We examined the effects of repeat Voluntary HIV counseling and testing (VCT) on sexual risk behaviors and HIV incidence in 6,377 initially HIV-negative subjects enrolled in a prospective STD control for HIV prevention trial in rural Rakai district, southwestern Uganda. Sixty-four percent accepted VCT, and of these, 62.2% were first time acceptors while 37.8% were repeat acceptors. Consistent condom use was 5.8% in repeat acceptors, 6.1% in first time acceptors and 5.1% in non-acceptors. A higher proportion of repeat acceptors (15.9%) reported inconsistent condom use compared to first-time acceptors (12%) and non-acceptors (11.7%). Also, a higher proportion of repeat acceptors (18.1%) reported 2+ sexual partners compared to first-time acceptors (14.1%) and non-acceptors (15%). HIV incidence rates were 1.4/100 py (person-years) in repeat acceptors, 1.6/100 py in first time acceptors and 1.6/100 py in non-acceptors. These data suggest a need for intensive risk-reduction counseling interventions targeting HIV-negative repeat VCT acceptors as a special risk group.
"Among MSM, repeat testers are often younger, better educated and unmarried compared to first-time testers [7–9]. However, repeat testing is associated with several risk factors for HIV: a higher number of sexual partners , having ever had an STI , unprotected anal intercourse (UAI) [12, 13] and working as a male sex worker . Additionally, in a study among MSM in seven US cities, over 75% of repeat testers who seroconverted did so within a year after their last test . "
[Show abstract][Hide abstract] ABSTRACT: Introduction
Little is known about HIV testing, HIV infection and sexual behaviour among bathhouse patrons in China. This study aims to assess differences in HIV prevalence and high-risk sexual behaviours between repeat and first-time testers among men who have sex with men (MSM) attending bathhouse in Tianjin, China.
Between March 2011 and September 2012, a HIV voluntary counselling and testing station was established in a gay bathhouse, which provided HIV testing and conducted a survey among participants recruited through snowball sampling. Differences in demographic and high-risk sexual behaviours between repeat and first-time testers were assessed using the chi-square test. Univariate and multivariate logistic regression analyses were conducted to identify predictors for HIV infection.
Of the 1642 respondents, 699 (42.6%) were repeat testers and 943 (57.4%) were first-time testers. Among repeat testers, a higher proportion were men aged 18 to 25, single, better educated, had a history of STIs and worked as male sex workers or “money boys” (MBs). Repeat testers were less likely to report having unprotected anal intercourse in the past six months. The overall HIV prevalence was 12.4% (203/1642). There was no difference in HIV prevalence between repeat (11.2%, 78/699) and first-time (13.3%, 125/943) testers. The HIV prevalence increased with age among first-time testers (χtrend2=9.816, p=0.002). First-time MB testers had the highest HIV prevalence of 34.5%.
MSM attending bathhouse had an alarmingly high HIV infection rate, particularly in MB. Targeted interventions are urgently needed especially focusing on older MSM and MBs.
Journal of the International AIDS Society 07/2014; 17(1):18848. DOI:10.7448/IAS.17.1.18848 · 5.09 Impact Factor
"Our study examining the trends in HCT among 21,798 married individuals enrolled in the Rakai Community Cohort Study (RCCS) between 2003-2009 reveals three interesting and important trends: (i) the proportion of never-tested individuals increased significantly over time, (ii) uptake of individual HCT increased between 2003 and 2005 but declined between 2006 and 2009, and (iii) uptake of couples’ HCT remain low and stabilized below 30%. We also found among a sub-set of our study population that prior receipt of HCT was a significant predictor of individual and couples’ HCT, suggesting high levels of repeat testing  and the need to devise alternative approaches to create demand for HCT uptake among individuals with no prior HCT. "
[Show abstract][Hide abstract] ABSTRACT: Despite efforts to promote HIV counseling and testing (HCT) - among couples, few couples know their own or their partners' HIV status. We assessed trends in HCT uptake among married individuals in Rakai district, southwestern Uganda.
We analysed data for 21,798 married individuals aged 15-49 years who were enrolled into the Rakai Community Cohort Study (RCCS) between 2003 and 2009. Married individuals were interviewed separately but were retrospectively linked to their partners at analysis. All participants had serologic samples obtained for HIV testing, and had the option of receiving HCT together (couples' HCT) or separately (individual HCT). Individuals were categorized as concordant HIV-positive if both partners had HIV; concordant HIV-negative if both did not have HIV; or HIV-discordant if only one of the partners had HIV. We used chi2 tests to assess linear trends in individual and couples' HCT uptake in the entire sample and conducted multinomial logistic regression on a sub-sample of 10,712 individuals to assess relative risk ratios (RRR) and 95% Confidence Intervals (95%CI) associated with individual and couples' HCT uptake. Analysis was done using STATA version 11.0.
Uptake of couples' HCT was 27.2% in 2003/04, 25.1% in 2005/06, 28.5% in 2006/08 and 27.8% in 2008/09 (chi2 for trend = 2.38; P = 0.12). Uptake of individual HCT was 57.9% in 2003/04, 60.2% in 2005/06, 54.0% in 2006/08 and 54.4% in 2008/09 (chi2 for trend = 8.72; P = 0.003). The proportion of couples who had never tested increased from 14.9% in 2003/04 to 17.8% in 2008/09 (chi2 for trend = 18.16; P < 0.0001). Uptake of couples' HCT was significantly associated with prior HCT (Adjusted [Adj.] RRR = 6.80; 95%CI: 5.44, 8.51) and being 25-34 years of age (Adj. RRR = 1.81; 95% CI: 1.32, 2.50). Uptake of individual HCT was significantly associated with prior HCT (Adj. RRR = 6.26; 95%CI: 4.24, 9.24) and the female partner being HIV-positive (Adj. RRR = 2.46; 95%CI: 1.26, 4.80).
Uptake of couples' HCT remained consistently low (below 30%) over the years, while uptake of individual HCT declined over time. These findings call for innovative strategies to increase demand for couples' HCT, particularly among younger couples and those with no prior HCT.
BMC Public Health 07/2013; 13(1):618. DOI:10.1186/1471-2458-13-618 · 2.26 Impact Factor
"HIV Voluntary Counseling and Testing (VCT) is now a key component of national AIDS programmes in sub-Saharan Africa , and is a major component of HIV/AIDS prevention, treatment and care efforts in Uganda . The UNAIDS in its guidelines on terminology reports that an alternative term for VCT is client initiated testing . "
[Show abstract][Hide abstract] ABSTRACT: In Uganda, public human immunodeficiency virus (HIV) Voluntary Counseling and Testing (VCT) services are mainly provided through the facility based model, although the home based approach is being promoted as a strategy for improving access to VCT. However the uptake of VCT varies according to service delivery model and is influenced by a number of factors. The aim of this study therefore, was to compare predictors for uptake of facility and home based VCT in a rural context.
A longitudinal study with cross-sectional investigative phases was conducted at two sites (Rugando and Kabingo) in southwestern Uganda between November 2007 (baseline) and March 2008 (follow up). During the baseline visit, facility based VCT was offered at the main health centre in Rugando while home based VCT was offered at the household level in Kabingo and a mixed survey questionnaire administered to the respondents. The results presented in this paper are derived from only the baseline data.
Nine hundred ninety four (994) respondents were interviewed, of whom 500 received facility based VCT in Rugando and 494 home based VCT in Kabingo during the baseline visit. The respondents had a mean age of 32.2 years (SD 10.9) and were mainly female (68 percent). Clients who received facility based VCT were less likely to be residents of the more rural households (adjusted Odds Ratio (aOR)=0.14, 95% CI 0.07, 0.22). The clients who received home based VCT were less likely to report having an STI symptom (aOR=0.63, 95% CI 0.46, 0.86), and more likely to be worried about discrimination if they contracted AIDS (aOR=1.78, 95% CI 1.22, 2.61).
The uptake of VCT provided through either the facility or home based models is influenced by client characteristics such as proximity to service delivery points, HIV related symptoms, and fear of discrimination in rural Uganda. Interventions that seek to improve uptake of VCT should provide potential clients with both facility and home based VCT options within a given setting. The clients are then able to select a model for VCT that best fits their characteristics. This is likely to have positive implications for both service coverage and uptake by different sub-groups within particular communities.
BMC Health Services Research 03/2011; 11(1):54. DOI:10.1186/1472-6963-11-54 · 1.71 Impact Factor
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