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Objectives: This qualitative sub‐study aimed to explore how cisgender gay, bisexual, and other men who have sex with men (cis‐GBMSM) and transgender people who reported non‐consensual sex (NCS) accessed health care services, what barriers they faced, and how this experience influenced subsequent HIV testing. Methods: SELPHI is an online randomized controlled trial evaluating both acceptability and efficiency of HIV‐self testing among cis‐GBMSM and transgender people. Semi‐structured interviews were conducted, audio‐recorded, transcribed, and analysed through a framework analysis, as a qualitative sub‐study. We identified narratives of NCS from interviews and investigated experiences of cis‐GBMSM and transgender people accessing health care services following sexual assault. Results: Of 95 participants, 15 (16%) spontaneously reported NCS. Participants reported a broad range of NCS, including partner's coercive behaviours, non‐consensual removal of condoms, and rapes. All feared HIV transmission, leading them to test for HIV, underlining a marked lack of awareness of post‐exposure prophylaxis (PEP). Most had negative experiences in communicating with reception staff in sexual health clinics following these incidents. A lack of confidentiality and empathy was described in these situations of psychological distress. Clinic visits were primarily focused on testing for HIV and sexually transmitted infection, and generally no specific psychological support was offered. Getting a negative HIV result was a key step in regaining control for people who experienced NCS. Conclusions: Sexual health care providers should take care to more fully address the issue of NCS with cis‐GBMSM and transgender people when it arises. Recognizing and managing the emotional impact of NCS on affected patients would prevent negative experiences and increase confidence in care. [ABSTRACT FROM AUTHOR]

Introduction: Currently, Indonesia still has one of the highest rates of new HIV/AIDS infections among countries in Asia and the Pacific region. The WHO has recommended pre‐exposure prophylaxis (PrEP) as an additional HIV epidemic prevention step, which has been applied globally and related to the reduction in the number of HIV cases. However, information on the cost of implementing PrEP is rarely available in developing countries, especially in Southeast Asia. Designing a cost‐effective approach to scale up PrEP and to estimate the potential budget impact requires information on the cost of implementing PrEP. This study aims to estimate the cost of implementing PrEP at community‐based clinics in Indonesia. Methods: We collected healthcare and non‐healthcare/client costs from nine community‐based clinics in various cities/districts in Indonesia. The healthcare costs included data on resource utilisation and costs to deliver PrEP, divided into recurrent and capital costs using a discount rate of 3%. Non‐healthcare costs included out‐of‐pocket costs (e.g., transportation, meals) and productivity loss by clients and accompanying person(s) in accessing PrEP. On average, we interviewed 27 clients/clinic. Results: The annual cost of providing PrEP per client is US $365.03, 39% lower than the yearly cost of antiretroviral treatment (ART) per person (approximately US $600). Drugs and non‐healthcare costs contribute approximately 67% of the cost. The cost of PrEP amounts to US $292,756.45/year, covering 802 clients. The non‐healthcare cost per visit at all sites never reaches more than 10% of the average monthly household expenditure. Conclusions: The cost of providing PrEP per person is approximately US $365 and is 39% lower than the annual cost of ART per person. Lowering the cost of PrEP ARV drugs would reduce the cost. Scaling up PrEP should recognise this cost structure and strive to reach economies of scale as the intervention gains more clients while simultaneously controlling new HIV infections. [ABSTRACT FROM AUTHOR]

Background: Accurate HIV diagnosis is essential for appropriate patient care. Rapid tests (RTs) are considered key to HIV screening and management. Some studies have found RTs to be comparable with the ELISA test whilst others have reported lower sensitivity. Aim and study design: The aim of this retrospective, descriptive study was to evaluate the sensitivity and specificity of the HIV 1/2/O Tri‐line rapid test (HIV‐TRT) device compared with ELISA. Method: The study sample comprised 45 records of patients who tested for HIV using the HIV‐TRT device and ELISA. Results: As compared with ELISA as the 100% gold standard, the sensitivity of the HIV‐TRT was 80% (CI: 59%–93%) and specificity was 100% (CI: 83%–100%). ROC area of 0.9 at 95% CI was determined. Conclusion: The low sensitivity of HIV‐TRT is a concern, since HIV screening in South Africa makes use of RTs. [ABSTRACT FROM AUTHOR]

Background and Objectives The major interventions used to reduce the risk of HIV transmission from blood transfusion include the nucleic acid amplification assays (NAT). In Mozambique, screening for HIV infection in blood donors using serological assays is performed routinely. The aim of this study was to evaluate the use of a NAT test to screen blood donors at the blood bank of Hospital Central de Maputo. Material and Methods A cross-sectional study was conducted in a blood bank in the city of Maputo. Overall, 1500 blood donors were enrolled in the study from November 2014 to October 2015. The blood from each participant was drawn and used for both serological and HIV quantification. For HIV viral load quantification, mini-pools of six specimens were tested and, if positive, each sample was retested separately. Results Among the 1500 blood donors, the median age was 31 years old, 78·2% were men, and 74·7% were replacement donors. Our results showed a good sensitivity of (80/80) 100·0% (95·5-100%) and a specificity of (1408/1409) 99·9% (99·6- 100%) for the NAT when compared to the serological assay used at the blood bank. The kappa value of 0·99 (0·98-1·0) and confidence interval of 95·0% were observed indicating a good correlation between the NAT and serological assay. Conclusion Our data show that the HIV nucleic acid quantification assay has a good performance when compared to the serological assays, can detect infected donors/donations and can be used in mini-pools to minimize HIV infection resulting from the blood transfusion in the blood banks of Mozambique. [ABSTRACT FROM AUTHOR]

Introduction: HIV self-testing (HIVST) is a discreet and convenient way to reach people with HIV who do not know their status, including many who may not otherwise test. To inform World Health Organization (WHO) guidance, we assessed the effect of HIVST on uptake and frequency of testing, as well as identification of HIV-positive persons, linkage to care, social harm, and risk behaviour. Methods: We systematically searched for studies comparing HIVST to standard HIV testing until 1 June 2016. Meta-analyses of studies reporting comparable outcomes were conducted using a random-effects model for relative risks (RR) and 95% confidence intervals. The quality of evidence was evaluated using GRADE. Results: After screening 638 citations, we identified five randomized controlled trials (RCTs) comparing HIVST to standard HIV testing services among 4,145 total participants from four countries. All offered free oral-fluid rapid tests for HIVST and were among men. Meta-analysis of three RCTs showed HIVST doubled uptake of testing among men (RR = 2.12; 95% CI: 1.51, 2.98). Meta-analysis of two RCTs among men who have sex with men showed frequency of testing nearly doubled (Rate ratio = 1.88; 95% CI: 1.17; 3.01), resulting in two more tests in a 12-15-month period (Mean difference = 2.13; 95% CI: 1.59, 2.66). Meta-analysis of two RCTs showed HIVST also doubled the likelihood of an HIV-positive diagnosis (RR = 2.02; 95% CI: 0.37, 10.76, 5.32). Across all RCTs, there was no indication of harm attributable to HIVST and potential increases in risk-taking behaviour appeared to be minimal. Conclusions: HIVST is associated with increased uptake and frequency of testing in RCTs. Such increases, particularly among those at risk who may not otherwise test, will likely identify more HIV-positive individuals as compared to standard testing services alone. However, further research on how to support linkage to confirmatory testing, prevention, treatment and care services is needed. WHO now recommends HIVST as an additional HIV testing approach. [ABSTRACT FROM AUTHOR]

Introduction: Global effort to increase early diagnosis and engagement in HIV care emphasize the importance of developing novel approaches to reaching those missed by traditional methods. Such needs are particularly great for men who have sex with men (MSM), transgender women (TW), and other populations who face stigma. Myanmar's HIV epidemic is concentrated among key populations and the revised National Strategy aims to reduce late diagnosis and barriers to care to curb HIV incidence among these groups. HIV self-testing (HIVST) may be one method to improve testing and diagnosis among key populations, by placing HIV testing and disclosure within the individual's control. Methods: Formative, qualitative research including in-depth interviews with adult MSM (N = 12) and TW (N = 13) and focus group discussions with MSM, TW, and community key informants (N = 35) were conducted in June-September 2015 in Yangon, Myanmar. To inform a subsequent HIV care continuum intervention, including HIVST, participants' opinions and perceptions about HIVST were elicited. Results: The confidentiality and privacy of HIVST, particularly as it related to disclosure of HIV status and sexual behaviour, was widely recognized among participants. These major advantages were further supported by the opportunity to avoid stigma, convenience of self-testing (reduced need for transportation and time to go to clinics), and the availability of a painfree testing option. Participants weighed these benefits against perceived disadvantages of HIVST, the majority of which centred on the perception that HIVST does not include counselling. Participants were concerned that potential lack of counselling would result in poor mental health outcomes, inadequate linkage to HIV care and surveillance, and reductions in disclosure of HIV status. Participants did not view these disadvantages as an impediment, but provided suggestions for future implementation of HIVST in Myanmar. Conclusions: MSM and TW are optimistic about the confidentiality and privacy afforded by HIVST but wanted HIV counselling and linkage to appropriate services. The domestic reprioritization of HIV and opening of the country to international support has substantially increased the availability of HIV treatment and provides new opportunities, like HIVST, to potentially improve the HIV response for key populations who are at risk for HIV acquisition. [ABSTRACT FROM AUTHOR]

Policy Points:In situations of scientific uncertainty, public health interventions, such as counseling for HIV infection, sometimes must be implemented before obtaining evidence of efficacy.The history of HIV counseling and testing, which served as the cornerstone of HIV prevention efforts at the US Centers for Disease Control and Prevention (CDC) for a quarter of a century, illustrates the influence of institutional resistance on public health decision making and the challenge of de‐implementing well‐established programs. Context: In 1985, amid uncertainty about the accuracy of the new test for HIV, public health officials at the Centers for Disease Control and Prevention (CDC) and AIDS activists agreed that counseling should always be provided both before and after testing to ensure that patients were tested voluntarily and understood the meaning of their results. As the “exceptionalist” perspective that framed HIV in the early years began to recede, the purpose of HIV test counseling shifted over the next 30 years from emphasizing consent, to providing information, to encouraging behavioral change. With this increasing emphasis on prevention, HIV test counseling faced mounting doubts about whether it “worked.” The CDC finally discontinued its preferred test counseling approach in October 2014. Methods: Drawing on key informant interviews with current and former CDC officials, behavioral scientists, AIDS activists, and others, along with archival material, news reports, and scientific and governmental publications, we examined the origins, development, and decline of the CDC's “counseling and testing” paradigm for HIV prevention. Findings: Disagreements within the CDC emerged by the 1990s over whether test counseling could be justified on the basis of efficacy and cost. Resistance to the prospect of policy change by supporters of test counseling in the CDC, gay activists for whom counseling carried important ethical and symbolic meanings, and community organizations dependent on federal funding made it difficult for the CDC to de‐implement the practice. Conclusions: Analyses of changes in public health policy that emphasize the impact of research evidence produced in experimental or epidemiological inquiries may overlook key social and political factors involving resistance to deimplementation that powerfully shape the relationship between science and policy. [ABSTRACT FROM AUTHOR]

Introduction To identify sociocultural determinants of self‐reported condom use and HIV testing and examine variables related to accessibility, motivation and obstacles among men who have sex with men (MSM) in Jordan. Design Cross‐sectional study among MSM who were identified through services of a local non‐governmental organization (NGO). Methods Respondents were studied with a semi‐structured interview based on the Explanatory Model Interview Catalogue (EMIC) framework. The vignette‐based EMIC interview considered locally relevant HIV/AIDS‐related knowledge, risk perception and perceived causes, as well as awareness of services and sources of support. Results Of the 97 respondents, 27% reported that they used a condom at last intercourse; 38% had been tested at least once for HIV. Positive determinants of condom use were higher education level, acknowledging MSM as a high‐risk group, seeking advice from a medical doctor and the perceived causes “sex with prostitutes” and “sex with animals.” Awareness of available treatment was a positive determinant of HIV testing. Blood transfusion as a perceived cause and asking advice from friends were negative determinants. Conclusions Jordanian MSM seem to be aware of the risk of HIV infection and effective prevention methods, and they are willing to be tested for HIV. Our findings addressed the importance of the sexual meaning of HIV/AIDS on the control of HIV/AIDS among MSM. More effective engagement of NGOs and MSM in the prevention and control of HIV/AIDS is needed, enlisting the support of medical doctors and community health workers. Peer education should be strategically strengthened. Political commitment is needed to mitigate social stigma. [ABSTRACT FROM AUTHOR]

Objective To describe HIV-infected people's experience of the HIV test procedure in Europe. Methods Between August 1996 and September 1997, anonymous self-administered questionnaires were distributed to HIV-infected people in 11 European countries. Results A total of 1366 people completed the questionnaire (50% response rate). Of these, 194 (16%) had more than five negative HIV tests before being diagnosed as HIV positive, 179 (14%) were tested without consent and 192 (15%) were informed about the HIV positive test result by mail or by telephone. Of the 963 people who received a positive test result during a consultation, 247 (26%) reported that this visit lasted less than 10 min, 336 (35%) between 10 and 20 min, and 289 (30%) more than 20 min. Over half the total respondents (591, 54%) felt they did not receive adequate support when they were informed about being HIV positive, with 249 (19%) experiencing feelings of rejection. People who were diagnosed as HIV positive after 1994 reported more frequently receiving adequate support, information and understanding when the positive test result was revealed compared with those diagnosed before 1990. Conclusion A large number of our study participants did not endorse the way HIV tests were conducted and positive test results revealed. Although there was an improvement over time in the way HIV tests were conducted, they often did not conform to international guidelines. [ABSTRACT FROM AUTHOR]

In this paper we consider the amount of undetected replication in HIV infection diagnoses as reported to the Public Health Laboratory Service AIDS Centre, Colindale, London. These diagnoses are usually reported with the date of birth of the individual but no names held on the database. The PHLS cannot always tell whether two reports with the same date of birth correspond to the same individual. The number of replications of date of birth recorded in sixteen birth years was provided for investigation. This paper examines statistical methods for deciding whether there is a greater amount of replication of birthdates in the sample than expected by chance alone. Three methods are outlined. The first uses X²-tests to compare the observed and expected number of i-tuples. The second uses a partial ranking scheme for the possible values of the replication vector and the third uses a test based on the number of pairs in a sample. Using a 5% significance level, these tests reveal that, respectively, five out of the last eleven, one out of the first five and five out of the total sixteen birth years show evidence of more replication than expected by chance alone. [ABSTRACT FROM AUTHOR]