Better to know: the importance of early HIV diagnosis

Associations Between Negative Body Image and Sexual Health Practices in Emerging Adults from Malaysia

Past findings on the association between negative body image and sexual health behaviors have been mixed and mostly derived from Western samples. The aim of the current study was to examine associations between indices of negative body image and sexual health practices that reduce the risk of disease transmission in emerging adults, and whether these associations are moderated by gender. Using an online survey, a convenience sample of 584 Malaysian adults aged 18-30 years (230 men, 354 women) completed measures of satisfaction with overall appearance, body size dissatisfaction, weight satisfaction, height satisfaction, and genital image evaluation. They also reported if they ever had partnered sex, condomless sex, and been screened for human immunodeficiency virus (HIV), as well as their lifetime number of penetrative sex partners. Hierarchical logistic and ordinal regression analyses indicated that more positive genital image evaluation, but not the other body image indices, was significantly associated with having had partnered sex and fewer lifetime penetrative sex partners. None of the body image indices were significantly associated with condomless sex. All associations were consistent across men and women. For HIV testing, a significant interaction between genital image evaluation and gender emerged. However, this was reduced to non-significance after controlling for the number of penetrative sex partners. Overall, our findings underline the importance of promoting improved genital image in interventions aimed at increasing positive sexual health behaviors.

Concurrent sexual partnerships and HIV testing among heterosexual Black men in Ontario, Canada: findings from the weSpeak study

BACKGROUND

African, Caribbean, and Black men constitute the second-highest category of males living with HIV in Ontario, which increased from 15.4% to 17% between 2011 and 2016. Previous studies have attributed this disproportionately higher rate to multiple concurrent sexual partnerships and low rates of HIV testing. Drawing on theoretical constructs of the health belief model (HBM), this study examined the relationship between multiple concurrent sexual partnerships and the uptake of HIV testing services among heterosexual Black men in Ontario.

METHODS

Using a cross-sectional sample data of 829 individuals from four cities in Ontario, we employed the multinomial logit analysis to examine the relationship between multiple sexual partnerships and the uptake of HIV testing services among heterosexual Black men.

RESULTS

The findings show that heterosexual Black men with multiple concurrent sexual partners were more than twice (RRR = 2.306, P < 0.01) as likely to test for HIV within the past 12 months when compared to those with one partner. Furthermore, being an immigrant, having good knowledge of HIV transmission, and earning lower annual income predicted higher odds of testing while sexual debut between the ages of 16 and 20 years, no visit to a healthcare provider in the past year and difficulty accessing healthcare significantly predicted lower likelihood of testing for HIV.

CONCLUSIONS

These findings align with the theoretical constructs of the health belief model but more importantly, they suggest heterosexual Black men with concurrent sexual partners may be aware of their HIV risk and are taking measures to know their serostatus. Hence, making HIV screening services accessible and at safer spaces could increase their use of HIV screening services.

The epidemiology of delayed HIV diagnosis in Ibadan, Nigeria

BACKGROUND

Human immunodeficiency virus infection (HIV) is one of the major health burdens in Nigeria. Delayed HIV diagnosis remains a significant driver of HIV transmission. The risk factors of delayed HIV diagnosis have not been widely studied in Nigeria. This observational study examined demographic risk factors for delayed HIV diagnosis and the trends in the annual total cases of delayed HIV diagnosis in Ibadan, Nigeria.

METHODS

We examined the data on HIV patients enrolled in care at the University College Hospital's Antiretroviral Therapy (ART) clinic in Ibadan, Nigeria. Delayed HIV diagnosis was defined as a Cluster of Differentiation 4 (CD4) count of less than 350 cells/mm³ at the time of diagnosis. The association between delayed HIV diagnosis and risk factors was analyzed using logistic regression. The trends in the annual total cases of delayed HIV diagnosis over time were examined.

RESULTS

This study included 3458 HIV patients. There were 1993/3458 prevalent cases of delayed HIV diagnosis (57.6%). The risk factors for delayed HIV diagnosis were older age, retirement, marriage separation, never married, and widowed female. The factors that were significantly associated with a low risk of delayed HIV diagnosis were student and tertiary education. There was a progressive decline in the annual cases of delayed HIV diagnosis.

CONCLUSIONS

Although the cases of delayed HIV diagnosis are still high, they are declining. Human immunodeficiency virus testing should be targeted at populations at risk of delayed diagnosis. Considerable public awareness and education programs about HIV testing may significantly reduce delayed HIV diagnosis in Nigeria.

How informal healthcare providers improve uptake of HIV testing: qualitative results from a randomized controlled trial

OBJECTIVE

Uganda is HIV-endemic with a prevalence of 5.7%. Lack of epidemic control has been attributed to low engagement with HIV testing. Collaborating with informal healthcare providers, such as traditional healers, has been proposed as a strategy to increase testing uptake. We explored acceptability and implementation of an HIV testing program where traditional healers delivered point-of-care testing and counseling to adults of unknown serostatus (clinicaltrials.gov NCT#03718871).

METHODS

This study was conducted in rural, southwestern Uganda. We interviewed participating traditional healers ( N  = 17) and a purposive sample of trial participants ( N  = 107). Healers were practicing within 10 km of Mbarara township, and 18+ years old. Participants were 18+ years old; sexually active; had received care from participating healers; self-reported not receiving an HIV test in prior 12 months; and not previously diagnosed with HIV infection. Interviews explored perceptions of a healer-delivered HIV testing model and were analyzed following a content-analysis approach.

RESULTS

Most participants were female individuals ( N  = 68, 55%). Healer-delivered HIV testing overcame structural barriers, such as underlying poverty and rural locations that limited use, as transportation was costly and often prohibitive. Additionally, healers were located in villages and communities, which made services more accessible compared with facility-based testing. Participants also considered healers trustworthy and 'confidential'. These qualities explain some preference for healer-delivered HIV testing, in contrast to 'stigmatizing' biomedical settings.

CONCLUSION

Traditional healer-delivered HIV testing was considered more confidential and easily accessible compared with clinic-based testing. Offering services through traditional healers may improve uptake of HIV testing services in rural, medically pluralistic communities.

Virologic failure in people living with HIV in 1st line ART: A 10-year Mexican population-based study

Background

In Mexico, the number of people living with HIV (PLWH) receiving antiretroviral therapy (ART) has increased in the last 20 years. The elimination of a CD4 threshold to initiate publicly funded ART was a major policy implemented in 2014. The study objective was to assess the determinants of Virologic Failure (VF) in Mexican PLWH on first-line ART between 2008 and 2017 and to evaluate the effects of changes following the 2014 policy.

Methods

A 10-year patient-level data analysis was conducted using the Mexican SALVAR database. The main outcome was the proportion of PLWH with VF. A multivariable logistic regression was conducted to identify the association between covariates and VF before and after the 2014 policy implementation.

Results

We found a lower proportion of people with VF in 2014–2017 compared with 2008–2013 (50% vs 33%, p<0.001). The multivariable analysis showed a reduction in the odds of virologic failure after 2014 (Odds ratio: 0.50 [95% CI: 0.48–0.51]). Place of treatment and level of deprivation were significant predictors of VF in during 2014–2017, but not before.

Conclusion

This study indicates that, by lowering threshold levels of CD4 required for treatment initiation in Mexico, a higher number of PLWH initiated treatment during 2014–2017, compared to 2008–2013 and the odds of VF were reduced.

Reaching for the 'first 95': a cross-country analysis of HIV self-testing in nine countries in sub-Saharan Africa

OBJECTIVES

HIV self-testing (HIVST) offers a promising approach to increase HIV diagnosis and advance progress towards the UNAIDS 95-95-95 targets. We aimed to understand patterns of HIVST awareness and utilization in nine sub-Saharan African (SSA) countries, with the goal of identifying populations to target in disseminating this technology.

DESIGN

A cross-sectional study.

METHODS

We pooled individual-level population-based data from nine Demographic and Health Surveys (DHS) in SSA conducted 2015-2019 (Burundi, Cameroon, Guinea, Malawi, Senegal, Sierra Leone, South Africa, Zambia, Zimbabwe). Primary outcomes were HIVST awareness and utilization. We used logistic regression with survey fixed effects to explore the relationship between sociodemographic characteristics and these outcomes. Models were adjusted for sex, age, rural/urban residence, education, wealth, and marital status. We accounted for complex survey design.

RESULTS

The study sample included 177 572 people (66.0% women, mean age 29 ± 10 years), of whom 86.6% [95% confidence interval (95% CI) 86.4-86.7] were unaware of HIVST, 11.7% (95% CI 11.6-11.9) were aware of but never used HIVST, and 1.7% (95% CI 1.6-1.8) had used HIVST. In adjusted models, women were less likely to be aware of HIVST [odds ratio (OR) 0.75, 95% CI 0.71-0.79], but more likely to have used HIVST (OR 1.17, 95% CI 1.03-1.32) compared with men. Rural residents, those who were least educated, and poorest were less likely to have heard of or used HIVST.

CONCLUSION

HIVST awareness and uptake were low. Rural, less educated, and lower income populations were least likely to have heard of or used HIVST. Efforts to scale-up HIVST in these settings should aim to reach these less advantaged groups.

Delayed antiretroviral therapy in HIV-infected individuals leads to irreversible depletion of skin- and mucosa-resident memory T cells

People living with HIV (PLWH) are at increased risk for developing skin and mucosal malignancies despite systemic reconstitution of CD4⁺ T cells upon antiretroviral therapy (ART). The underlying mechanism of chronic tissue-related immunodeficiency in HIV is unclear. We found that skin CD4⁺ tissue-resident memory T (Trm) cells were depleted after HIV infection and replenished only upon early ART initiation. TCR clonal analysis following early ART suggested a systemic origin for reconstituting CD4⁺ Trm cells. Single-cell RNA sequencing in PLWH that received late ART treatment revealed a loss of CXCR3⁺ Trm cells and a tolerogenic skin immune environment. Human papilloma virus-induced precancerous lesion biopsies showed reduced CXCR3⁺ Trm cell frequencies in the mucosa in PLWH versus HIV^- individuals. These results reveal an irreversible loss of CXCR3⁺ Trm cells confined to skin and mucosa in PLWH who received late ART treatment, which may be a precipitating factor in the development of HPV-related cancer.

Acceptability and facilitators of and barriers to point-of-care HIV testing in a homeless-focused service in Gloucestershire: a qualitative evaluation

OBJECTIVES

Late HIV diagnosis increases the risks of onward transmission, morbidity and mortality. Rapid point-of-care testing (POCT) reaches people who have never been tested and people living with HIV who are undiagnosed. This study explored the acceptability and feasibility of HIV POCT from the perspectives of service providers and users.

METHODS

A pilot study introduced HIV POCT to one service in Gloucestershire, England. Eleven semi-structured interviews with service users and a focus group with three service providers were conducted. The Theoretical Framework of Acceptability and the Theoretical Domains Framework were used to design the topic guide and analysis.

RESULTS

Acceptability of HIV POCT was high. Seven facilitators were identified (e.g. understanding the test purpose and process), alongside two potential barriers, one relevant to service providers and users (anxiety) and the other to service users (stigma).

CONCLUSIONS

To maximize the benefits of implementation of HIV POCT, health care providers require appropriate training and supervision to offer and administer POCT.

Invasive Pneumococcal Disease in People With Human Immunodeficiency Virus in England, 1999-2017

BACKGROUND

The 7-valent and 13-valent pneumococcal conjugate vaccines (PCVs) were introduced into the UK childhood immunization program in 2006 and 2010, respectively, with high effectiveness and resulting in both direct and indirect protection. We describe the epidemiology of invasive pneumococcal disease (IPD) in adults with human immunodeficiency virus (HIV) in England following the introduction of both PCVs.

METHODS

Data on a national cohort of people with HIV were linked to confirmed IPD cases in adults aged ≥ 15 years during 1999-2017. Date of HIV infection was estimated using a CD4 slope decline algorithm.

RESULTS

Among 133 994 adults with HIV, 1453 developed IPD during 1999-2017, with 70% (1016/1453) developing IPD ≥ 3 months after their HIV diagnosis. IPD and HIV were codiagnosed within 90 days in 345 (24%) individuals. A missed opportunity for earlier HIV diagnosis was identified in 6% (89/1453), mostly in earlier years. IPD incidence in people with HIV increased from 147/100 000 in 1999 to 284/100 000 in 2007 before declining and stabilizing between 92 and 113/100 000 during 2014-2017. Mean annual IPD incidence was lower among those receiving antiretroviral therapy during 2014-17 (68 vs 720/100 000; incidence rate ratio [IRR] 9.3; 95% confidence interval [CI], 7.3-11.8; P < .001) and was markedly lower in those with a suppressed viral load (50 vs 523/100 000; IRR 10.4; 95% CI, 7.6-14.1; P < .001). The latter group still had 4.5-fold higher (95% CI, 3.8-5.3; P < .001) IPD incidence compared to the general population (11.2/100 000).

CONCLUSIONS

IPD incidence among people with HIV reduced after PCV13 introduction and has remained stable. Adults presenting with IPD should continue to be tested for HIV infection.

A Cross-Sectional Study Comparing Two Opt-Out HIV Testing Strategies in the Out-Patient Setting

Background: HIV infections are generally asymptomatic, leading to undetected infections and late-stage diagnoses. There are a lack of acceptable testing strategies for routine opt-out HIV screening. Our aim was to evaluate and compare the diagnostic yield of routine opt-out HIV testing strategies in two out-patient settings in a low HIV prevalence country: The public primary care and specialist out-patient care setting

Methods: A cross-sectional study was conducted in a primary care clinic over a four-week period in 2016 to 2017 and in a specialist out-patient clinic over a concurrent 11-month period. Patients were invited to complete a questionnaire assessing demographic characteristics, acceptance of opt-out HIV testing as a policy in all out-patient clinics in Hong Kong and reasons if refusing the HIV test. All respondents were offered an HIV test.

Results: This study included 648 and 1,603 patients in the primary care and specialist out-patient clinic, respectively. Test acceptability was 86 and 87% in the primary care and specialist out-patient setting, respectively. Test uptake was 35 and 68% in the primary care and specialist out-patient setting, respectively. No HIV infections were detected.

Conclusion: Opt-out HIV testing during routine blood taking in the specialist out-patient setting achieved a high test uptake and acceptability. In contrast, opt-out HIV testing using rapid finger-prick tests in the primary care setting was not effective.

At-home HIV self-testing during COVID: implementing the GetaKit project in Ottawa

Setting

In March 2020, COVID-19 shuttered access to many healthcare settings offering HIV testing and there is no licensed HIV self-test in Canada.

Intervention

A team of nurses at the University of Ottawa and Ottawa Public Health and staff from the Ontario HIV Treatment Network (OHTN) obtained Health Canada’s Special Access approval on April 23, 2020 to distribute bioLytical’s INSTI HIV self-test in Ottawa; we received REB approval on May 15, 2020. As of July 20, 2020, eligible participants (≥18 years old, HIV-negative, not on PrEP, not in an HIV vaccine trial, living in Ottawa, no bleeding disorders) could register via www.GetaKit.ca to order kits.

Outcomes

In the first 6 weeks, 637 persons completed our eligibility screener; 43.3% (n = 276) were eligible. Of eligible participants, 203 completed a baseline survey and 182 ordered a test. These 203 participants were an average of 31 years old, 72.3% were white, 60.4% were cis-male, and 55% self-identified as gay. Seventy-one percent (n = 144) belonged to a priority group for HIV testing. We have results for 70.9% (n = 129/182) of participants who ordered a kit: none were positive, 104 were negative, 22 were invalid, and 2 “preferred not to say”; 1 participant reported an unreadiness to test.

Implications

Our results show that HIV self-testing is a pandemic-friendly strategy to help ensure access to sexual health services among persons who are good candidates for HIV testing. It is unsurprising that no one tested positive for HIV thus far, given the 0.08% positivity rate for HIV testing in Ottawa. As such, we advocate for scale-up of HIV self-testing in Canada.

Characteristics of newly diagnosed HIV-positive service users using a pan-London e-sexually transmitted infection screening service

Maximising opportunities and removing barriers to HIV testing can help reduce the undiagnosed HIV population. Digital STI/HIV screening services have increased in availability and can improve access and testing coverage. We identified the characteristics of individuals who tested HIV positive using a regional, integrated, self-sampling STI service. The e-notes of service users with reactive HIV screening results were reviewed. Between 8 January 2018 and 31 December 2019, 0.097% (144/148,257) users received a reactive HIV result, 30/144 (20.8%) of whom had previously diagnosed HIV infection. All of the remaining 114 users were notified of their screening result, an estimated 109/114 (95.6%) received confirmatory testing (CT) at a sexual health clinic (SHC) and the confirmatory outcome was documented in 102/114 (89.5%) of cases: 34/114 (29.8%)were HIV positive, 68/114 (59.6%) HIV were negative and the result was unknown in 12/114 (10.5%). All new diagnoses transitioned to HIV outpatient care. These individuals were median age 28 years; 94.1% (32/34) male; 88.2% (30/34) men who have sex with men and 11.8% (4/34) heterosexual; 58.8% (20/34) of white/'white other' ethnicity and 42.2% of Black, Asian and minority ethnic group; 50%(17/34) had a concurrent STI; 9% and 21% had never tested for HIV or attended a SHC before. n HIV test reactivity rate of 0.1%(95% CI) was observed. Confirmed new HIV diagnoses comprised 0.023% of all HIV tests performed. All individuals where CT confirmed a new HIV diagnosis transitioned to HIV specialist care.

Baseline CD4 count and the time interval between the initial HIV infection and diagnosis among PLHIV in Bhutan

INTRODUCTION

CD4 count is an important predictor of disease progression, opportunities infection, deaths, and to understand the time interval between initial HIV infection to the first diagnosis. However, baseline CD4 count and the time period between initial infection and the diagnosis amongst PLHIV in Bhutan never been evaluated.

METHODS

This is a retrospective study of the diagnosed PLHIV from the existing data system from January 10 to 30, 2021. Out of 512 reported HIV cases, 488 of those who were more than or equal to 18 years old and had their CD4 count testing within 6 months before initiating ART were considered for analysis. Descriptive statistical analysis was used to analyze the characteristics of the study population and relationship were established using the χ ² Test. We have sought ethics approval and waiver for informed consent as it is the retrospective study of the client's record. The client's confidentiality was ensured by removing all the identifiers.

RESULTS

The mean CD4 was 345 cells/ml for males and females. Twenty-five percent of the clients had CD4 counts below 200, 30%, between 200 and 349, 25% between 350 and 499, and 20% above 500 cells/ml. A larger number of males showed a CD4 count below 200 cells/ml while more females showed a CD4 count more than 500 cells/ml. The mean time interval between initial infection to the first diagnosis was 4 years in males and females. However, about one-fourth were found to have been infected between 5 and 8 years before diagnosis and less than 10% were diagnosed within less than 1 year of infection.

CONCLUSIONS

The study revealed a late diagnosis of HIV infection in Bhutan thereby risking the transmission to the community and risk of severe disease and mortality. The upscaling of voluntary counseling and testing, medical screening, and alternative methods like community-based testing including HIV Self Testing for early detection needs to be implemented in the country.

A microfluidic field-effect transistor biosensor with rolled-up indium nitride microtubes

Field-effect-transistor (FET) biosensors capable of rapidly detecting disease-relevant biomarkers have long been considered as a promising tool for point-of-care (POC) diagnosis. Rolled-up nanotechnology, as a batch fabrication strategy for generating three-dimensional (3D) microtubes, has been demonstrated to possess unique advantages for constructing FET biosensors. In this paper, we report a new approach combining the two fascinating technologies, the FET biosensor and the rolled-up microtube, to develop a microfluidic diagnostic biosensor. We integrated an excellent biosensing III-nitride material-indium nitride (InN)-into a rolled-up microtube and used it as the FET channel. The InN possesses strong, intrinsic, and stable electron accumulation (~10¹³ cm^-2) on its surface, thereby providing a high device sensitivity. Multiple rolled-up InN microtube FET biosensors fabricated on the same substrate were integrated with a microfluidic channel for convenient fluids handling, and shared the same external electrode (inserted into the microchannel outlet) for gating voltage modulation. Using human immunodeficiency virus (HIV) antibody as a model disease marker, we characterized the analytical performance of the developed biosensor and achieved a limit of detection (LOD) of 2.5 pM for serum samples spiked with HIV gp41 antibodies. The rolled-up InN microtube FET biosensor represents a new type of III-nitride-based FET biosensor and holds significant potential for practical POC diagnosis.

Developing HIV assisted partner notification services tailored to Mexican key populations: a qualitative approach

Background

Assisted partner notification services (APNS) may increase HIV testing, early diagnosis, and treatment, but they are not formally implemented in Mexico, where the HIV epidemic is concentrated in men who have sex with men (MSM) and transwomen (TW). This study aimed to explore the awareness of and need for HIV partner notification, as well as to outline potential strategies for APNS based on identified barriers and facilitators.

Methods

We conducted semi-structured interviews to explore partner notification with MSM, TW, and counselors. Afterwards, brainstorm sessions were carried out to produce strategies for implementing APNS.

Results

Most participants reported experiences with informal partner notification and serostatus disclosure, but not with APNS. Only one counselor indicated assisting notification systematically. The main barriers for notifying or disclosing mentioned by both MSM and TW included fear of (violent) reactions, discrimination and lacking contact information of casual partners. Participants thought it was easier to inform a formal partner, conditional of being well informed about HIV. Given current stigma and lack of awareness, it was suggested that APNS should be preceded by HIV awareness efforts, and be provided by counselors or peers to mitigate potential rejection or violent reactions.

Conclusions

While APNS are not formally implemented in Mexico, all participants supported the service, indicating that APNS could potentially enhance early HIV diagnosis in Mexico. Strategies to implement such services need to be flexible addressing the individual needs of participants, guaranteeing the safety of more vulnerable participants.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10612-3.

Assessment of HIV testing recommendations in Greek specialty guidelines: A missed opportunity and room for improvement for recommending testing

HIV testing for individuals presenting with indicator conditions (ICs) including AIDS-defining conditions (ADCs) is explicitly recommended by European guidelines. We aimed to review specialty guidelines in Greece and assess if HIV was discussed and testing recommended. We reviewed European guidelines to produce a list of 25 ADCs and 48 ICs. We identified Greek guidelines for 11 of 25 (44%) ADCs and 30 of 48 (63%) ICs. In total, 47 guidelines were reviewed (range: 1-6 per condition); 11 (23%) for ADCs and 36 (77%) for ICs. Association with HIV was discussed in 7 of 11 (64%) ADC and 8 of 36 IC guidelines (22%), whereas HIV testing was appropriately recommended in two of 11 ADC (18%) and 10 of 36 IC guidelines (28%). Significant differences were found for the distribution of recommendations to test in both types of condition, with ICs having higher percentage of non-recommendation (50%, p < 0.05). No association was found between source of guideline or publication year and testing recommendation. Most guidelines for ICs and ADCs do not recommend testing. Specialists managing most ICs and ADCs may be unaware of the actual prevalence of undiagnosed HIV infection among their patients or the respective recommendations produced by HIV societies.

Barriers Preventing Access by Men who have Sex with Men to HIV-related health services in Southeast Asia: A Scoping Review

The objective of this scoping review was to identify and describe barriers experienced by men who have sex with men (MSM) when accessing HIV-related health care in Southeast Asia. A systematic search identified thirteen papers, which were full text reviewed and data extracted. An intersection of stigma and discrimination, fear and shame, cultural norms and societal expectations coalesce to influence the ability, either physically through lack of service provision or emotionally through personal restraint, of MSM to access HIV-related health services. Many of the factors continuing to drive the ongoing HIV epidemic across the Southeast Asia region have humanitarian origin - access to safe and non-discriminatory healthcare, education on sexual health, and not being persecuted for having a health condition. These must be addressed with an interdisciplinary response at local, government and regional level.

Identifying key elements to inform HIV-testing interventions for primary care in Belgium

General practitioners (GPs) play a key role in reducing the hidden HIV-epidemic, but many diagnostic opportunities are missed in primary care. This study aimed at informing the development of an HIV-testing intervention for GPs in Flanders (Belgium) using formative research with a participatory approach. Through the active involvement of an advisory board and 16 group discussions with 122 Flemish GPs, GPs’ current HIV-testing practices and perceived practical relevance of 2 distinct HIV-testing strategies (i.e. provider-initiated testing of key populations and indicator condition-based testing) were explored in terms of their relevance and feasibility in routine primary care. Self-reported HIV-testing practices revealed that most tests performed were patient-initiated, pretest counseling was rarely done, and post-test counseling was offered mainly for patients with an HIV-diagnosis. GPs reported multiple barriers to provider-initiated HIV-testing, i.e. personal discomfort, fear of offending their patient, limited knowledge of benefits of early HIV-diagnosis, misconceptions about HIV-risks, lack of guidelines and time. Difficulties to identify patient’s sexual orientation or ethical concerns were mentioned as barriers for target group-based HIV testing. GPs assessed the current list of 64 indicator conditions as too difficult to integrate in routine care, deeming a reduced list of GP-relevant conditions as more feasible. Combined strategies (i.e. target group- and indicator-based testing) supported by official screening recommendations were perceived as successful strategies for provider-initiated HIV-testing in primary care. This formative research delivered qualitative evidence for the development of an HIV-testing intervention for primary care settings.

Improved Enumeration of Weakly Fluorescent CD4+ T-lymphocytes by Confining Cells in a Spinning Sample Cartridge with a Helical Minichannel

The CD4 (cluster of differentiation 4) counting method is used to measure the number of CD4+ T-lymphocytes per microliter of blood and to evaluate the timing of the initiation of antiretroviral therapy as well as the effectiveness of treatment in patients with human immunodeficiency virus. We developed a three-dimensional helical minichannel-based sample cartridge in which a thread-like microgroove formed in the cylindrical surface and configured a particle-positioning and imaging system equipped with a single DC (direct current) motor that can be controlled by a smartphone application. Confinement and enrichment of CD4 cells within a sharp focal depth along the helical minichannel is accomplished by spinning the cylindrical sample cartridge at high speed before acquiring cell images and thus CD4+ cells with weak fluorescence intensity can be detected even in a channel much deeper than existing two-dimensional flat chambers without an autofocusing module. By detecting more cells in a larger sample volume, the accuracy of the CD4 cell count is improved by a factor of 5.8 with a channel of 500 μm depth and the precision is enhanced by a factor of 1.5 with a coefficient of variation of 2.6%.

Risk factors for late HIV diagnosis in the East of England: evidence from national surveillance data and policy implications

In 2014, 42% of all HIV diagnoses in the East of England were diagnosed late. Individuals unaware of their HIV status will not benefit from lifesaving and infectious-limiting antiretroviral therapy, and they remain at risk of decreased life expectancy and onward transmission of HIV. We sought to identify risk factors associated with late HIV diagnosis in the East of England to inform future HIV testing and prevention strategies relevant to the local population. Data on all HIV infected individuals aged ≥16 years and diagnosed between 2008 and 2014 in the East of England were obtained from the national HIV and AIDS Reporting System. Late diagnosis was defined as CD4 cell count below 350 cells/mm³ within 91 days of diagnosis. Logistic regression investigated risk factors for late HIV diagnosis. A total of 2469 people were included; 1342 (54%) were late HIV diagnoses. In multivariable analysis risk factors for late diagnosis were: age ≥30 years, originating from WHO regions of South-East Asia or Europe (excluding UK), heterosexual orientation and being diagnosed as an inpatient or by a general practitioner. The odds of late diagnosis significantly reduced every year (OR 0.95, 95% CI 0.90-0.99, p = 0.042). Despite this year-on-year reduction continued high rates suggest future HIV testing and prevention strategies should be informed by local regional epidemiology to allow those at greatest risk to be targeted appropriately.