Individual- and school-level correlates of HIV testing among secondary school students in Kenya

Awareness of and willingness to use oral HIV self-test kits among Kenyan young adults living in informal urban settlements: a cross-sectional survey

Self-administered HIV testing may be a promising strategy to improve testing in hard-to-reach young adults, provided they are aware of and willing to use oral HIV self-testing (HIVST). This study examined awareness of and willingness to use oral HIVST among 350 high-risk young adults, aged 18-22, living in Kenya's informal urban settlements. Bivariate and multivariate logistic regressions were used to examine differences in HIVST awareness and willingness by demographic and sexual risk factors. Findings showed that most participants were male (56%) and less than 20 years old (60%). Awareness of oral HIVST was low (19%). However, most participants (75%) were willing to use an oral HIV self-test in the future and ask their sex partner(s) to self-test before having sex (77%). Women (OR = 1.80, 95%CI:1.11, 2.92), older participants (aged 20+) (OR = 2.57, 95% CI:1.48, 4.46), and more educated participants (OR = 2.25, 95%CI:1.36, 3.70) were more willing to use HIVST as compared to men, teen-aged, and less educated participants, respectively. Young adults who reported recent engagement in high-risk sexual behaviors, such as unprotected sex, sex while high or drunk, or sex exchange, were significantly less likely to be willing to use an oral HIV self-test kit (OR = 0.34, 95%CI:0.13,0.86). Those with the highest monthly income (OR = 0.47, 95%CI: 0.25, 0.89) were also less willing to use HIVST. More community- and peer-based efforts are needed to highlight the range of benefits of HIVST (i.e., social, clinical, and structural) to appeal to various youth demographics, in addition to addressing concerns relating to HIVST.

Determinants of Voluntary Counseling and Testing Service Uptake Among Adult Sub-Saharan Africans: A Systematic Review and Meta-Analysis

Objective: To examine the major determinants of VCT service uptake among adults in SSA.

Methods: Electronic databases were searched to identify eligible English language publications. Reporting of the study selection procedure was done according to PRISMA and the selected articles were also critically appraised.

Results: We found 8 significant determinants of VCT uptake among adults in SSA, such as less physical access [OR (Odds ratio): 0.77 (95% CI (Confidence interval): 0.62–0.96), p < 0.01], older age [OR: 1.36 (95% CI: 1.08–1.73), p < 0.01], higher education level [OR: 1.60 (95% CI: 1.24–2.05), p < 0.01], high knowledge of HIV and VCT awareness [OR: 1.40 (95% CI: 1.03–1.90), p < 0.01], unprotected sexual practices [OR: 1.75 (95% CI: 1.18–2.58), p < 0.01], discussion on HIV among partners and others [OR: 1.76 (95% CI: 1.10–2.81), p < 0.01], other STIs [OR: 1.40 (95% CI: 1.00–1.98), p < 0.01], and divorced/separated [OR: 1.39 (95% CI: 1.12–1.72), p < 0.01].

Conclusion: This study showed that 8 determinants were significantly associated with VCT service uptake in SSA. Thus, HIV interventions and policy initiatives should be tailored to these determinants to ensure scale-up of VCT service uptake in SSA.

Prevalence of self-reported HIV testing and associated factors among adolescent girls and young women in South Africa: Results from a 2017 nationally representative population-based HIV survey

Objectives

This article estimated the prevalence of self-reported HIV testing and identified associated factors among sexually active adolescent girls and young women (AGYW), aged 15–24 years, in South Africa.

Study design

This is a secondary data analysis of a nationally representative population-based cross-sectional multi-stage cluster survey of households in South Africa conducted in 2017.

Methods

Descriptive statistics were used to describe AGYW characteristics and the multivariable logistic regression model was used to determine factors associated with HIV testing. All analyses were adjusted for unequal sampling probabilities using survey weights.

Results

From the 1360 AGYW analysed (70.3% aged 20–24 years, 89.0% Black African, 95.5% unmarried, 88.7% unemployed), 1154 (estimate 85.8% (95% Confidence Interval (CI): 83.0 to 88.1)) had ever tested for HIV. In adjusted analysis, AGYW who had been pregnant in the past 24 months (adjusted Odds Ratio [aOR] 3.67, 95%CI: 1.68 to 8.02), were older (20–24 years: aOR 3.13, 95%CI: 1.86 to 5.28), or did not use condoms consistently compared to using them every time (almost every time: aOR 3.31, 95%CI: 1.07 to 10.22; sometimes: aOR 2.54, 95%CI: 1.29 to 4.98) had significantly higher odds of ever testing for HIV.

Conclusions

This research identified an unmet need for HIV testing among AGYW and increasing awareness of HIV counselling and testing among AGYW in South Africa is recommended.

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The prevalence of self-reported HIV testing among AGYW in South Africa in 2017 was 85.8% (95% CI: 83.0 to 88.1).

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Being pregnant in the past 24 months is associated with HIV testing among AGYW in South Africa.

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Being older (20–24 years) is associated with HIV testing among AGYW in South Africa.

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Inconsistent use of condoms is associated with HIV testing among AGYW in South Africa.

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There is an unmet need for HIV testing among AGYW in South Africa.

Venue-Based HIV Testing at Sex Work Hotspots to Reach Adolescent Girls and Young Women Living With HIV: A Cross-sectional Study in Mombasa, Kenya

BACKGROUND

We estimated the potential number of newly diagnosed HIV infections among adolescent girls and young women (AGYW) using a venue-based approach to HIV testing at sex work hotspots.

METHODS

We used hotspot enumeration and cross-sectional biobehavioral survey data from the 2015 Transition Study of AGYW aged 14-24 years who frequented hotspots in Mombasa, Kenya. We described the HIV cascade among young females who sell sex (YFSS) (N = 408) versus those young females who do not sell sex (YFNS) (N = 891) and triangulated the potential (100% test acceptance and accuracy) and feasible (accounting for test acceptance and sensitivity) number of AGYW that could be newly diagnosed through hotspot-based HIV rapid testing in Mombasa. We identified the profile of AGYW with an HIV in the past year using generalized linear mixed regression models.

RESULTS

N = 37/365 (10.1%) YFSS and N = 30/828 (3.6%) YFNS were living with HIV, of whom 27.0% (N = 10/37) and 30.0% (N = 9/30) were diagnosed and aware (P = 0.79). Rapid test acceptance was 89.3%, and sensitivity was 80.4%. There were an estimated 15,635 (range: 12,172-19,097) AGYW at hotspots. The potential and feasible number of new diagnosis was 627 (310-1081), and 450 (223-776), respectively. Thus, hotspot-based testing could feasibly reduce the undiagnosed fraction from 71.6% to 20.2%. The profile of AGYW who recently tested was similar among YFSS and YFNS. YFSS were 2-fold more likely to report a recent HIV test after adjusting for other determinants [odds ratio (95% confidence interval): 2.2 (1.5 to 3.1)].

CONCLUSION

Reaching AGYW through hotspot-based HIV testing could fill gaps left by traditional, clinic-based HIV testing services.

Explaining the Education-Health Gradient in Preventing STIs in Andean Peru: Cognitive Executive Functioning, Awareness and Health Knowledge

CONTEXT

Little is known about the pathways mediating the relationship between education and health. It is widely assumed that formal schooling leads to awareness of health risks (e.g., STIs) and, in turn, to adoption of preventive behavior (e.g., condom use); however, evidence supporting this mechanism has been limited.

METHODS

Survey data were collected in 2010 from a sample of 247 adults aged 30-62 living in an isolated Andean district of Peru; these individuals had widely varying exposure to schooling, and their community had recently experienced elevated risks of STIs. Structural equation modeling was used to estimate the degree to which schooling is associated with cognitive resources, STI awareness and sexual health knowledge, and how these jointly are associated with ever-use of condoms.

RESULTS

Thirty-two percent of respondents reported ever-use of condoms. One additional year of schooling was associated with a 2.7-percentage-point increase in the probability of condom use, after adjustment for covariates. The pathway between education and condom use was mediated by cognitive executive functioning (CEF) skills (0.26 standard deviations), STI awareness (0.09) and sexual health knowledge (0.10); CEF skills were associated with condom use both directly and indirectly, through STI awareness and sexual health knowledge, and accounted for two-thirds of the education-condom use gradient.

CONCLUSIONS

The relationship between education and STI prevention may be more complex than is often assumed and is mediated by CEF skills, STI awareness and sexual health knowledge. Studies should examine whether STI prevention interventions are more effective if they enhance cognitive skills used to translate information into protective behaviors.

HIV risk perception and sexual behaviors among female sex workers in Tehran, Iran

Background: An adequate perception of the degree to which one is at risk of having or contracting HIV is necessary for behavioural change and the adoption of safe behaviours. There are limited data regarding HIV risk perceptions among female sex workers in Iran. This study aimed to determine the HIV risk perception status and its association with sexual behaviours among female sex workers in Tehran. Methods: A cross sectional study was conducted among 170 female sex workers in Tehran. Participants were recruited using a combination of snowball, purposeful, and convenience sampling methods. Multiple logistic regression was used to identify adjusted associations between background factors, sexual behaviours, and HIV risk perception. The analysis was conducted by the "logistf" package in the R statistical system. P-value less than .05 was considered as statistically significant. Results: Among the participants, 122 (77%) reported high HIV risk perception. Most female sex workers with high HIV risk perception reported that they did not consistently use condoms (n=120, 98%. Female sex workers with a higher frequency of sex work (AOR=1.18, 95% CI: 1.08, 1.31), inconsistent condom use (AOR=0.15, 95% CI: 0.02, 0.66), a history of HIV testing (AOR=5.1, 95% CI: 1.2, 26.0), and low HIV knowledge (AOR=0.97, 95% CI=0.95, 0.996) were more likely to report high HIV risk perception. Conclusion: Most female sex workers with risky sexual behaviours had a high HIV risk perception. Effective educational programs are suggested to enable female sex workers to correctly assess their own HIV risk and change risk behaviors based on self-assessment of actual risk.

Using multilevel models to evaluate the influence of contextual factors on HIV/AIDS, sexually transmitted infections, and risky sexual behavior in sub-Saharan Africa: a systematic review

PURPOSE

To describe the use of multilevel models (MLMs) in evaluating the influence of contextual factors on HIV/AIDS, sexually transmitted infections (STIs), and risky sexual behavior (RSB) in sub-Saharan Africa.

METHODS

Ten databases were searched through May 29, 2016. Two reviewers completed screening and full-text review. Studies examining the influence of contextual factors on HIV/AIDS, STIs, and RSB and using MLMs for analysis were included. The Quality Assessment Tool for Quantitative Studies was used to evaluate study quality.

RESULTS

A total of 118 studies met inclusion criteria. Seventy-four studies focused on HIV/AIDS-related topics; 46 focused on RSB. No studies related to STIs other than HIV/AIDS met the eligibility criteria. Of five studies examining HIV serostatus and community socioeconomic factors, three found an association between poverty and measures of inequality and increased HIV prevalence. Among studies examining RSB, associations were found with numerous contextual factors, including poverty, education, and gender norms.

CONCLUSIONS

Studies using MLMs indicate that several contextual factors, including community measures of socioeconomic status and educational attainment, are associated with a number of outcomes related to HIV/AIDS and RSB. Future studies using MLMs should focus on contextual-level interventions to strengthen the evidence base for causality.

Modeling Beliefs, Attitudes, and Intentions of Condom Use Among Secondary School Students in Kenya

As in other parts of sub-Saharan Africa, youth in Kenya report low rates of condom use. Although several studies have explored reasons for the low condom use among Kenyan youth, not many have established linkages between lack of use and normative beliefs and attitudes around condoms. Using the Theory of Planned Behavior (TPB), this article examined whether beliefs and attitudes around condoms influenced intentions and actual condom use. Data for the study were restricted to 1453 sexually active youth during the last school break. Path analysis was used to examine the relationship between the TPB constructs and condom use among Kenyan youth. Results indicated a direct relationship between attitudes and condom use for male respondents and an indirect relationship between these two variables for females. Both males and females who expressed greater intentions to use condoms were significantly more likely to report they used condoms consistently. Also, male and female youth with higher perceived behavioral control were significantly more likely to have used condoms consistently. Males with friends who used condoms were significantly more likely to use condoms consistently. The findings suggest the importance of examining young people's attitudes toward condoms-in particular, those deeply rooted in misconceptions that serve to discourage safer sexual behaviors.

A Framework for Health Communication Across the HIV Treatment Continuum

Supplemental Digital Content is Available in the Text.

Background:

As test and treat rolls out, effective interventions are needed to address the determinants of outcomes across the HIV treatment continuum and ensure that people infected with HIV are promptly tested, initiate treatment early, adhere to treatment, and are virally suppressed. Communication approaches offer viable options for promoting relevant behaviors across the continuum.

Conceptual Framework:

This article introduces a conceptual framework, which can guide the development of effective health communication interventions and activities that aim to impact behaviors across the HIV treatment continuum in low- and medium-income countries. The framework includes HIV testing and counseling, linkage to care, retention in pre-antiretroviral therapy and antiretroviral therapy initiation in one single-stage linkage to care and treatment, and adherence for viral suppression. The determinants of behaviors vary across the continuum and include both facilitators and barriers with communication interventions designed to focus on specific determinants presented in the model. At each stage, relevant determinants occur at the various levels of the social–ecological model: intrapersonal, interpersonal, health services, community, and policy. Effective health communication interventions have mainly relied on mHealth, interpersonal communication through service providers and peers, community support groups, and treatment supporters.

Discussion:

The conceptual framework and evidence presented highlight areas across the continuum where health communication can significantly impact treatment outcomes to reach the 90-90-90 goals by strategically addressing key behavioral determinants. As test and treat rolls out, multifaceted health communication approaches will be critical.

Accuracy and determinants of perceived HIV risk among young women in South Africa

BACKGROUND

HIV risk perceptions are a key determinant of HIV testing. The success of efforts to achieve an AIDS-free generation - including reaching the UNAIDS 90-90-90 target - thus depends critically on the content of these perceptions. We examined the accuracy of HIV-risk perceptions and their correlates among young black women in South Africa, a group with one of the highest HIV incidence rates worldwide.

METHODS

We used individual-level longitudinal data from the Cape Area Panel Study (CAPS) from 2005 to 2009 on black African women (20-30 years old in 2009) to assess the association between perceived HIV-risk in 2005 and the probability of testing HIV-positive four years later. We then estimated multivariable logistic regressions using cross-sectional data from the 2009 CAPS wave to assess the relationship between risk perceptions and a wide range of demographic, sexual behaviour and psychosocial covariates of perceived HIV-risk.

RESULTS

We found that the proportion testing HIV-positive in 2009 was almost identical across perceived risk categories in 2005 (no, small, moderate, great) (χ ²  = 1.43, p = 0.85). Consistent with epidemiologic risk factors, the likelihood of reporting moderate or great HIV-risk perceptions was associated with condom-use (aOR: 0.57; 95% CI: 0.36, 0.89; p < 0.01); having ≥3 lifetime partners (aOR: 2.38, 95% CI: 1.53, 3.73; p < 0.01); knowledge of one's partner's HIV status (aOR: 0.67; 95% CI: 0.43, 1.07; p = 0.09); and being in an age-disparate partnerships (aOR: 1.73; 95% CI: 1.09, 2.76; p = 0.02). However, the likelihood of reporting moderate or great self-perceived risk did not vary with sexually transmitted disease history and respondent age, both strong predictors of HIV risk in the study setting. Risk perceptions were associated with stigmatising attitudes (aOR: 0.53; 95% CI: 0.26, 1.09; p = 0.09); prior HIV testing (aOR: 0.21; 95% CI: 0.13, 0.35; p < 0.01); and having heard that male circumcision is protective (aOR: 0.38; 95% CI: 0.22, 0.64; p < 0.01).

CONCLUSIONS

Results indicate that HIV-risk perceptions are inaccurate. Our findings suggest that this inaccuracy stems from HIV-risk perceptions being driven by an incomplete understanding of epidemiological risk and being influenced by a range of psycho-social factors not directly related to sexual behaviour. Consequently, new interventions are needed to align perceived and actual HIV risk.

Factors associated with changes in uptake of HIV testing among young women (aged 15-24) in Tanzania from 2003 to 2012

Background

This study explored the factors associated with changes in HIV testing uptake among young women in Tanzania, based on an analysis of data from the 2003–2004 Tanzania HIV/AIDS Indicator Survey, and the 2007–2008 and 2011–2012 Tanzania HIV/AIDS and Malaria Indicator Surveys.

Methods

The study population consisted of young women aged 15–24 years at the time of the survey. Multivariate decomposition analysis was used to assess factors associated with changes in HIV testing uptake between the 2003–2004 and 2007–2008 surveys, and between the 2007–2008 and 2011–2012 surveys.

Results

HIV testing uptake among the study population was 7 % in 2003–2004, 31 % in 2007–2008 and 40 % in 2011–2012. The time period of the survey had a substantial effect on the uptake of HIV testing independent of other covariates. The characteristics that were significantly associated with a higher chance of HIV testing uptake across the surveys were age (20–24), education level (primary and secondary), ever being married, having at least one lifetime sexual partner, having a sexually transmitted infection or associated symptoms, and receiving antenatal care.

Conclusions

Changes in the study participants’ characteristics in the 2003–2004 survey compared with the 2007–2008 survey were associated with a decrease in HIV testing uptake. Comparing the 2007–2008 survey with the 2011–2012 survey shows that the changes in the participants’ characteristics contributed to 22 % of the changes in HIV testing uptake, while 78 % of the changes were attributed to coefficients.

Electronic supplementary material

The online version of this article (doi:10.1186/s40249-016-0180-3) contains supplementary material, which is available to authorized users.

Perceived Risk of HIV Infection and Associated Factors among Secondary School Students in Wakiso District, Uganda

Introduction. HIV/AIDS remain a major public health problem in Uganda and 4% of individuals aged between 15 and 24 years are living with HIV. Few studies have examined HIV risk perception among adolescents in Uganda.Methods. We conducted a cross-sectional study among 379 secondary school students using multistage sampling techniques. Data were collected using an interviewer-administered questionnaire. Descriptive and logistic regression analyses were conducted.Results. One hundred ninety-one (49.6%) of the respondents perceived themselves to be at risk of contracting HIV, 174 (45.9%) had ever had sex, and 139 (80.4%) had first sexual encounter at 16 years or less. Only 49% of respondents who had sex within 12 months used a condom. Being older than 17 years, knowing someone who died of HIV, early sexual debut, and having ever had sex were associated with perceived risk of contracting HIV. After multivariate analysis, knowledge of someone who died of HIV (Adjusted Odds Ratio (AOR) 16, 95% CI 1.49–171.97) remained statistically significant.Conclusion. Many secondary school students perceived themselves to be at risk of contracting HIV; this perception is associated with knowing someone who died of HIV/AIDS. There is a need to strengthen HIV risk reduction interventions in Wakiso secondary schools.

Predictors of Intention to Use HIV Testing Service Among Sexually Experienced Youth in Thailand

This study examined the predictors of intention to use HIV counseling and testing (HCT) services among those who had never used HCT services in a sample of 2,536 Thai youth in Bangkok (ages 15-24). Web-based questionnaires included assessments of HIV knowledge, HIV testing attitude, AIDS stigma, and youth-friendly HCT (YFHCT) service expectation. More than 80% of the sexually experienced youth had never used HCT services but among this group 74.06% reported having intentions to do so. The significant predictors consisted of favorable expectations of YFHCT services (p < .001), positive attitude toward HIV testing (p < .005), perceived high risk for HIV infection (p < .01), having multiple sex partners while also using condoms consistently (p < .01), willingness to pay (p < .001), and being informed about HCT and knowing service locations (p < .001). Policy makers, as well as health promotion program developers and researchers can use these findings to increase intention and use of HCT services among at-risk youth.

Perceived vulnerability and HIV testing among youth in Cape Town, South Africa

The importance of perceived vulnerability to risk-reducing behaviors, including HIV testing, is fairly established, especially among youth in sub-Saharan Africa. Yet, the majority of studies that examined this important relationship used cross-sectional data that inherently assume that perceived vulnerability does not change. While these studies have been useful, the assumption of perceived vulnerability as time invariant is a major flaw and has largely limited the practical usefulness of this variable in AIDS prevention and programing. Using longitudinal data and applying random-effects logit models, this study makes a major contribution to scholarship by examining if changes in perceived vulnerability associate with a change to test for HIV among 857 young people in Cape Town, South Africa. Results show that female youth who changed their risk perceptions were more likely to also change to test for HIV, but the effects were completely attenuated after controlling for theoretically relevant variables. No significant relationships were observed for males. Also, females who were virgins at wave 2 but had sex between waves were significantly more likely to have changed to test for HIV. Of most importance was that sexual behavior eliminated the effects of change in risk perceptions suggesting that a change in perception may have occurred as a result of changes in sexual behavior. AIDS prevention programs must pay particular attention to helping youth become aware of their vulnerability to HIV risks, especially as these have implications for risk-reducing behaviors, especially for females who are burdened.

Role of community-level factors across the treatment cascade: a critical review

Addressing community-level factors (CLFs) is integral to the ongoing effort to design multilevel, effective, and sustainable interventions to address each element of the HIV/AIDS treatment cascade. This review, the first critical review of this topic, identified 100 articles that (1) assessed CLFs in relation to the HIV/AIDS treatment cascade, (2) had been peer-reviewed, and (3) were based on studies conducted in low- or middle-income countries. Social support and social networks, cultural norms, gender norms, and stigma were the key CLFs associated with treatment and care. This extensive review found only 5 evaluations of interventions designed to affect CLFs, reflecting a major gap in the literature. All were communication interventions designed to create a more positive environment for HIV testing and access to treatment and care, thus pointing to some of the potential extraindividual effects of communication interventions. The qualitative data are rich and vital for understanding the context; yet, more quantitative analysis to provide evidence regarding the distribution of these factors is essential, as only 19 of the studies were quantitative. There is a pressing need to (1) collect community-level data, (2) validate social and gender norm scales, and (3) better use available data regarding social norms, gender norms, and other CLFs. These data could be aggregated at the cluster, neighborhood, or community levels and incorporated into multilevel analysis to help clarify the pathways to enhanced outcomes across the treatment cascade and thereby mitigate HIV sequelae.