暗娼人群接受艾滋病自愿咨询检测的内在影响因素探讨

目的为探索暗娼人群接受自愿咨询检测（VCT）的内在影响因素，提高高危人群主动接受艾滋病病毒（HIV）检测的比例。方法对暗娼人群采取非条件Logistic回归分析的方法，比较其接受VCT的内在促进因素。结果通过对服务场所、所在镇区、年龄、民族、婚姻状况、文化程度、艾滋病相关防治知识、使用安全套情况和对VCT的了解情况进行分析比较，有统计学意义的有：年龄因素（OR=1．2499，95％CI为1．0656～1．4660）；婚姻状况中已婚暗娼相对于未婚者有统计学意义（OR=5．6250，95％CI为1．4667～21．5728）；在艾滋病相关知识的掌握中，预防知识的全面掌握有利于其接受VCT；出现下身不适也有助于其接受检测（OR=7．1558，95％CI为2．3577～21．7187）；知道VCT免费（OR=15．7500，95％CI为4．4960～55．1739）和知晓检测匿名（OR=14．4000，95％CI为3．9225～52．8644）都有统计学意义；其他因素如服务场所、服务地区、民族、学历及是否使用安全套都不存在统计学意义。多因素分析仅出现下身不适（OR=15．5013，95％CI为1．5048～159．6884）和知晓检测匿名（OR=13．9291，95％CI为1．1400～170．1892）有统计学意义。结论影响暗娼人群接受VCT的内在因素应该是多方面、相互影响的，今后应深化艾滋病及VCT的宣传，强化性病门诊的监测，以利于提高VCT的接受利用程度。     

云南省目标人群寻求和接受艾滋病自愿咨询检测服务的困难和障碍调查

目的了解阻碍云南省高危人群寻求和接受艾滋病自愿咨询检测（VCT）服务的影响因素,为改进现行的咨询检测服务体系和服务质量,提高VCT服务在高危人群中覆盖率提供科学依据。方法采用个人深入访谈和问卷调查相结合的方法,对云南省艾滋病流行水平和VCT服务水平不同的4个县（市）区的注射吸毒者、暗娼、男男性行为者和男性流动人口进行了调查,对VCT服务提供方进行个人深入访谈。对访谈资料进行归纳、整理和分析,用EPI和SPSS软件进行问卷资料的录入和分析。结果目标人群寻求和接受VCT服务的困难和障碍如下：（1）艾滋病本身的不可治愈性以及沉重的医疗负担;（2）社会恐惧和歧视;（3）VCT服务质量不高,服务方式单一;（4）对艾滋病及其相关服务的宣传不到位;（5）治疗、关怀和支持措施的落实不到位;（6）VCT服务资源投入不足,服务的主动性不够。结论（1）建立以咨询为基础的检测服务体系,完善转介服务网络,提高服务的可及性;（2）正面宣传艾滋病,加强对咨询检测和治疗、关怀服务的宣传;（3）加强对咨询检测工作的投入,建立和完善咨询检测工作的考核和激励机制,维护队伍的稳定,提高咨询检测服务质量。     

安徽省性病门诊艾滋病VCT项目评价及效果分析

目的 对2006年安徽省性病门诊艾滋病自愿咨询检测(VCT)项目进行评价和分析. 方法 在全省26个性病门诊设置艾滋病咨询室,提供规范的VCT服务,并对33 708名求询者的主要信息进行统计分析和评价. 结果 1年内共为33 708名求询者提供VCT服务,接受艾滋病病毒(HIV)抗体检测的28 666人,检出阳性者295例,阳性率为1.03%;与我国成人总人口感染率水平0.1%比较,经u检验,P＜0.005.但也存在着VCT宣传效果不理想、性乱人群覆盖率较低等问题. 结论 在性病门诊开展VCT服务,可以高效地发现HIV感染者,为促进此项工作的持续开展,应加强VCT网络建设和规范管理.     

构建三级网络创新服务模式突出搞好艾滋病自愿咨询检测工作

目的对艾滋病自愿咨询检测三级网络管理模式进行效果评价。方法在县疾病预防控制中心建立起一个以组织管理、督导培训、初筛检测为主要职能的县级自愿咨询检测(VCT)服务中心;在乡(镇、办)卫生院防保科,以及市直、区直、民营医院各建立1个乡级VCT服务室,主要职责是咨询检测,提供转介。在行政村卫生所和城区社区卫生服务站各建立1个VCT宣传点,主要职责是宣传VCT服务内容和艾滋病防治知识。结果更多的高危人群能够接受到VCT服务;大众人群及高危人群的艾防知识和防护意识逐渐增强;在求询人群中发现了12例感染者。结论在以农业人口为主的中小城市,通过建立艾滋病自愿咨询检测三级服务网络,可以最大限度地发现艾滋病病毒感染者和病人,能更好地为高危人群提供就近的咨询服务。     

艾滋病自愿咨询检测人群特征的病例对照研究

目的对主动参加艾滋病自愿咨询与检测（HIV Voluntary Counseling ＆ Tesing,VCT）人群的特征进行分析比较,了解其特点和规律,为今后改进VCT工作、更好地发挥其作用提供实践依据。方法以2006年1月至2008年12月,参加上海市原南汇区疾病预防控制中心VCT门诊的205名对象为病例组,以同期同地区报告的53名艾滋病病毒感染者/艾滋病病人（HIV/AIDS病人）为对照组,开展病例对照研究,比较两组人群的各种特征。结果 VCT人群中女性（χ2=13.70,P〈0.01）、高中以下学历（χ2=46.20,P〈0.01）和有注射吸毒史（χ2=17.35,P〈0.01）者所占的比例显著低于HIV/AIDS病人群。结论在女性、低学历和吸毒人群中,深入加强艾滋病自愿咨询与检测的宣传,对及早发现HIV/AIDS病人,更好地开展艾滋病防治工作具有十分重要的意义。     

2005年天津市艾滋病自愿咨询检测者调查分析

目的 了解天津市艾滋病自愿咨询检测（VCT）工作开展情况，进一步做好艾滋病预防控制工作。方法 对天津市2005年部分VCT者的人口学状况、咨询缘由、危险行为等进行统计分析。采用国家统一制定的《咨询个案登记表》进行分析。结果 126名求询者中男性72人，女性54人，大多数因发生婚前（外）性行为前来咨询、检测，以异性性接触为主，多性伴和商业性性行为较普遍；疑病症者较多，普遍需求心理支持。结论 应加强重点人群艾滋病病毒（HIV）感染的预防措施，深入开展自愿咨询、检测工作。     

2010-2012年武汉市某艾滋病VCT门诊数据分析

目的对近3年来武汉市某艾滋病自愿咨询检测（VCT）门诊的数据进行分析,为完善VCT服务,为求询者提供更好的健康教育提供依据。方法收集武汉市某VCT示范门诊2010-2012年的数据,对求询者的一般人口学资料、高危因素及HIV和梅毒抗体初筛结果进行统计分析。结果 3年总求询者为3148人,进行艾滋病病毒（HIV）检测3048人,检测率为96.8%,HIV阳性124人,阳性率为4.1%;梅毒检测2529人,梅毒阳性142人,阳性率为5.6%。结论 VCT门诊求询者HIV、梅毒检测率较高,但还应提高VCT服务质量和水平,加大对全人群的艾滋病防治知识宣传力度,控制性传播疾病向普通人群蔓延。     

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。     

女性商业性服务人群是否利用VCT服务的比较

目的 对是否利用艾滋病自愿咨询检测(VCT)服务的女性商业性服务人群进行比较,探讨在该人群中开展可及性VCT服务的策略.方法 采用二阶段抽样和便利抽样法,从湖北、安徽、河北9个城市抽取838名女性商业性服务者,其中420人(50.12%)既往寻求过VCT服务(VCT组),418人(49.88%)从未寻求过VCT服务(非VCT组).对她们进行问卷调查和访谈.结果 与非VCT组相比,VCT组文化程度更低,外省籍人更多,艾滋病和VCT方面的知识和信息掌握更多,相应的态度及行为更正确.逐步 Logistic回归分析显示,文化程度、户籍地、关注当地HIV宣传活动、被医务人员动员作HIV检测、认为自己有必要做HIV检测、了解当地HIV流行情况、艾滋病性病知识水平,是女性商业性服务者利用VCT服务的影响因素.结论 女性商业性服务人群利用VCT受多种因素影响,主要是对艾滋病及VCT的认知和态度、医务人员的督促、VCT门诊的交通便利性和工作质量等.必须有针对性地加强干预和宣传,完善VCT门诊建设,才能增强VCT服务对该人群的可及性.     

深圳市MSM利用自愿咨询检测服务的影响因素

目的了解深圳市男男性行为人群（MSM）自愿咨询检测（VCT）的情况及其影响因素。方法对2005-2011年深圳市MSM接受VCT服务等的资料,进行Cochran-Armitage趋势检验和Logistic回归分析。结果 2005-2011年,共有5 232名MSM接受VCT服务,338人（6.46%）确认感染艾滋病病毒（HIV）,1 097人（20.97%）确认感染梅毒,既往VCT接受率呈逐年增加趋势（z=-15.479 8,P〈0.000 1）。单因素和多因素分析结果均显示,年龄≥30岁、大专及以上文化程度、曾经献血、性取向为同性恋及双性恋、梅毒感染阳性,是MSM既往接受VCT服务的促进因素;职业为待业/无业、工人和学生,是既往接受VCT服务的阻碍因素。结论应有针对性地对MSM进行VCT宣传教育,并充分发挥性病门诊在该人群VCT服务中的作用。     

The evolving role of HIV counseling and testing in resource-limited settings: HIV prevention and linkage to expanding HIV care access

The role of voluntary counseling and testing (VCT) of HIV in resource-limited settings has recently broadened from primarily that of a prevention intervention to its identification as the key entry point into expanding access to life-saving antiretroviral therapy, additional HIV-specific medical care, and other support services. To fulfill this expanded mandate, calls for routine counseling and testing in diverse health care settings, in addition to other innovative approaches to traditional VCT, are emerging. The efficacy and cost effectiveness of traditional facility-based VCT with respect to risk-behavior reduction of HIV have been demonstrated rigorously in resource-limited settings. Additional research is needed urgently to evaluate the feasibility, acceptability, and effectiveness of streamlined counseling and testing interventions that seek to reach as many individuals as possible to meet dual prevention and treatment goals.     

云南省艾滋病自愿咨询检测培训现状分析

目的分析云南省2005、2006年艾滋病自愿咨询检测(VCT)培训班举办情况,参照省对县培训的具体要求,为16州市VCT培训工作的下一步开展提出建议。方法对2005、2006年云南省级VCT培训情况、培训效果及咨询员情况进行分析。结果两年共培训省级合格咨询人员2 344人,其中疾病预防控制系统占31.4%,医院占27.3%,妇幼系统占25.3%,乡镇卫生院占8.4%。德宏、玉溪、大理、保山、红河咨询员队伍已扩展到乡镇卫生院,并结合计划生育宣传工作的三级预防网络,成员也包括了计生专干和防保宣传员。全省咨询员队伍以女性居多,占66.7%,初、中级职称占73.9%。结论通过两年的培训工作,云南省咨询员队伍已初具规模,为建立健全云南省VCT网络奠定了良好的人力基础。     

A randomized trial on acceptability of voluntary HIV counselling and testing

OBJECTIVES: To examine factors affecting readiness for and acceptability of voluntary HIV counselling and testing (VCT). METHODS: Participants in a population-based HIV survey conducted in an urban population in Zambia in 1996 were offered VCT. Although 29% of them expressed interest in being tested (readiness), only 4% of this group used the services (i.e. acceptability). When the survey was repeated 3 years later, VCT was designed differently to assess acceptability. At the cluster level the participants were randomly allocated to VCT either at the local clinic (similar to 1996, n = 1102) or at an optional location (n = 1343). RESULTS: Readiness varied significantly by age group (47% in age group 20-24 years vs. 18% in age group 40-49 years). There were contrasts between young (15-24 years) and older age groups (25-49 years) regarding the main factors associated with readiness. Whereas self-perceived risk of being HIV infected was the only significant factor among the young, poor self-rated health and ever HIV tested were important factors among the older. The acceptability was 11.8% among the group allocated to VCT at the local clinic compared with 55.8% for the group allocated to an optional location (RR, 4.7). CONCLUSIONS: Perceived risk of HIV infection had a major influence on VCT readiness among young people, whereas declining general health status, as indicated by self-rated health, was most evident among those of older age. A strong effect of placement on acceptability of VCT was demonstrated, indicating this barrier to be important in explaining low demands for VCT in the past. Differences in perceptions of how confidentiality is handled at the two locations might be an important underlying factor.     

Is shared care with annual hospital review better value for money than predominantly hospital-based care in patients with established stable rheumatoid arthritis?

OBJECTIVE: To assess the cost effectiveness and cost effectiveness acceptability of symptom control delivered by shared care (SCSC) and aggressive treatment delivered in hospital (ATH) for established rheumatoid arthritis (RA). METHODS: Economic data were collected within the British Rheumatoid Outcome Study Group randomised controlled trial of SCSC and ATH. A broad perspective was used (UK National Health Service, social support services and patients). Cost per quality adjusted life year (QALY) gained, net benefit statistics and cost effectiveness acceptability curves were estimated. Costs and outcomes were discounted at 3.5%. Sensitivity analysis tested the robustness of the results to analytical assumptions. RESULTS: The mean (SD) cost per person was 4540 pounds (4700) in the SCSC group and 4440 pounds (4900) in the ATH group. The mean (SD) QALYs per person for 3 years were 1.67 (0.56) in the SCSC group and 1.60 (0.60) in the ATH group. If decision makers are prepared to pay > or = 2000 pounds to gain 1 QALY, SCSC is likely to be cost effective in 60-90% of cases. CONCLUSIONS: The primary economic analysis and sensitivity analyses indicate that SCSC is likely to be more cost effective than ATH in 60-90% of cases. This result seems to be robust to assumptions required by the analysis. This study is one of a limited number of randomised controlled trials to collect detailed resource use and health status data and estimate the costs and QALYs of treatment for established RA. This trial is one of the largest RA studies to use the EuroQol.     

Malaria and pregnancy: the implementation of interventions

The choice of interventions for improving malaria control during pregnancy depends on several factors. These include the efficacy of the intervention, consumer acceptability and compliance, provider acceptability, cost, safety, integration with other interventions and the local system of health-care delivery, and the degree of combination of these factors. For successful implementation the following should be recognized: appropriate policy formulation based on a process of advocacy, research and demonstration programmes; regulation and legislation; resource mobilization; consumer awareness; and appropriate delivery, targeting, monitoring and evaluation. Malaria in pregnancy is a priority area for control and a major public-health problem. Improved control of such disease requires better integration into health-care practices.     

Vena cava thrombosis after vena cava filter placement: Incidence and risk factors

Background The objective of this study was to assess the clinical safety and efficacy of vena cava filter (VCF) placement, with particular emphasis on the incidence and risk factors of inferior vena cava thrombosis (VCT) after VCF placement. Methods Clinical data of patients with venous thromboembolism (VTE), with or without placement of VCF, were analyzed in a retrospective single-center audit of medical records from January 2005 to June 2009. The collected data included demographics, procedural details, filter type, indications, and complications. Results A total of 168 cases of VTE (82 with VCF; 86 without VCF) were examined. Over a median follow-up of 24.2 months, VCT occurred in 18 of 82 patients with VCFs (11 males, 7 females, mean age 55.4 years). In 86 patients without VCFs, VCT occurred in only 6 individuals (4 males, 2 females) during the study period. VCT was observed more frequently in patients fitted with VCFs than in those without VCFs (22% vs. 7.0%). Conclusions The incidence of VCT in patients with VTE after VCF implantation was 22% approximately. Anticoagulation therapy should be continued for all patients with VCF placement, unless there is a specific contraindication. Almost all instances of VCT in patients with VCF implants in our study occurred after stopping anticoagulation treatment. The use of VCFs is increasing, and more trials are needed to confirm their benefit and accurately assess their safety.     

Cost-effectiveness of including tuberculin skin testing in an IPT program for HIV-infected persons in Uganda.

SETTING: Tuberculosis (TB) is the most common opportunistic infection among persons with human immunodeficiency virus or the acquired immune-deficiency syndrome (HIV/AIDS). Isoniazid preventive therapy (IPT) effectively treats latent TB infection (LTBI) and prevents progression to active TB. OBJECTIVE: To analyse the costs and cost-effectiveness of tuberculin skin testing (TST) prior to offering IPT. DESIGN: We implemented a program for LTBI screening and IPT using TST for persons with HIV at a voluntary counseling and testing (VCT) center in Kampala, Uganda. Cost-effectiveness analyses using Markov methods were adopted to compare strategies of using and not using TST before offering IPT. RESULTS: The program enrolled 7073 persons with HIV. Based on the prevalence of LTBI in the population, 34/100 HIV-infected patients would benefit from IPT. The results showed that 28% of LTBI patients would be treated using the TST strategy, and 40% would be treated with a non-TST strategy. Compared to no intervention, the estimated incremental cost of identifying and providing IPT using TST was dollars 211 per patient; the incremental cost using a non-TST strategy was dollars 768 per patient. CONCLUSION: At a large VCT center in Uganda, the inclusion of TST to identify the HIV-infected persons who will most benefit from IPT is cost-effective.     

High acceptability of HIV voluntary counselling and testing among female sex workers: impact of individual and social factors

Objectives

Voluntary counselling and testing (VCT) for HIV infection is an important tool for prevention of HIV infection and AIDS in high‐risk groups. Our goal was to describe the acceptability and consequences of VCT among a stigmatized and vulnerable group, female sex workers (FSWs), in Conakry, Guinea.

Methods

Acceptance of the test and return for test results at baseline and consequences of testing 1 year later were described. The perceived risk of HIV infection and perceived benefits and barriers to testing were examined using quantitative and qualitative methods.

Results

All 421 FSW participants agreed to undergo VCT and most participants (92%) returned for their results. The main reason cited for VCT acceptance was the wish to know their HIV status. However, some managers of FSW worksites urged FSWs to be tested, curtailing FSWs' free decision‐making. One year later, status disclosure was common (90% of the 198 individuals who knew their results among those who participated in the follow‐up part of the study). Positive consequences of testing were far more frequently reported than negative consequences (98% vs. 2%, respectively). Negative life events included banishment from the worksite (one case) and verbal abuse (two cases).

Conclusion

Acceptability of VCT appears high in the FSW population in Conakry as a consequence of both perceptions of high individual risk and social pressures.     

A comparison of voluntary counseling and testing uptake between a China CARES county and a county not designated for the china CARES program

A cross-sectional study employing two-stage cluster sampling was conducted between December 2005 and March 2006 to compare adults' knowledge of HIV/AIDS voluntary counseling and testing (VCT) and the attitudes toward and acceptance of VCT between a county in which a comprehensive HIV/AIDS program, China CARES (CC), was available, and a county where it was not. Information on HIV/AIDS knowledge, awareness of VCT, and attitudes was collected. All participants were given a coupon for free VCT after the cross-sectional interview. Uptake of VCT was measured within 2 months of the interview. More participants in the CC county knew someone infected with HIV, had participated in AIDS-related activities, and/or had heard about China CARES. In the control county, education and income levels were higher, there were fewer minorities, and there was a higher proportion of women. VCT uptake was low. Overall, no significant differences in uptake were found between the two counties. Urban residents of the CC county had higher HIV/AIDS knowledge levels than urban residents of the comparison county (p = 0.002). Residents of the CC county were more discriminative against HIV/AIDS and persons living with HIV/AIDS (PLWHA) and had lower perceptions of risk. The differences may be due to the higher proportion of rural residents in the CC county (p < 0.001). The China CARES program may have had a positive effect on urban areas of Guizhou Province in terms of improving HIV/AIDS and VCT knowledge and reducing discrimination, but had little impact in the rural areas. If the China CARES program is to be successful, it must implement a more effective education program and increase the acceptability of testing.     

Feasibility of voluntary counselling and testing services for HIV among pregnant women presenting in labour in Pune, India

Factors affecting the eligibility and acceptability of voluntary counselling and rapid HIV testing (VCT) were examined among pregnant women presenting in labour in Pune, India. Of the 6702 total women appearing at the delivery room from April 2001 to March 2002, 4638 (69%) were admitted for normal delivery. The remaining women presented with obstetrical complications, delivered immediately or were detected to be in false labour. Overall, 2818 (61%) of the admitted women had been previously tested for HIV during their pregnancy. If previously seen in the hospital's affiliated antenatal clinic, the likelihood of being previously tested was 89%, in contrast to 27% of women having prenatal care elsewhere. Of the admitted women, 3436 (74.3%) were assessed for their eligibility for rapid HIV VCT in the delivery room. Only 1322 (38%) of these women were found to be in early labour and without severe pain or complications, and therefore eligible for rapid HIV screening in the delivery room (DR). Of those 1322 eligible women, only 582 (44%) consented and were tested for HIV, of whom nine (1.6%) were found to be HIV-infected. Of the 1674 women arriving in the DR with no evidence of previous HIV testing, through this DR screening programme, we identified four women with HIV who could now benefit from treatment with ART. Given the high rates of HIV testing in the antenatal clinic at this site and the challenges inherent to conducting DR screening, alternatives such as post-partum testing should be considered to help reduce maternal to infant transmission in this population.