HIV testing week 2015: lowering barriers for HIV testing among high-risk groups in Amsterdam.

BACKGROUND: Evaluation of the HIV Testing Week (HTW) 2015 in Amsterdam: the number of (positive) tested persons, characteristics and testing history of the tested population, the differences in attendance per location and the healthcare workers' experiences and opinions concerning the HTW. METHODS: The HTW took place from 28 November till 4 December 2015. Anonymous HIV rapid testing (INSTI™ HIV1/HIV2 Ab test or Determine™ HIV-1/2 Ag/Ab test) was offered free of charge at four hospitals, 12 general practitioner (GP) clinics, a sexually transmitted infections (STI) clinic, a laboratory, sites of a community-based organisation, and at outreach locations. Home-based testing (OraQuick® In-Home HIV Test) was offered online. The focus was to motivate two groups to test: men who have sex with men (MSM) and non-Western migrants. Questionnaires regarding participant's characteristics and HIV testing history were collected. Also healthcare workers were asked to complete a questionnaire evaluating the HTW. RESULTS: In total, 1231 participants were tested. With three positive HIV tests, the detection rate was 0.3% (95%CI 0.26-0.37). Of all participants, 24.7% (304/1231) were MSM. Respectively, 22.3% (275/1231) and 15.7% (193/1231) were first- and second-generation migrants from a non-Western country. Altogether, 56.7% (698/1231) of participants belonged to one of the targeted risk groups. For 32.7% (402/1231) of participants, it was the first time they received testing, and 35.1% (432/1231) were tested more than 1 year ago. Among MSM 13.2% were tested for the first time, among first- and second-generation non-Western migrants this percentage was significantly higher at 27.2% and 33.5% respectively (p < 0.01). The number of tested participants per location varied widely, especially between GP clinics (range 3-63). Healthcare workers were positive about the HTW: about half (46.2%) stated they would more readily offer an HIV test following their experience with the HTW. CONCLUSIONS: This was the first time the Amsterdam HTW was organised on such a large scale. The majority of the tested population belonged to one of the targeted risk groups and received testing either for the first time or for the first time in over a year. It is important to further build upon the experiences of the HTW and offer free of charge low-threshold HIV testing more structurally. An evaluation of cost-effectiveness is also warranted for future editions of the HTW.

Point-of-care management of urogenital Chlamydia trachomatis via Gram-stained smear analysis in male high-risk patients. Diagnostic accuracy and cost-effectiveness before and after changing the screening indication at the STI Clinic in Amsterdam.

OBJECTIVES: To measure the effect of changing the point-of-care (POC) testing algorithm of urogenital chlamydia for all male high-risk patients to those with only symptoms with respect to: diagnostic accuracy, loss to follow-up, correctly managed consultations and costs. METHODS: Retrospective comparison of the diagnostic accuracy and cost-effectiveness of Gram-stained urethral smear analysis for the POC management of urogenital Chlamydia trachomatis infections. Between 2008 and 2009 Gram-stained urethral smear analysis was offered to all men irrespective of symptoms; between 2010 and 2011 only to those with symptoms. The Aptima CT assay was the reference diagnostic test. RESULTS: The number of examined Gram-stained smears in the two periods was respectively 7185 (2008-2009 period) and 18,852 (2010-2011 period). The sensitivity of the Gram stain analysis was respectively 83.8% (95% CI 81.2% to 86.1%) and 91.0% (95% CI 89.5% to 92.3%) (p<0.001). The specificity was respectively 74.1% (95% CI 73.0% to 75.2%) and 53.1% (95% CI 51.8% to 54.4%) (p<0.001). The positive predictive value was low in both periods, respectively 31.7% (95% CI 29.8% to 33.6%) and 35.6% (95% CI 34.1% to 37.1%) (p=0.002), whereas the negative predictive value was high, respectively 97.0% (95% CI 96.4% to 97.4%) and 95.4% (95% CI 94.6% to 96.1%) (p=0.002). The loss to follow-up rate between 2008-2009 and 2010-2011 was, respectively, 1.8% (95% CI 1.0% to 2.9%) vs 2.3% (95% CI 1.7% to 3.0%) (p=0.36). There was a small difference in overtreatment, 68.0% (95% CI 66.0% to 69.8%) vs 64.1% (95% CI 62.6% to 65.5%) (p=0.001). The cost per correctly managed consultation was 14.3% lower in the 2010-2011 period (€94.31 vs €80.82). The percentage of delayed treated infections was significantly lower in the 2008-2009 period (10.5%) compared with the 2010-2011 period (22.8%) (p<0.001). CONCLUSIONS: With a high sensitivity in male high-risk patients, the Gram-stained urethral smear is a useful POC test to detect urogenital C. trachomatis. When offered only to men with urogenital symptoms the specificity decreases but the cost per correctly managed consultation is reduced with 14.3% without a significant difference in loss to follow-up but with a significantly higher rate of delayed treatment.

Comparison of two Gram stain point-of-care systems for urogenital gonorrhoea among high-risk patients: diagnostic accuracy and cost-effectiveness before and after changing the screening algorithm at an STI clinic in Amsterdam.

OBJECTIVES: To compare point-of-care (POC) systems in two different periods: (1) before 2010 when all high-risk patients were offered POC management for urogenital gonorrhoea by Gram stain examination; and (2) after 2010 when only those with symptoms were offered Gram stain examination. METHODS: Retrospective comparison of a Gram stain POC system to all high-risk patients (2008-2009) with only those with urogenital symptoms (2010-2011) on diagnostic accuracy, loss to follow-up, presumptively and correctly treated infections and diagnostic costs. Culture was the reference diagnostic method. RESULTS: In men the sensitivity of the Gram stain was 95.9% (95% CI 93.1% to 97.8%) in 2008-2009 and 95.4% (95% CI 93.7% to 96.8%) in 2010-2011, and in women the sensitivity was 32.0% (95% CI 19.5% to 46.7%) and 23.1% (95% CI 16.1% to 31.3%), respectively. In both periods the overall specificity was high (99.9% (95% CI 99.8% to 100%) and 99.8% (95% CI 99.7% to 99.9%), respectively). The positive predictive value (PPV) and negative predictive value (NPV) before and after 2010 were also high: PPV 97.0% (95% CI 94.5% to 98.5%) and 97.7% (95% CI 96.3% to 98.6%), respectively; NPV 99.6% (95% CI 99.4% to 99.7%) and 98.8% (95% CI 98.5% to 99.0%), respectively. There were no differences between the two time periods in loss to follow-up (7.1% vs 7.0%). Offering Gram stains only to symptomatic high-risk patients as opposed to all high-risk patients saved €2.34 per correctly managed consultation (a reduction of 7.7%). CONCLUSIONS: The sensitivity of the Gram stain is high in men but low in women. When offered only to high-risk patients with urogenital symptoms, the cost per correctly managed consultation is reduced by 7.7% without a significant difference in accuracy and loss to follow-up.

[Clinical reasoning and decision-making in practice. A man with swelling of both corners of the jaw]. / Klinisch denken en beslissen in de praktijk. Een man met een zwelling van beide kaakhoeken.

A 33-year-old man was referred to an oral surgeon by his general practitioner because ofa bilateral swelling in both jaws. A CT-scan of the head showed enlargement of the parotid glands. After exclusion of mumps and sialolithiasis the patient was treated with oral antibiotics. The swelling failed to improve and the patient was sent to an internist. A repeated medical history revealed that he also had symptoms of sicca syndrome. Sjögren's syndrome was excluded only after negative immunoserological tests and sublabial salivary gland biopsy. A chest X-ray showed enlarged bilateral hilar lymph nodes, confirming the diagnosis of sarcoidosis. A gallium scintigraphy provided further support for this diagnosis. No treatment was initiated and the patient recovered slowly afterwards.

[The HIV pandemic in the year 2007, an overview]. / De hiv-pandemie anno 2oo7, een overzicht.

--40 million people are infected with HIV worldwide, the majority of whom (63%) are in sub-Saharan Africa. --While the absolute number of HIV infections continues to increase, the rate of growth of the pandemic is stabilising, possibly as a result of changes in sexual behaviour or a maturing ofthe epidemic in countries with high AIDS-related mortality. --80% of people infected with HIV that requires treatment do not have access to antiretroviral drugs. --A single dose of nevirapine given to mothers before delivery and to newborns after delivery can reduce the risk oftransmission to 10-15%. Only 9% of HIV-positive pregnant women worldwide have access to this method of prevention. --Two studies showed that male circumcision reduces the risk of HIV infection by 53-60%. --About 60 different vaginal microbicides are under investigation at this time; so far results with this approach have been disappointing. --More than 35 vaccines have been tested in clinical trials; none have appeared to be sufficiently effective. Most candidate vaccines under current investigation focus on T cell immunity. --Increasingly more people favour an 'opting-out' strategy for HIV testing.

[Mental illness in the former Dutch Indies--four psychiatric syndromes: amok, latah, koro and neurasthenia]. / Geestesziek in Nederlands-Indië--vier psychiatrische syndromen: amok, latah, koro en tropenneurasthenie.

--At the beginning of the 20th century Dutch psychiatrists in the former Dutch Indies encountered exotic psychiatric syndromes and variant expressions of psychopathological diseases that were also prevalent in Europe. --The amok and latah syndromes were reported relatively frequently and were considered typical endemic psychopathologies. Amok is an acute condition of insanity in which the affected individual, a man, attempts to kill others. Latah is a shock-like condition in which the affected individual, a woman, mimics the movements and sounds of those nearby against her will. --The koro syndrome is considered a typical but rare psychosis seen primarily among the Chinese population of the former Dutch Indies. Patients have a recurring fear of the penis retracting into the body. --A diagnosis of 'tropical neurasthenia' was frequently made in Europeans for what today would be referred to as dysthymic disorder or minor depressive disorder.

Characterization of the gene encoding dihydroflavonol 4-reductase in tomato.

A cDNA clone (DFR) encoding dihydroflavonol 4-reductase was identified from tomato hypocotyls. Nucleotide and amino acid sequence comparisons to Petunia hybrida, Antirrhinum majus and Zea mays DFR sequences confirmed that the cDNA encodes the structural DFR gene. In tomato, the DFR sequence appeared to be present as a single gene and mapped to a region on chromosome 2 near two loci affecting anthocyanin pigmentation, are and aw. DFR was expressed in both leaf and hypocotyl tissue. Sequencing data from two DFR cDNA clones indicated there are alternative polyadenylation sites on DFR.