Decliners of provider-initiated HIV testing and counselling: Characteristics of participants who refused HIV testing in a population survey in Zambia

Objective: To assess the prevalence of HIV infection, to highlight HIV-testing refusal rates among participants in a population-based tuberculosis survey and to assess the implication for programme implementation.Methods: This cross-sectional study on the characteristics of participants who refused HIV testing was conducted in a national survey in Zambia. All eligible participants were aged above 15 years and included in the analysis.Results: Out of the 44 791 tuberculosis survey participants, 14 164(31.6%) refused to participate in HIV testing. The unemployed, rural dwellers, married, and those aged 15-24 years were associated with higher refusal rates.Conclusions: Strategies to improve HIV testing acceptance are necessary. Qualitative research is recommended to understand the reasons for testing refusals so that remedial interventions can be implemented.     

HIV testing of hospital patients

This article sets out the issues involved in the development of hospital policy that will allow or require human immunodeficiency virus (HIV) testing of patients in hospital. It considers the shared and competing interests of patients and staff, and the obligations of employers to worker health and safety. It shows that hospitals are in a position to influence the definition of the public interest in this matter.     

Evidence-based guidelines for universal counselling and offering of HIV testing in pregnancy in Canada

OBJECTIVE: To provide Canadian health care workers with evidence-based guidelines for universal counselling about HIV testing and the offering of such testing to all pregnant women. OPTIONS: Universal counselling and offering of HIV testing to all pregnant women versus targeted testing of only pregnant women at high risk for HIV infection. Antiretroviral treatment protocols for HIV-positive mothers and their infants are discussed as the intervention to reduce mother-to-child transmission rates. OUTCOMES: Main outcomes are mother-to-child HIV transmission rates and consequences of HIV testing on the mother and infant. EVIDENCE: Articles published from January 1985 to March 1997 identified through a MEDLINE search; articles published in pertinent medical journals in 1996 and 1997 identified through a manual search; and abstracts presented at international HIV/AIDS conferences. BENEFITS, HARMS AND COSTS: Early diagnosis of HIV infection in a pregnant woman optimizes her medical and psychosocial care, decreases the incidence of mother-to-child transmission and decreases the risk of horizontal transmission to sexual partners. New, third-generation HIV tests have reduced false-positive rates and thus diminished the harm of screening. RECOMMENDATIONS: A screening strategy consisting of universal counselling and offering of HIV testing is recommended for all pregnant women in Canada (grade B recommendation). Targeted testing of only pregnant women at high risk for HIV infection fails to identify a substantial proportion of HIV-positive pregnant women and is therefore not recommended (grade D recommendation). Women who identify themselves as being at high risk and whose initial HIV test result is negative should be counselled about the reduction of high-risk behaviours and retested in 6 months (grade B recommendation). Treatment of seropositive women and infants with zidovudine to prevent mother-to-child transmission is recommended (grade A or B recommendation depending on gestational age and CD4 count). VALIDATION: These guidelines are endorsed by the Canadian Pediatric AIDS Research Group and are in agreement with the recommendations of the Canadian Paediatric Society and the US Public Health Service Task Force.     

深圳市医务人员艾滋病检测咨询效果分析

目的对医疗机构医务人员主动提供艾滋病检测咨询（PITC）项目工作情况进行评价,以期为PITC服务的广范推广提供依据。方法按照PITC工作指南,在项目科室对就诊者主动提供艾滋病检测和咨询（PITC）服务,并对咨询和检测相关数据进行统计分析和评价。结果共对74 076名就诊者提供了艾滋病检测和咨询（PITC）服务,提供信息率为11.2%,其中47.0%（34784/74 076）就诊者接受了HIV检测,HIV检测率为5.2%,检出阳性者11例,阳性率检出率为0.32‰;与基线相比较,提供HIV检测信息率、HIV检测率均显著提高（χ2=1456.96,P〈0.001;χ2=6.33,P〈0.05）。不同类型医疗机构之间以及不同科室之间医务人员主动提供HIV检测信息率、HIV检测率的差异具有统计学意义（χ2=3161.24,P〈0.001;χ2=1809.46,P〈0.001）。结论 PITC取得一定成效,但人群接受度有待进一步提高,在性病门诊等重点科室进行开展此项目效果更为明显。     

Qualitative evaluation of the Canadian Medical Association's counselling guidelines for HIV serologic testing.

OBJECTIVE: To evaluate the face and content validity of the CMA's counselling guidelines for HIV serologic testing in order to prepare a revised edition. DESIGN: Qualitative evaluation by structured focus groups in September and October 1994 to assess the relevance, clarity and practicality of the guidelines, followed by content analysis of the discussions. SETTING: Vancouver, Winnipeg, Toronto, Montreal, Quebec City and St. John's. PARTICIPANTS: Primary care physicians randomly selected from the CMA database and nonrandomly selected from the Canadian Medical Directory who had limited experience with HIV testing and counselling and who provided an appropriate mix of characteristics in terms of practice type (solo and group), setting (urban and rural), age and sex. A total of 1247 physicians were approached for the study; a convenience sample of 68 were recruited, of whom 56 participated. The average size of each focus group was eight physicians. OUTCOME MEASURES: Clinical experience and information sources with respect to HIV testing, reactions to the counselling guidelines, and suggestions for revisions and improvements to the guidelines. RESULTS: Most (96% [54/56] of the participants had ordered HIV serologic testing for patients in the 6 months preceding the focus groups, and about half of them (52% [28/54]) had at least one patient with a positive test result. Many (59% [33/56]) of the participants had a copy of the guidelines at the time of recruitment; 19 (58%) of them had used the guidelines in the months before the focus groups. The parts of the guidelines most often read were the checklists and inset boxes. Recommendations for revisions in content were for more information on legal and ethical issues, information on new issues (e.g., rapid testing) and guidelines on how best to tell a patient about a positive test result; recommendations for revisions in format included more tables, algorithms, bulleted points and white space, less text, larger type and plainer language. CONCLUSIONS: The focus groups provided detailed, credible and consistent information about the face and content validity of the HIV counselling guidelines. They are a useful qualitative method for evaluating the relevance, clarity and practicality of clinical practice guidelines at the inception or revision stage.     

Analysis of the use of HIV antibody testing in a Minnesota hospital

We retrospectively studied the clinical use of human immunodeficiency virus (HIV) antibody serology at one 450-bed medical center and affiliated clinics from April 1985 through August 1986. No restrictions were placed on the use of HIV antibody serology during that time, although it was recommended that consent be obtained and risk-reduction information be provided. Testing was performed for 275 patients; results for 25 (9%) of these were positive. Nearly half (44%) of the patients had no recognized risk factor for HIV infection recorded in their charts. For an additional 44% of the patients, the test was medically indicated but consent and counseling were not documented. For only 10% of HIV antibody tests was there notation that consent was obtained and that risk-reduction information was provided. These results indicate that HIV antibody testing is often done without consent and that opportunities to provide risk-reduction counseling are being missed.     

老年病房医院感染的现状与主要对策

目的：研究老年病房医院感染的现状和控制对策。方法：在回顾调查基础上对老年病房医院感染的现状、问题、对策逐一进行分析探讨。结果：老年人是医院感染的主要危险因素之一。临床分析表明，老年病房医院感染多为内源性医院感染，较难控制。结论：老年病房医院感染的控制应采取加强全员教育，然后尽早控制原发病，注意免疫支持治疗，合理使用抗生素，认真加强消毒隔离及院内护理等措施入手。