RESUMO
In a Policy Forum, Peter Ehrenkranz and colleagues discuss the contribution of CD4 and viral load testing to outcomes for people with HIV in low- and middle-income countries.
Assuntos
Contagem de Linfócito CD4 , Países em Desenvolvimento , Saúde Global , Infecções por HIV/diagnóstico , HIV , Carga Viral , Fármacos Anti-HIV/uso terapêutico , Países em Desenvolvimento/economia , Saúde Global/economia , HIV/efeitos dos fármacos , HIV/crescimento & desenvolvimento , HIV/imunologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Infecções por HIV/virologia , Custos de Cuidados de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Valor Preditivo dos Testes , Prognóstico , Fatores de RiscoRESUMO
Sydney Rosen and colleagues describe an operations research agenda to accelerating uptake of HIV treatment initiation.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , África Subsaariana/epidemiologia , Algoritmos , Fármacos Anti-HIV/administração & dosagem , Fortalecimento Institucional , Análise Custo-Benefício , Diagnóstico Precoce , Fidelidade a Diretrizes/organização & administração , Fidelidade a Diretrizes/normas , Infecções por HIV/diagnóstico , Pesquisa sobre Serviços de Saúde , Humanos , Adesão à Medicação , Melhoria de Qualidade/organização & administração , Fatores de TempoRESUMO
BACKGROUND: Almost 1 million Americans are infected with HIV, yet it is estimated that as many as 250,000 of them do not know their serostatus. This study examined whether people residing in states with statutes requiring written informed consent prior to HIV testing were less likely to report a recent HIV test. METHODS: The study is based on survey data from the 2004 Behavioral Risk Factor Surveillance System. Logistic regression was used to assess the association between residence in a state with a pre-test written informed-consent requirement and individual self-report of recent HIV testing. The regression analyses controlled for potential state- and individual-level confounders. RESULTS: Almost 17% of respondents reported that they had been tested for HIV in the prior 12 months. Ten states had statutes requiring written informed consent prior to routine HIV testing; nine of those were analyzed in this study. After adjusting for other state- and individual-level factors, people who resided in these nine states were less likely to report a recent history of HIV testing (OR=0.85; 95% CI=0.80, 0.90). The average marginal effect was -0.02 (p<0.001, 95% CI=-0.03, -0.01); thus, written informed-consent statutes are associated with a 12% reduction in HIV testing from the baseline testing level of 17%. The association between a consent requirement and lack of testing was greatest among respondents who denied HIV risk factors, were non-Hispanic whites, or who had higher levels of education. CONCLUSIONS: This study's findings suggest that the removal of written informed-consent requirements might promote the non-risk-based routine-testing approach that the Centers for Disease Control and Prevention (CDC) advocates in its new testing guidelines.