Abstract
Increasing HIV diagnosis is important for combatting HIV. We invited individuals aged ≥ 13 years seeking voluntary HIV testing at Mildmay Clinic in Uganda to undertake a computer or audio-computer-assisted self-interview to facilitate post-test counseling. We evaluated first-visit data from 12,233 consenting individuals between January 2011 and October 2013. HIV prevalence was 39.0%. Of those with HIV, 37.2% already knew they were infected. Undiagnosed infection was associated with not being single, screening positive for depression (aOR 1.16, 95% CI 1.04–1.28), and screening for harmful drinking behavior (aOR 1.23, 95% CI 1.10–1.39). The odds of retesting subsequent to HIV diagnosis were lower for males (aOR 0.80, 95% CI 0.70–0.92) and those screening positive for harmful drinking behavior (aOR 0.77, 95% CI 0.66–0.88). Retesting was also associated with higher education and perceived social status below ‘better off’. Our findings reiterate the value of population-based HIV surveys to provide estimates of testing coverage.
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The dataset used and analyzed during the current study is available from the corresponding author on reasonable request.
References
UNAIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014.
Justman J, Hoos D, Kalton G, et al. Real progress in the HIV epidemic: PHIA findings from Zimbabwe, Malawi, and Zambia. Seattle: CRO; 2014.
UNAIDS. Global AIDS update 2018: miles to go: closing gaps, breaking barriers, righting injustices. Geneva: UNAIDS; 2018.
Bradley H, Tsui A, Kidanu A, Gillespie D. Client characteristics and HIV risk associated with repeat HIV testing among women in Ethiopia. AIDS Behav. 2011;15:725–33.
Grabbe K, Courtenay-Quirk C, Baughman AL, et al. Re-testing and seroconversion among HIV testing and counseling clients. AIDS Educ Prev. 2015;27(4):350–61.
Pettifor A, MacPhail C, Suchindran S, Delany-Moretlwe S. Factors associated with HIV testing among public sector clinic attendees in Johannesburg, South Africa. AIDS Behav. 2010;14(4):913–21.
Vuylsteke B, Semde G, Auld AF, et al. Retention and risk factors for loss to follow-up of female and male sex workers on antiretroviral treatment in Ivory Coast: a retrospective cohort analysis. J Acquir Immune Defic Syndr. 2015;68(Suppl 2):S99–106.
Uganda Ministry of Health. National HIV Testing Services Policy and Implementation Guidelines, Uganda. Kampala: Ministry of Health; 2016.
Uganda AIDS Commission. The HIV and AIDS Uganda Country Progress Report 2014. 2015.
Fuente-Soro L, Lopez-Varela E, Augusto O, et al. Monitoring progress towards the first UNAIDS target: understanding the impact of people living with HIV who re-test during HIV-testing campaigns in rural Mozambique. J Int AIDS Soc. 2018;21(4):e25095.
Hladik W, Sande E, Berry M, et al. Men who have sex with men in Kampala, Uganda: results from a bio-behavioral respondent driven sampling survey. AIDS Behav. 2016;21(5):1478–90.
Doshi R, Sande E, Ogwal M, et al. HIV, serostatus knowledge, and viral load suppression among female sex workers in Kampala, Uganda, 2012: a respondent-driven sampling survey. Paris: IAS; 2017.
Cawley C, Wringe A, Isingo R, et al. Low rates of repeat HIV testing despite increased availability of antiretroviral therapy in rural Tanzania: findings from 2003–2010. PLoS ONE. 2013;8(4):e62212.
Matkovic Puljic V, Kosanovic Licina ML, Kavic M, Nemeth Blazic T. Repeat HIV testing at voluntary testing and counseling centers in Croatia: successful HIV prevention or failure to modify risk behaviors? PLoS ONE. 2014;9(4):e93734.
Orne-Gliemann J, Zuma T, Chikovore J, et al. Community perceptions of repeat HIV-testing: experiences of the ANRS 12249 treatment as prevention trial in rural South Africa. AIDS Care. 2016;28(Suppl 3):14–23.
Regan S, Losina E, Chetty S, et al. Factors associated with self-reported repeat HIV testing after a negative result in Durban, South Africa. PLoS ONE. 2013;8(4):e62362.
Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–92.
Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption. Addiction. 1993;88:791–804.
Hladik W, Benech I, Bateganya M, Hakim AJ. The utility of population-based surveys to describe the continuum of HIV services for key and general populations. Int J STD AIDS. 2016;27(1):5–12.
Kim AA, Mukui I, Young PW, et al. Undisclosed HIV infection and antiretroviral therapy use in the Kenya AIDS indicator survey 2012. Aids. 2016;30(17):2685–95.
UNAIDS. Uganda, UNAIDS 2016. http://www.unaids.org/en/regionscountries/countries/uganda/.
Dilernia DA, Monaco DC, Cesar C, et al. Estimation of HIV-testing rates to maximize early diagnosis-derived benefits at the individual and population level. PLoS ONE. 2013;8(1):e53193.
Egger M, May M, Chene G, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet. 2002;360(9327):119–29.
Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.
Kroon E, Phanuphak N, Shattock AJ, et al. Acute HIV infection detection and immediate treatment estimated to reduce transmission by 89% among men who have sex with men in Bangkok. J Int AIDS Soc. 2017;20(1):1–9.
Cohen MA, Gorman JM, Jacobson JM, Volberding PC, Letendre SL. Comprehensive textbook of AIDS psychiatry: a paradigm for integrated care. 2nd ed. Oxford: Oxford University Press; 2017.
Hensen B, Taoka S, Lewis JJ, Weiss HA, Hargreaves J. Systematic review of strategies to increase men’s HIV-testing in sub-Saharan Africa. Aids. 2014;28(14):2133–45.
Geng EH, Odeny TA, Lyamuya R, et al. Retention in care and patient-reported reasons for undocumented transfer or stopping care among HIV-infected patients on antiretroviral therapy in Eastern Africa: application of a sampling-based approach. Clin Infect Dis. 2016;62(7):935–44.
Wilkinson LS, Skordis-Worrall J, Ajose O, Ford N. Self-transfer and mortality amongst adults lost to follow-up in ART programmes in low- and middle-income countries: systematic review and meta-analysis. Trop Med Int Health. 2015;20(3):365–79.
van der Elst EM, Okuku HS, Nakamya P, et al. Is audio computer-assisted self-interview (ACASI) useful in risk behaviour assessment of female and male sex workers, Mombasa, Kenya? PLoS ONE. 2009;4(5):e5340.
Adebajo S, Obianwu O, Eluwa G, et al. Comparison of audio computer assisted self-interview and face-to-face interview methods in eliciting HIV-related risks among men who have sex with men and men who inject drugs in Nigeria. PLoS ONE. 2014;9(1):e81981.
Simoes AA, Bastos FI, Moreira RI, Lynch KG, Metzger DS. A randomized trial of audio computer and in-person interview to assess HIV risk among drug and alcohol users in Rio De Janeiro, Brazil. J Subst Abuse Treat. 2006;30(3):237–43.
Hewett PC, Mensch BS, Erulkar AS. Consistency in the reporting of sexual behaviour by adolescent girls in Kenya: a comparison of interviewing methods. Sex Transm Infect. 2004;80(Suppl 2):43–8.
Phillips AE, Gomez GB, Boily MC, Garnett GP. A systematic review and meta-analysis of quantitative interviewing tools to investigate self-reported HIV and STI associated behaviours in low- and middle-income countries. Int J Epidemiol. 2010;39(6):1541–55.
Langhaug LF, Sherr L, Cowan FM. How to improve the validity of sexual behaviour reporting: systematic review of questionnaire delivery modes in developing countries. Trop Med Int Health. 2010;15(3):362–81.
Acknowledgements
Funding for data collection and analysis came from PEPFAR through the US Centers for Disease Control and Prevention under the cooperative agreement number 5U2GPS000971. We thank the staff at Mildmay Clinic who provide an invaluable service to the community as well as the clinic clients who allowed us to analyze their data.
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The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.
Funding
This study was funded by PEPFAR through the US Centers for Disease Control and Prevention under the cooperative agreement number 5U2GPS000971.
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WH designed the research with ES, BM, MO (Mary Odiit), and SS. BM coordinated data collection supervised by MO (Mary Odiit) and YK. MO (Moses Ogwal), ES, and SS provided technical support. AH and LH analyzed and interpreted the data. AH, LH, and WH were major contributors in writing the manuscript. All authors read and approved the final manuscript.
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This article does not contain any studies with animals performed by any of the authors. All procedures performed with human participants in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Hakim, A.J., Mukasa, B., Hundley, L. et al. Correlates of Undiagnosed HIV Infection and Retesting Among Voluntary HIV Testing Clients at Mildmay Clinic, Uganda. AIDS Behav 23, 820–834 (2019). https://doi.org/10.1007/s10461-018-2274-3
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DOI: https://doi.org/10.1007/s10461-018-2274-3