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PubMed2004

Voluntary counselling and testing (VCT) for Human Immunodeficiency Virus: a study on acceptability by Nigerian women attending antenatal clinics.

This study was carried out among 345 pregnant women attending antenatal clinics at two health facilities in Lagos, Nigeria. It was undertaken to determine their knowledge and acceptability of HIV voluntary counselling and testing in pregnancy as a strategy for the prevention of mother-to-child transmission (PMTCT) of HIV. Data were collected on issues relating to mother-to-child transmission of HIV, willingness to go for voluntary counselling and testing, actions to be taken if a pregnant woman was found to be HIV positive including infant feeding options. Majority of the women (89.9%) had good knowledge of the modes of HIV transmission, however, knowledge of specific aspects of PMTCT was poor. Close to half of the women (41.7%) were not aware of the association between breast milk and HIV transmission. Almost all the women (96.1%) were willing to undergo HIV testing in pregnancy particularly if it would assist preventing transmission of HIV to their babies; but only few would undergo the test if the result would be shared with relatives. Many of the women would still prefer breastfeeding even if they were found to be HIV positive. Awareness of anti-retroviral drugs among the study group was very poor. As the country is about to embark on its PMTTCT programme, there is need to increase the level of knowledge, acceptability and adoption of VCT and other PMTCT strategies among potential beneficiaries. Innovative information and education techniques need to be developed to provide HIV positive mothers with knowledge and skills that can enable them to make informed choices about infant feeding options and other forms of care.

AIDS Serodiagnosis↗
PubMed1992

HIV testing: an ethical analysis.

As the epidemic of the human immunodeficiency virus continues to grow, the relationship between patients and health care workers is being tainted with fear and mistrust. The demand for mandatory testing of health care providers has caused many of us to assess our basic values of autonomy, beneficence, nonmaleficence, and justice. Is our "right to privacy" more important than our "right to know"? This article will analyze some of the legal, moral, and ethical issues to be considered in identifying possible alternatives and a justified solution to this dilemma.

AIDS Serodiagnosis↗
PubMed1979

Disability benefits as disincentives to rehabilitation.

The relations among physical disability, governmental and voluntary benefit programs, and rehabilitation outcome are more complex than has generally been assumed. Factors of motivation and functional capacity are not adequately accommodated by current methods and level of benefit provision. Preliminary investigation shows that programs may, in fact, deter some of the disabled from return to work. Proposed congressional legislation does not appear to likely to resolve conflicting goals and expectations of the labor market, the disabled, and the taxpayer.

Adult↗
PubMed1992

Postnatal human immunodeficiency virus antibody testing. The effects of current policy on infant care and maternal informed consent.

Routine human immunodeficiency virus (HIV) antibody screening of umbilical cord blood identifies neonates at risk for HIV infection but may hold risks as well as benefits for infants and mothers. We describe the effect of testing on infant placement and care and report the women's understanding of pretest counseling and consent. In a case-control analysis of 327 tested infants, seropositive infants (13) had a higher rate of discharge to home (62%) than did controls (31%). More case infants (100%) received follow-up care and vaccinations than control infants (46%). Of 32 women interviewed after HIV antibody test informed consent, only 31% understood that a positive cord blood test result was inconclusive for the infant, and most (78%) did not identify any associated socioeconomic risks. Most (88%) stated an interest in learning their serostatus, but only 22% returned for test results. Despite the benefits of HIV antibody testing of at-risk infants, current testing and counseling procedures inadequately inform women, limiting the testing benefits to them.

AIDS Serodiagnosis↗
PubMedDate not supplied

Cost and efficiency of HIV voluntary counselling and testing centres in Andhra Pradesh, India.

BACKGROUND: [corrected] As part of the effort to control HIV/AIDS, the number of HlV voluntarycounselling and testingcentres (VCTCs) is increasing rapidly in the public health system of the Indian state of Andhra Pradesh, which is estimated to have one of the highest rates of HIV infection in India. However, systematic data on the cost and efficiency of providing VCT services in India are not available to help guide efficient use of resources for these services. METHODS: We used standardized methods to obtain detailed cost and output data for the 2002-03 fiscal year from written records and interviews in 17 VCTCs in the public health system in Andhra Pradesh. We calculated the economic cost per client receiving VCT services, and analysed the variation and determinants of total and unit costs across VCTCs. We used multivariate regression techniques to estimate incremental unit costs. We assessed hurdles towards serving an optimal number of clients by VCTCs. RESULTS: In the 2002-03 fiscal year, 32 413 clients received the complete sequence of services at the 17 VCTCs, including post-HIV test counselling. The number of clients served by each VCTC ranged from 334 to 7802 (median 979). The overall HIV-positive rate in post-test counselled clients was 20.5% (range 5.4%-52.6%). The cost per client for the complete VCT sequence varied 6-fold between VCTCs (range Rs 141.5-829.6 [US 2.92-17.14 dollars], median Rs 363.5 [US 7.51 dollars]). The cost per client was significantly lower at VCTCs with more clients (p < 0.001, R2 = 0.83; power function) due to substantial fixed costs. Personnel made up the largest component of cost (53.7%). The cost per client had a significant direct relation with percent personnel cost for VCTCs (p < 0.001, R2 = 0.58; exponential function). A multiple regression model revealed that the incremental cost of providing complete VCT services to each HIV-positive and -negative client was Rs 123.5 (US 2.54 dollars) and Rs 59.2 (US 1.22 dollars), respectively. Fourteen VCTCs (82.4%) reported that they could serve more clients with the available personnel and infrastructure, and that inadequate demand for their services was the main hurdle towards achieving this. CONCLUSION: These data suggest that the efforts of the National AIDS Control Organisation of India and the Andhra Pradesh State AIDS Control Society in increasing VCTCs could yield even higher benefit if the demand for these services was enhanced, as this would increase the number of clients served and reduce the cost per client. Ongoing systematic cost-efficiency analysis is necessary to help guide efficient use of HIV-control resources in India.

AIDS Serodiagnosis↗
PubMed2005

Report on a flawed "report card": the public citizens ranking of medical licensing boards.

Any global ranking of states with respect to the health and safety of its citizens using specific, singular scales is fraught with difficulty and all such efforts should be interpreted with caution. It becomes even more problematic when one attempts to link physician discipline rates directly to either quality of care or injury and deaths of patients, as the Health Resource Group alleges. Any bona fide ranking of states with respect to health care or patient safety overall, whatever its source or its attempted correlations, would require a very complex, sophisticated equation with multiple, defined, distinct, quantifiable variables. The HRG report does not meet that high threshold. First, its report ranks states from best to worst using FSMB physician discipline action data despite the FSMB disclaimer that none of its numbers should be used to compare one state to another. Second, HRG sets up its own selective criteria for "seriousness" of discipline, and in so doing specifically excludes the category C disciplines, which Wisconsin uses often and responsibly in protecting the public and disciplining physicians. This arbitrary exclusion puts Wisconsin into an unwarranted "worst" state category. Third, HRG then links its worst states to practices that "injure or kill patients." However when one attempts to verify such allegations by comparing HRG rankings to specific quality-of-care rankings, using such measurements as Medicare data or Hospital HealthGrade data, such a sweeping allegation is unsupported. Finally, HRG's conclusion that "more is better" with respect to physician discipline rates needs to be examined and weighed very carefully. It may be, in fact, that in those states with lower rates of physician discipline ("worse" states by HRG standards) there are fewer complaints filed per capita in the first place, which would point toward a "better" level of practice in those states. Or it may be that a lower ("worse") record of disciplines is due to "better," more stringent screening of physicians in the initial licensing process, thus keeping out the problem physicians in the first place. Or those states with lower discipline rates may have more alternative programs and resources such as a voluntary impaired professional program, which has stringent monitoring but does not require formal discipline. HRG's ranking of Wisconsin as 49th in physician discipline rates is flawed in process and in fact. The accusation that such a low rating results in danger to patients or "not practicing medicine in the best manner" is an unsupported one. Comparison of the HRG ranking system with two other measures of quality of care--the Medicare Beneficiaries Quality of Care Study and the HealthGrades Hospital Quality in America Study--shows little consistency between those rankings and the HRG study. Overall, the Wisconsin Medical Examining Board continues to carry out its important mission of patient safety and physician licensing and discipline in a very responsible and accountable fashion, and a closer analysis of the Health Research Group report, which suggests otherwise, demonstrates it to be a flawed "report card".

Humans↗
PubMed2005

It's one step toward quality. Many hurdles remain to establishing new patient-safety groups, which will use confidential provider data on medical errors.

The new Patient Safety and Quality Improvement Act, passed late last month, would provide incentives for healthcare providers to report medical errors. While the idea behind the new bill is universally popular--to reduce errors and increase quality of care--some members of the industry, such as physician Steve McDermott, left, say that implementing a national reporting system will be harder than it sounds.

Database Management Systems↗