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Horyniak D, Guy R, Prybylski D, Hellard M, Kaldor J. The utility of voluntary counselling and testing data as a source of information on HIV prevalence: a systematic review. Int J STD AIDS 2010; 21:305-11. [DOI: 10.1258/ijsa.2009.009427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We explored the utility of routine HIV testing data from clinical services for estimating HIV prevalence. A systematic review identified 28 eligible publications, covering concentrated epidemics (16 of 28) and generalized epidemics (12). Of the 16 papers from concentrated epidemics, five presented estimates by risk group and four by testing history with a median HIV prevalence of 1.8% in first-time testers compared with 3% in repeat testers. Two reports from generalized epidemics restricted estimates to asymptomatic clients and three included breakdowns by reason-for-test, with the median HIV prevalence higher in symptomatic clients (62%) than others (24%). Two papers from generalized epidemics showed prevalence estimates based on routine HIV testing data were slightly higher than estimates derived from other surveillance methods, but did not restrict estimates to asymptomatic patients. We conclude that routine HIV testing data may be a supplementary data source for HIV surveillance provided careful analyses are conducted.
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Affiliation(s)
- D Horyniak
- Centre for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Rd, Melbourne VIC 3004
| | - R Guy
- Centre for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Rd, Melbourne VIC 3004
- National Centre in HIV Epidemiology and Clinical Research (NCHECR), University of New South Wales, 45 Beach St, Coogee, NSW, Australia
| | - D Prybylski
- Family Health International, Asia-Pacific Regional Office, 130-132 Sindhorn Bldg, 19th Floor, Bangkok, Thailand
| | - M Hellard
- Centre for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Rd, Melbourne VIC 3004
| | - J Kaldor
- National Centre in HIV Epidemiology and Clinical Research (NCHECR), University of New South Wales, 45 Beach St, Coogee, NSW, Australia
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Duran D, Usman HR, Beltrami J, Alvarez ME, Valleroy L, Lyles CM. HIV counseling and testing among Hispanics at CDC-funded sites in the United States, 2007. Am J Public Health 2010; 100 Suppl 1:S152-8. [PMID: 20147691 PMCID: PMC2837436 DOI: 10.2105/ajph.2009.166355] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2009] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to determine whether Hispanic-White HIV testing disparities exist and to identify characteristics associated with newly diagnosed HIV among Hispanics. METHODS We used 2007 HIV Counseling and Testing System data to compare test-level records of Hispanics and non-Hispanic Whites, and we conducted a multivariate logistic regression analysis to identify characteristics associated with newly diagnosed HIV. RESULTS Relative to Whites, Hispanics were more likely to have had a positive HIV test result (1.2% versus 0.8%), to have newly diagnosed HIV (0.8% versus 0.6%), and to have test results returned and receive posttest counseling more than 2 weeks after testing (24.3% versus 21.5%). Newly diagnosed HIV among Hispanics was most strongly associated with being a man who has sex with men (MSM; adjusted odds ratio [AOR] = 6.8; 95% confidence interval [CI] = 6.1, 7.6), being both an MSM and an injection drug user (AOR = 3.7; 95% CI = 2.6, 5.3), and being aged 40 to 49 years (AOR = 6.4; 95% CI = 4.9, 8.2). CONCLUSIONS Hispanic-White disparities exist with respect to rates of positive HIV test results and late return of results. HIV prevention strategies such as rapid testing should focus on Hispanic MSM.
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Affiliation(s)
- Denise Duran
- Program Evaluation Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-59, Atlanta, GA 30333, USA.
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Anderson SA, Yang H, Gallagher LM, O'Callaghan S, Forshee RA, Busch MP, McKenna MT, Williams I, Williams A, Kuehnert MJ, Stramer S, Kleinman S, Epstein J, Dayton AI. Quantitative estimate of the risks and benefits of possible alternative blood donor deferral strategies for men who have had sex with men. Transfusion 2009; 49:1102-14. [DOI: 10.1111/j.1537-2995.2009.02124.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Weiss ES, Cornwell EE, Wang T, Syin D, Millman EA, Pronovost PJ, Chang D, Makary MA. Human immunodeficiency virus and hepatitis testing and prevalence among surgical patients in an urban university hospital. Am J Surg 2007; 193:55-60. [PMID: 17188088 DOI: 10.1016/j.amjsurg.2006.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2005] [Revised: 07/22/2006] [Accepted: 07/22/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV), hepatitis B, and hepatitis C represent significant public health problems in an urban community. Early diagnosis and treatment of these infections can improve survival and allow for preventive strategies to reduce further transmission within a community. The aim of this study was to evaluate the surgical setting as a potential opportunity for early diagnosis of HIV, hepatitis B, and hepatitis C among trauma and non-trauma patients. METHODS We performed a retrospective review of patients presenting for surgery over a 10-year period (July 1994 to July 2004) in an urban, university-based general surgical practice that includes all trauma services, as well as emergency department, inpatient, and outpatient surgical consultations. Data collected included diagnosis, operation, age, race, history of intravenous drug abuse, and HIV, hepatitis B, and hepatitis C test results. RESULTS Among 2876 patients presenting for surgery, testing for blood-borne pathogens was less likely among trauma patients (21%, 79/380) compared to non-trauma patients (47%, 1183/2496) (P < .001). Among patients tested, the incidence of blood-borne pathogens was similar in the two groups: HIV (26% trauma vs 24% non-trauma, not significant [NS]), hepatitis B (4% trauma vs 3% non-trauma, NS), hepatitis C (33% trauma vs 41% non-trauma, NS), and co-infection with HIV and hepatitis C (18% trauma vs 12% non-trauma, NS). In both groups, blood-borne pathogens were associated with intravenous drug abuse (P < .01). CONCLUSION HIV, hepatitis B, and hepatitis C are common in an urban community among both trauma and non-trauma surgical patients, although testing is less common among trauma patients. Testing of patients during a surgical admission may represent an excellent opportunity for early disease-specific services and preventive interventions.
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Affiliation(s)
- Eric S Weiss
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA.
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Abstract
OBJECTIVE To evaluate testing practices and perceptions of HIV risk among a geographically diverse, population-based sample of sexually active adults who reported behaviors that could transmit HIV. DESIGN Secondary analysis of the Centers for Disease Control and Preventions Behavioral Risk Factor Surveillance System (BRFSS) 2000 survey. PATIENTS/PARTICIPANTS Sexually active adults less than 50 years old, who completed the Sexual Behavior Module of the BRFSS 2000 survey administered in 4 U.S. states. MEASUREMENTS AND MAIN RESULTS Nineteen percent of the study population reported one or more behaviors in the past year that increased their risk of HIV infection (men 23%; women 15%). In this subgroup at any increased risk of HIV infection, 49% reported having had an HIV test in the past year. For 71% of those tested, the HIV test was self-initiated. Younger age was the only factor independently associated with whether or not individuals with behaviors that increased their risk of HIV infection had had a recent HIV test. Among the 51% of individuals at risk who reported no recent HIV test, 84% perceived their risk as low or none. CONCLUSIONS In this study, about half of the individuals who reported behaviors that could transmit HIV had not been recently tested for HIV. Of those not tested, most considered their risk of HIV to be low or none. Interventions to expand HIV testing and increase awareness of HIV risk appear to be needed to increase early detection of HIV infection and to reduce its spread.
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Affiliation(s)
- Traci A Takahashi
- Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA 98108, USA.
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Fernyak SE, Page-Shafer K, Kellogg TA, McFarland W, Katz MH. Risk behaviors and HIV incidence among repeat testers at publicly funded HIV testing sites in San Francisco. J Acquir Immune Defic Syndr 2002; 31:63-70. [PMID: 12352152 DOI: 10.1097/00126334-200209010-00009] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE More than 25% of HIV tests are for individuals who have previously been tested. To characterize repeat testers, we 1) estimated the seroincidence of HIV infection, stratified by risk behavior, and examined the association between 2) testing rates and risk level and 3) repeat testing and tester characteristics. METHODS Records from HIV counseling and testing (C&T) sites were reviewed. Seroincidence was estimated by linking results of current test with date of last reported HIV negative test. A risk hierarchy of behaviors was created. Repeat testing rates were calculated for each risk level strata. Multivariate models explored the association of repeat testing with tester characteristics. RESULTS The HIV seroincidence among repeaters was 1.3 per 100 person-years (range 0.7-7.0 per 100 person-years). The high-risk level subject had a repeater rate of 92%, with 5.3 tests/person and was more likely (odds ratio = 4.96, 95% confidence interval 3.8-6.5) to have tested two or more times, compared with those in the low risk group. CONCLUSION The highest users of repeat testing are those who are practicing the highest risk behaviors and have the highest incidence of HIV. This suggests that prevention messages should be modified to more explicitly address the behaviors that are putting individuals at high risk for HIV.
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Affiliation(s)
- Susan E Fernyak
- San Francisco Department of Public Health, Communicable Disease Prevention Unit, USA.
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Vernon KA, Mulia N, Downing M, Knight K, Riess T. "I don't know when it might pop up": understanding repeat HIV testing and perceptions of HIV among drug users. JOURNAL OF SUBSTANCE ABUSE 2002; 13:215-27. [PMID: 11547621 DOI: 10.1016/s0899-3289(01)00067-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The study sought to understand the HIV testing patterns of low-income drug users. METHODS Sixty-seven low-income drug users were recruited from street outreach venues in three San Francisco Bay Area counties. Participants were interviewed using an open-ended questionnaire eliciting information on HIV testing histories, sexual behavior, and drug use. Transcripts from interviews were coded and analyzed using methods consistent with the grounded theory approach of qualitative research. RESULTS Participants identified four themes related to HIV testing: (1) anticipating positive results, (2) belief in a 10-year window period during which the virus is undetectable, (3) regular HIV testing as part of self-care, and (4) the HIV test as a means of control. These themes did not relate to personal risk behavior but rather to the community experience of HIV in small, dense populations of low-income drug users with high rates of HIV infection. IMPLICATIONS Participants used HIV testing like regular mammograms or blood pressure checks, as if it were a screening procedure for a chronic illness. This is a reasonable response given the context of HIV within their communities. HIV testing in this population should not be limited.
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Affiliation(s)
- K A Vernon
- Center for AIDS Prevention Studies, University of California-San Francisco, 74 New Montgomery, San Francisco, CA 94105, USA.
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Riess TH, Kim C, Downing M. Motives for HIV testing among drug users: an analysis of gender differences. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2001; 13:509-523. [PMID: 11791783 DOI: 10.1521/aeap.13.6.509.21437] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This article examines gender differences related to why 66 injection and noninjection drug users tested for HIV. Study participants from three northern California counties underwent an open-ended qualitative interview covering: access to HIV testing, the meaning of HIV testing and test results, drug and sexual risk behaviors, and behavior changes associated with HIV testing, as well as a brief quantitative survey. The responses were analyzed using the following categories: (a) financial incentives for testing, (b) concerns related to family members and significant others, and (c) personal anxieties due to lack of knowledge of HIV status. Analyses showed that gender differences exist regarding reasons for HIV testing. The most significant finding was that women were motivated to test with regard to concerns related to family and significant others in their life more so than men, particularly during pregnancy. The impetus to test for many individuals was dependent on a social setting, such as jail, hospital, or drug rehabilitation program. Further research examining the motivational factors why drug users test for HIV can provide valuable information for outreach and marketing of HIV counseling-and-testing services.
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Affiliation(s)
- T H Riess
- University of California, San Francisco, Center for AIDS Prevention Studies, 94105, USA.
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Downing M, Knight K, Reiss TH, Vernon K, Mulia N, Ferreboeuf M, Carroll A, Vu C. Drug users talk about HIV testing: motivating and deterring factors. AIDS Care 2001; 13:561-77. [PMID: 11571004 DOI: 10.1080/09540120120063205] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Injection drug use plays a critical role in the spread of HIV/AIDS, with an estimated 19,000 drug users infected each year. Counselling and testing services can be an important gateway for engaging HIV-infected individuals into medical care and can positively influence the preventive behaviours of IDUs. This study seeks to document and understand the complexity and range of motivations and deterrents to HIV testing among IDUs. Participants were recruited using a convenience sampling method. Interviews consisted of a qualitative guide and a quantitative survey to collect HIV testing histories, sex and drug risk behaviours, and demographic information. Interview data was coded and content analyzed to identify emerging themes and clarify the processes that drug users employ in deciding whether or not to test. Sixty-six drug users were interviewed. The sample reported a median of four lifetime HIV tests. Participants described a range of motivating and deterring factors to HIV testing across personal, interpersonal and structural categories. Drug users' decision to test is influenced by a complex network of factors. Better understanding of these motivators and deterrents can help providers develop a more holistic approach to targeting this high-risk population for HIV prevention efforts.
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Affiliation(s)
- M Downing
- Center for AIDS Prevention Studies, University of California, San Francisco, 94105, USA.
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Berbel Garcia A, Latorre Ibarra A, Porta Etessam J, Martinez Salio A, Perez Martinez D, Siaz Diaz R, Toledo Heras M. Protease inhibitor-induced carbamazepine toxicity. Clin Neuropharmacol 2000; 23:216-8. [PMID: 11020127 DOI: 10.1097/00002826-200007000-00009] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neurologic manifestations of HIV infection are quite diverse and can develop into seizures. Because new drug therapies have been developed, it is important to know the interactions between antiretroviral and antiepileptic agents. A 36-year-old patient with HIV developed a set of progressive left hemiparesis and secondarily generalized partial seizures related to progressive multifocal leukoencephalopathy. Phenytoin and carbamazepine were necessary to control the seizures. Instead of diverse antiretroviral therapies, the viral load was increased. Protease inhibitors (ritonavir and saquinavir) were added to the treatment and the patient developed progressive ataxia related to carbamazepine toxicity. Carbamazepine was discontinued and the patient remained asymptomatic. The patient was diagnosed with carbamazepine toxicity related to the introduction of ritonavir. Ritonavir is a potent inhibitor of hepatic cytochrome P450, mainly the CYP3A4 isoform. Carbamazepine is metabolized by this subsystem. Ritonavir acted as a CYP3A4 inhibitor, diminishing carbamazepine metabolism and provoking an increase in serum levels and clinical toxicity. We present a case of interaction between ritonavir and carbamazepine. Interaction between antiepileptic and antiretroviral agents is an emergent problem caused by the increasing association of the two therapies. We recommend strict monitoring of serum antiepileptic drug (AED) levels to avoid toxicity and inadequate seizure control.
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Affiliation(s)
- A Berbel Garcia
- Department of Neurology, Hospital 12 de Octubre, Madrid, Spain
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Walkup J, McAlpine DD, Olfson M, Boyer C, Hansell S. Recent HIV testing among general hospital inpatients with schizophrenia: findings from four New York City sites. Psychiatr Q 2000; 71:177-93. [PMID: 10832159 DOI: 10.1023/a:1004632620890] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND While widely acknowledged to be an important clinical and public health issue, HIV assessment, counseling, and testing for the seriously mentally ill has not been well studied. OBJECTIVE To determine what proportion and which inpatients with schizophrenia have been recently tested for HIV. METHOD A sample of 300 inpatients with schizophrenia were recruited from four general hospitals in New York City over a one year period. After confirmation of diagnosis with a structured interview, and elicitation of sociodemographic and drug use information, medical record review identified recent HIV testing. Bivariate and multivariate analyses were used to identify subgroups more likely to be tested. FINDINGS Recent HIV testing had been performed for 17% of the sample and was concentrated among those with higher documented risks. The majority of patients remain untested even in groups with direct risks, such as injection drug use, and indirect risks, such as frequent cocaine use in last year. Some evidence was found that white patients at risk may be less likely to be tested than Hispanic or African American patients. CONCLUSIONS Aggressive efforts are needed to improve knowledge of HIV status among acutely ill patients with schizophrenia.
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Affiliation(s)
- J Walkup
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey 08901, USA. ,
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Home Collection Versus Publicly Funded HIV Testing in San Francisco: Who Tests Where? J Acquir Immune Defic Syndr 1999. [DOI: 10.1097/00126334-199908150-00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Marks G, Burris S, Peterman TA. Reducing sexual transmission of HIV from those who know they are infected: the need for personal and collective responsibility. AIDS 1999; 13:297-306. [PMID: 10199219 DOI: 10.1097/00002030-199902250-00001] [Citation(s) in RCA: 152] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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