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HIV self-testing (HIVST) shows promise to improve HIV diagnosis among those seeking privacy and anonymity in HIV testing. This may include sexual and gender diverse populations, who experience disproportionately high burdens of stigma and HIV globally. To inform potential scale-up of HIVST in Myanmar, we implemented a community-led, mixed-methods randomized trial in Yangon. Adult trans-feminine individuals and cisgender men who have sex with men were recruited via respondent-driven sampling. Participants (N = 577) completed a baseline survey and were randomized to community-based HIV testing services (HTS) or HIVST. One-third of participants reported lifetime HIV testing. Over half (59.4%) returned for a second study visit to report their test result and test acceptability, which was lower among HTS-assigned participants compared to those assigned to HIVST (55.6% vs. 63.1%; p = 0.096). Participants reported that both HIVST and HTS were easy to access, test, and interpret/understand the results of their HIV test. Ninety percent of HTS-assigned participants indicated they would test regularly if they could access HIVST. Qualitative participants (N = 20) described that the convenience and privacy afforded by HIVST may increase the availability and coverage of testing. Taken together, these results suggest HIVST is an acceptable, low-barrier complement to community-based HTS for key populations in Myanmar.

Background Increasing the uptake of HIV testing in people who may have undiagnosed HIV is essential to reduce the morbidity associated with late HIV diagnosis. Methods We conducted a multicentre, longitudinal, mixed-methods study, surveying the attitudes, knowledge and practice of non-HIV specialist hospital physicians in South-East Scotland and North-East England with respect to HIV testing. Results We found that although awareness of indications for HIV testing had improved over time, only 13% of clinicians recognised all of the surveyed HIV indicator conditions. Physicians were better at recognising the indicator conditions relevant to their specialty. The perception of working with a low-risk patient population was the most frequently cited barrier to offering an HIV test. Only a third of study respondents had requested more than 10 HIV tests in the preceding year. Conclusions Our study supports a need for targeted and sustained educational initiatives to increase rates of HIV testing in secondary care.

Introduction Few studies have examined the factors associated with HIV testing, specifically among U.S. high-school girls. Methods Investigators analyzed 2015 and 2017 Youth Risk Behavior Survey data to calculate the prevalence ratios and the corresponding 95% CIs for the association of HIV-related risk behaviors and other factors with HIV testing. Analyses were completed in March 2020. Results Approximately 1 in 10 high-school girls reported ever having had an HIV test. Ever having had an HIV test was most common among girls who had ≥4 lifetime sexual partners and those who had ever injected illegal drugs. Conclusions High-school girls who engage in behaviors or experience other factors that put them at higher risk for HIV are more likely to have ever gotten tested. However, the prevalence of having ever had an HIV test remains relatively low, indicating that continued efforts may be warranted to reduce risk behaviors and increase testing among high-school girls.

Since the beginning of the HIV epidemic, there have been more than 75 million cases. Currently, there about 1.2 million living with HIV in the USA. Despite current testing recommendations, test rates continue to be suboptimal. Investigators have studied the use of digital technology to promote HIV testing, especially among high-risk populations. Purpose of Review This non-systematic review provides an overview of the scientific research between 2015 and 2020 focused on the use of digital technology to bolster HIV testing and suggests novel technologies for exploration. Recent Findings A total of 40 studies were included in the review that span a wide range of available technology. Studies effectively increased HIV testing among study participants. Generally, participants in the intervention/exposure groups had significantly higher rates of HIV test uptake compared to participants in the comparison groups at study follow-up. Summary For a variety of reasons (e.g., differences in ways the technologies were used and study design), no digital tool clearly performed better than others, but each have the capacity to increase outreach and self-testing. An exploration of the potential use of nascent technologies is also discussed, as well as the authors’ experiences using a number of these technologies in our research.

Previous research has indicated that major depression is a chronic illness with people experiencing several depressive episodes over the course of their lifetime. To this extent people who currently report major depression are more likely to enter and exit future depressive episodes than those who do not. We studied 500 South Africans seeking an HIV test to determine whether past depressive disorders predicted present depression. Among our sample, 14.40% met the diagnostic criteria for current major depression and 10.42% reported past major depression. Using chi-square analysis we found that study participants with current major depression were 9.25 times more likely to have had past major depression than those without past major depression. These results have important implications for HIV care. Persons who test positive for HIV and who have major depression are less likely to accept and adhere to antiretroviral therapy. Thus identifying positive cases of depression and thus the risk of future depressive episodes among this population will enhance the likelihood of referral for mental health treatment which in turn is likely to yield improved HIV treatment outcomes.

I examine the effect of the Patient Protection and Affordable Care Act dependent coverage mandate on young adult human immunodeficiency virus (HIV) testing using a birth cohort analysis. I find that targeted young adults are 3.6 percentage points more likely to report ever having an HIV test. I find larger, but not significantly different, effects for males and for individuals in states without mandatory pre-test counseling.

A fourth-generation HIV test is conventionally performed at baseline for individuals given HIV post-exposure prophylaxis (PEP). However, early HIV infection may be missed by fourth-generation tests especially in settings of high HIV incidence, meaning that recently infected individuals are potentially at risk of transmitting HIV. In 2013, HIV incidence in PEP recipients at the 56 Dean Street clinic was 7.6 per 100 person-years. We therefore wished to see if using a point-of-care PCR HIV test in such individuals would shorten the testing window period and pick up early infections that would be undiagnosed by conventional tests. We compared HIV detection in PEP recipients using the Cepheid GeneXpert® HIV-1 Qual viral load (Qual VL) assay with the standard HIV tests used in our clinical service. Between March 2017 and August 2018, a Qual VL assay was performed in addition to standard baseline HIV tests in consented PEP recipients. Of 494 consented PEP recipients, 476 had valid Qual VL assay results. Of these, 474 (99.6%) had a negative Qual VL result and were also negative on standard baseline HIV tests. Two (0.4%) tested positive for HIV on Qual VL. One of these patients was also HIV-positive on all baseline HIV tests. The other had discordant baseline point-of-care HIV test results. Although no additional HIV infections were diagnosed in PEP recipients using Qual VL, in one individual, it provided confirmation of new HIV infection more quickly than the standard HIV testing pathway.

Background Persons with STIs or HCV infection often have indicators of HIV risk. We used weighted data from 6 cycles of the National Health and Nutrition Examination Survey (NHANES) to assess the proportion of persons who reported ever being diagnosed as having a selected STI or HCV infection and who reported that they were ever tested for HIV. Methods Persons aged 20 to 59 years with prior knowledge of HCV infection before receiving NHANES HCV RNA-positive results (2005-2012) or reporting ever being told by a doctor that they had HCV infection (2013-2016), or ever had genital herpes, or had chlamydia or gonorrhea in the past 12 months were categorized as having had a selected STI or HCV infection. Weighted proportions and 95% confidence intervals were estimated for reporting ever being tested for HIV for those who did and did not report a selected STI or HCV infection. Results A total of 19,102 respondents had nonmissing data for STI and HCV diagnoses and HIV testing history; 44.4% reported ever having been tested for HIV, and 5.2% reported being diagnosed as having a selected STI or HCV infection. The proportion reporting an HIV test was higher for the group that reported an STI or HCV infection than for the group that did not. Conclusion Self-reported HIV testing remains low in the United States, even among those who reported a previous selected STI or HCV infection. Ensuring HIV tests are conducted routinely for those with overlapping risk factors can help facilitate the diagnosis of HIV infections.

International audience; Uptake of HIV testing is suboptimal in Uganda, particularly in rural communities. Reaching UNAIDS 95-95-95 goals requires strategies to increase HIV testing among hard-to-reach populations. This cross-sectional study sought to characterize engagement with HIV testing among traditional healers and their clients in rural Uganda. We enrolled 175 traditional healers and 392 adult clients of healers in Mbarara District. The primary outcome for this study was having received an HIV test in the prior 12 months. Most clients ( n = 236, 65.9%) had received an HIV test within 12 months, compared to less than half of healers ( n = 75, 46.3%) who had not. In multivariate regression models, male clients of healers were half as likely to have tested in the past year, compared with female (adjusted odds ratios (AORs) = 0.43, 95% CI = 0.26–0.70). Increasing age negatively predicted testing within the past year (AOR = 0.95, 95% CI = 0.93–0.97) for clients. Among healers, more sexual partners predicted knowing ones serostatus (AOR = 1.6, 95% CI 1.03–2.48). Healers (AOR = 1.16, 95% CI 1.07–1.26) and clients (AOR = 1.28, 95% CI 1.13–1.34 for clients) with greater numbers of lifetime HIV tests were more likely to have tested in the past year. Traditional healers and their clients lag behind UNAIDS benchmarks and would benefit from programs to increase HIV testing uptake.

Introduction/Background* Cervical dysplasia is an HIV indicator condition and according international recommendations HIV testing is strongly advised in women with cervical dysplasia, because the risk of an undiagnosed HIV is thought to be >0.1%. Therefore an HIV test should be offered to all women with cervical dysplasia. There is no literature about the opinion of Gynaecologist on HIV screening in patients with cervical dysplasia. Methodology We sent an online questionnaire to gynecologist in South West Netherlands to investigate 1) what they know about this issue, 2) their opinion and willingness on active HIV testing for this cervical dysplasia. Result(s)* The questionaire was sent to 103 gynaecologists of whom fifty-six participants replied (54%). Forty-eight (86%) think patients are not offended when HIV testing is offered and 50 (89%) have no difficulty to address HIV testing. Thirty-nine (70%) gynaecologist think that the prevalence of undiagnosed HIV infection is lower than 0.1% , and only seven (12,5%) accept HIV testing in case of a prevalence of 0.1% or less. Thirthy-two (57%) are willing to test with a prevalence of 1% or higher. Conclusion* To address and offer HIV testing seems not an issue for the gynaecologists questioned in our study. However, the willingness to routinely perform an HIV test for cervical dysplasia at the assumed 0.1% prevalence looks insufficient and differs from the recommendations of international policy makers. Discussion is needed tot change the treshold or the willingness for testing.

HIV self-testing (HIVST) devices are acknowledged as having the potential to enable the acceleration of HIV diagnosis and linkage to care. How efficiently professional and trained users engaged with the Asante HIV-1/2 Oral Self-Test (Asante) (Sedia Biosciences, Portland, OR, USA), and the accuracy of the device in comparison to other HIV rapid diagnostic tests (RDT), was assessed to be able to guide the development and adoption of the device in Senegal and South Africa. Using convenience sampling, potential participants were recruited from catchment areas where HIV was prevalent. Trained users performed an HIV test on participants using an Oral HIVST. The professional user’s interpretation of results was then measured against the results of various other RDTs. The South African study had 1652 participants and the Senegalese, 500. Most of the participants in each study were 18–35 years old. Senegal had a higher number of females (346/500, 69.2%) compared to South Africa (699/1662, 42.1%). Asante displayed very high sensitivity and specificity when tested against other devices. In the final enzyme-linked immunosorbent assay (ELISA) comparison, in South Africa, the sensitivity: specificity was 99.1:99.9% and in Senegal, 98.4:100.0%. Senegal further identified 53/63 (84.1%) with HIV-1, 8/63 (12.7) with HIV-2 and 2/63 (3.2%) with HIV-1/2 co-infections. Professional or trained users’ interpretations of Asante results correlated strongly to results when using various RDTs, the ELISA assay and Western blot tests, making it a dependable HIV testing instrument.

Background Compared to HIV-negative individuals, people living with HIV have a higher risk of malignant lymphoma. To what extent hematologists miss HIV testing opportunities among lymphoma patients (LP) in the Amsterdam University Medical Centers (UMC) is currently unknown. We quantified the HIV testing rate among LP and assessed factors influencing hematologists’ HIV testing behavior in LP at both Amsterdam UMC locations. Methods In this mixed-methods study, quantitative data from 2015 to 2019 from electronic health records of LP were retrospectively collected to assess both the HIV testing rate within three months around lymphoma diagnosis and the HIV positivity prevalence. An online survey among hematologists and semi-structured interviews among hematologists and authors of hematology guidelines were conducted. Results Data from 656 LP and 21 hematologists who responded to the survey out of 40 were used. Interviews were held with four hematologists and two authors of hematology guidelines. The HIV testing rates were 56.4% and 57.6%, and the HIV positivity prevalences were 0.8% and 0.9% for both locations. Eighty-five percent (18/21) of hematologists indicated they often offered an HIV test to LP in the past year, and 42% (9/21) revealed HIV testing in LP is often discussed in their department. The type of lymphoma, lack of awareness regarding HIV testing recommendations in LP, low perceived risk of HIV among LP because of older age, and lack of guidelines recommending universal HIV testing regardless of lymphoma type, each influenced hematologists’ HIV testing behavior. Conclusion Our results show routine HIV testing among LP and hematologists’ attitudes and knowledge towards testing at the Amsterdam UMC are suboptimal, despite HIV testing being recommended in most lymphoma guidelines. This highlights the need for interventions to improve hematologists’ behavior towards testing, such as education, as well as expansion and enhanced implementation of the hematology guidelines.

Background Nearly 6% of American men report having had sex with another male since puberty. However, as men age, their sexual repertoires likely change. Recent sexual behaviors may be more important with respect to risk for bacterial STDs. We investigated recent sexual behaviors and STD/HIV testing among US men who report having had sex with both men and women in their lifetime (MSMW). Methods MSMW aged 15–44 years who participated in the National Survey of Family Growth during 2011–2019 were included. MSMW were further classified based on gender of recent (past 12 months) sex partners: (1) both men and women, (2) only men and (3) only women. Weighted percentages and corresponding 95% confidence intervals (CI) of behaviors were estimated. Results Among all MSMW (n=801), 23% (95% CI: 20–27) reported recent sex with both men and women, 21% (95% CI: 17–24) with only men and 56% (95% CI: 51–61) with only women. Among MSMW who recently had sex with both men and women, half (52%, 95% CI: 41–62) identified as bisexual and almost half (46%, 95% CI: 36–56) had 4+ sex partners in the past year, higher than MSMW who recently had sex with only men (29%, 95% CI: 20–38) or only women (6%, 95% CI: 4–9). Compared to MSMW who recently had sex with both men and women, MSMW who recently had sex with men only were more likely to have had a recent HIV test (57%, 95% CI: 49–68 versus 30%, 95% CI: 21–39) and a recent STD test (55%, 95% CI: 46–64 versus 45%, 95% CI: 35–55). Conclusion MSMW are a heterogeneous group with respect to recent sexual behaviors and may have different sexual health needs. The collection of sexual history at clinical visits is critical to ensuring culturally competent sexual health care for this population.

Because adolescents and emerging adults are frequently not offered HIV testing, and often decline tests when offered, we developed and tested a tablet-based intervention to increase HIV test rates among emergency department (ED) patients aged 13-24 years. Pediatric and adult ED patients in a high volume New York City hospital (N = 295) were randomized to receive a face-to-face HIV test offer, or to complete a tablet-based intervention that contained an HIV test offer delivered via computer. Test rates in both conditions were then compared to historic test rates in the same ED during the previous six months. Among participants aged 19 years and younger who were offered HIV testing and declined before enrollment in the study, participants in the tablet-based condition were 1.7 times more likely to test for HIV compared to participants in the face-to-face condition. Participants aged 19 years and younger were three times as likely to test for HIV compared to patients the same age who were treated in the previous six months (26.39%, n = 71 study participants vs. 10.29%, n = 189 prior patients, OR = 3.13, \begin{document}\chi\end{document}2 = 54.76, p < 0.001). Protocols designed to offer HIV testing to all eligible patients can significantly increase adolescent test rates compared to standard practice. Because tablets are equally effective compared to face-to-face offers, and in some cases more so, EDs may consider tablet-based interventions that require fewer staff resources and may integrate more easily into high-volume workflows.

Young MSM, especially ethnic and racial minority young MSM, bear a disproportionate burden of new HIV infections. This group also has the highest rates of undiagnosed infection and lowest rates of viral suppression. Previous research indicates that young MSM are testing for HIV too late, which may explain why rates of new HIV infection are rising in young Hispanic MSM and not falling in young Black and White MSM despite advances in preventive medications. Analysis of our sample showed an overall average age at first HIV test of approximately 26. The average age at first HIV test was 25.5 years for Black/African American individuals, 24.7 years for Hispanic individuals, and 28 years for White individuals. More testing resources and innovative outreach methods are needed to increase rates of testing among young MSM.

Objectives: In the United States, about 15% of persons living with HIV infection do not know they are infected. Opt-out HIV screening aims to normalize HIV testing by performing an HIV test during routine medical care unless the patient declines. The primary objective of this systematic review and meta-analysis was to assess the acceptance of opt-out HIV screening in outpatient settings in the United States. Methods: We searched in PubMed and CINAHL (Cumulative Index to Nursing and Allied Health Literature) for studies published from January 1, 2006, through December 31, 2018, of opt-out HIV screening in outpatient settings. We collected data from selected studies and calculated for each study (1) the percentage of persons who were offered HIV testing, (2) the percentage of persons who accepted the test, and (3) the percentage of new HIV diagnoses among persons tested. We also collected information on the reasons given by patients for opting out. The meta-analysis used a random-effects model to estimate the average percentages of HIV testing offered, HIV testing accepted, and new HIV diagnoses. Results: We initially identified 6986 studies; the final analysis comprised 14 studies. Among the 8 studies that reported the size of the study population eligible for HIV screening, 71.4% (95% confidence interval [CI], 53.9%-89.0%) of the population was offered an HIV test on an opt-out basis. The test was accepted by 58.7% (95% CI, 47.2%-70.2%) of persons offered the test. Among 9 studies that reported data on new HIV diagnoses, 0.18% (95% CI, 0.08%-0.26%) of the persons tested had a new HIV diagnosis. Patients’ most frequently cited reasons for refusal of HIV screening were that they perceived a low risk of having HIV or had previously been tested. Conclusions: The rates of offering and accepting an HIV test on an opt-out basis could be improved by addressing health system and patient-related factors. Setting a working target for these rates would be useful for measuring the success of opt-out HIV screening programs.

Introduction In the Community of Madrid there is 42.7% late HIV diagnosis. Primary care is the gateway to the health system and the frequency of serological tests requested by these professionals is unknown. The objectives were to establish the frequency of requests for HIV serology by medical and nursing primary care professionals in the Community of Madrid and the factors associated with these requests. Method An ‘on-line’ survey was conducted, asking professionals who participated in the evaluation study of strategies to promote early diagnosis of HIV in primary care in the Community of Madrid (ESTVIH) about the number of HIV-serology tests requested in the last 12 months. The association between HIV-serology requesting and the sociodemographic and clinical practice characteristics of the professionals was quantified using adjusted odds ratios (aOR) according to logistic regression. Results 264 surveys (59.5% physicians). Eighty-two point two percent of medical and 18.7% of nursing professionals reported requesting at least one HIV-serology in the last 12 months (median: 15 and 2 HIV-serology request, respectively). The doctors associated the request with: being male (aOR: 2.95; 95% C I: 0.82–10.56), being trained in pre-post HIV test counselling (aOR: 2.42; 95% CI: 0.84–6.93) and the nurses with: age ( 13 years; aOR: 3.02; 95% CI: 1.07–8.52). Conclusion It is necessary to promote HIV testing and training in pre–post HIV test counselling for medical and nursing professionals in primary care centres.

Millions of people are infected with human immunodeficiency virus (HIV); however, limited research focuses on post-mortem HIV detection. Post-mortem HIV testing is vital because medical records are not always available, and the HIV status can be unknown. The aims of this study were to review the available literature and determine the most efficient HIV test for post-mortem samples, the optimal tissue or bodily fluid to be tested, and the duration that HIV remains reliably detectable. A literature search was conducted using PubMed and Google Scholar. Terms were related to HIV (HIV detection, HIV testing, HIV prevalence) and deceased individuals (post-mortem, cadaver, deceased, organ donor). Inclusion criteria included English studies, or articles with at least an English abstract, while review articles were excluded. From this literature search, 43 studies were applicable. These studies most commonly used enzyme-linked immunosorbent assay and Western blot as screening and confirmation tests, respectively. As for the optimal tissue or bodily fluid, serum remained the golden standard, while testing skin seemed promising. HIV remains detectable in the body up to 58 days after death, although few studies tested samples after 48 h. Knowledge of the HIV status can be beneficial in the case of accidental exposure and can create a range of possible research opportunities on the effects of HIV in different organ systems. This review outlined several gaps in the current literature and future studies should investigate these gaps because this information can be relevant to numerous professions. Clin. Anat. 32:603-610, 2019. © 2019 Wiley Periodicals, Inc.

In Australia, HIV testing services have become increasingly available in non-traditional settings such as peer-led, community-based services to expand access and increase uptake of HIV testing among gay and bisexual men (GBM). This study aimed to compare the socio-demographic and behavioural characteristics of GBM whose last HIV test was conducted at a community-based service to GBM whose last test was at a traditional clinical setting. We analysed behavioural surveillance data collected from 5988 participants in seven states and territories in the period 2016-2017. We found that non-HIV-positive GBM who attended community-based services were largely similar to men attending clinic-based settings, particularly in terms of sexual practice and risk of HIV. However, non-HIV-positive GBM who were younger, born in Asia, more socially engaged with other gay men but who had not recently used PrEP were more likely to attend community-based services for their last HIV test. This study points to the successful establishment of community-based HIV testing services in Australia as a way to attract subgroups of GBM at potentially higher risk of HIV.

In 2017, rapid human immunodeficiency virus (HIV) testing services enabled the HIV diagnosis and treatment of approximately 15.3 million persons with HIV infection in sub-Saharan Africa with life-saving antiretroviral therapy (ART) (1). Although suboptimal testing practices and misdiagnoses have been reported in sub-Saharan Africa and elsewhere, trends in population burden and rate of false positive HIV diagnosis (false diagnosis) have not been reported (2,3). Understanding the population prevalence and trends of false diagnosis is fundamental for guiding rapid HIV testing policies and practices. To help address this need, CDC analyzed data from 57,655 residents aged 15–59 years in the Chókwè Health and Demographic Surveillance System (CHDSS) in Mozambique to evaluate trends in the rate (the percentage of false diagnoses among retested persons reporting a prior HIV diagnosis) and population prevalence of false diagnosis. From 2014 to 2017, the observed rate of false diagnosis in CHDSS decreased from 0.66% to 0.00% (p

Introduction Misclassification errors have been reported in rapid diagnostic HIV tests (RDTs) in sub‐Saharan African countries. These errors can lead to missed opportunities for prevention‐of‐mother‐to‐child‐transmission (PMTCT), early infant diagnosis and adult HIV‐prevention, unnecessary lifelong antiretroviral treatment (ART) and wasted resources. Few national estimates or systematic quantifications of sources of errors have been produced. We conducted a comprehensive assessment of possible sources of misclassification errors in routine HIV testing in Zimbabwe. Methods RDT‐based HIV test results were extracted from routine PMTCT programme records at 62 sites during national antenatal HIV surveillance in 2017. Positive‐ (PPA) and negative‐percent agreement (NPA) for HIV RDT results and the false‐HIV‐positivity rate for people with previous HIV‐positive results (“known‐positives”) were calculated using results from external quality assurance testing done for HIV surveillance purposes. Data on indicators of quality management systems, RDT kit performance under local climatic conditions and user/clerical errors were collected using HIV surveillance forms, data‐loggers and a Smartphone camera application (7 sites). Proportions of cases with errors were compared for tests done in the presence/absence of potential sources of errors. Results NPA was 99.9% for both pregnant women (N = 17224) and male partners (N = 2173). PPA was 90.0% (N = 1187) and 93.4% (N = 136) for women and men respectively. 3.5% (N = 1921) of known‐positive individuals on ART were HIV negative. Humidity and temperature exceeding manufacturers’ recommendations, particularly in storerooms (88.6% and 97.3% respectively), and premature readings of RDT output (56.0%) were common. False‐HIV‐negative cases, including interpretation errors, occurred despite staff training and good algorithm compliance, and were not reduced by existing external or internal quality assurance procedures. PPA was lower when testing room humidity exceeded 60% (88.0% vs. 93.3%; p = 0.007). Conclusions False‐HIV‐negative results were still common in Zimbabwe in 2017 and could be reduced with HIV testing algorithms that use RDTs with higher sensitivity under real‐world conditions and greater practicality under busy clinic conditions, and by strengthening proficiency testing procedures in external quality assurance systems. New false‐HIV‐positive RDT results were infrequent but earlier errors in testing may have resulted in large numbers of uninfected individuals being on ART.

Introduction:couples HIV testing and counseling is an important intervention to make an informed decision on reproductive health, to adopt preventive behaviors, support each other, and prevent mother-to-child HIV transmissions. Despite the importance of partners of pregnant women HIV testing uptake, there is limited study in Ethiopia. Hence, this study aimed to assess the proportion of HIV testing uptake and its determinants among partners of pregnant women. Methods:a community-based cross-sectional study was conducted from January to February 2020 in Addis Ababa. A multistage cluster sampling technique was used to recruit 812 partners of pregnant women. A pre-tested and structured questionnaire was used to collect the data. Binary logistic regression analysis was performed to identify the determinants of HIV testing uptake among partners of pregnant women. Adjusted odds ratio with 95% confidence interval was used to declare statistical association and the direction of the association between the dependent variable and independent variables. Results:overall, a total of 63.7% (95% CI: 60-67%) of partners of pregnant women were tested for HIV/AIDS. Knowledge on mother to child transmission of HIV (AOR=2.0, 95% CI: 1.37-3.06), previous history of couple HIV testing and counseling (AOR=3.8, 95% CI: 2.49-5.85), discussion with spouse (AOR= 6.6, 95% CI: 4.44-9.91), and having information about discordant HIV test result (AOR =2.3, 95% CI: 1.48-4.14) were significantly associated with partners of pregnant women HIV test uptake. Conclusion:HIV testing uptake among partners of pregnant women was low. To increase the uptake of HIV testing, program designers and implementors should work on knowledge of the spouse´s on mother to child transition of HIV, to have more discussion between couples, and consider and strengthen activities that increase couple HIV testing and counseling at the community level before pregnancy.

Background. HIV testing is an important step for entry and linkage into HIV care. Utilization of HIV testing services among transport workers may be challenging, because of the mobile nature of their jobs. We assessed utilization of HIV testing services and identified factors influencing the utilization of HIV testing services among motorcycle taxi (boda-boda) riders in Fort Portal Municipality, Kabarole District, Southwestern Uganda. Methods. We conducted a cross-sectional study among boda-boda riders, aged 18 years and above, from July 15 to July 29, 2020. We recruited participants through simple random sampling. Data were captured using a self-administered questionnaire. Binary logistic regression was used to identify factors associated with utilization of HIV testing services. Results. Of the 315 participants who received questionnaires, 305 (97%) responded. The mean age of the participants was 32 (±7.1) years and ranged from 18 to 55 years. Of the 305 participants, 238 reported having taken an HIV test and received results in the past 12 months, for an HIV testing utilization rate of 78.0% (95% CI: 73.0–82.6%). In multivariable analysis, participants who were less likely to utilize HIV testing services were those aged ≥30 years ( aOR = 0.33 ; 95% CI: 0.16–0.70, P = 0.004 ) and those who had HIV-related stigma ( aOR = 0.27 ; 95% CI: 0.08–0.88, P = 0.030 ). Participants who were more likely to utilize HIV testing services were those who knew HIV status of their primary partners ( aOR = 4.23 ; 95% CI: 1.24–14.49, P = 0.022 ) and those who had good knowledge on HIV/AIDS ( aOR = 3.94 ; 95% CI: 1.65–9.41, P = 0.002 ). Conclusions. Utilization of HIV testing services among the boda-boda riders in Fort Portal Municipality, Southwestern Uganda, was high. More efforts should focus on targeting older boda-boda riders for HIV testing, reduction of HIV-related stigma, improving knowledge on HIV/AIDS, and encouraging communication and disclosure between partners, in order to consolidate the gains made in HIV testing services in this bridge population.

Objective To describe a pilot implementation of couple's human immunodeficiency virus (HIV) testing and counseling in an antenatal care clinic in the United States. Methods We used a cross-sectional study design. Couples were recruited from an antenatal care clinic of a large, urban, tertiary medical center, and were eligible if both partners agreed to receive HIV test results together and reported no coercion to participate in testing and counseling and no intimate partner violence. We assessed relationship characteristics, HIV risk-related behaviors and concordance of couples' sexual agreement (ie, mutual agreement about sexual risk behaviors that are permissible within or outside of their relationship). Acceptability of couple's HIV testing and counseling (ie, format, quality of the sessions, ability to meet their needs) was assessed after completing the session. Barriers and facilitators to couple's HIV testing and counseling were assessed at the individual-level among decliners and participants and at the clinic-level among members of the care team. Results Dyadic data were collected from 82 individuals (41 couples). Most partners (n=56, 68%) did not have a sexual agreement or had differing expectations about their sexual agreement. Partners with a concordant sexual agreement (n=26) felt more confident working with their partners on condom use when having sex outside of their relationship (P=.008) and were more likely to agree with their partner to get tested regularly for HIV or sexually transmitted infections (P=.015). Acceptability was high, with a rating of 93 or more (out of 100) among all items. Individual-level barriers to couple's HIV testing and counseling included difficulty bringing the male partner for counseling and a perception by either member of the couple that they were at low-risk for HIV. At the clinic level, need for training, staff turnover, and integration of couple's HIV testing and counseling in the clinic flow presented as barriers, whereas commitment by the clinic leadership facilitated the couple's HIV testing and counseling program. Conclusion Despite barriers, couple's HIV testing and counseling can be implemented in antenatal clinics and is a highly acceptable method of HIV testing.

Objective: Human immunodeficiency virus (HIV) test uptake among college and university students in China remains suboptimal. This study aimed to identify and weigh the relative importance of HIV testing preferences among university students in China. Participants and methods: Qualitative interviews and discrete choice experiments (DCE) were used to identify and assess HIV testing preferences in hypothetical HIV testing scenarios. Study participants were sexually experienced university students in Suzhou city, China. Results: 198 participants completed 1980 DCE choice tasks. Risk of nosocomial HIV infection, accuracy, and distance were identified as the most important factors when deciding whether to test for HIV. Risk of nosocomial HIV infection was the most influential factor, accounting for 35.5% of the variation in participants' DCE stated choices. Conclusions: Fear of HIV nosocomial infection may be influencing HIV test preferences and possibly test uptake among university students in China. Interventions should consider addressing students' fear of HIV nosocomial infection as a potential barrier to HIV testing.

The American Men’s Internet Survey (AMIS) is an annual web-based behavioral survey conducted in the United States of men who have sex with men (MSM). This rapid surveillance report describes the sixth cycle of data collection (September-December 2018; AMIS 2018). The key indicators were the same as those previously reported for past AMIS cycles. The AMIS methodology has not substantively changed since AMIS 2017. MSM were recruited from a variety of websites using banner advertisements and email blasts. In addition, participants from AMIS 2017 who agreed to be recontacted for future research were emailed a link to AMIS 2018. Men were eligible to participate if they were aged ≥15 years, resided in the United States, provided a valid US ZIP code, and reported ever having sex with a man or identified as gay or bisexual. The analysis was limited to those who reported having oral or anal sex with a male partner in the past 12 months. We examined demographic and recruitment characteristics using multivariable regression modeling (P

Background In high-income countries with a low HIV prevalence, primary care doctors are likely the first point of medical contact for people at high risk of HIV. One of the key factors for successful implementation of preventive measures is the cooperation of primary healthcare providers. Hong Kong’s population mostly seek primary care in the private sectors. Our study evaluated the involvement of private primary healthcare providers in HIV prevention and care. Methods A cross-sectional postal structured questionnaire was administered to 1102 private primary care doctors in Hong Kong in December 2017. Responses were received via postal mail, fax or online. Non-respondents received a phone-call reminder to complete the survey. Descriptive analyses were performed for all the question items. Chi-square test was used to assess the association between participants’ level of involvement in HIV prevention and care and their demographics and medical practice characteristics. Results The response rate was 17.9% (197/1102). Most of the respondents were Chinese (95%) and have obtained their primary medical qualifications in Hong Kong (72%). More than half of the doctors have practiced in the private sector for more than 20 years (54%). Six aspects were used to evaluate practices or involvements in HIV prevention or care: Most of the responding doctors had offered advice (61%) and/or HIV test (76%) to patients with high-risk behaviors. However, fewer doctors had diagnosed HIV (27%), provided care for HIV positive patients (21%), reported HIV cases (19%) or prescribed antiretrovirals (4%). Nine (4.5%) did not answer all six questions on their practices or involvements in HIV prevention or care. The remaining respondents were then categorized into no/low involvement group and high involvement group. Overall,71% had no/low involvement (133/188) compared to 29% who had high involvement (55/188). Factors associated with high involvement included being in the 50–59 age group (OR: 2.48, 95% CI: 1.12–5.5), and belonging to a large practice (OR: 3.16, 95% CI: 1.4–7.12). Conclusions Overall, most private primary care doctors in Hong Kong have no or low involvement in HIV prevention and care. However, most were willing and experienced in providing general preventive services, such as HIV testing and advice.

Background Point-of-care early infant diagnosis (POC EID) increases access to HIV test results and shortens time to result-return and antiretroviral therapy initiation, as compared to central laboratory-based EID. However, to scale-up POC EID, governments need more information about programmatic costs. Methods We evaluated POC EID costs from a health systems perspective. Our primary analysis assessed the Abbott m-PIMA and 2 versions of the Cepheid GeneXpert IV platforms-with a solar battery or gel battery-used in Zimbabwe, with instrument purchase. We also included the following 2 scenarios with zero upfront equipment purchase: (1) m-PIMA using a reagent rental model, with an all-inclusive price when the buyer commits to an average testing volume, and (2) GeneXpert IV, reflecting contexts where GeneXpert is already in place for tuberculosis diagnosis or HIV viral load monitoring. We collected data from project expenditures, observations of health workers, and from government salary scales. We calculated cost per EID test based on number of EID tests performed on each machine per day. Results The cost per successfully completed test was $44.55 for m-PIMA with platform purchase and $25.89 for m-PIMA reagent rental. Costs for GeneXpert IV with platform purchase were $25.70 using a solar battery, $25.29 using a gel battery, and $23.85 under a scenario assuming no equipment costs. In our primary analyses, materials costs comprised 73%-74% total costs, equipment 14%-20%, labor 5%-8%, training 1%, facility upgrades 1%, and monitoring 1%. Conclusions As countries consider scaling up POC EID, these data are important for budgeting and planning.

Currently, most HIV tests are performed with blood samples, or alternatively saliva samples are used for HIV testing. Simple HIV tests need to be performed in hospitals or other medical agencies instead of more invasive HIV blood tests. To enable point-of-care (POC) HIV diagnostics, based on a recently developed lateral flow strip for HIV urine testing, a microfluidic immunoassay cassette with a handheld optical reader is developed. Based on lateral flow strip with gold colloid reporter, the integrated immunoassay cassette can perform sample introduction, metering, discharging, applying and detection which simplifies HIV testing. An indicator is incorporated into the cassette to guide sample introduction based on color change, and further, the excess test sample is stored inside the sealed cassette to avoid any contamination. The low-cost handheld optical reader can provide a test result within a few seconds, which is useful for simple, sensitive and affordable HIV onsite detection. Instead of using normal white LEDs, a customized back light module embedded with green LEDs is adopted to illuminate the lateral flow strip with an appropriate working current to achieve optimal performance. Compared to the standard lateral flow strips using a benchtop reader, with the disposable immunoassay cassette assisted by the handheld optical reader, more convenient, easier-to-operate, and more affordable HIV urine testing can be achieved in POC diagnostics.

Background Geenius HIV 1/2 Supplemental Assay (Geenius; Bio-Rad Laboratories) is the only Food and Drug Administration-approved HIV-1/HIV-2 antibody differentiation test for the second step in the HIV laboratory testing algorithm. We characterized the occurrence of true HIV-1 and HIV-2 infections as well as false results in 6 US clinical laboratories using Geenius. Methods We examined routine HIV testing outcome data from the time the laboratories began using the algorithm with Geenius until September 30, 2017. We calculated the positive predictive value for Geenius HIV-1 and HIV-2 reactivity separately. Results Of 5,046,684 specimens tested, 41,791 had reactive antigen/antibody test results. Most specimens with reactive antigen/antibody results were HIV-1 antibody-positive established infections (n = 32,421), 1,865 of which also had indeterminate HIV-2 bands present. Ninety-three specimens were HIV-2 antibody positive or untypable for HIV-1/HIV-2 antibody. Acute HIV-1 infections were found in 528 specimens; 881 specimens lacked the nucleic acid test to determine the possibility of acute HIV-1 infection. False-positive antigen/antibody test results were present in 7505 specimens. Few specimens (n = 363) had false-positive antigen/antibody results with indeterminate Geenius and negative HIV-1 nucleic acid test results. The positive predictive values of Geenius reactivity were 99.4% for HIV-1 and 4.3% for HIV-2. Conclusions Routine testing using the laboratory testing algorithm with Geenius resulted in most specimens resolving as HIV negative or HIV-1 positive. The occurrence of indeterminate HIV-2 bands with a Geenius final assay interpretation of HIV-1 positive was more common than true HIV-2 infections. Reporting indeterminate HIV-2 results in this situation may cause confusion with interpreting HIV infection status.

Uptake of HIV testing remains lower among children and adolescents compared to adults. This study explored adolescents' perceptions of HIV self-testing (HIVST) and caregivers' perceptions of testing their children using an oral mucosal transudate (OMT) rapid HIV test (caregiver-provided testing). We conducted 31 interviews with adolescents aged 16-18 years and caregivers of children aged 2-15 years who received an OMT test. Participants described barriers to HIV testing including lack of privacy and the potential for discrimination by community members towards children and adolescents who received an HIV test. Most participants felt caregiver-provided testing and HIVST could address these barriers through increased privacy. Some participants expressed worry about their ability to correctly perform the OMT and their anxious reactions to a positive result. Counseling and assistance from health care workers were viewed as ways to alleviate concerns. Concerns shaped participants' preferences for facility-based HIVST and caregiver-provided testing. Findings demonstrate HIVST performed by adolescents and caregiver-provided testing could increase the uptake of HIV testing. Concerns related to being able to test correctly and the availability of post-test counseling must be addressed in any future delivery mechanisms.

The American Men’s Internet Survey (AMIS) is an annual Web-based behavioral survey of men who have sex with men (MSM) who live in the United States. This Rapid Surveillance Report describes the fifth cycle of data collection (July 2017 to November 2017: AMIS 2017). The key indicators are the same as those previously reported for past AMIS cycles (December 2013 to May 2014: AMIS 2013; November 2014 to April 2015: AMIS 2014; September 2015 to April 2016: AMIS 2015; and September 2016 to February 2017: AMIS 2016). The AMIS methodology has not substantively changed since AMIS 2016. The MSM were recruited from a variety of websites using banner advertisements and email blasts. Additionally, participants from AMIS 2016 who agreed to be recontacted for future research were emailed a link to AMIS 2017. Men were eligible to participate if they were aged ≥15 years, resided in the United States, provided a valid US zone improvement plan code, and reported ever having sex with a man or identified as gay or bisexual. The analysis was limited to those who reported having oral or anal sex with a male partner in the past 12 months. We examined demographic and recruitment characteristics using multivariable regression modeling (P

The uptake of HIV testing has always been found to be lower among men compared with women in many developing countries. The aim of this study was to ascertain the level and determinants of HIV testing uptake among men aged 15 to 59 in Ghana. This article was based on data from the 2003, 2008 and 2014 Ghana Demographic and Health Surveys. A bivariate statistical method was used to calculate the levels of uptake while three logit models were fitted to estimate the determinants of HIV uptake among the respondents. The total levels of the uptake of HIV testing among the respondents were 9.1%, 14.7% and 22.7% for 2003, 2008 and 2014, respectively; 15% overall. These were significantly determined by age, educational attainment, religious affiliation, wealth and work status, region of residence and media exposure. HIV testing uptake is very low among men in Ghana, albeit it has seen consistent improvements over the past years. Specially tailored HIV education and prevention programmes should be targeted at men in areas of low uptake, based on their different characteristics, in order to increase uptake.

Objectives: To assess the validity of self-reported HIV status, and investigate factors that influence accurate reporting of HIV-positive status, in a population tested and informed of their HIV test result. Design: Prospective cohort study. Methods: We compared self-reported HIV status with biomarker-confirmed HIV test status among participants of Karonga Health and Demographic Surveillance Site in rural northern Malawi. We linked information on HIV test results to subsequent self-reported HIV status, and calculated sensitivity, specificity, positive predictive value and negative predictive value for self-reported HIV status (considered as a diagnostic test). We used Poisson regression with robust variance estimators to examine predictors of accurate self-reporting of HIV-positive status. Results: Among 17 445 adults who tested for HIV, were recorded as having received their HIV test results, and had a subsequent self-reported HIV status between 2007 and 2018: positive predictive value of self-reported HIV status was 98.0% (95% confidence interval: 97.3–98.7); negative predictive value was 98.3 (98.1–98.5); sensitivity was 86.1% (84.5–87.7); and specificity was 99.8% (99.7–99.9). Among true HIV-positive people, those who were younger, interviewed in community settings, and had tested for HIV longer ago were more likely to misreport their HIV-positive status. Conclusion: In this setting, self-report provides good estimates of test-detected HIV prevalence, suggesting that it can be used when HIV test results are not available. Despite frequent HIV testing, younger people and those interviewed in community settings were less likely to accurately report their HIV-positive status. More research on barriers to self-reporting of HIV status is needed in these subgroups.

Background The United Kingdom National Guidelines for Human Immunodeficiency Virus (HIV) Testing 2008 suggest that an HIV test should be considered in all general medical admissions, when diagnosed HIV prevalence exceeds 2 in 1000 in the local population. We evaluated physician-initiated HIV testing rates in the Acute Assessment Unit of an East London hospital. Methods All acute presentations over one month were reviewed retrospectively, using electronic records. Patients with confirmed HIV were identified and the requested diagnostic HIV tests were measured. The number of patients with clinical indicator conditions for adult HIV infection, as defined in the United Kingdom National Guidelines for HIV Testing 2008, who did not receive appropriate testing, was calculated. Results In the cohort of 1023 patients, two patients had known HIV. 58 diagnostic HIV tests were performed, including 40 tests in patients with no clinical indicator diseases. There were five admissions with ‘AIDS-defining conditions’, all of which were pulmonary tuberculosis and four out of five (80.0%) were tested. There were 118 admissions with ‘conditions where HIV testing should be offered’, 14 of which (11.9%) were tested. All HIV tests were negative. Conclusion Physician-initiated HIV testing was inadequate for such a high prevalence area, even in clinical indicator diseases. Physician-initiated HIV testing should be replaced with routine opt-out HIV testing in acute medical admissions units in areas of high HIV prevalence, as suggested by BHIVA (British HIV Association) guidelines, as we progress towards ending the HIV epidemic in the United Kingdom.

Background: In Tanzania, HIV testing data are reported aggregately for national surveillance, making it difficult to accurately measure the extent to which newly diagnosed persons are entering care, which is a critical step of the HIV care cascade. We assess, at the individual level, linkage of newly diagnosed persons to HIV care. Methods: An expanded two-part referral form was developed to include additional variables and unique identifiers. The expanded form contained a corresponding number for matching the two-parts between testing and care. Data were prospectively collected at 16 health facilities in the Magu District of Tanzania. Results: The records of 1,275 unique people testing HIV positive were identified and included in our analysis. Of these, 1,200 (94.1%) responded on previous testing history, with 184 (15.3%) testing twice or more during the pilot, or having had a previous HIV positive test. Three-quarters (932; 73.1%) of persons were linked to care during the pilot timeframe. Health service provision in the facility carrying out the HIV test was the most important factor for linkage to care; poor linkage occurred in facilities where HIV care was not immediately available. Conclusions: It is critical for persons newly diagnosed with HIV to be linked to care in a timely manner to maximize treatment effectiveness. Our findings show it is feasible to measure linkage to care using routinely collected data arising from an amended national HIV referral form. Our results illustrate the importance of utilizing individual-level data for measuring linkage to care, as repeat testing is common.

Despite recent progress in enhancing the accessibility of HIV-related health services worldwide, opportunities to diagnose patients are often missed due to genuine barriers at different levels. The aim of the study is to explore the factors that affect the HIV testing uptake by young people in Saudi Arabia. For the quantitative strand of the study a newly developed self-completed online questionnaire was used and the study sample was drawn using a convenience sampling technique. Then, a semi-structured interviews were used to gather the perspective of healthcare professionals working in the field of HIV/AIDS in the country. 394 participants completed the questionnaires: 30% male and 70% female. Only 20 participants had previously been tested for HIV. On HIV/AIDS-related knowledge scale, the male participants scored higher than the females (6.4 V 5.7). For the risk perception scale, female participants appeared to have lower levels of risk perception than male participants (10.5 V 11.7). The female participants showed slightly more positive attitudes towards HIV testing than male participants (111.32 V 108.14). On the other hand, healthcare professionals indicated; stigma, HIV/AIDS knowledge gap and fear of positive result consequences as the main factors hindering the HIV test uptake. Knowledge, attitudes and HIV risk perception are critical factors that inform the decision to undertake HIV testing however, socio-cultural constraints are significant additional burden that hinder the efforts to scale up the HIV testing uptake in Saudi Arabia. Key words: HIV testing, young people, attitude, knowledge, perception.

Zusammenfassung Ziel In Deutschland liegen die jährlichen HIV-Neu-Infektionen bei 3100 (2016) und betreffen v. a. Männer, die Sex mit Männern haben sowie intravenös Drogengebrauchende. Es wird eine Rate von 30 % der HIV-Infektionen angenommen, die erst in einer fortgeschrittenen Phase der Infektion diagnostiziert werden, oft jenseits des optimalen Zeitpunkts des Behandlungsbeginns. Die hohe Rate an Late-Presentern ist ein starkes Argument für eine Stärkung von Beratungs- und HIV-Testangeboten. Ziel dieser Literaturanalyse ist es daher zu beschreiben, welche Zugangsschwellen zu HIV-Testangeboten existieren. Methodik Mit einer Literaturanalyse wurde der aktuelle Erkenntnisstand in Forschung und Praxis darauf hin abgebildet, welche Barrieren Risikogruppen vom HIV-Test abhalten. In die Suche wurden alle Veröffentlichungen zwischen 2010 und 2014 aus Australien, Europa und Nordamerika einbezogen, die sich auf Klienten-initiierte Tests beziehen. Ergebnisse 132 Veröffentlichungen wurden in eine Volltextanalyse einbezogen. Die meisten Veröffentlichungen basieren auf Klientenbefragungen. Die individuelle Risikowahrnehmung beeinflusst die Entscheidung für oder gegen einen HIV-Test maßgeblich. Diese kann über Öffentlichkeitsarbeit und über aufsuchende Angebote beeinflusst werden. In den Strukturen und Abläufen des HIV-Test-Angebotes sind Vertraulichkeit und Anonymität an jeder Stelle zentral. Darüber hinaus ist den Klienten wichtig, dass ihnen in den Beratungsgesprächen mit Akzeptanz und Vorurteilsfreiheit begegnet wird. Die Angst der Klienten vor Stigmatisierung, Verurteilung und Ausgrenzung verlangt eine besondere Sensibilität und lebensstilakzeptierende Haltung auf Seiten des Personals. Schlussfolgerung Die Faktoren, die für Klienten bei der Entscheidung über einen HIV-Test und der Auswahl eines Test-Angebots von Bedeutung sind, werden klar abgebildet. Die zentralen Elemente in der Entscheidungsfindung sind die eigene Risikowahrnehmung sowie die Furcht vor Stigmatisierung aufgrund vermeintlich abweichenden Sexualverhaltens oder aufgrund einer befürchteten HIV-Infektion. Die Öffentlichkeitsarbeit sollte Risikofaktoren bzw. -wahrnehmung in Bezug auf HIV sowie Vertraulichkeit und Anonymität des Angebots betonen. Die Nutzung sozialer Netzwerke ist hierbei besonders empfehlenswert. Neue Angebotsformen wie Heimtests könnten die Sorgen hinsichtlich Vertraulichkeit und Anonymität auflösen.

Purpose There is a need to increase access to HIV testing in the UK in male migrant communities. The purpose of this paper is to assess the uptake and acceptability of a workplace HIV testing intervention aimed at increasing access to testing in non-clinical settings. Design/methodology/approach A total of 20 health check events were delivered at 11 UK organisations employing male migrant workers. Intervention included HIV testing, cholesterol, BMI, blood glucose, blood pressure; tailored health advice; take-away resources; optional post-event text reminders about HIV and general health. Mixed-methods evaluation included exit questionnaires (n=771), follow-up text messages (n=465) and qualitative interviews (n=35) to assess event acceptability. Qualitative data were analysed thematically. Findings Attendees were 776 employees from 50 countries (51 per cent male; 30 per cent migrant workers). A total of 52 per cent of attendees undertook an HIV test (75 per cent were first-time testers). In total, 96 per cent considered HIV testing to be an acceptable element of workplace health checks; 79 per cent reported new health-related knowledge; 60 per cent of attendees opted for follow-up text messaging; 26 per cent of text respondents reported independently taking HIV test post-event. High acceptability and uptake of HIV testing was associated with convenience, opportunity taking (through removal of deliberation and intentional test-seeking), and normalisation of HIV testing within a general health check. Originality/value This study is the first to demonstrate that opt-in HIV testing can be successfully delivered in the workplace within a multi-component health check. The workplace is an effective means of increasing access to HIV testing in groups at risk for HIV, including male migrant workers.

Background HIV screening (i.e. antigen/antibody) tests are followed by a supplemental (i.e. antibody-only) if the screen is positive. Discrepant results can result from two scenarios: a false-positive screening test or acute HIV infection. These scenarios can be distinguished by a molecular HIV test, but due to contamination concerns, our laboratory recently implemented a policy requiring a second specimen dedicated for molecular HIV testing. Our objective was to (1) characterize the effect of this policy on the time-to-diagnosis for patients with discrepant screening and supplemental test results, and (2) explore "strength of positivity" as an interim predictor of screening test accuracy while awaiting confirmatory test results. Methods Data from our laboratory information system, electronic health record, and instrument logs were used to collate data for all HIV testing performed at Barnes-Jewish Hospital (BJH) between January 1, 2014 and October 18, 2017. Results Requiring a dedicated specimen for molecular testing significantly increased the time-to-diagnosis for patients with discrepant screening and supplemental HIV tests (p = 0.0084). This policy also contributed to loss-to-followup, with 0/35 discrepant cases lost-to-followup prior to policy implementation compared to 2/10 after implementation. However, by optimizing the signal-to-cutoff (S/CO) ratio of the screening test, we were able to more accurately distinguish false-positives from acute-HIV prior to molecular testing (sensitivity of 100%, specificity of 89%). Conclusions We propose utilizing quantitative fourth-generation assay results (S/CO) ratios as a predictor of infection true positivity in situations where the screening assay is reactive but the supplemental test is negative and confirmatory molecular results are not immediately available.

Rapid HIV testing programs in emergency departments (EDs) have been shown to promote early diagnosis and linkage to specialty care. However, sensitivity of the subject-matter and stigmatization of disclosing associated risk factors may make patients reluctant to consent to testing in this setting. This study sought to determine whether men are more likely to refuse rapid HIV testing in the ED as compared to women and to analyze the influence of tester gender on the response. This retroactive study utilized demographic and testing information from a rapid HIV testing program housed within two urban EDs for a 5-month period. Gender and age were collected for both testers and patients, along with patient consent outcome. A total of 5358 patients (males = 2230; females = 3128) were approached and offered an HIV test by one of 19 testers during the study period. From the sample population, male and female patient refusal rates were similar (30.0% vs 29.1%, respectively). Female testers approached 57.8% (n = 3,095) of the patients; however, they had a significantly higher refusal rate compared to male testers (35.6% vs 21.4%; p

* Abbreviations: AAP — : American Academy of Pediatrics AMSM — : adolescent men who have sex with men PrEP — : preexposure prophylaxis SRH — : sexual and reproductive health In “Factors Associated with HIV Testing in Teenage Men Who Have Sex with Men,” Mustanski et al1 explore individual, family, school, and health care factors associated with lifetime receipt of an HIV test in a sample of adolescent men who have sex with men (AMSM) ( n = 699) between ages 13 to 18. The authors report low testing rates (23.3%) in this sample but found the following factors to be significant predictors of HIV testing: older age; sexual experience; HIV-related information, motivation, and behavioral skills; and discussions with a doctor about sexual orientation or male partners. Mustanski et al1 conclude with important recommendations for pediatricians to improve physician–patient communication about sex and sexuality with adolescent patients. The individual and practice-level changes suggested by Mustanski et al1 are important for pediatric providers and consistent with American Academy of Pediatrics (AAP) recommendations.2,3 There are numerous AAP policy statements and clinical reports emphasizing importance of sexual and reproductive health (SRH) services for adolescents as well as specific guidelines for the care of sexual and gender minority youth issued by the AAP2,4 and Society for Adolescent Health and Medicine, … Address correspondence to Errol L. Fields, MD, PhD, MPH, Department of Pediatrics, Johns Hopkins School of Medicine, 200 N Wolfe St #2027, Baltimore, MD 21287. E-mail: errol.fields{at}jhmi.edu

Background Door-to-door distribution of HIV self-testing kits (HIVST) has the potential to increase uptake of HIV testing services (HTS). However, very few studies have explored the social response to and implications of door-to-door including secondary distribution of HIVST on household relations and the ability of individuals to self-test with or without supervision within households. Methods A CRT of HIVST distribution was nested within the HPTN 071 (PopART) trial, in four Zambian communities randomised to receive the PopART intervention. The nested HIVST trial aimed to increase knowledge of HIV status at population level. Between February 1 and April 30, 2017, 66 zones (clusters) within these four communities were randomly allocated to either the PopART standard of care door-to-door HTS (33 clusters) or PopART standard of care door-to-door HTS plus oral HIVST (33 clusters). In clusters randomised to HIVST, trained Community HIV care provider (CHiPs) visited households and offered individuals aged ≥ 16 and eligible for an offer of HTS the choice of HIV testing using HIVST or routine door-to-door HTS (finger-prick RDT). To document participants’ experiences with HIVST, Interviews (n = 40), observations (n = 22) and group discussions (n = 91) with household members and CHiPs were conducted. Data were coded using Atlas.ti 7 and analysed thematically. Results The usage and storage of HIVST kits was facilitated by familiarity with and trust in CHiPs, the novelty of HIVST, and demonstrations and supervision provided by CHiPs. Door-to-door distribution of HIVST kits was appreciated for being novel, convenient, private, empowering, autonomous and easy-to-use. Literacy and age influenced accurate usage of HIVST kits. The novelty of using oral fluids to test for HIV raised questions, some anxiety and doubts about the accuracy of HIVST. Although HIVST protected participants from experiencing clinic-based stigma, it did not address self-stigma. Within households, HIVST usually strengthened relationships but, amongst couples, there were a few reports of social harms. Conclusion Door-to-door distribution of HIVST as a choice for how to HIV test is appreciated at community level and provides an important testing option in the sub-Saharan context. However, it should be accompanied by counselling to manage social harms and by supporting those testing HIV-positive to link to care.