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BackgroundDetection and management of acute HIV infection (AHI) is a clinical and public health priority, and HIV infections diagnosed among young adults aged 18 to 39 years are usually recent. Young adults with recent HIV acquisition frequently seek care for symptoms and could potentially be diagnosed through the health care system. Early recognition of HIV infection provides considerable individual and public health benefits, including linkage to treatment as prevention, access to risk reduction counseling and treatment, and notification of partners in need of HIV testing. ObjectiveThe Tambua Mapema Plus study aims to (1) test 1500 young adults (aged 18-39 years) identified by an AHI screening algorithm for acute and prevalent (ie, seropositive) HIV, linking all newly diagnosed HIV-infected patients to care and offering immediate treatment; (2) offer assisted HIV partner notification services to all patients with HIV, testing partners for acute and prevalent HIV infection and identifying local sexual networks; and (3) model the potential impact of these two interventions on the Kenyan HIV epidemic, estimating incremental costs per HIV infection averted, death averted, and disability-adjusted life year averted using data on study outcomes. MethodsA modified stepped-wedge design is evaluating the yield of this HIV testing intervention at 4 public and 2 private health facilities in coastal Kenya before and after intervention delivery. The intervention uses point-of-care HIV-1 RNA testing combined with standard rapid antibody tests to diagnose AHI and prevalent HIV among young adults presenting for care, employs HIV partner notification services to identify linked acute and prevalent infections, and follows all newly diagnosed patients and their partners for 12 months to ascertain clinical outcomes, including linkage to care, antiretroviral therapy (ART) initiation and virologic suppression in HIV-infected patients, and pre-exposure prophylaxis uptake in uninfected individuals in discordant partnerships. ResultsEnrollment started in December 2017. As of April 2020, 1374 participants have been enrolled in the observation period and 1500 participants have been enrolled in the intervention period, with 13 new diagnoses (0.95%) in the observation period and 37 new diagnoses (2.47%), including 2 AHI diagnoses, in the intervention period. Analysis is ongoing and will include adjusted comparisons of the odds of the following outcomes in the observation and intervention periods: being tested for HIV infection, newly diagnosed with prevalent or acute HIV infection, linked to care, and starting ART by week 6 following HIV diagnosis. Participants newly diagnosed with acute or prevalent HIV infection in the intervention period are being followed for outcomes, including viral suppression by month 6 and month 12 following ART initiation and partner testing outcomes. ConclusionsThe Tambua Mapema Plus study will provide foundational data on the potential of this novel combination HIV prevention intervention to reduce ongoing HIV transmission in Kenya and other high-prevalence African settings. Trial RegistrationClinicalTrials.gov NCT03508908; https://clinicaltrials.gov/ct2/show/NCT03508908 International Registered Report Identifier (IRRID)DERR1-10.2196/16198

Background: Community pharmacies are the first point of contact for most people seeking treatment for minor illnesses globally. In recent years, the role of community pharmacists has evolved, and they play a significant role in the delivery of public health interventions (PHIs) aimed at health promotion and prevention such as smoking cessation services, weight management services, HIV prevention, and vaccination. This review aims to explore the evidence on the factors that influence community pharmacists to take up the role of delivery of such interventions. Methods: Three electronic databases namely, Embase (1947-December 2023), Medline (1975-December 2023), and Scopus (1823-December 2023) were searched for relevant literature from the inception of the database to December 2023. Reference lists of included articles were also searched for relevant articles. A total of 22 articles were included in the review based on our inclusion and exclusion criteria. The data were analyzed and synthesized using a thematic approach to identify the factors that influence the community pharmacist's decision to take up the role of PHI delivery. Reporting of the findings was done according to the PRISMA checklist. Findings: The search identified 10,927 articles of which 22 were included in the review. The main factors that drive the delivery of PHIs by community pharmacists were identified as; training and continuous education, remuneration and collaboration with other healthcare professionals. Other factors included structural and workflow adjustments and support from the government and regulatory bodies. Conclusions: Evidence from this review indicates that the decision to expand the scope of practice of community pharmacists is influenced by various factors. Incorporating these factors into the design of policies and public health programs is critical for the successful integration of community pharmacists in the delivery of broader public health to meet the rising demand for health care across health systems. [ABSTRACT FROM AUTHOR]

Background: Young men who have sex with men (MSM) are a key population at high risk of sexually transmitted infections (STIs). We conducted a respondent-driven sampling (RDS) bio-behavioural survey to estimate the prevalence of five curable STIs: chlamydia, gonorrhoea, syphilis, trichomoniasis and Mycoplasma genitalium infection, and associated risk factors among tertiary student MSM (TSMSM) in Nairobi, Kenya. Methods: Between February and March 2021, we recruited 248 TSMSM aged ≥18 years who self-reported engaging in anal and/or oral sex with another man in the past year. Samples collected included urine, anorectal and oropharyngeal swabs for pooled Chlamydia trachomatis , Mycoplasma genitalium , Neisseria gonorrhoeae and Trichomonas vaginalis testing using multiplex nucleic acid amplification tests, and venous blood for serological Treponema pallidum screening and confirmation of current infection. Participants self-completed a behavioural survey on a REDCap digital platform. Data analysis was done using RDS-Analyst (v0.72) and Stata (v15). Differences in proportions were examined using the chi-squared (χ 2) test, and unweighted multivariate logistic regression was used to assess factors associated with STI prevalence. Results: RDS-adjusted prevalence rates of at least one of the five STIs, chlamydia, gonorrhoea, Mycoplasma genitalium infection, trichomoniasis and latent syphilis were 58.8%, 51.0%, 11.3%, 6.0%, 1.5% and 0.7%, respectively. Factors independently associated with STI prevalence were inconsistent condom use (adjusted odds ratio (AOR) = 1.89, 95% confidence interval (CI): 1.03–3.47, P = 0.038) and the last sex partner being a regular partner (AOR = 2.35, 95% CI: 1.12–4.92, P = 0.023). Conclusion: STI prevalence among TSMSM in Nairobi, Kenya, is disturbingly high, demonstrating urgent need for tailored testing, treatment and prevention interventions for this population. Young gay, bisexual and other men who have sex with men (YMSM) are disproportionately affected by sexually transmitted infections (STIs). Our study tested and found that more than half of the sampled 248 college and university YMSM in Nairobi, Kenya, had at least one of five curable STIs. There is thus need for concerted efforts to address the high burden of STIs in this population. [ABSTRACT FROM AUTHOR]

Background: Young men who have sex with men (MSM) are a key population at high risk of sexually transmitted infections (STIs). We conducted a respondent-driven sampling (RDS) bio-behavioural survey to estimate the prevalence of five curable STIs: chlamydia, gonorrhoea, syphilis, trichomoniasis and Mycoplasma genitalium infection, and associated risk factors among tertiary student MSM (TSMSM) in Nairobi, Kenya. Methods: Between February and March 2021, we recruited 248 TSMSM aged ≥18 years who self-reported engaging in anal and/or oral sex with another man in the past year. Samples collected included urine, anorectal and oropharyngeal swabs for pooled Chlamydia trachomatis , Mycoplasma genitalium , Neisseria gonorrhoeae and Trichomonas vaginalis testing using multiplex nucleic acid amplification tests, and venous blood for serological Treponema pallidum screening and confirmation of current infection. Participants self-completed a behavioural survey on a REDCap digital platform. Data analysis was done using RDS-Analyst (v0.72) and Stata (v15). Differences in proportions were examined using the chi-squared (χ 2) test, and unweighted multivariate logistic regression was used to assess factors associated with STI prevalence. Results: RDS-adjusted prevalence rates of at least one of the five STIs, chlamydia, gonorrhoea, Mycoplasma genitalium infection, trichomoniasis and latent syphilis were 58.8%, 51.0%, 11.3%, 6.0%, 1.5% and 0.7%, respectively. Factors independently associated with STI prevalence were inconsistent condom use (adjusted odds ratio (AOR) = 1.89, 95% confidence interval (CI): 1.03–3.47, P = 0.038) and the last sex partner being a regular partner (AOR = 2.35, 95% CI: 1.12–4.92, P = 0.023). Conclusion: STI prevalence among TSMSM in Nairobi, Kenya, is disturbingly high, demonstrating urgent need for tailored testing, treatment and prevention interventions for this population. Young gay, bisexual and other men who have sex with men (YMSM) are disproportionately affected by sexually transmitted infections (STIs). Our study tested and found that more than half of the sampled 248 college and university YMSM in Nairobi, Kenya, had at least one of five curable STIs. There is thus need for concerted efforts to address the high burden of STIs in this population. [ABSTRACT FROM AUTHOR]

Background: In sub‐Saharan Africa, adult outpatients with symptoms of acute infectious illness are not routinely tested for prevalent or acute HIV infection (AHI) when seeking healthcare. Methods: Adult symptomatic outpatients aged 18–39 years were evaluated by a consensus AHI risk score. Patients with a risk score ≥ 2 and no previous HIV diagnosis were enrolled in a stepped‐wedge trial of opt‐out delivery of point‐of‐care (POC) HIV‐1 nucleic acid testing (NAAT), compared with standard provider‐initiated HIV testing using rapid tests in the observation period. The primary outcome was the number of new diagnoses in each study period. Generalized estimating equations with a log‐binomial link and robust variance estimates were used to account for clustering by health facility. The trial is registered with ClinicalTrials.gov NCT03508908. Results: Between 2017 and 2020, 13 (0.9%) out of 1374 participants in the observation period and 37 (2.5%) out of 1500 participants in the intervention period were diagnosed with HIV infection. Of the 37 newly diagnosed cases in the intervention period, two (5.4%) had AHI. Participants in the opt‐out intervention had a two‐fold greater odds of being diagnosed with HIV (odds ratio = 2.2, 95% confidence interval: 1.39–3.51) after adjustment for factors imbalanced across study periods. Conclusions: Among symptomatic adults aged 18–39 years targeted by our POC NAAT intervention, we identified one chronic HIV infection for every 40 patients and one AHI patient for every 750 patients tested. Although AHI yield was low in this population, routinely offered opt‐out testing could diagnose twice as many patients as an approach relying on provider discretion. [ABSTRACT FROM AUTHOR]