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Daniel D, Hasen H, Sinebo Y, Bereku T, Mekuria M, Jemal Z, Amare M, Habtu Y. Level of knowledge and intention to use oral fluid HIV self-testing and associated factors among Ethiopian health care workers in southern Ethiopia. AIDS Res Ther 2024; 21:56. [PMID: 39182097 PMCID: PMC11344910 DOI: 10.1186/s12981-024-00642-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 08/02/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND The World Health Organization has recommended a new method for HIV self-testing (HIVST) using oral fluid, intending to increase HIV testing rates, and linking individuals to medical care. Healthcare workers are chief health advocates in the community who need adequate knowledge and intention to use the newly recommended HIVST approach. However, studies on awareness and the intention to use oral fluid for HIV self-testing among Ethiopian healthcare workers are limited. Therefore, this study aimed to assess healthcare workers' knowledge of and intentions to use oral fluid for HIV self-testing in Hadiya Zone public hospitals in southern Ethiopia in 2022. METHODS We conducted a facility-based cross-sectional study among a sample of 352 healthcare workers from 1 to 30 June 2022. The data were entered into Epidata version 4.2 and exported to SPSS version 23 for analysis. We used a logistic regression model with a 95% confidence interval for the interpretation of adjusted odds ratios (AORs) with P < 0.05. RESULTS Of the total participants, 40.3% had good knowledge, and 63.1% intended to use oral fluid (HIVST). Approximately 92% of healthcare workers had not received training, and 48.3% had heard about HIVST. Only 12.3% knew about the availability of the kit in hospitals, and 19.9% had ever used HIVST. Being male (AOR = 2.28; 95% CI 1.33-3.95), receiving support for the implementation of HIVST (AOR = 2.07; 95% CI 1.21-3.56), hearing about HIVST (AOR = 5.05; 95% CI 2.89-8.81), having prior experience using HIVST (AOR = 2.94; 95% CI 1.71-5.05), having a spouse or partner (AOR = 2.78; 95% CI 1.14-6.82), and having multiple sexual partners (AOR = 2.76; 95% CI 1.13-6.78) were associated with good knowledge of oral HIVST. Being aged 25-29 years (AOR = 2.54; 95% CI 1.18, 5.41), perceiving the high cost of the HIVST kit (AOR = 0.37; 95% CI 0.16-0.84), and having poor knowledge (AOR = 1.91; 95% CI 1.13-3.23) were significantly associated with the intention to use the oral fluid for HIVST. CONCLUSION This study highlights the need for technical updating training for healthcare workers to increase their knowledge of and intention to use oral fluid for HIVST. Promoting oral fluid HIVST through targeted education, supporting initiatives, and addressing cost concerns related to the testing kit may increase the uptake of oral fluid HIVST among healthcare workers.
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Affiliation(s)
- Dinku Daniel
- Department of Public Health, Hossana College of Health Science, Hossana, Ethiopia
| | - Habtamu Hasen
- Department of Public Health, Hossana College of Health Science, Hossana, Ethiopia.
| | - Yisak Sinebo
- Department of Public Health, Hossana College of Health Science, Hossana, Ethiopia
| | - Tessema Bereku
- Department of Midwifery, Hossana College of Health Science, Hossana, Ethiopia
| | - Melese Mekuria
- Department of Medical Laboratory, Hossana College of Health Science, Hossana, Ethiopia
| | - Zemzem Jemal
- Department of Midwifery, Hossana College of Health Science, Hossana, Ethiopia
| | - Mesganew Amare
- School of Midwifery, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Yitagesu Habtu
- Department of Public Health, Hossana College of Health Science, Hossana, Ethiopia
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HIV Testing Strategies, Types of Tests, and Uptake by Men Who have Sex with Men and Transgender Women: A Systematic Review and Meta-analysis. AIDS Behav 2023; 27:678-707. [PMID: 35984608 DOI: 10.1007/s10461-022-03803-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/01/2022]
Abstract
This systematic review and meta-analysis investigated the effectiveness of strategies and types of tests on HIV testing uptake by men who have sex with men (MSM) and transgender women (TGW), and in reaching PLWH. Articles published up to July 2020 were identified from major electronic databases and grey literature. Data were extracted and assessed for risk of bias. Estimates were pooled using random-effect meta-analysis while heterogeneity was evaluated by Cochran's Q test and I2. This study is registered with PROSPERO (CRD42020192740). Of 6820 titles, 263 studies (n = 67,288 participants) were included. The testing strategies reported in most studies were community- (71.2%) and facility-based (28.8%). Highest uptake, with facility-based testing, occurred and reached more PLWH while with standard laboratory tests, it occurred with the highest HIV prevalence among MSM. However, urine test showed a highest rate of new HIV infection. Multiple test combinations had the highest uptake and reached more PLWH among TGW. Various testing strategies, considering barriers and regional differences, and different test types, need be considered, to increase uptake among MSM and TGW.
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Guerras JM, Hoyos J, de la Fuente L, Donat M, Pulido J, Sordo L, García de Olalla P, Belza MJ. Awareness and Use of HIV Self-Testing Among Men Who Have Sex With Men Remains Low in Spain 2 Years After Its Authorization. Front Public Health 2022; 10:888059. [PMID: 35784245 PMCID: PMC9247638 DOI: 10.3389/fpubh.2022.888059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives HIV self-testing has been available in Spain since 2017 as a diagnostic tool to promote earlier diagnosis. We aimed to assess awareness and previous use of HIV self-testing in a sample of men who have sex with men (MSM) recruited online more than 2 years after its legal authorization in Spain. Methods We analyzed 5,492 MSM recruited between May and July 2020 in gay dating apps/websites and other social networks. We estimated the proportion of participants who were aware of the existence of HIV self-testing and the proportion who reported previous use. To identify factors associated with both outcomes we built two Poisson regression models. Among those who reported previous use we described several aspects related to their last self-test. Results Awareness of HIV self-test was reported by 29.7% and its previous use by 5% of participants. Awareness was independently associated with recruitment in gay dating apps/websites, being ≥40 years old, born in Spain-other European countries, having higher educational level, living in medium-small municipalities and living sex life openly. Independent associations were also found with having received a sexually transmitted infection diagnosis (STI) or an HIV negative test in the last 12 months, and being HIV positive. Use was significantly higher among participants who were paid for sex or diagnosed with an STI in the last 12 months and who received their last HIV test in the preceding year. Self-testing occurred recently, with kits acquired at pharmacies and carried out alone. Conclusion Awareness and use probably have not increased sufficiently in order to make a relevant impact to the promotion of early HIV diagnosis. Additional efforts, mainly focused on less favored MSM, should be made to take better advantage of the possibilities offered by this testing option.
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Affiliation(s)
- Juan-Miguel Guerras
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
| | - Juan Hoyos
- Independent Researcher, Madrid, Spain
- *Correspondence: Juan Hoyos
| | - Luis de la Fuente
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
| | - Marta Donat
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Departamento de epidemiología y bioestadística, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
| | - José Pulido
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Sordo
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia García de Olalla
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - María-José Belza
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Departamento de epidemiología y bioestadística, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
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Guerras JM, Belza MJ, Fuster MJ, de la Fuente L, García de Olalla P, Palma D, García-Pérez JN, Hoyos J. Knowledge and Prior Use of HIV Self-Testing in Madrid and Barcelona among Men Who Have Sex with Men More than One Year after Its Legal Authorization in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031096. [PMID: 35162118 PMCID: PMC8834423 DOI: 10.3390/ijerph19031096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 01/25/2023]
Abstract
This study assessed the knowledge and prior use of HIV self-testing in a sample of men who have sex with men (MSM) recruited in a sexual health clinic and two community-based testing sites in Madrid and Barcelona, >12 months after its legal authorization. Between March 2019 and December 2020, we recruited 2044 MSM. Participants completed a self-administered questionnaire while waiting to be tested for HIV and other STIs. We built two Poisson regression models to assess factors associated with prior knowledge and with use. Among those who had used self-testing in the past we assessed frequency of use and several aspects related to the last testing episode. The proportion of participants that knew about the existence of self-testing and had already used it was of 26.3% and 5.1% respectively. Both, knowledge and use were independently associated with being born in Spain or other western European countries, university education and more recent HIV testing. Additionally, knowledge was associated with older age, having a more favorable economic situation, and not living sexuality in total secrecy. Use was also associated with having received money in exchange for sex. Most (69.5%) reported having self-tested once, 64.8% had self-tested <12 months ago, 63.8% self-tested alone and 71.4% acquired the kit at a pharmacy over the counter. In spite of its authorization and becoming legally available, knowledge and use of HIV self-testing remain low among MSM attending sites specialized in the diagnosis of HIV and other STIs. When designing scale-up strategies, lower levels of knowledge and use in less favored subgroups of MSM need to be factored in.
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Affiliation(s)
- Juan-Miguel Guerras
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.-M.G.); (L.d.l.F.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
| | - María-José Belza
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
| | - María-José Fuster
- Sociedad Española Interdisciplinaria del SIDA, SEISIDA, 28036 Madrid, Spain;
- Departamento de Psicología Social y de las Organizaciones, Universidad Nacional de Educación a Distancia, 28040 Madrid, Spain
| | - Luis de la Fuente
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.-M.G.); (L.d.l.F.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
| | - Patricia García de Olalla
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | - David Palma
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | | | - Juan Hoyos
- Independent Researcher, 28013 Madrid, Spain;
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Hoyos J, Maté T, Guerras JM, Donat M, Agustí C, Kuske M, Fuertes R, Chanos S, Pichon F, Sordo L, Pulido J, Belza MJ. Preference towards HIV Self-Testing above Other Testing Options in a Sample of Men Who Have Sex with Men from Five European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094804. [PMID: 33946300 PMCID: PMC8125199 DOI: 10.3390/ijerph18094804] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/16/2021] [Accepted: 04/27/2021] [Indexed: 12/24/2022]
Abstract
We analyzed men who have sex with men (MSM) from Denmark, Germany, Greece, Portugal and Spain to identify who would choose HIV self-testing as their preferred testing method and assessed their preferred setting to acquire a self-testing kit and to confirm a reactive result. In 2016, we recruited an online sample of 3725 HIV-negative MSM. We used Poisson regression to identify factors associated with choosing self-testing as the preferred testing option. For those choosing it as their preferred option, we assessed the preferred settings to acquire a self-testing kit and to confirm a reactive result. Not being open about one's sexual behaviors with men was associated with choosing self-testing as the preferred option, except in Greece; older age in Greece and Spain; reporting condomless anal intercourses (CAI) in Germany and Portugal; reporting one previous test in Greece; between 2 and 5 in Spain and with having been tested ≥ 12 months ago in Germany, Portugal and Spain. The internet (32.8%) was the preferred place to acquire a self-testing kit and primary care (34.0%) for confirmation purposes. Self-testing was highly valued, especially among individuals who were not open about their sexual behaviors with men. In certain countries, it was also associated with older age, CAI and being undertested.
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Affiliation(s)
- Juan Hoyos
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.H.); (L.S.); (J.P.)
| | - Tomás Maté
- Gerencia de Atención Primaria de Valladolid Este, Gerencia Regional de Salud de Castilla y León (SACYL), 47010 Valladolid, Spain
- Correspondence:
| | - Juan-Miguel Guerras
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.-M.G.); (C.A.); (M.-J.B.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marta Donat
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Cristina Agustí
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.-M.G.); (C.A.); (M.-J.B.)
- Departament de Salut, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Generalitat de Catalunya, 08005 Badalona, Spain
| | | | - Ricardo Fuertes
- GAT-Grupo de Ativistas em Tratamentos, 1000-228 Lisboa, Portugal;
| | | | | | - Luis Sordo
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.H.); (L.S.); (J.P.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.-M.G.); (C.A.); (M.-J.B.)
| | - José Pulido
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.H.); (L.S.); (J.P.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.-M.G.); (C.A.); (M.-J.B.)
| | - María-José Belza
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.-M.G.); (C.A.); (M.-J.B.)
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain;
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Hoyos J, Guerras JM, Maté T, Agustí C, Fernández-López L, de la Fuente L, Belza MJ. Opinions Towards Key Operational Aspects for the Implementation of HIV Self-Testing in Spain: A Comparison between Stakeholders and Potential Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041428. [PMID: 33546500 PMCID: PMC7913712 DOI: 10.3390/ijerph18041428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/18/2021] [Accepted: 01/30/2021] [Indexed: 11/16/2022]
Abstract
We assessed previous knowledge about the existence of HIV self-testing of stakeholders in Spain, as well as their personal position towards this methodology. We also assessed their views on potential users’ (PU) opinions towards several key operational aspects surrounding self-testing, and compared them to those expressed by a sample of PU comprised of men who have sex with men. In 2017, we recruited three types of stakeholders: public health professionals and policy makers (PHPPM) (n = 33), clinical providers (n = 290) and community-based/non-governmental organization (CBO/NGO) workers (n = 55). Data on PU (n = 3537) were collected in 2016. Previous knowledge about the existence of self-testing was higher in stakeholders than in PU, but being in favor was less frequent. PUs’ willingness to pay 25–30 euros for a self-test was higher than that which stakeholders considered. According to clinical providers and PHPPM, pharmacies would be PUs’ preferred place to obtain a self-test, which was in line with PUs’ actual choice. CBO/NGO workers on the other hand thought it would be CBO/NGOs. PHPPM and clinical providers considered primary care as PUs’ preferred setting to confirm a reactive self-test and CBO/NGO chose CBO/NGOs, but PUs preferred an HIV/STI testing service or clinic. Stakeholders’ opinions significantly differed from those of PUs. This divergence needs to be brought up to stakeholders as it could vary their position towards self-testing as well as the actions taken in the implementation of a testing option with the potential of increasing testing frequency.
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Affiliation(s)
- Juan Hoyos
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Juan-Miguel Guerras
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (C.A.); (L.F.-L.); (L.d.l.F.); (M.-J.B.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid 28029, Spain
- Correspondence:
| | - Tomás Maté
- Gerencia de Atención Primaria Valladolid Este, 47010 Valladolid, Spain;
| | - Cristina Agustí
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (C.A.); (L.F.-L.); (L.d.l.F.); (M.-J.B.)
- Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, 08005 Badalona, Spain
| | - Laura Fernández-López
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (C.A.); (L.F.-L.); (L.d.l.F.); (M.-J.B.)
- Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, 08005 Badalona, Spain
| | - Luis de la Fuente
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (C.A.); (L.F.-L.); (L.d.l.F.); (M.-J.B.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - María-José Belza
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (C.A.); (L.F.-L.); (L.d.l.F.); (M.-J.B.)
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Awareness and Attitudes Toward HIV Self-Testing in Northern Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030852. [PMID: 33498211 PMCID: PMC7908521 DOI: 10.3390/ijerph18030852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/15/2021] [Accepted: 01/17/2021] [Indexed: 11/25/2022]
Abstract
Human Immunodeficiency Virus self-testing (HIVST) was recently introduced in Thailand, but little is known about receptivity among its residents. Because Human Immunodeficiency Virus (HIV) testing is a critical component of HIV prevention, it is important to understand how HIVST is perceived among potential users. The purpose of this study was to examine awareness and attitudes toward HIVST among adults in Northern Thailand. A convenience sample of 403 adult residents of the Sanpatong district, Chiang Mai Province, was interviewed using a structured questionnaire in 2019. Awareness of HIVST was low (14%), as was the overall HIVST negative attitude score (6.44; possible range of 0–14). The odds of being aware of HIVST were more than twice as high for those with more education compared to those with less (AOR = 2.29, 95% CI: 1.22–4.30), and roughly half as high for those who expressed HIV stigma compared to those who did not (AOR = 0.49, 95% CI: 0.26–0.91). Holding negative attitudes towards HIVST also was associated with lower education and expressing HIV stigma, but these relationships disappeared in multivariate analysis. Findings may be used by local health organizations to tailor HIVST education efforts.
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Hoyos J, Guerras JM, Koutentakis K, de la Fuente L, Pulido J, Sordo L, Vallejo F, Belza MJ. The incorporation of HIV self-testing as an exclusive option among men who have sex with men in Spain: results of an online cross-sectional study. BMC Public Health 2020; 20:1865. [PMID: 33276743 PMCID: PMC7718697 DOI: 10.1186/s12889-020-09976-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background We assessed to what extent HIV self-testing would be incorporated by men who have sex with men (MSM) with previous testing history as their exclusive testing option and describe what actions they would take in the case of obtaining a reactive self-test. Methods We conducted an online survey among Spanish resident MSM recruited mainly in gay dating apps and analyze 6171 ever tested individuals. We used Poisson regression to estimate factors associated with the incorporation of self-testing as the exclusive testing option. Among those who would incorporate self-testing as their exclusive option, we described actions taken if obtaining a reactive self-test by number of tests in the past. Results Nearly half of the participants (48.3%) were > =35 years old, 84.6% were born in Spain, 57.9% had attained a university degree, 55.1% lived in a municipality of ≤500.000 and 86.4% self-identified as homosexual. For 37.2%, self-testing would become their exclusive testing option. The incorporation of self-testing as the exclusive option increased with age 25–34 (PR:1.1, 95%CI:1.0–1.3), 35–44 (PR:1.3, 95%CI:1.2–1.5), 45–49 (PR:1.5, 95%CI:1.3–1.7) and > 50 (PR:1.5, 95%CI:1.3–1.8) and in those who reported unprotected anal intercourse (PR:1.1, 95%CI:1.0–1.2) or having paid for sex (PR:1.2, 95%CI:1.0–1.3) in the last 12 months. It was also associated with having had < 10 HIV test in the past (2–9 tests (PR:1.3, 95%CI:1.1–1.4); 1 test (PR:1.5, 95%CI:1.3–1.7)), and having been tested ≥2 years (PR:1.4, 95%CI:1.3–1.5) or between 1 and 2 years ago (PR:1.1, 95%CI:1.0–1.2). Of participants who would use self-testing exclusively 76.6% would confirm their result in case of obtaining a reactive self-test and only 6.1% wouldn’t know how to react. Only one individual expressed that he would do nothing at all. Conclusion HIV self-testing could become the exclusive testing option for more than a third of our participants. It was chosen as the exclusive option especially by older, at risk and under-tested MSM. Self-testing strategies need to especially consider the linkage to care process. In this sense, only a small fraction would not know how to react and virtually nobody reported taking no action if obtaining a reactive result. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09976-9.
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Affiliation(s)
- J Hoyos
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
| | - J M Guerras
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain. .,National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain.
| | - K Koutentakis
- National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - L de la Fuente
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain.,National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - J Pulido
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
| | - L Sordo
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
| | - F Vallejo
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain.,Department of Biostatistics and Epidemiology, National School of Health, Carlos III Health Institute, Madrid, Spain
| | - M J Belza
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain.,Department of Biostatistics and Epidemiology, National School of Health, Carlos III Health Institute, Madrid, Spain
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Hoyos J, Maté T, Indave BI, Agustí C, Chanos S, Pichon F, Kuske M, Cigan B, Fuertes R, Ooms L, Stefanescu R, Cabeza de Vaca C, Arranz B, de la Fuente L, Belza MJ. Knowledge, actual and potential use of HIV self-sampling testing kits among MSM recruited in eight European countries. HIV Med 2019; 19 Suppl 1:27-33. [PMID: 29488699 DOI: 10.1111/hiv.12593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/28/2022]
Abstract
AIM To describe the knowledge as well as current and potential use of self-sampling kits among men who have sex with men (MSM) and to analyse their preferred biological sample and result communication method. METHODS We analyse data of MSM of HIV negative or unknown serostatus from an online survey conducted in eight countries (Belgium, Denmark, Germany, Greece, Portugal, Romania, Slovenia and Spain) between April and December 2016. It was advertised mainly in gay dating websites. We conduct a descriptive analysis of the main characteristics of the participants, and present data on indicators of knowledge, use and potential use of HIV self-sampling as well as their preferences regarding blood or saliva sample and face or non-face-to-face result communication by country of residence. RESULTS A total of 8.226 participants of HIV negative or unknown serostatus were included in the analysis. Overall, 25.5% of participants knew about self-sampling (range: 18.8-47.2%) and 1.1% had used it in the past (range: 0.3-8.9%). Potential use was high, with 66.6% of all participants reporting that they would have already used it if available in the past (range: 62.1-82.1%). Most (78.6%) reported that they would prefer using a blood-based kit, and receiving the result of the test through a non-face-to-face-method (70.8%), even in the case of receiving a reactive result. CONCLUSION The high potential use reported by MSM recruited in eight different European countries suggests that self-sampling kits are a highly acceptable testing methodology that could contribute to the promotion of HIV testing in this population.
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Affiliation(s)
- J Hoyos
- CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | - T Maté
- Primary Health Care Management of East Valladolid, Valladolid, Spain
| | - B I Indave
- Institute of Health Carlos III, Centro Nacional de Epidemiología, Madrid, Spain
| | - C Agustí
- CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.,Departament de Salut, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Generalitat de Catalunya, Badalona, Spain
| | - S Chanos
- Checkpoint Athens, Athens, Greece
| | - F Pichon
- AIDS Fondet, Copenhaguen, Denmark
| | - M Kuske
- AIDS Hilfe NRW e.V., Berlin, Germany
| | - B Cigan
- Legebitra, Ljubljana, Slovenia
| | - R Fuertes
- GAT-Grupo de Ativistas em Tratamentos, Lisboa, Portugal
| | - L Ooms
- Institute of Tropical Medicine, Antwerp, Belgium
| | - R Stefanescu
- ARAS-Asociatia Romana Anti-SIDA, Bucharest, Romania
| | - C Cabeza de Vaca
- Institute of Health Carlos III, Escuela Nacional de Sanidad, Madrid, Spain
| | - B Arranz
- Institute of Health Carlos III, Centro Nacional de Epidemiología, Madrid, Spain
| | - L de la Fuente
- CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.,Institute of Health Carlos III, Centro Nacional de Epidemiología, Madrid, Spain
| | - M J Belza
- CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.,Institute of Health Carlos III, Escuela Nacional de Sanidad, Madrid, Spain
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10
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Factors associated with poor linkage to HIV care and related barriers among men who have sex with men. Enferm Infecc Microbiol Clin 2019; 37:521-524. [PMID: 30948138 DOI: 10.1016/j.eimc.2018.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/07/2018] [Accepted: 12/15/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We assessed poor linkage to HIV care in a sample of HIV positive men who have sex with men (MSM) diagnosed in Spain. METHODS From 2012 to 2013 we recruited a sample of MSM mainly through gay-dating websites. Poor linkage to care was defined as receiving the first CD4 count >3 months after HIV diagnosis. We performed a logistic regression analysis to estimate factors associated with poor linkage to care and analyzed the underlying reasons. RESULTS Some 9.4% self-reported poor linkage to care. Those diagnosed in clinical settings other than sexual health clinics or in non-clinical settings presented increased odds of poor linkage to care. The most common reason was being assigned an appointment for first CD4 count >3 months after initial HIV diagnosis. CONCLUSION Poor linkage to care was very low, but for further improvements fast-track referral pathways should be created, especially in contexts outside sexual health clinics.
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11
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Koutentakis K, Hoyos J, Rosales-Statkus ME, Guerras JM, Pulido J, de la Fuente L, Belza MJ. HIV self-testing in Spain: A valuable testing option for men-who-have-sex-with-men who have never tested for HIV. PLoS One 2019; 14:e0210637. [PMID: 30759090 PMCID: PMC6373894 DOI: 10.1371/journal.pone.0210637] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 12/29/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We assessed the capacity of HIV self-testing to promote testing among untested men who have sex with men (MSM) and determined the most benefited subpopulations. METHODS An online questionnaire was disseminated on several gay websites in Spain from September 2012 to April 2013. We used Poisson regression to estimate factors associated with the intention to use self-testing if already available. Among those who reported intention of use, we assessed several aspects related to the testing and linkage to care process by type of barrier reported: low perceived risk (LR), structural barriers (SB) and fear of testing positive (FTP). RESULTS Of 2589 never-tested MSM, 83% would have used self-testing if already available. Intention of use was associated with age ≥30 (adj.PR, 95%CI: 1.05, 1.01-1.10), having had protected (adj.PR, 95%CI: 1.15, 1.02-1.30) or unprotected (adj.PR, 95%CI: 1.21, 1.07-1.37) anal intercourse and reporting FTP (adj.PR, 95%CI: 1.12, 1.05-1.20) or SB to access HIV testing (adj.PR, 95%CI: 1.23, 1.19-1.28). Among those who reported intention of using a self-testi, 78.3% declared it their preferred option (83.8% in the SB group; p<0.001), and 56.8% would always use this testing option (60.9% among the SB group; p = 0.001). In the case of obtaining a positive self-test, 69.3% would seek confirmatory testing, 15.3% would self-test again before taking any decision and 13.0% reported not being sure of what they would do. CONCLUSION HIV self-testing in Spain has the potential of becoming a highly used testing methodology for untested MSM and could represent the gateway to testing especially among older, at risk MSM who report SB or FTP as main barriers to testing.
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Affiliation(s)
| | - Juan Hoyos
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP),Madrid, Spain.,Department of Public and Mother-child health, Faculty of Medicine, Madrid Complutense University, Madrid, Spain
| | - María-Elena Rosales-Statkus
- Carlos III Health Institute, National Center of Epidemiology, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP),Madrid, Spain
| | | | - Jose Pulido
- Department of Public and Mother-child health, Faculty of Medicine, Madrid Complutense University, Madrid, Spain.,Carlos III Health Institute, National School of Health, Department of Health Programs, Madrid, Spain
| | - Luis de la Fuente
- Carlos III Health Institute, National Center of Epidemiology, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP),Madrid, Spain
| | - María-José Belza
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP),Madrid, Spain.,Carlos III Health Institute, National School of Health, Department of Epidemiology and Biostatistics, Madrid, Spain
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12
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Gumede SD, Sibiya MN. Health care users' knowledge, attitudes and perceptions of HIV self-testing at selected gateway clinics at eThekwini district, KwaZulu-Natal province, South Africa. SAHARA J 2018; 15:103-109. [PMID: 30175655 PMCID: PMC6127809 DOI: 10.1080/17290376.2018.1517607] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Progress in promoting knowledge of HIV status has been made globally, but half of all people living with HIV are still unaware of their HIV status. It is argued the new innovative HIV self-testing strategy could increase the uptake of HIV testing among the people. The aim of the study was to assess outpatients' health care user's knowledge, attitudes and perceptions towards HIV self-testing (HIVST) at selected Gateway clinics at eThekwini District, KwaZulu-Natal Province, South Africa. The objectives of the study were to determine health care users' knowledge of HIVST, assess health care users' attitudes and perceptions towards HIVST and establish if there is any relationship between knowledge, attitudes and perceptions of health care users towards HIVST. A quantitative, non-experimental descriptive design was used to determine knowledge, attitudes and perceptions of health care users at three purposefully selected Addington, R. K. Khan and Prince Mshiyeni Memorial Hospital Gateway clinics at eThekwini Health District. A convenience sampling of 442 respondents were sampled from the three study sites. Results of the study revealed that health care users had a reasonable knowledge of HIV self-testing and there were indications that they could use it if it can be made freely available to the public and be properly regulated. Generally, health care users indicated positive attitudes towards HIV self-testing. Nevertheless, issues of lack of pre and post-test counselling, false negative results and sale of unregulated testing kits seemed to be issues of concern that require addressing if HIV self-testing is to be promulgated in South Africa.
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13
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Luo W, Katz DA, Hamilton DT, McKenney J, Jenness SM, Goodreau SM, Stekler JD, Rosenberg ES, Sullivan PS, Cassels S. Development of an Agent-Based Model to Investigate the Impact of HIV Self-Testing Programs on Men Who Have Sex With Men in Atlanta and Seattle. JMIR Public Health Surveill 2018; 4:e58. [PMID: 29959112 PMCID: PMC6045793 DOI: 10.2196/publichealth.9357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/05/2018] [Accepted: 04/24/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the United States HIV epidemic, men who have sex with men (MSM) remain the most profoundly affected group. Prevention science is increasingly being organized around HIV testing as a launch point into an HIV prevention continuum for MSM who are not living with HIV and into an HIV care continuum for MSM who are living with HIV. An increasing HIV testing frequency among MSM might decrease future HIV infections by linking men who are living with HIV to antiretroviral care, resulting in viral suppression. Distributing HIV self-test (HIVST) kits is a strategy aimed at increasing HIV testing. Our previous modeling work suggests that the impact of HIV self-tests on transmission dynamics will depend not only on the frequency of tests and testers' behaviors but also on the epidemiological and testing characteristics of the population. OBJECTIVE The objective of our study was to develop an agent-based model to inform public health strategies for promoting safe and effective HIV self-tests to decrease the HIV incidence among MSM in Atlanta, GA, and Seattle, WA, cities representing profoundly different epidemiological settings. METHODS We adapted and extended a network- and agent-based stochastic simulation model of HIV transmission dynamics that was developed and parameterized to investigate racial disparities in HIV prevalence among MSM in Atlanta. The extension comprised several activities: adding a new set of model parameters for Seattle MSM; adding new parameters for tester types (ie, regular, risk-based, opportunistic-only, or never testers); adding parameters for simplified pre-exposure prophylaxis uptake following negative results for HIV tests; and developing a conceptual framework for the ways in which the provision of HIV self-tests might change testing behaviors. We derived city-specific parameters from previous cohort and cross-sectional studies on MSM in Atlanta and Seattle. Each simulated population comprised 10,000 MSM and targeted HIV prevalences are equivalent to 28% and 11% in Atlanta and Seattle, respectively. RESULTS Previous studies provided sufficient data to estimate the model parameters representing nuanced HIV testing patterns and HIV self-test distribution. We calibrated the models to simulate the epidemics representing Atlanta and Seattle, including matching the expected stable HIV prevalence. The revised model facilitated the estimation of changes in 10-year HIV incidence based on counterfactual scenarios of HIV self-test distribution strategies and their impact on testing behaviors. CONCLUSIONS We demonstrated that the extension of an existing agent-based HIV transmission model was sufficient to simulate the HIV epidemics among MSM in Atlanta and Seattle, to accommodate a more nuanced depiction of HIV testing behaviors than previous models, and to serve as a platform to investigate how HIV self-tests might impact testing and HIV transmission patterns among MSM in Atlanta and Seattle. In our future studies, we will use the model to test how different HIV self-test distribution strategies might affect HIV incidence among MSM.
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Affiliation(s)
- Wei Luo
- Spatial Analysis Research Center, School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, United States
| | - David A Katz
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Deven T Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, United States
| | - Jennie McKenney
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Steven M Goodreau
- Center for Studies in Demography and Ecology, Department of Anthropology, University of Washington, Seattle, WA, United States
| | - Joanne D Stekler
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Eli S Rosenberg
- School of Public Health, Epidemiology and Biostatistics, Rensselaer, Albany, NY, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Susan Cassels
- Department of Geography, University of California Santa Barbara, Santa Barbara, CA, United States
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