Background: Zimbabwe recorded a 55% increase in HIV testing from 2011 to 2018 but with decreasing HIV-testing yields from 20% to 6% respectively as we aim to identify the narrowing gap of undiagnosed people living wit...Background: Zimbabwe recorded a 55% increase in HIV testing from 2011 to 2018 but with decreasing HIV-testing yields from 20% to 6% respectively as we aim to identify the narrowing gap of undiagnosed people living with HIV. As such adoption of screening tools during targeted HIV testing services improves efficiency by identifying individuals who are likely to test positive. Effective utilization of screening tools requires an understanding of health care worker perception and willingness to use the tools. Methods: We conducted a qualitative study among healthcare workers at 8 selected primary healthcare facilities in Zimbabwe. Interviewer-guided, in-depth interviews were conducted with healthcare workers and their immediate supervisors. Thematic analysis was performed following a framework built around the grounded theory model to describe perspectives that influence the utilization of HIV screening tools and suggestions for improved eligibility screening. Results: Behavioural factors facilitating the utilisation of the screening tool included motivation to adhere to standard practice, awareness of screening in targeting testing, and its ability to manage workload through screening out ineligible clients. This was evident across service delivery levels. Barriers included limited healthcare capacity, confidentiality space, multiple screening tools and opaque screening in/out criteria and the potential of clients not responding to screening questions truthfully. Conclusions: Across geographical and service delivery levels, placing screening tools at HIV testing entry points, healthcare worker knowledge on screening in/out criteria emerged as enablers for correct and consistent utilization. Further, standardizing the tools and adopting a decision aid algorithm would improve the accurate utilisation of screening tools.展开更多
Background:This study explored the factors associated with changes in HIV testing uptake among young women in Tanzania,based on an analysis of data from the 2003–2004 Tanzania HIV/AIDS Indicator Survey,and the 2007–...Background:This study explored the factors associated with changes in HIV testing uptake among young women in Tanzania,based on an analysis of data from the 2003–2004 Tanzania HIV/AIDS Indicator Survey,and the 2007–2008 and 2011–2012 Tanzania HIV/AIDS and Malaria Indicator Surveys.Methods:The study population consisted of young women aged 15–24 years at the time of the survey.Multivariate decomposition analysis was used to assess factors associated with changes in HIV testing uptake between the 2003–2004 and 2007–2008 surveys,and between the 2007–2008 and 2011–2012 surveys.Results:HIV testing uptake among the study population was 7%in 2003–2004,31%in 2007–2008 and 40%in 2011–2012.The time period of the survey had a substantial effect on the uptake of HIV testing independent of other covariates.The characteristics that were significantly associated with a higher chance of HIV testing uptake across the surveys were age(20–24),education level(primary and secondary),ever being married,having at least one lifetime sexual partner,having a sexually transmitted infection or associated symptoms,and receiving antenatal care.Conclusions:Changes in the study participants’characteristics in the 2003–2004 survey compared with the 2007–2008 survey were associated with a decrease in HIV testing uptake.Comparing the 2007–2008 survey with the 2011–2012 survey shows that the changes in the participants’characteristics contributed to 22%of the changes in HIV testing uptake,while 78%of the changes were attributed to coefficients.展开更多
HIV counseling and testing(HCT)has become paramount in the prevention and control of HIV/AIDS worldwide.However,the uptake of HCT has been very slow globally,especially in sub-Saharan Africa.Student nurses formed the ...HIV counseling and testing(HCT)has become paramount in the prevention and control of HIV/AIDS worldwide.However,the uptake of HCT has been very slow globally,especially in sub-Saharan Africa.Student nurses formed the largest group undergoing health care training in the country compared to doctors and other health cadres.According to WHO,they are part of the most vulnerable group to HIV infection,judging by the fact that they interact more with patients/clients than other healthcare professionals.This study aimed to determine the prevalence of HCT uptake,knowledge,and attitude and evaluate influencing factors among student nurses and midwives in public nursing schools.An institutional-based cross-sectional study design was employed to collect data from 305 randomly selected nursing students and midwives using a validated and reliable self-administered questionnaire.Descriptive statistics(percentages,mean and standard deviation)and inferential statistics(chi square,logistics regression,one-way ANOVA and independent samples t-test)were used for data analysis using SPSS version 25.0.A p-value<0.05 was considered for statistical significance.Out of the 305 students recruited for the study,60.98%were females,with a mean age of 25.5 years old.About 58.4%of the participants had tested for HIV in the past.About 95.7%acknowledged the importance of HCT in the prevention and control of HIV/AIDS.HCT uptake among student nurses and midwives was influenced by factors ranging from an individual that are interpersonal challenges(such as concerns of friends),perceived susceptibility to the disease,lack of confidentiality,stigma and discrimination from health service providers.Therefore,these barriers can be addressed through an organized targeted health education intervention and advocacy programs across health training institutions in the Gambia and beyond.展开更多
Introduction: HIV screening tests are routinely conducted on dialysis patients as the constant exposure of their blood during the dialysis process makes them a reasonable risk for blood-borne infections. However, in l...Introduction: HIV screening tests are routinely conducted on dialysis patients as the constant exposure of their blood during the dialysis process makes them a reasonable risk for blood-borne infections. However, in low prevalence settings, where HIV rates are <0.1% of the population, false positive results are more likely. This results in apprehension in the dialysis unit as breaches in infectious disease protocols could be presumed. This is illustrated in the case report below. Case Summary: A 62-year-old male Saudi end-stage kidney disease patient secondary to DM nephropathy began dialysis a year before presentation in a hemodialysis center in Saudi Arabia. Routine screening tests done at the start of dialysis revealed negative Hepatitis C, HIV 1 and 2 screening but a positive Hepatitis B surface antigen screen. The patient went for holiday dialysis at another facility and had a routine fourth-generation HIV test done which was positive. A confirmatory HIV PCR test was negative. Conclusion: This case highlights the need for caution in interpreting highly sensitive and specific HIV screening tests in a low-prevalence setting. Routine screening beyond the national recommendation may not be necessary in low-prevalence areas.展开更多
Testing for Human Immunodeficiency Virus (HIV), widely distributed in sub-Saharan Africa since it is mainly invasive but, could be non-invasive and quick also, reducing waiting time especially when required for presur...Testing for Human Immunodeficiency Virus (HIV), widely distributed in sub-Saharan Africa since it is mainly invasive but, could be non-invasive and quick also, reducing waiting time especially when required for presurgical procedures. This study determined the HIV status of patients using Urine screening test method and to compare its performance to blood-based testing methods. The routine pre and post-test counselling for HIV screening were done for all provider-initiated HIV testing using blood-based screening methods. Due to the cost and unavailability of enough urine testing kits, only patients who tested positive for HIV with blood-based methods and were scheduled for surgery or a surgical procedure were enrolled in the study. Informed consent was obtained. Paired urine and blood samples were collected at the same visit into clean universal bottles and analyzed immediately. A colloidal gold enhanced rapid immuno-chromatographic assay (Alliance Biomedical) kit for the rapid qualitative detection of antibodies to Human Immunodeficiency Virus (HIV) I and II in urine were used in comparison to the standard HIV testing of ante-cubital venous blood collected in EDTA vacutainer and analyzed using Determine (T) HIV 1 and 2 <i>in vitro</i> qualitative immunoassay strip, UNI GOLD rapid test kit and the Chembio HIV 1/2 STAT PAK assay strip. A total of 7568 patients were tested for routine provider-initiated HIV testing, 521 tested HIV positive. There were 105 (20.15%) males and 416 (79.85%) females, age ranged from 15 years to >80 years. Most of the surgeries performed were Caesarian section 93 (37%), Hernia 55 (22%), Lumps 48 (19%), Acute appendicitis 33 (13%), Uterine fibroids 10 (4%), Ruptured ectopic pregnancy 2 (1%) and others (Intestinal obstruction, Postoperative adhesions, Ingrown toe nails, Breast abscess, Hemorrhoids, Anal fissures etc.) 10 (4%). DETERMINE RAPID HIV TEST METHOD USING BLOOD: A total of 521 HIV positive samples were tested, 502 (96.35%) tested HIV positive and 19 (3.65%) tested HIV negative. These 19 HIV negatives were re-tested with Stak Pak: 19 (100%) tested HIV positive. UNI GOLD HIV TEST METHOD USING BLOOD: A total of 521 HIV positive samples were tested, 521 (100%) tested HIV positive. URINE TESTING METHOD: A total of 251 (48.18%) of the 521 HIV positive patients were scheduled to undergo a surgical procedure. These were re-tested using the Urine testing method, 235 (93.63%) tested HIV positive while 16 (6.37%) tested negative. The blood sample of the 16 who tested negative using the Urine testing method was subjected to confirmatory test using Stat Pak and all 16 (100%) tested HIV positive. The specificity for Unigold and Determine blood testing was 100%. All three tests had a Positive Predictive Value (PPV) of 100% while the Negative Predictive Values (NPV) were 100% and 99.73% for Unigold and Determine respectively. The use of Urine HIV testing method compared well to the blood HIV testing methods and could be a better non-invasive sample method for screening of HIV/AIDS in the population especially among surgeons’ pre-surgical procedures.展开更多
This article is about a report of the experiment of PRO/PET-Saúde students in the anti-HIV tests implementation in the town of Santa Cruz-RN. The goal is to report the importance and discuss the aspects of the mo...This article is about a report of the experiment of PRO/PET-Saúde students in the anti-HIV tests implementation in the town of Santa Cruz-RN. The goal is to report the importance and discuss the aspects of the moment experienced above inside the basic health unit in the town of Santa Cruz-RN. The experience occurred in the months from February to March 2014 and they were conducted within 8 hours per week. This way, it is observed that the period lived made possible great reflection about the making of the examination in the pre-natal appointment routines, cataloguing challenges which come up during their adequacy within the services. Lastly, the action developed aimed for the aggregation of an active learning process in the search for a critical sense in the experienced practice, allowing and prioritizing the basic health unit as a scope of reference and counter-reference in the public health service, increasing concrete answers and the needs of the population, guaranteeing an adequate service delivery and strengthening the SUS more and more. The insertion of students through the PRO/PET-Saúde-Rede Cegonha enables a reorientation of professional formation, from the integration between service and teaching.展开更多
Background Men who have sex with men （MSM） in China remain at high risk for HIV infection, the proportion of reported HIV/AIDS cases that occurred among MSM rose greatly from 2005 to 2011. HIV testing and counseling...Background Men who have sex with men （MSM） in China remain at high risk for HIV infection, the proportion of reported HIV/AIDS cases that occurred among MSM rose greatly from 2005 to 2011. HIV testing and counseling is a critical HIV prevention strategy among HIV related high-risk population, including MSM in China. This article aimed to assess the association between receiving HIV testing and high-risk sexual behaviors among MSM in Langfang, Hebei Province, China. Methods Between September and November 2007, 233 MSM were recruited to receive an HIV testing intervention. Face-to-face interviews were conducted before HIV testing and 3 months later HIV-related risk behaviors were assessed. Serological testing for HIV and other sexually transmitted infections （STIs） was performed. Results Of the recruited 233 MSM, 200 completed follow-up. Baseline prevalence was 7.8% for HIV, 21.0% for syphilis, 15.8% for gonorrhea, and 5.0% for chlamydia. Multivariate analysis indicated that inconsistent condom use （OR=7.9, 95% CI： 0.9-66.7, P=0.059） and bleeding during anal sex （OR=5.9, 95% Cl： 1.3-26.2, P=0.019） were risk factors for HIV infection, and group sex （OR=6.6, 95% Cl： 2.2-19.7, P=0.001） was a risk factor for syphilis infection at baseline. At 3 months follow-up, among STI-positive MSM, self-reported anal sex fell from 73.1% to 38.5% （P 〈0.001）; group sex fell from 19.2% to 5.8% （P 〈0.001）; and bleeding during anal sex fell from 23.1% to 5.8% （P 〈0.001）. Among STI-negative MSM, the frequency of one-night stands fell from 32.5% to 17.2% （P 〈0.001）, and oral sex rose from 57% to 78.5% （P 〈0.001）. STI-positive MSM were less likely to engage in anal sex compared to STI-negative MSM （X^2=5.189, P=0.023）. Conclusions HIV testing is an important intervention strategy among MSM. HIV testing services among MSM need to be scaled up, along with comprehensive, tailored interventions including condom promotion and STI treatment.展开更多
Background:Gonorrhea and chlamydia testing rates are poor among Chinese men who have sex with men(MSM).A quasi-experimental study suggested that a pay-it-forward strategy increased dual gonorrhea/chlamydia testing amo...Background:Gonorrhea and chlamydia testing rates are poor among Chinese men who have sex with men(MSM).A quasi-experimental study suggested that a pay-it-forward strategy increased dual gonorrhea/chlamydia testing among MSM.Pay-it-forward offers an individual a gift(e.g.,a free test)and then asks the same person if they would like to give a gift to another person.This article reports the protocol of a randomized controlled trial to evaluate dual gonorrhea/chlamydia test uptake and other outcomes among MSM in three arms-a pay-it-forward arm,a pay-what-you-want arm,and a standard of care arm.Methods:Three hundred MSM will be recruited at three HIV testing sites in Guangzhou and Beijing.Testing sites include two hospital-based MSM sexually transmitted diseases clinics and one MSM community-based organization.Eligible participants will be born biologically male,aged 16 years or older,reporting previous anal sex with another man,having never participated in the pay-it-forward program,without previous gonorrhea and chlamydia testing in the past 12 months,and residing in China.Following a cluster randomized design,every cluster of ten participants will be randomly allocated into one of three arms:(1)a pay-it-forward arm in which men are offered free gonorrhea and chlamydia testing and then asked whether they would like to donate("pay it forward")toward testing for future testers;(2)a pay-what-you-want arm in which men are offered free testing and told to decide how much to pay after receiving the test;(3)a standard of care arm in which men can pay the full price for dual gonorrhoea and chlamydia testing.The primary outcome is dual gonorrhoea/chlamydia testing as verified by administrative records.Secondary outcomes include incremental cost per test,incremental cost per diagnosis,community connectedness,and social cohesion.Primary outcome will be calculated for each arm using intention-to-treat and compared using one-sided 95%confidence intervals with a margin of 20%increase defined as superiority.Discussion:This study will examine the pay-it-forward strategy in comparison to the standard of care in improving test uptake for gonorrhea and chlamydia.We will leverage the cluster randomized controlled trial to provide scientific evidence on the potential effect of pay-it-forward.Findings from this study will shed light on novel intervention methods for increasing preventive health service utilization and innovate ways to finance it among communities.Trial registration:ClinicalTrials.gov,NCT03741725.Registered on 12 November 2018.展开更多
Background:As a response to a severe HIV epidemic in the Liangshan Prefecture,one of the worst in China,population based HIV interventions,including two population-wide HIV screening,have been carried out since 2005 a...Background:As a response to a severe HIV epidemic in the Liangshan Prefecture,one of the worst in China,population based HIV interventions,including two population-wide HIV screening,have been carried out since 2005 at two townships in a remote mountainous region of Liangshan.The objective of our mathematical modeling study is to assess the temporal dynamics of the HIV epidemic in the two townships based on the data collected in the study area during the period 2005e2010.Methods:A mathematical model was set up to describe the population dynamics of HIV transmission in study area.The model was calibrated by fitting it to the HIV testing and treatment data from 2005 to 2008.Validation of the model was done by comparing its predicted value of HIV prevalence in 2010 to the prevalence data obtained in the 2010 population wide HIV testing.The validated model was used to produce estimation of HIV incidence,prevalence and death.Results:Our model estimations show that population-based HIV interventions have significantly slowed down the rise of the HIV epidemic in the two townships.Over the five-year period from 2005 to 2010,the year-over-year rate of increase in HIV incidence,prevalence,and death has declined by 91.5%,28.7%,and 52.3%,respectively.Conclusion:Mathematical models,when integrated with epidemiological and surveillance data,can be an effective tool for predicting the temporal dynamics of HIV and assessing the impacts of HIV interventions.展开更多
A traditional Chinese medicinal capsule capable of curing HIV/AIDS has been put under clinical test with the approval of the State Food and Drug Administration.
Background:Diagnostics are essential for identifying and controlling diseases.However,limited access to diagnostics hinders public health efforts in many settings.Social innovation may provide a framework for expandin...Background:Diagnostics are essential for identifying and controlling diseases.However,limited access to diagnostics hinders public health efforts in many settings.Social innovation may provide a framework for expanding access to diagnostics in the global south.Here social innovation is defined as implementing a known public health tool via a novel,community-driven technique.Main Body:In this article,we discuss three diverse cases that show the potential for using social innovation in diagnostics.The cases chosen for inclusion here demonstrate the importance of social innovation in diagnostics across different geographic,cultural,and health system contexts.They include malaria testing via schools in Malawi,cervical human papillomavirus(HPV)sample self-collection in Peru,and crowdsourcing human immunodeficiency virus(HIV)testing in China.For each case,we present the public health problem and the impact of using social innovation to increase accessibility of diagnostics.We discuss implications of each diagnostic approach and the importance of social innovation in creating these potential solutions.We argue that social innovation is useful in improving the delivery of essential diagnostic tools in low-and middle-income countries.Conclusions:Interventions in Malawi,Peru,and China suggest social innovation increases uptake of diagnostics.The same tools and principles utilized in these cases can be adapted for use in other contexts.Such diagnostic innovations may help improve identification of and linkage to care for many diseases.The approach presents a unique opportunity to better address public health issues and increase accessibility in LMIC health systems.展开更多
文摘Background: Zimbabwe recorded a 55% increase in HIV testing from 2011 to 2018 but with decreasing HIV-testing yields from 20% to 6% respectively as we aim to identify the narrowing gap of undiagnosed people living with HIV. As such adoption of screening tools during targeted HIV testing services improves efficiency by identifying individuals who are likely to test positive. Effective utilization of screening tools requires an understanding of health care worker perception and willingness to use the tools. Methods: We conducted a qualitative study among healthcare workers at 8 selected primary healthcare facilities in Zimbabwe. Interviewer-guided, in-depth interviews were conducted with healthcare workers and their immediate supervisors. Thematic analysis was performed following a framework built around the grounded theory model to describe perspectives that influence the utilization of HIV screening tools and suggestions for improved eligibility screening. Results: Behavioural factors facilitating the utilisation of the screening tool included motivation to adhere to standard practice, awareness of screening in targeting testing, and its ability to manage workload through screening out ineligible clients. This was evident across service delivery levels. Barriers included limited healthcare capacity, confidentiality space, multiple screening tools and opaque screening in/out criteria and the potential of clients not responding to screening questions truthfully. Conclusions: Across geographical and service delivery levels, placing screening tools at HIV testing entry points, healthcare worker knowledge on screening in/out criteria emerged as enablers for correct and consistent utilization. Further, standardizing the tools and adopting a decision aid algorithm would improve the accurate utilisation of screening tools.
基金We are grateful to the USAID for funding this research through the DHS Fellows Program implemented by ICF International。
文摘Background:This study explored the factors associated with changes in HIV testing uptake among young women in Tanzania,based on an analysis of data from the 2003–2004 Tanzania HIV/AIDS Indicator Survey,and the 2007–2008 and 2011–2012 Tanzania HIV/AIDS and Malaria Indicator Surveys.Methods:The study population consisted of young women aged 15–24 years at the time of the survey.Multivariate decomposition analysis was used to assess factors associated with changes in HIV testing uptake between the 2003–2004 and 2007–2008 surveys,and between the 2007–2008 and 2011–2012 surveys.Results:HIV testing uptake among the study population was 7%in 2003–2004,31%in 2007–2008 and 40%in 2011–2012.The time period of the survey had a substantial effect on the uptake of HIV testing independent of other covariates.The characteristics that were significantly associated with a higher chance of HIV testing uptake across the surveys were age(20–24),education level(primary and secondary),ever being married,having at least one lifetime sexual partner,having a sexually transmitted infection or associated symptoms,and receiving antenatal care.Conclusions:Changes in the study participants’characteristics in the 2003–2004 survey compared with the 2007–2008 survey were associated with a decrease in HIV testing uptake.Comparing the 2007–2008 survey with the 2011–2012 survey shows that the changes in the participants’characteristics contributed to 22%of the changes in HIV testing uptake,while 78%of the changes were attributed to coefficients.
文摘HIV counseling and testing(HCT)has become paramount in the prevention and control of HIV/AIDS worldwide.However,the uptake of HCT has been very slow globally,especially in sub-Saharan Africa.Student nurses formed the largest group undergoing health care training in the country compared to doctors and other health cadres.According to WHO,they are part of the most vulnerable group to HIV infection,judging by the fact that they interact more with patients/clients than other healthcare professionals.This study aimed to determine the prevalence of HCT uptake,knowledge,and attitude and evaluate influencing factors among student nurses and midwives in public nursing schools.An institutional-based cross-sectional study design was employed to collect data from 305 randomly selected nursing students and midwives using a validated and reliable self-administered questionnaire.Descriptive statistics(percentages,mean and standard deviation)and inferential statistics(chi square,logistics regression,one-way ANOVA and independent samples t-test)were used for data analysis using SPSS version 25.0.A p-value<0.05 was considered for statistical significance.Out of the 305 students recruited for the study,60.98%were females,with a mean age of 25.5 years old.About 58.4%of the participants had tested for HIV in the past.About 95.7%acknowledged the importance of HCT in the prevention and control of HIV/AIDS.HCT uptake among student nurses and midwives was influenced by factors ranging from an individual that are interpersonal challenges(such as concerns of friends),perceived susceptibility to the disease,lack of confidentiality,stigma and discrimination from health service providers.Therefore,these barriers can be addressed through an organized targeted health education intervention and advocacy programs across health training institutions in the Gambia and beyond.
文摘Introduction: HIV screening tests are routinely conducted on dialysis patients as the constant exposure of their blood during the dialysis process makes them a reasonable risk for blood-borne infections. However, in low prevalence settings, where HIV rates are <0.1% of the population, false positive results are more likely. This results in apprehension in the dialysis unit as breaches in infectious disease protocols could be presumed. This is illustrated in the case report below. Case Summary: A 62-year-old male Saudi end-stage kidney disease patient secondary to DM nephropathy began dialysis a year before presentation in a hemodialysis center in Saudi Arabia. Routine screening tests done at the start of dialysis revealed negative Hepatitis C, HIV 1 and 2 screening but a positive Hepatitis B surface antigen screen. The patient went for holiday dialysis at another facility and had a routine fourth-generation HIV test done which was positive. A confirmatory HIV PCR test was negative. Conclusion: This case highlights the need for caution in interpreting highly sensitive and specific HIV screening tests in a low-prevalence setting. Routine screening beyond the national recommendation may not be necessary in low-prevalence areas.
文摘Testing for Human Immunodeficiency Virus (HIV), widely distributed in sub-Saharan Africa since it is mainly invasive but, could be non-invasive and quick also, reducing waiting time especially when required for presurgical procedures. This study determined the HIV status of patients using Urine screening test method and to compare its performance to blood-based testing methods. The routine pre and post-test counselling for HIV screening were done for all provider-initiated HIV testing using blood-based screening methods. Due to the cost and unavailability of enough urine testing kits, only patients who tested positive for HIV with blood-based methods and were scheduled for surgery or a surgical procedure were enrolled in the study. Informed consent was obtained. Paired urine and blood samples were collected at the same visit into clean universal bottles and analyzed immediately. A colloidal gold enhanced rapid immuno-chromatographic assay (Alliance Biomedical) kit for the rapid qualitative detection of antibodies to Human Immunodeficiency Virus (HIV) I and II in urine were used in comparison to the standard HIV testing of ante-cubital venous blood collected in EDTA vacutainer and analyzed using Determine (T) HIV 1 and 2 <i>in vitro</i> qualitative immunoassay strip, UNI GOLD rapid test kit and the Chembio HIV 1/2 STAT PAK assay strip. A total of 7568 patients were tested for routine provider-initiated HIV testing, 521 tested HIV positive. There were 105 (20.15%) males and 416 (79.85%) females, age ranged from 15 years to >80 years. Most of the surgeries performed were Caesarian section 93 (37%), Hernia 55 (22%), Lumps 48 (19%), Acute appendicitis 33 (13%), Uterine fibroids 10 (4%), Ruptured ectopic pregnancy 2 (1%) and others (Intestinal obstruction, Postoperative adhesions, Ingrown toe nails, Breast abscess, Hemorrhoids, Anal fissures etc.) 10 (4%). DETERMINE RAPID HIV TEST METHOD USING BLOOD: A total of 521 HIV positive samples were tested, 502 (96.35%) tested HIV positive and 19 (3.65%) tested HIV negative. These 19 HIV negatives were re-tested with Stak Pak: 19 (100%) tested HIV positive. UNI GOLD HIV TEST METHOD USING BLOOD: A total of 521 HIV positive samples were tested, 521 (100%) tested HIV positive. URINE TESTING METHOD: A total of 251 (48.18%) of the 521 HIV positive patients were scheduled to undergo a surgical procedure. These were re-tested using the Urine testing method, 235 (93.63%) tested HIV positive while 16 (6.37%) tested negative. The blood sample of the 16 who tested negative using the Urine testing method was subjected to confirmatory test using Stat Pak and all 16 (100%) tested HIV positive. The specificity for Unigold and Determine blood testing was 100%. All three tests had a Positive Predictive Value (PPV) of 100% while the Negative Predictive Values (NPV) were 100% and 99.73% for Unigold and Determine respectively. The use of Urine HIV testing method compared well to the blood HIV testing methods and could be a better non-invasive sample method for screening of HIV/AIDS in the population especially among surgeons’ pre-surgical procedures.
文摘This article is about a report of the experiment of PRO/PET-Saúde students in the anti-HIV tests implementation in the town of Santa Cruz-RN. The goal is to report the importance and discuss the aspects of the moment experienced above inside the basic health unit in the town of Santa Cruz-RN. The experience occurred in the months from February to March 2014 and they were conducted within 8 hours per week. This way, it is observed that the period lived made possible great reflection about the making of the examination in the pre-natal appointment routines, cataloguing challenges which come up during their adequacy within the services. Lastly, the action developed aimed for the aggregation of an active learning process in the search for a critical sense in the experienced practice, allowing and prioritizing the basic health unit as a scope of reference and counter-reference in the public health service, increasing concrete answers and the needs of the population, guaranteeing an adequate service delivery and strengthening the SUS more and more. The insertion of students through the PRO/PET-Saúde-Rede Cegonha enables a reorientation of professional formation, from the integration between service and teaching.
文摘Background Men who have sex with men （MSM） in China remain at high risk for HIV infection, the proportion of reported HIV/AIDS cases that occurred among MSM rose greatly from 2005 to 2011. HIV testing and counseling is a critical HIV prevention strategy among HIV related high-risk population, including MSM in China. This article aimed to assess the association between receiving HIV testing and high-risk sexual behaviors among MSM in Langfang, Hebei Province, China. Methods Between September and November 2007, 233 MSM were recruited to receive an HIV testing intervention. Face-to-face interviews were conducted before HIV testing and 3 months later HIV-related risk behaviors were assessed. Serological testing for HIV and other sexually transmitted infections （STIs） was performed. Results Of the recruited 233 MSM, 200 completed follow-up. Baseline prevalence was 7.8% for HIV, 21.0% for syphilis, 15.8% for gonorrhea, and 5.0% for chlamydia. Multivariate analysis indicated that inconsistent condom use （OR=7.9, 95% CI： 0.9-66.7, P=0.059） and bleeding during anal sex （OR=5.9, 95% Cl： 1.3-26.2, P=0.019） were risk factors for HIV infection, and group sex （OR=6.6, 95% Cl： 2.2-19.7, P=0.001） was a risk factor for syphilis infection at baseline. At 3 months follow-up, among STI-positive MSM, self-reported anal sex fell from 73.1% to 38.5% （P 〈0.001）; group sex fell from 19.2% to 5.8% （P 〈0.001）; and bleeding during anal sex fell from 23.1% to 5.8% （P 〈0.001）. Among STI-negative MSM, the frequency of one-night stands fell from 32.5% to 17.2% （P 〈0.001）, and oral sex rose from 57% to 78.5% （P 〈0.001）. STI-positive MSM were less likely to engage in anal sex compared to STI-negative MSM （X^2=5.189, P=0.023）. Conclusions HIV testing is an important intervention strategy among MSM. HIV testing services among MSM need to be scaled up, along with comprehensive, tailored interventions including condom promotion and STI treatment.
基金the National Key Research and Development Program of China(2017YFE0103800)the National Institutes of Health NIAID NIAID K24AI143471,1UG3HD096929-01,NIA P30(P30AG034420)+3 种基金UNC-South China STD Research Training Center(FIC 1D43TW009532-01)UNC Center for AIDS Research(NIAID 5P30AI050410)Doris Duke Charitable Foundation(International Clinical Research Fellowship to TZ)SESH(Social Entrepreneurship to Spur Health)Global.
文摘Background:Gonorrhea and chlamydia testing rates are poor among Chinese men who have sex with men(MSM).A quasi-experimental study suggested that a pay-it-forward strategy increased dual gonorrhea/chlamydia testing among MSM.Pay-it-forward offers an individual a gift(e.g.,a free test)and then asks the same person if they would like to give a gift to another person.This article reports the protocol of a randomized controlled trial to evaluate dual gonorrhea/chlamydia test uptake and other outcomes among MSM in three arms-a pay-it-forward arm,a pay-what-you-want arm,and a standard of care arm.Methods:Three hundred MSM will be recruited at three HIV testing sites in Guangzhou and Beijing.Testing sites include two hospital-based MSM sexually transmitted diseases clinics and one MSM community-based organization.Eligible participants will be born biologically male,aged 16 years or older,reporting previous anal sex with another man,having never participated in the pay-it-forward program,without previous gonorrhea and chlamydia testing in the past 12 months,and residing in China.Following a cluster randomized design,every cluster of ten participants will be randomly allocated into one of three arms:(1)a pay-it-forward arm in which men are offered free gonorrhea and chlamydia testing and then asked whether they would like to donate("pay it forward")toward testing for future testers;(2)a pay-what-you-want arm in which men are offered free testing and told to decide how much to pay after receiving the test;(3)a standard of care arm in which men can pay the full price for dual gonorrhoea and chlamydia testing.The primary outcome is dual gonorrhoea/chlamydia testing as verified by administrative records.Secondary outcomes include incremental cost per test,incremental cost per diagnosis,community connectedness,and social cohesion.Primary outcome will be calculated for each arm using intention-to-treat and compared using one-sided 95%confidence intervals with a margin of 20%increase defined as superiority.Discussion:This study will examine the pay-it-forward strategy in comparison to the standard of care in improving test uptake for gonorrhea and chlamydia.We will leverage the cluster randomized controlled trial to provide scientific evidence on the potential effect of pay-it-forward.Findings from this study will shed light on novel intervention methods for increasing preventive health service utilization and innovate ways to finance it among communities.Trial registration:ClinicalTrials.gov,NCT03741725.Registered on 12 November 2018.
基金This study was supported by grants from Natural Sciences and Engineering Research Council of Canada(NSERC)(grant no.RGPIN 238901-2010)Canada Foundation for Innovation(CFI)(project#7112),the International Development Research Center of Canada(IDRC)(grant#104519-010)+1 种基金University of Alberta China Opportunity Fund,Ministry of Science and Technology of the People’s Republic of China(2009ZX10004-905,2011ZX10001-002,2013ZX10004-908,2012ZX10001-002)a Chinese State Key Laboratory of Infectious Disease Development Grant.
文摘Background:As a response to a severe HIV epidemic in the Liangshan Prefecture,one of the worst in China,population based HIV interventions,including two population-wide HIV screening,have been carried out since 2005 at two townships in a remote mountainous region of Liangshan.The objective of our mathematical modeling study is to assess the temporal dynamics of the HIV epidemic in the two townships based on the data collected in the study area during the period 2005e2010.Methods:A mathematical model was set up to describe the population dynamics of HIV transmission in study area.The model was calibrated by fitting it to the HIV testing and treatment data from 2005 to 2008.Validation of the model was done by comparing its predicted value of HIV prevalence in 2010 to the prevalence data obtained in the 2010 population wide HIV testing.The validated model was used to produce estimation of HIV incidence,prevalence and death.Results:Our model estimations show that population-based HIV interventions have significantly slowed down the rise of the HIV epidemic in the two townships.Over the five-year period from 2005 to 2010,the year-over-year rate of increase in HIV incidence,prevalence,and death has declined by 91.5%,28.7%,and 52.3%,respectively.Conclusion:Mathematical models,when integrated with epidemiological and surveillance data,can be an effective tool for predicting the temporal dynamics of HIV and assessing the impacts of HIV interventions.
文摘A traditional Chinese medicinal capsule capable of curing HIV/AIDS has been put under clinical test with the approval of the State Food and Drug Administration.
文摘Background:Diagnostics are essential for identifying and controlling diseases.However,limited access to diagnostics hinders public health efforts in many settings.Social innovation may provide a framework for expanding access to diagnostics in the global south.Here social innovation is defined as implementing a known public health tool via a novel,community-driven technique.Main Body:In this article,we discuss three diverse cases that show the potential for using social innovation in diagnostics.The cases chosen for inclusion here demonstrate the importance of social innovation in diagnostics across different geographic,cultural,and health system contexts.They include malaria testing via schools in Malawi,cervical human papillomavirus(HPV)sample self-collection in Peru,and crowdsourcing human immunodeficiency virus(HIV)testing in China.For each case,we present the public health problem and the impact of using social innovation to increase accessibility of diagnostics.We discuss implications of each diagnostic approach and the importance of social innovation in creating these potential solutions.We argue that social innovation is useful in improving the delivery of essential diagnostic tools in low-and middle-income countries.Conclusions:Interventions in Malawi,Peru,and China suggest social innovation increases uptake of diagnostics.The same tools and principles utilized in these cases can be adapted for use in other contexts.Such diagnostic innovations may help improve identification of and linkage to care for many diseases.The approach presents a unique opportunity to better address public health issues and increase accessibility in LMIC health systems.
