HIV Testing & Counseling Update
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Development of an Oral Fluid Self-test for HIV Infection: Evaluation in Populations of Unknown HIV Status
Lee, S.R., Roehler, M., Miller, K. et al. (2012). XIX International AIDS Conference, Poster #TUPE187. Washington, D.C.
Clinical studies of HIV self-test kits, OraQuick, were conducted with U.S. populations of “intended” users of the test kits (i.e. men who have sex with men, African Americans, and heterosexuals with multiple sex partners or inconsistent safe sexual practices) and with a smaller portion of low risk persons. 500 participants, with unknown risk for HIV, were studied to determine their ability to properly self-test. Testing was observed and results were compared with results from FDA approved tests conducted by professionals. Among persons identified as HIV positive through self-testing – primarily MSM and African Americans, sensitivity was high (97.9 percent); and in those with unknown status, specificity was also high (99.8 percent), when compared to professional testing.
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HIV Self-testing Among Health Workers: A Review of the Literature and Discussion of Current Practices, Issues and Options for Increasing Access to HIV Testing in Sub-Saharan Africa
Mavedzenge, S.N., Baggaley, R., Lo, Y.R. et al. World Health Organization (2011). Geneva, Switzerland.
The World Health Organization (WHO) conducted a literature review regarding HIV self-testing among health care workers in sub-Saharan Africa because of the high risk of HIV infection in their personal lives and/or through occupational exposure. Additionally, high levels of interest for self-testing among health care workers have been indicated and actual self-testing by health care workers has been informally reported. Of 70 databases, a total of 17 studies on HIV self-testing that met the inclusion criteria were identified. The review provides an overview of studies and issues, discussion of implementation considerations and proposed self-testing models, and action points for operational research.
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Supervised Blood-based Self-sample Collection and Rapid Test Performance: A Valuable Alternative to the Use of Saliva by HIV Testing Programmes with no Medical or Nursing Staff
Belza, M.J., Rosales-Statkus, M.E, Hoyos, J. et al. Sexually Transmitted Infections, (2012), Vol. 88, pp. 218-221
This feasibility study in Madrid, Spain aimed to evaluate whether persons seeking rapid HIV testing are able to perform a blood-based self-test sample after a brief training and supervision with a counselor as an alternative when medical staff are not available for blood collection. 208 attendees at a street-based HIV testing program accepted to participate. Participants were tested twice; first in the program and then performed again on themselves using the same blood-based rapid test following a demonstration and under direction of a counselor. 99 percent of participants had a valid result – the same result as those in the program conducted by a doctor or nurse. Findings suggest that this methodology is an alternative to saliva HIV testing in programs where a nurse or doctor are required to take blood samples, yet are unavailable.
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Access to and Use of Unauthorized Online HIV Self-tests by Internet-using French-speaking Men who Have Sex with Men
Greacen, T., Friboulet, D., Fugon, L. et al. Sexually Transmitted Infections, (2012), Vol. 88, No. 5, pp. 368-74
Awareness, access to, and use of unauthorized online HIV self-tests by men who have sex with men (MSM) in France were assessed using an online survey. Over 9000 (n=9169) MSM (ages 18 or older) completed the survey. Thirty percent of respondents were aware of online self-tests; of those who were not HIV positive, only 82 respondents (3.5 percent) indicated having accessed an online HIV test and only 69 respondents reported using it. Various factors were independently associated with accessing HIV self-tests including living their sex life with men in secrecy and having unprotected anal intercourse in the last 12 months. While MSM are aware of self-tests, few reported having used them. Self-testing may remove testing barriers for this segment of MSM.
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High Prevalence of Self-Reported Undiagnosed HIV despite High Coverage of HIV Testing: A Cross-Sectional Population Based Sero-Survey in South Africa
Kranzer, K., van Schaik, N., Karmue U., et al. PLoS One (September 2011), Vol. 6, No. 9, p. e25244
A random sample of adults in a South African peri-urban community was invited for mobile HTC services. Of 1,300 randomly selected adults, 1,144 participated, among whom 71 percent had previously tested for HIV, and nearly 38 percent had tested for HIV in the previous 12 months. Overall HIV prevalence was nearly 23 percent. Men, migrants, and older (> age 35) and younger (< age 20) individuals were less likely to have had a previous HIV test. The high burden of undiagnosed HIV in persons who had recently tested highlights the importance of repeat testing.
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Use of a Rapid HIV Testing Algorithm to Improve Linkage to Care
Martin, E., Salaru, G., Paul, S., et al. Journal of Clinical Virology (2011), Epub ahead of print.
This study evaluated the accuracy of single visit, two-test HIV rapid testing algorithm and its effect on referral to care in 24 sites in New Jersey. The program screened over 51,000 individuals and obtained 426 reactive rapid test results, with 93 percent reactive by a second rapid test. Rapid testing decreased false positive results by 6 percent and had high agreement with Western Blot results (99.5 percent). Compared to traditional HIV testing algorithms, a highly accurate two-test rapid HIV test can reduce delays in receiving tests results and can improve referral when provided immediately following test results.
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Local Residents Trained as ‘Influence Agents’ Most Effective in Persuading African Couples on HIV Counseling and Testing
Lambdin, B., Kanwka, W., Inambao, M., et al. Health Affairs (August 2011), Vol. 30, No. 8, pp.1488-1497.
This study evaluates the effectiveness of promotional strategies for couples HTC during a two-year program in Zambia that provided free HTC for couples. The program used several promotional strategies, including radio programs, billboards, drama group performances, stakeholder meetings, and “influence network agents,” respected community volunteers who invite couples they know, including family members, friends, and church members, to seek couples HTC. The services were well received. The most effective recruiting technique was use of the influence agents, as reported by 80 percent of couples who agreed to be tested. Influence network agents, in combination with other promotional strategies, may increase uptake of couples HTC.
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Delays in Presenting for Tuberculosis Treatment Associated with Fear of Learning One Is HIV-positive
Møller, V., Erstad, I., Cramm, J., et al. African Journal of AIDS Research (2011), Vol. 10, No. 1, pp. 25-36.
A representative survey of 1,020 adults in a high-prevalence region of South Africa found that the largest proportion of respondents (approximately 89 percent) delayed attending TB treatment clinics because they feared learning that they were HIV-positive. While the majority of respondents agreed that they should know their HIV status, lack of privacy and stigma during testing and counseling are disincentives to seeking testing. Integrating HIV and TB services is crucial for TB control, and psychological factors play an equal or greater role than do structural factors in delaying clients from presenting at TB clinics.
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Linkage to HIV Care and Survival Following Inpatient HIV Counseling and Testing
Wanyenze, R., Hahn, J., Liechty, C., et al. AIDS Behavior (2011), Vol. 15, No. 4, pp. 751-760.
To assess outcomes of inpatient uptake of HTC, linkage to care and treatment, and survival, inpatients in a hospital in Uganda were randomized to inpatient HTC (intervention) or referral to free HTC (control). Results and post-test counseling occurred the day after HTC. Participants in the control group received a referral to schedule an appointment for HTC one week following discharge. Among 590 eligible patients, 85 percent agreed to participate. In the intervention, 99 percent (n=251) received HTC, compared to 68 percent (n=249) in the control group. Disclosure of HIV status was higher among intervention participants than control participants, 97 percent and 62 percent, respectively. Only 56 percent of intervention participants accessed HIV care, compared with 74 percent of control participants. Mortality was higher in the intervention group, at 30 percent, than in the control group, at 17 percent. Inpatient HTC identified more HIV- positive persons than did referring for HTC following discharge—supporting the value of provider-initiated testing and counseling (PITC). The high mortality among participants indicates that HIV diagnosis may have occurred at an advanced stage of disease, a problem that might not be eliminated by PITC, though could be improved if PITC is applied to outpatient settings. Results emphasized the need for inpatient HTC to identify HIV-infected individuals and provide immediate linkage to care.
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The Uptake and Accuracy of Oral Kits for HIV Self-Testing in High HIV Prevalence Setting: A Cross-Sectional Feasibility Study in Blantyre, Malawi
Talumba Choko, A., Desmond, N., Webb, E. et al. PLoS Medicine (Oct. 2011), Vol. 8, No. 10, p. e1001102.
In a random cluster sample of adults from 60 households and of 72 members of community peer groups in urban Malawi, participants were interviewed about HIV testing history and then offered the following HIV testing options: 1) a self-test for HIV followed by confirmatory testing, in which a counselor re-read the self-test kit, checked for errors, and conducted two parallel rapid HIV test kits from a finger-prick, followed by post-counseling, 2) standard VCT alone, and 3) no HIV testing. Of a total of 298 adults, 283 adults were interviewed; approximately 92 percent (260 adults) opted for self-testing. Results indicate self-testing was accurate, with concordant results for 256 of 258 participants (approximately 99 percent). These results suggest that self-testing is acceptable and accurate, with potentially high uptake in the community. The authors recommend that HIV self-testing be supervised and linked to care and treatment services.
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Linkage to HIV Care from a Mobile Testing Unit in South Africa by Different CD4 Count Strata
Govindasamy, D., van Schaik, N., Kranzer, K., et al. Journal of Acquired Immune Deficiency Syndromes (2011), ahead of print.
In South Africa, a random sample (n=192) was drawn of newly diagnosed HIV-positive individuals tested at an HIV testing and counseling (HTC) mobile clinic who had received a laboratory CD4 count to assess successful linkage to HIV care. Participants were interviewed about linkage to care; for those who reported seeking care, clinic folders were reviewed to verify their self-reported linkage. Women made up the majority of the sample; the average age was 35, and about 60 percent had previously tested for HIV. Just over 50 percent of those who received a CD4 count result accessed HIV care, and individuals with lower CD4 counts (making them eligible for HIV treatment) were more likely to link to care. Approximately 70 percent of those who accessed care said that the referral letter from the mobile clinic assisted linkage into care. The most common barrier linking to care was the inability to reach health facilities during work days or to take time off from work. Findings suggest linkage to care from mobile HTC is feasible.
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High acceptance of home-based HIV counseling and testing in an urban community setting in Uganda
Sekandi, J., Sempeera, H., List, J., et al. BMC Public Health (2011), Vol. 11, p.730.
A cross-sectional, door-to-door survey of residents ages 15 or older in urban Kampala was conducted in 2009. Residents were interviewed and offered home-based HIV testing and counseling (HBHTC); 69 percent of participants accepted testing (408 of 588 enrolled participants). Factors significantly associated with acceptance of testing included being male, 25 years of age and older, previously married, and having been tested previously for HIV. These factors should be considered for future HBHTC programs in urban settings in Uganda.
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