O diagnóstico do HIV na atenção primária à saúde: uma revisão realista / HIV diagnosis in primary health care: a realistic review / El diagnóstico de VIH en atención primaria de salud: una revisión realista

É fundamental a identificação e a compreensão das estratégias empregadas na atenção primária à saúde para a oferta do diagnóstico do vírus da imunodeficiência humana (HIV), de modo a possibilitar o planejamento de políticas que promovam o início oportuno da terapia antirretroviral para garantir uma melhor qualidade de vida às pessoas que vivem com HIV. Desse modo, o estudo objetivou elaborar preceitos teóricos a partir das evidências científicas acerca das estratégias para a oferta do diagnóstico do HIV na atenção primária. Trata-se de uma revisão realista, realizada a partir de levantamento conduzido em seis bases de dados no ano de 2022, que teve como questão norteadora: quais são as estratégias para a oferta do diagnóstico da infecção pelo HIV na atenção primária à saúde? Foram incluídos oito estudos. No que se refere a estratégias empregadas e público-alvo, observou-se o predomínio de testes de rotina (n = 5) nas unidades básicas de saúde para a população adscrita, sem especificação de idade e/ou grupo (n = 4). A partir disso emergiu o seguinte preceito teórico: estratégias para a oferta de testes de HIV na atenção primária à saúde, com abordagens holísticas, pautadas na relação profissional-usuário e em condições rotineiras apresentam melhor receptividade pela população adscrita e contribuem para a redução do estigma associado. Sugere-se, assim, que as ações de testagem de HIV valorizem práticas integrais ao usuário em suas consultas de rotina e sejam livres de discriminação e julgamento, a fim de que o estigma associado à infecção deixe de ser um fator limitador para a testagem.

It is essential to identify and understand the strategies employed in primary health care to offer diagnosis of human immunodeficiency virus (HIV), to enable the planning of policies that promote the timely initiation of antiretroviral therapy to guarantee a better quality of life for people who live with HIV. Thus, the study aimed to develop theoretical precepts based on scientific evidence about strategies for offering HIV diagnosis in Primary Care. This is a realistic review, carried out from a screening in six databases in the year 2022, which had as its guiding question: what are the strategies for offering the diagnosis of HIV infection in primary health care?. A total of eight studies were included. Regarding the strategies employed and the target audience, there was a predominance of routine tests (n = 5) in basic health units for the enrolled population, without specifying age and/or group (n = 4). From this, the following theoretical precept emerged: strategies for offering HIV tests in primary health care, with holistic approaches, based on the professional-user relationship and under routine conditions show more receptivity of the enrolled population and contribute to reduce the associated stigma. It is suggested, therefore, that HIV testing actions should value integral practices for the user in their routine consultations and be free of discrimination and judgments, so that the stigma associated with the infection ceases to be a limiting factor for testing.

Es fundamental identificar y comprender las estrategias empleadas en la atención primaria de salud para ofrecer el diagnóstico del virus de la inmunodeficiencia humana (VIH), con el fin de posibilitar la planificación de políticas que promuevan el inicio oportuno de la terapia antirretroviral y, así, garantizar una mejor calidad de vida a las personas que viven con el VIH. Así, este estudio tuvo como objetivo desarrollar preceptos teóricos basados en evidencia científica sobre estrategias para ofrecer el diagnóstico de VIH en la atención primaria. Se trata de una revisión realista, realizada en seis bases de datos en el año 2022, que se basó en la siguiente pregunta orientadora: ¿Cuáles son las estrategias para ofrecer el diagnóstico de infección por VIH en la atención primaria de salud? Se incluyeron ocho estudios. En cuanto a las estrategias empleadas y el público objetivo, hubo predominio de las pruebas de rutina (n = 5) en las unidades básicas de salud para la población en estudio, sin precisar edad y/o grupo (n = 4). De allí surgió el siguiente precepto teórico: las estrategias de oferta de pruebas de VIH en la atención primaria de salud, con enfoques holísticos, basadas en la relación profesional-usuario y en condiciones de rutina son más receptivas a la población inscrita y contribuyen a la reducción del estigma asociado. Se recomienda, por tanto, que las acciones de prueba del VIH deben valorar prácticas integrales para el usuario en sus consultas de rutina y estar libres de discriminación y juicios, para que el estigma asociado a la infección deje de ser un factor limitante para la prueba.

Aceitabilidade ao autoteste de HIV entre adolescentes Homens que fazem Sexo com Homens, travestis e mulheres transexuais em três capitais brasileiras / Acceptability of HIV self-test among adolescent Men who have Sex with Men, travestis and transgender women in Brazil

RESUMO Introdução: O objetivo deste estudo é analisar a aceitabilidade do autoteste de HIV entre adolescentes Homens que fazem Sexo com Homens e mulheres travestis e transexuais em três capitais brasileiras. Método: estudo qualitativo, com 6 Grupos Focais e 37 Entrevistas em profundidade, envolvendo 58 participantes, nas cidades de Belo Horizonte, Salvador e São Paulo, cuja análise temática de conteúdo orientou-se pelo Theoretical Framework of Acceptability. Resultados: boa aceitabilidade do autoteste de HIV, ainda que não homogênea entre participantes. Entre os aspectos positivos dos testes estão, por exemplo, a agilidade, a privacidade, a autonomia no monitoramento da própria saúde e a gestão emocional e de estigma. Em outra direção tem-se a preocupação em como lidar com um eventual resultado reagente e o questionamento do autoteste como estratégia de prevenção. O local de dispensação do autoteste é decisivo para potencializar ou não o uso, a depender da competência cultural para acolher a diversidade sexual e de identidade de gênero de adolescentes. Conclusão: Este estudo identificou o autoteste de HIV como uma estratégia fundamental para o incremento da autonomia e autocuidado entre adolescentes. Estas devem ser consideradas para maior adequação às culturas juvenis locais e, consequentemente, maior adesão à testagem.

ABSTRACT Introduction: The objective of this study is to analyze the acceptability of the HIV self-test among male adolescents who have sex with male and transgender women in three Brazilian capitals. Method: qualitative study, with 6 focus groups and 37 in-depth interviews with 58 participants, from the cities of Belo Horizonte, Salvador and São Paulo, whose thematic analysis was based on the Theoretical Framework of Acceptability. Results: the HIV self-test had good acceptability, although it was not homogeneous among participating adolescents. Positive aspects include, for example, agility, privacy, autonomy, monitoring one's health, and emotional and stigma management. In another direction are concerns about how to deal with an eventual reactive result and whether self-testing is a prevention strategy. The place where self-tests are given out is decisive to improving their use, which depends on cultural competence to accommodate sexual and gender diversities of adolescents. Conclusion: This study has shown that HIV self-testing is a fundamental strategy to increase adolescent autonomy and self-care. These should be considered to better adapt the test to local youth cultures and, consequently, achieve better compliance.

Analysis of combined prevention measures on HIV/AIDS incidence in Brazil (1980-2020) / Análise de medidas de prevenção combinadas sobre a incidência de HIV/AIDS no Brasil (1980­2020)

Introduction: The Human Immunodeficiency Virus (HIV) attacks the immune system, with acquired immunodeficiency syndrome (AIDS) being the most advanced clinical manifestation. Prevention strategies have evolved over time in response to scientific advancements. From an institutional perspective, the Unified Health System (SUS) provides tools for Combined Prevention to the entire Brazilian population, universally and free of charge. However, despite therapeutic advances, HIV/AIDS remains a significant public health problem. Objective: To analyze the impact of Combined Prevention measures on the incidence of HIV/AIDS in Brazil from 1980 to 2020. Methods: Quantitative, observational, longitudinal, and retrospective study. Descriptive and multivariate analyses were conducted, specifically employing linear regression techniques. The variables of interest included case incidence and the distribution of: tests for sexually transmitted infections (STIs), condoms, post-exposure prophylaxis for HIV (PEP), and pre-exposure prophylaxis for HIV (PrEP). Publicly available data were sourced from governmental repositories. Results: The country has accumulated 1,037,878 infection cases, with an average of 25,947 new cases per year. Regarding prophylaxis inputs, five out of six variables demonstrated a negative correlation with the incidence rate, with only the distribution of male condoms showing a positive correlation. The analysis of the effect of PrEP was not statistically significant. Conclusion:Brazil has reduced the incidence of the disease as Combined Prevention measures have advanced. More time is needed to assess the impact of PrEP on the incidence of new cases.

Introdução: O vírus da imunodeficiência humana (HIV) ataca o sistema imunológico. A síndrome da imunodeficiência adquirida (AIDS) é a manifestação clínica mais avançada. As estratégias de prevenção evoluíram ao longo do tempo conforme os avanços científicos. Do ponto de vista institucional, o Sistema Único de Saúde (SUS) disponibiliza ferramentas de prevenção combinada a toda a população brasileira de forma gratuita e universal. Contudo, apesar de todos os avanços terapêuticos, o HIV/AIDS continua sendo um grave problema de saúde pública. Objetivo: Analisar as medidas de prevenção combinada sobre a incidência de HIV/AIDS no Brasil no período entre 1980 e 2020. Métodos: Quantitativo, observacional, longitudinal e retrospectivo. Estatisticamente, foram realizadas análises descritiva e multivariada, mais especificamente a técnica de correção linear. As variáveis de interesse foram a incidência de caso e as distribuições de: testes para infecções sexualmente transmissíveis (IST), preservativos, profilaxia pós-exposição sexual ao HIV (PEP) e a profilaxia pré-exposição ao HIV (PrEP). Os dados utilizados são de caráter público e obtidos em repositórios governamentais. Resultados: O país acumula 1.037.878 casos de infecção, com média de 25.947 novos casos por ano. Quanto aos insumos de profilaxia, cinco das seis variáveis demonstraram correlação negativa com a taxa de incidência. Apenas a distribuição de preservativos masculinos teve correlação positiva. A análise do efeito da PrEP não foi estatisticamente significativa. Conclusão: O Brasil tem reduzido a incidência da doença à medida que avançam as medidas de prevenção combinada. É necessário mais tempo para analisar o impacto da PrEP na incidência de novos casos

Challenges faced by the HIV testing system in low- and middle-income countries

Introduction: Determining the HIV status of some individuals remains challenging due to multidimensional factors such as flaws in diagnostic systems, technological challenges, and viral diversity. This report pinpoints challenges faced by the HIV testing system in Cameroon. Case presentation: A 53-year-old male received a positive HIV result by a rapid testing algorithm in July 2016. Not convinced of his HIV status, he requested additional tests. In February 2017, he received a positive result using ImmunoComb® II HIV 1 & 2 BiSpot and Roche cobas electrochemiluminescence assays. A sample sent to France in April 2017 was positive on the Bio-Rad GenScreen™ HIV 1/2, but serotyping was indeterminate, and viral load was < 20 copies/mL. The Roche electrochemiluminescence immunoassay and INNO-LIA HIV I/II Score were negative for samples collected in 2018. A sample collected in July 2019 and tested with VIDAS® HIV Duo Ultra enzyme-linked fluorescent assay and Geenius™ HIV 1/2 Confirmatory Assay was positive, but negative with Western blot; CD4 count was 1380 cells/mm3 and HIV proviral DNA tested in France was 'target-not-detected'. Some rapid tests were still positive in 2020 and 2021. Serotyping remained indeterminate, and viral load was 'target-not-detected'. There were no self-reported exposure to HIV risk factors, and his wife was HIV-seronegative.Management and outcome: Given that the patient remained asymptomatic with no evidence of viral replication, no antiretroviral therapy was initiated. Conclusion: This case highlights the struggles faced by some individuals in confirming their HIV status and the need to update existing technologies and develop an algorithm for managing exceptional cases.

Validation of HIV risk screening tool to identify infected adults and adolescents greater than 14 years at community level in Tanzania and Zambia

Introduction: There are several risk factors being used to identify undiagnosed HIV-infected adults. As the number of undiagnosed people gets less and less, it is important to know if existing risk factors and risk assessment tools are valid for use. Methods: Data from the Tanzania and Zambia Population-Based HIV Impact Assessment (PHIA) household surveys which were conducted during 2016 was used. We first included 12 risk factors (being divorced, separated or widowed; having an HIV+ spouse; having one of the following within 12-months of the survey: paid work, slept away from home for ≥1-month, having multiple sexual partners, clients of sex workers, sexually transmitted infection, being tuberculosis suspect, being very sick for ≥3-months; ever sold sex; diagnosed with cervical cancer; and had TB disease into a risk assessment tool and assessed its validity by comparing it against HIV test result. Sensitivity, specificity and predictive value of the tool were assessed. Receiver Operating Characteristic (ROC) curve comparison statistics was also used to determine which risk assessment tool was better. Results: HIV prevalence was 2.3% (2.0%-2.6%) (n=14,820). For the tool containing all risk factors, HIV prevalence was 1.0% when none of the risk factors were present (Score 0) compared to 3.2% when at least one factor (Score ≥1) was present and 8.0% when ≥4 risk factors were present. Sensitivity, specificity, PPV, and NPV were 82.3% (78.6%-85.9%), 41.9%(41.1%-42.7%), 3.2%(2.8%-3.6%), and 99.0%(98.8%-99.3%), respectively. The use of a tool containing conventional risk factors (all except those related with working and sleeping away) was found to have higher AUC (0.65 vs 0.61) compared to the use of all risk factors (p value <0.001). Conclusions: The use of a screening tool containing conventional risk factors improved HIV testing yield compared to doing universal testing. Prioritizing people who fulfill multiple risk factors should be explored further to improve HIV testing yield.

Prevalence of HIV seropositivity and associated factors among the spouses of HIV/AIDS patients in Shanghai， 2018‒2022 / 上海预防医学

ObjectiveTo analyze the HIV infection characteristics and influencing factors among the spouses of HIV/AIDS patients in Shanghai. MethodsA cross-sectional survey was conducted to collect demographic， behavioral， epidemiological and spousal HIV detection information of newly reported and married patients with HIV/AIDS in Shanghai from January 2018 to July 2022 in the comprehensive HIV prevention and control information system of Chinese Center for Disease Prevention and Control. Descriptive analysis was used to analyze the HIV positivity rate of the spouses of HIV patients and the influencing factors were analyzed by univariate and multivariate logistic regression models. ResultsA total of 1 233 subjects were investigated， and the first HIV-testing positivity rate of the spouses of HIV/AIDS patients was 29.3% （361/1 233）. There were statistically significant differences in the HIV-testing positivity rate among spouses of HIV/AIDS patients by different age， gender， education level， occupation， transmission route， quantity of non-marital sexual activities， quantity of homo-sexual activities， and baseline CD4 cell count level （P<0.05）. Spouses of the HIV/AIDS patients aged ≥65 years old， female， heterosexual transmission， less non-marital sex， and no history of homosexual sex had relatively high HIV positive rate. The HIV-positive detection rate of spouses in the ≥65 age group was 1.81 times higher than that in the <45 age group. The HIV-positive detection rate of spouses in the female group was 3.66 times higher than that in the male group， and the HIV-positive detection rate of spouses in the homosexual transmission group was 0.25 times higher than that of the heterosexual transmission group. ConclusionRisk awareness of HIV infection among married people with spouses should be improved. The key populations with the characteristics such as females as the first HIV-positive reporter， and heterosexual transmission should be paid special attention.Their spouses should be mobilized to conduct HIV-testing as early as possible

Oral HIV self-testing among men who have sex with men in New Delhi, India: Perceptions & apprehensions: A qualitative study

Background & objectives: The overall adult prevalence of HIV in India was estimated to be 0.22 per cent in 2019. The HIV prevalence among men who have sex with men (MSM), a high-risk group for HIV, was estimated to be 4.3 per cent, which is 16 times higher than the national average. In Delhi, the estimated prevalence among MSM was 1.8 per cent. Despite free HIV testing services being made available by the National AIDS Control Programme for more than two decades, many MSM were not aware about their HIV status. Therefore, newer testing strategies are needed. Oral HIV self-testing (HIVST) has proved to be one such promising innovation. At present, there are no programme guidelines on HIVST and oral HIVST kit is not available in India. The aim of this study was to understand the perceived advantages and disadvantages of introduction of oral HIVST strategy among MSM. Methods: MSM who were registered with the selected non-governmental organizations working as targeted intervention sites in Delhi, India, were recruited for focus group discussions (FGDs) between January and May 2021. For the purpose of this study, MSM were defined as males who had anal/oral sex with male/hijra partner in the past one month. A total of six FGDs were conducted using a prepared FGD guide. The FGD guide included questions on problems faced during conventional HIV testing, participants’ awareness, acceptability and perceptions of oral HIVST. The data were manually coded and entered in NVivo release 1.5 and themes were identified. Results: A total of 67 respondents participated in the FGDs. A total of 28.4 per cent MSM were beggars at traffic lights, 12 per cent were sex workers and 11.9 per cent were bar/event dancers. Nearly half (50.7%) of the participants had undergone HIV testing less than twice in the preceding one year. None of the MSM were aware about oral HIVST. Perceived advantages of oral HIVST were ease of use, confidentiality and the non-invasive pain-free procedure. Perceived concerns included lack of post-test counselling, linkage to care, poor mental health outcomes and forced testing. Interpretation & conclusions: Most MSM had positive perceptions about oral HIVST. Therefore, it is likely that the introduction of oral HIVST may result in higher uptake of HIV testing among MSM

Encuesta en línea de comportamiento sexual y prácticas de prevención del virus de inmunodeficiencia humana en varones gais y hombres que tienen sexo con hombres en Uruguay / Web-based survey on sexual behavior and HIV prevention practices in gay men and men who have sex with men in Uruguay / Pesquisa online de comportamento sexual e práticas de prevenção do Vírus da Imunodeficiência Humana em gays e homens que fazem sexo com homens no Uruguai

Resumen: Introducción: por ser los varones gais y los hombres que tienen sexo con hombres (HSH) una población con mayor incidencia de virus de inmunodeficiencia humana (VIH), ONUSIDA recomienda el monitoreo periódico mediante encuestas que releven información para reportar indicadores de prevención. La implementación de estos estudios en nuestro medio es limitada debido a la complejidad y costos de las metodologías tradicionales. Objetivo: generar información actualizada sobre prevención del VIH, con énfasis en uso de condón y realización de pruebas de tamizaje en gais/HSH de 15 a 49 años en Uruguay, implementando una estrategia metodológica innovadora. Material y método: estudio de corte transversal y analítico, en base a una encuesta online disponible entre octubre y diciembre de 2019. Resultados: se incluyeron 693 varones, 67% de Montevideo y 67% con nivel educativo terciario. Un 17% fue forzado a mantener relaciones sexuales alguna vez, 20% sufrió maltrato por su orientación y 68,4% ocultaba su orientación sexoafectiva en algún grado. Un 57,2% usó condón en la última relación sexual anal casual, observándose un descenso respecto al año 2012 (67,6%), mientras que la tendencia en la cobertura de prueba de VIH (66%) fue creciente comparada con estudios previos. La proporción de positividad de VIH fue de 13,3%. El análisis multivariado mostró que la menor probabilidad de uso de condón se asocia a: pareja estable en el último año, autoidentificación gay, prueba de VIH en el último año y vacunación para virus papiloma humano. La mayor probabilidad de uso se asoció a: participación en actividades de información, relaciones sexuales con personas con ITS/VIH. La menor probabilidad de realización de prueba de VIH se asoció con pareja estable y la mayor con el conocimiento de lugares de acceso a prueba y conocimiento de la profilaxis posexposición. Entre quienes conocían la profilaxis preexposición (375), 46,1% estaba dispuesto a recibirla y 1,3% había accedido. Conclusiones: la persistencia de situaciones de discriminación y violencia hacia varones gais/HSH necesita acciones más efectivas de promoción de derechos. Es necesario integrar innovaciones biomédicas en prevención que se complementen y potencien para el control de la epidemia. El uso de una encuesta en línea fue eficiente en el reclutamiento, aunque con sesgos en la selección, lo que desafía a mejorar esta estrategia metodológica.

Summary: Introduction: as gay men and men who have sex with men (MSM) constitute a population with a greater incidence of HIV, UNAIDS recommends regular surveillance by means of surveys that provide information that allows reporting prevention indicators. The implementation of these studies is limited in our context given the high complexity and costs of traditional methodologies. Objectives: to generate updated information about HIV prevention, with an emphasis on condom use and to implement screening tests in gay/MSM population between 15 and 49 years old in Uruguay, using an innovative methodological strategy. Method: transversal, analytical study by means of a web-based survey available between October and December 2019. Results: 693 men were included in the study, 67% from Montevideo and 67% of which had university studies. 17% of them had been forced to have sex in the past, 20% had suffered abuse because of their sexual orientation and 68.4% concealed their sex-affective orientation to some extent. 57.2% used condoms in their last casual anal sexual relationship, what evidences a decrease with regard to 2012 (67.6%), whereas a growing tendency in the HIV test coverage (66%) was observed, when compared to previous studies. HIV positivity rate was 13.3%. The multivariate analysis revealed a lower probability of condom use was associated to: a stable partner in the last year, gay self-identification, HIV test in the last year and having the HPV vaccine. The greater likelihood of use was associated to: participating in informative activities, having sex with people with STD/HIV. The lowest probability of having an HIV test was associated to a stable partner and the highest was associated to knowing where they could get tested for HIV and also knowing about the post-exposure prophylaxis. When considering those who knew about the pre-exposure prophylaxis (375), 46.1% was willing to receive it and 1.3% had agreed to it. Conclusions: the continuation of discrimination and violence towards gay men and MSM needs more effective right promoting actions. We need to integrate into prevention biomedical innovations that complement and leverage one another. The web-based survey was effective in terms of recruiting, although there were bias in the selection, what results challenging to improve the methodological strategy.

Resumo: Introdução: como gays e homens que fazem sexo com homens (HSH) são uma população com maior incidência de HIV, o UNAIDS recomenda o monitoramento regular por meio de pesquisas que coletem informações para calcular indicadores de prevenção. A implementação desses estudos em nosso ambiente é limitada devido à complexidade e custo das metodologias tradicionais. Objetivo: gerar informações atualizadas sobre prevenção do HIV, com ênfase no uso de preservativos e testes de triagem em gays/HSH de 15 a 49 anos no Uruguai, implementando uma estratégia metodológica inovadora. Método: estudo transversal e analítico, baseado em questionário online disponível entre outubro e dezembro de 2019. Resultados: foram incluídos 693 homens, 67% de Montevidéu e 67% com nível superior. 17% foram obrigados a ter relações sexuais em algum momento, 20% sofreram maus-tratos devido à sua orientação e 68,4% ocultaram sua orientação sexual-afetiva em algum grau. 57,2% usaram preservativo na última relação anal casual, mostrando um decréscimo em relação a 2012 (67,6%), enquanto a tendência da cobertura do teste anti-HIV (66%) foi de aumento em relação a estudos anteriores. A taxa de positividade do HIV foi de 13,3%. A análise multivariada mostrou menor probabilidade de uso de preservativo associado a: parceiro estável no último ano, autoidentificação gay, teste de HIV no último ano e vacinação para papiloma vírus humano. A maior probabilidade de uso esteve associada a: participação em atividades informativas, relações sexuais com pessoas com IST/HIV. A menor probabilidade de realização do teste anti-HIV foi associada ao parceiro estável e a maior ao conhecimento dos locais de acesso ao teste e conhecimento da profilaxia pós-exposição. Entre os que conheciam a profilaxia pré-exposição (375), 46,1% estavam dispostos a recebê-la, 1,3% já haviam recebido. Conclusões: a persistência de situações de discriminação e violência contra gays/HSH requer ações mais efetivas de promoção de direitos. É necessário integrar inovações biomédicas na prevenção que se complementem e se fortaleçam para o controle da epidemia. A utilização de uma pesquisa online foi eficiente no recrutamento, embora com vieses de seleção, o que desafia a melhorar essa estratégia metodológica.

Factors influencing HIV testing and counselling services among men who have sex with men in Western China: a cross-sectional study based on Andersen's Behavioral Model

BACKGROUND@#Men who have sex with men (MSM), as a marginal population, has been largely ignored by health service projects. We assessed the utilization of HIV testing and counselling services and its influencing factors based on Andersen's Behavioral Model, so as to provide a theoretical basis for future infectious disease prevention and control strategies and health services policy formulation for these population.@*METHOD@#This was a cross-sectional study. A sample survey was conducted in Western China, and an anonymous self-administered questionnaire survey was conducted among MSM. Based on Andersen's Behavioral Model, the questionnaire divided the influencing factors into predisposing factor, enabling factor and need factor. Multivariate logistic regression analysis was used to explore the factors influencing the utilization of HIV testing and counselling.@*RESULTS@#There were 3184 valid questionnaires. In the survey of HIV health services, 82.85% MSM had HIV testing and 64.98% MSM had HIV counselling, respectively. Among the predisposing factor, age 25 years old and over was a facilitator of HIV testing and counselling, and ethnicity was a factor associated with HIV testing. Among the enabling factor, MSM living in urban were more likely to have access to testing and counselling services, and income was also linked to HIV testing. Among the need factor, a high level of HIV knowledge could promote testing and counselling, and a history of sexually transmitted diseases (STD) was a facilitator of testing.@*CONCLUSIONS@#HIV testing is widespread in Western China and higher than counselling service. MSM with high-risk characteristics should be identified as a priority in the future public health services.

Evaluation for the performance of HIV Ag/Ab assay based on ECLIA in blood screening / 中国输血杂志

【Objective】 To evaluate the performance of electrochemiluminescence immunoassay (ECLIA) in detecting HIV antigen/antibody in blood screening. 【Methods】 A total of 128 donors, reactive to anti-HIV(ELISA)testing, from September 2016 to September 2020 were enrolled, and seven samples were reactive to double anti-HIV reagents, among which 6 were confirmed by WB, 1 confirmed by NAT as negative.Two group of donors, reactive to solo anti-HIV reagent but being confirmed negative by WB(n=121) vs.randomly selected donors non-reactive to ELISA + NAT(June to September 2020, n=1360), were subjected to HIV antigen/antibody testing using ECLIA to compare the testing results, including concordance rate, sensitivity and specificity. 【Results】 The ECLIA results remained non-reactive for 1360 samples initially non-reactive to both ELISA and NAT.The concordance rate of anti-HIV reactivity by ECLIA and ELISA+ WB were 100%(6/6). For 122 samples, reactive to ELISA anti-HIV testing but nonreactive to confirmatory testing, 4(3.28%)of them were reactive to HIV antigen/antibody testing and 118(96.72%) nonreactive, with the concordance rate of ECLIA and ELISA at 96.88%(124/128). The sensitivity, specificity and false positive rate of ECLIA and ELISA were 100% vs 100%, 99.73% vs 91.77%, and 0.27% vs 8.23%, respectively. 【Conclusion】 ECLIA for HIV antigen/antibody detection has good sensitivity and specificity, which can meet the requirements of blood screening, and the false positive rate is lower than that of ELISA, adopted commonly in blood bank at present.

Adaptação cultural e validação da The Barriers to HIV testing scale-Karolinska version para homens brasileiros que fazem sexo com outros homens / Cultural adaptation and validation of The Barriers to HIV testing scale-Karolinska version for Brazilian men who have sex with other men

Introdução: A infecção causada pelo HIV afeta de forma desigual homens que fazem sexo com homens (HSH) em comparação com a população geral. O teste anti-HIV é uma estratégia importante de acompanhamento da saúde sexual desses homens e as recomendações indicam que este deve ser feito anualmente para aqueles com vida sexual ativa. Entretanto, há barreiras que podem dificultar o acesso à testagem e,no Brasil, ainda não há escalas para identificar e mensurar tais obstáculos. Objetivo: O objetivo principal desta tese foi realizar adaptação cultural e validação da The Barriers to HIV testing scale-Karolinska version para homens brasileiros que fazem sexo com outros homens. Método: Estudo metodológico para adaptação cultural e validação da The Barriers to HIV testing scale-Karolinska version para homens brasileiros que fazem sexo com outros homens. Essa escala possui 18 itens, três opções de respostas e quatro fatores e possibilita a identificação de diferentes barreiras à testagem anti-HIV. As seguintes etapas foram seguidas para o processo de adaptação cultural e validação: tradução; comitê de juízes; retrotradução (back-translation); análise semântica; pré-teste e avaliação das propriedades psicométricas. A escala foi pré-testada (53 pessoas) e, depois, aplicada a 1290 homens que fazem sexo com homens. O instrumento foi disponibilizado por viasonline em redes sociais e em sites de relacionamento, entre Abril e Maio de 2020. Foram realizadas análises de confiabilidade, análise fatorial exploratória, análise fatorial confirmatória, e testes de validade convergente e discriminante. Os dados foram analisados por meio do software SPSS versão 20.0, com apoiono pacote AMOS para realização da análise fatorial confirmatória. Os aspectos éticos foram contemplados. Resultados: A confiabilidade geral da escala pelo Alfa de Cronbach foi de 0,89. Foram extraídos quatro fatores na análise fatorial exploratória: F1 - Consequências pessoais; F2 - Barreiras estruturais; F3 - Confidencialidade e F4 - Consequências econômicas e preocupações individuais. A estrutura fatorial da escala foi confirmada e o modelo final obtido na análise fatorial confirmatória apresentou bons índices de ajuste: (X²)/GL (2,71); GFI (0,94); RMSEA (0,05); TLI (0,94); NFI (0,93); IFI (0,95); CFI (0,95). A validade convergente foi avaliada pela Confiabilidade Composta (CC) e os resultados foram maiores que 0,7 para os quatro fatores: Fator 1 (0,87); Fator 2 (0,75); Fator 3 (0,77) e Fator 4 (0,73). A validade discriminante foi verificada a partir do critério Heterotrait-Monotrait Ratioof Correlations (HTMT) e todos os resultados foram inferiores a 0,85. Conclusão: A versão adaptada da escalaapresentou confiabilidade e validade satisfatórias para avaliar barreiras ao teste anti-HIV entre HSH e, deste modo, recomenda-se sua aplicação em pesquisas futuras, continuando a verificação de suas propriedades e dimensões, e em ambientes prestadores de serviços de saúde que forneçam testagem anti-HIV para verificações de barreiras a esta, conforme indicação de sua finalidade.

Introduction: HIV infection unevenly affects men who have sex with men (MSM) compared to the general population. The HIV test is an important strategy for monitoring these men's sexual health, and the recommendations indicate that it should be done annually for those with an active sex life. However, some barriers can hinder access to testing, and, in Brazil, there are still no scales to identify and measure such obstacles. Objective: This thesis's main objective was to perform cultural adaptation and validation of The Barriers to HIV testing scale-Karolinska version for Brazilian men who have sex with other men. Method: Methodological study for cultural adaptation and validation of The Barriers to HIV testing scale-Karolinska version for Brazilian men who have sex with other men. This scale has 18 items, three answer options, and four factors and allows identifying different barriers to HIV testing. The following steps were followed for the process of cultural adaptation and validation: translation; committee of judges; back-translation; semantic analysis; pre-test and evaluation of psychometric properties. The scale was pre-tested (53 people) and then applied to 1290 men who have sex with men. The instrument was made available online via social networks and social networking sites between April and May 2020. Reliability analyzes, exploratory factor analysis, confirmatory factor analysis, and convergent and discriminant validity tests were performed. The data were analyzed using SPSS software version 20.0, supported by the AMOS package to carry out confirmatory factor analysis. Ethical aspects were considered. Results: The general reliability of the scale by Cronbach's alpha was 0.89. Four factors were extracted in the exploratory factor analysis: F1 - Personal consequences; F2 - Structural barriers; F3 - Confidentiality and F4 - Economic consequences and individual concerns. The factorial structure of the scale was confirmed and the final model obtained in the confirmatory factor analysis showed good adjustment rates: (X²) / GL (2.71); GFI (0.94); RMSEA (0.05); TLI (0.94); NFI (0.93); IFI (0.95); CFI (0.95). Convergent validity was assessed by Composite Reliability (CC) and the results were greater than 0.7 for the four factors: Factor 1 (0.87); Factor 2 (0.75); Factor 3 (0.77) and Factor 4 (0.73). The discriminant validity was verified using the Heterotrait-Monotrait Ratio of Correlations (HTMT) criteria, and all results were less than 0.85. Conclusion: The adapted version of the scale showed satisfactory reliability and validity to assess barriers to anti-HIV testing among MSM and, therefore, its application in future research is recommended, continuing to verify its properties and dimensions, and in environments providing health services that provide anti-HIV testing to check for barriers to it, as indicated by its purpose.

Utilization of facility-based HIV testing and associated factors among men who have sex with men in Shanghai / 上海预防医学

Objective:To determine the prevalence of facility-based HIV testing and its associated factors among men who have sex with men （MSM） in Shanghai. Methods:From June 2018 to December 2020， MSM were recruited by a community organization “Shanghai CSW&MSM Center （SCMC）”. A total of 3 251 MSM were included as follows： being 18 years old and above， being HIV-negative or with unknown HIV status， living in Shanghai， had homosexual behavior in the past year， and completed informed consent. Using a self-designed questionnaire， we performed an online survey powered by www.wjx.cn to collect information on demographics， sexual behavior， and facility-based HIV testing. A total of 3 240 valid questionnaires were collected. Univariate and multivariate logistic regression were used to determine the factors associated with facility-based HIV testing. Results:A total of 3 240 MSM participated in the study with mean age of （29.7±6.2） years .The prevalence of facility-based HIV testing was 63.2% （2 049/3 240）， Multivariate logistic regression showed that the participants with a college degree or above were less likely to have facility-based HIV testing（OR=0.73，P=0.008）， compared to those with lower educational background. The proportion of the MSM who sought sexual partners through the internet received facility-based testing was 68.7%. Compared to the participants with the sexual role being 0 （only be penetrated）， those being 0.5 （both penetrated and be penetrated） and 1 （only penetrated） were both more likely to have the HIV testing （both P<0.05）. Those who used condoms during the last homosexual behavior were more likely to be tested than those who did not （OR=1.39， P=0.001）. Those who had been diagnosed with sexually transmitted diseases were more likely to be tested than those who did not （OR=2.05， P<0.001）. The participants who had used HIV self-testing kits in the past were more likely to be tested than those who did not （OR=2.31， P<0.001）. Conclusion:MSM in Shanghai have lower utilization of facility-based HIV testing， which may be improved by strengthening the advocacy of facility-based HIV testing services through the internet and peer education， and innovating service models.

Barriers to Effective HIV Testing Services and Strategies for Its Promotion at the Primary Health Care Facilities in Ibadan, Nigeria

Background:HIV testing services (HTS) act as a critical entry point to HIV care, treatment and prevention services, and offer the opportunity for specially-trained health care providers to encourage avoidance of high risk sexual behaviour among both HIV negative andHIV-positive individuals. However,there aresome challenges that can hinder effective delivery ofHIV Counseling and Testingservices by health care providers. This studywastherefore designed to investigate barriers to effective HIV testing services and strategies for its promotion at the primary health care facilities in Ibadan.Methods: This descriptive cross-sectional study was carried out among health care providers in primary health care facilities in five local government areas in Ibadan metropolis, Nigeria. A 4-stage sampling techniques was used to select 19 respondents and interviewed using key informan interview guide. Interviews were transcribed verbatim. Spot check of transcripts wereconducted to ensure completeness of the transcription. Thedata were sorted, categorized, and analyzed using a qualitative data analysis computer software package (NVivo). Results: All the respondents interviewed reported that,there were pre and post-tests counseling including HIV testing services in their facilities. Some respondents added there were laboratory services and linkages to other care and support services for those tested positive to HIV. However, most of the respondents reported insufficient consumables, insufficient staff, no privacy, lack of infrastructures as barriers to effective HIV testing services. Many of the respondents recommended community sensitization, more provision for consumables, drugs and kits as strategies for promoting HIV testing services. Conclusion: This study revealed that the primary health centres have pre-test and post-test HIV counseling services but insufficient consumables and staff were the major barriers to HIV testing services in this study. Itis therefore necessary for government to make provision for consumables and more personnel to boost the activities of the health facilities.

Psychosocial factors associated with HIV testing in Colombian university students / Factores psicosociales asociados a la realización de la prueba diagnóstica del VIH en estudiantes universitarios colombianos

Abstract The objectives of this research were: (a) to relate sexual risk, knowledge, and attitudes towards HIV testing in Colombian university students; and (b) to describe the perceived barriers in those who had not been tested, analyzing the differences according to sex. A cross-sectional study was carried out, in which 1057 Colombian university students participated. The instruments applied were the Cuestionario Confidencial Vida Sexual Activa (CCVSA, for its Spanish acronym), the tests Barreras Hacia la Prueba del VIH, Escala de Actitudes hacia el VIH-Sida and an ad hoc questionnaire on knowledge about the test. The students who were tested (n = 214) reported a lower age of sexual initiation (p < .01), a higher number of sexual partners (p = .01), and a lower use of condoms in the first (p = .02) and last (p = .04) sexual intercourse. They also reported more knowledge about HIV testing (p < .001). The main barriers were associated with low risk perception of the disease (29.8 %), trust in sexual partners (29.2 %), and lack of offer of the test (25.2 %). In conclusion, being tested for HIV is related to exposure to risky sexual behaviors and to knowledge about the test, but not to attitudes towards it. The identification of the associated psychosocial factors could contribute to the design of interventions aimed at the prevention and timely treatment of the disease.

Resumen Los objetivos de esta investigación fueron: (a) relacionar el riesgo sexual, los conocimientos y las actitudes hacia la prueba del VIH con su realización en estudiantes universitarios colombianos; y (b) describir las barreras percibidas en aquellos que no se la habían realizado, identificando las diferencias según el sexo. Se llevó a cabo un estudio transversal en el que participaron 1057 estudiantes colombianos, y en el que se utilizó el Cuestionario Confidencial sobre Vida Sexual Activa (CCVSA), el test Barreras Hacia la Prueba del VIH, la Escala de Actitudes hacia el VIH-Sida y un cuestionario ad hoc de conocimientos sobre la prueba. Los estudiantes que se realizaron la prueba (n = 214) reportaron una edad inferior de iniciación sexual (p < .01), un número superior de parejas sexuales (p = .01) y un menor uso de condón en la primera (p = .02) y la última (p = .04) relación sexual, así como mayores conocimientos sobre la prueba del VIH (p < .001). Las principales barreras estuvieron relacionadas con la baja percepción del riesgo de la enfermedad (29.8 %), la confianza en las parejas sexuales (29.2 %) y la falta de ofrecimiento de la prueba (25.2 %). En conclusión, la realización de la prueba está relacionada con la exposición a conductas sexuales de riesgo y con los conocimientos, mas no con las actitudes hacia la prueba. La identificación de los factores psicosociales vinculados podría contribuir al diseño de intervenciones orientadas a la prevención y al tratamiento oportuno de la enfermedad.

Studying prevention of parent to child transmission services, interventions, coverage and utilization

Background: Human immunodeficiency virus (HIV) infection is increasing at an alarming rate globally. Apart from heterosexual route, mother to-child transmission is the next most important route of HIV transmission accounting for over 90% of infections in children. The present retrospective study is undertaken to evaluate the effectiveness of implementation of PPTCT programmed in GMERS Medical College, Sola, Ahmedabad, Gujarat, India.Methods: At ICTCs, registered ANCs are counseled and tested for HIV. HIV+ve ANCs are linked to services and followed-up for institutional delivery. Antiretroviral prophylaxis with nevirapine was given to seropositive mother-baby pairs during delivery and children testing. HIV+ve ANCs since 2014 to 2016 subsequently delivered till December 2018 and their exposed children followed up till 18 months for confirmation of their seropositivity status in PPTCT were study at GMERS medical college, sola, Ahmedabad, Gujarat, India.Results: 13595 ANCs registered, 100% were counseled pre-test, and 99.5% of them tested, 79.5% were counseled post-test.  CD4 testing was carried out in all HIV+ve ANCs. 55 ANCs were detected HIV+ve inclusive of 37 new registered, 16 re-pregnancy and 2 unregistered cases. 55 pregnancy outcomes reported institutionally total 85.9% delivered at institute out of them 26.5% were caesarian sections and 62.4% delivered vaginally. Out of 48 live births, 47 sdNVP-MB-Pair were given. 48 children were traced till 18 months, 82.5% of live births were alive, and 68.75% of live births were tested. 1 was found HIV+ve with history of adherence to all prescribed PPTCT guidelines.Conclusions: PMTCT services - counseling and testing should be provided to all ANCs. EDD-based tracking, institutional deliveries, postnatal counseling to be encouraged along with complete MB pair coverage, capacity building of concerned staff regarding delivery of HIV+ve ANCs and exposed children tracking.

To Assess the Outcome of Pregnancy of the Women Detected as HIV Positive Cases in PPTCT Program Since its Initiation in 2005 in Umaid Hospital, Jodhpur (Rajasthan)

Background: Our study is planned to note the outcome ofpregnancy of the women detected as HIV positive in thePPTCT program as well as to have an evaluation of thePPTCT program in our institute since the initiation of thisprogramme in 2005.Materials & Methods: The present study was carried out inthe department of Obstetrics and Gynaecology, Umaid Hospitalattached to Dr. S. N. Medical College, Jodhpur. The data overthis period were analyzed. As per the strategy and policyprescribed by NACO, tests (E/R/S) were performed on theserum samples. Those found HIV positive went for confidentialpost-test information and counselling regarding throughintimation about the vertical transmission and importance oftheir institutional deliveries.Results: Our study observed that out of the total deliveredbabies of seropositive women 95.31% were live births, 3.90%were IUD babies and one was still birth. Out of the totaldelivered babies 64 i.e. 52.45% had physiological jaundice,35 i.e. 28.68% had acute diarrheal disease, 2 i.e. 1.63% hadoral thrush, 20 i.e. 16.93% had URI, 2 i.e. 1.63% had ServerSepticaemia, 9 babies i.e. 7.37 % expired in neonatal periodand another 9 expired after one month.Conclusion: PPTCT programs are feasible in Governmenthospital were resources are limited. Rural pregnant women arereceptive to voluntary counselling and testing.

HIV testing and HIV knowledge among men who have sex with men in Natal, Northeast Brazil

ABSTRACT Background: Men who have sex with men (MSM) account for the highest prevalence of HIV in Brazil. HIV testing allows to implement preventive measures, reduces transmission, morbidity, and mortality. Methods: We conducted a cross-sectional study to evaluate HIV testing during lifetime, factors associated with the decision to test, knowledge about HIV transmission, and use of condoms between MSM from the city of Natal, northeast Brazil. Results: Out of 99 participants, 62.6% had been tested for HIV during lifetime, 46.2% in the last year. The most frequent reported reason to be tested for HIV infection was curiosity (35.5%). Correct knowledge about HIV was observed in only 9.2% of participants. In multivariate analysis, age (PR 0.95; 95%CI, 0.91-0.99; p = 0.041) and previous syphilis test (PR 4.21; 95%CI, 1.52-11.70; p = 0.006) were associated with HIV testing. Conclusions: The frequency of HIV testing among MSM from Natal is rather low, especially in younger MSM, and knowledge about HIV transmission is inappropriate.

Analysis of HIV testing status and relevant factors in male sexually transmitted diseases patients in Shandong Province / 中华预防医学杂志

A survey was conducted to analyze the HIV testing status and related influencing factors of male sexually transmitted diseases(STD) patients attending 18 county-level hospitals in Shandong Province from July 2015 to August 2016. The HIV detection rate of 1 570 subjects was 77.58% (1 218/1 570), and the HIV-antibody positive rate was 0.99% (12/1 218). Compared with general hospitals patients, urinary and anorectal patients, non-sexual patients, and patients with negative attitudes toward HIV testing, patients were more likely to be tested for HIV from specialized hospitals (OR=3.74, 95%CI:2.53-5.54), the skin and venereal section (OR=1.92, 95%CI: 1.31-2.79), the STD group (OR=2.02, 95%CI: 1.34-3.03) and patients with positive attitude (OR=15.20, 95%CI:10.74-21.52).

Qualitative research on factors of HIV testing among men who have sex with men in China based on Blued / 中华预防医学杂志

Objective@#To understand the cognition and attitudes of men who have sex with men (MSM) towards HIV testing and explore in-depth reasons preventing them from testing.@*Methods@#The function of "opinion" in Blued, a gay geo-social networking application (GSN), was adopted to collect qualitative data of ideas and attitudes towards HIV testing of the users between December 2017 and January 2018. The data was analyzed based on grounded theory approach.@*Results@#28 269 Blued users participated in the activity and 1 977 posted comments. Four key themes were identified, i.e. no/low risk of contracting HIV, stigmatization of HIV testing, long-term relationship and conventional impediments of HIV testing.@*Conclusion@#The cognition and attitudes of the target population derived from the analysis of "opinion" function in Blued, such as the stigmatization of the behavior of HIV testing influencing the attitude of HIV testing, could help researchers build a more accurate detection and promotion strategy instead of a very general intervention on the public.

Individual- and contextual-level factors associated with client-initiated HIV testing / Fatores individuais e contextuais associados à realização do teste anti-HIV por busca espontânea

ABSTRACT: Background: Knowing the reasons for seeking HIV testing is central for HIV prevention. Despite the availability of free HIV counseling and testing in Brazil, coverage remains lacking. Methods: Survey of 4,760 respondents from urban areas was analyzed. Individual-level variables included sociodemographic characteristics; sexual and reproductive health; HIV/AIDS treatment knowledge and beliefs; being personally acquainted with a person with HIV/AIDS; and holding discriminatory ideas about people living with HIV. Contextual-level variables included the Human Development Index (HDI) of the municipality; prevalence of HIV/AIDS; and availability of local HIV counseling and testing (CT) services. The dependent variable was client-initiated testing. Multilevel Poisson regression models with random intercepts were used to assess associated factors. Results: Common individual-level variables among men and women included being personally acquainted with a person with HIV/AIDS and age; whereas discordant variables included those related to sexual and reproductive health and experiencing sexual violence. Among contextual-level factors, availability of CT services was variable associated with client-initiated testing among women only. The contextual-level variable "HDI of the municipality" was associated with client-initiated testing among women. Conclusion: Thus, marked gender differences in HIV testing were found, with a lack of HIV testing among married women and heterosexual men, groups that do not spontaneously seek testing.

RESUMO: Introdução: O motivo da busca pelo teste anti-HIV é questão central para a prevenção do HIV. Apesar da realização do teste e aconselhamento ser gratuito no Brasil há lacunas na cobertura do teste. Esse estudo analisou a associação entre os fatores individuais e contextuais e a realização do teste anti-HIV na população brasileira. Métodos: Inquérito populacional, com 4.760 residentes em áreas urbanas. As variáveis do nível individual foram sociodemográficas; saúde sexual e reprodutiva; conhecimento sobre HIV/AIDS; conhecer pessoas com HIV/AIDS; ideias discriminatórias sobre pessoas vivendo com HIV. As variáveis contextuais: índice de desenvolvimento humano (IDH) do município de moradia; prevalência municipal de HIV/AIDS e presença de Centro de Testagem e Aconselhamento no município de moradia (CTA). A variável dependente foi realização do teste por busca espontânea. Na análise dos fatores associados utilizou-se modelo multinível de Poisson com intercepto aleatório. Resultados: Foram observadas variáveis individuais comuns e discordantes associadas ao teste entre homens e mulheres. As variáveis individuais comuns foram o conhecimento de alguém com HIV/AIDS e idade; as discordantes incluíram as relativas à saúde sexual e reprodutiva e violência sexual. Entre os fatores do nível contextual, a presença de CTA e o IDH alto foram associados positivamente com a busca espontânea do teste somente entre as mulheres. Conclusão: A busca espontânea pelo teste anti-HIV é marcada pelas diferenças de gênero, com lacunas de testagem entre mulheres casadas e homens heterossexuais.