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PubMed1995

HIV and AIDS. Legal and ethical issues in the emergency department.

The treatment of individuals infected with HIV in the emergency department presents difficult and unique medical, social, legal, and ethical issues. These issues include: (1) informed consent for testing for HIV status, (2) mandatory testing of patients for HIV, (3) confidentiality of patients infected with HIV, (4) the duty to treat individuals infected with HIV, and (5) issues concerning health care workers infected with HIV.

AIDS Serodiagnosis↗
PubMed2000

International military human immunodeficiency virus/acquired immunodeficiency syndrome policies and programs: strengths and limitations in current practice.

A survey was conducted to evaluate military human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) policies and programs in 119 countries. Ninety-eight percent of the 62 respondents provide prevention education, 95% in group settings but only 53% individually. Predeployment briefings are more common than postdeployment briefings. Condoms are promoted more often than provided. Seventy-eight respondents report some form of mandatory HIV testing, and 58% perform mandatory recruit testing, with recruitment denied to HIV-positive individuals in 17%. Counseling accompanies mandatory testing less than voluntary testing. In-service care for AIDS patients is universal. Many military prevention programs can be improved through postdeployment briefings and proactive interventions involving education, condom distribution, and counseling combined with testing. Mandatory testing is often inconsistent with stated goals, and AIDS care policies may strain military budgets. Testing based on cost-benefit assessments may increase efficiency in military HIV control. Military budgets may benefit from greater civil-military cost sharing in AIDS care.

AIDS Serodiagnosis↗
PubMed1998

Interpretation of indeterminate HIV serology results in an incarcerated population.

The objective of this study was to evaluate the significance of indeterminate HIV test results in the prison setting. No specific information or guidelines are currently available to direct counseling of incarcerated persons with an indeterminate HIV test. A medical chart review was conducted on all incarcerated inmates at the Rhode Island State Prison who received indeterminate HIV test results between the inception of mandatory testing in 1990 and October 1996. Thirty-five inmates had an indeterminate HIV Western blot (WB) result, and 31 had follow-up HIV testing. Twenty-three of 31 (74%) of the prisoners with follow-up HIV tests seroconverted (95% confidence interval, 55%-88%). Drug/alcohol use, including crack cocaine and injection drug use, was strongly associated with seroconversion (p < 0.01, odds ratio [OR] = 11.8, relative risk [RR] = 2.04). Injection drug use was also significantly associated with seroconversion (p = 0.03, OR = 9.3, RR = 1.56). This is the highest rate of seroconversion ever reported for persons with indeterminate WB test results. Indeterminate test results need to be interpreted differently in the prison setting than in the community. Prison inmates with indeterminate HIV serology should be counseled that in all likelihood they are HIV-infected, and confirmatory viral load testing should be conducted immediately.

Adult↗
PubMed1993

State regulations and the HIV-positive health care professional: a response to a problem that does not exist.

An announcement in July 1990 concerning the possible transmission of the Human Immunodeficiency Virus from an HIV-positive health care professional to a patient launched a public outcry for patient protection from acquiring HIV from health care professionals. As a result of numerous debates, Congress issued a mandate requiring the states to adopt the Centers for Disease Control and Prevention's guidelines concerning HIV-positive health care professionals or an equivalent policy. This Note explores the regulations and guidelines established by various states in response to this mandate. The author concludes that policies requiring adherence to universal precautions within the health care setting, and not mandatory testing of health care professionals or mandatory disclosure of their HIV status, are best for protecting public health.

Federal Government↗
PubMed1997

Universal Screening for HIV in Pregnant Women?

The fact that zidovudine therapy can prevent perinatal transmission of HIV infection strongly supports the need to screen for HIV during pregnancy. Controversy continues to revolve around which testing strategy offers the benefits of zidovudine to the greatest number of infants while still allowing the mother some degree of autonomy in making her own health care decisions. Screening based on patient-reported risk factors has repeatedly been shown to exclude many seropositive women. Voluntary testing has had inconsistent results, and mandatory testing may discourage women from getting the prenatal care they need. Despite the controversy, HIV testing and education should be recommended to all pregnant women. Counseling should be geared to the educational level of the patient, and risk-factor reduction is an important component of counseling. Health care providers must be prepared to address the social as well as the medical ramifications of a diagnosis of HIV infection for both the mother and the unborn child.

Journal Article↗
PubMed2004

Microbial screening of UC blood units by an automated culture system: effect of delayed testing on bacterial detection.

BACKGROUND: Microbial screening is a mandatory test for banked UC blood (UCB) to comply with the code of good manufacturing practice (GMP). Cord blood banks (CBBs) are not always closely located to a GMP-licensed microbiology laboratory, resulting in time delays for transport of specimens prior to microbiological testing. This study investigated the influence of >/=24 h delays in initiating automated microbial screening on the detection of bacteria in UCB, by analysis of specimens deliberately spiked with bacteria and the recovery of bacteria from cryopreserved spiked-UCB. MATERIALS AND METHODS: UCB was processed according to standard CBB procedures and spiked with Staphylococcus epidermidis or Escherichia coli [2-2000 colony forming units (CFU)/mL]. Spiked-UCB (0.5 mL) was (1) held at room temperature (RT) and inoculated into pediatric BacT/Alert bottles (bioMérieux) at Days 1, 4 and 7 (delayed inoculation); and (2) inoculated directly (Day 0) into replicate BacT/Alert bottles and held at RT for 1, 4 or 7 days before loading onto the BacT/ALERT system (delayed loading). Spiked-UCB samples were cryopreserved. Bacterial counts were quantitated on horse blood agar plates. RESULTS: Bacterial growth in UCB spiked with a single bacterium was capable of detection by the BacT/ALERT system. S. epidermidis grew in all conditions of delayed testing (ie. delayed inoculation and delayed loading). E. coli failed to grow under conditions of delayed inoculation but grew at all time points of delayed loading. S. epidermidis and E. coli were recovered from cryopreserved spiked-UCB. DISCUSSION: Inoculation of culture bottles as soon as possible after sample preparation is preferable. Bacteria can maintain viability in BacT/ALERT bottles inoculated and held at RT for up to 7 days prior to automated culture testing. Bacteria can be successfully recovered from cryopreserved UCB.

Bacteria↗
PubMed2004

Nova Scotia: "blood samples" legislation passed.

On 18 October 2004 the Nova Scotia legislature passed the Mandatory Testing and Disclosure Act, thus becoming the third Canadian province or territory to pass similar legislation.

AIDS Serodiagnosis↗
PubMed1997

HIV counseling and testing of pregnant women and women of childbearing age by primary care providers: self-reported beliefs and practices.

This study describes primary care providers' beliefs and self-reported practices regarding HIV counseling and testing of pregnant women and women of childbearing age. The Centers for Disease Control and Prevention (CDC) recommends that providers counsel and encourage all pregnant women and women of childbearing age to be voluntarily tested, and California requires providers to offer voluntary testing to all pregnant women. We randomly sampled 180 primary care providers in 1995 from the nine-county San Francisco Bay area using a self-administered, mailed survey (response rate = 73%, N = 121). Eighty-six percent of primary care providers (obstetricians/gynecologists, internists, family practitioners, or general practitioners) support voluntary testing, 61% support routine testing without explicit consent, and 55% support mandatory testing. Although 90% of providers are very likely to encourage pregnant women with risk factors to be tested, only 34% are very likely to encourage pregnant women without risk factors to be tested and only 9% are very likely to encourage women of childbearing age without risk factors to be tested. Few providers state that they support policies targeting testing to women with risk factors, yet in practice, providers are much more likely to encourage testing for women with risk factors than those without risk factors. We conclude that providers may be missing opportunities to encourage women to be tested, and women may not be receiving adequate information to make an informed testing decision. Future research is needed to determine the viability of voluntary testing and how to remove barriers to its implementation.

California↗
PubMed1997

Management of healthcare workers infected with hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or other bloodborne pathogens. AIDS/TB Committee of the Society for Healthcare Epidemiology of America.

This article provides the current recommendations of the Society for Healthcare Epidemiology of America (SHEA) regarding the management of healthcare workers infected with hepatitis B virus (HBV), hepatitis C virus (HCV), or the human immunodeficiency virus (HIV). For the reasons cited in the article, SHEA now maintains that separate virus-specific management strategies are appropriate for healthcare workers who are infected with these unrelated viruses. SHEA emphasizes the use of appropriate infection control procedures to minimize exposure of patients or providers to blood, emphasizes that transfers of blood from patients to providers and from providers to patients should be avoided, and argues that infected healthcare workers should not be prohibited from participating in patient-care activities solely on the basis of their blood-borne pathogen infection. SHEA recommends that hepatitis B e-antigen-positive healthcare workers routinely should double glove and should not perform those activities that have been identified epidemiologically as associated with a risk for provider-to-patient HBV transmission despite the use of appropriate infection control procedures. SHEA also recommends that HCV- and HIV-infected providers use double gloving for procedures, but recommends that these providers not be excluded from any aspect of patient care unless epidemiologically incriminated in the transmission of these infections despite adequate precautions. SHEA argues for comprehensive education concerning bloodborne pathogens for all healthcare providers and trainees and against mandatory pathogen-specific educational requirements for infected providers. SHEA recommends against specific competence-monitoring procedures directed at these healthcare workers infected with bloodborne pathogens, arguing for managing infected providers in the context of a comprehensive approach to the management of all impaired providers. SHEA emphasizes the importance of worker privacy and medical confidentiality. SHEA emphasizes the importance of offering employees who have disabilities reasonable accommodation for their disabilities. The article discusses exposure management in detail and, in general, recommends adherence to existing guidelines for managing exposures to these agents. Finally, SHEA recommends against routine mandatory testing of providers. Specific details and the rationale for these recommendations are included in the body of the article.

Blood-Borne Pathogens↗
PubMed1997

Recommendations for chemoprophylaxis after occupational exposure to human immunodeficiency virus: a public health agency perspective.

Public health agencies across the country uniformly retain three core functions, as identified in a 1988 Institute of Medicine report: assessment, assurance, and planning and policy development. The conduct of these functions will influence the ways the Public Health Service recommendations for postexposure prophylaxis are implemented locally. State, territorial, and local health departments play a key role in the monitoring and prevention of occupationally acquired human immunodeficiency virus (HIV) infections. Through assessment, public health agencies often are responsible for investigating healthcare workers who apparently have contracted HIV infection through an occupational exposure. In their function of providing assurance, public health agencies disseminate the national recommendations and may provide expert consultation taking into consideration local conditions. Specific healthcare worker exposure situations may pose complex medical and legal challenges best handled by public health agencies. In their role of providing policy development, public health agencies may convene an expert panel to review local data that affect postexposure prophylaxis, such as antiretroviral drug resistance and drug availability. The recommendations may result in legislative action in the form of mandatory testing of patients or other groups, and public health agencies must be wary of such attempts that are of unproven efficacy. Public health agencies nationwide must see that exposed healthcare workers and the clinicians counseling them are adequately informed about the risks of HIV transmission and the options available for prophylaxis.

Anti-HIV Agents↗
PubMed2005

Balancing benefits and risks for cystic fibrosis newborn screening: implications for policy decisions.

Policy decisions for newborn screening (NBS) are particularly challenging when the balance of benefits and risks is not tipped dramatically in 1 direction. When this is the case, as with cystic fibrosis (CF), the traditional approach of mandatory testing of all newborns in all states may not be appropriate. Alternative approaches may produce a substantial reduction in psychosocial risks, at the cost of a small reduction in medical benefits, and thus improve the benefit/risk balance. At the provider level, this could include greater engagement and discussion with parents before testing. At the program implementation level, specific decisions about tradeoffs between sensitivity and specificity that could result in not identifying all infants with CF may be appropriate. At the policy decision level, deciding whether to implement CF NBS in a particular state could involve consideration of the availability of the financial resources, clinical services, and systems for assessing outcomes. Although CF NBS can be justified in settings in which the specific approach has a favorable benefit/risk balance, an inadequately designed screening program has the potential for being less favorable than the current approach of diagnosis on the basis of clinical criteria or family history.

Adaptation, Psychological↗
PubMed1989

Recommendations for control and prevention of human immunodeficiency virus (HIV) infection in intravenous drug users.

Considerable evidence indicates that intravenous drug users are emerging as the group at greatest risk for both acquiring and spreading human immunodeficiency virus (HIV) infection. Thus, all possible methods to control the spread of HIV infection in intravenous drug users should be explored. Key recommendations are that HIV antibody testing of intravenous drug users should be voluntary, because mandatory testing is counterproductive; free distribution of needles and syringes to intravenous drug users should occur only in carefully controlled circumstances to determine its effectiveness in decreasing infection rates; and drug-free and methadone maintenance treatment programs should be available on demand to all intravenous drug users as a means of reducing the spread of HIV infection. At present, the primary strategy for prevention must be education resulting in behavioral change. Education is currently the only definitive means for controlling the spread of HIV infection among intravenous drug users, their sex contacts, and to fetuses.

AIDS Serodiagnosis↗
PubMed1993

AIDS in the Republic of China, 1992.

From May 1985 to December 1992, a total of 5,931,032 serum samples from eight population groups were tested for antibody to human immunodeficiency virus type 1 (HIV). Mandatory testing is carried out for blood donors, military recruits, immigrants, and prisoners. The other population groups were tested anonymously with consent. A total of 407 samples were seropositive. Of those HIV carriers, 63 developed AIDS: 37 were homosexuals, 6 were hemophiliacs, 1 was an intravenous drug user, 15 were heterosexuals, and 4 had no known risk factors. Although the prevalence of HIV infection and AIDS in Taiwan has remained low, the increase since 1988 has been rapid. Before 1987, all of the 48 persons with HIV infection were homosexuals or hemophiliacs. Thereafter, the risk groups diversified, with the main group shifting from homosexuals to heterosexuals and the number of intravenous drug users surpassing the number of hemophiliacs. Among the 63 patients with AIDS, 59 were male and only 4 were female; 53 have died (3 committed suicide).

Acquired Immunodeficiency Syndrome↗
PubMed2005

Seroprevalence of hepatitis C virus among blood donors in Rivers State, Nigeria.

Anti-HCV pre-transfusion testing among blood donors has not been introduced as a mandatory test in Rivers State, hence the risk of transfusion-transmitted HCV cannot be fully ascertained. One thousand (1000) apparently healthy blood donors were screened using a rapid second - generation test, the HEP C SPOT HCV assay. An overall prevalence of 2.9% was observed in this study. The highest prevalence (8.1%) was found among adults aged between 26 and 33 years and commercial donors.

Adolescent↗
PubMed1997

Attitudes of family practice residency program directors toward mandatory preemployment drug testing.

BACKGROUND AND OBJECTIVES: As health care institutions adopt policies on substance use and abuse and mandatory substance abuse testing in the workplace, applicants for house staff positions may become the subjects of testing as a requirement for acceptance into a residency program. This study attempted to learn what directors of family practice residency programs feel about mandatory preemployment drug testing and its effect on house staff recruitment. METHODS: We surveyed the directors of 420 US family practice residency programs, as listed by the American Academy of Family Physicians, in November 1994. All programs (community based, university affiliated, university based, and military) were included in the survey. RESULTS: A total of 308 (73%) program directors responded. Of these, almost half disagreed with mandatory substance abuse testing and felt it should not be a condition of acceptance for a house staff position. Eighty-eight percent believed that the existence of a policy did not hinder recruitment. None felt it was an enhancement. CONCLUSIONS: Preemployment drug testing for potential house staff remains a controversial issue, and it is unlikely that it will be universally implemented in the near future.

Attitude of Health Personnel↗
PubMed1989

HIV antibody testing: who benefits and who loses?

From a public health perspective, a significant milestone in the AIDS crisis so far has been the development of serologic tests to detect exposure to the HIV. With AIDS now reported in more than 124 countries and in every state of the Union, with the possibility that in excess of two million Americans have been infected and in the absence of a cure or vaccine, the issue of testing cannot be ignored anymore. Unfortunately, the testing debate has generated more heat than light. This paper examines the proposed "benefit" to public health in testing certain target groups deemed "at risk", and also discusses socio-ethical implications of such testing. The whole question of HIV antibody testing essentially raises the need for a balance between voluntary and mandatory testing; and society's commitment to protect public health as well as safeguard individual civil rights.

AIDS Serodiagnosis↗
PubMed1989

Detection and recognition of visual field defects resulting from lesions involving the visual pathways.

A prospective study of visual field defects associated with lesions of the visual pathway was carried out using kinetic and suprathreshold static stimuli with a view to establishing the most effective screening method for these field defects. The 215 abnormal fields so obtained showed that all field defects due to lesions of the visual pathways are detectable within 30 degrees of fixation and that not only is central field testing mandatory in excluding such a field defect, but more peripheral field testing alone is ineffective. This study also revealed that when kinetic fields are charted, it is probably not worthwhile searching for scotomata other than within the most central part of the field. Furthermore, where outer and inner isopter depression is not coextensive, inner isopters are always depressed more than outer isopters when the field defect is due to a lesion of the visual pathway.

Central Nervous System Diseases↗
PubMedDate not supplied

Human immunodeficiency virus infection in Taiwan, 1984 to 1994.

From 1984 to September 1994, a total of 9,099,734 serum samples from six population groups were tested for the antibody to human immunodeficiency virus type 1 (HIV). Mandatory testing was carried out for blood donors, military recruits, immigrants and prisoners; other population groups were tested anonymously with consent. A total of 695 samples were seropositive and, of these HIV carriers, 142 developed acquired immunodeficiency syndrome (AIDS). Although the prevalence of HIV infection and AIDS has remained low, there has been a rapid increase since 1991. Of the 142 AIDS cases, 68 were in homosexuals/bisexuals, 6 were in hemophiliacs, 7 were in prisoners/intravenous drug users, 49 were in heterosexuals and for 12 cases, the risk factors were unknown. Before 1987, 69 (90.8%) of the 76 HIV-infected persons were homosexuals or hemophiliacs. Thereafter, the risk groups diversified, with the main group shifting from hemophiliacs to intravenous drug users, and the number of heterosexuals surpassing that of homosexuals. Among the 142 cases of AIDS, 135 were males and only 7 were females. Despite the short period of follow-up, 114 have died (including 3 suicides).

Adolescent↗