malaria infection (OR 2.77, 95%CI 1.48–5.21, p = 0.002), and type of residency (where camps’ residents were less likely affected with anaemia than rural children (OR 0.38, 95%CI 0.17–0.87, p = 0.022)). Conclusions About half of the under-5 children in Sudan are anaemic, with worse prevalence in younger children. Efforts targeted at improving socio-economic status, decreasing maternal anaemia and childhood malaria infection may mitigate this alarming trend.

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Actual Versus Perceived HIV Testing Norms, and Personal HIV Testing Uptake: A Cross-Sectional, Population-Based Study in Rural Uganda

AIDS and Behavior ◽

10.1007/s10461-017-1691-z ◽

2017 ◽

Vol 22 (2) ◽

pp. 616-628 ◽

Cited By ~ 17

Author(s):

Jessica M. Perkins ◽

Viola N. Nyakato ◽

Bernard Kakuhikire ◽

Pamela K. Mbabazi ◽

H. Wesley Perkins ◽

...

Keyword(s):

Hiv Testing ◽

Population Based ◽

Cross Sectional ◽

Population Based Study ◽

Testing Uptake

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A community-based study to examine the effect of a youth HIV prevention programme in South Africa

International Journal of STD & AIDS ◽

10.1258/ijsa.2012.011457 ◽

2012 ◽

Vol 23 (9) ◽

pp. 653-658 ◽

Cited By ~ 1

Author(s):

K Peltzer ◽

S Ramlagan ◽

W Chirinda ◽

G Mlambo ◽

G Mchunu

Keyword(s):

Hiv Prevention ◽

Household Survey ◽

Total Sample ◽

Population Based ◽

Cluster Sampling ◽

Eastern Cape ◽

Transmitted Infection ◽

Cross Sectional ◽

The Past ◽

Prevention Programmes

The aim of this study was to examine the relationships among changes in self-reported HIV and sexually transmitted infection (STI) and exposure to the loveLife youth HIV prevention programmes. A cross-sectional population-based household survey was conducted using a multistage stratified cluster sampling approach. The total sample included 3123 participants, aged 18–24, 54.6% men and 45.4% women, from four provinces (Eastern Cape, Gauteng, KwaZulu-Natal and Mpumalanga). Results indicate a self-reported STI past-year prevalence of 2.6%, experienced genital sores or ulcers in the past year prevalence of 3.9% and an HIV self-reported prevalence of 7.4%. In multivariable analyses it was found that knowing a person living with HIV and a person who has died from AIDS, lower education, having had two or more sexual partners in the past year, not having talked with a partner about condom use, difficulty of getting condoms and not having been male circumcised were associated with having been diagnosed with an STI in the past 12 months and/or HIV. Face-to-face and multimedia youth HIV prevention programmes had limited effect.

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Trust And Investments Across Cultures

International Business & Economics Research Journal (IBER) ◽

10.19030/iber.v7i3.3231 ◽

2011 ◽

Vol 7 (3) ◽

Author(s):

Thomas Berry ◽

Omur Suer

Keyword(s):

Survey Data ◽

Perceived Risk ◽

Business Students ◽

Economic Status ◽

Household Survey ◽

Cross Sectional ◽

The Usa ◽

Household Survey Data ◽

Potential Impact ◽

Graduate Business Students

This study uses survey data to examine notions of trust relative to investments and perceived risk. Rather than using nation cross-sectional household survey data we target a specific group across four distinct cultures. We survey graduate business students in four countries (Turkey, Bahrain, Czech Republic, and the USA). We attempt to gauge investor perceptions about trust and the potential impact of trust on equity investing. The groups are fairly homogeneous in terms of education and relative social and economic status leaving cultural differences as the main source of observed response differences.

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Oral health status and associated lifestyle behaviors among Iranian adults: a population based household survey

10.21203/rs.2.9844/v1 ◽

2019 ◽

Author(s):

Leila Jahangiry ◽

Raziollah Bagheri ◽

Parvin Sarbakhsh ◽

Fatemeh Darabi ◽

Mohammad Mehdi Naghibi Sistani

Keyword(s):

Health Status ◽

Oral Health ◽

Adult Population ◽

Household Survey ◽

Population Based ◽

Oral Health Status ◽

Population Increase ◽

Cluster Sampling ◽

Oral Diseases ◽

Cross Sectional

Abstract Background: A poor oral health can lead to serious oral diseases like periodontitis, tooth decay, pain and discomfort in teeth or gums, infection and loss of tooth. Iran will experience a dramatic aging population increase in the next decades. Despite increasing attention into healthy ageing, there is relatively less emphasis on oral health. This household survey aimed to investigate oral health status by WHO oral health assessment questionnaire among adults population in Tabriz. This knowledge may provide vital information to those who are planning strategies of oral health care for adult population. Method: A population-based household survey was conducted in order to recruit a representative sample of adults from the community. This cross-sectional study carried out among adults aged 18 to 65 years old between May and October 2016 in Tabriz (Iran). The study population was sampled using multi-stage cluster sampling design. The WHO’s oral health questionnaire (WHO’s OHQ) for adults was used for measuring oral health status and oral health behavior. Results: In this study, a total of 2310 respondents completed the survey. The mean age (SD) of the participants was 41.6 (23.4) years. About 48.8% of participants were male and 51.2% were female. 187 (8.1%) were edentulous of which 152(20.7%) were participants aged 50-65 year. 72.3% of populations were dentate in that they had 20 or more teeth. Half of adults aged 50-65 years they had 20 or more teeth. About one third of participants reported that they don’t brush their teeth daily (23% for 18-35 years old adults, 35.9 for 36-50 years,and 44.6 for 51-65 years). 39.4% of adults in 18-35 years, 34.1% in 36-50 years and 26.6 in 51-65 years had visited a dentist less than 6-month ago. One third of participants have frequent sweets meals every day and frequently consume tea with sugar. Conclusion: The combination of oral health status indicates that even though the majority of Iranian assess their teeth positively, a minority of participants display routinely dental visits. The study findings suggest that by increasing age and also dramatically Iranian population aging, poor oral health may increase the risk of adverse health outcomes.

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Hepatitis and tuberculosis testing are much less common than HIV testing among adults in Kisumu, Kenya: results from a cross-sectional assessment

BMC Public Health ◽

10.1186/s12889-021-11164-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Joshua Tunnage ◽

Adam Yates ◽

Chiaka Nwoga ◽

Valentine Sing’oei ◽

John Owuoth ◽

...

Keyword(s):

Secondary Education ◽

Viral Hepatitis ◽

Hiv Testing ◽

Spatial Location ◽

Tuberculosis Screening ◽

Cross Sectional ◽

The Past ◽

Prior Testing ◽

Testing Uptake ◽

One Year

Abstract Background Kenya has a high burden of HIV, viral hepatitis, and tuberculosis. Screening is necessary for early diagnosis and treatment, which reduces morbidity and mortality across all three illnesses. We evaluated testing uptake for HIV, viral hepatitis, and tuberculosis in Kisumu, Kenya. Methods Cross-sectional data from adults aged 18–35 years who enrolled in a prospective HIV incidence cohort study from February 2017 to May 2018 were analyzed. A questionnaire was administered to each participant at screening for study eligibility to collect behavioral characteristics and to assess prior testing practices. Among participants without a history of previously-diagnosed HIV, multivariable robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for factors potentially associated with HIV testing in the 12 months prior to enrollment. A hierarchical model was used to test for differential access to testing due to spatial location. Results Of 671 participants, 52 (7.7%) were living with HIV, 308 (45.9%) were female, and the median age was 24 (interquartile range 21–28) years. Among 651 (97.0%) who had ever been tested for HIV, 400 (61.2%) reported HIV testing in the past 6 months, 129 (19.7%) in the past 6–12 months, and 125 (19.1%) more than one year prior to enrollment. Any prior testing for viral hepatitis was reported by 8 (1.2%) participants and for tuberculosis by 51 (7.6%). In unadjusted models, HIV testing in the past year was more common among females (PR 1.08 [95% CI 1.01, 1.17]) and participants with secondary education or higher (PR 1.10 [95% CI 1.02, 1.19]). In the multivariable model, only secondary education or higher was associated with recent HIV testing (adjusted PR 1.10 [95% CI 1.02, 1.20]). Hierarchical models showed no geographic differences in HIV testing across Kisumu subcounties. Conclusions Prior HIV testing was common among study participants and most had been tested within the past year but testing for tuberculosis and viral hepatitis was far less common. HIV testing gaps exist for males and those with lower levels of education. HIV testing infrastructure could be leveraged to increase access to testing for other endemic infectious diseases.

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Association of Edentulism with Various Chronic Diseases in Mexican Elders 60+ Years: Results of a Population-Based Survey

Healthcare ◽

10.3390/healthcare9040404 ◽

2021 ◽

Vol 9 (4) ◽

pp. 404

Author(s):

Alejandro José Casanova-Rosado ◽

Juan Fernando Casanova-Rosado ◽

Mirna Minaya-Sánchez ◽

José Luís Robles-Minaya ◽

Juan Alejandro Casanova-Sarmiento ◽

...

Keyword(s):

Angina Pectoris ◽

Mental Disorders ◽

Chronic Diseases ◽

Population Based ◽

Self Report ◽

World Health ◽

Complex Nature ◽

Cluster Sampling ◽

World Health Survey ◽

Cross Sectional

Objective: To determine the association of edentulism with different chronic diseases and mental disorders in Mexicans aged 60 years and over. Material and Methods: A cross-sectional study was carried out using data from the World Health Survey for Mexico, in a probabilistic, multi-stage cluster sampling framework. Data for self-report of chronic diseases (diabetes, arthritis, angina pectoris and asthma), mental disorders (depression and schizophrenia) and edentulism were analyzed. Edentulism data were available for 20 of the 32 States of Mexico. Statistical analysis was performed in Stata 14.0 using the svy module for complex sampling (Complex nature under which individuals are sampled). Results: In total 4213 subjects were included, representing a population of 7,576,057 individuals. Mean age was 70.13 ± 7.82 years (range 60 to 98); 56.2% were women. Chronic diseases’ prevalence and mental disorders prevalence were as follows: diabetes 15.0% (N = 1,132,693); arthritis 13.2% (N = 1,001,667); depression 5.5% (N = 414,912); angina pectoris 4.5% (344,315); asthma 3.6% (N = 269,287); and schizophrenia 2.2% (N = 16,988). The prevalence of edentulism was 26.3%, which pertained to 1,993,463 people aged 60 years and over. Angina in women aged 60 to 69 years (p < 0.05) and depression in men aged 70 years and over (p < 0.0001) were associated with higher prevalence of edentulism. Conclusions: There was generally sparse association between edentulism on chronic diseases and mental disorders included in the study, except for women aged 60 to 69 years for angina, and in men aged 70 and over, for depression. Although our findings are misaligned with previous reports, longitudinal studies are required to test causal and temporal relationships between edentulism with chronic diseases and mental disorders.

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Uptake of provider-initiated HIV and syphilis testing among heterosexual STD clinic patients in Guangdong, China: results from a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-041503 ◽

2020 ◽

Vol 10 (12) ◽

pp. e041503

Author(s):

Peizhen Zhao ◽

Weiming Tang ◽

Huanhuan Cheng ◽

Shujie Huang ◽

Heping Zheng ◽

...

Keyword(s):

Condom Use ◽

Hiv Testing ◽

Transmitted Disease ◽

Cross Sectional Study ◽

Health Priorities ◽

Consistent Condom ◽

Sectional Study ◽

Cross Sectional ◽

Syphilis Testing ◽

Testing Uptake

ObjectivesUnderscreening of HIV and syphilis in clinical settings is pervasive in resource-constrained settings. Heavy patient loads and competing health priorities in these settings inhibit provider’s ability to meet screening coverage targets. The objective of this study was to examine determinants of provider-initiated HIV and syphilis testing uptake at sexually transmitted disease (STD) clinics in China.DesignA cross-sectional study was performed between July 2016 and December 2016.SettingSeven STD clinics in Guangdong Province, China.ParticipantsHeterosexual STD clinic patients met the inclusion criteria, regardless of their interest in receiving HIV or syphilis testing.Outcome measuresThe syphilis and HIV testing uptake determined by patient receipt of results.ResultsA total of 1943 individuals were recruited in this study. Among those participants, 60.6% (1177/1943) and 74.3% (1443/1943) conducted HIV testing and syphilis testing during the study, respectively, of whom, 2.2% (26/1177) and 21.5% (310/1443) were found to be HIV-positive and syphilis-positive, respectively. The most common reason for rejecting HIV and syphilis testing was a low self-perceived risk of HIV and syphilis infection. After adjusting for covariates, condom use in the last sexual act, consistent condom use in the last 6 months, having paid sex in the last 6 months and having received any kind of HIV/STD-related knowledge during the last 12 years were positively associated with both HIV and syphilis testing uptake.ConclusionsThe low-level of HIV and syphilis testing uptake, alongside with the high-level of engagement in risky sexual behaviours among heterosexual STD clinic patients, warranted a more targeted and intensive behavioural interventions to promote HIV and syphilis testing in this population.

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