Evaluation of Determine HIV-1/2 rapid diagnostic test by 4th generation ELISA using blood donors' serum at Felege Hiwot Referral Hospital, northwest Ethiopia

OBJECTIVE: The study aims to evaluate the HIV-1/2 rapid diagnostic test kit is routinely used to screen HIV infection for safe blood transfusion and VCT services in many parts of Ethiopia. METHODS: A total of 324 sera were collected from consecutive blood donors from February to May 2006. All samples were screened for HIV infection using Determine HIV-1/2 (Abbott Japan) at hospital blood bank laboratory. Blindly, all serums were retested at Regional Health Research Laboratory using 4th generation ELISA (Vironostika HIV Uni-Form II AG/Ab) and Determine HIV-1/2 (Abbott lab). Discordant samples were repeatedly retested using the same ELISA and Determine HIV-1/2 to avoid technical errors. Finally, discordant results were resolved using Western Blot at the National HIV/AIDS Laboratory. RESULTS: Determine HIV-1/2 and ELISA showed 94.4% concordance in HIV antibody testing with fair Cohen's Kappa statistic value (0.68) among blood donors. The sensitivity, specificity, positive and negative predictive values of Determine HIV-1/2 were 60.5%, 98.9%, 88.5% and 94.9% respectively. CONCLUSION: As a rapid HIV screening test for blood donors, Determine HIV-1/2 showed poor sensitivity. Further evaluation at multiple centres is recommended to test its validity as a routine HIV screening test in blood donors. Use of a combination of rapid assays is also recommended for screening of HIV infection among the donor population.     

Evaluation of rapid HIV test kits on whole blood and development of rapid testing algorithm for voluntary testing and counseling centers in Ethiopia

Five simple and rapid HIV antibody detection assays viz. Determine, Capillus, Oraquick, Unigold and Hemastrip were evaluated to examine their performance and to develop an alternative rapid test based testing algorithm for voluntary counseling and testing (VCT) in Ethiopia. All the kits were tested on whole blood, plasma and serum. The evaluation had three phases: Primary lab review, piloting at point of service and implementation. This report includes the results of the first two phases. A total of 2,693 specimens (both whole blood and plasma) were included in the evaluation. Results were compared to double Enzyme Linked Immuno-Sorbent Assay (ELISA) system. Discordant EIA results were resolved using Western Blot. The assays had very good sensitivities and specificities, 99-100%, at the two different phases of the evaluation. A 98-100% result agreement was obtained from those tested at VCT centers and National Referral Laboratory for AIDS (NRLA), in the quality control phase of the evaluation. A testing strategy yielding 100% [95% CI; 98.9-100.0] sensitivity was achieved by the sequential use of the three rapid test kits. Direct cost comparison showed serial testing algorithm reduces the cost of testing by over 30% compared to parallel testing in the current situation. Determine, Capillus/Oraquick (presence/absence of frefrigeration) and Unigold were recommended as screening, confirmation and tiebreaker tests, respectively.     

Assessment of the implementation of HIV-rapid test kits at different levels of health institutions in Ethiopia

OBJECTIVE: Evaluation and monitoring of Human Immunodeficiency Virus (HIV) testing reagents at the point of service is helpful to prevent the occurrence of problems related to testing and interpretation. To evaluate the implementation of HIV rapid test kits at the point of services in voluntarily counseling and testing (VCT) and diagnostic centers in Ethiopia. METHODS: The assessment was the third phase of evaluation of HIV rapid test kits in Ethiopia followed from phase-I and phase-II. Known proficiency testing panels, well-structured questionnaire (addressing type of tests, human resource and problems related to tests), onsite supervision and retesting of samples collected from sites were used to evaluate the performances of reagents and laboratories. RESULTS: Forty-four health institutions were included. Thirty-six (90.0%) health institutions had trained human resource on HIV testing. In 27 (61.4%) three types of HIV rapid test kits (Determine, Capillus and Unigold) were available. Serial-algorithm was used in all the laboratories. In 31 (70.4%) of them external quality control specimens were not used. Twenty two (50.0%) of the laboratories reported frequent shortage of reagents. All (100%) were able to identify negative specimens distributed. Positive proficiency panel samples were identified in 37 (94.8%) of the 39 laboratories. There was 98.3% agreement at a screening level between the sites and the central laboratory. Rate of discrepancy between screening and confirmatory assays was found to be 3.0% and 2.1% at the sites and at central laboratory, respectively. CONCLUSION: The test kits showed a good performance at the point of services in the field sites. However, continuous assessment of HIV test kits at the point of service and training of professionals on newly arrived techniques are recommended to have effective testing performance with acceptable sensitive and specific testing algorithm. Effective quality assurance program should be in place to support programs such as VCT, prevention of mother-to-child-transmission and antiretroviral therapy.     

Diagnostic detection of human immunodeficincy virus type-1 antibodies in urine, Jimma Hospital, south west Ethiopa

BACKGROUND: Testing for human immunodeficiency virus (HIV) specific antibodies continues to be the most important measure in diagnosis and HIV intervention. Detection of anti-HIV antibodies in serum or plasma samples are common strategies. However, body fluids such as urine and saliva could serve as an alternative sample for diagnosis of HIV infection. OBJECTIVE: To determine the diagnostic accuracy of Calypte HIV-1 urine EIA test kits for detection of HIV antibodies in urine sample. METHODS: Urine and serum samples were collected from a total of 365 subjects (HIV suspected (n=156), VCT clients (n=129) and 80 known HIV positive individuals at Jimma Hospital VCT center, OSSA, Red Cross and Mekaneyessus Jimma cohort sites in unlinked anonymous testing method. Urine sample were tested using Calypte HIV-1 urine EIA kits parallel to the golden standard method of testing serum samples by combination of Determine and Vironostica (Rapid test followed by ELISA) test algorithm. All discordant samples (by urine serum tests) were resolved using urine western blot (Calypte HIV-1 urine Western Blot). RESULT: Comparing the results obtained with a golden standard (HIV test algorithm) the sensitivity and specificity of urine EIA test kit were 99.5% (187/188) and 98.3% (174/177) respectively. Beside to this kappa's test of agreement showed perfect agreement with kappa 0.98. CONCLUSION: The result showed the utility of urine test as an alternative method for HIV antibody detection. Since the method of collection of urine specimen is non-invasive, it reduces occupational exposure for health professionals involved in collecting samples. Furthermore patient's stronger acceptance to give urine samples will make this test more applicable than serum or whole blood test.     

Validation of a simple and cheap gelatin particle agglutination test for human immunodeficiency virus using dried blood spot samples

OBJECTIVES: To validate a Gelatin Particle Agglutination (GPA) test for HIV using dried blood spots with a view to applying the test in large epidemiological studies. DESIGN: A method comparison study with standard enzyme linked immunosorbent assay (ELISA) using the Recombigen HIV-1/2 kit as the gold standard. SETTING: Blair Research Laboratory, Harare, Zimbabwe. SUBJECTS: Sera and dried blood spots samples were available from 379 women from Mbare, Harare and Mupfure, Shamva District, Zimbabwe who had participated in HIV studies conducted by Blair Research Laboratory. MAIN OUTCOME MEASURES: Results of the GPA and Recombigen HIV-1/2 ELISA using serum and dried blood spots. RESULTS: With the Recombigen HIV-1/2 ELISA as the gold standard, sensitivity and specificity of the GPA were 100% and 99.2% respectively using serum. With dried blood spots sensitivity and specificity of the GPA test were 100%. The cost of analysing one sample, based on cost of reagents and accessory materials only, was Z$300 for GPA compared to Z$1,200 for ELISA. Furthermore, hands-on time was significantly reduced with the GPA compared to ELISA. CONCLUSION: The GPA method is simple, less labour intensive and much cheaper, yet is equally sensitive when compared to standard ELISA. The high sensitivity with blood spots makes the test ideal for large-scale epidemiological studies in remote rural areas with no infrastructure for advanced diagnostic methods.     

结核菌、艾滋病病毒双重感染的预防管理探讨

目的了解结核菌、艾滋病病毒双重感染患者的情况,探讨有利于双重感染预防的管理模式为建立TB/HIV双重感染患者的监测系统,制定治疗和管理机制提供依据。方法在同一单位整合AIDS/TB医疗负责小组,负责患者的诊断治疗管理工作,对结核患者进行AIDS咨询及人类免疫缺陷病毒(HIV)抗体检测,具体为结核患者抽取静脉血4mL,进行艾滋病病毒抗体检测,如两次酶联免疫吸附试验(ELISA)检测阳性,再做蛋白印迹试验(WB)确认,WB阳性者确认为艾滋病病毒阳性。另一方面对有咳嗽、咳痰、发热的AIDS患者筛查TB,检测上述化验的准确性。根据户籍、年龄、性别等因素统计分析TB/HIV双重感染者的分布特征。结果临湘市疾病预防控制中心提供300例结核患者中检出HIV阳性5例,双重感染为1.67%,男女无显著性差异(P>0.05),市区与农村也没有统计学意义(P>0.05)。结论同一单位小组管理模式有利于提高检测率和及时确诊,减少患者丢失、中断治疗、提高治愈率、降低病死率,对隔离治疗有益,值得进一步推广。     

HIV-1 seroprevalence and subtypes in police recruits from Afar regional state,Ethiopia

Surveillance for HIV-1 prevalence and subtypes in Afar Region, Ethiopia was performed among police recruits in the year 2000, by unlinked anonymous testing. Of 408 samples tested, 26 (6.4%) appeared positive for HIV-1 antibodies. There was a trend for higher HIV-1 seroprevalence in women (9.5%, 9/95) than men (5.4%, 17/313), which was significant in one of the 5 administrative areas: Zone 4 (p = 0.01). Around the principal transportation route connecting Addis Ababa to the harbor of Djibouti there was a significantly (p = 0.03) higher HIV-1 seroprevalence of 12.7% (14/110) than elsewhere in Afar Region. In addition, 13 (34%) of the 29 administrative sub-areas (woredas) of Afar Region delivered HIV-1 positive police recruits. Prevalence of syphilis antibodies was 7.4% (30/408), increasing by age, correlating with HIV-1 positive serology (p = 0.001) and with 23.3% (7/30) active cases. Of 22 specimens sequenced, 12 had gp120 V3 regions from Ethiopian subtype C, 9 subtype C' and 1 subtype A. In conclusion, even in very remote areas in Ethiopia, such as Afar Region, the HIV-1 epidemic is established, being primarily of subtype C. Regular HIV-1 surveillances will be necessary to guide action to prevent further spread in this vulnerable area.     

贵州省HIV-1毒株亚型分布研究

目的揭示贵州省HIV-1亚型毒株分布特点。方法用套式PCR扩增HIV-1毒株外膜蛋白并基因测序分析。结果62例样本扩增测序成功52例,其中B亚型3例,B’亚型4例,C亚型2例,E亚型2例,BC重组亚型41例。结论贵州省HIV-1病毒以BC重组亚型流行为主,多亚型并存;提示亚型分布复杂,来源广泛,防治难度大。     

单人份核酸检测在降低输血感染人类免疫缺陷病毒残余风险中的应用

目的 分析单人份核酸检测技术(individual donor-nucleic acid amplification test,ID-NAT)对窗口期人类免疫缺陷病毒(HIV)阳性标本的检出能力,探讨ID-NAT对降低输血感染HIV残余风险的作用.方法 采用Procleix Tigris单人份核酸检测系统和两种不同厂家的ELISA试剂对采集的血液标本进行平行检测,对ELISA检测阴性ID-NAT检测阳性标本进行HIV鉴别试验,并对HIV鉴别阳性的献血者进行追踪检测.结果 采集血液标本196900份,检出ELISA阴性ID-NAT联检阳性标本256例,HIV鉴别实验阳性标本2例.第1例HIV阳性献血者献血后29 d免疫印迹确证试验为HIV-1抗体阳性,且HIV(1+2)抗体及HIV-1 P24抗原ELISA双试剂检测均呈阳性反应.第2例HIV阳性献血者,献血后第0、4、7 d血液标本病毒载量呈上升趋势,第4天仅单试剂ELISA检测呈阳性反应,第7天和第14天时,双试剂ELISA检测已均呈阳性反应,且第30天确证试验为HIV-1抗体阳性.结论 ID-NAT应用于血液筛查可缩短HIV检测窗口期,降低输血感染HIV残余风险,从而有效提高血液安全性.     

Comparative evaluation and assessment of the diagnostic usefulness of four commercial HIV-1/HIV-2 antibody assays using two well-characterized serum panels from Blood Transfusion Service and the National Health Laboratory Services in Zimbabwe

OBJECTIVE: To evaluate four Enzyme Linked Immunosorbent Assay (ELISA) HIV kits for possible use as a combination at the National Health Laboratory Services (NHLS) in Zimbabwe. DESIGN: Laboratory evaluation, sensitivity, specificity and cost effectiveness of HIV diagnostic kits. SETTING: Blood Transfusion Service (BTS) and Parirenyatwa Hospital in Zimbabwe. SUBJECTS: A total of 346 samples from 245 patients referred to Parirenyatwa Hospital and 101 blood donors at BTS. MAIN OUTCOME: The main goal was to come out with the best combination of ELISA kits in terms of sensitivity, specificity and cost effectiveness for use in diagnosis of HIV infection in Zimbabwe. RESULTS: The best combination kit was the Murex/Innotest with 100% sensitivity and 98.9% specificity, being slightly superior to the Genelavia/Vironostika combination kits in current use at NHLS. In addition, the Murex/Innotest combination has the shortest assay running time and requires fewer internal controls thereby increasing the number of test specimens per run. CONCLUSION: We recommend the use of the Murex/Innotest kits as a suitable combination for HIV infection diagnosis in Zimbabwe. The combination has a relatively low number of discordant results, drastically reducing the cost of running a third confirmatory test to resolve the discordant results. Most importantly, this combination maximizes HIV infection diagnosis by its ability to detect antibodies to HIV-1 groups M and O as well as HIV-2.     

全自动酶免分析仪检测HIV抗体待复检标本确证结果分析

目的对ADCC ELISA 500全自动酶免分析仪检测HIV抗体待复检标本的确证结果进行分析,以探讨试验"灰区"样本的正确处理,从而避免漏报、误报不良医疗事件的发生。方法选择某综合医院2018年12月~2019年6月送检血清标本,采用ADCC ELISA 500全自动酶免分析仪进行HIV抗体初筛,对检测待复检标本送到确证实验室经蛋白印迹试验(WB)确证,并对其结果统计分析。结果共初筛出64份待复检样本,其中50份初筛有反应样本经WB确认均为阳性(100.0%),14份"灰区"样本经确认有6份为不确定,8份为阴性。50份确证阳性样本中,GP160条带出现频率最高(100.0%),P55出现频率最低(48.0%);6份不确定样本中,GP160条带出现频率为100.0%。结论全自动酶免分析仪检测HIV抗体标本S/CO值在"灰区"附近时,S/CO值大小不能有效判断结果,要及时送检确证实验室进行WB确证。     

An update on the diagnosis and treatment of HIV, 1998

Major recent advances in HIV diagnosis include rapid screening serological tests that yield results on the same day of testing, new serological tests that detect infection with a wide variety of different HIV infections including HIV-1 group O and HIV-2, qualitative gene amplification tests (e.g.) that help confirm infection in persons with indeterminate serology, and quantitative gene amplification tests that detect low levels of plasma viremia (>50 virions/ml) and provide prognostic data essential for patient management. Major advances in treatment include the development of drug combinations that completely block HIV replication in a large proportion of adherent previously untreated HIV-infected persons, the demonstration that antiretroviral treatment, under some circumstances, prevents transmission - during pregnancy and following occupational exposure, and the development of sophisticated assays for assessing the drug susceptibility of clinical HIV isolates. Ongoing clinical trials will help clinicians choose the optimal treatment for both previously treated and untreated patients.     

The use of enzyme-linked immunosorbent assay for the quantitation of Calloselasma rhodostoma (Malayan pit viper) venom and venom antibodies.

The specificity and sensitivity of an indirect and two (an ‘ordinary’ and a ‘rapid’) double sandwich enzyme-linked immunosorbent assay (ELISA) procedures for the quantitation of Calloselasma rhodostoma (Malayan pit viper) venom were examined. The three assays were equally sensitive and the accuracy of the assays was not substantially affected by individual variation in the venom composition. The specificity of the assays was examined against 26 venoms from snakes of the families Viperidae and Elapidae. While the double sandwich ELISA procedures were sufficiently specific to be used in the clinical immunodiagnosis of C. rhodostoma bite in Malaysia, the indirect ELISA procedure exhibited extensive cross-reactivity with other Malaysian pit viper venoms. Attempts were made to improve the specificity of the indirect ELISA procedure for the quantitation of C. rhodostoma venom. A ‘low ELISA cross-reactivity’ venom fraction (termed VF52) was isolated from C. rhodostoma venom by repeated Sephadex G-100 gel filtration chromatography. The indirect ELISA procedure using antibodies to VF52 as immunoreagent showed an improvement in specificity. The use of the indirect ELISA procedure for the detection of C. rhodostoma antibodies was also examined and the results show that the assay was sufficiently specific to be used for retrospective diagnosis of C. rhodostoma bite in Malaysia, in particular when VF52 was used as the coating antigen.     

HIV/AIDS and injection drug use in the neighborhoods of Dar es Salaam, Tanzania

This study examines the intersection between needle-sharing practices and HIV recovered from used syringes collected from 73 heroin injection drug users (IDUs) in Dar es Salaam, Tanzania, between October 2003 and January 2004. To extract blood residue, syringes were flushed and 10 microliters of solution mixed with 120 microliters of a latex solution was placed on a Capillus HIV-1/2 slide. Thirty-five (57%) of the useable syringes tested positive for HIV antibodies. Results varied significantly: 90% of syringes tested HIV positive in a mixed-income neighborhood 2 kilometers from the city center: 0% of syringes tested HIV positive in the outlying areas. In addition, semistructured interviews were conducted with 51 IDUs. The interviews were content coded, and codes were collapsed into emergent themes regarding syringe-use practices. Injecting is a recent practice, particularly among heroin users in neighborhoods far from the city center. Sharing syringes has resulted in a high proportion of used syringes containing HIV-positive blood residue. Geographic distance is an indicator of recent adoption of IDU in neighborhoods and correlates strongly with the distribution of syringes containing HIV-positive blood residue.     

尿液与血液标本中HIV-1抗体的检测结果分析

目的 比较应用ELISA法检测尿液和血液标本中HIV-1抗体结果的一致性.方法 对15244例被检测尿液和血液HIV-1抗体者进行回顾性分析,应用ELISA方法分别采用尿和血初筛试剂检测尿液和血液标本中HIV-1抗体.结果 15244例被检测的样本中,26份样本尿和血标本检测结果同时为阳性,以血液标本为标准,检测尿液HIV-1抗体的灵敏度为100%,特异性为99.33%,尿液标本和血液标本检测的符合率达99.25%.结论 可通过尿液ELISA初筛诊断试剂进行HIV-1感染情况的监测和筛查.     

Potent anti-HIV (type 1 and type 2) activity of polyoxometalates: structure-activity relationship and mechanism of action

A series of polyoxometalates have been synthesized and evaluated for their inhibitory effects on HIV-1(III(B)) and HIV-1(ROD) replication in MT-4 cells. All compounds showed activity against HIV-1 and HIV-2, but the antiviral potency of the heteropolytungstates varied considerably depending on their chemical structure. The antiviral activity of single, double, and triple Keggin-type of compounds against HIV-1(III(B)) replication was comparable (IC(50): 0.4-0.5 microgram/mL), whereas HIV-2(ROD) appeared to become less sensitive with the increasing number of Keggin structures per compound. The same trend was observed for single and double Dawson structures. Some of these compounds were examined for their inhibitory effect on the replication of HIV-1(RF) and SIV(MAC(251)) in MT-4 cells. Their anti-HIV-1(RF) and anti-SIV(MAC(251)) potencies were comparable to those for the HIV-1(III(B)) or HIV-2(ROD) strain, respectively. The polyoxometalates represent a class of polyanionic compounds, which block the binding of the envelope glycoprotein gp120 of HIV to CD4(+) cells. The compounds interfered with the binding of anti-CD4 mAb to the OKT4A/Leu3a epitope of the CD4 receptor, compound 24 being the most active in this regard, and inhibited the binding of anti-gp120 mAb to infected MT-4 cells. None of the polyoxometalates inhibited the binding of a specific CXCR4 mAb to SUP-T1 cells, suggesting that they do not interact with CXCR4, the main co-receptor for T-tropic HIV strains, and thus act as virus binding, and not as fusion, inhibitors.     

蛋白免疫印迹法（WB）试验结果与HIV感染关系的分析

目的通过对蛋白免疫印迹法（WB）试验结果的观察,确定个体是否感染HIV以及HIV感染的状况。方法对60份抗-HIV初筛阳性血清使用蛋白免疫印迹法（WB）进行确认实验。结果在被检测样品中,HIV-1型确认试验阳性54例,占90%;HIV-1型确认试验阳性,且提示HIV-2阳性感染1例,占1.6%;HIV-1型确认试验弱阳性（不确定）3例,占5%;HIV-1型确认试验阳性2例,占3.3%。结论蛋白免疫印迹法（WB）试验确定个体有无HIV感染以及HIV感染情况提供依据。     

Antiretroviral adherence and HIV treatment outcomes among HIV/HCV co-infected injection drug users: the role of methadone maintenance therapy

OBJECTIVE: We examined the association of methadone maintenance therapy (MMT) with highly active antiretroviral therapy (HAART) adherence and HIV treatment outcomes among a cohort of HIV/HCV co-infected injection drug users (IDUs). METHODS: We obtained demographic, drug use, and addiction care history from the Vancouver Injection Drug User Study (VIDUS), which is an open cohort study of IDUs. The questionnaires were longitudinally linked to the British Columbia HIV/AIDS Drug Treatment Program to obtain HAART adherence and HIV treatment outcome data. There were 278 VIDUS participants who accessed HAART from August 1, 1996 to November 24, 2003. We constructed longitudinal logistic models using generalized estimating equations to examine the independent associations between methadone maintenance therapy and the following outcomes: HAART adherence; plasma HIV-1 RNA suppression; and CD4 cell rise of 100cells/mm(3). RESULTS: Among participants who reported at least weekly heroin use, MMT was independently associated with lower odds of subsequent weekly heroin use during the follow-up period (adjusted odds ratio; 95% confidence interval [AOR; 95% CI]: 0.24; 0.14-0.40). We also found that MMT was positively associated with adherence (AOR 1.52; 95% CI 1.16-2.00), HIV-1 RNA suppression (AOR 1.34; 95% CI 1.00-1.79), and CD4 cell count rise (AOR 1.58; 95% CI 1.26-1.99). CONCLUSIONS: Among HIV/HCV co-infected IDUs on HAART, enrollment in MMT was associated with reduced heroin use, and improved adherence, HIV-1 RNA suppression and CD4 cell count response. Integrating opiate addiction care and HIV care may provide improved health outcomes for this vulnerable population and should be further explored.     

河北省2008年HIV-1感染者分子流行病学研究

目的利用分子生物学方法,了解2008年河北省新发现的感染者艾滋病病毒1型（HIV-1）毒株基因亚型的分布和变异情况。方法采集2008年河北省检测新发现的HIV-1感染者血样,提取血浆病毒RNA,使用套式聚合酶链反应对gag基因区和env基因区进行扩增并测定其序列。结果采集血样64份,扩增后获得序列共56份,共存在5种亚型。河北省HIV-1流行株主要为B亚型毒株,占43.1%（25/64）;其次是CRF01-AE和CRF07-BC亚型毒株,各占25.9%（15/64）。结论河北省发现了5种HIV-1亚型毒株,B亚型毒株是主要的流行株,CRF01-AE亚型毒株所占比例较以往（2007年）有所下降。CRF-BC亚型毒株所占比例明显上升。可见,随着HIV-1流行时间的推移和传播途径的多样化,HIV-1流行的亚型比例也在发生变化。     

街头暗娼危险行为监测和HIV HCV HbsAg梅毒检测结果分析

目的分析本市女性性服务人群艾滋病病毒(HIV)、梅毒螺旋体(TP)、丙型肝炎病毒(HCV)、乙型肝炎病毒(HBV)感染情况。为我市疾病预防和控制提供依据。方法对性服务者填写调查问卷、采集血液标本,用酶联免疫吸附试验(ELISA)、蛋白印迹试验(WB)检测、确证HIV感染;用快速血浆凝集试验(RPR)明胶颗粒凝集试验(TPPA)检测梅毒感染;用ELISA检测丙肝和乙肝。结果最近一次与客人使用安全套的占55.69,与客人每次都用安全套的占12.66%。475例性服务人员中检出HIV抗体阳性1例(0.21%),梅毒阳性4例(0.84%),HbsAg阳性38例(11.95%),HCV阳性26例(5.42%)。结论应加大对该类人群的宣传和干预力度,充分利用各种机构促进SSWs人群的健康,从而遏制AIDS/STDR流行。