[Introduction of rapid HIV tests to a public health center in Japan and evaluation of its effects].

OBJECTIVE: As an attempt to make HIV testing more accessible to many people, rapid HIV tests were introduced to a public health center. We evaluated logistic issues and effects of the introduction. METHODS: In January 2003, the Tochigi Prefectural Kennan Public Health and Welfare Center introduced rapid HIV tests simultaneously with conventional HIV tests. We studied the number and types of the clients before and after its introduction as well as comparing them with those of other public centers. Information on rapid HIV test practices was uploaded on the website, "HIV Kensa-Soudan Map" and its effects were also evaluated. RESULTS: The public health center had performed 130 conventional HIV tests in 2002 prior to the introduction of rapid HIV tests but performed 453 HIV tests in 2003 (250% increase). Of those, 404 clients (94%) preferred the rapid tests. Out of the 404 rapid HIV tests performed, five were tested positive but only one was confirmed to be positive (false positive rate 1%). The introduction of rapid HIV tests had a negative impact on other sexually transmitted infection (STI) tests. The access rates to TP antibody tests (rapid tests) and Chlamydia antibody tests (non rapid tests) offered to HIV test recipients declined from 77% to 63% and from 76% to 33%, respectively. However, the actual number of these STI tests increased due to the increased number of HIV tests. Sixty-one per cent of those who came to take the HIV tests referred to the website "HIV Kensa-Soudan Map". During the same time period, the increase rate in the number of those who took the non rapid HIV tests provided at other public health centers in Tochigi prefecture was 0% and the increase rate nationwide was 20%. CONCLUSIONS: The introduction of these tests to public health centers greatly increases access to HIV testing. It was found that the website "HIV Kensa-Soudan Map" was a useful information source for HIV testing. However, because of high false positive rate (about 1%), it is important to establish an effective pre- and post-test counseling system. It is also necessary to prevent the number of tests for other STIs from declining when rapid HIV tests are implemented simultaneously.

Current state and need for improvement of system for antibody testing and counseling for HIV infection at public health centers in Japan.

BACKGROUND: Public Health Centers (PHCs) throughout Japan have been playing a role in preventing HIV in Japan. The number of HIV seropositive persons and AIDS patients is increasing from year to year in Japan. METHODS: A survey regarding the HIV antibody test was sent out to 594 PHCs between January 1997 and December 2001. The response rate was 73.9%. In order to assess the HIV testing system at PHCs, Pearson's correlation coefficient, an analysis of variance (ANOVA) and multiple regression analysis were used. RESULTS: There was a difference in the demand for HIV antibody tests according to area. The change in number of HIV antibody tests per 100,000 persons was high in metropolitan areas during the 5-year period. It was influenced by two factors; population density and ratio of daytime population to nighttime population. Rate of examinees who did not return to receive their test results was influenced by the area where the PHC was located. CONCLUSIONS: PHCs need to establish an HIV testing system which reflects the characteristics of the area and meets the needs of people who want to get tested.

[Changes in community health and welfare services with introduction of the long-term care insurance system in Japan].

OBJECTIVE: In Japan, a long-term care insurance system for elderly people was introduced in April, 2000. We have conducted a survey using a questionnaire in order to explore consequent changes in community health and welfare services. METHODS: We sent questionnaires to all municipal governments (671 cities, 1,991 towns, 567 villages and 23 wards) in Japan in November, 2001, and obtained replies from 441 cities (response rate: 65.7%), 800 towns (40.2%), 197 villages (34.9%), and 16 wards (69.6%). The questionnaire included questions concerning the budget and manpower for community health and welfare services, the state of the long term care insurance system, and the activities of public health nurses. RESULTS: A total of 57% of all municipal governments was found to be carrying out the long term care insurance program in collaboration with other governments. In order to clarify the changes in welfare services for elderly people from the budgetary viewpoint, we calculated the ratios of the 2000 and 2001 fiscal budgets applied for welfare services for elderly people, in comparison with the 1999 fiscal year. The budgets for elderly people declined to about 40% in 2000 and 2001 compared with 1999, since the budget for care services was transferred to the account of the long term care insurance system. The activities of public health nurses employed by municipal governments were not affected by the introduction of long term care insurance system. About 80% of all municipal governments suggested that both the amounts of care services received by each elderly people and the number of elderly people who received care services were increasing, and about 70% indicated that the quality of care services was improved with introduction of the long term care insurance system. DISCUSSION: Most municipal governments consider that introduction of the long term care insurance system has had a good influence on community health and welfare services. Moreover, our results suggest that the long term care insurance has a beneficial impact on care services themselves.