Factors associated with submission to HIV rapid test in childbirth care. / Fatores associados à submissão ao teste rápido anti-HIV na assistência ao parto.

Rapid HIV tests are used in maternity hospitals to prevent mother-to-child transmission. This study aimed to analyze factors associated with submission to the rapid HIV test (outcome). This is a cross-sectional study conducted in 2009 in 15 hospitals from the Rio de Janeiro's Unified Health System (SUS) by interviewing a representative sample of 835 pregnant women hospitalized for birth and by verifying medical records. Adjusted prevalence ratios were obtained by Poisson regression according to a hierarchical model, and variables associated with the outcome (p ≤ 0.05) remained in the final model. According to medical records (MR), 79.6% of mothers were submitted to rapid HIV test and, according to interviews (INT), 55.7%. At the distal level, the lack of a partner (MR), having ≥ 6 residents at home (MR) and non-white skin color (INT) were associated with a higher prevalence of the outcome. At the intermediate level, not having a negative HIV serology from prenatal care (MR and INT) was associated with a higher prevalence of the outcome, as well as PHC prenatal care (MR) and lack of prenatal care (INT). At the proximal level, delivery in a hospital not certified as Baby-Friendly was associated with a higher prevalence of outcome (MR and INT).

Os testes rápidos anti-HIV vêm sendo empregados nas maternidades com vistas à prevenção da transmissão vertical. O objetivo do estudo foi analisar os fatores associados à submissão ao teste rápido anti-HIV (desfecho). Estudo transversal, conduzido em 2009, em 15 hospitais do SUS do Rio de Janeiro/RJ, mediante entrevista a amostra representativa de 835 parturientes internadas e consulta a prontuários. Razões de prevalência ajustadas foram obtidas por regressão de Poisson, segundo modelo hierarquizado, permanecendo no modelo final as variáveis associadas ao desfecho (p ≤ 0,05). Segundo os prontuários (SP), 79,6% das mães foram submetidas ao teste rápido anti-HIV e, segundo as entrevistas (SE), 55,7%. No nível distal, a ausência de companheiro (SP), ter ≥ 6 moradores na residência (SP) e a cor da pele não branca (SE) se associaram a uma maior prevalência do desfecho. No nível intermediário, não dispor de sorologia negativa para o HIV do pré-natal (SP e SE) se associou a uma maior prevalência do desfecho, bem como a realização de pré-natal na rede básica (SP) e a não realização de pré-natal (SE). No nível proximal, o parto em hospital não certificado como amigo da criança se associou a uma maior prevalência do desfecho (SP e SE).

Fatores associados à submissão ao teste rápido anti-HIV na assistência ao parto / Factors associated with submission to HIV rapid test in childbirth care

Resumo Os testes rápidos anti-HIV vêm sendo empregados nas maternidades com vistas à prevenção da transmissão vertical. O objetivo do estudo foi analisar os fatores associados à submissão ao teste rápido anti-HIV (desfecho). Estudo transversal, conduzido em 2009, em 15 hospitais do SUS do Rio de Janeiro/RJ, mediante entrevista a amostra representativa de 835 parturientes internadas e consulta a prontuários. Razões de prevalência ajustadas foram obtidas por regressão de Poisson, segundo modelo hierarquizado, permanecendo no modelo final as variáveis associadas ao desfecho (p ≤ 0,05). Segundo os prontuários (SP), 79,6% das mães foram submetidas ao teste rápido anti-HIV e, segundo as entrevistas (SE), 55,7%. No nível distal, a ausência de companheiro (SP), ter ≥ 6 moradores na residência (SP) e a cor da pele não branca (SE) se associaram a uma maior prevalência do desfecho. No nível intermediário, não dispor de sorologia negativa para o HIV do pré-natal (SP e SE) se associou a uma maior prevalência do desfecho, bem como a realização de pré-natal na rede básica (SP) e a não realização de pré-natal (SE). No nível proximal, o parto em hospital não certificado como amigo da criança se associou a uma maior prevalência do desfecho (SP e SE).

Abstract Rapid HIV tests are used in maternity hospitals to prevent mother-to-child transmission. This study aimed to analyze factors associated with submission to the rapid HIV test (outcome). This is a cross-sectional study conducted in 2009 in 15 hospitals from the Rio de Janeiro's Unified Health System (SUS) by interviewing a representative sample of 835 pregnant women hospitalized for birth and by verifying medical records. Adjusted prevalence ratios were obtained by Poisson regression according to a hierarchical model, and variables associated with the outcome (p ≤ 0.05) remained in the final model. According to medical records (MR), 79.6% of mothers were submitted to rapid HIV test and, according to interviews (INT), 55.7%. At the distal level, the lack of a partner (MR), having ≥ 6 residents at home (MR) and non-white skin color (INT) were associated with a higher prevalence of the outcome. At the intermediate level, not having a negative HIV serology from prenatal care (MR and INT) was associated with a higher prevalence of the outcome, as well as PHC prenatal care (MR) and lack of prenatal care (INT). At the proximal level, delivery in a hospital not certified as Baby-Friendly was associated with a higher prevalence of outcome (MR and INT).

The Cost-Effectiveness of Integrating HIV Counseling and Testing into Primary Health Care in the Ukraine.

We estimate the number of HIV cases diagnosed, costs, and cost per HIV case detected associated with integrating HIV counseling and testing (HCT) into primary health care facilities in Ukraine. The study uses a difference-in-difference design with four districts implementing the intervention compared to 20 districts where HCT were offered only at specialized HIV clinics. There was a 2.01 (95 % CI: 1.12-3.61) times increase in the number of HIV cases detected per capita in intervention districts compared to other districts. The incremental cost of the intervention was $21,017 and the incremental cost per HIV case detected was $369. The average cost per HIV case detected before the intervention was $558. Engaging primary health care facilities to provide HCT is likely desirable from an efficiency point-of-view. However, the affordability of the intervention needs to be assessed because expansion will require additional investment.

Enfermería Basada en la Evidencia: plan de cuidados para pacientes con VIH/SIDA (parte 1) / Evidence-Based Nursing: care plan for patients with HIV / AIDS (part 1)

Resumen:

Introducción: la infección por el virus de inmunodeficiencia humana (VIH) sigue siendo un importante problema de salud pública a nivel mundial. La fase más avanzada de la infección es el síndrome de inmunodeficiencia adquirida (SIDA). El tratamiento con fármacos antirretrovirales pueden controlar el virus y ayudar a prevenir su transmisión, de modo que las personas con VIH o con alto riesgo de contraerlo pueden disfrutar de una vida saludable y productiva. En ese sentido, el personal de enfermería debe proporcionar atención integral con una visión holística a las personas a las personas afectadas por el VIH/SIDA, sus familiares y amigos.

Desarrollo: la elaboración del plan de cuidados basado en la evidencia, incluye la conformación de grupos nominales de expertos, selección del problema a abordar, priorización de etiquetas diagnósticas, búsqueda de información sistematizada, análisis crítico de la evidencia científica, uso de taxonomía enfermera y modelo de priorización de razonamiento en red, así como la adopción y adaptación de recomendaciones de Guías de Práctica Clínica (GPC) nacionales e internacionales y validación interna por pares del documento final.

Conclusiones: el cuidado de enfermería debe basarse en un plan que apoye al personal de enfermería en la toma de decisiones, mediante una metodología ordenada y eficiente, que conduzca a la solución del problema de salud del paciente.

Abstract:

Introduction: Infection with human immunodeficiency virus (HIV) remains a major public health problem worldwide. The most advanced stage of infection is acquired immunodeficiency syndrome (AIDS). Treatment whit antiretroviral drugs can control the virus and help prevent transmission, so that people with HIV or at high risk of contracting it can enjoy a healthy and productive life. In that sense, the nursing staff should provide comprehensive care with a holistic view to people affected by HIV/AIDS, their families and friends.

Development: The preparation of care plan included the creation of nominal groups of experts, meetings, selection of the problem to be addressed, prioritization of diagnostic labels, search of systematic information, critical analysis of scientific evidence, use of nursing taxonomy and prioritization model of reasoning network, adopting and adapting national and international recommendations of Clinical Practice Guidelines (CPG) and internal validation by peers to the final document. Conclusions: The care provided by the nurse should be based on a care plan that supports nursing staff in decision-making through an organized and efficient methodology, leading to the solution of the patient's health problem.

Evidence and the Politics of Deimplementation: The Rise and Decline of the "Counseling and Testing" Paradigm for HIV Prevention at the US Centers for Disease Control and Prevention.

POLICY POINTS: In situations of scientific uncertainty, public health interventions, such as counseling for HIV infection, sometimes must be implemented before obtaining evidence of efficacy. The history of HIV counseling and testing, which served as the cornerstone of HIV prevention efforts at the US Centers for Disease Control and Prevention (CDC) for a quarter of a century, illustrates the influence of institutional resistance on public health decision making and the challenge of de-implementing well-established programs. CONTEXT: In 1985, amid uncertainty about the accuracy of the new test for HIV, public health officials at the Centers for Disease Control and Prevention (CDC) and AIDS activists agreed that counseling should always be provided both before and after testing to ensure that patients were tested voluntarily and understood the meaning of their results. As the "exceptionalist" perspective that framed HIV in the early years began to recede, the purpose of HIV test counseling shifted over the next 30 years from emphasizing consent, to providing information, to encouraging behavioral change. With this increasing emphasis on prevention, HIV test counseling faced mounting doubts about whether it "worked." The CDC finally discontinued its preferred test counseling approach in October 2014. METHODS: Drawing on key informant interviews with current and former CDC officials, behavioral scientists, AIDS activists, and others, along with archival material, news reports, and scientific and governmental publications, we examined the origins, development, and decline of the CDC's "counseling and testing" paradigm for HIV prevention. FINDINGS: Disagreements within the CDC emerged by the 1990s over whether test counseling could be justified on the basis of efficacy and cost. Resistance to the prospect of policy change by supporters of test counseling in the CDC, gay activists for whom counseling carried important ethical and symbolic meanings, and community organizations dependent on federal funding made it difficult for the CDC to de-implement the practice. CONCLUSIONS: Analyses of changes in public health policy that emphasize the impact of research evidence produced in experimental or epidemiological inquiries may overlook key social and political factors involving resistance to deimplementation that powerfully shape the relationship between science and policy.

Gender identity, healthcare access, and risk reduction among Malaysia's mak nyah community.

Transgender women (TGW) face compounded levels of stigma and discrimination, resulting in multiple health risks and poor health outcomes. TGW identities are erased by forcing them into binary sex categories in society or treating them as men who have sex with men (MSM). In Malaysia, where both civil and religious law criminalise them for their identities, many TGW turn to sex work with inconsistent prevention methods, which increases their health risks. This qualitative study aims to understand how the identities of TGW sex workers shapes their healthcare utilisation patterns and harm reduction behaviours. In-depth, semi-structured interviews were conducted with 21 male-to-female transgender (mak nyah) sex workers in Malaysia. Interviews were transcribed, translated into English, and analysed using thematic coding. Results suggest that TGW identity is shaped at an early age followed by incorporation into the mak nyah community where TGW were assisted in gender transition and introduced to sex work. While healthcare was accessible, it failed to address the multiple healthcare needs of TGW. Pressure for gender-affirming health procedures and fear of HIV and sexually transmitted infection screening led to potentially hazardous health behaviours. These findings have implications for developing holistic, culturally sensitive prevention and healthcare services for TGW.

Avaliação da testagem anti-HIV no pré-natal e na assistência ao parto no Rio de Janeiro, Brasil / An evaluation of HIV testing during preand perinatal care in Rio de Janeiro, Brazil

Avaliar a testagem anti-HIV durante a assistência pré-natal e ao parto no Sistema Único de Saúde. Métodos: estudo transversal conduzido em 2009 em 15 maternidades no Rio de Janeiro, sendo entrevistada amostra representativa de 835 parturientes e observados prontuários. Para avaliação da adequação da testagem anti-HIV foi elaborado um modelo lógico. Resultados: segundo informação das parturientes, 86,7 por cento dispunham de sorologia não reagente do pré-natal e 55,7 por cento foram submetidas ao teste rápido anti-HIV no hospital; em 49,9 por cento dos casos o procedimento relativo ao teste rápido anti-HIV no hospital foi considerado adequado: mães com status ignorado de HIV do pré-natal submetidas ao teste rápido e mães com status conhecido não submetidas ao mesmo. Segundo dados do prontuário, 68,0 por cento dispunham de sorologia não reagente e 79,6 por cento foram submetidas ao teste rápido anti-HIV; em 50,9 por cento dos casos o procedimento relativo ao teste rápido anti- HIV no hospital foi adequado. Conclusões: o protocolo de exames anti-HIV no pré-natal e na maternidade, vigentes em 2009, não foram cumpridos a contento, tanto por gerar procedimentos desnecessários quanto falhas na testagem da população alvo, ameaçando a instituição oportuna de medidas profiláticas de controle da transmissão vertical...

To evaluate HIV testing during preand perinatal care in the Brazilian National Health System. Methods: a cross-sectional study was carried out in 2009 covering 15 maternity hospitals in Rio de Janeiro. Interviews were conducted with a sample of 835 pregnant women and their medical records consulted. A logical model was drawn up to assess the adequacy of HIV testing. Results: according to the information gathered from the pregnant women, 86.7 percent underwent a prenatal non-reactive serology test and 55.7 percent a rapid HIV test in hospital.In 49.9 percent of cases, the rapid hospital HIV test procedure was deemed to be adequate both for mothers with unknown prenatal HIV status undergoing the rapid test and for those with known HIV status who did not undergo this test. According to medical records, 68.0 percent underwent the non-reactive serum testand 79.6 percent the rapid HIV test.In 50.9 percent of cases the rapid hospital HIV test procedure was found to be adequate. Conclusions: the pre- and perinatal HIV test protocol in force in 2009 was not followed in a satisfactory manner, as unnecessary tests were performed and the target population was not fully tested, thereby jeopardizing the adoption of adequate prophylactic measures to control vertical transmission...

Ethical issues surrounding the provider initiated opt--Out prenatal HIV screening practice in Sub-Saharan Africa: a literature review.

BACKGROUND: Prevention of mother to child transmission of HIV remains a key public health priority in most developing countries. The provider Initiated Opt - Out Prenatal HIV Screening Approach, recommended by the World Health Organization (WHO) lately has been adopted and translated into policy in most Sub - Saharan African countries. To better ascertain the ethical reasons for or against the use of this approach, we carried out a literature review of the ethics literature. METHODS: Papers published in English and French Languages between 1990 and 2015 from the following data bases were searched: Pubmed, Cochrane literature, Embase, Cinhal, Web of Science and Google Scholar. After screening from 302 identified relevant articles, 21 articles were retained for the critical review. DISCUSSION: Most authors considered this approach ethically justifiable due to its potential benefits to the mother, foetus and society (Beneficence). The breaching of respect for autonomy was considered acceptable on the grounds of libertarian paternalism. Most authors considered the Opt - Out approach to be less stigmatizing than the Opt - In. The main arguments against the Opt - Out approach were: non respect of patient autonomy, informed consent becoming a meaningless concept and the HIV test becoming compulsory, risk of losing trust in health care providers, neglect of social and psychological implications of doing an HIV test, risk of aggravation of stigma if all tested patients are not properly cared for and neglect of sociocultural peculiarities. CONCLUSIONS: The Opt - Out approach could be counterproductive in case gender sensitive issues within the various sociocultural representations are neglected, and actions to offer holistic care to all women who shall potentially test positive for HIV were not effectively ascertained. The Provider Initiated Opt - Out Prenatal HIV Screening option remains ethically acceptable, but deserves caution, active monitoring and evaluation within the translation of this approach into to practice.

HIV self-testing could "revolutionize testing in South Africa, but it has got to be done properly": perceptions of key stakeholders.

South Africa bears the world's largest burden of HIV with over 6.4 million people living with the virus. The South African government's response to HIV has yielded remarkable results in recent years; over 13 million South Africans tested in a 2012 campaign and over 2 million people are on antiretroviral treatment. However, with an HIV & AIDS and STI National Strategic Plan aiming to get 80 percent of the population to know their HIV status by 2016, activists and public health policy makers argue that non-invasive HIV self-testing should be incorporated into the country HIV Counseling and Testing [HCT] portfolios. In-depth qualitative interviews (N = 12) with key stakeholders were conducted from June to July 2013 in South Africa. These included two government officials, four non-governmental stakeholders, two donors, three academic researchers, and one international stakeholder. All stakeholders were involved in HIV prevention and treatment and influenced HCT policy and research in South Africa and beyond. The interviews explored: interest in HIV self-testing; potential distribution channels for HIV self-tests to target groups; perception of requirements for diagnostic technologies that would be most amenable to HIV self-testing and opinions on barriers and opportunities for HIV-linkage to care after receiving positive test results. While there is currently no HIV self-testing policy in South Africa, and several barriers exist, participants in the study expressed enthusiasm and willingness for scale-up and urgent need for further research, planning, establishment of HIV Self-testing policy and programming to complement existing facility-based and community-based HIV testing systems. Introduction of HIV self-testing could have far-reaching positive effects on holistic HIV testing uptake, giving people autonomy to decide which approach they want to use for HIV testing, early diagnosis, treatment and care for HIV particularly among hard-to reach groups, including men.

Identification of acute HIV infection using fourth-generation testing in an opt-out emergency department screening program.

STUDY OBJECTIVE: Acute HIV infection is a clinical diagnosis aided by technology. Detecting the highly infectious acute stage of HIV infection is critical to reducing transmission and improving long-term outcomes. The Maricopa Integrated Health System implemented nontargeted, opt-out HIV screening with a fourth-generation antigen/antibody combination HIV assay test in our adult emergency department (ED) at Maricopa Medical Center to assess the prevalence of both acute and chronic unrecognized HIV. METHODS: Eligible patients aged 18 to 64 years were tested for HIV if they did not opt out and had blood drawn as part of their ED care. Patients were not eligible if they had a known HIV or AIDS diagnosis, exhibited altered mental status, were a current resident of a long-term psychiatric or correctional facility, or prompted a trauma activation. Reactive test results were delivered by a physician with the assistance of a linkage-to-care specialist. Specimens with a reactive fourth-generation assay result underwent confirmatory testing. RESULTS: From July 11, 2011, through January 5, 2014, 27,952 HIV screenings were performed for 22,468 patients tested for HIV; 78 (0.28%) had new HIV diagnoses. Of those, 18 (23% of all new diagnoses) were acute HIV infections, and 22 patients (28%) had a CD4 count of less than 200 cells/mL, or an opportunistic infection. CONCLUSION: HIV testing with a fourth-generation antigen/antibody laboratory test producing rapid results is feasible in an ED. Unexpectedly, nearly one fourth of patients with undiagnosed HIV had acute infections, which would have been more difficult to detect with previous testing technology.

WHO Expert Committee on Biological Standardization. Sixty-third report.

This report presents the recommendations of a WHO Expert Committee commissioned to coordinate activities leading to the adoption of international recommendations for the production and control of vaccines and other biologicals, and the establishment of international biological reference materials. Following a brief introduction, the report summarizes a number of general issues brought to the attention of the Committee. The next part of the report, of particular relevance to manufacturers and national regulatory authorities, outlines the discussions held on the development of revised WHO Recommendations and Guidelines for a number of vaccines, blood products and related substances. Specific discussion areas included the development of WHO guidance on the quality, safety and efficacy of poliomyelitis vaccines; recombinant malaria vaccines; diphtheria vaccines; tetanus vaccines; combined vaccines based on diphtheria and tetanus vaccines; and Japanese encephalitis vaccines. Subsequent sections of the report then provide information on the current status and proposed development of international reference materials in the areas of vaccines and related substances; blood products and related substances; in vitro diagnostic device reagents; biotherapeutics other than blood products; and antibiotics. A series of annexes are then presented which include an updated list of WHO Recommendations, Guidelines and other documents on biological substances used in medicine (Annex 1), followed by a series of WHO Recommendations and Guidelines adopted on the advice of the Committee (Annexes 2-7). All additions made during the meeting to the list of International Standards and Reference Reagents for biological substances maintained by WHO are then summarized in Annex 8, and are also available at: http://www. who.int/biologicals.

Organizational capacity for service integration in community-based addiction health services.

OBJECTIVES: We examined factors associated with readiness to coordinate mental health, public health, and HIV testing among community-based addiction health services programs. METHODS: We analyzed client and program data collected in 2011 from publicly funded addiction health services treatment programs in Los Angeles County, California. We analyzed a sample of 14 379 clients nested in 104 programs by using logistic regressions examining odds of service coordination with mental health and public health providers. We conducted a separate analysis to examine the percentage of clients receiving HIV testing in each program. RESULTS: Motivational readiness and organizational climate for change were associated with higher odds of coordination with mental health and public health services. Programs with professional accreditation had higher odds of coordinating with mental health services, whereas programs receiving public funding and methadone and residential programs (compared with outpatient) had a higher percentage of clients receiving coordinated HIV testing. CONCLUSIONS: These findings provide an evidentiary base for the role of motivational readiness, organizational climate, and external regulation and funding in improving the capacity of addiction health services programs to develop integrated care.

[Identification of barriers to routine HIV testing prescription by midwifes and doctors in Guadeloupe]. / Identification des freins à la prescription du test de dépistage de l'infection au VIH par les sages-femmes et médecins en Guadeloupe.

OBJECTIVES: Guadeloupe is the second highest French area for diagnosis and prevalence of HIV infection and AIDS. In October 2009, the French High Health Authority has published guidelines for a more systematic HIV screening. The goal of this study is to identify the limitations in HIV testing prescription by the Guadeloupian prescribers according to these new recommendations. MATERIALS AND METHODS: Data were collected with a questionnaire submitted to physicians and midwives after random selection. RESULTS: Among 285 randomly selected prescribers, 67 midwives and 40 physicians participated from August to December 2010. The main limitations to HIV testing prescription were: a consultation for another purpose, patient or his life style were known, and lack of HIV infection symptoms. Some characteristics of more easily screened patient did not match with those who had been newly diagnosed in Guadeloupe. Finally, both quantitative and qualitative knowledge of these new recommendations was insufficient. CONCLUSION: Implementation of these new testing recommendations should give emphasis to the systematic and annual nature of HIV testing for whole population. It should also insist on distinction between HIV testing and diagnosis of a symptomatic patient.

Preventing HIV transmission through antiretroviral treatment-mediated virologic suppression: aspects of an emerging scientific agenda.

PURPOSE OF REVIEW: This review describes important aspects of the research agenda that have emerged as a result of the recent findings of the HIV transmission study in sero-discordant couples conducted by the National Institute of Allergy and Infectious Disease (NIAID)-supported HIV Prevention Trials Network (HPTN) and referred to as HPTN 052. RECENT FINDINGS: The HPTN 052 study provided strong evidence that antiretroviral treatment (ART), given to HIV-infected partners with the purpose of achieving and maintaining full virologic suppression, could prevent linked HIV transmission in sero-discordant couples. These findings have implications in all future combination prevention strategies. SUMMARY: The HPTN 052 study demonstrated that sustained virus suppression, below detectable levels, can prevent HIV transmission in sero-discordant couples. As a result of this study, we have now identified ART as a key component for all combination prevention strategies. Additionally, this study demonstrates that HIV testing is the single door of entry for individualized HIV treatment and prevention. The challenge now is to create a robust, seamless linkage and retention system so that the vision of HIV treatment as prevention can be realized. Such a system will maximize both the treatment and the prevention benefits of ART. The research agenda outlined here describes the need to extend this finding to areas of implementation science, such as the development of simpler, easier to use point-of-care assays for virus load, and improved, better tolerated, more durable combinations and formulations of antiretroviral drugs.

Experiences about HIV-AIDS preventive-control activities. Discourses fromnon-governmental organizations professionals and users

Objectives: The main aim of this study was to identify the experiences of professionals in nongovernmental organizations (NGO) in Catalonia (Spain) working in HIV/AIDS prevention and control activities and potential areas of improvement of these activities and their evaluation. A further aim was to characterize the experiences, knowledge and practices of users of these organizations with regard to HIV infection and its prevention. Methods: A phenomenological qualitative study was conducted with the participation of both professionals and users of Catalan nongovernmental organizations (NGO) working in HIV/AIDS. Theoretical sampling (professional) and opportunistic sampling (users) were performed. To collect information,the following techniques were used: four focus groups and one triangular group (professionals), 22 semi-structured interviews, and two observations (users). A thematic interpretive content analysis was conducted by three analysts. Results: The professionals of nongovernmental organizations working in HIV/AIDS adopted a holisticapproach in their activities, maintained confidentiality, had cultural and professional competence and followed the principles of equality and empathy. The users of these organizations had knowledge of HIV/AIDS and understood the risk of infection. However, a gap was found between knowledge, attitudes and behavior. Conclusions: NGO offer distinct activities adapted to users’ needs. Professionals emphasize the need for support and improvement of planning and implementation of current assessment. The preventive activities of these HIV/AIDS organizations are based on a participatory health education model adjusted to people’s needs and focused on empowerment (AU)

Objetivos: Identificar las experiencias y actividades de las organizaciones no gubernamentales (ONG) que trabajan en la prevención y control del VIH/sida, las posibles áreas de mejora de las actividades y de su evaluación, e identificar las experiencias, conocimientos y prácticas de sus usuarios sobre el VIH y suprevención. Métodos: Estudio cualitativo fenomeno lógico en el que participan los profesionales y usuarios de las ONG que trabajan en VIH. Se realizó un muestreo teórico (profesionales) y un muestreo opinático (usuarios). Se utilizaron cuatro grupos focales y uno triangular (profesionales), 22 entrevistas semi-estructuradas y dos observaciones (usuarios). Se realizó un análisis de contenido temático realizado por tres analistas. Resultados: Los profesionales de las ONG ofrecen un enfoque holístico, confidencialidad, competencia cultural y profesional, y aplican los principios de igualdad y empatía. Los usuarios tienen conocimientos sobre el VIH/sida y comprenden el riesgo de infección. Existe una separación entre conocimiento, actitud y conducta. Conclusiones: Las ONG ofrecen diversas actividades adaptadas a las necesidades de los usuarios. Los profesionales destacan la necesidad de apoyo y mejora de la planificación y ejecución del proceso de evaluación actual. Las actividades preventivas de las ONG que trabajan en VIH/sida se basan en un modelo de educación sanitaria participativa ajustado a las necesidades de la población, basada en el empoderamiento (AU)

Inadequate coordination of maternal and infant HIV services detrimentally affects early infant diagnosis outcomes in Lilongwe, Malawi.

OBJECTIVE: To assess the continuity of care and outcome of pediatric HIV prevention, testing, and treatment services, focusing on early infant diagnosis with DNA polymerase chain reaction (PCR). DESIGN: A retrospective observational cohort. METHODS: Maternal HIV antibody, infant HIV DNA PCR test results, and outcome data from HIV-infected infants from the prevention of mother-to-child transmission, early infant diagnosis, and pediatric HIV treatment programs operating in Lilongwe, Malawi, between 2004 and 2008 were collected, merged, and analyzed. RESULTS: Of the 14,669 pregnant women who tested HIV antibody positive, 7875 infants (53.7%) received HIV DNA PCR testing. One thousand eighty-four infants (13.8%) were HIV infected. Three hundred twenty (29.5%) children enrolled into pediatric HIV care, with 202 (63.1%) at the Baylor Center of Excellence. Among these, antiretroviral therapy was initiated on 110 infants (54.5%) whose median age was 9.1 months (interquartile range, 5.4-13.8) and a median of 2.5 months (interquartile range, 1.4-5.2) after HIV clinic registration. Sixty-nine HIV-infected infants (34.2%) died or were lost by December 2008. Initiation of antiretroviral therapy increased the likelihood of survival 7-fold (odds ratio, 7.1; 95% confidence interval, 3.68 to 13.70). CONCLUSIONS: Separate programs for maternal and infant HIV prevention and care services demonstrated high attrition rates of HIV-exposed and HIV-infected infants, elevated levels of mother-to-child transmission, late infant diagnosis, delayed pediatric antiretroviral therapy initiation, and high HIV-infected infant mortality. Antiretroviral therapy increased HIV-infected infant survival, emphasizing the urgent need for improved service coordination and strategies that increase access to infant HIV diagnosis, improve patient retention, and reduce antiretroviral therapy initiation delays.

Evaluation of a rapid HIV testing initiative in an urban, hospital-based dental clinic.

Performing rapid HIV testing in nontraditional clinical settings such as dental clinics is a potential method for targeting high-risk individuals who may not otherwise access health care settings that offer HIV testing. In March 2008, Harlem Hospital Center, located in New York City, launched a counselor-based rapid HIV testing initiative in its on-site dental clinic. A full-time, trained counselor consented and tested patients as they waited for their appointments. HIV screening was performed using a whole-blood, finger-stick rapid HIV test. Through this initiative, 3864 HIV tests were performed from March 1, 2008 to December 31, 2009, representing 3565 unique individuals and 97.6% of dental patients approached for testing. Of those tested, the mean age was 38.5 years, with 47.1% female, 75.5% black, and 20.6% Hispanic. Self-reported HIV risk behaviors included 73.5% with recent unprotected heterosexual intercourse, 4.6% with recent or past injection drug use, and 2.6% who identified as men who have sex with men. Nineteen previously undiagnosed individuals (0.53%) were confirmed HIV positive. Of these individuals, mean age was 38.3 years with males representing 84.2%. Fifteen newly diagnosed patients (78.9%) were linked to care. Of those linked to care, median initial CD4 cell count was 317 cells/mm(3); 6 of these individuals (40%) had CD4 cell counts below 200 cells/mm(3). Our results demonstrate that a counselor-based rapid HIV testing program with linkage to specialized HIV care can be successfully integrated into the dental clinic setting.

Study of HIV-1 subtypes in serodiscordant couples attending an integrated counselling and testing centre in Mumbai using heteroduplex mobility analysis and DNA sequencing.

AIMS: To determine the prevalent subtypes of HIV-1 in serodiscordant couples. SETTING: Integrated Counselling and Testing Centre (ICTC), Department of Microbiology. STUDY DESIGN: Prospective pilot study. PARTICIPANTS: Thirty HIV-1 serodiscordant couples. INCLUSION CRITERIA: a) Documentation of HIV-1 infection in one partner and seronegative status in the other, current history of continued unprotected sexual activity within the partnership, demonstration that they have been in a partnership for at least 1 year and are not currently on highly active antiretroviral therapy HAART; b) willingness of both partners to provide written informed consent including consent to continued couple counselling for 3 months. MATERIALS AND METHODS: HIV-1 subtyping was carried out by heteroduplex mobility analysis (HMA) by amplifying env region; and DNA sequencing by amplifying gag region. RESULTS: HIV-1 env gene was amplified successfully in 10/30 samples; gag gene, in 25/30 samples; and both env and gag gene were amplified successfully in 5/30 samples. HIV-1 subtype C was detected from 21 samples; subtype B, from 7; and subtype A, from 2. Sample from 1 positive partner was detected as subtype C by env HMA and subtype B by gag sequencing. CONCLUSION: HIV-1 subtype C was found to be the predominant subtype of HIV-1 in serodiscordant couples attending our ICTC, followed by HIV-1 subtype B and HIV-1 subtype A, respectively. DNA sequencing was found to be the most reliable method for determining the subtypes of HIV-1.