Factors Associated with Ever Being HIV-Tested in Zimbabwe

INTRODUCTION:

Zimbabwe has a high human immunodeficiency virus (HIV) burden. It is therefore important to scale up HIV-testing and counseling (HTC) as a gateway to HIV prevention, treatment and care.

OBJECTIVE:

To determine factors associated with being HIV-tested among adult men and women in Zimbabwe.

METHODS:

Secondary analysis was done using data from 7,313 women and 6,584 men who completed interviewer-administered questionnaires and provided blood specimens for HIV testing during the Zimbabwe Demographic and Health Survey (ZDHS) 2010-11. Factors associated with ever being HIV-tested were determined using multivariate logistic regression.

RESULTS:

HIV-testing was higher among women compared to men (61% versus 39%). HIV-infected respondents were more likely to be tested compared to those who were HIV-negative for both men [adjusted odds ratio (AOR) = 1.53; 95% confidence interval (CI) (1.27-1.84)] and women [AOR = 1.42; 95% CI (1.20-1.69)]. However, only 55% and 74% of these HIV-infected men and women respectively had ever been tested. Among women, visiting antenatal care (ANC) [AOR = 5.48, 95% CI (4.08-7.36)] was the most significant predictor of being tested whilst a novel finding for men was higher odds of testing among those reporting a sexually transmitted infection (STI) in the past 12 months [AOR = 1.86, 95%CI (1.26-2.74)]. Among men, the odds of ever being tested increased with age ≥20 years, particularly those 45-49 years [AOR = 4.21; 95% CI (2.74-6.48)] whilst for women testing was highest among those aged 25-29 years [AOR = 2.01; 95% CI (1.63-2.48)]. Other significant factors for both sexes were increasing education level, higher wealth status and currently/formerly being in union.

CONCLUSIONS:

There remains a high proportion of undiagnosed HIV-infected persons and hence there is a need for innovative strategies aimed at increasing HIV-testing, particularly for men and in lower-income and lower-educated populations. Promotion of STI services can be an important gateway for testing more men whilst ANC still remains an important option for HIV-testing among pregnant women.

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

By:  Takarinda KC1,2, Madyira LK1, Mhangara M1, Makaza V3, Maphosa-Mutsaka M3, Rusakaniko S4,5, Kilmarx PH6, Mutasa-Apollo T1, Ncube G1, Harries AD2,7.

• 1AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
• 2International Union Against Tuberculosis and Lung Disease, Paris, France.
• 3National AIDS Council, Harare, Zimbabwe.
• 4Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
• 5Centre for Research and Training in Clinical Epidemiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
• 6Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Harare, Zimbabwe.
• 7Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom. 
• PLoS One. 2016 Jan 25;11(1):e0147828. doi: 10.1371/journal.pone.0147828. eCollection 2016.

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How Many People Are Living with Undiagnosed HIV Infection? An Estimate for Italy, Based on Surveillance Data

OBJECTIVE:

To estimate the size and characteristics of the undiagnosed HIV population in Italy in 2012 applying a method that does not require surveillance data from the beginning of the HIV epidemic.

METHODS:

We adapted the method known as "London method 2"; the undiagnosed population is estimated as the ratio between the estimated annual number of simultaneous HIV/clinical AIDS diagnoses and the expected annual progression rate to clinical AIDS in the undiagnosed HIV population; the latter is estimated using the CD4-count distribution of asymptomatic subjects reported to surveillance. Under-reporting/ascertainment of new diagnoses was also considered. Also, the total number of PLWHIV was estimated.

RESULTS:

The undiagnosed HIV population in 2012 was 13,729 (95%CI: 12,152-15,592), 15,102 (13,366-17,151) and 16,475 (14,581-18,710), assuming no under-reporting/ascertainment, 10% and 20% of under-reporting/ascertainment, respectively. The percentage of undiagnosed cases was higher among HIV people aged <25 years (25-28%), MSM (16-19%) and people born abroad (16-19%), while is small among injection drug users were (3%).

CONCLUSIONS:

The estimate of people in Italy with undiagnosed HIV in 2012 was in a plausible range of 12,000-18,000 cases, corresponding to 11-13% of the overall prevalence. The method is straightforward to implement only requiring annual information from the HIV surveillance system about CD4-count and clinical stage at HIV diagnosis. Thus, it could be used to monitor if a certain prevention initiative lead to the reduction of the undiagnosed HIV population over time. It can also be easily implemented in other countries collecting the same basic information from the HIV surveillance system.

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By:  Mammone A1, Pezzotti P, Regine V, Camoni L, Puro V, Ippolito G, Suligoi B, Girardi E.

• 1"L. Spallanzani" National Institute for Infectious Diseases, IRCCS, Rome, Italy bIstituto Superiore di Sanità, Rome, Italy. 

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Using Peer-Referral Chains with Incentives to Promote HIV Testing and Identify Undiagnosed HIV Infections among Crack Users in San Salvador

In El Salvador, crack users are at high risk for HIV but they are not targeted by efforts to promote early HIV diagnosis. 

We evaluated the promise of peer-referral chains with incentives to increase HIV testing and identify undiagnosed HIV infections among networks of crack users in San Salvador. For 14 months, we offered HIV testing in communities with a high prevalence of crack use. For the following 14 months, we promoted chains in which crack users from these communities referred their peers to HIV testing and received a small monetary incentive. We recorded the monthly numbers of HIV testers, and their crack use, sexual risk behaviors and test results. 

After launching the referral chains, the monthly numbers of HIV testers increased significantly (Z = 6.90, p < .001) and decayed more slowly (Z = 5.93, p < .001), and the total number of crack-using testers increased nearly fourfold. Testers in the peer-referral period reported fewer HIV risk behaviors, but a similar percentage (~5 %) tested HIV positive in both periods. More women than men received an HIV-positive diagnosis throughout the study (χ²(1, N = 799) = 4.23, p = .040). 

Peer-referral chains with incentives can potentially increase HIV testing among networks of crack users while retaining a focus on high-risk individuals.

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By:   Glasman LR1, Dickson-Gomez J2, Lechuga J3, Tarima S4, Bodnar G5, de Mendoza LR6.

• 1Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N Summit Ave., Milwaukee, WI, USA. lglasman@mcw.edu.
• 2Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N Summit Ave., Milwaukee, WI, USA.
• 3Department of Psychology, University of Texas, El Paso, TX, USA.
• 4Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
• 5Departamento de Investigación, Fundación Antidrogas de El Salvador (FUNDASALVA), Santa Tecla, El Salvador.
• 6Department of Psychology, Universidad Centroamericana José Simeón Cañas, San Salvador, El Salvador. 

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Effect of Nondisclosure of HIV Status in Sexual Health Clinics on Unlinked Anonymous HIV Prevalence Estimates in England, 2005–2009

Objectives: To assess the extent of nondisclosure of known HIV status among sexual health clinic attendees and to quantify the impact of nondisclosure on estimates of undiagnosed HIV prevalence and of the proportion of patients remaining undiagnosed on leaving the clinic.

Methods: Serum samples from the unlinked anonymous survey of clinic attendees’ archive were tested for antiretrovirals. Estimates of undiagnosed HIV were adjusted using the findings.

Results: Antiretrovirals were detected in 27% of samples taken from ‘previously undiagnosed’ attendees, who did not have an HIV test but were HIV positive as detected by unlinked anonymous testing, indicating nondisclosure; 24% of such samples from MSM had antiretrovirals present compared with 32% of heterosexual men and women. Antiretrovirals were detected in 33% of samples from London clinics and in 21% from non-London clinics. Following adjustment, the estimated prevalence of undiagnosed HIV decreased nonsignificantly from 3.04% to 2.66% (2.35–3.01) among men who have sex with men (MSM), 0.31% (0.26–0.37) to 0.30% (0.25–0.36) in heterosexual men and 0.40% (0.35–0.46) to 0.37% (0.32–0.43) in women; 7% of MSM who do not have an HIV test at a clinic visit will be infected with HIV and remain unaware of their infection.

Conclusion: Nondisclosure of HIV status to healthcare professionals occurs among clinic attendees. Adjustment for nondisclosure results in a small, nonsignificant decrease in the prevalence of undiagnosed HIV estimated from the unlinked anonymous survey in sexual health clinics. Testing the population of MSM not having an HIV test remains a priority as levels of undiagnosed HIV are high.

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By:  Savage, Emma J.^a; Lowndes, Catherine M.^a; Sullivan, Ann K.^b; Back, David J.^c; Else, Laura J.^c; Murphy, Gary^d; Gill, O. Noel^a

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HIV Indicator Condition-Guided Testing to Reduce the Number of Undiagnosed Patients & Prevent Late Presentation in a High-Prevalence Area: A Case–Control Study in Primary Care

Recent guidelines advocate accelerated provider-initiated HIV testing by general practitioners (GPs). We aimed to identify the number of patient consultations in six general practices in the South-East of Amsterdam, and the incidence of HIV indicator conditions reported in their medical files prior to diagnosis.

A cross-sectional search in an electronic general practice database. We used a case–control design to identify those conditions most associated with an HIV-positive status.

We included 102 HIV cases diagnosed from 2002 to 2012, and matched them with 299 controls. In the year prior to HIV diagnosis, 61.8% of cases visited their GP at least once, compared with 38.8% of controls. In the 5 years prior to HIV diagnosis, 58.8% of HIV cases had exhibited an HIV indicator condition, compared with 7.4% of controls. The most common HIV-related conditions were syphilis and gonorrhoea. The most common HIV-related symptoms were weight loss, lymphadenopathy and peripheral neuropathy. During this period, average HIV prevalence among people aged 15–59 years increased from 0.4% to 0.9%.

This study revealed many opportunities for HIV indicator condition-guided testing in primary care. As yet, however, HIV indicator conditions are not exploited as triggers for early HIV testing.

Below:  Trends in prevalence of HIV in six general practices in a South-Eastern district of Amsterdam, the Netherlands, 2002–2012

Full article at: http://goo.gl/S5rjFl

By: Ivo K Joore¹, Derk L Arts¹, Marjan JP Kruijer¹, Eric P Moll van Charante¹,Suzanne E Geerlings², Jan M Prins², Jan EAM van Bergen¹,³,⁴

¹ Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands

² Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands

³ STI AIDS Netherlands (Soa Aids Nederland), Amsterdam, The Netherlands

⁴ Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands

  

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