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ABSTRACTJustice-impacted persons may inconsistently access HIV testing. This cross-sectional secondary analysis investigates lifetime HIV testing prevalence among adults with prior histories of incarceration in Southern California, United States, participating in health-focused programming (n = 3 studies). Self-reported demographic and lifetime HIV testing data were collected between 2017-2023; descriptive analyses were conducted. Across the three samples, at least 74% of participants were male; Latino and African American individuals accounted for nearly two-thirds of participants. Lifetime HIV testing ranged from 72.8% to 84.2%. Males were significantly more likely than females to report never being tested in two samples and accounted for >95% of those never tested. No statistically significant differences in testing were observed by race/ethnicity. Single young adults (ages 18-26) were less likely than their partnered peers to report testing. HIV testing is critical for ensuring that individuals access prevention and treatment. HIV testing among justice-impacted adults in this study was higher than in the general population, potentially due to opt-out testing in correctional settings. Nevertheless, these findings underscore the importance of implementing targeted interventions to reduce structural (e.g., health insurance, access to self-testing kits) and social barriers (e.g., HIV stigma) to increase HIV testing among justice-impacted males and single young adults.

BACKGROUND: Exposure to antiretrovirals at or early after HIV acquisition can suppress viral replication and blunt antibody (Ab) responses; a reduced HIV detectability could impact diagnosis and blood donation screening. METHODS: We used three antigen (Ag)/Ab assays and one nucleic acid test (NAT) to analyze samples collected in pre-exposure prophylaxis (PrEP) trials (iPrEx; Partners PrEP) before infection detection by Ab-only rapid diagnostic tests (RDTs), and in early antiretroviral treatment (ART) initiation studies (RV254; SIPP). RESULTS: Reactivity using NAT and Ag/Ab assays in samples collected up to 8 weeks prior to the first reactive RDT from 251 PrEP trials participants varied between 49-61% for active PrEP users and between 27-37% for placebo users. Among RV254 participants, reactivity in Ag/Ab assays was

BackgroundHIV testing rates among South African men lag behind rates for women and national targets. Community-based HIV self-screening (HIVSS) distribution and follow-up by community health workers (CHWs) is a scalable option to increase testing coverage, diagnosis, and treatment initiation. We provided HIVSS and assisted linkage to care to men not recently tested (within the past 12 months) residing in high-HIV-burden areas of Johannesburg.MethodsCHWs distributed HIVSS in 6 clinic catchment areas. Follow-up to encourage confirmatory testing and antiretroviral therapy initiation was conducted through personal support (PS) or an automated short message service (SMS) follow-up and linkage system in 3 clinic areas each. Using a quasi-experimental pre-post design, we compared differences in the proportion of men testing in the clinic catchment areas during the HIVSS campaign (June-August 2019) to the 3 months prior (March-May 2019) and compared treatment initiations by assisted linkage strategy.ResultsAmong 4793 participants accepting HIVSS, 62% had never tested. Among 3993 participants with follow-up data, 90.6% reported using their HIVSS kit. Testing coverage among men increased by 156%, from under 4% when only clinic-based HIV testing services were available to 9.5% when HIVSS and HIV testing services were available (z = -11.6; P < 0.01). Reported test use was higher for men followed through PS (99% vs. 68% in SMS); however, significantly more men reported reactive self-test results in the SMS group compared with PS (6.4% vs. 2.0%), resulting in more antiretroviral therapy initiations in the SMS group compared with PS (23 vs. 9; P < 0.01).ConclusionsCHW HIVSS distribution significantly increases testing among men. While PS enabled personalized follow-up, reporting differences indicate SMS is more acceptable and better aligned with expectations of privacy associated with HIVSS.

Across sub-Saharan Africa, men are less likely to know their HIV status than women, leading to later treatment initiation. Little is known about how experiences with general health services affect men's use of HIV testing. We used data from a 2019 community-representative survey of men in Malawi to understand frequency and cause of men's negative health service experiences (defined as men reporting they "would not recommend" a facility) and their association with future HIV testing. We conducted univariable and multivariable logistic regressions to determine which aspects of health facility visits were associated with would-not-recommend experiences and to determine if would-not-recommend experiences 12-24 months prior to the survey were associated with HIV testing in the 12 months prior to the survey. Among 1,098 men eligible for HIV testing in the 12 months prior to the survey, median age was 34 years; 9% of men reported at least one would-not-recommend experience, which did not differ by sociodemographics, gender norm beliefs, or HIV stigma beliefs. The factors most strongly associated with would-not-recommend experiences were cost (aOR 5.8, 95%CI 2.9-11.4), cleanliness (aOR 4.2, 95%CI 1.8-9.9), medicine availability (aOR 3.3, 95%CI 1.7-6.4), and wait times (aOR 2.7, 95%CI 1.5-5.0). Reporting a would-not-recommend experience 12-24 months ago was associated with a 59% decrease in likelihood of testing for HIV in the last 12 months (aOR 0.41; 95% CI:0.17-0.96). Dissatisfaction with general health services was strongly associated with reduced HIV testing. Coverage of high-priority screening services like HIV testing may benefit from improving overall health system quality.

Introduction: Recent policy changes in Washington State presented a unique opportunity to pair evidence-based interventions with first responder services to combat increasing opioid overdoses. However, little is known about how these interventions should be implemented. In partnership with the Research with Expert Advisors on Drug Use team, a group of academically trained and community-trained researchers with lived and living experience of substance use, we examined facilitators and barriers to adopting leave-behind naloxone, field-based buprenorphine initiation, and HIV and hepatitis C virus (HCV) testing for first responder programs.Methods: Our team completed semi-structured, qualitative interviews with 32 first responders, mobile integrated health staff, and emergency medical services (EMS) leaders in King County, Washington, from February–May 2022. Semi-structured interviews were recorded, transcribed, and coded using an integrated deductive and inductive thematic analysis approach grounded in community-engaged research principles. We collected data until saturation was achieved. Data collection and analysis were informed by the Consolidated Framework for Implementation Research. Two investigators coded independently until 100% consensus was reached.Results: Our thematic analysis revealed several perceived facilitators (ie, tension for change, relative advantage, and compatibility) and barriers (ie, limited adaptability, lack of evidence strength and quality, and prohibitive cost) to the adoption of these evidence-based clinical interventions for first responder systems. There was widespread support for the distribution of leave-behind naloxone, although funding was identified as a barrier. Many believed field-based initiation of buprenorphine treatment could provide a more effective response to overdose management, but there were significant concerns that this intervention could run counter to the rapid care model. Lastly, participants worried that HIV and HCV testing was inappropriate for first responders to conduct but recommended that this service be provided by mobile integrated health staff.Conclusion: These results have informed local EMS strategic planning, which will inform roll out of process improvements in King County, Washington. Future work should evaluate the impact of these interventions on the health of overdose survivors.

IntroductionGlobally, transgender ('trans') women experience extreme social and economic marginalisation due to intersectional stigma, defined as the confluence of stigma that results from the intersection of social identities and positions among those who are oppressed multiple times. Among trans women, gender-based stigma intersects with social positions such as engagement in sex work and substance use, as well as race-based stigma to generate a social context of vulnerability and increased risk of HIV acquisition. In Brazil, trans women are the 'most at-risk' group for HIV, with 55 times higher estimated odds of HIV infection than the general population; further, uptake of HIV testing and pre-exposure prophylaxis (PrEP) among trans women is significantly lower than other at-risk groups. Through extensive formative work, we developed Manas por Manas, a multilevel intervention using HIV prevention strategies with demonstrated feasibility and acceptability by trans women in Brazil, to address intersectional stigma and increase engagement in the HIV prevention continuum.Methods and analysisWe are conducting a two-arm randomised wait-list controlled trial of the intervention's efficacy in São Paulo, Brazil, to improve uptake of HIV testing and PrEP among transgender women (N=400). The primary outcomes are changes in HIV testing (self-testing and clinic based), changes in PrEP uptake and changes in PrEP persistence at baseline and follow-up assessment for 12 months at 3-month intervals.Ethics and disseminationThis study was approved by University of California, San Francisco Institutional Review Board (15-17910) and Comissão Nacional de Ética em Pesquisa (Research Ethics National Commission, CAAE: 25215219.8.0000.5479) in Brazil. Participants provided informed consent before enrolment. We are committed to collaboration with National Institutes of Health officials, other researchers, and health and social services communities for rapid dissemination of data and sharing of materials. The results will be published in peer-reviewed academic journals and scientific presentations.Trial registration numberNCT03081559.

Developmental assets are critical to the health and wellbeing of youth. The current study examines the influence of developmental assets on PrEP use and HIV testing among YBMSM ages 18-24. Using a cross-sectional survey of YBMSM (N = 225), this study explored the role of external (e.g., family support, other adult support) and internal (e.g., personal responsibility) assets in explaining HIV prevention behaviors. Participants were recruited from Mechanical Turk (M-Turk) internet-based platform, social media sites, and community-based organizations. A path analysis was conducted to investigate the direct/indirect effects of internal and external assets on PrEP use and HIV testing. Family support (β = 0.40, p

BACKGROUND: Prior research has consistently shown that the involvement of families plays a vital role in reducing risk behaviors, such as engaging in condomless sex, and promoting HIV prevention behaviors among young Black men who have sex with men (YBMSM). With the aim of expanding the existing knowledge, this study aimed to examine the specific influence of families and other supportive adults in facilitating casual condom use, partner condom use, HIV testing, and preexposure prophylaxis (PrEP) utilization among young Black MSM. METHODS: A sample of YBMSM aged 18-29 years (N = 400) was collected online. We used a path analysis to examine the influence of family factors on PrEP stigma and PrEP use. Respondents were recruited from December 1, 2021, to January 31, 2022. We used a path analysis to examine the direct and indirect effects of family factors on PrEP use through HIV testing and encouraging condom use. RESULTS: Among BMSM, other adult support was positive and directly associated with condom use by both casual partners (β = 0.04, p

Objective To describe the scale-up of cervical cancer screening and treatment for women living with human immunodeficiency virus (HIV), aged 25-49 years in Uganda, and to analyse the programme data. Methods The health ministry targeted existing HIV clinics in a 2-year scale-up of cervical cancer screening services from October 2020. In preparation, we trained health workers to assess women attending HIV clinics for screening eligibility, provided either by human papillomavirus (HPV) testing and/or visual inspection with acetic acid. Clinic staff treated women with precancerous cervical lesions with thermocoagulation or referred women with suspected cancer to external services. We analysed data reported every 6 months for the number of clinics offering screening, screening uptake, the number of positive diagnoses and the number of women who received treatment. Findings The number of HIV clinics offering cervical cancer screening services increased from 11, before the programme launch, to 1571. During the programme, screening uptake increased from 5.0% (6506/130 293) to 107.3% (151872/141 527) of targets. The cumulative proportion of positive diagnoses was 5.9% (23 970/407 323) overall, but was much lower for screening offering visual inspection only compared with clinics offering HPV testing. Although the proportion of women receiving treatment if positive increased from 12.8% (53/413) to 84.3% (8087/9592), the World Health Organization target of 90% was not reached. Conclusion We demonstrated marked increases, potentially replicable by other countries, in screening and treatment. These increases could be improved further by expanding HPV testing and same-day treatment of precancerous lesions. Objectif Decrire Intensification du depistage et du traitement du cancer du col de l'uterus chez les femmes vivant avec le virus de l'immunodeficience humaine (VIH) et agees de 25 a 49 ans en Ouganda, puis analyser les donnees du programme. Methodes Le Ministere de la Sante a cible les cliniques de prise en charge du VIH existantes dans le cadre d'un renforcement des services lies au cancer du col de l'uterus sur une periode de deux ans, a partir d'octobre 2020. En amont, nous avons forme des professionnels de la sante a examiner les femmes frequentant les cliniques du VIH afin de determiner leur admissibility au depistage, par un test de detection du papillomavirus humain (HPV) et/ou une inspection visuelle apres application d'acide acetique. Le personnel des cliniques a traite les femmes presentant des lesions precancereuses du col de l'uterus par thermocoagulation, ou les ont renvoyees vers des services externes lorsqu'elles etaient susceptibles d'etre atteintes d'un cancer. Nous avons analyse les donnees transmises tous les six mois concernant le nombre de cliniques proposant un depistage, la participation au depistage, le nombre de diagnostics positifs et le nombre de femmes ayant repu un traitement. Resultats Le nombre de cliniques du VIH disposant de services de depistage du cancer du col de l'uterus a augmente: 11 avant le lancement du programme, 1571 apres. Au cours de ce programme, la participation au depistage est passee de 5,0% (6506/130 293) a 107,3% (151 872/141 527) des cibles. Le pourcentage cumule de diagnostics positifs s'elevait a 5,9% (23 970/407 323) au total; cependant, il etait nettement moins important dans des cliniques effectuant uniquement des inspections visuelles que dans celles proposant un test de detection du HPV. Bien que le pourcentage de femmes ayant regu un traitement en cas de diagnostic positif ait progresse de 12,8% (53/413) a 84,3% (8087/9592), l'objectif de l'Organisation mondiale de la Sante, fixe a 90%, n'a pas ete atteint. Conclusion Nous avons observe des hausses considerables, susceptibles de se reproduire dans d'autres pays, en matiere de depistage et de prise en charge. Ces hausses pourraient etre accentuees par le developpement des tests de detection du HPV et de traitement des lesions precancereuses le jour meme. Objetivo Describir la ampliacion del cribado y tratamiento del cancer de cuello uterino para mujeres con el virus de la inmunodeficiencia humana (VIH) de entre 25 y 49 anos en Uganda, y analizar los datos del programa. Metodos El Ministerio de Salud se centro en las clinicas de VIH existentes en una ampliacion de dos anos de los servicios de cribado del cancer de cuello uterino a partir de octubre de 2020. Como preparacion, formamos a profesionales sanitarios para que evaluaran a las mujeres que acudian a las clinicas de VIH para determinar si cumplian los requisitos para someterse al cribado, mediante pruebas del virus del papiloma humano (VPH) o inspeccion visual con acido acetico. El personal clinico trato a las mujeres que presentaban lesiones cervicales precancerosas con termocoagulacion o derivo a las mujeres con sospecha de cancer a servicios externos. Se analizaron los datos comunicados cada seis meses sobre el numero de clinicas que ofrecian el cribado, la aceptacion del cribado, el numero de diagnosticos positivos y el numero de mujeres que recibieron tratamiento. Resultados El numero de clinicas de VIH que ofrecen servicios de cribado del cancer de cuello uterino aumento de 11, antes del lanzamiento del programa, a 1571. Durante el programa, la aceptacion del cribado aumento del 5,0% (6506/130 293) al 107,3% (151 872/141 527) de los objetivos. El porcentaje acumulado de diagnosticos positivos fue del 5,9% (23 970/407 323) en general, pero fue mucho menor en el caso de los diagnosticos en clinicas que solo ofrecian inspeccion visual en comparacion con las clinicas que ofrecian pruebas del VPH. Aunque el porcentaje de mujeres que recibieron tratamiento en caso positivo aumento del 12,8% (53/413) al 84,3% (8087/9592), no se alcanzo el objetivo del 90% que habia fijado la Organizacion Mundial de la Salud. Conclusion Se registraron aumentos notables, potencialmente reproducibles en otros paises, en el cribado y el tratamiento. Estos aumentos podrian mejorarse aun mas ampliando las pruebas del VPH y el tratamiento en el mismo dia de las lesiones precancerosas. [phrase omitted], Introduction Cervical cancer is a disease of the female reproductive tract caused primarily by oncogenic types of human papillomavirus (HPV). In 2020, it was the fourth most common cancer among [...]

BACKGROUND: Cost-effectiveness analysis of HIV self-testing using patient-level data from a randomized clinical trial can inform HIV prevention funding decisions. Cost-effectiveness analysis using net-benefit regression addresses the sampling uncertainty in the trial data and the variability of policymakers willingness to pay (WTP). METHODS: We used published data from a 12-month longitudinal randomized clinical trial that enrolled 2665 men who had sex with men randomly assigned to the self-testing arm (participants receiving self-test kits) and control arm (participants receiving standard-of-care), and the self-testing arm identified 48 additional new HIV cases. We used net-benefit regression to investigate the cost-effectiveness of an HIV self-testing intervention, which compared the incremental cost per new HIV diagnosis with policymakers WTP thresholds. We addressed the uncertainties in estimating the incremental cost and the policymakers WTP per new diagnosis through the incremental net-benefit (INB) regression and cost-effectiveness acceptability curve (CEAC) analyses. RESULTS: From the health care providers perspective, the INB analysis showed a positive net benefit of HIV self-testing compared with standard-of-care when policymakers WTP per new HIV diagnosis was $9365 (95% confidence interval: $5700 to $25,500) or higher. The CEAC showed that the probability of HIV self-testing being cost-effective compared with standard-of-care was 58% and >99% at a WTP of $10 000 and $50 000 per new HIV diagnosis, respectively. CONCLUSION: The INB and CEAC analyses suggest that HIV self-testing has the potential to be cost-effective for relatively low values of policymakers WTP.

BackgroundFacility HIV self-testing (HIVST) in outpatient departments can dramatically increase testing among adult outpatients. However, it is still unclear why populations opt out of facility HIVST and reasons for opt outing. Using data from a parent facility HIVST trial, we sought to understand individual characteristics associated with opting out of facility HIVST and reported reasons for not testing.MethodsExit surveys were conducted with outpatients aged ≥15 years at 5 facilities in Central and Southern Malawi randomized to the facility HIVST arm of the parent trial. Outpatients were eligible for our substudy if they were offered HIVST and eligible for HIV testing (ie, never previously tested HIV positive and tested ≥12 months ago or never tested). Summary statistics and multivariate regression models were used.ResultsSeven hundred seventy-one outpatients were included in the substudy. Two hundred sixty-three (34%) opted out of HIVST. Urban residency (adjusted risk ratios [aRR] 3.48; 95% CI: 1.56 to 7.76) and self-reported poor health (aRR 1.86; 95% CI: 1.27 to 2.72) were associated with an increased risk of opting out. Male participants had a 69% higher risk of opting out (aRR 1.69; 95% CI: 1.14 to 2.51), with risk being 38% lower among working male participants. Primary reasons for not testing were feeling unprepared to test (49·4%) and perceived low risk of HIV infection (30·4%)-only 2.6% believed that HIVST instructions were unclear, and 1.7% were concerned about privacy.ConclusionWorking, risky sexual behavior, rural residence, and good self-rated health were positively associated with opting out of HIVST among outpatients. Strategies to address internalized barriers, such as preparedness to test and perceived need to test, should be incorporated into facility HIVST interventions.

HIV testing services (HTS) enable early linkage to HIV prevention, treatment and care. A review of Chegutu District Health Information System 2 sexually transmitted infection (STI)/HIV data revealed HIV testing rates among those infected with STIs were 41%, 48%, 50%, 51% and 68%, respectively, for the period 2016–2020 against a target of 100%. We investigated factors associated with the uptake of HTS among STI clients.Methods: We conducted a 1:1 unmatched case–control study. We randomly selected cases from STI registers and controls from HTS registers. We defined a case as an individual 18–49 years old diagnosed with STI, unknown HIV status and no documented HIV test result from 01 August 2020 through 31 August 2021. We recruited 115 cases and 115 controls. We used questionnaires to collect data from cases and controls after obtaining written consent. Epi Info7 generated frequencies, proportions, odds ratios and confidence intervals (CIs) at a 0.05 significance level. We applied forward stepwise logistic regression to determine independent factors for HIV testing uptake.Results: Independent factors for uptake of HIV testing among STI clients were: being employed [aOR 0.23; 95% CI(0.09–0.50)], having no stigma towards people living with HIV [aOR 0.19;95% CI(0.06–0.61)], preferring health facility for HIV testing [aOR 0.30;95% CI(0.13–0.65)], male head of family [aOR 2.95. 95% CI(1.25–6.95)], and confidence in clinic staff’s commitment to confidentiality [aOR 0.19; 95% CI(0.06–0.63)].Conclusion: Male decision-makers may deter partner involvement in HTS. We recommended strengthening male involvement in HIV programming through community dialogues that address gender inequalities. [ABSTRACT FROM AUTHOR]

Aims Design, setting and participants Measurements Findings Conclusions The aim of this study was to identify longitudinal trajectories of medication for opioid use disorder (MOUD) use throughout 1 year following MOUD initiation and to examine the association of trajectory membership with HIV testing among people who inject drugs in India.The study comprised group‐based trajectory modeling using longitudinal clinic‐based MOUD use data, set in seven Indian cities with integrated care centers (ICC) delivering MOUD, predominantly buprenorphine, in 2018−2019. A total of 1562 people who inject drugs who initiated MOUD for the first time at an ICC between 1 January 2018 and 31 December 2018 were included in this study. Median age was 26 years, 98% were male and 22% were living with HIV.Daily directly observed MOUD visits were biometrically verified and entered into an electronic database. A dichotomous variable for MOUD use each day throughout 1 year following initiation was created for the trajectory models. Client socio‐demographics, HIV status and testing at the ICC and dose were extracted from the clinical database.We found five MOUD trajectory groups: (1) early dropout (41%), (2) late dropout (18%), (3) delayed dropout (10%), (4) intermittent use (12%) and (5) persistent use (19%). Differences between the dropout groups were characterized by the rate of decline in MOUD use over time. The late dropout group had an 18% higher rate of HIV testing [adjusted rate ratio (aRR) = 1.18, 95% confidence interval (CI) = 1.10–1.27] and those with persistent MOUD use had a 91% higher rate of testing (aRR = 1.91, 95% CI = 1.77–2.05) compared with the early dropout group.Nearly 70% of clients initiating medication for opioid use disorder (MOUD) at integrated care centers (ICCs) in India stop MOUD use within 1 year, with trajectories characterized by the rate of decline in engagement. Clients with better MOUD adherence appear to return more frequently for HIV testing at the ICCs, underscoring the value of integrated care models. [ABSTRACT FROM AUTHOR]

Introduction: Increasing effectiveness, efficiency, and reach of HIV case-finding strategies among priority populations is essential for epidemic control. Index testing is effective but presents potential risks, including stigma, violence, abandonment, and challenges such as fear of disclosure and reluctance to list contacts. We integrated the enhanced peer outreach approach (EPOA) social network strategy into index testing to increase case finding among Haitian migrants and individuals of Haitian descent in Dominican Republic. Methods: The index-EPOA intervention implemented in two successive projects in the Dominican Republic offered index clients index-EPOA referral coupons to distribute to contacts. We analyzed retrospective client records from routine, aggregate program data. We compared overall case-finding rates pre-intervention (baseline October 2019–December 2020) and post-intervention (midline January 2021–March 2022; endline April 2022–June 2023), and case finding for index-EPOA versus standalone index. We calculated case-finding differences using the Student t-test. Results: HS3/EHSEC tested 7,305 contacts of index clients, with 23% case finding. At baseline, 1,234 contacts were tested through standalone index, identifying 211 HIV-positive contacts with case finding at 17%. During the rollout of the intervention, the case-finding rate for standalone index testing remained similar to baseline (16%), while the rate for index-EPOA was 33%. Combined case finding for standalone index and index-EPOA increased to 22% at midline and 29% at endline, resulting in an overall case-finding rate of 25% during the intervention. The statistical analysis found overall case finding post-intervention (combined case-finding rate of 25% at midline + endline for standalone index and index-EPOA) significantly higher than at baseline (17% standalone index) (p < 0.001; 95% CI 8.5%–9.2%). Statistical significance of overall case-finding rates pre- and post-intervention was observed when disaggregated by sex: females 19% versus 26% (p < 0.001; 95% CI 7.2%–7.9) and males 15% versus 23% (p < 0.001; 95% CI 10.1%–10.9%). Conclusions: Integrating the EPOA into index testing strengthened overall case finding for index testing among Haitian migrants and individuals of Haitian descent in the Dominican Republic, suggesting hybrid strategies can maximize program resources and impact. [ABSTRACT FROM AUTHOR]

Objective Design Methods Results Conclusions Opt‐out screening for blood‐borne viruses (BBVs) in emergency departments (EDs) has been established in areas with a high prevalence of HIV diagnoses in England. This multi‐site study explored the attitudes of healthcare workers (HCWs) towards BBV screening in EDs post‐implementation.This was a cross‐sectional electronic survey of HCWs.Between November 2023 and February 2024, HCWs across 33 EDs in England participating in opt‐out BBV screening were invited to complete a survey about the feasibility and acceptability of screening, including the opt‐out consent process. Factors independently associated with acceptability of opt‐out screening were identified using multivariable logistic regression. Free‐text responses were analysed thematically.Responses from 610 HCWs in 19 EDs were provided: 50.4% were nurses, 43.1% doctors, and 6.5% other healthcare professionals. Acceptability of the screening programme and opt‐out consent was high (90.3% and 77.7%, respectively), with some variation between EDs. Acceptability of opt‐out consent was greater among doctors than among other HCWs, and among HCWs who proactively discussed screening further with patients who opted out. However, 50.8% of HCWs felt that patients should be verbally reminded at blood draw, and 44.3% of HCWs wanted more training in discussing opt‐out screening with patients. Free‐text answers suggested changes to test‐ordering systems, including simple integration of tick boxes to document whether patients opted out and to block repeated testing.There was substantial support from ED HCWs for routine opt‐out ED BBV screening, including opt‐out consent. Key areas suggested for improvement included changes to test‐ordering systems and additional training for HCWs. Frequent preference for verbal reminders at the point of blood draw suggests continued HIV testing exceptionalism. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Cervical cancer and its precursor are labeled as HIV indicator conditions, justifying the recommendation of HIV testing for all patients. This study aimed to assess the acceptance and patients' and gynecologists' perceptions on HIV testing in patients with cervical dysplasia at the colposcopy outpatient clinic in hospitals in the Netherlands.A cross‐sectional study was conducted between May 2021 and February 2023 to implement point‐of‐care HIV testing in five hospitals in the Rotterdam region, the Netherlands. We included patients aged 18 years and older, without documented HIV, presenting with cervical dysplasia. The primary outcome was the HIV test acceptance rate. Secondary outcomes were the HIV positivity rate and the association between dysplasia severity and test acceptance. We also assessed patients' and gynecologists' perspectives on this testing strategy with a questionnaire.Of 563 patients, 523 accepted HIV testing, resulting in a test acceptance rate of 92.9% (95% confidence interval, 90.45%–94.88%). Testing rates were consistent among participating hospitals (91.6%–100.0%) None of the patients tested positive for HIV. Severity of dysplasia was not associated with test acceptance (P = 0.768). Most patients (n = 500, 96.0%) reported good or higher experience with this testing strategy. The main barriers for gynecologists to offer HIV testing were lack of time (n = 22, 33.9%) and fear to offend a patient (n = 7, 12.5%). Less than half (n = 19, 39.3%) of gynecologists believed an HIV test should be offered to all patients with cervical dysplasia.Point‐of‐care HIV testing at colposcopy outpatient clinics was well accepted by patients. The data indicate that the primary barrier lies with the physicians to offer such testing. [ABSTRACT FROM AUTHOR]

Latino men, especially Latino men who have sex with men (LMSM), experience disparities in HIV prevention. Lack of attention to key barriers to care, such as stigma, result in inequitable access to HIV prevention and care for LMSM. This paper describes how intersectional stigma and related factors act as barriers to HIV prevention among Latino men and proposes strategies to overcome these barriers. Qualitative data were collected via in-depth interviews (n = 15) with Latino men about HIV prevention services, mobile outreach, peer navigation and care coordination, and analyzed using rapid qualitative methods. Three key themes emerged: (1) HIV stigma as a barrier to HIV testing, (2) sexual minority stigma as a barrier to accessing HIV prevention services and (3) strategies for stigma reduction, such as confidentiality, comprehensive education about HIV and prevention, and empathy and warmth from staff/care providers. Identified stigmas were intersectional. Addressing and reducing stigma is critical to engaging Latino men in HIV prevention and care, and requires strategies sensitive to the Latino cultural context and community. [ABSTRACT FROM AUTHOR]

Introduction: The emergency department (ED) may be an optimal setting to screen for substance use disorders (SUDs) and co-occurring psychiatric disorders (CODs). We report on the frequency of problematic substance use and comorbid elevated mental health symptoms detected during a 1-year implementation period of an ED-based SUD/COD screening approach within an established ED HIV screening program. Methods: Patients (N = 1,924) were approached by dedicated HIV screening staff in an urban, Midwestern ED. Patients first completed measures assessing problematic alcohol (Alcohol Use Disorder Identification Test-Concise [AUDIT-C]) and substance use across 10 categories of substances (National Institute on Drug Abuse–Modified Alcohol, Smoking, and Substance Involvement Screening Test [NIDA-Modified ASSIST]). Patients with positive alcohol and/or substance use screens completed measures assessing symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and post-traumatic stress disorder (PTSD) (PTSD Checklist-Civilian [PCL-C]). Results: Patients were predominantly male (60.3%) with a mean age of 38.1 years (SD = 13.0); most identified as White (50.8%) or Black (44.8%). A majority (58.5%) had a positive screen for problematic alcohol and/or other substance use. Of those with a positive substance use screen (n = 1,126), 47.0% had a positive screen on one or more of the mental health measures with 32.1% endorsing elevated depressive symptoms, 29.6% endorsing elevated PTSD-related symptoms, and 28.5% endorsing elevated anxiety symptoms. Conclusions: Among those receiving ED HIV screening, a majority endorsed problematic alcohol and/or other substance use and co-occurring elevated mental health symptoms. Substance use and mental health screening programs that can be integrated within other ED preventive services may enhance the identification of individuals in need of further assessment, referral, or linkage to substance use treatment services. [ABSTRACT FROM AUTHOR]

To determine the percentage of female adolescent patients (13-26 years old) who had HIV testing ordered within 90 days of incident sexually transmitted infection (STI) diagnosis during an outpatient clinic visit. This was a retrospective chart review study evaluating 830 visits among 589 female patients 13 to 26 years who had an incident STI diagnosed in outpatient Adolescent Medicine or Pediatric Practices in an urban, nonprofit, academic, free-standing children's hospital at the main campus and a community site in the Northeast United States. Odds of HIV screening was greater at the community-based adolescent medicine practice (odds ratio [OR] = 3.17; 95% confidence interval [CI]: [1.92, 5.24]) and when seen by an adolescent medicine provider (OR = 1.44; 95% CI: [1.02, 2.03]). Only 33.5% (n = 283) of 844 clinical encounters had HIV screening obtained within 90 days of incident STI diagnosis. Overall, HIV screening rates within 90 days of STI diagnosis was low, and there is much room for improvement. [ABSTRACT FROM AUTHOR]

We describe a provider-focused intervention to increase universal HIV testing among adolescent users in a network of School-Based Health Centers (SBHC) and compare the rate of HIV test offer and acceptance for SBHCs with and without the HIV testing intervention. The intervention was implemented at the six largest SBHCs in the 12-site network and included system- and staff-level initiatives, including an implementation coach to support SBHC associates. Rates of HIV test offer and acceptance at six sites in the Intervention Cohort were compared to that at the six sites in a Non-Intervention Cohort which was not randomly selected but had comparable distributions by age, gender and race/ethnicity. The model showed an intervention effect for universal HIV test offer, but no overall effect for test acceptance. Analyzing the intervention effect by whether a patient had a history of sexual activity, the intervention was very effective early in its implementation at increasing test offer to those with no history of sexual activity, and late in its implementation at increasing test acceptance for those with no or unknown sexual activity. Increasing and sustaining universal HIV testing in SBHCs may benefit from using Implementation Science frameworks to guide adaptation of the intervention. [ABSTRACT FROM AUTHOR]

This study examined the prevalence of HIV late diagnosis (LD) and identified associated factors with LD among people living with HIV (PLWH). We extracted sociodemographic, epidemiological, and immunological information between 2018 and 2021 in Hunan, China from the HIV/AIDS Comprehensive Response Information Management System of China. The chi-squared test and multivariable logistic regression model were used to identify the factors associated with LD. Among 22,504 PLWH, 14,988 (66.6%) were diagnosed late. PLWH aged 50 and older had a higher proportion of LD (71.2%) than the younger group (60.0%). Older age, being male, Han ethnicity, being registered in Western Hunan, being transferred from health facilities, and being infected through heterosexual intercourse were associated with LD. Among PLWH younger than 50 years, apart from the factors mentioned above, individuals who had primary school or lower education, were non-student, and were divorced or widowed were more likely to be diagnosed late. Unlike younger PLWH, these factors were not associated with LD in the older group. But regional disparities in LD were more significant among them. LD in PLWH remains a severe issue, especially among older people. The study findings provided valuable insights into designing programs targeting groups at higher risk of LD to reduce its prevalence. [ABSTRACT FROM AUTHOR]

Objective: To identify innovation and implementation determinants of HIV testing, diagnosis, and linkage-to-care in the U.S. Data sources and study setting: Between November 2020 and January 2022, a broad search strategy was employed in three literature databases: Ovid MEDLINE, PsycINFO, and Web of Science. Study design: A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Data collection/extraction methods: A team of master's and Ph.D.-level researchers screened eligible studies against the inclusion criteria and extracted the data using COVIDENCE software in pairs with consensus performed by a senior member of the team. Barriers and facilitators were extracted and analyzed according to the Consolidated Framework for Implementation Research (CFIR). Frequency of determinants across studies was mapped according to CFIR, valence, study design, delivery setting, unit of analysis, population of interest, region of the U.S., and year. Results: We identified 1,739 implementation and innovation determinants from 186 articles. Most determinants were for HIV testing rather than linkage-to-care. Most determinants were identified in the inner setting and individuals domains of CFIR, with the fewest identified in the process and innovations domains. Determinants of providers were only slightly more frequently identified than determinants of recipients. However, determinants of organizations and systems were rarely identified. Conclusion: This review provides a synthesis of innovation and implementation determinants of HIV testing and linkage-to-care using the most-cited implementation science (IS) framework, CFIR. This synthesis enables the larger field of HIV science to utilize IS in efforts to end the HIV epidemic and positions IS to consider the application of IS frameworks to fields like HIV. [ABSTRACT FROM AUTHOR]

Introduction: The South and Southeast Asia region has the second‐highest number of people living with HIV globally. Despite progress in reducing HIV incidence and AIDS‐related deaths, the region still has a long way to go in achieving the Joint United Nations Programme on HIV and AIDS (UNAIDS) 95‐95‐95 HIV testing, treatment and viral suppression targets. HIV self‐testing (HIVST) is recommended by the World Health Organization as an additional approach to HIV testing. This paper provides a commentary on the implementation status, benefits, barriers and recommendations for HIVST implementation in South and Southeast Asia. Additionally, it presents perspectives from HIV testing service experts from 11 countries in the region to put forth recommendations to accelerate the implementation of HIVST in South and Southeast Asia. Discussion: There is uneven progress in national HIVST policy development and implementation across the region. HIVST, as an additional testing approach, can help to enhance testing coverage, frequency and demand for follow‐up HIV services among key populations. Key factors influencing the implementation and scale‐up of HIVST include the degree of awareness of HIVST among general and key populations, the development and implementation of supportive national HIVST policies and the availability of public funding for HIVST. To address barriers and leverage enablers to HIVST implementation, generating evidence on cost‐effectiveness and budget impact, developing multisectoral partnerships for market shaping, promoting differentiated and decentralized delivery models, and optimizing linkage to further testing and care are recommended. Conclusions: It is crucial to accelerate the implementation and scale‐up of HIVST to differentiate and decentralize the delivery of HIV testing services in South and Southeast Asian countries. Sharing experiences among country experts is vital to foster the adoption of best practices and facilitate the trial‐and‐error process of HIVST implementation. Such collaborative approaches can help South and Southeast Asian countries attain the UNAIDS 95‐95‐95 targets, especially the first 95 on HIV diagnosis, and play a significant role in ending the global AIDS epidemic. [ABSTRACT FROM AUTHOR]

Men in Eswatini test for HIV at lower rates compared to women despite the widespread availability of HIV testing services in the country. HIV self-test kits have been proposed as an HIV testing model to reach more men by bypassing the health facility, which is known to be a barrier for men using HIV testing services. In this study, we sought to understand men's perspectives on HIV self-testing in Eswatini. We conducted semi-structured interviews with 22 men, recruited from a rural community and from an urban men's clinic, to assess their awareness of HIV self-testing and their perceptions of it as an alternative HIV testing option. Findings show that men were aware of HIV self-testing but had concerns that left most feeling hesitant about adopting it. Many men expressed doubts about the accuracy of self-testing and their own technical competence to use the kit without supervision. They also expressed fears about testing, and possibly learning they were HIV positive, without adequate pre – and post-HIV test counseling. To allay men's fears and improve uptake of HIV self-testing, practitioners might consider innovative methods such as virtual counseling services and linking HIV self-testing to other community-based HIV care services. [ABSTRACT FROM AUTHOR]

Background: Assisted partner services (APS) is a recommended public health approach to promote HIV testing for sexual partners of individuals diagnosed with HIV. We evaluated the cost and cost-effectiveness of integrating oral HIV self-testing (HIVST) into existing APS programs. Methods: Within the APS-HIVST study conducted in western Kenya (2021–2022), we conducted micro-costing, time-and-motion, and provider surveys to determine incremental HIVST distribution cost (2022 USD). Using a decision tree model, we estimated the incremental cost per new diagnosis (ICND) for HIVST incorporated into APS, compared to APS with provider-delivered testing only. Scenario, parameter and probabilistic sensitivity analyses were conducted to explore influential assumptions. Results: The cost per HIVST distributed within APS was USD 8.97, largest component costs were testing supplies (38%) and personnel (30%). Under conditions of a facility-based testing uptake of <91%, or HIVST utilization rates of <27%, HIVST integration into APS is potentially cost-effective. At a willing-to-pay threshold of USD 1000, the net monetary benefit was sensitive to the effectiveness of HIVST in increasing testing rates, phone call rates, HIVST sensitivity, HIV prevalence, cost of HIVST, space allocation at facilities, and personnel time during facility-based testing. In a best-case scenario, the HIVST option was cheaper by USD 3037 and diagnosed 11 more cases (ICND = 265.82). Conclusions: Implementers and policy makers should ensure that HIVST programs are implemented under conditions that guarantee efficiency by focusing on facilities with low uptake for provider-delivered facility-based testing, while deliberately targeting HIVST utilization among the few likely to benefit from remote testing. Additional measures should focus on minimizing costs relating to personnel and testing supplies. [ABSTRACT FROM AUTHOR]

This review identifies which elements of home-based comprehensive sexual health care (home-based CSH) impacted which key populations, under which circumstances. A realist review of studies focused on home-based CSH with at least self-sampling or self-testing HIV and additional sexual health care (e.g., treatment, counseling). Peer-reviewed quantitative and qualitative literature from PubMed, Embase, Cochrane Register of Controlled Trials, and PsycINFO published between February 2012 and February 2023 was examined. The PRISM framework was used to systematically assess the reach of key populations, effectiveness of the intervention, and effects on the adoption, implementation, and maintenance within routine sexual health care. Of 730 uniquely identified records, 93 were selected for extraction. Of these studies, 60% reported actual interventions and 40% described the acceptability and feasibility. Studies were mainly based in Europe or North America and were mostly targeted to MSM (59%; 55/93) (R). Overall, self-sampling or self-testing was highly acceptable across key populations. The effectiveness of most studies was (expected) increased HIV testing. Adoption of the home-based CSH was acceptable for care providers if linkage to care was available, even though a minority of studies reported adoption by care providers and implementation fidelity of the intervention. Most studies suggested maintenance of home-based CSH complementary to clinic-based care. Context and mechanisms were identified which may enhance implementation and maintenance of home-based CSH. When providing the individual with a choice of testing, clear instructions, and tailored dissemination successful uptake of STI and HIV testing may increase. For implementers perceived care and treatment benefits for clients may increase their willingness to implement home-based CSH. Therefore, home-based CSH may determine more accessible sexual health care and increased uptake of STI and HIV testing among key populations. [ABSTRACT FROM AUTHOR]

Background: There remain key knowledge gaps regarding HIV testing needs and priorities among refugee youth in low and middle-income country (LMIC) humanitarian settings. The HIV prevention cascade framework focuses on three domains (motivation, access, effective use) central to prevention uptake, yet is understudied in relationship to HIV testing, particularly among refugee youth. Uganda is an exemplar context to explore refugee youth HIV testing needs and priorities as it hosts 1.5 million refugees and is Africa's largest refugee hosting nation. In this study, we explored perceptions and experiences regarding HIV testing among refugee youth living in Bidi Bidi refugee settlement, Uganda. Methods: We conducted a community-based research study in Bidi Bidi Refugee Settlement, one of the world's largest refugee settlements with over 195,000 residents. This qualitative study involved four focus groups (2 with young women, 2 with young men) with refugee youth aged 16–24 living in Bidi Bidi refugee settlement. We applied thematic analysis informed by the HIV prevention cascade to understand domains of motivation, access, and effective use that emerged as salient for HIV testing engagement. Results: Participants (n = 40; mean age: 20 years, standard deviation: 2.2) included refugee young women (n = 20) and young men (n = 20), of whom 88% had a lifetime HIV test and 58% had ever heard of HIV self-testing. Participant discussions described HIV testing motivation was influenced by dimensions of: HIV treatment and testing knowledge; risk perception; positive and negative consequences of use; and social norms regarding gender and age. Access to HIV testing was shaped by: limited availability; distance and language barriers; confidentiality concerns; and affordability. Effective use of and engagement with HIV testing was related to HIV serostatus knowledge self-efficacy and in/equitable partner dynamics. Conclusions: Complex, multi-level factors shape motivation for, access to, and effective use of HIV testing among refugee youth in Bidi Bidi. Findings align with the HIV prevention cascade framework that helps to identify gaps to inform intervention development with youth in humanitarian settings. HIV testing approaches tailored for refugee youth in contexts such as Bidi Bidi can foster HIV prevention and treatment literacy, gender equity, gender-based violence prevention, and intersectional stigma reduction. [ABSTRACT FROM AUTHOR]

AbstractBackground: Black men who have sex with men (BMSM) face multiple minority stressors (e.g., homophobia, racism, and presumed HIV status) that may indirectly erode their confidence in pursuing HIV testing uptake through exacerbating alcohol use disorder (AUD). Objectives: Using cross-sectional data from 203 community-based BMSM (71.4% as homosexual with a mean age of 26 years) living in a Southern US city, we conducted a causal mediation and moderation analysis to investigate in/direct pathways linking minority stressors, AUD risk, and self-efficacy of HIV testing, including how resilience may moderate these associations. Results: Our mediation analysis revealed that AUD risk accounted for 32.1% of the total effect of internalized homonegativity (βtotal effect = -0.424; SE=0.071; p<0.001), 28.6% of the total effect of experienced homophobia (βtotal effect = -0.684; SE=0.122; p<0.001), and 15.3% of the total effect of perceived HIV stigma (βtotal effect = -0.361; SE=0.164; p<0.05) on HIV testing self-efficacy. Resilience significantly moderated the associations of experienced homophobia (β = -0.049; SE=0.011; p<0.001), internalized homonegativity (β = -0.065; SE=0.027; p<0.01), and perceived HIV stigma (β = -0.034; SE=0.013; p<0.05) with AUD risk. Resilience also significantly moderated the associations of experienced homophobia (β = -0.073; SE=0.021; p<0.01), internalized homonegativity (β = -0.082; SE=0.012; p<0.001), perceived HIV stigma (β = -0.037; SE=0.039; p<0.05), and AUD risk (β = -0.021; SE=0.015; p<0.05) with HIV testing self-efficacy. Conclusions: Our study provides important implications in identifying multilevel sources for building resilience among BMSM to buffer the effects of minority stress on AUD risk and improve HIV testing outcomes. [ABSTRACT FROM AUTHOR]

Background: In Burkina Faso, only 70% of people living with HIV knew their status in 2018, while the first 95 target of the UNAIDS suggests that by 2025 at least 95% of people living with HIV (PLHIV) know their HIV status. Female sex workers (FSW) are one of the most HIV-vulnerable groups, making it crucial to estimate the rate and associated factors of HIV testing among FSW. Methods: We conducted a cross-sectional study focused on FSW in five main cities of Burkina Faso (Ouagadougou, Bobo-Dioulasso, Koudougou, Tenkodogo, and Ouahigouya). A respondent-driven sampling (RDS) approach was used to recruit participants. Data were collected through in-person interviews between June and August 2022. The HIV testing rate in the past twelve months was examined by sociodemographic characteristics and risky behaviors. A modified Poisson regression in a generalized estimating equation with an exchangeable correlation structure was used to explore the associated factors of HIV testing. Results: Of 1338 FSW (average age: 27.6 ± 7.25 years) HIV negative, 57.8% (95% CI: 54.2–61.3) reported having been tested for HIV in the last 12 months. Among those who started sex work before the age of 18, 48.0% (95% CI: 39.1–57.1) reported having been tested for HIV in the last 12 months. The HIV testing rate among FSWs within the last 12 months was independently associated with age, education level, and being member of an FSW supportive association. Indeed, FSW aged 25 years and more had a 14% higher rate of being tested for HIV within 12 months compared to those 15 to 24 years old (adjusted prevalence ratio (aPR): 1.14 [95%CI: 1.05–1.24]). The HIV testing rate among those who are not members of an FSW supportive association was 16% lower (aPR: 0.84 [95%CI: 0.72–0.97]) than those who are members of FSW supportive associations. Conclusion: The HIV testing rate among FSW is low in Burkina Faso, suggesting an important challenge to reach the first 95% target of UNAIDS among FSW. Innovative diagnostic strategies for the early identification of HIV-infected FSW are essential to achieve the first 95 target by 2025 in Burkina Faso. [ABSTRACT FROM AUTHOR]

Objective: Voluntary counselling and testing points (VCTs) offer anonymous and free HIV tests in Poland. They also play an essential role in educational initiatives focused on the prevention and diagnosis of HIV and other sexually transmitted infections. However, no comprehensive data is available that summarizes the results of the work carried out by these VCTs. Therefore, our aim was to conduct a comparative analysis of epidemiological data obtained from VCTs and data reported by the epidemiological surveillance undertaken by the National Institute of Public Health NIH–National Research Institute (NIPH NIH–NRI) covering the period from 2015 to 2022. Methods: This retrospective analysis was conducted on data from 258 071 people attending VCTs in Poland in 2015–2022. Results: On average, 32 259 individuals underwent testing each year, with a notable increase in the number of people being tested in November. The average positivity rate was 1.39% (3576/258 071). The Masovian voivodeship conducted the most tests and had the highest number of positive results. The comparative analysis of the frequency of detecting positive results in VCTs and those reported in NIPH NIH–NRI data revealed that, on average, 31.49% (3576/11 356) of positive results in Poland between 2015 and 2022 were identified through tests conducted at VCTs. Conclusion: The positive results identified in VCTs constituted approximately one‐third of all results reported by the National Institute of Public Health NIH–National Research Institute, highlighting the importance of VCTs. Moreover, the high availability of testing in the Masovian voivodeship resulted in better detection of HIV. The educational actions performed during European Testing Week increased the number of tests performed in November. [ABSTRACT FROM AUTHOR]

Introduction: Globally, there have been significant declines in HIV incidence over the past two decades, but this decline is slowing, and in some settings, declines have stalled or are growing—particularly where epidemics are concentrated in key populations (KPs). Understanding temporal changes in HIV incidence among KP is critical yet, due to logistical constraints, there are few sources of longitudinal incidence data, particularly among KP. Methods: We present HIV incidence rates from June 2014 to December 2022 among cisgender men who have sex with men (MSM) and people who inject drugs (PWID) attending community‐based integrated care centres (ICCs) in 15 Indian cities. ICCs, established between 2014 and 2017, provide HIV testing and other services to MSM (eight sites) or PWID (eight sites). Client HIV testing data were included in the analysis if they had ≥2 tests and were not positive on the first test. We calculated incidence rates per 100 person‐years (PY), stratified by KP, city/site and year. Poisson regression explored associations of incidence with time, age, gender (PWID only) and ICC use. Results: From June 2014 to December 2022, 13,501 clients (5722 MSM, 7779 PWID) had ≥2 HIV tests over a median of 1.8 years. There were a total of 1093 incident HIV acquisitions. Overall incidence rates for MSM and PWID were 1.9/100 PY (95% CI: 1.7−2.2) and 4.1 (3.9−4.4), respectively. Among MSM sites, incidence ranged from 0.4 to 3.5 and in PWID sites from 0.6 to 17.9. From adjusted models, incidence increased by 17% annually among MSM. Among PWID, incidence increased by 11% annually up until 2020 and then decreased by 29% after 2020; when excluding the outlier of New Delhi, incidence was stable among PWID. MSM and PWID 21−25 years old had the highest risk of HIV and among PWID, those more consistently engaged in medication for opioid use disorder were at the lowest risk. Conclusions: While there was substantial geographic variability, MSM and PWID engaged in a free community‐based clinic experienced persistently high HIV incidence (>2/100 PY). KP in low‐ and middle‐income countries should be a focus when considering novel strategies such as long‐acting pre‐exposure prophylaxis to curtail incidence. [ABSTRACT FROM AUTHOR]

Description: New York State Department of Health (NYSDOH) recommends that all pregnant patients receive human immunodeficiency virus (HIV) screening during pregnancy. This study assessed the prevalence of repeat prenatal HIV testing and factors associated with receipt of the recommended tests. Methods: Data from the NYSDOH newborn screening program were used to randomly select pregnant persons without HIV who delivered a liveborn infant in 2017. Receipt of repeat testing was defined as an initial HIV test in the first or second trimesters and the final in the third trimester (relaxed); or an initial test in the first trimester and the final in the third trimester (strict). Relative risks (RRs) and 95% confidence intervals were calculated in bivariate analyses. Adjusted RRs were calculated to determine associations between demographic and clinical factors and receipt of repeat HIV testing. Results: The cohort included 2,225 individuals. Roughly one quarter (24%) received the recommended tests in the first or second and third trimesters and 17% received them in the first and third trimesters. Individuals who reported Hispanic or Asian race/ethnicities, had government-funded insurance, started prenatal care in the first trimester, delivered in New York City, or received prenatal hepatitis C virus screening were significantly more likely to receive repeat testing using either definition. Conclusions: Despite the benefits and cost-effectiveness, the prevalence of repeat prenatal HIV screening during the third trimester remains persistently low. Improved messaging and targeted education and resources to assist prenatal providers could reinforce the importance of repeat testing and reduce residual perinatal HIV transmission. [ABSTRACT FROM AUTHOR]

Introduction There have been nearly 1,600 new diagnoses of Human Immunodeficiency Virus (HIV) across the US Armed Forces between 2017 and 2022. While treatment has improved overall survival, self-perception of acquiring HIV may not align with actual risk of acquiring HIV, thus slowing diagnosis and treatment. We aim to evaluate self-perceived risk (SPR) versus calculated risk (CR) of HIV infection in US Air Force (USAF) members with incident HIV diagnosis. Methods All USAF members with new HIV diagnosis evaluated at a specialty care military medical center between January 2015 and March 2020 with case report forms were included (n  = 142). SPR was compared to CR using the Denver HIV Risk Score (DHRS). The study was approved by the Army Public Health Center's Public Health Review Board (#14-311) and the Walter Reed Army Institute of Research Human Subjects Protection Branch (#1861E). Results Patients were predominantly male (98%), with a median age of 26 (IQR 22-30) years, and the majority (85%) reported same-sex partners. Most patients reported a low SPR (n  = 78; 55%). A higher proportion of low SPR patients were married or partnered than high SPR patients (29% versus 14%; P  = 0.04). Both groups had median DHRS scores in the highest risk category with similar results by reason for HIV screening. Conclusion The majority of USAF members with incident HIV infection reported a low SPR despite risk factors and CRs identical to high SPR patients. In order to inform HIV prevention strategies in the military, further efforts are needed to educate the military population and providers about HIV risk perception. [ABSTRACT FROM AUTHOR]

Our aims were: (1) to characterize gay, bisexual and other men who have sex with men (GBMSM) and transgender (TG) populations using internet-based self-sampling services in the TESTATE project or attending community-based STI/HIV voluntary counselling and testing (CBVCT) services as alternative strategies to formal HIV testing within the Spanish national health system, and (2) to identify factors associated with repeat use of the same screening strategy from November 2018 to December 2021. Demographic, health, and behavioral characteristics of users using complementary strategies were analyzed. We developed a cross-sectional study, with descriptive analysis, HIV cascade, and a multivariate logistic model to identify factors associated with participants' repeated use of the same screening strategy. We included 9939 users, of whom 94.1% were GBMSM (n = 9348) and 5.9% TG (n = 580), with a high representation of migrants. Reactive results were 3.4% (n = 340), with 3.0% in GBMSM (n = 277/9348) and 10.7% in TG (n = 63/591). 73.8% (n = 251) were confirmed HIV positive and 76.7% (n = 194) were linked to health services. Users repeated the online screening strategy more than CBVCT (44.3% vs. 31.8%), but TG population used face-to-face community services more (8.4% vs. 0.6%). Factors influencing the repetition of the online self-sampling strategy included older age, non-migrant status, and recent HIV testing. In the CBVCT strategy, factors included older age, TG identity, non-migrant status, condom use during the last sexual encounter, and recent HIV testing. In conclusion, both CBVCT and online-requested self-sampling at home are important alternatives to the health system for the provision of HIV testing to GBMSM and TG. [ABSTRACT FROM AUTHOR]

Abstract Introduction Increasing effectiveness, efficiency, and reach of HIV case-finding strategies among priority populations is essential for epidemic control. Index testing is effective but presents potential risks, including stigma, violence, abandonment, and challenges such as fear of disclosure and reluctance to list contacts. We integrated the enhanced peer outreach approach (EPOA) social network strategy into index testing to increase case finding among Haitian migrants and individuals of Haitian descent in Dominican Republic. Methods The index-EPOA intervention implemented in two successive projects in the Dominican Republic offered index clients index-EPOA referral coupons to distribute to contacts. We analyzed retrospective client records from routine, aggregate program data. We compared overall case-finding rates pre-intervention (baseline October 2019–December 2020) and post-intervention (midline January 2021–March 2022; endline April 2022–June 2023), and case finding for index-EPOA versus standalone index. We calculated case-finding differences using the Student t-test. Results HS3/EHSEC tested 7,305 contacts of index clients, with 23% case finding. At baseline, 1,234 contacts were tested through standalone index, identifying 211 HIV-positive contacts with case finding at 17%. During the rollout of the intervention, the case-finding rate for standalone index testing remained similar to baseline (16%), while the rate for index-EPOA was 33%. Combined case finding for standalone index and index-EPOA increased to 22% at midline and 29% at endline, resulting in an overall case-finding rate of 25% during the intervention. The statistical analysis found overall case finding post-intervention (combined case-finding rate of 25% at midline + endline for standalone index and index-EPOA) significantly higher than at baseline (17% standalone index) (p

Abstract Objective To identify innovation and implementation determinants of HIV testing, diagnosis, and linkage-to-care in the U.S. Data sources and study setting Between November 2020 and January 2022, a broad search strategy was employed in three literature databases: Ovid MEDLINE, PsycINFO, and Web of Science. Study design A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Data collection/extraction methods A team of master’s and Ph.D.-level researchers screened eligible studies against the inclusion criteria and extracted the data using COVIDENCE software in pairs with consensus performed by a senior member of the team. Barriers and facilitators were extracted and analyzed according to the Consolidated Framework for Implementation Research (CFIR). Frequency of determinants across studies was mapped according to CFIR, valence, study design, delivery setting, unit of analysis, population of interest, region of the U.S., and year. Results We identified 1,739 implementation and innovation determinants from 186 articles. Most determinants were for HIV testing rather than linkage-to-care. Most determinants were identified in the inner setting and individuals domains of CFIR, with the fewest identified in the process and innovations domains. Determinants of providers were only slightly more frequently identified than determinants of recipients. However, determinants of organizations and systems were rarely identified. Conclusion This review provides a synthesis of innovation and implementation determinants of HIV testing and linkage-to-care using the most-cited implementation science (IS) framework, CFIR. This synthesis enables the larger field of HIV science to utilize IS in efforts to end the HIV epidemic and positions IS to consider the application of IS frameworks to fields like HIV.

Abstract This study examined the prevalence of HIV late diagnosis (LD) and identified associated factors with LD among people living with HIV (PLWH). We extracted sociodemographic, epidemiological, and immunological information between 2018 and 2021 in Hunan, China from the HIV/AIDS Comprehensive Response Information Management System of China. The chi-squared test and multivariable logistic regression model were used to identify the factors associated with LD. Among 22,504 PLWH, 14,988 (66.6%) were diagnosed late. PLWH aged 50 and older had a higher proportion of LD (71.2%) than the younger group (60.0%). Older age, being male, Han ethnicity, being registered in Western Hunan, being transferred from health facilities, and being infected through heterosexual intercourse were associated with LD. Among PLWH younger than 50 years, apart from the factors mentioned above, individuals who had primary school or lower education, were non-student, and were divorced or widowed were more likely to be diagnosed late. Unlike younger PLWH, these factors were not associated with LD in the older group. But regional disparities in LD were more significant among them. LD in PLWH remains a severe issue, especially among older people. The study findings provided valuable insights into designing programs targeting groups at higher risk of LD to reduce its prevalence.

Abstract Background In Burkina Faso, only 70% of people living with HIV knew their status in 2018, while the first 95 target of the UNAIDS suggests that by 2025 at least 95% of people living with HIV (PLHIV) know their HIV status. Female sex workers (FSW) are one of the most HIV-vulnerable groups, making it crucial to estimate the rate and associated factors of HIV testing among FSW. Methods We conducted a cross-sectional study focused on FSW in five main cities of Burkina Faso (Ouagadougou, Bobo-Dioulasso, Koudougou, Tenkodogo, and Ouahigouya). A respondent-driven sampling (RDS) approach was used to recruit participants. Data were collected through in-person interviews between June and August 2022. The HIV testing rate in the past twelve months was examined by sociodemographic characteristics and risky behaviors. A modified Poisson regression in a generalized estimating equation with an exchangeable correlation structure was used to explore the associated factors of HIV testing. Results Of 1338 FSW (average age: 27.6 ± 7.25 years) HIV negative, 57.8% (95% CI: 54.2–61.3) reported having been tested for HIV in the last 12 months. Among those who started sex work before the age of 18, 48.0% (95% CI: 39.1–57.1) reported having been tested for HIV in the last 12 months. The HIV testing rate among FSWs within the last 12 months was independently associated with age, education level, and being member of an FSW supportive association. Indeed, FSW aged 25 years and more had a 14% higher rate of being tested for HIV within 12 months compared to those 15 to 24 years old (adjusted prevalence ratio (aPR): 1.14 [95%CI: 1.05–1.24]). The HIV testing rate among those who are not members of an FSW supportive association was 16% lower (aPR: 0.84 [95%CI: 0.72–0.97]) than those who are members of FSW supportive associations. Conclusion The HIV testing rate among FSW is low in Burkina Faso, suggesting an important challenge to reach the first 95% target of UNAIDS among FSW. Innovative diagnostic strategies for the early identification of HIV-infected FSW are essential to achieve the first 95 target by 2025 in Burkina Faso.

Abstract Background There remain key knowledge gaps regarding HIV testing needs and priorities among refugee youth in low and middle-income country (LMIC) humanitarian settings. The HIV prevention cascade framework focuses on three domains (motivation, access, effective use) central to prevention uptake, yet is understudied in relationship to HIV testing, particularly among refugee youth. Uganda is an exemplar context to explore refugee youth HIV testing needs and priorities as it hosts 1.5 million refugees and is Africa’s largest refugee hosting nation. In this study, we explored perceptions and experiences regarding HIV testing among refugee youth living in Bidi Bidi refugee settlement, Uganda. Methods We conducted a community-based research study in Bidi Bidi Refugee Settlement, one of the world’s largest refugee settlements with over 195,000 residents. This qualitative study involved four focus groups (2 with young women, 2 with young men) with refugee youth aged 16–24 living in Bidi Bidi refugee settlement. We applied thematic analysis informed by the HIV prevention cascade to understand domains of motivation, access, and effective use that emerged as salient for HIV testing engagement. Results Participants (n = 40; mean age: 20 years, standard deviation: 2.2) included refugee young women (n = 20) and young men (n = 20), of whom 88% had a lifetime HIV test and 58% had ever heard of HIV self-testing. Participant discussions described HIV testing motivation was influenced by dimensions of: HIV treatment and testing knowledge; risk perception; positive and negative consequences of use; and social norms regarding gender and age. Access to HIV testing was shaped by: limited availability; distance and language barriers; confidentiality concerns; and affordability. Effective use of and engagement with HIV testing was related to HIV serostatus knowledge self-efficacy and in/equitable partner dynamics. Conclusions Complex, multi-level factors shape motivation for, access to, and effective use of HIV testing among refugee youth in Bidi Bidi. Findings align with the HIV prevention cascade framework that helps to identify gaps to inform intervention development with youth in humanitarian settings. HIV testing approaches tailored for refugee youth in contexts such as Bidi Bidi can foster HIV prevention and treatment literacy, gender equity, gender-based violence prevention, and intersectional stigma reduction.

Objective To estimate the feasibility, positivity rate and cost of offering child testing for human immunodeficiency virus (HIV) to mothers living with HIV attending outpatient clinics in Burkina Faso. Methods We conducted this implementation study in nine outpatient clinics between October 2021 and June 2022. We identified all women [less than or equal to] 45 years who were attending these clinics for their routine HIV care and who had at least one living child aged between 18 months and 5 years whose HIV status was not known. We offered these mothers an HIV test for their child at their next outpatient visit. We calculated intervention uptake, HIV positivity rate and costs. Findings Of 799 eligible children, we tested 663 (83.0%) and identified 16 new HIV infections: 2.5% (95% confidence interval, CI: 1.5-4.1). Compared with HIV-negative children, significantly more HIV-infected children were breastfed beyond 12 months (8-value: 0.003) and they had not been tested before (8-value: 0.003). A significantly greater proportion of mothers of HIV-infected children were unaware of the availability of child testing at 18 months (8-value: < 0.001) and had more recently learnt their HIV status (8-value: 0.01) than mothers of HIVnegative children. The intervention cost 98.1 United States dollars for one child testing HIV-positive. Barriers to implementing this strategy included shortages of HIV tests, increased workload for health-care workers and difficulty accessing children not living with their mothers. Conclusion Testing HIV-exposed children through their mothers in outpatient clinics is feasible and effective in a low HIV-prevalence setting such as Burkina Faso. Implementation of this strategy to detect undiagnosed HIV- infected children is recommended. Objectif Evaluer la faisabilite, le taux de positivite et le cout que representerait un depistage du virus de l'immunodeficience humaine (VIH) chez les enfants s'il est propose aux meres vivant avec le VIH qui se rendent dans des cliniques externes au Burkina Faso. Methodes Nous avons deploye cette etude de mise en oeuvre dans neuf cliniques externes entre octobre 2021 et juin 2022. Nous avons identifie toutes les femmes agees de [less than or equal to] 45 ans qui frequentaient ces cliniques pour leurs soins de routine dans le cadre d'une prise en charge du VIH et avaient au moins un enfant vivant de minimum 18 mois et maximum 5 ans, dont le statut VIH n'etait pas connu. Nous avons propose a ces meres de proceder au depistage de leur enfant lors de leur prochaine visite a la clinique. Enfin, nous avons calcule le nombre de recours a cette intervention, le taux de positivite du VIH et les couts. Resultats Sur 799 enfants eligibles, nous en avons teste 663 (83,0%) et avons detecte 16 nouvelles infections au VIH: 2,5% (intervalle de confiance de 95%: 1,5-4,1). Par rapport aux enfants seronegatifs, un nombre nettement superieur d'enfants seropositifs avaient ete allaites au-dela de 12 mois (valeur-p: 0,003) et n'avaient pas ete testes auparavant (valeur-p: 0,003). Un pourcentage sensiblement plus eleve de meres d'enfants seropositifs ignoraient l'existence d'un depistage chez les enfants ages de 18 mois (valeur-p: < 0,001) et avaient appris leur statut VIH plus recemment (valeur-p: 0,01) que les meres d'enfants seronegatifs. Cette intervention a coute 98,1 dollars americains par enfant seropositif. Parmi les obstacles a cette strategie figurent la penurie de tests de depistage du VIH, l'augmentation de la charge de travail pour les professionnels de la sante et les difficultes d'acces aux enfants qui ne vivent pas avec leur mere. Conclusion Tester les enfants exposes au VIH par l'intermediaire de leur mere dans les cliniques externes est faisable et efficace dans les lieux oU la prevalence du VIH est faible, comme au Burkina Faso. Nous recommandons l'application de cette strategie pour identifier les enfants seropositifs non diagnostiques. Objetivo Estimar la viabilidad, la tasa de positividad y el coste de ofrecer pruebas de deteccion del virus de la inmunodeficiencia humana (VIH) en ninos a las madres seropositivas que acuden a las clinicas de atencion ambulatoria de Burkina Faso. Metodos Se realizo este estudio de implementacion en nueve clinicas de atencion ambulatoria entre octubre de 2021 y junio de 2022. Se identifico a todas las mujeres [less than or equal to] 45 anos que acudian a estas clinicas para su atencion de rutina del VIH y que tenian al menos un hijo vivo de entre 18 meses y 5 anos, cuyo estado serologico respecto al VIH se desconocia. Se ofrecio a estas madres una prueba del VIH para su hijo en su siguiente consulta externa. Se calcularon la aceptacion de la intervencion, la tasa de positividad del VIH y los costes. Resultados De 799 ninos que cumplian los requisitos, se realizaron pruebas a 663 (83,0%) y se identificaron 16 nuevas infecciones por VIH: 2,5% (intervalo de confianza del 95%: 1,5-4,1). En comparacion con los ninos seronegativos, un numero significativamente mayor de ninos infectados por el VIH fueron amamantados mas de 12 meses (valor de p: 0,003) y no se habian sometido a pruebas anteriormente (valor de p: 0,003). Un porcentaje significativamente mayor de madres de ninos infectados por el VIH desconocia la disponibilidad de pruebas infantiles a los 18 meses (valor de p: Conclusion La realizacion de pruebas a ninos expuestos al VIH a traves de sus madres en clinicas de atencion ambulatoria es viable y eficaz en un entorno de baja prevalencia del VIH como Burkina Faso. Se recomienda la aplicacion de esta estrategia para detectar a los ninos infectados por el VIH no diagnosticados., Introduction Despite great improvements in the response to human immunodeficiency virus (HIV), the 90-90-90 targets of the Joint United Nations Programme on HIV and AIDS (acquired immunodeficiency syndrome) for 2020 [...]

Objective To investigate the status and epidemiological characteristics of human immunodeficiency virus (HIV) infection in voluntary blood donors in Jinan, China, and to provide a basis for formulating reasonable HIV blood screening strategies and improving blood donation recruitment in this region. Methods A retrospective analysis was performed for the preliminary screening results of HIV antibody/antigen and nucleic acid of the blood samples of all voluntary blood donors in Jinan Blood Supply and Security Center from 2014 to 2020. According to the confirmation results of reactive samples from Jinan Center for Disease Control and Prevention, the epidemiological data and blood donation data of HIV-positive individuals were collected by consulting the information management system of Shinow Blood Station. Results Among the 284 778 samples, 277 were reactive for primary screening, resulting in a reactivity rate of 0.97‰. Among the 65 reactive samples based on dual-reagent ELISA, 46 were confirmed positive, with a confirmed positive rate of 0.16‰, while 9 samples were uncertain. Among the confirmed positive blood donors, there were 45 male individuals and 1 female individual, and most of the infected individuals were aged 21-40 years, especially 21-30 years. The highest proportion of the individuals with HIV infection was observed among the first-time blood donors (65.22%), the whole blood donors (95.65%), and the individual voluntary blood donors (95.65%). Conclusion There is a relatively high coincidence rate between ELISA dual-reagent reactivity and confirmation results, and ELISA and nucleic acid testing should be used in combination for blood screening to prevent the missed detection of HIV. HIV infection in voluntary blood donors shows the characteristics of sex, age, and occupation distribution, and targeted publicity of the knowledge of HIV prevention and treatment should be strengthened for different populations. Meanwhile, the internet information sharing system should be used to eliminate HIV-positive blood donors, so as to improve the quality of blood supply from the source.

Abstract Background Associations between perceived and actual risk of HIV infection and HIV prevention services uptake are inconclusive. This study aimed to evaluate the discrepancy between the perceived and actual HIV risk, and quantify the associations between perceived and actual risk of HIV infection and three HIV prevention services utilization among men who have sex with men (MSM) in Shandong province, China. Methods A cross-sectional study was conducted in Shandong province in June 2021. Participants were eligible if they were born biologically male, aged 18 years or older, had negative or unknown HIV status, and had sex with men in the past year. Participants were recruited online. The discrepancy between their perceived and actual risk of HIV infection was evaluated by calculating the Kappa value. Bayesian model averaging was used to assess the associations between perceived and actual risk of HIV infection and HIV prevention services uptake. Results A total of 1136 MSM were recruited, most of them were 30 years old or younger (59.9%), single (79.5%), with at least college education level (74.7%). Most participants (97.4%) perceived that they had low risk of HIV infection, and 14.1% were assessed with high actual risk. The discrepancy between their perceived and actual risk of HIV infection was evaluated with a Kappa value of 0.076 (P

Introduction: Approximately 240,000 people in Ukraine are living with HIV. Recent changes in medical legislation have significantly strengthened the role of family doctors and primary care pediatricians in the prevention, early detection and follow-up of patients with HIV. Thus, the purpose of the study was to examine the experience of primary care physicians in testing and providing care to patients with HIV. Methods: Qualitative semi-structured in-depth interviews with typical representatives of the target audience from different regions of Ukraine were conducted. Inductive thematic content analysis was used to analyze the data upon standardized research protocols using the Theoretical Domain System. Results: The results identify knowledge, skills, motivation, barriers, and opportunities in the context of HIV testing among family doctors in Ukraine. Primary health care providers consider HIV testing of patients to be an important part of their professional activities. In most cases, HIV testing is initiated upon detection of clinical indicators or when a person is identified as a key population. Preventive testing at the request of the patient is less common. Although most family doctors believe that they are sufficiently informed to conduct testing, there is a certain knowledge gap regarding communication with the patient and further treatment in case of a positive HIV result. The main obstacle to regular HIV testing is the reluctance and resistance of patients, as well as in some cases insufficient or non-existent tests in primary health care facilities. In order to improve the situation with HIV testing among the population, family doctors believe that it is necessary to organize regular trainings and courses to improve the skills of doctors on HIV, provide primary health care facilities with sufficient tests and establish high-quality information support. Conclusions: The obtained results clearly outline the main problems that concern family doctors in Ukraine regarding work with key vulnerable groups and persons living with HIV. [ABSTRACT FROM AUTHOR]

PurposeMethodResultsConclusionTo report a case of seroreversion in a patient with HIV-associated bilateral CMV retinitis and the challenges associated with detection of this phenomenon in late stages of HIV.Retrospective single case report.The clinical picture of the patient on presentation was suggestive of viral retinitis. PCR confirmed a diagnosis of CMV retinitis. Serology for HIV-1 & 2 was negative. A viral load of HIV and CD-4 count confirmed his sero status to be positive for HIV. Improvement in visual acuity and slow resolution of the lesion was noted with both anti-viral for CMV and HIV. A repeat HIV-1 testing was positive with an improvement in CD4 count.In highly suspicious individual, with a negative serology (post screening test) for HIV, the disease status should be confirmed by testing the individual for HIV viral load and CD4 count. [ABSTRACT FROM AUTHOR]

Introduction: HIV self‐testing (HIVST) has been shown to increase the uptake of HIV testing and help achieve the UNAIDS 95‐95‐95 targets. This study assessed the acceptability, usability (ease of use and result interpretation) and the willingness to pay for HIVST kits distributed through three distribution models, namely the community‐based, PLHIV network‐led and private practitioners models, in India. Methods: This cross‐sectional study was implemented across 14 states in India between September 2021 and June 2022. All participants could choose between blood‐based or oral‐fluid‐based test kits. Participants were shown a test‐kit usage demonstration video, and pre‐ and post‐test counselling was provided for all. Participants were followed‐up after testing, and if reported reactive, were further supported for linkage to confirmatory testing and antiretroviral therapy (ART) initiation. Results: Among the 90,605 participants found eligible, 88,080 (97%) accepted an HIVST kit. Among the 87,976 who reported using an HIVST kit, 45,207 (51%) preferred a blood‐based kit, and 42,120 (48%) reported testing for the first time. For future testing, 77,064 (88%) reported preferring HIVST over other HIV testing methods. Among those who used the kit, 83,308 (95%) found the kit easy to use, and 83,237 (95%) reported that the test results were easy to interpret. Among those who preferred HIVST for future use, 52,136 (69%) were willing to pay for the kit, with 35,854 (69%) of those willing to pay less than US$ 1.20. Only one instance of social harm was reported, with a participant reporting suicidal tendencies due to discord with their partner. Out of 328 participants (0.4%) who tested reactive with HIVST, 291 (89%) were linked to confirmatory testing; of these, 254 were confirmed HIV positive, and 216 (85%) successfully initiated ART. Conclusions: Overall, we report that nearly all participants were willing to accept HIVST, found the test kits easy to use and interpret, and about two‐thirds were willing to pay for HIVST. Given the high levels of acceptance and the ability to reach a large proportion of first‐time testers, HIVST in India could contribute to achieving the UNAIDS first 95 and ending the HIV epidemic. [ABSTRACT FROM AUTHOR]

Several machine learning (ML) techniques have demonstrated efficacy in precisely forecasting HIV risk and identifying the most eligible individuals for HIV testing in various countries. Nevertheless, there is a data gap on the utility of ML algorithms in strengthening HIV testing worldwide. This systematic review aimed to evaluate how effectively ML algorithms can enhance the efficiency and accuracy of HIV testing interventions and to identify key outcomes, successes, gaps, opportunities, and limitations in their implementation. This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A comprehensive literature search was conducted via PubMed, Google Scholar, Web of Science, Science Direct, Scopus, and Gale OneFile databases. Out of the 845 identified articles, 51 studies were eligible. More than 75% of the articles included in this review were conducted in the Americas and various parts of Sub-Saharan Africa, and a few were from Europe, Asia, and Australia. The most common algorithms applied were logistic regression, deep learning, support vector machine, random forest, extreme gradient booster, decision tree, and the least absolute shrinkage selection operator model. The findings demonstrate that ML techniques exhibit higher accuracy in predicting HIV risk/testing compared to traditional approaches. Machine learning models enhance early prediction of HIV transmission, facilitate viable testing strategies to improve the efficiency of testing services, and optimize resource allocation, ultimately leading to improved HIV testing. This review points to the positive impact of ML in enhancing early prediction of HIV spread, optimizing HIV testing approaches, improving efficiency, and eventually enhancing the accuracy of HIV diagnosis. We strongly recommend the integration of ML into HIV testing programs for efficient and accurate HIV testing. [ABSTRACT FROM AUTHOR]

HIV prevention in adolescents and young adults (AYA) requires a multi-pronged strategy encompassing behavioral, biologic, and structural approaches. This article reviews the epidemiology of HIV infection in the United States and its pathogenesis and transmission. Prevention approaches are discussed in more detail, with an emphasis on how each approach is relevant to AYA populations. Information is summarized in a resource table with links to references and in-depth discussions of the topics reviewed in this article. [ABSTRACT FROM AUTHOR]

Evaluating routine HIV testing and treatment and use of services for people who inject drugs (PWID) is critical to curb the ongoing HIV epidemic. We analyzed data from the 2018 National HIV Behavioral Surveillance of PWID aged 18 years or older, recruited using respondent-driven sampling and offered anonymous HIV testing after survey. We performed bivariate and multivariable analyses with log-linked Poisson regression of the generalized linear models to examine the associations between demographics and PWID service use, past-year HIV testing, and current antiretroviral therapy (ART) use. Among 10,311 HIV-negative PWID, 56% reported past-year HIV testing, and of the 553 HIV-positive PWID, 69% reported current ART use. Of the HIV-negative PWID, 64% (2874/4482) in drug treatment and 62% (3386/5440) who used syringe service programs (SSPs) reported past-year HIV testing. Among HIV-positive PWID, 75% (187/248) in drug treatment and 67% (200/298) SSP participants were on ART. In the adjusted multivariable model, past-year HIV testing was associated with drug use treatment (aPR 1.26, 95% CI 1.23–1.31) and SSP participation (aPR 1.19, 95% CI 1.13–1.26) among HIV-negative PWID. Current ART use was associated with drug use treatment (aPR 1.13, 95% CI 1.00–1.28) but the link was not significant probably due to small sample size. Findings support the expansion and improvement of PWID-targeted services, into comprehensive programs, including drug use treatment, SSP, and HIV testing and treatment. [ABSTRACT FROM AUTHOR]

Background A human immunodeficiency virus (HIV) outbreak was identified among people who inject drugs (PWID) in Glasgow in 2015, with >150 diagnoses by the end of 2019. The outbreak response involved scaling up HIV testing and improving HIV treatment initiation and retention. Methods We parameterized and calibrated a dynamic, deterministic model of HIV transmission among PWID in Glasgow to epidemiological data. We use this model to evaluate HIV testing and treatment interventions. We present results in terms of relative changes in HIV prevalence, incidence, and cases averted. Results If the improvements in both testing and treatment had not occurred, we predict that HIV prevalence would have reached 17.8% (95% credible interval [CrI], 14.1%–22.6%) by the beginning of 2020, compared to 5.9% (95% CrI, 4.7%–7.4%) with the improvements. If the improvements had been made on detection of the outbreak in 2015, we predict that peak incidence would have been 26.2% (95% CrI, 8.8%–49.3%) lower and 62.7% (95% CrI, 43.6%–76.6%) of the outbreak cases could have been averted. The outbreak could have been avoided if the improvements had already been in place. Conclusions Our modeling suggests that the HIV testing and treatment interventions successfully brought the HIV outbreak in Glasgow under control by the beginning of 2020. [ABSTRACT FROM AUTHOR]

Introduction: Assisted partner services (APS), or exposure notification and HIV testing for sexual partners of persons diagnosed HIV positive (index clients), is recommended by the World Health Organization. Most APS literature focuses on outcomes among index clients and their partners. There is little data on the benefits of providing APS to partners of partners diagnosed with HIV. Methods: We utilized data from a large‐scale APS implementation project across 31 facilities in western Kenya from 2018 to 2022. Females testing HIV positive at facilities were offered APS; those who consented provided contact information for all male sexual partners in the last 3 years. Male partners were notified of their potential HIV exposure and offered HIV testing services (HTS). Males newly testing positive were also offered APS and asked to provide contact information for their female partners in the last 3 years. Female partners of male partners (FPPs) were provided exposure notification and HTS. All participants with HIV were followed up at 12 months post‐enrolment to assess linkage‐to antiretroviral treatment (ART) and viral suppression. We compared HIV positivity, demographics and linkage outcomes among female index clients and FPPs. Results: Overall, 5708 FPPs were elicited from male partners, of whom 4951 received HTS through APS (87% coverage); 291 FPPs newly tested HIV positive (6% yield), an additional 1743 (35.2%) reported a prior HIV diagnosis, of whom 99% were on ART at baseline. At 12 months follow‐up, most FPPs were taking ART (92%) with very few adverse events: <1% reported intimate partner violence or reported relationship dissolution. FPPs were more likely than female index clients to report HIV risk behaviours including no condom use at last sex (45% vs. 30%) and multiple partners (38% vs. 19%). Conclusions: Providing HIV testing via APS to FPP is a safe and effective strategy to identify newly diagnosed females and achieve high linkage and retention to ART and can be an efficient means of identifying HIV cases in the era of declining HIV incidence. The high proportion of FPPs reporting HIV risk behaviours suggests APS may help interrupt community HIV transmission via increased knowledge of HIV status and linkage to treatment. [ABSTRACT FROM AUTHOR]