Who are the missing men? Characterising men who never tested for <scp>HIV</scp> from population‐based surveys in six sub‐Saharan African countries

Quinn, Caitlin; Kadengye, Damazo T.; Johnson, Cheryl; Baggaley, Rachel; Dalal, Shona

doi:10.1002/jia2.25398

Cited by 42 publications

(71 citation statements)

References 43 publications

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“…Consistent with the estimated decreases in median time to diagnosis, the probability of receiving an HIV test within 1 year following infection or before reaching a CD4 count threshold lower than 350 cells per µL increased respectively by 31 and 52 percentage points from to 2020 in SSA (Table 1; Figure 5B-C). 31 As part of these efforts, facilitating linkage and retaining men with HIV care remains a key challenge for further progress towards HIV testing and treatment targets.…”

Section: Resultsmentioning

confidence: 99%

Trends in knowledge of HIV status and efficiency of HIV testing services in Sub-Saharan Africa (2000-2020): a modelling study of survey and HIV testing program data

Giguère

Eaton

Marsh

et al. 2020

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Background: Knowledge of HIV status (KOS) among people living with HIV (PLHIV) is essential for an effective national HIV response. This study estimates progress and gaps in reaching the UNAIDS 2020 target of 90% KOS, and the efficiency of HIV testing services (HTS) in sub-Saharan Africa (SSA), where two thirds of all PLHIV live. Methods: We used data from 183 population-based surveys (N=2.7 million participants) and national HTS programs (N=315 country-years) from 40 countries as inputs into a mathematical model to examine trends in KOS among PLHIV, median time from HIV infection to diagnosis, HIV testing positivity, and proportion of new diagnoses among all positive tests, adjusting for retesting. Findings: Across SSA, KOS steadily increased from 6% (95% credible interval [95%CrI]: 5% to 7%) in 2000 to 84% (95%CrI: 82% to 86%) in 2020. Twelve countries and one region, Southern Africa, reached the 90% target. In 2020, KOS was lower among men (79%) than women (87%) across SSA. PLHIV aged 15-24 years were the least likely to know their status (65%), but the largest gap in terms of absolute numbers was among men aged 35-49 years, with over 700,000 left undiagnosed. As KOS increased from 2000 to 2020, the median time to diagnosis decreased from 10 to 3 years, HIV testing positivity declined from 9% to 3%, and the proportion of first-time diagnoses among all positive tests dropped from 89% to 42%. Interpretation: On the path towards the next UNAIDS target of 95% diagnostic coverage by 2030, and in a context of declining positivity and yield of first-time diagnoses, we need to focus on addressing disparities in KOS. Increasing KOS and treatment coverage among older men could be critical to reduce HIV incidence among women in SSA, and by extension, reducing mother-to-child transmission.

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Section: Resultsmentioning

confidence: 99%

Trends in knowledge of HIV status and efficiency of HIV testing services in Sub-Saharan Africa (2000-2020): a modelling study of survey and HIV testing program data

Giguère

Eaton

Marsh

et al. 2020

Preprint

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“…Efforts should be made to increase the coverage of HIV testing in particular among these sub-populations. 2 Cannot read at all, or can read part of a sentence only 3 We defined the prevalence as the proportion of positive tests among the conclusive (positive and negative) tests results 10.0% 6.4% 0.8% 13.0% 0.5% 3.9% 4 Can read a whole sentence 5 Cannot read at all, or can read part of a sentence only 6 Sexually Transmitted Infection 7 We defined the prevalence as the proportion of positive tests among the conclusive (positive and negative) tests results. 3 -"adolescent, literate, never married" 4 -"over 35, married, media access" 5 -"adolescent, illiterate, never married" 6 -"20-35 years, married, media access"…”

Section: Discussionmentioning

confidence: 99%

Identifying groups of people with similar sociobehavioural characteristics in Malawi to inform HIV interventions: a Latent Class Analysis

Merzouki

Styles

Estill

et al. 2019

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Background: Within many sub-Saharan African countries including Malawi, HIV prevalence varies widely between regions. This variability may be related to the distribution of population groups with specific sociobehavioural characteristics that influence the transmission of HIV and the uptake of prevention. In this study, we intended to identify groups of people in Malawi with similar risk profiles. Methods: We used data from the Demographic and Health Survey in Malawi from 2016, and stratified the analysis by sex. We considered demographic, socio-behavioural and HIV-related variables. Using Latent Class Analysis (LCA), we identified clusters of people sharing common sociobehavioural characteristics. The optimal number of clusters was selected based on the Bayesian information criterion. We compared the proportions of individuals belonging to the different clusters across the three regions and 28 districts of Malawi. Results: We found nine clusters of women and six clusters of men. Most women in the clusters with highest risk of being HIV infected were living in female-headed households and were formerly married or in a union. Among men, older men had the highest risk of being HIV infected, followed by young (20-25) single men. Generally, low HIV testing uptake correlated with lower risk of having HIV. However, rural adolescent girls had a low probability of being tested (48.7%) despite a relatively high HIV prevalence. Urban districts and Southern region had a higher percentage of high-prevalence and less tested clusters of individuals than other areas. Conclusions: LCA is an efficient method to find clusters of people sharing common HIV risk profiles, identify particularly vulnerable population groups, and plan targeted interventions focusing on these groups. Tailored support, prevention and HIV testing programmes should focus particularly on female household heads, adolescent girls living in rural areas, older married men, and young men who have never been married.

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“…Across southern Africa, men are less well served by HIV programmes than women, less likely to have ever tested [4] and more likely to develop advanced HIV disease, reflecting late diagnosis and/or treatment initiation [5]. Men have fewer opportunities for HIV testing compared to women, as well as social-cultural, economic and systemic barriers that reduce access to and uptake of services [6,7].…”

Section: Introductionmentioning

confidence: 99%

Use and awareness of and willingness to self-test for HIV: an analysis of cross-sectional population-based surveys in Malawi and Zimbabwe

et al. 2020

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Background: Many southern African countries are nearing the global goal of diagnosing 90% of people with HIV by 2020. In 2016, 84 and 86% of people with HIV knew their status in Malawi and Zimbabwe, respectively. However, gaps remain, particularly among men. We investigated awareness and use of, and willingness to self-test for HIV and explored sociodemographic associations before large-scale implementation. Methods: We pooled responses from two of the first cross-sectional Demographic and Health Surveys to include HIV self-testing (HIVST) questions in Malawi and Zimbabwe in 2015-16. We investigated sociodemographic factors and sexual risk behaviours associated with previously testing for HIV, and past use, awareness of, and future willingness to self-test using univariable and multivariable logistic regression, adjusting for the sample design and limiting analysis to participants with a completed questionnaire and valid HIV test result. We restricted analysis of willingness to self-test to Zimbabwean men, as women and Malawians were not systematically asked this question. Results: Of 31,385 individuals, 31.2% of men had never tested compared with 16.5% of women (p < 0.001). For men, the likelihood of having ever tested increased with age. Past use and awareness of HIVST was very low, 1.2 and 12.6%, respectively. Awareness was lower among women than men (9.1% vs 15.3%, adjusted odds ratio [aOR] = 1.55; 95% confidence interval [CI]: 1.37-1.75), and at younger ages, and lower education and literacy levels. Willingness to self-test among Zimbabwean men was high (84.5%), with greater willingness associated with having previously tested for HIV, being at high sexual risk (highest willingness [aOR = 3.74; 95%CI: 1.39-10.03, p < 0.009]), and being ≥25 years old. Wealthier men had greater awareness of HIVST than poorer men (p < 0.001). The highest willingness to self-test (aOR = 3.74; 95%CI: 1.39-10.03, p < 0.009) was among men at high HIV-related sexual risk.

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Who are the missing men? Characterising men who never tested for HIV from population‐based surveys in six sub‐Saharan African countries

Cited by 42 publications

References 43 publications

Trends in knowledge of HIV status and efficiency of HIV testing services in Sub-Saharan Africa (2000-2020): a modelling study of survey and HIV testing program data

Trends in knowledge of HIV status and efficiency of HIV testing services in Sub-Saharan Africa (2000-2020): a modelling study of survey and HIV testing program data

Identifying groups of people with similar sociobehavioural characteristics in Malawi to inform HIV interventions: a Latent Class Analysis

Use and awareness of and willingness to self-test for HIV: an analysis of cross-sectional population-based surveys in Malawi and Zimbabwe

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