Articles tagged as "HIV testing"

August
2
2010

HIV Testing

HIV-1 subtype C-infected individuals maintaining high viral load as potential targets for the "test-and-treat" approach to reduce HIV transmission.

Novitsky V, Wang R, Bussmann H, Lockman S, Baum M, Shapiro R, Thior I, Wester C,  Wester CW, Ogwu A, Asmelash A, Musonda R, Campa A, Moyo S, van Widenfelt E, Mine  M, Moffat C, Mmalane M, Makhema J, Marlink R, Gilbert P, Seage GR 3rd, DeGruttola V, Essex M.  PLoS One. 2010;5:e10148.

The first aim of the study is to assess the distribution of HIV-1 RNA levels in subtype C infection. Among 4,348 drug-naïve HIV-positive individuals participating in clinical studies in Botswana, the median baseline plasma HIV-1 RNA levels differed between the general population cohorts (4.1-4.2 log(10)) and  combination antiretroviral therapy-initiating cohorts (5.1-5.3 log(10)) by about one log(10). The proportion of individuals with high (> or = 50,000 (4.7 log(10)) copies/ml) HIV-1 RNA levels ranged from 24%-28% in the general HIV-positive population cohorts to 65%-83% in  combination antiretroviral therapy-initiating cohorts. The second aim is to estimate the proportion of individuals who maintain high HIV-1 RNA levels for an extended time and the duration of this period. For this analysis, the authors estimate the proportion of individuals who could be identified by repeated 6- vs. 12-month-interval HIV testing, as well as the potential reduction of HIV transmission time that can be achieved by testing and antiretroviral treatment. Longitudinal analysis of 42 seroconverters revealed that 33% (95% CI: 20%-50%) of individuals maintain high HIV-1 RNA levels for at least 180 days post seroconversion and the median duration of high viral load period was 350 (269; 428) days post seroconversion. They found that it would be possible to identify all HIV-infected individuals with viral load > or = 50,000 (4.7 log(10)) copies/ml using repeated six-month-interval HIV testing. Assuming individuals with high viral load initiate combination antiretroviral therapy after being identified, the period of high transmissibility due to high viral load can potentially be reduced by 77% (95% CI: 71%-82%). Therefore, if HIV-infected individuals maintaining high levels of plasma HIV-1 RNA for extended period of time contribute disproportionally to HIV transmission, a modified "test-and-treat" strategy targeting such individuals by repeated HIV testing (followed by initiation of combination antiretroviral therapy) might be a useful public health strategy for mitigating the HIV epidemic in some communities.

For full text access click here:

Editors’ note: Viral load studies in sub-type B infection have shown that for most people the initial peak of viral load resolves to a steady-state setpoint in 4 to 6 months, with higher viral setpoint associated with an increased risk of disease progression and onward HIV transmission. Although we do not know what the threshold for HIV transmission is, it is assumed to be between 10,000 and 100,000 copies/ml, with 50,000 copies/ml used in most studies. This study of over 4000 people with sub-type C infection participating in 7 cohort studies in Botswana found that 24-28% of people in the general population studies and 65-83% in the populations staring on antiretroviral therapy had viral loads over 50,000. In the acute infection cohort, the mean and median duration of high viral load was about 12 months, with around 33% of people maintaining high viral loads. Modelling to determine the optimal testing frequency to identify these individuals and offer them immediate treatment revealed that more HIV transmission could be prevented (77%) with 6-monthly viral load testing than with an annual test. Clearly, people in need of life-prolonging treatment should be prioritised for access to therapy. Thereafter, strategies such as offering treatment to people who are not eligible for treatment based on CD4 count but who are most likely to transmit to others could be considered.

HIV testing
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
  • Web page addresses and e-mail addresses turn into links automatically.

More information about formatting options

August
2
2010

HIV Testing

Couple-oriented prenatal HIV counseling for HIV primary prevention: an acceptability study.

Orne-Gliemann J, Tchendjou PT, Miric M, Gadgil M, Butsashvili M, Eboko F, Perez-Then E, Darak S, Kulkarni S, Kamkamidze G, Balestre E, Desgrees du Lou A, Dabis F. BMC Public Health. 2010;10:197.

A large proportion of the 2.5 million new adult HIV infections that occurred worldwide in 2007 were in stable couples. Feasible and acceptable strategies to improve HIV prevention in a conjugal context are scarce.  In the preparatory phase of the ANRS 12127 Prenahtest multi-site HIV prevention trial, the authors assessed the acceptability of couple-oriented post-test HIV counselling and men's involvement within prenatal care services, among pregnant women, male partners, and health care workers in Cameroon, Dominican Republic, Georgia, and India. Quantitative and qualitative research methods were used:  direct observations of health services; in-depth interviews with women, men, and health care workers; monitoring of the couple-oriented post-test HIV counselling intervention; and exit interviews with couple-oriented post-test HIV counselling participants. In-depth interviews conducted with 92 key informants across the four sites indicated that men rarely participated in antenatal care services, mainly because these are traditionally and programmatically a woman's domain. However men's involvement was reported to be acceptable and needed in order to improve antenatal care and HIV prevention services. Couple-oriented post-test HIV counselling was considered by the respondents to be a feasible and acceptable strategy to actively encourage  men to participate in prenatal HIV counselling and testing and overall in  reproductive health services. One of the keys to men's involvement within prenatal HIV counselling and testing is the better understanding of couple relationships, attitudes, and communication patterns between men and women, in terms of HIV and sexual and reproductive health; this conjugal context should be taken into account in the provision of quality prenatal HIV counselling, which aims at integrated prevention of mother-to-child transmission and primary prevention of HIV.

 

For full text access click here:

Editors’ note: The Prenahtest trial assessing the impact of couple-oriented post-test counselling, underway in 4 low-to-medium HIV prevalence countries, will be completed in 2011. This preparatory study revealed support for the idea of increasing men’s involvement but identified a number of barriers that first must be overcome. These include making antenatal care services more physically and interpersonally receptive to male participation and challenging gender norms to address the social barriers to male involvement. This process can help change the paternalistic, unidirectional nature of relationships between most health care providers and patients which can reveal itself as lectures without opportunities for personalised prevention messages. Testing options for men are limited to sexually transmitted disease clinics, voluntary counselling and testing services, and male circumcision programmes. Couple counselling and testing in the context of pregnancy is an opportunity to increase the testing options for men while decreasing the likelihood of transmission to infants. It is an opportunity that should not to be missed – most men and women living in a serodiscordant couple do not know their status nor that of their partner.

HIV testing
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
March
22
2010

Test and treat

Examining the promise of HIV elimination by 'test and treat' in hyperendemic settings.

Dodd PJ, Garnett GP, Hallett TB. AIDS. 2010 Feb 11. [Epub ahead of print]

It has been suggested that a new strategy for HIV prevention, 'Universal Test and Treat', whereby everyone is tested for HIV once a year and treated immediately with antiretroviral therapy if they are infected, could 'eliminate' the epidemic and reduce antiretroviral therapy costs in the long term. The authors investigated the impact of test-and-treat interventions under a variety of assumptions about the epidemic using a deterministic mathematical model. Their model shows that such an intervention can substantially reduce HIV transmission, but that impact depends crucially on the epidemiological context; in some situations, less aggressive interventions achieve the same results, whereas in others, the proposed intervention reduces HIV by much less. It follows that testing every year and treating immediately is not necessarily the most cost-efficient strategy. Dodd and colleagues also show that a test-and-treat intervention that does not reach full implementation or coverage could, perversely, increase long-term antiretroviral therapy costs. Interventions that prevent new infections through antiretroviral therapy scale-up may hold substantial promise. However, as plans move forward, careful consideration should be given to the nature of the epidemic and the potential for perverse outcomes.

For abstract access click here: 1
Editors’ note: This modelling analysis highlights three important aspects of ‘test and treat’ strategies that require thoughtful consideration. The first is epidemic context and, in particular, the properties of the sex partner network (heterogeneity, concurrency, and mixing) that can influence the impact of a ‘test and treat’ approach. The second is the diminishing returns of yearly testing – this modelling suggests that testing everyone every 3 to 5 years appears most cost-efficient, depending on the epidemic context, life expectancy, and the costs of testing and treatment. The third is the dramatic spiralling in treatment costs that is likely if testing is not frequent enough and treatment coverage is suboptimal. These qualitative insights are helpful and they show that we need more evidence to inform the modelling. There is no doubt that the science underpinning ‘test and treat’ is promising: viral load drops in individuals placed on antiretroviral treatment and reduced transmission in discordant couple studies. Policy makers need the results of clinical trials, such as HPTN 052, and community impact evaluations such as the British Columbia Seek and Treat pilot project and the NIH Test and Treat feasibility assessments in Washington and the Bronx, to inform policy and programming. In the meantime, millions of people in need of treatment now, whether defined by the old under 200 CD4+ count criterion or the new under 350 CD4+ cell count guidelines, will die if we don’t get treatment to them urgently.
HIV testing
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
February
15
2010

HIV testing

Effect of provider-initiated testing and counselling and integration of ART services on access to HIV diagnosis and treatment for children in Lilongwe, Malawi: a pre- post comparison.

Weigel R, Kamthunzi P, Mwansambo C, Phiri S, Kazembe PN. BMC Pediatr. 2009. 9(1):80.

The HIV prevalence in Malawi is 12 % and Kamuzu Central Hospital, in the capital Lilongwe, is the main provider of adult and paediatric HIV services in the central region. The Lighthouse at Kamuzu Central Hospital offers voluntary HIV testing and counselling for adults and children. In June 2004, Lighthouse was the first clinic to provide free antiretroviral treatment in the public sector, but few children accessed the services. In response, provider-initiated HIV testing and counselling and an antiretroviral treatment clinic were introduced at the paediatric department at Kamuzu Central Hospital in Quarter 4 (Q4) 2004. The authors analysed prospectively collected, aggregated data of quarterly reports from Q1 2003 to Q4 2006 from opt-in HIV testing and counselling centre registers, antiretroviral treatment registers and clinic registrations at the antiretroviral treatment clinics of both Lighthouse and the paediatric department. By comparing data of both facilities before (Q1 2003 to Q3 2004), and after the introduction of the services at the paediatric department (Q4 2004 to Q4 2006), they assessed the effect of this intervention on the uptake of HIV services for children at Kamuzu Central Hospital. Overall, 3971 children were tested for HIV, 2428 HIV-infected children were registered for care and 1218 started antiretroviral treatment. Between the two periods, the median (IQR) number of children being tested, registered and starting antiretroviral treatment per quarter rose from 101 (53-109) to 358 (318-440), 56 (50-82) to 226 (192-234) and 18 (8-23) to 139 (115-150), respectively. The median proportion of tested clients per quarter that were children rose from 3.8% (2.7-4.3) to 9.6% (8.8 to 10.0) (p=0.0009) and the proportion of antiretroviral treatment starters that were children rose from 6.9% (4.9-9.3) to 21.1% (19.2-24.2) (p=0.0036). The proportion of registered children and adults starting antiretroviral treatment each quarter increased similarly, from 26% to 53%, and 20% to 52%, respectively. Implementation of provider-initiated HIV testing and counselling and integration of antiretroviral treatment services within the paediatric ward are likely to be the main reasons for improved access to HIV testing and counselling and antiretroviral treatment for children at Kamuzu Central Hospital, and can be recommended to other hospitals with paediatric inpatients in resource limited settings with high HIV prevalence.

For full text access click here: 1

Editors’ note: Even though providers initiated an offer of HIV testing and counselling with the caregivers of only 10% of admitted children at the Kamazu Central Hospital, there was a marked increase in the absolute numbers and proportions of children tested for HIV and started on antiretroviral treatment at this facility, compared to the era of parent/caregiver-initiated voluntary testing and counselling. It is unclear whether this modest increase in provider-initiated testing and counselling made the difference or whether it was the advent of free antiretroviral treatment that changed both client and health worker attitudes towards HIV counselling and testing. In any case, 41% of all children tested at the hospital were tested through the paediatric ward and the yield there was high, providing an additional entry point to antiretroviral treatment for children in Lilongwe.

"It's better not to know": perceived barriers to HIV voluntary counseling and testing among sub-Saharan African migrants in Belgium.

Manirankunda L, Loos J, Alou TA, Colebunders R, Nöstlinger C. AIDS Educ Prev. 2009. 21:582-93.

This study explored perceptions, needs, and barriers of sub-Saharan African migrants in relation to HIV voluntary counselling and testing. Using an inductive qualitative methodological approach, data were obtained from focus group discussions. Results showed that participants were in principle in favour of voluntary counselling and testing. However, they indicated that barriers outweighed advantages. Such barriers included fear of positive test results and its related personal and social consequences, lack of information, lack of preventive health behaviour, denial of HIV risk, and missed opportunities. Limited financial resources were only a concern for some subgroups like young people, asylum seekers, and recent migrants. This study identified multiple and intertwined barriers to voluntary counselling and testing from a community perspective. In order to promote voluntary counselling and testing, interventions such as raising awareness through culturally sensitive education should be adopted at community level. At level of service provision, provider initiated HIV testing including target group tailored counselling should be promoted.

For abstract access click here: 1 

Editors’ note: This first qualitative community-based study of the barriers to uptake of voluntary counselling and testing among sub-Saharan migrants in Belgium found that previously acquired experiences in their countries of origin negatively influenced testing uptake. The images of relatives or friends, who had been ill and died of AIDS, shaped attitudes toward knowledge of serostatus, as did the considerable responsibilities that many recent migrants have toward family and community members back home. Focus group participants indicated that provider-initiated discussions of HIV testing, combined with the testimonies of people living with HIV and in good health on how to live with HIV, would help reduce fears of HIV testing and counselling. Efforts to reduce stigma, increase social support, and increase testing uptake in a culturally sensitive manner will increase the proportion of migrants wanting to learn their HIV status.

HIV testing
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
January
19
2010

HIV testing

Home testing for HIV infection in resource-limited settings.

Ganguli I, Bassett IV, Dong KL, Walensky RP. Curr HIV/AIDS Rep. 2009;6:217-23.

Among an estimated 33 million individuals who are infected with HIV worldwide, only 10% are aware of their status. HIV testing is the cornerstone to preventing further transmission and to caring for those infected, particularly as access to treatment improves in resource-limited settings. However, efforts to expand testing through facilities-based testing have not achieved adequate testing coverage, prompting efforts to reach more individuals through strategies such as home-based HIV testing. Home testing is showing promising early results in some high-prevalence, resource-limited settings. This article reviews the mechanisms and literature to date of this door-to-door approach.

Abstract: 1

Editors’ note: This review contrasts the literature on self-specimen collection and self-testing at home in the United States of America with ‘counsellor-initiated home-based testing’ in high HIV prevalence resource-limited settings. Those most likely to benefit from the latter may be the poor who have the lowest uptake of traditional, facility-based testing and counselling. Home-based testing in low- and middle-income settings may reach couples and families more efficiently than other strategies but individuals and the public will only benefit if there are strong links to effective HIV prevention, medical care, and psychosocial support for those who learn their test result.

Inaccurate diagnosis of HIV-1 group M and O is a key challenge for ongoing universal access to antiretroviral treatment and HIV prevention in Cameroon.

Aghokeng AF, Mpoudi-Ngole E, Dimodi H, Atem-Tambe A, Tongo M, Butel C, Delaporte E, Peeters M. PLoS One. 2009 ;4:e7702.

Increased access to HIV testing is essential in working towards universal access to HIV prevention and treatment in resource-limited countries. The authors evaluated currently used HIV diagnostic tests and algorithms in Cameroon for their ability to correctly identify HIV infections. They estimated sensitivity, specificity, and positive and negative predictive values of 5 rapid/simple tests, of which 3 were used by the national program, and 2 fourth generation ELISAs. The reference panel included 500 locally collected samples; 187 HIV -1 M, 10 HIV-1 O, 259 HIV negative and 44 HIV indeterminate plasmas. None of the 5 rapid assays and only 1 ELISA reached the current WHO/UNAIDS recommendations on performance of HIV tests of at least 99% sensitivity and 98% specificity. Overall, sensitivities ranged between 94.1% and 100%, while specificities were 88.0% to 98.8%. The combination of all assays generated up to 9% of samples with indeterminate HIV status, because they reacted discordantly with at least one of the different tests. Including HIV indeterminate samples in test efficiency calculations significantly decreased specificities to a range from 77.9% to 98.0%. Finally, two rapid assays failed to detect all HIV-1 group O variants tested, with one rapid test detecting only 2 out of 10 group O specimens. In the era of antiretroviral therapy scaling-up in Africa, significant proportions of false positive but also false negative results are still observed with HIV screening tests commonly used in Africa, resulting in inadequate treatment and prevention strategies. Depending on tests or algorithms used, up to 6% of HIV-1 M and 80% of HIV-1 O infected patients in Cameroon do not receive antiretroviral therapy and adequate counselling to prevent further transmission due to low sensitivities. Also, the use of tests with low specificities could imply inclusion of up to 12% HIV negative people in antiretroviral therapy programs and increase budgets in addition to inconveniences caused to patients.

Full text: 1

Editors’ note: False-positive and false-negative HIV test results have negative implications for both individuals and programmes – all efforts must be made to minimise them. The first step is to evaluate assay performance using a serum panel from patients infected with subtypes that are circulating locally and the second step is instituting ongoing quality control. Inadequate sensitivity (ability to correctly identify presence of infection) and specificity (ability to correctly identify lack of infection) mean that infections are missed which can delay treatment or, on the other hand, that people who are not infected believe that they are, with personal and programmatic costs. When test kits are chosen by officials on the basis of lower price rather than performance efficacy, the results can be dire. This article should be essential reading for all national laboratory directors .

HIV testing
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
December
17
2009

HIV testing

Comparing Couples’ and Individual Voluntary Counseling and Testing for HIV at Antenatal Clinics in Tanzania: A Randomized Trial.

Becker S, Mlay R, Schwandt HM, Lyamuya E. AIDS Behav 2009. Sep. [Epub ahead of print]

Voluntary counselling and testing for couples is an important HIV-prevention effort in sub-Saharan Africa where a substantial proportion of HIV transmission occurs within stable partnerships. This study aimed to determine the acceptance and effectiveness of couples voluntary counselling and testing as compared to individual voluntary counselling and testing. 1,521 women attending three antenatal clinics in Dar es Salaam were randomized to receive individual voluntary counsellingduring that visit or couples voluntary counselling with their husbandsat a subsequent visit. The proportion of women receiving test results in the couples voluntary counselling and testing arm was significantly lower than in the individual voluntary counselling and testing arm (39 vs. 71%). HIV prevalence overall was 10%. In a subgroup analysis of HIV-positive women, those who received couples voluntary counselling and testing were more likely to use preventive measures against transmission (90 vs. 60%) and to receive nevirapine for themselves (55 vs. 24%) and their infants (55 vs. 22%) as compared to women randomized to individual voluntary counselling and testing. Uptake of couples voluntary counselling and testing is low in the antenatal clinic setting. Community mobilization and couple-friendly clinics are needed to promote couples voluntary counselling and testing.

For abstract access click here: 1

Editors’ note: In this study, only 16% of the women randomised to the couples voluntary counselling and testing arm were counselled, tested, and shared results together with their husbands/cohabiting partners. This is an opportunity to learn together about HIV transmission, discuss personal and combined risks, and develop a collaborative plan to prevent further transmission, assisted by a professional. Antenatal clinics are clearly either not perceived by men as male-friendly places or not perceived by couples as couple-friendly places. Given that a considerable proportion of HIV transmission in sub-Saharan Africa is occurring within married or cohabiting couples and given that individual testing and counselling addresses only half of the sexual partnership, strategies to create new social norms to increase the acceptability of couple testing and determine the best venues for it are urgently needed.

HIV testing
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
July
13
2009

HIV Testing

Moodley D, Esterhuizen TM, Pather T, Chetty V, Ngaleka L. High HIV incidence during pregnancy: compelling reason for repeat HIV testing. AIDS. 2009 May 18. [Epub ahead of print]

The objective of this study was to determine the incidence of HIV during pregnancy as defined by seroconversion using a repeat HIV rapid testing strategy during late pregnancy. In this cross-sectional study nested in a prevention of mother-to-child transmission program, pregnant women were retested between 36 and 40 weeks of gestation, provided that they had been tested HIV negative at least 3 months prior. Among the 2377 HIV-negative women retested, 1099 (46.2%) and 1278 (53.4%) were tested at urban and rural health facilities, respectively. Seventy-two women (3%) were HIV-positive (679 woman years of exposure) yielding a HIV incidence rate of 10.7/100 woman years [95% confidence interval (CI) 8.2-13.1]. HIV incidence in pregnancy was higher but not statistically significant at the urban facilities (12.4/100 woman years versus 9.1/100 woman years) and at least two-fold higher among the 25-29 and 30-34-year age groups (3.8 and 4.5%, respectively) as compared with the less than 20-year age group (1.9%). Single women were at 2.5 times higher risk of seroconverting during pregnancy (P = 0.017). HIV incidence during pregnancy was four times higher than in the non-pregnant population reported in a recent survey. Public health programs need to continue to reinforce prevention strategies and HIV retesting during pregnancy. The latter also offers an additional opportunity to prevent mother-to-child transmission and further horizontal transmission. Further research is required to understand the cause of primary HIV infection in pregnancy.

Editors’ note: Condom use, multiple sex partners, and the frequency of sexual activity were not significantly different between HIV-negative and seroconverting women in this study, giving support to the idea that hormonal changes affecting either genital mucosa or immune responses may be key. The striking HIV incidence of 10.7 per 100 women-years underscores the importance of counselling and community education about HIV prevention in pregnancy, as has been done for cigarette smoking and alcohol, to protect pregnant women. Repeat HIV testing offers an additional opportunity to prevent mother-to-child and sexual transmission, along with clinical assessment and care for women who seroconvert.

Helleringer S, Kohler HP, Frimpong JA, Mkandawire J. Increasing Uptake of HIV Testing and Counseling Among the Poorest in Sub-Saharan Countries Through Home-Based Service Provision. J Acquir Immune Defic Syndr. 2009 Apr 6. [Epub ahead of print].

Uptake of HIV testing and counselling is lower among members of the poorest households in sub-Saharan countries, thereby creating significant inequalities in access to HIV testing and counselling and possibly antiretroviral treatment. Helleringer and colleagues set out to measure uptake of home-based HIV testing and counselling and estimate HIV prevalence among members of the poorest households in a sub-Saharan population. Residents of 6 villages of Likoma Island ( Malawi) aged 18-35 and their spouses were offered home-based HIV testing and counselling services. Socioeconomic status, HIV testing history, and HIV risk factors were assessed. Differences in uptake of HIV testing and counselling and in HIV infection prevalence between members of households in the lowest income quartile and the rest of the population were estimated using logistic regression. Members of households in the lowest income quartile were significantly less likely to have ever used facility-based HIV testing and counselling services than the rest of the population (odds ratio = 0.60, 95% confidence interval (CI): 0.36 to 0.97). In contrast, they were significantly more likely to use home-based HIV testing and counselling services provided during the study (adjusted odds ratio = 1.70, 95% CI: 1.04 to 2.79). Socioeconomic differences in uptake of home-based HIV testing and counselling were not due to underlying differences in socioeconomic characteristics or HIV risk factors. The prevalence of HIV was significantly lower among members of the poorest households tested during home-based HIV testing and counselling than among the rest of the population (adjusted odds ratio = 0.37, 95% CI: 0.14 to 0.96). HIV testing and counselling uptake was high during a home-based HIV testing and counselling campaign on Likoma Island, particularly among the poorest. Home-based HIV testing and counselling has the potential to significantly reduce existing socioeconomic gradients in HIV testing and counselling uptake and help mitigate the impact of AIDS on the most vulnerable households.

Editors’ note: Less than a quarter of this study population had participated in facility-based HIV testing and counselling but more than 75% accepted to be tested and immediately retrieved their test results at home. HIV prevalence overall was 8%. This is the first study to document the impact that a home-based approach can have in increasing uptake of HIV testing and counselling among young adults in the poorest households. Young women from these households were the least likely to have used facility-based testing and were the second most likely to participate in home-based HIV testing and counselling after their male counterparts. Reaching out to poorer people in their homes can help ensure that access to HIV prevention and treatment services is more equitable.

HIV testing
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
January
15
2009

HIV testing

Obare F, Fleming P, Anglewicz P, Thornton R, Martinson F, Kapatuka A, Poulin M, Watkins S, Kohler HP. Acceptance of repeat population-based voluntary counseling and testing for HIV in rural Malawi. Sex Transm Infect 2008 Oct 16. [Epub ahead of print]

Obare and colleagues set out to examine the acceptance of repeat population-based voluntary counselling and testing for HIV in rural Malawi. Behavioural and biomarker data were collected in 2004 and 2006 from approximately 3,000 adult respondents. In 2004, oral swab specimens were collected and analyzed using enzyme-linked immunosorbent assay (ELISA) and confirmatory Western blot tests while finger-prick rapid testing was done in 2006. The authors use cross-tabulations with chi-square tests and significance tests of proportions to determine the statistical significance of differences in acceptance of voluntary counselling and testing by year, individual characteristics, and HIV risk. First, over 90% of respondents in each round accepted HIV test, despite variations in testing protocols. Second, the percentage of individuals who obtained their test results significantly increased from 67% in 2004 when the results were provided in randomly selected locations several weeks after the specimens were collected, to 98% in 2006 when they were made available immediately within the home. Third, whereas there were significant variations in the socio-demographic and behavioural profiles of those who were successfully contacted for a second HIV test, this was not the case for those who accepted repeat voluntary counselling and testing. This suggests that variations in the success of repeat testing might come from contacting the individuals rather than from accepting the test or knowing the results. Repeat HIV testing at home by trained health care workers from outside the local area, and with either saliva or blood, is almost universally acceptable in rural Malawi, and thus likely to be acceptable in similar contexts.

Editors’ note: Both the distance people must travel to receive their HIV results and the delay between the time of testing and availability of results can reduce the numbers of people who receive their test results. This study reveals persistently high HIV testing acceptance levels when people are offered at-home testing and immediate test results. Reasons for this may include both reduced transport costs and the perception that at-home testing is more confidential than clinic-based testing.

HIV testing
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
January
15
2009

HIV testing

Khumalo-Sakutukwa G, Morin SF, Fritz K, Charlebois ED, Rooyen HV, Chingono A, Modiba P, Mrumbi K, Visrutaratna S, Singh B, Sweat M, Celentano DD, Coates TJ; for the NIMH Project Accept Study Team. Project Accept (HPTN 043): A Community-Based Intervention to Reduce HIV Incidence in Populations at Risk for HIV in Sub-Saharan Africa and Thailand. J Acquir Immune Defic Syndr 2008 Oct 16. [Epub ahead of print]

Changing community norms to increase awareness of HIV status and reduce HIV-related stigma has the potential to reduce the incidence of HIV-1 infection in the developing world. Khumalo-Sakutukwa and colleagues developed and implemented a multilevel intervention providing community-based HIV mobile voluntary counselling and testing, community mobilization, and post test support services. Forty-eight communities in Tanzania, Zimbabwe, South Africa, and Thailand were randomized to receive the intervention or clinic-based standard voluntary counselling and testing, the comparison condition. The authors monitored utilization of community-based HIV mobile voluntary counselling and testing and clinic-based standard voluntary counselling and testing by community of residence at 3 sites, which was used to assess differential uptake. They also developed quality assurance procedures to evaluate staff fidelity to the intervention. In the first year of the study, a 4-fold increase in testing was observed in the intervention versus comparison communities. The authors also found an overall 95% adherence to intervention components. Study outcomes, including prevalence of recent HIV infection and community-level HIV stigma, will be assessed after 3 years of intervention. The provision of mobile services, combined with appropriate support activities, may have significant effects on utilization of voluntary counselling and testing. These findings also provide early support for community mobilisation as a strategy for increasing testing rates.

Editors’ note: Project Accept is the first international community-randomised controlled phase III trial (48 communities in 4 countries) to determine the effects of a multi-level structural intervention with HIV incidence and stigma reduction as primary end points. Its theoretical foundations are diffusion of innovation, tipping point theory, and social action theory. This first report of process data for the first year of the trial shows a significant difference in HIV testing uptake, providing early validation of the intervention’s theoretical model.

HIV testing
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
December
15
2008

HIV testing

Mkwanazi NB, Patel D, Newell ML, Rollins NC, Coutsoudis A, Coovadia HM, Bland RM. Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa. Rapid testing may not improve uptake of HIV testing and same day results in a rural South African community: a cohort study of 12,000 women. PLoS ONE. 2008;3(10):e3501.

Rapid testing of pregnant women aims to increase uptake of HIV testing and results and thus optimize care. Mkwanazi and colleagues report on the acceptability of HIV counselling and testing, and uptake of results, before and after the introduction of rapid testing in this area. HIV counsellors offered counselling and testing to women attending 8 antenatal clinics, prior to enrolment into a study examining infant feeding and postnatal HIV transmission. From August 2001 to April 2003, blood was sent for HIV ELISA testing in line with the Prevention of Mother-to-Child Transmission (PMTCT) programme in the district. From May 2003 to September 2004 women were offered a rapid HIV test as part of the PMTCT programme, but also continued to have ELISA testing for study purposes. Of 12,323 women counselled, 5,879 attended clinic prior to May 2003, and 6,444 after May 2003 when rapid testing was introduced; of whom 4,324 (74.6%) and 4,810 (74.6%) agreed to have an HIV test respectively. Of the 4,810 women who had a rapid HIV test, only 166 (3.4%) requested to receive their results on the same day as testing, the remainder opted to return for results at a later appointment. Women with secondary school education were less likely to agree to testing than those with no education (adjusted odds ratio 0.648, p<0.001), as were women aged 21-35 (adjusted odds ratio 0.762, p<0.001) and >35 years (adjusted odds ratio 0.756, p<0.01) compared to those <20 years. Contrary to other reports, few women who had rapid tests accepted their HIV results the same day. Finding strategies to increase the proportion of pregnant women knowing their HIV results is critical so that appropriate care can be given.

Editors’ note: Rapid HIV testing avoids transportation of samples to laboratories and ensures that women presenting late in pregnancy can receive their results prior to labour and delivery. This study of rapid testing among pregnant women attending clinics that offered HIV testing from 2001 as part of a postnatal transmission study, found little interest in the same-day result that rapid testing allows. Rapid testing had no effect on the proportion of women agreeing to have an HIV test (about 75%). This could be due to women wanting time to consider their personal risks and support networks before accepting results. It is important to respect pregnant women’s abilities and readiness to receive HIV test results. Community mobilisation for stigma reduction and serostatus knowledge may work better than a technological advancement to increase the proportion of women who know their HIV status in pregnancy. Only then will the current unacceptable rates of mother-to-child transmission decrease and will more eligible women get on antiretroviral drugs for their own health.

HIV testing
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.