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1.
Background
Despite several years of implementation, prevention of mother-to-child transmission (PMTCT) programmes in many resource poor settings are failing to reach the majority of HIV positive women. We report on a data driven participatory quality improvement intervention implemented in a high HIV prevalence district in South Africa. 相似文献2.
3.
Khadija I Yahya-Malima Mecky I Matee Bjørg Evjen-Olsen Knut Fylkesnes 《BMC public health》2007,7(1):103
Background
Previous surveillance among antenatal clinic (ANC) attendees within the remote rural Manyara and Singida regions in Tanzania identified an imminent but still, relatively low HIV epidemic. We conducted a population-based HIV study to identify risk factors and validate the representativeness of ANC-based estimates. 相似文献4.
H. Muttai K. F. Laserson I. Akello L. Nyabiage J. Gondi J. Mutegi J. Williamson A. K. Nakashima M-L. Ackers 《Public Health Action》2013,3(4):286-293
Setting:
In 2008, the Kenya tuberculosis (TB) program reported low (31%) antiretroviral therapy (ART) uptake among human immunodeficiency virus (HIV) infected TB patients.Objective:
To confirm ART coverage and identify factors associated with HIV clinic enrollment and ART initiation among TB patients.Design:
Retrospective chart abstraction of adult TB patients newly diagnosed with HIV and eligible for ART at 58 Nyanza Province TB clinics between October 2006 and April 2008. TB data were linked to HIV clinic data at 50 facilities that provided ART. Associations with HIV clinic enrollment and ART were evaluated.Results:
Among 1137 ART-eligible TB patient records sampled, 32% documented HIV clinic enrollment and 29% ART. Date fields were largely incomplete; 11% of the patient records included HIV testing dates and ≤1% had dates for cotrimoxazole prophylaxis, HIV clinic enrollment and ART initiation. Adding HIV clinic data increased HIV clinic enrollment and ART documentation to respectively 62% and 44%. Among TB patients in HIV care, female sex, older age group and baseline CD4 documentation were associated with ART initiation.Conclusion:
Linking data increased documentation of HIV clinic enrollment and ART uptake. Continued efforts are required to improve the documentation of HIV service delivery, especially in TB clinics. Interventions to increase ART uptake are needed for younger patients and men. 相似文献5.
6.
Iñigo Gorostiza Isabel Elizondo López de Landache Leire Braceras Izagirre 《Gaceta sanitaria / S.E.S.P.A.S》2013
Objectives
To describe the outcomes of the pilot program of a rapid HIV antibody screening test offered at Basque pharmacies, the socio-demographic characteristics of users and their acceptance of the test.Methods
Users of a rapid HIV antibody screening test (20 pharmacies) were surveyed. A random sample of 3514 tests (N = 806) performed in 1 year was taken. Statistical analyses included exact tests.Results
There were 806 valid questionnaires. Seven tests were positive (0.85%; 95% confidence interval: 0.34-1.75); five of the users with positive tests were men. The mean age was 36.2 years (standard deviation = 11.0; range: 16-82 years; 70.7% men). Users’ risk behavior was predominantly heterosexual and half of the users (58.6%) had no previous HIV tests. The main reasons for choosing this test were its speed, and the convenience and accessibility of community pharmacies.Conclusions
This new rapid HIV antibody screening test in community pharmacies could supplement other HIV screening programs currently in operation. 相似文献7.
Yves Lafort Diederike Geelhoed Luisa Cumba Carla das Dores Mosse Lázaro Wim Delva Stanley Luchters Marleen Temmerman 《BMC health services research》2010,10(1):144
Background
Different models exist to provide HIV/STI services for most-at-risk populations (MARP). Along the Tete traffic corridor in Mozambique, linking Malawi and Zimbabwe, a night clinic opening between 4 and 10 PM was established targeting female sex workers (FSW) and long-distance truck drivers (LDD). The clinic offers free individual education and counselling, condoms, STI care, HIV testing, contraceptive services and outreach peer education. To evaluate this clinic model, we assessed relevance, service utilisation, efficiency and sustainability. 相似文献8.
Joseph B Babigumira Barbara Castelnuovo Mohammed Lamorde Andrew Kambugu Andy Stergachis Philippa Easterbrook Louis P Garrison 《BMC health services research》2009,9(1):192-6
Background
Lower-income countries face severe health worker shortages. Recent evidence suggests that this problem can be mitigated by task-shifting--delegation of aspects of health care to less specialized health workers. We estimated the potential impact of task-shifting on costs of antiretroviral therapy (ART) and physician supply in Uganda. The study was performed at the Infectious Diseases Institute (IDI) clinic, a large urban HIV clinic. 相似文献9.
Background
Tuberculosis is the commonest opportunistic infection and the number one cause of death in HIV/AIDS patients in developing countries. To address the extent of the tuberculosis HIV coinfection in rural Tanzania we conducted a cross sectional study including HIV/AIDS patients attending care and treatment clinic from September 2006 to March 2007. 相似文献10.
Jay A Pandit Nicole Sirotin Robin Tittle Elijah Onjolo Elizabeth A Bukusi Craig R Cohen 《BMC public health》2010,10(1):245
Background
HIV/AIDS negatively impacts poverty alleviation and food security, which reciprocally hinder the rapid scale up and effectiveness of HIV care programs. Nyanza province has the highest HIV prevalence (15.3%), and is the third highest contributor (2.4 million people) to rural poverty in Kenya. Thus, we tested the feasibility of providing a micro-irrigation pump to HIV-positive farmers in order to evaluate its impact on health and economic advancement among HIV-positive patients and their families. 相似文献11.
Grundmann N Iliff P Stringer J Wilfert C 《Bulletin of the World Health Organization》2011,89(7):513-520
Objective
To develop a new algorithm for the presumptive diagnosis of severe disease associated with human immunodeficiency virus (HIV) infection in children less than 18 months of age for the purpose of identifying children who require antiretroviral therapy (ART).Methods
A conditional probability model was constructed and non-virologic parameters in various combinations were tested in a hypothetical cohort of 1000 children aged 6 weeks, 6 months and 12 months to assess the sensitivity, specificity, and positive and negative predictive values of these algorithms for identifying children in need of ART. The modelled parameters consisted of clinical criteria, rapid HIV antibody testing and CD4+ T-lymphocyte (CD4) count.Findings
In children younger than 18 months, the best-performing screening algorithm, consisting of clinical symptoms plus antibody testing plus CD4 count, showed a sensitivity ranging from 71% to 80% and a specificity ranging from 92% to 99%. Positive and negative predictive values were between 61% and 97% and between 95% and 96%, respectively. In the absence of virologic tests, this alternate algorithm for the presumptive diagnosis of severe HIV disease makes it possible to correctly initiate ART in 91% to 98% of HIV-positive children who are at highest risk of dying.Conclusion
The algorithms presented in this paper have better sensitivity and specificity than clinical parameters, with or without rapid HIV testing, for the presumptive diagnosis of severe disease in HIV-positive children less than 18 months of age. If implemented, they can increase the number of HIV-positive children successfully initiated on ART. 相似文献12.
Background
Injection overuse and unsafe injection practices facilitate transmission of bloodborne pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Anecdotal reports of unsafe and unnecessary therapeutic injections and the high prevalence of HBV (8.0%), HCV (6.5%), and HIV (2.6%) infection in Cambodia have raised concern over injection safety. To estimate the magnitude and patterns of such practices, a rapid assessment of injection practices was conducted. 相似文献13.
Yong Cai Rong Shi Tian Shen Bei Pei Xueqin Jiang Xiuxia Ye Gang Xu Shenghui Li Hong Huang Meili Shang 《BMC public health》2010,10(1):377
Background
China is currently facing a rapid and widespread increase in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). The activities of female sex workers (FSWs) have contributed to the mounting epidemic of HIV/AIDS and other sexually transmitted diseases (STDs). Therefore, this study aimed to assess the HIV/AIDS-related knowledge, attitude and risk behaviors among FSWs operating in Shanghai China. 相似文献14.
Sanne Jespersen Bo Langhoff H?nge Inés Oliveira Candida Medina David da Silva Té Faustino Gomes Correia Zacarias José da Silva Christian Erikstrup Lars ?stergaard Alex Lund Laursen Christian Wejse 《Bulletin of the World Health Organization》2014,92(12):909-914
Problem
The introduction of antiretroviral therapy (ART) for HIV infection in sub-Saharan Africa has improved the quality of life of millions of people and reduced mortality. However, substantial problems with the infrastructure for ART delivery remain.Approach
Clinicians and researchers at an HIV clinic in Guinea-Bissau identified problems with the delivery of ART by establishing a clinical database and by collaborating with international researchers.Local setting
The Bissau HIV cohort study group was established in 2007 as a collaboration between local HIV physicians and international HIV researchers. Patients were recruited from the HIV clinic at the country’s main hospital in the capital Bissau.Relevant changes
Between 2005 and 2013, 5514 HIV-positive patients were treated at the clinic. Working together, local health-care workers and international researchers identified the main problems affecting ART delivery: inadequate drug supply; loss of patients to follow-up; and inadequate laboratory services. Solutions to these problems were devised. The collaborations encouraged local physicians to start their own research projects to find possible solutions to problems at the clinic.Lessons learnt
The HIV clinic in Bissau faced numerous obstacles in delivering ART at a sufficiently high quality and patients’ lives were put in jeopardy. The effectiveness of ART could be enhanced by delivering it as part of an international research collaboration since such collaborations can help identify problems, find solutions and increase the capacity of the health-care system. 相似文献15.
Background
As other countries, Switzerland experiences a high or even rising incidence of HIV and sexually transmitted infections (STI) among men who have sex with men (MSM). An outpatient clinic for gay men (" Checkpoint ") was opened in 2006 in Zurich (Switzerland) in order to provide sexual health services. The clinic provides counselling, testing, medical treatment and follow-up at one location under an "open-door-policy" and with a high level of personal continuity. We describe first experiences with the new service and report the characteristics of the population that utilized it. 相似文献16.
Luciene Cardoso Scherer Rosa Dea Sperhacke Carla Jarczewski Patrícia I Cafrune Simone Minghelli Marta Osório Ribeiro Fernanda CQ Mello Antonio Ruffino-Netto Maria LR Rossetti Afrânio L Kritski 《BMC public health》2007,7(1):356
Background
Smear-negative pulmonary tuberculosis (SNPTB) accounts for 30% of Pulmonary Tuberculosis (PTB) cases reported annually in developing nations. Polymerase chain reaction (PCR) may provide an alternative for the rapid detection of Mycobacterium tuberculosis (MTB); however little data are available regarding the clinical utility of PCR in SNPTB, in a setting with a high burden of TB/HIV co-infection. 相似文献17.
Susannah Tomkins Elizabeth Allen Olga Savenko Jim McCambridge Lyudmila Saburova Nikolay Kiryanov Alexey Oralov Artyom Gil David A Leon Martin McKee Diana Elbourne 《BMC health services research》2008,8(1):1-6
Background
HIV counseling and testing is an important intervention in the prevention, control and management of the human immunodeficiency virus (HIV). Counseling and testing can be an entry point for prevention, care and support. Knowledge of the quality of services and motivations for testing by individuals is important for effective understanding of the testing environment.Methods
A cross sectional explorative study of clients accessing HIV voluntary counseling and testing (VCT) and counselors was conducted in 6 government health centers in Blantyre City, Malawi. We aimed to assess the availability of critical clinic supplies and identify the motivations of clients seeking counseling and testing services. We also aimed to identify the health professional cadres that were providing VCT in Blantyre city.Results
102 VCT clients and 26 VCT counselors were interviewed. Among the VCT clients, 74% were <=29 years, 58.8% were females and only 7% reported no formal education. 42.2% were single, 45.1% married, 8.8% widowed and 3.9% divorced or separated. The primary reasons for seeking HIV counseling and testing were: recent knowledge about HIV (31.4%), current illness (22.5%), self-assessment of own behavior as risky (15.5%), suspecting sexual partner's infidelity (13.7%) and seeking HIV confirmatory test (9.8%) and other reasons (6.9%). Of the 26 VCT counselors, 14 were lay volunteers, 7 health surveillance assistants and 5 nurses. All except one had been trained specifically for HIV counseling and testing. All 6 facilities were conducting rapid HIV testing with same day test results provided to clients. Most of the supplies were considered adequate for testing.Conclusion
HIV counseling and testing facilities were available in Blantyre city in all the six public health facilities assessed. The majority of counseling and testing clients were motivated by perceptions of being at risk of HIV infection. In a country with 12% of individuals 15 to 49 years infected, there is need to encourage testing among population groups that may not perceive themselves to be at risk of infection. 相似文献18.
Shenghui Li Hong Huang Yong Cai Gang Xu Fengrong Huang Xiaoming Shen 《BMC public health》2009,9(1):195
Background
China is facing a critical challenge of rapid and widespread human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) increase. Rural-to-urban migration plays a crucial role in shifting the HIV/sexual transmitted infection (STI) epidemic. The purpose of this study was to assess the prevalence of sexual behaviors and the correlates among the early adolescents of migrant workers in China. 相似文献19.
Christine M. Borges Preeti Pathela Robert Pirillo Susan Blank 《Public health reports (Washington, D.C. : 1974)》2015,130(1):81-86
Objective
Staff at public New York City sexually transmitted disease (STD) clinics screen patients for acute HIV infection (AHI) using pooled nucleic acid amplification tests. AHI screening is expensive but important for populations at high risk of acquiring HIV. We analyzed if targeting AHI screening in STD clinics could reduce program costs while maintaining AHI case detection.Methods
From January 2009 through May 2010, we screened all patients with negative rapid HIV tests for AHI. Using risk information on cases detected during this universal screening period, we developed criteria for targeted AHI screening and compared case yields and testing costs during 12 months of universal screening (June 2009 through May 2010) vs. 12 months of targeted screening (June 2010 through May 2011).Results
During the defined period of universal screening, we identified 40 AHI cases, and during targeted screening, we identified 35 AHI cases. Because of targeting efforts, the number needed to test to find one AHI case dropped from 1,631 to 254. With targeted screening, it cost an average of $4,535 per case detected and 39.3 cases were detected per 10,000 specimens; using universal screening, $29,088 was spent per case detected and 6.1 cases were detected per 10,000 specimens processed.Conclusion
Targeted screening identified similar numbers of AHI cases as when screening all clinic patients seeking HIV testing, but at one-seventh the cost.During the acute phase of human immunodeficiency virus (HIV) infection (AHI), infected people are often unaware of their condition, as AHI symptoms—which include fever, sore throat, fatigue, myalgia, lymphadenopathy, rash, joint pain, night sweats, and diarrhea—are nonspecific.1 During AHI, patients are highly viremic (and, thus, highly infectious), and antibodies to HIV have not yet developed.2 This stage of infection, therefore, is not detected by traditional antibody tests. Detecting AHI requires nucleic acid amplification or antigen tests and enables infected people to adopt safer behaviors and be linked to earlier treatment and care, all of which may reduce HIV transmission.3,4 A multisite study conducted in 14 clinics in New York City (NYC); Los Angeles, California; and four counties in Florida from 2006 to 2008 found that AHI screening, when added to point-of-care rapid testing, increased HIV detection by 8.2% across all sites; in three NYC clinics, 24% more HIV infections were detected using AHI screening than with HIV detection using rapid antibody tests alone (seven cases detected by nucleic acid amplification testing [NAAT]; 22 cases detected by rapid test).5 NAAT is an important tool for identifying AHI, and NAAT pooling methods (pNAATs) help to contain the costs of screening.6 By 2009, the NYC Department of Health and Mental Hygiene (NYC DOHMH) had implemented routine AHI screening via pNAAT for all patients with negative rapid HIV tests in all of its sexually transmitted disease (STD) clinics. At that time, the NYC DOHMH joined just a handful of state and local health departments in the United States that were routinely using pNAAT.7While AHI screening increased HIV detection in NYC STD clinics, it came at a considerable cost. Annualized other-than-personnel costs of this screening were more than $1 million, or approximately $30,000 per new diagnosis, which was as much as 16 times greater than the average cost of routine opt-out HIV screening in health-care facilities in the U.S.8 We present our evaluation of a strategy to reduce program costs while maintaining a high level of AHI case detection among clinic patients. 相似文献20.
Arielle Lasry Michael W Carter Gregory S Zaric 《Cost effectiveness and resource allocation : C/E》2008,6(1):1-19