Early observations from the HIV self-testing program among key populations and sexual partners of pregnant mothers in Kampala, Uganda: A cross sectional study

Background HIV self-testing (HIVST) was adopted for key populations (KPs) and sexual partners of pregnant and lactating women (mothers) in Uganda in October 2018. We report early observations during HIVST implementation in Kampala, Uganda. Methods HIVST was rolled out to reach those with unknown HIV status at 38 public health facilities, using peer-to-peer community-based distribution for female sex workers (FSW) and men who have sex with men (MSM) and secondary distribution for mothers, who gave HIVST kits to their partners. Self-testers were asked to report results within 2 days; those who did not report received a follow-up phone call from a trained health worker. Those with HIV-positive results were offered confirmatory testing at the facility using the standard HIV-testing algorithm. Data on kits distributed, testing yield, and linkage to care were analysed. Results We distributed 9,378 HIVST kits. Mothers received 5,212 (56%) for their sexual partners while KPs received 4,166 (44%) (MSM, 2192 [53%]; FSW1, 974, [47%]). Of all kits distributed, 252 (3%) individuals had HIV-positive results; 126 (6.5%) FSW, 52 (2.3%) MSM and 74 (1.4%) partners of mothers. Out of 252 individuals who had HIV-positive results, 170 (67%) were confirmed HIV-positive; 36 (2%) were partners of mothers, 99 (58%) were FSW, and 35 (21%) were MSM. Linkage to treatment (126) was 74%. Conclusions HIVST efficiently reached, tested, identified and modestly linked to care HIV positive FSW, MSM, and partners of mothers. However, further barriers to confirmatory testing and linkage to care for HIV-positive self-testers remain unexplored.

Knowledge, attitudes and perceptions about HIV self-testing amongst college students in Namibia

Background: In 2019, the Namibian Ministry of Health introduced HIV self-testing (HIVST) as an additional strategy to increase uptake of HIV self-testing in traditionally hard-to-reach subpopulations, such as young adults and males. It is unclear how the utilisation of HIV self-testing iw optimised in young adults. The study objective is understanding knowledge, attitudes, and perception levels amongst college-going young adults in Namibia. Methods: This quantitative study utilised a sample of 97 young college students who received a pre-test structured questionnaire. One sample t-test was used to analyse the average score from the Likert scale. A cut-off p-value of 0.05 to determine statistical significance of variables was used. Logistic regression computation was used to identify independent variables significantly associated with the dependent variable. A univariate analysis was done on awareness and acceptability with statistical significance of p<0.05 to obtain preliminary insights into the association between independent and dependent variables. The net effect variables are assessed using multivariate analysis using STATA 13.1, taking into account confounding factors. Results: Out of the 97 participants, only 23.7% knew about HIV self-testing. The logistic regression had a significant association with awareness of HIV self-testing (p≤0.05): on condom use during a first sexual encounter; being with a single sexual partner in the last 12 months; not having a sexually transmitted infection. The univariate analysis revealed an association with the acceptability of HIV self-testing from females; those who live in urban settlements; having not had sexually transmitted infection in the last twelve months. Moreover, findings reveal there are low levels of awareness, yet participants had positive attitudes and levels of acceptability to HIV self-testing. Conclusion: This study shows promise if awareness through health education and promotion about HIV self-testing can be increased. This can form part of scaling up HIV testing in Namibia.

Operationalizing the distribution of oral HIV self-testing kits to men who have sex with men (MSM) in a highly homophobic environment: the Nigerian experience

Background Self-care health interventions are innovative approaches for improving health and achieving the sustainable development goals (SDGs). Men who have sex with men (MSM) have been disproportionately affected by Human Immunodeficiency Virus (HIV). In spite of this, stigma from healthcare workers has reportedly prevented MSM from accessing HIV testing in health facilities. This paper explored the operationalization of using key opinion leaders (KOLs) to distribute HIVST (HIV self-test) kits to MSM. This qualitative survey used a combination of in-depth interviews (IDI) with HIVST users and focus group discussions (FGDs) with KOLs to collect data three months after the distribution of the test kits by the KOLs. Thematic analysis of the data was carried out. Result Three themes were generated namely: KOLs serve as a trusted resource to promote and support HIVST for the MSM community; Skills and qualifications required for KOLs to effectively distribute and promote uptake of HIVST; and Effective strategies used to create demand and promote uptake of HIVST. Conclusion This study showed the practical steps involved in operationalizing KOL support system distribution of HIVST that positively influenced the testing experience for the participants irrespective of the HIV status and engagement in care. KOLs are a reliable resource to leverage for ensuring that HIV self-test kit is utilized and HIV positive individuals are linked to treatment and care in homophobic environments.

Is it possible to recruit HIV self-test users for an anonymous phone-based survey using passive recruitment without financial incentives? Lessons learned from a pilot study in Côte d’Ivoire

Background Due to the discreet and private nature of HIV self-testing (HIVST), it is particularly challenging to monitor and assess the impacts of this testing strategy. To overcome this challenge, we conducted a study in Côte d’Ivoire to characterize the profile of end users of HIVST kits distributed through the ATLAS project (AutoTest VIH, Libre d’Accéder à la connaissance de son Statut). Feasibility was assessed using a pilot phone-based survey. Methods The ATLAS project aims to distribute 221300 HIVST kits in Côte d’Ivoire from 2019 to 2021 through both primary (e.g., direct distribution to primary users) and secondary distribution (e.g., for partner testing). The pilot survey used a passive recruitment strategy—whereby participants voluntarily called a toll-free survey phone number—to enrol participants. The survey was promoted through a sticker on the HIVST instruction leaflet and hotline invitations and informal promotion by HIVST kit-dispensing agents. Importantly, participation was not financially incentivized, even though surveys focussed on key populations usually use incentives in this context. Results After a 7-month period in which 25,000 HIVST kits were distributed, only 42 questionnaires were completed. Nevertheless, the survey collected data from users receiving HIVST kits via both primary and secondary distribution (69% and 31%, respectively). Conclusion This paper provides guidance on how to improve the design of future surveys of this type. It discusses the need to financial incentivize participation, to reorganize the questionnaire, the importance of better informing and training stakeholders involved in the distribution of HIVST, and the use of flyers to increase the enrolment of users reached through secondary distribution.

Constant-sized correlations are sufficient to self-test maximally entangled states with unbounded dimension

Let p be an odd prime and let r be the smallest generator of the multiplicative group Zp&#x2217;. We show that there exists a correlation of size &#x0398;(r2) that self-tests a maximally entangled state of local dimension p&#x2212;1. The construction of the correlation uses the embedding procedure proposed by Slofstra (Forum of Mathematics, Pi. (2019)). Since there are infinitely many prime numbers whose smallest multiplicative generator is in the set {2,3,5} (D.R. Heath-Brown The Quarterly Journal of Mathematics (1986) and M. Murty The Mathematical Intelligencer (1988)), our result implies that constant-sized correlations are sufficient for self-testing of maximally entangled states with unbounded local dimension.

HIV testing behaviour and associated factors in men who have sex with men by level of urbanisation: a cross-sectional study in the Netherlands

ObjectivesRegular HIV testing in men who have sex with men (MSM) enables timely entry into care and reduces the likelihood of HIV transmission. We aimed to assess HIV-testing behaviour and associated factors in MSM by urbanisation of place of residence.DesignData were derived from online survey (‘Men & Sexuality’) in the Netherlands, which was mainly advertised on social media (Facebook and Instagram), dating websites, apps for MSM (Grindr and PlanetRomeo) and gay media.Primary and secondary outcome measuresHIV testing was defined as recent (<1 year), not recent (≥1 year) or never. Using multinominal regression analyses, factors associated with not recent testing and never testing, compared with recent testing, were assessed among MSM living in highly (>2500 residences/km2) or non-highly (≤2500 residences/km2) urbanised areas.ParticipantsThe study sample included 3815 MSM, currently living in the Netherlands. The mean age was 36 years (SD 14.7), and 67.6% were highly educated.ResultsIn highly urbanised areas, 11.8% was never and 19.8% was not recently HIV-tested. In non-highly urbanised areas, this was 25.2% and 19.6%. Among MSM living in highly urbanised areas, independently associated with never and not recent testing were younger age, self-identification as bisexual, fewer sex partners, never notified of HIV and no recent condomless anal intercourse. Among MSM living in non-highly urbanised areas, lower perceived HIV severity, higher perceived HIV risk and a lower proportion gay friends were associated with never and not recent testing. Among never tested MSM, those in non-highly urbanised areas preferred self-sampling/self-testing over facility-based testing; those in highly urbanised areas preferred testing at healthcare facilities.ConclusionsThe proportion of never tested MSM was high (25%) in non-highly urbanised areas in the Netherlands. MSM living in non-highly urbanised areas may possibly be reached with targeted approaches to increase HIV testing uptake such as self-testing/self-sampling strategies.

Detection of the omicron variant virus with the Abbott BinaxNow SARS-CoV-2 Rapid Antigen Assay

The US Centers for Disease Control and Prevention recommends rapid testing for SARS-CoV-2 infection as a key element of epidemic control. The Abbott BinaxNow is in widespread use in the United States for self-testing and as part of public health screening campaigns, but has not been evaluated for use with the omicron variant of SARS-CoV-2. We recruited individuals testing positive for COVID-19 PCR at an academic medical center. Anterior nasal swabs were stored in viral transport media and evaluated by viral load quantification and whole genome sequencing. We created serial dilutions from 2.5x103- 2.5x105 viral copies/specimen for two delta and omicron specimens, respectively, and tested each with the BinaxNow assay per manufacturer instructions. Results were interpreted by three readers, blinded to the specimen variant and concentration. All omicron and delta specimens with concentrations of 100,000 copies/swab or greater were positive by the BinaxNow Assay, a concentration similar to previously reported limits of detection for this assay. Assay sensitivity diminished below that. This study demonstrates that Omicron variant SARS-CoV-2 infections are detected by the BinaxNow rapid antigen assay. Additional laboratory and clinical validation assessments are needed to better determine their limits of detection and performance in real-world settings.