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Architect-HIV Ag/Ab combo chemiluminescence assay is globally recognized for its sensitivity but has a notable false-positive rate. In this study, we aim to evaluate the performance of a new cost-effective screening alternative, the chemiluminescence Ag/Ab combo assay (CL-900i-HIV) from Mindray, China. We selected 195 archived samples categorized according to the INNO-LIA™ HIV I/II, the gold standard confirmatory assay. These samples included true positive (n = 38; positive by Architect-HIV & INNO-LIA-HIV), true negative (n = 101; negative by Architect-HIV & INNO-LIA-HIV), false positive (n = 20; positive by Architect-HIV & negative by INNO-LIA-HIV), and indeterminate results (n = 26). We tested all samples using the Mindray CL-900i-HIV and all positive Architect-HIV samples (n = 80) were confirmed by PCR. Compared to INNO-LIA™ HIVI/II line immunoassay confirmatory assay, Mindray CL-900i-HIV demonstrated a sensitivity of 100% (95% CI 90.7-100), specificity of 100% (95% CI 97.0-100), overall percent agreement (OPA) of 100% (95% CI 97.7-100.0), and perfect agreement with the INNO-LIA confirmatory assay (κ = 1.00). Additionally, Mindray's CL-900i-HIV exhibited a significantly lower false-positive rate (8.75%) compared to Architect-HIV's (55%). Mindray CL900i demonstrated high sensitivity and very low false-positive rate, thus, has the potential to serve as an excellent, cost-effective surrogate for HIV screening, overcoming the limitations of existing automated assays., Competing Interests: Declarations Competing interests All kits of the Mindray CL-900i-HIV Ag/Ab combo assay used in this study were received from Mindray as in-kind support to Dr. Gheyath. However, it is important to note that Mindray had no influence or involvement in the study design, data collection, analysis, interpretation, or the decision to publish the results., (© 2024. The Author(s).)

Background: Men who have sex with men (MSM) are increasingly using the internet to meet casual sexual partners. Those who do are at higher risk of sexually transmitted diseases. However, little is known about the rates and associations of frequent HIV testing and self-testing among such MSM., Objective: We aimed to examine HIV serostatus communication and perceptions regarding the HIV infection risk of internet-based partners, along with their associations with frequent HIV testing and self-testing., Methods: A cross-sectional study was conducted between May 2018 and April 2019 in Zhejiang Province, China. The study participants were assigned male at birth, were aged 18 years or older, had had casual sex with another male found through the internet in the last 6 months, and were HIV-negative. Information was obtained on HIV-testing behavior, along with demographic characteristics, HIV-related knowledge, internet-based behaviors, sexual behaviors with male partners, HIV serostatus communication, and perceptions regarding the HIV infection risk of internet-based partners. Uni- and multivariate logistic regression models were used to measure the associations of HIV testing and self-testing., Results: The study recruited 281 individuals who had sought casual sexual partners through the internet during the previous 6 months. Of the participants, 61.9% (174/281) reported frequent HIV testing (twice or more frequently) and 50.9% (119/234; 47 with missing values) reported frequent HIV self-testing. MSM who always or usually communicated about the HIV serostatus of internet-based partners in the previous 6 months had 3.12 (95% CI 1.76-5.52) and 2.45 (95% CI 1.42-4.22) times higher odds of being frequently tested or self-tested for HIV, respectively, compared with those who communicated about this issue minimally or not at all., Conclusions: There remains a need to improve the frequency of HIV testing and self-testing among internet-based MSM. HIV serostatus communication should be improved within the context of social networking applications to promote frequent HIV testing among internet-based MSM, especially for those who communicated about this issue minimally or not at all., (©Wanjun Chen, Lin Chen, Zhikan Ni, Lin He, Xiaohong Pan. Originally published in JMIR Formative Research (https://formative.jmir.org), 14.11.2024.)

Background: Whether, and how, co-occurring HIV-1 infection (HIV) and tuberculosis (TB) impact cardiovascular status, especially in adolescents with perinatally acquired HIV (APHIV), have not been examined. We hypothesised that APHIV with previous TB disease have worse cardiac efficiency than APHIV without TB, which is mediated by increased inflammation and disordered cardiometabolism., Methods: APHIV in Cape Town, South Africa, completed 3T cardiovascular magnetic resonance examination and high sensitivity C reactive protein (hsCRP), fasting plasma glucose (FPG), low-density lipoprotein (LDL) and triglyceride measurement. Ventriculoarterial coupling (VAC) was estimated as the ratio of arterial elastance (Ea) to ventricular end-systolic elastance (Ees). Regression models were applied to estimate cross-sectional associations between Ea/Ees ratio and TB status, with decomposition of these associations into direct and mediated effects of hsCRP, FPG and dyslipidaemia, if any, attempted., Results: We enrolled 43 APHIV with prior TB and 23 without TB of mean (SD) age 15.0 (1.5) and 15.4 (1.7) years, respectively. Prior TB was associated with lower Ea/Ees ratio (0.59 (0.56 to 0.64)) than no TB (0.66 (0.62 to 0.70)), which corresponded to an adjusted mean difference -0.06 (-0.12 to 0.01) (p=0.048). However, previous TB was not associated with increased hsCRP, FPG, LDL or triglycerides nor were hsCRP, FPG, LDL and triglycerides associated with Ea/Ees ruling out their mediated effects in the association between TB and cardiac efficiency., Conclusions: Previous TB in APHIV is associated with comparatively reduced cardiac efficiency, related to altered VAC. The clinical significance of these findings requires further study, including a wider range of biomarkers of specific immune pathways., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Oral HIV self-testing (HIVST) among men is relatively low and still inadequate in Sub-Saharan Africa. Delivering HIVST kits by pregnant women attending antenatal care to their partners is a promising strategy for increasing HIV testing among men. However, even amidst the HIV testing interventions, most men do not know their HIV status. This study, aimed to determine the proportion of partners who received and used oral HIVST kits delivered by pregnant women, associated factors, barriers, and facilitators for uptake., Methods: We conducted an exploratory sequential mixed methods study among 380 sampled partners. Lists of partners from HIVST logbooks whose women picked an HIVST kit were obtained and systematic sampling was done to recruit participants. Fourteen (14) male partners were purposively selected for in-depth interviews to identify barriers and facilitators. We used modified poison regression to determine factors associated with oral HIVST. We used an inductive thematic analysis for qualitative analysis., Results: Out of 380 participants, 260(68.4%) received an oral HIVST kit from their pregnant women, and 215(82.7%) used it for HIVST. Oral HIVST was associated with; Information Education and Communication like availability of HIVST guiding materials (aPR = 1.64, 95%CI: 1.48-1.82), being reached at home (aPR = 1.04, 95%CI 1.01-1.08), and being aware of the woman's HIV status (aPR = 1.04, 95%CI 0.99-1.09). In-depth results identified barriers to uptake as, lack of trust in the HIVST kit results, fear of test outcome in the presence of their partner and inclination that the HIV status of their women is the same as theirs; Facilitators included convenience, ease of use, prior awareness of their HIV status, and fear of relationship consequences and breakup., Conclusion: Delivery of oral HIVST kits to men through pregnant women reached a high number of men and achieved high uptake. Accessing information, education, communication and the kit's convenience were major reasons for uptake among men who received the kit as; trust issues affected its use among partners. Scaling up the delivery of oral HIVST kits at all departments of hospitals through women seeking health services is paramount to support HIV screening among men to reach the UNAIDS 95 strategy., Competing Interests: Declarations Human ethics and consent to participate Informed consent for all participants was obtained before being interviewed. Information about the study procedures, benefits and risks were explained to them. There was no anticipated harm to the participants during this study except for their time during data collection. The study protocol was approved by Makerere University School of Public Health (MakSPH-REC 063). Permission was sought from the District Health Officer of Wakiso District to conduct the study within the district. All principles of research involving human subjects outlined in the Declaration of Helsinki were adhered to. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Human immunodeficiency virus (HIV) infection screening and diagnosis are critical to control the HIV epidemic. Testing for anti-HIV antibodies (Ab) and antigens (Ag) in blood samples is the first step to screen people who have been potentially exposed to the virus. This study aimed to evaluate the performance of the MAGLUMI HIV Ab/Ag Combi for detection of HIV antibodies and antigens., Methods: We used residual samples to assess the diagnostic specificity and sensitivity of the MAGLUMI HIV Ab/Ag Combi retrospectively. All samples that met the test criteria were tested with the MAGLUMI HIV Ab/Ag Combi according to manufacturer's instruction. Results of the MAGLUMI HIV Ab/Ag Combi were compared with the Architect HIV Ag/Ab Combo test., Results: The specificity of the MAGLUMI HIV Ab/Ag Combi was 99.85% in 5,057 unselected blood donors and 100.00% in 213 hospitalized patient samples, respectively. The sensitivity of the Test in 614 HIV-1 Ab, HIV-1 Ag or HIV-2 Ab positive samples was 100.00%. Seroconversion sensitivity from results of 30 panels was comparable between the MAGLUMI HIV Ab/Ag Combi and the Architect assay., Conclusions: The reactivity of the MAGLUMI HIV Ab/Ag Combi test is comparable to the Architect HIV Ag/Ab Combo assay., Competing Interests: Declarations Ethics approval and consent to participate The clinical performance study was conducted by a third-party organization (laboratories of Biomex GmbH, Heidelberg, Germany) and carried out in accordance with the ethical principles laid down in the Declaration of Helsinki. The samples used in this study were all residual samples with a general authorization for ethical approval and subjects signed broad informed consent. Consent for publication All authors give consent for the publication of the data in this study. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Pre-exposure prophylaxis (PrEP) is a highly effective, safe and acceptable intervention for preventing HIV infection. However, identifying individuals who could best benefit from PrEP remains a significant challenge. Existing HIV risk assessment tools vary in performance depending on context. This systematic review aims to synthesise evidence on their diagnostic performances to predict incident HIV infection., Methods and Analysis: This protocol is informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Protocols. We will search MEDLINE (Ovid), Embase (Ovid) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases (January 1998-May 2024) for observational and relevant interventional studies assessing the diagnostic performance of HIV risk tools to predict incident HIV for PrEP eligibility. There will be no restrictions on study language or location. Two reviewers will conduct the search, data extraction and risk of bias assessment using the Johanna Briggs Institute Critical Appraisal Checklist for Diagnostic Studies. Standardised templates will be used in Covidence for data extraction. We will conduct a meta-analysis if appropriate, otherwise, a narrative review. We will use the PRISMA guidelines to guide reporting., Ethics and Dissemination of Research: Ethical approval is not required as data is publicly available. This review will inform updates to Canadian HIV PrEP guidelines and guide healthcare professionals in using HIV risk assessment tools for identifying PrEP candidates. Findings will be presented at guideline panel meetings and submitted for publication in a peer-reviewed journal and conferences., Prospero Registration Number: CRD42024543975., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Current programs to engage marginalized populations such as gay and bisexual individuals and other men who have sex with men (MSM) in HIV prevention interventions do not often reach all MSM who may benefit from them. To reduce the global burden of HIV, far-reaching strategies are needed to engage MSM in HIV prevention and treatment. Globally, including low- and middle-income countries, MSM are now widely using internet-based social and mobile technologies (SMTs; eg, dating apps, social media, and WhatsApp [Meta]), which provides an unprecedented opportunity to engage unreached and underserved groups, such as MSM for HIV prevention and care., Objective: This study aimed to assess the effectiveness of a multilevel mobile health (mHealth)-based intervention to improve HIV testing uptake and status neutral linkage-to-care among sexually active MSM reached through internet-based platforms in Mumbai, India., Methods: In this randomized controlled trial, we will determine whether CHALO! 2.0 (a theory-based multilevel intervention delivered in part through WhatsApp) results in increased HIV testing and linkage-to-care (prevention or treatment). This study is being conducted among 1000 sexually active MSM who are unaware of their HIV status (never tested or tested >6 months ago) and are recruited through SMTs in Mumbai, India. We will conduct a 12-week, 3-arm randomized trial comparing CHALO! 2.0 to 2 control conditions-an attention-matched SMT-based control (also including a digital coupon for free HIV testing) and a digital coupon-only control. The primary outcomes will be HIV testing and status neutral linkage-to-care by 6 months post enrollment. Participants will be followed up for a total of 18 months to evaluate the long-term impact., Results: The study was funded in 2020, with recruitment having started in April 2022 due to delays from the COVID-19 pandemic. Baseline survey data collection began in April 2022, with follow-up surveys starting in July 2022. As of April 2022, we enrolled 1004 participants in the study. The completion of follow-up data collection is expected in January 2025, with results to be published thereafter., Conclusions: While global health agencies have called for internet-based interventions to engage populations vulnerable to HIV who are not being reached, few proven effective and scalable models exist and none is in India, which has one of the world's largest HIV epidemics. This study will address this gap by testing a multicomponent mHealth intervention to reach and engage MSM at high priority for HIV interventions and link them to HIV testing and prevention or treatment., Trial Registration: ClinicalTrials.gov NCT04814654; https://clinicaltrials.gov/study/NCT04814654. Clinical Trial Registry of India CTRI/2021/03/032280., International Registered Report Identifier (irrid): DERR1-10.2196/59873., (©Jatin Chaudary, Shruta Rawat, Alpana Dange, Sarit A Golub, Ryung S Kim, Venkatesan Chakrapani, Kenneth H Mayer, Julia Arnsten, Viraj V Patel. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 05.11.2024.)

Kaposi's sarcoma-associated herpesvirus (KSHV) is an oncogenic virus involved in several diseases. The gold standard for KSHV sero diagnosis remains the indirect immunofluorescence assay (IFA), which is time-consuming and operator-dependent. We compared this method with an enzyme-linked immunosorbent assay (ELISA) targeting solubilized KSHV whole-genome extract among positive ( n = 49, including 76% of HIV-infected patients) and negative ( n = 14) control groups. We also included 14 sera with equivocal IFA results. ELISA showed better performance in detecting KSHV antibodies (McNemar's test, P = 0.0455). The sensitivity and specificity of both methods were 79% (64-89) and 100% (66-100) for the IFA, respectively, and 94% (83-99) and 100% (66-100) for ELISA, respectively. All IFA equivocal results were either negative or positive with ELISA. ELISA is more reliable and could be a good alternative for determining KSHV serological status, particularly in the context of immunocompromised patients and equivocal serology with the IFA.IMPORTANCEKaposi's sarcoma-associated herpesvirus (KSHV) sero status remains challenging because no perfect reference is available for the detection of KSHV antibodies. The current gold-standard method, the indirect immunofluorescence assay (IFA), has a very good specificity of close to 100%, but a lower sensitivity of around 80-85%, which decreases to 64-67% in immunocompromised patients. Additionally, this method is time-consuming and operator-dependent compared with new serological assays such as the enzyme-linked immunosorbent assay (ELISA). Thus, further research is still needed to improve KSHV sero diagnosis. Here, we compare the KSHV IgG ELISA kit assay (Advanced Biotechnologies Inc) with the gold-standard IFA, targeting the LANA-1 protein from latent BC-3 cell lines., Competing Interests: The authors declare no conflict of interest.

In sub-Saharan Africa, young people are at high risk of HIV infection, representing nearly 4 out of 5 new infections. HIV self-testing (HIVST), a new and proactive testing scheme that involves self-collection of a specimen and interpretation of results, is deemed potentially helpful for increasing testing amongst population groups like young people who do not frequently use routine testing services. This study assessed young people's intention to use HIVST in urban areas of southern Ethiopia drawing on the Theory of Planned Behaviour. A community-based cross-sectional study was conducted with 634 participants aged 15-24 years from six town administrations of two zones in January to February 2023. The participation rate was 634/636 yielding 99.7%. The OraQuick HIVST kit was demonstrated to young people recruited in a door-to-door survey with a face-to-face interview using an electronic questionnaire in a mobile phone-based application. Intention to use HIVST was measured from a 6-point Likert scale with scores of agreements ranging from 1 to 6. Descriptive statistics and ordinal logistic regression analysis were done using STATA version 18. Most of the participants agreed that they would use HIVST if it was available (86.3% agreeing or strongly agreeing). Interestingly, young people who perceived themselves at some to high risk were 0.51 times less likely to be in the higher order of intention to use when HIVST is available to them than those who perceived themselves at no to low risk. Intention to use HIVST increased by a factor of 1.29, 1.84 and 2.35 for every one-unit increase on the mean favourable attitude, perceived behavioural control, and acceptability scores, respectively. The majority of young people intended to use HIVST. Young people's perceived behavioural control, and acceptability of HIVST affected their intention to use. Intention and subsequent use of HIVST can be enhanced through an understanding of the role of risk perception and positive attitude, confidence to perform and acceptance of the test. Implementation studies are required to examine the actual uptake of HIVST among young people., (© 2024. The Author(s).)

The risk of developing cervical cancer is not equal across populations-individual health history, economic, political, and societal factors influence cervical cancer risk. Certain health conditions, including human immunodeficiency virus (HIV) infection, immunosuppression, and history of high-grade cervical dysplasia, are associated with higher cervical cancer risk and warrant distinct screening, surveillance, and management guidelines. It is imperative for clinicians to recognize high-risk groups and apply appropriate corresponding guidelines. However, this can be difficult in practice, as recommendations regularly evolve. This review offers up-to-date guidance in a case-based format on cervical cancer screening, surveillance, and management for high-risk patients., (Copyright © 2024 The Cleveland Clinic Foundation. All Rights Reserved.)

As most HIV rapid tests (HRT) detect only HIV-1/2 antibodies, their performance during primary HIV infection is poor. Determine HIV Early detect (Abbott) (Determine) is the only HRT with an HIV-1 p24-antigen detection, but the impact of this addition in shortening the diagnostic window remains unclear. A total of 183 HIV-1 primary infection samples were tested using the HRTs Determine and ONE STEP anti-HIV (1&2) Test (InTec Products) (One-Step). The pre-seroconversion subgroup was defined as p24-antigen positivity without Western blot nor Liaison XL (fouth generation enzyme immunoassay with distinct signal for p24-antigen and HIV-1 antibody) HIV-1 antibodies. Global sensitivity (95% CI) was 95% (91-97) for Determine versus 80% (74%-85%) for One-Step (difference p = 1.38e-06). Pre-seroconversion subgroup sensitivity was lower, at 71.9 (54.6%-84.4%) for Determine and 9.7% (3.3%-24.9%) for One-Step. Among the 45 samples with an HIV-1 infection date, no HRT was reactive up to 2 weeks. Between 2 and 3 weeks, Determine sensitivity was 78% (45%-95%) versus 56% (27%-81%) for One-Step. From 3 weeks to 1 month Determine sensitivity was 90% (62%-98%) and One-Step 45% (21%-72%). The last negative sample occurred at 3 weeks for Determine versus 70-90 days for One-Step. HRT with p24-antigen detection significantly shortens the diagnostic window from approximatively 3 months to 1 month. HRTs should be used with caution in the first month after HIV infection., (© 2024 The Author(s). Journal of Medical Virology published by Wiley Periodicals LLC.)

The perinatal transmission of HIV is preventable through a regimen that includes testing of all pregnant individuals, antiretroviral treatment (ART) for the pregnant individual, prophylactic or preventative ART for the infant, and cesarean section delivery for mothers with HIV viremia at the time of delivery. Under this protocol, the United States has seen a significant decline in the perinatal transmission of HIV and achieved a perinatal HIV transmission rate of 0.9% in 2019. However, despite this progress nationally and after zero transmissions in 2021, Maryland recorded 6 cases of perinatal HIV diagnoses in 2022. Each of the 3 major referral centers for pediatric HIV patients in Maryland reported 2 new cases in 2022. A root cause analysis of the cases identified risk factors including delayed entry into perinatal and HIV care, premature birth, maternal adherence challenges in the setting of substance use and other adverse social determinants of health, and failure to diagnose maternal HIV infection in a timely way. All patients were successfully linked to care and initiated on ART. Multiple factors contributed to the 2022 increase in cases of perinatal HIV in Maryland. To achieve and then sustain the elimination of perinatal HIV transmission, the constancy of systems that eliminate barriers for all pregnant people to access testing, prevention, and treatment is critical., (Copyright © 2024 by the American Academy of Pediatrics.)

The Central African Republic (CAR) is characterized by widespread HIV epidemic with notable prevalence and genetic diversity. We herein analysed the genetic diversity of atypical non-M HIV-1 strains. In-house serotyping assays for variants of HIV-1 (M, N, O, P) and HIV-2 were used to test a biological collection of 6092 HIV-seropositive blood samples collected between 2003 and 2014 at the Institut Pasteur de Bangui. Samples indicative of recombinant M/O groups, HIV-2, or those that yield doubtful/negative results underwent further PCR tests and sequencing. We found six atypical HIV strains: specifically, three (0.05%) HIV-1 group O strains (subtype H) detected in samples from 2005, 2008 and 2009, alongside three (0.05%) HIV-2 strains (two group A and one group B) identified in samples from 2007 and 2009. HIV-1/O strains showed a genetic link to Cameroon and Gabon strains. This study highlights the dominance of HIV-1/M in the CAR's HIV epidemic over time and underscores the infrequent occurrence of HIV-1 group O and HIV-2 strains. These findings validate the efficacy of WHO-recommended HIV testing protocols and emphasize the need for adaptive surveillance and management strategies to confront the complexities introduced by the genetic diversity of HIV strains., (© 2024 Scandinavian Societies for Pathology, Medical Microbiology and Immunology.)

Objectives: The diagnostic gaps for childhood tuberculosis (TB) remain considerable in settings with high TB incidence and resource constraints. We established and evaluated the performance of a scoring system based on a combination of serological tests and T-cell cytokine release assays, chosen for their ability to detect immune responses indicative of TB, in a context of high prevalence of pediatric HIV infection., Methods: We enrolled 628 consecutive children aged ≤15 years, admitted for TB suspicion. Multiple cytokine levels in QuantiFERON Gold In-Tube supernatants and antigen 85B (Ag85B) antibodies were assessed in children who tested positive with either Xpert TB or mycobacterial culture. The results were compared with those of control children., Results: Among the biomarkers most strongly associated with TB, random forest classification analysis selected Ag85B antibodies, interleukin-2/interferon-γ ratio, and monokine induced by interferon-γ for the scoring system. The receiver operating characteristic curve derived from our scoring system showed an area under the curve of 0.95 (0.91-0.99), yielding 91% sensitivity and 88% specificity. The internal bootstrap validation gave the following 95% confidence intervals for the score performance: sensitivity 71%-97% and specificity 79%-99%., Conclusions: This study suggests that supplementing the QuantiFERON assay with a combination of serological and T-cell markers could enhance childhood TB screening regardless of HIV status and age. Further validation among the target population is necessary to confirm the performance of this scoring system., Competing Interests: Declarations of competing interest The authors have no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

HIV self-testing, which has been increasingly available since 2016, can substantially enhance the uptake of HIV testing, especially for key populations. Clinical trials have explored the application of self-testing in various HIV prevention strategies, including post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and voluntary medical male circumcision. Research indicates that self-testing can facilitate PrEP initiation and improve adherence and continuation. However, evidence on the effectiveness of linkage to PrEP post HIV self-testing is mixed, underscoring the need to further understand contextual factors and optimal implementation strategies. Studies on linking voluntary medical male circumcision post HIV self-testing show no statistically significant difference compared with standard voluntary medical male circumcision demand creation strategies. There is a shortage of trials examining the role of self-testing in PrEP reinitiation, PEP initiation, or PEP follow-up. Evidence for the use of HIV prevention models that support self-testing is accumulating, but there is a need for further research in different contexts and among different populations to assess its value when scaled up to contribute to reducing HIV infections globally., Competing Interests: Declaration of interests JJO is supported by an Australian National Health and Medical Research Council Emerging Leadership Investigator Grant (GNT1193955). YZ is supported by an Australian Government Research Training Program scholarship. All other authors declare no competing interests. WHO receives grants to support activities on HIV testing services, including HIV prevention and self-testing, from the US Agency for International Development, the Bill & Melinda Gates Foundation, and Unitaid. The views expressed in this Review are those of the authors and do not necessarily represent the official position of WHO., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Objective: HIV molecular epidemiology (HIV ME) is a tool that aims to improve HIV research, surveillance, and cluster detection and response. HIV ME is a core pillar of the U.S. initiative to End the HIV Epidemic but faces some challenges and criticisms from stakeholders. We sought to assess user experience to identify the current needs for HIV ME., Methods: Users of HIV ME, including researchers and public health practitioners, were engaged via a structured survey. Needs were assessed via open-ended questions about HIV ME. Data were analyzed using reflexive thematic analysis; the concordance of results was assessed semi-quantitatively., Results: Of 90 possible HIV-ME end-users, 57 completed the survey (response rate = 63%), which included users engaged in research ( n  = 29) and public health ( n  = 28). Respondents identified current imperatives, challenges, and strategies to improve HIV ME. Imperatives included characterization of the virus, identification of HIV hotspots, and tailoring of HIV interventions. Challenges encompassed technological issues, ethical concerns, and implementation difficulties. Strategies to improve HIV ME involved improving data access and analysis, enhancing implementation guidance and resources, and fostering community engagement and support. Researchers and public health practitioners prioritized different imperatives, but similarly emphasized the ethical concerns with HIV ME., Conclusion: The imperatives identified by users underscore the necessity of HIV ME, while the challenges highlight the hurdles to be overcome, including ethical concerns which emerged as a shared emphasis across user groups. The strategies outlined offer a roadmap for overcoming these challenges. These insights, drawn from user experience, present a valuable opportunity to inform the development of guidelines for the ethical application of HIV ME in research, surveillance, and cluster detection and response.

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., (© 2024. The Author(s).)

Black gay, bisexual, and other men who have sex with men (GBM) are disproportionately affected by HIV and STIs. Safe Spaces 4 Sexual Health (SS4SH), a community-informed, status-neutral HIV/STI testing intervention combines online outreach via geo-social networking apps and social media with mobile van testing. During 2018-2019, we recruited 25 participants for interviews about their perceptions of SS4SH compared to clinic-based testing. Participants were aged 21-65 years (mean 35); 22 (88%) identified as Black/African American; 20 (80%) identified as gay; and 10 (40%) were living with HIV. Interviews were transcribed, coded, and analyzed using a modified thematic constant comparative approach. Five themes emerged; two related to perceptions of online outreach materials (participants were drawn to eye-catching and to-the-point messages and desired more diversity and representation in messages), and three related to preference for the mobile van (participants found SS4SH provided more comfort, more privacy/confidentiality, and increased accessibility and efficiency). GBM is increasingly using geo-social networking apps to meet sexual partners, and tailored online outreach has the potential to reach historically underserved populations. SS4SH is a barrier-reducing strategy that may serve as an entry to a status-neutral approach to services and help reduce stigma and normalize accessing HIV services.

Purpose of Review: HIV-associated tuberculosis (TB) remains a major driver of morbidity and mortality in children and adolescents younger than 15 years (CLWH). The purpose of this review is to highlight recent findings in the areas of prevention, diagnosis, and treatment of HIV-associated TB in CLWH and to highlight knowledge and implementation gaps., Recent Findings: We found that despite access to antiretroviral therapy (ART), high rates of HIV-associated TB are still reported, and with an unacceptably high mortality. There are no advances in screening for TB, but shorter courses of rifapentine-based TB preventive therapy are becoming available. The use of algorithms in TB diagnosis can potentially simplify the therapeutic decision making. There are more data supporting the use of dolutegravir (DTG) with rifampicin and a need to study unadjusted DTG especially in the youngest children. Short course therapy for nonsevere pulmonary TB is currently implemented and programmatic outcome should be studied in CLWH. Low uptake of ART and poor suppression remains an important driver of HIV-associated TB., Summary: Although screening and diagnosis remains challenging, there are several advances in the prevention and treatment of HIV-associated TB. Effective implementation of these strategies is needed to advance the outcomes of CLWH., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

HCV RNA test determines current active infection and is a requirement prior to initiating HCV treatment. We investigated trends and factors associated with post-diagnosis HCV RNA testing rates prior to HCV treatment, and risk factors for first positive HCV RNA among people living with HIV (PLHIV) with HCV in the Asia-Pacific region. PLHIV with positive HCV antibody and in follow-up after 2010 were included. Patients were considered HCV-antibody positive if they ever tested positive for HCV antibody (HCVAb). Repeated measures Poisson regression model was used to analyse factors associated with post-diagnosis HCV RNA testing rates from positive HCVAb test. Factors associated with time to first positive HCV RNA from positive HCVAb test were analysed using Cox regression model. There were 767 HCVAb positive participants included (87% from LMICs) of whom 11% had HCV RNA tests. With 163 HCV RNA tests post positive HCVAb test, the overall testing rate was 5.05 per 100 person-years. Factors associated with increased testing rates included later calendar years of follow-up, HIV viral load ≥1000 copies/mL and higher income countries. Later calendar years of follow-up, ALT >5 times its upper limit of normal, and higher income countries were associated with shorter time to first positive HCV RNA test. Testing patterns indicated that uptake was predominantly in high income countries possibly due to different strategies used to determine testing in LMICs. Expanding access to HCV RNA, such as through lower-cost point of care assays, will be required to achieve elimination of HCV as a public health issue., (© 2024 John Wiley & Sons Ltd.)

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.

Objective: To ascertain whether a novel expanded social network recruitment to HIV testing (E-SNRHT) intervention recruits men and individuals with previously undiagnosed HIV at higher rates than risk network recruitment., Design: Initial "seed" participants were prospectively randomly assigned to the E-SNRHT intervention or to risk network recruitment. Their network members were included in the study arm of their recruiter., Setting: Three Department of Health clinics and two drug treatment centers (DTCs) in the Msunduzi municipality of KwaZulu-Natal, South Africa., Participants: Clinics and DTCs referred 110 newly HIV-diagnosed adult "seeds" to the study from June 2022 to February 2023. E-SNRHT seeds were asked to recruit network members as described below; risk network recruitment arm seeds were asked to recruit recent sex and/or injection partners. Presenting a recruitment coupon (from clinic/DTC staff or another participant) was required for eligibility., Intervention: E-SNRHT seeds were shown educational material about HIV transmission risks and then asked to recruit anyone they know (e.g., friends, family) whom they thought could benefit from HIV testing., Main Outcome Measures: Rates of recruiting men to HIV testing and locating individuals with previously undiagnosed HIV., Results: E-SNRHT recruited significantly higher proportions of men to HIV testing (70.3 vs. 40.4%; χ2  = 16.33; P  < 0.0005) and located significantly more previously undiagnosed cases of HIV per seed than risk network recruitment (rate ratio = 9.40; P  < 0.0001). E-SNRHT also recruited significantly higher proportions of women with previously undiagnosed HIV (29.0 vs. 10.7%; χ2  = 3.87; P  = 0.049)., Conclusion: E-SNRHT is an important strategy to expand the reach of HIV testing among men and undiagnosed cases of HIV in KwaZulu-Natal., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To describe other reasons for requesting HIV serology in emergency departments (ED) other than the 6 defined in the SEMES-GESIDA consensus document (DC-SEMES-GESIDA) and to analyze whether it would be efficient to include any of them in the future., Methods: Review of all HIV serologies performed during 2 years in 20 Catalan EDs. Serologies requested for reasons not defined by the DC-SEMES-GESIDA were grouped by common conditions, the prevalence (IC95%) of seropositivity for each condition was calculated, and those whose 95% confidence lower limit was >0.1% were considered efficient. Sensitivity analysis considered that serology would have been performed on 20% of cases attended and the remaining 80% would have been seronegative., Results: There were 8044 serologies performed for 248 conditions not recommended by DC-SEMES-GESIDA, in 17 there were seropositive, and in 12 the performance of HIV serology would be efficient. The highest prevalence of detection corresponded to patients from endemic countries (7.41%, 0.91-24.3), lymphopenia (4.76%, 0.12-23.8), plateletopenia (4.37%, 1.20-10.9), adenopathy (3.45%, 0.42-11.9), meningoencephalitis (3.12%, 0.38-10.8) and drug use (2.50%, 0.68-6.28). Sensitivity analysis confirmed efficiency in 6 of them: endemic country origin, plateletopenia, drug abuse, toxic syndrome, behavioral-confusional disorder-agitation and fever of unknown origin., Conclusion: The DC-SEMES-GESIDA targeted HIV screening strategy in the ED could efficiently include other circumstances not previously considered; the most cost-effective would be origin from an endemic country, plateletopenia, drug abuse, toxic syndrome, behavioral-confusional-agitation disorder and fever of unknown origin., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Abstract: Migrants have accounted for more than 40% of new HIV diagnoses in Europe in 2022. Among the population of asylum seekers currently present in the Trento Province, screening for HIV infection is poorly carried out for various reasons. Here we report our experience about screening for HIV infection in asylum seekers present in that area using rapid self HIV-testing.

Purpose of Review: This review examines the impact of HIV on kidney disease, which remains significant despite advances in antiretroviral therapy (ART). The review is timely due to the shifting epidemiology of kidney disease in people with HIV (PWH), driven by increased ART access, noncommunicable diseases, and region-specific opportunistic infections like tuberculosis., Recent Findings: The literature highlights a decline in HIV-associated nephropathy (HIVAN) and a rise in tubulointerstitial diseases and noncommunicable diseases among PWH. Studies from the United States and South Africa report decreased HIVAN prevalence and increased rates of tubulointerstitial diseases linked to tenofovir disoproxil fumarate (TDF) toxicity and tuberculosis (TB). Immune complex glomerulonephritis (ICGN) and diabetic kidney disease (DKD) are also prevalent., Summary: The findings underscore the need for improved diagnostic tools for opportunistic infections, management of ART-related complications, and strategies to address noncommunicable diseases in PWH. There is a need to centralize care to address all health needs simultaneously. Future research should focus on APOL1-targeted therapies and the role of SGLT2 inhibitors in CKD. Enhanced transplantation outcomes and the development of guidelines for managing DKD in PWH are critical for advancing clinical practice and improving patient outcomes., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Injection of opioids has contributed to growing HIV epidemics in Tajikistan and Afghanistan. This qualitative study explored determinants of access to primary prevention and screening for HIV among people who inject drugs (PWID) residing in border communities of Gorno-Badakhshan, Tajikistan and Badakhshan, Afghanistan., Methods: Semi-structured interviews were conducted with PWID, community leaders, and healthcare workers. The social-ecological model was used to inform a thematic analysis of determinants of access., Results: There were no preventive or screening services for HIV in the border districts of Afghanistan. Barriers to accessing HIV-related services in Tajikistan, and to accessing general health services in Afghanistan, included: lack of knowledge about HIV, inaccessible communities with poor infrastructure, discrimination and violence against women, and stigmatization of PWID and people living with HIV. Access to HIV-related and other health services by PWID was facilitated by community leader support, family support, outreach services, and linkage of harm reduction services with HIV testing and care., Conclusion: Urgent interventions are needed to stem the escalating HIV epidemic in Afghanistan and enhance existing services in Tajik border communities. This qualitative study offers insights into barriers and facilitators for accessing HIV prevention and screening services among PWID, suggesting potential interventions., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Studies have reported lower incidence of prostate cancer in men living with HIV compared with men without HIV for reasons that remain unclear. Lower prostate cancer screening in men living with HIV could explain these findings. We describe receipt of prostate-specific antigen (PSA) test each calendar year by HIV status in Medicaid beneficiaries enrolled in 14 U.S. states, 2001-2015. A total of 15,299,991 Medicaid beneficiaries aged 18-64 with ≥7 months of continuous enrollment were included in analyses. HIV diagnosis and PSA tests were identified using non-drug claims. Incidence rate ratios comparing receipt of PSA test by HIV status adjusted for age, race/ethnicity, state of residence, calendar year, comorbid conditions, benign prostatic conditions, and receipt of testosterone-replacement therapy were estimated using Poisson regression. Models were also stratified by state, and estimates were pooled using random-effects meta-analysis to account for heterogeneity by state. Models were additionally stratified by age and race/ethnicity. There were 42,503 PSA tests over 314,273 person-years and 1,669,835 PSA tests over 22,023,530 person-years observed in beneficiaries with and without HIV, respectively. The incidence of PSA test was slightly lower in men living with HIV than men without HIV (incidence rate ratio [IRR] = 0.98; 95% confidence interval [CI]: 0.97, 0.99) when adjusting for state. In the pooled estimate, the rate was higher among men living with HIV (IRR = 1.11; 95% CI: 0.97, 1.27). Pooled estimates indicated approximately equal or higher rates of PSA test in men living with HIV compared with men without HIV across models stratified by age and race/ethnicity groups. Findings do not support the hypothesis that differences in prostate cancer screening explain differences in incidence by HIV status.

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 <100% at all timepoints, and lower among those initiating ART earlier. Seroreversions occurred for 29% (16/55), and blood donation screening with NAT and Ag/Ab assays could have missed up to 36% (20/55) of RV254 participants. For SIPP participants, who started ART at later timepoints, Ag/Ab assays identified infections with no evidence of reactivity waning., Conclusion: PrEP and early ART initiation can delay or reduce HIV detectability. Considerations for the implementation of NAT and Ag/Ab tests in PrEP/PEP programs relying on Ab-only RDTs should be balanced according to feasibility and public health impact. While blood transfusion services using Ab-only RDTs for HIV screening should adopt higher sensitivity tests, surveillance and further research are needed to determine the need for novel HIV testing algorithms for those already using NAT and Ag/Ab screening assays., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: SF has received consulting support from Gilead Sciences for unrelated work. MPB has received research support from Abbott, Grifols, Roche, and QuidelOrtho. He received no personal compensation, equity, advisory committee role or travel support. MLM is an employee and shareholder of Gilead Sciences. BC received research funding and reagents from Hologic and from Grifols Diagnostic Solutions and has been part of the speakers´ bureau of Abbott Inc. SB is an employee and received honoraria for lectures from Grifols Diagnostic Solutions., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Current guidelines recommend concurrent screening for HIV and syphilis with gonorrhea and chlamydia testing. Despite this, many patients are still not screened. This study describes trends in demographics and encounter locations associated with missed opportunities for HIV and syphilis screening among patients tested for gonorrhea or chlamydia., Methods: This is a retrospective review of all encounters with gonorrhea or chlamydia testing in a large, urban hospital from November 1, 2018, to July 31, 2021. Demographic information and encounter location were extracted from the medical record. Encounters were categorized as including both HIV and syphilis (complete) screening, HIV screening only, or neither. Logistic regression was used to examine associations between demographics and encounter location and likelihood of complete screening., Results: There were 42,791 patient encounters, of which 40.2% had complete screening, 6.2% had concurrent HIV screening only, and 53.6% had no concurrent screening. Increasing age, female sex (adjusted odds ratio [aOR], 0.58; 95% confidence interval [CI], 0.55-0.61; P < 0.01), non-Hispanic Black race (aOR, 0.52; 95% CI, 0.49-0.55; P < 0.01), and public insurance (aOR, 0.72; 95% CI, 0.69-0.75; P < 0.01) were associated with lower odds of complete screening. Emergency department (ED) encounters were most likely to include complete screening (aOR, 3.11; 95% CI, 2.96-3.26; P < 0.01)., Conclusions: This study found that a large proportion of patients tested for gonorrhea and chlamydia had missed opportunities for HIV and syphilis screening. Significant demographic disparities were found. The emergency department was most likely to screen for both HIV and syphilis. Decreasing disparities in screening could have profound effects on the HIV and syphilis epidemics., Competing Interests: Conflict of Interest and Sources of Funding: Dr. McNulty has served on an advisory board for Gilead Sciences, Inc. Dr. Hazra has served on an advisory board for Gilead Sciences, Inc, and ViiV Healthcare. All other authors have no conflicts of interest to disclose., (Copyright © 2024 American Sexually Transmitted Diseases Association. All rights reserved.)

ABSTRACT Justice-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.

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., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: In the 4 largest cities in the Netherlands, an estimated 400 people live with undiagnosed HIV, including 170 in Amsterdam. Amsterdam targets having zero new HIV infections in 2026. Undocumented migrants are disproportionately affected by HIV and often contract HIV after migration. Moreover, they often experience difficulties accessing health care. The aim of this study was to analyze the outcomes of an HIV/sexually transmitted infection testing program for undocumented migrants through community based testing., Methods: Between May 2021 and January 2022, data for this cross-sectional study were collected during outreach testing activities of the Amsterdam Center for Sexual Health of the Public Health Service, and the NGO Doctors of the World. Activities were organized in collaboration with migrant partner organizations. Participants were tested free-of-charge for HIV, syphilis, gonorrhea, chlamydia, and, if indicated, hepatitis B and C. Before testing, a health care provider-administered questionnaire was filled out., Results: A total of 126 people from 22 countries were tested for HIV during 28 outreach activities. Mean age was 37 (IQR 32-43). Forty-nine people (39%) were additionally tested, (through self-sampling) for chlamydia, gonorrhea and syphilis, 42 (33%) for Hepatitis B and 14 (11%) for Hepatitis C. We found zero new HIV infections and 5 positive chlamydia cases.Reaching 52 HIV first time testers and 19 first time testers since migration shows the importance of these activities. The number of participants tested were lower than initially expected due to lower attendance per testing day for various reasons., Conclusions: To increase the likelihood of reaching undocumented migrants for HIV/sexually transmitted infection testing and linkage to care, focus should be on on-site provider-initiated testing, e.g. during outreach health care activities, and on easy access to centers for sexual health. Collaboration between health care providers and community stakeholders is essential., Competing Interests: Conflict of Interest and Sources of Funding: None declared., (Copyright © 2024 American Sexually Transmitted Diseases Association. All rights reserved.)

People living with HIV are disproportionately affected by depression, anxiety, and substance use which impede engagement with HIV treatment services and can increase risks of HIV-related morbidity and mortality. Capturing timely, accurate patient data at point of care is recommended to inform clinical decision-making and retain patients on the HIV care continuum. Currently, there is limited use of validated screening tools for substance use and mental health at the point of care in HIV clinics, even though people with HIV (PWH) have a high prevalence of these comorbidities. Even fewer clinics screen in a manner that encourages disclosure of stigmatized substance use, depression, and anxiety. Electronic patient-reported outcomes (ePROs) are an evidence-based modality to overcome such limitations by eliciting responses directly from patients via tablet, smartphone, or computer. To date, there is limited consensus on how to implement ePROs into non-academic settings and enhance uptake. Our team sought to address this gap by examining the implementation of ePROs, previously implemented in an academic clinic, to enhance screening and treatment of mental health (MH) and substance use at five Ryan White HIV/AIDS Program-funded clinics in Alabama. The ePROs were delivered through a multi-component intervention titled HIV + Service delivery and Telemedicine through Effective Patient Reported Outcomes (+STEP), which also provides targeted training to frontline clinicians, and resources for MH and substance use treatment for PWH without access to care. The objective of this study is to provide an implementation blueprint that can be tested and utilized in other HIV clinics to integrate ePROs and increase evidence-based screening for depression, anxiety, and substance use among PWH, as well as outline lessons learned from implementation to date. The findings from this study provide practical steps and advice based on our experience in implementing electronic patient-reported outcomes in HIV clinics in the US Deep South., Competing Interests: EE reports honorarium from Gilead for participating in the HIV Re-engagement working group and from PRIME, DKBMed, and IAS-USA for developing HIV continuing education content. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Gagnon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: HIV self-testing (HIVST) may facilitate marginalised populations' uptake of HIV testing, but whether the extent of marginalisation challenges individual uptake of HIVST remains under-researched. We aim to explore the perspectives of multiply marginalised cis-gender gay, bisexual and other men who have sex with men (GBMSM) and trans women on whether HIVST might increase their uptake of HIV testing., Methods: We reanalysed qualitative interview data from SELPHI (the UK's largest HIVST randomised trial) collected between 2017 and 2020 from marginalised populations, defined as people self-identifying as non-heterosexual, transgender, non-White ethnicity and/or with low educational attainment. Thirty-eight interviews with multiply marginalised individuals were thematically examined using the framework method. We specifically focussed on kit usability (a function of the interaction between blood-based HIVST kits and users), perspectives on how HIVST can improve access to HIV testing and suggestions on need-based scale-up of HIVST., Results: HIVST kits were considered usable and acceptable by multiply marginalised GBMSM and trans women. The majority of interviewees highlighted multi-levelled barriers to accessing HIV testing services due to structural and social marginalisation. Their multiply marginalised identities did not impede HIVST uptake but often form motivation to self-test. Three potential roles of HIVST in the HIV testing landscape were identified: (1) alternation of HIVST and facility-based testing, (2) integration of HIVST into sexual health services and (3) substituting facility-based testing with HIVST in the future. Perceived beneficiaries of HIVST included trans communities, individuals with undisclosed sexuality and people with physical disabilities., Discussion: HIVST can facilitate marginalised populations' access and uptake of HIV testing by alternating with, integrating into and substituting for facility-based services in the UK. Marginalised identities did not present challenges but rather opportunities for person-centred scale-up of HIVST. Future implementation programmes should ensure equitable access to HIVST among trans people, men unable to disclose their sexuality, and perhaps people with physical disabilities., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: To date, no randomized controlled trials have specifically addressed behavior changes after HIV self-testing (HIVST) among transgender women., Objective: This study aims to evaluate the effects of HIVST on changes in HIV testing behavior, frequency of condomless sex, and partner numbers among transgender women in China., Methods: Participants were recruited from 2 Chinese cities using both online and offline methods. Transgender women were randomly assigned to receive an HIVST intervention. Data from the previous 3 months were collected at baseline, 3 months, and 6 months. The primary outcome was the mean change in the number of HIV tests among transgender women during the 6-month follow-up. An intention-to-treat analysis was conducted. The statistical analysis used analysis of covariance and linear mixed-effects models., Results: From February to June 2021, and 255 transgender women were recruited, of which only 36.5% (93/255) had a steady job, and 27.1% (69/255) earned less than US $414.9 of income per month. They were randomly assigned to the intervention (n=127) and control (n=128) groups. At 6 months, the mean number of HIV tests was 2.14 (95% CI 1.80-2.48) in the intervention group and 1.19 (95% CI 0.99-1.40) in the control group (P<.001), with increases of 0.84 (95% CI 0.54-1.14) and 0.11 (95% CI -0.19-0.41) over 6 months, respectively. The net increase was 0.73 (95% CI 0.31-1.15; P<.001), with a similar adjusted result. No significant differences in the frequency of condomless sex or partner numbers were observed between the 2 groups., Conclusions: HIVST is an effective strategy for enhancing regular HIV testing behavior among transgender women in China. This strategy should be combined with measures to address the financial vulnerability of the transgender women community to reduce subsequent risk behaviors, including condomless sex., Trial Registration: Chinese Clinical Trial Registry ChiCTR2000039766; https://www.chictr.org.cn/showproj.html?proj=61402., (©Yan-Yan Zhu, Ze-Hao Ye, Zhen-Xing Chu, Yingjie Liu, Jie Wei, Le Jia, Yong-Jun Jiang, Hong Shang, Qing-Hai Hu. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 29.10.2024.)

Background: Diabetes mellitus, human immunodeficiency virus (HIV), hepatitis B and anaemia are major global public health issues according to the World Health Organization (WHO). Access to diagnostic testing is essential for their prompt detection and treatment. The WHO has recommended a list of essential in-vitro diagnostics for testing at all levels of care. However, a survey preceding this study showed limited availability of point-of-care (POC) tests for these conditions in the Bono Region (BR) of Ghana. This study assessed the geographical access to diabetes, anaemia, hepatitis B, and HIV POC testing in the BR, Ghana for targeted improvement., Methods: We gathered the geolocated data of 137 facilities (CHPS, Clinics, healthcare centres, and hospitals) in the BR that were providing glucose, haemoglobin (Hb), Hepatitis B Surface Antigen (Hep B), and HIV POC testing services in July 2022. We used ArcGIS 10.1 to quantify the geographical access (distance and travel time) to the nearest available testing site for each test and show places with inadequate access, for targeted improvement. The journey time was calculated assuming a speed of 20 kilometres (km)/h. ArcMap 10.1 was employed to run spatial autocorrelation (Moran Index (MI)) to determine the spatial distribution of the facilities providing the tests investigated., Results: Of the 137 facilities, the glucose test was available in 67 (49%), the Hb test in 55 (40%), the Hep B test in 44 (32%), and the HIV test in 73 (53%). The mean (standard deviation (SD)) for obtaining glucose tests in the region was 7.4 ± 3.7 km, Hb was 8.1 ± 4.06 km, Hep B was 8.2 ± 4.1 km, and HIV test was 7.3 ± 3.7 km by a motorised cycle. The mean SD travel time in the region to obtain the glucose test was 94.4 ± 47.2 min compared to 95.7 ± 47.8 min for Hb, 95.9 ± 47.93 min for Hep B, and 92.7 ± 46.3 min for the HIV test. Three districts (Berekum East, Dormaa East, and Jaman North) recorded shorter distances (< 10 km) and a shorter travel time to the glucose, Hb, Hep B, and HIV tests compared to the Banda district, which recorded more than 10 km for all tests investigated. Positive IM values were recorded for all the POC tests, suggesting that the health facilities providing the glucose, Hb, Hep B, and HIV tests in the BR were spatially distributed at random., Conclusions: The findings revealed moderate access to all the tests in districts across the region. However, geographical access to glucose, Hb, Hep B, and HIV POC testing was poor (distance ≥ 10 km and travel time of ≥ 93 min), in the Banda district. This study showed the need to prioritise the Banda district for targeted improvement for all the tests. A further study is recommended to identify potential solutions to addressing the POC testing implementation in the BR, as demonstrated by this study., (© 2024. The Author(s).)

Background: This analysis aimed to evaluate the effectiveness of eliciting sexual partners from HIV-positive clients using the elicitation box model (where an HIV-positive index can report sexual contacts on paper and insert in a box for a health care provider to contact at a later time) compared to the conventional model (in which a health care provider elicits sexual contacts directly from clients) in Akwa Ibom, Southern Nigeria. Methods: Between March 2021 and April 2022, data were collected from index testing registers at 4 health facilities with a high volume of HIV clients currently on treatment in 4 local government areas in Akwa Ibom State. Primary outcome analyzed was the elicitation ratio (number of partners elicited per HIV-index offered index testing services). Secondary outcomes were the index testing acceptance (index HIV-positive clients accepted index testing service), testing coverage (partners tested for HIV from a list of partners elicited from HIV-index accepted index testing services), testing yield (index partners identified HIV positive from index partners HIV-tested), and linkage rate (index partners identified HIV positive and linked to antiretroviral therapy). Results: Of the total 2,705 index clients offered index testing services, 91.9% accepted, with 2,043 and 439 indexes opting for conventional elicitation and elicitation box models, respectively. A total of 3,796 sexual contacts were elicited: 2,546 using the conventional model (elicitation ratio=1:1) and 1,250 using the elicitation box model (elicitation ratio=1:3). Testing coverage was significantly higher in the conventional compared to the elicitation box model ( P <.001). However, there was no significant difference in the testing yield ( P =.81) and linkage rate using the conventional compared to elicitation box models ( P =.13). Conclusion: The implementation of the elicitation box model resulted in an increase in partner elicitation compared to the conventional model. Increasing the testing coverage by implementing the elicitation box model should be considered., (© Dibia et al.)

Background: We developed the HIV Triplex multiplex bead assay to identify and serotype HIV infection with high sensitivity and specificity; and distinguish recent from long-term HIV-1 infections. It can facilitate accurate incidence estimation, while reducing the number of tests and blood collected, which is highly desirable for use in future studies and surveys. Using previously collected, treatment-naive longitudinal seroconversion HIV-1 positive panels and specimens from individuals infected for >12 months, we determined the assay's mean duration of recent infection (MDRI) and false-recency rate (FRR) respectively, at various mean fluorescent intensity (MFI) cutoffs., Methods: We tested seroconversion specimens (N = 814) from 142 individuals infected with HIV-1 subtypes B, C, or AE, and 1341 cross-sectional specimens from individuals infected >12 months. The MFI cutoffs of 1000 to 2000 were evaluated for recency classification, including an MFI of 1250 corresponding to the limiting antigen avidity enzyme immunoassay (LAg-EIA) cutoff of 1.5 normalized optical density for MDRI and FRR. We used four statistical methods: Methods 1 and 2 used the empirically balanced observation time approach. Method 2 MFI values were raised to power = 1.33, based on a repeated measures model to linearize the relationship between MFI and time points, whereas Method 1 was not linearized. Methods 3 and 4 employed quadratic and linear interpolations for each seroconversion panel. FRR was calculated by dividing the number of specimens misclassified as recent by the total number of specimens tested., Results: MDRI values ranged from 135-146 days at MFI = 1000 to 229-279 days at MFI = 2000 by the 4 methods. FRR varied from 0.15%-1.27% with increasing MFI cutoff. At MFI = 1250, the average MDRI of 4 methods was 169 days and ranged from 159-183 with overlapping 95% CIs and FRR = 0.52%., Conclusion: The HIV Triplex assay demonstrates a longer dynamic range compared to current HIV recency assays with a low FRR for cutoffs examined. With a longer dynamic range and low FRR, the MDRI for recent infection can be extended as appropriate to detect more recent infections, increasing the value of incidence assays benefiting public health surveillance and future surveys., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Background: Screening rates for Human Immunodeficiency Virus (HIV) remain low despite guidelines by both the CDC and USPSTF recommending that all adolescents and adults be screened at least once. The aim of this quality improvement study was to increase HIV screening among eligible patients., Methods: This quality improvement study assessed the impact of interventions to increase HIV screening in an outpatient population at a large urban safety-net hospital. Outcomes were compared from the preintervention (December 2020 to November 2021) to postintervention years (December 2021 to November 2022). Stepwise electronic alerts to prompt HIV screening paired with provider financial incentives were implemented. The proportion of eligible individuals screened for HIV were compared after intervention implementation., Results: Average monthly HIV screening increased from 506 ± 97 to 2484 ± 663 between the pre- and postintervention periods, correlating to a 5.1-fold increase in screening (7.8% to 39.8%, P  < .01). Increases were seen across all ages, and those aged 55 to 64 and 65+ had the highest relative increase in screening at 7.5 and 9.3-fold, respectively ( P  < .01). Screening rates increased for Hispanics (7.9% preintervention vs 43.6% postintervention, P  < .01). In the pre- and postintervention periods, 41 patients with new HIV diagnoses were identified (13 preintervention and 28 postintervention) and 85.4% were linked to care within 30 days., Conclusions: Stepwise interventions targeted at primary care clinicians are an effective way to increase HIV screening rates, particularly in older demographics. Earlier HIV diagnosis coupled with linkage to care is an important strategy in ending the HIV epidemic., Competing Interests: Conflict of interest: None., (© Copyright 2024 by the American Board of Family Medicine.)

Background: A pilot HIV testing programme, Au Labo sans Ordo (ALSO; "to the laboratory without prescription") was implemented in two French Fast-Track Cities Initiative areas from 07/2019 to 12/2020. ALSO aimed to remove barriers to HIV testing by providing free testing with widespread access through all laboratories, extended opening hours, and no prescription requirements., Objectives: Assessing the ALSO programme in terms of testing activity, user characteristics, and costs, compared to other HIV testing offers., Methods: Laboratories and STI clinics reported the monthly numbers of tests performed and positive tests. Two short surveys were carried out 12 months apart in people who sought HIV testing. In each offer, the mean costs of HIV testing have been estimated according to negative or positive results using a microcosting approach., Results: During the study period, 214/264 laboratories reported performing 38,941 ALSO tests that accounted for 7.2% of laboratory HIV testing activity. Positivity rates of ALSO and prescribed tests were similar (2.2/1000) but lower than that in STI clinics (6.0/1000). Heterosexual men, and individuals with multiple sexual partners, poor health insurance and few visits to GPs were more likely to use the ALSO offer than tests upon prescription. Compared to ALSO, STI clinic users were younger, more exposed to HIV and with a less favourable socio-economic situation. ALSO had low costs: €13 for a negative test, €163 for a positive test and €5,388 to identify an HIV-positive person (versus €9,068 in STI clinics and €20,126 with prescribed tests)., Conclusion: ALSO has attracted users less likely to visit STI clinics or to seek a prescribed test, particularly heterosexual men. Activities, user profiles and costs suggested the complementarity of the HIV testing offers and the relevance of making them coexist. French health authorities have decided to maintain and expand this programme to complement existing HIV testing offers., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Champenois et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: HIV self-testing is a complementary screening strategy that could facilitate access to HIV care services for street adolescents. The objectives of this study were to assess the acceptability and feasibility of HIV self-testing and their associated factors, to estimate HIV prevalence among street adolescents in Togo, and to describe the sexual behavior of this population., Methods: A cross-sectional study was conducted between July 2021 and May 2022 in Lomé and Kara (Togolese cities with the highest number of street adolescents). Street adolescents aged 13-19 years were included. An oral HIV self-test (OraQuick®) was used. Acceptability was defined as the proportion of adolescents who completed the test, and feasibility was defined as the proportion of adolescents who reported a test with a valid result. An HIV serological test was performed for all participants. A weighted logistic regression model was used to identify the factors associated with the acceptability and feasibility of HIV self-testing., Results: A total of 432 street adolescents (12.3% female) with a median age of 15 years, interquartile range (IQR) [14-17], were included in this study. Of the 231 sexually active adolescents, only 30.3% (n = 70) reported having used a condom during their last sexual intercourse. HIV self-test was offered to a sub-sample of 294 street adolescents. Acceptability was 96.6% (284/294), (95%CI = [93.8-98.3]) and feasibility 98.9% (281/284), (95%CI = [97.0-100.0]). Being 16 years of age or older (aOR = 28.84; p<0.001) was associated with HIV self-test acceptability. Reporting drug abuse (aOR = 0.47; p = 0.020) was negatively associated to acceptability. Having an educational level at least equivalent to secondary school was associated to HIV self-testing feasibility (aOR = 3.92; p = 0.040). Self-test results were correctly interpreted by 98.6% of street adolescents. HIV prevalence was estimated at 0.9% (95%CI [0.4-2.4])., Conclusion: HIV self-testing is acceptable and feasible among street adolescents, a population at high risk of HIV infection in Togo. The provision of HIV self-testing kits, coupled with condom distribution, represents an opportunity to improve access to HIV care services., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sadio et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: To determine associations between the banning of sex work during the COVID-19 pandemic, and work, financial problems, mental well-being and HIV/sexually transmittable infection (STI) testing among sex workers in the Netherlands., Design: Two cross-sectional online surveys. The first survey covered two time-periods: pre-COVID-19 (1 January 2019 to 31 December 2019) and period 1 (15 March 2020 to 1 July 2020). The second survey covered period 2 (1 January 2021 to 31 December 2021)., Setting: The Netherlands PARTICIPANTS: In total, 106 (first survey) and 196 (second survey) sex workers participated. Most of the participants in the first and second survey were cisgender women (respectively, 76.4% and 66.5%), followed by cisgender men (respectively, 12.3% and 15.7%) and the combination of transgender men, transgender women, non-binary or other (respectively, 11.3% and 17.6%). Most participants were born in the Netherlands (respectively, 61.4% and 69.7%)., Primary and Secondary Outcome Measures: We provide descriptive statistics of self-reported work during and prior to COVID-19 measures, financial problems due to COVID-19 measures and HIV/STI testing and mental well-being during the COVID-19 pandemic. We also performed logistic and linear regression analyses to identify risk factors associated with reporting financial problems due to COVID-19 measures, not testing for HIV/STIs and lower mental well-being during the COVID-19 pandemic., Results: In periods 1 and 2, respectively, 69.6% and 62.0% reported financial problems due to the COVID-19 measures. Among those who reported to have had sex with clients, the percentage not HIV/STI testing was: 4.5% (95% CI: 0.9; 12.5) pre-COVID-19, 28.2% (95% CI: 15.0; 44.9) in period 1, and 15.2% (95% CI: 9.7; 22.3) in period 2. In the multivariate analysis, reported financial problems due to the COVID-19 pandemic was associated with not HIV/STI testing (OR: 12.1, p<0.001) and lower mental well-being (B: -2.7, p<0.001)., Conclusion: The COVID-19 pandemic control measures in the Netherlands were associated with major financial problems, low mental well-being and reduced HIV/STI testing among sex workers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In 2016, The World Health Organization introduced HIV self-testing (HIVST) as an alternative to traditional HIV testing (1), the present study aims to study the acceptability of HIV self-testing among Iranian women injecting drug users (WIDUs). The results of this study are expected to provide valuable evidence for the proper implementation of this program in Iran., Methods: This study employed a content analysis approach to gather qualitative data. The investigation was conducted from April to July 2023. We have chosen the following five provinces, namely Mashhad, Tehran, Kurdistan, Mazandaran, and Kerman, as the designated areas for our study. A sample of Iranians (17-62 years) was selected by purposeful and snowball sampling methods to participate in the study, and 31 semi-structured interviews were conducted. The data collection tool was an interview guide, which was designed based on a review of the literature. The data were analyzed using conventional content analysis. The interviews continued until data saturation was reached., Results: Based on our findings, we distilled 2 main themes and 9 categories including Inhibiting factors (Access and Affordability, Accuracy Concerns, Low knowledge, linkage to HIV treatment, the window period, Ignoring the danger) and Focalizing factors (Empowerment and autonomy, Stigma and privacy., Conclusion: Iran's HIV stigma may discourage regular testing, but self-testing can help overcome challenges. Support for counseling, care links, and accurate information dissemination are crucial., (© 2024. The Author(s).)

Background: HIV continues to have a disproportionate impact on specific populations in Malaysia, particularly men who have sex with men (MSM). HIV self-testing (HIVST) is a strategy that has been shown to scale up HIV testing rates. However, it faces shortcomings because of concerns about self-efficacy, result interpretation, and lack of counseling and linkage to care. This underscores the need for an innovative approach that integrates HIVST with timely counseling, expert guidance, and referrals to enhance engagement in relevant HIV prevention or treatment., Objective: This study aims to describe the protocol used in developing and testing a web-based platform (ie, CINTAI) providing an HIVST kit and real-time e-counseling to support online-to-offline linkage to HIV care services for MSM in Malaysia., Methods: The methods are reported according to the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 guidelines. In phase I, we will adapt existing HIVST web-based platforms to create a new online-to-offline HIVST and counseling platform called "CINTAI" for Malaysian MSM. In phase II, we will use a type 1 hybrid implementation trial design to determine the feasibility, acceptability, and preliminary efficacy of "CINTAI" compared with treatment as usual among Malaysian MSM, with assessments conducted over 6 months. Multilevel implementation factors will also be collected to guide future adoption and scale-up. We will enroll 78 MSM in the pilot randomized controlled trial. Baseline characteristics will be tested for homogeneity between groups using appropriate statistical tests. A generalized linear mixed model with random subject effects will account for within-subject correlation. Treatment assignment, time, interaction, and confounders will be included. The proportion of MSM tested for HIV over 6 months and other outcomes (pre-exposure prophylaxis for HIV or antiretroviral therapy linkage, HIV risk behaviors, and chemsex harm reduction) will be compared using linear contrasts., Results: We completed phase I of the proposed study in April 2024 and started phase II in May 2024, with 15 participants recruited (7 in the CINTAI and 8 in the treatment-as-usual groups). On the basis of a series of formative works completed during phase I, we developed a fully functional, web-based platform that provides a digital platform for MSM in Malaysia to order HIVST kits for free and to receive HIV counseling, followed by offline linkage to HIV prevention services (if HIV negative) or HIV treatment services (if HIV positive)., Conclusions: Despite being at high risk for HIV transmission, MSM in Malaysia have alarmingly low testing and linkage to HIV care services, prompting the need for innovative approaches to support HIV prevention efforts. If found to be feasible and acceptable, CINTAI can be easily adapted for a range of health outcomes and health care delivery services for MSM, including adaptation to other low- and middle-income countries., International Registered Report Identifier (irrid): DERR1-10.2196/60962., (©Antoine Khati, Jeffrey A Wickersham, Kamal Gautam, Kiran Paudel, Panyaphon Phiphatkhunarnon, Sin How Lim, Kirthana Puniamurthy, Frederick L Altice, Nittaya Phanuphak, Iskandar Azwa, Roman Shrestha. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 23.10.2024.)

Background: In order to attain the ambitious 95-95-95 UNAIDS goals, HIV testing serves as the pivotal starting point and plays a crucial role in preventing, treating, and managing HIV. Equal access to HIV testing is crucial to stop the spread of the virus. Measuring healthcare disparities is vital for promoting fairness in health services and achieving global goals for HIV prevention and treatment. Ethiopia is actively engaged in efforts to achieve these goals and is dedicated to combating HIV/AIDS. To the best of our knowledge, no previous systematic review or meta-analysis has been conducted on sociodemographic inequalities in prenatal HIV testing in Ethiopia. Hence, this study aims to assess sociodemographic inequalities in prenatal HIV testing in Ethiopia., Methods: We conducted an extensive search across various databases, such as PubMed, Scopus, Google Scholar, and Embase, to collect articles and reports. The data we gathered was then exported to R software for further analysis. Our analysis involved performing a meta-analysis of proportions using a random effect model. To assess the variability among the included studies, we used statistical measures such as I2 statistics and the Cochran's Q test. The results of the pooled prenatal HIV testing, along with its corresponding 95% confidence interval, were presented using a forest plot., Results: A comprehensive analysis of 20 research papers on prenatal HIV testing in Ethiopia revealed that the overall pooled prevalence of testing was 69% (95% CI [60.0-80.0]). Factors such as higher education, urban residence, income, a positive attitude towards testing, marriage, and discussions about testing during antenatal care (ANC) were found to positively influence testing rates., Conclusion: The prevalence of prenatal HIV testing among antenatal care attendees in Ethiopia falls short of the UNAIDS target. In order to enhance the testing rates, it is advised to implement targeted initiatives within Ethiopia's public health programs. To ensure effectiveness, these initiatives should adopt a sustainable and customized approach that takes into account the specific needs and circumstances of women, particularly those who are economically disadvantaged. Ethiopia can make significant strides in enhancing the prenatal HIV testing landscape by effectively implementing policies and programs that prioritize the welfare of the less privileged., Limitations: As limitation this systematic review did not include longitudinal and qualitative studies that might have provided different results., Clinical Trial Registration: Trial registration in PROSPERO with ID: CRD42024550564., Competing Interests: The authors have no competing interest., (Copyright: © 2024 Alie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Sierra Leone faces a significant challenge in addressing HIV/AIDS, particularly among adolescent girls and young women. This age group is considered highly vulnerable due to biological factors and social inequalities. Understanding the prevalence of HIV testing in this demographic is crucial for designing effective prevention and treatment strategies. This study investigated the spatial distribution of HIV testing and its associated factors among adolescent girls and young women in Sierra Leone., Methods: Data from the 2019 Sierra Leone Demographic and Health Survey was used for the study. The sample comprised 6,062 adolescent girls and young women between the ages of 15 and 24. Spatial autocorrelation and Moran's I statistic were employed to analyze the spatial distribution of HIV testing. An analysis utilising mixed-effect multilevel binary logistic regression was performed to determine the factors associated with HIV testing. The findings were presented as adjusted odds ratios (aOR) and a 95% confidence interval (CI)., Results: The national prevalence of HIV testing among adolescents and young women in Sierra Leone was 42.1% [40.3,43.9]. Kailahun, Kambia, Tonkolil, some parts of the Western rural area, and Bonthe districts were found to be statistically significant hotspot for HIV testing. Whereas, Karene, Falaba, Bo, kenema, and some parts of Pujuhun were statistically cold spot districts. Adolescent girls and young women aged 20-24 [aOR = 1.63, 95% CI = 1.29, 2.07] had higher odds of HIV testing than those aged 15-19. Those with secondary/higher education [aOR = 1.87, 95% CI = 1.40, 2.51] had higher odds of HIV testing than those with no education. The odds of HIV testing was higher among adolescent girls and young women who use the Internet [aOR = 1.75, 95% CI = 1.32, 2.33] than those who did not use internet. Adolescent girls and young women with one [aOR = 16.56, 95% CI = 12.31, 22.29] and two or more parity [aOR = 16.37, 95% CI = 10.86, 24.68] had higher odds of HIV testing than those with no parity. The likelihood of HIV testing was higher among adolescent girls and young women who had sex below 18 [aOR = 4.54, 95% CI = 3.25, 6.34] and those who had sex at 18+ [aOR = 5.70, 95% CI = 3.84, 8.45] compared to those who had never had sex. Adolescent girls and young women who visited health facilities in the past 12 months [aOR = 1.82, 95% CI = 1.46, 2.26] had higher odds of HIV testing than those who did not., Conclusion: Despite some positive trends, HIV testing rates among adolescent girls and young women in Sierra Leone remain moderate. Spatial autocorrelation analysis consistently revealed hotspots and cold spots for HIV testing, with Kailahun, Kambia, Tonkolil, some parts of the Western rural area, and Bonthe districts remaining persistent hotspots. Age, education, internet use, sexual history, parity, and healthcare access are significant factors influencing testing behaviour. To improve testing rates, the government and policymakers should prioritize educational campaigns, expand internet access, integrate HIV testing into routine healthcare, and address stigma associated with HIV., (© 2024. The Author(s).)

Background: HIV treatment programs in Africa have implemented centralized testing for routine viral load monitoring (VLM), which may result in specimen processing delays inhibiting timely return of viral load results. Decentralized, point-of-care (PoC) VLM is a promising tool for expediting HIV clinical decision-making but remains unavailable in most African settings. We qualitatively explored the perceived feasibility and appropriateness of PoC VLM to address gaps along the viral load monitoring continuum in rural Uganda., Methods: Between May and September 2022, we conducted 15 in-depth interviews with HIV clinicians (facility in-charges, clinical officers, nurses, counselors) and six focus group discussions with 47 peer health workers from three south-central Ugandan districts. Topics explored centralized VLM implementation and opportunities/challenges to optimizing routine VLM implementation with PoC testing platforms. We explored perspectives on PoC VLM suitability and feasibility using iterative thematic analysis. Applying the Framework Method, we then mapped salient constraints and enablers of PoC VLM to constructs from the Consolidated Framework for Implementation Research., Results: Clinicians and peers alike emphasized centralized viral load monitoring's resource-intensiveness and susceptibility to procedural/infrastructural bottlenecks (e.g., supply stockouts, testing backlogs, community tracing of clients with delayed VLM results), inhibiting timely clinical decision-making. Participants reacted enthusiastically to the prospect of PoC VLM, anticipating accelerated turnarounds in specimen processing, shorter and/or fewer client encounters with treatment services, and streamlined efficiencies in HIV care provision (including expedited VLM-driven clinical decision-making). Anticipated constraints to PoC VLM implementation included human resource requirements for processing large quantities of specimens (especially when machinery require repair), procurement and maintenance costs, training needs in the existing health workforce for operating point-of-care technology, and insufficient space in lower-tier health facilities to accommodate installation of new laboratory equipment., Conclusions: Anticipated implementation challenges, primarily clustering around resource requirements, did not diminish enthusiasm for PoC VLM monitoring among rural Ugandan clinicians and peer health workers, who perceived PoC platforms as potential solutions to existing inefficiencies within the centralized VLM ecosystem. Prioritizing PoC VLM rollout in facilities with available resources for optimal implementation (e.g., adequate physical and fiscal infrastructure, capacity to manage high specimen volumes) could help overcome anticipated barriers to decentralizing viral load monitoring., (© 2024. The Author(s).)

Summaries of HIV seropositivity for members of the U.S. military have been published with MSMR since 1995. The current report summarizes numbers and trends of newly identified HIV-antibody seropositivity from January 1, 2019 through June 30, 2024 among military members of 5 services under the active and reserve components of the U.S. Armed Forces, in addition to the Army and Air Force National Guard. From January 2023 through June 2024, approximately 1.8 million service members (active component, Guard, and reserve) were tested for antibodies to HIV, and 403 (0.22 per 1,000 tested) were identified as HIV-antibody positive. Of the 403 new HIV infections that were identified during this period, only 10 (2.5%) were among female service members. The HIV-antibody seropositivity rates first reported in MSMR 3 decades ago remain comparable to rates presented in 2023, under scoring a continued value of HIV testing programs. The cost-effectiveness of HIV testing strategies, differentiated by universal or indications-based testing following military accession, may be instructive to further understand the value of current screening efforts in different clinical settings.

In 2014, the World Health Organisation (WHO) published target product profiles (TPP) for development of novel tuberculosis (TB) diagnostics. One of the key highlights is the need for point-of-care non-sputum-based tests capable of detecting all forms of TB through identification of characteristic biomarkers or biosignatures. Compared to the limitations associated with sputum-based TB tests, non-sputum samples are easy to collect, non-invasive, with potential to improve TB diagnosis among children and among people living with HIV/AIDS (PLHIV). This review gives an overview of the existing evidence on TB diagnostic studies of non-sputum-based samples collected non-invasively from or through the oral-gastrointestinal tract (GI) and nasal pharynx regions of humans and the biomarkers detected. We further summarized evidence of these biomarkers and sample types from research done in paediatric and PLHIV. The review identified; saliva, cough aerosols, oral swabs, oral wash, dental plaque, tongue swabs, face mask sampling, exhaled breath, and stool, as the non-sputum samples investigated. These biomarkers can be categorized into Deoxyribose Nucleic Acid (DNA), Ribonucleic Acid (RNA), inflammatory, antigen-antibody, volatile and non-volatile compounds, microbiome and microbiota. The biomarkers identified were derived both from the host and pathogen. Similar biomarkers were identified in the general population, children and among PLHIV. These biomarkers have been detected by either already approved simple point of care or sophisticated devices. Differences in methodology and sample types investigated, small sample size of children and PLHIV populations, bias due to confounding factors, were some of the identified challenges in these studies. There is need to conduct larger and standardized multi centre studies to evaluate non-sputum-based biomarker-based tests in children and PLHIV., (© 2024. The Author(s).)