Self-reported non-receipt of HIV test results: A silent barrier to HIV epidemic control in Mozambique

Spatial variation of HIV testing and associated factors among pregnant women: a Spatial and multilevel analysis, DHS of sub-Saharan African countries

BACKGROUND

Human Immunodeficiency Virus (HIV) has infected an estimated of more 84 million individuals. Even though Sustainable Development Goal's 3 targets to end HIV/AIDS epidemics by year 2030, and many organizations work to eliminate mother-to-child transmission HIV/AIDS. Despite these efforts, Mother-to-child transmission of HIV continues as a major public health problem in sub-Saharan African countries.

METHODS

To recruit study participants, a two-stage stratified sampling procedure was used in conjunction with the Demographic Health Survey (DHS). A total of 118, 748 women were considered from the most recent DHS data of 33 sub-Saharan African countries. The data management and analysis was done using STATA V.17. ArcGIS version 10.7 and SaTScan version 10.1 software used for spatial analysis and SaTScan analysis, respectively. Multilevel logistic regression analysis was employed to account for the hierarchical nature of the DHS data. Deviance (-2LL) was applied to select the best fitted model.

RESULTS

HIV testing among pregnant women accounts about 87% in this study. The spatial hotspot indicates significantly low HIV testing areas found in Madagascar, Ethiopia, Democratic Republic of Congo, Guinea, Chad, Senegal, Mali, Mauritania, Niger, Burkina Faso and Angola. Age from 25 to 34 years (AOR = 1.82: 95% CI; 1.43, 2.32), being married (AOR = 3.69: 95% CI; 1.33, 10.20), media exposure (AOR = 1.47: 95% CI; 1.15, 1.88), having higher level of education (AOR = 1.83; 95% CI; 1.31, 2.55), richest wealth index (AOR = 6.24: 95% CI; 3.57, 10.90), working (AOR = 2.09: 95% CI; 1.67, 2.63), discriminatory attitude (AOR = 1.91: 95% CI; 1.48, 2.46), high risky sexual behavior (AOR = 3.23: 95% CI; 2.32, 5.74), visiting healthcare facilities (AOR = 1.63: 95% CI; 1.23, 2.16), early sexual initiation (AOR = 1.71: 95% CI; 1.15, 2.56), and community media exposure (AOR = 1.73: 95% CI; 1.10, 2.72), were significant factors associated with HIV testing in pregnant women, as shown from a multi-level analysis.

CONCLUSION

The prevalence of HIV testing among pregnant women was lower than expected by Sustainable Development Goal's 3 targets. Hotspot analysis indicates that most western African countries were areas of low HIV testing. Both individual and community level factors were found to be associated with HIV testing uptake significantly. Therefore, giving special attention for pregnant women in hotspot areas of SSA could increase HIV testing uptake.

Suboptimal Follow-Up on HIV Test Results among Young Men Who Have Sex with Men: A Community-Based Study in Two U.S. Cities

Frequent HIV testing and knowledge of HIV serostatus is the premise before timely access to HIV prevention and treatment services, but a portion of young men who have sex with men (YMSM) do not always follow up on their HIV test results after HIV testing, which is detrimental to the implementation of HIV prevention and care among this subgroup. The comprehensive evaluation of factors associated with inconsistent follow-up on HIV test results may inform relevant interventions to address this critical issue among YMSM. To this end, we conducted a cross-sectional study in Nashville, Tennessee and Buffalo, New York from May 2019 to May 2020 to assess demographic, behavioral, and psychosocial correlates of inconsistent follow-up on HIV test results among YMSM. Of the 347 participants, 27.1% (n = 94) reported inconsistent follow-up on their HIV test results. Multivariable logistic regression showed that inconsistent follow-up on HIV test results was positively associated with condomless receptive anal sex, group sex, recreational drug use before or during sex, internalized homophobia, and stress; while negatively associated with housing stability, social support, and general resilience. Future HIV prevention intervention efforts should target these modifiable determinants to enhance the follow-up on HIV test results among YMSM.

Prevalence and associated factors of HIV testing among reproductive-age women in eastern Africa: multilevel analysis of demographic and health surveys

BACKGROUND

Despite efforts made to reduce the spread of the human immune-deficiency virus (HIV), its testing coverage remains low in low and middle-income countries (LMIC). Besides, information on factors associated with HIV counseling and testing among reproductive-age women is not sufficiently available. Therefore, this study was aimed to determine the pooled prevalence and factors associated with HIV testing among reproductive-age women in eastern Africa.

METHODS

Secondary data analysis was conducted based on the Demographic and Health Surveys (DHS) data conducted in East African countries. We pooled the most recent DHS surveys done in 11 East African countries. A total weighted sample of 183,411 reproductive-age women was included for this study. Both bivariable and multivariable multilevel logistic regression models were fitted. Variables with a p-value ≤0.2 in the bivariable analysis were selected for multivariable analysis. Finally, in the multivariable analysis, variables with a p-value ≤0.05 were considered as significant factors affecting HIV testing.

RESULTS

The pooled prevalence of HIV testing in eastern Africa was 66.92% (95%CI: 66.70, 67.13%). In the multivariable multilevel analysis factors such as the age of respondent, marital status, educational level, HIV knowledge, HIV stigma indicator, risky sexual behavior and women who visit a health facility were positively associated with HIV testing coverage among reproductive-age women. While women from rich and richest households, having multiple sexual partners, being from rural dwellers, late initiation of sex and higher community illiteracy level had a lower chance of being tested for HIV.

CONCLUSION

The pooled prevalence of HIV testing in eastern Africa was higher than most previous studies. Age of respondent, residence, wealth index, marital status, educational level, HIV knowledge, stigma indicator, risky sexual behavior, women who visit a health facility, multiple sexual partnerships, early initiation of sex and community illiteracy level were significantly associated with HIV testing. There should be an integrated strategic plan to give education about methods of HIV transmission and the implication of HIV testing and counseling. So all the stakeholders should have an integrated approach by giving special attention to the factors that hinder HIV testing to increase awareness regarding the benefit of HIV testing and counseling to control the spread of HIV/AIDS.

Patterns of mobility and its impact on retention in care among people living with HIV in the Manhiça District, Mozambique

Introduction

Retention in HIV care is a challenge in Mozambique. Mozambique´s southern provinces have the highest mobility levels of the country. Mobility may result in poorer response to HIV care and treatment initiatives.

Methods

We conducted a cross-sectional survey to explore the impact of mobility on retention for HIV-positive adults on ART presenting to the clinic in December 2017 and January 2018. Survey data were linked to participant clinical records from the HIV care and treatment program. This study took place in Manhiça District, southern Mozambique. We enrolled self-identified migrants (moved outside of Manhiça District ≤12 months prior to survey) and non-migrants, matched by age and sex.

Results

390 HIV-positive adults were included. We found frequent movement: 45% of migrants reported leaving the district 3–5 times over the past 12 months, usually for extended stays. South Africa was the most common destination (71%). Overall, 30% of participants had at least one delay (15–60 days) in ART pick-up and 11% were delayed >60 days, though no significant difference was seen between mobile and non-mobile cohorts. Few migrants accessed care while traveling.

Conclusion

Our population of mobile and non-mobile participants showed frequent lapses in ART pick-up. Mobility could be for extended time periods and HIV care frequently did not continue at the destination. Studies are needed to evaluate the impact of Mozambique´s approach of providing 3-months ART among mobile populations and barriers to care while traveling, as is better education on how and where to access care when traveling.

Ethical Implications of eHealth Tools for Delivering STI/HIV Laboratory Results and Partner Notifications

Purpose of Review

eHealth tools are increasingly utilized for communication with patients. Although efficacious and cost-effective, these tools face several barriers that challenge their ethical use in sexual health. We reviewed literature from the past decade to pick illustrative studies of eHealth tools that deliver results of laboratory tests for sexually transmitted infections, including the human immunodeficiency virus, as well as partner notifications. We describe ethical implications for such technologies.

Recent Findings

Our review found that despite widespread research on the use of eHealth tools in delivering laboratory results and partner notifications, these studies rarely measured or reported on the ethical implications. Such implications can be organized according to the four major principles in bioethics: beneficence, patient autonomy, non-maleficence, and justice. The beneficence of eHealth typically measures efficacy in comparison to existing standards of care. Patient autonomy includes the ability to opt in or out of eHealth tools, right-based principles of consent, and sovereignty over healthcare data. To adhere to the principle of non-maleficence, relevant harms must be identified and measured—such as unintentional disclosure of illness, sexual orientation, or sexual activity. Justice must also be considered to accommodate all users equally, irrespective of their literacy level, with easy-to-use platforms that provide clear messages.

Summary

Based on case studies from this review, we developed a list of recommendations for the ethical development and evaluation of eHealth platforms to deliver STI/HIV results to patients and notifications to partners.

Prevalence and Associated Factors of HIV Testing Among Pregnant Women: A Multilevel Analysis Using the Recent Demographic and Health Survey Data from 11 East African Countries

Aim

In developing countries, particularly in sub-Saharan Africa, the burden of mother to child transmission (MTCT) of HIV is higher. Although the Joint United Nations Programme on HIV/AIDS (UNAIDS) and other organizations are working to eliminate MTCT, a large number of pregnant women are not screened for HIV in most African countries.

Methods

The demographic health survey (DHS) used two-stage stratified sampling technique to select the study participants and we appended the most recent DHS done in the 11 East African countries. A weighted sample of 53, 420 women were included. A multilevel logistic regression analysis was used due to the hierarchical structure of the DHS data. To determine whether or not there was a clustering, the Interclass Correlation Coefficient (ICC) and Median Odds Ratio (MOR) were determined. Model comparison was conducted using deviance (−2LL).

Results

The prevalence of HIV testing among pregnant women was 77.56% [95% CI= 77.20%, 77.91%]. In the Multivariable multi-level analysis, variables such as respondent age, wealth index, marital status, educational level, HIV knowledge, HIV stigma indicator, risky sexual activity, women visiting health care facilities, multiple sexual partnership, early sexual initiation, and awareness about MTCT were the individual-level factors that were associated with HIV testing among pregnant women. While residence and community-level education were the community-level factors that were significantly associated with HIV testing.

Conclusion

The prevalence of HIV testing and counseling among pregnant women was higher compared to the previous report. Respondent age, wealth index, marital status, educational level, HIV knowledge, HIV stigma indicator, risky sexual activity, women visiting health care facilities, multiple sexual partnership, early sexual initiation, residence, community-level education and awareness about MTCT were the significant determinant of HIV testing.

A network-based model to explore the role of testing in the epidemiological control of the COVID-19 pandemic

BACKGROUND

Testing is one of the most effective means to manage the COVID-19 pandemic. However, there is an upper bound on daily testing volume because of limited healthcare staff and working hours, as well as different testing methods, such as random testing and contact-tracking testing. In this study, a network-based epidemic transmission model combined with a testing mechanism was proposed to study the role of testing in epidemic control. The aim of this study was to determine how testing affects the spread of epidemics and the daily testing volume needed to control infectious diseases.

METHODS

We simulated the epidemic spread process on complex networks and introduced testing preferences to describe different testing strategies. Different networks were generated to represent social contact between individuals. An extended susceptible-exposed-infected-recovered (SEIR) epidemic model was adopted to simulate the spread of epidemics in these networks. The model establishes a testing preference of between 0 and 1; the larger the testing preference, the higher the testing priority for people in close contact with confirmed cases.

RESULTS

The numerical simulations revealed that the higher the priority for testing individuals in close contact with confirmed cases, the smaller the infection scale. In addition, the infection peak decreased with an increase in daily testing volume and increased as the testing start time was delayed. We also discovered that when testing and other measures were adopted, the daily testing volume required to keep the infection scale below 5% was reduced by more than 40% even if other measures only reduced individuals' infection probability by 10%. The proposed model was validated using COVID-19 testing data.

CONCLUSIONS

Although testing could effectively inhibit the spread of infectious diseases and epidemics, our results indicated that it requires a huge daily testing volume. Thus, it is highly recommended that testing be adopted in combination with measures such as wearing masks and social distancing to better manage infectious diseases. Our research contributes to understanding the role of testing in epidemic control and provides useful suggestions for the government and individuals in responding to epidemics.