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PubMedDate not supplied

A successful approach to immunizing men who have sex with men against hepatitis B.

This paper reports the success of outreach efforts to immunize adults at high risk of acquiring hepatitis B virus (HBV) infection. Local health department testers recruited clients when they sought anonymous HIV testing. Interested clients were serologically tested for HBV infection. Susceptibles were offered a free hepatitis B vaccine. Of 189 clients who were tested, 161 (86%) were susceptible to HBV infection and 140 (74%) were men who have sex with men (MSM). Of the susceptibles, 82 (51%) started the hepatitis B vaccine series. Sixty-five (80%) received three doses of hepatitis B vaccine and an additional 10 (12%) received two doses. Completing the hepatitis B vaccine series was associated with being a MSM (odds ratio [OR] 8.8, confidence interval [CI] 1.5-56.0) and with not being an injection drug user (IDU) (OR 0.2, CI 0.02-1.0). One way to provide hepatitis B vaccine to MSM is to attach an immunization program to a successful anonymous HIV testing program. The feasibility of implementing such programs would increase if public vaccine policymakers made more federally purchased hepatitis B vaccine available for adults.

Adolescent↗
PubMed1996

Routine voluntary antepartum HIV antibody counseling and testing: a sound public health prevention strategy.

Routine voluntary antepartum HIV antibody counseling and testing are important HIV prevention strategies based on sound public health principles. The ultimate goal of this testing strategy is two-fold: identification of high-risk seronegative women for risk reduction counseling; and identification of HIV-infected parturients for counseling, prenatal care, and long-term medical management. To achieve these objectives, there must be nationwide implementation of the CDC HIV prenatal testing guidelines. Our challenge as healthcare providers is to ensure that all of our prenatal patients are afforded the opportunity to have HIV counseling and testing performed.

Anonymous Testing↗
PubMed2001

Late diagnosis of HIV infection in women seeking counseling and testing services in São Paulo, Brazil.

We investigated whether women positive for human immunodeficiency virus (HIV) infection were late in seeking an anonymous HIV counseling and testing service, and the factors associated with a low CD4 count, in São Paulo, Brazil. Seventy-one consecutive HIV-1-seropositive women were interviewed by means of a structured questionnaire. Blood samples were collected for CD4+ T-lymphocytes count and determination of HIV-1 subtypes. Hepatitis C, syphilis, human T-cell lymphotrophic virus type I (HTLV-I), and HTLV-II infections were assessed by serologic tests. More than 70% of the women had less than 500 CD4+ cells/mm3 (20% below 200). Low CD4 count was significantly associated with sex work history, condom use in the last 6 months, and seropositivity to HTLV-I and syphilis. There was no relation between low CD4 count and HIV-1 subtypes. These results indicate that in Sao Paulo many women are seeking an anonymous testing service late in the course of HIV infection. The main purposes of anonymous HIV testing services - early diagnosis of infection, and counseling to prevent infection - are not being achieved. Another strategy for reducing the interval between infection and diagnosis in women must be addressed.

Adolescent↗
PubMed1992

Anonymous HIV surveillance in Saughton Prison, Edinburgh.

OBJECTIVES: To estimate the prevalence of HIV by anonymous saliva testing in Her Majesty's Prison, Saughton (Saughton Prison), Edinburgh, UK. To elicit linked anonymous risk factor information from which to estimate risk scores for those who had taken an HIV blood test and, among drug injectors, for those who were HIV-1-antibody-positive on saliva testing. SETTING: Saughton Prison on 15 and 16 August 1991; HIV Immunology and Regional Virus Laboratories, Edinburgh, and the Medical Research Council Biostatistics Unit, Cambridge, UK. PARTICIPANTS: Male inmates (378 out of a total of 499) of Saughton Prison. MAIN OUTCOME MEASURES: Answers to a brief questionnaire about age, usual residence, present and past custodial sentences, drug injecting and sexual behaviour prior to and in prison, HIV testing and history of acute hepatitis. HIV-1-antibody status was established by saliva testing. RESULTS: Eighteen per cent of participants were injecting drug users (IDU), of whom approximately one-half (47%) had injected while inside prison. Ninety men (26%), including 40 (14%) of 278 participants who had never injected drugs and 77% of IDU participants, had taken an HIV blood test. Nine per cent of all participants and 35% of IDU participants had had an acute attack of hepatitis. Forty-one (62%) of 66 IDU had been imprisoned five or more times before their current prison sentence. After taking account of region of residence, injecting drug history and acute hepatitis, aspects of sentencing and sexual behaviour were not determinants of those who had been tested for HIV. On the study days, 18 out of 499 (3.6%) participants were known to prison medical officers to be HIV-infected. Following saliva testing, HIV prevalence was 17 out of 375 (4.5%) inmates tested. All 17 had at some time 'taken the blood test for HIV' and all had injected non-medically prescribed drugs. Edinburgh residence, age 26-30 years, have injected in prison and having first injected before 1983 all contributed to the risk score for whether an IDU was HIV-1-antibody-positive on saliva testing. CONCLUSIONS: Documented HIV prevalence in saliva was 4.5%, which--assuming no volunteer bias (as supported by questionnaire returns)--suggests that actual HIV prevalence was 25% greater than revealed to Saughton's prison medical service. All 17 inmates who were HIV-1-antibody-positive on saliva testing had injected non-medically prescribed drugs. The high reported frequency by inmates of injecting in prison highlights the urgent requirement for drug reduction and rehabilitation programmes for injecting inmates. Linked anonymous voluntary HIV testing of saliva can provide valuable information about HIV prevalence for the planning of prison resources and policy.

Adult↗
PubMed1990

Evaluation of the Recombigen HIV-1 Latex Agglutination Test.

The Recombigen HIV-1 Latex Agglutination (LA) Test was recently licensed by the U.S. Food and Drug Administration for use as a rapid screening assay for human immunodeficiency virus type 1 (HIV-1) antibodies. However, its performance in various settings and in different populations has not been firmly established. Consequently, we evaluated the test in the Cleveland Clinic Retrovirus Laboratory, a regional reference laboratory for HIV diagnostic testing and a testing laboratory for the Ohio Department of Health Anonymous HIV Testing and Counseling Program. Serum samples from 93 individuals presumed to be at high risk for HIV infection were evaluated. The sera were initially tested for HIV antibodies by enzyme-linked immunosorbent assay (ELISA). All repeatedly reactive sera were subjected to confirmatory Western blot (WB; immunoblot) testing. Of 97 serum specimens tested (5 were from one seroconverter), 44 were repeatedly reactive by ELISA and 53 were nonreactive. Of the reactive serum specimens, 31 were confirmed positive and 12 were indeterminate by WB. All of the sera were coded and then retested by the LA test. Of 53 serum specimens nonreactive by ELISA, 51 were also nonreactive in the LA test. Of the 44 serum specimens reactive by ELISA, 16 were nonreactive by LA; however, 3 of the latter were WB positive. No serum specimen with an ELISA ratio (specimen optical density/cutoff optical density) of less than 2.1 scored reactive in the LA test. The LA test was positive for only two of five consecutive serum specimens from a seroconverter despite the fact that all but the earliest of these were ELISA reactive and WB positive. Although the LA test appears to be an adequate first-line screening test when appropriately used according to the directions of the manufacturer, our data suggest that occasional sera with low levels of reactivity by ELISA may not be readily detected as reactive by the LA test.

Blotting, Western↗
PubMed1994

HIV infection among women in prison: an assessment of risk factors using a nonnominal methodology.

The relative contributions of needle use practices and sexual behaviors to human immunodeficiency virus (HIV) antibody seropositivity among 394 women incarcerated in Quebec were determined by risk factor assessment and serology with a nonnominal methodology. HIV positivity was found in 6.9% (95% confidence interval [CI] = 4.6, 9.9) of all participants and in 13% (95% CI = 8.6, 18.6) of women with a history of injection drug use. HIV seropositivity among women with a history of injection drug use was predicted by sexual or needle contact with a seropositive person, self-reported genital herpes, and having had a regular sexual partner who injected drugs, but it was not predicted by prostitution. Nonnominal testing is an ethical alternative to mandatory and anonymous unlinked testing among correctional populations.

Adolescent↗
PubMed1992

Voluntary testing to measure HIV prevalence in sexually transmitted disease clinics.

Voluntary HIV testing was used to study the extent of HIV-1 infection in patients attending sexually transmitted disease (STD) clinics in England and Wales between 1985 and 1990. Homosexual and bisexual men and 10-20% of heterosexual men and women were invited to complete a study record and have an HIV-1 antibody test. The rate of newly diagnosed HIV-1 infection was higher in homosexual and bisexual men than in heterosexual clinic attenders. It was also higher in patients attending clinics in the South East compared with those attending clinics in other regions. From 1988 onwards, HIV infection was identified in heterosexual men and women who did not report behavioural risk factors associated with increased risk of HIV transmission. In the early years of the study, the proportion that agreed to complete a study record and have an HIV-1 antibody test was high in all groups. This proportion declined in those attending clinics in the South East, particularly among heterosexual men and women, less than 50% of whom agreed to take part in the study in 1989 and 1990. The decline in acceptance rate made voluntary testing unsuitable for monitoring trends in HIV infection. Unlinked anonymous HIV testing, which minimises the effect of participation bias, has become the method of choice for monitoring the prevalence of HIV infection.

AIDS Serodiagnosis↗
PubMed1992

The low rate of HIV infection in Japanese homosexual and bisexual men: an analysis of HIV seroprevalence and behavioural risk factors.

OBJECTIVE: To assess the seroprevalence of HIV-1 infection in homosexual and bisexual men in Nagoya City, Japan. DESIGN: A prospective study ongoing since April 1986. METHODS: Nine hundred and thirty-eight serum samples were collected from 531 participants in August 1990 in an anonymous, confidential testing programme. A self-administered questionnaire was completed and all participants anonymized by a code number. Interviews were conducted and HIV-antibody test results given by telephone, except for the positive test results, which were given in person and counselling offered. RESULTS: Two out of the 531 participants (0.38%) were found to be seropositive for HIV-1, although the seroprevalences of sexually transmitted diseases, including hepatitis B, syphilis, chlamydia infection and amoebiasis, were remarkably high. A small number of participants had had sexual contact with individuals from countries where HIV infection rates are high. No patient had had a recent episode of intravenous drug use. Numbers of male sexual partners were decreasing and unsafe sexual practices, such as anal intercourse without condom use, were also decreasing. CONCLUSIONS: The apparent low-risk behaviour of the men studied here (low levels of sexual contact with foreigners, absence of intravenous drug use, decreasing numbers of sexual partners and unsafe sexual practices) may explain the low prevalence of HIV infection.

Adolescent↗
PubMedDate not supplied

Date of first positive HIV test: reliability of information collected for HIV/AIDS surveillance in the United States.

OBJECTIVES: This study examined the reliability of the first positive HIV test date reported in the U.S. HIV/AIDS Reporting System (HARS). This date is essential to determine case counts for resource allocation for HIV treatment and prevention efforts. METHODS: The dates of first positive HIV tests reported by individuals with HIV in an interview survey conducted in 16 states (n=16,394, interviewed 1995-2002) were compared with the dates of HIV diagnosis reported to HARS. The percentage of agreement for the year of diagnosis and the weighed kappa (k) with 95% confidence intervals (CIs) was calculated. RESULTS: Self-reported year of diagnosis agreed with the year of diagnosis in HARS for 56% of date pairs (k=0.69; 95% CI 0.68, 0.70); 30% reported an earlier diagnosis year. Agreement differed by sex, age, race, exposure, and reason or place of testing (p<.01). Lower agreement was found when the self-reported diagnostic test was anonymous (k=0.57; 95% CI 0.52, 0.62) compared with confidential tests (k=0.66; 95% CI 0.64, 0.68). Lower agreement was also found for cases first reported with AIDS (k=0.58; 95% CI 0.55, 0.62) compared with cases first reported with HIV not AIDS (k=0.71; 95% CI 0.70, 0.73) as well as for participants interviewed three years or more after their HARS diagnosis date (k=0.55; 95% CI 0.52, 0.57) compared with those interviewed within one year (k=0.62; 95% CI 0.61, 0.63). More than 20% of participants in almost all groups, however, reported earlier diagnosis years than those recorded in HARS. CONCLUSION: As many as 30% of HIV diagnoses may have occurred earlier than recorded in HARS. Additional studies need to determine mechanisms to adequately capture diagnosis dates in HARS.

Adolescent↗