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1.
PLoS One ; 15(8): e0237633, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32845933

RESUMO

BACKGROUND: Indeterminate HIV test results are common, but little is known about the evolution of indeterminate serology and its sociodemographic and behavioral correlates. We assessed future HIV serological outcomes for individuals with indeterminate results and associated factors in Rakai, Uganda. METHODS: 115,944 serological results, defined by two enzyme immunoassay (EIAs), among 39,440 individuals aged 15-49 years in the Rakai Community Cohort Study were assessed. Indeterminate results were defined as contradictory EIAs. Modified Poisson regression models with generalized estimating equations were used to assess prevalence ratios (PRs) of subsequent HIV serological outcomes and factors associated with HIV indeterminate results. RESULTS: The prevalence of HIV serologically indeterminate results was 4.9%. Indeterminate results were less likely among women than men (adjPR 0.76, 95% CI 0.71,0.81), in unmarried participants than married participants (adjPR 0.92, 95% CI 0.85,99), and in individuals with primary (adjPR 0.90, 95% CI 0.80,1.02), secondary (adjPR 0.83, 95% CI 0.73,0.96) and post-secondary (adjPR 0.75, 95% CI 0.60,0.94) education, relative to no education. The proportions of persons with indeterminate results progressing to HIV positive, negative or indeterminate results in subsequent visits was 5%, 71% and 24%, respectively. CONCLUSION: HIV serologically indeterminate results were associated with gender and marital status. HIV surveillance programs should develop a protocol for reporting individuals with mixed or persistently indeterminate HIV results on multiple follow-up visits. Most indeterminate results became HIV-negative over time, but follow-up is still needed to detect positive serologies.


Assuntos
Sorodiagnóstico da AIDS/normas , Infecções por HIV/diagnóstico , HIV/isolamento & purificação , Adolescente , Adulto , Feminino , Seguimentos , Infecções por HIV/sangue , Infecções por HIV/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Casamento , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Uganda/epidemiologia , Adulto Jovem
2.
AIDS Educ Prev ; 32(3): 229-242, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32749875

RESUMO

Latinxs in the United States are disproportionately affected by HIV and present with more advanced disease than their non-Latinx peers, due to numerous barriers to care including HIV stigma. We describe the adaptation, implementation, and reach of Sólo Se Vive Una Vez (You Only Live Once), Baltimore's first social marketing campaign promoting HIV screening among Spanish-speaking Latinxs. The 6-month campaign promoted free HIV testing by addressing HIV stigma. The campaign included a website, a social marketing campaign, community outreach events, and advertisements via radio, billboards, local partners, and buses. During the campaign, there were 9,784 unique website users, and ads were served to over 84,592 people on social media platforms. Among Latinx HIV testers at the Baltimore City Health Department, 31.6% reported having seen or heard of Sólo Se Vive Una Vez and 25.3% of Latinx HIV testers reported that the campaign influenced them to get tested.


Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Relações Comunidade-Instituição , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Promoção da Saúde/métodos , Hispano-Americanos/educação , Marketing Social , Estigma Social , Migrantes/educação , Baltimore , Infecções por HIV/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Hispano-Americanos/psicologia , Humanos , Masculino , Programas de Rastreamento/métodos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Mídias Sociais , Migrantes/psicologia , Estados Unidos
3.
AIDS Educ Prev ; 32(3): 196-211, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32749878

RESUMO

In-depth interviews were conducted with 42 HIV-positive fisherfolk and 15 health care providers to identify experiences of social support and its influence on access to and use of HIV testing, treatment, and care. Fisherfolk participants reported receiving support at some point. Prior to HIV diagnosis, this usually took the form of advice on what illness they were dealing with and remedies to use. After HIV diagnosis and disclosure to friends or family, emotional support enabled fisherfolk to come to terms with an HIV diagnosis, informational support offered guidance on how best to live with HIV, while instrumental support enabled access to relevant HIV services. Finally, affiliative support, in the form of new friends met through HIV clinic visits, provided a sense of belonging. Each of these different kinds of support assisted fisherfolk to respond positively to HIV with important consequences for secondary and tertiary prevention.


Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Antirretrovirais/uso terapêutico , Pesqueiros , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Pessoal de Saúde/psicologia , Acesso aos Serviços de Saúde , Apoio Social , Adulto , Aconselhamento , Emprego , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Humanos , Entrevistas como Assunto , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Pesquisa Qualitativa , Uganda
4.
PLoS One ; 15(8): e0237580, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790740

RESUMO

BACKGROUND: HIV screening (i.e. antigen/antibody) tests are followed by a supplemental (i.e. antibody-only) if the screen is positive. Discrepant results can result from two scenarios: a false-positive screening test or acute HIV infection. These scenarios can be distinguished by a molecular HIV test, but due to contamination concerns, our laboratory recently implemented a policy requiring a second specimen dedicated for molecular HIV testing. Our objective was to (1) characterize the effect of this policy on the time-to-diagnosis for patients with discrepant screening and supplemental test results, and (2) explore "strength of positivity" as an interim predictor of screening test accuracy while awaiting confirmatory test results. METHODS: Data from our laboratory information system, electronic health record, and instrument logs were used to collate data for all HIV testing performed at Barnes-Jewish Hospital (BJH) between January 1, 2014 and October 18, 2017. RESULTS: Requiring a dedicated specimen for molecular testing significantly increased the time-to-diagnosis for patients with discrepant screening and supplemental HIV tests (p = 0.0084). This policy also contributed to loss-to-followup, with 0/35 discrepant cases lost-to-followup prior to policy implementation compared to 2/10 after implementation. However, by optimizing the signal-to-cutoff (S/CO) ratio of the screening test, we were able to more accurately distinguish false-positives from acute-HIV prior to molecular testing (sensitivity of 100%, specificity of 89%). CONCLUSIONS: We propose utilizing quantitative fourth-generation assay results (S/CO) ratios as a predictor of infection true positivity in situations where the screening assay is reactive but the supplemental test is negative and confirmatory molecular results are not immediately available.


Assuntos
Sorodiagnóstico da AIDS/normas , Anticorpos Anti-HIV/sangue , Antígenos HIV/imunologia , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , HIV-1/imunologia , Programas de Rastreamento/métodos , Algoritmos , Reações Falso-Positivas , Anticorpos Anti-HIV/imunologia , Infecções por HIV/sangue , Infecções por HIV/virologia , Humanos
5.
BMC Infect Dis ; 20(1): 455, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600260

RESUMO

BACKGROUND: Men who have sex with men (MSM) bear a high burden of syphilis infection. Expanding syphilis testing to improve timely diagnosis and treatment is critical to improve syphilis control. However, syphilis testing rates remain low among MSM, particularly in low- and middle-income countries. We describe the protocol for a randomised controlled trial (RCT) to assess whether provision of syphilis self-testing services can increase the uptake of syphilis testing among MSM in China. METHODS: Four hundred forty-four high-risk MSM will be recruited online and randomized in a 1:1:1 ratio to (1) standard syphilis self-testing arm; (2) a self-testing arm program enhanced with crowdsourcing and a lottery-based incentive, and (3) a standard of care (control). Self-testing services include a free syphilis self-test kit through the mail at monthly intervals. Participants in the lottery incentive arm will additionally receive health promotion materials generated from an open crowdsourcing contest and be given a lottery draw with a 10% chance to win 100 RMB (approximately 15 US Dollars) upon confirmed completion of syphilis testing. Syphilis self-test kits have step-by-step instructions and an instructional video. This is a non-blinded, open-label, parallel RCT. Participants in each arm will be followed-up at three and 6 months through WeChat (a social media app like Facebook messenger). Confirmation of syphilis self-test use will be determined by requiring participants to submit a photo of the used test kit to study staff via secure data messaging. Both self-testing and facility-based testing will be ascertained by sending a secure photographic image of the completed kit through an existing digital platform. The primary outcome is the proportion of participants who tested for syphilis in the past 3 months. DISCUSSION: Findings from this study will provide much needed insight on the impact of syphilis self-testing on promoting routine syphilis screening among MSM. The findings will also contribute to our understanding of the safety, effectiveness and acceptability of syphilis self-testing. These findings will have important implications for self-testing policy, both in China and internationally. TRIAL REGISTRATION: ChiCTR1900022409 (10 April, 2019).


Assuntos
Testes Diagnósticos de Rotina/métodos , Promoção da Saúde/métodos , Homossexualidade Masculina , Imunoensaio/métodos , Programas de Rastreamento/métodos , Minorias Sexuais e de Gênero , Sorodiagnóstico da Sífilis/métodos , Sífilis/diagnóstico , Treponema pallidum/imunologia , Sorodiagnóstico da AIDS/métodos , China , Crowdsourcing/métodos , Testes Diagnósticos de Rotina/efeitos adversos , Seguimentos , Infecções por HIV/diagnóstico , Infecções por HIV/virologia , HIV-1/imunologia , HIV-2/imunologia , Humanos , Masculino , Programas de Rastreamento/efeitos adversos , Motivação , Mídias Sociais , Sífilis/microbiologia , Sorodiagnóstico da Sífilis/efeitos adversos
6.
PLoS One ; 15(6): e0234384, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555703

RESUMO

INTRODUCTION: Men who have sex with men and transgender individuals (MSM/TG) carry a disproportionately high burden of HIV, including in South Africa. However, there are few empirical population-representative estimates of viral suppression and the HIV care cascade including HIV testing among this population, nor of factors associated with these outcomes. METHODS: We conducted a respondent driven sampling (RDS) survey among 301 MSM/TG in Johannesburg in 2017. Participants gave blood samples for HIV testing and viral load. Participants self-completed a survey including sociodemographics, HIV testing history, and engagement in care. We calculated RDS-II weighted estimates of the percentage of HIV-negative MSM/TG reporting HIV testing in the previous 6 months, their testing experience and preferences. Among those HIV-positive, we estimated the percentage status-aware, on ART, and virally suppressed (<50 viral copies/ml plasma). We conducted RDS-weighted robust Poisson regression to obtain weighted prevalence ratios of factors associated with 1) HIV testing among those HIV-negative; and 2) viral suppression among those HIV-positive. RESULTS: There were 118/300 HIV-positive MSM/TG, (37.5%). Of the HIV-negative MSM/TG, 61.5% reported that they had tested for HIV in the previous 6 months, which was associated with selling sex to men (Prevalence Ratio = 1.67, 95% CI 1.36-2.05). There were 76/118 HIV-positive MSM/TG (56.5%) who reported having previously tested positive for HIV and 39/118 (30.0%) who reported current ART. There were 58/118 HIV-positive MSM/TG with viral loads <50 copies/ml plasma (46.9%). Viral suppression was associated with older age (adjusted PR = 1.03, 95% CI 1.00-1.06 for each year), neighbourhood, and having bought sex from men (adjusted PR = 1.53, 95% CI 1.12-2.08). CONCLUSIONS: HIV prevalence was very high. Viral suppression among those HIV-positive was similar to the general male population in South Africa, but remains far short of national and international targets. A majority of HIV-negative MSM/TG had HIV tested in the previous 6 months, though there is room for improvement.


Assuntos
Infecções por HIV/epidemiologia , Homossexualidade Masculina , Pessoas Transgênero , Sorodiagnóstico da AIDS/estatística & dados numéricos , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/virologia , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Prevalência , Fatores Socioeconômicos , África do Sul/epidemiologia , Inquéritos e Questionários , Carga Viral , Adulto Jovem
7.
BMC Infect Dis ; 20(1): 320, 2020 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-32366227

RESUMO

BACKGROUND: Rapid diagnostic tests (RDTs) are a cornerstone of HIV diagnosis and rely on good quality processing and interpretation, particularly in the era of test and treat. The Deki Reader (Fio Corporation®, Toronto, Ontario, Canada) is a portable device designed specifically for analysing RDTs and was selected for evaluation in South Africa in the context of HIV RDT analysis. METHODS: This study consisted of a laboratory evaluation and two-part field evaluation of the Deki Reader v100, covering two RDT testing algorithms, and an evaluation of the continuous quality monitoring through the Fionet™ web portal. Based on user feedback from the field evaluation, the device underwent hardware and software redesign, and the Deki Reader v200 was evaluated in the laboratory. Ethics approval for this evaluation was obtained from the University of the Witwatersrand Human Research Ethics Committee: M150160. RESULTS: The intra- and inter-device laboratory precision of the Deki Reader v100 were 98.3 and 99.2% respectively, and 99.3 and 100% for the Deki Reader v200. The laboratory concordances compared to standard-of-care reporting were 99.5 and 98.0% for the two respective models, while sensitivity and specificity were 99.5 and 99.4% for the Deki Reader V100 and 100 and 93.1% for the Deki Reader V200 respectively. Screening and confirmatory concordances in the field were 99.3 and 96.5% under algorithm 1 and 99.7 and 100% under algorithm 2. Sensitivity and specificity for the field evaluation were 99.8 and 97.7%. Overall robustness of the device was acceptable and continuous quality monitoring through Fionet™ was feasible. CONCLUSIONS: The Deki Reader provides an option for improved and reliable quality assessment for rapid diagnosis of HIV using RDTs to enhance the quality of healthcare at the point-of-care. However, the introduction of new RDTs and modification of current algorithms necessitates ongoing and agile RDT reader adjustments, which will require cost modelling to ensure sustainability of devices implemented into national HIV programs.


Assuntos
Sorodiagnóstico da AIDS/instrumentação , Testes Diagnósticos de Rotina/instrumentação , Ensaio de Imunoadsorção Enzimática/instrumentação , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , HIV-1/imunologia , HIV-2/imunologia , Sorodiagnóstico da AIDS/métodos , Algoritmos , Testes Diagnósticos de Rotina/métodos , Ensaio de Imunoadsorção Enzimática/métodos , Infecções por HIV/virologia , Humanos , Programas de Rastreamento/métodos , Aplicativos Móveis , Sistemas Automatizados de Assistência Junto ao Leito , Prevalência , Sensibilidade e Especificidade , África do Sul/epidemiologia
8.
PLoS One ; 15(5): e0233396, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32470004

RESUMO

BACKGROUND: Mother to child transmission (MTCT) of HIV remains a challenge in resource-limited settings. Central to elimination of MTCT is effective Provider Initiated HIV Counseling and Testing (PICT). Research has shown that conducting PICT only at the initial antenatal care (ANC) visit fails to benefit pregnant women who seroconvert later in their pregnancy. This study aimed to determine the most cost effective time to perform repeat HIV testing during ANC and perinatal care (PNC). METHODS: We studied the repeat HIV testing results of pregnant women ≥ 18 and adolescent girls aged 15-17 in the Sauri, Kenya Millennium Villages Project (MVP) site. Nurses provided HIV screening to 1,403 expectant women and 256 adolescent girls following the 1st, 2nd, 3rd and 4th ANC visits, at birth and 6 and 14 weeks postpartum. RESULTS: Five women seroconverted during the study period (incidence proportion 0.41%). One woman seroconverted at the 2nd ANC visit, another one at the 3rd, two at the 4th and one at 6 weeks post-partum. Of all the women who seroconverted, four reported an HIV negative primary partner, while one reported an unknown partner status. None of the participants reported condom use during pregnancy. Two of the seroconverters vertically transmitted HIV to their babies. The results did not suggest a clear pattern of seroconversion during ANC and PNC. CONCLUSIONS: The low rates of seroconversion suggest that testing pregnant women multiple times during ANC and PNC may not be cost effective, but a follow-up test during birth may be protective of the newborn.


Assuntos
Infecções por HIV/complicações , Infecções por HIV/prevenção & controle , Soropositividade para HIV/complicações , Soropositividade para HIV/diagnóstico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/diagnóstico , Sorodiagnóstico da AIDS/economia , Sorodiagnóstico da AIDS/métodos , Adolescente , Adulto , Análise Custo-Benefício , Feminino , Infecções por HIV/transmissão , Recursos em Saúde , Humanos , Quênia , Estudos Longitudinais , Assistência Perinatal/economia , Assistência Perinatal/métodos , Gravidez , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/métodos , Estudo de Prova de Conceito , Adulto Jovem
9.
AIDS Behav ; 24(11): 3232-3243, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32385676

RESUMO

For those most at risk of contracting HIV, new strategies for preventing transmission and increasing testing are needed. As part of a multi-site, randomized, controlled trial, we explored attitudes and preferences among 272 HIV-negative men who have sex with men and HIV-negative transgender women using an HIV self-testing (HIVST) kit to test partners. Less than one quarter had previously self-tested with HIVST kits (21.7%) and few had partner-tested (4.8%). Most preferred gum swab (96%) over fingerprick tests (69%), but would prefer a blood test if it gave results for other sexually transmitted infections (STIs) (86%). Five percent reported difficulties performing the test, four percent with storage, and 26% with portability. Ninety-three percent reported likelihood of using HIVST to test partners in future, but only 3% were willing to pay the current price. Efforts to improve HIVST uptake should focus on incorporating testing for other STIs, reducing test kit size, and reducing cost.


Assuntos
Infecções por HIV/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/psicologia , Autocuidado/métodos , Parceiros Sexuais , Sorodiagnóstico da AIDS , Atitude , Infecções por HIV/prevenção & controle , Humanos , Masculino , Programas de Rastreamento , Preferência do Paciente
10.
PLoS One ; 15(4): e0230988, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32282808

RESUMO

BACKGROUND: There is a growing body of evidence positioning targeted provider-initiated testing and counselling (tPITC, also known as index case testing) as a promising HIV case-finding and linkage strategy among children and adolescents. However, the effectiveness and efficiency of this strategy is limited by low HIV testing uptake and case detection rates. Despite this fact, there is very little literature on factors associated with HIV testing uptake, HIV seropositivity and ART-enrolment in tPITC implementation among African children. This study aims to bridge this information gap and contribute in improving the effectiveness and efficiency of tPITC among children and adolescents in Cameroon and beyond. METHODS: In three ART clinics where tPITC was previously inexistent, we introduced the routine implementation of this strategy by inviting parents living with HIV/AIDS in care to have their biological children (6 weeks-19 years) HIV-tested. Children of consenting parents were HIV-tested; those testing positive were enrolled on ART. Parental and child-level characteristics associated with HIV testing uptake, seropositivity and ART-enrollment were assessed using bivariate and multivariate regression analysis at 5% significance level. RESULTS: We enrolled 1,236 parents, through whom 1,990 children/adolescents were recruited for HIV testing. Among enrolled parents, 46.2% (571/1,236) had at least one child tested, and 6.8% (39/571) of these parents had at least one HIV-positive child. Among enrolled children/adolescents, 56.7% (1,129/1,990) tested for HIV and 3.5% (40/1129) tested HIV-positive. Parental predictors of HIV testing uptake among children/adolescents were sex, occupation and duration on ART: female [aOR = 1.6 (1.1-2.5)], office workers/students [aOR = 2.0 (1.2-3.3)], and parents with ART duration > 5 years [aOR = 2.0 (1.3-2.9)] had significantly higher odds to test a child than male, farmers/traders, and parents with ART duration < 5 years respectively. The only child-level predictor of testing uptake was age: children < 18 months [aOR = 5(2-10)] had significantly higher odds to test for HIV than adolescents > 15 years. Parents of children identified as HIV-positive were more likely to be female, aged 40-60 years, farmers/traders, widows/divorcees and not on ART. Children found HIV-positive and who were ART-enrolled were more likely to be female and aged 5-9 years. However, none of the above-mentioned associations was statistically significant. CONCLUSIONS: Parents who were male, farmers/traders, and on ART for ≤ 5 years were less likely to test their children for HIV. Also, adolescents 10-19 years old were less likely to be tested. Therefore, these groups should be targeted with intensive counseling and follow-up to facilitate optimal testing uptake. No association was found between parental or child-level characteristics and HIV seropositivity among tested children. This finding prompts for further research to investigate approaches to better identify and target HIV testing to children/adolescents with the highest likelihood of HIV seropositivity. CLINICAL TRIAL REGISTRATION: Reg: CinicalTrials.gov # NCT03024762.


Assuntos
Infecções por HIV/diagnóstico , Sorodiagnóstico da AIDS/estatística & dados numéricos , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Camarões/epidemiologia , Criança , Pré-Escolar , Aconselhamento , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Soropositividade para HIV/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Relações Pais-Filho , Pais , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto Jovem
11.
Rev. bioét. (Impr.) ; 28(1): 34-37, jan.-mar. 2020.
Artigo em Português | LILACS | ID: biblio-1092412

RESUMO

Resumo A postura do médico em relação a diagnóstico e esclarecimentos ao paciente infectado pelo vírus da imunodeficiência humana baseia-se principalmente na percepção pessoal e experiência humanística. O objetivo deste estudo foi relatar a experiência de estudantes de medicina do sexto período do Centro Universitário Metropolitano da Amazônia, em Belém/PA, durante as aulas do módulo de Habilidades Clínicas (Eixo Infectologia) no Centro de Atenção à Saúde em Doenças Infecciosas Adquiridas. Depois de prestarem atendimentos ambulatoriais e discutirem casos clínicos por cinco meses, os estudantes se deram conta da necessidade de humanização nessa área, considerando questões biopsicossociais. De modo geral, a experiência ampliou os conhecimentos adquiridos nas aulas e permitiu aplicar o cuidado integral ao paciente, além de estimular formação mais humanística e crítica desses profissionais de saúde.


Abstract The physicians's attitude towards diagnosis and clarifications to the patient infected by the human immunodeficiency virus is based mainly on personal perception and humanistic experience. The objective of this study was to report the experience of medical students from the sixth period of the Centro Universitário Metropolitano da Amazônia, in Belém, Pará, Brazil, during classes of the Clinical Skills module (Infectious Axis) at the Center for Attention on Acquired Infectious Diseases. After providing outpatient care and discussing clinical cases for five months and considering biopsychosocial issues, the students realized a need for humanization in this area. The experience expanded the knowledge acquired in class and allowed the delivery of comprehensive care to the patient, in addition to encouraging more humanistic and critical training of these health professionals.


Resumen La actitud del médico respecto al diagnóstico y la aclaración de la condición del paciente infectado por el VIH está relacionada con la percepción personal y la experiencia humanística. El presente estudio tuvo el objetivo de presentar la experiencia de estudiantes de medicina del sexto período del Centro Universitário Metropolitano da Amazônia, en Belém, Pará, Brasil, durante las clases del módulo Habilidades Clínicas (Eje Infectología) en el Centro de Atención de Enfermedades Infecciosas Adquiridas. Los estudiantes ofrecieron atención ambulatoria y tuvieron discusión de casos durante cinco meses y pudieron advertir la necesidad de humanización en esta área debido a problemas biopsicosociales. La experiencia brindó la oportunidad de ampliar los conocimientos adquiridos durante las clases y aplicar una atención integral al paciente, y estimular la capacitación de profesionales de la salud con un perfil humanístico y crítico.


Assuntos
Sorodiagnóstico da AIDS , Antígenos HIV , Educação Médica , Humanização da Assistência , Infectologia
12.
AIDS Behav ; 24(9): 2732-2741, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32193729

RESUMO

HIV partner-testing (PT) may represent a unique and empowering HIV prevention strategy for groups that face structural and institutional barriers to HIV testing and care, including transgender women. We report on in-depth interviews (IDIs) with N = 10 transgender women who used HIV self-test kits for three months to screen potential sexual partners in a randomized controlled trial (iSUM; "I'll Show You Mine") that took place in New York City and San Juan, Puerto Rico. Participants were assigned to intervention (supplied with 10 self-test kits immediately) or control groups (received 6 test kits after 3 months). We conducted IDIs with the first N = 10 transgender women to enroll in the intervention group after three months in the study (after participants used kits with partners) to understand their experiences. Themes discussed in IDIs included: partners' reaction to HIV testing, participants' reactions to partners' test results or refusal to test, partners' own reaction to their test results, and decision-making around test use. Data were independently analyzed by two coders. Overwhelmingly, participants' experiences with PT was positive. Participants reported kits were convenient and acceptable to most partners. Transgender women felt that PT could pose additional risk for them; one woman experienced violence related to kit use. Furthermore, the availability of kits appeared to encourage participants and their partners to think about their HIV status and, in some cases, modify sexual behavior. Work suggests that HIV PT could be a viable risk-reduction strategy for transgender women.


Assuntos
Sorodiagnóstico da AIDS/métodos , Infecções por HIV/diagnóstico , Kit de Reagentes para Diagnóstico , Autocuidado/métodos , Parceiros Sexuais , Pessoas Transgênero/psicologia , Adulto , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Humanos , Entrevistas como Assunto , Masculino , Programas de Rastreamento/métodos , Cidade de Nova Iorque , Porto Rico , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto , Testes Sorológicos , Comportamento Sexual , Inquéritos e Questionários , Adulto Jovem
13.
J Acquir Immune Defic Syndr ; 84(1): e1-e6, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32049774

RESUMO

BACKGROUND: A prior randomized control trial showed financial incentives increase HIV testing rates for children of unknown HIV status. Translating evidence-based interventions such as these to scale requires an implementation science approach. METHODS: A qualitative study evaluating health care providers' perceptions of barriers and facilitators of a previously completed financial incentives intervention for pediatric HIV testing was conducted at health care facilities in Kisumu, Kenya. Six focus group discussions with 52 providers explored determinants of acceptability, feasibility, and sustainability of financial incentive scale-up for pediatric HIV testing using the Consolidated Framework for Implementation Research to inform question guides and thematic analysis. RESULTS: Providers found the use of financial incentive interventions for pediatric HIV testing to be highly acceptable. First, providers believed financial incentives had a relative advantage over existing strategies, because they overcame cost barriers and provided additional motivation to test; however, concerns about how financial incentives would be implemented influenced perceptions of feasibility and sustainability. Second, providers expressed concern that already overburdened staff and high costs of financial incentive programs would limit sustainability. Third, providers feared that financial incentives may negatively affect further care because of expectations of repeated financial support and program manipulation. CONCLUSIONS: Providers viewed financial incentives as an acceptable intervention to scale programmatically to increase uptake of pediatric testing. To ensure feasibility and sustainability of financial incentives in pediatric HIV testing programs, it will be important to clearly define target populations, manage expectations of continued financial support, and establish systems to track testing.


Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Financiamento Pessoal , Infecções por HIV/economia , Pessoal de Saúde/psicologia , Motivação , Criança , Humanos , Quênia , Pesquisa Qualitativa
14.
J Acquir Immune Defic Syndr ; 84(1): 5-9, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32058458

RESUMO

BACKGROUND: Serological tests can distinguish recent (in the prior 12 months) from long-term HIV infection. Integrating recency testing into routine HIV testing services (HTS) can provide important information on transmission clusters and prioritize clients for partner testing. This study assessed the feasibility and use of integrating HIV recency into routine testing. METHODS: We conducted a multi-method study at 14 facilities in Kenya, and key informant interviews with health care providers. We abstracted clinical record data, collected specimens, tested specimens for recent infection, returned results to participants, and conducted a follow-up survey for those recently infected. RESULTS: From March to October 2018, we enrolled 532 clients who were diagnosed HIV-positive for the first time. Of these, 46 (8.6%) were recently infected. Women aged 15-24 years had 2.9 (95% confidence interval: 1.46 to 5.78) times higher adjusted odds of recent infection compared with 15-24-year-old men and those tested within the past 12 months having 2.55 (95% confidence interval: 0.38 to 4.70) times higher adjusted odds compared with those tested ≥12 months previously. Fourteen of 17 providers interviewed found the integration of recency testing into routine HTS services acceptable and feasible. Among clients who completed the follow-up interview, most (92%) felt that the recency results were useful. CONCLUSIONS: Integrating recent infection testing into routine HTS services in Kenya is feasible and largely acceptable to clients and providers. More studies should be done on possible physical and social harms related to returning results, and the best uses of the recent infection data at an individual and population level.


Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Infecções por HIV/epidemiologia , Adolescente , Adulto , Estudos de Viabilidade , Feminino , Infecções por HIV/diagnóstico , Humanos , Quênia/epidemiologia , Masculino , Parceiros Sexuais , Adulto Jovem
15.
AIDS Behav ; 24(7): 2220-2226, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32030526

RESUMO

Men who have sex with men and transgender women who had multiple sexual partners in the prior 3 months participated in ISUM, a randomized, controlled trial of self- and partner-testing in New York City and San Juan, PR. Only 2% of screened participants were ineligible to enroll due to anticipating they would find it very hard to avoid or handle violence. The intervention group received free rapid HIV self-test kits. During the trial, 114 (88%) of intervention participants who were assessed at follow-up used self-tests with at least one potential partner. Only 6% of participants who asked a partner in person to test reported that at least one of their partners got physically violent, some in the context of sex work. In total, 16 (2%) partners reacted violently. Post-trial, only one participant reported finding it very hard to handle violence, and none found it very hard to avoid potential violence.


Assuntos
Sorodiagnóstico da AIDS/métodos , Agressão , Homossexualidade Masculina/psicologia , Programas de Rastreamento/estatística & dados numéricos , Autocuidado/métodos , Autoexame/estatística & dados numéricos , Parceiros Sexuais/psicologia , Pessoas Transgênero/psicologia , Violência/estatística & dados numéricos , Adulto , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Cidade de Nova Iorque/epidemiologia , Porto Rico/epidemiologia , Autocuidado/psicologia , Comportamento Sexual , Minorias Sexuais e de Gênero
16.
J Int AIDS Soc ; 23(2): e25452, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32072743

RESUMO

INTRODUCTION: The HPTN 071 (PopART) trial evaluated the impact of an HIV combination prevention package that included "universal testing and treatment" on HIV incidence in 21 communities in Zambia and South Africa during 2013-2018. The primary study endpoint was based on the results of laboratory-based HIV testing for> 48,000 participants who were followed for up to three years. This report evaluated the performance of HIV assays and algorithms used to determine HIV status and identify incident HIV infections in HPTN 071, and assessed the impact of errors on HIV incidence estimates. METHODS: HIV status was determined using a streamlined, algorithmic approach. A single HIV screening test was performed at centralized laboratories in Zambia and South Africa (all participants, all visits). Additional testing was performed at the HPTN Laboratory Center using antigen/antibody screening tests, a discriminatory test and an HIV RNA test. This testing was performed to investigate cases with discordant test results and confirm incident HIV infections. RESULTS: HIV testing identified 978 seroconverter cases. This included 28 cases where the participant had acute HIV infection at the first HIV-positive visit. Investigations of cases with discordant test results identified cases where there was a participant or sample error (mixups). Seroreverter cases (errors where status changed from HIV infected to HIV uninfected, 0.4% of all cases) were excluded from the primary endpoint analysis. Statistical analysis demonstrated that exclusion of those cases improved the accuracy of HIV incidence estimates. CONCLUSIONS: This report demonstrates that the streamlined, algorithmic approach effectively identified HIV infections in this large cluster-randomized trial. Longitudinal HIV testing (all participants, all visits) and quality control testing provided useful data on the frequency of errors and provided more accurate data for HIV incidence estimates.


Assuntos
Sorodiagnóstico da AIDS/métodos , Algoritmos , Infecções por HIV/diagnóstico , Adulto , Confiabilidade dos Dados , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Incidência , Masculino , Programas de Rastreamento , Ensaios Clínicos Controlados Aleatórios como Assunto , África do Sul/epidemiologia , Zâmbia/epidemiologia
17.
J Int AIDS Soc ; 23(2): e25455, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32091179

RESUMO

INTRODUCTION: Achieving HIV epidemic control globally will require new strategies to accelerate reductions in HIV incidence and mortality. Universal test and treat (UTT) was evaluated in four randomized population-based trials (BCPP/Ya Tsie, HPTN 071/PopART, SEARCH, ANRS 12249/TasP) conducted in sub-Saharan Africa (SSA) during expanded antiretroviral treatment (ART) eligibility by World Health Organization guidelines and the UNAIDS 90-90-90 campaign. DISCUSSION: These three-year studies were conducted in Botswana, Zambia, Uganda, Kenya and South Africa in settings with baseline HIV prevalence from 4% to 30%. Key observations across studies were: (1) Universal testing (implemented via a variety of home and community-based testing approaches) achieved >90% coverage in all studies. (2) When coupled with robust linkage to HIV care, rapid ART start and patient-centred care, UTT achieved among the highest reported population levels of viral suppression in SSA. Significant gains in population-level viral suppression were made in regions with both low and high baseline population viral load; however, viral suppression gains were not uniform across all sub-populations and were lower among youth. (3) UTT resulted in marked reductions in community HIV incidence when universal testing and robust linkage were present. However, HIV elimination targets were not reached. In BCPP and HPTN 071, annualized HIV incidence was approximately 20% to 30% lower in the intervention (which included universal testing) compared to control arms (no universal testing). In SEARCH (where both arms had universal testing), incidence declined 32% over three years. (4) UTT reduced HIV associated mortality by 23% in the intervention versus control communities in SEARCH, a study in which mortality was comprehensively measured. CONCLUSIONS: These trials provide strong evidence that UTT inclusive of universal testing increases population-level viral suppression and decreases HIV incidence and mortality faster than the status quo in SSA and should be adapted at a sub-country level as a public health strategy. However, more is needed, including integration of new prevention interventions into UTT, in order to reach UNAIDS HIV elimination targets.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Epidemias/prevenção & controle , Infecções por HIV/prevenção & controle , Programas de Rastreamento , Sorodiagnóstico da AIDS , Adolescente , Adulto , Botsuana/epidemiologia , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Incidência , Quênia/epidemiologia , Masculino , Prevalência , Saúde Pública , África do Sul/epidemiologia , Tempo para o Tratamento , Uganda/epidemiologia , Carga Viral , Zâmbia/epidemiologia
18.
BMC Womens Health ; 20(1): 21, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32028952

RESUMO

BACKGROUND: The Dominican Republic (DR) ranks among nations with the highest burden of HIV in the Caribbean. Cultural and gender roles in rural areas of the DR may place women at increased HIV risk. However, little is known about sexual health and HIV testing behaviors among women in the rural DR. METHODS: We conducted a needs assessment among a systematic sample of adult women in a rural DR community in 2016. Demographic and behavioral attributes related to HIV testing, sexual health, and healthcare utilization were evaluated. Poisson regression analysis was used to identify demographics and behaviors associated with having had a previous HIV test. Significance was defined as a p-value < 0.05. RESULTS: Among 105 women evaluated, 77% knew someone with HIV and 73% of women reported that they would be very or extremely likely to take an HIV test if offered. Only 68% reported a previous HIV test, including 47% who were tested over 2 years prior. Barriers to HIV testing included low risk perception (23%), distance or requisite travel (13%), and discomfort being tested (11%). Women who had never been tested for HIV were more likely than those who had been tested to be older (p = 0.03), to have a lower level of education (p = 0.04), and to have never been tested for other sexually transmitted infections (STI; p <  0.01). In the Poisson multiple regression model, the only significant predictor of having had an HIV test was having had an STI test (p = 0.03). CONCLUSIONS: In the rural DR, numerous barriers contribute to low prevalence of HIV testing among women. Most women report willingness to have an HIV test and many engage in routine health care, indicating that this population may benefit from incorporating HIV testing and other sexual health promotion activities into routine medical care.


Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Infecções por HIV/diagnóstico , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde da Mulher/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , República Dominicana/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Prevalência , População Rural/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Inquéritos e Questionários , Adulto Jovem
20.
BMC Infect Dis ; 20(1): 9, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906866

RESUMO

BACKGROUND: An individual is considered HIV positive when a confirmatory HIV-1/HIV-2 differentiation test returns positive following an initial reactive antigen/antibody combination screen. Falsely reactive HIV screens have been reported in patients with various concomitant infectious and autoimmune conditions. Falsely positive confirmatory HIV differentiation assays are seen less frequently, but have been observed in cases of pregnancy, pulmonary embolism, and malaria. CASE PRESENTATION: A healthy 27 year-old man was referred after a reactive ADVIA Centaur® HIV Ag/Ab screen and positive Bio-Rad Geenius™ HIV 1/2 Confirmatory assay, suggesting HIV-1 infection. The patient's HIV viral load was undetectable prior to initiation of antiretroviral therapy, and remained undetectable on subsequent testing after initiation of antiretroviral therapy. Both Centaur® and Geenius™ tests were repeated and returned reactive. As this patient was believed to be at low risk of acquiring HIV infection, samples were additionally run on Genscreen™ HIV-1 Ag assay and Fujirebio Inno-LIA™ HIV-1/2 score, with both returning non-reactive. For confirmation, the patient's proviral HIV DNA testing was negative, confirming the initial results as being falsely positive. The patient disclosed that he had been using a variety of anabolic steroids before and during the time of HIV testing. DISCUSSION AND CONCLUSIONS: The erroneous diagnosis of HIV can result in decreased quality of life and adverse effects of antiretroviral therapy if initiated, hence the importance of interpreting the results of HIV testing in the context of an individual patient. This reports suggests a potential association between the use of anabolic steroids and falsely-reactive HIV testing.


Assuntos
Sorodiagnóstico da AIDS/normas , Reações Falso-Positivas , Infecções por HIV/diagnóstico , HIV/imunologia , Congêneres da Testosterona/efeitos adversos , Adulto , Anticorpos Anti-HIV/sangue , Infecções por HIV/sangue , Infecções por HIV/virologia , Humanos , Masculino , Autoadministração , Congêneres da Testosterona/administração & dosagem , Congêneres da Testosterona/imunologia
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