Psychosocial determinants of HIV testing across stages of change in Spanish population: a cross-sectional national survey

Abstract Background The goal of this research is to study the psychosocial determinants of HIV-testing as a function of the decision or change stage concerning this health behavior. The determinants considered in the major ongoing health models and the stages contemplated in the Precaution Adoption Process Model are analysed. Methods A cross-sectional survey was administered to 1,554 people over 16 years of age living in Spain by a computer-assisted telephone interview (CATI). The sample design was randomised, with quotas of sex and age. The survey measured various psychosocial determinants of health behaviors considered in the main cognitive theories, the interviewees' stage of change concerning HIV-testing (lack of awareness, decision not to act, decision to act, action, maintenance, and abandonment), and the signal for the action of getting tested or the perceived barriers to being tested. Results Approximately two thirds of the population had not ever had the HIV test. The predominant stage was lack of awareness. The most frequently perceived barriers to testing were related to the health system and to the stigma. We also found that the psychosocial determinants studied differed depending on the respondents' stage of change. Perception of risk, perceived self-efficacy, proximity to people who had been tested, perceived benefits of knowing the diagnosis, and a positive instrumental and emotional attitude were positively associated with the decision and maintenance of testing behavior. However, unrealistic underestimation of the risk of HIV infection, stereotypes about the infection, and the perceived severity of HIV were associated with the decision not to be tested. Conclusions There are various sociocognitive and motivational profiles depending on people’s decision stage concerning HIV-testing. Knowing this profile may allow us to design interventions to influence the psychosocial determinants that characterise each stage of change

Widening the Access to HIV Testing: The Contribution of Three In-Pharmacy Testing Programmes in Spain

BACKGROUND AND OBJECTIVE: Spain has implemented several in-pharmacy HIV testing programmes performed by pharmacists as part of their everyday routine. We aim to assess the feasibility and the main outcomes of three programmes implemented in three Spanish regions with different sociological profiles and also different epidemiology for HIV. METHODS: The characteristics of the 24151 people tested between 2009 and 2013 at 74 urban pharmacies are studied. We compare the main outcomes of the programmes with those of each Regional HIV Surveillance System (RHSS) assessing the contribution to the total new diagnosis in each region and if priority groups are being reached. RESULTS: 45.7% were heterosexual men (MSW), 14.4% men who have sex with men (MSM), and 27% women. The 35% were younger than 30 and 9.6% foreigners. The 52% were previously untested, and women were the most likely to be untested. The three programmes altogether diagnosed 226 people, resulting in a global prevalence of 0.9% (95%CI: 0.8-1.1); 3.4% in MSM (95%CI: 2.8-4.0). The prevalence among Spaniards was 0.8% (0.7-1.0) vs. 2.2 (1.6-2.9) among foreigners. The percentages of MSM diagnosed by all three programmes were higher than the one reported by their respective RHSS. Thirty four percent of the reactive MSM and the 71.4% of the reactive MSW did not have a previous HIV test although big testing history differences were observed across the programmes. Altogether, these services contributed with the 10.6% of all HIV diagnoses in these regions. CONCLUSIONS: In-pharmacy HIV testing programmes are a valuable testing option, having been able to uncover 1 out of 10 the new diagnoses reported in each region. They showed a good capacity of reaching and diagnosing previously untested populations, not only a priority population such as MSM but also heterosexual population who are more affected by delayed diagnosis. They seem to be particularly suitable for regions without large cities and specific HIV diagnostic services.This study was supported by Foundation for Research and Prevention of AIDS in Spain (FIPSE) grant [240961/10] and The Ministry of Health, Social Services and Equality grant [MSSSI EC11-279]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.S

Additional file 1: of Psychosocial determinants of HIV testing across stages of change in Spanish population: a cross-sectional national survey

“Telephone interview questionnaire” contains the translation into English of the questionnaire used in the telephone interviews. (DOC 201 kb

Predictors of advanced disease and late presentation in new HIV diagnoses reported to the surveillance system in Spain

Objective: To present surveillance data on advanced disease (AD) and late presentation (LP) of HIV in Spain and their determinants. Methods: We included all new HIV diagnoses notified by the autonomous regions that consistently reported such cases throughout the period 2007–2011. Coverage was 54% of the total Spanish population. Data sources consisted of clinicians, laboratories and medical records. AD was defined as the presence of a CD4 cell count <200 cells/μL in the first test after HIV diagnosis, while LP was defined as the presence of a CD4 cell count <350 cells/μL after HIV diagnosis. Odds ratios and their 95% confidence intervals (OR, 95% CI) were used as the measure of association. Logistic regressions were fit to identify predictors of AD and LP. Results: A total of 13,021 new HIV diagnoses were included. Among these, data on the outcome variable were available in 87.7%. The median CD4 count at presentation was 363 (interquartile range, 161–565). Overall, 3356 (29.4%) patients met the definition of AD and 5494 (48.1%) were classified as LP. Both AD and LP increased with age and were associated with male sex and infection through drug use or heterosexual contact. All immigrants except western Europeans were more prone to AD and LP. Multivariate models disaggregated by sex showed that the effect of age and region of origin was weaker in women than in men. Conclusions: Despite universal health care coverage in Spain, men, immigrants and people infected through drug use or heterosexual contact seem to be experiencing difficulties in gaining timely access to HIV care

Characteristics of participants and those with a reactive result in three in-pharmacy rapid HIV testing programmes.

<p>¹ Comprising main cities in the provinces of Tarragona and Barcelona but no Barcelona city.</p><p>² 3100 men could not be classified according to their sexual behaviour. Their responses are included within the total. 22 tested positive.</p><p>³ 1611 men could not be classified according to their sexual behaviour. Their responses are included within the total. 13 tested positive.</p><p>⁴ 1290 men could not be classified according to their sexual behaviour. Their responses are included within the total. 9 tested positive.</p><p>⁵ 199 men could not be classified according to their sexual behaviour. Their responses are included within the total. None tested positive.</p><p>⁶ At the Catalonian programme, this question was available in que questionnaire only for 3287 participants and 36 positives.</p><p>Percentages calculated on contestants. MSM: Men who have sex with men; MSW: Men who have sex with women.</p><p>Spain.</p

Distribution of the participating pharmacies on three rapid HIV testing programmes.

<p>Spain (2009–2013).</p

Comparison between the regional HIV surveillance systems on new diagnoses (RHSS) and three in-pharmacy rapid HIV testing programmes.

<p>¹ Comprising main cities from the provinces of Tarragona and Barcelona but no Barcelona city.</p><p>² It includes data only from the territory in which the in-pharmacy programme takes place.</p><p>Comparison between the regional HIV surveillance systems on new diagnoses (RHSS) and three in-pharmacy rapid HIV testing programmes.</p