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PubMed2006

Demographic predictors of a positive HIV test result among clients attending a large metropolitan voluntary counselling and testing centre in Thailand.

OBJECTIVES: The Thai Red Cross Anonymous Clinic in Bangkok, established in 1991, was the first centre in Asia to provide anonymous, voluntary counselling and testing for HIV infection. We present outcomes of testing for the period 1997-2004. METHODS: Newcomers to the Thai Red Cross Anonymous Clinic were invited to complete a brief questionnaire concerning HIV risk behaviour and personal characteristics. The questionnaire was linked by code numbers to the HIV test result. Information obtained from the pretest questionnaire and HIV antibody test results from January 1997 to December 2004 were analysed. Data are presented as means [with standard deviation (SD)], medians [with interquartile range (IQR)] or percentages. Multivariate analysis using logistic regression was performed to identify factors predicting a positive HIV test result. RESULTS: Over the 8-year study period, 65,807 new clients attended the clinic. Two-thirds were male and the mean age was 31.7 years (SD 9 years), and more than half were single. The proportion of high-school graduates was 43%, and 36% earned more than 10,000 Baht a month (40 Baht:1 US dollar). Of 54,578 new clients who had an HIV test during the study period, 17.5% had a positive test result. In multivariate analysis, predictive factors for HIV positivity included female gender, age group 25-34 years, widowed status (women), residence outside Bangkok, birthplace in a northern province, no formal schooling, farmer as profession, and salary less than 5000 Baht a month (the current legal minimum daily wage set by the Thai Ministry of Labor is 181 Baht). CONCLUSIONS: With nearly 7000 clients newly tested for HIV infection each year, the Anonymous Clinic in Bangkok has provided a unique epidemiological window into the patterns of HIV infection in the Thai capital.

Adolescent↗
PubMed1995

Harnessing the heightened public awareness of celebrity HIV disclosures: "Magic" and "Cookie" Johnson and HIV testing.

This article investigates the impact NBA basketball star Earvin ("Magic") Johnson's HIV disclosure had on changes in demand for HIV counseling and testing services in New York State's 61 Anonymous HIV Counseling and Testing sites. Interrupted time-series analyses were conducted on weekly data from over 34,000 clients seeking anonymous HIV counseling and testing services from January 1991 to June 1992, to determine whether demand for these services changed as a result of the disclosure. Results indicated that immediately following the HIV disclosure, there was a substantial increase in service demand, which transcended all sex, race, age, and most HIV risk-related boundaries. Seven months later, demand had not returned to pre-disclosure levels. The strong impact on females, coupled with additional data analyses in obstetrical settings, suggests that previous research has been too narrow in focus, and that the effect of Johnson's HIV disclosure has been enhanced, in part, by the publicity surrounding his wife and baby. The importance of harnessing the heightened public awareness of celebrity HIV disclosures is discussed.

AIDS Serodiagnosis↗
PubMedDate not supplied

National campaign against hepatitis C in France (1999-2002).

Since 1988, several measures have been applied in France to control HCV infection. HCV seroprevalence in the adult population is estimated at 1.1% (500,000 to 650,000 persons) and the number of chronically infected at 400,000 to 500,000 persons. In 1994, most of them might not be aware of their infection. Blood products administration and injecting-drug use are identified as the main transmission routes. The national hepatitis C plan (1999-2002) was based on scientific data and developed after a consensus conference and several expert consultations. It involves six programs and quantified objectives: prevention of new infections, enforcement of screening access; improvement of care management; implementation of a surveillance system, clinical research and evaluation. Specific financial supports were attributed for the implementation of the plan. The 2001 progress report confirmed a major increase in national and regional actions. In 2000, considering the high proportion of persons still unaware of their infection (at least one third) and the increase of treatment efficacy, the target population of the screening strategy was considerably extended after scientific analysis. A national consciousness-raising campaign directed at general practitioners was launched in June 2000. In 2001, a media campaign directed to the general population was developed, in newspapers and on radio stations. Since the end of 1999, a national toll free phone number provides information to the public. In order to improve access to screening, a new regulation added HCV testing to the missions of anonymous and free HIV testing centres, as well as of family planning centres. The hepatitis C prevention strategy is still included in a national public health program and improved in view of its renewal.

Cost-Benefit Analysis↗
PubMed2000

A comparison of seven tests for serological diagnosis of tuberculosis.

Seven serological tests, two immunochromatographic tests, ICT Tuberculosis and RAPID TEST TB, and five enzyme-linked immunosorbent assays, TUBERCULOSIS IgA EIA, PATHOZYME-TB complex, PATHOZYME-MYCO IgG, PATHOZYME-MYCO IgA, and PATHOZYME-MYCO IgM, were evaluated simultaneously with 298 serum samples from three groups of individuals: 44 patients with active tuberculosis, 204 controls who had undergone the Mantoux test (89 Mantoux test-positive and 115 Mantoux test-negative controls), and 50 anonymous controls. The sensitivities of the tests with sera from patients with active tuberculosis were poor to modest, ranging from 16 to 57%. All the tests performed equally with sera from subgroups of those with active tuberculosis, those with pulmonary (33 patients) versus extrapulmonary (11 patients) disease, and those who were smear positive (24 patients) versus smear negative (12 patients) (P > 0.05). The specificities of the tests ranged from 80 to 97% with sera from the Mantoux test controls and 62 to 100% with sera from the anonymous controls. The TUBERCULOSIS IgA EIA had the highest sensitivity (57%) with sera from patients with active tuberculosis, with a high specificity of 93% with sera from the Mantoux test controls, but a very poor specificity of 62% with sera from the anonymous controls. Overall, ICT Tuberculosis followed by PATHOZYME-MYCO IgG had the best performance characteristics, with sensitivities of 41 and 55%, respectively, with sera from patients with active tuberculosis and specificities of 96 and 89%, respectively, with sera from the Mantoux test controls and 88 and 90%, respectively, with sera from the anonymous controls. By combining all the test results, a maximum sensitivity of 84% was obtained, with reciprocal drops in specificities to 55 and 42% for the Mantoux test controls and anonymous controls, respectively. The best combination was that of ICT Tuberculosis and PATHOZYME-MYCO IgG, with a sensitivity of 66% and a specificity of 86% for the Mantoux test controls and a sensitivity and specificity of 78% for the anonymous controls. While a negative result by any one of these tests would be useful in helping to exclude disease in a population with a low prevalence of tuberculosis, a positive result may aid in clinical decision making when applied to symptomatic patients being evaluated for active tuberculosis.

Adolescent↗
PubMed2000

The prevalence and genetic diversity of hepatitis C infection in antenatal clinic attenders in two regions of England.

The prevalence and genetic diversity of hepatitis C infection in women attending antenatal clinics in two regions of England was investigated to inform future surveillance and control measures. Women booking into antenatal care are routinely offered a test for immunity to rubella. Serum residues from these tests were unlinked, anonymized and archived as part of the Unlinked Anonymous Prevalence Monitoring Programme (UAPMP). The serum specimens were tested for anti-HCV using a cost-effective pooling strategy. After taking into account differential sampling from the UAPMP serum archive, the adjusted overall prevalence of anti-HCV was 0.43% (95% CI: 0.32-0.53) in London and 0.21% (95% CI: 0.14-0.28) in the Northern and Yorkshire region. Restriction fragment length polymorphism of amplified HCV RNA identified type 3a as the most common HCV genotype in these antenatal women. The prevalence of anti-HCV in antenatal women in the UK is low and consistent with that expected from injecting drug use.

Adolescent↗
PubMed1998

HIV seropositivity rates in outreach-based counseling and testing services: program evaluation.

A common assumption is that outreach-based HIV counseling and testing services reach a clientele with a higher HIV seroprevalence than clinic-based counseling and testing. To examine this assumption, we analyzed Wisconsin's anonymous counseling and testing client records for 62,299 contacts (testing episodes) from 1992 to 1995. Bivariate analysis of counseling and testing service setting (outreach-based or clinic-based) and HIV test results suggested that outreach contacts were 23% (odds ratio [OR], 1.23; 95% confidence interval [95% CI], 1.0-1.5) more likely to test HIV-seropositive than clinic-based contacts. Relations between HIV test outcome and variables for client age, race, gender, previous testing history, mode of risk exposure, and region, as well as service setting, were examined by logistic regression. An inverted relation between service setting and seropositivity (OR, 0.65; 95% CI, 0.5-0.8) indicated that, within some subpopulations, outreach contacts were significantly less likely to test HIV-positive than clinic-based contacts. Analysis of interactions among the covariates identified race as a critical codeterminant in the relation between service setting and test outcome. These results support retargeting outreach services to enhance their overall effectiveness. Specific recommendations include the need for aggressive strategies to better "market" HIV counseling and testing to nonwhite populations, and to focus resources more selectively on gay/bisexual men of all races.

Adolescent↗
PubMed1996

Voluntary universal antenatal HIV testing.

OBJECTIVES: To assess the uptake of universal voluntary named HIV testing of hospital booked antenatal women and to identify behavioural and demographic factors associated with testing. To identify the number of previously undiagnosed women detected by the new policy and to compare prevalence among those testing with that measured by unlinked anonymous monitoring. DESIGN: Self-completion questionnaire and data abstraction from structured booking forms and virology laboratory records. SETTING: Central London teaching hospital antenatal clinic. PARTICIPANTS: One thousand three hundred and seventy-four women booking with a hospital based midwife during the 49 weeks from 27 July 1993 to 1 July 1994. RESULTS: Before the introduction of the new testing policy fewer than 10 women per year had an HIV test, and during the study this rose to 41% (548/1340). In univariate analysis, caucasian and Mediterranean ethnic origin, fewer previous live births, and more than one lifetime sexual partner were associated with higher uptake of HIV testing. In a multivariate model only the number of previous live births and ethnic origin remained significantly associated with testing. Six women out of 828 (1%) who completed the question about nonprescribed drug use stated that they had injected drugs, and four of these women accepted a test. Two women, both with recognised major risk factors for HIV infection, were diagnosed HIV antibody positive (a prevalence in the tested women of 0.36%). A further three women were already known to be HIV antibody positive. During the 12 months from July 1993 seven women (0.24%) were found to be positive by unlinked anonymous testing. CONCLUSIONS: The introduction of a universal approach to antenatal HIV testing appears feasible: it increased the uptake of the test and detected previously unrecognised infections. Many women chose not to be tested, however, and cases remained undiagnosed. Further studies are required to examine different models of offering HIV testing, reasons for declining the test, and the cost-benefit of antenatal HIV screening.

Adolescent↗
PubMed1999

Home collection versus publicly funded HIV testing in San Francisco: who tests where?

We examined records of all HIV antibody tests performed at anonymous publicly funded (PF) sites and by home collection (HC) testing for residents of San Francisco from August 1996 to December 1997. Although far fewer tests were performed by HC testing than at PF sites (715 versus 8712, respectively), a higher proportion of HC testers reported no prior history of HIV testing (33.1% versus 17.9%). HIV seroprevalence was higher among PF tests (1.8%) than among HC tests (0.9%). Compared with PF testers, HC testers were less likely to be gay men, lesbian or bisexual women, heterosexual women, African American, or Latino. HC testers were more likely to report sex with a known HIV-positive partner. HC testers were also more likely to reside in affluent neighborhoods. HC testing reaches some high-risk persons who may not otherwise seek PF testing, although, overall, the risk profile of HC testers appeared lower than that of PF testers. HC testing reaches some individuals who can financially afford HC testing, thus saving public prevention resources for hard-to-reach, high-risk populations.

AIDS Serodiagnosis↗
PubMed1995

Coverage of routine neonatal metabolic screening in children born to women known to be infected with HIV-1.

Unlinked anonymous HIV-1 testing of neonatal samples routinely collected for metabolic screening is now carried out in many parts of the United Kingdom. The purpose of this study was to assess the completeness of screening coverage in infants born to women known to be infected with HIV-1. Research nurses at family HIV clinics in three London hospitals searched for Guthrie cards from all infants born to known infected residents of North East, North West, and South West Thames regions over a 32 month period. If no card was found initially, mothers were approached for more information. Overall coverage was estimated to be 96.4% (94.6% in infants of African origin and 100% in white infants). These figures are similar to recent general population coverage estimates in inner London. We conclude that the anonymous newborn HIV testing programme is providing sufficiently accurate information on both absolute levels and time trends in maternal seroprevalence.

Africa↗
PubMedDate not supplied

[Threat of drug addiction in the army].

UNLABELLED: Drug addiction belongs to those phenomena of social pathology with complex canses, mechanisms and conditionings. Drug addiction mainly concerns young people, also those from the military environment despite the fact that recruitment boards consider detected drug addicts-conscripts to be completely or temporarily unfit for service. AIM: The aim of this study is to assess the scale of drug addiction among soldiers taking into account the reasons and range of the phenomenon. METHOD: Using the method of the auditorial questionnaire, the tests were carried out on the amount trial among servicemen using anonymous questionnaires. The tests were performed in 1996 and the trial consisted of 552 soldiers and then they were repeated using the same questionnaire among 682 soldiers in 2001. RESULTS: It was found that in the years 1996-2001 the number of soldiers using psychoactive agents increased threefold. Marijuana and amphetamine were the most frequently used drugs. Nearly half of the soldiers tested think that in the army there are no problems with the supply with drugs, and over half of those who take drugs are of the opinion that drugs do not disturb their ability to service. THE RESULTS: Of the tests point to the following conclusions: in 2001 16.6% of the tested soldiers confessed to having contact with drugs, in 1996 this result was 5.1%. CONCLUSION: Marijuana and amphetamine still are the most popular among active soldiers. Although majority of servicemen consider taking drugs as a negative phenomenon, every tenth tested soldier pointed to positive effects of their taking. First contacts with drugs the tested soldiers had as early as in secondary school (58.3%), whereas as many as 25% of the tested subjects reported that they had the first contact with drugs in the army.

Activities of Daily Living↗
PubMed2001

Screening for Chlamydia trachomatis in an anonymous and confidential HIV counseling and testing site: feasibility and prevalence rates.

BACKGROUND: Chlamydia trachomatis is the most common bacterial sexually transmitted disease (STD) in the United States. The development of nucleic acid amplification tests for C trachomatis in urine specimens allows for screening outside traditional clinic settings. Persons visiting an HIV counseling and testing site may be at increased risk for STDs, including C trachomatis. GOAL: To measure the acceptance of C trachomatis urine screening and the prevalence of C trachomatis infection among clients at an HIV counseling and testing site. STUDY DESIGN: Site HIV counselors offered urine C trachomatis screening to clients, administered a questionnaire, and collected urine samples. RESULTS: Of 808 counseling and testing site clients approached for C trachomatis screening, 572 (71%) accepted. The most common reasons for declining screening were absence of symptoms (33%) and recent STD testing (32%). Men were more likely to accept urine screening than women (risk ratio, 1.31; 95% CI, 1.06-1.62), as were clients who practiced oral sex, had a history of STD, or who had never been screened for STD. Of 560 urine specimens processed, only 8 (1.43%; 95% CI, 0.66-2.91%) were infected with C trachomatis. CONCLUSIONS: Sites offering HIV testing and counseling are a feasible alternative to clinical settings for C trachomatis screening. Prevalence may be too low for screening to be cost effective unless higher-risk subpopulations can be identified.

Adolescent↗
PubMed1989

Survey of attitudes to testing for human immunodeficiency virus infection in antenatal clinics in West Glamorgan.

A total of 1023 women attending hospital antenatal clinics in West Glamorgan was surveyed by means of a self-administered questionnaire, to determine their attitudes to HIV testing in pregnancy. The response rate was 98%. Of the responders, 94% had no objection to their antenatal blood specimen being tested for HIV infection. Of the non-objectors, 55% wished their permission to be asked first, and 92% wished to be informed of the result, i.e. they wished for named testing. With regard to knowledge of other tests for infectious diseases performed on antenatal blood specimens, only 1.5% had totally correct knowledge, and only one in three knew that their blood was tested for syphilis. The implications of anonymous and named HIV testing are discussed, together with estimates of prevalence of HIV infection in women attending antenatal clinics, the rate of vertical transmission, and the prognosis for an infected baby.

AIDS Serodiagnosis↗
PubMedDate not supplied

Randomized testing of alternative survey formats using anonymous volunteers on the World Wide Web.

Consenting visitors to a health survey Web site were randomly assigned to a "matrix" presentation or an "expanded" presentation of survey response options. Among 4,208 visitors to the site over 3 months, 1,615 (38 percent) participated by giving consent and completing the survey. During a pre-trial period, when consent was not required, 914 of 1,667 visitors (55 percent) participated (odds ratio 1.9, P<0.0001). Mean response times were 5.07 minutes for the matrix format and 5.22 minutes for the expanded format (P=0.16). Neither health status scores nor alpha reliability coefficients were substantially influenced by the survey format, but health status scores varied with age and gender as expected from U.S. population norms. In conclusion, presenting response options in a matrix format may not substantially speed survey completion. This study demonstrates a method for rapidly evaluating interface design alternatives using anonymous Web volunteers who have provided informed consent.

Health Status↗
PubMed1992

HIV antibody testing in France: results of a national survey.

Data from a knowledge, attitudes, and behavior survey conducted at the end of 1988 suggest that 13% of the population in France, aged 16 to 50 years, had been tested for HIV antibodies. Geographical differences in testing were observed, with a greater number of respondents tested in the regions where AIDS is most prevalent. Important variations in the percentage of HIV antibody-tested persons were found in relation to age, education, and occupation, but not to gender. Multiple logistic regression analysis identified significant predictors of HIV antibody testing. Behavioral predictors were multiple partners (odds ratio = 2.4), anal intercourse (odds ratio = 1.8), and drug use. A positive relationship was demonstrated between HIV testing and condom use. These correlations could indicate that the opportunity for anonymous and free testing encourages high-risk individuals to be tested.

AIDS Serodiagnosis↗
PubMedDate not supplied

AIDS and HIV: the dilemma of the health care worker.

1. An estimated 5,800 health care workers have AIDS. Many times that number have HIV but have not yet developed AIDS. As of this date, 29 health care workers in the United States have seroconverted to HIV positive due to occupational exposure to the virus. Eleven are nurses. 2. Although much has been done to study the characteristics and etiology of the disease, there is still much debate over the methods of transmission, the best techniques of prevention, and the employability of those infected. 3. Over half the people surveyed would no longer seek medical attention from a health care provider if they knew that the provider had AIDS or HIV infection. This statistic demonstrates an almost irrational fear on the part of the public, since the chance of actual transmission from health care worker to patient is minimal. 4. Over 10 years of epidemiologic studies of HIV infected health care workers who performed highly invasive procedures have indicated that no transmissions have occurred. Therefore, the ANA is opposed to mandatory testing and mandatory disclosure of HIV status of patients and/or nurses. Voluntary anonymous or confidential testing--in conformance with informed consent laws--and counselling are encouraged. 5. Despite the laws and recommendations for employability of infected workers, there still exists widespread discrimination against individuals infected with HIV or individuals with AIDS, largely due to the confusion generated by the various guidelines and recommendations.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Cirrhosis mortality in Ontario: effects of alcohol consumption and Alcoholics Anonymous participation.

AIMS: We test the hypotheses that cirrhosis mortality rates are positively associated with per capita alcohol consumption and negatively associated with Alcoholics Anonymous (AA) membership rates. DESIGN: The impact of alcohol consumption levels and AA membership rates on cirrhosis mortality rates in Ontario from 1968 to 1989 were examined. Time-series analyses with ARIMA modelling were applied to male and female cirrhosis mortality rates in three age groups: 15-44, 45-64 and 65 + years. Missing AA membership data were interpolated using two methods: linear splines and cubic splines. FINDINGS: In general, cirrhosis mortality rates were positively associated with alcohol consumption and negatively associated with AA membership. For some age and gender combinations, these effects were not statistically significant. CONCLUSIONS: The limits of this study include restrictions in the length of series available and in the ability to infer causality. Despite these limitations, these findings are consistent with previous research demonstrating that per capita consumption is a strong determinant of cirrhosis mortality rates, and also that higher levels of AA membership can reduce cirrhosis mortality rates.

Adolescent↗