Determinants of HIV voluntary counseling and testing: a multilevel modelling of the Ethiopian Demographic and Health Survey

Background Human immunodeficiency virus (HIV) counseling and testing services are vital to reduce the spread of HIV infection, and to create an opportunity for early treatment and reduction of HIV/AIDS-related mortality. However, only 12 sub-Saharan African (SSA) countries reached the first 90% target (90% of people living with HIV to know their status). Hence, this study aimed to investigate the determinants of HIV counseling and testing among reproductive-age women in Ethiopia. Methods Ethiopian Demographic and Health Survey (EDHS 2016) data was used to identify the determinants of HIV counseling and testing among reproductive-age women in Ethiopia. A weighted sample of 14,599 reproductive age women was included in the study. A multilevel binary logistic regression model was fitted to identify the determinants of HIV counseling and testing. The odds’ ratio with a 95% Confidence Interval (CI) and the corresponding P-value ≤ 0.05 was employed to declare the statistically significant variables. Results In this study, both individual and community-level variables were significantly associated with Voluntary Counseling and Testing (VCT) uptake among women. Women aged 25–34 years (Adjusted Odds Ratio (AOR) 2.29, 95% CI 2.05, 2.56), aged ≥ 35 years (AOR 1.55, 95% CI 1.38, 1.75), attending primary education (AOR 1.68, 95% CI 1.51, 1.88), secondary education (AOR 3.07, 95% CI 2.64, 3.58), and higher education (AOR 5.15, 95% CI 4.17, 6.36), women with medium household wealth (AOR 1.56, 95% CI 1.32, 1.84), richer (AOR 1.88, 95% CI 1.58, 2.24), and richest wealth index (AOR 2.37, 95% CI 1.91, 2.94), having comprehensive knowledge (AOR 1.21, 95% CI 1.06, 1.37), ever married (AOR 3.87, 95% CI 3.46, 4.32), having sexual risky behavior (AOR 2.09, 95% CI 1.69, 2.49), women from communities with high HIV knowledge (AOR 2.03, 95% CI 1.68, 2.45), women from communities with high literacy level (AOR 1.16, 95% CI 1.05, 1.51) and women from communities with high wealth quintile (AOR 1.20, 95% CI 1.03,1.57) had higher odds of VCT uptake. However, those women having stigma (AOR 0.81, 95% CI 0.74, 0.92) had reduced odds of VCT uptake. Conclusion This study revealed that not only individual level factors but also community level factors determine the status of HIV voluntary counseling and testing. Hence, strengthening both individual and community based interventions are crucial to increase the women HIV counseling and testing practice in the country.

Intention to Use Voluntary Counseling and Testing Services among College Students

Background: HIV is a health problem of global concern. A large number of HIV cases in Surakarta is due to various factors such as the characteristics of adolescents, knowledge, attitudes, and beliefs to reduce HIV prevention through the use of VCT services. This study aims to analyze the relationship between age, gender, type of study program, information exposure, organizational participation, knowledge, attitudes, and beliefs in using VCT to use Voluntary Counseling and Testing (VCT) services for college students. Method: This research was a quantitative study with a cross-sectional approach. The study population was all students at one university in Surakarta in the 2016-2017 class as many as 12,457 students, while the research sample was 500 students who were taken using a proportional random sampling technique. Data analysis using chi-square test and logistic regression. Results: The results of the multivariate analysis showed that students' knowledge of HIV / AIDS and VCT affected the intention to use VCT services with an OR = 1.776 (CI = 1.170-2.695). The bivariate test results showed that there was a relationship between information exposure (p-value = 0.001), knowledge (p-value = 0.007), attitude (p-value = 0.006) and belief (p-value = 0.013) with the intention to use VCT services. Meanwhile, there was no relationship between age (p-value = 0.118), gender (p-value = 0.579), type of study program (p-value = 1,000), organizational participation (p-value = 0.352) with the intention of using VCT services. Students' knowledge of HIV / AIDS and VCT was the most dominant VCT intention. Therefore, providing information about VCT to students is necessary to increase students' knowledge and confidence in using VCT services.

Voluntary HIV Counseling and Testing (VCT): Knowledge, attitudes, hinderances, and practices of adults seeking treatment at Gulu Regional Referral Hospital on the spread of HIV in Northern Uganda. A cross-sectional study

Background: In 2011, Uganda had a national HIV prevalence of 6.7%. Between 2008 and 2009, there was an upsurge in HIV in Gulu District from 9.4% to 16.0% with Gulu Municipality at 22.1%. Similarly, in 2020, the prevalence of HIV in Gulu District persistently remained high at 14.0%, much higher than the national average at 6.0%.The objective of this study was to assess knowledge, attitudes, hindrances, and practices on voluntary HIV counseling and testing (VCT) and determine factors associated with VCT practices among adults seeking treatment at the outpatient department of Gulu Regional Referral Hospital.Methods: A cross-sectional study was conducted with 384 participants. Simple random sampling was used to recruit participants. Knowledge and practices on VCT were determined using knowledge ratings and attitudes using a modified Likert scale. A questionnaire with an internal validity of Cronbach’s α=0.71 was used. Ethical approval was obtained, and SPSS was used for data analysis at univariate, bivariate and multivariable logistic regression. A p-value less than 0.05 was considered significant.Results: The most significant findings were that knowledge and attitude significantly affect VCT practices among adults in Gulu Hospital. Most participants had adequate knowledge (297/379, 78.4%), the most common source of VCT information was radio (236/372, 63.4%) and few from parents (30/372, 8.1%). 158/380(41.6%) had strongly positive attitudes however, 4/10(40.0%) believed knowing HIV status was not beneficial because of fear of stigma, 299/380(78.7%) had good practices,13/45(28.9%) did not undertake VCT due to ignorant on the importance, 9/45(20.0%) feared positive results, and 5/45(11.0%) for far-off service centers. Among those who discouraged others, 15/45 (83.0%) did it for no reason, while 2/45 (11.0%) believed it was a risky and painful process.Knowledge and attitude on VCT practices had an adjusted R square of 0.421, p<0.001. The independent predictors of VCT practices in a multivariable regression analysis was knowledge (β=0.478, t=10.374, p<0.001) and attitudes (β=0.257, t=5.570, p<0.001).Conclusion: Knowledge and attitudes significantly influenced VCT practices among adults attending outpatient services at Gulu Hospital. The independent determinants of VCT practices were knowledge and attitudes. However, HIV stigma, fear of positive results and divorce/separation were the most deterring factors on VCT practices among participants.

Leveraging Expertise from Community Resources to Improve the Role of the Pharmacist in HIV Testing and Counseling

The human immunodeficiency virus (HIV) epidemic continues to be a major global public health issue. Moreover, disparities continue to persist in HIV among racial and ethnic minority populations, with the highest rates of new diagnoses in Black/African American and Hispanic/Latino men who have sex with men in the United States. Pharmacists are one of the most accessible and trusted health care professionals. Therefore, it is imperative that student pharmacists are educated on culturally-competent HIV testing and risk behaviors counseling. This study describes the development of a partnership between a pharmacy school and a community-based organization to offer an HIV counseling and testing training program to help develop skills in delivering HIV testing services. The HIV counseling and testing training program contains learning modules that provide a wide array of in-depth information about HIV patient care in the community. The partnership allows for the enjoyment of a myriad of benefits for students, the pharmacy program, the community-based organization, and the public health of the community-at-large. Students feel more prepared and comfortable working with patients in discussing HIV transmission risk factors and test results as a result of this training. Such partnerships support the pharmacist’s role in the public health arena. A successful and durable relationship between a community partner and a school of pharmacy is a feasible strategy for pharmacy progress in public health.

Genetic Diagnostic Strategies and Counseling for Families Affected by Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia (CDH) is a relatively common and severe birth defect with variable clinical outcome and associated malformations in up to 60% of patients. Mortality and morbidity remain high despite advances in pre-, intra-, and postnatal management. We review the current literature and give an overview about the genetics of CDH to provide guidelines for clinicians with respect to genetic diagnostics and counseling for families. Until recently, the common practice was (molecular) karyotyping or chromosome microarray if the CDH diagnosis is made prenatally with a 10% diagnostic yield. Undiagnosed patients can be reflexed to trio exome/genome sequencing with an additional diagnostic yield of 10 to 20%. Even with a genetic diagnosis, there can be a range of clinical outcomes. All families with a child with CDH with or without additional malformations should be offered genetic counseling and testing in a family-based trio approach.

Inequities in the utilization of HIV counseling and testing services among undergraduates in mainland China

Background HIV counseling and testing (HCT) is provided free of charge on college campuses, but very few studies have examined whether HCT uptake is equitably distributed. This cross-sectional study aimed to compare the relative importance of various determinants of HCT uptake among undergraduates in mainland China so as to assess and subsequently to suggest ways to eliminate inequities in its use, guided by the Andersen’s behavioral model. Methods A total of 10,665 eligible undergraduates were conveniently selected to complete an online survey. Hierarchical logistic regression analyses were performed to identify the factors associated with HCT utilization. Results Only 7.7% of undergraduates had utilized HCT services. HCT uptake was inequitably distributed, since it was mainly determined by predisposing and enabling factors rather than by need factors. Further analysis indicated that HCT uptake was significantly related to two need factors, one enabling factor and six predisposing factors. Those with a higher need [i.e., perceiving themselves to be at higher risk of acquiring HIV infection (AOR = 2.76, 95% CI:2.02–3.78) and engaging in condomless sex (AOR = 1.29, 95% CI:1.00–1.67)] and those with more resources [i.e., being knowledgeable of local AIDS service organization (AOR = 1.59, 95% CI:1.37–1.85)] were more likely to utilize HCT services. Compared to non-heterosexual men, non-heterosexual women (AOR = 0.51, 95% CI:0.37–0.72), heterosexual men (AOR = 0.44, 95% CI:0.33–0.57) and women (AOR = 0.31, 95%CI: 0.24–0.41) were less likely to utilize HCT service. Furthermore, those with more knowledge (AOR = 0.80, 95% CI:0.69–0.94) and taking a positive attitude towards HCT services [i.e, expressing their willingness to utilize HCT services (AOR = 0.68, 95% CI:0.56–0.81) and having recognized the necessity to provide HTC services in the local university (AOR = 0.46, 95% CI:0.36–0.57)] were less likely to utilize HCT services. However, medical students (AOR = 1.34, 95% CI: 1.15–1.56) and non-freshmen (AOR = 1.22, 95% CI:1.03–1.45) were more likely to utilize HCT services. Conclusions To increase HCT uptake and simultaneously reduce the remaining inequities, a comprehensive intervention should be continued to target non-heterosexual men and non- freshmen and those with a higher need for HCT services, conduct health education, improve the availability and accessibility of HIV testing services.

Hubungan Voluntary Counseling and Testing (VCT) dengan Tingkat Depresi pada Penderita HIV/AIDS

Introduction: VCT counseling is a counseling activity that provides psychological support, information and knowledge of HIV/AIDS and ensures the resolution of various problems related to HIV/AIDS, including the behavior of prisoners in each prison. Methods: This study used a cross sectional design. The number of samples is 56 prisoners or inmates who suffer from HI/AIDS. The research instrument used a questionnaire measuring instrument and statistical tests using the Chi Square test. Results: Depression of HIV/AIDS sufferers in Cipinang Jati Negara Class 1 Prison experienced depression 61% more. The bivariate results showed that there was a relationship between Voluntary Counseling and Testing (VCT) and the level of depression in HIV/AIDS sufferers in Cipinang Jati Negara Jakarta Class 1 Prison with a P-value of 0.009 and an Odds Ratio of 4.63. Discussion: There is a relationship between Voluntary Counseling and Testing (VCT) and the level of depression in HIV/AIDS sufferers at the Class 1 Cipinang Jati State Prison, East Jakarta in 2020.

Genetic Counseling and Testing in African American Patients With Breast Cancer: A Nationwide Survey of US Breast Oncologists

PURPOSE To determine if physicians' self-reported knowledge, attitudes, and practices regarding genetic counseling and testing (GCT) vary by patients' race. METHODS We conducted a nationwide 49-item survey among breast oncology physicians in the United States. We queried respondents about their own demographics, clinical characteristics, knowledge, attitudes, practices, and perceived barriers in providing GCT to patients with breast cancer. RESULTS Our survey included responses from 277 physicians (females, 58.8%; medical oncologists, 75.1%; academic physicians, 61.7%; and Whites, 67.1%). Only 1.8% indicated that they were more likely to refer a White patient than refer an African American patient for GCT, and 66.9% believed that African American women with breast cancer have lower rates of GCT than White women. Regarding perceived barriers to GCT, 63.4% of respondents indicated that African American women face more barriers than White women do and 21% felt that African American women require more information and guidance during the GCT decision-making process than White women. Although 32% of respondents indicated that lack of trust was a barrier to GCT in all patients, 58.1% felt that this was a greater barrier for African American women ( P < .0001). Only 13.9% believed that noncompliance with GCT is a barrier for all patients, whereas 30.6% believed that African American women are more likely than White women to be noncompliant ( P < .0001). CONCLUSION We demonstrated that racial differences exist in oncology physicians' perceived barriers to GCT for patients with breast cancer. This nationwide survey will serve as a basis for understanding physicians' determinants of GCT for African American women and highlights the necessity of education and interventions to address bias among physicians. Awareness of such physician biases can enable further work to address inequities, ultimately leading to improved GCT equity for African American women with breast cancer.