***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Zambia ’s national HIV testing algorithm specifies use of two rapid blood based antibody assays , Determine ® HIV-1/2 ( Inverness Medical ) and if positive then Uni-GoldTM Recombigen HIV-1/2 ( Trinity Biotech ) . Little is known about the performance of oral fluid based HIV testing in Zambia . The aims of this study are two-fold : 1 ) to compare the diagnostic accuracy ( sensitivity and specificity ) under field conditions of the OraQuick ® ADVANCE ® Rapid HIV-1/2 ( OraSure Technologies , Inc. ) to two blood-based rapid antibody tests currently in use in the Zambia National Algorithm , and 2 ) to perform a cost analysis of large-scale field testing employing the OraQuick ® . Methods This was a operational retrospective research of HIV testing and question naire data collected in 2010 as part of the ZAMSTAR ( Zambia South Africa TB and AIDS reduction ) study . R and omly sample d individuals in twelve communities were tested consecutively with OraQuick ® test using oral fluid versus two blood-based rapid HIV tests , Determine ® and Uni-GoldTM . A cost analysis of four algorithms from health systems perspective were performed : 1 ) Determine ® and if positive , then Uni-GoldTM ( Determine ® /Uni-GoldTM ) ; based on current algorithm , 2 ) Determine ® and if positive , then OraQuick ® ( Determine ® /OraQuick ® ) , 3 ) OraQuick ® and if positive , then Determine ® ( OraQuick ® /Determine ® ) , 4 ) OraQuick ® and if positive , then Uni-GoldTM ( OraQuick ® /Uni-GoldTM ) . This information was then used to construct a model using a hypothetical population of 5,000 persons with varying prevalence of HIV infection from 1–30 % . Results 4,458 participants received both a Determine ® and OraQuick ® test . The sensitivity and specificity of the OraQuick ® test were 98.7 ( 95%CI , 97.5–99.4 ) and 99.8 ( 95%CI , 99.6–99.9 ) , respectively when compared to HIV positive serostatus . The average unit costs per algorithm were US$ 3.76 , US$ 4.03 , US$ 7.35 , and US$ 7.67 for Determine ® /Uni-GoldTM , Determine ® /OraQuick ® , OraQuick ® /Determine ® , and OraQuick ® /Uni-GoldTM , respectively , for an HIV prevalence of 15 % . Conclusions An alternative HIV testing algorithm could include OraQuick ® test which had a high sensitivity and specificity . The current Determine ® /Uni-GoldTM testing algorithm is the least expensive when compared to Determine ® /OraQuick ® , OraQuick ® /Determine ® , and OraQuick ® /Uni-GoldTM in the Zambian setting . From our field experience , oral fluid based testing offers many advantages over blood-based testing , especially with self testing on the horizon Background Despite the substantial investment for providing  HIV counselling and testing ( VCT ) services in Zambia , there has been little effort to systematic ally evaluate the quality of  VCT services provided by various types of health providers . This study , conducted in 2009 , examines  VCT in the public and private sectors including private for-profit and NGO/faith-based sectors in Copperbelt and Luapula . Methods The study used five primary data collection methods to gauge quality of  VCT services  : closed-ended client interviews with clients exiting  VCT sites ; open-ended client interviews ; interviews with facility managers ; review of service statistics ; and an observation of the physical environment for VCT by site .  Over 400 clients and 87 facility managers were interviewed from almost 90 facilities . Sites were r and omly selected and results are generalizable at the provincial level . Results The study shows concerning levels of underperformance in VCT services  across the sectors . It reveals serious underperformance in counselling about key risk-reduction methods . Less than one-third of clients received counselling on reducing number of sexual partners and only approximately 5 % of clients received counselling about disclosing test results to partners . In terms of client profiles , the NGO sector attracts the most educated clients and less educated Zambians seek  VCT  services at very low rates ( 7 % ) . The private for-profit performs equally or sometimes better than other sectors even though this sector is not adequately integrated into the Zambian national response to HIV . Conclusion The private for-profit sector provides  VCT services  on par in quality with the other sectors . Most clients did not receive counselling on partner reduction or disclosure of HIV test results to partners . In a generalized HIV epidemic where multiple concurrent sexual partners are a significant problem for transmitting the disease , risk-reduction methods and discussion should be a main focus of pre-test and post-test counselling This paper explores the effect of social relations and gender-based conflicts on the uptake of HIV testing in the South and Central provinces of Zambia . We conducted a community-based cross-sectional study of 1716 r and omly selected individuals . Associations were examined using mixed-effect multivariable logistic regression . A total of 264 men ( 64 % ) and 268 women ( 56 % ) had never tested for HIV . The strongest determinants for not being tested were disruptive couple relationships ( OR = 2.48 95 % CI = 1.00–6.19 ) ; tolerance to gender-based violence ( OR = 2.10 95 % CI = 1.05–4.32 ) and fear of social rejection ( OR = 1.48 95 % CI = 1.23–1.80 ) . In the Zambian context , unequal power relationships within the couple and the community seem to play a pivotal role in the decision to test which until now have been largely underestimated . Policies , programs and interventions to rapidly increase HIV testing need to urgently address gender-power inequity in relationships and prevent gender-based violence to reduce the negative impact on the lives of couples and families Background Across sub-Saharan Africa , men 's levels of HIV-testing remain inadequate relative to women ’s . Men are less likely to access anti-retroviral therapy and experience higher levels of morbidity and mortality once initiated on treatment . More frequent HIV-testing by men at continued risk of HIV-infection is required to facilitate earlier diagnosis . This study explored the frequency of HIV-testing among a rural population of men and the factors associated with more frequent HIV-testing . Methods We conducted a secondary analysis of a population -based survey in three rural district in Zambia , from February-November , 2013 . Households ( N = 300 ) in r and omly selected squares from 42 study sites , defined as a health facility and its catchment area , were invited to participate . Individuals in eligible households were invited to complete question naires regarding demographics and HIV-testing behaviours . Men were defined as multiple HIV-testers if they reported more than one lifetime test . Upon question naire completion , individuals were offered rapid home-based HIV-testing . Results Of the 2376 men , more than half ( 61 % ) reported having ever-tested for HIV . The median number of lifetime tests was 2 ( interquartile range = 1 - 3 ) . Just over half ( n = 834 ; 57 % ) of ever-testers were defined as multiple-testers . Relative to never-testers , multiple-testers had higher levels of education and were more likely to report an occupation . Among the 719 men linked to a spouse , multiple-testing was higher among men whose spouse reported ever-testing ( adjusted prevalence ratio = 3.02 95 % CI : 1.37 - 4.66 ) . Multiple-testing was higher in study sites where anti-retroviral therapy was available at the health facility on the day of a health facility audit . Among ever-testers , education and occupation were positively associated with multiple-testing relative to reporting one lifetime HIV-test . Almost half ( 49 % ) of ever-testers accepted the offer of home-based HIV-testing . Discussion Reported HIV-testing increased among this population of men since a 2011/12 survey . Yet , only 35 % of all men reported multiple lifetime HIV-tests . The factors associated with multiple HIV-testing were similar to factors associated with ever-testing for HIV . Men living with HIV were less likely to report multiple HIV-tests and employment and education were associated with multiple-testing . The offer of home-based HIV-testing increased the frequency of HIV-testing among men . Conclusion Although men 's levels of ever-testing for HIV have increased , strategies need to increase the lifetime frequency of HIV-testing among men at continued risk of HIV-infection Background We assessed the integration of early infant HIV diagnosis with the exp and ed programme for immunization in a rural Zambian setting with the aim of determining whether infant and postpartum maternal HIV testing rates would increase without harming immunization uptake . Methods In an unblinded , location stratified , cluster r and omised controlled trial , 60 facilities in Zambia ’s Southern Province were equally allocated to a control group , Simple Intervention group that received a sensitization meeting and the resupply of HIV testing commodities in the event of a stock-out , and a Comprehensive Intervention group that received the Simple Intervention as well as on-site operational support to facilitate the integration of HIV testing services with EPI . Findings The average change in number of first dose diphtheria , pertussis , and tetanus vaccine ( DPT1 )  provided per month , per facility was approximately 0.86 doses higher [ 90 % confidence interval ( CI ) -1.40 , 3.12 ] in Comprehensive Intervention facilities compared to the combined average change in the Simple Intervention and control facilities . The interventions result ed in a 16.6 % [ 90 % CI : -7 % , 46 % , P-value = 0.26 ] and 10 % [ 90 % CI : -10 % , 36 % , P-value = 0.43 ] greater change in average monthly infant DBS testing compared to control for the Simple and Comprehensive facilities respectively . We also found 15.76 ( 90 % CI : 7.12 , 24.41 , P-value < 0.01 ) and 10.93 ( 90 % CI : 1.52 , 20.33 , P-value = 0.06 ) additional total maternal re-tests over baseline for the Simple and Comprehensive Facilities respectively . Conclusions This study provides strong evidence to support Zambia ’s policy of integration of HIV testing and EPI services . Actions in line with the interventions , including HIV testing material supply reinforcement , can increase HIV testing rates without harming immunization uptake . In response , Zambia ’s Ministry of Health issued a memo to remind health facilities to provide HIV testing at under-five clinics and to include under-five HIV testing as part of district performance assessment s. Trial Registration Clinical Trials.gov Registration Number : Home-based voluntary HIV counselling and testing ( HB-VCT ) has been reported to have a high uptake , but it has not been rigorously evaluated . We design ed a model for HB-VCT appropriate for wider scale-up , and investigated the acceptance of home-based counselling and testing , equity in uptake and negative life events with a cluster-r and omized trial . Thirty six rural clusters in southern Zambia were pair-matched based on baseline data and r and omly assigned to the intervention or the control arm . Both arms had access to st and ard HIV testing services . Adults in the intervention clusters were offered HB-VCT by local lay counsellors . Effects were first analysed among those participating in the baseline and post-intervention surveys and then as intention-to-treat analysis . The study was registered with www.controlled-trials.com , number IS RCT N53353725 . A total of 836 and 858 adults were assigned to the intervention and control clusters , respectively . In the intervention arm , counselling was accepted by 85 % and 66 % were tested ( n = 686 ) . Among counselled respondents who were cohabiting with the partner , 62 % were counselled together with the partner . At follow-up eight months later , the proportion of adults reporting to have been tested the year prior to follow-up was 82 % in the intervention arm and 52 % in the control arm ( Relative Risk ( RR ) 1.6 , 95 % CI 1.4 - 1.8 ) , whereas the RR was 1.7 ( 1.4 - 2.0 ) according to the intention-to-treat analysis . At baseline the likelihood of being tested was higher for women vs. men and for more educated people . At follow-up these differences were found only in the control communities . Measured negative life events following HIV testing were similar in both groups . In conclusion , this HB-VCT model was found to be feasible , with a very high acceptance and to have important equity effects . The high couple counselling acceptance suggests that the home-based approach has a particularly high HIV prevention potential The objective of this study is to describe HIV-testing among men in rural Lusaka Province , Zambia , using a population -based survey for a cluster-r and omized trial . Households ( N = 120 ) were r and omly selected from each of the 42 clusters , defined as a health facility catchment area . Individuals aged 15–60 years were invited to complete question naires regarding demographics and  HIV-testing  history . Men testing in the last year were defined as recent-testers . After question naire completion adults were offered home-based rapid HIV-testing . Of the 2,828 
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The results indicated that higher education was a common facilitator of HIV testing , while misconception of HIV testing and the fear of negative consequences were the major barriers for using the testing services .
Other factors , such as demographic characteristics , marital dynamics , partner relationship , and relationship with the health care services , also greatly affects the participants ' decision making .