Dataset Information

Suboptimal Recent and Regular HIV Testing Among Black Men Who Have Sex With Men in the United States: Implications From a Meta-Analysis.

ABSTRACT: BACKGROUND: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 HIV testing efforts among this subgroup. METHODS:We meta-analytically analyzed various HIV testing 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 HIV testing prevalence and I-square statistics to measure heterogeneity. Funnel plots and Egger tests were used to assess for publication bias. We also performed subgroup and meta-regression analyses to explore aggregate-level characteristics that explain the heterogeneity across studies. RESULTS:Our meta-analysis includes a total of 42,074 BMSM pooled from 67 studies. Lifetime HIV testing prevalence was high, 88.2% [95% confidence interval (CI): 86.2% to 90.1%], but recent (after 6 months = 63.4%; 95% CI: 59.3% to 67.4%) and frequent (42.2%, 95% CI: 34.1% to 50.3%) HIV testing prevalence was low. Meta-regression suggests that younger age (borderline significant), lower annual income, and homelessness were correlated with lower lifetime/recent HIV testing prevalence; while ever having condomless insertive/receptive sex, alcohol consumption, and illicit drug use were associated with higher lifetime/recent HIV testing prevalence. CONCLUSIONS:Recent and frequent HIV testing remains suboptimal among BMSM. Future testing programs should prioritize strategies to enhance self-initiated, regular HIV testing among BMSM.

SUBMITTER: Liu Y

PROVIDER: S-EPMC6956840 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Suboptimal Recent and Regular HIV Testing Among Black Men Who Have Sex With Men in the United States: Implications From a Meta-Analysis.

Liu Yu Y Silenzio Vincent M B VMB Nash Robertson R Luther Patrick P Bauermeister Jose J Vermund Sten H SH Zhang Chen C

Journal of acquired immune deficiency syndromes (1999) 20190601 2

<h4>Background</h4>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 HIV testing efforts among this subgroup.<h4>Methods</h4>We meta-analytically analyzed various HIV testing 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 Sc ...[more]

PMID: 30844996

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Project description:INTRODUCTION:HIV testing is an essential prerequisite for accessing treatment with antiretroviral therapy or prevention using pre-exposure prophylaxis. Internet distribution of HIV self-tests is a novel approach, and data on the programmatic cost of this approach are limited. We analyse the costs and cost-effectiveness of a self-testing programme. METHODS:Men who have sex with men (MSM) reporting unknown or negative HIV status were enrolled from March to August 2015 into a 12-month trial of HIV self-testing in the United States. Participants were randomly assigned either to the self-testing arm or the control arm. All participants received information on HIV testing services and locations in their community. Self-testing participants received up to four self-tests each quarter, which they could use themselves or distribute to their social network associates. Quarterly follow-up surveys collected testing outcomes, including number of tests used and new HIV diagnoses. Using trial expenditure data, we estimated the cost of implementing a self-testing programme. Primary outcomes of this analysis included total programme implementation costs, cost per self-test completed, cost per person tested, cost per new HIV diagnosis among those self-tested and cost per quality adjusted life year (QALY) saved. RESULTS:A total of 2665 men were assigned either to the self-testing arm (n = 1325) or the control arm (n = 1340). HIV testing was reported by 971 self-testing participants who completed a total of 5368 tests. In the control arm, 619 participants completed 1463 HIV tests. The self-testing participants additionally distributed 2864 self-tests to 2152 social network associates. Testing during the trial identified 59 participants and social network associates with newly diagnosed HIV infection in the self-testing arm; 11 control participants were newly diagnosed with HIV. The implementation cost of the HIV self-testing programme was $449,510. The cost per self-test completed, cost per person tested at least once, and incremental cost per new HIV diagnosis was $61, $145 and $9365 respectively. We estimated that self-testing programme potentially averted 3.34 transmissions, saved 14.86 QALYs and nearly $1.6 million lifetime HIV treatment costs. CONCLUSIONS:The HIV self-testing programme identified persons with newly diagnosed HIV infection at low cost, and the programme is cost saving.

Project description:Men who have sex with men (MSM) represent the largest HIV risk group in the United States. Sexual concurrency catalyzes HIV transmission in populations by increasing the indirect exposure of one's sex partners to one another. Although individual-level (egocentric) designs have demonstrated a high prevalence of concurrency among MSM respondents, methods are lacking for understanding the exposure implications for partners (dyads) reported in such studies.A new technique for manipulating egocentrically collected partnership timing data to measure the degree to which respondents' patterns of concurrency and serial monogamy resulted in the indirect exposure of respondents' partners to other partners was developed. Two outcomes were constructed for each partner: any concurrent or serially monogamous exposure to another partner (any exposure) and any concurrent exposure to another partner, irrespective of serial monogamy (any concurrent exposure). Reports of unprotected anal intercourse (UAI) were incorporated to construct the outcomes of 'any UAI exposure' and 'any concurrent UAI exposure.' This method was applied to an online study of MSM aged ?18 years, with comparisons made by partner's race-ethnicity, age, type, and meeting location.Among 4060 repeat partners of 2449 MSM, 73% had any exposure in the previous 6 months; 58% had any concurrent exposure. Among UAI partners, 37% had concurrent UAI exposure. Black UAI partners were more likely than whites to have any concurrent UAI exposure [unadjusted odds ratio (95% confidence interval) = 1.34 (1.05 to 1.70)], as were casual UAI partners relative to main partners [unadjusted odds ratio (95% confidence interval) = 4.37 (3.58 to 5.35)]. In adjusted models, black UAI partners were significantly more likely to have any UAI exposure, but not concurrent UAI exposure. Casual UAI partners remained more exposed by both outcomes.Sex partners of MSM, particularly casual and black non-Hispanic partners, face a high degree of exposure to other partners.

Project description:BackgroundPromoting consistent HIV testing is critical among young, Black Men Who Have Sex With Men (MSM) and transgender women who are overrepresented among new HIV cases in the United States. New HIV test options are available, including mobile unit testing, one-minute testing, at home or self-testing and couples HIV testing and counseling (CHTC). In the context of these newer options, the objective of this study was to explore whether and how preferences for specific characteristics of the tests acted as barriers to and/or facilitators of testing in general and consistent testing specifically among young Black MSM and transgender women aged 16 to 29.MethodsWe conducted 30 qualitative, semi-structured, in-depth interviews with young, Black, gay, bisexual or MSM and transgender women in the New York City metropolitan area to identify preferences for specific HIV tests and aspects of HIV testing options. Participants were primarily recruited from online and mobile sites, followed by community-based, face-to-face recruitment strategies to specifically reach younger participants. Thematic coding was utilized to analyze the qualitative data based on a grounded theoretical approach.ResultsWe identified how past experiences, perceived test characteristics (e.g., accuracy, cost, etc.) and beliefs about the "fit" between the individual, and the test relate to preferred testing methods and consistent testing. Three major themes emerged as important to preferences for HIV testing methods: the perceived accuracy of the test method, venue characteristics, and lack of knowledge or experience with the newer testing options, including self-testing and CHTC.ConclusionsThese findings suggest that increasing awareness of and access to newer HIV testing options (e.g., free or reduced price on home or self-tests or CHTC available at all testing venues) is critical if these new options are to facilitate increased levels of consistent testing among young, Black MSM and transgender women. Addressing perceptions of test accuracy and supporting front line staff in creating welcoming and safe testing environments may be key intervention targets. Connecting young Black MSM and transgender women to the best test option, given preferences for specific characteristics, may support more and more consistent HIV testing.

Project description:BackgroundThe Centers for Disease Control and Prevention recommends routine HIV testing in all healthcare settings, but it is unclear how consistently physicians adopt the recommendation. Making the most of each interaction between black physicians and their patients is extremely important to address the HIV health disparities that disproportionately afflict the black community. The goal of this survey-based study was to evaluate the perceptions and practices of black, primary care physicians regarding HIV testing.MethodsA physician survey was administered at the 2010 National Medical Association Annual Convention, via online physician panels, and by email. Physician eligibility criteria: black race; practicing at least 1 year in the US; practice comprised of at least 60% adults and 20% black patients. Contingency tables and ordinary least squares regression were used for comparisons and statistical analyses. A Chi-square test compared percentages of physicians who gave a particular response and a t-test compared the means of values provided by physicians.ResultsPhysicians over-estimated HIV prevalence and believed that HIV is a crisis in the black community, yet reported that only 34% of patients were HIV tested in the past year. Physicians reported that 67% of those patients tested did so due to a physician recommendation. Physicians who were younger, female, obstetricians/gynecologists, and had a higher proportion of black, low-socioeconomic status, and Medicaid patients reported higher testing rates. Most testing was risk-based rather than routine, and three of the five most commonly reported barriers to testing were related to disease stigma and perceived value judgments. Physicians reported that in-office patient informational materials, increased media attention, additional education and training on HIV testing, government mandates requiring routine testing, and accurate pre-packed tests would most help them test more frequently for HIV.ConclusionsIn this sample of black, primary care physicians, HIV testing practices differed according to physician characteristics and practice demographics, and overall reported testing rates were low. More physician education and training around testing guidelines is needed to enable more routine testing, treatment, and long-term management of patients with HIV.

Dataset Information

Suboptimal Recent and Regular HIV Testing Among Black Men Who Have Sex With Men in the United States: Implications From a Meta-Analysis.

Publications

Suboptimal Recent and Regular HIV Testing Among Black Men Who Have Sex With Men in the United States: Implications From a Meta-Analysis.

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