Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis

Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here

Traces of Fallback Breccia on the Rim of Barringer Meteorite Crater (a.k.a. Meteor Crater), Arizona

Barringer Meteorite Crater (a.k.a. Meteor Crater), Arizona, is one of the youngest and best preserved impact craters on Earth. For that rea-son, it provides a baseline for similar craters formed in the geologic past, formed elsewhere in the Solar Sys-tem, and illuminates the astronomical and geological processes that produce them. The crater has not, how-ever, escaped erosion completely. While Shoemaker [1] mapped a breccia with fallback components inside the crater, he did not locate it beyond the crater rim. He only found remnants of that type of debris in re-worked alluvium [1; see also 2]. Fallback breccia and any base-surge deposits have, thus, been missing components in studies of material ejected beyond the transient crater rim

African Americans, Gentrification, and Neoliberal Urbanization: the Case of Fort Greene, Brooklyn

This article examines the gentrification of Fort Greene, which is located in the western part of black Brooklyn, one of the largest contiguous black urban areas in the USA. Between the late 1960s and 2003, gentrification in Fort Greene followed the patterns discovered by scholars of black neighborhoods; the gentrifying agents were almost exclusively black and gentrification as a process was largely bottom-up because entities interested in the production of space were mostly not involved. Since 2003, this has changed. Whites have been moving to Fort Greene in large numbers and will soon represent the numerical majority. Public and private interventions in and around Fort Greene have created a new top-down version of gentrification, which is facilitating this white influx. Existing black residential and commercial tenants are replaced and displaced in the name of urban economic development

Meatal stenosis and lichen sclerosus in children: is it a real risk? A single-centre retrospective observational study

Background: Early diagnosis, early treatment and long-term follow-up in paediatric patients with Lichen Sclerosus (LS) are mandatory to avoid complications such as urethral meatal stenosis. Methods: All patients older than five years who underwent circumcision from January 2015 to December 2021 at our centre with positive histology for LS were included. Demographic, preoperative, surgical and postoperative data were analysed. Patients were physically evaluated, and they were asked to fill in two quality of life questionnaires and to perform an uroflowmetry. They were stratified into clusters according to physical and histological examination. Urethral dilatations were investigated to assess the correlation between circumcision and incidence of LS-linked complications. Results: Among 99 patients included in the study, 95 were finally evaluated. Median age at diagnosis was seven years (range, five to ten years). Median age at surgery was 10.8 years (6-17). Urethral meatus was grade 0 in 47% of cases, grade 1 in 41% and grade 2 in 12%. A total of 19% of circumcised patients with LS had pathological uroflowmetry: the number of patients with pathological uroflowmetry increased as the grade of meatal stenosis increased (13% grade 0, 15% grade 1 and 33% grade 2). Four (4.7%) patients with diagnosis of meatal stenosis underwent meatal dilatations. Conclusions: By assessing histology of LS it is possible to determine who will develop LS-linked complications such as meatal stenosis. Patients with LS must be followed-up closely and should be treated with corticosteroids for at least for one month to improve their postoperative outcomes

Home-based voluntary HIV counselling and testing found highly acceptable and to reduce inequalities

<p>Abstract</p> <p>Background</p> <p>Low uptake of voluntary HIV counselling and testing (VCT) in sub-Saharan Africa is raising acceptability concerns which might be associated with ways by which it is offered. We investigated the acceptability of home-based delivery of counselling and HIV testing in urban and rural populations in Zambia where VCT has been offered mostly from local clinics.</p> <p>Methods</p> <p>A population-based HIV survey was conducted in selected communities in 2003 (n = 5035). All participants stating willingness to be HIV tested were offered VCT at home and all counselling was conducted in the participants' homes. In the urban area post-test counselling and giving of results were done the following day whereas in rural areas this could take 1-3 weeks.</p> <p>Results</p> <p>Of those who indicated willingness to be HIV tested, 76.1% (95%CI 74.9-77.2) were counselled and received the test result. Overall, there was an increase in the proportion ever HIV tested from 18% before provision of home-based VCT to 38% after. The highest increase was in rural areas; among young rural men aged 15-24 years up from 14% to 42% vs. for urban men from 17% to 37%. Test rates by educational attainment changed from being positively associated to be evenly distributed after home-based VCT.</p> <p>Conclusions</p> <p>A high uptake was achieved by delivering HIV counselling and testing at home. The highest uptakes were seen in rural areas, in young people and groups with low educational attainment, resulting in substantial reductions in existing inequalities in accessing VCT services.</p

The Uptake and Accuracy of Oral Kits for HIV Self-Testing in High HIV Prevalence Setting: A Cross-Sectional Feasibility Study in Blantyre, Malawi

Augustine Choko and colleagues assess the uptake and acceptability of home-based supervised oral HIV self-testing in Malawi, demonstrating the feasibility of this approach in a high-prevalence, low-income environment

Physicians’ misperceived cardiovascular risk and therapeutic inertia as determinants of low LDL-cholesterol targets achievement in diabetes

Background: Greater efforts are needed to overcome the worldwide reported low achievement of LDL-c targets. This survey aimed to dissect whether and how the physician-based evaluation of patients with diabetes is associated with the achievement of LDL-c targets. Methods: This cross-sectional self-reported survey interviewed physicians working in 67 outpatient services in Italy, collecting records on 2844 patients with diabetes. Each physician reported a median of 47 records (IQR 42–49) and, for each of them, the physician specified its perceived cardiovascular risk, LDL-c targets, and the suggested refinement in lipid-lowering-treatment (LLT). These physician-based evaluations were then compared to recommendations from EAS/EASD guidelines. Results: Collected records were mostly from patients with type 2 diabetes (94%), at very-high (72%) or high-cardiovascular risk (27%). Physician-based assessments of cardiovascular risk and of LDL-c targets, as compared to guidelines recommendation, were misclassified in 34.7% of the records. The misperceived assessment was significantly higher among females and those on primary prevention and was associated with 67% lower odds of achieving guidelines-recommended LDL-c targets (OR 0.33, p &lt; 0.0001). Peripheral artery disease, target organ damage and LLT-initiated by primary-care-physicians were all factors associated with therapeutic-inertia (i.e., lower than expected probability of receiving high-intensity LLT). Physician-suggested LLT refinement was inadequate in 24% of overall records and increased to 38% among subjects on primary prevention and with misclassified cardiovascular risk. Conclusions: This survey highlights the need to improve the physicians’ misperceived cardiovascular risk and therapeutic inertia in patients with diabetes to successfully implement guidelines recommendations into everyday clinical practice

Knowledge and Perceptions of Couples' Voluntary Counseling and Testing in Urban Rwanda and Zambia: A Cross-Sectional Household Survey

Most incident HIV infections in sub-Saharan Africa occur between cohabiting, discordant, heterosexual couples. Though couples' voluntary HIV counseling and testing (CVCT) is an effective, well-studied intervention in Africa, <1% of couples have been jointly tested.We conducted cross-sectional household surveys in Kigali, Rwanda (n = 600) and Lusaka, Zambia (n = 603) to ascertain knowledge, perceptions, and barriers to use of CVCT.Compared to Lusaka, Kigali respondents were significantly more aware of HIV testing sites (79% vs. 56%); had greater knowledge of HIV serodiscordance between couples (83% vs. 43%); believed CVCT is good (96% vs. 72%); and were willing to test jointly (91% vs. 47%). Stigma, fear of partner reaction, and distance/cost/logistics were CVCT barriers.Though most respondents had positive attitudes toward CVCT, the majority were unaware that serodiscordance between cohabiting couples is possible. Future messages should target gaps in knowledge about serodiscordance, provide logistical information about CVCT services, and aim to reduce stigma and fear