BACKGROUND: Men in sub-Saharan Africa are less likely than women to get tested for HIV, less likely to present for treatment, less likely to be maintained in treatment, more likely to have detectable viral load, more likely to transmit HIV with unprotected intercourse, and more likely to progress to AIDS and die sooner from HIV. The ultimate objective of this research is to provide evidence-based strategies to improve HIV testing and treatment of HIV-infected men. METHODS: This study is being conducted in the Greater Edendale Area and Vulindlela region in KwaZulu-Natal, South Africa. It is a two-stage design of a cluster-randomized trial and an individual randomized trial to test how structural and individual-level interventions address the demand-side factors that affect HIV testing and treatment for hard-to reach, high-risk men. It combines male-focused mobilization, community-based mobile HIV testing services, and a small incentive to determine if the strategies singly and in combination can result in more men diagnosed with HIV, and more men linked to and maintained in care with undetectable viral load. DISCUSSION: A priority for sub-Sahara Africa is developing and evaluating novel and cost-effective strategies for identifying hard-to-reach groups such as men, linking them to HIV testing and care services, and maintaining them in care to the point of viral suppression. We propose a combination prevention intervention that addresses men's individual, interpersonal, and structural barriers to testing and care. This includes male-led mobilization to encourage uptake of testing and treatment, male-focused testing venues, male-only counselors, developing counseling models that are flexible and responsive to men, and strategies for adhering to clinic visits without missing work and navigating the healthcare system. By thoughtfully combining male-focused mobilization, and testing and addressing some of the barriers to male engagement with health facilities, this study hopes to add to the growing evidence base about how to reach, test, link, and maintain a hard-to-reach group such as men in HIV treatment and care services. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03794245. Registered on 4 January 2019.

• Klíčová slova
• HIV testing, KwaZulu-Natal, Linkages to care, Men, South Africa,
• MeSH
• adherence a compliance při léčbě * MeSH
• ELISA MeSH
• HIV infekce diagnóza   farmakoterapie   epidemiologie   virologie   MeSH
• HIV imunologie   MeSH
• lidé MeSH
• následné studie MeSH
• plošný screening MeSH
• poradenství MeSH
• poskytování zdravotní péče metody   MeSH
• prevalence MeSH
• sexuální faktory MeSH
• virová nálož MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• Geografické názvy
• Jihoafrická republika epidemiologie   MeSH

Youth represent a large proportion of new HIV infections worldwide, yet their utilization of HIV testing and counseling (HTC) remains low. Using the post-intervention, cross-sectional, population-based household survey done in 2011 as part of HPTN 043/NIMH Project Accept, a cluster-randomized trial of community mobilization and mobile HTC in South Africa (Soweto and KwaZulu Natal), Zimbabwe, Tanzania and Thailand, we evaluated age-related differences among socio-demographic and behavioral determinants of HTC in study participants by study arm, site, and gender. A multivariate logistic regression model was developed using complete individual data from 13,755 participants with recent HIV testing (prior 12 months) as the outcome. Youth (18-24 years) was not predictive of recent HTC, except for high-risk youth with multiple concurrent partners, who were less likely (aOR 0.75; 95% CI 0.61-0.92) to have recently been tested than youth reporting a single partner. Importantly, the intervention was successful in reaching men with site specific success ranging from aOR 1.27 (95% CI 1.05-1.53) in South Africa to aOR 2.30 in Thailand (95% CI 1.85-2.84). Finally, across a diverse range of settings, higher education (aOR 1.67; 95% CI 1.42, 1.96), higher socio-economic status (aOR 1.21; 95% CI 1.08-1.36), and marriage (aOR 1.55; 95% CI 1.37-1.75) were all predictive of recent HTC, which did not significantly vary across study arm, site, gender or age category (18-24 vs. 25-32 years).

Los jóvenes representan una gran proporción de nuevas infecciones por el VIH en todo el mundo, sin embargo, su utilización de las pruebas de detección del VIH y el asesoramiento (HTC) sigue siendo baja. Utilizando la encuesta de población transversal de la población realizada en 2011 como parte del proyecto HPTN 043 / NIMH Project Accept, un ensayo aleatorizado por grupos de movilización comunitaria y HTC móvil en Sudáfrica (Soweto y KwaZulu Natal), Zimbabwe, Tanzania y Tailandia, evaluamos las diferencias relacionadas con la edad entre los determinantes sociodemográficos y conductuales de HTC en los participantes del estudio por brazo de estudio, sitio y sexo. Se desarrolló un modelo multivariado de regresión logística utilizando datos individuales completos de 13,755 participantes con pruebas de VIH recientes (antes de 12 meses) como resultado. Los jóvenes (18-24 años) no eran predictivos de HTC recientes, excepto los jóvenes de alto riesgo con múltiples parejas concurrentes, que eran menos probables (aOR 0,75; IC del 95%: 0,61-0,92) compañero. Es importante destacar que la intervención fue exitosa en hombres con éxito específico en el sitio, desde aOR 1,27 (IC 95% 1,05-1,53) en Sudáfrica hasta aOR 2,30 en Tailandia (IC 95%: 1,85-2,84). Por último, en una amplia gama de contextos, la educación superior (aO 1,67; IC del 95%: 1,42; 1,96); mayor estatus socioeconómico (aOR 1,21; IC del 95%: 1,08-1,36) y matrimonio (aOR 1,55; IC del 95%: 1,37 -1.75) eran todos predictivos de HTC recientes, que no variaron significativamente entre brazo de estudio, sitio, sexo o categoría de edad (18-24 vs 25-32 años).

• Klíčová slova
• Determinants HTC, High-risk sexual behavior, Mobile HIV testing and counseling, Project accept, Youth,
• MeSH
• dospělí MeSH
• HIV infekce diagnóza   prevence a kontrola   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• pacientův souhlas se zdravotní péčí MeSH
• plošný screening statistika a číselné údaje   MeSH
• poradenství * MeSH
• průřezové studie MeSH
• sexuální partneři * MeSH
• socioekonomické faktory MeSH
• věkové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Research Support, N.I.H., Extramural MeSH
• Geografické názvy
• Jihoafrická republika MeSH
• Tanzanie MeSH
• Thajsko MeSH
• Zimbabwe MeSH

BACKGROUND: Antiretroviral (ARV) drug treatment benefits the treated individual and can prevent HIV transmission. We assessed ARV drug use in a community-randomized trial that evaluated the impact of behavioral interventions on HIV incidence. METHODS: Samples were collected in a cross-sectional survey after a 3-year intervention period. ARV drug testing was performed using samples from HIV-infected adults at 4 study sites (Zimbabwe; Tanzania; KwaZulu-Natal and Soweto, South Africa; survey period 2009-2011) using an assay that detects 20 ARV drugs (6 nucleoside/nucleotide reverse transcriptase inhibitors, 3 nonnucleoside reverse transcriptase inhibitors, and 9 protease inhibitors; maraviroc; raltegravir). RESULTS: ARV drugs were detected in 2011 (27.4%) of 7347 samples; 88.1% had 1 nonnucleoside reverse transcriptase inhibitors ± 1-2 nucleoside/nucleotide reverse transcriptase inhibitors. ARV drug detection was associated with sex (women>men), pregnancy, older age (>24 years), and study site (P < 0.0001 for all 4 variables). ARV drugs were also more frequently detected in adults who were widowed (P = 0.006) or unemployed (P = 0.02). ARV drug use was more frequent in intervention versus control communities early in the survey (P = 0.01), with a significant increase in control (P = 0.004) but not in intervention communities during the survey period. In KwaZulu-Natal, a 1% increase in ARV drug use was associated with a 0.14% absolute decrease in HIV incidence (P = 0.018). CONCLUSIONS: This study used an objective, biomedical approach to assess ARV drug use on a population level. This analysis identified factors associated with ARV drug use and provided information on ARV drug use over time. ARV drug use was associated with lower HIV incidence at 1 study site.

• MeSH
• antiretrovirové látky terapeutické užití   MeSH
• dospělí MeSH
• HIV infekce farmakoterapie   prevence a kontrola   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• Národní institut pro duševní zdraví (USA) MeSH
• průřezové studie MeSH
• randomizované kontrolované studie jako téma MeSH
• retrospektivní studie MeSH
• spotřeba léčiv * MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Afrika MeSH
• Spojené státy americké MeSH
• Názvy látek
• antiretrovirové látky MeSH

BACKGROUND: In resource-limited settings, HIV infection is often diagnosed using 2 rapid tests. If the results are discordant, a third tie-breaker test is often used to determine HIV status. This study characterized samples with discordant rapid tests and compared different testing strategies for determining HIV status in these cases. METHODS: Samples were previously collected from 173 African adults in a population-based survey who had discordant rapid test results. Samples were classified as HIV positive or HIV negative using a rigorous testing algorithm that included two fourth-generation tests, a discriminatory test, and 2 HIV RNA tests. Tie-breaker tests were evaluated, including rapid tests (1 performed in-country), a third-generation enzyme immunoassay, and two fourth-generation tests. Selected samples were further characterized using additional assays. RESULTS: Twenty-nine samples (16.8%) were classified as HIV positive and 24 of those samples (82.8%) had undetectable HIV RNA. Antiretroviral drugs were detected in 1 sample. Sensitivity was 8.3%-43% for the rapid tests; 24.1% for the third-generation enzyme immunoassay; 95.8% and 96.6% for the fourth-generation tests. Specificity was lower for the fourth-generation tests than the other tests. Accuracy ranged from 79.5% to 91.3%. CONCLUSIONS: In this population-based survey, most HIV-infected adults with discordant rapid tests were virally suppressed without antiretroviral drugs. Use of individual assays as tie-breaker tests was not a reliable method for determining HIV status in these individuals. More extensive testing algorithms that use a fourth-generation screening test with a discriminatory test and HIV RNA test are preferable for determining HIV status in these cases.

• MeSH
• časové faktory MeSH
• dospělí MeSH
• HIV antigeny krev   MeSH
• HIV infekce diagnóza   epidemiologie   MeSH
• HIV protilátky krev   MeSH
• imunoanalýza metody   normy   MeSH
• lidé MeSH
• senzitivita a specificita MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH
• Geografické názvy
• Jihoafrická republika epidemiologie   MeSH
• Tanzanie epidemiologie   MeSH
• Názvy látek
• HIV antigeny MeSH
• HIV protilátky MeSH

BACKGROUND: Fourth-generation HIV assays detect both antigen and antibody, facilitating detection of acute/early HIV infection. The Bio-Rad GS HIV Combo Ag/Ab assay (Bio-Rad Combo) is an enzyme immunoassay that simultaneously detects HIV p24 antigen and antibodies to HIV-1 and HIV-2 in serum or plasma. OBJECTIVE: To evaluate the performance of the Bio-Rad Combo assay for detection of HIV infection in adults from Southern Africa. STUDY DESIGN: Samples were obtained from adults in Soweto and Vulindlela, South Africa and Dar es Salaam, Tanzania (300 HIV-positive samples; 300 HIV-negative samples; 12 samples from individuals previously classified as having acute/early HIV infection). The samples were tested with the Bio-Rad Combo assay. Additional testing was performed to characterize the 12 acute/early samples. RESULTS: All 300 HIV-positive samples were reactive using the Bio-Rad Combo assay; false positive test results were obtained for 10 (3.3%) of the HIV-negative samples (sensitivity: 100%, 95% confidence interval [CI]: 98.8-100%); specificity: 96.7%, 95% CI: 94.0-98.4%). The assay detected 10 of the 12 infections classified as acute/early. The two infections that were not detected had viral loads<400 copies/mL; one of those samples contained antiretroviral drugs consistent with antiretroviral therapy. CONCLUSIONS: The Bio-Rad Combo assay correctly classified the majority of study specimens. The specificity reported here may be higher than that seen in other settings, since HIV-negative samples were pre-screened using a different fourth-generation test. The assay also had high sensitivity for detection of acute/early infection. False-negative test results may be obtained in individuals who are virally suppressed.

• Klíčová slova
• Africa, Diagnosis, Enzyme immunoassay, Fourth-generation, HIV,
• MeSH
• HIV antigeny * imunologie   MeSH
• HIV infekce diagnóza   imunologie   virologie   MeSH
• HIV korový protein p24 imunologie   MeSH
• HIV protilátky * imunologie   MeSH
• HIV-1 imunologie   MeSH
• HIV-2 imunologie   MeSH
• HIV imunologie   MeSH
• imunoenzymatické techniky * metody   normy   MeSH
• lidé MeSH
• reagenční diagnostické soupravy * normy   MeSH
• reprodukovatelnost výsledků MeSH
• senzitivita a specificita MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Research Support, N.I.H., Extramural MeSH
• Geografické názvy
• jižní Afrika MeSH
• Názvy látek
• HIV antigeny * MeSH
• HIV korový protein p24 MeSH
• HIV protilátky * MeSH
• reagenční diagnostické soupravy * MeSH

BACKGROUND: There is increased focus on HIV prevention with African men who report experiencing childhood sexual (CSA) or physical abuse (CPA). OBJECTIVE: To better understand the effects of a community-based intervention (Project Accept HPTN 043) on HIV prevention behaviors among men who report CSA or CPA experiences. METHODS: Project Accept compared a community-based voluntary mobile counseling and testing (CBVCT) intervention with standard VCT. The intervention employed individual HIV risk reduction planning with motivational interviewing in 34 African communities (16 communities at 2 sites in South Africa, 10 in Tanzania, and 8 in Zimbabwe). Communities were randomized unblinded in matched pairs to CBVCT or SVCT, delivered over 36 months. The post-intervention assessment was conducted using a single, cross-sectional random survey of 18-32 year-old community members (total N = 43,292). We analyzed the effect of the intervention on men with reported CSA or CPA across the African sites. Men were identified with a survey question asking about having experienced CSA or CPA across the lifespan. The effect of intervention on considered outcomes of the preventive behavior was statistically evaluated using the logistic regression models. RESULTS: Across the sites, the rates of CSA or CPA among men indicated that African men reflected the global prevalence (20%) with a range of 13-24%. The statistically significant effect of the intervention among these men was seen in their increased effort to receive their HIV test results (OR 2.71; CI: (1.08, 6.82); P: 0.034). The intervention effect on the other designated HIV prevention behaviors was less pronounced. CONCLUSION: The effect of the intervention on these men showed increased motivation to receive their HIV test results. However, more research is needed to understand the effects of community-based interventions on this group, and such interventions need to integrate other keys predictors of HIV including trauma, coping strategies, and intimate partner violence.

• MeSH
• direktivní poradenství MeSH
• dítě MeSH
• dospělí MeSH
• HIV infekce epidemiologie   prevence a kontrola   psychologie   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• náhodné rozdělení MeSH
• Národní institut pro duševní zdraví (USA) MeSH
• prevalence MeSH
• průřezové studie MeSH
• sexuální zneužívání dítěte psychologie   statistika a číselné údaje   MeSH
• spolupráce organizací a občanů * MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Research Support, N.I.H., Extramural MeSH
• Geografické názvy
• Jihoafrická republika epidemiologie   MeSH
• Spojené státy americké MeSH
• Tanzanie epidemiologie   MeSH
• Zimbabwe epidemiologie   MeSH