Self-Sampling for SARS-CoV-2 Diagnostic Testing by Using Nasal and Saliva Specimens: Protocol for Usability and Clinical Evaluation.

BACKGROUND: SARS-CoV-2 is a novel coronavirus discovered in December 2019 and is currently the cause of the global COVID-19 pandemic. A critical aspect of fighting this pandemic is to obtain accurate and timely test results so that patients who have tested positive for COVID-19 can be identified and isolated to reduce the spread of the virus. Research has shown that saliva is a promising candidate for SARS-CoV-2 diagnostics because its collection is minimally invasive and can be reliably self-administered. However, little research has been conducted on saliva testing and SARS-CoV-2 self-sampling (SARS-CoV-2SS) in Sub-Saharan Africa. OBJECTIVE: The primary objective of this study is to comparatively evaluate the clinical sensitivity and specificity of nasal and oral samples self-collected by individuals for SARS-CoV-2 testing against a reference method involving sample collection and testing by a health care professional. The secondary objectives of this study are to evaluate the usability of nasal self-sampling and saliva self-sampling as a sample collection method for SARS-CoV-2 diagnostic testing by using failure mode and error assessment. METHODS: Participants will be recruited from the general population by using various methods, Participants will be screened progressively as they present at the clinical trial sites as well as in primary health care catchment areas in the inner city of Johannesburg, South Africa. In the event that recruitment numbers are low, we will use a mobile van to recruit participants from outlying areas of Johannesburg. We aim to enroll 250 participants into this study in approximately 6 weeks. Two sample types-a self-administered nasal swab and a self-administered saliva sample-will be collected from each participant, and a health care professional will collect a third sample by using a nasopharyngeal swab (ie, the standard reference method). RESULTS: This protocol has been approved by the University of the Witwatersrand Human Research Ethics Committee on July 31, 2020 (Protocol number EzCov003). As of May 13, 2021, 120 participants have been enrolled into the study. CONCLUSIONS: SARS-CoV-2SS may offer many benefits to individuals, by allowing for initial self-identification of symptoms and collection of samples without involving third parties and potential risk of infection provided the sample can be safely processed via a collection system. The results of this study will provide preliminary data on the acceptability, feasibility, and usability of SARS-CoV-2SS among the general population for its future implementation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24811.

Socio-Cognitive Factors Associated With Lifestyle Changes in Response to the COVID-19 Epidemic in the General Population: Results From a Cross-Sectional Study in France.

BACKGROUND: The aims of the present study were to assess changes in lifestyles in the general population in response to coronavirus disease 2019 (COVID-19) lockdown and the influence of COVID-19 perceptions, as assessed by the Extended Parallel Process Model (EPPM), on these changes. METHODS: Data were collected from 4005 individuals through an online survey conducted 3-4 weeks after the nationwide lockdown implementation in France. Participants were asked whether they practiced five behaviors (i.e., screen watching, snacking, eating fruits and vegetables, exercising, and walking) less often, as often as, or more often than prior to the lockdown. Beliefs and expectations toward the COVID-19 epidemic were also assessed using an adapted version of Witte's EPPM, together with sociodemographic and environmental variables. Among the respondents consuming regularly alcohol and tobacco, logistic regressions were performed to estimate the Odds ratios (ORs) of increase (yes/no) and decrease (yes/no) in drinking and smoking since the lockdown. RESULTS: More than 8 in 10 respondents reported unhealthy changes in lifestyle since the lockdown, mostly in relation to physical activity. The unhealthy changes were positively associated with male sex (RR = 1.17; confidence interval [95% CI] = 1.10-1.24), living urban density, having a garden (RR = 1.16 [1.07-1.26]), financial difficulties because of COVID-19 (RR = 1.09 [1.02-1.18]), and lack of fear control (RR = 1.04 [1.01-1.09]) and negatively with cognitive avoidance (RR = 0.92 [0.89-0.95]). Less than 4 in 10 respondents reported healthy changes over the same period, mostly in relation to better eating habits. They were positively associated with living with more than two persons (RR = 1.22 [1.02-1.45]), having a terrace (RR = 1.14 [1.02-1.29], and perceived efficacy (RR = 1.11 [1.04-1.08]) and negatively with being aged 40 or higher. Alcohol consumption overall declined in regular drinkers, while a slight increase in tobacco use was observed in regular smokers. DISCUSSION: The COVID-19 pandemic and lockdown resulted in frequent and mostly unhealthy changes in lifestyle among the general population. These changes were related to individual and environmental characteristics but also to EPPM appraisals in the wake of fear appeal from COVID-19 campaigns. Communication and preventive measures should include messages and initiatives toward the maintenance of healthy lifestyles during pandemics such as the adaptation of physical activity and eating guidelines to the particular contexts of mobility restriction and infection control.

Microfinance and Peer Health Leadership Intervention Implementation for Men in Dar es Salaam, Tanzania: A Qualitative Assessment of Perceived Economic and Health Outcomes.

Men in sub-Saharan Africa continue to experience health disparities that are exacerbated by low employment. This study qualitatively assessed men's perceptions of the economic and health-care-seeking effects of participation in an integrated microfinance and peer health leadership intervention on violence and HIV risk reduction in Tanzania. Three focus group discussions with 27 men, aged 20 to 44 years, examined the perceived effects on income generation, employability, mental health, and uptake of HIV and related health services. All discussions were recorded, transcribed, and analyzed using deductive and inductive coding methods. Men reported that the benefits of the intervention included increased employability and income-earning activities due to greater access to entrepreneurial training, low-interest microfinancing, and male-oriented group supports to start or strengthen their businesses. Increased wages through business or other forms of employment were also attributed to men's lower anxiety and distress as financial providers for their families. However, men indicated that apart from the uptake of free HIV testing services, there was limited change in overall health-care-seeking behavior given the high clinic fees and lost time to earn income when attending routine health visits. Men recommended that future microfinance and health promotion interventions provide larger loan amounts, less frequent repayment intervals, and access to health and social insurance. Microfinance and peer health leadership interventions may help to address economic and health disparities in poor, urban men. Efforts are needed to assist lower income men in accessing financial tools as well as fee-based preventive and health-care services.

Towards ending the human immunodeficiency virus epidemic in the US: State of human immunodeficiency virus screening during physician and emergency department visits, 2009 to 2014.

Human immunodeficiency virus (HIV) testing is important for prevention and treatment. Ending the HIV epidemic is unattainable if significant proportions of people living with HIV remain undiagnosed, making HIV testing critical for prevention and treatment. The Centers for Disease Control and Prevention (CDC) recommends routine HIV testing for persons aged 13 to 64 years in all health care settings. This study builds on prior research by estimating the extent to which HIV testing occurs during physician office and emergency department (ED) post 2006 CDC recommendations.We performed an unweighted and weighted cross-sectional analysis using pooled data from 2 nationally representative surveys namely National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2009 to 2014. We assessed routine HIV testing trends and predictive factors in physician offices and ED using multi-stage statistical survey procedures in SAS 9.4.HIV testing rates in physician offices increased by 105% (5.6-11.5 per 1000) over the study period. A steeper increase was observed in ED with a 191% (2.3-6.7 per 1000) increase. Odds ratio (OR) for HIV testing in physician offices were highest among ages 20 to 29 ([OR] 7.20, 99% confidence interval [CI: 4.37-11.85]), males (OR 1.34, [CI: 0.91-0.93]), African-Americans (OR 2.97, [CI: 2.05-4.31]), Hispanics (OR 1.80, [CI: 1.17-2.78]), and among visits occurring in the South (OR 2.06, [CI: 1.23-3.44]). In the ED, similar trends of higher testing odds persisted for African Americans (OR 3.44, 99% CI 2.50-4.73), Hispanics (OR 2.23, 99% CI 1.65-3.01), and Northeast (OR 2.24, 99% CI 1.10-4.54).While progress has been made in screening, HIV testing rates remains sub-optimal for ED visits. Populations visiting the ED for routine care may suffer missed opportunities for HIV testing, which delays their entry into HIV medical care. To end the epidemic, new approaches for increasing targeted routine HIV testing for populations attending health care settings is recommended.

An examination of the HIV serostatus disclosure process among Haitian immigrants in New York City.

Little is known about the HIV serostatus disclosure experience of Haitian immigrants in the USA. We employed the disclosure processes model to examine the disclosure experience of 21 HIV-positive Haitian immigrants in New York City. Data were collected through in-depth interviews conducted between May 2012 and January 2013 with participants from four community-based organizations providing HIV/AIDS services. Analysis of the interviews yielded several enablers relevant to reasons for disclosure including participants being in a close relationship with someone they trusted or felt comfortable with, and the need for support and understanding about the illness. Some of the barriers to HIV serostatus disclosure were fear of being stigmatized, rejected. For participants who had disclosed to significant others in the USA and in Haiti, they reported that they experienced both positive and negative outcomes including social support, emotional relief, encouragement to take their medication, and on some occasions mistreatments, isolation, and stigma. The strategies participants employed during the disclosure event also revealed the additional challenges immigrants face when deciding to disclose their HIV serostatus to family members living in their country of origin. These findings suggest the need to develop culturally appropriate interventions to address the disclosure needs of ethnic minorities residing in the USA.