School of Public Health

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The collections in this community comprise faculty research works, as well as graduate theses and dissertations.

Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.

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Subject: search.filters.subject.HIV testing

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Now showing 1 - 3 of 3
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    Sexual Risk Behavior and Lifetime HIV Testing: The Role of Adverse Childhood Experiences
    (MDPI, 2022-04-05) Dyer, Typhayne V.; Turpin, Rodman E.; Hawthorne, David J.; Jain, Vardhmaan; Sayam, Sonica; Mittal, Mona
    Despite the success of HIV prevention drugs such as PrEP, HIV incident transmission rates remain a significant problem in the United States. A life-course perspective, including experiences of childhood adversity, may be useful in addressing the HIV epidemic. This paper used 2019 BRFSS data to elucidate the role that childhood adversity plays in the relationship between HIV risk and HIV testing. Participants (n = 58,258) completed self-report measures of HIV risk behaviors, HIV testing, and adverse childhood experiences (ACEs). The median number ACEs in the sample was 1, with verbal abuse (33.9%), and parental separation (31.3%) being the most common ACEs reported. Bivariate findings showed that all ACEs were associated with increased HIV risk and testing. However, increased risk was not correlated with increased HIV testing, with the highest incongruence related to mental health problems of household member (53.48%). While both self-reported HIV risk and ACEs were positively associated with HIV testing, their interaction had a negative association with testing (aPR = 0.51, 95%CI 0.42, 0.62). The results highlight the need for targeted HIV prevention strategies for at-risk individuals with a history of childhood adversity.
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    Men missing from the HIV care continuum in sub-Saharan Africa: a meta-analysis and meta-synthesis
    (Journal of the International AIDS Society, 2022-03-24) Nardell, Maria; Adeoti, Oluwatomi; Peters, Carson; Kakuhikire, Bernard; Govathson-Mandimika, Caroline; Long, Lawrence; Pascoe, Sophie; Tsai, Alexander; Katz, Ingrid
    Introduction: Men are missing along the HIV care continuum. However, the estimated proportions of men in sub-Saharan Africa meeting the UNAIDS 95-95-95 goals vary substantially between studies. We sought to estimate proportions of men meeting each of the 95-95-95 goals across studies in sub-Saharan Africa, describe heterogeneity, and summarize qualitative evidence on factors influencing care engagement. Methods: We systematically searched PubMed and Embase for peer-reviewed articles published between 1 January 2014 and 16 October 2020. We included studies involving men ≥15 years old, with data from 2009 onward, reporting on at least one 95-95-95 goal in sub-Saharan Africa. We estimated pooled proportions of men meeting these goals using DerSimonion-Laird random effects models, stratifying by study population (e.g. studies focusing exclusively on men who have sex with men vs. studies that did not), facility setting (healthcare vs. community site), region (eastern/southern Africa vs. western/central Africa), outcome measurement (e.g. threshold for viral load suppression), median year of data collection (before vs. during or after 2017) and quality criteria. Data from qualitative studies exploring barriers to men’s HIV care engagement were summarized using meta-synthesis. Results and discussion: We screened 14,896 studies and included 129 studies in the meta-analysis, compiling data over the data collection period. Forty-seven studies reported data on knowledge of serostatus, 43 studies reported on antiretroviral therapy use and 74 studies reported on viral suppression. Approximately half of men with HIV reported not knowing their status (0.49 [95% CI, 0.41–0.58; range, 0.09–0.97]) or not being on treatment (0.58 [95% CI, 0.51–0.65; range, 0.07–0.97]), while over three-quarters of men achieved viral suppression on treatment (0.79 [95% CI, 0.77–0.81; range, 0.39–0.97]. Heterogeneity was high, with variation in estimates across study populations, settings and outcomes. The meta-synthesis of 40 studies identified three primary domains in which men described risks associated with engagement in HIV care: perceived social norms, health system challenges and poverty. Conclusions: Psychosocial and systems-level interventions that change men’s perceptions of social norms, improve trust in and accessibility of the health system, and address costs of accessing care are needed to better engage men, especially in HIV testing and treatment.
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    SYNDEMICS AND HIV TESTING AMONG HISPANIC/LATINO GAY AND BISEXUAL MEN
    (2020) xu, yixi; Dyer, Typhanye; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Hispanic/Latino gay and bisexual men (HLGBM) are especially vulnerable to HIV acquisition compared to their heterosexual counterparts. In an era of treatment as prevention, HIV testing is a crucial point to link individuals with HIV infection to treatment and healthcare services. In this dissertation, I addressed three specific aims: 1) to assess the prevalence of mental health conditions and socioeconomic risk factors among HLGBM comparing those who have and have not been tested for HIV; 2) to examine the applicability of syndemic theory to HIV testing among HLGBM; and, 3) to assess whether race/ethnicity modifies the association between health care access and socioeconomic factors with HIV testing in gay and bisexual men (GBM). In Aim 1, bivariate associations indicated that depression (prevalence ratio [PR]=1.36; 95% CI: 1.12, 1.64) and frequent high stress (PR=1.23; 95% CI: 1.02, 1.49) were associated with a higher prevalence of HIV testing, whereas poverty was associated with a lower prevalence of HIV testing (PR=0.64, 9% CI: 0.55, 0.75). In an adjusted model that included all mental health and demographic variables including age, marital status, health insurance status, access to a personal doctor, and education, only poverty status maintained an association with HIV testing at p<.05 (PR=0.77, 95% CI:0.65, 0.92). In Aim2, results from interaction tests supported the application of syndemic theory to HIV testing (p-values <.05 for all pair-wise interactions between risk factors). We used strata-specific estimates to display the synergistic relationships between combinations of risk factors, adjusted for demographic characteristics. For example, individuals who were poor and had a mental health condition (i.e., depressive disorder, heavy alcohol consumption, frequent high stress) had a lower prevalence of HIV testing relative to those with poverty or a mental health condition alone (e.g. among HLGBM living in poverty, those who were heavy drinkers had 0.16 (95% CI: 0.05, 0.54) times the prevalence of having an HIV test compared to those were not in poverty and not heavy drinkers). In Aim 3, analyses revealed that race/ethnicity modified the associations between health care access and socioeconomic factors with HIV testing (all p-values <.05). In adjusted models stratified by race/ethnicity, poverty was associated with HIV testing among Black GBM (PR=1.21; 95%CI 1.06, 1.38) and White GBM (PR=0.86; 95% CI: 0.80, 0.93) in opposite directions; and, having a personal doctor was associated with a higher prevalence of HIV test among Hispanic/Latino GBM only (PR=1.30; 95% CI: 1.10, 1.53). Taken together, results from these studies suggest that sociodemographic factors and mental health conditions facing HLGBM work in tandem and contribute to syndemic conditions; being White and having insurance, having a personal doctor, as well as higher household income were protective, which advance knowledge about HIV testing among GBM. Findings from this study further support addressing racial disparities in health care access and improving socioeconomic conditions, which together may promote HIV testing uptake among high-risk populations.