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Rao A, Nagourney EM, Chen VH, Hill S, Klein EY, Whalen M, Quinn TC, Hansoti B. Assessing attitudes to ED-based HIV testing: Development of a short-structured survey instrument. PLoS One 2021; 16:e0252372. [PMID: 34043713 PMCID: PMC8158958 DOI: 10.1371/journal.pone.0252372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 05/15/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Emergency Department (ED)-based HIV counseling and testing (HCT) has had a significant impact on improving rates of HIV diagnosis and linkage to care. Unfortunately, expansion of this strategy to low- and middle-income countries has been limited. Successful implementation of ED-based HCT is dependent on patient and provider acceptance of the intervention, and their attitudes and pre-existing biases towards the disease. This study sought to develop validated survey instruments to assess attitudes towards ED-based HCT. METHODS This cross-sectional study surveyed patients and providers in three EDs in the Eastern Cape province, South Africa. A convenience sample of patients and providers in the ED were surveyed. Exploratory factor analysis was conducted using questions on attitudes to HIV testing to develop validated survey instruments. An ANOVA test assessed variance in attitudes towards HCT based on demographic variables collected. RESULTS A total of 104 patient and 132 provider surveys were completed. Exploratory factor analysis resulted in a 17- and 7-question attitudes survey for patients and providers, respectively. Overall, 92.3% of patients and 70.7% of providers supported ED-based HCT, however, both groups displayed only mildly positive attitudes. Questions representing 'confidentiality' and 'stigma around HIV testing' had the least positive influence on patients' overall attitudes. Questions representing 'comfort with HIV testing' had the least positive influence on providers' overall attitudes. CONCLUSION Our study demonstrated ED patients and providers are generally supportive of ED-based HCT. A validated survey instrument was able to provide a standardized approach to identify barriers to HCT implementation in an ED setting, across contexts. For successful implementation, behavioral interventions must focus on strengthening patient beliefs around confidentiality and the consent process, and providers' comfort levels with providing HIV testing services in the ED.
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Affiliation(s)
- Aditi Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Emily M. Nagourney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Victoria H. Chen
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, United States of America
| | - Sarah Hill
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, United States of America
| | - Eili Y. Klein
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Madeleine Whalen
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Thomas C. Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Division of Intramural Research, National Institutes of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
| | - Bhakti Hansoti
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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Gao B, Wang L, Santella AJ, Zhuang G, Huang R, Xu B, Liu Y, Xiao S, Wang S. HIV testing behaviors and willingness to receive oral rapid HIV testing among dental patients in Xi'an, China. PLoS One 2021; 16:e0248585. [PMID: 33765025 PMCID: PMC7993620 DOI: 10.1371/journal.pone.0248585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/02/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction HIV testing is an important strategy for controlling and ultimately ending the global pandemic. Oral rapid HIV testing (ORHT) is an evidence-based strategy and the evidence-based shows is favored over traditional blood tests in many key populations. The dental setting has been found to be a trusted, convenient, and yet untapped venue to conduct ORHT. This study assessed the HIV testing behaviors and willingness to receive ORHT among dental patients in Xi’an, China. Methods A cross-sectional survey of dental patients from Xi’an was conducted from August to September 2017. Dental patients were recruited using a stratified cluster sampling. A 44-item survey was used to measure HIV/AIDS knowledge, HIV testing behaviors, and willingness to receive ORHT. Results Nine hundred and nine dental patients completed the survey with a mean HIV/AIDS knowledge score of 10.7/15 (SD 2.8). Eighty-four participants (9.2%) had previously received an HIV test. Participants would have a high rate of HIV testing if they had higher monthly income (OR = 1.982, 95% CI: 1.251–3.140) and a higher HIV/AIDS knowledge score (OR = 1.137, 95% CI: 1.032–1.252). Five hundred and eighty-two participants (64.0%) were willing to receive ORHT before a dental treatment, 198 (21.8%) were not sure, and 129 (14.2%) were unwilling. Logistic regression showed that age (OR = 0.970, 95% CI: 0.959–0.982), HIV/AIDS knowledge score (OR = 1.087, 95% CI: 1.031–1.145), previous HIV test (OR = 2.057, 95% CI: 1.136–3.723), having advanced HIV testing knowledge (OR = 1.570, 95% CI: 1.158–2.128), and having advanced ORHT knowledge (OR = 2.074, 95%: CI 1.469–2.928) were the factors affecting the willingness to receive ORHT. Conclusions The majority of dental patients had not previously received an HIV test, although many were receptive to being tested in the dental setting. The dental setting as a venue to screen people for HIV needs further exploration, particularly because many people do not associate dentistry with chairside screenings. Increasing awareness of ORHT and reducing testing price can further improve the patient’s willingness to receive ORHT.
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Affiliation(s)
- Bei Gao
- Department of Orthodontics, Stomatology Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Lirong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
- * E-mail:
| | - Anthony J. Santella
- Department of Health Professions, School of Health Professions and Human Services, Hofstra University, Hempstead, New York, United States of America
| | - Guihua Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Ruizhe Huang
- Department of Preventive Dentistry, Stomatology Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Boya Xu
- Department of Oral Implantology, Stomatology Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Yujiao Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Shuya Xiao
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Shifan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
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Brown B, Marg L, LeComte-Hinely J, Brinkman D, Zhang Z, Sullivan G. Indicators of self-reported human immunodeficiency virus risk and differences in willingness to get tested by age and ethnicity: An observational study. Medicine (Baltimore) 2018; 97:e11690. [PMID: 30075566 PMCID: PMC6081145 DOI: 10.1097/md.0000000000011690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 07/01/2018] [Indexed: 11/26/2022] Open
Abstract
There are many barriers that prevent people from receiving human immunodeficiency virus (HIV) testing; however, little is known about the impact of age and ethnicity on HIV testing. We explored differences in self-reported HIV risk and willingness to be tested in the 2014 Get Tested Coachella Valley Community Survey by age and ethnicity.Data were collected from 995 participants via survey methods (online, hard copy, and in person). Surveys asked about demographics, sexual history, HIV testing history, thoughts on who should get tested, and future preferences for HIV testing.Most participants were women (62.5%), Hispanic (55.8%), and older than 50 years (51%). Participants who did not receive testing said they did not do so because they did not perceive themselves as at risk of contracting HIV (51.8%). Many participants (24.1%) said they did not receive testing because their health care provider never offered them the HIV test. Participants were more likely to have been tested if they were between 25 and 49 years old, compared to participants aged 50 or older (70.2% vs 48.6%, respectively, P < .001). Participants who were not Hispanic or Latino were more likely to have had an HIV test compared to Hispanic or Latino participants (62.5% vs 51.1%, P < .001).Interventions are needed to reach older adults to address HIV testing and beliefs. These interventions must debunk beliefs among physicians that older adults are not sexually active and beliefs among older adults that only certain populations are at risk of HIV.
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Affiliation(s)
- Brandon Brown
- School of Medicine, University of California, Riverside, Riverside
| | - Logan Marg
- School of Medicine, University of California, Riverside, Riverside
| | | | | | - Zhiwei Zhang
- Department of Statistics, University of California, Riverside
| | - Greer Sullivan
- School of Medicine, University of California, Riverside, Riverside
- Borrego Community Health Foundation, CA
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Hansoti B, Stead D, Parrish A, Reynolds SJ, Redd AD, Whalen MM, Mvandaba N, Quinn TC. HIV testing in a South African Emergency Department: A missed opportunity. PLoS One 2018; 13:e0193858. [PMID: 29534077 PMCID: PMC5849282 DOI: 10.1371/journal.pone.0193858] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 02/20/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND South Africa has the largest HIV epidemic in the world, with 19% of the global number of people living with HIV, 15% of new infections and 11% of AIDS-related deaths. Even though HIV testing is mandated in all hospital-based facilities in South Africa (SA), it is rarely implemented in the Emergency Department (ED). The ED provides episodic care to large volumes of undifferentiated who present with unplanned injury or illness. Thus, the ED may provide an opportunity to capture patients with undiagnosed HIV infection missed by clinic-based screening programs. METHODS AND FINDINGS In this prospective exploratory study, we implemented the National South African HIV testing guidelines (counselor initiated non-targeted universal screening with rapid point of care testing) for 24-hours a day at Frere Hospital in the Eastern Cape from September 1st to November 30th, 2016. The purpose of our study was to quantify the burden of undiagnosed HIV infection in a South African ED setting. Furthermore, we sought to evaluate the effectiveness of the nationally recommended HIV testing strategy in the ED. All patients who presented for care in the ED during the study period, and who were clinically stable and fully conscious, were eligible to be approached by HIV counseling and testing (HCT) staff to receive a rapid point-of-care HIV test. A total of 2355 of the 9583 (24.6%) patients who presented to the ED for care during the study period were approached by the HCT staff, of whom 1714 (72.8%) accepted HIV testing. There was a high uptake of HIV testing (78.6%) among a predominantly male (58%) patient group who mostly presented with traumatic injuries (70.8%). Four hundred (21.6%) patients were HIV positive, including 115 (6.2%) with newly diagnosed HIV infection. The overall prevalence of HIV infection was twice as high in females (29.8%) compared to males (15.4%). Both sexes had a similar prevalence of newly diagnosed HIV infection (6.0% for all females and 6.4% for all males) in the ED. CONCLUSIONS Overall there was high HIV testing acceptance by ED patients. A non-targeted testing approached revealed a high HIV prevalence with a significant burden of undiagnosed HIV infection in the ED. Unfortunately, a counselor-driven HIV testing approach fell short of meeting the testing needs in this setting, with over 75% of ED patients not approached by HCT staff.
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Affiliation(s)
- Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - David Stead
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
- Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, East London, Eastern Cape, South Africa
| | - Andy Parrish
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
- Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, East London, Eastern Cape, South Africa
| | - Steven J. Reynolds
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
| | - Andrew D. Redd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
| | - Madeleine M. Whalen
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Nomzamo Mvandaba
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Thomas C. Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
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Li S, Su S, Li S, Gao L, Cai Y, Fu J, Guo C, Lu W, Cheng F, Jing J, Chen L, Zhang L. A comparison of effectiveness between oral rapid testing and routine serum-based testing for HIV in an outpatient dental clinic in Yuxi Prefecture, China: a case-control study. BMJ Open 2017; 7:e014601. [PMID: 28667206 PMCID: PMC5734579 DOI: 10.1136/bmjopen-2016-014601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To compare the outcomes of routine provider-initiated HIV testing and counselling (PITC) and oral rapid HIV testing for dental clinic outpatients in a hospital. DESIGN We employed a case-control study design and recruited dental outpatients into routine serum-based and oral rapid testing groups. We compared the acceptance, completion and result notification rate between groups. SETTING A dental outpatient clinic in the Yuxi People's Hospital, Yunnan. PARTICIPANTS A total of 758 and 816 dental outpatients were enrolled for routine and oral rapid testing, respectively. RESULTS The percentage of participants willing to receive routine HIV testing was 28.1% (95% CI 24.9% to 31.3%) and 96.1% (95% CI 94.8% to 97.4%, χ2=186.4, p<0.001) for the rapid testing. Among accepted participants, the percentage of participants who received HIV testing was 26.8% (95% CI 20.9% to 32.7%) in the routine testing group and 100.0% in the oral rapid HIV testing group (χ2=77.5, p<0.001). About 93.0% of routine testers returned for the test results on the next day, whereas all rapid testers received their test results on the same day (χ2=34.6, p<0.001). These correspond to an overall completion rate of 7.0% (95% CI 5.2% to 8.8%) and 96.1% (95% CI 94.8% to 97.4%, p<0.001), respectively. Among the 545 patients who declined routine serum-based HIV testing, the main reasons included, an unnecessary hassle (254/545, 46.6%), having been previously tested (124/545, 22.8%) and self-perceived low risk of HIV infection (103/545, 18.9%). In contrast, only 32 individuals declined oral rapid testing, and having received a previous test was the primary reason. Three patients in the rapid testing group were later confirmed HIV-positive, yielding an HIV prevalence of 0.38%. CONCLUSION Oral rapid HIV testing is a feasible and efficient approach in a clinical setting.
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Affiliation(s)
- Shifu Li
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Shu Su
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Shunxiang Li
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Liangmin Gao
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Ying Cai
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Jincui Fu
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Chunyuan Guo
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Wei Lu
- Department of Stomatology, The First People's Hospital of Yuxi, Yuxi Prefecture, Yunnan, China
| | - Feng Cheng
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Jun Jing
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Liang Chen
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Lei Zhang
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
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Hansoti B, Hill SE, Whalen M, Stead D, Parrish A, Rothman R, Hsieh YH, Quinn TC. Patient and provider attitudes to emergency department-based HIV counselling and testing in South Africa. South Afr J HIV Med 2017; 18:707. [PMID: 29568634 PMCID: PMC5843014 DOI: 10.4102/sajhivmed.v18i1.707] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/24/2017] [Indexed: 12/02/2022] Open
Abstract
Background The national South African HIV Counselling and Testing (HCT) guidelines mandate that voluntary counselling and testing (VCT) should be offered in all healthcare facilities. Emergency departments (EDs) are at the forefront of many healthcare facilities, yet VCT is not routinely implemented in this setting. Methods We conducted a cross-sectional study that surveyed patients and healthcare providers at a tertiary care ED in the spring and summer of 2016 to ascertain their attitudes to VCT in the ED. We also used two previously validated survey instruments to gather data on patients’ HIV knowledge and providers’ stigma against patients living with HIV, as we anticipated that these may have an impact on providers’ and patients’ attitudes to the provision of HIV testing within the ED, and may offer insights for future intervention development. Results A total of 104 patients and 26 providers were enrolled in the study. Overall, patients responded more favourably to ED-based HIV testing (92.3%) compared to providers (only 40% responded favourably). When asked about potential barriers to receiving or providing HIV testing, 16.4% of patients and 24% of providers felt that the subject of HIV was too sensitive and 58.7% of patients and 80% of providers indicated that privacy and confidentiality issues would pose major barriers to implementing ED-based HIV testing. Conclusion This study shows that while ED-based HIV testing is overall highly acceptable to patients, providers seem less willing to provide this service. The survey data also suggest that future development of ED-based testing strategies should take into consideration privacy and confidentiality concerns that may arise within a busy emergency care setting. Furthermore, every effort should be made to tackle HIV stigma among providers to improve overall attitudes towards HIV-positive individuals that present for care in the ED.
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Affiliation(s)
- Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University, United States
| | - Sarah E Hill
- Kriegler School of Arts and Sciences, Johns Hopkins University, United States
| | - Madeleine Whalen
- Department of Emergency Medicine, Johns Hopkins University, United States
| | - David Stead
- Department of Internal Medicine, Frere Hospital, South Africa.,Department of Medicine, Walter Sisulu University, South Africa
| | - Andy Parrish
- Department of Internal Medicine, Frere Hospital, South Africa.,Department of Medicine, Walter Sisulu University, South Africa
| | - Richard Rothman
- Department of Emergency Medicine, Johns Hopkins University, United States
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University, United States
| | - Thomas C Quinn
- Department of Emergency Medicine, Johns Hopkins University, United States.,Division of Intramural Research, NIAID, NIH, Bethesda, United States
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HIV testing in US tuberculosis care settings: a survey of current practice and perceived barriers. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 21:E11-5. [PMID: 24335610 DOI: 10.1097/phh.0000000000000039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Extent of and challenges to implementation of the Centers for Disease Control and Prevention (CDC) 2006 recommendation for routine HIV testing have not been reviewed specifically within tuberculosis (TB) care settings. OBJECTIVE To determine current adherence to the CDC's HIV testing recommendations in TB care settings and identify barriers. DESIGN An online survey was designed and distributed via Survey Monkey. SETTING The 2011 National TB Conference attendees, National TB Nurse Controllers, and the CDC's TB-educate mailing list were invited to participate via e-mail. PARTICIPANTS A total of 153 respondents from US states: 30 physicians, 91 nurses, 19 public health practitioners, and 13 other. MAIN OUTCOME MEASURES Perceived importance of HIV testing, current HIV testing practices, perceived barriers to HIV testing, and understanding of state HIV testing laws. RESULTS One hundred forty-one of 153 (92.2%) reported that patients with TB disease were "always" or "almost always" HIV tested; 65 of 153 (42.5%) reported the same for patients with latent TB infection (LTBI). Among those not routinely testing LTBI patients, "patient refusal of test" (53/88; 60.2%), "cost" (41/88; 46.6%), and "prevalence too low to justify" (33/88; 37.5%) were the most commonly identified barriers to opt-out testing. Forty-seven of 59 providers (79.7%) who reported that their state required written consent for HIV testing had incorrect knowledge regarding HIV testing legislation. CONCLUSIONS Rates of HIV testing are high for patients with TB disease, but fewer than half of providers' care settings routinely test LTBI patients. Knowledge of HIV status is required to appropriately interpret TST results and make decisions regarding treatment in TB infection, since HIV coinfection increases risk of progression to active TB. Lack of HIV testing in LTBI patients represents a missed opportunity to prevent TB disease and its resultant morbidity and mortality. In addition, incorrect knowledge regarding testing legislation was a common problem among our TB providers. Further work is necessary to improve HIV testing rates in patients who have not yet progressed to active TB disease.
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Rosen DL, Golin CE, Grodensky CA, May J, Bowling JM, DeVellis RF, White BL, Wohl DA. Opt-out HIV testing in prison: informed and voluntary? AIDS Care 2014; 27:545-54. [PMID: 25506799 DOI: 10.1080/09540121.2014.989486] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
HIV testing in prison settings has been identified as an important mechanism to detect cases among high-risk, underserved populations. Several public health organizations recommend that testing across health-care settings, including prisons, be delivered in an opt-out manner. However, implementation of opt-out testing within prisons may pose challenges in delivering testing that is informed and understood to be voluntary. In a large state prison system with a policy of voluntary opt-out HIV testing, we randomly sampled adult prisoners in each of seven intake prisons within two weeks after their opportunity to be HIV tested. We surveyed prisoners' perception of HIV testing as voluntary or mandatory and used multivariable statistical models to identify factors associated with their perception. We also linked survey responses to lab records to determine if prisoners' test status (tested or not) matched their desired and perceived test status. Thirty-eight percent (359/936) perceived testing as voluntary. The perception that testing was mandatory was positively associated with age less than 25 years (adjusted relative risk [aRR]: 1.45, 95% confidence interval [CI]: 1.24, 1.71) and preference that testing be mandatory (aRR: 1.81, 95% CI: 1.41, 2.31) but negatively associated with entry into one of the intake prisons (aRR: 0.41 95% CI: 0.27, 0.63). Eighty-nine percent of prisoners wanted to be tested, 85% were tested according to their wishes, and 82% correctly understood whether or not they were tested. Most prisoners wanted to be HIV tested and were aware that they had been tested, but less than 40% understood testing to be voluntary. Prisoners' understanding of the voluntary nature of testing varied by intake prison and by a few individual-level factors. Testing procedures should ensure that opt-out testing is informed and understood to be voluntary by prisoners and other vulnerable populations.
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Affiliation(s)
- David L Rosen
- a Department of Medicine , University of North Carolina , Chapel Hill , NC , USA
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Ha S, Foley S, Paquette D, Seto J. A review of Human Immunodeficiency Virus (HIV) rapid testing. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2014; 40:408-419. [PMID: 29769872 PMCID: PMC5864438 DOI: 10.14745/ccdr.v40i18a06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In Canada, it is estimated that 71,300 persons were living with HIV at the end of 2011. Approximately 25% (14,500 to 21,500) of prevalent cases were unaware of their HIV infection. Expanded use of HIV rapid tests may increase the detection of undiagnosed infections, enable earlier treatment and support services and prevent the onward transmission of HIV. OBJECTIVE To examine patient acceptability, impact (defined as receipt of test results and linkage to care) and cost-effectiveness of HIV rapid tests. METHODS A search was conducted for systematic reviews on HIV rapid testing, with studies from both developed and developing countries, published in English and between 2000 and 2013. The Assessment of Multiple Systematic Review (AMSTAR) tool was used to assess the included systematic reviews for methodological quality. Results were summarized narratively for each of the outcomes. RESULTS Eight systematic reviews were included. Acceptability of HIV rapid tests was generally high in medical settings (69% to 98%) especially among pregnant women and youth attending emergency rooms but was lower in non-medical settings (14% to 46%). The percentage of people who obtained their test results was variable. It was high (83% to 93%) in emergency rooms but was low in a rapid care setting with regular business hours (27%). Impact on linkage to care was limited. Only one systematic review examined cost-effectiveness of rapid testing and concluded that HIV rapid tests were cost-effective in comparison to traditional methods; however, results were all based on static models. CONCLUSION Overall, HIV rapid tests demonstrated generally high acceptability, variability in receiving test results and limited impact on linkage to care. While these findings suggest that HIV rapid tests may be useful, further research is needed to confirm in whom, when and where they are best used and how to ensure better linkage to care.
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Affiliation(s)
- S Ha
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - S Foley
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - D Paquette
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - J Seto
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
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10
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Durall PS, Enciso R, Rhee J, Mulligan R. Attitude toward rapid HIV testing in a dental school clinic. SPECIAL CARE IN DENTISTRY 2014; 35:29-36. [PMID: 25329819 DOI: 10.1111/scd.12096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Detection of HIV infection provides an opportunity for transmission reduction and lifesaving treatment strategies. This study examined patients' willingness to take a routine, rapid oral HIV test if offered at a dental school clinic. For fifteen days in 2011, an anonymous survey containing demographic information and willingness to be tested questions was offered to all patients awaiting treatment. A total of 383 of 443 people approached, answered the questionnaire (40.2% Hispanic, 27.2% Caucasian, and 19.3% African American) with 58.8% indicating that they had been previously tested for HIV (as compared to the California mean of 39.2%). Patients were highly likely to participate (84.0% of Hispanics, 63.6% of Caucasians, 80.0% of African Americans and 66.7% of Asians) in a free HIV rapid test when given the opportunity. Of respondents never tested before, 62.6% reported a willingness to be tested in this study. HIV screening in a dental clinic during routine visits may allow new undiagnosed cases to be detected with subsequent referral into medical treatment.
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Affiliation(s)
- Piedad Suarez Durall
- Assistant Professor of Clinical Dentistry and Section Chair of Geriatrics and Special Patients, Division of Dental Public Health and Pediatric Dentistry, Ostrow School of Dentistry, University of Southern California, Los Angeles, California
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11
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Setse RW, Maxwell CJ. Correlates of HIV testing refusal among emergency department patients in the opt-out testing era. AIDS Behav 2014; 18:966-71. [PMID: 24197971 DOI: 10.1007/s10461-013-0654-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Opt-out HIV screening is recommended by the CDC for patients in all healthcare settings. We examined correlates of HIV testing refusal among urban emergency department (ED) patients. Confidential free HIV screening was offered to 32,633 ED patients in an urban tertiary care facility in Washington, DC, during May 2007-December 2011. Demographic differences in testing refusals were examined using χ(2) tests and generalized linear models. HIV testing refusal rates were 47.7 % 95 % CI (46.7-48.7), 11.7 % (11.0-12.4), 10.7 % (10.0-11.4), 16.9 % (15.9-17.9) and 26.9 % (25.6-28.2) in 2007, 2008, 2009, 2010 and 2011 respectively. Persons 33-54 years of age [adjusted prevalence ratio (APR) 1.42, (1.36-1.48)] and those ≥ 55 years [APR 1.39 (1.31-1.47)], versus 33-54 years; and females versus males [APR 1.07 (1.02-1.11)] were more likely to refuse testing. Opt-out HIV testing is feasible and sustainable in urban ED settings. Efforts are needed to encourage testing among older patients and women.
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Affiliation(s)
- Rosanna W Setse
- Department of Medicine, Howard University Hospital, 2041 Georgia Avenue, N.W., Washington, DC, 20060, USA,
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12
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Nakao JH, Wiener DE, Newman DH, Sharp VL, Egan DJ. Falling through the cracks? Missed opportunities for earlier HIV diagnosis in a New York City Hospital. Int J STD AIDS 2014; 25:887-93. [PMID: 24535693 DOI: 10.1177/0956462414523944] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Summary Newly diagnosed HIV-positive patients have frequent health care encounters prior to diagnosis representing missed opportunities for diagnosis. This study determines the proportion of patients with new HIV diagnoses with encounters in the 3 years prior to diagnosis. We describe the characteristics of newly diagnosed patients and of "late testers" (CD4 <200 cells/mm(3) at the time of diagnosis). We identified all newly diagnosed with HIV in emergency department, inpatient, and outpatient settings between May 1, 2006, and December 31, 2009. Data abstractors searched hospital records to identify all emergency department, inpatient, and outpatient visits for the 3 years prior to diagnosis. In all, 23,271 HIV tests were performed and 253 persons were newly diagnosed (1.1%); 152 new positives (60.1%) made at least one prior visit. Of patients with CD4 counts available, 104/175 (59.4%) had CD4 <200 cells/mm(3). Patients with at least one prior visit had a median of three. There was no difference in numbers of visits between late testers and non-late testers, although late testers were more likely to have ED visits. Most newly diagnosed HIV-positive patients had multiple encounters prior to diagnosis. Many of these patients presented with CD4 counts below 200 cells/mm(3), indicating true missed opportunities for earlier diagnosis.
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Affiliation(s)
- Jolene H Nakao
- Department of Emergency Medicine, St. Luke's Roosevelt Hospital, New York, NY, USA
| | - Dan E Wiener
- Department of Emergency Medicine, St. Luke's Roosevelt Hospital, New York, NY, USA
| | - David H Newman
- David H. Newman, Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Victoria L Sharp
- Department of Medicine, St. Luke's Roosevelt Hospital Center, New York, NY, USA
| | - Daniel J Egan
- Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA
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13
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Turner SD, Anderson K, Slater M, Quigley L, Dyck M, Guiang CB. Rapid point-of-care HIV testing in youth: a systematic review. J Adolesc Health 2013; 53:683-91. [PMID: 24054913 DOI: 10.1016/j.jadohealth.2013.07.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 11/15/2022]
Abstract
PURPOSE This review examines the literature surrounding acceptability of, and preference for, rapid point-of-care (POC) human immunodeficiency virus (HIV) testing in youth, documents notification rates when youth were offered rapid POC testing, and identifies the sociodemographic factors associated with testing. METHODS The reviewers searched the scholarly literature indexed in MEDLINE, Embase, CINAHL, and PsycInfo using a set of keywords related to youth and rapid POC HIV testing. A total of 14 articles were included in the review. RESULTS Four themes were identified: (1) Youth will accept rapid POC testing, particularly if offered; (2) youth prefer rapid POC testing to traditional testing; (3) youth receive their rapid POC HIV test results; and (4) older youth and those with HIV risk factors or a concurrent genitourinary diagnosis are more likely to accept rapid POC HIV testing when it is offered. CONCLUSIONS Evidence shows that youth accept and prefer rapid POC HIV tests when offered. The routine use of rapid POC HIV tests in emergency departments and adolescent primary care clinics should be considered because of higher uptake in these environments. Youth receive their rapid POC test results more frequently and sooner than traditional test results. However, further work is needed to develop HIV testing programs that target younger adolescents.
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Affiliation(s)
- Suzanne D Turner
- Postgraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
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14
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Patient perspectives on the experience of being newly diagnosed with HIV in the emergency department/urgent care clinic of a public hospital. PLoS One 2013; 8:e74199. [PMID: 23991214 PMCID: PMC3753265 DOI: 10.1371/journal.pone.0074199] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 07/28/2013] [Indexed: 11/19/2022] Open
Abstract
We sought to understand patient perceptions of the emergency department/urgent care (ED/UC) HIV diagnosis experience as well as factors that may promote or discourage linkage to HIV care. We conducted in-depth interviews with patients (n=24) whose HIV infection was diagnosed in the ED/UC of a public hospital in San Francisco at least six months prior and who linked to HIV care at the hospital HIV clinic. Key diagnosis experience themes included physical discomfort and limited functionality, presence of comorbid diagnoses, a wide spectrum of HIV risk perception, and feelings of isolation and anxiety. Patients diagnosed with HIV in the ED/UC may not have their desired emotional supports with them, either because they are alone or they are with family members or friends to whom they do not want to immediately disclose. Other patients may have no one they can rely on for immediate support. Nearly all participants described compassionate disclosure of test results by ED/UC providers, although several noted logistical issues that complicated the disclosure experience. Key linkage to care themes included the importance of continuity between the testing site and HIV care, hospital admission as an opportunity for support and HIV education, and thoughtful matching by linkage staff to a primary care provider. ED/UC clinicians and testing programs should be sensitive to the unique roles of sickness, risk perception, and isolation in the ED/UC diagnosis experience, as these things may delay acceptance of HIV diagnosis. The disclosure and linkage to care experience is crucial in forming patient attitudes towards HIV and HIV care, thus staff involved in disclosure and linkage activities should be trained to deliver compassionate, informed, and thoughtful care that bridges HIV testing and treatment sites.
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15
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Trillo AD, Merchant RC, Baird JR, Ladd GT, Liu T, Nirenberg TD. Interrelationship of alcohol misuse, HIV sexual risk and HIV screening uptake among emergency department patients. BMC Emerg Med 2013; 13:9. [PMID: 23721108 PMCID: PMC3686630 DOI: 10.1186/1471-227x-13-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 04/03/2013] [Indexed: 01/29/2023] Open
Abstract
Background Emergency department (ED) patients comprise a high-risk population for alcohol misuse and sexual risk for HIV. In order to design future interventions to increase HIV screening uptake, we examined the interrelationship among alcohol misuse, sexual risk for HIV and HIV screening uptake among these patients. Methods A random sample of 18-64-year-old English- or Spanish-speaking patients at two EDs during July-August 2009 completed a self-administered questionnaire about their alcohol use using the Alcohol Use Questionnaire, the Alcohol Use Disorders Identification Test (AUDIT), and the HIV Sexual Risk Questionnaire. Study participants were offered a rapid HIV test after completing the questionnaires. Binging (≥ five drinks/occasion for men, ≥ four drinks for women) was assessed and sex-specific alcohol misuse severity levels (low-risk, harmful, hazardous, dependence) were calculated using AUDIT scores. Analyses were limited to participants who had sexual intercourse in the past 12 months. Multivariable logistic regression was used to assess the associations between HIV screening uptake and (1) alcohol misuse, (2) sexual risk for HIV, and (3) the intersection of HIV sexual risk and alcohol misuse. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated. All models were adjusted for patient demographic characteristics and separate models for men and women were constructed. Results Of 524 participants (55.0% female), 58.4% identified as white, non-Hispanic, and 72% reported previous HIV testing. Approximately 75% of participants reported drinking alcohol within the past 30 days and 74.5% of men and 59.6% of women reported binge drinking. A relationship was found between reported sexual risk for HIV and alcohol use among men (AOR 3.31 [CI 1.51-7.24]) and women (AOR 2.78 [CI 1.48-5.23]). Women who reported binge drinking were more likely to have higher reported sexual risk for HIV (AOR 2.55 [CI 1.40-4.64]) compared to women who do not report binge drinking. HIV screening uptake was not higher among those with greater alcohol misuse and sexual risk among men or women. Conclusions The apparent disconnection between HIV screening uptake and alcohol misuse and sexual risk for HIV among ED patients in this study is concerning. Brief interventions emphasizing these associations should be evaluated to reduce alcohol misuse and sexual risk and increase the uptake of ED HIV screening.
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Rizza SA, MacGowan RJ, Purcell DW, Branson BM, Temesgen Z. HIV screening in the health care setting: status, barriers, and potential solutions. Mayo Clin Proc 2012; 87:915-24. [PMID: 22958996 PMCID: PMC3538498 DOI: 10.1016/j.mayocp.2012.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 06/27/2012] [Accepted: 06/29/2012] [Indexed: 10/27/2022]
Abstract
Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.
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Affiliation(s)
| | - Robin J. MacGowan
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - David W. Purcell
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Bernard M. Branson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Christopoulos KA, Weiser SD, Koester KA, Myers JJ, White DAE, Kaplan B, Morin SF. Understanding patient acceptance and refusal of HIV testing in the emergency department. BMC Public Health 2012; 12:3. [PMID: 22214543 PMCID: PMC3267671 DOI: 10.1186/1471-2458-12-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 01/03/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite high rates of patient satisfaction with emergency department (ED) HIV testing, acceptance varies widely. It is thought that patients who decline may be at higher risk for HIV infection, thus we sought to better understand patient acceptance and refusal of ED HIV testing. METHODS In-depth interviews with fifty ED patients (28 accepters and 22 decliners of HIV testing) in three ED HIV testing programs that serve vulnerable urban populations in northern California. RESULTS Many factors influenced the decision to accept ED HIV testing, including curiosity, reassurance of negative status, convenience, and opportunity. Similarly, a number of factors influenced the decision to decline HIV testing, including having been tested recently, the perception of being at low risk for HIV infection due to monogamy, abstinence or condom use, and wanting to focus on the medical reason for the ED visit. Both accepters and decliners viewed ED HIV testing favorably and nearly all participants felt comfortable with the testing experience, including the absence of counseling. While many participants who declined an ED HIV test had logical reasons, some participants also made clear that they would prefer not to know their HIV status rather than face psychosocial consequences such as loss of trust in a relationship or disclosure of status in hospital or public health records. CONCLUSIONS Testing for HIV in the ED as for any other health problem reduces barriers to testing for some but not all patients. Patients who decline ED HIV testing may have rational reasons, but there are some patients who avoid HIV testing because of psychosocial ramifications. While ED HIV testing is generally acceptable, more targeted approaches to testing are necessary for this subgroup.
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Affiliation(s)
- Katerina A Christopoulos
- San Francisco General Hospital HIV/AIDS Division, University of California San Francisco, San Francisco, CA, USA.
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