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Background: Antiretroviral drug resistance is steadily growing in populations of HIV treatment-naive individuals due to person-to-person transmission. However, Iowa-specific data for transmitted antiretroviral drug resistance-associated mutations prevalence has not been previously reported. We postulate that the prevalence of drug resistance in Iowa does not differ significantly between HIV risk groups. Methods: Data were collected from electronic medical records and an HIV Program database between 2006 and 2011. Information included age, gender, risk exposure group, viral load, CD4 count, CD4%, and other HIV risk factors and behaviors. Results: Transmitted drug resistance mutations (TDRM) were not associated with many risk factors, but rapid plasma reagin (RPR) screening for syphilis was significant (p=0.02) and used as a proxy for highest level of sexual risk behavior. RPR was used with minor NRTI and NNRTI along with intravenous drug use in logistic regression to model the likelihood of acquiring TDRM. Conclusion: Some question the practicality of implementing genotypic ARV resistance testing guidelines because of uncertainty about the prevalence of ARV drug resistance among treatment-naïve patients but harboring resistance mutations puts patients at high risk of failing effective, first-line therapies. Hence, genotypic resistance testing at HIV diagnoses can not only improve disease management but also assist in surveillance.

abstract: Previous research from Rajsic et al. (2015, 2017) suggests that a visual form of confirmation bias arises during visual search for simple stimuli, under certain conditions, wherein people are biased to seek stimuli matching an initial cue color even when this strategy is not optimal. Furthermore, recent research from our lab suggests that varying the prevalence of cue-colored targets does not attenuate the visual confirmation bias, although people still fail to detect rare targets regardless of whether they match the initial cue (Walenchok et al. under review). The present investigation examines the boundary conditions of the visual confirmation bias under conditions of equal, low, and high cued-target frequency. Across experiments, I found that: (1) People are strongly susceptible to the low-prevalence effect, often failing to detect rare targets regardless of whether they match the cue (Wolfe et al., 2005). (2) However, they are still biased to seek cue-colored stimuli, even when such targets are rare. (3) Regardless of target prevalence, people employ strategies when search is made sufficiently burdensome with distributed items and large search sets. These results further support previous findings that the low-prevalence effect arises from a failure to perceive rare items (Hout et al., 2015), while visual confirmation bias is a bias of attentional guidance (Rajsic et al., 2015, 2017). / Dissertation/Thesis / Doctoral Dissertation Psychology 2018

abstract: The label-feedback hypothesis (Lupyan, 2007, 2012) proposes that language modulates low- and high-level visual processing, such as priming visual object perception. Lupyan and Swingley (2012) found that repeating target names facilitates visual search, reducing response times and increasing accuracy. Hebert, Goldinger, and Walenchok (under review) used a modified design to replicate and extend this finding, and concluded that speaking modulates visual search via template integrity. The current series of experiments 1) replicated the work of Hebert et al. with audio stimuli played through headphones instead of self-directed speech, 2) examined the label feedback effect under conditions of varying object clarity, and 3) explored whether the relative prevalence of a target’s audio label might modulate the label feedback effect (as in the low prevalence effect; Wolfe, Horowitz, & Kenner, 2005). Paradigms utilized both traditional spatial visual search and repeated serial visual presentation (RSVP). Results substantiated those found in previous studies—hearing target names improved performance, even (and sometimes especially) when conditions were difficult or noisy, and the relative prevalence of a target’s audio label strongly impacted its perception. The mechanisms of the label feedback effect––namely, priming and target template integrity––are explored. / Dissertation/Thesis / Doctoral Dissertation Psychology 2019

Introduction. Des traitements efficaces permettent la prise en charge des personnes vivant avec le VIH (PVVIH) et la prévention. Cependant, seulement 55% des PVVIH connaissent leur statut et ce taux est encore plus faible pour les pays de l’Afrique de l’Ouest et du Centre (35%). Afin d’accroître l’offre de Conseil et Test pour le VIH (CTV), l’OMS a publié en juillet 2015 un guide consolidé basé sur des études, dont certaines ont été réalisées en Afrique Subsaharienne. Et très peu d’entre elles concernent les pays à faible prévalence du VIH, notamment l’Afrique de l’Ouest francophone. Cette thèse a pour objectif général d’analyser les enjeux et les limites des politiques et programmes de CTV dans les pays africains de basse prévalence VIH, à partir de la situation du Burkina Faso, et de proposer de nouvelles mesures pour développer l’offre de CTV.Méthodes. Deux études ont été conduites. La première portait sur les motivations et les obstacles à la pratique du test VIH. Elle a été menée dans le cadre du projet « Multi-country African Testing and Counselling for HIV » (MATCH) portant sur quatre pays (Burkina Faso, Kenya, Malawi, Ouganda). Au Burkina Faso, l’étude a été conduite en 2008-2009 en milieu urbain (Ouagadougou) et rural (Dédougou) dans des sites sélectionnés selon leur niveau de fréquentation. Des approches quantitatives et qualitatives ont été utilisées.La deuxième étude a été conduite en 2015 auprès des acteurs et des décideurs du CTV au niveau national, et visait à analyser leurs perceptions des directives publiées par l’OMS en 2015. Un outil de collecte des données expliquant les changements a diffusé par voie électronique. Les réponses ont été analysées de manière quantitative et qualitative.Résultats. L’offre du CTV est basée au Burkina Faso sur des documents validés en 2008.L’analyse de l’utilisation du test à l’initiative du client a montré que les femmes étaient les plus nombreuses (58,5%). Cependant les hommes (p=0,02), les 18-34 ans (p=0,01), et les plus scolarisés (p=0,001) semblaient utiliser plus précocement les services.. En analyse multivariée, ces catégories utilisaient plus les campagnes. Les signes ou symptômes liés au VIH motivaient le test chez les femmes (p=0,008), les 35 ans et plus (p<0,001) et les non scolarisés (p<0,001) qui sollicitaient plus le test en sites fixes. L’utilisation du CTV pendant la campagne était associée au désir de connaître le statut (p<0,001), tandis qu’en dehors des campagnes, l'état de santé de l’utilisateur, la maladie ou le décès du partenaire était le principal motif (p=0,001). Aussi 61% des utilisateurs avaient réalisé 2 tests et plus. Dans une analyse multivariée, l’utilisation répétée du CTV par les personnes séronégatives était associée à la scolarisation (au moins le secondaire), au jeune âge et pour les PVVIH à la résidence en milieu urbain.Les prestataires déclaraient être confrontés à des difficultés logistiques et matérielles pour offrir adéquatement le CTV. Il en résultait une faible qualité des services, notamment un conseil post test dispensé partiellement, et une faible référence des PVVIH. Celles-ci avaient un vécu de stigmatisation élevé, soit 46% de stigmatisation interne, 40% dans les relations interpersonnelles et 11% dans les services de santé. Les décideurs et acteurs ont trouvé la plupart des directives de 2015 pertinentes, mais sont pessimistes sur leur faisabilité.Conclusion. Ce travail a identifié les limites du CTV au Burkina Faso et donne des éléments significatifs pour les pays africains de basse prévalence. Dans un contexte de raréfaction des ressources, l’accès équitable au CTV nécessite l’identification de stratégies innovantes. Le renforcement des capacités des prestataires pour une offre globale de services de qualité est nécessaire. La lutte contre la stigmatisation devrait être intensifiée. La prise en compte des avis des experts permettra la révision des documents nationaux et leur adaptation selon les directives OMS. / Background. Treatments are effective for people living with HIVAIDS (PLWHA) care and prevention. However, only 55% of PLWHA are aware of their status. This rate is lower in Central and West Africa (35%). In July 2015, WHO published new guidelines on HIV testing. In Sub-Saharan Africa, there are many studies which results are used to define policies and guidelines on HIV testing at the international level. Few of them are implemented in low HIV prevalence countries, notably French-Speaking West Africa. The overall objective of this thesis is to analyze the challenges and limitations of HIV testing and counselling (HTC) policies and programs in low prevalence countries, over the situation in Burkina Faso and propose new measures to increase the access to HTC services.Methods. Two studies have been conducted. The first one was carried out in the « Multi-country African Testing and Counselling for HIV » (MATCH) project which was implemented in four countries (Burkina Faso, Kenya, Malawi, Uganda). It aimed to analyze the motivations and barriers to HTC services practices by users, non-users and providers. In Burkina Faso, the study was carried out in Urban (Ouagadougou) and rural (Dédougou) areas in 2008-2009. In each locality, study sites (client initiated testing and provider initiated testing sites) were chosen, given the level of utilization. Quantitative and qualitative methods were used. The second study was conducted in 2015, with HTC providers and decision makers at national level. The objective was to analyze their perceptions on WHO 2015 guidelines. A data collection tool explaining the changes introduced in the guidelines has been designed and transmitted via electronic means. Their opinions were analyzed.Results. Guidelines for HTC in Burkina Faso were from 2008. In client initiated testing sites, there were more women (58.5%). However, men (p=0.02), 18-34 years old (p=0.01), and the more educated ones (p=0.001) appeared to have used early services. In multivariate analysis, those categories used often campaigns. Women (p=0.008), 35 years of age and over (p<0.001) and less educated people (p<0.001) sought more often the test in fixed sites. The use of HTC services during campaigns is associated with the desire to know one's HIV status (p<0.01), while outside of campaigns, the health status of the user, the illness or the partner's death was the main concern (p=0.001). Campaigns are associated with the hope of knowing one’s HIV status (p<0.001). There were 61% of users who were repeat testers (2 or more tests). In a multivariate analysis, repeat testing for HIV negative people was associated with higher education, young age and for PLWHA living in urban areas. HTC Providers declared that they faced logistic and material challenges. It resulted in a low quality of services, in particular post-test counselling sessions that were partially done and a low effective reference of PLWHA towards care services. HIV stigma was found to be very high (46% of PLWHA faced internal stigma, 40% of interpersonal stigma, and 11% in health services). Decision-makers and providers have found most of the 2015 guidelines relevant, but were pessimist about their feasibility.Conclusion. This work has identified limitations of HTC at the individual, community, health services and institutional levels in Burkina Faso, and provides significant elements for African low prevalence countries. Given the scarcity of resources, there is a need for innovative strategies for equitable access to HTC, in order to attract more men, and test earlier women, less educated and 34 years or older. Strengthening the capacity of service providers to include a comprehensive range of quality services is necessary. All the aforementioned should be supplemented by the fight against stigma. Paying attention to national HTC experts’ opinion will help for national guidelines review and adapt them to WHO guidelines.