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PubMed2004

Preliminary results from the new HIV surveillance system in France.

In addition to AIDS surveillance, data on HIV infection are necessary to better follow the dynamics of the epidemic. We report the first results of France's mandatory anonymous HIV notification system, which is linked to a virological surveillance of recent HIV infections and of circulating HIV types, groups and subtypes. HIV notifications are initiated by microbiologists who create an anonymous code of patient's identity. Clinicians complete the notification form with epidemiological and clinical data. Notifications are sent to the local health authorities and passed to the Institut de Veille Sanitaire (InVS). Laboratories voluntarily send sera from newly diagnosed HIV infected persons on dried blood spots to the national HIV reference laboratory where an immunoassay for recent infection (< or = 6 months) and a serotyping assay for the determination of group and subtype are done. The virological results are then merged at the InVS with the information from the mandatory reporting. Of the first 1301 new HIV diagnoses reported in 2003, 43% were in women, and overall, 53% were in heterosexuals, of whom 47% were of sub-Saharan African origin. MSM accounted for 36% of male notifications. A dried blood spot was available for 64% of new HIV diagnoses. Evidence of recent infection was found for 38%, ranging from 22% in IDUs to 58% in MSM. Twenty-six percent of infections in sub-Saharan migrants were recent infections. HIV-1 accounted for 98% of all notifications: 48% of these were non-B subtypes. The first results of the HIV notification system indicate that heterosexual transmission is the predominant mode of transmission and that persons originating from sub-Saharan Africa are particularly affected. Over half of infections shown to be recently acquired were in MSM; this may indicate an increased HIV incidence in this population.

Adult↗
PubMed2006

Prevalence of SIL and SCCA in human immunodeficiency virus-seropositive women at anonymous clinic in Chonburi Hospital.

UNLABELLED: The series of 231 HIV-infected women were recruited in Chonburi Hospital, Thailand. Demographic, gynecologic factors were interviewed Pap smear was performed and classified based on the Bethasda system (1991) by a cytotechnologist. All abnormal Pap smear slides were reviewed by a cytopathologist. The prevalence of LSIL, HSIL and SCCA were 2.2%, 8.3% and 2.2%, respectively. There was statistically significant association between the duration of HIV infection and occurrence of SIL and SCCA. (p = 0.007) CONCLUSION: The present study showed a high prevalence of SIL and SCCA in-HIV-infected women at Chonburi Hospital.

Adult↗
PubMed2006

Higher seroprevalence of Entamoeba histolytica infection is associated with human immunodeficiency virus type 1 infection in Taiwan.

We assessed the seroprevalence of Entamoeba histolytica infection using indirect hemagglutination antibody (IHA) assay among 667 HIV-infected persons (group A), 1,311 asymptomatic HIV-uninfected persons seeking anonymous HIV testing (group B), 616 HIV-uninfected controls with gastrointestinal symptoms (diarrhea and/or liver abscess) seeking medical care (group C), and 2,500 healthy controls undergoing health check-up (group D). An IHA titer >or= 128 was detected in 7.1% of group A, 2.5% of group B, 1.8% of group C, and 0.1% of group D (P < 0.0001). The highest seroprevalence (11.2%) was noted among HIV-infected persons who were men having sex with men (MSM) 30-39 years of age. Compared with persons with gastrointestinal symptoms, the adjusted odds ratio for having high IHA titers among HIV-infected persons was 3.206 (95% confidence interval, 1.433, 7.176; P = 0.005). These findings show that HIV-infected persons, especially MSM 30-39 years of age, are at significantly higher risk of E. histolytica infection.

Adolescent↗
PubMed2006

Masking through averages--intraprovincial heterogeneity in HIV prevalence within the Western Cape.

OBJECTIVE: To measure HIV prevalence at health-district level in the Western Cape (WC) and to compare these findings with those of the National HIV Antenatal Surveys (NHASs). This investigation aimed to estimate the degree of heterogeneity of HIV prevalence within the province in order to inform the design of appropriate and targeted HIV interventions. METHOD: Annual cross-sectional, unlinked district HIV antenatal surveys were implemented in all 25 health districts of the WC for the years 2001 - 2004, concurrently with the NHAS. A stratified proportional sample was drawn for each district, involving all 344 antenatal clinics in the province, and the anonymous screening method as described by the World Health Organization (WHO) was applied. RESULTS: The NHAS revealed a significant increase in HIV prevalence in the WC from 8.6% (95% confidence interval (CI): 5.6 - 11.6) in 2001 to 15.4% (95% CI: 12.5 - 18.2) in 2004. The district-level HIV surveys showed wide variation in HIV prevalence across the health districts, which increased progressively during this period (a range of 0.6 - 22% for the year 2001 increased to 1 - 33% in 2004). Spatial analysis of HIV prevalence by health district for this period also revealed progressive spatial growth of the sub-epidemics, with the highest prevalence observed in districts located in the Cape metropole region. CONCLUSIONS: These concurrent surveys highlight the fact that examining a provincial estimate of HIV prevalence alone has the potential to mask epicentres within the province. This underscores the importance of expanding the surveillance systems to detect heterogeneity sub-provincially, in order to link with local-level planning and resource allocation.

Anonymous Testing↗
PubMed2006

Retention of basic sciences knowledge at clinical years of medical curriculum.

AIM: To explore the association between the knowledge of basic (physiology and biochemistry) and clinical sciences (internal medicine) among medical students, and determine the level of retained basic science knowledge at the fifth year of medical studies. METHODS: Medical students attending the second (n=145, response rate 60%) or the fifth year (n=176, response rate 73%) of medical studies at the Zagreb University School of Medicine in Croatia were given an anonymous knowledge test with 15 pairs of questions developed specifically for this purpose. Each pair consisted of a basic and clinical question, with the correct answer to the basic question explaining the physiological or biochemical background of the clinical question. Three pairs of questions were excludes from the analysis due to poor psychometric characteristics. RESULTS: We found statistically significant correlation between basic and clinical tests scores for both groups of students (r=0.47, P<0.001 for the second year and r=0.45, P<0.001 for the fifth year). 2x2 within-between measures ANOVA revealed a significant interaction effect for knowledge test and study year (Wilks lambda=0.55, F(1, 319)=262.7, P<0.001; effect size=0.45), showing that fifth year students scored lower on the basic test than second year students but obtained higher scores on the clinical test. CONCLUSION: The core basic science knowledge is lost during the clinical years of medical studies. Although remembering and understanding basic science concepts as a background of clinical statements at the clinical years does not directly affect clinical knowledge, there is a positive correlation between retained basic science concepts and clinical knowledge.

Croatia↗
PubMed1992

High prevalence of recent cocaine use and the unreliability of patient self-report in an inner-city walk-in clinic.

OBJECTIVE: To determine the prevalence of recent cocaine use and the reliability of patient self-reported cocaine use. DESIGN: A survey with blinded comparison to a criterion standard. SETTING: Walk-in clinic of a large public hospital in metropolitan Atlanta, Ga. PARTICIPANTS: Male patients, aged 18 to 39 years, presenting to the triage desk for immediate care during weekdays. Of the 415 eligible men who agreed to participate (acceptance rate, 82%), the average age was 29.5 years, 91.6% were black, and 89% were uninsured. INTERVENTION: None. MAIN OUTCOME MEASURES: Comparison of self-reported illicit drug use with results from urinary immunoassays for benzoylecgonine, a major cocaine metabolite. Determination of which drug history questions produce the most accurate responses using anonymous urine testing as the criterion standard. RESULTS: Thirty-nine percent of patients tested positive for the presence of benzoylecgonine and were statistically more likely to be older, black, and have a prior history of sexually transmitted disease (P less than .01). Seventy-two percent of men with positive urinary assays denied illicit drug use in the 3 days prior to sampling. When queried with several formats, subjects with positive urine assays were more likely to admit to "any illegal drug" use (87.5%) than to the more specific "any form of cocaine" use (60.6%) within the prior year (P less than .0001). CONCLUSIONS: These results underscore the magnitude of cocaine abuse among black, inner-city men. Patient self-report of illicit drug use is highly inaccurate. Accuracy of self-report may be increased by asking less specific questions.

Adolescent↗
PubMed1990

Effects of outreach intervention on risk reduction among intravenous drug users.

Considerable voluntary risk reduction has occurred among IVDUs in New York City. The purpose of the AIDS Outreach Project was to improve upon the existing level of risk reduction by providing information and anonymous HIV testing to street-recruited IVDUs. Intake and follow-up interviews were conducted with 121 subjects (44% of 276 at intake), with a mean of 4.5 months between interviews. Significant risk reduction occurred in many drug and sexual risk behaviors, although not in bleach use, and more than half of the subjects continued to engage in high-risk sexual behavior. An analysis of differences in risk reduction between early and later intake groups indicated that external trends were not sufficient to account for observed risk reduction. Among subjects engaged in high-risk behavior at intake, those who injected less or were enrolled in drug abuse treatment were more likely to stop high-risk drug injecting. Subjects who (at intake) engaged in less frequent unprotected sex, or who had had sex with someone with AIDS, were more likely to stop high-risk sexual behavior. The majority of subjects at low risk at intake maintained low-risk behavior. Informational interventions appear to be most successful among those IVDUs already engaging in lower levels of risk behavior. More effective methods are needed for those whose level of risk behavior is greater. These might include peer pressure and distributing bleach (as opposed to only providing information about bleach).

Acquired Immunodeficiency Syndrome↗
PubMed1995

Informed consent for genetic research on stored tissue samples.

OBJECTIVE: To develop recommendations for obtaining adequate informed consent in the future when gathering tissue samples that may be used for genetic studies and defining the circumstances under which it is necessary to obtain further consent if tissue samples already in hand are to be used for such research. PARTICIPANTS: Scientists, ethicists, lawyers, and consumers selected by the National Center for Human Genome Research and the Centers for Disease Control and Prevention to represent a wide array of opinions. EVIDENCE: Statutes, regulations, and cases and articles on law and ethics. CONSENSUS PROCESS: Initial workshop, followed by circulation of several drafts of this document with opportunities for comment by workshop participants and others as well as smaller meetings involving participants with widely differing views. CONCLUSION: Genetic research using stored tissue samples poses an array of benefits and risks to individuals, researchers, and society. As a result, the workshop participants conclude that (1) informed consent is required for all genetic research using linkable samples unless conditions for limitation or waiver are met; (2) informed consent is not required for genetic research using anonymous samples but may be considered if identifiers are to be removed from currently linkable samples; (3) institutional review boards could usefully review all protocols that propose to use samples for genetic research; and (4) further work regarding these issues is warranted.

Anonymous Testing↗
PubMed1995

[Epidemiology of HIV in Germany].

In many developing countries, HIV is predominantly distributed among heterosexuals. This has given rise to the concern that similar patterns are to be expected in Europe. The current publication discusses different methods for estimation of the number of people infected. The figures published for the first time 1988-1990 by the author (1,2) are refined and consequences are discussed. It is demonstrated that legalizing drugs may reduce the import of HIV into the heterosexual population and that using condoms and spermicides in the first three months of a partnership may prevent the spread of HIV, while anonymous unlinked testing (AUT) is neither necessary for assessing the spread of HIV nor can it provide reliable estimates within a reasonable period of time.

Condoms↗
PubMed1995

[HIV surveillance in an outpatient clinic for sexually transmissible diseases in Amsterdam, 1991-1994; low and stable prevalence among heterosexual clients].

OBJECTIVE: To assess the HIV prevalence among heterosexual attenders of a clinic for sexually transmitted diseases (STD) and among subpopulations, including young gay men and ethnic minorities. SETTING: Outpatient clinic for sexually transmitted diseases (STD) of the Municipal Health Service of Amsterdam, the Netherlands. METHODS: Semi-annually in the period 1991-1994, blood samples given voluntarily and anonymously were tested for HIV antibodies and some characteristics were collected of approximately 1000 clinic attenders. RESULTS: Since 1991, 6766 clinic attenders were eligible for participation, of whom 6200 (92%) were actually tested. The overall HIV prevalence decreased from 3.9% in the first half of 1991 to 2.3% in the second half of 1994. Among heterosexual clinic attenders the prevalence remained stable below 1%, due mainly to visitors from abroad rather than to Dutch heterosexuals: 20 of the 23 HIV infected heterosexuals were not Dutch. None of these 23 seropositive persons knew of their HIV infection, mostly because they had not been tested previously. The HIV prevalence among gay men decreased over the years. In addition, the number of gay male attenders younger than 30 years decreased strongly over time. CONCLUSIONS: HIV infections among heterosexual STD clinic attenders are relatively few and are seen mainly among non-Dutch. We found no indications of an increase of the HIV prevalence among heterosexual clinic attenders. The results among young gay men are suggestive of a shift towards safer sexual behaviour in this group.

Adult↗