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Systematic or Test-Guided Treatment for Tuberculosis in HIV-Infected Adults. In regions with high burdens of tuberculosis and humanimmunodeficiencyvirus (HIV), many HIV-infected adults begin antiretroviral therapy (ART) when they are already severely immunocompromised. Mortality after ART initiation is high in these patients, and tuberculosis and invasive bacterial diseases are common causes of death.We conducted a 48-week trial of empirical treatment for tuberculosis as compared (...) with treatment guided by testing in HIV-infected adults who had not previously received ART and had CD4+ T-cell counts below 100 cells per cubic millimeter. Patients recruited in Ivory Coast, Uganda, Cambodia, and Vietnam were randomly assigned in a 1:1 ratio to undergo screening (Xpert MTB/RIF test, urinary lipoarabinomannan test, and chest radiography) to determine whether treatment for tuberculosis should be started or to receive systematic empirical treatment with rifampin, isoniazid, ethambutol
of screening strategies for early identification of HIV and HCV infection in injection drug users. PloS One. 2012;7(9). Sanders GD, Anaya HD, Asch S, Hoang T, Golden JF, Bayoumi AM, et al. Cost-effectiveness of strategies to improve HIVtesting and receipt of results: Economic analysis of a randomized controlled trial. Journal of General Internal Medicine. 2010;25(6):556–63. Dowdy DW, Rodriguez RM, Bradley Hare C, Kaplan B. Cost‐effectiveness of targeted humanimmunodeficiencyvirus screening in an urban (...) Cost-effectiveness of rapid point-of-care testing (POCT) programs for HIV Cost-effectiveness of rapid point-of-care testing (POCT) programs for HIV | The Ontario HIV Treatment Network The Ontario HIV Treatment Network Cost-effectiveness of rapid point-of-care testing (POCT) programs for HIV Cost-effectiveness of rapid point-of-care testing (POCT) programs for HIV , , , , Questions What evidence exists regarding the cost-effectiveness of rapid point-of-care testing (POCT) programs for HIV? How
Verification of HIV Self-Testing Use and Results: A Global Systematic Review. HIV self-testing (HIVST) allows individuals to interpret and report their own test results, thus decentralizing testing. Yet, this decentralization can make it difficult to verify self-testing results, which is important for linkage to care and surveillance. The aim of this systematic review is to summarize methods for verifying HIVST use and results. We followed guidance from the Cochrane Handbook 5.1 on systematic (...) reviews. We searched four journal databases (PubMed, Embase, Scopus, and Cochrane Library), one clinical trials database (ClinicalTrials.gov), two conference abstract databases (International AIDS Society and Conference on Retroviruses and Opportunistic Infections) and one gray literature database (OpenGrey). We included studies that verified opening of kits or test results. Two researchers independently screened articles and extracted data regarding HIVST location, method of verification, who
Uptake of couples HIVtesting and counselling among heterosexual couples in Sub-Saharan Africa: a systematic review and meta-analysis. There is a need for further research to inform policy and practice on Couples HIVTesting and Counselling (CHTC) in Sub-Saharan Africa (SSA). The aim of this systematic review and meta-analysis was to estimate and characterise the uptake of CHTC in the SSA. A comprehensive search of published studies was carried out in six electronic databases. Of 30,273 (...) was higher among pregnant women and their partners (OR = 1.66, 95%CI: 1.58-1.84), and when one person in the dyad first tested individually (OR = 3.16, 95%CI: 2.69-3.72) compared to their counterparts. These findings suggest that people may be cautious of testing together as a couple. Further studies are required to explore how couples intend to use HIV-testing services including CHTC and under what circumstances CHTC may be beneficial to individuals in a relationship.
HIVtesting barriers and intervention strategies among men, transgender women, female sex workers and incarcerated persons in the Caribbean: a systematic review. This systematic review summarises evidence on the HIVtesting barriers and intervention strategies among Caribbean populations and provides pertinent implications for future research endeavours designed to increase rates of HIVtesting in the region.We used a systematic approach to survey all literature published between January 2008 (...) and November 2018 using four electronic databases (MEDLINE/PubMed, Embase, Web of Science and Global Health). Only peer-reviewed articles published in English that examined HIVtesting uptake and interventions in the Caribbean with men, men who have sex with men, female sex workers, transgender women and incarcerated individuals were included.Twenty-one studies met the inclusion criteria. Lack of confidentiality, access to testing sites, stigma, discrimination, poverty and low HIV risk perception were
Men's perspectives on HIV self-testing in sub-Saharan Africa: a systematic review and meta-synthesis. Despite the many HIVtesting models implemented in Africa, the level of HIVtesting uptake remains relatively poor, especially among men. The HIV self-testing (HIVST) model offers an additional approach for encouraging men to get tested. This study aimed to synthesise evidence on men's perspectives regarding HIVST in sub-Saharan Africa (SSA).The databases searched included PubMed/MEDLINE (...) ; acceptability of HIVST; need for HIVST counselling; confidentiality of HIVST; convenience of HIVST; and accuracy of HIVST. The study shows that while HIVST provides men with an alternative, confidential and convenient testing model, the potential for psychological and physical harm remains a challenge.The introduction of the HIVST strategy has the potential of improving men's uptake in HIVtesting services, thereby contributing towards addressing the first cascade of the 90-90-90 strategy. While HIVST has
A Systematic Review of Interventions that Promote Frequent HIVTesting. As of 2017, the Centers for Disease Control and Prevention (CDC) HIVtesting guidelines recommend that those at increased risk for HIV are tested two to four times per year. Evidence-based interventions that promote frequent and repeated testing remain sparse. We conducted a systematic review to: (1) identify frequent testing interventions; and (2) determine which were successful in increasing frequent testing rates. We (...) searched PubMed, PsycINFO, Web of Science, Embase, and CINAHL for peer-reviewed articles published between January 1, 2010 and September 30, 2017. Ten studies met inclusion criteria. Operationalization of frequent HIVtesting varied widely across studies. Four interventions involved text message reminders for HIVtesting, three involved community-based testing, two self-testing, and one rapid testing. Text message reminder interventions were most successful in increasing rates of frequent HIVtesting
Men's perspectives on HIV self-testing in sub-Saharan Africa: a qualitative systematic review protocol. The aim of this review is to synthesize the best available evidence on men's perspectives on humanimmunodeficiencyvirus (HIV) self-testing in sub-Saharan Africa.Many factors influence men's poor HIVtesting uptake in healthcare facilities, including stigma and confidentiality. Due to men's low engagement with healthcare facilities, there remains a high proportion of HIV-positive men who (...) are unaware of their HIV status. The HIV self-testing models enable individuals to conduct and interpret their own HIVtest at their own convenient time and private space, removing some of the barriers associated with accessing healthcare facility-based HIVtesting services.This review will consider studies that explore men's perspectives and experiences on the use of HIV self-testing in sub-Saharan Africa. Studies with men of any age will be considered. The studies must provide evidence on HIV self
Systematic review of the accuracy of plasma preparation tubesÂ for HIV viral load testing. Expanding access to HIV viral load testing is essential to improving the care and treatment of people living with HIV/AIDS and ending the AIDS epidemic. Though significant investments have been made in the past five years, many high burden, low resource countries continue to have viral load access rates below 50%. Plasma preparation tubes (PPTs) can simplify storage, transport, and preparation of plasma (...) used for viral load testing. A systematic review was conducted to evaluate the accuracy of plasma preparation tubes for HIV viral load testing. Study results regarding the accuracy of PPT viral load measurements across various storage and transportation conditions were examined. The quality of evidence was evaluated using GRADE and QUADAS-2 criteria. The review identified 16 studies using PPTs with data from 6,141 individuals from 1995 to 2014. Overall the quality of evidence was rated as moderate
HIVtesting strategies outside of health care settings in the European Union (EU)/European Economic Area (EEA): a systematic review to inform European Centre for Disease Prevention and Control guidance. In recent years, new technologies and new approaches to scale up HIVtesting have emerged. The objective of this paper was to synthesize the body of recent evidence on strategies aimed at increasing the uptake and coverage of HIVtesting outside of health care settings in the European Union (EU (...) )/European Economic Area (EEA).Systematic searches to identify studies describing effective HIVtesting interventions and barriers to testing were run in five databases (2010-2017) with no language restrictions; the grey literature was searched for similar unpublished studies (2014-2017). Study selection, data extraction and critical appraisal were performed by two independent reviewers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Eighty studies on HIV
HIVtesting strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review. Despite the availability of HIVtesting guidelines to facilitate prompt diagnosis, late HIV diagnosis remains high across Europe. The study synthesizes recent evidence on HIVtesting strategies adopted in health care settings in the European Union/European Economic Area (EU/EEA).Preferred Reporting Items for Systematic Reviews and Meta-Analyses (...) (PRISMA) guidelines were followed and systematic searches were run in five databases (2010-2017) to identify studies describing HIVtesting interventions in health care settings in the EU/EEA. The grey literature was searched for unpublished studies (2014-2017). Two reviewers independently performed study selection, data extraction and critical appraisal.One hundred and thirty intervention and/or feasibility studies on HIVtesting in health care settings were identified. Interventions included testing
The Effectiveness of Social Marketing Interventions to Improve HIVTesting Among Gay, Bisexual and Other Men Who Have Sex with Men: A Systematic Review. HIVtesting is central to biomedical HIV prevention, but testing among men who have sex with men remains suboptimal. We evaluated effectiveness of mass media and communication interventions to increase HIVtesting and explored patterns between study type, internal validity and intervention effectiveness for the first time. Five databases were (...) , one medium and two low) and one RCT (medium validity) reported increased HIVtesting. Further work is required to develop and evaluate interventions to increase frequency and maintenance of HIVtesting.
HIVtesting and engagement with the HIV treatment cascade among men who have sex with men in Africa: a systematic review and meta-analysis. HIV disproportionately affects gay, bisexual, and other men who have sex with men (MSM) in Africa, where many countries criminalise same-sex behaviour. We assessed changes in the engagement of African MSM with HIVtesting and treatment cascade stages over time, and the effect of anti-LGBT legislation and stigma.We systematically searched Embase, Global (...) Health, MEDLINE, Scopus, and Web of Science for peer-reviewed cross-sectional or longitudinal studies recruiting at least ten MSM, published from Jan 1, 1980, to Oct 10, 2018. We extracted or derived estimates of HIVtesting, engagement with the HIV treatment cascade, or both among African MSM from published reports. We derived pooled estimates using inverse-variance random-effects models. We used subgroup and meta-regression analysis to assess associations between testing and status awareness
What are mass media interventions made of? Exploring the active content of interventions designed to increase HIVtesting in gay men within a systematic review. Mass media HIVtesting interventions are effective in increasing testing, but there has been no examination of their theory or behaviour change technique (BCT) content. Within a heterogeneous body of studies with weak evaluative designs and differing outcomes, we attempted to gain useful knowledge to shape future interventions.Within (...) interventions should improve knowledge about testing, and use well-branded and trusted sources that endorse testing. Future interventions should also provide clear information about the health benefits of testing. Our analysis also suggests that to improve levels of effectiveness characterizing the current field, it may be useful to elicit commitment, and action plans, relating to how to implement testing intentions.What is already known on this subject? Interventions are urgently needed to increase HIV
The Accuracy of Anal Swab-Based Tests to Detect High-Grade Anal Intraepithelial Neoplasia in HIV-Infected Patients: A Systematic Review and Meta-analysis. The incidence of high-risk human papillomavirus (HR-HPV)-induced anal cancer is increasingly problematic among HIV-positive patients. Anal cancer is preceded by precursor lesions, anal intraepithelial neoplasia (AIN). AIN detection requires high-resolution anoscopy, a cumbersome and time-consuming procedure. We aggregated evidence on anal (...) swab-based tests to detect AIN in HIV-positive patients.We searched MEDLINE and EMBASE for cross-sectional studies on AIN detection with anal cytology, HR-HPV DNA detection, HPV E6/E7 mRNA analysis, and P16INK4a and Ki-67 immunostaining. Summary estimates of sensitivity and specificity were calculated using bivariate logistic regression. Cytology was reported using the terms squamous intra-epithelial lesion (SIL) for AIN and high-grade SIL (HSIL) for high-grade AIN (HGAIN).We included 22 studies
Integration of HIVtesting services into family planning services: a systematic review. Despite significant interest in integrating sexual and reproductive health (SRH) services into HIV services, less attention has been paid to linkages in the other direction. Where women and girls are at risk of HIV, offering HIVtesting services (HTS) during their visits to family planning (FP) services offers important opportunities to address both HIV and unwanted pregnancy needs simultaneously.We (...) outcomes varied slightly across studies. One study found that women at integrated sites were more likely to have high satisfaction with services, but experienced longer waiting times. One study found a small increase in HIV seropositivity among female patients testing after full integration, compared to a dedicated HIV tester. No studies comparatively measured linkage to HIV care and treatment, dual method use, or provider knowledge/attitudes.Global progress and success for reaching SRH and HIV targets
Evidence for optimal HIV screening and testing intervals in HIV-negative individuals from various risk groups: A systematic review. Humanimmunodeficiencyvirus (HIV) testing plays a crucial role in Canada's HIV prevention and treatment efforts and is the first step to achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets; however, how often Canadians, including populations at increased risk of HIV exposure, should be tested is unclear. We conducted a systematic (...) screening through their primary care provider.There was insufficient evidence to support optimal HIV screening and testing intervals for different populations. Context-specific factors, such as budget allocation, human resources, local epidemiology, socioeconomic factors and risk behaviours, along with clinical judgement, inform whom and how often to screen, suggesting the need for research specific to Canada. Research on patient preferences as well as the benefits and harms of more frequent screening
Suboptimal Recent and Regular HIVTesting Among Black Men Who Have Sex With Men in the United States: Implications From a Meta-Analysis. The continuum of HIV care among black men who have sex with men (BMSM) continues to be the least favorable in the United States. BMSM are disproportionally HIV-infected-but-unaware, despite expanded HIVtesting efforts among this subgroup.We meta-analytically analyzed various HIVtesting patterns [lifetime, after 24 months, after 12 months, after 6 months (...) , and frequent (every 3-6 months) testing] among BMSM using the PRISMA guideline. PubMed, MEDLINE, Web of Science, and PsycINFO were searched for relevant articles, reports, conference proceedings, and dissertations published between January 1, 1996, and April 25, 2018. Two independent investigators reviewed and abstracted data into a standardized form. We used the DerSimonian-Laird random-effect model to pool the HIVtesting prevalence and I-square statistics to measure heterogeneity. Funnel plots and Egger
Meta-analysis of average costs of HIVtesting and counselling and voluntary medical male circumcision across thirteen countries. Objective: Explore facility-level average costs per client of HIVtesting and counselling (HTC) and voluntary medical male circumcision (VMMC) services in 13 countries.Methods: Through a literature search we identified studies that reported facility-level costs of HTC or VMMC programmes. We requested the primary data from authors and standardised the disparate data
Facilitators and barriers to HIVtesting among Asians in the United States: a systematic review. Asians have the highest rate of undiagnosed HIV in the United States. Limited research on factors implicated in HIVtesting among this population presents a barrier to monitoring and addressing HIVtesting disparities. To examine predictors of HIVtesting among Asians in the United States, a systematic search of articles published from January 1997 to December 2017 was conducted using four (...) electronic databases, including Medline, PubMed, PsycINFO, and Web of Science. Twenty-two articles were included according to predefined inclusion criteria: peer-reviewed, published in English, took place in the United States, included participants at least 18 years of age, reported data specifically on Asians or Asian subgroups, and assessed HIVtesting. Included studies were assessed by methodological quality scoring. Individual-level factors such as HIV knowledge and HIV risk perceptions were commonly