Primary care physicians and barriers to providing care to persons with HIV/AIDS

Primary care physicians play an increasingly important role in the care of persons with HIV/AIDS due to the rising number and changing geographic distribution of persons infected with HIV/AIDS. The study explored the relationship between barriers to health services and the experience and willingness of primary care physicians to care for persons with HIV/AIDS. The study was based on a random survey of primary care physicians in South Carolina. The results indicate that although primary care physicians' willingness to treat persons with HIV/AIDS is significantly associated with many self-reported barriers (i.e., financial, structural, knowledge, and attitudinal), their HIV/AID care experience was most significantly correlated with self-reported knowledge that overrides financial and structural barriers. The results emphasize the importance of programs and policy initiatives aimed at enhancing the primary care physicians' knowledge level and improving their attitudes related to HIV/AIDS.     

Estimating HIV incidence in the United States from HIV/AIDS surveillance data and biomarker HIV test results

The development of an human immunodeficiency virus (HIV) test that detects recent infection has enabled the U.S. Centers for Disease Control and Prevention (CDC) to estimate annual HIV incidence (number of new infections per year, not per person at risk) in the United States from data on new HIV and acquired immunodeficiency syndrome (AIDS) diagnoses reported to HIV/AIDS surveillance. We developed statistical procedures to estimate the probability that an infected person will be detected as recently infected, accounting for individuals choosing whether and how frequently to seek HIV testing, variation of testing frequency, the reporting of test results only for infected persons, and infected persons who never had an HIV-negative test. The incidence estimate is the number of persons detected as recently infected divided by the estimated probability of detection. We used simulation to show that, under the assumptions we make, our procedures have acceptable bias and correct confidence interval coverage. Because data on the biomarker for recent infection or on testing history were missing for many persons, we used multiple imputation to apply our models to surveillance data. CDC has used these procedures to estimate HIV incidence in the United States.     

2005年新泰市艾滋病资料分析

[目的]明确新泰市今后艾滋病防治的重点人群,为制定艾滋病防治战略规划和决策提供依据。[方法]2006年1月,对新泰市艾滋病的流行现状、各种影响因素及开展艾滋病防治工作的有利因素进行调查分析。[结果]截止2005年底,新泰市累积发现艾滋病病毒（HIV）感染者15例（均为有既往有偿献血史的农民）,现存活HIV感染者9例,其中艾滋病病人2例。大众人群、青少年、性服务人员、HIV感染者、流动人口艾滋病防治知识知晓率分别为62．53％、64．15％、72．26％、75．56％、51．33％;性服务人员最近1次性服务安全套使用率为64．96％,HIV感染者夫妻间最近1次性生活安全套使用率为4／9。目前既往有偿献血（浆）人员5505人中5504人已接受HIV抗体检测。估计有性服务人员600余人,男男同性恋者76人,流动人口51347人,在校学生17万余人。乡村诊所医用高压锅拥有率为67．94％,治疗室紫外线灯拥有率为52．89％,33．61％的医务人员知道普遍性防护原则。[结论]性传播、医源性传播是新泰市今后艾滋病流行的潜在危险因素,HIV感染者与艾滋病病人及其配偶（性伴）、暗娼、性病病人、流动人口、同性恋、医疗卫生人员、青少年是艾滋病防治的重点人群。     

The value of AIDS incidence data in assessing the spread of HIV infection

Changes over time in the cumulative number of cases of AIDS depend in a complex way on several features of the epidemic, including the distribution of the induction time between infection with the human immunodeficiency virus (HIV) and onset of symptoms of AIDS, heterogeneity in such behaviours as sexual practices, selection of partners, and IV drug use, and changes over time in these behaviours. Consequently, the observed increase in the doubling time in cumulative AIDS incidence from 5 to 13 months, since AIDS was first recognized in 1982, demonstrates neither that the epidemic has begun to 'run its course' nor that behavioural changes have had a major impact in reducing incidence. Even in a homogeneous population with known induction distribution, AIDS incidence data currently are of little value in determining the number of persons infected with HIV unless additional information is available about the shape of cumulative incidence curve of HIV infection.     

A short term projection of HIV infection and AIDS cases in Cameroon.

By September 1991 Cameroon had reported 650 cases of the acquired immune deficiency syndrome (AIDS). The results from the sentinnel surveillance system showed a seroprevalence of human immunodeficiency virus (HIV)1 of 1.3% among pregnant women, 2.5% in people attending sexually transmitted disease clinics and 3.5% in tuberculosis patients in 1990. The estimated number of persons infected with HIV varies between 10,000 and 30,000. The World Health Organization projection model was used to make a short-term projection of HIV infection and AIDS cases; it indicated that the number of persons infected with HIV will double by the year 1995, with an estimated 8500 AIDS cases. Even in a low prevalence country such as Cameroon, the impact of the HIV epidemic is important and will result in a burden for the health care system.     

艾滋病病毒感染者和艾滋病患者卫生服务利用及医疗费用的研究

目的 了解艾滋病病毒(HIV)感染者和艾滋病(AIDS)患者对卫生服务的利用及直接医疗费用。方法 于1999年12月对北京佑安医院收治的HIV感染者和AIDS患者进行回顾性研究。收集一般人口学特征、HIV感染及疾病进程的相关信息、过去一年内卫生服务利用情况及医疗费用资料。结果 共调查29例HIV感染者，其中17例(58．62％)为无症状期的HIV感染者，12例为AIDS患者。无症状期的HIV感染者平均每人年门诊6次，住院1．23次，每人年住院58．6天；AIDS患者平均每人年门诊7．8次，住院2．1次，住院200．2天。无症状期的HIV感染者平均每人年门诊费用为13729元，住院费用为4745元；AIDS患者平均每人年门诊及住院费用分别为15053元和22242元。既门诊又住院平均每人年的门诊及住院医疗费用，无症状期的HIV感染者为16248元，AIDS患者为36795元。结论 HIV感染者和AIDS患者医疗费用昂贵，对卫生服务的需求量大。需要进一步在更大范围内了解国内HIV感染者和AIDS患者对卫生服务利用的现状及需求。     

Role of the priority national health project in implementing HIV epidemic control strategy in the Russian Federation

According to the data of the UN AIDS control program, the estimated number of persons living with HIV infection worldwide is close to 36 million. There is only one way to reduce HIV infection treatment and care costs; this is to develop large-scale HIV prevention programs. The geography of the HIV infection epidemic is inhomogeneous; about 70% of the absolute number of all notified HIV cases are concentrated in 15 subjects of Russia; bulk of them are industrially developed high-income areas. The laboratory base of AIDS prevention and control centers has been drastically renewed; about 400 units of up-to-date laboratory equipment have been purchased. The problem of preventing the prevalence of HIV infection is being primarily solved within the framework of the priority national project. The programs to prevent HIV infection among particularly vulnerable population groups have been elaborated with regard to the realities and specific features of development of the epidemic of HIV infection.     

Studying the cost of HIV-related illnesses: reflections on the moving target

Although medical care costs of the HIV epidemic by 1991 may reach $6 billion, or 1.2 percent of all estimated personal health care expenditures in the United States, costs per patient of treating AIDS appear to be declining. Calculating the epidemic's costs is difficult, however, in that data are lacking on health care expenditures for HIV-infected persons other than those with AIDS, intravenous drug users, women, and children. Shifts in demographic segments affected, changes in medical treatments, and diffusion beyond initial urban centers will alter the economics of AIDS. Prospective studies at both national and local levels are needed to gauge the epidemic's costs and demands on health services.     

HIV prevalence estimates--United States, 2006

Accurate and timely data on the number of persons in the United States living with human immunodeficiency virus (HIV) infection (HIV prevalence) are needed to guide planning for disease prevention, program evaluation, and resource allocation. However, overall HIV prevalence cannot be measured directly because a proportion of persons infected with HIV have neither been diagnosed nor reported to local surveillance programs. In addition, national HIV prevalence data are incomplete because local reporting systems for confidential, name-based HIV reporting have been fully implemented only since April 2008. With the advent of highly active antiretroviral therapies that delay the progression of HIV to acquired immunodeficiency syndrome (AIDS), and of AIDS to death, and changes in the AIDS case definition to include an immunologic diagnosis, earlier back-calculation methods from the 1990s for estimating HIV prevalence based on the number of reported AIDS cases are no longer reliable. With 80% of states reporting name-based HIV diagnoses as of January 2006, an extended back-calculation method now can be used to estimate HIV prevalence more accurately. Based on this method, CDC now estimates that 1.1 million adults and adolescents (prevalence rate: 447.8 per 100,000 population) were living with diagnosed or undiagnosed HIV infection in the United States at the end of 2006. The majority of those living with HIV were nonwhite (65.4%), and nearly half (48.1%) were men who have sex with men (MSM). The HIV prevalence rates for blacks (1,715.1 per 100,000) and Hispanics (585.3 per 100,000) were, respectively, 7.6 and 2.6 times the rate for whites (224.3 per 100,000).     

布拖县新型农村合作医疗建立中艾滋病关怀机制研究

通过在布拖县建立新型合作医疗试点的过程中把艾滋病覆盖在其中,分析艾滋病纳入和不纳入到新型合作医疗中的筹资差异,以探索政府与社会共同筹集资金解决农村感染者医疗费用问题的关怀道路,寻找在不同情况下筹资的可能性及其影响,从而为政府有关艾滋病防治资源分配和相关投资决策提供依据.     

Consequences of adult HIV infection for outpatient morbidity and treatment costs: a prospective study in a factory clinic in Tanzania

Most studies of the medical costs of HIV infection focus on the terminal stage of this chronic illness when the patients have developed AIDS or severe HIV disease and in-patient care dominates. Data are also needed on the medical costs during the prolonged phase of HIV infection preceding severe terminal illness and the effects it may have on the provision of outpatient care. The study population was derived from a cohort study of factory workers and their spouses in Tanzania. Morbidity and outpatient health services utilization are estimated for 1832 adults who on average had been enrolled for two years and utilized the study clinic. Among those who had been enrolled at least 2 years, 50 cases (HIV+ since enrollment) and 150 control (HIV- until last visit) were selected, matched by age, sex and income level to estimate expenditure on drugs by HIV status. There was an increase in morbidity during HIV infection: the incidence of clinical diagnoses was 30% higher among HIV-positive than among HIV-negative adults (p < 0.001). HIV-infected adults also made more frequent use of the outpatient services (23% higher utilization). Estimates of essential drug costs among the subsample showed a 15% increase for HIV infected adults compared to HIV-negative adults, caused by higher use of antibiotics and other antimicrobial drugs. The overall increase in morbidity, outpatient care services utilization and essential drug use due to HIV infection was limited, as HIV prevalence in this adult population was 11%. For example, the net proportion of all illness episodes attributable to HIV infection was 3.2%. Possible biases are discussed and suggest that our findings are a minimum estimate of the effect of adult HIV infection on outpatient care costs. There is a need for more studies in different settings to assess the impact of HIV infection on outpatient care in developing countries.     

医学院校学生艾滋病歧视现状调查

目的 了解医学院校学生对艾滋病相关知识、歧视态度情况,为进一步开展艾滋病反歧视干预工作提供科学依据.方法 以班级为单位采用分层整群抽样法,从某医学院本科生中抽取2844名,采用自行设计的问卷以学生自填方式进行调查,采用SPSS 13.0软件进行统计分析.结果 共收集有效问卷2501份.调查对象艾滋病相关知识知晓率为73.1%(1828/2501);对HIV感染者和AIDS患者不同问题的歧视率不同,对不良性行为、共用针具感染艾滋病的歧视态度高达83.1%(2078/2501)、77.7%(1943/2501),对于身体接触、接触其生活用品、共用课桌、个人社交的歧视率均在40%以上.结论 医学院校学生对HIV感染者/AIDS患者歧视严重,亟须加强医学院校学生艾滋病反歧视教育.     

Fighting HIV/AIDS: is success possible?

The fight against HIV/AIDS poses enormous challenges worldwide, generating fears that success may be too difficult or even impossible to attain. Uganda has demonstrated that an early, consistent and multisectoral control strategy can reduce both the prevalence and the incidence of HIV infection. From only two AIDS cases in 1982, the epidemic in Uganda grew to a cumulative 2 million HIV infections by the end of 2000. The AIDS Control Programme established in 1987 in the Ministry of Health mounted a national response that expanded over time to reach other relevant sectors under the coordinating role of the Uganda AIDS Commission. The national response was to bring in new policies, expanded partnerships, increased institutional capacity for care and research, public health education for behaviour change, strengthened sexually transmitted disease (STD) management, improved blood transfusion services, care and support services for persons with HIV/AIDS, and a surveillance system to monitor the epidemic. After a decade of fighting on these fronts, Uganda became, in October 1996, the first African nation to report declining trends in HIV infection. Further decline in prevalence has since been noted. The Medical Research Council (UK) and the Uganda Virus Research Institute have demonstrated declining HIV incidence rates in the general population in the Kyamulibwa in Masaka Districts. Repeat knowledge, attitudes, behaviour and practice studies have shown positive changes in the priority prevention indicators. The data suggest that a comprehensive national response supported by strong political commitment may be responsible for the observed decline. Other countries in sub-Saharan Africa can achieve similar results by these means. Since success is possible, anything less is unacceptable.     

Projections of the number of persons diagnosed with AIDS and the number of immunosuppressed HIV-infected persons--United States, 1992-1994.

This report presents projections of the number of persons who will initially be diagnosed with a condition included in the 1987 surveillance definition for acquired immunodeficiency syndrome (AIDS) in the United States during the period 1992-1994. The report also presents estimates and projections of the prevalence of persons infected with the human immunodeficiency virus (HIV) who have CD4+ T-lymphocyte (T-cell) counts < 200/microL and who have not been diagnosed with a condition listed in the 1987 AIDS surveillance definition. These estimates and projections are used to predict the effect of expanding the AIDS surveillance definition to include all HIV-infected persons with a CD4+ T-cell count < 200/microL. Approximately 58,000 persons were diagnosed with AIDS in the United States during 1991. During the period 1992-1994, the number of persons newly diagnosed with AIDS is expected to increase by at most a few percent annually, with approximately 60,000-70,000 persons diagnosed per year. Although AIDS diagnoses among homosexual and bisexual men and among injecting drug users are projected to reach a plateau during this period, the number of AIDS diagnoses among persons whose HIV infection is attributed to heterosexual transmission of HIV is likely to continue to increase through 1994. The number of living persons who have been diagnosed with AIDS is expected to increase from approximately 90,000 in January 1992 to approximately 120,000 in January 1995. There is, however, considerable uncertainty in these projections. For example, the plausible range for the number of persons initially diagnosed with AIDS in 1994 is 43,000-93,000. CDC estimates that, as of January 1992, 115,000-170,000 U.S. residents had severe immunosuppression (a CD4+ T-cell count < 200 cells/microL without a diagnosis of AIDS in an HIV-infected person). Only about 50,000 of these persons were receiving medical care for HIV-related conditions and were known to have a CD4+ T-cell count < 200 cells/microL. The number of persons with severe immunosuppression is expected to increase to 130,000-205,000 by January 1995, with the actual number more likely to be in the lower half of this range than the upper half. The expanded AIDS surveillance definition, which includes severe immunosuppression, is predicted to result in an increase of approximately 75% in the number of persons reported during 1993, but an increase of < 20% in 1994 compared with the number of persons who would have been reported had the definition not been changed.(ABSTRACT TRUNCATED AT 400 WORDS)     

Estimating the size of the HIV epidemic among injecting drug users in Amsterdam

Aim of this study was to assess the cumulative incidence of HIV-infection, AIDS and pre-AIDS death in the population of injecting drug users (IDU) in Amsterdam. By assuming equivalence, between a cohort of IDU and the IDU population, of the ratios of incidences of AIDS and pre-AIDS death to the number of HIV positive persons giving rise to these incidences, the numbers of HIV positive persons and pre-AIDS deaths in the population could be calculated, given that other parameters were known. Cohort study data on HIV prevalence and incidences of HIV infection, AIDS, and pre-AIDS death, were combined with national AIDS surveillance data. As of 1 October 1994, the estimated cumulative number of HIV positive IDU in Amsterdam was approximately 1280, far higher than a recent back-calculation estimate. Of the 1280, 204 HIV positive IDU had been diagnosed with AIDS, while about 270 had died pre- AIDS. The HIV prevalence of IDU residing in Amsterdam that were still alive and free of AIDS was hence estimated at around 800. Since the incidence of pre-AIDS death and AIDS exceeded the number of seroconversions during the past four years, the HIV epidemic among IDU in Amsterdam appears to be dwindling. A lower bound of the number of HIV positive IDU being alive, AIDS-free and living elsewhere in the Netherlands was roughly estimated at 600. Because of untimely deaths, only a limited number of HIV positive IDU can be expected to be diagnosed with AIDS in the future. Since these estimates are based upon some rather bold assumptions, they should be interpreted with caution and require further validation by independent sources.     

Minnesota's Midwest AIDS Training and Education Center: helping health care providers remain current on a rapidly changing epidemic

Since 1990, the number of people in Minnesota living with HIV/AIDS has been steadily increasing. The demographics of who is infected with HIV have changed, with more women and people of color being diagnosed. In addition, with new therapies and continually updated treatment recommendations, the information needed to provide quality medical care to HIV-infected patients is constantly evolving. Thus, providers who care for patients with HIV/AIDS need ongoing education about the disease. The Midwest AIDS Training and Education Center (MATEC) is a federally funded program that helps health care providers stay abreast of HIV clinical care and management knowledge. Based at the University of Illinois at Chicago, MATEC provides services in seven states, including Minnesota. This article describes how MATEC's HIV/AIDS training and education programs are being implemented in Minnesota and the different ways MATEC is delivering provider education in this important area.     

Current estimates of HIV prevalence and incidence: sources and data.

The acquired immune deficiency syndrome (AIDS) is in reality only the most severe manifestation of an aggregate of overlying and interacting smaller epidemics. Distribution of these epidemics in the population remains extremely variegated and localized, making assessment of HIV prevalence and incidence extremely difficult. Data from a wide range of population surveys does give an indication of the number of persons infected. A working estimate, based on mathematical modeling and expert consensus, is that 1-1.5 million persons in the United States are currently infected.     

HIV/AIDS and economic growth: Evidence from West Africa

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is one of the leading causes of morbidity and mortality in West Africa. Prevalence among the most productive age group in West and Central Africa stood at 1.5%, 3.4.0%, 2.5%, and 2.1% in 1990, 2000, 2010, and 2015 respectively. This study examined the effect of HIV/AIDS on economic growth in West Africa with focus on 11 countries. The augmented Solow model, rooted in the neoclassical growth theory, was used, which was operationalized using dynamic panel data modeling approach. Incidence, prevalence, number of people living with HIV/AIDS (PLWHA), and AIDS‐related deaths were used to measure HIV/AIDS. Estimations using system GMM returned statistically significant results while those of first difference and difference GMM were not. From the outcome of system GMM analysis, a percentage increase in incidence, prevalence, PLWHA, and AIDS deaths correspondingly reduced growth significantly through their effects on life expectancy by 0.15%, 0.02%, 0.004%, and 0.03%. Acquired immune deficiency syndrome deaths and PLWHA lowered economic growth through enrolment but not significantly. The import of the findings is that HIV/AIDS threatens growth through life expectancy in West Africa. Therefore, its spread in the subregion should be effectively contained while proper treatment should be provided for all infected persons.     

Global surveillance and forecasting of AIDS

The short-term forecasting of future AIDS cases has been attempted by statistical extrapolations of the observed curve of reported AIDS cases. In areas where such reporting is very incomplete or has only recently started, extrapolation is not possible and an epidemiologically-based forecasting model has been developed to estimate the annual number of AIDS cases which may have occurred and to project the annual number and distribution of AIDS cases for up to ten years. This model, which relies on the current understanding of the epidemiology and natural history of HIV infections and on the available HIV serologic survey data, is used to provide estimates and short-term projections of AIDS cases for the USA, Europe, Africa and the world. Because of the very long (mean of 8-9 years) incubation period between HIV infection and the development of AIDS, new cases over the next five years will be mostly derived from persons who became infected with HIV in or before 1987. WHO has estimated that 5-10 million persons worldwide were infected with HIV in 1987. Based on the lower estimate of 5 million, the cumulative number of AIDS cases which can be projected for the end of 1991 is over one million, and for the mid-to-late 1990s could reach 2 to 3 million. HIV/AIDS will therefore be an increasing public health problem throughout the world. Health care systems everywhere will have to be strengthened to respond to this large toll of disease and death due to AIDS.     

The cost of inaction on HIV transmission among injection drug users and the potential for effective interventions

Estimated and potential medical costs of treating patients infected with human immunodeficiency virus (HIV) in urban areas of high HIV prevalence have not been well defined. We estimated the total medical cost of HIV disease among injection drug users in Vancouver, British Columbia, Canada, assuming stable and increasing HIV prevalence. Total medical costs were estimated by multiplying the average lifetime medical cost per person by the number of HIV-infected individuals. We assumed the cost of each HIV infection to be $150,000 (Canadian), based on empirical data, and HIV prevalence estimates were derived from the Vancouver Injection Drug Users Study (VIDUS) and external data sources. By use of Monte Carlo simulation methodology, we performed sensitivity analyses to estimate total medical cost, assuming the HIV prevalence remained stable at 31% and under a scenario in which the prevalence rose to 50%. Expected medical expenditures based on current HIV prevalence levels were estimated as $215,852,613. If prevalence rises to 50% as reported in other urban centers, the median estimated medical cost would be approximately $348,935,865. This represents a difference in the total costs between the two scenarios of $133,083,253. Health planners should consider that predicted medical expenditures related to the HIV epidemic among injection drug users in our setting may cost an estimated $215,852,613. If funding cannot be found for appropriate prevention interventions and the prevalence rises to 50%, a further $133,083,253 may be required.