Implementation of Rapid HIV & HCV Testing Within Harm Reduction Programs for People Who Inject Drugs

Including HCV and HIV rapid tests in harm reduction programmes (HRP) for people who inject drugs (PWID) can increase detection of these infections in high-risk populations who do not seek conventional health care.

AIMS:

To assess acceptability and feasibility of rapid HIV and HCV tests in HRP; to identify HIV and HCV prevalence rates in HRP; to identify the percentage of PWID with a reactive test that attend hospital for confirmation and follow-up. Rapid oral tests for HCV and HIV were offered to users of 13 HRP from both mobile units and facility-based centres. 

A total of 172 HCV and 198 HIV tests were performed, with a refusal rate of 1.7% and 10.4%, respectively. Injectors made up 64.9% of all drug users and 35.1% did not inject drugs. Overall, 20.3% of HCV tests and 2.5% of HIV test were reactive. Only 24 of the 35 reactive HCV could be confirmed (68.6%) and one was false-negative. Of the five HIV reactive cases, only two could be confirmed (40%) with 1 false-positive case.

 Acceptability of rapid HIV and HCV tests among HRP users was high. The usefulness of oral rapid tests in HRP has been demonstrated, especially in mobile HRP.

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By:  Fernàndez-López L1,2,3, Folch C1,2,3, Majó X4, Gasulla L4, Casabona J1,2,3,5.

• 1 Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT) , Institut Catala d'Oncologia (ICO), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya , Badalona , Spain.
• 2 CIBER Epidemiologia y Salud Pública (CIBERESP) , Madrid , Spain.
• 3 Fundació Institut d'Investigacio Germans Trias i Pujol (IGTP) , Badalona , Spain.
• 4 Subdirecció General de Drogodependències , Agència de Salut Pública de Catalunya , Barcelona , Spain.
• 5 Departament de Pediatria, d'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica , Univ Autonoma Barcelona , Badalona , Spain. 
• AIDS Care. 2016 Mar 23:1-5. 

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The Rapid HIV Test in Spanish Pharmacies: A Novel Program to Reach Heterosexual Men?

OBJECTIVES:

Spain has been a pioneer in the implementation of rapid HIV testing programmes in pharmacies to increase access to testing. However, no formal evaluation of the effectiveness of these programmes has been carried out to date. Our aim was to evaluate the ability of a novel in-pharmacy rapid HIV testing programme to promote diagnosis and reach vulnerable populations.

METHODS:

Between 2011 and 2012, 2168 people underwent testing in 16 urban pharmacies in 10 cities of a Spanish region with a low prevalence of HIV infection. The main outcomes of the programme were compared with those of the regional surveillance system for new HIV diagnoses (RHSS-CyL).

RESULTS:

Overall, 52.8% of those tested were heterosexual men, 15.8% were men who have sex with men (MSM) and 25.3% were women. Nine per cent were immigrants and 41.9% were < 30 years old. In total, 59.5% of the heterosexual men, 44.6% of the MSM and 65.3% of the women were previously untested. There were 23 positive results, representing 6% of all new regional diagnoses in 2011. The global prevalence was 1.1% (95% confidence interval 0.6-1.5%) and the prevalence in MSM was 3.8%. Of the reactive results, 60.9% were in MSM, 34.8% in heterosexual men and only 4.3% in women, vs. 35.4%, 37.5% and 15.0%, respectively, reported by the RHSS-CyL. The mean age of those testing positive was 32.7 years vs. 38.7 years in the RHSS-CyL. Fifty per cent of MSM and 75% of heterosexual men testing positive were previously untested.

CONCLUSIONS:

In Spain, this is the first programme not targeted at the most at-risk populations, and has been shown to be effective in reaching and diagnosing heterosexual men, who are the group most affected by delayed diagnoses. Heterosexual men accounted for over half of those tested and a third of those diagnosed, and most of them were previously untested. Young and previously untested MSM also greatly benefitted from the programme.

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By:  Fernández-Balbuena S1,2, Marcos H3, Pérez-Rubio A3, Hoyos J1,2, Belza MJ2,4, de la Fuente L1,2.

• 1National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain.
• 2CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
• 3Epidemiological Surveillance Service, Public Health Directorate, Regional Ministry of Health of Castilla and León, Valladolid, Spain.
• 4National School of Health, Carlos III Health Institute, Madrid, Spain. 
• HIV Med. 2015 Jul;16(6):362-9. doi: 10.1111/hiv.12224. Epub 2015 Feb 17.

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Implementation of Fast Tests for Syphilis and HIV in Prenatal Care in Fortaleza - Ceará

OBJECTIVE:

to describe the implementation of the Fast Test (FT) of syphilis and HIV in prenatal care in primary healthcare units in Fortaleza, Ceará.

METHOD:

a descriptive study with a quantitative approach. There were training supervisions carried out in 24 units between May and August 2014, and the inclusion criterion was to have at least one trained professional.

RESULTS:

the physical space, the availability, validity and the performance of FT in prenatal were analyzed. The data were presented in simple frequency tables. It was identified adequate space in 79.2% of the units, availability of FT in 62.5%, performing the tests in 37.5%, and of these, 55.6% doing these procedures in routine prenatal care.

CONCLUSION:

the primary units have difficulties in implementing FT in syphilis and HIV in the prenatal routine. This activity is seen as an effective strategy to reduce vertical transmission of these infections.

Aspects related to physical space to perform the Fast Test in primary health care units, Fortaleza, Ceará, Brazil, 2014 

Variables	n	%
Complete ESF (n=24)
Yes	11	44.8
No	13	55.2
Trained professionals (n = 24)
Nurses	20	83.3
Doctors	04	16.7
Private offices (n=24)
Yes	19	79.2
No	05	20.8
Refrigerator exclusive for FT (n = 24)
Yes	18	75.0
No	06	25.0

Aspects related to implementation of the Fast Test (TR) in Primary Health Care Units (UAPS), Fortaleza, Ceará, Brazil, 2014 

Variables	n	%
Had FT in the unit (n=24)
Yes	15	62.5
No	09	37.5
FT in the valdity date (n = 15)
Yes	05	33.4
No	10	66.6
Perform Ft in the unit (n=24)
Yes	09	37.5
No	15	62.5
Perform FT in the routine of PN care (n = 09)
Yes	05	55.6
No	04	44.4

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By:  Lopes AC1, Araújo MA1, Vasconcelo LD2, Uchoa FS3, Rocha HP4, Santos JR5.

• 1Programa de Pós-Graduação em Saúde Coletiva, Universidade de Fortaleza, Fortaleza, CE, Brasil.
• 2Área Técnica de Saúde da Mulher e Gênero, Rede Cegonha, Secretaria Municipal de Saúde, Fortaleza, CE, Brasil.
• 3Área Técnica de DST/Aids e Hepatites Virais, Secretaria Municipal de Saúde, Fortaleza, CE, Brasil.
• 4Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, CE, Brasil.
• 5Residência Integrada em Saúde, Escola de Saúde Pública do Ceará, Fortaleza, CE, Brasil.
• Rev Bras Enferm. 2016 Feb;69(1):62-66. 

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Explaining the Presence of "Heterosexual" Female Clients of a Rapid HIV Testing Site Located in the Gay Village of Montreal, Quebec

BACKGROUND:

Increasing access and uptake of HIV testing among at-risk women is needed. Examining women's motives for visiting a community-based rapid HIV testing site (Actuel sur Rue-AsR) oriented to men who have sex with men (MSM) could offer suggestions.

OBJECTIVE:

To compare the "heterosexual" female and male clients of AsR, located in Montreal's (Canada) gay village, to better understand the women's particular HIV prevention and sexual health service needs.

METHODS:

This cross-sectional pilot study analyzed questionnaire data provided by AsR clients and staff (nurse and community agent teams) between July 2012 and November 2013. Women and men reporting only opposite-sex partners were compared with chi-square, Fisher's exact, and Kruskal-Wallis tests, as appropriate, on sociodemographics, HIV-related behaviors, motives for visiting AsR, and health service provision.

RESULTS:

AsR received 1901 clients. Among these, 55 women and 147 men reported only opposite-sex partners. Women were significantly younger. Significantly greater proportions of women visited AsR because no appointment was necessary (67% vs 48%), sought testing for condom failure (18% vs 5%), and had no regular doctor (44% vs 27%). Both groups mainly chose AsR for the rapid test results (80% and 77%), visited it to receive the rapid HIV test (71% and 76%), and sought testing due to unprotected vaginal sex (44% and 43%). Similar proportions saw the nurse (91% and 89%), received the rapid HIV test (44% and 35%), and were linked to a medical clinic (49% and 52%), especially, to receive complete sexually transmitted infection testing (50% and 44%).

CONCLUSIONS:

The results of this innovative study highlight the draw of rapid HIV testing for "heterosexual" users of a site mainly targeting MSM. They also suggest that further research is warranted into the importance for this group of women clients of drop-in and linkage services, particularly given their possible lesser access to regular care.

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By:  Engler K1, Rollet K2, Lessard D3, Thomas R4, Lebouché B3.

• 1Research Institute of the McGill University Health Centre (http://rimuhc.ca/), Montreal, Quebec, Canada kimcengler@gmail.com.
• 2Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
• 3Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada McGill University, Montreal, Quebec, Canada.
• 4l'Actuel Medical Clinic, Montreal, Quebec, Canada
• J Prim Care Community Health. 2016 Jan 20. pii: 2150131915626563 

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Accuracy in HIV Rapid Testing among Laboratory and Non-Laboratory Personnel in Zambia: Observations from the National HIV Proficiency Testing System

Background

Despite rapid task-shifting and scale-up of HIV testing services in high HIV prevalence countries, studies evaluating accuracy remain limited. This study aimed to assess overall accuracy level and factors associated with accuracy in HIV rapid testing in Zambia.

Methods

Accuracy was investigated among rural and urban HIV testing sites participating in two annual national HIV proficiency testing (PT) exercises conducted in 2009 (n = 282 sites) and 2010 (n = 488 sites). Testers included lay counselors, nurses, laboratory personnel and others. PT panels of five dry tube specimens (DTS) were issued to testing sites by the national reference laboratory (NRL). Site accuracy level was assessed by comparison of reported results to the expected results. Non-parametric rank tests and multiple linear regression models were used to assess variation in accuracy between PT cycles and between tester groups, and to examine factors associated with accuracy respectively.

Results

Overall accuracy level was 93.1% (95% CI: 91.2–94.9) in 2009 and 96.9% (95% CI: 96.1–97.8) in 2010. Differences in accuracy were seen between the tester groups in 2009 with laboratory personnel being more accurate than non-laboratory personnel, while in 2010 no differences were seen. In both PT exercises, lay counselors and nurses had more difficulties interpreting results, with more occurrences of false-negative, false-positive and indeterminate results. Having received the standard HIV rapid testing training and adherence to the national HIV testing algorithm were positively associated with accuracy.

Conclusion

The study showed an improvement in tester group and overall accuracy from the first PT exercise to the next. Average number of incorrect test results per 1000 tests performed was reduced from 69 to 31. Further improvement is needed, however, and the national HIV proficiency testing system seems to be an important tool in this regard, which should be continued and needs to be urgently strengthened.

Below:  Distribution of reported false and indeterminate results by tester profession in PT1 and PT2

Full article at:   http://goo.gl/j4RTV8

By:  

Sheila Mwangala, Kunda G. Musonda, Mwaka Monze, Katoba K. Musukwa

Virology Laboratory, Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia

Sheila Mwangala, Knut Fylkesnes

Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway

Kunda G. Musonda

Pathogen Molecular Biology Department, London school of Hygiene and Tropical Medicine, University of London, London, United Kingdom

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Low Rates of Adoption and Implementation of Rapid HIV Testing in Substance Use Disorder Treatment Programs

Highlights

• We examine the availability and use of on-site rapid HIV testing (RHT).
• Most opioid treatment programs (OTP) do not offer on-site RHT.
• The availability of RHT on-site reduced the likelihood that an OTP did not test any of its clients.
• Among OTPs that conducted any HIV testing, availability of RHT on-site was not associated with increased number of clients tested.
• New strategies are needed to promote the adoption of RHT on-site and the offer of RHT when it is available.

Introduction

Rapid HIV testing (RHT) greatly increases the proportion of clients who learn their test results. However, existing studies have not examined the adoption and implementation of RHT in programs treating persons with substance use disorders, one of the population groups at higher risk for HIV infection.

Methods

We examined 196 opioid treatment programs (OTPs) using data from the 2011 National Drug Abuse Treatment System Survey (NDATSS). We used logistic regressions to identify client and organizational characteristics of OTPs associated with availability of on-site RHT. We then used zero-inflated negative binomial regressions to measure the association between the availability of RHT on-site and the number of clients tested for HIV.

Results

Only 31.6% of OTPs offered on-site rapid HIV testing to their clients. Rapid HIV testing was more commonly available on-site in larger, publicly owned and better-staffed OTPs. On the other hand, on-site rapid HIV testing was less common in OTPs that prescribed only buprenorphine as a method of opioid dependence treatment. The availability of rapid HIV testing on-site reduced the likelihood that an OTP did not test any of its clients during the prior year. But on-site availability rapid HIV testing was not otherwise associated with an increased number of clients tested for HIV at an OTP.

Conclusions

New strategies are needed to a) promote the adoption of rapid HIV testing on-site in substance use disorder treatment programs and b) encourage substance use disorder treatment providers to offer rapid HIV testing to their clients when it is available.

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By:   Jemima A. Frimpong, Ph.D., M.P.H., Thomas D’Aunno, Ph.D.¹, Stéphane Helleringer, Ph.D.², Lisa R. Metsch, Ph.Dd.³

Affiliations

Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA

¹Tel.: +1 212 99 7464.

²Tel.: +1 410 502 9071a; fax: +1 410 955 2303.

³Tel.: +1 212 304 5208; fax: +1 212 305 3577.

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Accuracy and Acceptability of Oral Fluid HIV Self-Testing in a General Adult Population in Kenya

We evaluated performance, accuracy, and acceptability parameters of unsupervised oral fluid (OF) HIV self-testing (HIVST) in a general population in western Kenya. 

In a prospective validation design, we enrolled 240 adults to perform rapid OF HIVST and compared results to staff administered OF and rapid fingerstick tests. All reactive, discrepant, and a proportion of negative results were confirmed with lab ELISA. 

Twenty participants were video-recorded conducting self-testing. All participants completed a staff administered survey before and after HIVST to assess attitudes towards OF HIVST acceptability. HIV prevalence was 14.6 %. Thirty-six of the 239 HIVSTs were invalid (15.1 %; 95 % CI 11.1-20.1 %), with males twice as likely to have invalid results as females. HIVST sensitivity was 89.7 % (95 % CI 73-98 %) and specificity was 98 % (95 % CI 89-99 %). 

Although sensitivity was somewhat lower than expected, there is clear interest in, and high acceptability (94 %) of OF HIV self-testing.

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By: Kurth AE1, Cleland CM2, Chhun N2, Sidle JE3, Were E4,5, Naanyu V6,5, Emonyi W7,5, Macharia SM8,5, Sang E5, Siika AM9,5.

• 1New York University College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10003, USA. akurth@nyu.edu.
• 2New York University College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10003, USA.
• 3Department of General Internal Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA.
• 4Department of Reproductive Health, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
• 5Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
• 6Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
• 7Department of Immunology, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
• 8Moi Teaching and Referral Hospital, Eldoret, Kenya.
• 9Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya. 

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A Cross Sectional Survey of the Barriers for Implementing Rapid HIV Testing among French General Practitioners

In France, almost 30,000 people are unaware of their HIV positive status. Innovative screening strategies are essential to reach this population. The aim of this study was to describe the acceptability of rapid HIV testing (RHT) among French general practitioners (GPs) working in the south of France and barriers for implementing this strategy. We analysed an anonymous questionnaire sent by mail to GPs about demographic data, routine practice, knowledge of RHT and barriers to its use. 

Between 1 April and 30 September 2013, out of the 165 GPs contacted, 78 sent back the questionnaires. The average GPs' age was 52 years, 49 were men. Fifty-one GPs reported that their registered patients included at least one HIV-infected person and 70 GPs reported taking care of high-risk people. Sixty-three percent of GPs reported being interested in using RHT in their daily practice. 

The main reasons reported by uninterested GPs were: greater confidence in standard HIV testing, difficulties including RHT during the routine consultation, difficulties to screen other sexually transmitted diseases simultaneously, and difficulties to deliver a positive result. French National Authorities for Health propose to screen the population at least once in their lifetime and high-risk people at least once a year. In order to achieve this aim, RHT should fit into the GPs' arsenal for HIV testing. 

We showed a high acceptability of RHT by GPs. If specific and adapted training is developed, and if solutions to barriers reported by GPs are found, RHT could be implemented in their routine activity.

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By: Fraisse T1, Fourcade C2, Brazes-Sanz J1, Koumar Y2, Lavigne JP3, Sotto A4, Laureillard D2.

• 1Department of Geriatric Medicine, General Hospital, Alès, France.
• 2Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France.
• 3Department of Microbiology, University Hospital, Nîmes, France.
• 4Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France 

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