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PubMed2005

Comparison of three methods to measure HIV incidence among persons seeking voluntary, anonymous counseling and testing.

OBJECTIVES: The authors compared 3 practical methods to estimate human HIV incidence rates using existing data from persons seeking anonymous testing in San Francisco between 1996-2002. Each method was assessed for strengths and limitations. METHODS: Three different approaches were used to determine HIV incidence: one based on self-reported dates of prior tests, one based on linking records of prior tests using an anonymous unique testing code, and one based on the Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS). RESULTS: The 3 methods found comparable rates of seroconversion overall (1.0, 1.2, and 1.3 per 100 person-years) and among men who have sex with men (1.4, 1.6, and 2.0 per 100 person-years). Incidence for all 3 methods saw a peak during 1999 followed by a decline. Greatest variability of incidence was observed among lower-risk populations, in whom few infections were expected. CONCLUSIONS: The 3 methods had complementary strengths and limitations, which may prevent proper interpretation of HIV incidence if any one method is analyzed alone. HIV incidence rates among persons seeking HIV testing should be interpreted cautiously using corroborative data on risk behavior and sexually transmitted diseases and other contextual information.

Anonymous Testing↗

PubMed2000

Prevalence of detectable abnormal prion protein in persons incubating vCJD: plausible incubation periods and cautious inference.

BACKGROUND: Both small and large variant Creutzfeldt Jakob disease (vCJD) epidemics are consistent with the current observed incidence. Uncertainty in vCJD projections could potentially be reduced by incorporating information on the prevalence of the infectious agent in persons incubating vCJD. The prospect of vCJD prevalence studies has been raised by detection of abnormal prion protein, thought to be the infectious agent, in appendices and tonsils removed from vCJD patients. Although unlinked anonymous testing of stored operative tissues for abnormal prion protein is very appealing, the design and interpretation of such prevalence studies is complicated by the lack of information on how early in the incubation period of vCJD the abnormal prion protein becomes detectable. METHODS: We simulate a range of vCJD epidemics, consistent with the limited available information on the incidence of vCJD, to illustrate some of the potential problems encountered when interpreting the results from prevalence studies of detectable abnormal prion protein. We assume plausible incubation period distributions and dietary exposure patterns. RESULTS: We demonstrate, in the context of our simulated epidemics, that prevalence studies of detectable abnormal prion protein would require the testing of tens of thousands of operative specimens and, even then, that unlinked anonymous testing positives would be unexpected.

Animals↗

PubMed2006

High HIV prevalence among patients choosing anonymous and free testing in Belgium, 1990-2002.

From 1990 through 2002, 25,250 anonymous and free HIV tests were performed at a testing site, which carried out the majority (85%) of anonymous testing in Belgium. During the same period, approximately 7.3 million confidential tests were registered nationwide. The rate of new HIV infections diagnosed at the anonymous testing site was 11.1/1000 tests; it was significantly higher than the rate observed among confidential tests (relative risk = 7.41; P < 0.0001). New HIV cases diagnosed through anonymous testing include a higher proportion of young adults (42.0% versus 32.5% in confidential testing; P < 0.001) and a higher proportion of men who have sex with men (32.7% vs. 25.9% in confidential testing; P < 0.02). Anonymous and free HIV testing was particularly sought by persons with higher infection risk, and efficiently contributed to HIV diagnosis in this population. Anonymous and free testing should be and remain an accessible alternative integrated in HIV testing policies.

Belgium↗

PubMed1967

Use of thiosemicarbazone and para-nitrobenzoic acid in screening tests for anonymous mycobacteria.

In screening for anonymous mycobacteria the use of thiosemicarbazone (10mug./ml.) may give rise to false positive results. Although these can usually be overcome by further tests, additional time and effort is required, which seriously limits the value of thiosemicarbazone as a true screening agent. Para-nitrobenzoic acid (500 mug./ml.) has proved more satisfactory in our hands; no false positive results have been obtained and it has the additional advantage that strains of M. kansasii (usually thiosemicarbazone sensitive) are resistant to para-nitrobenzoic acid.

Animals↗

PubMed2003

Prevalence of and risk factors for HIV infection in individuals testing for HIV at counseling centers in Brazil.

BACKGROUND: Risk factors for HIV infection have been scarcely studied in developing countries. GOAL: The goal was to examine the seroprevalence and the risk factors for HIV infection among individuals submitting to voluntary and anonymous testing at counseling and testing centers in Porto Alegre, Brazil. STUDY DESIGN: In this cross-sectional study HIV infection was diagnosed by enzyme-linked immunosorbent assays (ELISAs) and indirect immunofluorescence. Risk factors for HIV infection were investigated and fitted to logistic regression models according to a hierarchical framework. RESULTS: The overall prevalence of HIV infection was 11.9%. It was greater among homosexual men, individuals with an HIV-positive partner, and intravenous cocaine users. The factors independently associated with risk for HIV infection were: history of detention, homosexual or bisexual orientation, positive VDRL, sex with male prostitutes, HIV-positive sex partner, sex with injectable drug user (IDU), use of cocaine, and sharing needles or syringes. CONCLUSION: A high prevalence of HIV infection among individuals attending anonymous testing centers was related to sexual behavior and IDU. Other risk factors might be just proxies of true risk behaviors.

Adult↗

PubMed1989

Epidemiology of human T-cell leukaemia/lymphoma virus type 1 (HTLV-1) infections in a subpopulation of Afro-Caribbean origin in England.

Epidemiological studies on neurological diseases in residents of Afro-Caribbean origin in the West Midlands region of England have identified eight patients with tropical spastic paraparesis (TSP), all of whom were found to be infected with human T-cell leukaemia/lymphoma virus type 1 (HTLV-1). The husband of one of the patients with TSP was also infected with HTLV-1 and had a T-cell lymphoma. In addition, six asymptomatic HTLV-1-infected first-degree relatives of the TSP patients have been found. By anonymous testing of over 700 sera obtained from individuals of Afro-Caribbean, African, or Asian ethnic origin, seven HTLV-1-infected individuals were detected, who were all immigrants from the Caribbean. Overall, these numbers yielded a seroprevalence of HTLV-1 infections of 3.4% among the immigrant population of Afro-Caribbean origin, which is comparable with the prevalence of HTLV-1 in Jamaica in an equivalent age and sex cohort. Sera were tested for HTLV-1 antibody by means of three different procedures: passive particle agglutination test (Serodia), indirect enzyme-labeled immunosorbent assay (ELISA; Dupont), and indirect immunofluorescence test (in-house, using HTLV-1-infected MT2 cells). The results of all three tests correlated very well with each other. HTLV-1 antibody titres in TSP patients were on the whole significantly higher than those of asymptomatic carriers, but some of the apparently healthy first-degree relatives and one anonymously tested individual had titres as high as most of the TSP patients.

Black or African American↗

PubMedDate not supplied

Evaluation of the unlinked anonymous prevalence monitoring programme for HIV in England and Wales: science, ethics and health policy.

BACKGROUND: The Unlinked Anonymous Prevalence Monitoring Programme for HIV in England and Wales was set up in 1989 and has been operational for over a decade. This paper describes a wide-ranging evaluation of the programme encompassing different perspectives and approaches: epidemiological, ethical, social scientific and economic. MATERIAL AND METHODS: Epidemiological and ethical evaluation by critical review of the literature. Evaluation of the public's views on unlinked anonymous testing of blood by questions inserted into the Omnibus National Survey carried out by the Office for National Statistics. Evaluation of the views of planners of HIV/AIDS services by telephone questionnaire survey. Economic analysis by costing of the programme. RESULTS: Epidemiologically the programme's results contribute to the jigsaw of knowledge about HIV. The ethical debate has shifted with time, and moral justification for the programme was more valid at its inception than now. The majority of the public was unaware of unlinked anonymous testing of blood for HIV, and 25-30% disagreed with the policy. Local planners of HIV services found the programme generally useful. There are concerns about the programme's hidden costs and funding. CONCLUSIONS: To improve awareness and respect autonomy information leaflets, explaining opting out of testing, should be handed to all individuals at centres where the programme is operational. Data from the programme should be fed back quicker to local planners, and the programme's funding needs reappraisal. Further research on patients' views is indicated. Generic conclusions include the need for a definition of 'public health emergency', and establishment of a national healthcare ethics committee.

Bioethical Issues↗

PubMed1989

HIV testing in antenatal clinics: the impact on women.

One hundred and fifty-five women attending antenatal clinics in an inner city area where the rate of AIDS reporting is high were interviewed to examine the acceptability of different modes and purposes of antenatal HIV testing. Eighty-two per cent of women felt the test should be available in antenatal clinics, but only 48% reported that they themselves would take the test. Seventy-four per cent would accept anonymous testing. Potential anxiety levels surrounding the HIV test were significantly higher than for other (currently routine) tests in antenatal clinics. The implications of these findings for policy are discussed.

AIDS Serodiagnosis↗

PubMed1993

The prevalence of human retroviral infections in female patients attending a central London sexually transmitted disease clinic: 1985-1990.

OBJECTIVES: To determine the prevalence of infection with HIV-1, HIV2, HTLV-1 and HTLV-2 in female attenders at a central London sexually transmitted disease clinic in an 8 week period in 1989-1990, and compare it with similar samples studied between 1985 and 1987. DESIGN: Anonymous testing of serum samples from consecutive female patients having routine serological investigation for syphilis. Testing was for clinically important retroviruses, Hepatitis B core antibodies (anti-HBc), and p24 and reverse transcriptase (RT) antigens. Age (in 5 year bands), nationality (in broad geographical zones), diagnosis on the day of presentation, and history of intravenous drug usage were recorded for each patient. Annual gonorrhoea rates were analysed from 1981 to 1990. SETTING: Outpatients of the department of genitourinary medicine. PATIENTS: A total of 850 females attending consecutively and having routine syphilis serology. MAIN RESULTS: The prevalence of anti-HIV-1 in female attenders in 1989-1990 was 0.35% (3/850). Prevalence in the same clinic has remained statistically unchanged since the first female cases were identified in 1986. No cases of HIV-2, HTLV-1 or HTLV-2 were identified, and no early HIV-1 infection evidenced by the presence of p24 or RT antigenaemia was found. Female gonorrhoea rates continued to decline but other STD monthly/annual rates have remained unchanged. CONCLUSIONS: Over the last 5 years prevalence of HIV-1 infection in females in our clinic has remained unchanged and other retroviral infections have remained absent. However, the unaltered rates of other genital infections, their potential role in the heterosexual spread of HIV-1 infection, and the lack of evidence for any major changes in female sexual behaviour suggests there is a need to remain vigilant. This work complements the MRC multicentre, unlinked, genitourinary medicine clinic, anonymous testing programme, and our group will continue to apply this simple methodology to specimens from female attenders to contribute to the surveillance of the evolving HIV-1 epidemic.

Adolescent↗

PubMedDate not supplied