HIV Prevention in the Armed Forces: Perceptions and Attitudes of Regimental Officers

Background

Involvement of commanders and regimental officers is believed essential for a successful human immunodeficiency virus (HIV) infection prevention programme in the armed forces.

Methods

A structured questionnaire was sent to 40 different Information, Education and Communication (IEC) nodes to elicit the perception and attitude of regimental officers/commanders. From each station, 40 regimental officers/commanders were randomly selected and information from 1002 valid and completed questionnaires was analysed.

Results

Less than 50% could correctly assess the burden of HIV/AIDS in the armed forces. Only 41.19% felt HIV/AIDS is a problem serious enough to adversely affect operational efficiency. Majority had communicated with the troops on the subject of HIV/AIDS. The perceived threat of HIV being a problem in own unit was low. Though condom was often advocated, the felt need of condom in the unit was not commensurate with this advocacy. There were statistically significant differences in the perception and attitude among the three services. Only 7.08% of the officers emphasised the need of maintaining confidentiality while dealing with a HIV positive soldier.

Conclusion

Energetic advocacy on HIV prevention including condom promotion involving the regimental officers is indicated. Wider dissemination of surveillance figures generated at AIDS Control Organisation (ACO) is needed for apprising them about the menace of HIV in the armed forces.Key Words: HIV prevention, Condom promotion     

番禺区艾滋病自愿咨询检测现状分析

目的了解番禺区接受艾滋病自愿咨询检测(Voluntary Counseling and Testing,VCT)的人群现状,为更好地开展VCT项目提供科学的依据。方法由接受过专业知识培训的医务人员与求询者进行匿名的访谈式调查。结果2007年11月至2009年4月期间,共咨询574人,从中检出12例阳性。77.9%的求询者因有不安全性行为而前来咨询;仅有36.1%的人每次性接触坚持使用安全套;番禺区艾滋病VCT门诊求询者数量呈上升的趋势,65.0%的人通过大众传媒获得相关信息。结论加大宣传力度,广泛、有效地开展VCT服务工作,是预防和控制艾滋病传播的一种有效的措施。     

多种健康教育方法对武警某部新兵艾滋病知信行的影响

目的通过对武警某部 90 3名新兵艾滋病多种健康教育方法干预效果评价 ,为部队全面开展此项健康教育奠定基础和提供依据。方法整群多阶段抽样选定 4组对象 ,用 4种方法 (板书授课 VCD ;多媒体授课 VCD 资料 ;同伴教育 ;同伴教育 VCD 资料 )进行教育。结果干预前后 4种方法知识得分均有显著提高 (P <0 .0 1) ,除第 3种方法外 ,其余 3种干预前后态度和行为得分也有显著提高(P <0 .0 1)。 4种方法比较 ,以第 2种效果最佳 (P <0 .0 1)。结论在新兵群体采用同伴教育进行艾滋病健康教育效果不理想 ,应采取综合方法。     

Acceptance of Voluntary Counselling, Testing and Treatment for HIV Among Pregnant Women in Kumasi, Ghana

Summary BACKGROUND: Voluntary counselling and testing (VCT) for human immunodeficiency virus (HIV) and treatment of positive pregnant women can reduce mother to child transmission (MTCT) of HIV. OBJECTIVE: This study was conducted to assess acceptance of HIV VCT and antiretroviral therapy (ART) by pregnant women in Kumasi, Ghana, before and after VCT and ART were available. METHODS: Two cross-sectional studies were conducted among women in antenatal clinics. The first, in 2003 among 501 women, before VCT and ART were available in Kumasi. Women who were willing were counselled and tested for HIV. In 2005, after the introduction of VCT and ART by the Ghana Health Service, 675 pregnant women were surveyed regarding HIV/VCT acceptance and uptake. RESULTS: In 2003, 98% of women accepted counselling and 97% accepted testing; 3.3% tested HIV positive. Multivariate analysis showed that women with secondary education were 88% less likely than those with no/primary education to accept testing (OR=0.12, CI=0.03-0.54,p=0.006). Women who had prior HIV testing were 95% less likely to accept testing (OR=0.05, CI=0.01-0.19, p=0.0001). Women who reported two sexual partners in the past year were 6 times as likely to be HIV positive than those reporting one sexual partner (OR=5.76. CI=1.53 - 21.69, p=>0.05). In 2005, 76% of women reported no prior HIV counselling and 78% no testing. CONCLUSIONS: In 2003, there was wide uptake of VCT by prenatal women. However, in 2005 the majority of pregnant women were not accessing the available VCT services.     

Filaria surveys in the Armed Forces: Need for a revisit

BackgroundRoutine annual filarial surveys are conducted amongst various categories of military personnel and their families as per policies in vogue in the Armed Forces. The neglect and inattention faced by this disease needs to be addressed in terms of policy, provisioning and processes while dealing with filariasis in the Armed Forces.MethodsRoutine annual filarial survey was conducted in a garrison during the months of Nov and Dec in 2013 and 2014. Blood slides from 6305 and 10,162 persons were collected in 2013 and 2014 respectively. 546 (60.66%) civilian migratory labourers were also subjected to the filarial survey.ResultsOf the blood slides collected amongst service personnel, 41 were positive for mf in 2013 and 29 in 2014 (i.e. a slide positivity rate (SPR) of 0.65% and 0.28% respectively). Out of 546 blood slides of the migratory population, 10 were found mf positive (SPR 1.83%) and three males had lymphedema.ConclusionIt is recommended that routine annual filarial survey conducted in military garrisons should include all personnel belonging to known endemic states. Newer modalities of detection of infection may be considered to replace night blood surveys. An organization-specific surveillance programme on prevention and control of Lymphatic filariasis in the Armed Forces thus may need to be launched so that we can achieve elimination.     

青海省2011-2012年艾滋病自愿咨询检测（VCT）资料分析

目的了解青海省接受艾滋病自愿咨询检测（HIV V0luntary Counseling＆Testing,VCT）服务人群的信息来源、目标人群类型以及HIV感染状况,为更有针对性的在全省范围内开展VCT工作提供科学依据。方法收集2011-2012年到青海省各VCT点接受VCT服务的人群资料并进行分析。结果2011-2012年到青海省各VCT点接受VCT服务的总人数为39830人,男女性别比为0．62：1,以20-49岁的青壮年为主（占89．66％）;婚姻状态以已婚者为主,占70．29％,未婚次之,占19．43％。文化程度以低学历者为主,其中初中文化占32．67％,小学文化占22．56％;求询者类型以有非婚异性性行为史的求询者为主,占31．45％。39830人接受VCT服务后,39565人接受了HIV抗体初筛检测,接受HIV抗体初筛检测率为99．34％,其中HIV抗体初步筛查阳性113人（经确认实验,结果与初筛结果一致）,阳性率为0．29％。结论要加大对20～49岁年龄段人群艾滋病预防知识的宣传,特别是对外出务工人员的宣传。同时要注意加强对那些可能有过无保护非婚性行为的人群进行艾滋病预防知识的宣传、VCT推广等许多干预工作,尽最大可能扩大HIV抗体检测的覆盖面,使更多的HIV感染者在感染早期就能被发现。     

VCT门诊的设置与需求情况分析

目的了解全省艾滋病自愿咨询检测（VCT）的现状，为进一步规范VCT工作提供依据。方法采用普查的方法，对全省所有VCT门诊的求询者进行问卷调查。结果全省202个VCT门诊共服务69168名求询者，平均每个VCT门诊每年服务342名求询者。除了疾控中心以外，男性求询者主要集中在综合医院，女性求询者主要集中在妇幼机构，14～34岁的求询者主要分布在妇幼机构，35岁以上的求询者主要集中综合医院。性接触和血液接触类型的求询者主要分布在疾控中心，但血液接触类型中的接受输血或血制品者主要集中在综合医院，孕产妇主要分布在妇幼机构。结论全省VCT网络已经基本形成，并在艾滋病防治中发挥了重要作用，应加强综合医院的VCT工作，以提高VCT工作的可及性。     

Repeat HIV Testing and Incident Rates among Individuals Attending Voluntary Counseling and Testing Clinics in Wuxi,China: A Retrospective Study

Objective We aimed to elucidate the rates of repeat HIV testing and incident HIV diagnosis,and baseline CD~(4+) T cell count among individuals attending HIV voluntary counseling and testing(VCT) clinics in Wuxi,China.Methods A repeat HIV testing within 12 months was recorded if individuals had their first test with negative results,during 2013-2014 and retested within 12 months.An incident HIV diagnosis was recorded if individuals had their first test with negative results,during 2013-2015 and had a subsequent positive result at any point by the end of 2015.Data on HIV testing and diagnosis among individuals attending 32 VCT clinics from 2013 to 2015 and HIV diagnosis from other clinical services in Wuxi,China,were retrieved.A multivariate logistic regression model was used to analyze factors associated with repeat HIV testing.Cox regression was used to evaluate factors associated with incident HIV diagnosis.Results From 2013 to 2014,11,504 individuals tested HIV negative at their first recorded test,with 655(5.7%) retesting within 12 months.Higher repeat HIV testing within 12 months was associated with male gender [adjusted odds ratio(a OR) = 1.7,95% confidence interval(CI): 1.4-2.2],risk behaviors [commercial heterosexual behaviors(a OR = 1.4,CI: 1.1-1.6),male-male sexual behaviors(a OR = 3.7,CI: 2.7-4.9)],injection drug use(a OR = 9.9,CI: 6.5-15.1),and having taken HIV tests previously(a OR = 2.0,CI: 1.6-2.4).From 2013 to 2015,1,088 individuals tested negative on HIV test at their visit and at ≥ 2 subsequent tests; of them 30 had incident HIV diagnosis.The overall rate of incident HIV diagnosis among all VCT individuals was 1.6(95% CI: 1.1-2.1) per 100 person-years.Incident HIV diagnosis was associated with male gender [adjusted hazard ratio(a HR) = 8.5,95% CI: 1.9-38.1],attending hospital-based VCT clinics(a HR = 7.8,95% CI: 1.1-58.3),and male-male sexual behavior(a HR = 8.4,95% CI: 1.5-46.7).Individuals diagnosed at VCT clinics had higher CD~(4+) T cell count compared with those diagnosed at other clinical services(median 407 vs.326 copies/mm~3,P = 0.003).Conclusion VCT individuals in Wuxi,China,had a low repeat HIV testing rate and high HIV incidence.VCT-clinic-based interventions aimed at increasing repeat HIV testing are needed to detect more cases at an earlier stage,especially among individuals at high risk for HIV infection such as men who have sex with men.     

Usefulness of enzyme immunoassay (EIA) for screening of anti HIV antibodies in urinary specimens: A comparative analysis

Background

Standard HIV testing is done using serum or plasma. FDA approved ELISA to screen urine for IgG antibodies to HIV-1 in 1996. It is a simple, noninvasive test and is appropriate for developing countries where health care personnel may not be professionally trained or where clean needles for drawing blood may not always be available.

Methods

436 individuals with high-risk behavior and strong clinical suspicion of HIV infection were screened for IgG antibodies to HIV-1 in urine by ELISA. Urine HIV testing was performed by enzyme immunoassay, at the ongoing Voluntary Confidential Counseling and Testing Center (VCCTC) at a large tertiary care microbiology lab. The individuals enrolled for the study had high-risk exposure to the virus and majorities were from a state with a high incidence of HIV infection. In all individuals, both serum and urine were tested for IgG antibodies to HIV-1.

Results

Overall, 135 individuals (30.96%) were HIV-positive, of whom 96 (71%) had never previously tested positive; 87% of those who tested positive received their results, and most were referred for medical care. Sensitivity, specificity and predictive values of HIV-1 urine ELISA test kit were determined. Sensitivity was found to be 89.6%; 95% CI [82.9–94.0], specificity 97.3%; 95% CI [94.6–98.8], positive predictive value 93.8%; 95% CI [87.8–97.1] and negative predictive value 95.4%; 95% CI [92.3–97.4].

Conclusion

Efficiency, sensitivity, and specificity of the urine-based screening for HIV-1 test kits were excellent as compared to the reference test.     

Usefulness of enzyme immunoassay (EIA) for screening of anti HIV antibodies in urinary specimens: A comparative analysis

Background

Standard HIV testing is done using serum or plasma. FDA approved ELISA to screen urine for IgG antibodies to HIV-1 in 1996. It is a simple, noninvasive test and is appropriate for developing countries where health care personnel may not be professionally trained or where clean needles for drawing blood may not always be available.

Methods

436 individuals with high-risk behavior and strong clinical suspicion of HIV infection were screened for IgG antibodies to HIV-1 in urine by ELISA. Urine HIV testing was performed by enzyme immunoassay, at the ongoing Voluntary Confidential Counseling and Testing Center (VCCTC) at a large tertiary care microbiology lab. The individuals enrolled for the study had high-risk exposure to the virus and majorities were from a state with a high incidence of HIV infection. In all individuals, both serum and urine were tested for IgG antibodies to HIV-1.

Results

Overall, 135 individuals (30.96%) were HIV-positive, of whom 96 (71%) had never previously tested positive; 87% of those who tested positive received their results, and most were referred for medical care. Sensitivity, specificity and predictive values of HIV-1 urine ELISA test kit were determined. Sensitivity was found to be 89.6%; 95% CI [82.9–94.0], specificity 97.3%; 95% CI [94.6–98.8], positive predictive value 93.8%; 95% CI [87.8–97.1] and negative predictive value 95.4%; 95% CI [92.3–97.4].

Conclusion

Efficiency, sensitivity, and specificity of the urine-based screening for HIV-1 test kits were excellent as compared to the reference test.     

The patient cohort of the German competence network for HIV/AIDS (KompNet):a profile

Objective

In this paper, we describe the main objectives, the study design and the onset of the patient cohort of the German Competence Network for HIV/AIDS (KompNet). Furthermore, we depict sociodemographic and clinical baseline characteristics and an estimation of the coverage and representativity as to the composition of persons living with HIV/AIDS (PLWHA) in Germany.

Methods

The KompNet cohort is an open, retrospective and prospective, multicenter, disease-specific and nationwide cohort study that started gathering data in June 2004. Semi-annually, follow up visits of the patients are documented, covering clinical and sociodemographic data. At enrolment and three years afterwards, an EDTA-sample is taken; a serum-sample is taken at every follow up visit.

Results

As of 14.9.2008, a total of 15,541 patients were enrolled by 44 documenting sites. In September 2007, the cohort size was reduced to 10 outpatient clinics and fifteen private practitioners, covering a total of 9,410 patients. The documentation of these patients comprises 24,117 years of follow up-time since enrolment (mean: 2.6 years), 62,862 person years inclusive data documented retrospectively on course of HIV-infection and combined antiretroviral therapy (cART, mean: 6.7 years). 1,008 patients (10.7%) were lost to follow up and 175 (1.9%) died since enrolment. 84.9% of patients were men. Main risks of transmission were sex between men (MSM: 62.9%), heterosexual contacts (18.4%), intravenous drug use (IVDU: 7.0%) and origin from a high prevalence country (HPL: 5.2%). Mean age was 45 years.

Conclusion

The KompNet cohort covers about a quarter of all patients being under treatment in Germany. The composition of the cohort represents well the most important risks of transmission in Germany. The cohort contains a high proportion of patients being older than 49 years (28.1%). On basis of its comprehensive database and its biomaterials banks, the KompNet cohort serves as an important instrument to monitor and analyse the effects of combined antiretroviral therapy (cART) in Germany, interdigidating basis, clinical and psychosocial research in view to translational research.     

Cost-effectiveness of a novel strategy of HIV/AIDS care in Armed Forces: A stochastic model with Monte Carlo simulation

BackgroundDespite the initial success of HIV/AIDS policy, an increasing number of patients are failing the first-line antiretroviral therapy (ART) each year and the failure rates are increasing. There is a need for identification of novel strategies to reduce failure rates. The aims of the study are (1) to design a novel strategy to reduce ART failure rates and (2) to create a stochastic model using Monte Carlo (MC) simulation comparing the novel strategy with existing strategy.MethodsA novel strategy based on annual plasma viral load testing and resistance testing for HIV treatment at baseline and at the time of failure was designed. A cohort of 1000 patients each was created for the existing strategy and a novel strategy. Assumptions were included from Indian studies and own data. The two strategies were compared over 20 years of follow-up using stochastic modeling and MC simulation was done for death rates, failure rates, and cost-effectiveness analysis. SimVoi add-in software for MS Excel was used for simulations. Student's t-tests were performed for comparing continuous variables, and the cumulative rates for various outcomes were plotted using Kaplan–Meier analysis.ResultsThe novel strategy resulted in lower mortality over a 20-year period (279.9 + 7.13 deaths vs 130.43 + 6.03 deaths) with incremental cost per life saved at Rs 32,925 per year. Incremental cost-effectiveness ratio cost per quality-adjusted life year was Rs 1.33 lakhs/annum at constant rate of discounting and just under Rs 90,000 per annum using differential discounting.ConclusionArmed Forces are likely to benefit by adopting the novel strategy that is cost-effective with a significant mortality benefit.     

HIV(1+2)抗体/P24抗原联合法与胶体硒法在临床检测HIV中的应用研究

目的比较第4代酶联免疫吸附测定(ELISA)[HIV(1+2)抗体与P24抗原联合检测]和胶体硒法在临床检测HIV中的特点。方法分别用第4代ELISA检测试剂和胶体硒试剂检测HIV抗体,初筛阳性样本送重庆市疾病预防控制中心进行Western blot确证试验。结果第4代ELISA试剂检测、胶体硒检测及Western blot检测HIV的阳性率分别为0.34%、0.29%及0.27%。第4代ELISA的HIV漏检率(1.3%)低于胶体硒法(4.9%),而其检测HIV的假阳性率(0.03%)高于胶体硒试剂(0.01%)。结论第4代ELISA和胶体硒法联合应用可提高HIV检测的准确性。     

柳州市2007—2008年MSM的HIV、HCV、TP感染调查

目的了解柳州市2007～2008年度男男性接触者（MSM）的艾滋病病毒（HIV）、丙型肝炎病毒（HCV）、梅毒螺旋体（TP）感染情况。方法2007年4～7月、2008年4～7月及10～12月,连续三轮累计对柳州市区790名男男性行为者进行调查,采血检测抗-HIV、抗-HCV、梅毒抗体。结果双性恋MSM的HIV、HCV、TP感染率均高于同性恋,差异无统计学意义（P〉0．05）。40岁及以上年龄组的MSM人群HIV、梅毒感染率均大大高于40岁以下各组,不同年龄组间的差异均无统计学意义（P〉0．05）,最近6个月男性性伴数在增加的同时,HIV阳性人数及TP阳性人数也在相应增加,而选择记不清及拒答者的情况更是严重,普遍高于其他组。结论本地区男男性接触者因多性伴、异性性行为、经济原因等因素,导致HIV、HCV、TP感染率较高,应进一步加大在MSM人群中的艾滋病、性病防治知识的健康宣传教育和行为干预,才能进一步遏制其传播。     

Fertility,knowledge, attitude and practice (KAP) study in relation to family planning in a selected population of the Armed Forces

A study was carried out among the civil and military population in Poona, India, to determine their knowledge, attitude, and practices in relation to family planning and the fertility rates of women aged 15-44 in the following catagories: 1) total and age specific marital fertility rate; 2) order of birth of the children born during the previous year; 3) average number of living children per couple; and 4) percentage of currently pregnant women. 251 civilian wives and 230 military wives were interviewed. Both total marital fertility rates and age specific marital fertility rates were high among the Service families, due perhaps to the predominance of young people in the military. Most of the live births occurring in the previous year were of the 1-3 order. Similarly, the average number of children per couple was low, only 1.7, although the number of children in completed families (4.4) was not too much lower than in civilian Poona families (4.8) and in India in general (5.5). Nearly 2/3 considered 3 children the ideal, although the desire for boys was intense and could lead couples to seek more than 3 children. Only 10% favored abortion on demand. More Service than civilian families knew about and practiced family planning, though the number practicing was only 27.8%. The most widely known methods were sterilization, the condom, and the IUD. The image of family planning among the civilian population was of family limitation, whereas some Service personnel regarded it as a means of child spacing. Practice of family planning was highest among Junior Commissioned Officers, the more literate, and those in the 30-34 age group. There was a positive correlation between family planning practice and number of living children. It is recommended that fertility statistics on military personnel be maintained annually. Further, as it was discovered that 20% of the military wives were currently pregnant, the family welfare planning staff and maternal health services and the Military Hospitals have a good opportunity to provide service for both the limitation and spacing of families.     

吸毒严重地区暗娼艾滋病自愿咨询检测现况和需求的定性研究

目的了解四川省西昌市社区暗娼艾滋病自愿咨询检测的现况和需求及其影响因素,为进一步推广艾滋病自愿咨询检测提供依据。方法采取个人深入访谈的定性研究方法,在四川省西昌市抽取54名来自不同娱乐场所的暗娼进行调查。结果当地暗娼艾滋病相关预防知识的知晓率很高,但该人群艾滋病自愿咨询检测知晓率较低,大多数暗娼从未听说过艾滋病自愿咨询检测。年轻暗娼,尤其是彝族暗娼更缺乏对艾滋病自愿咨询检测的了解。只有少数暗娼参加过由当地外展服务提供的艾滋病自愿咨询检测。暗娼有很高的艾滋病自愿咨询检测需求,多数希望艾滋病自愿咨询检测服务能在工作场所进行。结论西昌市暗娼艾滋病自愿咨询检测知晓率很低,急需加强相关知识的普及,在暗娼中推广艾滋病自愿咨询检测服务来控制HIV的传播。