Robinson Cabello

Effect of an Online Video-Based Intervention to Increase HIV Testing in Men Who Have Sex with Men in Peru

Background Although many men who have sex with men (MSM) in Peru are unaware of their HIV status, they are frequent users of the Internet, and can be approached by that medium for promotion of HIV testing. Methods We conducted an online randomized controlled trial to compare the effect of HIV-testing motivational videos versus standard public health text, both offered through a gay website. The videos were customized for two audiences based on self-identification: either gay or non-gay men. The outcomes evaluated were ‘intention to get tested’ and ‘HIV testing at the clinic.’ Findings In the non-gay identified group, 97 men were randomly assigned to the video-based intervention and 90 to the text-based intervention. Non-gay identified participants randomized to the video-based intervention were more likely to report their intention of getting tested for HIV within the next 30 days (62.5% vs. 15.4%, Relative Risk (RR): 2.77, 95% Confidence Interval (CI): 1.42–5.39). After a mean of 125.5 days of observation (range 42–209 days), 11 participants randomized to the video and none of the participants randomized to text attended our clinic requesting HIV testing (p = 0.001). In the gay-identified group, 142 men were randomized to the video-based intervention and 130 to the text-based intervention. Gay-identified participants randomized to the video were more likely to report intentions of getting an HIV test within 30 days, although not significantly (50% vs. 21.6%, RR: 1.54, 95% CI: 0.74–3.20). At the end of follow up, 8 participants who watched the video and 10 who read the text visited our clinic for HIV testing (Hazard Ratio: 1.07, 95% CI: 0.40–2.85). Conclusion This study provides some evidence of the efficacy of a video-based online intervention in improving HIV testing among non-gay-identified MSM in Peru. This intervention may be adopted by institutions with websites oriented to motivate HIV testing among similar MSM populations. Trial registration Clinicaltrials.gov NCT00751192

Understanding the facilitators and barriers of antiretroviral adherence in Peru: A qualitative study

BackgroundAntiretroviral scale-up is increasing in resource-constrained settings. To date, few studies have explored the barriers and facilitators of adherence to ART in these settings. Facilitators and barriers of antiretroviral adherence in Peru are not completely understood.MethodsAt two clinics that serve a large number of HIV-positive individuals in Lima, Peru, 31 in-depth interviews were carried out in 2006 with adult HIV-positive individuals receiving ART. Purposive sampling was used to recruit the participants. Interviews were transcribed and coded using two Spanish-speaking researchers and a content analysis approach to identify themes in the data.ResultsAmong the participants, 28/31 (90%) were male, 25/31 (81%) were self-identified as mestizo, and 19/31 (61%) had an education above high school. The most frequently discussed barriers to adherence included side effects, simply forgetting, inconvenience, dietary requirements, being away from home, and fear of disclosure/stigma. The most frequently discussed facilitators to adherence included having a fixed routine, understanding the need for compliance, seeing positive results, treatment knowledge, and faith in treatment.ConclusionsOverall, these findings were similar to the facilitators and challenges experienced by individuals on ART in other resource constrained settings. Further treatment support tools and networks should be developed to decrease the challenges of ART adherence for HIV-positive individuals in Lima, Peru.

Internet as a tool to access high‐risk men who have sex with men from a resource‐constrained setting: a study from Peru

Objectives: In Peru, current interventions in high-risk men who have sex with men (MSM) reach a limited number of this population because they rely solely on peer education. The objective of this study was to assess the use of the internet as an alternative tool to access this population. Methods: Two nearly identical banner ads—both advertising an online survey but only one offering free HIV/syphilis tests and condoms—were displayed randomly on a Peruvian gay website. Results: The inclusion of the health incentive increased the frequency of completed surveys (5.8% vs 3.4% of delivered impressions; p<0.001), attracting high-risk MSM not previously tested for HIV but interested in a wide variety of preventive Web-based interventions. Eleven per cent (80/713) of participants who said they had completed the survey offering free testing visited our clinic: of those who attended, 6% had already been diagnosed as having HIV, while 5% tested positive for HIV. In addition, 8% tested positive for syphilis. Conclusions: The internet can be used as a tool to access MSM in Peru. The compensation of a free HIV/syphilis test increased the frequency of participation in our online survey, indicating that such incentives may be an effective means of reaching this population. However, as only a small percentage of participants actually reported for testing, future research should develop and assess tailored internet interventions to increase HIV/STI testing and delivery of other prevention services to Peruvian MSM.

Motivating Men Who Have Sex with Men to Get Tested for HIV through the Internet and Mobile Phones: A Qualitative Study

Background Men who have sex with men (MSM) have the highest HIV prevalence in Peru, yet they are underserved by traditional preventive programs. In Peru, the Internet and mobile phones have emerged as an effective and convenient tool to reach this population. Methods and Findings From October 2010 to February 2011, we conducted eight focus groups with gay identified MSM (closeted and out-of-the-closet) and with self-identified heterosexual MSM in order to identify key features and preferences to be used to tailor culturally-appropriate messages that could be delivered through Internet and mobile phones to motivate MSM to get tested for HIV. Participants reported that in order to motivate HIV testing among MSM, interventions need to be based on motivational messages that encourage participants to overcome the fear of getting tested. Messages should increase the HIV risk perception (of participants who do not consider themselves at risk) by eliciting risky situations experienced by MSM. Messages should emphasize confidentiality, respect and the professionalism of the personnel conducting the counseling and testing. A thorough explanation of the process of HIV testing and the steps to follow after receiving the results should be provided. Messages should also contain information about the venue where the test will be conducted in terms of client characteristics, location, hours of operation and personnel. Finally, stigmatizing and stereotyping messages or images about “being gay” should not be included, as they act as deterrents for getting tested. Conclusions Interventions aimed at motivating HIV testing among MSM should include motivational messages that reduce the fear of getting tested and increase the risk perception of participants. They should also market the venue where the testing will be conducted, the professionals who will perform the tests, and the type of tests available. Stigmatizing messages or images should be avoided.

Toward greater inclusion: lessons from Peru in confronting challenges of multi-sector collaboration

Despite widespread enthusiasm for broader participation in health policy and programming, little is known about the ways in which multi-sector groups address the challenges that arise in pursuing this goal. Based on the experience of Perus National Multi-sector Health Coordinating Body (CONAMUSA), this article characterizes these challenges and identifies organizational strategies the group has adopted to overcome them. Comprising nine government ministries, nongovernmental organizations, academia, religious institutions, and international cooperation agencies, CONAMUSA has faced three principal challenges: 1) selecting representatives, 2) balancing membership and leadership across sectors, and 3) negotiating role transition and conflict. In response, the group has instituted a rotation system for formal leadership responsibiliti es, and professionalized management functions; created electoral systems for civil society; and developed conflict of interest guidelines. This case study offers lessons for other countries trying to configure multi-sector groups, and for donors who mandate their creation, tempering unbridled idealism toward inclusive participation with a dose of healthy realism and practical adaptation.

P5.033 Bringing HIV Testing to the People- Benefits of Mobile Unit Testing in Lima, Peru, 2007–2009

Background Mobile unit (MU) HIV testing is an alternative method of providing healthcare access. We compared demographic and behavioural characteristics, HIV testing history, and HIV prevalence between people seeking testing at a MU vs. fixed community clinic (FC) in Lima, Peru. Methods Our analysis included men and transwomen (TW) in Lima ≥ 18 years old seeking HIV testing at their first visit to a community-based clinic’s MU or FC from Oct. 2007-Nov. 2009. Behavioral characteristics, including HIV testing history, and HIV serostatus of the following populations were compared in MU vs. FC attendees: TW, men who have sex with men (MSM), and heterosexually self-identified men who have sex with men and women (MSMW). Results A greater percentage of MU attendees self-identified as transgender (8% vs. 3% FC, p < 0.05) or heterosexual (52% vs. 15% FC, p < 0.05). MU and FC sites attracted similar proportions of MSMW (52% MU vs. 57% FC). MU attendees were more likely to engage in compensated sex (10% MU vs. 4% FC, p < 0.05), not use condoms during their last sexual encounter (64% MU vs. 45% FC, p < 0.05), and be a first-time HIV tester (50% MU vs. 41% FC, p < 0.05; see Table 1). MU HIV prevalence was 5% (vs. 17% FC, p < 0.05). Among first-time testers, HIV prevalence in both MSM and TW was not significantly different between MU and FC attendees (MSM: 13% MU vs. 19% FC p = 0.14; TW: 41% MU vs. 50% FC p = 0.71). Conclusion MU testing reached large numbers of high-risk (TW/MSM) and potentially bridging (MSMW) populations engaged in unsafe sexual behaviours. MU HIV prevalence for MSM/TW first-time testers was similar to that of the FC, making MU outreach a worthy complement to FC testing. Further investigation into whether MU attendees would not otherwise access HIV testing is warranted to determine the impact of MU testing. Abstract P5.033 Table 1 Proportion of first-time HIV testers in MU vs. FC attendees stratified by sexual identity MU(n = 3,496) FC(n = 1,854) p value MSM 164/590 (28%) 366/1,031 (36%) < 0.05 TW 42/282 (15%) 4/50 (8%) .19 MSMW 590/942 (63%) 88/154 (57%) .20 Total 1,764 (50%) 765 (41%) < 0.05

Syphilis in the Americas: A protocol for a systematic review of syphilis prevalence and incidence in four high-risk groups, 1980-2016

BackgroundSyphilis infection has recently resurfaced as a significant public health problem. Although there has been a tremendous amount of research on the epidemiology of syphilis, there has been limited work done to synthesize the extensive body of research and systematically estimate patterns of disease within high-risk groups in the Americas. The purpose of this systematic review and meta-analysis is to (1) summarize recent patterns of syphilis infection in North and South America among four high-risk groups (MSM, transgender women, sex workers, and incarcerated individuals) from 1980 to 2016, (2) identify and differentiate regional geographic epidemiologic characteristics, and (3) compare the epidemics of the economically developed countries of North America from the developing countries and public health systems of Latin America and the Caribbean.Methods/designPrimary studies reporting syphilis prevalence and/or incidence in at least one of the four high-risk groups will be identified from Medline/PubMed, Embase, Lilacs, SciELO, The Cochrane Library, Web of Science, Scopus, ProQuest, CINAHL, Clase, and Periódica, as well as “gray” literature sources (conference abstracts, country reports, etc.). Studies published from 1980 through 2016 will be included. Data will be extracted from studies meeting inclusion and exclusion criteria and a random effects meta-analysis of prevalence and incidence estimates will be conducted. Heterogeneity, risk of bias, and publication bias will be assessed. Pooled prevalence and incidence estimates will be calculated for comparisons based on geographic region, risk factors, and time period.DiscussionOur systematic review and meta-analysis aims to contribute to an improved understanding of global epidemiologic patterns of syphilis infection in most-at-risk populations. Through systematic classification of the existing literature, and comparison of disease patterns across regional, temporal and socio-behavioral differences, we hope to improve public health surveillance and improve efforts to control the spread of disease across the Americas.Systematic review registrationPROSPERO CRD42016047306.

O02.5 Narrating risk: new and traditional methods to understand sexual risk behaviour among hiv-uninfected men who have sex with men in lima, peru

Introduction Traditional risk-reduction counselling has had limited effect in modifying patterns of high-risk sexual behaviour among MSM. New methods like Personalised Cognitive Counselling (PCC) can be used to understand and address contexts of HIV transmission risk. Methods We conducted interviews and focus groups with HIV-uninfected MSM in 3 stages: I) 4 FGs (n=38) to explore community norms of male sexual interaction, HIV/STI testing practices, and acceptability of PCC; II) Interviews (n=15) where MSM narrated and reflected on a recent experience of receptive condomless anal intercourse (CAI) with an HIV-infected or unknown status partner; and III) 3 FGs (n=29) to discuss composite narratives of sexual risk constructed from Stage II interviews. Results In exploratory FGs, fear was the guiding principle of HIV counselling/testing. CAI was commonly reported, HIV status rarely discussed, and testing decisions motivated by fear of recent infection. Counselling interactions were described as robotic, repeating stale information in encounters where patients were routinely stigmatised, criticised for engaging in CAI, and threatened with inevitable seroconversion. Negative results were considered to validate prior sexual practices, which then continued unchanged. Stage II interviews used narratives to articulate cognitive processes, partnership interactions, and social contexts where CAI was tacitly encouraged. Limited access to condoms, alcohol prior to sex, and preferences for “bare” sex were cited as justifications for CAI. When common narrative elements were re-presented to Stage III FGs as composite vignettes, participants reverted to standard counselling recommendations, mandating condom use and regular HIV/STI testing, without acknowledging disjunctions between the guidelines and their lived experiences. Conclusion In contrast to static information transfer, narrative techniques to reconstruct and reflect on recent encounters provide depth and relevance to counselling interactions, addressing multiple dimensions of HIV/STI risk experienced by MSM in Latin America.

Cervical cancer screening practices, knowledge of screening and risk, and highly active antiretroviral therapy adherence among women living with human immunodeficiency virus in Lima, Peru

Cervical cancer (CC) is the leading cause of cancer death among Peruvian women. Awareness shown by women living with HIV (WLHIV) of their increased risk and Papanicoloau (Pap) smear frequency is understudied, particularly in Peru. We assessed the uptake of guidelines-based CC screening practices and its associations with two predictors, knowledge of CC screening and risk and highly active antiretroviral therapy (HAART) adherence, among WLHIV. Collected by self-administered questionnaires from 2014 to 2016, we analyzed the data of 71 WLHIV. Most WLHIV (77.5%, n = 55/71) were overdue to CC screening by not having a Pap smear within the prior 12 months. WLHIV who had on-time Pap smears had a higher median composite ‘knowledge’ score of 3.0 ([interquartile range] 1.5–4) compared to 2.0 (IQR 1–3) for overdue WLHIV. On-time and overdue WLHIV had the same median composite ‘HAART adherence’ score of 3.0 (IQR 2–4). Bivariate analysis found no association between knowledge nor adherence with on-time Pap smears. Although on-time WLHIV were more knowledgeable about CC screening and risk, overall CC screening uptake was poor. Larger studies of this population are needed to assess the educational, social, and structural barriers contributing to this low prevalence of screening.

Risk behaviors and reasons for not getting tested for HIV among men who have sex with men in Peru

Men who have sex with men (MSM) account for the greatest burden of the HIV epidemic in Peru. Given that MSM are frequent users of the Internet, understanding the risk behaviors and the reasons for not getting tested among MSM who surf the Internet may improve the tailoring of future online behavioral interventions.