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Ending the HIV epidemic requires increased testing, diagnosis, and linkage to care. In the past 10 years, rates of HIV have increased among people with substance use disorder (SUD). HIV testing is recommended during hospitalization. Despite rising rates of infections and recommendations, HIV testing remains suboptimal. This study sought to detect differences in HIV testing by race and ethnicity in people who use drugs (PWUD) admitted to Tufts Medical Center (TuftsMC). This study is a retrospective review of hospitalized PWUD admitted from January 1, 2017 to December 31, 2020. PWUD were identified through toxicology results, medication prescribed for SUD, and nursing intake questions. The primary outcome of interest was whether an HIV test was ordered during hospitalization. The indicator of interest was race and ethnicity. Of 13,486 PWUD admitted to TuftsMC, only 10% had an HIV test ordered. Compared with White patients, Black patients [adjusted odds ratio (AOR): 0.69, 95% confidence interval (CI) (0.59-0.83)] and Hispanic patients [AOR: 0.68, 95% CI (0.55-0.84)] had decreased odds of receiving an HIV test. Our report is the first to show racial and ethnic differences in HIV testing ordering for hospitalized PWUD. Without access to harm reduction tools and expanded systems-based testing strategies, the HIV epidemic will continue and disproportionately impact minoritized communities.

Background: The Kosovo province is being considered as a high-risk region for the spread of HIV. Objective: To estimate the prevalence and factors associated with HIV testing in a sample of university students from the Serbian northern Kosovo province. Material and Methods: A questionnaire examining socio-demographic characteristics, HIV–related knowledge, attitudes towards people living with HIV (PLHIV) and HIV testing was used in data collection. A total of 1,017 students from the University of Priština temporarily seated in Kosovska Mitrovica completed the questionnaire. Results: Only 5.4% of students have previously been tested for HIV, even though the majority (70.9%) had a positive approach to HIV testing. Factors associated with having been tested for HIV were being male and younger, having interest in HIV testing and having previous contact with PLHIV. Being more knowledgeable about HIV and having stronger positive attitude towards PLHIV, being older, receiving information about HIV through friends and special educational programs, using condom at last sexual intercourse, having positive opinion on gays/lesbians and previous contact with PLHIV were associated with positive approach to HIV testing. Conclusion: Having a positive approach to HIV testing does not suggest that students would take the HIV test. However, students who have low HIV-related knowledge, negative approach or lack of interest in HIV testing (believing that there is no need to take it) would likely never take the HIV test. Increasing HIV-related knowledge, acceptance of PLHIV and access to testing facilities should be public health priorities to raise HIV testing rates. Keywords: HIV testing; attitude; knowledge; University students.

HIV remains a key public health issue. National Institute for Health and Care Excellence and British HIV Association guidance recommends that patients should be offered HIV testing when admitted to hospital or attending emergency departments (EDs) in areas with a prevalence ≥ 2 per 1000. We report a novel method of testing and the first 3-year results from our HIV ED testing programme utilizing biochemistry samples for HIV testing, with the aim of improving uptake while ensuring no changes to clinical practice in EDs.Routine ED HIV testing was implemented on 1 October 2018; it was initially opt-in and was subsequently changed to opt-out on 1 February 2019. HIV testing was added to all ED blood test order sets and was performed on the biochemistry samples of those aged 18-59 years. The age range was extended to include those aged 16+ years on 1 March 2021 along with a move to notional consent.A total of 78 333 HIV tests were performed from an estimated 110 683 attendees who had bloods taken in the same age range, demonstrating an overall 69.5% testing coverage. On implementation of opt-out testing after the first 4 months, the proportion of tests increased (from 57.9% to 69%). After increase in age range to 16+ years and a move to notional consent, the overall testing coverage improved to 74.2%. Of 1054 reactive results, 728 (69%) were known people living with HIV, eight (0.8%) were not contactable, two (0.2%) re-tested elsewhere and three (0.3%) declined a re-test. A total of 259 false-positives were determined by follow-up testing and 50 (4.8%) were newly diagnosed with HIV. An HIV diagnosis was suspected in only 22%, and 48% had never previously tested for HIV.An opt-out HIV testing programme with notional consent and using biochemistry samples within the ED is feasible, acceptable and provides an excellent opportunity to diagnose patients who do not perceive themselves to be at risk or have never tested before.

HIV/AIDS is prevalent among adolescent girls and young women (AGYW) in Lesotho, and among the top five infectious diseases causing a high mortality rate in Africa. The paramount management of HIV is based on screening, prevention, and therapeutic interventions, of which HIV testing and counselling (HTC) is the gateway. The utilization of HTC services among AGYW is limited owing to numerous barriers encountered by this population group. The aim of this study was to assess trends and factors associated with HTC among AGYW in Lesotho. A secondary data analysis was used to analyze data sets extracted from the 2004, 2009, and 2014 Lesotho Demographic Health Surveys (LDHS). The LDHS was conducted using a cross-sectional study design and samples drawn were representative of the whole population of Lesotho. We used descriptive analysis to determine trends in HTC. In determining factors associated with the uptake of HTC, univariate and multivariable logistic regression models were applied on the 2014 LDHS. All analyses were adjusted for unequal sampling probabilities using survey weights. The number of AGYWs analyzed were 2743 in 2004, 2393 in 2009, and 2842 in 2014. The overall prevalence estimates of HTC uptake were 12%, 62.2%, and 72.5%, respectively. For the 15–19 years AGYW, HTC uptake rose from 6.2% (2004), 46.3% (2009), to 57.9% (2014), while for the 20–24 years age group, the rates were 18.7%, 80.2%, and 88.3%, respectively. For the 2842 AGYW in 2014, the odds of ever having an HIV test were significantly higher for those aged 20–24 years (aOR 2.15, 95% CI 1.61 to 2.87, p < 0.001), in a union (aOR 3.21, 95%CI 2.25 to 4.58, p < 0.001), with Mother-to-child transmission of HIV (MTCT) knowledge (aOR 1.53, 95%CI: 1.21 to 1.94, p < 0.001), with HIV non-discriminatory attitudes (aOR 2.50, 95%CI 1.87 to 3.34, p < 0.001), and those who had ever been pregnant (aOR 11.53, 95%CI 7.46 to 17.84, p < 0.001). HTC uptake among AGYW in Lesotho is below expected targets, hence we recommend optimizing access to HTC services, especially for AGYW aged 15–19 years.

Background Evidence among key populations supports acceptability of HIV self-testing (HIVST) due to its privacy and convenience. However, insufficient research has been done among transgender women (TGW), especially in Latin America. Consequently, the aim of this study was to explore the acceptability, perceptions and recommendations for HIVST implementation among TGW in Buenos Aires. Methods A focus group was conducted in July 2019. Particpants were invited to touch and learn about a displayed HIVST kit. The following main topics were explored: acceptability, reasons for seeking self-testing, preferences for training, distribution, periodicity and recommendations for HIVST implementation. Results The sample consisted of 12 TGWs; mean age of 26 years (IQR = 22–28); 66% had history of sex-work. The main motivations for seeking HIVST were convenience, privacy, and usage to reduce stigma and discrimination by health-care providers. Recommendations for HIVST were: distribution from primary health centers and trans-sensitive centers; affordable price; assistance by peer health promoters; and the provision of clear written and video instructions. Conclusions Tailored implementation of HIVST can increase HIV testing rates, early detection, and linkage to HIV-care in this high-prevalence group. This study provided community-driven suggestions to inform and adapt an HIVST feasibility pilot study and future implementation in Argentina.

New York State (NYS) was at the intersection of the HIV epidemic and coronavirus disease 2019 (COVID-19) pandemic leading to a disruption in HIV-preventive services. This study sought to determine the impact of the COVID-19 pandemic and mitigation efforts on HIV-testing trends in NYS among AIDS Institute (AI)-funded providers.We analyzed weekly testing data from the AI Reporting System from January 1, 2017, to June 27, 2021, to fit an interrupted time series model that predicted the expected number of HIV tests among AI-funded providers in NYS had the COVID-19 pandemic not occurred. The actual observed numbers of HIV testing that occurred from weeks beginning March 15, 2020, to June 30, 2021, were compared with the number of HIV tests predicted by the model.In the absence of the COVID-19 pandemic, our model predicted that there would have been 45,605 HIV tests among AI-funded providers between the weeks beginning March 15, 2020, to June 27, 2021. We observed 20,742 HIV tests, representing a 54.5% reduction. We observed percent decreases of greater than 50% for HIV testing among AI-funded providers for New York City (52.9%) and rest of state (59.8%) regions, male (50.6%) and female (66.8%) genders, as well as Black (59.2%), Hispanic (52.8%), mixed race (57.5%), other (50.3%), and White (50.1%) race and ethnicities.HIV testing among AI-funded providers in NYS has declined substantially following the COVID-19 pandemic, reflecting decreased access to, and/or demand for, testing among persons at elevated risk for HIV. Initiatives to increase HIV testing and maintain access to HIV prevention services need to be explored following COVID-19.

Purpose: In this study, we examined the nonuptake of HIV testing and the main reasons for never testing among transgender populations. Methods: Data on 26,927 respondents from the 2015 U.S. Transge...

Organizations offering HIV prevention services have reported interruptions during the COVID-19 pandemic. The national extent of these interruptions and their public health impact remain largely unexplored.Using data from 60 state and local health departments, we compared HIV testing services outcomes in calendar years 2019 and 2020, including the number of Centers for Disease Control and Prevention (CDC)-funded HIV tests conducted, the percentage of persons with newly diagnosed HIV infection (ie, HIV positivity), and the percentage linked to HIV medical care within 30 days after new diagnoses (ie, linkage to care) using χ2 and robust Poisson models. We also assessed the independent associations between the pandemic period (ie, March-December 2020) and the number of COVID-19 cases with monthly HIV testing services outcomes using multivariable robust Poisson models.There was a 46.0% (P0.001) reduction in the number of CDC-funded HIV tests conducted in 2020 (n = 1,255,895) compared with 2019 (n = 2,324,421). Although there were fewer persons with newly diagnosed HIV in 2020 (n = 5581 vs. n = 7739 in 2019), HIV positivity was greater in 2020 (0.4% vs. 0.3% in 2019; adjusted prevalence ratio [aPR] = 1.33, 95% confidence interval [CI]: 1.05 to 1.69). When adjusting for the monthly number of COVID-19 cases, the pandemic period was associated with a 56% reduction in the number of monthly CDC-funded HIV tests (adjusted rate ratio = 0.44, 95% CI: 0.37 to 0.52) but 28% higher monthly HIV positivity (aPR = 1.28 95% CI: 1.16 to 1.41) and 10% higher linkage to care (aPR = 1.10, 95% CI: 1.02 to 1.18).Despite increased HIV positivity, a drastic reduction in the number of CDC-funded HIV tests was observed in 2020, affecting the ability to identify persons with newly diagnosed HIV. CDC and health departments will need to expand testing strategies to cover tests not conducted in 2020 while adapting to the continuing pandemic.A visual abstract is available for this article at: http://links.lww.com/QAI/B941.

Objectives: Late HIV diagnosis (CD4

Community mobilisation, engaging communities in a process to collectively enact change, could improve HIV testing and care engagement. In South Africa, current rates fall below those needed for epidemic control. We assessed whether community mobilisation increased HIV testing, linkage to care, and retention in care over time in intervention relative to control communities.We conducted a cluster-randomised controlled trial in villages in the Agincourt sub-district of the rural Mpumalanga Province in South Africa. 15 villages were randomly assigned to either a community mobilisation intervention engaging residents to address social barriers to HIV testing and treatment (intervention arm) or to a control arm using balanced randomisation. Villages were eligible if they had been fully enumerated in 2014, had not been included in previous mobilisation activities, and included over 500 permanent adult residents aged 18-49 years. Primary outcomes included quarterly rates of HIV testing, linkage to care, and retention in care documented from health facility records among residents of the intervention and control communities over the 3-year study period. Intention-to-treat analyses employed generalised estimating equations stratified by sex. This trial is registered with ClinicalTrials.gov, NCT02197793.Between Aug 1, 2015, and July 31, 2018, residents in eight intervention communities (n=20 544 residents) and seven control communities (n=17 848) contributed data; 92 residents contributed to both arms. Among men, HIV testing increased quarterly by 12·1% (relative change [RC] 1·121, 95% CI 1·099 to 1·143, p0·0001) in the intervention communities and 9·5% (1·095, 1·075 to 1·114, p=0·011) in the control communities; although increases in testing were greater in the intervention villages, differences did not reach significance (exponentiated interaction coefficient 1·024, 95% CI 0·997 to 1·052, p=0·078). Among women, HIV testing increased quarterly by 10·6% (RC 1·106, 95% CI 1·097 to 1·114, p0·0001) in the intervention communities and 9·3% (1·093, 1·084 to 1·102, p=0·053) in the control communities; increases were greater in intervention communities (exponentiated interaction coefficient 1·012, 95% CI 1·001 to 1·023, p=0·043). Quarterly linkage increased significantly among women in the intervention communities (RC 1·013, 95% CI 1·002 to 1·023, p=0·018) only. Quarterly linkage fell among men in both arms, but decreased significantly among men in the control communities (0·977, 0·954 to 1·002, p=0·043). Quarterly retention fell among women in both arms; however, reductions were tempered among women in the intervention communities (exponentiated interaction coefficient 1·003, 95% CI1·000 to 1·006, p=0·062). Retention fell significantly among men in both arms with difference in rates of decline.Community mobilisation was associated with modest improvements in select trial outcomes. The sum of these incremental, quarterly improvements achieved by addressing social barriers to HIV care engagement can impact epidemic control. However, achieving optimal impacts will probably require integrated efforts addressing both social barriers through community mobilisation and provision of improved service delivery.US National Institutes of Health, National Institute of Mental Health, and United States President's Emergency Plan for AIDS Relief through Right to Care and Project SOAR.

The COVID-19 pandemic has posed a tremendous burden on healthcare services. We evaluated its impact on an emergency department (ED)-based opt-out Human immunodeficiency virus (HIV) testing in a public healthcare system.The programmatic data of ED-based HIV testing from July 2018 to March 2021 at the Memorial Regional Hospital, Hollywood, Florida was analyzed by interrupted time series analysis to evaluate the immediate and gradual effects of the COVID-19 pandemic on the number of monthly HIV tests, with an interruption point at March 2020.The average number of monthly HIV tests were significantly lower during the pandemic than the pre-pandemic (791 ± 187 vs 1745 ± 266, P.001). There was a slight decline trend in the number of monthly HIV tests before the pandemic (estimate -10.29, P = .541). HIV testing dramatically decreased during the initial 7 months of the pandemic, compared to the pre-pandemic period, with the largest decline in the number of HIV tests on March 2020 (estimate -678.48, P = .007). HIV testing slightly increased every month (estimate 4.84, P = .891) during the pandemic period, and the number of HIV tests per month rebounded to the pre-pandemic levels by October 2020.ED-based HIV testing significantly decreased during the initial 7 months of the pandemic in south Florida. Multiple strategies are necessary to maintain HIV testing during this pandemic era.

HIV incidence remains high among US youth, especially among sexual minority youth. However, only half of youth with HIV are aware of their status. One potential explanation for low HIV testing rates is that restrictive policies may prevent minors from access HIV testing due to parental consent requirements. Using pooled data from the local Youth Risk Behavior Survey, we assessed whether state HIV testing laws, including age restrictions and explicit inclusion of HIV in STI testing consent laws, were associated with differences in HIV testing rates; differences by sexual behavior were also examined. Among female youth, policies were not associated with HIV testing. However, among male youth, both the presence of age restrictions and explicit inclusion in STI services were significantly associated with increased odds of HIV testing. Results indicate that policy changes may be effective at increasing testing among male youth who have sex with other males.

Objective Men with HIV are less likely than women to know their status, be on antiretroviral therapy, and be virally suppressed. This review examined men’s community-based HIV testing services (CB-HTS) outcomes. Design Systematic review and meta-analysis. Methods We searched seven databases and conference abstracts through July 2018. We estimated pooled proportions and/or risk ratios (for meta-analyses) for each outcome using random effects models. Results 188 studies met inclusion criteria. Common testing models included targeted outreach (e.g. mobile testing), home-based testing, and testing at stand-alone community sites. Across 25 studies reporting uptake, 81% (CI: 75–86%) of men offered testing accepted it. Uptake was higher among men reached through CB-HTS than facility-based HTS (RR = 1.39; CI: 1.13–1.71). Over 69% (CI: 64–71%) of those tested through CB-HTS were men, across 184 studies. Across studies reporting new HIV-positivity among men ( n = 18), 96% were newly diagnosed (CI: 77–100%). Across studies reporting linkage to HIV care ( n = 8), 70% (CI: 36–103%) of men were linked to care. Across 57 studies reporting sex-disaggregated data for CB-HTS conducted among key populations, men’s uptake was high (80%; CI: 70–88%) and nearly all were newly diagnosed and linked to care (95%; CI: 94–100%; and 94%; CI: 88–100%, respectively). Conclusion CB-HTS is an important strategy for reaching undiagnosed men with HIV from the general population and key population groups, particularly using targeted outreach models. When compared to facility-based HIV testing services, men tested through CB-HTS are more likely to uptake testing, and nearly all men who tested positive through CB-HTS were newly diagnosed. Linkage to care may be a challenge following CB-HTS, and greater efforts and research are needed to effectively implement testing strategies that facilitate rapid ART initiation and linkage to prevention services.

Background: Lockdown measures for controlling the COVID-19 epidemic were enforced in China between January and May 2020. Previous studies showed a decrease in HIV highrisk behaviors (HRBs) and updated testing during the lockdown, but little is known about these behaviors during the post-lockdown period. Objective: We conducted quantitative and qualitative assessments of HIV-related behaviors among MSM during the lockdown and post-lockdown periods in Changsha, south-central China. Methods: Face-to-face structured interviews with open-ended questions were conducted using the TimeLine Follow Back (TLFB) method for collecting retrospective data on frequencies of HRBs and testing. McNemar’s Chi-square test and Wilcoxon signed-rank test were used to comparing frequencies of behaviors between lockdown (January-May 2020) and post-lockdown periods (June- October 2020). Content analysis was used to analyze qualitative data on the reasons for rebounding HRBs and testing. Results: Of 159 MSM participants, 64% had at least one HRB during the post-lockdown period. Men had increased condomless sex (from 24% to 35%), multiple partners (23% to 35%), and substance abuse (16% to 27%) between the two study periods due to the negative emotions and increased use of social networks during the lockdown. HIV testing frequency also increased from 37% to 66% due to resuming routine testing services in the community-based organizations and increased HRBs among MSM during post-lockdown. Conclusions: After lifting the lockdown measures, MSM had rebounding HRBs and uptake of testing. Effective preventive measures and healthcare services should be available to MSM after the lockdown measures are lifted.

OBJECTIVE: To determine the feasibility, acceptability, and implementation of a HIV self-test (HIVST) program through PrEP clients’ social and sexual networks. BACKGROUND: HIV testing is critical for treatment and prevention engagement. HIVST kits can overcome barriers to testing. A negative result is an opportunity to provide PrEP information. We describe implementation factors associated with engaging current Mobile PrEP (MP) clients to distribute HIVST kits and PrEP information through their networks. SETTING: Community venues in Miami-Dade County, Florida. METHODS: A baseline survey collected network information and explored distribution plans for offering HIVST kits. A follow-up survey evaluated use and distribution. A logic model describes the process of implementation and evaluation. Up to 4 Ora-Quick HIV ST kits were offered to 81 MP clients. A brief training included resources for post-test engagement. RESULTS: Forty-four percent of the kits were reported as distributed. Of 81 MP clients offered kits, 50 (62%) accepted. In a follow-up survey, 77% of MP clients distributed at least one kit. 56 (86%) social network (SN) members were Latino and 9 (14%) were Black. Three out of four MP clients engaged in PrEP discussions (77%) with SN members. Reported reasons for HIVST kit use included convenience, confidentiality, privacy concerns, and discomfort with going to a testing site. MP clients reported that kit distribution was impacted by the COVID-19 pandemic. CONCLUSION: HIV ST kits allowed PrEP users to engage others in their social and sexual networks for HIV testing and information regarding PrEP. Work to scale-up this intervention is underway.

HIV testing is a core strategy for the Ending the HIV Epidemic in the U.S. (EHE) initiative, which has the aim of reducing new HIV infections by at least 90% by 2030.* During 2016-2017, jurisdictions with the highest HIV diagnosis rates were those with higher prevalences of HIV testing; past-year HIV testing was higher among persons who reported recent HIV risk behaviors compared with those who did not report these risks (1). During 2020-2021, the COVID-19 pandemic disrupted health care delivery, including HIV testing in part because many persons avoided services to comply with COVID-19 risk mitigation efforts (2). In addition, public health departments redirected some sexual health services to COVID-19-related activities.

To achieve the 2030 goal of ending the HIV epidemic, we must consider social network- along with individual-level factors related to HIV prevention among young Black women (YBW). This cross-sectional study examined egocentric social network- and individual-level data of 180 YBW aged 18–24. Multivariable logistic regression models were used to study social network characteristics and individual sexual behaviors related to HIV prevention behaviors (e.g., HIV testing, condom use, and interest in preexposure prophylaxis, or PrEP). On average, YBW nominated 11 social network members (SNMs; seven friends, two family members, and one sex partner). About 92% of YBW spoke to at least one SNM about condom use and 58% spoke to at least one SNM about HIV testing. Respondents who spoke to a sex partner about condom use had 70% lower odds of being interested in PrEP, but 2.99 times the odds of reporting condom use during last sex. Odds of being tested for HIV in the prior 3 months were significantly increased by 3.97 times for those who spoke to at least one sex partner about HIV testing. However, odds of being interested in PrEP were significantly decreased by 63% for YBW who were tested for HIV in the prior 3 months. Findings underscore that understanding network- and individual-level factors is crucial in increasing HIV testing, condom use, and interest in PrEP among YBW.

Home-based service delivery has been used to improve access to HIV testing and antiretroviral initiation across sub-Saharan Africa, but it has yet to be leveraged to improve pre-exposure prophylaxis (PrEP) uptake. We interviewed 37 adolescent girls and young women (AGYW) in Eastern Cape, South Africa to explore why they chose to initiate PrEP or not following home-based HIV testing and referral for PrEP, and what influenced time to PrEP initiation. Participants reported that home visits provided a source of trusted information and a way to involve family members in their PrEP initiation decisions, motivating some to start PrEP. AGYW who initiated PrEP were more likely to qualitatively perceive themselves to be at high risk for HIV compared with those who never initiated PrEP. Integrating home-based HIV testing with PrEP education and referral may be a valuable way to reduce familial barriers and boost PrEP uptake among AGYW in South Africa. Trial registration: NCT03977181. Retrospectively registered on June 6, 2019.

PURPOSE: The objective of this study was to determine whether state-level policies that restrict minors’ access to confidential HIV testing without parental consent may suppress HIV testing in young men who have sex with men (YMSM) in the United States. METHODS: Secondary data from a national HIV prevention trial among YMSM aged 13–17 years (N=612) were analyzed to evaluate the association between living in a state with restrictive HIV testing policies for minors and HIV testing behavior, awareness of home-based HIV testing, and confidential interactions with healthcare providers. Multilevel logistic regression models adjusted for age, parents’ education level, race, ethnicity, sexual orientation, being sexually experienced, and health literacy of medical forms, and controlled for clustering by state. Age-stratified models by state-level age of consent for HIV testing and a sub-analysis (including only sexually experienced participants) were also conducted. RESULTS: Residing in a state with restrictive HIV testing policies was significantly associated with the lack of awareness of home-based HIV testing (aOR: 3.06; 95% CIs: 1.49, 6.28). No associations were found for HIV testing behavior (aOR: 1.81; 95% CIs: 0.85, 3.84), speaking privately with a physician (aOR: 1.00; 95% CI: 0.56, 1.79), or discussing confidentiality with a physician (aOR: 0.95; 95% CI: 0.52, 1.71) and HIV testing policies for minors. These results were consistent in both the age-stratified models and sub-analysis. CONCLUSION: HIV testing rates among YMSM did not differ by state-level minor consent laws. However, YMSM living in states with restrictive policies on HIV testing for minors were less likely to be aware of home-based HIV testing.

We assess the accuracy of self-reported testing, HIV status, and treatment responses compared to clinical records in Ehlanzeni District, South Africa. We linked a 2018 population-based survey of adults 18-49 years old with clinical data at local primary healthcare facilities from 2014 to 2018. We calculated self-reported testing, HIV status, and treatment, and triangulated findings with clinic record data. We adjusted testing estimates for known gaps in HIV test documentation. Of 2089 survey participants, 1657 used a study facility and were eligible for analysis. Half of men and 84% of women reported an HIV test in the past year. One third of reported tests could be confirmed in clinic data within 1 year and an additional 13% within 2 years; these fractions increased to 57% and 22% respectively limiting to participants with a verified clinic file. After accounting for gaps in clinic documentation, we found that prevalence of recent HIV testing was closer to 15% among men and 51% in women. Estimated prevalence of known HIV was 16.2% based on self-report vs. 27.6% with clinic documentation. Relative to clinical records among confirmed clinic users, self report of HIV testing and of current treatment were highly sensitive but non-specific (sensitivity 95.5% and 98.8%, specificity 24.2% and 16.1% respectively), while self report of HIV status was highly specific but not sensitive (sensitivity 53.0%, specificity 99.3%). While clinical records are imperfect, survey-based measures should be interpreted with caution in this rural South African setting.

Background: There exist a limited number of studies demonstrating the benefit of initiating anti-retroviral agents (ARVs) for the treatment of human immunodeficiency virus (HIV) in the critical care setting. However, there are physiological, practical, and ethical arguments against making HIV testing and initiation of ARVs routine practice. Methods: A self-administered, cross-sectional survey of healthcare professionals was conducted with data collected using a questionnaire distributed to delegates of the Critical Care Society of South Africa (CCSSA) 2016 Congress, and members of the society. Results: There were 101 respondents. Eight per cent would not consider testing a critically ill patient for HIV (status previously unknown), largely because they considered this unethical. Sixty-nine per cent would consider commencing ARVs in a patient newly-diagnosed with HIV during an inter-current critical illness. The factor most likely to guide them towards this was severity of illness. In general, the greatest concerns focused around biological/medical issues. However, those clinicians who would not consider initiation of ARVs were more likely than those who would, to be concerned about psychosocial issues. Conclusion: Although the majority of clinicians would consider initiation of ARVs acutely in critically ill patients, it is apparent that the clinical decision-making around this matter is complex. Advocacy is needed to further clarify relevant ethical and legal dilemmas, and in the interim consultative and collaborative care is encouraged.

This cross-sectional study examined the impact of perception of community, social network and individual variables on the likelihood of voluntary HIV testing of people 40 years and older living in Agincourt, South Africa. The data came from Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in SA (HAALSI) Cohort from Agincourt. We applied three logistic regression models. Results showed that voluntary uptake of HIV testing was significantly associated with two network factors, namely friendships within the network and frequency of fighting in the network. At the community level, attachment to place was significantly associated with voluntary testing, while at the individual level, education, sexual behaviour, employment and age were significantly associated with the voluntary uptake of HIV testing. The implications of these findings are that age-appropriate interventions must be devised to sensitise older people in Agincourt about HIV risks. Also, leadership at the community level and in social networks must encourage members to consider voluntary testing for their own and community interests.

The study's objective was to examine variations in viral load (VL) suppression definitions among clients in the Ryan White Program (RWP). Data from clients enrolled in the RWP during 2017 were examined to calculate the proportion of virally suppressed clients using three definitions: recent viral suppression, defined as having a suppressed VL ( 200 copies/mL) in the last test in 2017; maintained viral suppression, having a suppressed VL for both the first and last tests in 2017; and sustained viral suppression, having all tests in 2017 showing suppression. Relative differences across all three definitions were computed. Recent viral suppression measures were higher than maintained and sustained viral suppression measures by 7.0% and 10.1%, respectively. Significant relative differences in definitions by demographic, socioeconomic and clinical status were observed. It may be beneficial for care planning to report not only estimates of recent viral suppression but maintained and sustained viral suppression as well.

Purpose of Review HIV testing is the critical first step to direct people living with HIV (PLWH) to treatment. However, progress is still being made towards the UNAIDS benchmark of 95% of PLWH knowing their status by 2030. Here, we discuss recent interventions to improve HIV testing uptake in global settings. Recent Findings Successful facility-based HIV testing interventions involve couples and index testing, partner notification, and offering of incentives. Community-based interventions such as home-based self-testing, mobile outreach, and hybrid approaches have improved HIV testing in low-resource settings and among priority populations. Partnerships with trusted community leaders have also increased testing among populations disproportionally impacted by HIV. Summary Recent HIV testing interventions span a breadth of facility- and community-based approaches. Continued research is needed to engage men in sub-Saharan Africa, people who inject drugs, and people who avoid biomedical care. Interventions should consider supporting linkage to care for newly diagnosed PLWH.

The national “Ending the HIV Epidemic: A Plan for America” supports expanded testing in jurisdictions and groups with disproportionate HIV burden. Public health planners benefit from learning HIV testing service (HTS) strengths, challenges, and innovations. We conducted semistructured interviews with 120 HTS staff from local health departments, community-based organizations, and community members in Houston, Texas; Miami, Florida; New Orleans, Louisiana; and Washington, DC. We coded interview transcripts using qualitative methods to identify themes. Program strengths include HIV testing integration with other client services; prioritized testing and tailored incentives; multiple advertising methods; and partnerships among HTS providers. Challenges include stigma, fear, and disparities; funding requirements that create competition between providers; and service accessibility, unnecessary repeat testing, and insufficient innovation. The four jurisdictions addressed some, but not all, of these challenges. Cross-jurisdictional collaboration, together with state and federal partners plus program data may help identify additional strategies for strengthening HTS.

Expanding index and family-based testing (HBT) is a priority for identifying children living with HIV. Our study characterizes predictors that drive testing location choice for children of parents living with HIV. Kenyan adults living with HIV were offered a choice of HBT or clinic-based testing (CBT) for any of their children (0–12 years) of unknown HIV status. Multi-level generalized linear models were used to identify correlates of choosing HBT or CBT for children and testing all versus some children within a family, including caregiver demographics, HIV history, social support, cost, and child demographics and HIV prevention history. Among 244 caregivers living with HIV and their children of unknown HIV status, most (72%) caregivers tested children using CBT. In multivariate analysis, female caregivers [aRR 0.52 (95% CI 0.34–0.80)] were less likely to choose HBT than male caregivers. Caregivers with more children requiring testing [aRR 1.23 (95% CI 1.05–1.44)] were more likely to choose HBT than those with fewer children requiring testing. In subgroup univariate analysis, female caregivers with a known HIV negative spouse were significantly more likely to choose HBT over CBT than those with a known HIV positive spouse [RR 2.57 (95% CI 1.28–5.14), p = 0.008], no association was found for male caregivers. Child demographics and clinical history was not associated with study outcomes. Caregiver-specific factors were more influential than child-specific factors in caregiver choice of pediatric HIV testing location. Home-based testing may be preferable to families with higher child care needs and may encourage pediatric HIV testing if offered as an alternative to clinic testing.

What is already known about this topic? A novel HIV infection surveillance initiative was implemented in Malawi to collect data on recent HIV infections among new diagnoses to characterize the epidemic and guide the public health response. What is added by this report? Higher proportions of recent infections were identified among females, persons aged

HIV infections are prevalent among adolescents and young adults, of whom 44% remain unaware of their diagnosis. HIV screening presents numerous challenges including stigma, fear, and concerns about confidentiality, which may influence young people's acceptance of HIV screening and linkage to care differently from individuals in other age groups. It is imperative to understand which care delivery models are most effective in facilitating these services for youth. This systematic review analyzes the rates of HIV test acceptance and linkage to care by care delivery model for adolescents and young adults. Studies were classified into emergency department (ED), primary care/inpatient setting, community-based program, or sexually transmitted infection clinic models of care. From 6395 studies initially identified, 59 met criteria for inclusion in the final analyses. Rate of test acceptance and linkage to care were stratified by model of care delivery, gender, race, age ranges (13–17, 18–24 years) as well as site (North America vs rest of the world). A significant difference in acceptance of HIV testing was found between care models, with high rates of test acceptance in the ED setting in North America and primary care/hospital setting in the rest of the world. Similarly, linkage to care differed by model of care, with EDs having high rates of linkages to HIV care in North America. Future studies are needed to test mechanisms for optimizing outcomes for each care delivery model in addressing the unique challenges faced by adolescents and young adults.

Human immunodeficiency virus (HIV) partner services are an essential component of comprehensive HIV prevention and care. We examined factors associated with partner notification, HIV testing, and HIV positivity among partners of HIV-diagnosed persons (index persons) contacted by Centers for Disease Control and Prevention (CDC)-funded state and local health departments.We analyzed partner service data submitted to the CDC by 61 state and local health departments from 2013 to 2017. Using multivariate Poisson regression-adjusted for clustering effects among partners reported by a common index person-we assessed associations between 3 outcomes of interest (partner notification, HIV testing, and HIV positivity) and the demographic characteristics, risk behaviors, geographic region, and service year of index persons and their partners.A total of 51,368 sexual and/or needle-sharing partners were matched with 33,524 index persons. Of notifiable partners, 97.2% were notified of their potential HIV exposure, and 52.3% were tested for HIV. Among 21,842 notified and tested partners, 23.8% were newly diagnosed with an HIV infection. Partner notification, HIV testing, and HIV positivity were associated with both partner and index person characteristics (individually and interactively), geographic region, and year of service.Partner service programs provided through CDC-funded health departments were effective in both partner notification and identification of undiagnosed HIV infection among partners. However, HIV testing rate among notified partners remained low. Implementing strategies to address gaps in HIV testing can contribute toward ending the HIV epidemic in the United States.

We aimed to identify factors associated with linkage to care for individuals newly diagnosed with HIV in a refugee settlement. This study was conducted from October 2018 through January 2020 in Nakivale Refugee Settlement in Uganda. We conducted a cross-sectional survey among individuals accessing routine HIV testing services. The survey included questions on demographic factors, physical and mental health conditions, social support, and HIV-related stigma. We collected GPS coordinates of the homes of individuals newly diagnosed with HIV. Associations with linkage to care were assessed using bivariate and multivariable analyses. Linkage to care was defined as clinic attendance within 90 days of a positive HIV test, not including the day of testing. Network analysis was used to estimate the travel distance between participants’ homes and HIV clinic and to spatially characterize participants living with HIV and their levels of social support. Of 219 participants diagnosed with HIV (out of 5,568 participants screened), 74.4% linked to HIV care. Those who reported higher social support had higher odds of linking to care compared with those who reported lower social support. On spatial analysis, lower levels of social support were most prevalent in Nakivale Refugee Settlement itself, with more robust social support southeast and west of the study area. Social support is a salient correlate of linkage to care for individuals living in refugee settlements and could be the focus of an intervention for improving uptake of HIV care services.

Background Urban refugee youth may live in social contexts characterized by structural drivers of HIV such as poverty and violence. Knowledge gaps remain regarding HIV testing practices among urban refugee youth, despite the increasing trend toward refugee settlement in urban contexts. This study examined social contextual factors associated with lifetime HIV testing among urban refugee youth in Kampala, Uganda. Methods We conducted a community-based study with a peer-recruited cohort of urban refugee youth aged 16–24 years living in Kampala’s informal settlements, and present baseline cross-sectional findings. We conducted descriptive statistics and logistic regression to examine socio-demographic (e.g., gender and age), material (e.g., income insecurity and education), relational (e.g., social support), and symbolic contexts (e.g., HIV-related stigma and intimate partner violence (IPV]) associated with lifetime HIV testing. Results Participants ( n = 450) had a mean age of 20.4 years (standard deviation: 2.4 years), most lived in Uganda for 1–5 years (53.2%), and less than half reported lifetime HIV testing (43.4%). In multivariable analyses, odds of lifetime HIV testing were higher among youth with secondary school education or higher (adjusted odds ratio (aOR]: 2.30, 95% confidence interval (CI]: 1.27–4.17), currently employed (aOR: 1.79, 95% CI: 1.03–3.10), and reporting IPV (aOR: 3.61, 95% CI: 1.43–9.10). Having children was marginally associated with HIV testing (aOR: 2.17, 95% CI: 0.98–4.81, p = 0.052). Conclusions Findings demonstrate suboptimal HIV testing and the importance of tailored strategies to reach urban refugee youth who are unemployed and have limited formal education. There is a need to meaningfully engage urban refugee youth to create enabling environments for sexual health.

During COVID-19 lockdown, the in-hospital number of HIV indicator conditions decreased disproportionally compared with other non–COVID-19 diseases, which was accompanied by reduced HIV testing rates, number and proportion of positive HIV tests, and new HIV referrals, with more late presentation after lockdown cessation, indicating a significantly impacted HIV care continuum.

Background HIV testing is the first step to stop transmission. We aimed to evaluate HIV testing history and new diagnoses among adult outpatients in Kenya aged 18–39 years seeking care for symptoms of acute HIV infection (AHI). Methods The Tambua Mapema Plus study, a stepped-wedge trial, enrolled patients presenting to care at six primary care facilities with symptoms of AHI for a targeted HIV-1 nucleic acid (NA) testing intervention compared with standard provider-initiated testing using rapid antibody tests. Intervention participants underwent a questionnaire and NA testing, followed by rapid tests if NA-positive. Multinomial logistic regression was used to analyse factors associated with never testing or testing > 1 year ago (“late retesting”) relative to testing ≤ 1 year ago (“on-time testers”). Logistic regression was used to analyse factors associated with new diagnosis. All analyses were stratified by sex. Results Of 1,500 intervention participants, 613 (40.9%) were men. Overall, 250 (40.8%) men vs. 364 (41.0%) women were late retesters, and 103 (16.8%) men vs. 50 (5.6%) women had never tested prior to enrolment. Younger age, single status, lower education level, no formal employment, childlessness, sexual activity in the past 6 weeks, and > 1 sexual partner were associated with testing history among both men and women. Intimate partner violence > 1 month ago, a regular sexual partner, and concurrency were associated with testing history among women only. New diagnoses were made in 37 (2.5%) participants (17 men and 20 women), of whom 8 (21.6%) had never tested and 16 (43.2%) were late retesters. Newly-diagnosed men were more likely to have symptoms for > 14 days, lower education level and no religious affiliation and less likely to be young, single, and childless than HIV-negative men; newly-diagnosed women were more likely to report fever than HIV-negative women. Among men, never testing was associated with fivefold increased odds (95% confidence interval 1.4–20.9) of new diagnosis relative to on-time testers in adjusted analyses. Conclusion Most new HIV diagnoses were among participants who had never tested or tested > 1 year ago. Strengthening provider-initiated testing targeting never testers and late retesters could decrease time to diagnosis among symptomatic adults in coastal Kenya. Trial registration ClinicalTrials.gov Identifier: NCT03508908 registered on 26/04/2018.

Background Previous studies have shown that sexually transmitted infections (STI) and human immunodeficiency virus (HIV) testing has varied, but STI prevalence was not estimated among patients during their health care visits in which a high-risk sexual partnership was documented. This study estimated gonorrhea, chlamydia, syphilis, and HIV testing rates and chlamydia and gonorrhea prevalence. Methods From the de-identified commercial claims data of OptumLabs Data Warehouse, we identified men and women aged 15-60 years classified as having high-risk sexual relationships as diagnosis codes: Z72.51 for opposite-sex, Z72.52 for same-sex, and Z72.53 for same-and-opposite-sex relationships, stratified by gender, age group, region, type of health plan, and HIV status. We estimated STI testing rate and prevalence for chlamydia and gonorrhea among patients with high-risk sexual relationships. HIV testing was assessed only in high-risk sexual relationship patients without HIV. Results Among 8.2 million females and 7.3 million males aged 15-60 years in the database from 2016 to 2019, 115,884 patients (0.7% of female, 0.8% of male) including 3,535 patients with HIV were diagnosed with high-risk sexual relationships. The testing rates for gonorrhea, chlamydia, syphilis, and HIV were 69.4% (confidence interval [CI]: 69.1-69.7), 68.9% (CI: 68.6-69.2), 43.4% (CI: 43.1-43.7), and 41.7% (CI: 41.4-42.0), respectively. Among patients with valid chlamydia and gonorrhea tests, 7.2% (CI: 7.0-7.5) and 2.6% (CI: 2.4-2.8) had positive chlamydia and gonorrhea test results, respectively, and varied by type of high-risk sexual relationship. Conclusions Our study findings of suboptimal STI screening among patient in high-risk sexual relationships are consistent with previous studies. Administrative records confirmed by lab results indicate a need for STI counseling, testing, and treatment among patients who are diagnosed with high-risk sexual relationships with same-sex, opposite-sex, or same-and-opposite sex partners.

INTRODUCTION Routine HIV testing is expected to facilitate early diagnosis and treatment. Nevertheless, to date, limited data are available on the presumed benefit of early detection with improved outcomes through routine HIV testing. METHODS This study was based on the Taiwan national HIV/AIDS registry, with follow-up data validated through December 31, 2014. Outcomes of people diagnosed with HIV infection through the routine (routinely offered in specific settings, opt-out) versus through nonroutine (individual risk-based) testing were compared. The main outcomes of the study were late diagnosis, HIV-related mortality, and all-cause mortality. Individuals were matched by year of HIV diagnosis and adjusted for age, sex, transmission routes, and SES. Analyses were conducted in 2019-2020. RESULTS This study included all 28,674 people diagnosed with HIV infection during 1986-2014 (8,431 [29%] by routine testing, 18,305 [64%] by individual risk-based testing) with a mean follow-up time of 6.2 years. Routine testing was associated with an 80% lower likelihood of late HIV diagnosis (AOR=0.20, 95% CI=0.18, 0.23, p

Women who experience HIV seroconversion during pregnancy are missed during early routine pregnancy HIV screening and are at high risk of perinatal HIV transmission. Male partner HIV testing during routine prenatal care may be an effective primary prevention strategy by identifying women at risk of seroconversion and mitigating their risk. Our objective was to assess interest in and uptake of male partner HIV testing services offered during prenatal care. This demonstration project included all pregnant, English-speaking, HIV-negative women receiving publicly funded prenatal care in an urban hospital-based practice located in a high HIV prevalence area. Women were offered free HIV screening for their male sexual partners. From April 2017 to June 2018, enrolled women completed surveys on social demographics, medical access characteristics, and HIV testing history. Women were invited to bring their partners to a prenatal visit where HIV testing was offered to their male partners. Factors associated with women's interest in testing and completion of partner testing were assessed using bivariable and multivariable analyses. Of 392 women approached, 70% (N = 274) completed study surveys. Although the majority (76%, N = 200 of 264 respondents) of women desired their partner undergo HIV testing, testing was underutilized as only 18 (7%) male partners completed testing. While neither maternal characteristics nor male social or attitudinal factors were associated with interest in or completion of partner HIV testing, sensitivity analyses, performed with multiple imputation, demonstrated some association between interest and completion of partner testing and partner medical care access and utilization. In conclusion, although the majority of low-income women in an urban prenatal clinic expressed interest in having their partners undergo HIV testing, uptake of free partner HIV testing services was uncommon. A focused assessment of implementation and uptake barriers is needed to optimize partner testing and eliminate HIV transmission to mothers and their babies.

Background Ethiopia Population-based HIV Impact Assessment findings showed that in Addis Ababa, only 65.2% of people living with HIV (PLHIV) know their status. We present the enhanced HIV/AIDS data management and systematic monitoring experience in Addis Ababa City Administration Health Bureau (AACAHB). Methods AACAHB established a command-post with leadership and technical team members from the health bureau, 10 sub-city health offices, and non-governmental stakeholders. The command-post improved governance, standardized HIV program implementation, and established accountability mechanism. A web-based database was established at each health facility, sub-city, and AACAHB level. Performance was scored (green, ≥75%; yellow, 50–74%; red, Results After 6 months of intervention period, the monthly New HIV case finding in 47 health facilities increased from 422 to 734 (1.7 times) and treatment initiation increased from 302 to 616 (2 times). After 6 months, the aggregate scoring for HIV testing at city level improved from yellow to green, HIV case finding improved from red to green, and treatment initiation improved from red to yellow. An increasing trend was noted in HIV positive case finding with statistically significant improvement from 43.4% [95% Confidence Interval: 40.23–46.59%] in May 2019 to 74.9% [95% Confidence Interval: 72.03–77.6%] in September 2019. Similarly, significant improvement was recorded for new HIV treatment from 30.9% [95% Confidence Interval: 28.01–33.94%] in May 2019 to 62.5% [95% Confidence Interval: 59.38–65.6%] in September 2019. Conclusions Regular data driven HIV program review was institutionalized at city, sub-city and health facility levels which further improved HIV program monitoring and performance. The performance of HIV case finding and treatment initiation improved significantly via using intensified monitoring, data driven performance review, targeted site-level support based on the gap, and standardized approaches.

HIV self-testing (HIVST) offers a promising approach to increase HIV diagnosis and advance progress towards the UNAIDS 95-95-95 targets. We aimed to understand patterns of HIVST awareness and utilization in nine sub-Saharan African (SSA) countries, with the goal of identifying populations to target in disseminating this technology.A cross-sectional study.We pooled individual-level population-based data from nine Demographic and Health Surveys (DHS) in SSA conducted 2015-2019 (Burundi, Cameroon, Guinea, Malawi, Senegal, Sierra Leone, South Africa, Zambia, Zimbabwe). Primary outcomes were HIVST awareness and utilization. We used logistic regression with survey fixed effects to explore the relationship between sociodemographic characteristics and these outcomes. Models were adjusted for sex, age, rural/urban residence, education, wealth, and marital status. We accounted for complex survey design.The study sample included 177 572 people (66.0% women, mean age 29 ± 10 years), of whom 86.6% [95% confidence interval (95% CI) 86.4-86.7] were unaware of HIVST, 11.7% (95% CI 11.6-11.9) were aware of but never used HIVST, and 1.7% (95% CI 1.6-1.8) had used HIVST. In adjusted models, women were less likely to be aware of HIVST [odds ratio (OR) 0.75, 95% CI 0.71-0.79], but more likely to have used HIVST (OR 1.17, 95% CI 1.03-1.32) compared with men. Rural residents, those who were least educated, and poorest were less likely to have heard of or used HIVST.HIVST awareness and uptake were low. Rural, less educated, and lower income populations were least likely to have heard of or used HIVST. Efforts to scale-up HIVST in these settings should aim to reach these less advantaged groups.

Accurate diagnosis and treatment of patients with febrile respiratory symptoms is critical. Clinicians should not only focus on the most common conditions but also remain vigilant for other conditions that may exacerbate or result in similar presenting complaints. A detailed history is key to a successful diagnosis.

HIV exceptionalism refers to the fact that the illness is so different from other diseases that testing needs a special approach to informed consent. HIV infected people often visit health clinics, especially emergency departments, years before receiving a diagnosis without being tested for HIV. There is considerable public interest in increasing HIV testing in emergency departments. However, because these departments are sensitive environments that primarily provide urgent and emergency care, a number of ethical questions have been raised about the appropriateness of these settings for the implementation of universal screening programs. Human rights in patient care therefore constitutes an essential theoretical framework for analyzing ethical and legal dilemmas that arise in clinical encounters, thus strengthening the application of human rights principles to the context of patient care.O “excepcionalismo” da infecção pelo HIV diz respeito ao fato de essa doença ser considerada tão diferente das demais e de que sua testagem necessita de uma abordagem especial em relação ao consentimento informado. Frequentemente, pessoas infectadas pelo HIV visitam unidades de assistência à saúde, sobretudo prontossocorros, anos antes de receberem um diagnóstico, sem terem sido testadas nessas oportunidades. Existe considerável interesse público em ampliar a testagem para o HIV em prontos-socorros. Por se tratar de ambiente sensível, cuja missão principal é o cuidado de urgências e emergências, há questionamentos quanto a esse ser um local apropriado para um programa de rastreamento universal, notadamente por questões éticas. Assim, os “direitos humanos dos pacientes” (DHP) constituem referencial teórico essencial para a análise de conflitos éticos que surgem no encontro clínico, fortalecendo a efetiva aplicação dos direitos humanos ao cuidado em saúde.

Background:During the era of the Millennium Development Goals (MDG), children were shown to have less access to human immunodeficiency virus (HIV) services than their adult counterparts; hence the call to prioritise children in the implementation of the Sustainable Development Goals (SDGs). However, South African (SA) national data in 2019 indicated that almost 3 years into the implementation of the 90-90-90 strategy, only 59% of children living with HIV had been tested for HIV compared to 90% of adults. Objectives:To evaluate the access of children to HIV services and record the viral load (VL) suppression rates during the implementation of the 90-90-90 strategy in the City of Johannesburg (COJ), South Africa. Methods:This study applied a quasi-experimental interrupted time-series (ITS) design using the monthly District Health Information System (DHIS) and National Health Laboratory Services (NHLS) databases spanning the period from 2015 to 2020, that is, before and after the implementation and roll-out of the 90-90-90 strategy. Data were extracted from these databases into MS Excel 2010 spreadsheets and analysed with Stata 15 software from Stata Corp using a two-tailedt-test at a 5% level of significance. Results:Overall, a significant increase was observed in the number of individuals tested for HIV,n= 757,p= 0.0086, and retained in caren= 2523,p= 0.001 over the whole period of analysis beginning in April 2015. Adult HIV testing, antiretroviral treatment (ART) initiation and retention in care had been decreasing in absolute numbers over a 10-month period before the intervention. An increase in these three data elements was observed following the implementation of the 90-90-90 program. On the other hand, children aged 0–15 years had demonstrated a significant increase in absolute numbers tested for HIV,n= 171,p= 0.001, but an insignificant increase in number of ART initiations,n= 14.33,p= 0.252, before implementation but a decrease after this. The overall VL suppression rates for children were lower than those of adults. Conclusion:Although the COJ has recorded progress in adult HIV testing, ART initiation and retention, children living with HIV aged 0–15 years continue to experience less access to HIV services and lower VL suppression than youths and adults of ≥ 15 years. Therefore, to ensure that the 90-90-90 targets are achieved across different age groups, children must be prioritised so that they can equally access these services with adults.

Background Recent data on the rate and risk factors of induced abortion among women living with HIV (WLWH) are limited. Our aim was to use Finnish national health register data to 1) determine the nationwide rate of induced abortions of WLWH in Finland during 1987–2019, 2) compare the rates of induced abortions before and after HIV diagnosis over different time periods, 3) determine the factors associated with terminating a pregnancy after HIV diagnosis, and 4) estimate the prevalence of undiagnosed HIV at induced abortions to see whether routine testing should be implemented. Methods A retrospective nationwide register study of all WLWH in Finland 1987–2019 (n = 1017). Data from several registers were combined to identify all induced abortions and deliveries of WLWH before and after HIV diagnosis. Factors associated with terminating a pregnancy were assessed with predictive multivariable logistic regression models. The prevalence of undiagnosed HIV at induced abortion was estimated by comparing the induced abortions among WLWH before HIV diagnosis to the number of induced abortions in Finland. Results Rate of induced abortions among WLWH decreased from 42.8 to 14.7 abortions/1000 follow-up years from 1987–1997 to 2009–2019, more prominently in abortions after HIV diagnosis. After 1997 being diagnosed with HIV was not associated with an increased risk of terminating a pregnancy. Factors associated with induced abortion in pregnancies that began after HIV diagnosis 1998–2019 were being foreign-born (OR 3.09, 95% CI 1.55–6.19), younger age (OR 0.95 per year, 95% CI 0.90–1.00), previous induced abortions (OR 3.36, 95% CI 1.80–6.28), and previous deliveries (OR 2.13, 95% CI 1.08–4.21). Estimated prevalence of undiagnosed HIV at induced abortion was 0.008–0.029%. Conclusions Rate of induced abortions among WLWH has decreased. Family planning should be discussed at every follow-up appointment. Routine testing of HIV at all induced abortions is not cost-effective in Finland due to low prevalence.

Transgender women (TGW) in India, especially those who engage in sex work, are at high risk for HIV. Guided by the information-motivation-behavioral skills model and qualitative formative research findings, Sakhi (girlfriend), a 3-week smartphone-based pilot intervention consisting of short videos (one/week) and text messages (two/week), was implemented using a one-group pre- and post-test design to test its efficacy in promoting condom use and HIV testing among TGW (n = 50) who engage in sex work in Chennai. Changes in outcomes were assessed by conducting multivariable analyses using generalized estimating equations. Participants’ mean age was 26 years, and the mean monthly income was INR 21700 (USD 292). About one-third completed college, and 96% were HIV-negative. Significant changes in the desired direction were observed in the primary outcomes: condom use – decrease in the engagement of condomless anal sex with male partners (12% to 2%, p < 0.05) and HIV testing – increase in intentions to undergo HIV testing every 6 months (34% to 86%, p < 0.001); and in some of the secondary outcomes: decrease in alcohol use before sex, increase in intentions to use condoms consistently and increase in the well-being score. This study demonstrated the feasibility, acceptability, and preliminary efficacy of the Sakhi intervention and warrants a larger randomized trial among diverse subgroups in diverse settings.

Tuberculosis (TB) and infection with human immuno-deficiency virus (HIV) are leading infectious causes of morbidity particularly in sub-Saharan Africa, which is disproportionately affected by the two epidemics. Kenya is one of the 30 countries with the highest HIV and TB burden in the world. Kenya’s HIV prevalence was estimated to be 4,900 per 100,000 in 2019 while TB prevalence was 558 per 100,000 population in a 2016 survey. Estimates of mortality from TB and HIV were based on modeling of civil registration and vital statistics (CRVS) which may not be accurate in low- and middle-income countries due to under-reporting, poor documentation of causes of death and lack of verification of causes of death. In this thesis, we provide updated estimates of TB and HIV mortality using a variety of data sources including routine surveillance, post mortem surveillance for HIV infection and minimally invasive tissue sampling (MITS). We also evaluated two mortality preventive interventions. Our mortality studies documented a higher-than-expected HIV prevalence (28.5%) among 846 decedents received by high-volume mortuaries in western Kenya; 17% of deaths were attributable to HIV-infection. Half of HIV-infected decedents had viral load of ≥1,000 copies/milliliter. Among 456 decedents whose causes of death were determined by an expert panel, HIV/AIDS was the leading underlying cause of death (HIV cause-specific mortality rate: 251/100,000 population); TB was ranked 12th among immediate causes of death. Among 176 decedents aged under-five years, malnutrition, malaria, and HIV were the top three underlying causes of death. HIV prevalence among 176 decedents aged under-five years (14%) twenty-fold higher than the estimated prevalence among children in the population (0.7%); 96% of HIV-infected decedents were virally non-suppressed. While Mycobacterium tuberculosis was not detected among under-five decedents, five decedents (four HIV-infected) had been on TB treatment antemortem. Epidemiological analysis of national TB surveillance data showed that 28% of children aged

Tuberculosis (TB) and infection with human immuno-deficiency virus (HIV) are leading infectious causes of morbidity particularly in sub-Saharan Africa, which is disproportionately affected by the two epidemics. Kenya is one of the 30 countries with the highest HIV and TB burden in the world. Kenya’s HIV prevalence was estimated to be 4,900 per 100,000 in 2019 while TB prevalence was 558 per 100,000 population in a 2016 survey. Estimates of mortality from TB and HIV were based on modeling of civil registration and vital statistics (CRVS) which may not be accurate in low- and middle-income countries due to under-reporting, poor documentation of causes of death and lack of verification of causes of death. In this thesis, we provide updated estimates of TB and HIV mortality using a variety of data sources including routine surveillance, post mortem surveillance for HIV infection and minimally invasive tissue sampling (MITS). We also evaluated two mortality preventive interventions. Our mortality studies documented a higher-than-expected HIV prevalence (28.5%) among 846 decedents received by high-volume mortuaries in western Kenya; 17% of deaths were attributable to HIV-infection. Half of HIV-infected decedents had viral load of ≥1,000 copies/milliliter. Among 456 decedents whose causes of death were determined by an expert panel, HIV/AIDS was the leading underlying cause of death (HIV cause-specific mortality rate: 251/100,000 population); TB was ranked 12th among immediate causes of death. Among 176 decedents aged under-five years, malnutrition, malaria, and HIV were the top three underlying causes of death. HIV prevalence among 176 decedents aged under-five years (14%) twenty-fold higher than the estimated prevalence among children in the population (0.7%); 96% of HIV-infected decedents were virally non-suppressed. While Mycobacterium tuberculosis was not detected among under-five decedents, five decedents (four HIV-infected) had been on TB treatment antemortem. Epidemiological analysis of national TB surveillance data showed that 28% of children aged

Background: Human immunodeficiency virus self-testing (HIVST) is a most recent testing modality to reach young people to test for HIV, due to their increased vulnerability of contracting HIV. Limited literature is available describing sexual behaviours and the acceptability of HIVST and its perceived use among students.Aim: The aim of this study was to assess the acceptability and perceived use of HIV self-testing among students in Limpopo province, South Africa.Setting: The study was conducted in Limpopo province, at a technical and vocational education and training (TVET) college.Methods: A cross-sectional study was conducted with a sample of 396 students recruited from a TVET college.Results: The mean age of the students was 22.9 years, with the majority of the students being female (77.2%). The majority (81.4%) of the students sampled reported regular sexual activity. Sixty per cent of the students had used condoms during their last sexual encounter. The acceptability of HIVST was high, with more women showing the willingness to take up HIVST (82.5%). Being sexually active (odds ratio [OR] 1.23; (confidence interval [CI]: 2.14 -6.94; p = 0.000), a number of sexual partners (OR 1.045; CI: 1.98 -10.02; p = 0.000) and condom use during the last sexual encounter (OR 0.62; CI: 3.81 -9.59; p = 0.000) were factors associated with HIVST.Conclusion: The high acceptability of HIV shows a need for innovative demand creation in sexual and reproductive health (SRH) programming.Contribution: The study contributes to the body of literature about the acceptability and perceived use of HIV self-testing among students. Findings can be used for improving HIVST interventions using innovative approaches.