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Getaneh Y, Khairunisa S, Husada D, Kuntaman K, Lusida MI. Burden of HIV, HBV and syphilis among children in urban Ethiopia: Community-based cross-sectional study. HIV Med 2023. [PMID: 36709973 DOI: 10.1111/hiv.13457] [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: 11/15/2022] [Accepted: 12/30/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Children have largely been ignored in the fight against sexually transmitted infection (STI). Among children, STI is reported to be a globally emerging public health challenge. We evaluated the burden of HIV, hepatitis B virus (HBV) and syphilis among children (< 15 years old) and its determinants in urban Ethiopia. METHODS For this study, we used data from the Ethiopian Population-based HIV Impact Assessment (EPHIA), collected through a nationally representative, community-based study conducted in Ethiopia from October 2017 to April 2018. We used plasma samples from 4729 children. Moreover, we linked the data and analysed them alongside their respective mothers. Child and maternal HIV status was determined using the national testing algorithm. Plasma samples from children were also tested for syphilis and HBV surface antigen. A descriptive analysis was done followed by bivariable analysis with 95% confidence interval (CI) at a significance level of p < 0.05. We finally evaluated predictors of STIs using regression analysis. RESULTS HIV, HBV and syphilis prevalence rates among urban children in Ethiopia were 0.36%, 1.48% and 0.28%, respectively. Children living in Gambella and Addis Ababa had a 6.41-fold (95% CI: 3.20-9.88) and 4.20-fold (95% CI: 3.24-5.46) higher risk of HIV infection compared with those in Dire Dawa. Children of HIV-positive mothers had a 10.31-fold (95% CI: 3.20-18.19) higher risk of HIV infection, and if those mothers were not taking highly active antiretroviral therapy (HAART), the risk was 7.27 times higher (95% CI: 2.57-12.64). Those who were from HIV-positive mothers with viral load ≥ 1000 copies/mL had a 18.64-fold (95% CI: 6.36-31.24) higher risk of HIV infection and those with a history of breastfeeding had a 3.27-fold (95% CI: 1.11-5.67) higher risk. Children from Addis Ababa had a 3.26-fold (95% CI: 1.64-6.66) higher risk of HBV infection compared with those from Dire Dawa. Moreover, for those from HIV-positive mothers and whose mother was not taking HAART, the risk of HBV transmission was 6.37 (95% CI: 2.20-19.96) and 3.62 (95% CI: 1.27-11.29), respectively. Children living in Gambella, Somali, Afar and Tigray had a 7.21-fold (95% CI: 2.30-18.68), 3.10-fold (95% CI: 1.28-3.74) and 1.32-fold (95% CI: 1.11-3.38) higher risk of acquiring active syphilis compared with those living in Dire Dawa, respectively. Those from HIV-positive mothers also had a 4.22-fold (95% CI: 1.16-8.39) higher risk of acquiring active syphilis. CONCLUSION The burden of HIV, HBV and syphilis was high among children in urban Ethiopia. The key determinants for the high burden of HIV, syphilis and HBV were maternal factors including maternal HIV status and breastfeeding. This might be due to the challenges associated with mother-to-child transmission. Hence, the programme shall focus on the elimination of the triple infections of HIV, syphilis and HBV.
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Affiliation(s)
- Yimam Getaneh
- Doctoral Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Ethiopian Public Health Institute, Addis Ababa, Ethiopia.,Research Center on Global Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - SitiQ Khairunisa
- Research Center on Global Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Dominicus Husada
- Doctoral Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Kuntaman Kuntaman
- Doctoral Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Maria I Lusida
- Doctoral Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Research Center on Global Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
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Chu Q, Zhang X, Lan J, Zhang Q, Wei T, Fu Y, Fan Y. Prevalence and factors associated with late diagnosis among older adults living with HIV in liuzhou, China: 2010-2020. J Med Virol 2023; 95:e28288. [PMID: 36349389 DOI: 10.1002/jmv.28288] [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: 09/05/2022] [Revised: 10/23/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022]
Abstract
This paper aimed to quantify and characterize the prevalence and associated factors for late diagnosis in older adults living with human immunodeficiency virus (HIV) in Liuzhou, China, from 2010 to 2020. The characteristics of older adults living with HIV were described separately in time, space and population. Multivariate logistic regression analysis evaluates the factors influencing late diagnosis in HIV-positive adults ≥ 50 years of age. The majority of older adults living with HIV were over 60 years old, male, and with CD4 counts < 200 cells/μl at diagnosis, with most late diagnoses being more likely to report heterosexual transmission. These two factors may potentially provide a positive influence on late diagnosis: older and CD4 counts < 500 cells/μl. In contrast, females and those with homosexual or other transmission provide a negative. These results suggest that late diagnosis of HIV-positive adults ≥ 50 years of age remains a severe and growing epidemiological issue.
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Affiliation(s)
- Qinshu Chu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, PR China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, PR China
| | - Xinhong Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, PR China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, PR China
| | - Jianguo Lan
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi Zhuang Autonomous Region, PR China
| | - Qi Zhang
- Hefei Center for Disease Control and Prevention, Hefei, Anhui, PR China
| | - Tao Wei
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi Zhuang Autonomous Region, PR China
| | - Yuansheng Fu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, PR China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, PR China
| | - Yinguang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, PR China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, PR China
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Pereira LMS, Dos Santos França E, Costa IB, Lima IT, Freire ABC, de Paula Ramos FL, Monteiro TAF, Macedo O, Sousa RCM, Freitas FB, Costa IB, Vallinoto ACR. Epidemiological risk factors associated with primary infection by Epstein-Barr virus in HIV-1-positive subjects in the Brazilian Amazon region. Sci Rep 2021; 11:18476. [PMID: 34531433 PMCID: PMC8446016 DOI: 10.1038/s41598-021-97707-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022] Open
Abstract
To identify the prevalence and risk factors for primary Epstein–Barr virus (EBV) infection in human immunodeficiency virus (HIV)-1-positive adult treatment-naïve patients between January 2018 and December 2019 in a state of the Brazilian Amazon region. A total of 268 HIV-1 positive patients and 65 blood donors participated in the study. Epidemiological data were obtained from medical records and through a designed questionnaire. EBV infection was screened by the semiquantitative detection of anti-viral capsid antigen (VCA) EBV IgM and IgG, followed by molecular detection of the EBNA-3C gene. The plasma viral loads of HIV-1 and EBV were quantified using a commercial kit. The prevalence of primary coinfection was 7.12%. The associated risk factors were education level, family income, history of illicit drug use and sexually transmitted infections, homosexual contact and condom nonuse. Approximately 58.5% had late initiation of highly active antiretroviral therapy, which influenced the risk of HIV-EBV 1/2 multiple infection (odds ratio (OR): 4.76; 95% CI 1.51–15.04) and symptom development (p = 0.004). HIV viral load was associated with patient age (OR: 2.04; 95% CI 2.01–2.07; p = 0.026) and duration of illicit drug use (OR: 1.57; 95% CI 1.12–2.22; p = 0.0548). EBV viral load was associated with younger age (OR: 0.82; 95% CI 0.79–1.03; p = 0.0579). The replication of both viruses was associated with symptom development (HIV = OR: 2.06; 95% CI 1.22–3.50; p = 0.0073; EBV = OR: 8.81; 95% CI 1–10; p = 0.0447). The prevalence of HIV/EBV coinfection was lower than that observed in other studies, and social vulnerability and promiscuous sexual behavior were associated risk factors. A long time of HIV-1 infection, without therapy, influenced the risk of coinfection and disease progression. The viral loads of both viruses may be associated with some epidemiological aspects of the population.
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Affiliation(s)
| | - Eliane Dos Santos França
- Epstein-Barr Virus Laboratory, Virology Section, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | - Iran Barros Costa
- Epstein-Barr Virus Laboratory, Virology Section, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | - Igor Tenório Lima
- Epstein-Barr Virus Laboratory, Virology Section, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | | | | | | | - Olinda Macedo
- Laboratory of Retroviruses, Evandro Chagas Institute, Virology Section, Ananindeua, Pará, Brazil
| | - Rita Catarina Medeiros Sousa
- Epstein-Barr Virus Laboratory, Virology Section, Evandro Chagas Institute, Ananindeua, Pará, Brazil.,School of Medicine, Federal University of Pará, Belém, Pará, Brazil
| | - Felipe Bonfim Freitas
- Laboratory of Retroviruses, Evandro Chagas Institute, Virology Section, Ananindeua, Pará, Brazil
| | - Igor Brasil Costa
- Epstein-Barr Virus Laboratory, Virology Section, Evandro Chagas Institute, Ananindeua, Pará, Brazil.,Graduate Program in Biology of Infectious and Parasitic Agents, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Antonio Carlos Rosário Vallinoto
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil. .,Graduate Program in Biology of Infectious and Parasitic Agents, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil.
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Gompels M, Michael S, Davies C, Jones T, Macleod J, May M. Trends in HIV testing in the UK primary care setting: a 15-year retrospective cohort study from 2000 to 2015. BMJ Open 2019; 9:e027744. [PMID: 31767577 PMCID: PMC6887055 DOI: 10.1136/bmjopen-2018-027744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000-2015 as part of a wider investigation into reasons for late diagnosis of HIV. DESIGN Retrospective cohort study using the Clinical Practice Research Datalink (CPRD) which is derived from computerised clinical records produced during consultations in primary care. SETTING 404 general practices in England. PARTICIPANTS 5 979 598 adults aged ≥16 years registered between 2000 and 2015 with 45 093 761 person years of observation. OUTCOMES Annual HIV testing rates, proportion of positive tests and prevalence of HIV-infected people recorded in primary care 2000-2015. RESULTS HIV testing in primary care increased from 2000 to 2010, but then declined. Testing was higher in females than in males and in those aged 16-44 years compared with older adults. Rates per 100 000 in women aged 16-44 years were 177 (95% CI 167 to 188); 1309 (95% CI 1282 to 1336); 1789 (95% CI 1757 to 1821) and 839 (95% CI 817 to 862) in 2000, 2005, 2010 and 2015, respectively, and for non-pregnant women: 22.5 (95% CI 19 to 26); 134 (95% CI 125 to 143); 262 (95% CI 250 to 275); 190 (95% CI 179 to 201). For men aged 16-44 years rates were: 26 (95% CI 22 to 29); 107 (95% CI 100 to 115); 196 (95% CI 185 to 206); 137 (95% CI 127 to 146). Over the study period, there were approximately two positive results per 1000 HIV tests. Men were eightfold more likely to test positive than women. The percentage of HIV diagnoses among adults recorded in CPRD may be as low as 55% in London and 67% in the rest of the UK. CONCLUSIONS HIV testing rates in primary care peaked in 2010 and subsequently declined. Access to testing was higher for women despite the prevalence of HIV being higher in men. IMPLICATIONS AND FURTHER RESEARCH NEEDED Opportunities remain in primary care for increasing HIV testing to prevent costly late diagnoses and decrease HIV transmission. Interventions to improve targeting of tests and increase adherence to HIV testing guidelines are needed in primary care.
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Affiliation(s)
- Mark Gompels
- Department of Immunology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Skevi Michael
- Institute of Statistical Science, School of Mathematics, University of Bristol, Bristol, UK
| | - Charlotte Davies
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim Jones
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - John Macleod
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute of Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions, University of Bristol, Bristol, UK
| | - Margaret May
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute of Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions, University of Bristol, Bristol, UK
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Kesten JM, Davies CF, Gompels M, Crofts M, Billing A, May MT, Horwood J. Qualitative evaluation of a pilot educational intervention to increase primary care HIV-testing. BMC FAMILY PRACTICE 2019; 20:74. [PMID: 31151414 PMCID: PMC6544931 DOI: 10.1186/s12875-019-0962-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND UK guidelines recommend a 'routine offer of HIV testing' in primary care where HIV diagnosed prevalence exceeds 2 in 1000. However, current primary care HIV testing rates are low. Efforts to increase primary care HIV testing are needed. To examine how an educational intervention to increase HIV testing in general practice was experienced by healthcare professionals (HCPs) and to understand the perceived impacts on HIV testing. METHOD Qualitative interviews with general practitioners (GPs) and nurses 3-months after receiving an educational intervention developed from an adapted version of the Medical Foundation for HIV and Sexual Health (MEDFASH) HIV Testing In Practice (TIPs) online educational tool which included training on HIV associated clinical indicator conditions, why, who, and how to test. The intervention was delivered in 19 high-HIV prevalence general practices in Bristol. 27 semi-structured interviews were conducted across 13 practices with 16 GPs, 10 nurses and the sexual health clinician who delivered the intervention. Transcripts were analysed thematically informed by Normalisation Process Theory. RESULTS HCPs welcomed the opportunity to update their HIV knowledge through a tailored, interactive session. Post-training, HCPs reported increased awareness of HIV indicator conditions, confidence to offer HIV tests and consideration of HIV tests. Continued testing barriers include perceived lack of opportunity. CONCLUSIONS This qualitative study found that HIV education is perceived as valuable in relation to perceived awareness, confidence, and consideration of HIV testing. However, repetition and support from other strategies are needed to encourage HCPs to offer HIV tests. Future interventions should consider using behaviour change theory to develop a complex intervention that addresses not only HCP capability to offer an HIV test, but also issues of opportunity and motivation.
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Affiliation(s)
- Joanna M. Kesten
- National Institute for Health Research (NIHR) Health Protection Research Unit in Evaluation of Interventions, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
- NIHR Collaborations for Leadership in Applied Health Research and Care West (CLAHRC West), University Hospitals Bristol, NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Charlotte F. Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Mark Gompels
- Department of Immunology, Southmead Hospital, North Bristol NHS Trust, Westbury-on-Trym, Bristol, BS10 5NB UK
| | - Megan Crofts
- Genitourinary medicine, Unity Sexual Health, Bristol Sexual Health Services, Tower Hill, Bristol, BS2 0JD UK
| | - Annette Billing
- Bristol, North Somerset and South Gloucestershire CCG, South Plaza, Marlborough Street, Bristol, BS1 3NX UK
| | - Margaret T. May
- National Institute for Health Research (NIHR) Health Protection Research Unit in Evaluation of Interventions, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jeremy Horwood
- NIHR Collaborations for Leadership in Applied Health Research and Care West (CLAHRC West), University Hospitals Bristol, NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
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Davies CF, Kesten JM, Gompels M, Horwood J, Crofts M, Billing A, Chick C, May MT. Evaluation of an educational intervention to increase HIV-testing in high HIV prevalence general practices: a pilot feasibility stepped-wedged randomised controlled trial. BMC FAMILY PRACTICE 2018; 19:195. [PMID: 30545301 PMCID: PMC6292019 DOI: 10.1186/s12875-018-0880-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/22/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND HIV-infected patients often present to primary care several times with HIV-indicator conditions before diagnosis but the opportunity to test by healthcare professionals (HCPs) is frequently missed. Current HIV testing rates in primary care are low and educational interventions to facilitate HCPs to increase testing and awareness of HIV are needed. METHOD We implemented a pilot feasibility stepped-wedged randomised controlled trial of an educational intervention in high HIV prevalence practices in Bristol. The training delivered to HCPs including General Practitioners (GP) aimed to increase HIV testing and included why, who, and how to test. The intervention was adapted from the Medical Foundation for HIV and Sexual Health HIV Testing in Practice (MEDFASH) educational tool. Questionnaires assessed HCP feedback and perceived impacts of the intervention. HIV testing rates were compared between control and intervention practices using 12 monthly laboratory totals. RESULTS 169 HCPs (from 19 practices) received the educational intervention. 127 (75%) questionnaires were completed. Delivery of the intervention was received positively and was perceived as valuable for increasing awareness, confidence and consideration of testing, with HCPs gaining more awareness of HIV testing guidelines. The main pre-training HIV testing barrier reported by GPs was the patient not considering themselves at risk, whilst for nurses it was a concern about embarrassing or offending the patient. Most HCPs reported the intervention addressed these barriers. The HIV testing rate increased more in the control than in the intervention practices: mean difference 2.6 (95% CI 0.5,4.7) compared with 1.9 (- 0.5,4.3) per 1000 patients, respectively. The number of HIV tests across all practices increased from 1154 in the first 6 months to 1299 in the second 6 months, an annual increase in testing rate of 2.0 (0.7,3.4) from 16.3 to 18.3 per 1000 patients. CONCLUSION There was a small increase in HIV testing rates over the study period, but this could not be attributed to the educational intervention. More effective and sustainable programmes tailored to each practice context are needed to change testing culture and HCP behaviour. Repeated training, supported by additional measures, such as testing prompts, may be needed to influence primary care HIV testing.
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Affiliation(s)
- Charlotte F Davies
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Joanna M Kesten
- Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol, NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, England.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Mark Gompels
- Department of Immunology, Southmead Hospital, North Bristol NHS Trust, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - Jeremy Horwood
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol, NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, England
| | - Megan Crofts
- Genitourinary medicine, Unity Sexual Health, Bristol Sexual Health Services, Tower Hill, Bristol, BS2 0JD, UK.
| | - Annette Billing
- NHS Bristol, North Somerset and South Gloucestershire CCG, South Plaza, Marlborough Street, Bristol, BS1 3NX, UK.
| | - Charlotte Chick
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Margaret T May
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
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Bolsewicz K, Vallely A, Debattista J, Whittaker A, Fitzgerald L. Factors impacting HIV testing: a review--perspectives from Australia, Canada, and the UK. AIDS Care 2014; 27:570-80. [PMID: 25483628 DOI: 10.1080/09540121.2014.986050] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
With the current global focus on strengthening HIV prevention through greater testing and treatment uptake, it is increasingly salient to identify and address barriers to testing. A review of the published, peer-reviewed literature and national reports from Australia, Canada, and the UK (2003-2013) on barriers to HIV testing was conducted to provide new information relevant to Australia and to complement earlier reviews from Canada and the UK. A systematic database search using keywords and a set of inclusion criteria yielded 36 studies (Australia = 13; Canada = 6; and the UK = 17). In addition 17 unpublished reports were included in the review. Our study uses a novel, comprehensive framework to describe barriers to HIV testing, and thus contributes to moving beyond the traditional patient-provider-system categorization. Within that framework, barriers are categorized as either intrapersonal (reported in 15 studies), interpersonal (21), or extrapersonal (16) and conceptualized within wider sociocultural and structural contexts. People's abilities and motivations to test (intrapersonal factors) are influenced by a host of interconnected factors spanning relationship (interpersonal) and broader socioeconomic, political and cultural (extrapersonal) factors. We suggest that the relative effects of interventions targeting barriers to HIV testing at the intrapersonal and interpersonal levels are limited by the extent to which the social determinants of health are addressed. The framework may also lend itself to thinking about the enabling factors for HIV testing, and future research may investigate the application of that framework for strategizing the most effective response. Future studies should also capture the lived experiences of barriers to HIV testing experienced by patients, especially in populations which are hard to reach based on social and geographic distance. Context-specific studies to evaluate the feasibility and effectiveness of various interventions proposed in the literature to address barriers to HIV testing are needed.
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Affiliation(s)
- K Bolsewicz
- a School of Population Health , University of Queensland , Brisbane , QLD , Australia
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Johnson M, Afonina L, Haanyama O. The challenges of testing for HIV in women: experience from the UK and other European countries. Antivir Ther 2013; 18 Suppl 2:19-25. [DOI: 10.3851/imp2637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 10/26/2022]
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Affiliation(s)
- S Duncan
- Specialty Registrar Genitourinary Medicine, The Garden Clinic, Upton Hospital, Slough, UK.
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