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PubMed1995

HIV-testing of health care workers: unethical request or moral obligation?

Transmission of HIV from physician to patient is possible. Physicians should help the public understand the low level of this risk and put it in the perspective of other medical risks, while acknowledging public concern. Nevertheless, there is a clear need for national guidelines which give unambiguous, practicable guidance about HIV-testing of health care workers performing invasive procedures and consequences of positive results. It is an ethical obligation of us physicians to come forward with such distinct recommendations and clearly have identified "exposure-prone" procedures which might necessitate HIV-screening. Infection with HIV does not in itself justify restrictions on the practice of an otherwise competent health care worker, but seropositive physicians should place themselves under the guidance of an expert review panel, which should determine whether practice restrictions are appropriate.

AIDS Serodiagnosis↗
PubMed1994

Home testing for HIV.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Ethical issues in perinatal HIV.

Perinatal HIV raises difficult ethical issues and value conflicts for practitioners, patients, and the public. Part I gives an overview of US infant HIV realities and the devastating worldwide HIV and tuberculosis pandemics. In part II, the major ethical issues regarding perinatal HIV including confidentiality, advance directives, US rights, and right to medical care where HIV exists. Also reviewed are quality of life and death, consideration of selective and more general problems associated with prenatal and neonatal screening, and pregnancy termination and postponement where perinatal HIV is likely.

Abortion, Therapeutic↗
PubMed1994

The cost-effectiveness of HIV testing of physicians and dentists in the United States.

OBJECTIVE: To evaluate the cost-effectiveness of alternative policies for human immunodeficiency testing (HIV) testing of physicians and dentists. METHODS: Decision analysis and cost-effectiveness analysis from a societal perspective were used. Data were derived from extensive literature review and consultation with experts. We conducted sensitivity analyses and also performed a cost-benefit analysis. ANALYSES: We analyzed policies for mandatory or voluntary testing of all physicians, surgeons, and dentists; for those testing positive, we analyzed mandatory or voluntary exclusion from practice, restriction from performance of invasive procedures, or requirements to inform patients of serostatus. MAIN OUTCOME MEASURE: Cost per patient infection averted. RESULTS: Although one-time mandatory testing of surgeons and dentists with mandatory restriction of those found to be HIV-positive is more cost-effective than other policies, the cost-effectiveness varies tremendously under different scenarios. Results were highly sensitive to several data inputs, especially HIV seroprevalence of surgeons and dentists and transmission risk. For example, under a medium seroprevalence and transmission risk scenario, mandatory testing of all surgeons might avert 25 infections at a total cost of $27.9 million or $1,115,000 per infection averted and an incremental cost of $291,000 compared with current testing; however, the incremental cost-effectiveness per patient infection averted ranges from $29,807,000 under a low-risk scenario to a savings of $81,000 under a high-risk scenario. CONCLUSION: Our analysis neither justifies nor precludes a mandatory testing policy. Further research on the key data inputs is needed. Given the ethical, social, and public health implications, mandatory testing policies should not be implemented without greater certainty as to their cost-effectiveness.

AIDS Serodiagnosis↗
PubMed1994

The relationship of 1988 state HIV testing policies to previous and planned voluntary use of HIV testing.

This study analyzed whether state HIV testing policies were related to individuals' previous and planned voluntary use of HIV testing. Testing plays an important role in the prevention and treatment of HIV infection, yet little is known about how policies are related to testing use. Most states mandate the conditions under which testing is performed, but states vary widely in their policies. This cross-sectional study analyzed individual-level data from the 1988 AIDS Knowledge and Attitudes Survey, which was merged with state-level data on testing policies and incidence of AIDS cases. A multivariate regression model was used to assess the relationship of state policies to testing use, holding state AIDS incidence and individual characteristics (sociodemographics, AIDS knowledge, and risk status) constant. Individuals in states with policies protective of individual rights (i.e., early adoption of comprehensive antidiscrimination laws restricting screening by insurers and employers; provision of voluntary, anonymous testing) were significantly more likely to have been tested than individuals in comparison states (odds ratio = 1.5). Individual characteristics such as risk status, however, had the strongest relationships to testing use. No evidence was found that name-reporting requirements were related to previous or planned use of testing. Future research must address emerging testing issues such as policies covering the use of new testing technologies.

AIDS Serodiagnosis↗
PubMed1993

HIV testing and private insurance.

When insurers demand information about HIV infection or that an HIV test be performed, the personal rights of applicants for insurance are under pressure. How can the balance between the contracting parties be restored? Dutch arguments and statements are pointed out.

AIDS Serodiagnosis↗
PubMed1993

Urban community health volunteers.

An evaluation was made of the effectiveness of an urban community health volunteer programme in Pokhara, Nepal, in sensitizing and motivating people for the improvement of health knowledge and skills and the use of services. Despite weaknesses and inadequate management support, there has been a sharp increase in coverage by the health services. If management support were properly developed the programme could undoubtedly play a vital role in raising health standards. It was clearly demonstrated that the utilization of services can be increased if access to them is improved.

Child, Preschool↗