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1
Mak, Joelle, Susannah H. Mayhew, Ariane von Maercker, Integra Research Team, and Manuela Colombini. "Men’s use of sexual health and HIV services in Swaziland: a mixed methods study." Sexual Health 13, no. 3 (2016): 265. http://dx.doi.org/10.1071/sh15244.
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Background: Over one-quarter of the adult population in Swaziland is estimated to be HIV positive. Men’s use of sexual health (SH) services has significant implications for HIV prevention. This study aimed to understand Swazi men’s health-seeking behaviours in relation to SH and HIV services. Methods: A household survey was conducted in Manzini (n = 503), complemented by 23 semi-structured interviews and two focus group discussions (with a total of 10 participants). Results: One-third of male survey participants used SH services in the past year, most commonly HIV testing (28%). Service users were more likely to be sexually active (aOR 3.21, 95% CI: 1.81–5.68 for those with one partner; and aOR 2.35, 95% CI: 1.25–4.41 for those with multiple partners) compared with service non-users. Service users were less likely to prefer HIV services to be separated from other healthcare services (aOR 0.50, 95% CI: 0.35–0.71), or to agree with travelling further for their HIV test (aOR 0.52, 95% CI: 0.33–0.82) compared with non-users, after controlling for age-group and education. Men avoided SH services because they feared being stigmatised by STI/HIV testing, are uncomfortable disclosing SH problems to female healthcare providers, and avoided HIV testing by relying on their wife’s results as a proxy for their own status. Informal providers, such as traditional healers, were often preferred because practitioners were more often male, physical exams were not required and appointments and payment options were flexible. Conclusion: To improve men’s uptake of SH services, providers and services need to be more sensitive to men’s privacy concerns, time restrictions and the potential stigma associated with STI/HIV testing.
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Pathmanathan, Ishani, Munyaradzi Pasipamire, Sherri Pals, et al. "High uptake of antiretroviral therapy among HIV-positive TB patients receiving co-located services in Swaziland." PLOS ONE 13, no. 5 (2018): e0196831. http://dx.doi.org/10.1371/journal.pone.0196831.
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Rudy, Ellen T., Pamela J. Mahoney-Anderson, Anita M. Loughlin, et al. "Perceptions of Human Immunodeficiency Virus (HIV) Testing Services Among HIV-Positive Persons Not in Medical Care." Sexually Transmitted Diseases 32, no. 4 (2005): 207–13. http://dx.doi.org/10.1097/01.olq.0000156132.19021.ba.
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O’Byrne, Patrick, Paul MacPherson, Marie Roy, and Lauren Orser. "Community-based, nurse-led post-exposure prophylaxis: results and implications." International Journal of STD & AIDS 28, no. 5 (2016): 505–11. http://dx.doi.org/10.1177/0956462416658412.
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HIV medications can be used as post-exposure prophylaxis to efficaciously prevent an HIV-negative person who has come into contact with HIV from becoming HIV-positive. Traditionally, these medications have been available in emergency departments, which have constituted a barrier for the members of many minority groups who are greatly affected by HIV transmission (i.e. gay, bisexual and other men who have sex with men, and persons who use injection drugs). From 5 September 2013 through 4 September 2015, we sought to increase the use of HIV post-exposure prophylaxis by having registered nurses provide these medications, when indicated, in community clinics in Ottawa, Canada. We undertook a chart review of patients who accessed services for HIV post-exposure prophylaxis in this period. Over the two years of data collection, 112 persons requested HIV post-exposure prophylaxis and 64% (n = 72) initiated these medications. Most (93%, or n = 67, of the 72 initiations) were among men, with 88% (n = 59) of these men reporting same sex sexual partners. Among these 58 men, 31% (n = 18) had sexual contact with other men known to be HIV-positive. Among women (n = 8), five initiated post-exposure prophylaxis: three after needle-sharing contact or sexual contact with a male partner who reportedly shared needles, and two after unprotected vaginal sex with a male partner known to be HIV-positive. Overall, no one was diagnosed with HIV at the four-month HIV testing follow-up, although six persons were diagnosed with HIV from the baseline HIV testing, and an additional four were diagnosed with HIV during routine HIV testing one year after completing post-exposure prophylaxis. In total, nine persons in our sample were thus diagnosed with HIV during the study period, which accounted for 9.4% (n = 10 of 106) of all reported HIV diagnoses in Ottawa during this time. We conclude that nurse-initiated HIV post-exposure prophylaxis can be an effective way to provide HIV prevention services to persons who are at high-risk for HIV.
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Horberg, Michael, Diana Antoniskis, Susan Bersoff-Matcha, et al. "Perceptions of Human Immunodeficiency Virus Testing Services Among HIV-Positive Persons Not in Medical Care." Sexually Transmitted Diseases 33, no. 7 (2006): 464. http://dx.doi.org/10.1097/01.olq.0000218870.48395.c0.
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Heath, Katherine V., Gerry Bally, Benita Yip, Michael V. O'Shaughnessy, and Robert S. Hogg. "HIV/AIDS care giving physicians: their experience and practice patterns." International Journal of STD & AIDS 8, no. 9 (1997): 570–75. http://dx.doi.org/10.1258/0956462971920802.
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To identify associations between HIV-related experience and patterns of service provision, physicians across Canada were solicited by mail to register in a national network of HIV/AIDS care givers. Respondents provided data about: personal, demographic and practice characteristics; the number of HIV-positive patients ever seen; the nature of the HIV-positive client population; and services provided to HIV-positive patients. Univariate techniques provided a demographic and professional profile of participating physicians. Logistic regression was used to identify associations between level of HIV-related experience and the provision of patient services. The 566 registered physicians have provided care to 56,378 HIVinfected persons and represent every province and territory in Canada. Multivariate analysis revealed that highly experienced physicians were more likely to provide all 3 types of services considered, to practise in Montreal, Vancouver or Toronto, and to < be medical specialists (all P 0.001).
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Unkle, DW. "Mandatory HIV testing in critical care/emergency patients." Critical Care Nurse 10, no. 10 (1990): 22–25. http://dx.doi.org/10.4037/ccn1990.10.10.22.
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Testing for the presence of the human immunodeficiency virus (HIV) remains one of the most controversial issues of this decade. Among persons diagnosed to be HIV positive, social ostracism and exaggerated atypical behavior are common. The resulting impact on the delivery of healthcare services to the seropositive patient has raised many ethical and professional dilemmas. Discussion of HIV testing and the subsequent effects of seropositivity on the delivery of healthcare will be emphasized.
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Onyemelukwe, Cheluchi. "Discrimination on the basis of HIV status." International Journal of Discrimination and the Law 17, no. 3 (2017): 160–79. http://dx.doi.org/10.1177/1358229117727415.
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HIV/AIDS remains a significant public health challenge in Nigeria, with over three million persons living with the condition. Throughout the history of HIV/AIDS in Nigeria, persons living with the condition have faced stigma and discrimination in various areas including access to health services, access to education, access to employment, among others. In the past, because of lacunae in Nigerian law and jurisprudence, it has been the subject of debate whether Nigerians living with HIV/AIDS are adequately protected by law. Recent developments in legislation such as the federal HIV/AIDS Anti-Discrimination Act, 2014 and judicial decisions in 2012 and 2016 on discrimination on the basis of HIV status suggest a positive shift of the law to full protection of the rights of persons living with HIV/AIDS in Nigeria, particularly in the area of employment. This article provides an analysis of these recent developments in the law and argues that the time has come to amend the Constitution of the Federal Republic of Nigeria to include health status as a ground upon which one cannot be unduly discriminated against.
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Ruzagira, Eugene, Kathy Baisley, Anatoli Kamali, and Heiner Grosskurth. "Factors associated with uptake of home-based HIV counselling and testing and HIV care services among identified HIV-positive persons in Masaka, Uganda." AIDS Care 30, no. 7 (2018): 879–87. http://dx.doi.org/10.1080/09540121.2018.1441967.
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Pereyra, Margaret, Lisa R. Metsch, Scott Tomar, et al. "Utilization of dental care services among low-income HIV-positive persons receiving primary care in South Florida." AIDS Care 23, no. 1 (2011): 98–106. http://dx.doi.org/10.1080/09540121.2010.498861.
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Sekla, Laila, Gregory Hammond, Robert Tate, Walter Stackiw, Gudrun Eibisch, and Sherlyn Shewchook. "Human Immunodeficiency Virus as a Sexually Transmitted Disease: Manitoba’s HIV Unlinked Seroprevalence Study." Canadian Journal of Infectious Diseases 3, no. 6 (1992): 295–98. http://dx.doi.org/10.1155/1992/202698.
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Objective: To determine the prevalence of human immunodeficiency virus (HIV)-1 infections.Design: An unlinked seroprevalence study on all ‘left over’ blood submitted for syphilis testing during three consecutive six month periods (April 1, 1990 to September 30, 1991). After the capture of demographic data, sera to be tested for antibodies were stripped of all personal identifiers and assigned a random number. The study fulfilled Canadian ethical guidelines.Participants: Persons with a valid Manitoba Health Services Commission number were included only once in a study year. Persons were enrolled into one of five categories: infants, injection drug users, pregnant women, persons investigated for sexually transmitted diseases (STD) and routine testing.Results: Of the 50,929 persons tested. 133 (0.26%) were positive, a low prevalence of HIV infections. A significant increase in positivity was noticed in the second study period. While 77.7% of those tested were women, only 10 (0.025%) were positive for HIV. The rate of positivity for pregnant women was 0.72 per 10,000 tested. Of the 11,314 males tested. 123 (1.08%) had antibodies. Most of the positives were males in the STD category residing in Winnipeg; for them, the rate of positivity increased by middle age, while the rate of testing decreased with each decade of age (from age 15 to 44 years).Discussion/Recommendation: This is the first report from a sentinel laboratory in Canada of an unlinked seroprevalence study in persons with STD. Results suggest an urgent need to target strategies for the control of HIV for persons with STD, particularly males in urban centres, by routine HIV testing for STD patients.
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Diallo, Abdoulaye, Chia Vang, Belinda Rivas, Antonio Aguirre, Carl Flowers, and Ngai Kwan. "The Use of Employment/Vocational Rehabilitation Services for Persons with HIV/AIDS and Substance Abuse: A potential Health Benefit." Journal of Applied Rehabilitation Counseling 48, no. 4 (2017): 28–37. http://dx.doi.org/10.1891/0047-2220.48.4.28.
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This study investigates Vocational Rehabilitation (VR) services related to competitive employment closure among non-Hispanic Blacks (NHB), non-Hispanic Whites (NHW), and Hispanics with HIV/AIDS and substance use disorder (SUD). Data of 4150 was extracted from the Rehabilitation Services Administration (RSA-911) database. Descriptive statistics and multi-variate analysis showed consumers who received SSI and Medicare were less likely to be employed than those who did not, and, NHW who received rehabilitation counseling and guidance benefited the most compared to NHB who did not. Rehabilitation counselors can assist minorities with HIV/AIDS and SUD secure employment given the positive effects of employment for this population. Health professionals should consider incorporating employment, using VR services in their treatment strategies, while making sure clients with different racial ethnicity background benefit equally from all VR services.
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Goldstein, Alexa, and David J. Riedel. "327. Barriers to Positive Health Outcomes in the HIV-Infected Cancer Clinic Population." Open Forum Infectious Diseases 6, Supplement_2 (2019): S173—S174. http://dx.doi.org/10.1093/ofid/ofz360.400.
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Abstract Background Significant disparities in morbidity and mortality from cancer in HIV-infected persons exist compared with those with cancer in the general population. This study sought to identify psychological, social and economic factors impacting or impeding cancer care in the HIV-infected population. Methods A voluntary, anonymous one-time questionnaire was completed by patients diagnosed with cancer who are HIV-infected and HIV-uninfected at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC). Andersen’s Behavioral Model of Health Services Use served as the theoretical framework for assessing psychological, social, and economic barriers to care. We used the chi-square test to evaluate the association between HIV status and barriers to accessing cancer care. Results A total of 25 HIV-infected and 100 HIV-uninfected cases were included. More HIV-infected patients with cancer experienced self-esteem and fear barriers to a greater degree than their HIV-uninfected counterparts (28% vs. 15% for self-esteem, and 40% vs. 21%). A significant proportion of HIV-infected individuals reported experiencing insufficient social support (32% vs. 10% in the HIV-uninfected population, P = 0.01). HIV-infected individuals reported that they did not feel looked down upon in the cancer clinic. They also described that their cancer and HIV diagnoses were delivered in a similar manner by the provider. Conclusion Given that HIV-infected persons are experiencing lower survival rates for most cancer subtypes when compared with their HIV-uninfected counterparts, there is a need to further investigate the feelings of fear, low self-esteem, and insufficient support reported in the HIV-infected sample. Cancer care may need to be tailored to reflect the differences in psychological barriers and enabling resources that continue to be disproportionately prevalent in HIV-infected patients. Disclosures All authors: No reported disclosures.
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Skovdal, Morten, Alison Wringe, Janet Seeley, et al. "Using theories of practice to understand HIV-positive persons varied engagement with HIV services: a qualitative study in six Sub-Saharan African countries." Sexually Transmitted Infections 93, Suppl 3 (2017): e052977. http://dx.doi.org/10.1136/sextrans-2016-052977.
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Whyte IV, James, Maria D. Whyte, and Sabrina Dickey. "A study of HIV positive undocumented African migrants’ access to health services in the UK." Journal of Nursing Education and Practice 9, no. 1 (2018): 122. http://dx.doi.org/10.5430/jnep.v9n1p122.
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Newly immigrated persons, whatever their origin, tend to fall in the lower socioeconomic levels. In fact, failure of an asylum application renders one destitute in a large proportion of cases, often resulting in a profound lack of access to basic necessities. With over a third of HIV positive failed asylum seekers reporting no income, and the remainder reporting highly limited resources, poverty is a reality for the vast majority. The purpose of the study was to determine the basic social processes that guide HIV positive undocumented migrant’s efforts to gain health services in the UK. The study used the Grounded Theory Approach. Theoretical saturation occurred after 16 participants were included in the study. The data included reflections of the prominent factors related to the establishment of a safe and productive life and the ability of individuals to remain within the UK. The data reflected heavily upon the ability of migrants to enter the medical care system during their asylum period, and on an emerging pattern of service denial after loss on immigration appeal, which often resulted in a discontinuation of medical therapies. This inevitably was associated with a pattern of decline and inability to fundamental needs. The findings of this study are notable in that they have demonstrated sequence of events along a timeline related to the interaction between the asylum process and access to health related services. The results reflect that African migrants maintain a degree of formal access to health services during the period that they possess legal access to services and informal access after the failure of their asylum claim.
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Zhong, Yaoyu, Christopher M. Beattie, John Rojas, X. Pamela Farquhar, Paul A. Brown, and Ellen W. Wiewel. "Enrollment Length, Service Category, and HIV Health Outcomes Among Low-Income HIV-Positive Persons Newly Enrolled in a Housing Program, New York City, 2014–2017." American Journal of Public Health 110, no. 7 (2020): 1068–75. http://dx.doi.org/10.2105/ajph.2020.305660.
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Objectives. To evaluate the impact of duration and service category on HIV health outcomes among low-income adults living with HIV and enrolled in a housing program in 2014 to 2017. Methods. We estimated relative risk of engagement in care, viral suppression, and CD4 improvement for 561 consumers at first and second year after enrollment to matched controls through the New York City HIV surveillance registry, by enrollment length (enrolled for more than 1 year or not) and service category (housing placement assistance [HPA], supportive permanent housing [SPH], and rental assistance [REN]). Results. The SPH and REN consumers were enrolled longer and received more services, compared with HPA consumers. Long-term SPH and REN consumers had better engagement in care, viral suppression, and CD4 count than controls at both first and second year after enrollment, but the effect did not grow bigger from year 1 to 2. HPA consumers did not have better outcomes than controls regardless of enrollment length. Conclusions. Longer enrollment with timely housing placement and a higher number and more types of services are associated with better HIV health outcomes for low-income persons living with HIV with unmet housing needs.
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Balasubramaniam, Senthilsayinathan, Kasikrishnaraja Pauldurai, Madhushanthini Eswaran, Mohankumar Vethanayagam, and Rajesh Rajagopalan. "Prevalence and patterns of psychiatric morbidity in people living with HIV." International Journal of Research in Medical Sciences 5, no. 5 (2017): 2011. http://dx.doi.org/10.18203/2320-6012.ijrms20171834.
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Background: Diagnosis of HIV infection creates an overwhelming stress and leads to symptoms like guilt, fear, anxiety, sad mood, grief and suicidal ideation. Though the rate of suicide has decreased after the introduction of highly active anti-retroviral therapy (HAART), it still remains high. Indian studies assessing suicidal ideation in people living with HIV (PLHIV) are scarce. Psychiatric evaluation and treatment improves the quality of life in PLHIV. Aim of the study was to assess the prevalence and patterns of psychiatric morbidity including suicidal ideation in PLHIV attending Integrated Counselling and Testing Centre (ICTC), prior to initiation of ART.Methods: A cross sectional study design was used. 11476 persons attending ICTC of IRT Perundurai Medical College, Erode, Tamil Nadu, India were tested for their HIV status over a period of two years. 211 persons were found to be positive, 143 persons gave consent and met inclusion criteria. Every patient underwent a semi-structured clinical interview and their psychiatric morbidity was assessed based on ICD 10. Current suicidal behavior, hopelessness and depression were measured by appropriate rating scales. Data was analyzed by using the SPSS 16.Results: Psychiatric diagnosis was present in 36.4% of the sample. Depression was the commonest diagnosis followed by adjustment disorder, alcohol related problems and anxiety disorder. 26 persons (18.2%) had current suicidal ideation. 3 out of 143 persons had attempted suicide within 6 months following notification of their HIV status.Conclusions: Nearly 1/3rd of PLHIV require psychiatric referral and 1/5th of PLHIV have suicidal ideation. It will be highly beneficial to integrate psychiatric services into daily care of PLHIV.
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Thekkur, Pruthu, Hannock Tweya, Sam Phiri, et al. "Assessing the Impact of COVID-19 on TB and HIV Programme Services in Selected Health Facilities in Lilongwe, Malawi: Operational Research in Real Time." Tropical Medicine and Infectious Disease 6, no. 2 (2021): 81. http://dx.doi.org/10.3390/tropicalmed6020081.
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When the COVID-19 pandemic was announced in March 2020, there was concern that TB and HIV programme services in Malawi would be severely affected. We set up real-time monthly surveillance of TB and HIV activities in eight health facilities in Lilongwe to see if it was possible to counteract the anticipated negative impact on TB case detection and treatment and HIV testing. Aggregate data were collected monthly during the COVID-19 period (March 2020–February 2021) using an EpiCollect5 application and compared with monthly data collected during the pre-COVID-19 period (March 2019–February 2020); these reports were sent monthly to programme directors. During COVID-19, there was an overall decrease in persons presenting with presumptive pulmonary TB (45.6%), in patients registered for TB treatment (19.1%), and in individuals tested for HIV (39.0%). For presumptive TB, children and females were more affected, but for HIV testing, adults and males were more affected. During COVID-19, the TB treatment success rate (96.1% in pre-COVID-19 and 96.0% during COVID-19 period) and referral of HIV-positive persons to antiretroviral therapy (100% in pre-COVID-19 and 98.6% during COVID-19 period) remained high and largely unchanged. Declining trends in TB and HIV case detection were not redressed despite real-time monthly surveillance.
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Geelhoed, Diederike, Tom Decroo, Sergio Dezembro, et al. "Utilization of and Barriers to HIV and MCH Services among Community ART Group Members and Their Families in Tete, Mozambique." AIDS Research and Treatment 2013 (2013): 1–8. http://dx.doi.org/10.1155/2013/937456.
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Mozambique continues to face many challenges in HIV and maternal and child health care (MCH). Community-based antiretroviral treatment groups (CAG) enhance retention to care among members, but whether such benefits extend to their families and to MCH remains unclear. In 2011 we studied utilization of HIV and MCH services among CAG members and their family aggregates in Changara, Mozambique, through a mixed-method assessment. We systematically revised all patient-held health cards from CAG members and their non-CAG family aggregate members and conducted semistructured group discussions on MCH topics. Quantitative data were analysed in EPI-Info. Qualitative data were manually thematically analysed. Information was retrieved from 1,624 persons, of which 420 were CAG members (26%). Good compliance with HIV treatment among CAG members was shared with non-CAG HIV-positive family members on treatment, but many family aggregate members remained without testing, and, when HIV positive, without HIV treatment. No positive effects from the CAG model were found for MCH service utilization. Barriers for utilization mentioned centred on insufficient knowledge, limited community-health facility collaboration, and structural health system limitations. CAG members were open to include MCH in their groups, offering the possibility to extend patient involvement to other health needs. We recommend that lessons learnt from HIV-based activism, patient involvement, and community participation are applied to broader SRH services, including MCH care.
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Thekkur, Pruthu, Kudakwashe C. Takarinda, Collins Timire, et al. "Operational Research to Assess the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Health Facilities in Harare, Zimbabwe." Tropical Medicine and Infectious Disease 6, no. 2 (2021): 94. http://dx.doi.org/10.3390/tropicalmed6020094.
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When COVID-19 was declared a pandemic, there was concern that TB and HIV services in Zimbabwe would be severely affected. We set up real-time monthly surveillance of TB and HIV activities in 10 health facilities in Harare to capture trends in TB case detection, TB treatment outcomes and HIV testing and use these data to facilitate corrective action. Aggregate data were collected monthly during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data extracted for the pre-COVID-19 period (March 2019–February 2020). Monthly reports were sent to program directors. During the COVID-19 period, there was a decrease in persons with presumptive pulmonary TB (40.6%), in patients registered for TB treatment (33.7%) and in individuals tested for HIV (62.8%). The HIV testing decline improved in the second 6 months of the COVID-19 period. However, TB case finding deteriorated further, associated with expiry of diagnostic reagents. During the COVID-19 period, TB treatment success decreased from 80.9 to 69.3%, and referral of HIV-positive persons to antiretroviral therapy decreased from 95.7 to 91.7%. Declining trends in TB and HIV case detection and TB treatment outcomes were not fully redressed despite real-time monthly surveillance. More support is needed to transform this useful information into action.
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Sammons, Mary Katherine, Matthew Gaskins, Frank Kutscha, Alexander Nast, and Ricardo Niklas Werner. "HIV Pre-exposure Prophylaxis (PrEP): Knowledge, attitudes and counseling practices among physicians in Germany – A cross-sectional survey." PLOS ONE 16, no. 4 (2021): e0250895. http://dx.doi.org/10.1371/journal.pone.0250895.
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Background German statutory health insurance began covering the costs associated with HIV PrEP in September 2019; however, to bill for PrEP services, physicians in Germany must either be certified as HIV-specialists according to a nationwide quality assurance agreement, or, if they are non-HIV-specialists, have completed substantial further training in HIV/PrEP care. Given the insufficient implementation of PrEP, the aim of our study was to explore the potential to increase the number of non-HIV-specialists providing PrEP-related services. Methods We conducted an anonymous survey among a random sample of internists, general practitioners, dermatologists and urologists throughout Germany using a self-developed questionnaire. We calculated a knowledge score and an attitudes score from individual items in these two domains. Both scores ranged from 0–20, with high values representing good knowledge or positive attitudes. We also asked participants about the proportion of PrEP advice they provided proactively to men who have sex with men (MSM) and trans-persons who met the criteria to be offered PrEP. Results 154 physicians completed the questionnaire. Self-assessed knowledge among HIV-specialists was greater than among non-HIV-specialists [Median knowledge score: 20.0 (IQR = 0.0) vs. 4.0 (IQR = 11.0), p<0.001]. Likewise, attitudes towards PrEP were more positive among HIV-specialists than non-HIV-specialists [Median attitudes score: 18.0 (IQR = 3.0) vs. 13.0 (IQR = 5.25), p<0.001]. The proportion of proactive advice on PrEP provided to at-risk MSM and trans-persons by HIV-specialists [Median: 30.0% (IQR = 63.5%)] was higher than that provided by non-HIV-specialists [Median: 0.0% (IQR = 11.3%), p<0.001]. However, the results of our multiple regression suggest the only independent predictor of proactive PrEP advice was the knowledge score, and not whether physicians were HIV-specialists or non-HIV-specialists. Conclusions These findings point to opportunities to improve PrEP implementation in individuals at risk of acquiring HIV. Targeted training, particularly for non-HIV-specialists, and the provision of patient-centered information material could help improve care, especially in rural areas.
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Burton, Nicole Theresa, Kavita Misra, Angelica Bocour, Sharmila Shah, Rodolfo Gutierrez, and Chi-Chi Udeagu. "Inconsistent condom use with known HIV-positive partners among newly diagnosed HIV-positive men who have sex with men interviewed for partner services in New York City, 2014." Sexually Transmitted Infections 95, no. 2 (2018): 108–14. http://dx.doi.org/10.1136/sextrans-2017-053479.
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ObjectivesCondomless anal intercourse contributes significantly to the spread of HIV among men who have sex with men (MSM). Factors related to condomless anal intercourse with known HIV-positive partners among MSM are not well understood. The authors describe factors associated with inconsistent condom use with known HIV-positive partners prior to participants’ diagnosis with HIV.MethodsNew York City health department disease intervention specialists interviewed newly HIV-diagnosed MSM ages ≥13 years reporting knowingly having anal sex with HIV-positive partners between June 2013 and October 2014. Univariate and bivariate statistics were calculated, in addition to logistic regression analysis.ResultsAmong 95 MSM interviewed, 56% were >30 years and 74% had higher than a high school education. Respondents reported a median of 2 known HIV-positive sex partners. Drug or alcohol use during last sex with their last known HIV-positive partner was reported by 53% of participants. Sixty-five per cent of participants reported inconsistent condom use with last known HIV-positive partner. Inconsistent condom use with all HIV-positive partners was higher among individuals reporting two or more known HIV-positive partners since sexual debut than among those with one (90% vs 59%, p<0.01) and among those reporting feelings of love/emotional attachment as a reason for having sex (85% vs 63%, p=0.02). In the bivariate logistic regression models for inconsistent condom use, feelings of love or emotional attachment were the only significant predictor of inconsistent condom use (OR 3.43, 95% CI 1.23 to 9.58). After adjusting for confounding, the relationship feelings of love or emotional attachment continued to be the only significant predictor of inconsistent condom use (OR 3.69, 95% CI 1.06 to 12.82).ConclusionsSurveyed MSM engaged in high-risk behaviours, including condomless anal sex and drug or alcohol use during sex with persons known to be HIV-positive. These findings can inform interventions with MSM in serodiscordant partnerships.
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Teresa Dawson, Maria, Paul Grech, Brendan Hyland, et al. "A Qualitative Approach to the Mental Health Care Needs of People Living with HIV/AIDS in Victoria." Australian Journal of Primary Health 8, no. 3 (2002): 30. http://dx.doi.org/10.1071/py02041.
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This article reports on the findings of the qualitative stage of a larger project on the mental care needs of people with HIV/AIDS and mental illness (Tender T1176 Department of Human Services, Mental Health Branch, Victoria - Research on the Mental Health Care Needs of People with HIV/AIDS and Mental Illness). The purpose of the larger research was to evaluate the needs and treatment requirements of persons with HIV/AIDS, who also suffer from mental health problems, with a view to developing proposals for improving existing service delivery in Victoria, Australia. The qualitative stage was designed to complement and elucidate data obtained through the quantitative stages of the project. Thirty in-depth open-ended interviews were carried out with service providers including HIV physicians, general practitioners, psychiatrists, clinical and managerial staff of Area Mental Health Services, Contact Tracers and forensic mental health services staff, as well as representatives of community groups such as People Living with HIV/AIDS and Positive Women and carers. The interviews explored the perspective of both service providers and users of such services with respect to needs for psychiatric care and service delivery, ease of access or barriers to mental health services, and the perceived strengths and weaknesses in current service provision. This paper presents the main findings and recommendations submitted to the funding body.
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Scheer, Susan, Alison J. Hughes, Judith Tejero, et al. "Regional Differences Among HIV Patients in Care: California Medical Monitoring Project Sites, 2007-2008." Open AIDS Journal 6, no. 1 (2012): 188–95. http://dx.doi.org/10.2174/1874613601206010188.
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Introduction: The Medical Monitoring Project (MMP) is a national, multi-site population-based supplemental HIV/AIDS surveillance project of persons receiving HIV/AIDS care. We compared California MMP data by region. Demographic characteristics, medical care experiences, HIV treatment, clinical care outcomes, and need for support services are described. Methods: HIV-infected patients 18 years or older were randomly selected from medical care facilities. In person structured interviews from 2007 - 2008 were used to assess sociodemographic characteristics, self-reported clinical outcomes, and need for supportive services. Pearson chi-squared, Fisher’s exact and Kruskal-Wallis p-values were calculated to compare regional differences. Results: Between 2007 and 2008, 899 people were interviewed: 329 (37%) in San Francisco (SF), 333 (37%) in Los Angeles (LA) and 237 (26%) in other California counties. Significant regional sociodemographic differences were found. Care received and clinical outcomes for patients in MMP were positive and few regional differences were identified. HIV case management (36%), mental health counseling (35%), and dental services (29%) were the supportive services patients most frequently needed. Unmet needs for supportive services were low overall. Significant differences by region in needed and unmet need services were identified. Discussion: The majority of MMP respondents reported standard of care CD4 and viral load monitoring, high treatment use, undetectable HIV viral loads and CD4 counts indicative of good immune function and treatment efficacy. Information from MMP can be used by planning councils, policymakers, and HIV care providers to improve access to care and prevention. Identifying regional differences can facilitate sharing of best practices among health jurisdictions.
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Donovan, Basil, Robert J. Finlayson, Kieran Mutimer, et al. "HIV Infection in Sexually Transmissible Disease Practice in Sydney: The Effects of Legislation, Public Education and Changing Clinical Spectrum." International Journal of STD & AIDS 1, no. 1 (1990): 21–27. http://dx.doi.org/10.1177/095646249000100106.
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The experience with human immunodeficiency virus (HIV) infection of a private inner-city sexually transmissible diseases (STD) clinic in Sydney was quantified. Between February 1984 and March 1988, 2073 of the Clinic's patients were tested for antibodies to HIV on 5095 occasions. Of those tested, 538 (26%) were positive for antibodies to HIV: 532 (98.9%) of the seropositives had practised male homosexual intercourse. This is the highest reported seroprevalence of HIV for any primary care service in Australia. Those individuals seropositive because of other risk behaviours were detected by voluntary contact tracing rather than by screening. Female prostitution was not found to be a risk factor for HIV. In general, rates of first HIV antibody tests were adversely affected by threatening legislation, and temporarily stimulated (among lower-risk persons) by a national television campaign. These data suggest that much of the counselling, detection and management of HIV infection in Australia is occurring in private practice, and that STD services (private and public) are at the forefront of the HIV epidemic. This has implications for disease surveillance and control, health services planning and medical education.
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Wiersema, Janet J., Jacqueline Cruzado-Quiñones, Carmen G. Cosme Pitre, and Alison O. Jordan. "Client Outcomes From a Multilevel Intervention to Support Persons Living With HIV and Returning to the Community After Incarceration in Puerto Rico." AIDS Education and Prevention 32, no. 3 (2020): 181–95. http://dx.doi.org/10.1521/aeap.2020.32.3.181.
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The twin epidemics of HIV and incarceration impact Puerto Rico, which has limited resources to address the social and structural determinants of health in incarcerated populations. A Special Programs of National Significance grant supported a Puerto Rican community-based organization to implement the evidence-informed Transitional Care Coordination intervention among incarcerated persons living with HIV, targeting changes at the individual, organization, and systems levels. After implementation (November 2015–July 2018; n = 69), 93.1% of eligible clients were linked to community-based HIV care, 86.3% remained in care for 6 months, and 78.6% remained for 12 months. A greater proportion reported consistent HIV care, ART adherence, food security, and transportation to access care. Integrating HIV case management with housing and employment services, and developing buy-in and collaboration from partners across systems of care, including after a natural disaster, led to positive client outcomes. This intervention shows promise for adaptation to other HIV care and service delivery systems.
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Bukenya, Dominic, Janet Seeley, Grace Tumwekwase, Elizabeth Kabunga, and Eugene Ruzagira. "How Follow-Up Counselling Increases Linkage to Care Among HIV-Positive Persons Identified Through Home-Based HIV Counselling and Testing: A Qualitative Study in Uganda." SAGE Open 10, no. 1 (2020): 215824401990016. http://dx.doi.org/10.1177/2158244019900166.
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We investigated how follow-up counselling had increased linkage to HIV care in a trial of referral to care and follow-up counseling, compared to referral to care only, for participants diagnosed as HIV-positive through home-based HIV counseling and testing. We carried out a cross-sectional qualitative study. Using random stratified sampling, we selected 43 trial participants (26 [60%] in the intervention arm). Sample stratification was by sex, distance to an ART facility, linkage, and nonlinkage to HIV care. Twenty-six in-depth interviews were conducted with participants in the intervention arm: 17 people who had linked to HIV care and 9 who had not linked after 6 months of follow-up. Home-based follow-up counseling helped to overcome worries resulting from an HIV-positive test result. In addition, the counseling offered an opportunity to address questions on HIV treatment side effects, share experiences of intimate partner violence or threats, and general problems linking to care. The counselling encouraged early linkage to HIV care and use of biomedical medicines, discouraging alternative medicine usage. Home-based follow-up counseling also helped to promote HIV sero-status disclosure, facilitating linkage to, retention in and adherence to HIV care and treatment. This study successfully demonstrated that home-based follow-up counselling increased linkage to care through encouragement to seek care, provision of accurate information about HIV care services and supporting the person living with HIV to disclose and manage stigma.
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Delva, Guesly J., Ingrid Francois, Cassidy W. Claassen, et al. "Active Tuberculosis Case Finding in Port-au-Prince, Haiti: Experiences, Results, and Implications for Tuberculosis Control Programs." Tuberculosis Research and Treatment 2016 (2016): 1–11. http://dx.doi.org/10.1155/2016/8020745.
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Background. Haiti has the highest tuberculosis (TB) prevalence in the Americas with 254 cases per 100,000 persons. Case detection relies on passive detection and TB services in many regions suffer from poor diagnostic and clinical resources.Methods.Mache Chache(“Go and Seek”) was a TB REACH Wave 3 funded TB case finding project in Port-au-Prince between July 2013 and September 2014, targeting four intervention areas with insufficient TB diagnostic performance.Results. Based on a verbal symptom screen emphasizing the presence of cough, the project identified 11,150 (11.75%) of all screened persons as TB subjects and 2.67% as smear-positive (SS+) TB cases. Enhanced case finding and strengthening of laboratory services led to a 59% increase in bacteriologically confirmed cases in the evaluation population. In addition, smear grades dropped significantly, suggesting earlier case detection. Xpert® MTB/RIF was successfully introduced and improved TB diagnosis in HIV-infected, smear-negative clinic patients, but not in HIV-negative, smear-negative TB suspects in the community. However, the number needed to screen for one additional SS+ case varied widely between clinic and community screening activities.Conclusion. Enhanced and active TB case finding in Haiti can improve TB diagnosis and care. However, screening algorithms have to be tailored to individual settings, necessitating long-term commitment.
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Sun, Christina J., Jennifer L. Nall, and Scott D. Rhodes. "Perceptions of Needs, Assets, and Priorities Among Black Men Who Have Sex With Men With HIV: Community-Driven Actions and Impacts of a Participatory Photovoice Process." American Journal of Men's Health 13, no. 1 (2018): 155798831880490. http://dx.doi.org/10.1177/1557988318804901.
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Black men who have sex with men (MSM) with HIV experience significant health inequities and poorer health outcomes compared with other persons with HIV. The primary aims of this study were to describe the needs, assets, and priorities of Black MSM with HIV who live in the Southern United States and identify actions to improve their health using photovoice. Photovoice, a participatory, collaborative research methodology that combines documentary photography with group discussion, was conducted with six Black MSM with HIV. From the photographs and discussions, primary themes of discrimination and rejection, lack of mental health services, coping strategies to reduce stress, sources of acceptance and support, and future aspirations emerged. After the photographs were taken and discussed, the participants hosted a photo exhibition and community forum for the public. Here, 37 community attendees and influential advocates collaborated with the participants to identify 12 actions to address the men’s identified needs, assets, and priorities. These included making structural changes in the legal and medical systems, encouraging dialogue to eliminate multiple forms of stigma and racism, and advocating for comprehensive care for persons with HIV. As a secondary aim, the impacts of photovoice were assessed. Participants reported enjoying photovoice and found it meaningful. Results suggest that in addition to cultivating rich community-based knowledge, photovoice may result in positive changes for Black MSM with HIV.
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Camino, Andres, Meghan Whitfield, and Nicholas Van Wagoner. "10543 Assessing Sexual Health Services at a public university in the Deep South." Journal of Clinical and Translational Science 5, s1 (2021): 26. http://dx.doi.org/10.1017/cts.2021.472.
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ABSTRACT IMPACT: Our work helps show universities that embedding dedicated sexual health clinics within university health and wellness clinics may expand the amount of students they see for sexual health screenings during a time of increased sexual behavior and exploration. OBJECTIVES/GOALS: The National College Health Association reports that college students have frequent, condomless sex. Student health and wellness clinics (SHWC) offer sexual health services, but few have dedicated sexual health clinics (SHC). We evaluated sexual health service use at a university SHWC after implementation of a dedicated SHC two half-days per week. METHODS/STUDY POPULATION: This was a retrospective analysis of data collected from patients receiving sexual health screening at the University of Alabama at Birmingham (UAB) SHWC between January 2015 and June 2019. Demographic variables, sexual behaviors, reason for testing, and rates of STIs were extracted from the electronic medical record and were compared by clinic (SHC vs. SHWC). Data on screening visits of patients over 18 were included in the final analysis. Variables were summarized with frequencies and percentages. Univariate models were fit, and multi-variable models will be fit, selecting variables with p values of 0.1 or less. Odds ratios with corresponding 95% confidence intervals for univariate analysis are presented. The study was approved by the UAB Institutional Review Board. RESULTS/ANTICIPATED RESULTS: A total of 5025 STI screenings were performed. Males (OR 4.13; 3.61-4.72), undergraduates (OR 1.33; 1.15-1.54), and persons reporting sex with the same sex (OR 1.88; 1.56-2.28), were significantly more likely to seek care at the SHC. Students with symptoms were more likely to seek care at the SHWC (OR 0.53; 0.47-0.61), while persons who reported contact with STIs were more likely to seek care at the SHC (OR 2.88; 2.22-3.74). The overall percentage of positive screenings was 9.3% for chlamydia (CT), 3.0% for gonorrhea (GC), 0.8% for trichomoniasis (TV), 0.7% for syphilis, and 0.3% for HIV with higher percentages of positive for CT (OR 1.60; 1.30-1.96) and GC (OR 2.02; 1.44-2.85) in the SHC. A greater percentage of positives for TV (OR 0.37; 0.14-0.96) was found in the SHWC. DISCUSSION/SIGNIFICANCE OF FINDINGS: Based on demographics of persons utilizing services, embedding a dedicated SHC within a university SHWC may expand populations reached for STI screening. With higher percentages of patients testing positive for CT and GC, a SHC may allow for greater diagnosis and treatment of STIs in general screening and persons presenting as contacts.
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Lin, Carol, Isabelle Casavant, Alicia Jaramillo, and Timothy Green. "Using repeated home-based HIV testing services to reach and diagnose HIV infection among persons who have never tested for HIV, Chókwè health demographic surveillance system, Chókwè district, Mozambique, 2014–2017." PLOS ONE 15, no. 11 (2020): e0242281. http://dx.doi.org/10.1371/journal.pone.0242281.
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Background HIV prevalence in Mozambique (12.6%) is one of the highest in the world, yet ~40% of people living with HIV (PLHIV) do not know their HIV status. Strategies to increase HIV testing uptake and diagnosis among PLHIV are urgently needed. Home-based HIV testing services (HBHTS) have been evaluated primarily as a 1-time campaign strategy. Little is known about the potential of repeating HBHTS to diagnose HIV infection among persons who have never been tested (NTs), nor about factors/reasons associated with never testing in a generalized epidemic setting. Methods During 2014–2017, counselors visited all households annually in the Chókwè Health and Demographic Surveillance System (CHDSS) and offered HBHTS. Cross-sectional surveys were administered to randomly selected 10% or 20% samples of CHDSS households with participants aged 15–59 years before HBHTS were conducted during the visit. Descriptive statistics and logistic regression were used to assess the proportion of NTs, factors/reasons associated with never having been tested, HBHTS acceptance, and HIV-positive diagnosis among NTs. Results The proportion of NTs decreased from 25% (95% confidence interval [CI]:23%–26%) during 2014 to 12% (95% CI:11% –13%), 7% (95% CI:6%–8%), and 7% (95% CI:6%–8%) during 2015, 2016, and 2017, respectively. Adolescent boys and girls and adult men were more likely than adult women to be NTs. In each of the four years, the majority of NTs (87%–90%) accepted HBHTS. HIV-positive yield among NTs subsequently accepting HBHTS was highest (13%, 95% CI:10%–15%) during 2014 and gradually reduced to 11% (95% CI:8%–15%), 9% (95% CI:6%–12%), and 2% (95% CI:0%–4%) during 2015, 2016, and 2017, respectively. Conclusions Repeated HBHTS was helpful in increasing HIV testing coverage and identifying PLHIV in Chókwè. In high HIV-prevalence settings with low testing coverage, repeated HBHTS can be considered to increase HIV testing uptake and diagnosis among NTs.
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Kalichman, Seth C., Dominica Hernandez, Stephanie Finneran, Devon Price, and Redd Driver. "Transgender women and HIV-related health disparities: falling off the HIV treatment cascade." Sexual Health 14, no. 5 (2017): 469. http://dx.doi.org/10.1071/sh17015.
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Background Transgender women living with HIV infection experience poorer health outcomes across the HIV continuum of care. While disparities are well established, their underlying mechanisms are not well understood. This study examined the HIV continuum of care (also known as the HIV treatment cascade), including linkage and engagement in care and health status among transgender women and cisgender women and cisgender men living with HIV. Method: Case-control matching was applied to a cohort of 1101 people living with HIV; 70 transgender women living with HIV were matched on years since testing HIV positive with cisgender women and cisgender men. Participants provided measures indicative of the HIV treatment cascade that included linkage and engagement in care, receiving and adhering to antiretroviral therapy (ART), and HIV viral suppression. Common correlates of HIV-related health status: depression symptoms, HIV-related stress, alcohol and drug use, healthcare conspiracy beliefs, medical mistrust, emotional social support and tangible social support, were also assessed. Results: Transgender women were significantly less likely to receive ART, were less adherent to ART and had poorer HIV viral suppression than cisgender persons. Multivariable models demonstrated that health disparities were predicted by transgender women having poorer tangible social support over and above the other correlates of health outcomes. Conclusion: Tangible support is amenable by interventions such as building and strengthening supportive networks and paraprofessional services. Socially supportive interventions should be considered critical in efforts to decrease HIV health disparities among transgender women.
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Fadul, Nada, Ciarra Dortche, Richard Baltaro, and Tim Reeder. "1273. Routine Opt-out HIV Screening and Detection of HIV Infection Among Emergency Department Patients." Open Forum Infectious Diseases 5, suppl_1 (2018): S388. http://dx.doi.org/10.1093/ofid/ofy210.1106.
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Abstract Background The Southeastern United States bears a disproportionate burden of HIV infection, accounting for nearly half of all new cases. The Centers for Disease Control and Prevention released routine opt-out testing recommendations in 2006. Our emergency department collaborated with our infectious diseases clinic (ECU-ID) to implement suggested guidelines among adults since March 2017. Methods Our primary aim was to implement routine, opt-out HIV testing in the Vidant Medical Center Emergency Department (ED) for patients between 18 and 65 years of age who have blood work completed, and have not had a test documented in the electronic medical record (EMR) in the last year. A secondary aim was to successfully link HIV-positive patients to care at ECU-ID or preferred clinic. Methods defining programmatic success included developing nurse directed opt-out ordering protocol, integrating testing into normal ED workflow, utilizing the existing EMR to prompt testing, and hiring a linkage coordinator to initiate post-test counseling and linkage-to-care. Results Since March 2, 2017, a total of 7,109 HIV tests were performed; an average of 592 monthly tests conducted compared with a previous average of 10 stat tests. Testing increased 5,820% compared with 2015. Of the 21 HIV-positive patients found, 16 were newly diagnosed. Among those newly diagnosed, 14 (87.5%) were linked to care; and among the five known positives, two (40%) were linked to care. Reasons why patients could not be linked included incarceration, refusal to link to care, and re-location. Conclusion Joined with the implementation of a routinized ED HIV testing program, a seamless process was developed to link persons found to be positive in the ED to HIV care services; therefore, establishing a systems-level prevention model. Future plans include expanding testing to adolescents and utilizing similar methods to integrate Hepatitis C testing. Disclosures All Authors. Gilead Sciences, Inc.: Grant Investigator, Grant recipient and Salary.
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Zinski, Anne, Sarah M. Dougherty, Ashutosh Tamhane, Kelly L. Ross-Davis, and James L. Raper. "Point-of-Care HIV Testing and Linkage in an Urban Cohort in the Southern US." AIDS Research and Treatment 2013 (2013): 1–12. http://dx.doi.org/10.1155/2013/789413.
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The Southern states experience the highest rates of HIV and AIDS in the US, and point-of-care (POC) testing outside of primary care may contribute to status awareness in medically underserved populations in this region. To evaluate POC screening and linkage to care at an urban south site, analyses were performed on a dataset of 3,651 individuals from an integrated rapid-result HIV testing and linkage program to describe this test-seeking cohort and determine trends associated with screening, results, and linkage to care. Four percent of the population had positive results. We observed significant differences by test result for age, race and gender, reported risk behaviors, test location, and motivation for screening. The overall linkage rate was 86%, and we found significant differences for clients who were linked to HIV care versus persons whose linkage could not be confirmed with respect to race and gender, location, and motivation. The linkage rate for POC testing that included a comprehensive intake visit and colocated primary care services for in-state residents was 97%. Additional research on integrated POC screening and linkage methodologies that provide intake services at time of testing is essential for increasing status awareness and improving linkage to HIV care in the US.
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Gosselin, Anne, Andrainolo Ravalihasy, Julie Pannetier, France Lert, and Annabel Desgrées du Loû. "When and why? Timing of post-migration HIV acquisition among sub-Saharan migrants in France." Sexually Transmitted Infections 96, no. 3 (2019): 227–31. http://dx.doi.org/10.1136/sextrans-2019-054080.
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ObjectiveRecent studies highlighted that many HIV-positive migrants in Europe acquired their infections post-migration. However, the timing of these infections is not always known. This study aims to estimate the timing of post-migration HIV acquisition among sub-Saharan migrants in France and to understand the correlates of post-migration infection.MethodsWithin the PARCOURS retrospective survey conducted in 2012–2013 in 74 healthcare facilities in the Paris region, life-event data were collected among a random sample of 926 patients living with HIV in HIV services and 763 patients undiagnosed with HIV in primary care centres born in sub-Saharan Africa (reference group). Based on previous analysis, we considered the first 6 years in France after migration as a settlement period. Among the persons who acquired HIV after migration, we estimated the proportion of persons infected during settlement (0–6 years after migration) and after settlement (>6 years after migration) by using an algorithm that combines life-event data and a modelisation of CD4+ T-cell count decline. We then assessed the determinants of HIV acquisition during settlement and after settlement using bivariate logistic regression models.ResultsOverall, 58% of sub-Saharan migrants who acquired HIV after migration were infected during the first 6 years in France. HIV acquisition during settlement was found to be linked to short/transactional partnerships and lack of a resident permit. 42% of migrants had contracted HIV after settlement. After settlement, HIV acquisition was associated with short/transactional but also with concurrent partnerships and not with social hardship.ConclusionTwo profiles of HIV post-migration acquisition emerged. The majority of HIV post-migration acquisition occurs during the settlement period: comprehensive combination prevention programmes among recently arrived migrants are needed. However, long-term migrants are also at risk for HIV through multiple partnerships. Prevention programmes should address the different profiles of migrants at risk for post-migration HIV acquisition.
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Gachanja, Grace, and Gary J. Burkholder. "A model for HIV disclosure of a parent’s and/or a child’s illness." PeerJ 4 (February 4, 2016): e1662. http://dx.doi.org/10.7717/peerj.1662.
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HIV prevalence in Kenya remains steady at 5.6% for adults 15 years and older, and 0.9% among children aged below 14 years. Parents and children are known to practice unprotected sex, which has implications for continued HIV spread within the country. Additionally, due to increased accessibility of antiretroviral therapy, more HIV-positive persons are living longer. Therefore, the need for HIV disclosure of a parent’s and/or a child’s HIV status within the country will continue for years to come. We conducted a qualitative phenomenological study to understand the entire process of disclosure from the time of initial HIV diagnosis of an index person within an HIV-affected family, to the time of full disclosure of a parent’s and/or a child’s HIV status to one or more HIV-positive, negative, or untested children within these households. Participants were purposively selected and included 16 HIV-positive parents, seven HIV-positive children, six healthcare professionals (physician, clinical officer, psychologist, registered nurse, social worker, and a peer educator), and five HIV-negative children. All participants underwent an in-depth individualized semistructured interview that was digitally recorded. Interviews were transcribed and analyzed in NVivo 8 using the modified Van Kaam method. Six themes emerged from the data indicating that factors such as HIV testing, living with HIV, evolution of disclosure, questions, emotions, benefits, and consequences of disclosure interact with each other and either impede or facilitate the HIV disclosure process. Kenya currently does not have guidelines for HIV disclosure of a parent’s and/or a child’s HIV status. HIV disclosure is a process that may result in poor outcomes in both parents and children. Therefore, understanding how these factors affect the disclosure process is key to achieving optimal disclosure outcomes in both parents and children. To this end, we propose an HIV disclosure model incorporating these six themes that is geared at helping healthcare professionals provide routine, clinic-based, targeted, disclosure-related counseling/advice and services to HIV-positive parents and their HIV-positive, HIV-negative, and untested children during the HIV disclosure process. The model should help improve HIV disclosure levels within HIV-affected households. Future researchers should test the utility and viability of our HIV disclosure model in different settings and cultures.
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Mbithi, Irene, Pruthu Thekkur, Jeremiah Muhwa Chakaya, et al. "Assessing the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Selected Health Facilities in Nairobi, Kenya." Tropical Medicine and Infectious Disease 6, no. 2 (2021): 74. http://dx.doi.org/10.3390/tropicalmed6020074.
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There was concern that the COVID-19 pandemic would adversely affect TB and HIV programme services in Kenya. We set up real-time monthly surveillance of TB and HIV activities in 18 health facilities in Nairobi so that interventions could be implemented to counteract anticipated declining trends. Aggregate data were collected and reported monthly to programme heads during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data collected during the pre-COVID period (March 2019–February 2020). During the COVID-19 period, there was an overall decrease in people with presumptive pulmonary TB (31.2%), diagnosed and registered with TB (28.0%) and in those tested for HIV (50.5%). Interventions to improve TB case detection and HIV testing were implemented from August 2020 and were associated with improvements in all parameters during the second six months of the COVID-19 period. During the COVID-19 period, there were small increases in TB treatment success (65.0% to 67.0%) and referral of HIV-positive persons to antiretroviral therapy (91.2% to 92.9%): this was more apparent in the second six months after interventions were implemented. Programmatic interventions were associated with improved case detection and treatment outcomes during the COVID-19 period, suggesting that monthly real-time surveillance is useful during unprecedented events.
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Fallon, Stephen J., Kimberly Molnar, Ekaterina S. Taneva, Laura Simone, Jeffrey Carter, and Tamar Sapir. "626. Tackling the HIV Epidemic in South Florida: Patient Insights on Approaches for HIV Counseling, Testing, and Access to Prevention or Treatment." Open Forum Infectious Diseases 7, Supplement_1 (2020): S372—S373. http://dx.doi.org/10.1093/ofid/ofaa439.820.
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Abstract Background The South Florida Metropolitan Statistical Area has for several years recorded the highest HIV incidence in the nation, and prevalence in the top three of all counties. To address the alarming disparity in HIV impact, we developed a survey study to learn about the beliefs, attitudes, and perspectives of persons who accessed services at an HIV community-based organization in South Florida. Methods Surveys were administered in English and Spanish to 109 persons who visited a community-based HIV service provider (Latinos Salud) at any of its three South Florida sites in April 2019. The survey evaluated the participants’ perspectives on different avenues for HIV counseling, screening, and accessing HIV medications for prevention or treatment. Results The majority of survey participants were male (90%), homosexual/gay/queer (75%), and Hispanic/Latino (56%; Table 1). Participants’ self-reported their HIV status as negative (64%), positive (30%), or unknown (6%; Table 1). Of those not currently living with HIV, 77% reported having been tested within the past 6 months, and 81% reported recent engagement in high-risk activities (Table 1). Most participants considered using social media to promote awareness of HIV and related services a good idea (Table 2). Large proportions of participants endorsed receiving HIV counseling through in-person conversations with clinicians (91%), staff at community-based organizations (83%), friends (83%), telehealth visits (69%), conversations with teachers (63%), or church members (56%; Table 2). Most participants endorsed a range of both clinical (e.g. local health clinic) and non-clinical (e.g. mobile van) locations as acceptable settings for HIV testing (Table 2). Large proportions of participants endorsed receiving medications to prevent or treat HIV immediately after testing (82%), by home delivery (78%), or through telehealth (60%; Table 2). Meaningful associations were found between certain patient demographics (race/ethnicity, testing history, or insurance status) and the participants’ perspectives on specific strategies (Table 3). Table 1. Participant Characteristics Table 2. Participants’ Views on Strategies for HIV Counseling, Testing, and Access to Medications Table 3. Participants’ Views on Strategies for HIV Counseling, Testing, and Access to Medications Stratified by Patient Characteristics Conclusion These real-world findings can be used to inform clinic- and community-based interventions tailored to individual patient characteristics. Disclosures Tamar Sapir, PhD, Gilead Sciences, Inc. (Other Financial or Material Support, Independent medical education grant)
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Stijović, Vesna, Pavle Piperac, Biljana Begović, and Sandra Grujičić. "Differences in demographic characteristics, risky behavior and HIV status of men and women who were voluntarily and confidentially counseled and tested at the Counseling Center for HIV/AIDS of the Institute of Public Health in Belgrade." Zdravstvena zastita 50, no. 2 (2021): 13–28. http://dx.doi.org/10.5937/zdravzast50-32921.
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Introduction/Aim: Voluntary and confidential counseling and testing (VCCT) means getting information about HIV, ways of transmission, recognizing, reducing or avoiding risks for HIV infection, about safe sexual relations, the place where people can be tested, and what they should do depending on the test results in order to protect themselves and other people. The aim of this study was to examine differences in demographic characteristics, risky behavior and HIV status between men and women who were voluntarily and confidentially counseled and tested at the Counseling Center for HIV/AIDS of the Institute of Public Health in Belgrade. Methods: This research was conducted as a cross-sectional study and it included 3,480 persons (43.2% of women and 56.8% of men), who were counseled and tested at the Counseling Center for HIV/AIDS of the Institute of Public Health in Belgrade from 2017 to 2019. ch2 or Fisher's test was used for the statistical analysis of data. Results: The majority of women (42.1%) and men (42.5%) who were counseled and tested were in the age group 21-30 years. Men used DPST services significantly more often than women. HIV positive status was significantly more frequent in men (2.5%) than in women (0.3%). Women came significantly more often to voluntary counseling and testing due to the possible exposure to HIV infection by heterosexual contact (84.9%), accident (11.1%) and raping (1.0%), while men were counseled and tested due to heterosexual contact (59.3%), homosexual and bisexual contact (33.6%) and intravenous drug abuse (1.1%). Men used condoms always or often (40.1%) and had two or more partners (53.2%) more frequently during the last 12 months in comparison to women (24.2% and 20.6%). Conclusion: Voluntary and confidential counseling and testing is necessary in the fight against HIV infection, especially from the perspective of early discovering of people with this infection and education of HIV negative persons about risky sexual behavior and possible prevention measures.
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Hunt, Bijou R., Rachel Anderson, Paarul Sinha, Hollyn Cetrone, and Nancy Glick. "481. Epidemic – Pandemic Impacts Inventory (EPII) Survey Results for Persons Living with HIV in Chicago’s West and Southwest Communities." Open Forum Infectious Diseases 7, Supplement_1 (2020): S307—S308. http://dx.doi.org/10.1093/ofid/ofaa439.674.
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Abstract Background The rapid spread of COVID-19 in recent months has caused local and regional governments to enact protective measures that have hindered economies and imposed demanding restrictions on daily life. Households may be experiencing physical, psychological, social, and economic challenges due to these preventative measures. Populations with fewer resources and/or pre-existing conditions may be at higher risk for these negative, life-altering effects. Therefore, we investigated COVID-19 impact on daily life among persons living with HIV (PLH) in Chicago’s under-resourced, largely minority, west and southwest side communities. Methods We modified the EPII, a survey designed to measure pandemic disease impact over nine domains of life, to assess how COVID-19 affected PLH receiving outpatient HIV care. From 5/11–29/2020, participants (n=49) completed the survey online or over the phone and received a $10 grocery gift card. We present the proportion of respondents who reported that they or any household member was impacted by select survey items. Results More than half of respondents reported a household member getting laid off and/or furloughed (63%), increased mental health (45%) or sleep problems (51%), less physical activity (61%), and increased screen time (82%); 45% were unable to pay important bills. Positive changes included eating healthier foods (53%), more time for enjoyable activities (63%), more quality time with friends or family (65%), and paying more attention to personal health (76%). We observed differences by gender, age, and race/ethnicity over all domains (Table 1). Finally, 80% of those who participated in telehealth services were satisfied with their experience. Table 1. Conclusion Overall, respondents struggled with employment, emotional and physical health effects of COVID-19, yet also experienced aspects of positive life change. In the future, these results should be compared with results from a general population to determine whether PLH are disproportionately burdened. Regardless, COVID-19 has negatively impacted daily life for everyone, including PLH, and these individuals may need additional resources compared to their less resource-challenged counterparts. Disclosures All Authors: No reported disclosures
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Conserve, Donaldson F., Larissa Jennings, Carolina Aguiar, Grace Shin, Lara Handler, and Suzanne Maman. "Systematic review of mobile health behavioural interventions to improve uptake of HIV testing for vulnerable and key populations." Journal of Telemedicine and Telecare 23, no. 2 (2016): 347–59. http://dx.doi.org/10.1177/1357633x16639186.
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Introduction This systematic narrative review examined the empirical evidence on the effectiveness of mobile health (mHealth) behavioural interventions designed to increase the uptake of HIV testing among vulnerable and key populations. Methods MEDLINE/PubMed, Embase, Web of Science, and Global Health electronic databases were searched. Studies were eligible for inclusion if they were published between 2005 and 2015, evaluated an mHealth intervention, and reported an outcome relating to HIV testing. We also reviewed the bibliographies of retrieved studies for other relevant citations. The methodological rigor of selected articles was assessed, and narrative analyses were used to synthesize findings from mixed methodologies. Results A total of seven articles met the inclusion criteria. Most mHealth interventions employed a text-messaging feature and were conducted in middle- and high-income countries. The methodological rigor was moderate among studies. The current literature suggests that mHealth interventions can have significant positive effects on HIV testing initiation among vulnerable and key populations, as well as the general public. In some cases, null results were observed. Qualitative themes relating to the use of mobile technologies to increase HIV testing included the benefits of having low-cost, confidential, and motivational communication. Reported barriers included cellular network restrictions, poor linkages with physical testing services, and limited knowledge of appropriate text-messaging dose. Discussion MHealth interventions may prove beneficial in reducing the proportion of undiagnosed persons living with HIV, particularly among vulnerable and key populations. However, more rigorous and tailored interventions are needed to assess the effectiveness of widespread use.
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Assan Ninson, Enoch, and Heather Morgan. "The Recruitment, Enlistment, and Deployment of HIV-Positive Military Service Members: An Evaluation of South African and U.S. National, Alongside International, Policies." Military Medicine 186, no. 9-10 (2021): 897–902. http://dx.doi.org/10.1093/milmed/usab167.
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ABSTRACT Introduction Since its detection in the early 1980s, HIV and AIDS have claimed 32.7 million lives. The HIV epidemic continues to plague the world with its most devastating effects felt in Eastern and Southern Africa. The exposure, vulnerability, and impact of HIV have been prominent among military personnel due to environmental, demographic, and socioeconomic characteristics. Policies have been developed to mitigate its exposure, vulnerability, and impact on the military. However, there are disparities across these policies, especially on recruitment, enlistment, and deployment. These contentions inspired this evaluation, which was designed to provide vital information and insights for militaries developing new HIV policies, for example, the Ghana Armed Forces (GAF). Materials and Methods Content analyses of key documents and secondary resources from South Africa (SA), the USA, and the United Nations and International Labour Organizations were undertaken. The key documents evaluated included HIV and AIDS policies of the SA National Defence Force (SANDF), the U.S. DoD, UN Department of Peacekeeping Operations, and International Labour Organization (ILO); national HIV and AIDS policies; and legislations of SA and the USA. Results The SANDF policy permits the recruitment of HIV-positive applicants while the U.S. DoD policy does not. Mandatory pre-employment health assessments including HIV testing is conducted for prospective applicants. Again, discrimination against persons living with HIV (PLHIV) is discouraged by national policies and legislations of both countries and the ILO policy. At the same time, the SA national policy permits discrimination based on requirement of the job.On deployment, the SANDF policy explicitly permits deployment of HIV-positive service members, while the U.S. DoD policy cautiously does so. Both policies support mandatory pre-deployment health assessments in line with the UN peacekeeping policy and medical standards even though voluntary confidential HIV counseling and testing is recommended by the UN. All HIV-positive service members are retained and offered treatment and care services; however, the U.S. DoD policy retires unfit service members after 12 months of consecutive non-deployment. Further, the UN policy repatriates service members with pre-existing medical conditions and pays no compensation for death, injury, or illness, which is due to pre-existing medical conditions or not mission-related. Conclusions First, the contents of the military policies are not very diverse since most militaries do not enlist or deploy PLHIV except few countries including SA. Implementation and interpretation is however inconsistent. Some militaries continue to exclude PLHIV despite the existence of policies that permit their inclusion. Second, discrepancies exist among the military policies, national legislations, and international policies. The UN policy is not coherent and empowers the military to exclude PLHIV. Also, potential costs to be incurred, in the form of compensation and repatriation, seem to be a major factor in the decision to deploy HIV-positive service members. Harmonization of military HIV policies to ensure uniform standards, interpretation, and implementation and the coherence of the UN policy are essential to guide countries developing new policies, for example, GAF.
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Janse van Rensburg, Bernard. "The South African Society of Psychiatrists (SASOP) and SASOP State Employed Special Interest Group (SESIG) position statements on psychiatric care in the public sector." South African Journal of Psychiatry 18, no. 3 (2012): 16. http://dx.doi.org/10.4102/sajpsychiatry.v18i3.374.
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<p><strong>Executive summary.</strong> National mental health policy: SASOP extends its support for the process of formalising a national mental health policy as well as for the principles and content of the current draft policy.</p><p><strong> Psychiatry and mental health:</strong> psychiatrists should play a central role, along with the other mental health disciplines, in the strategic and operational planning of mental health services at local, provincial and national level.</p><p><strong>Infrastructure and human resources:</strong> it is essential that the state takes up its responsibility to provide adequate structures, systems and funds for the specified services and facilities on national, provincial and facility level, as a matter of urgency.</p><p><strong>Standard treatment guidelines (STGs) and essential drug lists (EDLs)</strong>: close collaboration and co-ordination should occur between the processes of establishing SASOP and national treatment guidelines, as well as the related decisions on EDLs for different levels.</p><p><strong>HIV/AIDS in children:</strong> national HIV programmes have to promote awareness of the neurocognitive problems and psychiatric morbidity associated with HIV in children.</p><p><strong>HIV/AIDS in adults:</strong> the need for routine screening of all HIV-positive individuals for mental health and cognitive impairments should also be emphasised as many adult patients have a mental illness, either before or as a consequence of HIV infection, constituting a ‘special needs’ group.</p><p><strong> Substance abuse and addiction:</strong> the adequate diagnosis and management of related substance abuse and addiction problems should fall within the domain of the health sector and, in particular, that of mental health and psychiatry.</p><p><strong>Community psychiatry and referral levels:</strong> the rendering of ambulatory specialist psychiatric services on a community-centred basis should be regarded as a key strategy to make these services more accessible to users closer to where they live.</p><p><strong>Recovery and re-integration:</strong> a recovery framework such that personal recovery outcomes, among others, become the universal goals by which we measure service provision, should be adopted as soon as possible.</p><p><strong> Culture, mental health and psychiatry:</strong> culture, religion and spirituality should be considered in the current approach to the local practice and training of specialist psychiatry, within the professional and ethical scope of the discipline.</p><p><strong> Forensic psychiatry:</strong> an important and significant field within the scope of state-employed psychiatrists, with 3 recognised groups of patients (persons referred for forensic psychiatric observation, state patients, and mentally ill prisoners), each with specific needs, problems and possible solutions.</p><p><strong> Security in psychiatric hospitals and units:</strong> it is necessary to protect public sector mental healthcare practitioners from assault and injury as a result of performing their clinical duties by, among others, ensuring that adequate security procedures are implemented, appropriate for the level of care required, and that appointed security staff members are appropriately trained and equipped.</p>
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McNulty, Moira C., Ellen Almirol, Jessica P. Ridgway, et al. "Identifying African American Women with HIV Infection in an Expanded HIV testing and Linkage to Care (X-TLC) Program in Healthcare Settings on the South and West Sides of Chicago." Open Forum Infectious Diseases 4, suppl_1 (2017): S425—S426. http://dx.doi.org/10.1093/ofid/ofx163.1073.
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Abstract Background Women account for 25 % of HIV infections nationally, and African American (AA) women are disproportionately affected. We report important gender differences observed in an expanded HIV testing and linkage to care (X-TLC) program conducted on the South and West Sides of Chicago. Methods X-TLC is funded by CDPH with CDC prevention B funds. X-TLC has expanded from 3 sites to 14 sites, including acute care hospitals (academic, community), community health centers (CHCs), and family planning clinics. We report descriptive stats, group comparisons by Chi-square, and multivariate analyses adjusted for demographics. Results Since 2011, X-TLC has conducted 308,038 HIV screens, and 63.7 % of those tested were women. Overall seroprevalence for HIV was 0.56 %, and 30.5 % of HIV patients identified were cis-gender women (seroprevalence 0.15 %). The seroprevalence for women testing in EDs was higher (0.44 %). Similar to men, only 52.9 % of HIV positive women were new diagnoses. Women accounted for 28.5 % of all new diagnoses, compared with 15.4 % for Chicago overall. In 2016 X-TLC screened 91,865 persons for HIV, and 65.2 % of those tested were women. There were 193 new diagnosis and 32.1 % (62) were women, 85.7 % AA. In comparison, in 2015 there were 139 women with a new HIV diagnosis for all of Chicago. Women newly diagnosed were less likely to be linked to care (adjusted odds ratio, aOR, 0.54, 0.35–0.85). Linkage was lower for women diagnosed at CHCs (84.6 % vs. 76.3 %, P = 0.02). Most CHCs did not have on site HIV providers. At our site, however, women linked to care were more likely to be retained in care (aOR 0.58, 0.43–0.78). We also conduct targeted outreach testing, partner services (PS) testing, and social network strategy (SNS) testing, but women are not identified by these programs (16/171 tested women, 8 new diagnoses were men for PS; 507 tested, 471 men and 36 trans-gender women, 38 new positives, 0 cis-gender women for SNS). Conclusion More women than men were offered and/or accept HIV screening in healthcare settings. The proportion of seropositive women identified was higher than the national average. X-TLC is reaching a large proportional of AA women with HIV unaware of their status. Other testing strategies will rarely identify cis-gender women with HIV infection. Gender differences in linkage to and retention in care will require strategies targeted at women. Disclosures J. P. Ridgway, Gilead FOCUS: Grant Investigator, Grant recipient; N. Glick, Gilead FOCUS: Grant Investigator, Grant recipient; D. Pitrak, Gilead Sciences FOCUS: Grant Investigator, Grant recipient
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Mena, Leandro, Richard A. Crosby, and Angelica Geter. "A novel measure of poverty and its association with elevated sexual risk behavior among young Black MSM." International Journal of STD & AIDS 28, no. 6 (2016): 602–7. http://dx.doi.org/10.1177/0956462416659420.
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This study determined whether a novel (single-item) measure of poverty is associated with elevated sexual risk among young Black men who have sex with men who reside in a US city with high HIV seroprevalence. A convenience sample of 600 Black men who have sex with men (ages 16–29) completed a computer-assisted self-interview. The questionnaire included an item asking men, ‘In the past 12 months have you missed meals because you did not have enough money to eat?’ Selected measures of sexual risk and prevalence of chlamydia, gonorrhea, and HIV were assessed as outcomes of this novel measure of poverty. About 22% had missed meals due to lack of money. In age-adjusted analyses, these men were more likely to report: (1) having concurrent sex partners ( P = .03), (2) having sex with partners who were generally five or more years older ( P = .02), (3) not using condoms the first time they had sex with their most recent new partner ( P = .015), (4) having sex with persons not known by name ( P = .02), (5) depending on sex partners for food, money, and shelter ( P < .0001), and (6) testing positive for Chlamydia at study enrollment ( P < .02). Of interest, an association in frequency of recent condomless anal sex as top ( P = .04) was observed; however, the association for recent condomless sex as bottom ( P = .37) was not significant. For young Black men who have sex with men, a novel method of assessing poverty may be predictive of many sexual risk behaviors. Clinicians may benefit this population by including this question as part of their patient interview and prioritizing services when indicated.
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Rajaram, Akshay, Trevor Morey, Sonam Shah, Naheed Dosani, and Muhammad Mamdani. "Providing Data-Driven Equitable Palliative and End-of-Life Care for Structurally Vulnerable Populations: A Pilot Survey of Information Management Strategies." American Journal of Hospice and Palliative Medicine® 37, no. 4 (2019): 244–49. http://dx.doi.org/10.1177/1049909119872756.
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Background: Considerable gains are being made in data-driven efforts to advance quality improvement in health care. However, organizations providing hospice-oriented palliative care for structurally vulnerable persons with terminal illnesses may not have the enabling data infrastructure or framework to derive such benefits. Methods: We conducted a pilot cross-sectional qualitative study involving a convenience sample of hospice organizations across North America providing palliative care services for structurally vulnerable patients. Through semistructured interviews, we surveyed organizations on the types of data collected, the information systems used, and the challenges they faced. Results: We contacted 13 organizations across North America and interviewed 9. All organizations served structurally vulnerable populations, including the homeless and vulnerably housed, socially isolated, and HIV-positive patients. Common examples of collected data included the number of referrals, the number of admissions, length of stay, and diagnosis. More than half of the organizations (n = 5) used an electronic medical record, although none of the record systems were specifically designed for palliative care. All (n = 9) the organizations used the built-in reporting capacity of their information management systems and more than half (n = 6) augmented this capacity with chart reviews. Discussion: A number of themes emerged from our discussions. Present data collection is heterogeneous, and storage of these data is highly fragmented within and across organizations. Funding appeared to be a key enabler of more robust data collection and use. Future work should address these gaps and examine opportunities for innovative ways of analysis and reporting to improve care for structurally vulnerable populations.
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QIU, Ren-Zong. "艾滋病防治中的倫理和政策問題". International Journal of Chinese & Comparative Philosophy of Medicine 1, № 4 (1998): 7–60. http://dx.doi.org/10.24112/ijccpm.11348.
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LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文討論了艾滋病在中國大陸傳播引起的倫理和政策問題。作者首先指出在預防控制艾滋病問題上中國正處在十字路口。挨著作者分析了中國會不會成為艾滋病和艾滋病病毒感染的高發國，討論了制訂有效而合乎倫理的艾滋病防治政策的理論預設和價值以及評價政策的倫理學框架，討論了艾滋病治療和預防中的倫理和政策問題。The AIDS/HIV prevention and control in China is at crossroad. At present, there are insufficient grounds for us to say that China will definitely become a country with a high HIV infection rate in the future. However, we have much less sufficient grounds for saying that China will never reach that stage. On the contrary, we have much more reason to say that it is very probable for China to become a country with high HIV infection rate if we leave the current policy unchanged. The reasons are: economic reforms associated with large scale population movements in unprecedented way; proliferation of all sorts of high risk behavior, presence of other STDs which facilitate the spread of HIV; the risk of iatrogenic spread through untested blood transfusion; the "sex revolution" with changes in patterns of sex behaviour and increased casual sex, multiple sex partners among the younger generation; most Chinese still do not know how to protect themselves; and the ethical and legal atmosphere necessary for effectively preventing the HIV epidemic has not been formed.The conventional public health approach is not sufficient to prevent or control an HIV epidemic. When the cases of HIV infection were detected one by one in China, health professionals and programmers believed that they could take a conventional public health approach to cope with HIV epidemic. But they are wrong. HIV infection is an epidemic so special that the conventional public health measures such as testing, reporting, contact tracing, isolation are inadequate or ineffective to control the epidemic. HIV is often spread among those groups who are usually marginalized or stigmatized by society through behaviours both confidential or private.An effective policy of preventing HIV cannot be insensitive to ethical issues. However, many of health professionals and programmers bypassed ethical issues emerged in the prevention of the HIV epidemic. Even some health educators, sexologists and officials believe that "AIDS is the punishment by God" or "AIDS is the punishment for promiscuity". For them suffering AIDS is not morally irrelevant, and thus the ancient conception of disease was revived. But this conception of disease has already proved wrong and harmful to the treatment and prevention of any disease, especially to HIV. The consequence entailed by this conception is that the IIIV positive and AIDS patients were discriminated against and stigmatized. When their positive serological status was disclosed, they were faced with the risk of being expelled from school or fired from working unit, even rejected for admission into hospital, and their tights to confidentiality and privacy were often infringed upon. If all these ethical issues cannot be properly treated, how can those persons in danger or risk get access to information, services, education, counselling and techniques necessary to prevent HIV infection? One Chinese adage says that "You cannot have fish and bear palm both". In the prevention of HIV epidemic we have to have the protection of public health and the safeguarding of individual rights.For controlling HIV epidemic what we need is not a repressive law, but a supportive law to build a supportive environment in treatment and prevention of AIDS/HIV. So the policy and law involving AIDS/ HIV should be reformed.DOWNLOAD HISTORY | This article has been downloaded 19 times in Digital Commons before migrating into this platform.
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Mulenga, Joyce, Lonia Mwape, and Patricia Mukwato. "Factors Influencing Utilisation of Diagnostic Counselling and Testing for HIV among Tuberculosis Patients at Monze Mission Hospital, Zambia." University of Zambia Journal of Agricultural and Biomedical Sciences 4, no. 4 (2020): 9–17. http://dx.doi.org/10.53974/unza.jabs.4.4.394.
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Background: Tuberculosis (TB) and human immunodeficiency virus (HIV) constitute the main burden of infectious disease in resource-limited Countries6. Persons infected with HIV are particularly susceptible to tuberculosis, both from the reactivation of latent infection and from new infection with rapid progression to active disease8. An individual who is HIV-positive has 10 times increased risk of developing TB compared to an HIV-negative person the lifetime risk is 50% for an HIV-positive person and 5–10 percent for an HIV-negative9. Estimates by the World Health Organization (WHO) indicate that there are more than 9 million new active cases of TB and close to 2 million deaths per year and that 2.6 million new cases of HIV infection and 1.8 million AIDS-related deaths occur per year6. TB programmes have focused on TB case finding and treatment, with little attention to HIV/AIDS interventions. According to David, (2004) untreated HIV infection leads to increased susceptibility to infections including TB. Currently, global estimates show that about 42 million people are HIV infected and almost one third are also infected with TB (WHO, 2005). The dual epidemics of TB and HIV are particularly pervasive in Africa, where HIV has been the single most common factor contributing to the incidence of TB over the last 10 years. TB and HIV are also a growing concern in Asia, where TB accounts for 40 percent of AIDS deaths (WHO, 2005).Therefore, HIV testing is particularly important in TB because mortality among HIV-infected TB patients is reduced if ART are provided (WHO, 2007). Main objective: To explore factors influencing utilization of Diagnostic Counselling and Testing for HIV among TB patients. Design:.A hospital-based cross-sectional study was carried out to assess the utilization of Diagnostic Testing and Counselling for Human Immune Virus/Acquired Immune Deficiency among tuberculosis patients. Zambia. Research design: A non-experimental which is exploratory study design was used in this study. The study employed a quantitative approach because little is known about DCT utilization. Research setting: The study was undertaken at Monze Mission Hospital chest clinic as it was selected purposively because of the convenience and ease accessibility to the facilities. It was also chosen on the basis that it conducts TB programmes on a daily basis and records showed low utilization of DCT services for HIV among TB patients. Study population: Men and women aged between 18 and 49 years will be included in the study as the above age group may give consent to DCT (MOH/NAC, 2006). The study will require 226 patients to participate. Sample: The sample size was calculated using the Epi- info version 6.0 statistical. The sampling frame will comprise all TB patients visiting chest clinic at the time of the study and who meet the set criteria. The participants were selected using simple random sampling method. The sample size was calculated basing on Krejcie and Morgan's18 formula for calculating sample size of a finite population. The calculated sample size comprised 226 participants. Inclusion criteria: TB patients within Monze Hospital aged between 18 and 49 years. This group was appropriate because it is sexually active and at risk of contracting TB and HIV infection. Patients will include those who are not critically ill to avoid withdraw before the end of the study. In addition, patients who will consent to participate in the study will be enrolled in the study. Exclusion criteria: TB patients outside Monze catchment referred to the chest clinic will not be included in the study because they may withdraw from the study due to distance. Patients aged less than 18 or more than 49 years who are referred to the ART sites for DCT will also not participate in the study. They may not consent to participate as they may think they are young or old to be at risk of contracting TB and HIV infection. Patients who will not consent or volunteer to participate in the study will be freely left out. Data collection tools and technique: Data was collected using a questionnaire. A structured interview schedule was used to collect socio-demographic data, measured variables and entering results of all the participants under study. Pretest: The tool was pre-tested on TB patients at Chikuni Mission Hospital. This hospital was selected because it has similar characteristics as the actual research site. Validity and reliability: A semi-structured interview schedule was used to capture data on demographic characteristics and factors results. The interview schedule was developed based on the World Health Organization (WHO) stepwise survey (STEPS) instrument 22. The same instruments were used on all the patients to ensure reliability and validity. Statistical analyses were carried out using IBM® SPSS® Statistics for Windows Version 20.0 (IBM Corp. Armonk, NY, and USA). The frequencies and descriptive statistics of the variables were calculated. Ethical considerations: Ethical approval and permission was sought from ERESConverge Ethics Committee. Main outcome measures: Diagnostic Counselling and Testing utilization among tuberculosis was assessed to determine the level of uptake. An interview schedule was used to assess utilization and determine the relationships among the factors. Results: The level of knowledge and confidentiality were statistically associated with DCT.Overall (n=226), majority 150(66.3%) of the patients did not utilize diagnostic counselling and testing services while 76 (33.6%) utilized diagnostic counselling and testing. The odds ratio of confidentiality was OR 0.52-1.637 and P-value 0.050 while level of knowledge; OR was 0.719-45.785 and P-value was 0.048 and the variables were statistically significantly associated with Diagnostic Counselling and Testing. The study showed that the patients who did not utilize DCT had 47% decrease in the odds of achieving high level of knowledge and confidentiality were less than 0.05 and therefore failed to reject the null hypothesis. Multivariate binary logistic regression model predicted that confidentiality and knowledge were associated with DCT at p-value of 0.05. Conclusion: Diagnostic Counselling and Testing utilization were low in the study population. Level of knowledge and confidentiality were the factors found to be associated with diagnostic testing and counselling. The findings suggest the need for information, education and communication as patients lack information on the importance of tuberculosis patients taking up the test.
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Tran, Duc Q., Vaughn Barry, Ana G. Antun, Maria J. A. Ribeiro, Sidney F. Stein, and Christine L. Kempton. "The Impact of Health Literacy on Adherence to Factor Replacement in the Hemophilia Population." Blood 124, no. 21 (2014): 2173. http://dx.doi.org/10.1182/blood.v124.21.2173.2173.
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Abstract Background: Health literacy (HL) is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Numeracy, a component of HL, is defined as the ability to handle numerical concepts. Both low HL and low numeracy have been associated with poor adherence to treatment regimens in a variety of chronic diseases. For the management of hemophilia, a chronic bleeding disorder, adherence to treatment regimens can be difficult and requires completion of multiple complex tasks. We hypothesized that lower HL and lower numeracy are associated with decreased adherence to treatment in persons with hemophilia (PWH). A secondary aim of this study was to evaluate other demographic and clinical characteristics that may be associated with adherence. Methods: In a cross-sectional study, adult PWH completed questionnaires to assess the main outcome variable, adherence measured by the validated hemophilia regimen treatment adherence scale (VERITAS) and the primary independent variables, HL as measured by the shortened Test of Functional Health Literacy in Adults (sTOFHLA) and numeracy as measured by the Schwartz-Woloshin questions. Other potential independent or confounding variables including general demographic and clinical information, the General Self-Efficacy (GSE) Scale, the Wake Forest Physician Trust Scale (WFPTS), and the Haem-A-QoL were also collected. Analysis proceeded from descriptive statistics to bivariable associations using simple linear regression and multivariable analysis using multiple linear regression. Results: All were men (n=99); 91% had hemophilia A and 78% had severe disease. Mean age was 34 years (standard deviation (SD) 11.5). White race was reported by 69% and 6% were Hispanic. Income was reported to be ≥$50,000 in 39%; and 37% had received an undergraduate degree or higher. Mean length of time seen at the Hemophilia Treatment Center (HTC) was 16.0 years (SD 11). HIV infection was noted in 26%, and 59% were HCV positive; depression history was reported in 21%; 49% infused replacement factor prophylactically. Most of the study population (95%) had high HL; but only 23% were numerate. The mean VERITAS-Pro was 45.6 (SD 12.7) and mean VERITAS-PRN was 51.0 (SD 11.2) with a lower score indicating greater adherence. On bivariable analysis, adherence was significantly associated with depression history, GSE score, WFPTS score, and Haem-A-QoL score (p < 0.05). On multivariable analysis, HL score and numerate status were not significantly associated with adherence (see Table). Being on any chronic medication, longer time seen at HTC, higher physician trust, and better quality of life were significantly associated with higher adherence. Depression history was significantly associated with lower adherence. This model overall accounted for a moderate proportion of the variability of adherence between subjects (adjusted R2 = 0.296). Conclusion: In this study population, HL and numeracy were not associated with adherence. A large majority of the PWH in our study were health literate; however, the study population was limited to those who made it to their scheduled HTC appointments and were sufficiently on time to allow completion of study questionnaires which may have biased this study toward a more literate population. This study population did show that being on any chronic medication, longer time seen at the HTC, higher physician trust, and better quality of life were significantly associated with better adherence. Depression history was significantly associated with lower adherence. These factors provide a better understanding of characteristics that influence adherence and may prove important for optimizing the care of PWH. Table: Multivariable Linear Regression of the Association of Adherence with Predictors (n=91) Predictor Beta Coefficient Standard Error p-value* sTOFHLA score -0.09 0.22 0.67 Numerate 1.04 3.01 0.73 On chronic medication(s) -5.13 2.47 0.041 Depression history 6.89 3.02 0.025 Time seen at HTC -0.27 0.11 0.022 WFPTS score -0.51 0.18 0.006 Haem-A-QoL score 0.12 0.038 0.0024 *Significant if < 0.05 sTOFHLA: The higher the score, the better the HL; WFPTS: The higher the score, the higher the physician trust Haem-A-QoL: The lower the score, the better the quality of life Disclosures No relevant conflicts of interest to declare.
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Priyanka, Dr. "Role of counseling services for HIV positive persons in coping with HIV/AIDS." Journal of Medical Science And clinical Research 6, no. 5 (2018). http://dx.doi.org/10.18535/jmscr/v6i5.90.
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