Recent HIV type 1 infection among participants in a same-day mobile testing pilot study in Zimbabwe

We estimated HIV-1 incidence and characterized risk factors associated with recent infection among participants of a mobile HIV voluntary counseling and testing (VCT) pilot program in two communities in Zimbabwe (N = 1096). HIV-1 infection was diagnosed using a parallel rapid testing algorithm. Recent HIV-1 infections were characterized using the BED immunoglobulin G capture enzyme immunoassay (BED-CEIA). HIV prevalence was 28.9% overall and nearly twice as high in women compared to men (39.5% vs. 21.4%, p < 0.001). HIV-1 incidence was 1.91% and was comparable between men and women (1.99% vs.1.88%; p = 0.626). Although not significant, the proportion of recent infections among all infections was highest among persons ages 25 to 34 years old (10.5%) for both men (11.9%) and women (9.2%). Persons recently infected compared to those with long-term infections were more likely to report STD symptoms (33% vs. 13%; OR = 3.2; p = 0.075) and prior STD treatment (13% vs. 6%; OR = 3.4; p = 0.187) in the previous 6 months. There were no associations found between recent versus long-term HIV infection status and perceived risk or expectation of negative test results. Recent HIV-1 infection detection among mobile VCT participants is a valuable measure for tracking the spread of the epidemic among persons who might otherwise not have access to HIV testing due to practical and logistical barriers. Mobile VCT presents opportunities to expand HIV testing services and evaluate at-risk populations within community settings. Given the challenges of longitudinal cohort studies, recent infection may be a practical endpoint for community-based prevention intervention trials employing mobile testing.     

北京市朝阳区艾滋病自愿咨询检测情况分析

目的调查北京市朝阳区艾滋病自愿咨询检测（VCT）人群的社会人口学特征和艾滋病病毒（HIV）感染状况,有针对性地制定朝阳区艾滋病健康教育和高危干预措施。方法对2007年6月-2008年9月,朝阳区疾病预防控制中心艾滋病VCT门诊求询者的调查结果进行分析。结果868名求询者接受咨询和血清HIV抗体检测,以20～40岁男性青壮年为主,占89.9%;男女比例7.19∶1;未婚占68.9%。求询原因以发生危险性行为为主,占86.3%。HIV抗体阳性41例,感染率为4.7%,以性途径感染为主（75.6%）,22人通过同性性行为感染。结论朝阳区艾滋病的传播以性途径为主,求询者以年轻、未婚和高学历男性为主,HIV感染在男男性行为人群（MSM）中检出率较高。因此,应对男性青壮年、MSM人群进行广泛的艾滋病健康教育,加强针对MSM人群的行为干预措施。     

艾滋病门诊自愿咨询检测者HIV感染状况分析

目的了解艾滋病(AIDS)门诊自愿咨询检测(VCT)者艾滋病病毒(HIV)感染状况。方法对VCT人员的监测资料、HIV/AIDS患者的流行病学和临床资料进行统计分析。结果1 553例VCT者中共检测出37例HIV/AIDS患者。咨询者中以不洁性接触史(33.29%)、输血/血液制品(17.38%)及静脉吸毒(14.68%)的比例较高。结论静脉吸毒、输血/血液制品和性乱人群等是引起HIV传播的重要因素,在现有的医疗卫生服务条件下,实施可持续的VCT服务和综合关怀工作,可起到降低HIV传播风险及积极的预防干预作用。     

岱山县2010-2012年艾滋病VCT结果分析

目的了解岱山县接受艾滋病自愿咨询检测（VCT）服务人群的特征和艾滋病病毒（HIV）感染状况,为更有针对性地开展VCT工作提供科学依据。方法收集2010-2012年岱山县艾滋病自愿咨询点,接受VCT服务的人群资料并进行分析。结果共有1032人接受咨询检测服务,男女性别比为2.42∶1,以21~40岁青壮年占86.72%（895人）;求询者类型以非婚异性性行为占67.44%（696人）。接受HIV检测1032人,检出阳性5例,检出阳性率0.48%。配偶/固定性伴阳性者的阳性率最高为7.14%,其次有男男性行为史者为1.45%,有非婚异性性行为史者为0.43%。结论 VCT是发现HIV感染者的有效途径,开展干预的重要窗口,应针对不同人群进一步规范VCT服务,预防和减少艾滋病在社会上的传播。     

Trends in the uptake of voluntary counselling and testing for HIV in rural Tanzania in the context of the scale up of antiretroviral therapy

Objectives To describe trends in voluntary counselling and testing (VCT) use and to assess whether high‐risk and infected individuals are receiving counselling and learning their HIV status in rural Tanzania. Methods During two rounds of linked serological surveys (2003–2004 and 2006–2007) with anonymous HIV testing among adults, VCT was offered to all participants. The crude and adjusted odds ratios for completing VCT in each survey were calculated to compare uptake by demographic, behavioural and clinical characteristics, stratified by sex. Repeat testing patterns were also investigated. Results The proportion of participants completing VCT increased from 10% in 2003–2004 to 17% in 2006–2007, and among HIV‐infected persons from 14% to 25%. A higher proportion of men than women completed VCT in both rounds, but the difference declined over time. Socio‐demographic and behavioural factors associated with VCT completion were similar across rounds, including higher adjusted odds of VCT with increasing numbers of sexual partners in the past 12 months. The proportion having ever‐completed VCT reached 26% among 2006–2007 attendees, with repeat testing rates highest among those aged 35–44 years. Among 3923 participants attending both rounds, VCT completion in 2006–2007 was 17% among 3702 who were HIV negative in both rounds, 19% among 124 who were HIV infected in both rounds and 22% among 96 who seroconverted between rounds. Conclusion VCT services are attracting HIV‐infected and high‐risk individuals. However, 2 years after the introduction of antiretroviral therapy, the overall uptake remains low. Intensive mobilisation efforts are needed to achieve regular and universal VCT use.     

深圳南山区艾滋病自愿咨询门诊求询者HIV感染状况

目的了解深圳市南山区疾病预防控制中心(CDC)艾滋病自愿咨询(VCT)门诊求询者HIV感染状况,为预防控制艾滋病的流行提供科学依据。方法收集整理2010-01/2012-12南山区CDC门诊VCT人群HIV抗体检测结果,用描述性方法进行统计分析。结果共有2043人进行VCT门诊咨询和血清检测,确诊HIV抗体阳性者317例,阳性检出率占总数15.52%,其中男性302例、女性15例,男女之比为20.13∶1;年龄分布在18~81岁之间,年龄主要集中在20~39岁(252例),占79.50%;在317例阳性检测者中,因男男同性恋性接触感染285例,占全部感染人数的89.91%;配偶/固定性伴阳性感染18例,占5.68%;非婚异性接触9例,占2.84%;献血浆史4例,占1.26%;手术史1例,占0.32%。结论深圳市南山区VCT门诊艾滋病感染者的主要传播途径为性传播,以男男同性恋传播为主。     

2016-2018年鞍山市VCT门诊HIV感染者发现情况

目的分析鞍山市艾滋病自愿咨询检测(VCT)门诊检测者的基本特征及艾滋病病毒(HIV)感染情况,为调整艾滋病防控策略提供理论依据。方法对2016-2018年鞍山市VCT门诊求询者的人口学特征、求询原因和HIV抗体检测结果进行分析。结果2016-2018年共有18398人次接受VCT服务,男女性别比为1∶2.67,20~39岁青壮年占79.66%(14655人次),已婚占55.38%(10189人次),初中及以下文化占54.07%(9947人次)。HIV阳性率为1.69%(311/18398),大专及以上文化程度的HIV阳性率为2.28%(100/4384),有高危性行为史者占80.20%(14756人次),男男性行为者(MSM)HIV阳性检出率为10.94%(254/2322)。结论鞍山市VCT门诊主要求询并检测者以青壮年为主,MSM是感染HIV的高危人群,提高检测咨询服务质量,是高危人群发现HIV感染并提供干预的重要途径。     

Frequent detection of acute primary HIV infection in men in Malawi

BACKGROUND: Acute (antibody-negative) HIV infection is associated with high transmission potential but is rarely recognized. DESIGN: Cross-sectional study. METHODS: We examined the prevalence and predictors of acute HIV infection among 1361 consecutive male outpatients attending sexually transmitted disease (STD; n = 929) and dermatology (n = 432) clinics in Lilongwe, Malawi. Serum specimens negative for HIV antibodies were screened by HIV RNA PCR using a highly specific pooling/resolution testing algorithm. RESULTS: Five-hundred and fifty-three men (40.6%) were HIV antibody positive and 24 (1.8%) had acute HIV infection; 23 of 24 acutely infected men were from the STD clinic, where they represented 4.5% of all HIV antibody-negative men and 5.0% of all HIV infections. HIV RNA levels for acutely infected men were significantly higher [median (interquartile range), 6.10 (5.19-6.54) log10 HIV RNA copies/ml] than for 58 HIV antibody-positive men [4.42 (3.91-4.95) log10 copies/ml; P < 0.0001]. The factor most strongly associated with acute HIV infection was STD clinic attendance: (odds ratio, 15.2; 95% confidence interval, 2.04-113.0). In multivariate analysis considering only STD patients, factors associated with acute HIV infection included inguinal adenopathy, genital ulceration and age 24-26 years, the age stratum associated with peak incidence of HIV infection among Malawian men. CONCLUSIONS: Traditional HIV antibody tests alone are not sufficient to exclude HIV infection among men with acute STD in Malawi due to a surprising proportion of acute HIV infections in this population. Alternative screening methods are required for diagnosis of acute HIV infection; such screening could be important for research and for prevention of the sexual transmission of HIV in select populations.     

Identification of primary HIV-1C infection in Botswana

Methods for identification of primary HIV infections seem increasingly important to understand pathogenesis, and to prevent transmission, which is particularly efficient during acute infection. Most current algorithms for HIV testing are based on detection of HIV antibodies and are unable to identify early infections before seroconversion. The efficiency of prospective cohorts, which is a standard approach for identifying primary HIV-1 infection, depends on a variety of epidemiological and cultural factors including HIV incidence and stigma and, not surprisingly, varies significantly in different geographical areas. We report a voluntary counseling and testing (VCT)-based approach to identifying primary HIV-1C infection that was developed as part of a primary HIV-1 subtype C infection study in Botswana. The referral strategy was based on: (1) collaboration with VCT centers at city clinics operated by the Ministry of Health; (2) partnering with the busiest non-government VCT center; (3) educating healthcare workers and the community about primary HIV infection; and (4) pairing with diverse VCT providers, including NGOs and private-sector organizations. Acute HIV-1 infections were defined by a negative HIV-1 serology combined with a positive HIV-1 RT-PCR test. Recent HIV-1 infections were identified by detuned EIA testing according to the classic STARTH algorithm. The VCT-based referral strategy resulted in the successful identification of 57 cases of acute and early HIV infection. A referral strategy of expanded VCT with viral RNA (Ribonucleic acid) testing to a national program in Botswana may be a promising approach for identification of primary HIV infections on a countrywide level. The program should offer VCT with viral RNA testing to the general public, facilitate proper counseling and risk reduction, and allow initiation of early HAART, and may reduce new viral transmissions.     

Investigating the relationship between HIV testing and risk behaviour in Britain: National Survey of Sexual Attitudes and Lifestyles 2000

OBJECTIVES: To estimate the prevalence of, and identify factors associated with, HIV testing in Britain. DESIGN: A large, stratified probability sample survey of sexual attitudes and lifestyles. METHODS: A total of 12,110 16-44 year olds completed a computer-assisted face-to-face interview and self-interview. Self-reports of HIV testing, i.e. the timing, reasons for and location of testing, were included. RESULTS: A total of 32.4% of men and 31.7% of women reported ever having had an HIV test, the majority of whom were tested through blood donation. When screening for blood donation and pregnancy were excluded, 9.0% of men and 4.6% of women had had a voluntary confidential HIV test (VCT) in the past 5 years. However, one third of injecting drug users and men who have sex with men had a VCT in the past 5 years. VCT in the past 5 years was significantly associated with age, residence, ethnicity, self-perceived HIV risk, reporting greater numbers of sexual partners, new sexual partners from abroad, previous sexually transmitted infection diagnosis, and injecting non-prescribed drugs for men and women, and same-sex partners (men only). Whereas sexually transmitted disease clinics were important sites for VCT, general practice accounted for almost a quarter of VCT. CONCLUSION: HIV testing is relatively common in Britain; however, it remains largely associated with population-based blood donation and antenatal screening programmes. In contrast, VCT remains highly associated with high-risk (sexual or drug-injecting) behaviours or population sub-groups at high risk. Strategies to reduce undiagnosed prevalent HIV infection will require further normalization and wider uptake of HIV testing.     

Behavior change following HIV diagnosis: findings from a Cohort of Los Angeles MSM

The effect of an HIV diagnosis on subsequent behavior of men who have sex with men (MSM) remains unclear. From 2009 to 2012 the NIDA funded Metromates Study enrolled and followed for one year MSM seeking testing for HIV in Los Angeles, assessing those with new HIV diagnoses for acute/recent HIV infection. Behavioral data were collected via Computer-Assisted Self-Interview from 321 men of whom 125 were classified as recently HIV infected, 91 as not recently HIV infected, and 105 as HIV-negative. Differences over time between those with recent HIV infection, not recent HIV infection, and no HIV were evaluated using bivariate and multivariable analyses for repeat measures to assess associations between HIV group, behaviors and condomless receptive (CRAI), intersertive (CIAI), or any condomless anal intercourse (CAI). Participants were mostly young (59%?相似文献   

湖州市2011年艾滋病自愿咨询检测结果分析

目的了解湖州市接受艾滋病自愿咨询检测（VCT）服务人群的现状,为艾滋病防治措施的制定提供科学依据。方法对2011年在湖州市接受VCT服务的人员的人口学状况、求询原因、危险行为等进行统计学分析。结果3 778名求询者中,3 759人（99.5%）接受了HIV抗体检测,检出阳性9例,HIV检出率为0.24%。求询者男女性别比为0.8∶1;年龄主要集中在20～49岁,占90.3%;初中学历占38.6%。各类高危行为中,有性乱史者占58.8%。结论青壮年和性接触是湖州市艾滋病传播的高危人群及方式;加强艾滋病知识宣传和VCT服务、提高求询者阳性者转介率,是今后VCT工作的重点。     

2010-2012年武汉市某艾滋病VCT门诊数据分析

目的对近3年来武汉市某艾滋病自愿咨询检测（VCT）门诊的数据进行分析,为完善VCT服务,为求询者提供更好的健康教育提供依据。方法收集武汉市某VCT示范门诊2010-2012年的数据,对求询者的一般人口学资料、高危因素及HIV和梅毒抗体初筛结果进行统计分析。结果 3年总求询者为3148人,进行艾滋病病毒（HIV）检测3048人,检测率为96.8%,HIV阳性124人,阳性率为4.1%;梅毒检测2529人,梅毒阳性142人,阳性率为5.6%。结论 VCT门诊求询者HIV、梅毒检测率较高,但还应提高VCT服务质量和水平,加大对全人群的艾滋病防治知识宣传力度,控制性传播疾病向普通人群蔓延。     

Screening for acute HIV infection in South Africa: finding acute and chronic disease*

Background

The yield of screening for acute HIV infection among general medical patients in resource‐scarce settings remains unclear. Our objective was to evaluate the strategy of using pooled HIV plasma RNA to diagnose acute HIV infection in patients with negative or discordant rapid HIV antibody tests in Durban, South Africa.

Methods

We prospectively enrolled patients with negative or discordant rapid HIV antibody tests from a routine HIV screening programme in an out‐patient department in Durban with an HIV prevalence of 48%. Study participants underwent venipuncture for pooled qualitative HIV RNA, and, if this was positive, quantitative RNA, enzyme immunoassay and Western blot (WB). Patients with negative or indeterminate WB and positive quantitative HIV RNA were considered acutely infected. Those with chronic infection (positive RNA and WB) despite negative or discordant rapid HIV tests were considered to have had false negative rapid antibody tests.

Results

Nine hundred and ninety‐four participants were enrolled with either negative (n=976) or discordant (n=18) rapid test results. Eleven [1.1%; 95% confidence interval (CI) 0.6–2.0%] had acute HIV infection, and an additional 20 (2.0%; 95% CI 1.3–3.1%) had chronic HIV infection (false negative rapid test).

Conclusions

One per cent of out‐patients with negative or discordant rapid HIV tests in Durban, South Africa had acute HIV infection readily detectable through pooled serum HIV RNA screening. Pooled RNA testing also identified an additional 2% of patients with chronic HIV infection. HIV RNA screening has the potential to identify both acute and chronic HIV infections that are otherwise missed by standard HIV testing algorithms.     

Patterns of Self-reported Behaviour Change Associated with Receiving Voluntary Counselling and Testing in a Longitudinal Study from Manicaland, Zimbabwe

Voluntary counselling and testing (VCT) is promoted as a potential HIV prevention measure. We describe trends in uptake of VCT for HIV, and patterns of subsequent behaviour change associated with receiving VCT in a population-based open cohort in Manicaland, Zimbabwe. The relationship between receipt of VCT and subsequent reported behaviour was analysed using generalized linear models with random effects. At the third survey, 8.6% of participants (1,079/12,533), had previously received VCT. Women who received VCT, both those positive and negative, reduced their reported number of new partners. Among those testing positive, this risk reduction was enhanced with time since testing. Among men, no behavioural risk reduction associated with VCT was observed. Significant increases in consistent condom use, with regular or non-regular partners, following VCT, were not observed. This study suggests that, among women, particularly those who are infected, behavioural risk reduction does occur following VCT.     

HIV voluntary counselling and testing in Nakuru, Kenya: findings from a community survey

OBJECTIVES: HIV voluntary counselling and testing (VCT) is important for prevention, detection and treatment of HIV infection. A study was conducted to determine the extent of utilization of VCT, and to study the attitudes and preferences of the community regarding VCT. METHODS: A total of 301 adults, aged 18-49 years, residing in Nakuru, Kenya were randomly selected using a two-stage sampling process. A self-administered questionnaire delivered during home visits was used to collect data over a 4-week period. RESULTS: The majority of study participants (184 of 287; 64.1%) had never been tested for HIV; 77 (26.8%) had received VCT, and 26 (9.1%) had received HIV testing without counselling. A total of 219 (78.2%) of the 280 responding participants expressed readiness to have VCT. The majority of participants (216 of 296; 73%) preferred VCT, while 46 (15.5%) preferred testing without counselling. The majority (227; 76.7%) preferred couple testing and dedicated clinics and private doctors' offices as testing facilities. The choice of a nearby facility was ranked above the provision of anonymity by most participants (162 of 298; 54.4%; vice versa for 136 of 298; 45.6%). CONCLUSIONS: With HIV/AIDS continuing to be a major public health concern in Kenya, the issues surrounding acceptance and use of VCT need to be addressed. Enhancing community awareness of the benefits of early HIV diagnosis, providing couple-based VCT as an integral part of VCT and increasing access to VCT testing sites may enhance utilization of VCT.     

Focusing HIV prevention on those most likely to transmit the virus.

Despite some success in reducing HIV incidence, the global epidemic continues to grow. For every person with AIDS in developing countries placed on treatment in 2005, many others were newly infected. We need more effective prevention programs that focus interventions on those most at risk for HIV transmission (MART), particularly those with 1) high behavioral risk and 2) high viral loads due to acute or recent infection, co-infections with other diseases, high viral set points, or untreated AIDS. This article provides examples of how prevention programs can incorporate emerging testing technologies and social/behavioral approaches to reach these individuals, their partners, and the social networks where active transmission is occurring.     

Approaching the CDC's guidelines on the HIV testing of inpatients: physician-referral versus nonreferral-based testing

Despite ongoing evidence that one quarter of HIV-infected people in the United States are unaware of their infection, widespread implementation of the Centers for Disease Control and Prevention's 1993 recommendations regarding routine inpatient HIV testing has not occurred. This study compares two HIV testing strategies: the initial phase of inpatient HIV testing (1999-2001) utilized a physician-referral-based system. The second phase (2001-2003) included the first 2 years' experience with having trained HIV counselors directly approach inpatients regarding their willingness to undergo voluntary HIV counseling and testing (VCT) without physician referral. This latter phase was prompted by a patient attitude survey demonstrating favorable responses to unsolicited approaches by staff regarding HIV testing. Barriers to implementing the latter strategy are discussed and initial experience with rapid HIV testing on this service is also presented. Referral-based testing yielded 2.3 patient referrals (6.4% of total admissions) resulting in 1.2 HIV tests and 0.7 counseling only sessions per day. Nonreferral based testing resulted 6.2 HIV tests and another 3.0 counseling-only sessions per day. HIV VCT on an inpatient service is feasible but challenging. Most patients respond favorably to being approached for VCT. Routinely offering HIV tests to inpatients yields higher testing rates than physician referral-based systems and increases the number of patients who know their HIV status. Recommendations for implementing routing HIV testing on an inpatient service are made.     

Identifying,linking, and treating people who inject drugs and were recently infected with HIV in the context of a network-based intervention

ABSTRACT

Identifying and linking people to care soon after HIV infection could limit viral transmission and protect their health. This work aims at describing the continuum of care among recently HIV-infected people who inject drugs (PWID) and participated in an intervention in the context of an HIV outbreak in Athens, Greece. The Transmission Reduction Intervention Project (TRIP) conducted risk network-based contact tracing and screened people for recent HIV infection. A comprehensive approach with a case management component that aimed to remove barriers to accessing care was adopted. Follow-up data on antiretroviral treatment (ART) and HIV-RNA levels were obtained from HIV clinics. TRIP enrolled 45 recently HIV-infected PWID (80% male) with a median viral load at recruitment of 5.43 log₁₀ copies/mL. Of the recently infected persons in TRIP, 87% were linked to care; of these, 77% started ART; and of those on ART, 89% achieved viral load <200 copies/mL. TRIP and its public health allies managed to get most of the recently HIV-infected PWID who were identified by the program into care and many of them onto ART. This resulted in very low HIV-RNA levels. Treatment as prevention can work if individuals are aided in overcoming difficulties in entry to, or attrition from care.

Trial registration: Uniform Trial Number identifier: NCT01827228.     

Voluntary counselling and testing sites as a source of sentinel information on HIV prevalence in a concentrated epidemic: a pilot project from Indonesia

A new system for monitoring HIV voluntary counselling and testing (VCT) outcomes was established in 2007 at seven VCT clinics in Jakarta and Bali, Indonesia. Counsellors collected demographic and risk information from VCT clients. Logistic regression was used to determine factors associated with HIV infection. In 15 months, HIV prevalence in 5569 new clients without HIV symptoms was 63.3% in injecting drug users (IDUs) (n = 783), 7.7% in female sex workers (n = 1437), 31.6% among transgender people (n = 395), 9.3% in men who have sex with men (n = 268), 13.5% in clients of sex workers (n = 643), 21.1% in people with high-risk partners (n = 569) and 3.2% in other VCT clients (n = 822). Among IDUs, being older, tested though outreach, tested due to being 'at risk' and having injected for one or more years were independently associated with HIV infection. This network confirmed high HIV prevalence among IDUs and transgender people. HIV prevalence estimates were consistent with serosurveys.