Uptake of HIV/AIDS Services Following a Positive Self-Test Is Lower in Men Than Women in the Democratic Republic of the Congo

As far as HIV self-testing (HIVST) is concerned, proving the link to HIV care for users with a positive result contributes to understanding the implementation of HIVST. We sought to examine whether there were differences by sex in the uptake of HIV services following a positive self-test in the Democratic Republic of the Congo (DRC). This was a mixed-methods study exploring linkage to care for HIVST through a secondary analysis of collected data from three pilot surveys recently conducted in three cities (Kinshasa, Kisangani, and Kindu) during 2018 and 2020 in the DRC. Linkage to HIV care was defined as delayed when observed beyond 1 week. A total of 1,652 individuals were self-tested for HIV. Overall, the proportion of linkage to HIV care was high (n = 258; 82.2%) among individuals having a positive result with HIV self-test (n = 314), but it was significantly lower in men (65.2%) than women (89.2%). Furthermore, linkage to HIV care of men was significantly delayed as compared with that of women (40.0 vs. 20.7%). These findings show a lower uptake of care following a positive self-test in men than women. This trend already previously observed in sub-Saharan Africa shed light on the need to increase linkages to care among men newly diagnosed through HIV self-testing.

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Comparison of practicability and effectiveness between unassisted HIV self-testing and directly assisted HIV self-testing in the Democratic Republic of the Congo: A randomized feasibility trial

10.21203/rs.3.rs-19502/v2 ◽

2020 ◽

Author(s):

Serge Tonen-Wolyec ◽

Charles Kayembe Tshilumba ◽

Salomon Batina-Agasa ◽

Roland Marini Djang’eing’a ◽

Marie-Pierre Hayette ◽

...

Keyword(s):

High Risk ◽

Hiv Infection ◽

Democratic Republic ◽

Linkage To Care ◽

Feasibility Trial ◽

Test Results ◽

Self Testing ◽

Willingness To Buy ◽

Republic Of The Congo ◽

Self Test

Abstract Background. HIV self-testing (HIVST) can be performed using directly assisted and unassisted approaches in facilities or communities to reach different populations. The aim of this study was to compare the practicability and effectiveness of the two delivery approaches for HIVST, unassisted HIVST (UH) and directly assisted HIVST (DAH), in the field setting of Kisangani, the Democratic Republic of the Congo (DRC).Methods. A randomized (1:1), non-blinded, non-inferiority trial using a blood-based and facility-based HIVST method was carried out in four facilities in Kisangani, the DRC, targeting populations at high risk for HIV infection. The primary outcome was the difference in the practicability of the HIV self-test between the two arms. Practicability was defined as successfully performing the test and correctly interpreting the result. Requests for assistance, positivity rate, linkage to care, and willingness to buy an HIV self-test kit constituted the secondary outcomes for HIVST effectiveness. The adjusted risk ratios (aRRs) were calculated using Poisson regression. Results. The rate of successfully performing the test was same (93.2%) in the UH and DAH arms. The rate of correctly interpreting the results was 86.9% in the UH arm versus 93.2% in the DAH arm, for a difference of -6.3%. After the follow-up 72 h later, participants in the UH arm had a significantly lower chance of correctly interpreting the test results than those in the DAH arm (aRR: 0.60; P=0.019). Although the positivity rate was 3.4% among the participants in the DAH arm and 1.7% among those in the UH arm, no significant differences were found between the two arms in the positivity rate, requests for assistance, and linkage to care. Willingness to buy an HIV self-test was higher in the UH arm than in the DAH arm (92.3% versus 74.1%; aRR: 4.20; P<0.001). Conclusion. The results of this study indicate that UH is as practicable and effective as DAH among individuals at high risk for HIV infection in Kisangani, the DRC. However, additional support tools need to be assessed to improve the interpretation of the self-test results when using the UH approach. Trial registration: PACTR201904546865585. Registered 03 April 2019 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=6032

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Practicability and effectiveness of the unassisted HIV self-testing compared to the directly assisted HIV self-testing in the Democratic Republic of the Congo: A Randomized Implementation Trial

10.21203/rs.3.rs-19502/v1 ◽

2020 ◽

Author(s):

Serge Tonen-Wolyec ◽

Charles Kayembe Tshilumba ◽

Salomon Batina-Agasa ◽

Roland Marini Djang’eing’a ◽

Marie-Pierre Hayette ◽

...

Keyword(s):

Democratic Republic ◽

Linkage To Care ◽

Correct Interpretation ◽

Successful Performance ◽

Self Testing ◽

Willingness To Buy ◽

Significant Difference ◽

Republic Of The Congo ◽

Self Test ◽

Additional Support

Abstract Background. HIV self-testing (HIVST) may be use free or assisted by health care workers. The aim of this trial was to assess the practicability and effectiveness of unassisted HIVST (UH) versus directly assisted HIVST (DAH) in field settings in the Democratic Republic of the Congo (DRC). Methods. A non-inferiority evaluation using a blood-based HIV self-test was conducted in Kisangani, DRC. Participants were randomized in a 1:1 ratio to UH or DAH. Practicability was defined as the successful performance and the correct interpretation of the result. The linkage to care and the willingness to buy self-test constituted the outcome for HIVST effectiveness. Results. The rate of successful performance of the test was same (93.2%) in UH and DAH. The rate of correct interpretation of the results was 86.9% in UH versus 93.2% in DAH yielding the difference of -6.3% (95% CI: -10.8 to 2.5). UH significantly decreased the rate of correct interpretation of results as compared to DAH (aRR: 0.60 [95% CI: 0.36 to 0.98]; P=0.019). None significant difference was found between two arms in evaluating the linkage to care. Willingness to buy HIV self-test was higher in UH as compared to DAH (92.3% versus 74.1%; aRR: 4.20 [95% CI: 2.42 to 7.32]; P<0.001). Conclusion. This study demonstrates that both UH and DAH show high level of practicability and effectiveness for HIVST. However, additional support tools will be need to improve the practicability of the test in UH. Taken together, UH as well as DAH should improve access to HIV testing in DRC. Trial registration: PACTR201904546865585. Registered 03 April 2019 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=6032

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Comparison of practicability and effectiveness between unassisted HIV self-testing and directly assisted HIV self-testing in the Democratic Republic of the Congo: a randomized feasibility trial

BMC Infectious Diseases ◽

10.1186/s12879-020-05554-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Serge Tonen-Wolyec ◽

Charles Kayembe Tshilumba ◽

Salomon Batina-Agasa ◽

Roland Marini Djang’eing’a ◽

Marie-Pierre Hayette ◽

...

Keyword(s):

High Risk ◽

Hiv Infection ◽

Democratic Republic ◽

Linkage To Care ◽

Feasibility Trial ◽

Test Results ◽

Self Testing ◽

Willingness To Buy ◽

Republic Of The Congo ◽

Self Test

Abstract Background HIV self-testing (HIVST) can be performed using directly assisted and unassisted approaches in facilities or communities to reach different populations. The aim of this study was to compare the practicability and effectiveness of the two delivery approaches for HIVST, unassisted HIVST (UH) and directly assisted HIVST (DAH), in the field setting of Kisangani, the Democratic Republic of the Congo (DRC). Methods A randomized (1:1), non-blinded, non-inferiority trial using a blood-based and facility-based HIVST method was carried out in four facilities in Kisangani, the DRC, targeting populations at high risk for HIV infection. The primary outcome was the difference in the practicability of the HIV self-test between the two arms. Practicability was defined as successfully performing the test and correctly interpreting the result. Requests for assistance, positivity rate, linkage to care, and willingness to buy an HIV self-test kit constituted the secondary outcomes for HIVST effectiveness. The adjusted risk ratios (aRRs) were calculated using Poisson regression. Results The rate of successfully performing the test was same (93.2%) in the UH and DAH arms. The rate of correctly interpreting the results was 86.9% in the UH arm versus 93.2% in the DAH arm, for a difference of − 6.3%. After the follow-up 72 h later, participants in the UH arm had a significantly lower chance of correctly interpreting the test results than those in the DAH arm (aRR: 0.60; P = 0.019). Although the positivity rate was 3.4% among the participants in the DAH arm and 1.7% among those in the UH arm, no significant differences were found between the two arms in the positivity rate, requests for assistance, and linkage to care. Willingness to buy an HIV self-test was higher in the UH arm than in the DAH arm (92.3% versus 74.1%; aRR: 4.20; P < 0.001). Conclusion The results of this study indicate that UH is as practicable and effective as DAH among individuals at high risk for HIV infection in Kisangani, the DRC. However, additional support tools need to be assessed to improve the interpretation of the self-test results when using the UH approach. Trial registration PACTR201904546865585. Registered 03 April 2019 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=6032

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Analytical Performance of the Exacto Test HIV Self-Test: A Cross-Sectional Field Study in the Democratic Republic of the Congo

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa554 ◽

2020 ◽

Vol 7 (12) ◽

Author(s):

Serge Tonen-Wolyec ◽

Jérémie Muwonga Masidi ◽

Luc Ferdinand Kamanga Lukusa ◽

Gaetan Nsiku Dikumbwa ◽

Angèle Sarassoro ◽

...

Keyword(s):

Field Study ◽

Democratic Republic ◽

Analytical Performance ◽

Viable Option ◽

Excellent Performance ◽

Cross Sectional ◽

Performance Sensitivity ◽

Self Testing ◽

Republic Of The Congo ◽

Self Test

Abstract The Democratic Republic of the Congo (DRC) has begun implementing HIV self-testing to boost the first “95” of the UNAIDS 95-95-95 targets by 2025. This study aims to assess the performance and usability of the Exacto Test HIV (Biosynex, Strasbourg, France) self-test in the lab and in the field. The Exacto Test HIV self-test demonstrated high virological performance (sensitivity, 99.6%; specificity, 100%) in the lab and in the field in the hand of untrained users (sensitivity, 100%; specificity, 98.9%). Taken together, the excellent performance and usability characteristics of the Exacto Test HIV (Biosynex) self-test make the kit a viable option for HIV self-testing in the DRC.

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A systematic review of qualitative evidence on factors enabling and deterring uptake of HIV self-testing in Africa

BMC Public Health ◽

10.1186/s12889-019-7685-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 13

Author(s):

Bernard Njau ◽

Christopher Covin ◽

Esther Lisasi ◽

Damian Damian ◽

Declare Mushi ◽

...

Keyword(s):

Systematic Review ◽

Hiv Testing ◽

Linkage To Care ◽

Ease Of Use ◽

Sub Saharan Africa ◽

Care Providers ◽

African Countries ◽

Qualitative Evidence ◽

Self Testing ◽

Self Test

Abstract Background More than 40% of adults in Sub-Saharan Africa are unaware of their HIV status. HIV self-testing (HIVST) is a novel approach with a potential to increase uptake of HIV testing and linkage to care for people who test HIV positive. We explored HIV stakeholder’s perceptions about factors that enable or deter the uptake of HIV self-testing and experiences of self-testing of adult users in Africa. Methods This systematic review of qualitative evidence included articles on qualitative studies published or made available between January 1998 to February 2018 on perspectives of key stakeholders, including HIV policymakers, HIV experts, health care providers, and adult men and women (18 years and above) about factors that enable or deter the uptake of HIV self-testing and experiences of self-testing among adult users. We searched CINAHL, MEDLINE in Pubmed, EMBASE, AJOL, PsycINFO, Social Science Citation Index (SSCI), and Web of Science for articles in English on HIVST with qualitative data from different African countries. Results In total, 258 papers were retrieved, and only nine (9) studies conducted in 5 African countries were eligible and included in this synthesis. Perceived facilitators of the uptake of HIVST were autonomy and self-empowerment, privacy, confidentiality, convenience, opportunity to test, including couples HIV testing, and ease of use. The perceived barriers included the cost of buying self-test kits, perceived unreliability of test results, low literacy, fear and anxiety of a positive test result, and potential psychological and social harms. HIV stakeholder’s concerns about HIVST included human right issues, lack of linkage to care, lack of face-to-face counseling, lack of regulatory and quality assurance systems, and quality of self-test kits. Actual HIVST users expressed preference of oral-fluid self-testing because of ease of use, and that it is less invasive and painless compared to finger-stick/whole blood-based HIV tests. Lack of clear instructions on how to use self-test kits, and existing different products of HIVST increases rates of user errors. Conclusions Overcoming factors that may deter HIV testing, and HIVST, in particular, is complex and challenging, but it has important implications for HIV stakeholders, HIVST users, and public health in general. Research is warranted to explore the actual practices related to HIVST among different populations in Africa.

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Venues and methods to improve professional men’s access to HIV self-testing and linkage to HIV prevention or treatment: a qualitative study

BMC Health Services Research ◽

10.1186/s12913-021-07259-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Patience A. Muwanguzi ◽

Esther M. Nasuuna ◽

Florence Namimbi ◽

Charles Peter Osingada ◽

Tom Denis Ngabirano

Keyword(s):

Qualitative Study ◽

Hiv Testing ◽

Underserved Populations ◽

Linkage To Care ◽

Sub Saharan Africa ◽

Hiv Care ◽

Eligibility Criteria ◽

Prevention Services ◽

Self Testing ◽

Engaging Men

Abstract Background HIV testing among men in sub-Saharan Africa is sub-optimal. Despite several strategies to improve access to underserved populations, evidence regarding engaging men in professional and formal occupations in HIV testing is limited. This study explored employed professional men’s preferences for uptake of HIV self-testing, and linkage to HIV care, or prevention services. Methods This was an explorative-descriptive qualitative study where a sample of 33 men from six Ugandan urban centres. Participants were purposively selected guided by the International Standard Classification of Occupations to participate in in-depth interviews. The data were collected using an interview guide and the sample size was determined by data saturation. Eligibility criteria included fulltime formal employment for over a year at that organization. The data were analyzed manually using thematic content analysis. Results Three categories emerged: uptake of HIV self-tests, process of HIV self-testing and linkage to post-test services. The different modes of distribution of HIV self-test kits included secondary distribution, self-tests at typically male dominated spaces, delivery to workplaces and technology-based delivery. The process of HIV self-testing may be optimized by providing collection bins, and mHealth or mobile phone applications. Linkage to further care or prevention services may be enhanced using medical insurance providers, giving incentives and tele counselling. Conclusion We recommend utilization of several channels for the uptake of HIV self-tests. These include distribution of test kits both to offices and men’s leisure and recreation ‘hot spots’, Additionally, female partners, peers and established men’s group including social media groups can play a role in improving the uptake of HIV self-testing. Mobile phones and digital technology can be applied in innovative ways for the return of test results and to strengthen linkage to care or prevention services. Partnership with medical insurers may be critical in engaging men in professional employment in HIV services.

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Community-Based Interventions as Opportunities to Increase HIV Self-Testing and Linkage to Care Among Men Who Have Sex With Men – Lessons From Ghana, West Africa

Frontiers in Public Health ◽

10.3389/fpubh.2021.660256 ◽

2021 ◽

Vol 9 ◽

Author(s):

Gamji M'Rabiu Abubakari ◽

DeAnne Turner ◽

Zhao Ni ◽

Donaldson F. Conserve ◽

Debbie Dada ◽

...

Keyword(s):

Hiv Testing ◽

Linkage To Care ◽

Mobile App ◽

Sub Saharan Africa ◽

Security And Privacy ◽

Hiv Care ◽

Hiv Education ◽

Community Based Interventions ◽

Community Based ◽

Self Testing

MSM in Ghana encounter challenges in accessing HIV services and may experience barriers to HIV self-testing due to multiple forms of stigma present in health care settings. We worked with community-based organization partners to implement three interventions that successfully engaged and retained MSM which provides an opportunity for linkage to self-testing and medical care. These interventions were (1) Many Men Many Voices (3MV) a locally-led culturally grounded group-level HIV prevention program, (2) Auntie's Corner: a mobile-app based connecting MSM to health monitoring by a registered nurse and (3) HIV Education, Empathy, & Empowerment (HIVE3): a mobile-app based peer support intervention for MSM living with HIV. The 3MV intervention may be effective in improving HIV self-testing due to its effectiveness in engaging MSM, increasing HIV testing, and improving MSM understanding of the need for HIV testing. The utilization of apps like Auntie's Corner could positively impact HIV self-testing among MSM because it increases contact with nurses and reporting of symptoms. In HIVE3, participants expressed appreciation of the security and privacy that protects their identities as MSM and the peer mentors' abilities to make referrals to the nurses in Auntie's Corners. The confidentiality component has proven key among MSM and connecting MSM to self-testing through apps to report their process and receive care could increase utilization. Together, we show the efficacy of using the community-engaged process in reaching and engaging highly stigmatized populations like Ghana and sub-Saharan Africa, and its potential in increasing HIV self-testing and linkage to HIV care.

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Conflicts in Biafra, Katanga and Cabinda as a result of the geopolitical legacy of colonialism

OOO Zhurnal Voprosy Istorii ◽

10.31166/voprosyistorii202010statyi60 ◽

2020 ◽

Vol 2020 (10-3) ◽

pp. 238-246

Author(s):

Olga Dzhenchakova

Keyword(s):

Democratic Republic ◽

Economic Factor ◽

Colonial Period ◽

Sub Saharan Africa ◽

Negative Consequences ◽

Post Colonial ◽

Republic Of The Congo ◽

Sub Saharan ◽

The Republic ◽

The Impact

The article considers the impact of the colonial past of some countries in sub-Saharan Africa and its effect on their development during the post-colonial period. The negative consequences of the geopolitical legacy of colonialism are shown on the example of three countries: Nigeria, the Democratic Republic of the Congo and the Republic of Angola, expressed in the emergence of conflicts in these countries based on ethno-cultural, religious and socio-economic contradictions. At the same time, the focus is made on the economic factor and the consequences of the consumer policy of the former metropolises pursuing their mercantile interests were mixed.

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Arresting Vertical Transmission of Hepatitis B Virus (AVERT-HBV) in the Democratic Republic of the Congo

10.1101/2021.03.19.21253929 ◽

2021 ◽

Author(s):

Peyton Thompson ◽

Camille E. Morgan ◽

Patrick Ngimbi ◽

Kashamuka Mwandagalirwa ◽

Noro Ravelomanana ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Pregnant Women ◽

Democratic Republic ◽

Sub Saharan Africa ◽

Pmtct Program ◽

B Virus ◽

Birth Dose ◽

Republic Of The Congo ◽

Dose Vaccine

Background: Hepatitis B virus (HBV) remains endemic throughout sub-Saharan Africa despite the widespread availability of effective vaccines. We evaluated the feasibility of adding HBV testing and treatment of pregnant women and birth-dose vaccination of HBV-exposed infants to the HIV prevention of MTCT (PMTCT) program infrastructure in the Democratic Republic of the Congo (DRC), where HBV treatment and birth-dose vaccination programs are not established. Methods: As part of the HIV PMTCT program at two maternity centers in Kinshasa, DRC, pregnant women were screened for HBV at routine prenatal care registration. Pregnant women with high viral load and/or HBeAg positivity were offered tenofovir disoproxil fumarate (TDF). HBV-exposed infants received a birth-dose of HBV vaccine within 24 hours of life. The primary endpoint was the feasibility and acceptability of the study. Results: Of 4,016 women screened, 109 (2.7%) were HBsAg-positive. Ten of 91 (11.1%) women evaluated had high-risk disease. Of 88 infants, 60 (68.2%) received a birth-dose vaccine; of these, 46 (76.7%) received a timely birth-dose. No cases of HBV MTCT were observed in our cohort. There were no serious adverse events associated with TDF nor with birth-dose vaccine. The study procedures were highly acceptable (>80%) among mothers. Conclusions: Adding HBV screening and treatment of pregnant women and infant birth-dose vaccination to existing HIV PMTCT platforms is feasible in countries like the DRC. Birth-dose vaccination against HBV integrated within the current Expanded Programme on Immunization (EPI) and HIV PMTCT program could accelerate progress toward HBV elimination in Africa.

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