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Anonymous HIV testing.

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Acquired Immunodeficiency Syndrome↗

[Acceptance of HIV antibody testing among pregnant women].

During the period April 17-July 14, 1989, 820 pregnant women were offered HIV-antibody testing at the antenatal clinic, Aarhus Municipality Hospital. Seven hundred and seventy-nine (95%) agreed to complete a questionnaire concerning, among other things, previous HIV-antibody testing. 20% of the participants had been tested previously, half of them because they were blood donors. More than 3% had been tested because of self-perceived risk behaviour or a risk environment. In three women, the previous test had shown HIV-antibodies to be present, and three further women refused to report the test result. 81% of the women consented to be tested. Acceptance declined during the project period. Those who had not been tested previously consented more frequently than those who had. Students were less willing to consent than others. Nineteen out of 20 women (2.6%), who considered themselves at high risk, accepted the offer to be tested. Thirty-eight (5%) of the 150 women who declined to be tested, would have accepted if their general practitioner had suggested it. None of the women tested at present were found to be HIV-antibody positive. When the project was terminated, a total of 87% of the women had been HIV-antibody tested previously or at present. We suggest routine HIV surveillance of pregnant women by use of voluntary HIV-antibody testing in combination with anonymous testing (AUT technique) in case the women does not want to know the test result.

Acquired Immunodeficiency Syndrome↗

Anonymous AIDS testing.

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Acquired Immunodeficiency Syndrome↗

Prevalence of smoking in early pregnancy by census area: measured by anonymous cotinine testing of residual antenatal blood samples.

AIM: To accurately measure the prevalence of smoking in early pregnancy by census area units (CAU) in Christchurch. METHODS: Smoking status in pregnancy was determined by serum cotinine assay for all antenatal blood samples taken over a 6 month period. CAUs in Christchurch were grouped into quartiles according to the proportion of maternal smokers. Social factors from 1991 census data were used to describe the characteristics of each quartile. RESULTS: The overall rate of smoking in pregnancy was 33.0%. Rates ranged from 10.6% to 56.9% for the census area groups. CAUs in the upper quartile (39-57% of women smoking in pregnancy) were clustered together geographically and were associated with lower socioeconomic indices. The strongest correlation was between average income with smoking rates (Pearson correlation coefficient 0.76). CONCLUSION: Smoking rates in pregnancy have remained at around 30% for at least 20 years, with some areas of the city having rates nearly double this. It would seem logical to promote smoke-free pregnancy activities in localities with the highest rates of smoking. Future evaluation of the efficacy of such programmes should be done using objective measurements.

Confidence Intervals↗

Anonymous versus confidential HIV testing: client and provider decision making under uncertainty.

Six intensive observational studies of HIV testing sites were undertaken in order to improve understanding of confidential and anonymous testing. Three sites offered only confidential testing (a large health maintenance organization's Urgent Care clinic, the same organization's HIV clinic, and a private medical practitioner's office), one offered only anonymous testing (a free clinic), and two offered a choice of confidential or anonymous testing (a thrift shop alternate testing site and a mobile testing unit). Multiple data collection strategies were used including direct field observation, semistructured interviews with clients and providers, and document and policy analysis. Using an organizational/interactional uncertainty framework, this study found that the choice between anonymous and confidential testing is a central aspect of the HIV testing process, that some clients are unclear about the differences between anonymous and confidential testing, that alternate testing sites' providers play a significant role in encouraging confidential rather than anonymous testing in order to further their organization's resource needs and public health goals, and that testing counselors' may consider that some clients prefer anonymous testing because of fear of stigma, discrimination, or loss of privacy.

AIDS Serodiagnosis↗

Prevention of mother-to-child transmission and voluntary counseling and testing programme data: what is their utility for HIV surveillance?

OBJECTIVE: Antenatal clinic (ANC)-based surveillance through unlinked anonymous testing (UAT) for HIV without informed consent provides solid long-term trend data in resource-constrained countries with generalized epidemics. The rapid expansion of the prevention of mother-to-child transmission (PMTCT) and voluntary counseling and testing (VCT) programmes prompts the question regarding their utility for HIV surveillance and their potential to replace UAT-based ANC surveillance. METHODS: Four presentations on the use of PMTCT or VCT data for HIV surveillance were presented at a recent international conference. The main findings are presented in this paper, and the operational and epidemiological aspects of using PMTCT or VCT data for surveillance are considered. RESULTS: VCT data in Uganda confirm the falling trend in HIV prevalence observed in ANC surveillance. Thailand, a country with nationwide PMTCT coverage and a very high acceptance of HIV testing, has replaced UAT data in favor of PMTCT data for surveillance. Studies from Botswana and Kenya showed that PMTCT-based HIV prevalences was similar, but the quality and availability of the PMTCT data varied. CONCLUSION: The strength of UAT lies in the absence of selection bias and the availability of individual data. Conversely, the quantity of VCT and PMTCT programme testing data often exceed those in UAT, but may be subject to bias due to self-selection or test refusal. When using VCT or PMTCT data for surveillance, investigators must consider these caveats, as well as their varying data quality, accessibility, and availability of individual records.

Adolescent↗

Rapid HIV antibody testing in the New York State Anonymous HIV Counseling and Testing Program: experience from the field.

OBJECTIVES: To assess rapid and conventional HIV test use, client satisfaction, and counselors' comfort. METHODS: At 61 HIV test sites in New York State, we compared HIV test use during the first 6 months of rapid testing in 2003 with the same time period in 2002. We administered surveys to clients at each site during the first 30 days of rapid testing and to counselors before and after training and after 12 weeks of using rapid tests in the field. RESULTS: Almost all (1249 [96.5%] of 1294) clients surveyed selected rapid over conventional HIV testing. During the evaluation period, 6187 HIV tests were reported, 1667 (36.9%) more than during the same period in 2002. All 5771 (100%) of 5771 clients received their rapid HIV test results compared with 333 (85.8%) of 388 clients (P < 0.0001) who had elected conventional testing. After performing rapid testing for 12 weeks, 32 (80%) of 40 trained counselors reported feeling "very comfortable" delivering reactive rapid test results compared with 14 (35%) of 40 trained counselors (P < 0.001) before training. CONCLUSIONS: Rapid testing presents a key opportunity to increase the number of people undergoing HIV testing and the proportion receiving their test results.

AIDS Serodiagnosis↗