Sexual behaviour change following HIV testing services: a systematic review and meta‐analysis

Tiwari, Ruchi; Wang, Jiayu; Han, Hannah; Kalu, Ngozi; Sims, Lee B; Katz, David A.; Burke, Barbara A.; Tsegaye, Adino Tesfahun; Carter, Kayla A.; Freije, Sophie; Guo, Boya; Albirair, Mohamed; Barr-DiChiara, Magdalena; Baggaley, Rachel; Jamil, Muhammad S; Senya, Kafui; Johnson, Cheryl; Khosropour, Christine M

doi:10.1002/jia2.25635

Cited by 16 publications

(15 citation statements)

References 89 publications

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“…15,16 Moreover, the impact of HIV testing services on risk reduction behaviors (e.g., frequency of condom use, multi-partnership) is more substantial among HIV-positive MSM than among HIV-negative ones. 17 HIV testing services may represent an opportunity to enhance the HIV prevention care continuum. However, it is understudied how HIV testing services moderate the association between PrEP/HIV stigma and PrEP care linkage and uptake.…”

Section: Introductionmentioning

confidence: 99%

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Understanding the Association Between PrEP Stigma and PrEP Cascade Moderated by the Intensity of HIV Testing

Zhang

Liu

2022

Preprint

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Background In the United States, men who have sex with men (MSM) account for the majority of new HIV infections. On the other hand, pre-exposure prophylaxis (PrEP) is an effective strategy to curb HIV transmission, but it is widely underutilized. It is unknown how stigma affects PrEP care in the context of other HIV prevention strategies (e.g., HIV testing).17 In the current study, we explored how PrEP and HIV-related stigma affect the PrEP care cascade (i.e., awareness, willingness, and uptake) and how the intensity of HIV testing services moderates the association. Methods We recruited a group of MSM from two cities in the U.S. With informed consent being collected, we included a total of 318 MSM in the current analysis. We employed bivariate and multivariable analyses to assess the association between PrEP stigma and PrEP cascade while controlling for potential confounders on each specific pathway. We further used a series of moderation analyses based upon the intensity of HIV testing within different timeframes to assess the association between PrEP stigma and PrEP cascade. In addition, we conducted the trend-analyses to assess the pattern of PrEP cascade across different time points of HIV testing. Results Compared with MSM who used PrEP, those who never used PrEP reported higher internalized (0.59 vs. 2.99) and vicarious PrEP stigma (3.66 vs. 5.56). Internalized PrEP stigma has significantly reduced the likelihood of PrEP willingness and PrEP uptake among this group. With the increased frequency of HIV testing, stigma became stronger to negatively impact the likelihood of PrEP willingness and PrEP uptake in MSM. The Jonckheere–Terpstra test with Monte Carlo permutations showed significant trend patterns across different frequencies of HIV testing. The same patterns have been identified under other timeframes (i.e., in the past 12m, 6m, and 3m). Conclusions Findings indicated that HIV prevention services might discourage MSM from PrEP use under the influence of stigma. A structural-level reform is urgently needed to turn the HIV service encounters into opportunities to facilitate and optimize the PrEP cascade among this group who may benefit from PrEP use.

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Section: Introductionmentioning

confidence: 99%

“…It is unknown how stigma affects PrEP care in the context of other HIV prevention strategies (e.g., HIV testing). 17 In the current study, we explored how PrEP and HIV-related stigma affect the PrEP care cascade (i.e., awareness, willingness, and uptake) and how the intensity of HIV testing services moderates the association.…”

mentioning

confidence: 99%

Understanding the Association Between PrEP Stigma and PrEP Cascade Moderated by the Intensity of HIV Testing

Zhang

Liu

2022

Preprint

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“… 21 22 A meta-analysis has shown that having received HIV testing was significantly associated with increased condom use after the test among those being diagnosed with HIV. 23 A study in the USA has estimated that sexual transmission of HIV is 3.5 times more likely to happen among individuals who are unaware of their HIV status. 24 However, the HIV testing coverage among key populations remains inadequate in many Southeast Asian countries.…”

Section: Introductionmentioning

confidence: 99%

Recent HIV testing and associated factors among people who use drugs in Cambodia: a national cross-sectional study

Eng

Tuot²,

Chann

et al. 2021

BMJ Open

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ObjectiveTo estimate the prevalence of HIV testing and examine factors associated with recent HIV testing among people who use drugs (PWUD) in Cambodia.DesignCross-sectional study.SettingTwelve major provinces with a high burden of HIV and drug use in Cambodia.ParticipantsThis study included 1677 PWUD recruited using a peer-based social network recruitment method. Participants’ selection criteria included being at least 18 years old and using any illicit drugs via any administration routes in the past 12 months.Primary outcome measureRecent HIV testing, defined as having an HIV test in the past 6 months.ResultsThe median age of the participants was 28 (IQR 22–34) years, and 56.6% were men. The prevalence of lifetime and recent HIV testing was 70.7% and 42.9%, respectively. After adjustment in multivariable logistic regression analysis, recent HIV testing remained positively associated with being female (adjusted OR (AOR) 1.55, 95% CI 1.18 to 2.04) or third gender identity (AOR 2.06, 95% CI 1.11 to 3.80), having ever been to a drug rehabilitation centre (AOR 1.60, 95% CI 1.13 to 2.29), having used any HIV services in the past 6 months (AOR 7.37, 95% CI 5.61 to 9.69), having received HIV education in the past 3 months (AOR 3.40, 95% CI 2.63 to 4.40) and having self-perception of higher HIV risk (AOR 1.81, 95% CI 1.19 to 2.73).ConclusionsRecent HIV test uptake among PWUD in Cambodia was suboptimal. This study highlights the roles of outreach HIV education and services in promoting regular HIV testing among PWUD. Strengthening the coordinated effort of government agencies and local civil society organisations to prioritise expanding community-based peer-driven interventions to reach out to this hidden population is warranted.

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“…Behaviour Change Effects: differential transmission risk due to behavioural changes related to engagement in the ART cascade [24, 25]…”

Section: Methodsmentioning

confidence: 99%

Risk heterogeneity in compartmental HIV transmission models of ART as prevention in Sub-Saharan Africa: A scoping review

Knight

Kaul

Mishra

2021

Preprint

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Objective. Transmission models provide complementary evidence to clinical trials about the potential population-level incidence reduction attributable to ART (ART prevention impact). Different modelling assumptions about risk heterogeneity may influence projected ART prevention impacts. We sought to review representations of risk heterogeneity in compartmental HIV transmission models applied to project ART prevention impacts in Sub-Saharan Africa. Design. Scoping review to identify common modelling assumptions and applications. Methods. We systematically reviewed studies published before January 2020 that used non-linear compartmental models of sexual HIV transmission to simulate ART prevention impacts in Sub-Saharan Africa. We summarized data on model structure/assumptions (factors) related to risk and intervention heterogeneity, and explored crude associations of ART prevention impact with modelled factors. Results. Of 1384 search hits, 94 studies were included, which primarily modelled medium/high prevalence epidemics in East/Southern Africa. 64 studies considered sexual activity stratification and 39 modelled at least one key population. 21 studies modelled faster/slower ART cascade transitions (HIV diagnosis, ART initiation, or cessation) by risk group, including 8 with faster and 4 with slower cascade transitions among key populations versus the wider population. Models without activity stratification predicted the largest ART prevention impacts, followed by models with key populations that had faster cascade transitions versus the wider population. Conclusions. Among compartmental transmission models applied to project ART prevention impacts, representations of risk heterogeneity and projected impacts varied considerably, where models with less heterogeneity tended to predict larger impacts. The potential influence of modelling assumptions about risk and intervention heterogeneity should be further explored.

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Sexual behaviour change following HIV testing services: a systematic review and meta‐analysis

Cited by 16 publications

References 89 publications

Understanding the Association Between PrEP Stigma and PrEP Cascade Moderated by the Intensity of HIV Testing

Understanding the Association Between PrEP Stigma and PrEP Cascade Moderated by the Intensity of HIV Testing

Recent HIV testing and associated factors among people who use drugs in Cambodia: a national cross-sectional study

Risk heterogeneity in compartmental HIV transmission models of ART as prevention in Sub-Saharan Africa: A scoping review

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