Use, awareness and willingness to self-test for HIV: An analysis of cross-sectional population-based surveys in Malawi and Zimbabwe

Abstract Background Many southern African countries are nearing the global goal to diagnose 90% of people with HIV by 2020. In 2016, 84% and 86% of people with HIV knew their status in Malawi and Zimbabwe respectively. Despite this progress, gaps remain, particularly among men (≥25 years). We investigated awareness, use and willingness to HIV self-test (HIVST) prior to large scale implementation and explored sociodemographic associations. Methods We pooled responses from two of the first cross-sectional Demographic Health Surveys to include HIVST questions: Malawi and Zimbabwe in 2015-16. Sociodemographic factors and sexual risk behaviours associated with previously testing for HIV, and awareness, past use and future willingness to self-test were investigated using univariable and multivariable logistic regression, adjusting for the sample design and limiting analysis to participants with completed questionnaire and a valid HIV result. Analysis of willingness to self-test was restricted to Zimbabwean men, as Malawians and women were not asked this question. Results Of 31 385 individuals, the proportion never-tested was higher for men (31.2%) than women (16.5%), p<0.001. For men, having ever tested increased with age. Past use and awareness of HIVST was very low, 1.2% and 12.6% respectively. Awareness was lower among women than men (9.1% vs 15.3%, adjusted odds ratio (aOR)=1.55; 95% confidence interval [CI]: 1.37-1.75), and at younger ages, and lower education and literacy levels. Willingness to self-test among Zimbabwean men was high (84.5%), with having previously tested for HIV, high sexual risk, and being ≥25 years associated with greater willingness. Wealthier men had greater awareness of HIVST than poorer men (p<0.001). Men at higher HIV-related sexual risk, compared to men at lower HIV-related sexual risk, had the greatest willingness to self-test (aOR=3.74; 95%CI: 1.39-10.03, p<0.009).Conclusions In 2015-16 many Malawian and Zimbabwean men had never tested for HIV. Despite low awareness and minimal HIVST experience at that time, willingness to self-test was high among Zimbabwean men, especially in older men with moderate to high HIV-related sexual risk. These data provide a valuable baseline against which to investigate population-level uptake of HIVST as programmes scale-up. Programmes introducing, or planning to introduce HIVST, should consider including questions in population-based surveys.

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Awareness, use and willingness to self-test for HIV: An analysis of cross-sectional population-based surveys in Malawi and Zimbabwe

10.21203/rs.3.rs-15570/v1 ◽

2020 ◽

Author(s):

Cheryl Case Johnson ◽

Melissa Neuman ◽

Peter MacPherson ◽

Augustine Choko ◽

Caitlin Quinn ◽

...

Keyword(s):

Sexual Risk ◽

Large Scale ◽

Scale Up ◽

Population Level ◽

Sociodemographic Factors ◽

Population Based ◽

African Countries ◽

Cross Sectional ◽

Self Test ◽

Result Analysis

Abstract Background Many southern African countries are nearing the global goal to diagnose 90% of people with HIV by 2020. In 2016, 84% and 86% of people with HIV knew their status in Malawi and Zimbabwe respectively. Despite this progress, gaps remain, particularly among men (≥25 years). We investigated awareness, use and willingness to HIV self-test (HIVST) prior to large scale implementation and explored sociodemographic associations.Methods We pooled responses from two of the first cross-sectional Demographic Health Surveys to include HIVST questions: Malawi and Zimbabwe in 2015-16. Sociodemographic factors and sexual risk behaviours associated with never testing for HIV, and awareness, past use and future willingness to self-test were investigated using univariable and multivariable logistic regression, adjusting for the sample design and limiting analysis to participants with completed questionnaire and a valid HIV result. Analysis of willingness to self-test was restricted to Zimbabwean men as Malawians and women were not asked this question.Results Of 31 385 individuals, the proportion never-tested was higher for men (31.2%) than women (16.5%), p<0.001. For men, having ever tested increased with age. Past use and awareness of HIVST was very low, 1.2% and 12.6% respectively. Awareness was lower among women than men (9.1% vs 15.3%, adjusted odds ratio (aOR)=1.55; 95% confidence interval [CI]: 1.37-1.75), and at younger age, and lower education and literacy levels. Willingness to self-test among Zimbabwean men was high (84.5%), with having previously tested for HIV, high sexual risk, and being older (≥25 years) associated with greater willingness. Wealthy men had greater awareness of HIVST than poorer men (p<0.001). Men at higher sexual risk, compared to men at lower risk, had the greatest willingness to self-test (aOR=3.74; 95%CI: 1.39-10.03, p<0.009).Conclusions In 2015-16 many Malawian and Zimbabwean men had never tested for HIV. Despite low awareness and minimal HIVST experience at that time, willingness to self-test was high, especially in older men with moderate to high sexual risk. These data provide a valuable baseline against which to investigate population-level uptake of HIVST as programmes scale-up. Programmes introducing, or planning to introduce HIVST, should consider including questions in population-based surveys.

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Prevalence of intermittent claudication in rural and urban Vellore, Tamil Nadu, India: a population-based study

International Surgery Journal ◽

10.18203/2349-2902.isj20182485 ◽

2018 ◽

Vol 5 (7) ◽

pp. 2620

Author(s):

Manjunath Krishna ◽

Anu M. Oommen ◽

Jackwin Sam Paul G. ◽

Vinod J. Abraham ◽

Kuryan George

Keyword(s):

Intermittent Claudication ◽

Tobacco Use ◽

Tamil Nadu ◽

Population Level ◽

Sociodemographic Factors ◽

Population Based ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Rural And Urban ◽

Background Population

Background: Population based estimates from India on the prevalence of Peripheral Artery Disease (PAD) are scarce. This study aimed to assess the population-based prevalence of PAD in rural and urban Vellore, Tamil Nadu, South India.Methods: A cross sectional survey was conducted using the WHO STEPS methodology and the WHO/Rose questionnaire for intermittent claudication for identifying symptomatic PAD among adults aged 30-64 years. The study was done in nine villages of one rural block and in 48 urban wards of Vellore, between 2011-12. Risk factors for PAD such as sociodemographic factors, tobacco use, anthropometry, known medical conditions, Fasting Plasma Glucose and lipid profile were also assessed and association with PAD estimated using odds ratios, chi-square tests and logistic regression.Results: Among 5429 adults aged 30-64 years, the prevalence of PAD (intermittent claudication) was 4.9/1000 (95% Confidence Interval CI: 3.0/1000 - 6.8/1000). The prevalence in urban Vellore was higher than in the rural area (6.9/1000 vs. 3.8/1000). After adjusting for sociodemographic factors and other confounding factors, current tobacco use was found to be significantly associated with the presence of PAD (adjusted Odds Ratio: 2.89, 95% CI: 1.10-7.54).Conclusions: This study provides estimates of the burden of PAD in rural and urban adults in Vellore, Tamil Nadu. The trend of this condition needs to be monitored in various locations to assess the public health significance and the need for population level measures for diagnosis, treatment and screening. Education regarding harmful effects of tobacco use should also involve education regarding risk of PAD.

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Very high relative seroprevalence of anti-SARS-CoV-2 antibodies among communities in Bangui, Central African Republic

10.1101/2021.11.18.21266496 ◽

2021 ◽

Author(s):

Alexandre Manirakiza ◽

Christian Malaka ◽

Brice Martial Yambiyo ◽

Saint Calver Henri Diemer ◽

Jean de Dieu Longo ◽

...

Keyword(s):

Large Scale ◽

Central African Republic ◽

Venous Blood ◽

Population Level ◽

Significant Degree ◽

Population Based ◽

Cross Sectional Study ◽

Individual Characteristics ◽

Cross Sectional ◽

High Level

Background: Large-scale population-based seroprevalence studies of SARS-CoV-2 are essential to characterize the cumulative incidence of SARS-CoV-2 infection and to extrapolate the prevalence of presumptive immunity at the population level. Objective: The objective of our survey was to estimate the cumulative population immunity for COVID-19 and to identify individual characteristics associated with a positive serostatus. Method: This was a clustered cross-sectional study conducted from July 12 to August 20, 2021, in households in the city of Bangui, the capital of the Central African Republic. Information regarding demographic characteristics (age, gender, and place of residence), comorbidities (chronic diseases) was collected. A venous blood sample was obtained for each participant to determine the level of total anti-SARS-CoV-2 antibodies using a WANTAI SARS-CoV-2 Ab ELISA kit. Results: All up, 799 participants were surveyed. The average age was 27 years, and 45.8% of the respondents were male (sex ratio: 0.8). The overall proportion of respondents with a positive serostatus was 74.1%. Participants over 20 years of age were twice as likely to have a positive serostatus, with an OR of 2.2 (95% CI: [1.6, 3.1]). Interpretation: The results of this survey revealed a high cumulative level of immunity in Bangui, thus indicating a significant degree of spread of SARS-CoV-2 in the population. The public health implications of this high level of immunity to SARS-CoV-2, particularly on its variants burden, remain to be determined.

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Usage of purchased self-tests for HIV and sexually transmitted infections in Amsterdam, the Netherlands: results of population-based and serial cross-sectional studies among the general population and sexual risk groups

BMJ Open ◽

10.1136/bmjopen-2017-016609 ◽

2017 ◽

Vol 7 (9) ◽

pp. e016609 ◽

Cited By ~ 11

Author(s):

Janneke P Bil ◽

Maria Prins ◽

Ineke G Stolte ◽

Henriëtte Dijkshoorn ◽

Titia Heijman ◽

...

Keyword(s):

General Population ◽

The Netherlands ◽

Sexual Risk ◽

Risk Groups ◽

Population Based ◽

Cross Sectional ◽

Sexually Transmitted ◽

Self Test ◽

Test Usage ◽

Over Time

ObjectivesThere are limited data on the usage of commercially bought self-tests for HIV and other sexually transmitted infections (STIs). Therefore, we studied HIV/STI self-test usage and its determinants among the general population and sexual risk groups between 2007 and 2015 in Amsterdam, the Netherlands.SettingData were collected in four different studies among the general population (S1–2) and sexual risk groups (S3–4).ParticipantsS1–Amsterdam residents participating in representative population-based surveys (2008 and 2012; n=6044) drawn from the municipality register; S2–Participants of a population-based study stratified by ethnicity drawn from the municipality register of Amsterdam (2011–2015; n=17 603); S3–Men having sex with men (MSM) participating in an HIV observational cohort study (2008 and 2013; n=597) and S4–STI clinic clients participating in a cross-sectional survey (2007–2012; n=5655).Primary and secondary outcome measuresPrevalence of HIV/STI self-test usage and its determinants.ResultsThe prevalence of HIV/STI self-test usage in the preceding 6–12 months varied between 1% and 2% across studies. Chlamydia self-tests were most commonly used, except among MSM in S3. Chlamydia and syphilis self-test usage increased over time among the representative sample of Amsterdam residents (S1) and chlamydia self-test usage increased over time among STI clinic clients (S4). Self-test usage was associated with African Surinamese or Ghanaian ethnic origin (S2), being woman or MSM (S1 and 4) and having had a higher number of sexual partners (S1–2). Among those in the general population who tested for HIV/STI in the preceding 12 months, 5–9% used a self-test.ConclusionsDespite low HIV/STI self-test usage, we observed increases over time in chlamydia and syphilis self-test usage. Furthermore, self-test usage was higher among high-risk individuals in the general population. It is important to continue monitoring self-test usage and informing the public about the unknown quality of available self-tests in the Netherlands and about the pros and cons of self-testing.

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Modeling Hearing Loss Progression and Asymmetry in the Older Old: A National Population-Based Survey

Innovation in Aging ◽

10.1093/geroni/igaa057.693 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 214-215

Author(s):

Rahul Sharma ◽

Anil Lalwani ◽

Justin Golub

Keyword(s):

Hearing Loss ◽

Pure Tone ◽

Population Level ◽

Population Based ◽

National Database ◽

Cross Sectional ◽

Adult Lifespan ◽

Pure Tone Average ◽

Age Related ◽

Public Datasets

Abstract The progression and asymmetry of age-related hearing loss has not been well characterized in those 80 years of age and older because public datasets mask upper extremes of age to protect anonymity. We aimed to model the progression and asymmetry of hearing loss in the older old using a representative, national database. This was a cross-sectional, multicentered US epidemiologic analysis using the National Health and Nutrition Examination Study (NHANES) 2005-2006, 2009-2010, and 2011-2012 cycles. Subjects included non-institutionalized, civilian adults 80 years and older (n=621). Federal security clearance was granted to access publicly-restricted age data. Outcome measures included pure-tone average air conduction thresholds and the 4-frequency pure tone average (PTA). 621 subjects were 80 years old or older (mean=84.2 years, range=80-104 years), representing 10,600,197 Americans. Hearing loss exhibited constant acceleration across the adult lifespan at a rate of 0.0052 dB/year2 (95% CI = 0.0049, 0.0055). Compounded over a lifetime, the velocity of hearing loss would increase five-fold, from 0.2 dB loss/year at age 20 to 1 dB loss/year at age 100. This model predicted mean PTA within 2 dB of accuracy for most ages between 20 and 100 years. There was no change in the asymmetry of hearing loss with increasing age over 80 years (linear regression coefficient of asymmetry over age=0.07 (95% CI=-0.01, 0.24). In conclusion, hearing loss steadily and predictably accelerates across the adult lifespan to at least age 100, becoming near-universal. These population-level statistics will guide treatment and policy recommendations for hearing health in the older old.

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Maternal adherence to micronutrient supplementation before and during pregnancy in Northwest China: a large-scale population-based cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2018-028843 ◽

2019 ◽

Vol 9 (8) ◽

pp. e028843 ◽

Cited By ~ 6

Author(s):

Danmeng Liu ◽

Yue Cheng ◽

Shaonong Dang ◽

Duolao Wang ◽

Yaling Zhao ◽

...

Keyword(s):

Pregnant Women ◽

Large Scale ◽

Northwest China ◽

Population Based ◽

Shaanxi Province ◽

Micronutrient Supplementation ◽

Cross Sectional Survey ◽

Start Time ◽

Cross Sectional ◽

Scale Population

ObjectivesTo report the situation of maternal micronutrient supplementation before and during pregnancy in Northwest China and to examine the rates of and factors related to the adherence to micronutrient supplementation among pregnant women in this region, where dietary micronutrient intake is commonly insufficient.DesignA large-scale population-based cross-sectional survey.SettingTwenty counties and ten districts of Shaanxi Province.ParticipantsA sample of 30 027 women were selected using a stratified multistage random sampling method. A total of 28 678 women were chosen for the final analysis after excluding those who did not provide clear information about nutritional supplementation before and during pregnancy.Main outcome measuresMaternal adherence to micronutrient supplementation (high and low) were the outcomes. They were determined by the start time and duration of use according to Chinese guidelines (for folic acid (FA) supplements) and WHO recommendations (for iron, calcium and multiple-micronutrient (MMN) supplements).ResultsIn total, 83.9% of women took at least one kind of micronutrient supplement before or during pregnancy. FA (67.6%) and calcium (57.5%) were the primarily used micronutrient supplements; few participants used MMN (14.0%) or iron (5.4%). Adherence to supplementation of all micronutrients was low (7.4% for FA, 0.6% for iron, 11.7% for calcium and 2.7% for MMN). Higher educational levels, higher income levels, urban residence and better antenatal care (including pregnancy consultation and a higher frequency of antenatal visits) were associated with high adherence to micronutrient supplementation.ConclusionMaternal micronutrient supplementation before and during pregnancy in Northwest China was way below standards recommended by the Chinese guidelines or WHO. Targeted health education and future nutritional guidelines are suggested to improve this situation, especially in pregnant women with disadvantaged sociodemographic conditions.

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Association of Conventional Cardiovascular Risk Factors with Carotid Atherosclerosis Prevalence in General Population

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2018-14-4-552-557 ◽

2018 ◽

Vol 14 (4) ◽

pp. 552-557

Author(s):

V. S. Kaveshnikov ◽

V. N. Serebryakova ◽

I. A. Trubacheva ◽

S. A. Shalnova

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Carotid Atherosclerosis ◽

Population Level ◽

Educational Status ◽

Population Based ◽

High Density Lipoproteins ◽

Ultrasound Screening ◽

Cross Sectional ◽

Working Age

Material and methods. In the cross-sectional population-based study of general unorganized population of Tomsk aged 25-64 years ultrasound screening examination of the carotid arteries was done for detection of atherosclerotic plaques (plaque). As potential plaque determinants the following factors were studied: age, gender, smoking, low and high density lipoproteins (LDL-C and HDL-C), triglycerides, arterial hypertension, body mass index (BMI), low educational status (LES), high-sensitive C-reactive protein, glucose, diabetes mellitus, antihypertensive and hypolipidemic therapy. Study of relationships was carried out with logistic regression analysis. The error probability of less than 5% was considered statistically significant.Results. In the crude analysis most of the determinants under study showed statistically significant relationship with plaque presence. After adjustment for age and sex, LDL-C, smoking and LES were associated with CAS prevalence. In multivariable regression analysis 9 risk factors appeared to be independently associated with plaque presence, wherein age, male sex, LDL-C, BMI and HDL-C were the most significant. In the participants of 50 years and older the smoking effect was the next in significance after LDL-C.Conclusion. The results obtained focus attention on the comparative value of the major atherogenic risk factors and suggest that currently effective and timely control of LDL-C is of primary importance for prevention of carotid atherosclerosis in the general working-age population. As well the findings of the study evidence that at the population level smoking is still one of the leading atherogenic risk factors.

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Prospective predictors of sustainment of multiple EBPs in a system-driven implementation context: Examining sustained delivery based on administrative claims

Implementation Research and Practice ◽

10.1177/26334895211057884 ◽

2021 ◽

Vol 2 ◽

pp. 263348952110578

Author(s):

Anna S. Lau ◽

Teresa Lind ◽

Mojdeh Motamedi ◽

Joyce H. L. Lui ◽

Mary Kuckertz ◽

...

Keyword(s):

Large Scale ◽

Organizational Context ◽

Scale Up ◽

Volume Ratio ◽

Organizational Factors ◽

Self Report ◽

Administrative Claims ◽

Sustained Delivery ◽

Cross Sectional ◽

Program Leaders

Background System-driven scale-up of multiple evidence-based practices (EBPs) is an increasingly common method used in public mental health to improve care. However, there are little data on the long-term sustained delivery of EBPs within these efforts, and previous studies have relied on retrospective self-report within cross-sectional studies. This study identified prospective predictors of sustained EBP delivery at the EBP-, therapist-, and organizational-levels using survey and administrative claims data within a large-scale system-driven implementation effort. Methods 777 therapists and 162 program leaders delivering at least one of six EBPs of interest completed surveys assessing perceptions of EBPs and organizational context. These surveys were linked to administrative data to examine prospective predictors of therapists’ EBP delivery over 33 months. Results Five of the six EBPs implemented showed sustained delivery in the system, with volume varying by EBP. Although total EBP claim volume per therapist decreased over time, the volume ratio (ratio of EBP-specific claims to total EBP and non-EBP claims) stayed relatively stable. Multilevel models revealed that EBPs that required consultation, had unstructured content, higher therapist self-efficacy with the EBP, and more positive program leader perceptions of the EBP were associated with greater sustained volume and volume ratio of the EBP. Therapists who were trained in fewer EBPs, who were unlicensed, and who worked in agencies rated by program leaders as lower on organizational staff autonomy and stress showed greater sustained EBP volume and volume ratio. Finally, more direct service hours per week provided by therapist predicted greater sustained EBP volume, but lower volume ratio. Conclusions The results point to the importance of EBP, therapist, and organizational factors that may be targeted in implementation strategies to promote the sustainment of EBPs.

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Population preferences and attitudes towards COVID-19 vaccination: a cross-sectional study from Pakistan

BMC Public Health ◽

10.1186/s12889-021-11814-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Muhammad Junaid Tahir ◽

Muhammad Saqlain ◽

Waleed Tariq ◽

Summaiya Waheed ◽

Steven H. S. Tan ◽

...

Keyword(s):

Large Scale ◽

Positive Attitude ◽

Family Income ◽

Vaccine Development ◽

Population Level ◽

Cross Sectional Study ◽

Vaccine Uptake ◽

Sectional Study ◽

Government Officials ◽

Cross Sectional

Abstract Background While vaccine development is itself a challenge; ensuring optimal vaccine uptake at population level can present an even more significant challenge. Therefore, this study aimed to assess the Pakistani population’s attitude and preferences towards the Coronavirus disease 2019 (COVID-19) vaccine. Method A cross-sectional study was carried out through an online self-administered questionnaire from 27 September 2020 to 11 October 2020. A total of 883 people responded to the survey. The questionnaire included the participants’ socio-demographic variables, attitudes, beliefs towards the COVID-19 vaccine and acceptance and rejection of vaccination, and reasons for them. Logistic regression analysis was used to analyze the predictors for vaccine acceptance and willingness to pay for the vaccine. Results A majority (70.8%) of respondents will accept the COVID-19vaccine if available, and 66.8% showed a positive attitude towards vaccination. Monthly family income, education level, self-diagnosis of COVID-19 or a friend, family member, or colleague are significant factors influencing the acceptance of COVID-19 vaccination. The dogma of being naturally immune to COVID-19 was a key reason for the refusal of the vaccine. Less than half (48%) of those who refuse will vaccinate themselves if government officials have made it compulsory. A third (33.9%) of participants were willing to pay up to (7 USD) 1000 Pkr (Pakistani Rupees) for the vaccine. Conclusion The population’s positive attitude should be improved by increasing awareness and eradicating false myths about vaccines through large-scale campaigns.

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The impact of C-reactive protein levels on headache frequency in the HUNT study 2006–2008

BMC Neurology ◽

10.1186/s12883-019-1462-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Knut Hagen ◽

Lars Jacob Stovner ◽

Kristian Bernhard Nilsen ◽

Espen Saxhaug Kristoffersen ◽

Bendik Slagsvold Winsvold

Keyword(s):

Migraine With Aura ◽

Large Scale ◽

Population Based ◽

C Reactive Protein ◽

Cross Sectional ◽

Population Based Study ◽

Reactive Protein ◽

Scale Population ◽

Hs Crp ◽

The Impact

Abstract Background Increased high sensitivity C- reactive protein (hs-CRP) levels have been found in many earlier studies on migraine, and recently also in persons with migraine and insomnia. The aim of this study was to see whether these findings could be reproduced in a large-scale population-based study. Methods A total of 50,807 (54%) out of 94,194 invited aged ≥20 years or older participated in the third wave of the Nord-Trøndelag Health Study study performed in 2006–2008. Among these, 38,807 (41%) had valid measures of hs-CRP and answered questions on headache and insomnia. Elevated hs-CRP was defined as > 3.0 mg/L. The cross-sectional association with headache was estimated by multivariate analyses using multiple logistic regression. The precision of the odds ratio (OR) was assessed with 95% confidence interval (CI). Results In the fully adjusted model, elevated hs-CRP was associated with migraine (OR 1.14, 95% CI 1.04–1.25) and migraine with aura (OR 1.15, 95% CI 1.03–1.29). The association was strongest among individuals with headache ≥15 days/month for any headache (OR 1.26, 95% CI 1.08–1.48), migraine (OR 1.62, 95% CI 1.21–2.17), and migraine with aura (OR 1.84, 95% CI 1.27–2.67). No clear relationship was found between elevated hs-CRP and headache less than 7 days/month or with insomnia. Conclusions Cross-sectional data from this large-scale population-based study showed that elevated hs-CRP was associated with headache ≥7 days/month, especially evident for migraine with aura.

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