HIV testing among men in Nigeria: a comparative analysis between young people and adults

Effects of the COVID-19 Pandemic on ART Initiation and Access to HIV Viral Load Monitoring in Adults Living With HIV in West Africa: A Regression Discontinuity Analysis

OBJECTIVES

Efforts to control the COVID-19 pandemic have potentially compromised the availability and/or quality of HIV services. We aimed to assess the pandemic's impact on antiretroviral therapy (ART) initiation and HIV viral load (VL) monitoring in 3 West African countries.

METHODS

We used routinely collected data from 5 clinics contributing to the International epidemiologic Database to Evaluate AIDS collaboration in Burkina Faso, Côte d'Ivoire, and Nigeria. We included ART-naïve adults living with HIV initiating ART from January 1, 2018. We conducted regression discontinuity analysis to estimate changes in the number of ART initiations and VL measures per week, before and during the pandemic period in each country.

RESULTS

In clinics in Burkina Faso and Côte d'Ivoire, ART initiations per week remained constant throughout the studied periods (-0.24 points (p) of ART initiations/week 95% CI: -5.5 to 5.9, -0.9 p, 95% CI: -8.5 to 8.6, respectively), whereas in Nigeria's clinic, they decreased significantly (-6.3 p, 95% CI: -10.8 to -1.7) after the beginning of the pandemic. The volume of VL tests performed decreased significantly in all 3 countries (-17.0 p, 95% CI: -25.3 to -8.6 in Burkina Faso, -118.4 p, 95% CI: -171.1 to -65.8 in Côte d'Ivoire and -169.1 p, 95% CI: -282.6 to -55.6 in Nigeria).

CONCLUSIONS

HIV clinics in two out of three countries in West Africa demonstrated resilience as they successfully maintained access to ART for ALWH despite the challenges imposed by the pandemic. However, VL monitoring was severely disrupted and did not return to prepandemic levels approximately 1 year after the beginning of the pandemic. Continued monitoring of the HIV care continuum in the postpandemic period is essential to mitigate potential enduring effects on ALWH's virological and clinical outcomes.

Examining differentials in HIV transmission risk behaviour and its associated factors among men in Southern African countries

Sub-Saharan Africa (SSA), particularly Southern and East Africa, has the highest AIDS deaths and HIV-infected people in the world. Even though considerable effort has been made over the years to study HIV transmission risk behaviours of different population groups in SSA, there is little evidence of studies that have looked at pooled effects of associated HIV risk factors among men, particularly in Southern Africa. Thus, this study sought to fill this gap in knowledge by investigating the variations in HIV risk behaviours among men in the region. The study analysed cross-sectional data based on the most recent country Demographic and Health Survey (DHS) for six countries, namely Lesotho, Mozambique, Namibia, South Africa, Zambia and Zimbabwe. The study employed multivariate logistic regression models on a pooled dataset and individual country data to examine the relative risk of education and other factors on HIV risk behaviour indicators. It considered: (i) condom use during high risk-sex, (ii) multiple sexual partnerships, and (iii) HIV testing among men aged 15-59 years. Findings show that the proportion of men who engaged in HIV transmission risk behaviour was high in Southern Africa. Two-thirds of men reported non-use of a condom during last sex with most recent partners while 22% engaged in multiple sexual partnerships. The percentage of men who used condoms during sex with most recent partners ranged from 18% in Mozambique to 58% in Namibia. Age, residence, marital status and household wealth status were associated with HIV risk factors in the region. The study has established country variations in terms of how individual factors influence HIV transmission risk behaviour among men. Results show that the level of education was associated with increased use of condoms, only in Zambia and Mozambique. Delay in starting a sexual debut was associated with reduced odds of having multiple sexual partnerships in the region. Suggesting the need to strengthen comprehensive sexuality education among young men in school, to promote social behaviour change during adolescence age. The study presents important results to inform direct health policy, programme and government action to address HIV prevalence in the Southern region of Africa.

Socio-economic and demographic factors associated with never having tested for HIV among sexually active men across the four administrative regions of Uganda

BACKGROUND

HIV testing among men is paramount in the prevention, diagnosis, and treatment of HIV. There is limited literature in understanding the socio-economic and demographic factors associated with never having tested for HIV among sexually active men aged 15 - 54 across the four administrative regions of Uganda. The purpose of this study is to investigate the socio-economic and demographic factors associated with never having tested for HIV among sexually active men aged 15 - 54 across the four administrative regions in the country.

METHODS

The study used a cross-sectional research design to examine factors associated with never having tested for HIV among 4,168 sexually active men (15 - 54 years) across four administrative regions of Uganda using data from 2016 Uganda Demographic and Health Survey (UDHS). Frequency distributions, Pearson chi-square tests, and multivariable logistic regression were used to establish the association between never having tested for HIV among sexually active men (15 - 54 years) and selected independent variables across regions.

RESULTS

About 20% of sexually active men (15 - 54 years) never tested for HIV across regions of the country. The major correlates amidst variability of never testing for HIV among sexually active men across regions were; educational level and marital status. Age, religious status, wealth quintile, worked in the last 12 months, circumcised, and one sexual partner in the last 12 months were only correlates of never having tested for HIV among respondents in particular regions of the country.

CONCLUSION

Findings in the study suggest promotion of male education, and suggest further investigation into the relationship between HIV non-testing among sexually active men (15 - 54 years) and being married across regions of the country. The study also proposes appreciation of regional differences in the outcome of HIV non-testing and suggests that efforts be focused on addressing regional differences in order to attain high HIV testing among sexually active men (15 - 54 years) across regions of Uganda, and thus reduce HIV related morbidity and mortality.

Strategies for enhancing uptake of HIV self-testing among Nigerian youths: a descriptive analysis of the 4YouthByYouth crowdsourcing contest

INTRODUCTION

Youth are often the intended beneficiaries of HIV programs but are rarely involved in program design. Engaging youth in program design is one potential way of identifying promising approaches for HIV service delivery. The purpose of this study is to examine the feasibility of using a crowdsourcing contest to solicit ideas on ways to promote HIV self-testing (HIVST) services among Nigerian youths.

METHODS

From October-November, 2018 Nigerian youth 10-24 years old submitted ideas to a crowdsourcing contest on how to promote HIVST among their peers. Submissions were scored on feasibility, desirability, and impact, with an integer score of 1 (low) to 3 (high) in each domain. The three-domain scores were added to calculate a total score (3-9). The demographic characteristics of contestants were calculated using descriptive statistics.

RESULTS

Nine-hundred and three entries were received, 831 had unique valid responses, and 769 were eligible for scoring. Youth submitted ideas on paper (44.9%), Google Forms (39.4%), WhatsApp (9.6%), and email (6.1%). Participants' ages were 10-14 years (37%), 15-19 years (44%), and 20-24 years (22%).Approximately half were female (51.2%). Mean scores were 1.4/3.0 (SD=0.6) for feasibility, 1.4/3.0 (SD=0.6) for desirability, 1.2/3.0 (SD=0.5) for impact, and 4.0/9.0 (SD=1.5) overall. Eight percent of submissions had an overall score >7. A disproportionate share of these high-quality submissions came from email and Google submissions.

CONCLUSION

The 4 Youth by Youth crowdsourcing contest engaged a broad audience and is a feasible way to elicit potential strategies to distribute HIVST kits to other youth. Several high-quality ideas require further evaluation.

Identifying groups of people with similar sociobehavioural characteristics in Malawi to inform HIV interventions: a latent class analysis

INTRODUCTION

Within many sub-Saharan African countries including Malawi, HIV prevalence varies widely between regions. This variability may be related to the distribution of population groups with specific sociobehavioural characteristics that influence the transmission of HIV and the uptake of prevention. In this study, we intended to identify groups of people in Malawi with similar risk profiles.

METHODS

We used data from the Demographic and Health Survey in Malawi (2015 to 2016), and stratified the analysis by sex. We considered demographic, socio-behavioural and HIV-related variables. Using Latent Class Analysis (LCA), we identified groups of people sharing common sociobehavioural characteristics. The optimal number of classes (groups) was selected based on the Bayesian information criterion. We compared the proportions of individuals belonging to the different groups across the three regions and 28 districts of Malawi.

RESULTS

We found nine groups of women and six groups of men. Most women in the groups with highest risk of being HIV positive were living in female-headed households and were formerly married or in a union. Among men, older men had the highest risk of being HIV positive, followed by young (20 to 25) single men. Generally, low HIV testing uptake correlated with lower risk of having HIV. However, rural adolescent girls had a low probability of being tested (48.7%) despite a relatively high HIV prevalence. Urban districts and the Southern region had a higher percentage of high-prevalence and less tested groups of individuals than other areas.

CONCLUSIONS

LCA is an efficient method to find groups of people sharing common HIV risk profiles, identify particularly vulnerable sub-populations, and plan targeted interventions focusing on these groups. Tailored support, prevention and HIV testing programmes should focus particularly on female household heads, adolescent girls living in rural areas, older married men and young men who have never been married.