An analysis of the HIV testing cascade of a group of HIV-exposed infants from birth to 18 months in peri-urban Khayelitsha, South Africa

Background Despite the reduction of HIV mother-to-child transmission, there are concerns regarding transmission rate in the breastfeeding period. We describe the routine uptake of 6 or 10 (6/10) weeks, 9 months and 18 months testing, with and without tracing, in a cohort of infants who received HIV PCR testing at birth (birth PCR) (with and without point of care (POC) testing) in a peri-urban primary health care setting in Khayelitsha, South Africa. Methods In this cohort study conducted between November 2014 and February 2018, HIV-positive mothers and their HIV-exposed babies were recruited at birth and all babies were tested with birth PCR. Results of routine 6/10 weeks PCR, 9 months and 18 months testing were followed up by a patient tracer. We compared testing at 6/10 weeks with a subgroup from historical cohort who was not tested with birth PCR. Results We found that the uptake of 6/10 weeks testing was 77%, compared to 82% with tracing. When including all infants in the cascade and comparing to a historical cohort without birth testing, we found that infants who tested a birth were 22% more likely to have a 6/10 weeks test compared to those not tested at birth. There was no significant difference between the uptake of 6/10 weeks testing after birth PCR POC versus birth PCR testing without POC. Uptake of 9 months and 18 months testing was 39% and 24% respectively. With intense tracing efforts, uptake increased to 45% and 34% respectively. Conclusion Uptake of HIV testing for HIV-exposed uninfected infants in the first 18 months of life shows good completion of the 6/10 weeks PCR but suboptimal uptake of HIV testing at 9 months and 18 months, despite tracing efforts. Birth PCR testing did not negatively affect uptake of the 6/10 weeks HIV test compared to no birth PCR testing.

Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention in Manila and Cebu, Philippines: Web-Based Survey of Filipino Cisgender Men Who Have Sex With Men

Background The Philippines is experiencing an HIV crisis and is considering implementing pre-exposure prophylaxis (PrEP) as a national public health strategy for HIV prevention for cisgender men who have sex with men (cis-MSM). However, critical information on the awareness of PrEP among cis-MSM is needed to roll out this public health initiative. Objective This study aims to assess PrEP awareness and related correlates (ie, sociodemographic variables, social factors, and health care access and use) among Filipino cis-MSM. Methods We conducted a web-based survey with Filipino cis-MSM (n=179) residing in the cities of Manila and Cebu, Philippines. Multivariable analysis procedures were performed to examine the factors associated with PrEP awareness. Results Our sample demonstrated high awareness (134/179, 74.9%) and interest (159/179, 88.8%) in taking PrEP. The adjusted model showed that greater odds of PrEP awareness were associated with having a college education or higher versus a high school education or lower (adjusted odds ratio [aOR] 7.30, 95% CI 1.01-52.47), earning between PHP 10,000 (US $198.6) and PHP 20,000 (US $397.2) versus <PHP 10,000 (US $198.60; aOR 9.32, 95% CI 1.41-6.22), having had a prior HIV test (aOR 6.06, 95% CI 1.20-13.55), having high HIV knowledge (aOR 3.50, 95% CI 1.11-10.98), and having friends who discussed PrEP (aOR 11.17, 95% CI 2.73-14.5). Conclusions Our findings demonstrate that Filipino cis-MSM are aware of and interested in taking PrEP, but there is currently an unmet need for such biomedical HIV prevention technologies among this population. Incorporating PrEP education into routine HIV screening and leveraging cis-MSM social networks may be useful in optimizing potential PrEP implementation in the Philippines.

Pediatric Provider Utilization of a Clinical Decision Support Alert and Association with HIV Pre-exposure Prophylaxis Prescription Rates

Objectives An electronic clinical decision support (CDS) alert can provide real-time provider support to offer pre-exposure prophylaxis (PrEP) to youth at risk for human immunodeficiency virus (HIV). The purpose of this study was to evaluate provider utilization of a PrEP CDS alert in a large academic-community pediatric network and assess the association of the alert with PrEP prescribing rates. Methods HIV test orders were altered for patients 13 years and older to include a hard-stop prompt asking if the patient would benefit from PrEP. If providers answered “Yes” or “Not Sure,” the CDS alert launched with options to open a standardized order set, refer to an internal PrEP specialist, and/or receive an education module. We analyzed provider utilization using a frequency analysis. The rate of new PrEP prescriptions for 1 year after CDS alert implementation was compared with the year prior using Fisher's exact test. Results Of the 56 providers exposed to the CDS alert, 70% (n = 39) responded “Not sure” to the alert prompt asking if their patient would benefit from PrEP, and 54% (n = 30) chose at least one clinical support tool. The PrEP prescribing rate increased from 2.3 prescriptions per 10,000 patients to 6.6 prescriptions per 10,000 patients in the year post-intervention (p = 0.02). Conclusion Our findings suggest a knowledge gap among pediatric providers in identifying patients who would benefit from PrEP. A hard-stop prompt within an HIV test order that offers CDS and provider education might be an effective tool to increase PrEP prescribing among pediatric providers.

Analysis of HIV/AIDS Health Problems in Pacitan District East Java 2020

The implementation of health problem analysis is carried out to increase the eff ectiveness and effi ciency of solving health problems through the selection of health problems that become priority problems in a region. The purpose of this study was to analyze the problem and determine the priority of health problems in the work area of the Pacitan District Health Office, East Java Province. This research is a descriptive observational study conducted at the Pacitan District Health Office in January 2020. The type of data used is secondary data obtained from the 2016-2019 Pacitan District Health Profile and primary data obtained through interviews with related parties, namely the head of the fi eld. , section head and program holder. Prioritization of health problems is carried out using the USG method based on the criteria of Urgency, Seriousness, Growth and fi nding the root of the problem using the fi shbone diagram method. The increase in HIV/AIDS cases with an USG score of 128 has become a top priority health problem in Pacitan District. An increase over the last 4 years with the highest number of cases in 2019, which was 39 cases. The fishbine diagram shows the root of the HIV/AIDS problem, namely the lack of public knowledge about HIV/AIDS, the lack of public knowledge about HIV/AIDS, the lack of awareness of people at risk for conducting an HIV test, this makes the community less aware of information about HIV/AIDS, causing public stigma. which results in people being closed / unwilling to check themselves at the puskesmas orhospital. The increase in HIV/AIDS cases is one of the problems in Pacitan district. To reduce the incidence, health workers need to optimize the dissemination of information about HIV/AIDS, especially risk factors, causes, prevention, symptoms and treatment. Increase the understanding of health workers and public awareness in conducting early detection.

‘It is not fashionable to suffer nowadays’: Community motivations to repeatedly participate in outreach HIV testing indicate UHC potential in Tanzania

Objective This study examined people’s motivations for (repeatedly) utilizing HIV testing services during community-based testing events in urban and rural Shinyanga, Tanzania and potential implications for Universal Health Coverage (UHC). Methods As part of a broader multidisciplinary study on the implementation of a HIV Test and Treat model in Shinyanga Region, Tanzania, this ethnographic study focused on community-based testing campaigns organised by the implementing partner. Between April 2018 and December 2019, we conducted structured observations (24), short questionnaires (42) and in-depth interviews with HIV-positive (23) and HIV-negative clients (8). Observations focused on motivations for (re-)testing, and the counselling and testing process. Thematic analysis based on inductive and deductive coding was completed using NVivo software. Results Regular HIV testing was encouraged by counsellors. Most participants in testing campaigns were HIV-negative; 51.1% had tested more than once over their lifetimes. Testing campaigns provided an accessible way to learn one’s HIV status. Motivations for repeat testing included: monitoring personal health to achieve (temporary) reassurance, having low levels of trust toward sexual partners, feeling at risk, seeking proof of (ill)-health, and acting responsibly. Repeat testers also associated testing with a desire to start treatment early to preserve a healthy-looking body, should they prove HIV positive. Conclusions Community-based testing campaigns serve three valuable functions related to HIV prevention and treatment: 1) enable community members to check their HIV status regularly as part of a personalized prevention strategy that reinforces responsible behaviour; 2) identify recently sero-converted clients who would not otherwise be targeted; and 3) engage community with general prevention and care messaging and services. This model could be expanded to include routine management of other (chronic) diseases and provide an entry for scaling up UHC.

Cash Transfer Programs and HIV-Related Outcomes: an Analysis of 42 Countries from 1996 to 2019

Background Many low- and middle-income countries have introduced cash transfer programs as part of their poverty reduction and social protection strategies. These programs have the potential to overcome various drivers of HIV risk behaviors and usage of HIV services, but their overall effects on a broad range of HIV-related outcomes remains unknown. Methods We used publicly reported data to determine whether low- and middle-income countries with HIV prevalence >1% and baseline annual incidence >1/1000 had conditional or unconditional cash transfer programs that covered >5% of the impoverished population, and the year in which those programs began and ended. We obtained country- and individual-level data on HIV-related outcomes from UNAIDS and population-representative household surveys, focusing on the period between 1996 and 2019. We conducted difference-in-differences analyses with country and year fixed effects to evaluate the effects of cash transfer programs on country- and individual-level HIV-related outcomes. Findings Forty-two countries across three continents were included. Among these, 21 were in the intervention group, having implemented cash program(s) with impoverished population coverage greater than 5% during the study period. Cash transfer programs were associated with lower probability of reporting sexually transmitted infection within the last 12 months among females (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.50-0.91) and higher probability of an HIV test within the last 12 months among females (OR 2.61, 95% CI 1.15-5.88) and males (OR 3.19, 95% CI 2.45-4.15). For country-level outcomes, cash transfer programs were associated with a reduction in new HIV infections (incidence rate ratio [IRR] 0.94, 95% CI 0.89-0.99), but not with the proportion of people with HIV receiving antiretroviral therapy (5.0%, 95% CI -0.2-10.1) or AIDS-related deaths (IRR 0.99, 95% CI 0.95-1.03), though temporal analyses showed delayed improvements in both antiretroviral coverage and deaths. Interpretations Cash transfer programs, which are being expanded in the context of the COVID-19 pandemic, have the potential to promote ongoing efforts to end HIV as a public health threat. Alongside the already existing focus on expanding biomedical services, these anti-poverty programs can play a greater role in achieving global targets for HIV prevention and treatment. Funding None

Hepatitis C testing and linkage to care among adults on probation in a large US city

Background Despite constituting the largest segment of the correctional population, individuals on probation remain largely unstudied with respect to hepatitis C virus (HCV) testing and linkage-to-care. We implemented an HCV testing and patient navigation program at an adult probation department. Methods Adults were tested at a local probation department with a rapid point-of-care HCV antibody (Ab) assay followed by a lab-based HCV RNA assay if anti-HCV positive. All individuals received counseling rooted in harm-reduction principles. Individuals testing positive for HCV Ab were immediately linked to a patient navigator in person or via telephone. The patient navigator assisted patients through cure unless lost to follow-up. Study participation involved an optional survey and optional point-of-care HIV test. Results Of 417 individuals tested, 13% were HCV Ab positive and 65% of those tested for HCV RNA (34/52) had detectable HCV RNA. Of the 14 individuals who linked to an HCV treatment provider, 4 completed treatment as measured by pharmacy fill documentation in the electronic medical record, and 1 obtained sustained virologic response. 193 individuals tested for HIV; none tested positive. Conclusions The study cohort had a higher HCV seroprevalence than the general population (13% vs 2%), but linkage-to-care, completion of HCV treatment, and successful test-of-cure rates were all low. This study indicates that HCV disproportionately impacts adults on probation and prioritizing support for testing and linkage-to-care could improve health in this population. Co-localization of HCV treatment within probation programs would reduce the barrier of attending a new institution and could be highly impactful.

Solidarity and HIV Testing Willingness During the COVID-19 Epidemic: A Study Among Men Who Have Sex With Men in China

Background: Solidarity, such as community connectedness and social cohesion, may be useful in improving HIV testing uptake among men who have sex with men (MSM). This study aimed to evaluate the impact of solidarity on HIV testing before the coronavirus disease 2019 (COVID-19) and HIV testing willingness during COVID-19 among MSM in China.Materials and Methods: An online survey was conducted to collect sociodemographic, sexual behavioral, and solidarity items' information from the participants. We first used factor analysis to reveal the principal component of the solidarity items and then used logistic regression to study the impact of solidarity on HIV testing, by adjusting the possible confounding factors, such as age and education.Results: Social cohesion and community connectedness were revealed by the factor analysis. MSM with high community connectedness were more willing to undergo HIV testing before the epidemic adjusted by age [odds ratio (OR): 1.07, 95% CI: 1.01–1.13]. The community connectedness was also related to the willingness of HIV testing during the epidemic, with adjustments of 1.09 (95% CI: 1.03–1.15). People who did not test for HIV before the COVID-19 epidemic were more willing to have the HIV test during the epidemic, which was correlated with the community connectedness, and the OR value was 1.14 (95%: 1.03–1.25).Conclusion: A high level of community connectedness helped to increase the HIV testing rate before COVID-19 and the willingness of HIV testing during the epidemic among MSM. Strategies can strengthen the role of the community in the management and service of MSM.

A Computer Based System for Evaluating the Risk of Contracting Human Immunodeficiency Virus (HIV)

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) remain global pandemics. The 2020 statistics released in 2021 showed that about 37.6 million people globally are living with HIV; 1.5 million people became newly infected in 2020 and 690,000 people died from AIDS related cases the same year. A literature search revealed that more than 1.6 million Nigerians have died of HIV/AIDS since the outbreak of the epidemic in 1985 while millions of Nigerians are living with HIV as of today. Certain factors have contributed to this alarming statistic. One of such is the unwillingness by most persons to undertake an HIV test due to the fear of stigmatization. A simple system that can be of help in evaluating a person’s risk of contracting HIV without stigmatization is developed in this work. The system takes into account some behavioural factors, signs and symptoms that suggest a person may be at risk of having or be prone to HIV and thus makes a prediction of the risk status based on the input supplied. A simple framework was developed with input from medical practitioners based on their wealth of experience. The input was used to derive twenty two (22) questions centered on behavioural factors, signs and symptoms which were designed to be answered by the users during interaction with the system. A simple evaluation takes place using the user’s inputs and a predefined set of rules to classify the risk value as one of (Very High, High, Moderate, Low and Not at Risk) with appropriate advice. The system was implemented in Visual Studio Environment using Visual Basic.Net. It is expected that after using the system, users will be encouraged to go for tests where it is recommended. However, it to be noted that this system does not confirm HIV status as only a blood test can do that

Ethical Implications of the Fecal Microbiota Transplantation: Disclosure of a False-Positive HIV Test

Fecal microbiota transplantation (FMT) has gained popularity as an effective therapeutic option for Clostridioides difficile infection (CDI). Since its FDA recognition as a treatment modality for recurrent CDI in 2013, screening protocols for FMT donor stool have been in flux. However, extensive health questionnaires, in combination with serological and stool assays, have become mainstays in the donor screening process, although ethical implications are yet to be thoroughly considered. Herein, we present the case of a family member found to have a false-positive HIV test during the donor screening process and discuss potential ethical ramifications associated with FMT stool donation.