Field-based video pre-test counseling, oral testing, and telephonic post-test counseling: implementation of an HIV field testing package among high-risk Indian men

HIV Testing Strategies, Types of Tests, and Uptake by Men Who have Sex with Men and Transgender Women: A Systematic Review and Meta-analysis

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.

Providing HIV testing in men who have sex with men through a gay social networking app in China: A qualitative interview study with multisectoral service providers

Objective

We explored the feasibility of app-based HIV testing services (AHTS) among men who have sex with men (MSM) according to the perspectives of testing service providers.

Methods

Twenty-one current or previous AHTS providers participated in a semi-structured interview which explored the facilitators and barriers to AHTS. Ten participants originating from the Center for Disease Control and Prevention (CDC) and 11 from the non-governmental organization (NGO) in Shijiazhuang, China took part in this study. Interviews was transcribed verbatim, and the socioecological model (SEM) was applied to thematic analysis.

Results

Twenty-one participants from AHTS services commented on the integration of online appointment schedules into HIV testing services. AHTS was deemed a convenient and efficient method for MSM and service providers to choose their preferred location and times. Moreover, it allowed for important HIV-related information to be accessed online and targeted toward at-risk individuals. Participants thought MSM may feel unsure about personal information security being stored within a privatized app and was considered a barrier to AHTS's usability. As such, they believed establishing a government-led national online platform for AHTS would allow for greater trust from MSM, rather than a social media app.

Conclusion

By linking booking services to an online platform, AHTS was deemed a convenient and efficient method for HIV testing services, especially for young MSM who are familiar with smartphone applications. To improve the use of these services, AHTS apps should focus on ensuring the confidentiality of personal information and internet security to build trust between MSM and service providers.

Methodologies of Stigma-Related Research Amongst Men Who Have Sex With Men (MSM) and Transgender People in Asia and the Pacific Low/Middle Income Countries (LMICs): A Scoping Review

Much stigma-related research focuses on marginalized populations, including men who have sex with men (MSM) and transgender people. The importance of research in this area is widely recognized, however methodologies and measures vary between studies. This scoping review will collate existing information about how stigma-related research has been conducted in low/middle income countries (LMICs) within the Asia Pacific region, and will compare research designs, sampling frameworks, and measures. Strengths and limitations of these studies will inform recommendations for future stigma-related health research. A methodological framework for scoping studies was applied. Searches of Psych INFO, Scopus, ProQuest, Global Health and PubMed were used to identify articles. Stigma-related research amongst MSM and transgender communities, published between 2010 and 2019 in LMICs within the Asia Pacific region were included. A total of 129 articles based on 123 different studies were included. Of the 129 articles 51.19% (n = 66) were quantitative; 44.96% (n = 57) were qualitative and 3.88% (n = 5) were mixed methods studies. The majority of studies (n = 57; 86.36%) implemented a cross sectional survey. In-depth interviews (n = 20, 34.48%) were also common. Only 3.88% of studies utilized mixed-methods design. Non-probabilistic and probabilistic sampling methods were employed in 99.22 and 0.78% of studies respectively. The most common measures used in quantitative studies were the Center for Epidemiological Study on Depression (CES-D) (n = 18) and the Self Stigma Scale (SSS) (n = 6). Strengths and limitations proposed by researchers included in this review are summarized as lesson learnt and best practices in stigma-related research.

Community HIV Screening Among MSM in Three Indonesian Cities

BACKGROUND

Indonesia lags behind its peers with regard to ART coverage of PLHIV. Insufficient HIV testing among MSM and other key affected populations remains a barrier to increasing ART coverage.

OBJECTIVE

This report presents the results of the first government-endorsed implementation research study of a community screening approach to increasing the rate of HIV testing among MSM in three cities.

METHODS

All new MSM outreach contacts meeting eligibility criteria during March-June 2017 were included in the study. HIV testing at a government health facility, which is required to qualify for government-supported ART, was advised for all new contacts. Men refusing formal testing were offered an HIV screening test in a community setting using a saliva-based rapid test and advised to get a confirmatory test at a health facility. All outreach contacts and testing activities were recorded on individual client records.

RESULTS

Of 1,149 eligible MSM, 27% were willing to be referred to receive HIV testing at a health facility, among which 83% were confirmed to have been tested. Of the 838 study subjects refusing health facility testing, 38% accepted community screening. The screening positivity rate was 14.8%. Only 38% of men with reactive screening tests received a confirmatory test at a health facility, along with 8% of those with non-reactive tests.

CONCLUSION

While community screening resulted in more MSM knowing their HIV status, reluctance to avail government health facility-based services, or indeed to be tested at all, must be addressed if community screening is to accelerate progress in getting HIV-positive MSM onto treatment.

Strategies to Increase HIV Testing Among MSM: A Synthesis of the Literature

More than 30 years into the HIV epidemic, men who have sex with men (MSM) continue to be disproportionately impacted. It is estimated that worldwide nearly half of MSM infected with HIV are unaware of their status, making HIV testing along with early linkage to care crucial to HIV prevention efforts. However, there remain significant barriers to HIV testing among MSM, due largely to complex issues of layered stigma that deter MSM from accessing traditional, clinic-based testing. We conducted a review and synthesis of the literature on strategies to increase uptake of HIV testing among MSM. We found that social network-based strategies, community-based testing, HIV self-testing, and modifications to the traditional clinic-based model can effectively reach a subset of MSM, but success was often context-specific and there are significant gaps in evidence. We provide recommendations for increasing HIV testing rates and status awareness among MSM.

Why individuals fail to collect HIV-test results: an exploratory study at a testing and counseling center in Mexico City

Objective

To identify the characteristics of clients at an HIV clinic in Mexico City who fail to collect their HIV test results and to explore the reasons for non-collection.

Methods

This was an exploratory, cross-sectional study that used 2016 program data from the HIV Testing and Counseling Center in Mexico City. Clients with a negative HIV-test result in 2016 were classified as collectors or non-collectors, and their sociodemographic and behavioral characteristics were compared by multivariate logistic regression. A telephone survey was conducted with individuals who failed to return for their results.

Results

In 2016, a total of 729 individuals obtained an HIV negative test result at the Center. Of these, 40% (n = 299) failed to collect results. In multivariate analysis, having a test requested by a physician, instead of by the individual, was the main variable associated with non-collection. The main reasons reported for not collecting were: unawareness of the collection process (23.6%, n = 21), already knowing the result (22.5%, n = 20), and scheduling difficulties (13.5%, n = 12). In all, 35% of clients were reached by telephone and 50% then returned to collect results.

Conclusion

Modifications to the result-delivery system are needed to increase results collection. Improving communication with clients on the collection process and with physicians that request HIV testing could be viable strategies. Alternative ways of delivering results and using rapid HIV are other possible solutions, as long as risk reduction counseling and intervention are still effectively offered.

Point of care HIV testing with oral fluid among returnee migrants in a rural area of Bangladesh

Objectives

To determine HIV prevalence and assess the acceptability of HIV testing using oral fluid as a point of care (PoC) test method among returnee migrants in a rural area of Bangladesh.

Design

A cross-sectional study.

Methods

Matlab is a rural area southeast of Dhaka where icddr,b hosts a health and demographic surveillance system covering 225 826 people of whom 934 are returnee migrants. The sample size of 304 was proportionately distributed among randomly selected households. HIV antibodies in oral fluid were tested using OraQuick Rapid HIV 1/2 antibody test. To understand reasons of acceptability a short questionnaire was applied and 32 in-depth interviews were conducted.

Results

Of 304 returnee migrants approached, 97.4% accepted the test. The prevalence of HIV was 0.3% without a confirmatory blood test. Reasons for acceptance included easy accessibility of the test at the door-step which saved resources (i.e., time and money), comfortable test-procedure without any pain and fear, and receiving quick results with confidentiality. Some described knowing HIV status as a way to ‘get certified’ (of sexual fidelity) and to confront a prevailing silent stigma against migrants. Acceptability was moreover found to be grounded in icddr,b's institutional reputation and its close relationship with the local community.

Conclusions

The PoC oral fluid test for HIV has shown for the first time that assessment of HIV prevalence in rural-based returnee migrants is possible. Findings also suggest that PoC oral fluid test has the potential of increasing accessibility to HIV testing as it was found to be highly acceptable.

A digital network approach to infer sex behavior in emerging HIV epidemics

Purpose

Improve the ability to infer sex behaviors more accurately using network data.

Methods

A hybrid network analytic approach was utilized to integrate: (1) the plurality of reports from others tied to individual(s) of interest; and (2) structural features of the network generated from those ties. Network data was generated from digitally extracted cell-phone contact lists of a purposeful sample of 241 high-risk men in India. These data were integrated with interview responses to describe the corresponding individuals in the contact lists and the ties between them. HIV serostatus was collected for each respondent and served as an internal validation of the model’s predictions of sex behavior.

Results

We found that network-based model predictions of sex behavior and self-reported sex behavior had limited correlation (54% agreement). Additionally, when respondent sex behaviors were re-classified to network model predictions from self-reported data, there was a 30.7% decrease in HIV seroprevalence among groups of men with lower risk behavior, which is consistent with HIV transmission biology.

Conclusion

Combining the relative completeness and objectivity of digital network data with the substantive details of classical interview and HIV biomarker data permitted new analyses and insights into the accuracy of self-reported sex behavior.

Willingness to use the oral fluid HIV rapid test among men who have sex with men in Beijing, China

Background

Early detection of HIV infection enables timely care and treatment. However, many men who have sex with men (MSM) remain unaware of their HIV status because they do not or are unable to access HIV testing services. Oral fluid HIV rapid tests have the potential to increase HIV testing. This study is the first to evaluate willingness to use the oral fluid test among MSM in China.

Methods

A cross-sectional study was conducted in Beijing from July to October, 2012. Data were collected by self-administered questionnaires.

Results

Of 262 who participated in the survey, 223(85.1%) reported that they were willing to use the oral fluid HIV rapid test. Willingness to use the oral fluid test was associated with higher education (adjusted odds ratio (AOR): 2.40, 95% confidence interval (CI): 1.13–5.10), lack of unprotected anal intercourse (UAI) with male partners in the past one month (AOR: 2.38; 95% 95%CI: 1.15–4.95), having taken more than 4 HIV tests (AOR: 3.54; 95%CI:1.52–8.28), and having ever heard of the oral fluid HIV rapid test from gay friends or gay organizations (AOR: 3.24, 95%CI: 1.40–7.51). Among those who expressed willingness to use the oral fluid HIV rapid test, the median amount of money they were willing to pay was 8 dollars. Among the 39 participants who were unwilling to use the oral fluid test, 79.5% (31/39) expressed concerns about the accuracy of the oral fluid HIV rapid test results and 17.9%(7/39) reported that they were not familiar with the oral fluid test and did not know how to use such a test.

Conclusions

A high proportion of MSM in Beijing appear to be willing to use the oral fluid HIV rapid test. Appropriate cost and education measures could help improve acceptance of the oral fluid test.