Rapid HIV testing, pregnancy, antiretroviral prophylaxis and infant abandonment in St Petersburg

In St Petersburg, Russia, a rapid HIV-testing programme was implemented in April 2004 for high-risk women giving birth. Among 670 women without prenatal care who received rapid HIV testing, 6.4% (43) had positive results. Among HIV-positive mothers, receipt of intrapartum antiretroviral prophylaxis increased significantly compared to pre-programme levels (76 versus 41%). Additionally, infant abandonment increased significantly (50% versus 26%), and was 10 times greater in women with unintended versus intended pregnancies (73% versus 7%).     

HIV testing and counseling among adolescents attending family planning clinics

This study examined whether an assessment tool combining HIV-related risk behaviors and symptoms would increase HIV testing and return for post-test counseling among 466 adolescents attending family planning clinics. The results indicted that high-risk behaviors were common among these adolescents. The majority (78.3%) identified themselves as not using condoms consistently, almost a quarter (24.7%) reported a history of STDs and 129 (27.7%) reported they had pierced their bodies. A total of 214 (45.9%) received HIV testing. Two (0.4%) adolescents, one male and one female, tested positive for HIV. Of the 214 adolescents who underwent testing, 183 (85.5%) returned to the clinic for post-test counseling. The results of this study indicated that adolescents who reported risk behaviors and symptoms were not more likely than those who reported no risk behaviors and symptoms to request testing and return for post-test counseling. In light of these results, the authors review the protocols associated with testing and post-test counseling and propose solutions that can potentially improve these processes. The authors recommend integrating a risk assessment tool with HIV testing in family planning clinics as testing and return for post-test counseling rates were high.     

Prenatal HIV counseling and testing in California: women's experiences and providers' practices.

Two concurrent surveys were conducted in four California counties to compare the prenatal HIV counseling and voluntary testing (C&VT) experiences of women with the self-reported practices of prenatal care providers. Participants were 850 women currently or recently receiving prenatal care and 254 providers. Although 79.9% of women reported being offered an HIV test during a prenatal visit, only 56.2% said they were told about the risks and benefits of taking an HIV test. Almost all providers (98.4%) indicated they offer an HIV test, and 76.8% reported offering counseling, to every patient. One third of the women (65.9%) knew that treatment exists for reducing the chance of prenatal transmission of HIV, and 78.7% of women said they were more likely to be tested given knowledge of such therapy. Women may have underreported prenatal C&VT because providers spend insufficient time discussing related issues or because C&VT information is not presented in a way that is relevant to all patients.     

适合VCT的HIV抗体检测替代策略研究

目的 探求适合在艾滋病自愿咨询检测(VCT)点应用的检测艾滋病病毒(HIV)抗体的替代策略.方法 从河南、安徽和山西省的27个VCT检测点日常工作中采集样品10 310份,离心分离血浆后,全部用HIV快速检测试剂1(RT1)和HIV快速检测试剂2(RT2)进行检测,其中任何一种试剂的检测.结果 为阳性时,分别用酶联免疫吸附试验(ELISA)试剂和免疫印迹试验(WB)试剂复检.当两种快速检测均为阴性时,保留血浆,集中用ELISA试剂复检,复检为阳性者,进一步用WB确认检测.结果 RT1检测为阳性的样品418份,WB确认阳性的样品386份;RT2检测为阳性的样品427份,WB确认阳性的样品388份;RT1和RT2均为阳性的样品391份,WB确认阳性的样品386份.RT1和RT2检测.结果 不一致的样品共63份,57份为ELISA阴性,6份为ELISA阳性.结论 使用任何一种HIV快速检测试剂可以筛查出99%以上的阴性样品;两种HIV快速检测试剂的检测.结果 均为阳性时,可以筛查出98%以上的阳性样品;两种HIV快速检测试剂的检测.结果 不一致时,ELISA复检为阴性的样品可按HIV抗体阴性咨询,ELISA复检为阳性的样品应进一步做WB确认检测.使用RT1 RT2 ELISA策略,可以替代98.54%的WB确认检测,并且与WB确认检测.结果 的符合率为99.94%,因而可以在保证检测.结果 质量的同时,大大减少检测费用,提高检测效率和成本效益.     

Smoking cessation counseling by resident physicians in internal medicine, family practice, and pediatrics

Residents in primary care specialties care for many patients who smoke cigarettes, but little is known about their smoking cessation counseling (SCC). We surveyed 309 residents (72 family practice, 171 internal medicine, and 66 pediatrics residents) in 13 programs to determine their practices, knowledge, attitudes, and training in SCC. More than 90% thought physicians are responsible for SCC, the majority routinely took smoking histories, and 80% attempted to motivate patients to quit smoking. However, 25% or fewer reported discussing obstacles to quitting, setting a quit date, prescribing nicotine gum, scheduling follow-up visits, or providing self-help materials. Family practice residents used more SCC techniques (1.8) than did internal medicine (0.8) and pediatrics (0.1) residents. Only 54% of residents reported recent SCC training and 13% reported formal SCC training. Recent training correlated with the number of counseling techniques used. Residents in primary care specialties report positive attitudes but inadequate practice and training in SCC.     

High uptake of home-based, district-wide, HIV counseling and testing in Uganda

More than 80% of the people infected with HIV in low-income countries of sub-Saharan Africa do not know their HIV serostatus. Innovative measures of increasing access to HIV counseling and testing (HCT) are urgently needed so as to improve care and prevention. We implemented a home-based HCT program in Bushenyi District from September 2004 to March 2007, in Uganda where approximately 90% of people aged older than 14 years had never tested for HIV to gauge whether it was acceptable and increased uptake of HCT. Twenty-nine teams comprising a counselor and a laboratory assistant systematically visited homes offering HCT for all people older than 14 years of age and at-risk children (mother deceased or HIV infected) using a rapid HIV testing three-test algorithm. HIV-infected people received cotrimoxazole prophylaxis, were supplied with long-lasting insecticide-treated bed nets and equipment for treatment of drinking water at home, and were referred for assessment for antiretroviral therapy. The program reached 92,984 (63%) of all the homes in the district. Of these, 32,3621 people were eligible for HCT, and 28,2857 (87%) were present at home and were offered pretest counseling. A total of 264,966 (94%) accepted testing and received their results, of whom 11,359 (4.3%) were HIV-infected. Ninety percent of those testing had never tested before. The cost of testing was $7.83 per previously untested client. Ninety-seven percent of HIV-infected people initiated cotrimoxazole prophylaxis, 74% received bed nets, 70% received water treatment equipment, and 11% began antiretroviral therapy. Forty-four percent of people who were in an HIV-discordant relationship were infected. These results demonstrate that home-based HCT was well-accepted, feasible, and effective in identifying HIV-infected individuals who did not know their HIV status in rural Uganda.     

湖州市2011年艾滋病自愿咨询检测结果分析

目的了解湖州市接受艾滋病自愿咨询检测（VCT）服务人群的现状,为艾滋病防治措施的制定提供科学依据。方法对2011年在湖州市接受VCT服务的人员的人口学状况、求询原因、危险行为等进行统计学分析。结果3 778名求询者中,3 759人（99.5%）接受了HIV抗体检测,检出阳性9例,HIV检出率为0.24%。求询者男女性别比为0.8∶1;年龄主要集中在20～49岁,占90.3%;初中学历占38.6%。各类高危行为中,有性乱史者占58.8%。结论青壮年和性接触是湖州市艾滋病传播的高危人群及方式;加强艾滋病知识宣传和VCT服务、提高求询者阳性者转介率,是今后VCT工作的重点。     

Private providers and HIV testing in Pune, India: challenges and opportunities

We explored HIV testing practices of private medical providers in an urban Indian setting in Pune, western India. 215 private practitioners (PPs) and 36 persons-in-charge of private laboratories were interviewed in separate surveys. 77% of PPs had prescribed HIV tests and 94% of laboratories had performed HIV tests, or collected samples for HIV testing. Among those providers who had prescribed/performed tests, practices which violated national policy guidelines were found to be common. 55% of PPs and 94% of laboratories had not prescribed/performed confirmatory HIV tests, 82% of PPs had conducted routine HIV screening tests, 53% of PPs and 47% of laboratories had never counselled patients before testing, and 39% of laboratories reported breaching confidentiality of test results. PPs' knowledge about HIV tests was also inadequate, with 28% of PPs who had prescribed HIV tests being unable to name the tests they had advised. Prolific HIV testing in the private medical sector is accompanied by inappropriate practices and inadequate knowledge, reflecting deficiencies in the implementation of policy guidelines. The perspectives and needs of private providers, the major source of health care in India, need to be acknowledged. Supportive and regulatory mechanisms can be used to involve private providers in the delivery of better HIV testing services.     

Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda

OBJECTIVE: To assess the acceptance of voluntary HIV counseling and testing (VCT) and the effects of VCT on sexual risk behavior and HIV acquisition in Rakai, Uganda. METHODS: In a rural cohort, 10 694 consenting adults were interviewed, provided blood for HIV testing and were offered free VCT by community resident counselors. The proportions receiving VCT and the adjusted risk ratio (adj. RR) of VCT acceptance were estimated by log binomial regression. Risk behaviors and HIV incidence per 100 person-years (PY) in HIV-negative acceptors and non-acceptors of VCT were assessed prospectively. RESULTS: Although 93% initially requested HIV results, 62.2% subsequently accepted VCT. VCT acceptance was lower among persons with no prior VCT [Adj. RR = 0.88; 95% confidence interval (CI), 0.85-0.90], individuals with primary education (adj. RR = 0.94; 95% CI, 0.90-0.99) or higher (adj. RR = 0.91; 95% CI, 0.87-0.97), individuals who were HIV-positive (adj. RR = 0.72; 95% CI, 0.68-0.76), and persons reporting condom use in the past 6 months (inconsistent users, adj. RR = 0.95; 95% CI, 0.90-0.99; consistent users, adj. RR = 0.88; 95% CI, 0.82-0.95). VCT acceptance was higher among the currently married (adj. RR = 1.14; 95% CI, 1.08-1.20) and previously married (adj. RR = 1.11; 95% CI, 1.04-1.18). Receipt of results was not significantly associated with age, gender, and self-perception of HIV risk. There were no significant differences in sexual risk behaviors, or in HIV incidence between acceptors (1.6/100 PY) and non-acceptors (1.4/100 PY) of VCT. CONCLUSION: In this rural cohort where VCT services are free and accessible, there is self-selection of individuals accepting VCT, and no impact of VCT on subsequent risk behaviors or HIV incidence.     

Sexual behavior of HIV discordant couples after HIV counseling and testing

BACKGROUND AND OBJECTIVES: Sexual behavior following voluntary HIV counseling and testing (VCT) is described in 963 cohabiting heterosexual couples with one HIV positive and one HIV negative partner ('discordant couples'). Biological markers were used to assess the validity of self-report. METHODS: Couples were recruited from a same-day VCT center in Lusaka, Zambia. Sexual exposures with and without condoms were recorded at 3-monthly intervals. Sperm detected on vaginal smears, pregnancy, and sexually transmitted diseases (STD) including HIV, gonorrhea, syphilis, and Trichomonas vaginalis were assessed. RESULTS: Less than 3% of couples reported current condom use prior to VCT. In the year after VCT, > 80% of reported acts of intercourse in discordant couples included condom use. Reporting 100% condom use was associated with 39-70% reductions in biological markers; however most intervals with reported unprotected sex were negative for all biological markers. Under-reporting was common: 50% of sperm and 32% of pregnancies and HIV transmissions were detected when couples had reported always using condoms. Positive laboratory tests for STD and reported extramarital sex were relatively infrequent. DNA sequencing confirmed that 87% of new HIV infections were acquired from the spouse. CONCLUSIONS: Joint VCT prompted sustained but imperfect condom use in HIV discordant couples. Biological markers were insensitive but provided evidence for a significant under-reporting of unprotected sex. Strategies that encourage truthful reporting of sexual behavior and sensitive biological markers of exposure are urgently needed. The impact of prevention programs should be assessed with both behavioral and biological measures.     

HIV testing in the critical care setting: views of patients,family members and health providers from urban South Africa

As antiretroviral treatment has led to decreased morbidity, HIV testing policy has increasingly shifted towards routine, provider-initiated approaches. Yet, few studies have examined the acceptability of provider-initiated HIV testing in the intensive, or critical care setting, where knowledge of HIV status is likely to impact on clinical management but explicit consent for testing is difficult to obtain. We conducted qualitative research in an urban hospital and clinic in Johannesburg. In-depth interviews were conducted among HIV testing clients (n = 20), recently discharged critical care patients (n = 13) and family members of critical care patients (n = 14). One focus group discussion was held with health care providers (n = 10). HIV testing in critical care was viewed as acceptable but challenging to implement. An overarching theme of ambivalence emerged from patients and families, who saw HIV testing as a pre-requisite to appropriate clinical care, but were concerned about the quality of its delivery. While providers were aware of the current “no testing without consent” policy, they expressed frustration in cases when testing was in the patient's best interest but consent could not be obtained. Furthermore, providers found it stressful to weigh up patient confidentiality against medical necessity when assessing patients' “best interests”. Without specific guidelines, they often developed pragmatic, ad hoc ways to resolve dilemmas around testing in critical care. Our findings suggest that HIV testing guidelines specific to the critical care setting may help providers do their jobs more ethically and transparently. Provider-initiated approaches are likely to be acceptable to patients and may improve clinical outcomes, but training and support in policy implementation and ethical decision-making are essential.     

Providing HIV counseling and testing services in methadone maintenance programs

Counseling about AIDS and optional confidential testing for antibody to HIV-1 have been available in state-supported methadone maintenance programs in Connecticut since 1 January 1987. In the first 2 years of the program, 2118 people received pre-test counseling. Overall, 1521 people agreed to anti-HIV-1-antibody testing and 1010 received post-test counseling. Other than the pre- and post-test counseling sessions, a total of 1600 HIV counseling sessions were conducted. This is the first statewide program for providing HIV counseling and testing in methadone maintenance programs in the United States. Our experience suggests that the prevention of both drug use and HIV-1 transmission can be integrated in drug treatment centers.     

Direct evaluation of adolescent HIV counseling and testing services

The incidence of HIV disease in adolescents is increasing. Studies indicate this population is not receiving adequate information or support to bring about healthy behavior choices that prevent infection, reinfection, or infection of a partner. Physicians themselves, according to a study, are providing services well below the current established guidelines. The current study provides direct evaluation of services provided to youths by adolescents trained to address critical issues using fictional (undercover) stories at actual sites advertising HIV/AIDS counseling and testing to teenagers. Thirty-three health-care sites were identified within the Washington, DC, area; eight were eliminated during the process, leaving 25 sites for appraisal. Less than 40% of the participating clinics that advertised HIV testing qualified for recommendation. In addition, many female youth evaluators reported they received unsolicited advice regarding abstinence or reduction of sexual activity; male evaluators did not report similar findings. Results of the study were translated into recommendations in the form of reports to those sites that chose to receive them. The authors recommend implementing a similar study on an annual basis of similar sites with publication of results in order to improve staff training and maintain standards that will encourage adolescent and young adult clients to be tested and follow through for test results and appropriate education and counseling.     

艾滋病自愿咨询检测的影响因素

目的了解高危(重点)人群中艾滋病自愿咨询检测(VCT)状况及影响因素,并为今后政府制定高危行为人群的VCT干预对策提供科学依据。方法采用匿名自填问卷的方式,对深圳市特种服务行业女性从业人员进行了有关VCT的认知、态度、行为现状及影响因素的问卷调查。结果61.3%的人不知道VCT免费;95.4%的人没有做过艾滋病病毒(HIV)抗体检测,其中有65.9%的人认为自己不会得艾滋病,没有必要检测;54.6%的人不知道在哪里检测HIV抗体。当怀疑自己感染了HIV时有16.5%的人表示不会去检测,其中有84.4%的人担心被别人知道曾经做过HIV检测而被瞧不起,53.1%的人害怕检测结果阳性,本人和家人遭受歧视。结论社会宣传和干预力度不够,求询者的畏惧心理和侥幸心理、社会歧视是影响高危(重点)人群自愿接受HIV检测的主要原因,应进一步加强对艾滋病知识和"四免一关怀"政策的宣传,把VCT作为在高危(重点)人群中开展行为干预的重点。     

HIV testing and antiretroviral treatment strategies for prevention of HIV infection: impact on antiretroviral drug resistance

'Test and treat' is a strategy in which widespread screening for human immunodeficiency virus (HIV) is followed by immediate antiretroviral therapy for those testing positive, thereby potentially reducing infectiousness in larger cohorts of infected patients. However, there is a concern that test and treat could lead to increased the levels of transmissible drug-resistant HIV, especially if viral load and/or drug resistance is not routinely monitored. Reviews of the existing literature show that up to now, even in the absence of laboratory tests, drug resistance has not created major problems in sub-Saharan Africa. Here, we discuss the current evidence for the effectiveness of a preventive test and treat approach and the challenges and implications for daily clinical practice and public health.     

艾滋病VCT服务中求询者感知风险的因子分析

目的 探讨艾滋病自愿咨询检测(VCT)服务利用中,求询者感知风险的构成和影响因素.方法 采用自填式问卷,调查北京地区268名求询者对VCT服务利用中各项感知风险的评价,使用因子分析方法探讨各项风险评价的内在联系,并对不同求询者的因子得分进行比较.结果 通过因子分析提取了6个感知风险因子,分别是隐私泄露恐惧、难为情心理、对检测质量的担忧、对有形成本的认知、对阳性结果社会后果的担忧、对阳性结果医疗费用的担忧.通过对求询者特征与风险感知水平的关系的分析,发现低收入和高收入求询者的感知风险明显高于中等收入者.结论 艾滋病VCT服务中,求询者感知风险有明确的内容结构,并且不同收入水平的求询者的感知风险有明显的差异.