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PubMed1995

Comparison of partner notification at anonymous and confidential HIV test sites in Colorado.

We compared health department-initiated partner notification at a single anonymous human immunodeficiency virus (HIV) test site in Denver to 13 confidential HIV test sites throughout Colorado over an 18-month period. The average number of named, notified, and counseled in-state partners was from 30 to 50% greater among confidential site index cases than anonymous site index cases, and the seropositivity rate in newly tested partners of confidential site index cases was more than twice the rate in partners of anonymous test site index cases. When analyses were restricted to gay/bisexual male index cases, the results were the same as for the total group. We recommend that state and local health departments collect data to evaluate and improve the delivery of partner notification services.

AIDS Serodiagnosis↗
PubMed1999

Return rates and partner notification in HIV-positive men seeking anonymous versus confidential antibody testing.

This study investigated whether HIV-positive men who seek confidential versus anonymous HIV counseling and testing differ in demographic variables, risk behaviors, return rates for posttest appointments, and agreement to partner notification. chi 2 tests were not statistically significant for return rates for post-test appointments or partner notification between the two groups. HIV-positive individuals in the confidential groups were more likely to utilize medical and follow-up services than those in the anonymous group. Anonymous and confidential counseling and testing both appear to achieve the public health objectives of HIV case finding and referral. Hypotheses are offered regarding what may be a progression of testing behaviors (i.e., from anonymous to confidential) with suggestions for future research are suggested.

Adult↗
PubMed1998

Errors by paediatric residents in calculating drug doses.

BACKGROUND: Errors in calculating drug doses in infants and small children can cause morbidity and mortality, especially with agents exhibiting a narrow therapeutic window. A previous study from this institution has detected potential life threatening errors in calculations performed by trainees while writing prescriptions. OBJECTIVES: To verify whether the true incidence of trainees' errors in prescribing can be explained by impaired calculation skills in written tests. SETTING: A tertiary paediatric hospital; educational rounds for core paediatric residents. METHODS: Two anonymous written tests, which included calculations of doses similar to those performed at the paediatric bedside; one was conducted in 1993 and one in 1995. RESULTS: Thirty four paediatric residents participated in 1993 and 30 in 1995. A substantial number of trainees in both years committed at least one error. In general, there was no correlation between the length of training (0 to 4 years) and likelihood of making a mistake. Three trainees in 1993 and four in 1995 committed 10-fold errors. These seven residents committed significantly more errors than the rest of the group in each of the tests separately. All seven were in their first two years of training, and six were in their first year of residency. CONCLUSIONS: A substantial proportion of paediatric trainees make mistakes while calculating drug doses under optimal test conditions. Some trainees commit 10-fold errors, which may be life threatening. The results of these anonymous tests suggest that testing of calculations skills should be mandatory, and appropriate remedial steps should follow to prevent paediatric patients receiving wrong drug dosages.

Clinical Competence↗
PubMed1991

Prevalence of maternal HIV-1 infection in Thames regions: results from anonymous unlinked neonatal testing.

To monitor the spread of human immunodeficiency virus (HIV) in the heterosexual population, residues of blood samples collected routinely on absorbent paper for neonatal screening (Guthrie cards) in NE, NW, and SW Thames Regions in England have been tested for antibodies to HIV-1 since June, 1988. 323,369 dried blood spots were analysed to end March, 1991. Prevalence of anti-HIV-1 in newborn babies has remained stable in outer London and non-metropolitan districts whereas prevalence in inner London has increased from 1 in 2000 in the 12 months beginning June, 1988, to 1 in 500 in the first 3 months of 1991. Either exponential or linear growth in the numbers of new seropositives could account for the results. That obstetricians were aware of maternal HIV infection in only 20% of infected pregnancies, indicates the extent to which HIV infection goes unrecognised in the heterosexual community.

Confidentiality↗
PubMed1997

Demographic and behavioral predictors of knowledge and HIV seropositivity: results of a survey conducted in three anonymous and free counselling and testing centers.

This paper deals with subjects seeking counselling and testing for human immunodeficiency virus (HIV); it analyses which sociodemographic and behavioral characteristics are related to beliefs concerning HIV infection and to HIV seropositivity. A one month survey among individuals who attended HIV testing in three anonymous and free centers (CIDAGs) was carried out in Paris city, on March 1994. 2059 subjects completed a self-administered questionnaire. Data collected included demographic information, sexual and IVDU behavior, and HIV seropositivity. Subjects also had to evaluate their own risk of getting the acquired immunodeficiency syndrome (AIDS) and the perceived risk of getting AIDS in specific situations such as unprotected anal/vaginal intercourse with a casual partner, with multiple partners, with a seropositive partner, current dental treatment, French kiss, etc.... Multiple linear and logistic regressions have been used to model the dependent variables. Subjects correctly evaluated the risk level of HIV transmission associated with different situations, and women, young men and those engaged in homo/bisexual behavior were in general more conscious of the increased danger resulting from high risk sexual practices. Among males, homo/bisexuals, drug users and the less educated considered themselves to be more at risk. The most important factors related to HIV seropositivity were sexual orientation, intravenous drug use (IVDU), and the perceived risk of getting aids. Despite a good awareness of HIV contamination and an accurate perception of their own risk, many subjects continued to engage in high risk AIDS activities. Better targeted interventions need to be developed to promote and maintain behavior changes.

Adolescent↗
PubMed1993

Prevalence and transmission of HTLV-I infection in Natal/KwaZulu.

A community-based seroprevalence survey for human T-cell lymphotropic virus type I (HTLV-I) was undertaken in the Ngwelezane district of Natal/KwaZulu. A total of 1,018 individuals was interviewed for risk factors and had blood drawn for serological examination. To exclude antibody cross-reactivity between anti-HTLV-I and anti-HTLV-II all Western blot HTLV-I-positive samples were further subjected to a Select HTLV test. For comparison, anonymous HIV testing was done. The areas of residence of patients with myelopathy associated with HTLV-I were also ascertained. The seroprevalence of HTLV-I was 2.6% (95% confidence interval (CI) 1.62-3.58). An age-related rise in HTLV-I seropositivity from 1.3% in the 15-24-year age group to 6.1% in the over 55-year-old group was noted. There was no significant association between HTLV-I antibody positivity and marital status, occupation, history of blood transfusion, scarification, age at first sexual experience and number of sexual partners. Anti-HIV-1 antibody testing revealed a positivity of 3.5% (95% CI 2.4-4.68) and the relative risk for co-infection with both HTLV-I and HIV-1 in the 15-24-year group was 1.16 (95% CI 1.08-1.24). The study also identified the first HTLV-II-seropositive case in the Natal/KwaZulu region. Up to December 1991, 90 cases of HTLV-I-associated myelopathy/tropical spastic paraparesis were seen at the Neurology Unit, Wentworth Hospital. The patients came from all parts of Natal, from Pongola in the north to Transkei in the south. The Natal/KwaZulu region is, therefore, an endemic HTLV-I area.

Adolescent↗
PubMed1994

Unlinked anonymous screening of antenatal patients for antibody to human immunodeficiency virus type 1 (HIV-1).

OBJECTIVES: To determine the prevalence of HIV-1 infection in the general community by using a target population (antenatal patients) as an indicator of infection, to monitor any change in the prevalence of HIV infection in this population and provide baseline information on heterosexual spread of HIV infection into this low prevalence population. PATIENTS AND DESIGN: Between January 1989 and January 1992, 4537 unlinked anonymous antenatal sera were tested in two study groups at Westmead Hospital. Repeatedly reactive sera were confirmed by western blot and other supplementary assays as appropriate. RESULTS: No significant change in the seroprevalence of HIV-1 infection was detected between the two study periods. Of the 2208 sera tested in 1989-1990, one (0.05%) was confirmed as positive and one (0.05%) gave a non-specific reaction by enzyme immunoassay (EIA). Of the 2329 sera tested in 1991-1992, there was one (0.04%) HIV-1 antibody positive serum, and two gave non-specific EIA reactions. These results were compared with three other sample populations tested at Westmead Hospital during the same period: linked antenatal patients, antenatal methadone clinic attendees and all women tested. CONCLUSIONS: Periodic anonymous testing of a sample antenatal population (combined with screening of high risk patients) is useful for monitoring the prevalence of HIV infection in these populations and estimating any future need for generalised screening.

Adult↗
PubMed1990

[A psychological study, using interviews and projective tests, of patients seeking anonymous donor artificial insemination].

A Thematic Aperception Test was used with 13 male and 16 female patients who were requesting A.I.D. The following main psychological reactions were found in women: anxiety and depression (fear of rejection by their family and friends; lowering the image of the husband--the donor being considered as a rival), aggression (the narcissistic woman "demands" A.I.D.; the donor is esteemed highly); mother is protective ("true" paternity comes through love of the child and the need to forget the donor). They found, in men: an inability to abandon fertility as lost (with denial of sterility); ambivalence, castration anxiety and a feeling of being excluded from the mother-child symbiosis with later acceptance of loss of fertility and (sometimes excessively) identification with the "mother". Most subjects studied were not intending telling the child about his true origin; because disclosure would be tantamount to transgressing twice over the laws of paternity and the rules against Oedipus behaviour. There is often a great difference between the ways the partners view the matter and inter-relate. We strongly recommend that psychological advice should be taken before treatment with A.I.D. is started.

Aggression↗
PubMed2004

Trends in HIV prevalence among public sexually transmitted disease clinic attendees in the Western region of the United States (1989-1999).

OBJECTIVES: Using data from anonymous unlinked testing of routinely collected sera, trends in HIV are compared among sexually transmitted disease patients in 4 Western urban centers. METHODS: Between 1989 and 1999, remnant sera obtained for routine syphilis testing from 256,819 patient visits to Denver, Los Angeles, San Francisco, and Seattle clinics were tested for HIV antibodies in an unlinked survey. HIV antibody test results were linked to anonymous demographic and risk information abstracted from the medical record. RESULTS: Overall cumulative HIV seroprevalences among women and among men who had sex exclusively with women were < or = 2%, declined over time, and did not exceed 8% among those who injected drugs. In contrast, cumulative HIV seroprevalences among men who have sex with men ranged from 13% in Seattle to 30% in San Francisco and declined a mean of 2.1% (95% CI, 1.6, 2.6) to 2.8% (CI 2.6, 3.1) per year, after adjustment. CONCLUSIONS: HIV infection declined over time across counties. Relative levels of HIV differed little by demographic and behavioral risk group despite differences in the severity of each county's epidemic. Because of the unique contribution of unlinked serosurveillance studies in monitoring these trends, their reinstitution in high-risk settings should be considered.

Adolescent↗
PubMed1996

The need for anonymous genetic counseling and testing.

Concerns are mounting about the risks of genetic discrimination resulting from the release of predictive and presymptomatic genetic test results to employers, insurers, and others. The ability to keep this information confidential is questionable, particularly in view of the expansion of electronic medical databases. One solution is to afford individuals access to anonymous genetic counseling and testing. Probands would be identified only by a code that would not reveal personal information, and test results would be stored, retrieved, and released solely on the basis of this code. The experience with anonymous HIV testing, while not completely analogous, suggests that such an approach would be both practical and effective.

Anonymous Testing↗
PubMed2005

Potential deterrent effect of name-based HIV infection surveillance.

To meet federal recommendations to collect case reports of HIV infection, California has adopted a non-name code system to conduct HIV surveillance. The objective of this study was to evaluate among HIV test takers the acceptability and preferences for the 3 major types of HIV infection reporting-name, name-to-code, and non-name code. Interviewer-administered exit surveys with spoken scripts and matching printed materials clearly outlining the 3 HIV reporting options were conducted among HIV test takers immediately following appointments for pretest HIV counseling and blood collection. The study enrolled 208 HIV test takers at 14 publicly funded HIV testing sites in 4 California counties (Los Angeles, Riverside, Fresno, and Santa Clara). Overall with respect to which would be the most acceptable system, 67% reported non-name code, 19% reported name-to-code, and 12% reported name-based HIV reporting (P < 0.0001). A second sample of 226 exit surveys taken 1 year following implementation of California's non-name code HIV infection reporting system continued to show a significant preference for non-name code HIV infection reporting. Significant independent predictors of a preference for coded HIV reporting in both the pre- and postimplementation period were men who have sex with men (odds ratio [OR] = 5.7, 95% CI: 1.2-26 in the preperiod) and having just taken an anonymous HIV test (OR = 3.6, 95% CI: 1.4-9.3, P = 0.009 preperiod). Were the state to adopt name-based HIV reporting, significantly fewer individuals report being likely in the next 12 months to have a confidential HIV test than report being likely to have an anonymous HIV test (51% likely confidential vs. 76% likely anonymous, P < 0.0001). This analysis documents strong support, among HIV test takers in California, for a non-name coded HIV reporting system and indicates a high probability of a shift away from confidential testing toward anonymous testing under a scenario of name-based reporting. This shift is of concern as confidential HIV testing is the basis of US HIV surveillance systems.

Adult↗
PubMedDate not supplied

The legality of unlinked anonymous screening for HIV infection: the U.S. approach.

The purpose of this article is to describe the legal approach, and in particular, the specific statutory vehicle adopted by the U.S. with respect to unlinked anonymous screening, and to offer the U.S. approach as a possible model for those countries presently considering the implementation of unlinked HIV screening programs. Clear legal authorization for unlinked anonymous HIV testing is provided for by statute or regulation in the U.S. Federal regulations and various state laws specifically permit unlinked anonymous testing. Under these regulations and statutes, informed consent of a test subject is not required so long as testing is done for research purposes and the test results are not individually traceable to particular subjects.

AIDS Serodiagnosis↗
PubMed2002

Spare non-occupational HIV post-exposure prophylaxis by active contacting and testing of the source person.

OBJECTIVE: HIV-1 post-exposure prophylaxis (PEP) is frequently prescribed after exposure to source persons with an undetermined HIV serostatus. To reduce unnecessary use of PEP, we implemented a policy including active contacting of source persons and the availability of free, anonymous HIV testing ('PEP policy'). METHODS: All consultations for potential non-occupational HIV exposures i.e. outside the medical environment) were prospectively recorded. The impact of the PEP policy on PEP prescription and costs was analysed and modelled. RESULTS: Among 146 putative exposures, 47 involved a source person already known to be HIV positive and 23 had no indication for PEP. The remaining 76 exposures involved a source person of unknown HIV serostatus. Of 33 (43.4%) exposures for which the source person could be contacted and tested, PEP was avoided in 24 (72.7%), initiated and discontinued in seven (21.2%), and prescribed and completed in two (6.1%). In contrast, of 43 (56.6%) exposures for which the source person could not be tested, PEP was prescribed in 35 (81.4%), P < 0.001. Upon modelling, the PEP policy allowed a 31% reduction of cost for management of exposures to source persons of unknown HIV serostatus. The policy was cost-saving for HIV prevalence of up to 70% in the source population. The availability of all the source persons for testing would have reduced cost by 64%. CONCLUSION: In the management of non-occupational HIV exposures, active contacting and free, anonymous testing of source persons proved feasible. This policy resulted in a decrease in prescription of PEP, proved to be cost-saving, and presumably helped to avoid unnecessary toxicity and psychological stress.

Anti-HIV Agents↗