HIV Counseling and Testing: Less Targeting, More Testing

New York City Department of Health and Mental Hygiene, לאנג איילענד סיטי, New York, United States
American Journal of Public Health (Impact Factor: 4.55). 07/2006; 96(6):962-4. DOI: 10.2105/AJPH.2006.089235
Source: PubMed
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Available from: Scott Kellerman, Feb 18, 2014
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    • "States such as New York that have streamlined regulations regarding pre-test counseling have seen increases in HIV testing (Koo et al. 2006). Given the recent licensure of rapid tests with processing times as little as 60 seconds (FDA 2010), an expedited/express testing approach that excludes prevention counseling sessions could be provided through street outreach programs at large events such as gay pride. "
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    ABSTRACT: Men who have sex with men (MSM) continue to be disproportionately impacted by the Human Immunodeficiency Virus (HIV) epidemic in the United States (US). Testing for HIV is the cornerstone of comprehensive prevention efforts and the gateway to early engagement of infected individuals in medical care. We sought to determine attitudes towards six different HIV testing modalities presented collectively to internet-using MSM and identify which options rank higher than others in terms of intended usage preference. Between October and November 2012, we surveyed 973 HIV-negative or -unknown status MSM and assessed their acceptability of each of the following services hypothetically offered free of charge: Testing at a physician's office; Individual voluntary counseling and testing (VCT); Couples' HIV counseling and testing (CHCT); Expedited/express testing; Rapid home self-testing using an oral fluid test; Home dried blood spot (DBS) specimen self-collection for laboratory testing. Kruskal-Wallis tests were used to determine whether the stated likelihood of using each of these modalities differed by selected respondent characteristics. Men were also asked to rank these options in order of intended usage preference, and consensual rankings were determined using the modified Borda count (MBC) method. Most participants reported being extremely likely or somewhat likely to use all HIV testing modalities except DBS self-collection for laboratory testing. Younger MSM indicated greater acceptability for expedited/express testing (P < 0.001), and MSM with lower educational levels reported being more likely to use CHCT (P < 0.001). Non-Hispanic black MSM indicated lower acceptability for VCT (P < 0.001). Rapid home self-testing using an oral fluid test and testing at a physician's office were the two most preferred options across all demographic and behavioral strata. Novel approaches to increase the frequency of HIV testing among US MSM are urgently needed. Combination testing packages could enable high risk MSM in putting together annual testing strategies personalized to their circumstances, and warrant due consideration as an element of combination HIV prevention packages.
    Full-text · Article · Feb 2014 · SpringerPlus
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    • "Thus far, supporters of this shift have justified their claims in two ways. First, preference for home-based testing compared to facility-based alternatives, as demonstrated in studies done in Africa – although in the context of smaller research studies – and second, wherever home-based VCT has been tried it has generated a massive increase in proportions tested in comparison to more traditional clinic-based VCT.39–41 Our findings provide preliminary evidence that the current SVHTP program may not be achieving its intended results, suggesting further monitoring and evaluation. "
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    ABSTRACT: To evaluate the human immunodeficiency virus (HIV) rapid test as an effective tool in the response to the HIV/acquired immunodeficiency syndrome (AIDS) epidemic in Trinidad. The study is comprised of a retrospective analysis of data collected from May 2008 to July 15, 2011 and a prospective arm of those tested during July 18, 2011 - August 30, 2011. During the prospective phase, blood samples were tested using rapid tests manufactured by Inverness Medical Innovation and Trinity Biotech followed by an enzyme-linked immunosorbent assay test, irrespective of the results of the rapid test. A structured questionnaire was administered to collect demographic data and risk behaviors. The study was conducted in one randomly selected primary health care facility of the eight that offered same-day HIV testing in Trinidad. A total of 297 persons participated in the prospective arm of the study and the rapid test was found to have a sensitivity of 100% and a specificity of 99.6%. Females and those aged 20-29 years were most likely to participate. Over the study period, the number of persons who received rapid tests increased but the prevalence of positive HIV test results decreased from 4.4% in 2008 to 2.1% in 2011. The main reasons for being tested were curiosity (38%), results being obtainable the same day (27%), and confidentiality (13%). Approximately 50% of respondents reported more than one sex partner in the previous year while 14% used condoms regularly. People need to know their own HIV status and that of their partners to make healthy decisions about sexual behavior. At the health facility studied, 2.6% of people who took the HIV rapid test were HIV positive.
    Full-text · Article · Aug 2013 · HIV/AIDS - Research and Palliative Care
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    • "The first has been to increase the number of sites—fixed and mobile—in which people are offered VCT services (Marum, Taegtmeyer, and Chebet 2006; Yeatman 2007). A second method, more recent, has been to substitute what is alternately referred to as "provider-initiated," "routine," "opt-out" testing for more traditional VCT approaches (Beckwith et al. 2005; Koo et al. 2006; Weiser et al. 2007). While each of these methods has generated increases in proportions tested, the time-trends graphed in Figure 2 show that they have not modified the differences in HIV testing between educational groups. "
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    ABSTRACT: The plan to increase HIV testing is a cornerstone of the international health strategy against the HIV/AIDS epidemic, particularly in sub-Saharan Africa. This paper highlights a problematic aspect of that plan: the reliance on clinic- rather than home-based testing. First, drawing on DHS data from across Africa, we demonstrate the substantial differences in socio-demographic and economic profiles between those who report having ever had an HIV test, and those who report never having had one. Then, using data from a random household survey in rural Malawi, we show that substituting home-based for clinic-based testing may eliminate this source of inequality between those tested and those not tested. This result, which is stable across modeling frameworks, has important implications for accurately and equitably addressing the counseling and treatment programs that comprise the international health strategy against AIDS, and that promise to shape the future trajectory of the epidemic in Africa and beyond.
    Full-text · Article · Jul 2009 · Demographic Research
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