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      Facilitators and barriers for HIV-testing in Zambia: A systematic review of multi-level factors

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          Abstract

          It was estimated that 1.2 million people live with HIV/AIDS in Zambia by 2015. Zambia has developed and implemented diverse programs to reduce the prevalence in the country. HIV-testing is a critical step in HIV treatment and prevention, especially among all the key populations. However, there is no systematic review so far to demonstrate the trend of HIV-testing studies in Zambia since 1990s or synthesis the key factors that associated with HIV-testing practices in the country. Therefore, this study conducted a systematic review to search all English literature published prior to November 2016 in six electronic databases and retrieved 32 articles that meet our inclusion criteria. The results indicated that higher education was a common facilitator of HIV testing, while misconception of HIV testing and the fear of negative consequences were the major barriers for using the testing services. Other factors, such as demographic characteristics, marital dynamics, partner relationship, and relationship with the health care services, also greatly affects the participants’ decision making. The findings indicated that 1) individualized strategies and comprehensive services are needed for diverse key population; 2) capacity building for healthcare providers is critical for effectively implementing the task-shifting strategy; 3) HIV testing services need to adapt to the social context of Zambia where HIV-related stigma and discrimination is still persistent and overwhelming; and 4) family-based education and intervention should involving improving gender equity.

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          Investigation into the use of short message services to expand uptake of human immunodeficiency virus testing, and whether content and dosage have impact.

          South Africa has one of the highest human immunodeficiency virus (HIV) prevalence rates in the world, but despite the well-established benefits of HIV counseling and testing (HCT), there is low uptake of HCT. The study aimed to investigate the effectiveness of using short message services (SMSs) to encourage HCT while interrogating the impact of altering SMS content and dosage (the number of SMSs). About 2,533 participants were recruited via an SMS sent to 24,000 mobiles randomly sampled from a pre-existing database. Recruits were randomly allocated to four intervention groups that received 3 or 10 informational (INFO) or motivational (MOTI) SMSs, and a control group. After the intervention, participants were prompted to go for HCT, and postintervention assessment was done after 3 weeks. In comparison with the control, receipt of 10 MOTI messages had the most impact on uptake of HCT with a 1.7-fold increased odds of testing (confidence interval 95%; p=0.0036). The lack of efficacy of three SMSs indicates a threshold effect, that is, a minimum number of MOTI SMSs is required. INFO SMSs, whether 3 or 10 were sent, did not have a statistically significant effect. The cost can be calculated for the marginal effect of the SMSs, that is, the cost to get people to test over and above those who were likely to test without the intervention. Use of 10 MOTI SMSs yielded a cost-per-tester of $2.41. While there are methodological issues apparent in our study, the results demonstrate the potential of SMSs to influence the uptake of HCT, the importance of appropriate content, and the need to determine a threshold for SMS-based interventions. These results indicate a potential for SMSs to be used more generally for interventions encouraging people to take health-related actions, and the need for further research in this field. The reasonable cost-per-tester is promising for the scale-up of such an intervention.
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            Task-shifting HIV counselling and testing services in Zambia: the role of lay counsellors

            Background The human resource shortage in Zambia is placing a heavy burden on the few health care workers available at health facilities. The Zambia Prevention, Care and Treatment Partnership began training and placing community volunteers as lay counsellors in order to complement the efforts of the health care workers in providing HIV counselling and testing services. These volunteers are trained using the standard national counselling and testing curriculum. This study was conducted to review the effectiveness of lay counsellors in addressing staff shortages and the provision of HIV counselling and testing services. Methods Quantitative and qualitative data were collected by means of semistructured interviews from all active lay counsellors in each of the facilities and a facility manager or counselling supervisor overseeing counseling and testing services and clients. At each of the 10 selected facilities, all counselling and testing record books for the month of May 2007 were examined and any recordkeeping errors were tallied by cadre. Qualitative data were collected through focus group discussions with health care workers at each facility. Results Lay counsellors provide counselling and testing services of quality and relieve the workload of overstretched health care workers. Facility managers recognize and appreciate the services provided by lay counsellors. Lay counsellors provide up to 70% of counselling and testing services at health facilities. The data review revealed lower error rates for lay counsellors, compared to health care workers, in completing the counselling and testing registers. Conclusion Community volunteers, with approved training and ongoing supervision, can play a major role at health facilities to provide counselling and testing services of quality, and relieve the burden on already overstretched health care workers.
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              Intimate partner violence functions as both a risk marker and risk factor for women's HIV infection: findings from Indian husband-wife dyads.

              Female victims of intimate partner violence (IPV) consistently demonstrate elevated sexually transmitted infection/HIV prevalence. IPV is thought to function indirectly as a marker of abusive men's elevated sexually transmitted infection/HIV infection and/or directly via facilitating transmission to wives. The present examination utilizes a nationally representative sample of married Indian couples to test these mechanisms and determine whether (1) abusive husbands demonstrate higher HIV infection prevalence compared with nonabusive husbands and (2) the risk of wives' HIV infection based on husbands' HIV infection varies as a function of their exposure to IPV. The Indian National Family Health Survey-3 was conducted across all Indian states in 2005-2006. Analyses were limited to 20,425 husband-wife dyads, which provided both IPV data and HIV test results. Logistic regression models estimated the odds ratios and 95% confidence intervals (CIs) to evaluate the following associations: (1) husbands' HIV acquisition outside the marital relationship based on their perpetration of IPV and (2) wives' HIV infection based on husbands' HIV infection, as a function of their IPV exposure. One third (37.4%) of wives experienced IPV; 0.4% of husbands and 0.2% of wives were HIV infected. Compared with nonabusive husbands, abusive husbands demonstrated increased odds of HIV acquisition outside the marital relationship in adjusted models (adjusted odds ratio [AOR] = 1.91; 95% CI 1.11 to 3.27). Husbands' HIV infection was associated with increased HIV risk among wives; this risk was elevated 7-fold in abusive relationships in adjusted models (AOR = 7.22; 95% CI 1.05 to 49.88). Findings provide the first empirical evidence that abused wives face increased HIV risk based both on the greater likelihood of HIV infection among abusive husbands and elevated HIV transmission within abusive relationships. Thus, IPV seems to function both as a risk marker and as a risk factor for HIV among women, indicating the need for interwoven efforts to prevent both men's sexual risk and IPV perpetration.
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                Author and article information

                Contributors
                Role: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: ResourcesRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: ResourcesRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Supervision
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                7 February 2018
                2018
                : 13
                : 2
                : e0192327
                Affiliations
                [1 ] Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
                [2 ] School of Information, Kent State University, Kent, OH, United States of America
                [3 ] Department of Psychology, University of Zambia, Central Administration Block Great East Road Campus, Lusaka, Zambia
                The Ohio State University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-6523-3647
                Article
                PONE-D-17-10977
                10.1371/journal.pone.0192327
                5802917
                29415004
                0607d525-8dd6-44fa-886f-0f35796c84f7
                © 2018 Qiao et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 March 2017
                : 22 January 2018
                Page count
                Figures: 2, Tables: 2, Pages: 27
                Funding
                Funded by: National Institution of Child and Human Development Grant
                Award ID: R01HD074221
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000060, National Institute of Allergy and Infectious Diseases;
                Award ID: 1R21AI122919 - 01A1
                Award Recipient :
                The study was supported by the National Institution of Child and Human Development Grant #R01HD074221 ( https://www.nichd.nih.gov/Pages/index.aspx) to XL and the National Institute of Allergy and Infectious Diseases Grant # 1R21AI122919 - 01A1 to SQ. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
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                Microbial Pathogens
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                Pathogens
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                All reviewed articles are available from the following databases: Academic Search Complete, CINAHL Complete, MEDLINE with Full Text databases, PsycINFO, PubMed, and Web of Science.

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