Las pruebas rápidas del VIH en España: descripción de programas, evaluación de impacto y análisis de su potencial como estrategia para promover el diagnóstico precoz

En ausencia de una cura o una vacuna preventiva eficaz frente al VIH, el diagnóstico precoz de la enfermedad es el eje en torno al cual pivotan las estrategias de prevención y la puerta de entrada al tratamiento, para poder así modificar el curso de la epidemia. Se considera a las pruebas de VIH prevención secundaria a nivel del individuo, ya que el tratamiento consigue reducir la morbi-mortalidad, y prevención primaria a nivel poblacional, puesto que disminuye la carga viral haciendo a los seropositivos menos infecciosos y además ofrece la posibilidad de adoptar estrategias sexuales más seguras para proteger a sus parejas. Con el fin de promover el diagnóstico precoz y reducir la fracción no diagnosticada, el centro para el control y prevención de enfermedades de Estados Unidos (CDC) puso en marcha en 2003 una estrategia que consistía en ofertar las pruebas de VIH fuera de los entornos clínicos1. Utilizando las pruebas rápidas, se pretendía facilitar el acceso a la prueba a ciertos grupos afectados de manera desproporcionada por la enfermedad y que, además, se enfrentaban a ciertas dificultades a la hora de acceder al sistema sanitario (como los hombres que mantienen relaciones sexuales con otros hombres y/o las minorías étnicas). Desde entonces, esta estrategia ha sido incluida de forma habitual en todas las guías y recomendaciones nacionales e internacionales2;3. En España, han existido programas que ofrecen la prueba del VIH fuera de los entornos clínicos desde mediados de los años 90. Sin embargo, fue la aprobación del uso de las pruebas rápidas en 2006 lo que llevó a una rápida expansión de esta estrategia. A partir de ese momento, se han implementado muchos programas de pruebas rápidas de VIH fuera de los entornos comunitarios llevamos a cabo, en su mayoría, por organizaciones no gubernamentales (ONG). Existe una enorme heterogeneidad dentro de éste grupo de programas, tanto en términos de población diana, como requerimiento de cita previa, tipos de pruebas utilizadas, etc. Algunos se dirigen a poblaciones especialmente vulnerables (hombres que tienen relaciones sexuales con otros hombres, inyectores de drogas, inmigrantes, etc.), mientras que otros han centrado su actividad en la población general. La mayor parte se realizan en sedes fijas, habitualmente en las sedes de las ONG, mientras que otros han puesto en marcha distintos tipos de programas de “outreach” o acercamiento de la prueba ofreciéndola en localizaciones que resultan más atractivas y accesibles que los servicios sanitarios convencionales..

Effectiveness of non-pharmaceutical interventions in nine fields of activity to decrease SARS-CoV-2 transmission (Spain, September 2020–May 2021)

Background: We estimated the association between the level of restriction in nine different fields of activity and SARS-CoV-2 transmissibility in Spain, from 15 September 2020 to 9 May 2021. Methods: A stringency index (0–1) was created for each Spanish province (n = 50) daily. A hierarchical multiplicative model was fitted. The median of coefficients across provinces (95% bootstrap confidence intervals) quantified the effect of increasing one standard deviation in the stringency index over the logarithmic return of the weekly percentage variation of the 7-days SARS-CoV-2 cumulative incidence, lagged 12 days. Results: Overall, increasing restrictions reduced SARS-CoV-2 transmission by 22% (RR = 0.78; one-sided 95%CI: 0, 0.82) in 1 week, with highest effects for culture and leisure 14% (0.86; 0, 0.98), social distancing 13% (0.87; 0, 0.95), indoor restaurants 10% (0.90; 0, 0.95) and indoor sports 6% (0.94; 0, 0.98). In a reduced model with seven fields, culture and leisure no longer had a significant effect while ceremonies decreased transmission by 5% (0.95; 0, 0.96). Models R2 was around 70%. Conclusion: Increased restrictions decreased COVID-19 transmission. Limitations include remaining collinearity between fields, and somewhat artificial quantification of qualitative restrictions, so the exact attribution of the effect to specific areas must be done with caution.This work has been partially supported by GAIN (Galician Innovation Agency) and the Regional Ministry of Economy, Employment and Industry, Xunta de Galicia IN845D 2020/26 (Grant COV20/00604) through the ERDF (2014-2020). The research of DGU has been financed in part by the Spanish Agencia Estatal de Investigación under grants PID2021-122154NB-I00 and TED2021-129455B-I00, and by a 2021 BBVA Foundation project for research in Mathematics. He also acknowledges support from the EU under the 2014-2020 ERDF Operational Programme and the Department of Economy, Knowledge, Business and University of the Regional Government of Andalusia (FEDER-UCA18-108393).S

An imported case of vaccine-derived poliovirus type 2, Spain in the context of the ongoing polio Public Health Emergency of International Concern, September 2021

The monthly retrospective search for unreported acute flaccid paralysis (AFP) cases conducted as a complementary component of the Spanish AFP surveillance system identified a case of AFP in a child admitted in Spain from Senegal during August 2021. Vaccine-derived poliovirus 2 was identified in the stool in September 2021. We present public health implications and response undertaken within the framework of the National Action Plan for Polio Eradication and the Public Health Emergency of International Concern.S

Epidemiologic Features and Control Measures during Monkeypox Outbreak, Spain, June 2022

During June 2022, Spain was one of the countries most affected worldwide by a multicountry monkeypox outbreak with chains of transmission without identified links to disease-endemic countries. We provide epidemiologic features of cases reported in Spain and the coordinated measures taken to respond to this outbreak.S

Knowledge and use of unauthorized HIV self-test kits among men who have sex with men in Spain, following approval of an over-the-counter self-test in the U.S: a cross-sectional study

BACKGROUND: Shortly after the approval of an over-the-counter HIV self-test in the US, we conducted a study to estimate the proportion of men who have sex with men (MSM) in Spain who knew that unauthorized HIV self-tests could be purchased online, and the proportion that had already used these tests, as well as their socio-demographic and behavioural correlates. METHODS: Between September 2012 and February 2013, MSM users of gay dating websites were invited to complete an online questionnaire. We calculated estimates of the knowledge and use of unauthorized HIV self-testing and assessed the associated factors by rare event logit regression models. RESULTS: Among 8620 participants, 4.2 % (95 % CI:3.8-4.6) knew they could buy an unauthorized HIV self-test kit online, and 12.7 % (95 % CI:12.0-13.4) thought that such a test might exist, although they had never seen one. Only 0.7 % (95 % CI:0.5-0.9) had ever self-tested. In the multivariable analysis, knowledge of online availability of self-tests was associated with being a non-Latin American foreigner, having at least two previous HIV tests, intending to test for HIV in the next year, and knowing about U.S. approval of self-testing. Ever-use of HIV self-testing was associated with being over 34 years of age, living outside Spain during the last 12 months, and knowing about U.S. approval of self-testing. CONCLUSIONS: Both knowledge and use of unauthorized HIV self-testing among MSM in Spain was very low among HIV negative or untested MSM in Spain. The recent approval in the United Kingdom and France might increase the number of MSM seeking such testing and possibly using unauthorized test kits not meeting quality standards.This study was supported by the Spanish Ministerio de Sanidad, Servicios Sociales e Igualdad (MSSSI EC11-279) and the Consumers, Health and Food Executive Agency (20131101)S

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

Preferred HIV testing services and programme characteristics among clients of a rapid HIV testing programme

BACKGROUND: In the current context of diversity and coexistence of HIV testing approaches, limited information exists on test recipient's views of HIV testing services and programme attributes that could ease the testing process and make it more appealing for at risk individuals who don't know their HIV status. This study analyzed ratings given to different testing sites and programme characteristics that might facilitate testing. METHODS: We analyzed data from 3120 persons attending a mobile HIV testing programme located on a central street in the gay district of Madrid. RESULTS: 64% were men (of which, 55% had had sex with other men), 59.5% were <30 years, 35.4% foreigners, 50.6% had a university degree,71.7% a regular employment, 59.3% reported multiple partners and inconsistent condom use and 56.5% had been tested for HIV. Non Governmental Organizations and specific HIV/STI centres received the maximum rating from over 60% of participants, followed by self-testing (38.9%). Pharmacies (20.8%) and hospital emergency departments (14.2%) were the worst valued testing sites. Over 80% gave the highest rating to having immediate test results, not needing a previous appointment, and free testing, while less than 50% gave the maximum rating to privacy and anonymity. CONCLUSIONS: HIV testing services that don't require an appointment, based on free tests with rapid results are most valued by a young, not socially marginalized but high risk sexual exposure population. On the contrary, issues traditionally highly valued by health care providers or AIDS social organizations (privacy and anonymity) are much less valued.This study was supported by the Fundación para Investigación y la Prevención del Sida en España (Fipse 24096/10), and by the Fondo de Investigaciones Sanitarias (FIS PI09/1706).S

Preferred HIV testing services and programme characteristics among clients of a rapid HIV testing programme

Abstract Background: In the current context of diversity and coexistence of HIV testing approaches, limited information exists on test recipient&apos;s views of HIV testing services and programme attributes that could ease the testing process and make it more appealing for at risk individuals who don&apos;t know their HIV status. This study analyzed ratings given to different testing sites and programme characteristics that might facilitate testing

Additional file 1: of Knowledge and use of unauthorized HIV self-test kits among men who have sex with men in Spain, following approval of an over-the-counter self-test in the U.S: a cross-sectional study

Contains the data used in the analysis. (XLSX 9721 kb

Are participants in a street-based HIV testing program able to perform their own rapid test and interpret the results?

OBJECTIVE: Availability of over-the-counter rapid HIV tests could improve access to testing those reluctant or unable to use current services. We aimed to evaluate the feasibility of HIV self-testing using a finger-stick whole-blood rapid test (Determine™ HIV Combo) to detect both antigen and antibody. METHODS: Before being tested, 313 participants in a street-based testing program were given adapted instructions and a test kit, and performed the self-test without supervision. These participants, together with another 207 who performed supervised self-testing, received additional instructions on how to interpret the test results shown in six colour photos and filled out a questionnaire. Logistic regression and generalized estimating equations (GEE) were used in the statistical analysis. RESULTS: About 8.0% (95%CI:4.8%-11.2%) obtained an invalid self-test. An invalid result was inversely associated with male participants who had sex with men (OR=0.3;95%CI:0.1-1.0). Of the 3111 photos interpreted,4.9% (95%CI:4.1-5.7) were incorrect. Only 1.1% (95%CI:0.3-1.8) of the positive results were interpreted as negative. Age 30 or older (OR=2.1; 95%CI:1.2-3.7), having been born in Latin America (OR=1.6; 95%CI:1.1-2.2),and not having university education (OR=2.1;95%CI:1.2-3.7) were associated with misinterpreting test results in the GEE. Participant's perceptions of both their proficiency when conducting the test and interpretation were related with actual outcomes. Most participants (83.9%) were more motivated than before to use the self-test in the future, and 51.7% would pay >10 Euros for the test if it was sold in pharmacies. CONCLUSIONS: This is the first study showing that blood-based self-testing with current technology is feasible in HIV-negative participants demanding the test and without prior training or supervision. Bearing in mind that it was conducted under difficult weather conditions and using a complex kit, over-the-counter tests could be a feasible option to complement current diagnostic strategies. More studies are needed to accommodate technology, minimise interpretation mistakes and provide on-line support