Trend Analysis of HIV Testing Services in Zimbabwe, 2007-2016: A Secondary Dataset Analysis

Background: HIV Testing Services (HTS) is a full range of services (e.g. counselling and post-test referrals) that are offered together with HIV testing. It is an important prevention strategy and the gateway to treatment. The national targets in 2016 were to test 1.1 million people of which 54% was achieved. We determined trends of HTS in Zimbabwe from 2007 to 2016. Methods: A secondary dataset analysis was conducted using National Aids Council Core-Output Indicators dataset. Variables captured include total and repeat tests, counselling and referrals. Microsoft excel and Epi Info was used to generate frequencies, percentages and conduct chi square test for trends. Panda-Class Libraries was to attain estimates of HTS uptake till 2020. We used χ2 and p-values for statistical significance. Results: All (10,847.223) records were analysed. HIV tests per year increased from 340,705 in 2007, to 1,974,795 in 2015 (χ2 0.10492, p-value 0.74615). In 2007, 31% (n = 106,884) clients tested positive whilst in 2016 only 7% (n = 121,196) were positive (χ2 0.01166, p-value 0.91402). The 25 - 49 year age-group tested consistently highest throughout the 10year period (χ2 0.0558 p-value 0.813). The 15 - 24 year age-group had the highest yield (11% in 2015). Females (χ2 0.1074, p-value 0.743) consistently tested higher than males (χ2 0.0614, p-value 0.804). From 2007 to 2013 women had higher yields but by September 2016 males had a higher positivity of 8% (p-value χ2 0.658 p-value = 0.417). We estimate that 179,935 people living with HIV will know their status by 2020. Conclusion: HIV tests in Zimbabwe have increased but yield has decreased. Increase in repeat tests may be an indication of exhaustion of particular HTS strategies. Following this analysis it was recommended that HTS utilize various models such as HIV self-test to cater for populations with high yields.

Utilization of HIV and Sexually Transmitted Infections Prevention Services, and Associated Factors among the Long-Distance Truck Drivers along the Northern Corridor Highway, Kenya

Background: Often, long-distance truck drivers’ (LDTDs’) work predisposes them to sexually transmitted infections (STIs) whose outcomes are influenced by access and behavior of seeking sexual health care. Methodology: In this study, we assessed the utilization of HIV/STI preventive services and associated factors among 296 LDTDs operating along the northern corridor highway using an interviewer-administered questionnaire for data collection at Mlolongo stopover in Machakos, Kenya. Responses for the investigated variables, including condom use, history of HIV testing, frequency of HIV testing, antiretroviral therapy (ART) use and follow-up for the HIV positive and STI treatment, were assigned a score of either 1 or 0 depending on the question’s dimension. Following summing up for each participant, we computed a weighted score ranging between 0 and 1 by dividing the summed responses by the number of eligible variables. We arbitrarily multiplied these scores by 8 to generate endpoint scores ranging from one to eight for each participant to help create a dichotomized outcome variable for utilization levels: limited utilization (1 to 4) and good utilization (5 to 8). Association between certain independent variables and the outcome variable (level of utilization of H.I.V./STIs preventive services) was analyzed using binomial logistic regression analysis in R statistical software. Results: The mean age of the LDTDs was 38.4 years, ranging from 24 - 57 years. The majority (n = 287, 97%) of the LDTDs had been tested on HIV at least once since the beginning of their career. Only 4.9% of the LDTDs had been tested on HIV within the previous three months. Of the 175 LDTDs who reported a history of STI, most (n = 173, 98.9%) of them had sought treatment. Condom use rates were higher (97.1%) among the LDTDs who had sexual interactions with casual sexual partners compared to 47.2% among regular sexual partners. Analyses classed most of the respondents (n = 231, 78.0%) as having good utilization, while the rest (22%) had limited utilization. History of STI was independently associated with utilizing HIV/STI preventive services (OR 8.4;95% CI;4.5, 16.7;P < 0.001). Conclusion: Although most of the LDTDs were classed to have good utilization of HIV/STI preventive services, the uptake of subsequent HIV testing services among them was low at only 4.9%. The association of STI history with utilization levels that we determined supports policies of integrating HIV and STI services in the delivery of sexual healthcare provision among LDTDs.

The Role of Library and Information Science Education in the Development of Community Health Information Services for People Living with HIV/AIDS: Perspectives of Directors and Managers of Public Libraries

This article identifies the role of library and information science (LIS) education in the development of community health information services for people living with HIV/AIDS (PLWHA). Preliminary findings are presented from semi- structured qualitative interviews that were conducted with eleven directors and managers of local branches in the Knox County Public Library (KCPL) System that is located in the East Tennessee region in the United States. Select feedback reported by research participants is summarized in the article about strategies in LIS education that can help local public librarians and others in their efforts to become more responsive information providers to PLWHA. Research findings help better understand the issues and concerns regarding the development of digital and non-digital health information services for PLWHA in local public library institutions.

Calculating the Number of Pregnant Women Receiving Standardized Services for PMTCT of HIV in Liangshan Prefecture,Based on the Equivalent Method

Objective To calculate the number of pregnant women who receive standardized prevention of mother-to-child transmission(PMTCT)services for HIV annually.Methods HIV-positive pregnant women in six counties of Liangshan Prefecture in 2017 were selected as study subjects.The entire process,from when the subjects first received the PMTCT of HIV services to the end,was divided into four stages,which were further divided into 25 phases.The equivalent coefficient was used to indicate the weight of workload in each phase.Seven experts were invited to score the equivalent coefficient;the number of pregnant women who received standardized services to prevent the transmission of HIV was calculated.Results A total of 663 HIV-positive pregnant women were registered in six Liangshan Prefecture counties in 2017.This figure was converted into 7,780 person-months devoted to HIV-positive pregnant women,with 260 person-months(3.34%)spent on the first antenatal care,1,510 person-months(19.41%)during pregnancy,378 person-months(4.86%)on delivery,and 5,632 person-months(72.39%)on post-partum period.The equivalent coefficient calculation showed that 314 HIV-positive pregnant women received standardized PMTCT services.Conclusion The number of pregnant women receiving standardized services for the PMTCT of HIV can be calculated accurately using the equivalent method to identify the gap between the level of PMTCT of HIV intervention services needed and the actual workload.

Beliefs and practices of young women on utilization of prevention of mother to child transmission of HIV services in Malawi

This study explored beliefs and actual practices of young women on utilization of Prevention of Mother to Child Transmission (PMTCT) of HIV services in Balaka district of Southern Malawi. The study design wascross sectional which utilized qualitative data collection and analysis methods. In-depth interviews were conducted on 12 young mothers of 15 to 24 years old. The respondents were drawn from 6 health centres in the district during their visits to either the under-five clinic, HIV and AIDS support groups or HIV follow up clinics. Data were analyzed using thematic analysis approach. Overall the respondents had positive beliefs on utilization of PMTCT services. They believed that adherence to PMTCT guidelines such as condom use, taking of Nevirapine (NVP) and exclusive breastfeeding protected the baby from contracting the virus. Nevertheless, all respondents believed that HIV testing was mandatory and that early weaning caused malnutrition and death of babies. Actual practice was very low. Very few young mothers breastfed exclusively, weaned their babies abruptly and took NVP as recommended. Not all positive beliefs translated into positive behavior. Lack of male support, inability of the midwives to provide comprehensive care to HIV infected mothers and their infants, and fear of stigma and discrimination were other factors that hindered utilization of PMTCT services. Culture was also a major barrier because traditionally babies are expected to be breastfed and supplements are fed to babies too. Therefore, there is a need to mobilize communities on PMTCT of HIV. Education programmes in HIV should emphasize behavior change interventions and should focus on both men and women and significant others. There is also need to intensify monitoring and evaluation of health workers’ activities to ensure that beliefs translate into positive behavior.

Utilization and Satisfaction with HIV Services at 7 Provinces in Vietnam: A Cross-Sectional Study

The study was carried out to determine utilization and satisfaction with essential HIV services from HIV individuals and high-risk populations in 7 socioeconomic provinces nationwide. A cross-sectional approach was applied in the study. Data were collected through face-to-face interviews using self-report questionnaires. Findings from 2380 respondents indicated a high percentage of utilization as well as a high level of satisfaction, in particular among men who have sex with men (MSM) and female sex worker (FSW) sub-group. Needle, syringe, and condom programs had lower usage and satisfaction mean scores in comparison with other services. The proportion of people who used drugs (PWID) and participated in the needle and syringe program was 53.6%. HIV counseling and testing uptake proportion of overall respondents in the last 12 months was 82.2% while the rate of antiretroviral treatment among infected PWID was 74.9%. The level of satisfaction with treatment services was found to be higher than preventive interventions (p < 0.05). Analysis using univariable logistic regression suggested an association between some socioeconomic factors such as income, employment, educational attainment, and marital status with subjects’ satisfaction with several HIV services. Preventive services, especially needle, syringe and condom programs should be prioritized to scale up the coverage and effectiveness. Innovative approaches targeting at PWID should be promoted to increase their access to prevention programs as well as HIV care when needed.

Exploring the Perspectives of Healthcare Providers on Providing HIV Prevention and Treatment Services for Key Populations in Rwanda: A Qualitative Study

Background: The overall HIV prevalence and incidence in Rwanda have decreased significantly in the past decade. However, opposite trends are seen among key populations (KP). The HIV prevalence among sex workers is as high as 51% and continues to rise. While the HIV prevalence among KP remains high, their adherence to treatment is low. Healthcare providers play a vital role in KP’s access and adherence to HIV treatment. This study aimed to explore the perspectives of healthcare providers on providing HIV services to key populations in Rwanda. Methods: An exploratory qualitative study was conducted with nurses, doctors, social workers, and psychologists who provide HIV services to KP in public health facilities in Rwanda. In-depth interviews were conducted using a semi-structured interview guide. All data were analyzed thematically using Dedoose. Results: Interviews were conducted with 18 healthcare providers. Three overarching themes emerged from the interviews: healthcare providers’ intrinsic feelings affect the ways they provide HIV services to key populations, key populations face a multitude of challenges related to accessing treatment and preventing the spread of HIV, and a more comprehensive and sensitive approach should be used to improve HIV services for key populations. Conclusion: Healthcare providers expressed difficulties in providing services to key populations and identified a lack of adherence to treatment and prevention guidelines, structural barriers, KP’s lack of trust in the healthcare system, and the discrimination and abuse KP face as challenges to effective HIV prevention and treatment. More comprehensive services including clinical, financial, and psychosocial support from trusted sources are needed. Some important policy changes are essential to facilitate access to HIV services for KP.

Knowledge of Cervical Cancer and Prevalence of the Screening Services among HIV-Infected Women in Blantyre, Malawi

HIV-infected women are at high risk of developing cervical cancer and are encouraged to undergo cervical cancer screening regularly. However, very little has been documented about the knowledge of cervical cancer and the utilization of the screening services by these women. This study aimed to investigate the knowledge of cervical cancer, prevalence of cervical cancer screening uptake and predictive factors that affect utilization of cervical cancer screening services among HIV-infected women. The study employed quantitative methods for data collection and analysis. It was conducted at Queen Elizabeth Central Hospital (QECH) from December 2017 to February 2018 where HIV-positive patients accessing QECH Antiretroviral Therapy (ART) clinic were recruited. Systematic random sampling was employed to select HIV-positive women for the survey. Data were collected using semi-structured questionnaires. STATA version 12 was used to analyze the data. Out of the 196 recruited women, the majority (98%;n = 192) indicated having heard of cervical cancer and of the 192 women, only 57% (n = 109) were able to know at least a single sign/symptom of cervical cancer, furthermore, only 47% (n = 91) indicated ever been screened, finally, getting information from health facilities and knowing at least a single sign/symptom of cervical cancer influenced HIV-infected women to go for cervical cancer screening services. The study revealed that knowledge of cervical cancer and the utilization of its screening services among HIV-infected women is low. Therefore, there is need to increase knowledge and strengthen cervical cancer screening services among HIV-infected women in the country.

不同场所暗娼的高危行为和HIV/STI感染状况调查

目的了解不同场所中暗娼与艾滋病(AIDS)传播有关的行为,以及艾滋病病毒/性传播感染(HIV/STI)的感染状况,为开展有针对性的行为干预提供依据。方法对贵阳市云岩区宾馆、酒店、卡拉OK歌厅等娱乐场所的暗娼进行两阶段概率抽样,发廊和街头的暗娼在知情同意后全部纳入调查。收集人口学和高危行为信息,并采集静脉血检测HIV、梅毒、乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)。结果432名暗娼中,来自宾馆、酒店及娱乐场所占50.9%,发廊占25.5%,街头占23.6%。与前两组相比,街头暗娼平均年龄较大(30.6岁),文化程度较低(小学和文盲占54.9%),首次性交年龄(18.7岁)和首次从事性交易年龄(27.9岁)较大,从事性交易时间较长(4年及以上者占21.6%)。调查对象最近一次与客人发生性关系时使用安全套的比例为81.3%,最近1个月与客人发生性关系时,每次都使用安全套的比例为44.9%,从未使用的占8.1%。17.6%的街头暗娼有吸毒行为。HIV感染率为0.2%,HBV感染率为4.6%,HCV感染率为4.9%,梅毒感染率为13.0%。结论街头暗娼高危行为的危险性最高,STI的感染率也高于其他场所的暗娼,应作为监测和干预的重点亚人群。

男性性工作者的STI/HIV高危行为研究

目的 监测男性性工作者 (MSW )的性传播感染 (STI) /艾滋病病毒 (HIV)感染的高危行为。方法 以定向抽样获取的男男性接触者 (MSM)中从事 (过 )性工作的男性为样本 ,将之与年龄相匹配的一般的MSM进行比较。结果 相对年轻、未婚、低教育水平、原来在农村地区从事体力劳动、低收入或无收入阶层的男性 ,更倾向于从事性工作。MSW组的首次性交年龄早于对照组 ,其累计男性伴侣数、累计肛交男性伴侣数、累计口交男性伴侣数、近 1年内男性伴侣数、近 1年内陌生男性伴侣数和近 1年内口交男性伴侣数均大于对照组 ;近 1年内曾接受同性性服务和近 1年内曾群交的比例均高于对照组。结论 MSW较一般的MSM有更多的高危性行为 ,应加大对这一亚人群的STI/HIV干预力度。

我国男男性接触者HIV/STIs感染状况及高危性行为研究进展

该文描述了我国男男性接触者(MSM)的艾滋病病毒/性传播感染(HIV/STIs)的感染状况,以及对高危性性行为、性伴状况、人群的隐秘性、研究的进展和存在的问题、困难。提出了进一步研究的方向。

男男性接触者多重STIs/HIV感染1例

患者男,18岁,同性恋史8个月。面部、躯干、四肢、掌跖部泛发斑丘疹,肛周见数个斑块状增生物,阴茎系带旁有两个糜烂面,肛门灼痛、有脓性分泌物。TRUST1∶16(+),TPPA(+),肛周皮损组织液暗视野显微镜查螺旋体(+),直肠分泌物涂片见细胞内革兰阴性双球菌,淋球菌培养(+),CT-PCR(+),UU-PCR(-),HSV-2-PCR(+)。结合临床、组织病理及血清学等实验室检查诊断为二期梅毒、生殖器疱疹、淋菌性直肠炎等多种性传播性疾病(STDs)和HIV感染。该患者免疫功能正常,治疗方法的选择及其疗效与一般STDs患者无异。

开远市CSW人群HIV/AIDS/STI监测结果分析

[目的]了解开远市暗娼人群HIV/AIDS/STI流行状况及相关知识知晓现状,为进一部宣传教育和行为干预活动方案的制定,提供科学依据。[方法]使用标准问卷进行一对一调查,实验室HIV和梅毒检测用项目统一方法,调查结果全部输入计算机用SPSS统计软件包进行分析。[结果]共调查366人,合格问卷363份,问卷合格率为99.18%,其中梅毒阳性率为11.82%,HIV阳性率为16.16%。[结论]暗娼人群、HIV/STIS流行形势较为严竣。目标人群相关知识、知晓率有待进一步提高。

HIV/AIDS Related Discrimination in Health Care Service:a Cross-sectional Study in Gejiu City, Yunnan Province

Objectives To investigate discrimination against people living with HIV （PLWH） and its impacts. Methods Forty people who were either HIV positive （7/40） or had high risk behavior （33/40） were interviewed. Focus group discussion was held in the interview with people who were suspected to be infected with HIV, and in-depth interview was conducted in the survey of HIV positive persons whose privacy was strictly protected to ensure the confidentiality of the collected information. Results It was identified that six forms of discrimination against people living with HIV occurred in health care service in Gejiu, including speaking to patients in an insulting manner, refusing to provide health care service, delaying treatment, treating differently, uncovering patients＇ privacy, and over-protecting themselves against patients. Discrimination against people living with HIV greatly affected their health conditions. Conclusions Discrimination against people living with HIV in health service has negative impact on their physical and mental health.

HIV/STIs防治与计划生育服务相结合:对政策发展的回顾

90年代,艾滋病病毒感染(HIV)与性传播感染(STIs)在低收入国家上升的流行趋势引起国际社会对这一问题的高度关注.

广西地区娱乐场所暗娼人群STI/HIV感染状况分析

性传播是艾滋病在全球流行的主要途径，暗娼在其中起到了重要的“桥梁”作用，随着暗娼人群中性传播疾病（STI）感染率越来越高，如何有效在暗娼人群中控制STI，从而减少通过性接触感染HIV已成为艾滋病防治的关键。为了解广西地区暗娟人群中STI和HIV感染状况，以便开展有针对性的宣传教育、行为干预措施、预测本地区暗娼人群中STDIHIV感染人数以及为将来性病艾滋病的预防控制工作提供科学依据，2007年5～8月本课题组在广西壮族自治区4个城市开展了娱乐场所暗娼人群中STD／HIV感染状况的调查研究。

Service Delivery Factors That Influence Utilization of HIV Integrated Primary Health Care Programme in Embu Referral Hospital, Kenya

Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waiting time was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served;they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.

Cognitive and Behavioral Effects of Participatory Sex Education on the Dual Prevention of STI/HIV/AIDS and Unwanted Pregnancies among Adolescents in Kinshasa High Schools, DR Congo

Context: With the view to reorient both STI/HIV/AIDS prevention and adolescents pregnancies, this research study aims at evaluating cognitive and behavioral acquisitions, as well as the process of interactive sex education participatory approach among adolescents in Kinshasa high schools. Methods: Based on a “pre and post” virtually experimental design, two crosswise surveys were conducted in Kinshasa, for six months in 2011-2012 on 484 high school students (pre-survey) and on 441 high school students (post-survey), whose age range from 14 - 19 years including both sexes. Two participatory educational talks (PET) “A” and “B”, covered weekly in two different schools, were compared to a control group school. The PET “A” consisted of interactive interpersonal communication sessions given by an external expert as a substitute for the life education course in one school. The PET “B” carried out in another school, included more educational talk sessions, led by the external expert and supplemented by a close follow-up of teenagers divided into small groups of 10 participants. The subjects’ assessment was based on their knowledge, attitudes and practices relating to STI/HIV/AIDS dual prevention as well as to unwanted pregnancies. Results: The subjects involved in the PET “B” displayed a better/higher performance based on their knowledge, attitudes and practices related to STI/HIV/AIDS dual prevention and unwanted pregnancies. Broadly speaking, knowledge has been improved 6 times with the PET “B” (OR = 6, 10, IC 95%) (3.24 - 11.9), and 3 times with the PET “A” (OR = 3, 45, IC 95%) (1.79 - 6.81), compared to control school. Similarly, findings on subjects’ attitudes show an improvement rated 12 times with the PET”B” (OR = 11, 99, IC 95%) (5.67 - 27.38) and 5 times for the PET “A” (OR = 5.51, IC 95%) (2.54 - 12.87). As far as the subjects’ practices are concerned, an improvement of 6 more times of protected sexual intercourses with the PET “B” compared with the control school group (OR = 6, 52, IC 95%) (3.60 - 12.0). The process assessment records a spontaneous involvement of schools enhanced by the positive contribution of Life Education and Biology teachers;add a massive participation of adolescents who requested permanent PET program. Conclusion: The results of this study suggest that school sexual education programs can be improved to increase the quality of apprenticeship. The use of interactive methods and the consideration of the adolescents’ specific needs that take into account the gender approach may bring about beneficial advantages on both educational outcomes and reproductive health of adolescents.

Gender Sensitive STIs/HIV/AIDS Prevention Policies: A Qualitative Study

Background: The global incidence of STIs is rising. It is estimated that 499 million new cases of curable STIs occur every year. The existence of more than one million reported cases of STIs annually in Iran shows that addressing this issue must be a priority for Iranian health authorities. While recognition of the importance of gender issues to reproductive health (RH) programs has grown significantly in the past several years, major challenges remain in implementing gender-sensitive programs. Gender mainstreaming in Iranian reproductive health program is a relatively new issue, so this study aims to explore gender sensitive STIs/HIV/AIDS prevention policies. Method: This study employed a qualitative research design. Participants were health managers, health policy makers and reproductive health providers. They were selected purposefully and then continued by snowball sampling method. 43 semi-structured in-depth interviews with 37 key informants were done. All the interviews were recorded and transcribed. The data were analyzed by content analysis method. Trustworthiness of the data was achieved by using credibility, trans-ferability and conformability. Results: Key informants clearly explained the gender sensitive STIs/ HIV/AIDS prevention policies in three main categories: 1) advocacy, 2) collaboration between different sectors and 3) community empowerment to gender sensitive STIs/HIV/AIDS prevention programs. Conclusion: Changing gender neural STIs/HIV/AIDS prevention policy to more complete gender sensitive policy needs advocacy, collaboration of sectors and community empowerment.