child transmission of HIV in Rivers State, Nigeria. ... Similarly, other resources for counselling such as television and video sets, posters and banners were in short supply. Important issues in post-test counselling such as information about ...
Thrun, Mark; Cook, Paul F.; Bradley-Springer, Lucy A.; Gardner, Lytt; Marks, Gary; Wright, Julie; Wilson, Tracey E.; Quinlivan, E. Byrd; O'Daniels, Christine; Raffanti, Stephen; Thompson, Melanie; Golin, Carol
The Centers for Disease Control and Prevention have recommended that HIV care clinics incorporate prevention into clinical practice. This report summarizes HIV care providers' attitudes and counseling practices before and after they received training to deliver a counseling intervention to patients. Providers at seven HIV clinics received training…
Myers, Janet J; Kang Dufour, Mi-Suk; Koester, Kimberly A; Rose, Carol Dawson; Shade, Starley B; Maiorana, Andres; Morin, Stephen F
The delivery of HIV risk assessment and behavioral counseling by clinicians in HIV clinical settings is one component in a comprehensive "positive prevention" strategy to help patients reduce their transmission risk behavior. Clinicians engage in behavioral prevention inconsistently, however, depending on whether patients are new to a practice or are established in regular care and on their attitudes and characteristics of their practices. We analyzed clinician reports of behavioral prevention delivered before and after participation in a large federal demonstration project of positive prevention interventions. The interventions that were part of this project were successful in increasing behavioral prevention among both new and returning patients. Prior to study interventions, clinicians reported counseling 69% of new patients and 52% of returning patients. In follow-up interviews 12 months after receiving training, clinicians reported delivering prevention messages to 5% more new patients and 9% of returning patients (both phelp clinicians more consistently deliver behavioral prevention messages to their HIV-infected patients.
Full Text Available Abstract Background A large proportion of the 2.5 million new adult HIV infections that occurred worldwide in 2007 were in stable couples. Feasible and acceptable strategies to improve HIV prevention in a conjugal context are scarce. In the preparatory phase of the ANRS 12127 Prenahtest multi-site HIV prevention trial, we assessed the acceptability of couple-oriented post-test HIV counseling (COC and men's involvement within prenatal care services, among pregnant women, male partners and health care workers in Cameroon, Dominican Republic, Georgia and India. Methods Quantitative and qualitative research methods were used: direct observations of health services; in-depth interviews with women, men and health care workers; monitoring of the COC intervention and exit interviews with COC participants. Results In-depth interviews conducted with 92 key informants across the four sites indicated that men rarely participated in antenatal care (ANC services, mainly because these are traditionally and programmatically a woman's domain. However men's involvement was reported to be acceptable and needed in order to improve ANC and HIV prevention services. COC was considered by the respondents to be a feasible and acceptable strategy to actively encourage men to participate in prenatal HIV counseling and testing and overall in reproductive health services. Conclusions One of the keys to men's involvement within prenatal HIV counseling and testing is the better understanding of couple relationships, attitudes and communication patterns between men and women, in terms of HIV and sexual and reproductive health; this conjugal context should be taken into account in the provision of quality prenatal HIV counseling, which aims at integrated PMTCT and primary prevention of HIV.
Steward, Wayne T; Koester, Kimberly A; Myers, Janet J; Morin, Stephen F
We examined the relationship between provider fatalism, a belief that behavior change among HIV-infected patients is unlikely, and HIV-prevention counseling in 16 publicly funded clinics. HIV-seropositive patients (N = 618) completed surveys assessing prevention counseling in the past 6 months. Additionally, 144 interviews were conducted with providers, administrators, and patients to examine beliefs about prevention counseling. We summed the number of fatalistic comments made by providers and administrators in each clinic, and assigned these counts as clinic-level fatalism scores to survey participants. Patients in high fatalism clinics were less likely to report prevention counseling than patients in low fatalism clinics. This difference remained significant even after controlling for clinic characteristics or patients' sexual risk and health status. However, clients in high fatalism clinics were more likely to be White, gay, educated, and older. Provider fatalism is a barrier that must be addressed when implementing HIV-prevention counseling in primary care settings.
Grillo, Michael P; Sloan, Margo; Wankie, Che; Woodland, Kelly; Reader, Elizabeth; Porter, Bruce; Shaffer, Richard; Macera, Caroline A; Bulterys, Marc
Compared with the general population in low- and middle-income countries, military members tend to be male, young, travel more frequently away from their main sexual partners, drink more alcohol and have a consistent source of income. All of these factors may lead to an increased risk of contracting HIV. In response, the Department of Defense HIV/AIDS Prevention Program advocates for the integration of HIV prevention "building blocks" into military health services to reduce the risk of acquiring HIV among foreign uniformed services. The building blocks include basic HIV education including outreach, condom promotion, enabling HIV policies, HIV testing services, screening for sexually transmitted infections, voluntary medical male circumcision where appropriate, prevention of mother-to-child transmission, and other supportive services. The Department of Defense HIV/AIDS Prevention Programs supports implementation of these building blocks though partnerships with foreign militaries. This comprehensive prevention package, when closely linked with HIV treatment services, is the cornerstone of creating an HIVfree generation in military and surrounding communities worldwide. Copyright© Bentham Science Publishers; For any queries, please email at email@example.com.
Osuji, Alice; Pharr, Jennifer R; Nwokoro, Uche; Ike, Anulika; Ali, Christiana; Ejiro, Ogheneaga; Osuyali, John; Obiefune, Michael; Fiscella, Kevin; Ezeanolue, Echezona E
Nigeria is second in the world for the number of people with HIV and has a high rate of mother-to-child transmission (MTCT). Over 60% of births in Nigeria occur outside of health care facilities, and because of this, Traditional Birth Attendants (TBAs) play a significant role in maternal and child health. It is important that TBAs be knowledgeable about HIV prevention. The purpose of this study was to determine the impact of HIV testing and counseling (HTC) knowledge on the HIV prevention practices among TBAs in Nigeria. Five hundred TBAs were surveyed. Chi-square and logistic regression were used to assess differences in HIV prevention practices between TBAs with and without HTC knowledge. TBAs with HTC knowledge are significantly more likely to engage in HIV prevention practices than TBAs without HTC. Prevention practices included: wearing gloves during delivery (p HTC training increases HIV prevention practices and can be a key to improve maternal and child health.
child Transmission of HIV Infection in Rivers State, South-South, Nigeria. ... However, three major barriers to accessing the services were identified as distance from home 31.7%, cost of transportation to clinics 20.1% and long waiting time to ...
Patel, Shilpa N.; Marks, Gary; Gardner, Lytt; Golin, Carol E.; Shinde, Sanjyot; O'Daniels, Christine; Wilson, Tracey E.; Quinlivan, E. Byrd; Banderas, Julie W.
Objective: The aim of this study was to examine whether brief training of human immunodeficiency virus (HIV) medical providers increased the frequency with which they routinely delivered prevention counselling to patients, and whether patient characteristics were associated with receipt of that counselling. Design: Longitudinal. Setting: Seven HIV…
Implementation of Couples' Voluntary HIV Counseling and Testing Services in Durban, South Africa, for HIV Prevention and Intervention. Heterosexual couples represent the largest HIV risk group in sub-Saharan Africa. Couples' Voluntary HIV Counseling and Testing (CVCT) is an effective HIV prevention strategy because ...
Johns, David Merritt; Bayer, Ronald; Fairchild, Amy L
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. 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. 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. 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
Confirmation by Western Blot: while during the second period- November 2003 to June 2004 (Period 2), the women received free HIV screening and confirmation tests (by Double ELISA) and additional individual pre-test counseling. Result: 638 women were seen in Period 1, out of which 269 (45.1%) accepted testing: ...
... Abroad Treatment Basic Statistics Get Tested Find an HIV testing site near you. Enter ZIP code or city Follow HIV/AIDS CDC HIV CDC HIV/AIDS See RSS | ... Collapse All Is abstinence the only 100% effective HIV prevention option? Yes. Abstinence means not having oral, ...
Wilson, Kristina; Durantini, Marta R; Albarracín, Julia; Crause, Candi; Albarracín, Dolores
Aspects of Latino culture (e.g., machismo, marianism) can act as barriers to enrollment in HIV-prevention programs. To lift these barriers, a culturally appropriate meta-intervention was designed to increase intentions to enroll in HIV-prevention counseling by Latinos. Latino participants (N=41) were recruited from the community and randomly assigned to either an experimental or control meta-intervention condition that varied the introduction to a HIV-prevention counseling program. Following the meta-intervention, participants were issued an invitation to take part in HIV-prevention counseling. The outcome measure was the intention to enroll in a HIV-prevention counseling session. Findings indicated that enrollment intentions were higher in the experimental meta-intervention condition (96%) than in the control meta-intervention condition (53%). In addition, the effects of the meta-intervention were comparable across genders and participant ages. Findings suggest that the use of a culturally appropriate meta-intervention may be an effective strategy for increasing Latino enrollment in HIV-prevention programs. These promising findings warrant further investigation into the efficacy and effectiveness of this meta-intervention.
HIV Prevention Counseling Intervention Delivered During Routine Clinical Care Reduces HIV Risk Behavior in HIV-Infected South Africans Receiving Antiretroviral Therapy: The Izindlela Zokuphila/Options for Health Randomized Trial
Fisher, Jeffrey D.; Cornman, Deborah H.; Shuper, Paul A.; Christie, Sarah; Pillay, Sandy; Macdonald, Susan; Ngcobo, Ntombenhle; Amico, K. Rivet; Lalloo, Umesh; Friedland, Gerald; Fisher, William A.
Context Sustainable interventions are needed to minimize HIV risk behavior among people living with HIV (PLWH) in South Africa on antiretroviral therapy (ART), a significant proportion of whom do not achieve viral suppression. Objective To determine whether a brief lay counselor delivered intervention implemented during routine care can reduce risky sex among PLWH on ART. Design Cluster randomized 16 HIV clinical care sites in KwaZulu Natal, South Africa, to intervention or standard-of-care. Setting Publicly funded HIV clinical care sites. Patients 1891 PLWH on ART received the HIV prevention counseling intervention (n = 967) or standard-of-care counseling (n = 924). Intervention Lay counselors delivered a brief intervention using motivational interviewing strategies based on the Information—Motivation—Behavioral Skills (IMB) model during routine clinical care. Main Outcome Measures Number of sexual events without a condom in the past four weeks with partners of any HIV status, and with partners perceived to be HIV-negative or HIV-status unknown, assessed at baseline, 6, 12, and 18 months. Results Intervention participants reported significantly greater reductions in HIV risk behavior on both primary outcomes, compared to standard-of-care participants. Differences in STI incidence between arms were not observed. Conclusion Effective behavioral interventions, delivered by lay counselors within the clinical care setting, are consistent with the strategy of linking HIV care and HIV prevention and integrating biomedical and behavioral approaches to stemming the HIV epidemic. PMID:25230288
Stephens, Torrance; Braithwaite, Ronald L.; Taylor, Sandra E.
Presents a HIV/AIDS preventive counseling protocol developed for use with African American young adults that makes use of hip-hop music. Contends that an increased understanding of the relationships that many African American young adults have with hip-hop music may be used by disease prevention personnel to educate these populations about…
Dr. Kevin Fenton, Director of CDCâs National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, talks about steps people can take to protect their health from HIV. Created: 2/1/2012 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). Date Released: 2/1/2012.
Despite huge prevention efforts the number of HIV infections worldwide continues to increase dramatically. Among other strategies, the HIV test offers an important chance for targeted prevention, provided quality counselling is offered. Several studies have revealed that HIV testing is often performed in less than optimal conditions and is often…
Full Text Available BACKGROUND: Integrated disease prevention in low resource settings can increase coverage, equity and efficiency in controlling high burden infectious diseases. A public-private partnership with the Ministry of Health, CDC, Vestergaard Frandsen and CHF International implemented a one-week integrated multi-disease prevention campaign. METHOD: Residents of Lurambi, Western Kenya were eligible for participation. The aim was to offer services to at least 80% of those aged 15-49. 31 temporary sites in strategically dispersed locations offered: HIV counseling and testing, 60 male condoms, an insecticide-treated bednet, a household water filter for women or an individual filter for men, and for those testing positive, a 3-month supply of cotrimoxazole and referral for follow-up care and treatment. FINDINGS: Over 7 days, 47,311 people attended the campaign with a 96% uptake of the multi-disease preventive package. Of these, 99.7% were tested for HIV (87% in the target 15-49 age group; 80% had previously never tested. 4% of those tested were positive, 61% were women (5% of women and 3% of men, 6% had median CD4 counts of 541 cell/µL (IQR; 356, 754. 386 certified counselors attended to an average 17 participants per day, consistent with recommended national figures for mass campaigns. Among women, HIV infection varied by age, and was more likely with an ended marriage (e.g. widowed vs. never married, OR.3.91; 95% CI. 2.87-5.34, and lack of occupation. In men, quantitatively stronger relationships were found (e.g. widowed vs. never married, OR.7.0; 95% CI. 3.5-13.9. Always using condoms with a non-steady partner was more common among HIV-infected women participants who knew their status compared to those who did not (OR.5.4 95% CI. 2.3-12.8. CONCLUSION: Through integrated campaigns it is feasible to efficiently cover large proportions of eligible adults in rural underserved communities with multiple disease preventive services simultaneously achieving
Stephens, T; Braithwaite, R L; Taylor, S E
Currently little attention has been directed, with the exception of peer education efforts, to constructively develop new and innovative ways to promote HIV/AIDS primary prevention among African American (AA) adolescents and young adults. With this in mind, the aim of this conceptual effort is to present a HIV/AIDS preventive counseling protocol developed for use with AA young adults that makes use of hip-hop music, a form of music popularized by young AAs. The author contend that an increased understanding of the relationships that many AA young adults have with hip-hop music may be used by disease prevention personnel to educate these populations about protective factors for HIV. Making use of hip-hop music is one strategy for integrating counseling in prevention and health maintenance. The overall implications of using hip-hop music in health promotion are unlimited. First, this method makes use of cultural relevant materials to address the educational and health needs of the target community. Second, it is grounded in an approach that serves to stimulate cooperative learning based on peer developed content. Moreover, the use of this medium can be applied to other health promotion activities such as violence/harm reduction and substance abuse prevention, upon reviews of songs for appropriate content. The authors contend that such an approach holds heuristic value in dealing with HIV/AIDS prevention among AA young adults. Additional testing of the intervention is warranted in the refinement of this innovative intervention.
Rasch, Vibeke; Yambesi, Fortunata; Massawe, Siriel
OBJECTIVE: To assess the acceptance and outcome of voluntary HIV counselling and testing (VCT) among women who had an unsafe abortion. METHOD: 706 women were provided with post-abortion contraceptive service and offered VCT. We collected data on socioeconomic characteristics and contraceptive use...... and determined the HIV status of those who accepted VCT. Using a nested case-control design, we compared women who accepted HIV testing with women who did not. To study the association between socioeconomic factors, HIV testing acceptance and condom use in more detail, we did stratified analyses based on age......-24 years and 25% among single women aged 25-45 years. CONCLUSION: HIV testing and condoms were accepted by most women who had an unsafe abortion. The poor reproductive health of these women could be improved by good post-abortion care that includes contraceptive counselling, VCT and condom promotion....
Full Text Available Abstract Background Voluntary counselling and testing (VCT for HIV first evolved in Western settings, with one aim being to promote behaviours which lower the risk of onward transmission or acquisition of HIV. However, although quantitative studies have shown that the impact of VCT on sexual behaviour change has been limited in African settings, there is a lack of qualitative research exploring perceptions of HIV prevention counselling messages, particularly among clients testing HIV-negative. We conducted a qualitative study to explore healthcare worker, community and both HIV-negative and HIV-positive clients’ perceptions of HIV prevention counselling messages in rural Tanzania. Methods This study was carried out within the context of an ongoing community HIV cohort study in Kisesa, northwest Tanzania. Nine group sessions incorporating participatory learning and action (PLA activities were conducted in order to gain general community perspectives of HIV testing and counselling (HTC services. Thirty in-depth interviews (IDIs with HIV-negative and HIV-positive service users explored individual perceptions of HIV prevention counselling messages, while five IDIs were carried out with nurses or counsellors offering HTC in order to explore provider perspectives. Results Two key themes revolving around socio-cultural and contextual factors emerged in understanding responses to HIV prevention counselling messages. The first included constraints to client-counsellor interactions, which were impeded as a result of difficulties discussing private sexual behaviours during counselling sessions, a hierarchical relationship between healthcare providers and clients, insufficient levels of training and support for counsellors, and client concerns about confidentiality. The second theme related to imbalanced gender-power dynamics, which constrained the extent to which women felt able to control their HIV-related risk. Conclusion Within the broader social
Full Text Available Abstract Background HIV testing rates have exceeded 90% among the pregnant women at Mbale Regional Referral Hospital in Mbale District, eastern Uganda, since the introduction of routine antenatal counselling and testing for HIV in June 2006. However, no documented information was available about opinions of pregnant women in eastern Uganda about this HIV testing approach. We therefore conducted a study to assess attitudes of antenatal attendees towards routine HIV counselling and testing at Mbale Hospital. We also assessed their knowledge about mother to child transmission of HIV and infant feeding options for HIV-infected mothers. Methods The study was a cross-sectional survey of 388 women, who were attending the antenatal clinic for the first time with their current pregnancy at Mbale Regional Referral Hospital from August to October 2009. Data were collected using a pre-tested questionnaire and analysed using descriptive statistics and logistic regression. Permission to conduct the study was obtained from the Makerere University College of Health Sciences, the Uganda National Council of Science and Technology, and Mbale Hospital. Results The majority of the antenatal attendees (98.5%, 382/388 had positive attitudes towards routine HIV counselling and testing, and many of them (more than 60% had correct knowledge of how mother to child transmission of HIV could occur during pregnancy, labour and through breastfeeding, and ways of preventing it. After adjusting for independent variables, having completed secondary school (odds ratio: 2.5, 95% confidence interval: 1.3-4.9, having three or more pregnancies (OR: 2.5, 95% CI: 1.4-4.5 and belonging to a non-Bagisu ethnic group (OR: 1.7, 95% CI: 1.0-2.7 were associated with more knowledge of exclusive breastfeeding as one of the measures for prevention of mother to child transmission of HIV. Out of 388 antenatal attendees, 386 (99.5% tested for HIV and 382 (98.5% received same-day HIV test results
Arnold, Emily A; Operario, Don; Cornwell, Stephanie; Benjamin, Michael; Smith, Carla Dillard; Lockett, Gloria; Kegeles, Susan M
African American men who have sex with both men and women (AAMSMW) are at high risk for acquiring and transmitting HIV, yet few interventions exist to address their unique prevention needs. We conducted 3 focus groups, 21 in-depth interviews, and a pilot test of our intervention with = 61 AAMSMW, which showed significant reductions in sexual risk behavior after 6 months. The intervention is currently being tested in a randomized controlled trial (RCT). We discuss the development of a culturally tailored, theoretically grounded counseling intervention for AAMSMW, presenting findings from our formative research, intervention development process, pilot study, and the implementation of our RCT. We describe the content of each session, our protocol for merging Bruthas with HIV testing, and best practices for recruiting AAMSMW. If Bruthas is found to be efficacious, the intervention will reach a vulnerable population to encourage uptake of regular HIV testing and reduced sexual risk taking.
McMahon, James M; Chimenti, Ruth; Trabold, Nicole; Fedor, Theresa; Mittal, Mona; Tortu, Stephanie
Heterosexual transmission of HIV often occurs in the context of intimate sexual partnerships. There is mounting evidence that couple-based HIV prevention interventions may be more effective than individual-based interventions for promoting risk reduction within such relationships. Yet, concerns have been raised about the safety of couple-based prevention approaches, especially with regard to the risk of intimate partner violence against women. Although several international studies have examined the potential for adverse consequences associated with couple-based interventions, with inconsistent results, there is little data from U.S. studies to shed light on this issue. The current study analyzed data from a randomized trial conducted in New York City with 330 heterosexual couples to examine whether participation in couple-based or relationship-focused HIV counseling and testing (HIV-CT) interventions resulted in an increased likelihood of post-intervention breakups, relationship conflicts, or emotional, physical, or sexual abuse, compared with standard individual HIV-CT. Multinomial logistic regression was used to model the odds of experiencing change in partner violence from baseline to follow-up by treatment condition. A high prevalence of partner-perpetrated violence was reported by both male and female partners across treatment conditions, but there was no conclusive evidence of an increase in relationship dissolution or partner violence subsequent to participation in either the couple-based HIV-CT intervention or relationship-focused HIV-CT intervention compared with controls. Qualitative data collected from the same participants support this interpretation. HIV prevention interventions involving persons in primary sexual partnerships should be sensitive to relationship dynamics and the potential for conflict, and take precautions to protect the safety of both male and female participants. © The Author(s) 2015.
Plazy, M; Orne-Gliemann, J; Balestre, E; Miric, M; Darak, S; Butsashvili, M; Tchendjou, P; Dabis, F; Desgrées du Loû, A
The Prenahtest study investigated the efficacy of a couple-oriented HIV counselling session (COC) in encouraging couple HIV counselling and testing, and improving intra-couple communication about sexual and reproductive health. We report here on the effect of COC on intra-couple communication about HIV. Within this 4-country trial (India, Georgia, Dominican Republic and Cameroon), 484 to 491 pregnant women per site were recruited and individually randomized to receive either the COC intervention, enhanced counselling with role playing, or standard post-test HIV counselling. Women were interviewed at recruitment, before HIV testing (T0), and 2 to 8 weeks after post-test HIV counselling (T1). Four dichotomous variables documented intra-couple communication about HIV at T1: 1) discussion about HIV, 2) discussion about condom use, 3) suggesting HIV testing and 4) suggesting couple HIV counselling to the partner. An intra-couple HIV communication index was created: low degree of communication ("yes" response to zero or one of the four variables), intermediate degree of communication ("yes" to two or three variables) or high degree of communication ("yes" to the four variables). To estimate the impact of COC on the intra-couple HIV communication index, multivariable logistic regressions were conducted. One thousand six hundred and seven women were included in the analysis of whom 54 (3.4%) were HIV-infected (49 in Cameroon). In the four countries, the counselling group was associated with intra-couple HIV communication (P≤0.03): women allocated to the COC group were significantly more likely to report high or intermediate degrees of intra-couple communication about HIV (versus low degree of communication) than women allocated to standard counselling. COC improved short-term communication about HIV within couples in different sociocultural contexts, a positive finding for a couple approach to HIV prevention. Copyright © 2013 Elsevier Masson SAS. All rights reserved.
Anna Maria Luzi
Full Text Available In the present work, we outline basic health counselling skills, specifically, those for performing pre-test and post-test counselling for HIV infection. The ultimate goal is to propose that counselling be performed in facilities that carry out screening for anti-HIV antibodies, following standardised (and thus replicable criteria, with consistent focus on the quality of the relationship between the healthcare professional and the individual undergoing testing and on the individual's specific needs.
Understanding Task Force Recommendations Behavioral Counseling to Prevent Skin Cancer The U.S. Preventive Services Task Force (Task Force) has issued a final recommendation statement on Behavioral Counseling ...
Norma C Ware
Full Text Available Introduction: The successes of HIV treatment scale-up and the availability of new prevention tools have raised hopes that the epidemic can finally be controlled and ended. Reduction in HIV incidence and control of the epidemic requires high testing rates at population levels, followed by linkage to treatment or prevention. As effective linkage strategies are identified, it becomes important to understand how these strategies work. We use qualitative data from The Linkages Study, a recent community intervention trial of community-based testing with linkage interventions in sub-Saharan Africa, to show how lay counsellor home HIV testing and counselling (home HTC with follow-up support leads to linkage to clinic-based HIV treatment and medical male circumcision services. Methods: We conducted 99 semi-structured individual interviews with study participants and three focus groups with 16 lay counsellors in Kabwohe, Sheema District, Uganda. The participant sample included both HIV+ men and women (N=47 and HIV-uncircumcised men (N=52. Interview and focus group audio-recordings were translated and transcribed. Each transcript was summarized. The summaries were analyzed inductively to identify emergent themes. Thematic concepts were grouped to develop general constructs and framing propositional statements. Results: Trial participants expressed interest in linking to clinic-based services at testing, but faced obstacles that eroded their initial enthusiasm. Follow-up support by lay counsellors intervened to restore interest and inspire action. Together, home HTC and follow-up support improved morale, created a desire to reciprocate, and provided reassurance that services were trustworthy. In different ways, these functions built links to the health service system. They worked to strengthen individuals’ general sense of capability, while making the idea of accessing services more manageable and familiar, thus reducing linkage barriers. Conclusions
Ware, Norma C; Wyatt, Monique A; Asiimwe, Stephen; Turyamureeba, Bosco; Tumwesigye, Elioda; van Rooyen, Heidi; Barnabas, Ruanne V; Celum, Connie L
The successes of HIV treatment scale-up and the availability of new prevention tools have raised hopes that the epidemic can finally be controlled and ended. Reduction in HIV incidence and control of the epidemic requires high testing rates at population levels, followed by linkage to treatment or prevention. As effective linkage strategies are identified, it becomes important to understand how these strategies work. We use qualitative data from The Linkages Study, a recent community intervention trial of community-based testing with linkage interventions in sub-Saharan Africa, to show how lay counsellor home HIV testing and counselling (home HTC) with follow-up support leads to linkage to clinic-based HIV treatment and medical male circumcision services. We conducted 99 semi-structured individual interviews with study participants and three focus groups with 16 lay counsellors in Kabwohe, Sheema District, Uganda. The participant sample included both HIV+ men and women (N=47) and HIV-uncircumcised men (N=52). Interview and focus group audio-recordings were translated and transcribed. Each transcript was summarized. The summaries were analyzed inductively to identify emergent themes. Thematic concepts were grouped to develop general constructs and framing propositional statements. Trial participants expressed interest in linking to clinic-based services at testing, but faced obstacles that eroded their initial enthusiasm. Follow-up support by lay counsellors intervened to restore interest and inspire action. Together, home HTC and follow-up support improved morale, created a desire to reciprocate, and provided reassurance that services were trustworthy. In different ways, these functions built links to the health service system. They worked to strengthen individuals' general sense of capability, while making the idea of accessing services more manageable and familiar, thus reducing linkage barriers. Home HTC with follow-up support leads to linkage by building
Full Text Available HIV voluntary counselling and testing (VCT is an integral component of HIV prevention and treatment programmes. However, testing coverage in sub-Saharan Africa is still low, particularly among young people. As treatment becomes more widely available, strategies to expand VCT coverage are critically important. We compare VCT uptake using two delivery strategies (opt-in and opt-out within the MEMA kwa Vijana trial in 20 communities in northwest Tanzania.We analysed data from 12,590 young persons (median (IQR age 22 years (20-23 to assess the effect of delivery strategy on VCT uptake. Ten communities used an opt-in approach and 10 used opt-out, balanced across intervention and control. Conditional logistic regression was used to examine factors associated with uptake within each strategy.VCT uptake was significantly higher with the opt-out approach (90.9% vs 60.5%, prevalence ratio = 1.51, CI = 1.41-1.62. Among females, uptake in the opt-out approach was associated with decreased knowledge of HIV acquisition, sex with a casual partner, and being HSV-2 seronegative; among males, uptake was associated with lower education and increasing lifetime partners. In contrast, uptake using the opt-in approach varied by ethnic group, religion and marital status, and increased with increasing knowledge of STI acquisition (males or pregnancy prevention (females.VCT uptake among young people was extremely high when offered an opt-out strategy. Sociodemographic and knowledge factors affected uptake in different ways depending on delivery strategy. Increased knowledge may increase young persons' self-efficacy, which may have a different impact on testing uptake, depending on the approach used.
Full Text Available Abstract Background Counselling human immunodeficiency virus (HIV positive mothers on safer infant and young child feeding (IYCF options is an important component of programmes to prevent mother to child transmission of HIV, but the quality of counselling is often inadequate. The aim of this study was to determine the effect the World Health Organization HIV and infant feeding cards on the quality of counselling provided to HIV positive mothers by health workers about safer infant feeding options. Method This was a un-blinded cluster-randomized controlled field trial in which 36 primary health facilities in Kafue and Lusaka districts in Zambia were randomized to intervention (IYCF counselling with counselling cards or non- intervention arm (IYCF counselling without counselling cards. Counselling sessions with 10 HIV positive women attending each facility were observed and exit interviews were conducted by research assistants. Results Totals of 180 women in the intervention group and 180 women in the control group were attended to by health care providers and interviewed upon exiting the health facility. The health care providers in the intervention facilities more often discussed the advantages of disclosing their HIV status to a household member (RR = 1.46, 95% CI [1.11, 1.92]; used visual aids in explaining the risk of HIV transmission through breast milk (RR = 4.65, 95% CI [2.28, 9.46]; and discussed the advantages and disadvantages of infant feeding options for HIV positive mothers (all p values Conclusion The addition of counselling cards to the IYCF counselling session for HIV positive mothers were a valuable aid to counselling and significantly improved the quality of the counselling session.
The overall acceptance of pre-test counseling in labour among women with unknown sero-status was 71.7% while acceptance of counseling and voluntary HIV testing was 56.6%. Among those who accepted pre-test counseling in labour, 78.9% accepted HIV testing and 8.6% of these were found to be HIV infected.
M.E.G. Wolfers (Mireille); J.B.F. de Wit (John); H.J. Hospers (Harm Jan); J.H. Richardus (Jan Hendrik); O. de Zwart (Onno)
textabstractBackground. There is currently a trend towards unsafe unprotected anal intercourse (UAI) among men who have sex with men. We evaluated a short individual counselling session on reducing UAI among gay and bisexual men. Methods. A quasi-experimental design was used to evaluate the
Hospers Harm J
Full Text Available Abstract Background There is currently a trend towards unsafe unprotected anal intercourse (UAI among men who have sex with men. We evaluated a short individual counselling session on reducing UAI among gay and bisexual men. Methods A quasi-experimental design was used to evaluate the counselling session. This session was conducted during consulting hours at four municipal health clinics during a Hepatitis B vaccination campaign. These clinics offered free vaccination to high-risk groups, such as gay and bisexual men. All gay and bisexual men attending health clinics in four cities in the Netherlands were asked to participate. Each participant in the intervention group received a fifteen-minute individual counselling based on the Theory of Planned Behaviour and Motivational Interviewing. Changes in UAI were measured over a 5-months period, using self-administered questionnaires. UAI was measured separately for receptive and insertive intercourse in steady and casual partners. These measures were combined in an index-score (range 0–8. Results While UAI in the counselling group remained stable, it increased in the controls by 66% from 0.41 to 0.68. The results show that the intervention had a protective effect on sexual behaviour with steady partners. Intervention effects were strongest within steady relationships, especially for men whose steady-relationship status changed during the study. The intervention was well accepted among the target group. Conclusion The fifteen-minute individually tailored counselling session was not only well accepted but also had a protective effect on risk behaviour after a follow-up of six months.
Background: Voluntary HIV counselling and testing (VCT) has been shown to be an acceptable and effective tool in the fight against HIV/AIDS. Couple HIV Counselling and Testing (CHCT) however, is a relatively new concept whose acceptance and efficacy is yet to be determined. Objective: To describe factors that ...
Introduction. HIV counseling and testing during labour can be emotional, but is important because it allows mothers and babies to receive PMTCT prophylaxis if previous identification of HIV infection has not occurred. The study explores how HIV testing and counseling during early labour affects women. Methodology.
that is conducting a multisite cluster randomised trial of an HIV prevention intervention for HIV-positive patients delivered in the context of ongoing clinical care in ... He also has certificates in Community Health Management, Epidemiology, Health Services ... inpatient, antenatal, sexually transmitted infection, tuberculosis.
Weerawadee Chandranipapongse; Gideon Koren
.... She contracted chickenpox and endured unnecessary anxiety. This led me to think that it would be useful to have a summary of all the preconception counseling advice we should give to our patients to ensure the best pregnancy outcomes possible...
Lyons, Thomas; Osunkoya, Emmanuel; Anguh, Ivonne; Adefuye, Adedeji; Balogun, Joseph
The prevalence rate of HIV infection in jails and prisons is approximately 5 times the rate in the U.S. general population. The authors surveyed state prison officials to assess HIV testing and HIV prevention policies--specifically voluntary testing, group HIV prevention counseling, and peer education--in the 50 states and to determine whether those policies are associated with the characteristics of the state and its prison population.
Background. Objective: To describe our experience with the feasibility and acceptance of home-based HIV counselling and testing (HBCT) in two large, rural, administrative divisions of western Kenya. Design: Setting: Results: Conclusion. : Home-based HIV counselling and testing was feasible among this rural population ...
A questionnaire was distributed to 64 of the 78 interns working at a teaching hospital in Cape Town in August 1992 to examine their attitudes and practice in respect of HIV test counselling. The questionnaire was completed by 61 interns. Thirteen per cent of those who responded counselled all patients, 49% counselled ...
Leta Tesfaye H; Sandøy Ingvild F; Fylkesnes Knut
Abstract Background Voluntary HIV counselling and testing (VCT) is one of the key strategies in the HIV/AIDS prevention and control programmes in Ethiopia. However, utilization of this service among adults is very low. The aim of the present study was to investigate factors associated with VCT utilization among adult men since men are less likely than women to be offered and accept routine HIV testing. Methods The study utilized data from the Ethiopian Demographic Health Survey (EDHS) 2005, w...
Mitiku, Israel; Addissie, Adamu; Molla, Mitike
Ethiopia has implemented routine HIV testing and counselling using a provider initiated HIV testing ('opt-out' approach) to achieve high coverage of testing and prevention of mother-to-child transmission of HIV. However, women's perceptions and experiences with this approach have not been well studied. We conducted a qualitative study to explore pregnant women's perceptions and experiences of routine HIV testing and counselling in Ghimbi town, Ethiopia, in May 2013. In-depth interviews were held with 28 women tested for HIV at antenatal clinics (ANC), as well as four health workers involved in routine HIV testing and counselling. Data were analyzed using the content analysis approach. We found that most women perceived routine HIV testing and counselling beneficial for women as well as unborn babies. Some women perceived HIV testing as compulsory and a prerequisite to receive delivery care services. On the other hand, health workers reported that they try to emphasise the importance HIV testing during pre-test counselling in order to gain women's acceptance. However, both health workers and ANC clients perceived that the pre-test counselling was limited. Routine HIV testing and counselling during pregnancy is well acceptable among pregnant women in the study setting. However, there is a sense of obligation as women felt the HIV testing is a pre-requisite for delivery services. This may be related to the limited pre-test counselling. There is a need to strengthen pre-test counselling to ensure that HIV testing is implemented in a way that ensures pregnant women's autonomy and maximize opportunities for primary prevention of HIV.
Muula Adamson S
Full Text Available Abstract Background HIV counseling and testing is an important intervention in the prevention, control and management of the human immunodeficiency virus (HIV. Counseling and testing can be an entry point for prevention, care and support. Knowledge of the quality of services and motivations for testing by individuals is important for effective understanding of the testing environment. Methods A cross sectional explorative study of clients accessing HIV voluntary counseling and testing (VCT and counselors was conducted in 6 government health centers in Blantyre City, Malawi. We aimed to assess the availability of critical clinic supplies and identify the motivations of clients seeking counseling and testing services. We also aimed to identify the health professional cadres that were providing VCT in Blantyre city. Results 102 VCT clients and 26 VCT counselors were interviewed. Among the VCT clients, 74% were Conclusion HIV counseling and testing facilities were available in Blantyre city in all the six public health facilities assessed. The majority of counseling and testing clients were motivated by perceptions of being at risk of HIV infection. In a country with 12% of individuals 15 to 49 years infected, there is need to encourage testing among population groups that may not perceive themselves to be at risk of infection.
Background: There is ample scientific evidence that a person with an untreated sexually transmitted infection (STI), particularly those inducing ulcers or discharge, is at an increased risk of passing on or acquiring HIV during sexual intercourse. HIV counseling and testing (HIV CT) for STI cases is thus an important tool in the ...
Dr Karen Kroeger a firstname.lastname@example.org, Allan W Taylor MD MPH a , Heather M Marlow b , Dr Douglas T Fleming c , Vanessa Beyleveld d , Mary Grace Alwano e e , Mabel Tebogo Kejelepula f , Kentsenao Busang Chilume g , Dr Dawn K Smith a , Dr Thierry Roels h & Dr Peter Kilmarx i
technical assistance in the development and implementation of PEPFAR supported HIV Testing and Counselling programmes in Botswana. Mabel Tebogo ... Hepatitis, STD, and TB Prevention at the US Centers for Disease Control and Prevention. Previously ... He is responsible for 9 countries in west and central. Africa and ...
Full Text Available Abstract Background Counselling and testing is important in HIV prevention and care. Majority of people in sub-Saharan Africa do not know their HIV status and are therefore unable to take steps to prevent infection or take up life prolonging anti-retroviral drugs in time if infected. This study aimed at exploring determinants of HIV testing and counselling in two Nairobi informal settlements. Methods Data are derived from a cross-sectional survey nested in an ongoing demographic surveillance system. A total of 3,162 individuals responded to the interview and out of these, 82% provided a blood sample which was tested using rapid test kits. The outcome of interest in this paper was HIV testing status in the past categorised as "never tested"; "client-initiated testing and counselling (CITC" and provider-initiated testing and counselling (PITC. Multinomial logistic regression was used to identify determinants of HIV testing. Results Approximately 31% of all respondents had ever been tested for HIV through CITC, 22% through PITC and 42% had never been tested but indicated willingness to test. Overall, 62% of females and 38% of males had ever been tested for HIV. Males were less likely to have had CITC (OR = 0.47; p value Conclusion Although the proportion of individuals ever tested in the informal settlements is similar to the national average, it remains low compared to that of Nairobi province especially among men. Key determinants of HIV testing and counselling include; gender, age, education level, HIV status and marital status. These factors need to be considered in efforts aimed at increasing participation in HIV testing.
Lelaka C Motshabi MPH , Professor Supa Pengpid MSc DrPH MBA a & Professor Karl Peltzer PhD DrHabil b email@example.com
Sep 3, 2011 ... UNAIDS (2002). HIV Voluntary Counselling and Testing. Geneva: UNAIDS. UNAIDS (2004). Voluntary Counselling and Testing and operational guidelines. 2004. Geneva: UNAIDS. Uys, L., Chirwa, M., Kohi, T., Greeff, M., Naidoo, J., Makoae, L., Dlamini, P.,. Durrheim, K., Cuca, Y., & Holzemer, W.L. (2009).
AJRH Managing Editor
Yawson et al. HIV Testing in Ghana. African Journal of Reproductive Health March 2014; 18(1): 145. ORIGINAL RESEARCH ARTICLE. Utilization of HIV Testing and Counseling in Ghana: Implications for Universal Coverage. Alfred E Yawson. 1, 2*. , Phyllis Dako-Gyeke. 3. , Stephen Ayisi Addo. 1. , Bernard T Dornoo. 1.
tested to update their status. Four women were found HIV-positive while 6 were HIVnegative. The primary theme was that women appreciated and accepted HIV testing and counseling. Testing was accepted as a necessary step to protect the ...
Introduction: While HIV testing and counseling (HTC) services remain to be amongst the effective strategies in slowing HIV transmission, its accessibility and uptake in Tanzania is low. In 2011, 50% of adults have been ever tested and received their results. We conducted this study to assess barriers to accessibility and ...
An intervention workshop was organised by a community-based project with aim to promote HIV Voluntary Counselling and Testing (VCT) and assess the perception of participants about the benefits of VCT and knowing their HIV status. The intervention workshop was conducted on a group of thirty teachers who consented ...
to HIV/AIDS. Objective: To assess factors affecting willingness towards HIV CT among patients with conventional STIs in Addis. Ababa. ... patient-centered risk reduction counseling for STI patients during the initial visit to health care facilities. [Ethiop. J. Health Dev .... tertiary level of education, and the rest 75 (17.9%) had no.
Objective: The objective of this qualitative study was to identify psychosocial correlates of HIV voluntary counselling and testing (VCT), with an emphasis on the association between fear of AIDS-related stigma and willingness to have an HIV test. Methods: The study was executed in Limpopo Province at University of ...
Routine HIV counseling and testing (RCT) is a necessary first step in accessing health care for persons who may test HIV-positive. Despite the availability of RCT in many South African settings, uptake has often been low. We sought to determine whether the main components of the Health Belief Model (HBM), namely ...
Background Routine HIV counselling and testing as part of antenatal care has been institutionalized in Uganda as an entry point for pregnant women into the prevention of mother-to-child transmission of HIV (PMTCT) programme. Understanding how women experience this mode of HIV testing is important to generate ideas on how to strengthen the PMTCT programme. We explored pregnant HIV positive and negative women’s experiences of routine counselling and testing in Mbale District, Eastern Uganda and formulated suggestions for improving service delivery. Methods This was a qualitative study conducted at Mbale Regional Referral Hospital in Eastern Uganda between January and May 2010. Data were collected using in-depth interviews with 30 pregnant women (15 HIV positive and 15 HIV negative) attending an antenatal clinic, six key informant interviews with health workers providing antenatal care and observations. Data were analyzed using a content thematic approach. Results Prior to attending their current ANC visit, most women knew that the hospital provided HIV counselling and testing services as part of antenatal care (ANC). HIV testing was perceived as compulsory for all women attending ANC at the hospital but beneficial, for mothers, especially those who test HIV positive and their unborn babies. Most HIV positive women were satisfied with the immediate counselling they received from health workers, but identified the need to provide follow up counselling and support after the test, as areas for improvement. However, most HIV negative women mentioned that they were given inadequate attention during post-test counselling. This left them with unanswered questions and, for some, doubts about the negative test results. Conclusions In this setting, routine HIV counselling and testing services are known and acceptable to mothers. There is need to strengthen post-test and follow up counselling for both HIV positive and negative women in order to maximize opportunities for
The advent of AIDS has had such a deep-reaching effect on the international haemophilia community that one can make a reasonable distinction between a pre-AIDS and a post-AIDS era in haemophilia management. In the context of counselling, however, talking about a 'before' and an 'after' in haemophilia does not (and, in our opinion, should not) necessarily imply a separation of the past from the present. Dealing with the psycho-social implications of haemophilia and HIV infection does not mean focusing exclusively on HIV-generated problems at the expense of haemophilia-related issues. Since the HIV crisis, counselling has posed the multiple challenge of: (a) assessing and alleviating the more immediate emotional effects of HIV infection; (b) paying due attention to the underlying influence of haemophilia on reaction, defence and coping; (c) formulating a flexible approach that is based on close cooperation with the medical staff and effective interpersonal communication with the counsellees.* In practice, the flexibility and effectiveness of the counselling model are promoted by means of: (a) ongoing counselling, (b) multiple counselling sites (i.e. the Haemophilia Centre and other appropriate locations), (c) interdisciplinary team-work, (d) respect for individual/ ethnic values, (e) maintenance of exo-empathy (i.e. neutrality), and (f) transfer of coping skills. The above framework can help maximize the effectiveness of counselling sessions through a personalized rapport of mutual trust and confidence between the counselling team and the counsellees.
Plazy, M.; Orne-Gliemann, J.; Balestre, E.; Miric, M.; Darak, S.; Butsashvili, M.; Tchendjou, P.; Dabis, F.; du Lou, A. Desgrees
Background. - The Prenahtest study investigated the efficacy of a couple-oriented HIV counselling session (COC) in encouraging couple HIV counselling and testing, and improving intra-couple communication about sexual and reproductive health. We report here on the effect of COC on intra-couple
Oppong Asante, Kwaku
HIV Counselling and Testing (VCT) and knowledge about HIV are some key strategies in the prevention and control of HIV/AIDS in Ghana. However, HIV knowledge and utilization of VCT services among university students is low. The main objective was to determine the level of HIV/AIDS knowledge and to explore factors associated with the use HIV counselling and testing among private university students in Accra, Ghana. A cross-sectional study was conducted using structured questionnaires among 324 conveniently selected students enrolled at a privately owned tertiary institution in Accra, Ghana. The respondents consisted of 56.2% males and 43.8% females aged 17 - 37 years. The mean HIV/AIDS knowledge score of was 7.70. There was a significant difference in knowledge of HIV/AIDS by gender where female students had more knowledge about HIV/AIDS than males [t (322) = 2.40, p = 0.017]. The ANOVA results showed that there was a significant difference in HIV/AIDS knowledge according to the age groups [F (3, 321) = 6.26, p = 0. 0001] and marital status [F (3, 321) = 4.86, p = 0. 008] of the sample. Over half of the participants had not tested for HIV, although over 95% of them knew where to access counseling and testing services. The study also revealed a significant association between demographic variables, testing for HIV and intention to test in the future. Participants who were never married (single), aged 17 - 20 years and had knowledge of two routes of HIV transmission were more likely to have taken an HIV test. Males were more likely to take an HIV test in the future than females. Majority of the students receive HIV/AIDS information from both print and electronic media, but few of them received such information from parents. The students HIV knowledge was very good, yet HIV testing were low. Health education and HIV intervention programmes must not only provide accurate information, but must be made to help to equip private university students
The thesis deals with the issue of mental hygiene as a burnout prevention of counselling staff working in counselling for family, marriage and human relations. It is focused on psychologists and social workers. The first part deals with the issues related to the counselling and requirements for counselling staff, as well as the specifics and risks associated with the profession, and the clientele that comes to counselling. Furthermore, the thesis deals with the issues of burnout syndrome and ...
Miranda, Karla Corrêa Lima; Barroso, Maria Grasiela Teixeira
The study aimed to investigate the strategies health professionals use in HIV/AIDS counseling. This study is a qualitative research, based on Paulo Freire's theory and practice. Bardin's content analysis was used as the analysis technique. For the studied group, the counseling is focused on cognition, although new concepts permeating this subject are emerging. The main difficulties in counseling are related to the clients and the institution. The main facility is related to the team, which according to the group has a good relationship. Counseling represents a moment of distress, especially because it brings up existential questions to the counselor. It can be inferred that counseling is a special moment, but it does not constitute an educational moment yet. To obtain this goal, a counseling methodology is proposed, based on Paulo Freire's principles and concepts.
Kivimets, K; Uuskula, A
We present data from an observational cohort study on human immunodeficiency virus (HIV) prevention and control measures in prisons in Estonia to assess the potential for HIV transmission in this setting. HIV testing and retesting data from the Estonian prison health department were used to estimate HIV prevalence and incidence in prison. Since 2002, voluntary HIV counselling and testing has routinely been offered to all prisoners and has been part of the new prisoners health check. At the end of 2012, there were 3,289 prisoners in Estonia, including 170 women: 28.5% were drug users and 15.6% were infected with HIV. Of the HIV-positive inmates, 8.3% were newly diagnosed on prison entry. In 2012, 4,387 HIV tests (including retests) were performed in Estonian prisons. Among 1,756 initially HIV-negative prisoners who were in prison for more than one year and therefore tested for HIV twice within 12 months (at entry and annual testing), one new HIV infection was detected, an incidence of 0.067 per 100 person-years (95% confidence interval (CI): 0.025–5.572). This analysis indicates low risk of HIV transmission in Estonian prisons. Implementation of HIV management interventions could impact positively on the health of prisoners and the communities to which they return.
Full Text Available Abstract Background HIV testing and counseling (HTC with linkage to care after known infection are key components for HIV transmission prevention. This study was conducted to assess HTC uptake, HIV risk perception and linkage to care among Thai university students. Methods An outreach HTC program was conducted in a large public university in Thailand from January 2013 to December 2014. The program consisted of brief HIV knowledge assessment, free HTC, HIV risk assessment and education provided by the healthcare personnel. Students were categorized into low, moderate and high-risk groups according to the pre-defined HIV risk characteristics. Results One-thousand-eight-hundred-one students participated in the program, 494 (27 % underwent HTC. Independent characteristics associated with no HTC uptake included female sex (P < 0.001, lower HIV knowledge score (P < 0.001, younger age (P < 0.001 and students from non-health science faculties (P = 0.02. Among the 494 students undergoing HTC, 141 (29 % were categorized into moderate or high-risk group, of whom 45/141 (32 % had false perception of low HIV risk. Being heterosexual was independently associated with false perception of low HIV risk (P = 0.04. The rate of new HIV infection diagnosis was 4/494 (0.8 %. Of these 4 HIV-infected students, 3 (75 % were men who have sex with men and only 2 of the 4 students (50 % showed up for HIV continuity care. Conclusions An outreach HIV prevention program with HTC was feasible and beneficial in detecting HIV risk and infection among the university students. However, interventions to improve HTC uptake, HIV risk perception and linkage to care are needed.
AIDS training course presented either by the medical school or an AIDS training centre. In view of the perceived lack of training in general counselling, this would perhaps be most effective as part of a formal general counselling programme for all undergraduates. In a tertiary hospital one has the added benefit of a large.
Simbaya, J.; Moyer, E.
HIV-related counselling practices have evolved since emerging in Zambia in 1987. Whereas, initially, the goal of HIV counselling was to provide psychological support to the dying and their families, as knowledge about HIV grew, counselling objectives expanded to include behavioural change,
Full Text Available Abstract Background The human resource shortage in Zambia is placing a heavy burden on the few health care workers available at health facilities. The Zambia Prevention, Care and Treatment Partnership began training and placing community volunteers as lay counsellors in order to complement the efforts of the health care workers in providing HIV counselling and testing services. These volunteers are trained using the standard national counselling and testing curriculum. This study was conducted to review the effectiveness of lay counsellors in addressing staff shortages and the provision of HIV counselling and testing services. Methods Quantitative and qualitative data were collected by means of semistructured interviews from all active lay counsellors in each of the facilities and a facility manager or counselling supervisor overseeing counseling and testing services and clients. At each of the 10 selected facilities, all counselling and testing record books for the month of May 2007 were examined and any recordkeeping errors were tallied by cadre. Qualitative data were collected through focus group discussions with health care workers at each facility. Results Lay counsellors provide counselling and testing services of quality and relieve the workload of overstretched health care workers. Facility managers recognize and appreciate the services provided by lay counsellors. Lay counsellors provide up to 70% of counselling and testing services at health facilities. The data review revealed lower error rates for lay counsellors, compared to health care workers, in completing the counselling and testing registers. Conclusion Community volunteers, with approved training and ongoing supervision, can play a major role at health facilities to provide counselling and testing services of quality, and relieve the burden on already overstretched health care workers.
Dolan, Kate; Larney, Sarah
HIV is a major health challenge for prison authorities. HIV in prisons has implications for HIV in the general community. The aim of this paper was to gather information on HIV risk, prevalence, prevention and treatment in prisons in India. Relevant published and unpublished reports and information were sought in order to provide a coherent picture of the current situation relating to HIV prevention, treatment and care in prisons in India. Information covered prison management and population statistics, general conditions in prisons, provision of general medical care and the HIV situation in prison. No data on drug injection in prison were identified. Sex between men was reported to be common in some Indian prisons. A national study found that 1.7 per cent of inmates were HIV positive. Some prisons provided HIV education. Condom provision was considered illegal. A few prisoners received drug treatment for drug use, HIV infection or co-infection with sexually transmitted infections (STIs). HIV prevalence in prisons in India was higher than that in the general community. Regular monitoring of information on HIV risk behaviours and prevalence in Indian prisons is strongly recommended. Evidence based treatment for drug injectors and nation-wide provision of HIV prevention strategies are urgently required. Voluntary counselling, testing and treatment for HIV and STIs should be provided.
Nolan, Robert P; Liu, Sam; Payne, Ada Y M
Lifestyle counseling that includes exercise training, diet modification, and medication adherence is critical to hypertension management. This article summarizes the efficacy of lifestyle counseling interventions in face-to-face, telehealth, and e-counseling settings. It also discusses the therapeutic potential of e-counseling as a preventive strategy for hypertension. The recent proliferation of telehealth and e-counseling programs increases the reach of preventive counseling for patients with cardiovascular disorders. Blood pressure reduction following these interventions is comparable to face-to-face interventions. However, the effectiveness of e-counseling varies depending on the design features of the core protocol. An evidence-based guideline needs to be established that identifies e-counseling components which are independently associated with blood pressure reduction. As the Internet becomes more sophisticated, e-counseling is demonstrating a therapeutic advantage in comparison with other telehealth interventions. Current evidence supports further development of preventive e-counseling programs for hypertension. A pressing challenge for investigators is to specify key evidence-based components of e-counseling that are essential to the core protocol. In order to achieve this goal, it will be necessary to ensure that e-counseling programs are also clinically organized, in order to guide patients through the process of initiating and sustaining therapeutic behavior change.
Coates, T J
Since early in the HIV epidemic, it has been known that HIV is transmitted in very specific ways. However, many personal and societal issues make it difficult to convince people that modifying behaviors can decrease their chances of infection. Physicians are in a unique position to slow the spread of the epidemic, but many are not comfortable discussing risky behaviors and sexual practices with their patients. HIV-positive individuals need tailored interventions that teach how to assume responsibility for preventing HIV transmission. The epidemiology of HIV transmission in the U.S. is discussed.
OBJECTIVE: To determine barriers and attitudes towards voluntary counseling and HIV-testing among secondary school students in Sengerema district. METHODOLOGY: A cross-sectional study was done in Sengerema district, Mwanza August 2006. A total of 400 secondary school students from the two schools ...
This study surveyed the counselling needs of HIV/AIDS-infected adolescents and young adults. Participants were 260 service providers (health care providers and Non-Governmental Organizations), age range 25-60, mean age 46.4, SD 9.9, 130 males, 130 females from five South Eastern States of Nigeria. They responded ...
The study assessed gender differences in practice of HIV voluntary counselling among secondary school adolescents in Edo State. One hypothesis guided the study. This was a descriptive study based on survey research design. One thousand, nine hundred and eighty eight (1988) secondary school adolescents were ...
This study assessed the demographic variables predicting the practice of HIV Voluntary Counselling among secondary school adolescents in Edo State. Thus, a descriptive survey research was adopted for the study. One thousand, nine hundred and eighty eight (1988) secondary school adolescents were sampled from ...
HIV testing and counselling (HTC) is a gateway to all systems of AIDS-related care. This study examined national programme data to highlight gaps in HTC service utilization, regional differences and differential use of various HTC programs in Ghana in the period, 2007-2010. Analysis showed HTC increased rapidly across ...
characterized young people aged 15-24 and their attitudes and knowledge towards HIV and voluntary. Counselling and testing. The purpose of this paper is to explore the prevalence and pattern of VCT uptake among youths in Nigeria, exploring the differences across the geopolitical zones, religions, etc. This will.
Samson, L; King, S
To provide Canadian health care workers with evidence-based guidelines for universal counselling about HIV testing and the offering of such testing to all pregnant women. Universal counselling and offering of HIV testing to all pregnant women versus targeted testing of only pregnant women at high risk for HIV infection. Antiretroviral treatment protocols for HIV-positive mothers and their infants are discussed as the intervention to reduce mother-to-child transmission rates. Main outcomes are mother-to-child HIV transmission rates and consequences of HIV testing on the mother and infant. Articles published from January 1985 to March 1997 identified through a MEDLINE search; articles published in pertinent medical journals in 1996 and 1997 identified through a manual search; and abstracts presented at international HIV/AIDS conferences. Early diagnosis of HIV infection in a pregnant woman optimizes her medical and psychosocial care, decreases the incidence of mother-to-child transmission and decreases the risk of horizontal transmission to sexual partners. New, third-generation HIV tests have reduced false-positive rates and thus diminished the harm of screening. A screening strategy consisting of universal counselling and offering of HIV testing is recommended for all pregnant women in Canada (grade B recommendation). Targeted testing of only pregnant women at high risk for HIV infection fails to identify a substantial proportion of HIV-positive pregnant women and is therefore not recommended (grade D recommendation). Women who identify themselves as being at high risk and whose initial HIV test result is negative should be counselled about the reduction of high-risk behaviours and retested in 6 months (grade B recommendation). Treatment of seropositive women and infants with zidovudine to prevent mother-to-child transmission is recommended (grade A or B recommendation depending on gestational age and CD4 count). These guidelines are endorsed by the Canadian
Conclusion: The study participants were at risk of HIV because of their sexual behavior and misconceptions related to the risk factors and means of prevention. Hence, basic police training should include BCC on HIV/AIDS, expansion of HIV counseling and testing services, strengthening of peer education and establishing ...
AIDS Counseling and Testing (HCT) is low in sub-Saharan Africa, where the disease continues to be a serious public health problem. This has in part been attributed to HIV/AIDS related stigma. Objective: To assess the level of HIV/AIDS related ...
Nelwan, Erni J; Indrati, Agnes K; Isa, Ahmad; Triani, Nurlita; Alam, Nisaa Nur; Herlan, Maria S; Husen, Wahid; Pohan, Herdiman T; Alisjahbana, Bachti; Meheus, Andre; Van Crevel, Reinout; van der Ven, Andre Jam
Validated data regarding HIV-transmission in prisons in developing countries is scarce. We examined sexual and injecting drug use behavior and HIV and HCV transmission in an Indonesian narcotic prison during the implementation of an HIV prevention and treatment program during 2004-2007 when the Banceuy Narcotic Prison in Indonesia conducted an HIV transmission prevention program to provide 1) HIV education, 2) voluntary HIV testing and counseling, 3) condom supply, 4) prevention of rape and sexual violence, 5) antiretroviral treatment for HIV-positive prisoners and 6) methadone maintenance treatment. During a first survey that was conducted between 2007 and 2009, new prisoners entered Banceuy Narcotics Prison were voluntary tested for HIV and HCV-infection after written informed consent was obtained. Information regarding sexual and injecting risk behavior and physical status were also recorded at admission to the prison. Participants who tested negative for both HIV and HCV during the first survey were included in a second survey conducted during 2008-2011. During both surveys, data on mortality among HIV-seropositive patients were also recorded. All HIV-seropositive participants receive treatment for HIV. HIV/ AIDS-related deaths decreased: 43% in 2006, 18% in 2007, 9% in 2008 and 0% in 2009. No HIV and HCV seroconversion inside Banceuy Narcotic Prison were found after a median of 23 months imprisonment (maximum follow-up: 38 months). Total of 484.8 person-years observation was done. Participants reported HIV transmission risk-behavior in Banceuy Prison during the second survey was low. After implementation of HIV prevention and treatment program, no new HIV or HCV cases were detected and HIV-related mortality decreased.
Full Text Available Background: Human immunodeficiency virus (HIV counseling and testing (HCT conducted at integrated counseling and testing centers (ICTCs is an entry point, cost-effective intervention in preventing transmission of HIV. Objectives: To study the prevalence of HIV among ICTC attendees, sociodemographic characteristics, and risk behaviors of HIV-seropositive clients. Materials and Methods: It was hospital record-based cross-sectional study of 26,518 registered ICTC clients at a tertiary care hospital in Ganjam district, Odisha, India over a 4-year period from January 2009 to September 2012. Results: A total of 1732 (7.5% out of 22,897 who were tested for HIV were seropositive. Among HIV-seropositives, 1138 (65.7% were males, while 594 (34.3% were females. Majority (88.3% of seropositives were between the age group of 15-49 years. Client-initiated HIV testing (12.1% was more seropositive compared to provider-initiated (2.9%. Among discordant couples, majority (95.5% were male partner/husband positive and female partner/wife negative. Positives were more amongst married, less educated, low socioeconomic status, and outmigrants (P<0.0001. Risk factors included heterosexual promiscuous (89.3%, parent-to-child transmission 5.8%, unknown 3.1%, infected blood transfusion 0.8%, homosexual 0.5%, and infected needles (0.5%. Conclusions: There is need to encourage activities that promote HCT in all health facilities. This will increase the diagnosis of new HIV cases. The data generated in ICTC provide an important clue to understand the epidemiology in a particular geographic region and local planning for care and treatment of those infected with HIV and preventive strategies for those at risk especially married, young adults, and outmigrants to reduce new infections.
Descriptive statistical analysis revealed a broad range of HIV&AIDS-related counselling services including life-skills education, care and support education and stigma reduction counselling. Teachers perceived a greater need for training in HIV&AIDS counselling skills and also in the use of information technology to support ...
Nguyen, T.A.; Oosterhoff, P.; Hardon, A.; Ngoc, Y.P.; Tran, H.N.; Coutinho, R.A.; Wright, P.
In Hanoi, Vietnam, HIV counseling and testing is available but apparently still many HIV-positive women were either not detected or were identified too late for optimal PMTCT intervention. The study looked at how easily pregnant women could find out about and use HIV counseling and testing and
Background: Many patients are referred to labour ward as emergencies, and therefore do not benefit from the antenatal HIV counselling and testing and treatment offered to registered patients. Objective: To assess the acceptability and suitability of offering HIV counselling and testing to women of unknown HIV status ...
Oct 14, 2008 ... all 28 days of treatment.5 Concerned by this low rate, ... support and counselling received by rape survivors after the rape. ... Only after they went home were they able to sit down and determine from the package inserts how the pills should be taken. Even if she explained, I wouldn't remember. You know ...
Leta Tesfaye H
Full Text Available Abstract Background Voluntary HIV counselling and testing (VCT is one of the key strategies in the HIV/AIDS prevention and control programmes in Ethiopia. However, utilization of this service among adults is very low. The aim of the present study was to investigate factors associated with VCT utilization among adult men since men are less likely than women to be offered and accept routine HIV testing. Methods The study utilized data from the Ethiopian Demographic Health Survey (EDHS 2005, which is a cross-sectional survey conducted on a nationally representative sample. Using cluster sampling, 6,778 men aged 15–59 years were selected from all the eleven administrative regions in Ethiopia. Logistic regression was used to analyze potential factors associated with VCT utilization. Results Overall, 21.9% of urban men and 2.6% of rural men had ever tested for HIV through VCT and most of them had learned their HIV test result. Having no stigmatizing attitudes toward people living with HIV/AIDS was found to be strongly and positively associated with VCT utilization in both urban and rural strata. In rural areas HIV test rates were higher among younger men (aged ≤44 years and those of higher socio-economic position (SEP. Among urban men, risky sexual behaviour was positively associated with VCT utilization whereas being Muslim was found to be inversely associated with utilization of VCT. Area of residence as well as SEP strongly affected men’s level of stigmatizing attitudes toward people living with HIV/AIDS. Conclusions VCT utilization among men in Ethiopia was low and affected by HIV/AIDS-related stigma and residence. In order to increase VCT acceptability, HIV/AIDS prevention and control programs in the country should focus on reducing HIV/AIDS-related stigma. Targeting rural men with low SEP should be given first priority when designing, expanding, and implementing VCT services in the country.
Wanyenze, Rhoda K; Kamya, Moses R; Fatch, Robin; Mayanja-Kizza, Harriet; Baveewo, Steven; Szekeres, Gregory; Bangsberg, David R; Coates, Thomas; Hahn, Judith A
HIV counselling and testing and linkage to care are crucial for successful HIV prevention and treatment. Abbreviated counselling could save time; however, its effect on HIV risk is uncertain and methods to improve linkage to care have not been studied. We did this factorial randomised controlled study at Mulago Hospital, Uganda. Participants were randomly assigned to abbreviated or traditional HIV counselling and testing; HIV-infected patients were randomly assigned to enhanced linkage to care or standard linkage to care. All study personnel except counsellors and the data officer were masked to study group assignment. Participants had structured interviews, given once every 3 months. We compared sexual risk behaviour by counselling strategy with a 6·5% non-inferiority margin. We used Cox proportional hazards analyses to compare HIV outcomes by linkage to care over 1 year and tested for interaction by sex. This trial is registered with ClinicalTrials.gov (NCT00648232). We enrolled 3415 participants; 1707 assigned to abbreviated counselling versus 1708 assigned to traditional. Unprotected sex with an HIV discordant or status unknown partner was similar in each group (232/823 [27·9%] vs 251/890 [28·2%], difference -0·3%, one-sided 95% CI 3·2). Loss to follow-up was lower for traditional counselling than for abbreviated counselling (adjusted hazard ratio [HR] 0·61, 95% CI 0·44-0·83). 1003 HIV-positive participants were assigned to enhanced linkage (n=504) or standard linkage to care (n=499). Linkage to care did not have a significant effect on mortality or receipt of co-trimoxazole. Time to treatment in men with CD4 cell counts of 250 cells per μL or fewer was lower for enhanced linkage versus standard linkage (adjusted HR 0·60, 95% CI 0·41-0·87) and time to HIV care was decreased among women (0·80, 0·66-0·96). Abbreviated HIV counselling and testing did not adversely affect risk behaviour. Linkage to care interventions might decrease time to enrolment
Fonchingong, Charles C; Mbuagbo, Timothy O; Abong, Jennifer T
The potential synergy between counselling and HIV/AIDS prevention is gaining recognition in Cameroon as counselling sessions are more often organised at health centres. In order to evaluate the actual achievements of these efforts, a qualitative ethnographic survey (based on interviews and focus group discussions) was conducted in two public and two private hospitals in the South-West Province. Churches and public health officials in Cameroon are struggling with the psycho-social, philosophical, psychological, theological, social, moral, ethical and cultural dimensions of HIV/AIDS, as they seek out viable prevention strategies. Health centres are also struggling to embrace the full meaning of counselling and to make psychological and spiritual support to AIDS patients available through the centres. Patients using these health centres may receive HIV testing against a backdrop of cultural standards that allow unsafe sex and bar open discussion on sex and sexuality. We propose that reversing the trend of the epidemic requires the intervention of the State, organisations in civil society and the family. Equally crucial is the role played by the churches - especially in confronting issues of stigmatisation and abandonment that often accompany patient disclosure, and in providing spiritual, emotional and psychological support to patients undergoing treatment.
Skip Navigation Bar Home Current Issue Past Issues HIV / AIDS HIV / AIDS: Symptoms , Diagnosis, Prevention and Treatment Past Issues / ... Most people who have become recently infected with HIV will not have any symptoms. They may, however, ...
Conclusion: The high prevalence of HIV sero-positivity in this study may be attributed to the hospital based survey since this centre is a national referral centre for HIV treatment. Most of the visitors to the HCT centre have risky behaviour except for the pregnant women who came for routine antenatal care in the hospital.
Bodika, Stephane M; Lekone, Phenyo E; Loeto, Peter; Alwano, Mary G; Zulu, Thekiso C; Kim, Evelyn; Machao, Gape; Voetsch, Andrew C
The World Health Organization recommends HIV testing and counseling (HTC) for all adolescents living in countries with generalized HIV epidemics. In Botswana, HIV prevalence among adolescents 15-19 years is 3.7% and among pregnant adolescents is 10%. We describe the proportion and characteristics of secondary school students who have accessed HTC. A multistage sample survey was conducted among students in Botswana's public secondary schools in 2010. The survey was self-administered using a personal digital assistant device. The HTC rate was estimated using self-reported history of HIV testing. Of 1,632 participants, 52% were girls, 43% aged below 16 years, and 27% had ever had sexual intercourse. Most (81%) students knew where to get tested for HIV. Overall, 2.2% of students were HIV positive by self-report. The HTC rate was 23% overall, 34% among students who had ever had sexual intercourse, and 45% among students who had sexual intercourse in the past 12 months. Being pregnant or having made someone pregnant and having had sexual intercourse in the past 12 months were associated with having been tested for HIV among students who had ever had sexual intercourse. Overall, the HTC rate was low, and the self- reported HIV prevalence was high among secondary students in Botswana. Most sexually active students have never been tested for HIV. Health communications efforts for adolescents that increase demand for HTC, routine opt-out HIV testing in healthcare facilities, and school-based HIV testing are needed as part of a national HIV prevention strategy.
Background HIV voluntary counselling and testing was a key HIV prevention strategy brought to scale by India's National AIDS Control Organization. Condom uptake is an essential metric of intervention impact given the expansion of the epidemic into an increasingly diverse population. With only 20% of first-time counselling and testing clients at the largest HIV treatment hospital in south India reporting previous condom use, the question of intervention impact on condom use deserves investigation. In this study, we track intervention impact across various demographic groups and identify the added value of more thorough counselling. Methods Data were collected from 8,865 individuals who attended counselling multiple times at the Tamil Nadu Government Hospital of Thoracic Medicine over the years 2004-2009. Counsellors recorded client demographic characteristics, HIV risk behaviours reported, and counselling services provided after each counselling session. Matching and regression methods were used to determine the probability of condom uptake by serostatus, gender, and receipt of personalized risk reduction counselling while controlling for other characteristics. Results HIV counselling and testing was associated with condom uptake among 29.2% of HIV positive women (CI 24.5-34.4%), 31.7% of HIV positive men (CI 27.8-35.4%), 15.5% of HIV negative women (CI 11.2-20.8%), and only 3.6% of HIV negative men (CI 1.9-5.9%) who had previously never used condoms. Personalized risk reduction counselling increased impact in some groups; for example an additional 18% of HIV negative women (CI 11.3-24.4%) and 17% of HIV positive men (CI 10.9-23.4%) started using condoms. The number of sexual partners was not associated with the impact of counselling completeness. Conclusions Because the components of testing and counselling impact the condom use habits of men and women differently, understanding the dynamics of condom use negotiation between partners is essential to optimizing
Nguyen Thi Thuy, Hanh; Gammeltoft, Tine; Rasch, Vibeke
ABSTRACT: BACKGROUND: HIV counselling and testing for pregnant women is a key factor for successful prevention of mother to child transmission of HIV. Women's access to testing can be improved by scaling up the distribution of this service at all levels of health facilities. However, this strategy...... will only be effective if pregnant women are tested early and provided enough counselling. OBJECTIVE: To assess early uptake of HIV testing and the provision of HIV counselling among pregnant women who attend antenatal care at primary and higher level health facilities. METHODS: A community based study...... was conducted among 1108 nursing mothers. Data was collected during interviews using a structured questionnaire focused on socio-economic background, reproductive history, experience with antenatal HIV counselling and testing as well as types of health facility providing the services. RESULTS: In all 91...
Visser, Maretha; Mabota, Princess
The HIV testing, treatment and care programme of the South African public healthcare system depends on HIV counselling and testing (HCT) that is primarily delivered by lay counsellors. Lay counsellors are expected to educate clients about HIV/AIDS, advocate behaviour change, convey test results and support those infected and affected to cope with the emotional and social challenges associated with HIV/AIDS. This research focuses on the emotional wellbeing of lay HCT counsellors because this influences the quality of services they provide. A mixed methods approach was used. The emotional wellbeing, level of burnout, depression and coping style of 50 lay HCT counsellors working at the City of Tshwane clinics were assessed. Additionally, five focus group discussions were conducted. The results showed that HCT counsellors reported average emotional wellbeing, high levels of emotional exhaustion and depression. They had a sense of personal accomplishment and positive coping skills. The results revealed that they may have difficulty dealing with clients' emotional distress without adequate training and supervision. This creates a dilemma for service delivery. In the light of the important role they play in service delivery, the role of the lay HCT counsellor needs to be reconsidered. HCT should develop as a profession with specific training and supervision to develop their emotional competencies to conduct effective counselling sessions.
Njau, B; Watt, M H; Ostermann, J; Manongi, R; Sikkema, K J
It is estimated that 5.6% of the Tanzanian population ages 15-49 are infected with HIV, but only 30% of adults have ever had an HIV test. Couples' testing has proven to increase testing coverage and introduce HIV prevention, but barriers include access to testing services and unequal gender dynamics in relationships. Innovative approaches are needed to address barriers to couple's testing and increase uptake of HIV testing. Using qualitative data collection methods, a formative study was conducted to assess the acceptability of a home-based couples counseling and testing (HBCCT) approach. Eligible study participants included married men and women, HIV-infected individuals, health care and home-based care providers, voluntary counseling and testing counselors, and community leaders. A total of 91 individuals participated in focus group discussions (FGDs) and in-depth interviews conducted between September 2009 and January 2010 in rural settings in Northern Tanzania. An HBCCT intervention appears to be broadly acceptable among participants. Benefits of HBCCT were identified in terms of access, confidentiality, and strengthening the relationship. Fears of negative consequences from knowing one's HIV status, including stigma, blame, physical abuse, or divorce, remain a concern and a potential barrier to the successful provision of the intervention. Lessons for implementation highlighted the importance of appointments for home visits, building relationships of confidence and trust between counselors and clients, and assessing and responding to a couple's readiness to undergo HIV testing. HBCCT should addresses HIV stigma, emphasize confidentiality, and improve communication skills for disclosure and decision-making among couples.
Khu, Naw H; Vwalika, Bellington; Karita, Etienne; Kilembe, William; Bayingana, Roger A; Sitrin, Deborah; Roeber-Rice, Heidi; Learner, Emily; Tichacek, Amanda C; Haddad, Lisa B; Wall, Kristin M; Chomba, Elwyn N; Allen, Susan A
HIV-discordant heterosexual couples are faced with the dual challenge of preventing sexual HIV transmission and unplanned pregnancies with the attendant risk of perinatal HIV transmission. Our aim was to examine uptake of two long-acting reversible contraceptive (LARC) methods--intrauterine devices (IUD) and hormonal implants--among HIV-discordant couples in Rwanda and Zambia. Women were interviewed alone or with their partner during routine cohort study follow-up visits to ascertain fertility goals; those not pregnant, not infertile, not already using LARC, and wishing to limit or delay fertility for ≥3 years were counseled on LARC methods and offered an IUD or implant on-site. Among 409 fertile HIV-discordant Rwandan women interviewed (126 alone, 283 with partners), 365 (89%) were counseled about LARC methods, and 130 (36%) adopted a method (100 implant, 30 IUD). Of 787 fertile Zambian women interviewed (457 alone, 330 with partners), 528 (67%) received LARC counseling, of whom 177 (34%) adopted a method (139 implant, 38 IUD). In both countries, a woman's younger age was predictive of LARC uptake. LARC users reported fewer episodes of unprotected sex than couples using only condoms. Integrated fertility goal-based family planning counseling and access to LARC methods with reinforcement of dual-method use prompted uptake of IUDs and implants and reduced unprotected sex among HIV-discordant couples in two African capital cities. Copyright © 2013 Elsevier Inc. All rights reserved.
Vardi, Yoram; Sadeghi-Nejad, Hossein; Pollack, Shimon; Aisuodionoe-Shadrach, Oseremen I; Sharlip, Ira D
Growing evidence has linked circumcision with some protection against HIV infection. Should nations with a high HIV infection rate encourage male circumcision? Four people with expertise and/or interest in the area of circumcision and HIV were asked to contribute their opinions. To provide food for thought, discussion, and possible further research in a poorly discussed area of sexual medicine. Three clinical trials in Africa showed the benefit of circumcision in reducing HIV incidence in men. Sadeghi-Nejad cites these, but balances this with the pandemic in India, and the cultural implications of circumcision. Pollack cites these studies as well, but reinforces the World Health Organization and UNAIDS recommendations that male circumcision should not replace safe sex. As a Nigerian, Aisuodionoe-Shadrach discusses the indirect ways in which circumcision can reduce the spread of HIV, and advocates the surgery, although he proposes infant circumcision may be wiser. Ira Sharlip, President of the International Society for Sexual Medicine, explains some of the physiology involved while again citing the three recent African studies. He questions who would be circumcised and who would perform the procedure if pro-circumcision policies were adopted. While three clinical trials in Africa were halted after it became evident that circumcision was beneficial in protecting against HIV, further information on the health risks and benefits of male circumcision is needed. Ethical decisions need to be made and medical recommendations developed before circumcision can be considered for HIV prevention.
Gokhale, Runa H; Bradley, Heather; Weiser, John
Advances in antiretroviral therapy (ART) and reproductive technologies have made transmission of HIV to partners and infants almost completely preventable. Comprehensive reproductive health counseling (CRHC) is an important component of care for women living with HIV, but few women report discussing reproductive health with an HIV care provider. We surveyed a probability sample of U.S. HIV care providers during 2013-2014. Of 2023 eligible providers, 1234 responded (64% adjusted provider response rate). We estimated the percentage delivering CRHC to their female patients. CRHC was defined as delivering each of five components of reproductive health care to most or all female patients. We assessed associations between provider characteristics and delivering CRHC using chi-squared tests and multivariable logistic regression. Of all providers, 49% (95% confidence interval [CI], 42-55) reported delivering all components of CRHC: 71% assessed reproductive intentions of reproductive-aged women, 78% explained perinatal transmission risk, 87% discussed ART for preventing perinatal transmission, 76% provided contraception as appropriate, and 64% provided referrals for preconception care. Among providers who offered primary care (83% of sample), 52% (CI: 44-60) delivered CRHC compared to 33% (CI: 22-44) of providers who did not offer primary care (P = .01). More female providers (46% of sample) compared to male providers delivered CRHC (57% [CI: 48-65] vs. 40% [CI: 31-50], P reproductive health with all reproductive-aged women who are living with HIV, even among providers offering primary care to their HIV patients.
Samson, L; King, S.
OBJECTIVE: To provide Canadian health care workers with evidence-based guidelines for universal counselling about HIV testing and the offering of such testing to all pregnant women. OPTIONS: Universal counselling and offering of HIV testing to all pregnant women versus targeted testing of only pregnant women at high risk for HIV infection. Antiretroviral treatment protocols for HIV-positive mothers and their infants are discussed as the intervention to reduce mother-to-child transmission rate...
Alvarez-del Arco, Debora; Monge, Susana; Azcoaga, Amaya; Rio, Isabel; Hernando, Victoria; Gonzalez, Cristina; Alejos, Belen; Caro, Ana Maria; Perez-Cachafeiro, Santiago; Ramirez-Rubio, Oriana; Bolumar, Francisco; Noori, Teymur; Del Amo, Julia
Background: The barriers to HIV testing and counselling that migrants encounter can jeopardize proactive HIV testing that relies on the fact that HIV testing must be linked to care. We analyse available evidence on HIV testing and counselling strategies targeting migrants and ethnic minorities in high-income countries. Methods: Systematic literature review of the five main databases of articles in English from Europe, North America and Australia between 2005 and 2009. Results: Of 1034 abstrac...
Kayigamba, Felix R.; van Santen, Daniëla; Bakker, Mirjam I.; Lammers, Judith; Mugisha, Veronicah; Bagiruwigize, Emmanuel; de Naeyer, Ludwig; Asiimwe, Anita; Schim van der Loeff, Maarten F.
Provider-initiated HIV testing and counselling (PITC) is promoted as a means to increase HIV case finding. We assessed the effectiveness of PITC to increase HIV testing rate and HIV case finding among outpatients in Rwandan health facilities (HF). PITC was introduced in six HFs in 2009-2010. HIV
... ET) Send us an email What is a Preventive HIV Vaccine? Last Reviewed: August 16, 2017 Key Points A preventive HIV vaccine is given to people who do ... infection in the future. There are currently no preventive HIV vaccines approved by the Food and Drug ...
The aim of this study was to determine predictors of HIV/AIDS knowledge and voluntary counselling and testing of undergraduate students in two campuses of the North-West University.The paper used cross-sectional data of 1,498 and 1,392 university students from Mafikeng and Potchefstroom Campuses. The major ...
Men aged 15-54 and women aged 15-49 were selected for the study because these are the ages most at risk to HIV/AIDS. Data on socio-demographic, sexual and ..... UNGASS Country. Progress Report Uganda, January 2008-. December 2009, March 2010. 12. Sebudde S, Nangendo F. Voluntary counselling and testing ...
Evans, Catrin; Nalubega, Sylivia; McLuskey, John; Darlington, Nicola; Croston, Michelle; Bath-Hextall, Fiona
Global progress towards HIV prevention and care is contingent upon increasing the number of those aware of their status through HIV testing. Provider-initiated HIV testing and counseling is recommended globally as a strategy to enhance uptake of HIV testing and is primarily conducted by nurses and midwives. Research shows that provider-initiated HIV testing and counseling implementation is sub-optimal. The reasons for this are unclear. The review aimed to explore nurses' and midwives' views and experiences of the provision and management of provider-initiated HIV testing and counseling. All cadres of nurses and midwives were considered, including those who undertake routine HIV testing as part of a diverse role and those who are specifically trained as HIV counselors. Types of phenomenon of interest: The review sought to understand the views and experiences of the provision and management of provider-initiated HIV testing and counseling (including perceptions, opinions, beliefs, practices and strategies related to HIV testing and its implementation in practice). The review included only provider-initiated HIV testing and counseling. It excluded all other models of HIV testing. The review included all countries and all healthcare settings. Types of studies: This review considered all forms of qualitative study design and methodology. Qualitative elements of a mixed method study were included if they were presented separately within the publication. A three-step search strategy was utilized. Eight databases were searched for papers published from 1996 to October 2014, followed by hand searching of reference lists. Only studies published in the English language were considered. Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Qualitative research findings were pooled
Full Text Available Sexual violence, an HIV determinant, is an integrated behavior in the D.R.Congo. We aimed to analyze the prevalence of forced sexual intercourse (FSI among people receiving HIV Voluntary Counseling and Testing in a hospital in Kinshasa, and its association with socio-demographics, behaviors and HIV status.Case-control study (2010-2012. Two-hundred and seventy-four cases with a new HIV+ test and 1,340 controls with an HIV- test were interviewed about HIV-related knowledge, attitudes and behaviors, including FSI.Thirty-four percent of the participants declared having had FSI (38% of women and 32% of men. Being a woman, aged 25-49 and reporting multiple sexual partners were associated with reporting FSI. For men, being single was protective against FSI; and cohabiting, having a high socioeconomic status, and alcohol consumption increased the odds. For women, being single, divorced/separated and widow was associated with reporting FSI. A significant positive association was found between FSI and an HIV positive test.Among our Congolese population, FSI was strongly associated with HIV infection and it was also associated with alcohol consumption and multiple sexual partnerships, other key HIV determinants. These behaviors need to be identified as potential risk factors of FSI during counseling interventions. Researchers, practitioners and decision-makers should work together to get violence prevention integrated into health, social and educational policies.
Bello, F A; Ogunbode, O O; Adesina, O A; Olayemi, O; Awonuga, O M; Adewole, I F
Many patients are referred to labour ward as emergencies, and therefore do not benefit from the antenatal HIV counselling and testing and treatment offered to registered patients. To assess the acceptability and suitability of offering HIV counselling and testing to women of unknown HIV status presenting in labour. A cross-sectional study comprising counselling and obtaining consent for HIV testing among 104 unregistered patients who presented in labour over a 3-month period. Rapid and enzyme-linked immunosorbent assay screening was performed for 90 consenting respondents. Reactive results were confirmed by Western blot. Appropriate therapy was instituted. Acceptance rate for HIV testing was 86.5%, prevalence of HIV was 6.7%. Women of lower educational status were more likely to accept testing in labour (OR: 0.3; 95% CI: 0.1-0.7; p=0.01); age, parity, occupation and knowledge of HIV had no influence. Most women (66.3%) had satisfactory knowledge of HIV. No one admitted to feeling coerced to test in fear of being denied care. Most refusals for screening were to avoid needle pricks (28.6%). Compared to ELISA screening test, specificity of the rapid test was 100%, sensitivity 85.7%, positive predictive value 100% and negative predictive value 98.8%. Attitude to testing was maintained on post-partum re-evaluation. The prevalence of HIV amongst unregistered parturients showed the importance of offering point-of-care HIV testing and intervention, especially in an environment where antenatal clinic attendance is poor. Rapid testing appeared to be acceptable and feasible in labour to prevent the mother-to-child transmission of HIV.
and testing (CICT); and (ii) PICT. In CICT, also referred to as voluntary counselling and testing (VCT), individuals actively seek. HIV testing and counselling at a facility that offers these services, as well as pre-test information. The process is voluntary and the. 'three Cs' (informed consent, counselling and confidentiality) are.
Polonsky, S; Kerr, S; Harris, B; Gaiter, J; Fichtner, R R; Kennedy, M G
High rates of human immunodeficiency virus (HIV) infection among jail and prison inmates suggest that HIV prevention efforts should focus on incarcerated populations. Overcrowding, the high prevalence of injection drug use, and other high-risk behaviors among inmates create a prime opportunity for public health officials to affect the course of the HIV epidemic if they can remedy these problems. Yet, along with the opportunity, there are certain obstacles that correctional institutions present to public health efforts. The various jurisdictions have differing approaches to HIV prevention and control. Whether testing should be mandatory or voluntary, whether housing should be integrated or segregated by HIV serostatus, and whether condoms, bleach, or clean needles should be made available to the prisoners, are questions hotly debated by public health and correctional officials. Even accurate assessment of risk-taking within the institutions leads to controversy, as asking questions could imply acceptance of the very behaviors correctional officials are trying to prevent. Education and risk-reduction counseling are the least controversial and most widely employed modes of prevention, but the effectiveness of current prevention efforts in reducing HIV transmission in this high-risk population is largely undetermined. PMID:7938381
Bardach, Shoshana H.; Schoenberg, Nancy E.
The prevalence of multiple health conditions or multiple morbidity (MM) is increasing. Providing medical care for adults with MM presents challenges, including balancing disease management with prevention. We conducted in-depth semi-structured interviews with 12 primary care physicians to explore their perspectives on prevention counseling among patients with MM. Participants described the complex relationship between disease management and prevention, highlighted the importance of patient motivation, and discussed various strategies to promote receptivity to prevention recommendations. The perceived potential benefits of prevention recommendations encouraged physicians to persist with such counseling, despite challenges presented by visit time constraints and reimbursement procedures and concerns over futility. Physicians recommended the development of alternate care delivery and reimbursement models to overcome challenges of the existing health care system and meet the prevention needs of patients with MM. We explore implications of these findings for maximizing the health and quality of life of adults with MM. PMID:22927702
Bardach, Shoshana H; Schoenberg, Nancy E
The prevalence of multiple health conditions, or multiple morbidity (MM), is increasing. Providing medical care for adults with MM presents challenges, including balancing disease management with prevention. We conducted in-depth semistructured interviews with 12 primary care physicians to explore their perspectives on prevention counseling among patients with MM. Participants described the complex relationship between disease management and prevention, highlighted the importance of patient motivation, and discussed various strategies to promote receptivity to prevention recommendations. The perceived potential benefits of prevention recommendations encouraged physicians to persist with such counseling, despite challenges presented by visit time constraints, reimbursement procedures, and concerns over futility. Physicians recommended the development of alternate care delivery and reimbursement models to overcome challenges of the existing health care system and to meet the prevention needs of patients with MM. We explore the implications of these findings for maximizing the health and quality of life of adults with MM.
Full Text Available Abstract Background Following universal access to antiretroviral therapy in Thailand, evidence from National AIDS Spending Assessment indicates a decreasing proportion of expenditure on prevention interventions. To prompt policymakers to revitalize HIV prevention, this study identifies a comprehensive list of HIV/AIDs preventive interventions that are likely to be effective and cost-effective in Thailand. Methods A systematic review of the national and international literature on HIV prevention strategies from 1997 to 2008 was undertaken. The outcomes used to consider the effectiveness of HIV prevention interventions were changes in HIV risk behaviour and HIV incidence. Economic evaluations that presented their results in terms of cost per HIV infection averted or cost per quality-adjusted life year (QALY gained were also included. All studies were assessed against quality criteria. Results The findings demonstrated that school based-sex education plus life-skill programs, voluntary and routine HIV counselling and testing, male condoms, street outreach programs, needle and syringe programs, programs for the prevention of mother-to-child HIV transmission, male circumcision, screening blood products and donated organs for HIV, and increased alcohol tax were all effective in reducing HIV infection among target populations in a cost-effective manner. Conclusion We found very limited local evidence regarding the effectiveness of HIV interventions amongst specific high risk populations. This underlines the urgent need to prioritise health research resources to assess the effectiveness and cost-effectiveness of HIV interventions aimed at reducing HIV infection among high risk groups in Thailand.
Background Many HIV voluntary testing and counselling centres in Africa use rapid antibody tests, in parallel or in sequence, to establish same-day HIV status. The interpretation of indeterminate or discrepant results between different rapid tests on one sample poses a challenge. We investigated the use of an algorithm using three serial rapid HIV tests in cohabiting couples to resolve unclear serostatuses. Methods Heterosexual couples visited the Rwanda Zambia HIV Research Group testing centres in Kigali, Rwanda, and Lusaka, Zambia, to assess HIV infection status. Individuals with unclear HIV rapid antibody test results (indeterminate) or discrepant results were asked to return for repeat testing to resolve HIV status. If either partner of a couple tested positive or indeterminate with the screening test, both partners were tested with a confirmatory test. Individuals with indeterminate or discrepant results were further tested with a tie-breaker and monthly retesting. HIV-RNA viral load was determined when HIV status was not resolved by follow-up rapid testing. Individuals were classified based on two of three initial tests as "Positive", "Negative" or "Other". Follow-up testing and/or HIV-RNA viral load testing determined them as "Infected", "Uninfected" or "Unresolved". Results Of 45,820 individuals tested as couples, 2.3% (4.1% of couples) had at least one discrepant or indeterminate rapid result. A total of 65% of those individuals had follow-up testing and of those individuals initially classified as "Negative" by three initial rapid tests, less than 1% were resolved as "Infected". In contrast, of those individuals with at least one discrepant or indeterminate result who were initially classified as "Positive", only 46% were resolved as "Infected", while the remainder was resolved as "Uninfected" (46%) or "Unresolved" (8%). A positive HIV serostatus of one of the partners was a strong predictor of infection in the other partner as 48% of individuals who
Van Der Borght, Stefaan; Schim Van Der Loeff, Maarten Franciscus; Clevenbergh, Philippe; Kabarega, Jean Pierre; Kamo, Emmanuel; Van Cranenburgh, Katinka; Rijckborst, Henk; Lange, Joep M; Rinke De Wit, Tobias Floris
International audience; High uptake of HIV voluntary counselling and testing (VCT) services is important for the success of HIV workplace programs in sub-Saharan Africa. From 2001 onwards Heineken, a multinational brewing company, implemented a comprehensive HIV prevention and treatment program for employees and their dependents of its African subsidiaries. Confidential in-house VCT is part of this program. VCT uptake dynamics over time, and factors associated with early uptake were studied. ...
Abstract High uptake of HIV voluntary counselling and testing (VCT) services is important for the success of HIV workplace programs in sub-Saharan Africa. From 2001 onwards Heineken, a multinational brewing company, implemented a comprehensive HIV prevention and treatment program for employees and their dependents of its African subsidiaries. Confidential in-house VCT is part of this program. VCT uptake dynamics over time, and factors associated with early uptake were studied. Be...
Joe, J. Richelle; Foster, Victoria A.
People living with HIV/AIDS will likely require services from mental health professionals to address the complex psychosocial effects of the illness. In the United States, counseling students are not likely to be well prepared to serve clients affected by HIV/AIDS, and little is known about their HIV-related knowledge and attitudes. The present…
Full Text Available Jennifer M Cocohoba,1 Keri N Althoff,2 Mardge Cohen,3 Haihong Hu,4 Chinazo O Cunningham,5 Anjali Sharma,6 Ruth M Greenblatt1,71University of California, San Francisco School of Pharmacy, San Francisco, CA; 2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; 3Department of Medicine, Stroger Hospital and Rush Medical College, Chicago, IL; 4Department of Medicine, Georgetown University, Washington, DC; 5Albert Einstein College of Medicine, Bronx, NY; 6SUNY Downstate Medical Center, Brooklyn, NY; 7University of California, San Francisco School of Medicine, San Francisco, CA, USABackground and methods: Achieving high adherence to antiretroviral therapy for human immunodeficiency virus (HIV is challenging due to various system-related, medication-related, and patient-related factors. Community pharmacists can help patients resolve many medication-related issues that lead to poor adherence. The purpose of this cross-sectional survey nested within the Women’s Interagency HIV Study was to describe characteristics of women who had received pharmacist medication counseling within the previous 6 months. The secondary objective was to determine whether HIV-positive women who received pharmacist counseling had better treatment outcomes, including self-reported adherence, CD4+ cell counts, and HIV-1 viral loads.Results: Of the 783 eligible participants in the Women’s Interagency HIV Study who completed the survey, only 30% of participants reported receiving pharmacist counseling within the last 6 months. Factors independently associated with counseling included increased age (odds ratio [OR] 1.28; 95% confidence interval [CI] 1.07–1.55, depression (OR 1.75; 95% CI 1.25–2.45, and use of multiple pharmacies (OR 1.65; 95% CI 1.15–2.37. Patients with higher educational attainment were less likely to report pharmacist counseling (OR 0.68; 95% CI 0.48–0.98, while HIV status did not play a statistically significant role. HIV
AJRH Managing Editor
the KYS data were disaggregated and shown as a separate category from the DC. Prevention of Mother-to-Child Transmission. (PMTCT) Services. Although Ghana adopted a policy of using combination antiretroviral therapy for all pregnant women carrying HIV since 2006,. PMTCT has been provided since initiation of ART.
Shayo Elizabeth H; Blystad Astrid; Njeru Mercy K; Nyamongo Isaac K; Fylkesnes Knut
Abstract Background Counselling is considered a prerequisite for the proper handling of testing and for ensuring effective HIV preventive efforts. HIV testing services have recently been scaled up substantially with a particular focus on provider-initiated models. Increasing HIV test rates have been attributed to the rapid scale-up of the provider-initiated testing model, but there is limited documentation of experiences with this new service model. The aim of this study was to determine the ...
Scheibe, A; Drame, F M; Shannon, K
Sex work occurs to meet the demand for sexual services and is a universal phenomenon. In Africa sex work takes many forms and is an important source of income for many women. Yet sex worker reproductive health needs remain largely unmet. The criminalisation of sex work; community and service provider stigma; violence; substance use and limited access to health services and prevention commodities contribute to the high HIV burden evident among female sex workers in Africa. Following UNAIDS' three pillar approach to HIV prevention and sex work we present an overview of current opportunities, barriers and suggestions to improve HIV prevention policy and programming for sex work in Africa. Universal access to a comprehensive package of HIV services is the first pillar. Reproductive health commodities; voluntary and anonymous HIV counselling and testing; treatment of sexually transmitted infections, HIV and opportunistic infections; harm reduction for substance use and psychosocial support services make up the recommended package of services. The second pillar is a sex worker-supportive environment. The inclusion of sex worker programmes within national HIV strategic planning; sex worker-led community mobilisation and the establishment of sex work community networks (comprised of sex workers, health service providers, law enforcers and other stakeholders) enable effective programme implementation and are recommended. The reduction of sex worker vulnerability and addressing structural issues form the final pillar. The decriminalisation of sex work; development of supportive policy; gender equality and economic development are key factors that need to be addressed to increase sex worker resilience. Evidence supports the public health benefit of human rights based approaches to HIV prevention; moralistic and restrictive policy and laws towards sex work are harmful and should be removed. The establishment of these pillars will increase sex worker safety and enhance the
Background. Early initiation of antiretroviral therapy reduces transmission of HIV and prolongs life. Expansion of HIV testing is therefore pivotal in overcoming the HIV pandemic. Provider-initiated counselling and testing (PICT) at first clinical contact is one way of increasing the number of individuals tested. Our impression is ...
Peart, Tasha; de Leon Siantz, MaryLou
Though many studies have examined the level of physician obesity prevention counseling among the general population, little is known about how homeless patients are advised about healthy eating and physical activity by their health care provider. The homeless are an at-risk population with whom physicians and other health professionals can play a…
Full Text Available Introduction: Pregnancy closely associated with anemia, where the condition of mothers with Hb under 11gr% in 1st and 3rd trimester or Haemoglobin (Hb levels below 10.5 g% in 2nd trimester. Knowledge, attitudes and practices of pregnant women on preventing anemia during pregnancy is one of the factors that influence incidence of anemia which affects the health of babies. Objective of this study was to explain the effect of counseling toward anemia prevention behaviour (knowledge, attitude, practice of pregnant women. Method: A pre-experimental (one group pretest-posttest simple random sampling design was used in this study. Population of this study was all pregnant women in Mrs. Wolita midwife practice Surabaya ( as many as 30 pregnant women a month. Sample of these 28 pregnant women were recruited over period of this study. Independent variable was counseling, while the dependent variable were knowledge, attitudes and practice. Data were collected by using questionnaires and analyzed with the Wilcoxon Signed Rank Test with significance level of α ≤0.05. Result: The result showed that counseling effected behaviour (knowledge, attitude and practice of pregnant women on anemia prevention with significance level p=0.000 (knowledge; p=0.007 (attitude and p=0.027 (practice. Analysis: It can be concluded that counseling or health education about prevention of pregnancy anemia is needed for pregnant women. Discussion: It is recomended that regular counseling must be provided by counselor to prevent anemia during pregnancy. Haemoglobin of pregnant women should also be checked regularly in the midwife practices, as a first step effort to decrease the incidence of anemia in pregnant women.
Becker, Stan; Taulo, Frank O; Hindin, Michelle J; Chipeta, Effie K; Loll, Dana; Tsui, Amy
HIV counseling and testing for couples is an important component of HIV prevention strategies, particularly in Sub Saharan Africa. The purpose of this pilot study is to estimate the uptake of couple HIV counseling and testing (CHCT) and couple family planning (CFP) services in a single home visit in peri-urban Malawi and to assess related factors. This study involved offering CHCT and CFP services to couples in their homes; 180 couples were sampled from households in a peri-urban area of Blantyre. Baseline data were collected from both partners and follow-up data were collected one week later. A pair of male and female counselors approached each partner separately about HIV testing and counseling and contraceptive services and then, if both consented, CHCT and CFP services (pills, condoms and referrals for other methods) were given. Bivariate and multivariate logistic regression analyses were done to examine the relationship between individual partner characteristics and acceptance of the services. Selected behaviors reported pre- and post-intervention, particularly couple reports on contraceptive use and condom use at last sex, were also tested for differences. 89% of couples accepted at least one of the services (58% CHCT-only, 29% CHCT + CFP, 2% CFP-only). Among women, prior testing experience (p contraceptive services to prevent the undesired consequences of sexually transmitted infection and unintended pregnancy via unprotected sex.
Noar, Seth M; Willoughby, Jessica Fitts
The rapidly changing media landscape and proliferation of new technologies creates vast new opportunities for HIV prevention. The fast growth of the relatively new eHealth field is a testament to the excitement and promise of these new technologies. eHealth interventions in HIV prevention tested to date include computer- and Internet-based interventions; chat room interventions; text messaging interventions; and social media. The current article provides a brief review of these types of interventions in HIV prevention, including their unique advantages and evidence of efficacy. Implications for future research in the eHealth HIV prevention field are discussed.
Mitchell, Jason W
Many men who have sex with men acquire HIV from their primary male partners while in a relationship. Studies with gay couples have demonstrated that relationship characteristics and testing behaviors are important to examine for HIV prevention. Recently, couples-based voluntary HIV counseling and testing (CVCT) has become available to male couples throughout the U.S. However, HIV-negative couples' attitudes toward using CVCT and how their relationship characteristics may affect their use of CVCT remain largely unknown. This information is particularly relevant for organizations that offer CVCT. To assess couples' attitudes, and associated factors toward using CVCT, a cross-sectional study design was used with a novel Internet-based recruitment method to collect dyadic data from a national sample of 275 HIV-negative gay couples. Multivariate multilevel modeling was used to identify factors associated with differences between and within couples about their attitudes towards using CVCT. Findings revealed that couples were "somewhat" to "very likely" to use CVCT. More positive attitudes toward using CVCT were associated with couples who had higher levels of relationship satisfaction and commitment toward their sexual agreement and among those who had at least one partner having had sex outside of the relationship. Less positive attitude toward using CVCT was associated with couples who had higher levels of trust toward their partners being dependable. Differences within couples, including age between partners, whether sex had occurred outside of the relationship, and value toward a sexual agreement also affected their attitudes toward using CVCT. Providing additional testing methods may help HIV-negative gay couples better manage their HIV risk.
Jane N Mutanga
Full Text Available BACKGROUND: Provider-initiated testing and counselling (PITC is a priority strategy for increasing access for HIV-exposed children to prevention measures, and infected children to treatment and care interventions. This article examines efforts to scale-up paediatric PITC at a second-level hospital located in Zambia's Southern Province, and serving a catchment area of 1.2 million people. METHODS AND PRINCIPAL FINDINGS: Our retrospective case study examined best practices and enabling factors for rapid institutionalization of PITC in Livingstone General Hospital. Methods included clinical observations, key informant interviews with programme management, and a desk review of hospital management information systems (HMIS uptake data following the introduction of PITC. After PITC roll-out, the hospital experienced considerably higher testing uptake. In a 36-month period following PITC institutionalization, of total inpatient children eligible for PITC (n = 5074, 98.5% of children were counselled, and 98.2% were tested. Of children tested (n = 4983, 15.5% were determined HIV-infected; 77.6% of these results were determined by DNA polymerase chain reaction (PCR testing in children under the age of 18 months. Of children identified as HIV-infected in the hospital's inpatient and outpatient departments (n = 1342, 99.3% were enrolled in HIV care, including initiation on co-trimoxazole prophylaxis. A number of good operational practices and enabling factors in the Livingstone General Hospital experience can inform rapid PITC institutionalization for inpatient and outpatient children. These include the placement of full-time nurse counsellors at key areas of paediatric intake, who interface with patients immediately and conduct testing and counselling. They are reinforced through task-shifting to peer counsellors in the wards. Nurse counsellor capacity to draw specimen for DNA PCR for children under 18 months has significantly enhanced early
Roman Isler, Malika; Eng, Eugenia; Maman, Susanne; Adimora, Adaora; Weiner, Bryan
The black church is influential in shaping health behaviors within African-American communities, yet few use evidence-based strategies for HIV prevention (abstinence, monogamy, condoms, voluntary counseling and testing, and prevention with positives). Using principles of grounded theory and interpretive description, we explored the social…
Approximately 96,000 people are living with HIV in the UK, a quarter of whom are unaware they are infected. While in some parts of the world the number of people newly infected with HIV has fallen, in the UK in 2011 there was a rise in the number of men who have sex with men being diagnosed. HIV prevention strategies are a public health priority, while ongoing research into HIV testing in all clinical settings remains a priority. This article explores preventive measures that can be used to reduce the spread of HIV and offers advice on how nurses can contribute to these.
Perez, Freddy; Orne-Gliemann, Joanna; Mukotekwa, Tarisai; Miller, Anna; Glenshaw, Monica; Mahomva, Agnes; Dabis, François
Zimbabwe has one of the highest rates of HIV seroprevalence in the world. In 2001 only 4% of women and children in need of services for prevention of mother to child transmission of HIV were receiving them. Pilot implementation of the first programme for prevention of mother to child transmission of HIV in rural Zimbabwe. 120 bed district hospital in Buhera district (285,000 inhabitants), Manicaland, Zimbabwe. Programme uptake indicators monitored for 18 months; impact of policy evaluated by assessing up-scaling of programme. Voluntary counselling and testing services for HIV were provided in the hospital antenatal clinic. Women identified as HIV positive and informed of their serostatus and their newborn were offered a single dose antiretroviral treatment of nevirapine; mother-child pairs were followed up through routine health services. Nursing staff and social workers were trained, and community mobilisation was conducted. No services for prevention of mother to child transmission of HIV were available at baseline. Within 18 months, 2298 pregnant women had received pretest counselling, and the acceptance of HIV testing reached 93.0%. Of all 2137 women who had an HIV test, 1588 (74.3%) returned to collect their result; 326 of the 437 HIV positive women diagnosed had post-test counselling, and 104 (24%) mother-child pairs received nevirapine prophylaxis. Minimum staffing, an enhanced training programme, and involvement of district health authorities are needed for the implementation and successful integration of services for prevention of mother to child transmission of HIV. Voluntary counselling and testing services are important entry points for HIV prevention and care and for referral to community networks and medical HIV care services. A district approach is critical to extend programmes for prevention of mother to child transmission of HIV in rural settings. The lessons learnt from this pilot programme have contributed to the design of the national expansion
Nyitray, Alan G; Bagyinszky, Ferenc; Ross, Michael W; Schmidt, Axel J
Using data from a large internet-based survey of European men having sex with men (MSM), we assessed factors associated with HIV testing and reasons for dissatisfaction with HIV testing and counselling among Hungarian MSM. A total of 2052 Hungarian MSM provided evaluable data for the European MSM Internet Survey (EMIS) in 2010. χ2 tests and Poisson regression with a robust variance estimator were used to assess factors associated with HIV testing and dissatisfaction with HIV testing and counselling. A total of 42.1% of MSM reported never being testing for HIV. Over one-half of men (54.1%) who reported condomless anal intercourse (CAI) in the prior 12 months with a person of unknown or sero-discordant HIV status reported no lifetime HIV testing. The factor most strongly associated with dissatisfaction with HIV testing and counselling was test site with increased dissatisfaction with inpatient hospital settings vs. community-based organizations. Both lack of HIV testing and dissatisfaction with testing were independently associated with MSM who reported that no one, or only a few people, knew they were attracted to men. Lack of HIV testing was strongly associated with CAI. MSM reported that community-based organizations better supported confidentiality and were more respectful during HIV testing.
Ajuwon, A J
HIV/AIDS is a major pubic health problem in Nigeria. This paper identifies the ethical issues involved in HIV/AIDS biomedical and behavioural research, counselling and testing in the country. These concerns are discussed in the context of the three universal ethical principles of respect for persons, beneficence, and justice. Written informed consent, which is a component of respect for persons, is a challenge in Nigeria because of skepticism to documentation, sensitivity of sexual practices often explored in behavioural research, and a tradition that discourages patients from questioning medical authority. Although monetary inducement of research participants is ethically acceptable, the high levels of poverty in Nigeria raise concerns that payment of money may unduly induce indigent participants to enroll in research. The disclosure of results in situations when married HIV positive persons insist that their status should not be revealed to their spouse illustrate the dilemma that health workers face in adhering to the ethical norm of keeping confidentiality and the public health obligation of preventing HIV transmission in a third party. Some recommendations are offered to address these concerns.
Review of antenatal-linked voluntary counseling and HIV testing in Sub-Saharan Africa: lessons and options for Ghana. F Baiden, Rita Baiden, J Williams, Patricia Akweongo, Christine Clerk, C Debpuur, J Philips, A Hodgson ...
Denisiuk, O; Smyrnov, P; Kumar, A M V; Achanta, S; Boyko, K; Khogali, M; Naik, B; Zachariah, R
One hundred and forty non-governmental organisations implementing human immunodeficiency virus (HIV) prevention programmes among clients, including people who inject drugs, prisoners, female sex workers, men who have sex with men and street children in Ukraine, 2010-2011. Among enrolled clients, to assess factors associated with HIV testing, HIV retesting within a year of initial testing and HIV seroconversion. Retrospective cohort study involving record reviews. Of 192 487 clients, 42 109 (22%) underwent an initial HIV test (22% were positive). Among HIV-negative clients at baseline, 10 858 (27%) were retested within a year: 317 (3%) of these were HIV-positive. HIV testing and retesting rates were lower among prisoners (0.3%) and others (street children and partners of those in risk groups, 6%), and those who did not receive counselling or services such as condom and needle distribution. Individuals who were not counselled were more likely to seroconvert. In this large cohort of high-risk groups from Eastern Europe, HIV testing was low and HIV sero-conversion was high. This is of public health concern, bringing into question the overall quality of counselling and how well it is tailored to the specific needs of various risk groups. Qualitative studies to understand the reasons for non-testing are urgently required for designing client-specific interventions.
AJRH Managing Editor
Standards and Guidelines for HIV Prevention Research: Considerations for Local Context in the Interpretation of Global .... African women19,20. But then there is the question of which guidelines should be used to structure ..... sponsors prior to initiating HIV prevention studies. The lessons from this case study show that in.
Amaro, Hortensia; Barker, Marybeth; Cassisy, Theresa; Hardy-Fanta, Carol; Hereen, Tim; Levenson, Suzette; McCloskey, Lois; Melendez, Michael
This report addresses the four research objectives that were established by the Massachusetts Primary Prevention Group (MPPG) and the Massachusetts Department of Public Health's HIV/AIDS Bureau. The objectives were to: (1) review and summarize literature that formally evaluated HIV prevention interventions; (2) describe how currently funded…
Shumba, Constance S; Atuhaire, Lydia; Memiah, Peter; Atukunda, Ruth
Home-based HIV counselling and testing (HBHCT) and community mobilization have been proven to be effective in increasing the number of people linked to HIV care and treatment. An assessment was conducted in 18 health facilities in Uganda to evaluate the availability and extent of home based testing services and community mobilization activities in underserved communities. The performance of the health facilities was assessed using a checklist with indicators of HBHCT and community mobilization. While most of the health facilities (72.2%) had active community mobilization, only 12.2% had HBHCT services and this might have affected universal access to HIV prevention, care and treatment. The health facilities did not accompany their intensive community mobilization activities with HBHCT yet this provided the ideal entry point and opportunity to improve linkage to HIV treatment and care.
Full Text Available Abstract Background Infant feeding is a subject of worry in prevention of mother to child transmission (pMTCT programmes in settings where breastfeeding is normative. Nurse-counsellors, expected to counsel HIV-positive women on safer infant feeding methods as defined in national/international guidelines, are faced with a number of challenges. This study aims to explore the experiences and situated concerns of nurses working as infant feeding counsellors to HIV-positive mothers enrolled in pMTCT programmes in the Kilimanjaro region, northern Tanzania. Methods A qualitative study was conducted using in-depth interviews and focus group discussions (FGDs with 25 nurse-counsellors at four pMTCT sites. Interviews were handwritten and FGDs were tape-recorded and transcribed, and the programme Open Code assisted in sorting and structuring the data. Analysis was performed using 'content analysis.' Results The findings revealed a high level of stress and frustration among the nurse-counsellors. They found themselves unable to give qualified and relevant advice to HIV-positive women on how best to feed their infants. They were confused regarding the appropriateness of the feeding options they were expected to advise HIV-positive women to employ, and perceived both exclusive breastfeeding and exclusive replacement feeding as culturally and socially unsuitable. However, most counsellors believed that formula feeding was the right way for an HIV-positive woman to feed her infant. They expressed a lack of confidence in their own knowledge of HIV and infant feeding, as well as in their own skills in assessing a woman's possibilities of adhering to a particular method of feeding. Moreover, the nurses were in general not comfortable in their newly gained role as counsellors and felt that it undermined the authority and trust traditionally vested in nursing as a knowledgeable and caring profession. Conclusion The findings illuminate the immense burden placed on
DeGuzman, Michael A.; Ross, Michael W.
Reviews Internet technological capabilities for counseling and assesses the application of HIV/AIDS related counseling on the Internet. Interviews with health professionals reveal four major themes: counselor client relationship, target population, ethics, and operation. Major concerns include the lack of visual and verbal cues during interaction,…
Tuthill, Emily L; Chan, Jessica; Butler, Lisa M
Exclusive breastfeeding (EBF) has been identified as the optimal nutrition and critical behavior in attaining human immunodeficiency virus (HIV)-free infant survival in resource-limited settings. Health-care providers (HCPs) in clinic- and community-settings throughout sub-Saharan Africa (sSA) provide infant-feeding counseling. However, rates of EBF at 6 months of age are suboptimal. HCPs are uniquely positioned to educate HIV-positive mothers and provide support by addressing known barriers to EBF. However, limited evidence exists on the experiences faced by HCPs in providing counseling on infant feeding to HIV-positive women. Our objective is to describe experiences faced by HCPs when delivering infant-feeding counseling in the context of HIV in program settings in sSA. We searched a range of electronic databases, including PubMed, CINAHL, and PsycINFO from January 1990 to February 2013, in addition to hand-searching, cross-reference searching, and personal communications. The search was limited to publications in English. Empirical studies of HCP experiences providing infant-feeding counseling in the prevention of mother-to-child transmission (PMTCT) of HIV programs in sSA were selected. We identified 10 peer-reviewed articles reporting HCP challenges in infant-feeding counseling that met inclusion criteria. Articles included qualitative, cross-sectional and mixed-method studies, and cumulatively reported 31 challenges faced by HCPs. Among the challenges identified, the most commonly reported were personal beliefs held by the HCPs toward infant feeding in the context of HIV, contradictory messages, staff workload, directive counseling styles, and a lack of practical strategies to offer mothers, often leading to improvised counseling approaches. Counseling strategies need to be developed that are relevant, meaningful, and responsive to the needs of both HCPs and mothers.
Cohen, Myron S; Smith, M Kumi; Muessig, Kathryn E; Hallett, Timothy B; Powers, Kimberly A; Kashuba, Angela D
Antiretroviral drugs that inhibit viral replication were expected to reduce transmission of HIV by lowering the concentration of HIV in the genital tract. In 11 of 13 observational studies, antiretroviral therapy (ART) provided to an HIV-infected index case led to greatly reduced transmission of HIV to a sexual partner. In the HPTN 052 randomised controlled trial, ART used in combination with condoms and counselling reduced HIV transmission by 96·4%. Evidence is growing that wider, earlier initiation of ART could reduce population-level incidence of HIV. However, the full benefits of this strategy will probably need universal access to very early ART and excellent adherence to treatment. Challenges to this approach are substantial. First, not all HIV-infected individuals can be located, especially people with acute and early infection who are most contagious. Second, the ability of ART to prevent HIV transmission in men who have sex with men (MSM) and people who use intravenous drugs has not been shown. Indeed, the stable or increased incidence of HIV in MSM in some communities where widespread use of ART has been established emphasises the concern that not enough is known about treatment as prevention for this crucial population. Third, although US guidelines call for immediate use of ART, such guidelines have not been embraced worldwide. Some experts do not believe that immediate or early ART is justified by present evidence, or that health-care infrastructure for this approach is sufficient. These concerns are very difficult to resolve. Ongoing community-based prospective trials of early ART are likely to help to establish the population-level benefit of ART, and-if successful-to galvanise treatment as prevention. Copyright © 2013 Elsevier Ltd. All rights reserved.
Trevor A Hart
Full Text Available Even in the presence of promising biomedical treatment as prevention, HIV incidence among men who have sex with men has not always decreased. Counseling interventions, therefore, continue to play an important role in reducing HIV sexual transmission behaviors among gay and bisexual men and other men who have sex with men. The present study evaluated effects of a small-group counseling intervention on psychosocial outcomes and HIV sexual risk behavior.HIV-positive (HIV+ peer counselors administered seven 2-hour counseling sessions to groups of 5 to 8 HIV+ gay and bisexual men. The intervention employed information provision, motivational interviewing, and behavioral skills building to reduce sexual transmission risk behaviors.There was a significant reduction in condomless anal sex (CAS with HIV-negative and unknown HIV-status partners, from 50.0% at baseline to 28.9% of the sample at 3-month follow-up. Findings were robust even when controlling for whether the participant had an undetectable viral load at baseline. Significant reductions were also found in the two secondary psychosocial outcomes, loneliness and sexual compulsivity.The findings provide preliminary evidence that this intervention may offer an efficient way of concurrently reducing CAS and mental health problems, such as sexual compulsivity and loneliness, for HIV+ gay and bisexual men.ClinicalTrials.gov NCT02546271.
Urmi, Arunthia Zaidi; Leung, Daniel T; Wilkinson, Vanessa; Miah, Mohammad Abdul Awal; Rahman, Mahfuza; Azim, Tasnim
Analysis of data from HIV testing and counseling (HTC) services provides an opportunity to identify important populations for targeting of HIV prevention efforts. Our primary aim was to describe the demographics of clients presenting to HTC in Bangladesh, a low HIV prevalence country. Our secondary aim was to determine the risk factors for HIV positivity among returning migrant workers who were tested. We performed a cross-sectional study of data collected between 2002 and 2010 from the first HTC service established in Bangladesh, located in three large cities. 8973 individuals attended HTC services, with 558 (6.2%) of clients testing positive for HIV, including 33 children. The majority of those who tested positive were aged 25-44 (71%), male (70%), and married (68%). Key populations considered at increased risk of HIV, such as female sex workers, people who inject drugs, and males who have sex with males accounted for only 11% of adults who tested positive. Notably, 75% of adults testing positive had a history of migrant work or was the spouse of a migrant worker. In multivariable logistic regression of those with a migrant work history presenting for HTC, we found rural residence, working in the Middle East, and longer duration of migrant work to be independently associated with testing positive, and female gender and higher level of education to be negatively associated. These data suggest that in Bangladesh, in addition to targeting traditional key populations, HIV prevention efforts should also focus on migrant workers and their spouses.
Onoya, D; Mohlabane, N; Maduna, V; van Zyl, J; Sewpaul, R; Naidoo, Y
To examine the association between testing in the 2010 HIV Testing and Counselling (HCT) campaign with HIV risk behaviours and enrolment on ART. Data for this study were collected as part of a nationally representative cross-sectional household survey conducted in 2012 in South Africa. Consenting participants completed a structured questionnaire and provided a dry blood spot specimen which was tested for HIV antibodies and antiretroviral drugs. Multinomial logistic regression was used to examine the association between HIV testing history and explanatory variables of interest. There was no association between testing in the 2010 HCT campaign and condom use at last sex, number of sexual partnerships or HIV knowledge. Individuals who tested in the HCT campaign were more likely to disclose their status (COR 2.6, 95% CI: 1.71-3.8) and those who tested HIV positive in the campaign were more likely to be receiving ART (COR 1.8, 95% CI: 1.1-2.9). Testing in the HCT campaign was associated with having received both pretest and post-test counselling while testing before the campaign was associated with having received HIV results with no counselling (COR 2.1, 95% CI: 1.2-3.8). We highlight the success of the 2010 HCT campaign in improving HIV status disclosure and enrolment on ART as well as shortcomings on HIV risk behaviours and HIV knowledge. These may be related to issues of quality assurance in the counselling process. Our results further highlight possible HCT counselling inconsistencies across sectors requiring stronger public-private partnership in the delivery of HCT in South Africa. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Grabowski, Mary K; Serwadda, David M; Gray, Ronald H; Nakigozi, Gertrude; Kigozi, Godfrey; Kagaayi, Joseph; Ssekubugu, Robert; Nalugoda, Fred; Lessler, Justin; Lutalo, Thomas; Galiwango, Ronald; Makumbi, Fred; Kong, Xiangrong; Kabatesi, Donna; Alamo, Stella T
BACKGROUND To assess the impact of combination HIV prevention (CHP) on HIV incidence, we analyzed the association between HIV incidence and scale-up of antiretroviral therapy (ART) and medical male circumcision in Rakai, Uganda. Changes in population-level viral load suppression and sexual behaviors were also examined. METHODS Between 1999 and 2016, data were collected through 12 surveys from 30 communities in the Rakai Community Cohort Study, an open population-based cohort of persons aged 1...
Monge, Susana; Azcoaga, Amaya; Rio, Isabel; Hernando, Victoria; Gonzalez, Cristina; Alejos, Belen; Caro, Ana Maria; Perez-Cachafeiro, Santiago; Ramirez-Rubio, Oriana; Bolumar, Francisco; Noori, Teymur; Del Amo, Julia
Background: The barriers to HIV testing and counselling that migrants encounter can jeopardize proactive HIV testing that relies on the fact that HIV testing must be linked to care. We analyse available evidence on HIV testing and counselling strategies targeting migrants and ethnic minorities in high-income countries. Methods: Systematic literature review of the five main databases of articles in English from Europe, North America and Australia between 2005 and 2009. Results: Of 1034 abstracts, 37 articles were selected. Migrants, mainly from HIV-endemic countries, are at risk of HIV infection and its consequences. The HIV prevalence among migrants is higher than the general population’s, and migrants have higher frequency of delayed HIV diagnosis. For migrants from countries with low HIV prevalence and for ethnic minorities, socio-economic vulnerability puts them at risk of acquiring HIV. Migrants have specific legal and administrative impediments to accessing HIV testing—in some countries, undocumented migrants are not entitled to health care—as well as cultural and linguistic barriers, racism and xenophobia. Migrants and ethnic minorities fear stigma from their communities, yet community acceptance is key for well-being. Conclusions: Migrants and ethnic minorities should be offered HIV testing, but the barriers highlighted in this review may deter programs from achieving the final goal, which is linking migrants and ethnic minorities to HIV clinical care under the public health perspective. PMID:23002238
Alvarez-del Arco, Debora; Monge, Susana; Azcoaga, Amaya; Rio, Isabel; Hernando, Victoria; Gonzalez, Cristina; Alejos, Belen; Caro, Ana Maria; Perez-Cachafeiro, Santiago; Ramirez-Rubio, Oriana; Bolumar, Francisco; Noori, Teymur; Del Amo, Julia
The barriers to HIV testing and counselling that migrants encounter can jeopardize proactive HIV testing that relies on the fact that HIV testing must be linked to care. We analyse available evidence on HIV testing and counselling strategies targeting migrants and ethnic minorities in high-income countries. Systematic literature review of the five main databases of articles in English from Europe, North America and Australia between 2005 and 2009. Of 1034 abstracts, 37 articles were selected. Migrants, mainly from HIV-endemic countries, are at risk of HIV infection and its consequences. The HIV prevalence among migrants is higher than the general population's, and migrants have higher frequency of delayed HIV diagnosis. For migrants from countries with low HIV prevalence and for ethnic minorities, socio-economic vulnerability puts them at risk of acquiring HIV. Migrants have specific legal and administrative impediments to accessing HIV testing-in some countries, undocumented migrants are not entitled to health care-as well as cultural and linguistic barriers, racism and xenophobia. Migrants and ethnic minorities fear stigma from their communities, yet community acceptance is key for well-being. Migrants and ethnic minorities should be offered HIV testing, but the barriers highlighted in this review may deter programs from achieving the final goal, which is linking migrants and ethnic minorities to HIV clinical care under the public health perspective.
Baryarama, Fulgentius; Bunnell, Rebecca E; Montana, Livia; Hladik, Wolfgang; Opio, Alex; Musinguzi, Joshua; Kirungi, Wilford; Waswa-Bright, Laban; Mermin, Jonathan H
To compare HIV prevalence from routine voluntary counseling and testing (VCT) data with a population-based serosurvey in Uganda and to assess the utility of VCT data as a supplemental data source for HIV surveillance. We analyzed HIV testing data from 75,640 unique VCT clients aged 15-59 years collected from August 2004 to January 2005 at 160 VCT sites. We excluded clients who reported illness as the reason for testing. During the same time period, 18,525 adults aged 15-59 years were tested for HIV in the Uganda HIV/AIDS Sero-Behavioral Survey (UHSBS). We compared UHSBS HIV prevalence with age-standardized VCT prevalence, overall and among stand-alone and facility-based VCT sites. HIV prevalence in urban areas was similar overall [UHSBS: 9.7%, 95% confidence interval (CI) 8.6 to 10.7; VCT: 10.1%, CI 9.8 to 10.5] and for both men (UHSBS: 6.3%, CI 4.9 to 7.6; VCT: 7.1, CI 6.6 to 7.5) and women (UHSBS: 12.2%, CI 10.6 to 13.7; VCT: 12.9%, CI 12.3 to 13.4). Urban prevalence from UHSBS (9.7%, CI 8.6 to 10.7), VCT stand-alone sites (10.3% CI 9.8 to 10.8), and VCT sites in health facility settings (10.0%, CI 9.5 to 10.4) was similar. However, in rural areas where VCT coverage is much lower than in urban areas (10% versus 31%), HIV prevalence was much higher among rural VCT clients (8.2%, CI 7.9% to 8.4%) than among rural UHSBS participants (5.2%, CI 4.8% to 5.5%). This resulted in overall higher HIV prevalence among all VCT clients (8.8%, CI 8.7 to 9.1) compared with all survey participants (5.9%, CI 5.6 to 6.2). After excluding clients who give illness as a reason for testing, VCT data may be used without further adjustment to monitor the HIV epidemic among urban Ugandans using either VCT data from stand-alone or health facility-based sites. However, monitoring rural and overall HIV prevalence using VCT data may not be appropriate until the uptake of VCT in rural areas is significantly improved or an adjustment factor is applied.
Manirankunda, Lazare; Loos, Jasna; Debackaere, Pieterjan; Nostlinger, Christiana
This study identified physicians' HIV testing practices and their barriers toward implementing provider-initiated HIV testing and counseling (PITC) for Sub-Saharan African migrants (SAM) in Flanders, Belgium. In-depth interviews were conducted on a purposive sample of 20 physicians (ten GPs and ten internists). GPs performed mainly…
Bemelmans, Marielle; Baert, Saar; Negussie, Eyerusalem; Bygrave, Helen; Biot, Marc; Jamet, Christine; Ellman, Tom; Banda, Amanda; van den Akker, Thomas; Ford, Nathan
Counselling services are recommended by the World Health Organization and have been partially adopted by national HIV guidelines. In settings with a high HIV burden, patient education and counselling is often performed by lay workers, mainly supported with international funding. There are few examples where ministries of health have been able to absorb lay counsellors into their health systems or otherwise sustain their work. We document the role of lay cadres involved in HIV testing and counselling and adherence support and discuss approaches to sustainability. We focused on a purposive sample of eight sub-Saharan African countries where Médecins Sans Frontières supports HIV programmes: Guinea, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Zambia and Zimbabwe. We reviewed both published and grey literature, including national policies and donor proposals, and interviewed key informants, including relevant government staff, donors and non-governmental organizations. Lay counsellors play a critical role in scaling up HIV services and addressing gaps in the HIV testing and treatment cascade by providing HIV testing and counselling and adherence support at both the facility and community levels. Countries have taken various steps in recognizing lay counsellors, including harmonizing training, job descriptions and support structures. However, formal integration of this cadre into national health systems is limited, as lay counsellors are usually not included in national strategies or budgeting. The current trend of reduced donor support for lay counsellors, combined with lack of national prioritization, threatens the sustainability of this cadre and thereby quality HIV service delivery.
Sefhedi, Sheila; Montsi, Mercy; Mpofu, Elias
This exploratory study describes the provision of HIV & AIDS counselling services in Botswana junior secondary schools as perceived by teachers. A total of 45 teachers (age range = 20-55; teaching experience range = 0-21 years) from three schools participated. The participants completed a questionnaire on the types of HIV & AIDS-related…
Between April and August 2004, all pregnant women in labour at JUTH, were offered rapid HIV testing and counseling with opportunity to decline testing. HIV positive women were offered the standard nevirapine mono-therapy prophylaxis regimen (HIVNET 012). Four hundred and thirty (99.8%) of the 431 pregnant women ...
Full Text Available Deborah L Jones,1 Marisa Echenique,1 JoNell Potter,2 Violeta J Rodriguez,1 Stephen M Weiss,1 Margaret A Fischl3 1Department of Psychiatry and Behavioral Sciences, 2Department of Obstetrics and Gynecology, 3Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA Background: Rates of pregnancy among women living with HIV are similar to those in the general population. Unintended pregnancies are also common, and among adolescents and young women perinatally infected (PHIV+ or behaviorally infected (BHIV+ with HIV, planning for both conception and contraception is an important element of HIV care that may be neglected. This pilot study examined the influence of intervention strategies targeting fertility planning, safer conception practices and patient-provider communication. It was hypothesized that preconception counseling interventions would enhance reproductive knowledge, planning and practices, as well as stimulate discussion with providers regarding conception. Methods: Adolescent girls and young women (N=34 perinatally (n=21 or behaviorally (n=13 infected with HIV, aged 16–29 years, were recruited from urban South Florida, and completed measures of reproductive knowledge, sexual practices and fertility intentions. Participants were randomized to condition, ie, video presentation plus Motivational Interviewing (MI, MI only, control. Results: The average age of women was 22 years (SD =3.27, and the majority of them were African American. Levels of depression were higher among BHIV+ compared to PHIV+ at baseline and 6 months. Pregnancy knowledge (pregnancy, safe conception and pregnancy planning and the proportion of those engaging in birth control planning (condom use, long-term birth control, patient-provider discussions on preventing pregnancy and fertility desires were similar between conditions at post-intervention and 6 months. Bayes factors indicated that the data were
Full Text Available Abstract Background To benefit from available care and treatment options, patients should first be counselled and tested for HIV. Our aim was to assess the acceptability of HIV testing among tuberculosis patients under routine care conditions in south Ethiopia. Methods We interviewed all adult tuberculosis patients who were treated at Arba Minch Hospital in Ethiopia between January and August 2005. After recording socio-demographic information and tuberculosis treatment history, we referred those patients who showed initial willingness to a counsellor for HIV counselling and testing. Rapid test methods were used following a pretest counselling session. The results were disclosed during a post-test counselling session. We used the logistic regression method to assess factors associated with willingness and acceptability. Results 190 adult tuberculosis patients were treated at the hospital and all of them consented to take part in the study. Their median age was 30 years (range, 15–68 and 52% of them were males. 49 patients (26% were previously tested including 29 (59% HIV positive. Of 161 patients (excluding the 29 already positive, 118 (73% were willing to be tested and 58% (68/118 of those willing accepted the test. The overall acceptability rate was 35% (56/161. Fourteen (20.6% were HIV positive and women were more likely to be HIV infected (p = 0.029. Unemployment and self-perceived high risk of HIV infection were associated with initial willingness (OR [95%CI]:2.6 [1.3–5.5] vs. 5.0 [1.1–22.4], respectively. However, only being unemployed was associated with accepting the test (OR = 4.2; 95%CI = 1.9–9.3. Conclusion The low acceptability of HIV counselling and testing among tuberculosis patients poses a challenge to the scale-up of TB/HIV collaborative efforts. There is a need for alternative counselling and testing strategies.
Ferguson, Yvonne Owens; Eng, Eugenia; Bentley, Margaret; Sandelowski, Margarete; Steckler, Allan; Randall-David, Elizabeth; Piwoz, Ellen G; Zulu, Cynthia; Chasela, Charles; Soko, Alice; Tembo, Martin; Martinson, Francis; Tohill, Beth Carlton; Ahmed, Yusuf; Kazembe, Peter; Jamieson, Denise J; van der Horst, Charles; Adair, Linda; Ahmed, Yusuf; Ait-Khaled, Mounir; Albrecht, Sandra; Bangdiwala, Shrikant; Bayer, Ronald; Bentley, Margaret; Bramson, Brian; Bobrow, Emily; Boyle, Nicola; Butera, Sal; Chasela, Charles; Chavula, Charity; Chimerang'ambe, Joseph; Chigwenembe, Maggie; Chikasema, Maria; Chikhungu, Norah; Chilongozi, David; Chiudzu, Grace; Chome, Lenesi; Cole, Anne; Corbett, Amanda; Corneli, Amy; Duerr, Ann; Eliya, Henry; Ellington, Sascha; Eron, Joseph; Farr, Sherry; Ferguson, Yvonne Owens; Fiscus, Susan; Galvin, Shannon; Guay, Laura; Heilig, Chad; Hoffman, Irving; Hooten, Elizabeth; Hosseinipour, Mina; Hudgens, Michael; Hurst, Stacy; Hyde, Lisa; Jamieson, Denise; Joaki, George; Jones, David; Kacheche, Zebrone; Kamanga, Esmie; Kamanga, Gift; Kampani, Coxcilly; Kamthunzi, Portia; Kamwendo, Deborah; Kanyama, Cecilia; Kashuba, Angela; Kathyola, Damson; Kayira, Dumbani; Kazembe, Peter; Knight, Rodney; Kourtis, Athena; Krysiak, Robert; Kumwenda, Jacob; Loeliger, Edde; Luhanga, Misheck; Madhlopa, Victor; Majawa, Maganizo; Maida, Alice; Marcus, Cheryl; Martinson, Francis; Thoofer, Navdeep; Matika, Chrissie; Mayers, Douglas; Mayuni, Isabel; McDonough, Marita; Meme, Joyce; Merry, Ceppie; Mita, Khama; Mkomawanthu, Chimwemwe; Mndala, Gertrude; Mndala, Ibrahim; Moses, Agnes; Msika, Albans; Msungama, Wezi; Mtimuni, Beatrice; Muita, Jane; Mumba, Noel; Musis, Bonface; Mwansambo, Charles; Mwapasa, Gerald; Nkhoma, Jacqueline; Pendame, Richard; Piwoz, Ellen; Raines, Byron; Ramdas, Zane; Rublein, John; Ryan, Mairin; Sanne, Ian; Sellers, Christopher; Shugars, Diane; Sichali, Dorothy; Snowden, Wendy; Soko, Alice; Spensley, Allison; Steens, Jean-Marc; Tegha, Gerald; Tembo, Martin; Thomas, Roshan; Tien, Hsiao-Chuan; Tohill, Beth; van der Horst, Charles; Waalberg, Esther; Wiener, Jeffrey; Wilfert, Cathy; Wiyo, Patricia; Zgambo, Onnocent; Zimba, Chifundo
A process evaluation of nurses' implementation of an infant-feeding counseling protocol was conducted for the Breastfeeding, Antiretroviral and Nutrition (BAN) Study, a prevention of mother-to-child transmission of HIV clinical trial in Lilongwe, Malawi. Six trained nurses counseled HIV-infected mothers to exclusively breastfeed for 24 weeks postpartum and to stop breastfeeding within an additional four weeks. Implementation data were collected via direct observations of 123 infant feeding counseling sessions (30 antenatal and 93 postnatal) and interviews with each nurse. Analysis included calculating a percent adherence to checklists and conducting a content analysis for the observation and interview data. Nurses were implementing the protocol at an average adherence level of 90% or above. Although not detailed in the protocol, nurses appropriately counseled mothers on their actual or intended formula milk usage after weaning. Results indicate that nurses implemented the protocol as designed. Results will help to interpret the BAN Study's outcomes.
Andrea L Wirtz
Full Text Available Introduction: There are limited data characterizing the burden of HIV among men who have sex with men (MSM in Malawi. Epidemiologic research and access to HIV prevention, treatment and care services have been traditionally limited in Malawi by criminalization and stigmatization of same-sex practices. To inform the development of a comprehensive HIV prevention intervention for Malawian MSM, we conducted a community-led assessment of HIV prevalence and correlates of infection. Methods: From April 2011 to March 2012, 338 MSM were enrolled in a cross-sectional study in Blantyre, Malawi. Participants were recruited by respondent-driven sampling methods (RDS, reaching 19 waves. Trained staff administered the socio-behavioural survey and HIV and syphilis voluntary counselling and testing. Results: Crude HIV and syphilis prevalence estimates were 15.4% (RDS-weighted 12.5%, 95% confidence interval (CI: 7.3–17.8 and 5.3% (RDS-weighted 4.4%, 95% CI: 3.1–7.6, respectively. Ninety per cent (90.4%, unweighted of HIV infections were reported as being previously undiagnosed. Participants were predominantly gay-identified (60.8% or bisexually identified (36.3%; 50.7% reported recent concurrent relationships. Approximately half reported consistent condom use (always or almost always with casual male partners, and proportions were relatively uniform across partner types and genders. The prevalence of perceived and experienced stigma exceeded 20% for almost all variables, 11.4% ever experienced physical violence and 7% were ever raped. Current age >25 years (RDS-weighted adjusted odds ratio (AOR 3.9, 95% CI: 1.2–12.7, single marital status (RDS-weighted AOR: 0.3; 95% CI: 0.1–0.8 and age of first sex with a man <16 years (RDS-weighted AOR: 4.3, 95% CI: 1.2–15.0 were independently associated with HIV infection. Conclusions: Results demonstrate that MSM represent an underserved, at-risk population for HIV services in Malawi and merit comprehensive HIV
O'Byrne, Patrick; Holmes, Dave; Roy, Marie
Recently, focus groups and qualitative interviews with nurses who provide frontline care for persons living with HIV highlighted the contentiousness surrounding the seemingly innocuous activity of counselling clients about HIV-status disclosure, hereafter disclosure counselling. These empirical studies highlighted that while some nurses felt they should instruct clients to disclose their HIV-positive status if HIV transmission were possible, other nurses were equally adamant that such counselling was outside the nursing scope of practice. A review of these opposing perceptions about disclosure counselling, including an examination of the empirical evidence which supports each point, revealed that the dichotomous arguments needed to be nuanced. The empirical evidence about serostatus disclosure neither supported nor refuted either of these assertions; rather, it substantiated parts of each. To create this understanding, both empirical and theoretical works are used. First, the results of empirical studies about serostatus disclosure, or lack thereof and HIV transmission is presented; as part of this, Marks and Crepaz's HIV disclosure and exposure framework is examined. Second, the work of Michel Foucault on disciplinary and pastoral power is drawn from. The outcome is a nuanced understanding about the interrelationships between disclosure counselling and nursing practice and a final interpretation about what this understanding means for public health practice. © 2014 John Wiley & Sons Ltd.
Full Text Available Jose G Castro,1 Deborah L Jones,2 Stephen M Weiss2 1Infectious Diseases, Department of Medicine, 2Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA Abstract: The objective of this pilot study was to explore the knowledge of and preferences regarding effective biomedical interventions among high risk individuals attending a sexually transmitted diseases clinic, and to examine the effect of a brief information intervention on preference. Participants completed a baseline assessment, attended a presentation on human immunodeficiency virus (HIV prevention methods, and completed a postintervention assessment. Outcome measures included: demographics and sexual risk factors, self-perceived HIV risk, and knowledge and attitudes regarding new biomedical methods of HIV prevention. After the baseline evaluation, participants were provided with information on new biomedical prevention strategies. Participants were given the option to review the information by reading a pamphlet or by viewing a brief video containing the same information. Participants (n=97 were female (n=51 and male (n=46. At baseline, only a small minority of participants were aware of the newer biomedical strategies to prevent HIV infection. Postintervention, 40% endorsed having heard about the use of HIV medications to prevent HIV infection; 72% had heard that male circumcision can decrease the risk of acquiring HIV infection in men; and 73% endorsed knowledge of the potential role of microbicides in decreasing the risk of acquiring HIV. Following the intervention, the most preferred prevention method was male condoms, followed by preexposure prophylaxis, and microbicides. The least preferred methods were male circumcision and female condoms. This study provides preliminary information on knowledge and attitudes regarding newer biomedical interventions to protect against HIV infection. Keywords: STD clinic, biomedical HIV prevention, PrEP, male
Full Text Available Carolyne Ajema,1 Charity Mbugua,2 Peter Memiah,3 Camille Wood,3 Courtney Cook,4 Ronald Kotut,2 Lina Digolo1 1Research and Strategic Information Department, LVCT Health, Nairobi, Kenya; 2Post Rape Care Department, LVCT Health, Nairobi, Kenya; 3Department of Public Health, University of West Florida, University Parkway, Pensacola, FL, USA; 4Biology Department, University of West Florida, University Parkway, Pensacola, FL, USA Purpose: Child sexual abuse and HIV are key health challenges in Kenya. In 2015, LVCT Health conducted a study aimed at assessing the quality of HIV-related services offered to child survivors of sexual violence in public health facilities.Materials and methods: A qualitative data collection approach was utilized. Qualitative data were collected through in-depth interviews with 31 providers. Quantitative methods included a retrospective review of 164 records of child survivors of rape who had accessed services 6 months prior to the commencement of the study. SPSS Version 22 was used in the descriptive analysis of the medical records. Client exit interviews and observation data were analyzed using MS Excel. In-depth interviews were analyzed using a thematic analytical approach.Results: Twenty-seven percent (n=164 survivors were documented to have received the first dose of postexposure prophylaxis (PEP. Providers did not conduct HIV pre- and posttest counseling for the survivors. There were no longitudinal follow-up mechanisms to ensure child survivors initiated on PEP adhered to the treatment plan. Less than 30% of survivors returned to the facility for PEP adherence counseling and follow-up HIV testing. Twenty providers cited capacity gaps in undertaking HIV risk assessment for child survivors. Limited availability of PEP is a barrier to HIV prevention, as most departments only offer services between 8 am and 5 pm. HIV tests were only available on weekdays before 5 pm. PEP being out of stock remains a barrier to HIV
Nava Yeganeh; Mariana Simon; Deborah Mindry; Karin Nielsen-Saines; Maria Cristina Chaves; Breno Santos; Marineide Melo; Brenna Mendoza; Pamina Gorbach
Background Providing HIV voluntary counseling and testing (VCT) to men who attend their partner's prenatal care is an intervention with potential to reduce HIV transmission to women and infants during the vulnerable period of pregnancy...
Kristin M Wall
Full Text Available OBJECTIVE: We describe rates of unintended pregnancy among HIV positive couples in Lusaka, Zambia. We also identify factors associated with unintended pregnancy among oral contraceptive pill (OCP using couples in this cohort. DESIGN: Data were analyzed from couples randomized in a factorial design to two family planning intervention videos. METHODS: Rates of unintended pregnancy were stratified by contraceptive method used at time of pregnancy. Predictors of time to unintended pregnancy among OCP users were determined via multivariate Cox modeling. RESULTS: The highest rates of unintended pregnancy were observed among couples requesting condoms only (26.4/100CY or OCPs (20.7/100CY; these rates were not significantly different. OCP users accounted for 37% of the couple-years (CY observed and 87% of unintended pregnancies. Rates of unintended pregnancy for injectable (0.7/100CY and intrauterine device (1.6/100CY users were significantly lower relative to condom only users. No pregnancies occurred among contraceptive implant users or after tubal ligation. Factors associated (p<0.05 with time to unintended pregnancy among OCP users in multivariate analysis included the man wanting more children, the woman being HIV negative versus having stage IV HIV disease, and the woman reporting: younger age, no previous OCP use, missed OCPs, or sex without a condom. CONCLUSIONS: Long-acting reversible contraceptive methods were effective in the context of integrated couples HIV prevention and contraceptive services. Injectable methods were also effective in this context. Given the high user failure rate of OCPs, family planning efforts should promote longer-acting methods among OCP users wishing to avoid pregnancy. Where other methods are not available or acceptable, OCP adherence counseling is needed, especially among younger and new OCP users. TRIAL REGISTRATION: ClinicalTrials.gov NCT00067522.
Toya V Russell
Full Text Available BACKGROUND: After the first two cases of locally-acquired HIV infection were recognized in Chuuk State, Federated States of Micronesia (FSM, a public health response was initiated. The purpose of the response was to assess the need for HIV education and prevention services, to develop recommendations for controlling further spread of HIV in Chuuk, and to initiate some of the prevention measures. METHODOLOGY/PRINCIPAL FINDINGS: A public health team conducted a survey and rapid HIV testing among a sample of residents on the outer islands in Chuuk. Local public health officials conducted contact tracing and testing of sex partners of the two locally-acquired cases of HIV infection. A total of 333 persons completed the survey. The majority knew that HIV is transmitted through unprotected sexual contact (81%, injection drug use (61%, or blood transfusion (64%. Sexual activity in the past 12 months was reported among 159 participants, including 90 females and 69 males. Compared to women, men were more likely to have had multiple sex partners, to have been drunk during sex, but less likely to have used a condom in the past 12 months. The two men with locally acquired HIV infection had unprotected anal sex with a third Chuukese man who likely contracted HIV while outside of Chuuk. All 370 persons who received voluntary, confidential HIV counseling and testing had HIV negative test results. CONCLUSIONS/SIGNIFICANCE: Despite the low HIV seroprevalence, risky sexual behaviors in this small isolated population raise concerns about the potential for rapid spread of HIV. The lack of knowledge about risks, along with stigmatizing attitudes towards persons infected with HIV and high risk sexual behaviors indicate the need for resources to be directed toward HIV prevention in Chuuk and on other Pacific Islands.
An, Selena J; George, Asha S; LeFevre, Amnesty E; Mpembeni, Rose; Mosha, Idda; Mohan, Diwakar; Yang, Ann; Chebet, Joy; Lipingu, Chrisostom; Baqui, Abdullah H; Killewo, Japhet; Winch, Peter J; Kilewo, Charles
Integration of HIV into RMNCH (reproductive, maternal, newborn and child health) services is an important process addressing the disproportionate burden of HIV among mothers and children in sub-Saharan Africa. We assess the structural inputs and processes of care that support HIV testing and counselling in routine antenatal care to understand supply-side dynamics critical to scaling up further integration of HIV into RMNCH services prior to recent changes in HIV policy in Tanzania. This study, as a part of a maternal and newborn health program evaluation in Morogoro Region, Tanzania, drew from an assessment of health centers with 18 facility checklists, 65 quantitative and 57 qualitative provider interviews, and 203 antenatal care observations. Descriptive analyses were performed with quantitative data using Stata 12.0, and qualitative data were analyzed thematically with data managed by Atlas.ti. Limitations in structural inputs, such as infrastructure, supplies, and staffing, constrain the potential for integration of HIV testing and counselling into routine antenatal care services. While assessment of infrastructure, including waiting areas, appeared adequate, long queues and small rooms made private and confidential HIV testing and counselling difficult for individual women. Unreliable stocks of HIV test kits, essential medicines, and infection prevention equipment also had implications for provider-patient relationships, with reported decreases in women's care seeking at health centers. In addition, low staffing levels were reported to increase workloads and lower motivation for health workers. Despite adequate knowledge of counselling messages, antenatal counselling sessions were brief with incomplete messages conveyed to pregnant women. In addition, coping mechanisms, such as scheduling of clinical activities on different days, limited service availability. Antenatal care is a strategic entry point for the delivery of critical tests and counselling messages
Yelnik, Cécile M; Richey, Monica; Haiduc, Virginia; Everett, Sotiria; Zhang, Meng; Erkan, Doruk
To determine if a cardiovascular disease (CVD) prevention counseling program for lupus patients decreases the prevalence of CVD risk factors. The assessment phase of a 3-year CVD prevention counseling program included the evaluation of CVD risk factors, diet, exercise habits, and medications. The education phase included discussion of the above risk factors, as well as CVD and thrombosis prevention strategies. Patients were prospectively followed every 3-6 months for risk assessment and continued education by a nurse practitioner and a medical doctor. Between March 2009 and December 2014, 121 patients were included. At baseline, abnormal blood pressure, blood glucose, cholesterol profile, and body mass index were found in 50 (41%), 7 (6%), 82 (68%), and 77 (64%) patients, respectively. During the 3-year followup, among those with abnormal baseline values, prevalence of abnormal blood pressure significantly decreased (odds ratio [OR] 0.94, 95% confidence interval [95% CI] 0.92-0.96, P lupus patients. © 2016, American College of Rheumatology.
Gasiorowicz, Mari; Llanas, Michelle R.; DiFranceisco, Wayne; Benotsch, Eric G.; Brondino, Michael J.; Catz, Sheryl L.; Hoxie, Neil J.; Reiser, William J.; Vergeront, James M.
Prevention case management (PCM) for HIV-infected persons is an HIV risk reduction intervention designed to assist clients who are aware of their HIV infection and who continue to engage in risk transmission behaviors. PCM combines individual risk reduction counseling with case management to address the psychosocial factors affecting HIV…
Full Text Available The study investigated the perceptions of the youth regarding Voluntary Counselling and Testing (VCT and sexual aspects related to HIV and AIDS. The study was grounded in qualitative methodology, using 4 focus group interviews for data collection - triangulating the results with field notes and literature. The participants of the four focus groups proved to be well informed on the topic and had clear perceptions concerning several aspects. They were very positive regarding the advantages of VCT for the prevention and management of HIV and AIDS. The participants recognised the need for the youth to be better informed about VCT and HIV and AIDS. They were much concerned by the lack of parental involvement in sexual education as well as the permissiveness of the youth who partook in alcohol and drug abuse as well as prostitution. Participants of the study stated that this problem was exacerbated by poverty and poor socio economic conditions.
Full Text Available Background: Studies have shown a reduced uptake of contraceptive methods in HIV-positive women of childbearing age, mainly because of unmet needs that may be a result of poor promotion of available methods of contraception, especially long-term and permanent methods (LTPM.Aim: To compare the uptake of contraceptive methods, and particularly LTPM, by HIV-positive and HIV negative post-partum mothers, and to assess the effects of counselling on contraceptive choices.Setting: Three government district hospitals in Swaziland.Methods: Interviews were conducted using a structured questionnaire, before and after counselling HIV negativeand HIV-positive post-partum women in LTPM use, unintended pregnancy rates, future fertility and reasons for contraceptive choices.Results: A total of 711 women, of whom half were HIV-positive, participated in the study. Most (72.3% HIV-negative and 84% HIV-positive were on modern methods of contraception, with the majority using 2-monthly and 3-monthly injectables. Intended use of any contraceptive increased to 99% after counselling. LTPM use was 7.0% in HIV-negative mothers and 15.3% in HIV-positive mothers before counselling, compared with 41.3% and 42.4% in HIV-negative and HIV-positive mothers, respectively, after counselling. Pregnancy intentions and counselling on future fertility were significantly associated with current use of contraception, whilst current LTPM use and level of education were significantly associated with LTPM post-counselling.Conclusion: Counselling on all methods including LTPM reduced unmet needs in contraception in HIV positive and HIV-negative mothers and could improve contraceptive uptake and reduce unintended pregnancies. Health workers do not always remember to include LTPM when they counsel clients, which could result in a low uptake of these methods. Further experimental studies should be conducted to validate these results.
Siveregi, Amon; Dudley, Lilian; Makumucha, Courage; Dlamini, Phatisizwe; Moyo, Sihle; Bhembe, Sibongiseni
Studies have shown a reduced uptake of contraceptive methods in HIV-positive women of childbearing age, mainly because of unmet needs that may be a result of poor promotion of available methods of contraception, especially long-term and permanent methods (LTPM). To compare the uptake of contraceptive methods, and particularly LTPM, by HIV-positive and HIV negative post-partum mothers, and to assess the effects of counselling on contraceptive choices. Three government district hospitals in Swaziland. Interviews were conducted using a structured questionnaire, before and after counselling HIV negativeand HIV-positive post-partum women in LTPM use, unintended pregnancy rates, future fertility and reasons for contraceptive choices. A total of 711 women, of whom half were HIV-positive, participated in the study. Most (72.3% HIV-negative and 84% HIV-positive) were on modern methods of contraception, with the majority using 2-monthly and 3-monthly injectables. Intended use of any contraceptive increased to 99% after counselling. LTPM use was 7.0% in HIV-negative mothers and 15.3% in HIV-positive mothers before counselling, compared with 41.3% and 42.4% in HIV-negative and HIV-positive mothers, respectively, after counselling. Pregnancy intentions and counselling on future fertility were significantly associated with current use of contraception, whilst current LTPM use and level of education were significantly associated with LTPM post-counselling. Counselling on all methods including LTPM reduced unmet needs in contraception in HIV positive and HIV-negative mothers and could improve contraceptive uptake and reduce unintended pregnancies. Health workers do not always remember to include LTPM when they counsel clients, which could result in a low uptake of these methods. Further experimental studies should be conducted to validate these results.
Madiba, Sphiwe; Mokgatle, Mathilda
The proposal by the South African Health Ministry to implement HIV testing and counselling (HTC) at schools in 2011 generated debates about the appropriateness of such testing. However, the debate has been between the Ministries of Education and Health, with little considerations of the students. The main aim of the study was to assess the students' opinions and uptake of HIV testing and counselling in general, and the acceptability of the provision of HIV testing and counselling in schools. The study also determined the association between socio-demographic characteristics, sexual behaviour, and HIV testing behaviour of the students. A survey was conducted among grade 10-12 high school students in North West and Gauteng provinces, South Africa. Seventeen high schools (nine rural and eight urban) were randomly selected for the administration of a researcher-assisted, self-administered, semi-structured questionnaire. A total of 2970 students aged 14-27 years participated in the study; 1632 (55%) were girls, 1810 (61%) ever had sex, and 1271 (49.8%) had more than one sex partner. The mean age of first sexual activity was 15.6. Half (n = 1494, 50.1%) had been tested for HIV. Having multiple sexual partners, age, and gender were significantly associated with increased odds of having had a HIV test. Fear, being un-informed about HTC, and low HIV risk perceptions were the reasons for not getting tested. The acceptability of HTC at school was high (n = 2282, 76.9%) and 2129 (71.8%) were willing to be tested at school. Appropriateness, privacy, and secrecy were the main arguments for and against HTC at school. One-third (n = 860, 29%) had intentions to disclose their HIV status to students versus 1258 (42.5%) for teachers. Stigma, discrimination and secrecy were the primary reasons students did not intend to disclose. A high acceptability of HTC and willingness to be tested at school suggest that HIV prevention programs tailored to youth have a high potential of success
Echenique, Marisa; Rodriguez, Violeta J; LaCabe, Richard P; Privette, C Kyle; Jones, Deborah L; Potter, JoNell Efantis; Fischl, Margaret A
This study aimed to describe demographic and psychological characteristics among HIV-infected young women, and to identify knowledge, attitudes, and behaviors associated with conception, with the goal of informing interventions or programmatic decisions regarding preconception counseling methods for young women living with HIV. Behaviorally and perinatally HIV-infected young women (n = 34) were conveniently sampled in Miami, Florida. Participants were asked to complete measures of reproductive knowledge, attitudes toward conception, and risk behaviors, as well as measures of depression and cognitive functioning. Perinatally and behaviorally HIV-infected young women were very similar in important areas of health preconception practices such as conception-related health literacy and conception-related communication with providers. Behaviorally infected women, however, were somewhat more likely to have been pregnant in the past, and had greater knowledge of healthy contraception practices and family planning. Despite the difference among groups, both the perinatally and behaviorally acquired women demonstrated having adequate overall knowledge. Depression was higher and consistent with moderate depression among the behaviorally HIV-infected women in comparison to perinatally infected women. This study found that that despite adequate reproductive knowledge, most young HIV-infected women were not using contraception. Given the consequences of presentation of advanced HIV during pregnancy, the need for both treatment adherence and preconception counseling is essential. Results suggest that interventions or programmatic decisions regarding preconception counseling methods for young women living with HIV are necessary and potentially transferrable between populations.
The Brazilian government, per pre-AIDS epidemic era economic policy, maintained until recently a 15% import tax on condoms. This policy made condoms too expensive for most people who needed them. In response, AIDS prevention activists in 1993 and 1994 launched an intensive information and advocacy campaign to convince policy makers that a supply of affordable condoms was crucial to slow the spread of HIV in Brazil; the tax was withdrawn in April 1994. This experience of AIDS in Brazil highlights the important role of policies in HIV/AIDS prevention and the influence advocates have over them. The responses of governments, business, and religious and nongovernmental organizations to the HIV/AIDS epidemic over the past decade have yielded important lessons about the creation of effective prevention policies. For example, it has been learned that policy often lags behind the HIV/AIDS epidemic, knowledge about HIV and AIDS among policy makers is often limited and inaccurate, women face the greatest impact from AIDS, HIV/AIDS prevention efforts must compete with other priorities for limited resources, comparative examples can influence and guide policy formulation, local prevention efforts too rarely inform the policy process, and prevention in the workplace is often neglected.
Full Text Available Abstract Background Couple HIV Counseling and Testing (CHCT is one of the key preventive strategies used to reduce the spread of HIV. In Uganda, HIV prevalence among married/living together is 7.2% among women and 7.6% among men. CHCT can help ease disclosure of HIV-positive status, which in turn may help increase opportunities to get social support and reduce new infections. The uptake of CHCT among attendees of health facilities in rural Uganda is as high as 34%. The purpose of this study was to explore the motivators of CHCT uptake in Mukono district, a rural setting in Uganda. Methods The study was conducted in two sub-counties in a rural district (Mukono district about 28 km east of the capital Kampala, using a descriptive and explorative qualitative research design. Specifically, we conducted focus group discussions and key informant interviews with HIV focal persons, village health team (VHT members, religious leaders and political leaders. We also interviewed persons in couple relationships. Data was analysed using NVivo 8 software. Ethical clearance was received from the Mengo Hospital Research Review Board and from the Uganda National Council of Science and Technology. Results The study was conducted from June 2013 to July 2013 We conducted 4 focus group discussions, 10 key informant interviews and interviewed 53 persons in couple relationships. None of the participants were a couple. The women were 68% (36/53 and 49% (26/53 of them were above 29 years old. The motivators of CHCT uptake were; perceived benefit of HIV testing, sickness of a partner or child in the family and suspicion of infidelity. Other important motivators were men involvement in antenatal care (ANC attendance and preparation for marriage. Conclusion The motivators for CHCT uptake included the perceived benefit of HIV testing, sickness of a partner or child, preparation for marriage, lack of trust among couples and men involvement in antenatal care. Greater
Van Thu Nguyen
Full Text Available Currently, HIV testing and counseling (HTC services in Vietnam are primarily funded by international sources. However, international funders are now planning to withdraw their support and the Government of Vietnam (GVN is seeking to identify domestic funding and generate client fees to continue services. A clear understanding of the cost to sustain current HTC services is becoming increasingly important to facilitate planning that can lead to making HTC and other HIV services more affordable and sustainable in Vietnam. The objectives of this analysis were to provide a snapshot of current program costs to achieve key program outcomes including 1 testing and identifying PLHIV unaware of their HIV status and 2 successfully enrolling HIV (+ clients in care.We reviewed expenditure data reported by 34 HTC sites in nine Vietnamese provinces over a one-year period from October 2012 to September 2013. Data on program outcomes were extracted from the HTC database of 42,390 client records. Analysis was carried out from the service providers' perspective.The mean expenditure for a single client provided HTC services (testing, receiving results and referral for care/treatment was US $7.6. The unit expenditure per PLHIV identified through these services varied widely from US $22.8 to $741.5 (median: $131.8. Excluding repeat tests, the range for expenditure to newly diagnose a PLHIV was even wider (from US $30.8 to $1483.0. The mean expenditure for one successfully referred HIV client to care services was US $466.6. Personnel costs contributed most to the total cost.Our analysis found a wide range of expenditures by site for achieving the same outcomes. Re-designing systems to provide services at the lowest feasible cost is essential to making HIV services more affordable and treatment for prevention programs feasible in Vietnam. The analysis also found that understanding the determinants and reasons for variance in service costs by site is an important
Full Text Available HIV counseling and testing (HCT is a critical gateway to treatment, care, and support services. For pregnant women, it is to access prevention of mother-to-child-transmission (PMTCT services. However, not much has been done to appraise this service from the perspective of the recipients in Nigeria. This study documents the appraisal of the HCT services received at the antenatal care (ANC services in three government hospitals in Ibadan, Nigeria, from the perspectives of pregnant women. Data were collected using focus group discussion guide among purposively selected 40 (21 primigravida and 19 multigravida pregnant women. Observation and inventory checklists were used to collect data on procedures and basic requirements of HCT. Content analysis was used to analyze the data. Participants were neither counseled nor given opportunity to voluntarily participate in HCT services as it was made compulsory before accessing ANC. Test results were reportedly handed over directly to participants without post-test counseling. Observation of HCT procedure showed that guidelines for counseling were not strictly adhered to. Inventory of facilities, staff, and materials revealed inadequate staffing, lack of a dedicated counseling room, and inadequate antiretroviral drugs and test kits. The HCT services as provided for pregnant women are fraught with procedural inadequacies. Training and supervision of health care workers as well as provision of resources are needed to address the situation.
Grabowski, M Kate; Serwadda, David M; Gray, Ronald H; Nakigozi, Gertrude; Kigozi, Godfrey; Kagaayi, Joseph; Ssekubugu, Robert; Nalugoda, Fred; Lessler, Justin; Lutalo, Thomas; Galiwango, Ronald M; Makumbi, Fred; Kong, Xiangrong; Kabatesi, Donna; Alamo, Stella T; Wiersma, Steven; Sewankambo, Nelson K; Tobian, Aaron A R; Laeyendecker, Oliver; Quinn, Thomas C; Reynolds, Steven J; Wawer, Maria J; Chang, Larry W
To assess the effect of a combination strategy for prevention of human immunodeficiency virus (HIV) on the incidence of HIV infection, we analyzed the association between the incidence of HIV and the scale-up of antiretroviral therapy (ART) and medical male circumcision in Rakai, Uganda. Changes in population-level viral-load suppression and sexual behaviors were also examined. Between 1999 and 2016, data were collected from 30 communities with the use of 12 surveys in the Rakai Community Cohort Study, an open, population-based cohort of persons 15 to 49 years of age. We assessed trends in the incidence of HIV on the basis of observed seroconversion data, participant-reported use of ART, participant-reported male circumcision, viral-load suppression, and sexual behaviors. In total, 33,937 study participants contributed 103,011 person-visits. A total of 17,870 persons who were initially HIV-negative were followed for 94,427 person-years; among these persons, 931 seroconversions were observed. ART was introduced in 2004, and by 2016, ART coverage was 69% (72% among women vs. 61% among men, P<0.001). HIV viral-load suppression among all HIV-positive persons increased from 42% in 2009 to 75% by 2016 (P<0.001). Male circumcision coverage increased from 15% in 1999 to 59% by 2016 (P<0.001). The percentage of adolescents 15 to 19 years of age who reported never having initiated sex (i.e., delayed sexual debut) increased from 30% in 1999 to 55% in 2016 (P<0.001). By 2016, the mean incidence of HIV infection had declined by 42% relative to the period before 2006 (i.e., before the scale-up of the combination strategy for HIV prevention) - from 1.17 cases per 100 person-years to 0.66 cases per 100 person-years (adjusted incidence rate ratio, 0.58; 95% confidence interval [CI], 0.45 to 0.76); declines were greater among men (adjusted incidence rate ratio, 0.46; 95% CI, 0.29 to 0.73) than among women (adjusted incidence rate ratio, 0.68; 95% CI, 0.50 to 0.94). In this
Mwisongo, Aziza; Mehlomakhulu, Vuyelwa; Mohlabane, Neo; Peltzer, Karl; Mthembu, Jacque; Van Rooyen, Heidi
With the launch of the national HIV Counselling and Testing (HCT) campaign in South Africa (SA), lay HIV counsellors, who had been trained in blood withdrawal, have taken up the role of HIV testing. This study evaluated the experiences, training, motivation, support, supervision, and workload of HIV lay counsellors and testers in South Africa. The aim was to identify gaps in their resources, training, supervision, motivation, and workload related to HCT services. In addition it explored their experiences with providing HIV testing under the task shifting context. The study was conducted in eight of South Africa's nine provinces. 32 lay counsellors were recruited from 67 HCT sites, and were interviewed using two questionnaires that included structured and semi-structured questions. One questionnaire focused on their role as HIV counsellors and the other on their role as HIV testers. Ninety-seven percent of counsellors reported that they have received training in counselling and testing. Many rated their training as more than adequate or adequate, with 15.6% rating it as not adequate. Respondents reported a lack of standardised counselling and testing training, and revealed gaps in counselling skills for specific groups such as discordant couples, homosexuals, older clients and children. They indicated health system barriers, including inadequate designated space for counselling, which compromises privacy and confidentiality. Lay counsellors carry the burden of counselling and testing nationally, and have other tasks such as administration and auxiliary duties due to staff shortages. This study demonstrates that HCT counselling and testing services in South Africa are mainly performed by lay counsellors and testers. They are challenged by inadequate work space, limited counselling skills for specific groups, a lack of standardised training policies and considerable administrative and auxiliary duties. To improve HCT services, there needs to be training needs with a
Peltzer, Karl; Tabane, Cily; Matseke, Gladys; Simbayi, Leickness
Objective: To evaluate the feasibility, fidelity, and effect of a human immunodeficiency virus (HIV) risk reduction intervention delivered to HIV-infected patients by lay counsellors during routine HIV counselling and testing (HCT) public service in Mpumalanga, South Africa. Methods: A total of 488 HIV-infected patients, aged 18 years and older,…
Full Text Available BACKGROUND: Men who have sex with men (MSM are a high-risk group for HIV. Implementation of effective preventive activities is an important way to combat HIV among MSM. However, in Ukraine there is no real HIV prevention policy among MSM and the need for its formulation is still open. MATERIAL AND METHODS: Analysis of legal acts, national reports and other official documents related to HIV prevention among MSM was carried out for Romania, Slovenia, the Netherlands, and Sweden.RESULTS: European countries use various approaches to HIV prevention among MSM: institutional, structural, and media approach.Countries under consideration have fully specified the minimum standard package for HIV prevention among MSM, who are defined as the highest priority group. Distinct strategies for MSM and ways to achieve them are outlined within the national plans and strategies for combating HIV/AIDS (Slovenia, Romania, the Netherlands. The National plan for HIV prevention among MSM will come into action in 2012 in Sweden. Countries, chosen for this study, use the principle of social contract by which the government provides subsidies and grants to nongovernmental organizations (NGOs working with MSM through its specialized health care units (Slovenia, Sweden, and sometimes only for one national NGO (the Netherlands. Outreach is the most common model of NGO’s activities.. In Sweden, MSM can get counseling and HIV testing in specialized HIV clinic for MSM. HIV prevention among MSM is run by representatives of NGOs through dating sites (Slovenia, Romania, through educating MSM and further promotion of healthy lifestyles among their friends. Along with the behavior modification activities, anti-discrimination strategies are used (Sweden, the Netherlands, Slovenia.CONCLUSIONS: Review of the regulatory frameworks, empowerment of NGOs, implementation of the social contract mechanisms, using interactive tools and providing education for MSM can be key points of HIV
Priddy, Frances H; Pilcher, Christopher D; Moore, Renee H; Tambe, Pradnya; Park, Mahin N; Fiscus, Susan A; Feinberg, Mark B; del Rio, Carlos
The southeastern United States has an increasing burden of HIV, particularly among blacks, women, and men who have sex with men. To evaluate HIV nucleic acid amplification testing (NAAT) and antibody-based algorithms in determination of HIV incidence, detection of acute HIV infections, and surveillance of drug-resistant virus transmission in the urban southeastern United States, we conducted a cross-sectional analysis of prospectively collected data from 2202 adults receiving HIV testing and counseling at 3 sites in Atlanta, GA from October 2002 through January 2004. After standard testing with an HIV enzyme immunoassay (EIA) and Western blot confirmation, HIV-positive specimens were tested with 2 standardized assays to detect recent infection. HIV antibody-negative specimens were pooled and screened for HIV using NAAT. Seventy (3.2%) of 2202 subjects were HIV infected. Only 66 were positive on the standard HIV antibody test; 4 were antibody-negative but acutely HIV infected. The overall annual HIV incidence was 1.1% (95% confidence interval [CI]: 0.4 to 1.8) based on the Vironostika-LS assay and 1.3% (95% CI: 0.6 to 2.1) based on the BED Incidence Enzyme Immunoassay (EIA). The prevalence of acute HIV infection was 1.8 per 1000 persons (95% CI: 0.7 to 4.6). The sensitivity of the current testing algorithm using an EIA and Western blot test for detectable infections was only 94.3% (95% CI: 86.2 to 97.8). All 3 of the acutely infected subjects genotyped had drug resistance mutations, and 1 had multiclass resistance. Adding NAAT-based screening to standard HIV antibody testing increased case identification by 6% and uncovered the first evidence of multidrug-resistant HIV transmission in Atlanta. Antibody tests alone are insufficient for public health practice in high-risk urban HIV testing settings.
Witzel, T Charles; Lora, Wezzie; Lees, Shelley; Desmond, Nicola
HIV testing and counselling (HTC) interventions are key to controlling the HIV epidemic in East and Southern Africa where HTC is primarily delivered through voluntary counselling and testing (VCT), provider initiated testing and counselling (PITC), and home-based counselling and testing (HBVCT). Decision making processes around uptake of HTC models must be taken into account when designing new interventions. Counselling in HTC aims to reduce post-test risk taking behaviour and to link individuals to care but its efficacy is unclear. This meta-ethnography aims to understand the contexts of HTC uptake in East and Southern Africa and to analyse the perceived impacts of counselling-based interventions in relation to sexual behaviour and linkage to care. We conducted a systematic literature review of studies investigating HTC in East and Southern Africa from 2003 -April 2014. The search and additional snowballing identified 20 studies that fit our selection criteria. These studies were synthesised through a thematic framework analysis. Twenty qualitative and mixed-methods studies examining impacts of HTC models in East and Southern Africa were meta-synthesised. VCT decisions were made individually while HBVCT decisions were located in family and community units. PITC was associated with coercion from healthcare providers. Low quality counselling components and multiple-intersecting barriers faced by individuals mean that counselling in HTC was not perceived to be effective in reducing post-test risk behaviour and had limited perceived effect in facilitating linkage to care. HBVCT is associated with minimal stigma and should be considered as an area of priority. Counselling components in HTC interventions were effective in transmitting information about HIV and sexual risk, but were perceived as ineffective in addressing the broader personal circumstances preventing sexual behaviour change and modulating access to care.
Ndabarora, Eléazar; Mchunu, Gugu
Various studies have reported that university students, who are mostly young people, rarely use existing HIV/AIDS preventive methods. Although studies have shown that young university students have a high degree of knowledge about HIV/AIDS and HIV modes of transmission, they are still not utilising the existing HIV prevention methods and still engage in risky sexual practices favourable to HIV. Some variables, such as awareness of existing HIV/AIDS prevention methods, have been associated with utilisation of such methods. The study aimed to explore factors that influence use of existing HIV/AIDS prevention methods among university students residing in a selected campus, using the Health Belief Model (HBM) as a theoretical framework. A quantitative research approach and an exploratory-descriptive design were used to describe perceived factors that influence utilisation by university students of HIV/AIDS prevention methods. A total of 335 students completed online and manual questionnaires. Study findings showed that the factors which influenced utilisation of HIV/AIDS prevention methods were mainly determined by awareness of the existing university-based HIV/AIDS prevention strategies. Most utilised prevention methods were voluntary counselling and testing services and free condoms. Perceived susceptibility and perceived threat of HIV/AIDS score was also found to correlate with HIV risk index score. Perceived susceptibility and perceived threat of HIV/AIDS showed correlation with self-efficacy on condoms and their utilisation. Most HBM variables were not predictors of utilisation of HIV/AIDS prevention methods among students. Intervention aiming to improve the utilisation of HIV/AIDS prevention methods among students at the selected university should focus on removing identified barriers, promoting HIV/AIDS prevention services and providing appropriate resources to implement such programmes.
Reed, Jason Bailey; Njeuhmeli, Emmanuel; Thomas, Anne Goldzier; Bacon, Melanie C.; Bailey, Robert; Cherutich, Peter; Curran, Kelly; Dickson, Kim; Farley, Tim; Hankins, Catherine; Hatzold, Karin; Justman, Jessica; Mwandi, Zebedee; Nkinsi, Luke; Ridzon, Renee; Ryan, Caroline; Bock, Naomi
As the science demonstrating strong evidence for voluntary medical male circumcision (VMMC) for HIV prevention has evolved, the President’s Emergency Plan for AIDS Relief (PEPFAR) has collaborated with international agencies, donors, and partner country governments supporting VMMC programming. Mathematical models forecast that quickly reaching a large number of uncircumcised men with VMMC in strategically chosen populations may dramatically reduce community-level HIV incidence and save billions of dollars in HIV care and treatment costs. Because VMMC is a 1-time procedure that confers life-long partial protection against HIV, programs for adult men are vital short-term investments with long-term benefits. VMMC also provides a unique opportunity to reach boys and men with HIV testing and counseling services and referrals for other HIV services, including treatment. After formal recommendations by WHO in 2007, priority countries have pursued expansion of VMMC. More than 1 million males have received VMMC thus far, with the most notable successes coming from Kenya’s Nyanza Province. However, a myriad of necessary cultural, political, and ethical considerations have moderated the pace of overall success. Because many millions more uncircumcised men would benefit from VMMC services now, US President Barack Obama committed PEPFAR to provide 4.7 million males with VMMC by 2014. Innovative circumcision methods—such as medical devices that remove the foreskin without injected anesthesia and/or sutures—are being rigorously evaluated. Incorporation of safe innovations into surgical VMMC programs may provide the opportunity to reach more men more quickly with services and dramatically reduce HIV incidence for all. PMID:22797745
to-door HIV testing, including convenience, confidentiality, capacity to increase the number of people tested, and opportunities to increase knowledge of HIV transmission, prevention and care through provision of correct information to ...
Barrio, Casey A.; Shoffner, Marie F.
Advances in medical treatment have greatly extended the life span and quality of life of persons living with HIV, with the nature of the disease evolving from causing an early death to chronic, manageable illness. Career counselors will increasingly be called upon to assist persons living with HIV. This article provides an overview of HIV disease…
There is a dire need to begin HIV/AIDS education early in the life of individuals before exposure to situations that put them at risk of HIV infection. It is also believed that the most common place for people to learn about HIV and AIDS is the school where the attitudes and behaviour of young people are shaped. Counsellors ...
Results indicate that a poor health system (OR=0.34, 95%CI:0.23 - 0.50) was inversely associated with HIV testing acceptance in prison, while age, educational level, population group, marital status, length of incarceration and access to HIV testing in prison were not associated with HIV testing acceptance in prison. Half of ...
Dorjgochoo, Tsogzolmaa; Noel, Francine; Deschamps, Marie Marcel; Theodore, Harry; Charles, Sabine; Dupont, William; Wright, Peter F; Fitzgerald, Dan W; Vermund, Sten H; Pape, Jean W
Many Haitian adolescents are highly vulnerable to HIV infection. Among 3,391 sexually active 13-25-year-olds in our Voluntary Counseling and Testing (VCT) Center in Port-au-Prince from October 2005 to September 2006, we assessed associations between demographic and behavioral factors and HIV status using multivariable logistic regression analyses. We diagnosed HIV infection in 6.3% of 2,533 females and 5.5% of 858 males. Age-specific prevalence was 3.4% for 13-15-year-olds, 4.7% for 16-19, and 6.8% for 20-25 (P=0.02). Poor education, not residing with parents, currently or formerly married, having a child, and being self-referred to VCT services by others were significant predictors of HIV in females. HIV infection was associated with considering oneself at higher risk, though most youth did not recognize this risk. HIV in females was also associated with suspected/confirmed sexually transmitted infection (STI), especially genital ulcers (ORadj=2.28, 95%CI:1.26-4.13), years of sexual activity (Ptrend=0.07), and suspicion that partners had other partners or an STI. Among males, HIV was associated with drug use (though uncommon), as well as sexual debut with a casual/unknown person (ORadj=3.18, 95%CI:1.58-6.42). HIV-infected young people were more likely to be RPR positive and less likely to use condoms. Young Haitians are a key target for HIV prevention and care and avail themselves readily of youth-focused VCT services. PMID:19738486
Friedman, Samuel R; Downing, Martin J; Smyrnov, Pavlo; Nikolopoulos, Georgios; Schneider, John A; Livak, Britt; Magiorkinis, Gkikas; Slobodianyk, Liudmyla; Vasylyeva, Tetyana I; Paraskevis, Dimitrios; Psichogiou, Mina; Sypsa, Vana; Malliori, Melpomeni M; Hatzakis, Angelos
Current ideas about HIV prevention include a mixture of primarily biomedical interventions, socio-mechanical interventions such as sterile syringe and condom distribution, and behavioral interventions. This article presents a framework for socially-integrated transdisciplinary HIV prevention that may improve current prevention efforts. It first describes one socially-integrated transdisciplinary intervention project, the Transmission Reduction Intervention Project. We focus on how social aspects of the intervention integrate its component parts across disciplines and processes at different levels of analysis. We then present socially-integrated perspectives about how to improve combination antiretroviral treatment (cART) processes at the population level in order to solve the problems of the treatment cascade and make "treatment as prevention" more effective. Finally, we discuss some remaining problems and issues in such a social transdisciplinary intervention in the hope that other researchers and public health agents will develop additional socially-integrated interventions for HIV and other diseases.
Rupsa C. Boelig
Full Text Available Objective. To describe the demographic and clinical characteristics of HIV-infected individuals and HIV-affected couples who were referred for preconception counseling (PCC at a large urban US-based HIV clinic. Methods. Electronic medical records were reviewed for HIV-infected individuals and HIV-affected couples. Medical, reproductive, surgical, psychosocial, and family history data were abstracted. Univariate analyses were done. Results. There were 8 single HIV-infected women and 100 HIV-affected couples who underwent PCC. HIV-infected women were older (mean age 35 years versus 32 years, P=0.06, were more likely to smoke (23% versus 0%, P<0.01, and had more medical comorbidities (57% versus 33%, P=0.04 than HIV-uninfected women. The majority of couples were serodiscordant (77%, and of these couples, 32% had a detectable plasma viral load and 33% report inconsistent condom use. Conclusions. HIV-infected women have a number of medical and psychosocial issues, including those related to HIV that may increase the risk of adverse pregnancy outcomes and HIV perinatal and sexual transmission. PCC is an important intervention to optimize maternal management to improve perinatal outcomes and minimize transmission risks.
Spector, Anya Y; Pinto, Rogerio M
Integrating HIV prevention into substance abuse counselling is recommended to ameliorate the health outcomes of men who have sex with men. However, culture-based countertransferences (CBCs) may hamper this effort. Using a case illustration, this paper will explain the manifestation of CBCs held among substance abuse counsellors and how they hinder counsellors' work with men who have sex with men. The following CBCs will be explored: distancing, topic avoidance, heteronormativity, assumptions and denying client strengths. These CBCs allow counsellors to avoid discussions about sexual practices and curtail HIV prevention counselling, while undermining the counsellor-client relationship. Based on the empirical literature on HIV and substance abuse prevention with men who have sex with men, we provide recommendations to help counsellors overcome CBCs and integrate HIV prevention consistently with men who are in treatment for substance abuse.
McNicholl, Janet M
Biomedical preventions for HIV, such as vaccines, microbicides or pre-exposure prophylaxis (PrEP) with antiretroviral drugs, can each only partially prevent HIV-1 infection in most human trials. Oral PrEP is now FDA approved for HIV-prevention in high risk groups, but partial adherence reduces efficacy. If combined as biomedical preventions (CBP) an HIV vaccine could provide protection when PrEP adherence is low and PrEP could prevent vaccine breakthroughs. Other types of PrEP or microbicides may also be partially protective. When licensed, first generation HIV vaccines are likely to be partially effective. Individuals at risk for HIV may receive an HIV vaccine combined with other biomedical preventions, in series or in parallel, in clinical trials or as part of standard of care, with the goal of maximally increasing HIV prevention. In human studies, it is challenging to determine which preventions are best combined, how they interact and how effective they are. Animal models can determine CBP efficacy, whether additive or synergistic, the efficacy of different products and combinations, dose, timing and mechanisms. CBP studies in macaques have shown that partially or minimally effective candidate HIV vaccines combined with partially effective oral PrEP, vaginal PrEP or microbicide generally provided greater protection than either prevention alone against SIV or SHIV challenges. Since human CBP trials will be complex, animal models can guide their design, sample size, endpoints, correlates and surrogates of protection. This review focuses on animal studies and human models of CBP and discusses implications for HIV prevention.
Nair, K S; Piang, L L K; Tiwari, V K; Raj, Sherin; Nandan, Deoki
Meeting the needs of HIV-positive pregnant women and their offspring is critical to India's political and financial commitment to achieving universal access to HIV prevention, treatment, care and support. This review of the strategy to prevent vertical transmission of HIV in Mysore district, Karnataka, highlights the need to integrate prevention of parent-to-child transmission (PPTCT) and reproductive and child health (RCH) services. All key officials who were involved in the integration of services at the state and district levels were interviewed by use of semistructured protocols. Policy documents and guidelines issued by the Department of Health and Family Welfare and Karnataka State AIDS Prevention Society were reviewed, as were records and official orders issued by the office of District Health and Family Welfare Officer and District HIV/AIDS Programme Office, Mysore. Routine data were also collected from all health facilities. This review found that 4.5 years of PPTCT-RCH integration resulted not only in a rise in antenatal registrations but also in almost all pregnant women counselled during antenatal care undergoing HIV tests. Based on the findings, we propose recommendations for successful replication of this strategy. Integration of PPTCT services with RCH should take place at all levels - policy, administration, facility and community. The increased demand for HIV counselling and testing resulting from service integration must be met by skilled human resources, sufficient facilities and adequate funds at the facility level.
Full Text Available Introduction: Counselling services are recommended by the World Health Organization and have been partially adopted by national HIV guidelines. In settings with a high HIV burden, patient education and counselling is often performed by lay workers, mainly supported with international funding. There are few examples where ministries of health have been able to absorb lay counsellors into their health systems or otherwise sustain their work. We document the role of lay cadres involved in HIV testing and counselling and adherence support and discuss approaches to sustainability. Methods: We focused on a purposive sample of eight sub-Saharan African countries where Médecins Sans Frontières supports HIV programmes: Guinea, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Zambia and Zimbabwe. We reviewed both published and grey literature, including national policies and donor proposals, and interviewed key informants, including relevant government staff, donors and non-governmental organizations. Results and discussion: Lay counsellors play a critical role in scaling up HIV services and addressing gaps in the HIV testing and treatment cascade by providing HIV testing and counselling and adherence support at both the facility and community levels. Countries have taken various steps in recognizing lay counsellors, including harmonizing training, job descriptions and support structures. However, formal integration of this cadre into national health systems is limited, as lay counsellors are usually not included in national strategies or budgeting. Conclusions: The current trend of reduced donor support for lay counsellors, combined with lack of national prioritization, threatens the sustainability of this cadre and thereby quality HIV service delivery.
Karita, Etienne; Nsanzimana, Sabin; Ndagije, Felix; Wall, Kristin M; Mukamuyango, Jeannine; Mugwaneza, Placidie; Remera, Eric; Raghunathan, Pratima L; Bayingana, Roger; Kayitenkore, Kayitesi; Bekan-Homawoo, Brigitte; Tichacek, Amanda; Allen, Susan
Couples' voluntary HIV counseling and testing (CVCT) is a WHO-recommended intervention for prevention of heterosexual HIV transmission which very few African couples have received. We report the successful nationwide implementation of CVCT in Rwanda. From 1988 to 1994 in Rwanda, pregnant and postpartum women were tested for HIV and requested testing for their husbands. Partner testing was associated with more condom use and lower HIV and sexually transmitted infection rates, particularly among HIV-discordant couples. After the 1994 genocide, the research team continued to refine CVCT procedures in Zambia. These were reintroduced to Rwanda in 2001 and continually tested and improved. In 2003, the Government of Rwanda (GoR) established targets for partner testing among pregnant women, with the proportion rising from 16% in 2003 to 84% in 2008 as the prevention of mother-to-child transmission program expanded to >400 clinics. In 2009, the GoR adopted joint posttest counseling procedures, and in 2010 a quarterly follow-up program for discordant couples was established in government clinics with training and technical assistance. An estimated 80%-90% of Rwandan couples have now been jointly counseled and tested resulting in prevention of >70% of new HIV infections. Rwanda is the first African country to have established CVCT as standard of care in antenatal care. More than 20 countries have sent providers to Rwanda for CVCT training. To duplicate Rwanda's success, training and technical assistance must be part of a coordinated effort to set national targets, timelines, indicators, and budgets. Governments, bilateral, and multilateral funding agencies must jointly prioritize CVCT for prevention of new HIV infections.
Full Text Available Reducing substance use and unprotected sex by HIV-positive persons improves individual health status while decreasing the risk of HIV transmission. Despite recommendations that health care providers screen and counsel their HIV-positive patients for ongoing behavioral risks, it is unknown how to best provide "prevention with positives" in clinical settings. Positive Choice, an interactive, patient-tailored computer program, was developed in the United States to improve clinic-based assessment and counseling for risky behaviors.We conducted a parallel groups randomized controlled trial (December 2003-September 2006 at 5 San Francisco area outpatient HIV clinics. Eligible patients (HIV-positive English-speaking adults completed an in-depth computerized risk assessment. Participants reporting substance use or sexual risks (n = 476 were randomized in stratified blocks. The intervention group received tailored risk-reduction counseling from a "Video Doctor" via laptop computer and a printed Educational Worksheet; providers received a Cueing Sheet on reported risks. Compared with control, fewer intervention participants reported continuing illicit drug use (RR 0.81, 95% CI: 0.689, 0.957, p = 0.014 at 3 months; and RR 0.65, 95% CI: 0.540, 0.785, p<0.001 at 6 months and unprotected sex (RR 0.88, 95% CI: 0.773, 0.993, p = 0.039 at 3 months; and RR 0.80, 95% CI: 0.686, 0.941, p = 0.007 at 6 months. Intervention participants reported fewer mean days of ongoing illicit drug use (-4.0 days vs. -1.3 days, p = 0.346, at 3 months; and -4.7 days vs. -0.7 days, p = 0.130, at 6 months than did controls, and had fewer casual sex partners at (-2.3 vs. -1.4, p = 0.461, at 3 months; and -2.7 vs. -0.6, p = 0.042, at 6 months.The Positive Choice intervention achieved significant cessation of illicit drug use and unprotected sex at the group-level, and modest individual-level reductions in days of ongoing drug use and number of casual sex partners compared with the
Meeks, Linda; And Others
The Gynecology Clinic, Wilce Health Center, Ohio State University, is putting into operation a comprehensive family planning service program that includes (1) patient education, (2) medical care, (3) pregnancy counseling, and (4) reproductive and sexuality counseling. (Author)
Mora Cárdenas, Claudia Mercedes; Monteiro, Simone; Moreira, Carlos Otávio Fiúza
Incentives to provide universal access to antiretroviral therapy in order to control the HIV/AIDS epidemic also encouraged the diversification of HIV testing strategies, as demonstrated by the simultaneous existence of Voluntary Counseling and Testing (VCT) and Provider-Initiated HIV Testing and Counseling (PITC). This paper analyzes the concepts, principles and implementation of the VCT and PITC models regarding counseling, confidentiality and informed consent in Brazil and other countries, based on a literature review of works in the Lilacs, Medline, Sociological Abstracts and Cochrane databases published between 2000 and 2013. According to the literature, PITC increases rates of testing in comparison with VCT, but reduces sexual and reproductive rights and the autonomy of users. These findings suggest technical challenges and ethical tensions between the paradigm of exceptionalism and the normalization of HIV testing. The necessity to reconcile increased access to HIV tests with the local capacity to offer comprehensive care for people living with HIV/AIDS is highlighted. It is recommended that interdisciplinary studies about the social effects of VCT and PITC be amplified.
The results showed that among 3774 antenatal attendees, 2528 (67%) accepted pre-test counselling and 2390 (63%) HIV testing. Majority (95%) of those who had (2528) pre-test counselling accepted HIV testing, post test counselling and test results. The prevalence of HIV infection was 41% (980) (95% CI, 39%-43%).
Kumar G Anil
Full Text Available Abstract Background Information on cost-effectiveness of the range of HIV prevention interventions is a useful contributor to decisions on the best use of resources to prevent HIV. We conducted this assessment for the state of Andhra Pradesh that has the highest HIV burden in India. Methods Based on data from a representative sample of 128 public-funded HIV prevention programs of 14 types in Andhra Pradesh, we have recently reported the number of HIV infections averted by each type of HIV prevention intervention and their cost. Using estimates of the age of onset of HIV infection, we used standard methods to calculate the cost per Disability Adjusted Life Year (DALY saved as a measure of cost-effectiveness of each type of HIV prevention intervention. Results The point estimates of the cost per DALY saved were less than US $50 for blood banks, men who have sex with men programmes, voluntary counselling and testing centres, prevention of parent to child transmission clinics, sexually transmitted infection clinics, and women sex worker programmes; between US $50 and 100 for truckers and migrant labourer programmes; more than US $100 and up to US $410 for composite, street children, condom promotion, prisoners and workplace programmes and mass media campaign for the general public. The uncertainty range around these estimates was very wide for several interventions, with the ratio of the high to the low estimates infinite for five interventions. Conclusions The point estimates for the cost per DALY saved from the averted HIV infections for all interventions was much lower than the per capita gross domestic product in this Indian state. While these indicative cost-effectiveness estimates can inform HIV control planning currently, the wide uncertainty range around estimates for several interventions suggest the need for more firm data for estimating cost-effectiveness of HIV prevention interventions in India.
This paper contextualises counselling within a broader historical formation that links disclosure to healing and deploys confessional technologies to incite disclosure and awareness of the mysterious substance of the self. Foucault's argument that sexuality was the privileged arena for using
Arunthia Zaidi Urmi
Full Text Available Analysis of data from HIV testing and counseling (HTC services provides an opportunity to identify important populations for targeting of HIV prevention efforts. Our primary aim was to describe the demographics of clients presenting to HTC in Bangladesh, a low HIV prevalence country. Our secondary aim was to determine the risk factors for HIV positivity among returning migrant workers who were tested.We performed a cross-sectional study of data collected between 2002 and 2010 from the first HTC service established in Bangladesh, located in three large cities.8973 individuals attended HTC services, with 558 (6.2% of clients testing positive for HIV, including 33 children. The majority of those who tested positive were aged 25-44 (71%, male (70%, and married (68%. Key populations considered at increased risk of HIV, such as female sex workers, people who inject drugs, and males who have sex with males accounted for only 11% of adults who tested positive. Notably, 75% of adults testing positive had a history of migrant work or was the spouse of a migrant worker. In multivariable logistic regression of those with a migrant work history presenting for HTC, we found rural residence, working in the Middle East, and longer duration of migrant work to be independently associated with testing positive, and female gender and higher level of education to be negatively associated.These data suggest that in Bangladesh, in addition to targeting traditional key populations, HIV prevention efforts should also focus on migrant workers and their spouses.
Ngangue, Patrice; Gagnon, Marie-Pierre; Bedard, Emmanuelle
The Cameroon government has made HIV testing and counselling (HTC) a priority in its HIV/AIDS strategic plan. However, there is a dearth of literature on the perspectives of providers on the quality of HTC services. The aim of this study was to explore challenges in the provision of HTC services and their implications on quality of HTC services in Douala's district hospitals. Two primary data collection methods supported by the Donabedian's model of healthcare were used to explain the challenges in the provision of HTC services and their implications on quality of HTC services. This consisted of semi-structured individual interviews with 6 nurses and 16 lay counsellors and a non-participant observation of the physical environment for HTC by site. The study sites were the prevention and voluntary testing and counselling centre (PVTCC) of the six district hospitals of the city of Douala. The study reveals concerns about confidentiality and privacy during the counselling sessions due to inadequate and limited space. An absence of consent, even verbal, was reported in one PVTCC. There is no specific accredited training curriculum that leads to a formal registration as a PVTCC staff, and some lay counsellors work without training. Lay counsellors carry the burden of HIV counselling, but the majority of them work for many years without remuneration and recognition. Another quality challenge is the high workload in the district hospitals' lab, which leads to long waiting times for HIV test results, thus contributing to failure to return for results. The findings of this study highlighted some issues such as lack of adequate space and equipment for HIV testing and counselling that hinder the quality of HTC services and should challenge the health authorities of Cameroon on the need to reorganize HTC services and create a national HIV quality assurance program.
South Africa's HIV epidemic disproportionately affects the youth.¹ The importance of knowing one's status via voluntary counselling and testing (VCT) is recognised as a key strategy in fighting the epidemic and is reflected in the National Strategic Plan (NSP),2 which has set targets of 70% of all adults knowing their status by ...
Izugbara, Chimaraoke O.; Undie, Chi-Chi; Mudege, Netsayi N.; Ezeh, Alex C.
There is limited research addressing the beliefs of adolescents related to Voluntary Counseling and HIV-Testing (VCT). This paper analyzes qualitative data on such beliefs elicited from male youth in Uganda and Malawi. Although study participants understood the mainstream public health rhetoric on VCT, much of their narratives framed going for HIV…
He, Na; Zhang, Jinling; Yao, Jinjian; Tian, Xiuhong; Zhao, Genming; Jiang, Qingwu; Detels, Roger
A study of knowledge, attitudes and practices (KAP) of voluntary HIV counseling and testing (VCT) among rural migrants was conducted in Shanghai, China. An anonymous questionnaire was administered face-to-face. Among 2,690 participants, 78% reported having had lifetime sexual intercourse with 41.3% of singles reporting sexual intercourse, 9.2%…
Psychologists may struggle with what to do when counseling recalcitrant HIV-positive clients who refuse to disclose to third parties at risk. This paper revisits the legal and ethical quagmire that pits "dangerous patient exception" against client confidentiality rights. A 'duty to maintain hope,' which may ultimately minimize the spread…
This article raises the question of whether the practice of HIV/AIDS counselling in Ghana can be linked to the wisdom that older people are said to have and use when they give advice to younger family members. Older people believe they have wisdom and life experience that young people should listen to; counsellors hold ...
Full Text Available HIV prevention efforts to date have not explored the potential for persons living with HIV to act as change agents for prevention behaviour in their social networks. Using egocentric social network analysis, this study examined the prevalence and social network correlates of prevention advocacy behaviours (discussing HIV in general; encouraging abstinence or condom use, HIV testing, and seeking HIV care enacted by 39 HIV clients in Uganda. Participants engaged in each prevention advocacy behaviour with roughly 50–70% of the members in their network. The strongest determinant of engaging in prevention advocacy with more of one’s network members was having a greater proportion of network members who knew one’s HIV seropositive status, as this was associated with three of the four advocacy behaviours. These findings highlight the potential for PLHA to be key change agents for HIV prevention within their networks and the importance of HIV disclosure in facilitating prevention advocacy.
Grabowski, Mary K; Serwadda, David M; Gray, Ronald H; Nakigozi, Gertrude; Kigozi, Godfrey; Kagaayi, Joseph; Ssekubugu, Robert; Nalugoda, Fred; Lessler, Justin; Lutalo, Thomas; Galiwango, Ronald; Makumbi, Fred; Kong, Xiangrong; Kabatesi, Donna; Alamo, Stella T; Wiersma, Steven; Sewankambo, Nelson K; Tobian, Aaron A R; Laeyendecker, Oliver; Quinn, Thomas C; Reynolds, Steven J
BACKGROUND To assess the impact of combination HIV prevention (CHP) on HIV incidence, we analyzed the association between HIV incidence and scale-up of antiretroviral therapy (ART) and medical male circumcision in Rakai, Uganda. Changes in population-level viral load suppression and sexual behaviors were also examined. METHODS Between 1999 and 2016, data were collected through 12 surveys from 30 communities in the Rakai Community Cohort Study, an open population-based cohort of persons aged 15-49 years. We assessed HIV incidence trends based on observed seroconversion data, self-reported ART and male circumcision coverage, viral load suppression, and sexual behaviors. RESULTS In total, 33,937 study participants contributed 103,011 person-visits (HIV prevalence ~13%). Follow-up of 17,870 HIV-negative persons contributed 94,427 person-years with 931 seroconversions. ART was introduced in 2004; by 2016 coverage was 69% (72% in women vs. 61% in men, p<0.001). HIV viral load suppression among all HIV-positive persons increased from 42% in 2009 to 75% by 2016 (p<0.001). Male circumcision coverage increased from 15% in 1999 to 59% by 2016 (p<0.001). Persons 15-19 years reporting n 71 ever having sex increased from 30% to 55% (p<0.0001). HIV incidence declined by 42% in 2016 relative to the pre-CHP period prior to 2010 (1.17/100 py to 0.66/100 py; adjIRR:0.58: 95%CI: 0.45-0.76); declines were greater in men (adjIRR=0.46; 95%CI: 0.29-0.73) than women (adjIRR=0.68, 95%CI: 0.50-0.94). CONCLUSIONS In this longitudinal study, HIV incidence significantly declined with CHP scale-up, providing empiric evidence that HIV control interventions can have substantial population-level impact. However, additional efforts are needed to overcome gender disparities and achieve HIV elimination. PMID:29171817
Gesinde, Abiodun M.
The HIV/AIDS pandemic is recognized globally as the greatest health challenge of the present generation. It is widely acknowledged to be the foremost killer disease in Africa. Since the first AIDS case was publicly announced in 1986, the astronomical increase in victims has been a matter of concern. The rates of HIV/AIDS infection indicate that…
Harper, Cynthia C; Henderson, Jillian T; Schalet, Amy; Becker, Davida; Stratton, Laura; Raine, Tina R
Abstinence-only education has had little demonstrable impact on teenagers' sexual behaviors, despite significant policy and funding efforts. Given the struggle over resources to improve teenagers' reproductive health outcomes, the views of clinicians serving teenagers at high risk for unintended pregnancy and STDs merit particular attention. In 2005, a qualitative study with 31 clinicians serving low-income, at-risk patients was conducted. A semistructured interview guide was used to ask clinicians about adolescent pregnancy, HIV and STD prevention counseling, and when they include abstinence. Thematic content analysis was used to examine the content of the counseling and the techniques used in different situations. Providers reported offering comprehensive counseling, presenting abstinence as a choice for teenagers, along with information about contraceptives and condoms. Several providers mentioned that with young, sexually inexperienced teenagers, they discuss delaying sexual activity and suggest other ways to be affectionate, while giving information on condoms. Providers explained how they assess whether teenagers feel ready to be sexually active and try to impart skills for healthy relationships. Some described abstinence as giving teenagers a way to opt out of unwanted sexual activity. Many support abstinence if that is the patient's desire, but routinely dispense condoms and contraceptives. Overall, providers did not give abstinence counseling as a rigid categorical concept in their preventive practices, but as a health tool to give agency to teenagers within a harm reduction framework. Their approach may be informative for adolescent policies and programs in the future.
In Tanzania, HIV counselling and testing practices are now widely accepted as the cornerstone of HIV prevention programmes. Within HIV testing and counselling, emphasis is placed on the importance of individuals to disclose their HIV status. Despite increasing focus on disclosure of HIV status, relatively little is known ...
Full Text Available ABSTRACTIntroduction:Scientific evidence supports the sinergy between biomedical and behavioral interventions aimed at preventing the transmission of HIV as a strategy to eradicate AIDS.Objective:To characterize comparatively the benefits from biomedical and behavioral interventions to prevent HIV transmission.Methods:Narrative review. We performed a comparative analysis of the benefits of studied interventions by means of estimating the number needed to treat (NNT. Evaluated interventions: counseling activities for behavior change to prevent exposure to HIV; antiretroviral pre-exposure prophylaxis (PrEP and antiretroviral post-exposure prophylasis (PEP for HIV and treatment of serodiscordant couples as a strategy for prevention of HIV transmission (TasP.Results:counseling interventions and TasP have smaller NNTs, equal to, respectively, 11 (95%CI 9 - 18 at 12 months and 34 (95%CI 23 - 54 in 42 months comparatively to PrEP interventions, that resulted in 41 (95%CI 28 - 67 individuals receiving antiretrovirals in order to prevent one case of HIV infection at 36 months for men and serodiscordant couples. PEP interventions are associated with protective effects estimated at 81%. Lack of trials evaluating PEP prevents estimate of NNT.Conclusion:The estimate of the NNT can be a helpful parameter in the comparison between the effectiveness of different behavioral and biomedical HIV prevention strategies. Studies evaluating the benefit and safety of combined behavioral and biomedical interventions are needed, especially considering the attributable fraction of each component. Integration of behavioral and biomedical interventions is required to achieve complete suppression of the virus, and thus reducing viral replication, infectivity and the number of cases.
Full Text Available Abstract Background HIV/AIDS is a major public health problem in Ethiopia. University students are often a young and sexually active group that is at risk of acquiring and transmitting HIV. We assessed risky HIV sexual behaviors and utilization of voluntary counseling and testing services among undergraduate students at Addis Ababa Science and Technology University, Ethiopia. Methods A cross-sectional study was conducted between May and June, 2013. Standardized semi-structured self-administered questionnaire was used to collect data. Simple random sampling technique was use to select departments from each school. All students in the selected departments were the study participants. Data were entered into EPI-Info and analyzed using SPPS statistical packages. P-value < 0.05 was considered as statistically significant. Results Of the total 602 students selected, an overall response rate of 557 (92.6% were registered. Among the participants 361 (60% were males. The student ages’ were ranged from 17 up to 25 years with mean age of 20.3 ± 1.6. Around 385 (64% of them were in the age group of 17 up to 20 years. Among the study participants, 161 (26.8% had sexual contact and the mean age of first sexual encounter was 17.4 (SD =2.3 years. About 443 (76% of students knew that condoms can prevent Sexually Transmitted Infections (STIs. Among sexually active students, 74 (46% had not used condom during first time sex. Among those responded, 488 (83.4% had heard information about VCT; however, 52% had not ever used VCT service. The overall mean score of knowledge and attitude of students towards risk perception on HIV was around 66% and 57%, respectively. Students who enrolled in health science departments had almost three time more knowledge [AOR(95%CI = 2.83 (1.67, 4.80] and two and half times more favorable [AOR (95% CI = 2.55 (1.60, 4.06] attitudes towards HIV risk reduction strategies than students in non-health related departments
Woldeyohannes, Desalegn; Asmamaw, Yehenew; Sisay, Solomon; Hailesselassie, Werissaw; Birmeta, Kidist; Tekeste, Zinaye
HIV/AIDS is a major public health problem in Ethiopia. University students are often a young and sexually active group that is at risk of acquiring and transmitting HIV. We assessed risky HIV sexual behaviors and utilization of voluntary counseling and testing services among undergraduate students at Addis Ababa Science and Technology University, Ethiopia. A cross-sectional study was conducted between May and June, 2013. Standardized semi-structured self-administered questionnaire was used to collect data. Simple random sampling technique was use to select departments from each school. All students in the selected departments were the study participants. Data were entered into EPI-Info and analyzed using SPPS statistical packages. P-value sexual contact and the mean age of first sexual encounter was 17.4 (SD =2.3) years. About 443 (76%) of students knew that condoms can prevent Sexually Transmitted Infections (STIs). Among sexually active students, 74 (46%) had not used condom during first time sex. Among those responded, 488 (83.4%) had heard information about VCT; however, 52% had not ever used VCT service. The overall mean score of knowledge and attitude of students towards risk perception on HIV was around 66% and 57%, respectively. Students who enrolled in health science departments had almost three time more knowledge [AOR(95%CI) = 2.83 (1.67, 4.80)] and two and half times more favorable [AOR (95% CI) = 2.55 (1.60, 4.06)] attitudes towards HIV risk reduction strategies than students in non-health related departments. Some students were engaged in risky sexual behaviour even though they had heard about HIV/AIDS. The perception of risk for acquisition of HIV infection and utilization of VCT were low. HIV prevention and control strategies including education in the areas of HIV/AIDS as part of university programs curriculum, specially non-health students, and strengthening health institutions to provide youth-friendly VCT services for HIV with "know
Seidman, Dominika L; Weber, Shannon; Cohan, Deborah
HIV prevention during pregnancy and lactation is critical for both maternal and child health. Pregnancy provides a critical opportunity for clinicians to elicit women's vulnerabilities to HIV and offer HIV testing, treatment and referral and/or comprehensive HIV prevention options for the current pregnancy, the postpartum period and safer conception options for future pregnancies. In this commentary, we review the safety of oral pre-exposure prophylaxis with tenofovir/emtricitabine in pregnant and lactating women and suggest opportunities to identify pregnant and postpartum women at substantial risk of HIV. We then describe a clinical approach to caring for women who both choose and decline pre-exposure prophylaxis during pregnancy and postpartum, highlighting areas for future research. Evidence suggests that pre-exposure prophylaxis with tenofovir/emtricitabine is safe in pregnancy and lactation. Identifying women vulnerable to HIV and eligible for pre-exposure prophylaxis is challenging in light of the myriad of individual, community, and structural forces impacting HIV acquisition. Validated risk calculators exist for specific populations but have not been used to screen and offer HIV prevention methods. Partner testing and engagement of men living with HIV are additional means of reaching at-risk women. However, women's vulnerabilities to HIV change over time. Combining screening for HIV vulnerability with HIV and/or STI testing at standard intervals during pregnancy is a practical way to prompt providers to incorporate HIV screening and prevention counselling. We suggest using shared decision-making to offer women pre-exposure prophylaxis as one of multiple HIV prevention strategies during pregnancy and postpartum, facilitating open conversations about HIV vulnerabilities, preferences about HIV prevention strategies, and choosing a method that best meets the needs of each woman. Growing evidence suggests that pre-exposure prophylaxis with tenofovir
Nannozi, Victoria; Wobudeya, Eric; Gahagan, Jacqueline
Couples HIV counselling and testing (CHCT) is a key preventive strategy used to reduce the spread of HIV. In Uganda, HIV prevalence among married or cohabiting couples is 5.6%, compared to 2.2% among those never married. CHCT can help ease disclosure of HIV positive status, which in turn may help increase opportunities to obtain social supports and reduce new infections. The purpose of this study was aimed at exploring the possible reasons for the low uptake of CHCT in Mukono district, a rural in setting in Uganda. The study was conducted in two sub-counties in a rural district (Mukono district) using a descriptive qualitative research design. Specifically, we conducted four focus group discussions and 10 key informant interviews. We also interviewed 53 individuals in couple relationships. Data were collected mainly in the local language Luganda and English, all data were transcribed into English and coded for emergent themes. Ethical clearance for this study was obtained from the Mengo Hospital Research Review Board and from the Uganda National Council of Science and Technology. Fear of a positive HIV test result emerged strongly as the most significant barrier to CHCT. To a lesser extent, perceptions and knowledge of CHCT, mistrust in marriages and culture were also noted by participants as important barriers to the uptake of CHCT among couples. Participants offered suggestions on ways to overcome these barriers, including peer couple counselling, offering incentives to couples that test together and door-to-door CHCT testing. In an effort to improve the uptake of CHCT, it is crucial to involve both females and males in the planning and implementation of CHCT, as well as to address the misconceptions about CHCT and to prioritise CHCT within health care systems management.
This 60 second public service announcement (PSA) is based on the November 24, 2015 CDC Vital Signs report. Preexposure prophylaxis, or PrEP, is a daily medicine that can be used to prevent getting HIV. PrEP is for people who donât have HIV but who are at very high risk for getting it from sex or injection drug use. Unfortunately, many people who can benefit from PrEP arenât taking it. Created: 11/24/2015 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). Date Released: 11/24/2015.
Brenner, Bluma G; Wainberg, Mark A
The success of the HIV Prevention Trials Network 052 trial has led to revisions in HIV-1 treatment guidelines. Antiretroviral therapy may reduce the risk of HIV-1 transmissions at the population level. The design of successful treatment as prevention interventions will be predicated on a comprehensive understanding of the spatial, temporal, and biological dynamics of heterosexual men who have sex with men and intravenous drug user epidemics. Viral phylogenetics can capture the underlying structure of transmission networks based on the genetic interrelatedness of viral sequences and cluster networks that could not be otherwise identified. This article describes the phylogenetic expansion of the Montreal men who have sex with men epidemic over the last decade. High rates of coclustering of primary infections are associated with 1 infection leading to 13 onward transmissions. Phylogeny substantiates the role of primary and recent stage infection in transmission dynamics, underlying the importance of timely diagnosis and immediate antiretroviral therapy initiation to avert transmission cascades.
Counseling is important to help HIV discordant couples accept safer sex practices to prevent. HIV transmission to the un-infected partner. Couple counseling on HIV can, thus, be provided as part of pre- marital counseling (1). Most HIV infection in sub-Saharan Africa occurs due to heterosexual intercourse between couples ...
Full Text Available Abstract Background HIV counselling and testing (HCT is a critical gateway for addressing HIV prevention and linking people to treatment, care, and support. Since national testing rates are often less than optimal, there is growing interest in expanding testing coverage through the implementation of innovative models such as home-based HIV counselling and testing (HBHCT. With the aim of informing scale up, this paper discusses client characteristics and acceptability of an HBHCT intervention implemented in rural South Africa. Methods Trained lay counsellors offered door-to-door rapid HIV testing in a rural sub-district of KwaZulu-Natal, South Africa. Household and client data were captured on cellular phones and transmitted to a web-based data management system. Descriptive analysis was undertaken to examine client characteristics, testing history, HBHCT uptake, and reasons for refusal. Chi-square tests were performed to assess the association between client characteristics and uptake. Results Lay counsellors visited 3,328 households and tested 75% (5,086 of the 6,757 people met. The majority of testers (73.7% were female, and 57% had never previously tested. With regard to marital status, 1,916 (37.7%, 2,123 (41.7%, and 818 (16.1% were single, married, and widowed, respectively. Testers ranged in age from 14 to 98 years, with a median of 37 years. Two hundred and twenty-nine couples received couples counselling and testing; 87.8%, 4.8%, and 7.4% were concordant negative, concordant positive, and discordant, respectively. There were significant differences in characteristics between testers and non-testers as well as between male and female testers. The most common reasons for not testing were: not being ready/feeling scared/needing to think about it (34.1%; knowing his/her status (22.6%, being HIV-positive (18.5%, and not feeling at risk of having or acquiring HIV (10.1%. The distribution of reasons for refusal differed significantly by gender
Åstrøm Anne N
Full Text Available Abstract Background This paper describes the process used to develop an integrated set of culturally sensitive, evidence-based counselling tools (job aids by using qualitative participatory research. The aim of the intervention was to contribute to improving infant feeding counselling services for HIV positive women in the Kilimanjaro Region of Tanzania. Methods Formative research using a combination of qualitative methods preceded the development of the intervention and mapped existing practices, perceptions and attitudes towards HIV and infant feeding (HIV/IF among mothers, counsellors and community members. Intervention Mapping (IM protocol guided the development of the overall intervention strategy. Theories of behaviour change, a review of the international HIV/IF guidelines and formative research findings contributed to the definition of performance and learning objectives. Key communication messages and colourful graphic illustrations related to infant feeding in the context of HIV were then developed and/or adapted from existing generic materials. Draft materials were field tested with intended audiences and subjected to stakeholder technical review. Results An integrated set of infant feeding counselling tools, referred to as 'job aids', was developed and included brochures on feeding methods that were found to be socially and culturally acceptable, a Question and Answer Guide for counsellors, a counselling card on the risk of transmission of HIV, and an infant feeding toolbox for demonstration. Each brochure describes the steps to ensure safer infant feeding using simple language and images based on local ideas and resources. The brochures are meant to serve as both a reference material during infant feeding counselling in the ongoing prevention of mother to child transmission (pMTCT of HIV programme and as take home material for the mother. Conclusion The study underscores the importance of formative research and a systematic theory
Pilcher, Christopher D; McPherson, J Todd; Leone, Peter A; Smurzynski, Marlene; Owen-O'Dowd, Judy; Peace-Brewer, Amy L; Harris, Juanita; Hicks, Charles B; Eron, Joseph J; Fiscus, Susan A
Acute human immunodeficiency virus (HIV) infection cannot be diagnosed by routine antibody tests and is rarely diagnosed in clinical practice. However, HIV nucleic acid-based testing is widely used to screen for antibody-negative acute infection among low-risk blood donors. To assess the feasibility of screening in high-volume laboratories for acute and long-term HIV infection in a routine HIV testing population, in which HIV infection prevalence is low, using specimen pooling and HIV RNA reverse transcriptase-polymerase chain reaction (RT-PCR) tests. Clinical diagnostic performance evaluation at a state-funded public health virology and serology laboratory. A total of 8505 consecutive individuals presenting for routine HIV counseling and testing during a total of 20 business days to simulate a month of testing in August and December 2001 at 110 publicly funded testing sites in North Carolina. Prevalence of acute and long-term HIV infection. Serum specimens negative by HIV enzyme immunoassay (EIA) were screened in pools by an ultrasensitive HIV RNA RT-PCR test. Results for individual HIV RNA-positive specimens were reclassified as true or false according to results of confirmatory testing. Of the 8505 individuals screened, 8194 had not previously tested HIV positive and had sufficient serum to complete the testing protocol. Of those, 39 had long-term HIV infection (prevalence, 47.6 per 10,000 at-risk persons [95% confidence interval, 33.8-65.0 per 10,000]). Of the 8155 at-risk individuals whose antibody tests were negative, 5 were HIV RNA positive. Four of those had true-positive acute infection (prevalence, 4.9 per 10,000 [95% confidence interval, 1.3-12.5 per 10,000]). All 4 were women; 2 developed symptoms consistent with an acute retroviral syndrome in the week after testing. Screening all specimens required 147 HIV RNA tests. Overall specificity of the strategy was 0.9999. These findings suggest the widespread diagnosis of acute HIV infections in a routine
Wall, Kristin M; Kilembe, William; Vwalika, Bellington; Haddad, Lisa B; Khu, Naw Htee; Brill, Ilene; Onwubiko, Udodirim; Chomba, Elwyn; Tichacek, Amanda; Allen, Susan
Dual method use, which combines condoms with a more effective modern contraceptive to optimize prevention of HIV and unplanned pregnancy, is underutilized in high-risk heterosexual couples. Heterosexual HIV-discordant Zambian couples were enrolled from couples' voluntary HIV counseling and testing services into an open cohort with 3-monthly follow-up (1994-2012). Relative to dual method use, defined as consistent condom use plus modern contraception, we examine predictors of (1) condom-only use (suboptimal pregnancy prevention) or (2) modern contraceptive use with inconsistent condom use (effective pregnancy prevention and suboptimal HIV prevention). Among 3,049 couples, dual method use occurred in 28% of intervals in M+F- and 23% in M-F+, p HIV+ (adjusted hazard ratio, aHR = 1.15); baseline oral contraceptive pill (aHR = 0.76), injectable (aHR = 0.48), or implant (aHR = 0.60) use; woman's age (aHR = 1.04 per 5 years) and lifetime number of sex partners (aHR = 1.01); postpartum periods (aHR = 1.25); and HIV stage of the index partner III/IV versus I (aHR = 1.10). Predictors (p HIV+ male circumcision (aHR = 1.51), while time-varying implant use was associated with more consistent condom use (aHR = 0.80). Three-quarters of follow-up intervals did not include dual method use. This highlights the need for counseling to reduce unintended pregnancy and HIV transmission and enable safer conception.
Young, Ingrid; Flowers, Paul; McDaid, Lisa
This article examines how biomedicalisation is encountered, responded to and negotiated within and in relation to new biomedical forms of HIV prevention. We draw on exploratory focus group discussions on pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) to examine how the processes of biomedicalisation are affected by and affect the diverse experiences of communities who have been epidemiologically framed as 'vulnerable' to HIV and towards whom PrEP and TasP will most likely be targeted. We found that participants were largely critical of the perceived commodification of HIV prevention as seen through PrEP, although this was in tension with the construction of being medical consumers by potential PrEP candidates. We also found how deeply entrenched forms of HIV stigma and homophobia can shape and obfuscate the consumption and management of HIV-related knowledge. Finally, we found that rather than seeing TasP or PrEP as 'liberating' through reduced levels of infectiousness or risk of transmission, social and legal requirements of responsibility in relation to HIV risk reinforced unequal forms of biomedical self-governance. Overall, we found that the stratifying processes of biomedicalisation will have significant implications in how TasP, PrEP and HIV prevention more generally are negotiated. © 2015 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
Barmania, Sima; Aljunid, Syed Mohamed
HIV screening has existed in numerous methods as an important part of HIV prevention efforts over the years. Premarital HIV testing for couples who wish to marry has been implemented in a number of regions, which often operate in a mandatory rather than voluntary basis and is considered a contentious issue, with viewpoints held in favour and against. One such region is Malaysia which has a policy of mandatory premarital HIV testing of prospective Muslim married couples. The purpose of this study is to understand stakeholders' views on premarital HIV testing given the Malaysian Islamic context. 35 in-depth face to face semi-structured interviews were undertaken with key stakeholder groups involved in HIV prevention policy in Malaysia, namely, officials from the Ministry of Health, religious leaders and people living with HIV. Participants were recruited from the Klang Valley area, from July to December 2013, using purposive sampling techniques. Inclusion criteria necessitated that participants were over the age of 18 and provided full consent. Interviews were audiotaped, followed a standardised topic guide, transcribed verbatim and analysed using a framework analysis. Participants identified pre-marital HIV testing as an effective HIV prevention policy implemented in Malaysia and was viewed, for the most part, as a positive initiative across all stakeholders. Religious leaders were supportive of testing as it provides a protective mechanism, in line with the teachings of the Shariah, while Ministry of Health officials considered it a normal part of their HIV prevention screening initiatives. However, there were concerns surrounding issues such as confidentiality, counselling and discrimination surrounding the test described by the PLHIV group. The findings of this study show that among the participants interviewed was strong support for mandatory premarital HIV testing, which could possibly expose the vulnerability to HIV, reluctance to test and other areas in the
Full Text Available Abstract Background To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO recommends exclusive breastfeeding followed by early, rapid cessation of breastfeeding. Only limited data are available on the attitudes of health workers toward this recommendation and the impact of these attitudes on infant feeding counselling messages given to mothers. Methods As part of the Breastfeeding, Antiretroviral, and Nutrition (BAN clinical trial, we carried out an in-depth qualitative study of the attitudes, beliefs, and counselling messages of 19 health workers in Lilongwe, Malawi. Results Although none of the workers had received formal training, several reported having counseled HIV-positive mothers about infant feeding. Health workers with counselling experience believed that HIV-infected mothers should breastfeed exclusively, rather than infant formula feed, citing poverty as the primary reason. Because of high levels of malnutrition, all the workers had concerns about early cessation of breastfeeding. Conclusion Important differences were observed between the WHO recommendations and the attitudes and practices of the health workers. Understanding these differences is important for designing effective interventions.
Omura, John D; Bellissimo, Moriah P; Watson, Kathleen B; Loustalot, Fleetwood; Fulton, Janet E; Carlson, Susan A
The US Preventive Services Task Force (USPSTF) recommends offering or referring adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. This study determined the proportion of primary care providers (PCPs) who discussed physical activity with most of their at-risk patients and referred them to intensive behavioral counseling, and reported barriers to counseling. Our analyses used data from DocStyles 2015, a Web-based panel survey of 1251 PCPs. Overall, 58.6% of PCPs discussed physical activity with most of their at-risk patients. Among these PCPs, the prevalence of components offered ranged from 98.5% encouraging increased physical activity to 13.9% referring to intensive behavioral counseling. Overall, only 8.1% both discussed physical activity with most at-risk patients and referred to intensive behavioral counseling. Barriers related to PCPs' attitudes and beliefs about counseling (e.g., counseling is not effective) were significantly associated with both discussing physical activity with most at-risk patients and referring them to intensive behavioral counseling (adjusted odds ratio, 1.92; 95% confidence interval, 1.15-3.20). System-level barriers (e.g., referral services not available) were not. Just over half of PCPs discussed physical activity with most of their at-risk patients, and few both discussed physical activity and referred patients to intensive behavioral counseling. Overcoming barriers related to attitudes and beliefs about physical activity counseling could help improve low levels of counseling and referrals to intensive behavioral counseling for CVD prevention. Published by Elsevier Inc.
Hart Graham J
Full Text Available Abstract Background Men who have sex with men (MSM remain the group most at risk of acquiring HIV in the UK and new HIV prevention strategies are needed. In this paper, we examine what contact MSM currently have with HIV prevention activities and assess the extent to which these could be utilised further. Methods Anonymous, self-complete questionnaires and Orasure™ oral fluid collection kits were distributed to men visiting the commercial gay scenes in Glasgow and Edinburgh in April/May 2008. 1508 men completed questionnaires (70.5% response rate and 1277 provided oral fluid samples (59.7% response rate; 1318 men were eligible for inclusion in the analyses. Results 82.5% reported some contact with HIV prevention activities in the past 12 months, 73.1% obtained free condoms from a gay venue or the Internet, 51.1% reported accessing sexual health information (from either leaflets in gay venues or via the Internet, 13.5% reported talking to an outreach worker and 8.0% reported participating in counselling on sexual health or HIV prevention. Contact with HIV prevention activities was associated with frequency of gay scene use and either HIV or other STI testing in the past 12 months, but not with sexual risk behaviours. Utilising counselling was also more likely among men who reported having had an STI in the past 12 months and HIV-positive men. Conclusions Men at highest risk, and those likely to be in contact with sexual health services, are those who report most contact with a range of current HIV prevention activities. Offering combination prevention, including outreach by peer health workers, increased uptake of sexual health services delivering behavioural and biomedical interventions, and supported by social marketing to ensure continued community engagement and support, could be the way forward. Focused investment in the needs of those at highest risk, including those diagnosed HIV-positive, may generate a prevention dividend in the long
Philpott, Sean; Heise, Lori; McGrory, Elizabeth; Paxton, Lynn; Hankins, Catherine; Alexander, Lorraine; Apuuli, David Kihumuro; Baeten, Jared; Birx, Deborah; de Bruyn, Guy; Bukusi, Elizabeth; Burns, David; Calazans, Gabriela; Campbell, James; Caswell, Georgina; Coutinho, Alex; Dawson, Liza; Dhai, Amaboo; Dube, Samukeliso; Ecuru, Julius; Essack, Zaynab; Farley, Timothy; Gafos, Mitzy; Irungu, Pauline; Kaleebu, Pontiano; Kamali, Anatoli; Kestelyn, Evelyne; Kublin, James; Lohse, Nicolai; Lutalo, Tom; Macklin, Ruth; Mâsse, Benôıt; Mauney, Chris; McCormack, Sheena; Miller, Lori; Mfutso-Bengo, Joseph; Misra, Rajender; Muganwa, Margaret; Ndase, Patrick; Nel, Annalene; Nielsen, Leslie; Nkala, Busisiwe; O'Reilly, Kevin; Okware, Sam; Paicheler, Geneviève; Rees, Helen; Rerks-Ngarm, Supachai; Ridzon, Renee; Rosenberg, Zeda; Singh, Jerome; Sugarman, Jeremy; Taylor, Douglas; Tusubira, Evans; Ukpong, Morenike; Umulisa, Marie-Michèle; Warren, Mitchell; Slevin, Katherine West; van de Wijgert, Janneke
As new HIV prevention tools are developed, researchers face a number of ethical and logistic questions about how and when to include novel HIV prevention strategies and tools in the standard prevention package of ongoing and future HIV prevention trials. Current Joint United Nations Programme on
Israel-Ballard, Kiersten; Waithaka, Margaret; Greiner, Ted
While WHO no longer recommends individual infant feeding counselling to HIV-positive women, it may still be practised in some settings and for specific cases. In any case, lessons can be learned by examining how well front line health workers are able to take on counselling tasks. This qualitative study was designed to assess how counsellors deal with challenges they face in two Kenyan provinces. It consisted of brief post-counselling exit interviews with 80 mothers, observations of 21 counselling sessions and 11 key informant interviews. Much infant feeding counselling was of reasonable quality, better than often reported elsewhere. However, nutrition and infant feeding were given low priority, counsellors' training was inadequate, individual postnatal counselling as well as growth monitoring and promotion were rarely done and complementary feeding was inadequately covered. Acceptable, feasible, affordable, sustainable and safe (AFASS) assessments were not of satisfactory quality. Breast milk expression was mentioned only to a minority and the possibility of heat treatment during the transition to cessation was not mentioned. Counsellors were often biased in discussing risks of breastfeeding and replacement feeding. Implementing the new WHO guidance will reduce the need for AFASS assessments, greatly simplifying both the government's and counsellors' tasks. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Canada's international response to the HIV/AIDS epidemic is largely built around the work of the Canadian HIV Vaccine Initiative (CHVI). CHVI proposes to increase the capacity of Canada and low- and middle-income countries to respond to the HIV/AIDS pandemic by developing new HIV vaccines and other preventive ...
LAMBDIN, Barrot; Kanweka, William; Inambao, Mubiana; Mwananyanda, Lawrence; Shah, Heena; Linton, Sabriya; Wong, Frank,; Luisi, Nicole; Tichacek, Amanda; Kalowa, James; Chomba, Elwyn; Allen, Susan
Couples in sub-Saharan Africa are the largest group in the world at risk for HIV infection. Couples counseling and testing programs have been shown to reduce HIV transmission, but such programs remain rare in Africa. Before couples counseling and testing can become the norm, it is essential to increase demand for the services. We evaluated the effectiveness of several promotional strategies during a two -year program in Kitwe and Ndola, Zambia. The program attracted more than 7,600 couples th...
Adesina Omololu Ayodele Adekanbi
Full Text Available Introduction: HIV counseling and testing is the vital and preliminary interventional step aimed at reducing the spread of HIV infection. The study was designed to determine the attitude of health care professionals towards voluntary counseling and testing (VCT for HIV/AIDS at Irrua Specialist Teaching Hospital. Materials & Methods: In this descriptive cross sectional prospective study a self –administered structured questionnaire was used, it contained sections on bio social variables and section aimed at fulfilling the objectives of the study; the participants were medical doctors, nurses, medical laboratory scientists, radiographers, social workers and pharmacists. Data were collated, inputted into a computer and statistical analysis performed using SPSS version 22 software. Descriptive variables were summarized using percentages and proportions for categorical variables. Bivariate analysis was done to test for association between categorical variables using the chi square test; p value of < 0.05 was considered statistically significant. Multiple logistic regressions were performed to identify predictive variables appropriate for the association between socio-demographic and willingness to go for screening. Results: Two hundred and thirty eight questionnaires were administered and statistically analyzed; the group consists of workers mostly females, (55% aged 21-30 years, (47.8%, married, (52.5% Christians, (96.2% medical doctors, (49.2% of Esan extraction; marital status and occupation of the participants significantly influenced their attitude towards voluntary counseling and testing for HIV/AID. A good percentage of the respondents have the right attitude towards VCT of HIV/AIDS. Conclusion: This study has shown that a good percentage of the respondents have the right attitude towards VCT of HIV/AIDS while a lesser proportion had negative attitude.
A secondary data analysis was carried out on Ethiopian Demographic and Health Survey 2005 and 2011 records. In the study 6564 (age 15-49 years) study subjects were included. Spatial data of Amhara region was integrated and analyzed with data mining techniques. HIV testing uptake coverage was much lower (2%) in ...
Dec 29, 2011 ... 2Department of Community Medicine & Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu,. Ogun State. ... roles to play--therefore, limited time for HCT, and burnout (emotional exhaustion) ..... HIV/AIDS among students in the University of Benin, Benin City, Nigeria. J. Community Med ...
Sep 3, 2017 ... ally low2,9-11. The proportion of those who are aware of their own or each other's HIV status becomes even much lower among those working in the informal ... After accounting for an estimated 20% non-response14, a sam- ple of 307 respondents was obtained. African Health Sciences Vol 17 Issue 3, ...
... the emotional and social challenges associated with HIV/AIDS. This research focuses on the emotional wellbeing of lay HCT counsellors because this influences the quality of services they provide. A mixed methods approach was used. The emotional wellbeing, level of burnout, depression and coping style of 50 lay HCT ...
Tomori, Cecilia; Risher, Kathryn; Limaye, Rupali J; Van Lith, Lynn M; Gibbs, Susannah; Smelyanskaya, Marina; Celentano, David D
: Health communication has played a pivotal role in HIV prevention efforts since the beginning of the epidemic. The recent paradigm of combination prevention, which integrates behavioral, biomedical, and structural interventions, offers new opportunities for employing health communication approaches across the entire continuum of care. We describe key areas where health communication can significantly enhance HIV treatment, care, and prevention, presenting evidence from interventions that include health communication components. These interventions rely primarily on interpersonal communication, especially individual and group counseling, both within and beyond clinical settings to enhance the uptake of and continued engagement in care. Many successful interventions mobilize a network of trained community supporters or accompagnateurs, who provide education, counseling, psychosocial support, treatment supervision, and other pragmatic assistance across the care continuum. Community treatment supporters reduce the burden on overworked medical providers, engage a wider segment of the community, and offer a more sustainable model for supporting people living with HIV. Additionally, mobile technologies are increasingly seen as promising avenues for ongoing cost-effective communication throughout the treatment cascade. A broader range of communication approaches, traditionally employed in HIV prevention efforts, that address community and sociopolitical levels through mass media, school- or workplace-based education, and entertainment modalities may be useful to interventions seeking to address the full care continuum. Future interventions would benefit from development of a framework that maps appropriate communication theories and approaches onto each step of the care continuum to evaluate the efficacy of communication components on treatment outcomes.
In Africa, HIV is having a devastating impact on young people. Globally, youth aged 15 to 24 account for almost one third of all new infections. There are unique challenges to implementing adolescent-friendly policies and HIV prevention programs. More research is needed to inform HIV prevention strategies focusing on ...
In Africa, HIV is having a devastating impact on young people. Globally, youth aged 15 to 24 account for almost one third of all new infections. There are unique challenges to implementing adolescent-friendly policies and HIV prevention programs. More research is needed to inform HIV prevention strategies focusing on ...
Granich, Reuben; Crowley, Siobhan; Vitoria, Marco; Smyth, Caoimhe; Kahn, James G; Bennett, Rod; Lo, Ying-Ru; Souteyrand, Yves; Williams, Brian
An estimated 33 million people are living with HIV and universal access remains a dream for millions of people. By the end of year 2008, four million people were on treatment; however, over five million needed treatment, and in 2007, there were 2.7 million new infections. Without significant improvement in prevention, we are unlikely to meet universal access targets including the growing demand for highly active antiretroviral treatment (HAART). This review examines HAART as a potential tool for preventing HIV transmission. We discuss recent scientific evidence regarding the treatment and prevention gap, importance viral load and HIV transmission, HAART and HIV transmission, when to start, HIV counseling and testing, modeling results and next steps. HAART has considerable treatment and prevention benefits and it needs to be considered as a key element of combination prevention. To explore HAART as an effective prevention strategy, we recommend further evaluation of human rights and ethical considerations, clarification of research priorities and exploration of feasibility and acceptability issues.
Harting, Janneke; van Assema, Patricia; van der Molen, Henk T.; Ambergen, Ton; de Vries, Nanne K.
Quality assessments of interventions are seen as essential in optimizing their implementation, interpreting their effectiveness, and illuminating their underlying processes. In Hartslag Limburg, a cardiovascular prevention project, the quality of a health counseling intervention was assessed as part
Background Despite evidence that HIV positive women may suffer higher rates of heart disease, diabetes, human papillomavirus infection, and some types of cancer, the provision of preventive health services to HIV positive women is unknown. Preventive health services recommended for such women include breast, colorectal and cervical cancer screening, sexually transmitted infection (STI) testing, vaccinations, and patient counseling on a number of issues including sexual behaviors. Methods This retrospective cohort study utilized medical record reviews of 192 HIV positive women who were patients at the University of Utah Infectious Diseases Clinic in 2009. Medical records were reviewed for all encounters during 2009 using a standardized data collection form; data were collected on patient demographics and a variety of preventive health services. Chi squared tests were used to assess receipt of preventive health services by demographic factors, and multivariable logistic regression was used to determine predictors of receiving select services. Results The most commonly recorded preventive services included blood pressure screening, screening for Hepatitis A and B, Tetanus-Diphtheria-Pertussis vaccination, Pneumococcal pneumonia vaccination, substance abuse screening, and mental health screening. STI testing and safe sex counseling were documented in the medical records of only 37% and 33.9% of women, respectively. Documentation of cancer screening was also low, with cervical cancer screening documented for 56.8% of women, mammography for 65% (N = 26/40) of women, and colorectal cancer screening for 10% (N = 4/40) of women, where indicated. In multivariable models, women with private health insurance were less likely to have documented STI testing (OR 0.20; 95% CI 0.08 - 0.52), and, Hispanic women were less likely to have documented safe-sex counseling (OR 0.26; 95% CI 0.07 - 0.94). Conclusions HIV/AIDS providers should focus on the needs of all women for
Kouassi-M ’Bengue A
Full Text Available Objective: To evaluate the co-infection of hepatitis B virus (HBV and immune deficiency virus (HIV among clients consulting at the Voluntary Counseling and Testing Center (VCT Center of the Institut Pasteur de C ôte d ’Ivoire (IPCI. Methods: A cross-sectional study was conducted from April to June 2010 at the VCT of IPCI. All clients attending the VCT of IPCI for HIV test after having signed the informed consent form were included in the study. Venous blood samples were collected from the clients after an interview. Then the rapid tests for screening of HIV infection (Determine HIV 1/2 of Abbott and Genie II HIV-1/HIV-2, Bio-Rad were performed. As for hepatitis B surface antigen (HBsAg test, it was performed using ELISA test system using Monolisa HBsAg Ultra-Bio-Rad. Results: Of 278 samples analyzed, 30 were positive to antibody against HIV-1, giving a seroprevalence of about 10.8%, and 35 were positive to HBsAg, giving a seroprevalence of 12.6%. As for co-infection of HIV and HBV, it was 7/278 cases about 2.5%. Conclusions: It can be concluded that co-infection of HBV and HIV is relatively low among clients consulting at the VCT of the IPCI. Serological surveillance should be systematic in various HIV testing centers in the country. The use of rapid tests for detection of HBsAg allows a lot of tests to be realized. However, the choice of these tests depends on the evaluation results in reference laboratories and situation on ground.
... moments, thereby motivating godmothers and novice girls and young women to be more aware and take precautions to prevent HIV infection. Keywords: cultural beliefs; cultural practices; dialogical communication; ethnology; health knowledge; HIV education; social anthropology; Sofala Province; southern Africa; women
Knowledge and attitudes about HIV infection and prevention of mother to child transmission of HIV in an urban, low income community in Durban, South Africa: Perspectives of residents and health care volunteers.
... Article 2 Science Clips Daily Pill Can Prevent HIV Reaching people who could benefit from PrEP Language: ... Problem Many people at very high risk for HIV infection are not getting PrEP. PrEP is for ...
Hayes Richard J
Full Text Available Abstract Background Only four out of 31 completed randomized controlled trials (RCTs of HIV prevention strategies against sexual transmission have shown significant efficacy. Poor adherence may have contributed to the lack of effect in some of these trials. In this paper we explore the impact of various levels of adherence on measured efficacy within an RCT. Analysis We used simple quantitative methods to illustrate the impact of various levels of adherence on measured efficacy by assuming a uniform population in terms of sexual behavior and the binomial model for the transmission probability per partnership. At 100% adherence the measured efficacy within an RCT is a reasonable approximation of the true biological efficacy. However, as adherence levels fall, the efficacy measured within a trial substantially under-estimates the true biological efficacy. For example, at 60% adherence, the measured efficacy can be less than half of the true biological efficacy. Conclusion Poor adherence during a trial can substantially reduce the power to detect an effect, and improved methods of achieving and maintaining high adherence within trials are needed. There are currently 12 ongoing HIV prevention trials, all but one of which require ongoing user-adherence. Attention must be given to methods of maximizing adherence when piloting and designing RCTs and HIV prevention programmes.
Bukola Olateju Omolase
Full Text Available AIM: This study was designed to determine the acceptability of voluntary counselling and testing (VCT for HIV and identify possible barriers to its uptake amongst pregnant women in a Nigerian community. METHODS: One hundred and twenty seven consenting pregnant women attending antenatal clinic at Federal Medical Centre, Owo were randomly selected and interviewed by the authors and two trained assistants. The study was conducted between August and October, 2007. The information obtained with the aid of semi structured questionnaire included their bio data, awareness about VCT and vertical transmission of HIV-AIDS. Other information obtained included acceptability of VCT and barriers to its uptake. RESULT: Majority (85% were aware about vertical transmission of HIV, most (83.5% knew of VCT. They were predominantly willing to accept VCT (77.2% and were ready to recommend VCT to others(76.2%. The main identified barriers to uptake of voluntary counseling were fear of possible outcome (82.7% and risk of divorce (70.9%. CONCLUSION: Most respondents were aware of voluntary counselling and testing for HIV as well as the vertical transmission of HIV. Majority were willing to accept HIV test and recommend same to others. Barriers to uptake of HIV test included fear of possible outcome, lack of felt need, stigmatization and financial constraint. There is need to extend voluntary counselling and testing for HIV to all antenatal patients. [TAF Prev Med Bull 2010; 9(4.000: 309-314
Collier, Alizanne C.; van der Borght, Stefaan F. M.; Rinke de Wit, Tobias; Richards, Sarah C.; Feeley, Frank G.
Heineken Breweries launched a workplace HIV/AIDS program at its Rwanda subsidiary in September 2001. By January 25, 2005, 736/2,595 eligible individuals had reported for counseling and HIV testing: 380/521 employees (72.9%), 254/412 spouses (61.7%), 99/1,517 children (6.5%), and 3/145 retired
Toma, S; Sartori, M; Moayedoddin, B; Weber, K; Toutous Trellu, L; Canuto, A; Calmy, A
Despite improvement of life expectancy of human immunodeficiency virus (HIV) infected people since the implementation of antiretroviral treatment, psychological suffering prevails and needs to be considered as part of the treatment to guarantee its efficiency. Mental disorders and social stigmatization substantially affect patients' quality of life and their adherence to treatment. The article details the benefits of a routine screening for mental disorders within this population, who is often reluctant to consult psychiatric services. The different treatments provided by the Geneva University Hospital (HUG) are introduced. A clinical case report illustrates the relevance of a multidisciplinary care program and the role of the liaison psychiatry in this field.
Chama, C M; Audu, B M; Kyari, O
The human immunodeficiency virus (HIV) can be transmitted vertically through the placenta in utero, during labour and delivery and through breast milk. In Nigeria, about 5.8% of women attending antenatal clinics were HIV infected as of December 2002. It was projected that by the end of the year 2002, there were about 849,000 orphans resulting from AIDS and about 755,000 established paediatric AIDS in this country. Interventions to prevent mother-to-child transmission of HIV include voluntary counselling and testing (VCT), administration of antiretroviral drugs (ARV), modification of obstetric practices and infant feeding options in HIV infection. Over the period July 2002-June 2003, 262 pregnant women received VCT at the antenatal clinic of the University of Maiduguri Teaching Hospital, and 207 (79%) agreed to be tested. Thirty-one (11.8%) were HIV positive. The majority of the HIV positive mothers received nevirapine in labour while 35% had combination ARV drugs in pregnancy. All the infants received nevirapine suspension within 72 hours of delivery. Expensive and slow testing facilities, insufficient and inconsistent counsellors, lack of ARV drugs for both mother and baby as well as unaffordable caesarean delivery were some of the constraints being faced at this centre. It is recommended that the governments at various levels should show more commitment to the programme of preventing mother-to-child transmission of HIV.
Wilkie, P A; Markova, I; Naji, S A; Forbes, C D
The advent of AIDS not only signifies the emergence of a new disease that affects hitherto healthy members of the general population but also highlights many unresolved problems of people with haemophilia, a life-long genetic disorder of blood clotting. Although HIV infection and the threat of AIDS has been a tragedy for people with haemophilia, the reported study shows that in spite of recent technological advancement in treatment, problems caused by haemophilia as such are still devastating for some severely affected patients. The ability of people with haemophilia to cope with their daily living problems such as chronic and acute pain, stress in the family, difficulties with unemployment and social relationships affects their response to HIV/AIDS. These facts have important implications for their rehabilitation and counselling and raise questions about coping with HIV/AIDS for other risk groups.
This essay discusses the rationale for targeting HIV prevention programs to the general public, as opposed to focusing strictly on high-risk populations. The author first considers varying definitions of the term "general public," then explains the goal of general public education programs. Additionally, the author lays down the theoretical foundations of general audience education programs and weights related research findings. Finally, he offers recommendations for future practice. Noting the complex socioecological elements involved in health behavior, the author argues in favor of a broad definition for the general public. This broad outlook allows programs to still target high-risk population while not bypassing low-risk persons, who are sometimes treated as irrelevant because they do not contribute to excess morbidity or mortality. When it comes to HIV educational programs for the general public, their goals should be to instruct the public on how the virus is transmitted, to allay unfounded fears, and to increase the level of support for AIDS prevention and control. Such a program would require a theoretical basis drawn from multiple sources: health education, health communication, clinical and social psychology, and social marketing. The author concludes by proving recommendations designed to reinforce existing programs: 1) strengthen efforts to ensure that all people are educated about HIV and to encourage people to treat AIDS patients with compassion; 2) continue to explore for the most effective communication channels; 3) strengthen the communication infrastructure for those who are disenfranchised from health education; and 4) strengthen evaluation efforts of health communication programs.
Full Text Available Background: Acquired immunodeficiency may impose considerableconsequences on patients’ family behaviors towardthem. The objective of the present study was to investigatewhether a counseling program at Behavioral Counseling Centerin the city of Shiraz, Iran could change the attitude, knowledgeand behavior of patients' family members.Methods: 125 HIV/AIDS patients’ family members were interviewed,using a valid and reliable questionnaire before andafter performing counseling sessions at Behavioral CounselingCenter. The findings were analyzed using nonparametric tests.Results: The age of the participants was 40±13 years. Sixty fivepercent were female, 63% married and 79% educated. Forty fourpercent of participants had spousal relationships with their patients.Their knowledge about the main routes of HIV transmissionwere 9.76 ± 2.59 and10.64±0.88 before and after counseling,respectively (P=0.028. Supportive behaviors of families towardtheir patients reached to 79% after counseling compared with 44% before that (P=0.004. Belief to isolate the patients and thepractice of this approach at home dropped from 71% to 15% andfrom 29% to 7% after counseling, respectively (P0.05.Conclusion: Ongoing counseling for HIV/AIDS patients’ familiesat Behavioral Counseling Center of Shiraz did advance theirknowledge about AIDS and improved their attitude and behaviortoward their patients However, the counseling program didnot show remarkable success in some aspects such as the removalof fear about HIV spread in the family or the change ofthe patients’ wives attitude to have protected sex with their HIVinfected husbands.Iran J Med Sci 2010; 35(4: 287-292.
Peck, Robert; Fitzgerald, Daniel W; Liautaud, Bernard; Deschamps, Marie Marcelle; Verdier, Rose Irene; Beaulieu, Marie Eugene; GrandPierre, Reynold; Joseph, Patrice; Severe, Patrice; Noel, Francine; Wright, Peter; Johnson Jr, Warren D; Pape, Jean William
HIV voluntary counseling and testing (VCT) may be an effective strategy to prevent transmission of HIV in developing countries. Hypothesizing that primary care services and HIV VCT have synergistic benefits, we examine the feasibility, the demand, and the effect of integrating on-site primary care services into VCT at a stand-alone VCT center in Port au Prince, Haiti. Through a retrospective review of patient records, we describe the integration of primary care services at the Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) VCT center between1985 and 2000. Between 1985 and 1999, services for HIV care, tuberculosis care, treatment of sexually transmitted diseases, and reproductive health were sequentially integrated into HIV VCT at GHESKIO. The number of new people seeking voluntary counseling and testing at GHESKIO increased from 142 in 1985 to 8175 in 1999, with an increasing percentage of women, adolescents, symptom-free clients, and self-referred clients. Of new adults seeking VCT in 1999, the center was able to provide AIDS care to 17%, tuberculosis treatment to 6%, sexually transmitted infection management to 18%, and family planning to 19%. HIV transmission between discordant couples was 0 infections/100 follow-up years (95% CI, 0-3.2); vertical transmission from mother to child was 11 infections/100 live births (95% CI, 4.6-21.9); These rates are significantly lower than expected rates of transmission in Haiti. This report demonstrates the feasibility, demand, and effective synergy of integrating on-site primary care services into HIV VCT in Haiti. VCT is a good entry point for people in need of services for communicable diseases and reproductive health, and, reciprocally, services attract more people to VCT, including populations that are at high risk for HIV infection. This program is being duplicated elsewhere in Haiti and can serve as a model for other countries.
Evans, Catrin; Ndirangu, Eunice
In 2007 WHO/UNAIDS issued new HIV testing guidelines recommending 'provider-initiated HIV testing and counselling' (PITC). In contrast to existing 'voluntary counselling and testing' guidelines (whereby individuals self refer for testing), the PITC guidance recommends that, in countries with generalised epidemics, all patients are routinely offered an HIV test during clinical encounters. In sub-Saharan Africa, PITC aims to dramatically increase HIV testing rates so that PITC becomes a vehicle to increase access to HIV prevention and care. Nurses in this region work on the frontlines of HIV testing but have been neglected in related policy development. To provide an overview of the PITC policy guidance and to critically consider its implications for the nursing profession in sub-Saharan Africa. Policy documents and published and unpublished research were identified from organisational websites, electronic databases and conference proceedings. PITC has generated widespread debate about whether it is the right approach in a context of HIV-related stigma and lack of human/material resources. Key concerns are whether/how informed consent, privacy and confidentiality will be upheld in overstretched health care settings, and whether appropriate post-test counselling, treatment and support can be provided. Limited available evidence suggests that health systems factors and organisational/professional culture may create obstacles to effective PITC implementation. Specific findings are that: PITC greatly increases nurses' workload and work-related stress. Nurses are generally positive about PITC, but express the need for more training and managerial support. Health system constraints (lack of staff, lack of space) mean that nurses do not always have time to provide adequate counselling. A hierarchical and didactic nursing culture affects counselling quality and the boundaries between voluntary informed consent and coercion can become rather blurred. Nurses are particularly
Prison privatization is being increasingly discussed as an alternative that might help drive down the cost of corrections in Canada. An Australian conference recently addressed prison privatization. Australia has a long history with privatizing corrections and historically being the site of private penal colonies. Private and State-owned corporations own and manage Australian prisons and the balance of private and public sector activity within the prisons is discussed. HIV/AIDS care and prevention programs provide bleach distribution, education programs for staff and inmates, and safety training. Moral issues debating how much time and money is allocated to HIV/AIDS are addressed. Private operators of prisons have no financial incentive to educate, rehabilitate, or release prisoners.
Segan, C. J.; Borland, R.
This randomized controlled trial tested whether extended callback counselling that proactively engaged ex-smokers with the task of embracing a smoke-free lifestyle (four to six calls delivered 1-3 months after quitting, i.e. when craving levels and perceived need for help had declined) could reduce relapse compared with a revised version of…
Forum: Tuberculosis prevention in HIV-infected pregnant women in South Africa. CE Martin, V Black. Abstract. The high burden of HIV and tuberculosis (TB) among pregnant women in South Africa contributes to a high maternal mortality rate. Isoniazid preventive therapy (IPT) is recommended for the prevention of active TB ...
Misconceptions about how HIV can be transmitted or prevented often prevent individuals from making informed choices and taking appropriate action. The purpose of the research was to explore the socio-demographic and behavioural factors in Botswana that are associated with misconceptions about HIV prevention and ...
Van der Borght, Stefaan F; Schim van der Loeff, Maarten F; Clevenbergh, Philippe; Kabarega, Jean Pierre; Kamo, Emmanuel; van Cranenburgh, Katinka; Rijckborst, Henk; Lange, Joep M; Rinke de Wit, Tobias F
High uptake of HIV voluntary counseling and testing (VCT) services is important for the success of HIV workplace programs in sub-Saharan Africa. From 2001 onwards, Heineken, a multinational brewing company, implemented a comprehensive HIV prevention and treatment program for employees and their dependents of its African subsidiaries. Confidential in-house VCT is part of this program. VCT uptake dynamics over time, and factors associated with early uptake were studied. Between September 2001 and December 2007, 9723 adult beneficiaries were tested for HIV in 14 company sites in five African countries. Three hundred and seventy (3.8%) of tested persons were infected with HIV-1. During the first 12 months 1412 tests were done, compared to 8311 tests in the subsequent years. The annual average uptake of testing among eligible persons varied between 15 and 32%. The coverage was higher among female compared to male employees, and higher among female compared to male spouses. Distinct peaks in uptake were linked to specific local events. HIV-1 infected persons were significantly more likely to be tested in the early period. The proportion of HIV-1 infected persons among testees was 8.8% in the first 12 months compared to 3.0% in the subsequent period (p<0.001). HIV-1 infected persons diagnosed in the early period were in a more advanced clinical stage, and had a significantly lower CD4 count than those tested later (median CD4 count 227 vs. 314 cells/microl; p=0.002). In this workplace program, HIV-1 infected individuals came earlier for an HIV test than uninfected people, and people with advanced infection came earlier than those with less advanced disease. Employees' spouses are harder to reach than employees and extra efforts should be undertaken to reach them as well. Uptake of HIV testing can be actively influenced by educational or promotional activities.
An exploratory study of HIV-prevention advocacy by persons in HIV care in Uganda. Christopher Tumwine, Annet Nannungi, Eric Ssegujja, Nicolate Nekesa, Sarah Ssali, Lynn Atuyambe, Gery Ryan, Glenn Wagner ...
Baggaley, Rebecca F; White, Richard G; Boily, Marie-Claude
...) and its potential contribution to heterosexual spread. We assessed the per-act and per-partner HIV transmission risk from AI exposure for heterosexuals and MSM and its implications for HIV prevention...
Bott, Sarah; Neuman, Melissa; Helleringer, Stephane; Desclaux, Alice; Asmar, Khalil El; Obermeyer, Carla Makhlouf
The rapid scale-up of human immunodeficiency virus (HIV) testing, counselling and treatment throughout sub-Saharan Africa has raised questions about how to protect patients' rights to consent, confidentiality, counselling and care in resource-constrained settings. The Multi-country African Testing and Counselling for HIV (MATCH) study investigated client and provider experiences with different modes of testing in sub-Saharan Africa. One component of that study was a survey of 275 HIV service providers in Burkina Faso, Kenya and Uganda that gathered quantifiable indicators and qualitative descriptions using a standardized instrument. This article presents provider perspectives on the challenges of obtaining consent, protecting confidentiality, providing counselling and helping clients manage disclosure. It also explores health workers' fear of infection within the workplace and their reports on discrimination against HIV clients within health facilities. HIV care providers in Burkina Faso, Kenya and Uganda experienced substantial rewards from their work, including satisfaction from saving lives and gaining professional skills. They also faced serious resource constraints, including staff shortages, high workloads, lack of supplies and inadequate infrastructure, and they expressed concerns about accidental exposure. Health workers described heavy emotional demands from observing clients suffer emotional, social and health consequences of being diagnosed with HIV, and also from difficult ethical dilemmas related to clients who do not disclose their HIV status to those around them, including partners. These findings suggest that providers of HIV testing and counselling need more resources and support, including better protections against HIV exposure in the workplace. The findings also suggest that health facilities could improve care by increasing attention to consent, privacy and confidentiality and that health policy makers and ethicists need to address some
Full Text Available INTRODUCTION: Pregnancy and the postpartum period present important intervention opportunities. Counseling can leverage the motivation women have during this time to change behaviors that may negatively affect their health and the heath of their infants. METHODS: Pregnant women attending an antenatal clinic in South Africa were randomly allocated to treatment (n=733 and control arms (n=747. Treatment arm participants received enhanced HIV pre- and post-test counseling, legal support and access to support groups at baseline, which occurred at the first antenatal visit, and then six and ten weeks postpartum. Control arm participants received standard HIV testing and counseling (HTC and two postpartum attention control sessions. Outcomes were incidence of sexually transmitted infection (STI by 14 weeks postpartum and past 30-day inconsistent condom use at 14 weeks and 9 months postpartum. RESULTS: There were no intervention effects on incident STIs for either HIV-negative (adjusted risk ratio (aRR 1.01, 95% CI 0.71-1.44 or HIV-positive participants (aRR 0.86, 95% CI 0.61-1.23. The intervention was associated with a 28% decrease in risk of past 30-day inconsistent condom use at nine-months among HIV-negative women (aRR 0.72,95% CI 0.59-0.88, but did not affect inconsistent condom use among HIV-positive women (aRR1.08; 95% CI 0.67-1.75. DISCUSSION: An enhanced counseling intervention during pregnancy and the postpartum period can lead to reductions in inconsistent condom use among HIV-negative women. Results underscore the importance of the counseling that accompanies HIV HTC. More work is needed to understand how to promote and sustain risk reduction among HIV-positive women. TRIAL REGISTRATION: ClinicalTrials.gov NCT01683461.
Mboya, Beati; Temu, Florence; Awadhi, Bayoum; Ngware, Zubeda; Ndyetabura, Elly; Kiondo, Gloria; Maridadi, Janneth
Introduction Currently, Tanzania's HIV prevalence is 5.7%. Gender inequality and Gender Based Violence (GBV) are among factors fuelling the spread of HIV in Tanzania. This study was conducted to assess universal access to HIV prevention services among GBV survivors in Iringa and Dar-es-Salaam where HIV prevalence is as high as 14.7% and 9% respectively compared to a national average of 5.7%. Methods In 2010, a mixed methods study using triangulation model was conducted in Iringa and Dar-es-Salaam regions to represent rural and urban settings respectively. Questionnaires were administered to 283 randomly selected survivors and 37 health providers while 28 in-depth interviews and 16 focus group discussions were conducted among various stakeholders. Quantitative data was analyzed in SPSS by comparing descriptive statistics while qualitative data was analyzed using thematic framework approach. Results Counseling and testing was the most common type of HIV prevention services received by GBV survivors (29%). Obstacles for HIV prevention among GBV survivors included: stigma, male dominance culture and fear of marital separation. Bribery in service delivery points, lack of confidentiality, inadequate GBV knowledge among health providers, and fear of being involved in legal matters were mentioned to be additional obstacles to service accessibility by survivors. Reported consequences of GBV included: psychological problems, physical trauma, chronic illness, HIV infection. Conclusion GBV related stigma and cultural norms are obstacles to HIV services accessibility. Initiation of friendly health services, integration of GBV into HIV services and community based interventions addressing GBV related stigma and cultural norms are recommended. PMID:23467278
Thirty years into combating the spread of HIV through behaviour change interventions experience has grown in the application of multiple approaches from one-for-one counseling and small group workshops, information sessions, and activities to large-scale rallies and mass media campaigns with reducing the spread of ...
Pope, Diana S; Deluca, Andrea N; Kali, Paula; Hausler, Harry; Sheard, Carol; Hoosain, Ebrahim; Chaudhary, Mohammad A; Celentano, David D; Chaisson, Richard E
To determine whether implementation of provider-initiated human immunodeficiency virus (HIV) counseling would increase the proportion of tuberculosis (TB) patients who received HIV counseling and testing. Cluster-randomized trial with clinic as the unit of randomization. Twenty, medium-sized primary care TB clinics in the Nelson Mandela Metropolitan Municipality, Port Elizabeth, Eastern Cape Province, South Africa. A total of 754 adults (18 years and older) newly registered as TB patients in the 20 study clinics. Implementation of provider-initiated HIV counseling and testing. Percentage of TB patients HIV counseled and tested. SECONDARY: Percentage of patients with HIV test positive, and percentage of those who received cotrimoxazole and who were referred for HIV care. : A total of 754 adults newly registered as TB patients were enrolled. In clinics randomly assigned to implement provider-initiated HIV counseling and testing, 20.7% (73/352) patients were counseled versus 7.7% (31/402) in the control clinics (P = 0.011), and 20.2% (n = 71) versus 6.5% (n = 26) underwent HIV testing (P = 0.009). Of those patients counseled, 97% in the intervention clinics accepted testing versus 79% in control clinics (P = 0.12). The proportion of patients identified as HIV infected in intervention clinics was 8.5% versus 2.5% in control clinics (P = 0.044). Fewer than 40% of patients with a positive HIV test were prescribed cotrimoxazole or referred for HIV care in either study arm. Provider-initiated HIV counseling significantly increased the proportion of adult TB patients who received HIV counseling and testing, but the magnitude of the effect was small. Additional interventions to optimize HIV testing for TB patients urgently need to be evaluated.
Pope, Diana S.; DeLuca, Andrea N.; Kali, Paula; Hausler, Harry; Sheard, Carol; Hoosain, Ebrahim; Chaudhary, Mohammed A.; Celentano, David D.; Chaisson, Richard E.
Objective To determine whether implementation of provider-initiated HIV counseling would increase the proportion of tuberculosis patients that received HIV counseling and testing. Design Cluster-randomized trial with clinic as unit of randomization Setting Twenty, medium-sized primary care TB clinics in the Nelson Mandela Metropolitan Municipality, Port Elizabeth, Eastern Cape Province, South Africa Subjects A total of 754 adults (≥ 18 years) newly registered as tuberculosis patients the twenty study clinics Intervention Implementation of provider-initiated HIV counseling and testing. Main outcome measures Percentage of TB patients HIV counseled and tested. Secondary Percentage of patients HIV test positive and percentage of those that received cotrimoxazole and who were referred for HIV care. Results A total of 754 adults newly registered as tuberculosis patients were enrolled. In clinics randomly assigned to implement provider-initiated HIV counseling and testing, 20.7% (73/352) patients were counseled versus 7.7% (31/402) in the control clinics (p = 0.011), and 20.2 % (n = 71) versus 6.5% (n = 26) underwent HIV testing (p = 0.009). Of those patients counseled, 97% in the intervention clinics accepted testing versus 79% in control clinics (p =0.12). The proportion of patients identified as HIV-infected in intervention clinics was 8.5% versus 2.5% in control clinics (p=0.044). Fewer than 40% of patients with a positive HIV test were prescribed cotrimoxazole or referred for HIV care in either study arm. Conclusions Provider-initiated HIV counseling significantly increased the proportion of adult TB patients that received HIV counseling and testing, but the magnitude of the effect was small. Additional interventions to optimize HIV testing for TB patients urgently need to be evaluated. PMID:18520677
Eke, Agatha N.; Mezoff, Jane S.; Duncan, Ted; Sogolow, Ellen D.
Although HIV prevention researchers have conducted numerous controlled outcome studies to evaluate the effectiveness of theory-based interventions aimed at reducing HIV risk behaviors, many HIV risk reduction interventions are conducted not by researchers but by staff in local health departments or community-based organizations (CBOs). Despite…
Rotheram-Borus, Mary Jane; Lee, Martha B.; Murphy, Debra A.; Futterman, Donna; Duan, Naihua; Birnbaum, Jeffrey M.; Lightfoot, Marguerita
Examined HIV transmission behaviors and health practices among HIV-infected youths over 15 months following participation in a preventive intervention that emphasized coping with HIV and reducing risky behaviors. The intervention resulted in increases in social support coping and reductions in risky sexual and lifestyle behaviors specifically…
Background: Utilization of religious institutions is one of the strategies for HIV prevention in Uganda. There is limited data on the association between religiosity and HIV infection rates. Objective: To determine the association between religiosity and HIV prevalence rates among Christians. Methods: An unmatched ...
Combination HIV prevention options for young women in Africa. Cheryl Baxter, Salim Abdool Karim. Abstract. Although the number of new HIV infections has declined by over 30% in the past decade, the number of people who acquire HIV each year remains unacceptably high. In 2014 the Joint United Nations Programme ...
Bastos Francisco I
Full Text Available Abstract Background BED-EIA HIV-1 Incidence Test (BED-CEIA has been described as a tool to discriminate recent (RS from long-term (LTS seroconversion of HIV-1 infection, contributing to a better understanding of the dynamics of the HIV/AIDS epidemic over time. This study determined the prevalence, estimated incidence and HIV-1 subtype infection among individuals seeking testing in Voluntary Counseling and Testing centers (VCTs from Rio de Janeiro, Brazil. Methods Demographics and behavioral data were obtained from 434 individuals, diagnosed as HIV-positive among 9,008 volunteers screened from November 2004 to October 2005 in three VCTs located in the Rio de Janeiro Metropolitan area, Brazil. BED-CEIA protocol was performed to identify RS. DNA samples from RS and a subset of LTS (under a proportion of 1:2 were selected for gp120 C2-V3 and pol (protease and reverse transcriptase regions genomic sequencing. Results Overall HIV-1 prevalence was 4.8%. Sixty-one of 434 seropositive individuals were classified as RS, corresponding to an incidence rate of 1.68%/year (95%CI 1.26% -2.10%. Estimated incidence between Men Who Have Sex with Men (MSM was 11 times higher than among heterosexual men and 55% of the new cases were identified in volunteers aged 25-40 years. A similar distribution of different HIV-1 subtypes was found among RS and LTS. Conclusions Our data suggest that prevention for MSM remains a challenge and efforts focusing on prevention targeting this population should be prioritized. No significant changes in HIV-1 subtypes were observed among the RS and LTS subgroups. One case of HIV-1 AUK (pol/A (env recombinant genome was detected for the first time in Brazil.
de Castro, Carlos A Velasco; Grinsztejn, Beatriz; Veloso, Valdiléa G; Bastos, Francisco I; Pilotto, José H; Morgado, Mariza G
BED-EIA HIV-1 Incidence Test (BED-CEIA) has been described as a tool to discriminate recent (RS) from long-term (LTS) seroconversion of HIV-1 infection, contributing to a better understanding of the dynamics of the HIV/AIDS epidemic over time. This study determined the prevalence, estimated incidence and HIV-1 subtype infection among individuals seeking testing in Voluntary Counseling and Testing centers (VCTs) from Rio de Janeiro, Brazil. Demographics and behavioral data were obtained from 434 individuals, diagnosed as HIV-positive among 9,008 volunteers screened from November 2004 to October 2005 in three VCTs located in the Rio de Janeiro Metropolitan area, Brazil. BED-CEIA protocol was performed to identify RS. DNA samples from RS and a subset of LTS (under a proportion of 1:2) were selected for gp120 C2-V3 and pol (protease and reverse transcriptase) regions genomic sequencing. Overall HIV-1 prevalence was 4.8%. Sixty-one of 434 seropositive individuals were classified as RS, corresponding to an incidence rate of 1.68%/year (95%CI 1.26% -2.10%). Estimated incidence between Men Who Have Sex with Men (MSM) was 11 times higher than among heterosexual men and 55% of the new cases were identified in volunteers aged 25-40 years. A similar distribution of different HIV-1 subtypes was found among RS and LTS. Our data suggest that prevention for MSM remains a challenge and efforts focusing on prevention targeting this population should be prioritized. No significant changes in HIV-1 subtypes were observed among the RS and LTS subgroups. One case of HIV-1 AUK (pol)/A (env) recombinant genome was detected for the first time in Brazil.
Görig, Tatiana; Mayer, Manfred; Bock, Christina; Diehl, Katharina; Hilger, Jennifer; Herr, Raphael M; Schneider, Sven
Primary care physicians (PCPs) play an important role in the promotion of healthy dietary behaviour. However, little is known about the practice of and factors associated with the provision of dietary counselling in primary health care in Germany. To explore the attitudes towards and factors associated with the routine provision of dietary counselling in Germany using data from the nationwide, representative sample of the Physician Survey on Cardiovascular Disease Prevention. A total of 4074 randomly selected PCPs (response rate: 33.9%) provided data on dietary counselling for prevention of cardiovascular disease (CVD) based on the 5 A's (Assess, Advise, Agree, Assist, Arrange), attitudes towards dietary counselling and patients' and practice characteristics. While the majority of PCPs (86%) reported having high levels of competence in providing dietary advice, only 49% felt they had been successful in counselling their patients on nutrition. PCPs routinely asked (68%) and advised patients to change their dietary habits more frequently (77%) compared to other counselling techniques based on the 5 A's. Female physicians and those with a higher percentage of privately insured patients and patients at higher risk of CVD were more likely to use the 5 A's to routinely counsel their patients on nutrition. The data showed high levels of involvement by German PCPs in CVD prevention and dietary counselling. The rather low perceived success of dietary intervention and differences with respect to patients' health insurance status indicate a need to address both communication skills in medical training and appropriate reimbursement of preventive services. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Wenzel, Suzanne L; Rhoades, Harmony; Harris, Taylor; Winetrobe, Hailey; Rice, Eric; Henwood, Ben
Homeless persons suffer disproportionately high rates of HIV infection, and moving into permanent supportive housing (PSH) can provide a stable base from which to access needed prevention services. However, little is known about HIV risk or prevention behavior during this critical time of transition. The current study investigated STI and HIV risk and prevention behavior and recent use of prevention and treatment services (i.e., education, testing, medication) among homeless persons preparing to move into PSH. Data come from interviews with 421 homeless adults before they moved into PSH. Thirty-seven percent of the respondents were sexually active; of those, 75.7% reported unprotected sex. Nearly two-thirds (64%) reported past year HIV testing and 40% reported testing for another STI. Fewer than one-third (31%) of respondents reported receiving posttest counseling at their last HIV test. HIV seropositivity was self-reported by 10%. Among those persons who were HIV-positive, 57.1% reported less than 100% antiretroviral (ARV) adherence. Among HIV-negative respondents, less than 1% had been prescribed preexposure prophylaxis (PrEP). Less than half (46.4%) of the sample reported any HIV prevention education in the past year. This population of homeless adults about to move into PSH report high rates of HIV risk behavior, but low rates of HIV prevention education and very little PrEP utilization. Further, low rates of ARV adherence among HIV-positive respondents indicate significant risk for HIV transmission and acquisition. Entering PSH is a period of transition for homeless persons when integrated care is critically important to ensure positive health outcomes, but these data suggest that PrEP and other HIV prevention services are poorly accessed among this population. As such, multipronged services that integrate PrEP and other HIV prevention services are needed to prevent transmission and acquisition of HIV in this high-risk, vulnerable population and ensure the
Matovu, Joseph K B; Todd, Jim; Wanyenze, Rhoda K; Wabwire-Mangen, Fred; Serwadda, David
Studies show that uptake of couples' HIV counseling and testing (couples' HCT) can be affected by individual, relationship, and socioeconomic factors. However, while couples' HCT uptake can also be affected by background HIV prevalence and awareness of the existence of couples' HCT services, this is yet to be documented. We explored the correlates of previous couples' HCT uptake among married individuals in a rural Ugandan district with differing HIV prevalence levels. This was a cross-sectional study conducted among 2,135 married individuals resident in the three HIV prevalence strata (low HIV prevalence: 9.7-11.2%; middle HIV prevalence: 11.4-16.4%; and high HIV prevalence: 20.5-43%) in Rakai district, southwestern Uganda, between November 2013 and February 2014. Data were collected on sociodemographic and behavioral characteristics, including previous receipt of couples' HCT. HIV testing data were obtained from the Rakai Community Cohort Study. We conducted multivariable logistic regression analysis to identify correlates that are independently associated with previous receipt of couples' HCT. Data analysis was conducted using STATA (statistical software, version 11.2). Of the 2,135 married individuals enrolled, the majority (n=1,783, 83.5%) had been married for five or more years while (n=1,460, 66%) were in the first-order of marriage. Ever receipt of HCT was almost universal (n=2,020, 95%); of those ever tested, (n=846, 41.9%) reported that they had ever received couples' HCT. There was no significant difference in previous receipt of couples' HCT between low (n=309, 43.9%), middle (n=295, 41.7%), and high (n=242, 39.7%) HIV prevalence settings (p=0.61). Marital order was not significantly associated with previous receipt of couples' HCT. However, marital duration [five or more years vis-à-vis 1-2 years: adjusted odds ratio (aOR): 1.06; 95% confidence interval (95% CI): 1.04-1.08] and awareness about the existence of couples' HCT services within the Rakai
Joseph K. B. Matovu
Full Text Available Background: Studies show that uptake of couples’ HIV counseling and testing (couples’ HCT can be affected by individual, relationship, and socioeconomic factors. However, while couples’ HCT uptake can also be affected by background HIV prevalence and awareness of the existence of couples’ HCT services, this is yet to be documented. We explored the correlates of previous couples’ HCT uptake among married individuals in a rural Ugandan district with differing HIV prevalence levels. Design: This was a cross-sectional study conducted among 2,135 married individuals resident in the three HIV prevalence strata (low HIV prevalence: 9.7–11.2%; middle HIV prevalence: 11.4–16.4%; and high HIV prevalence: 20.5–43% in Rakai district, southwestern Uganda, between November 2013 and February 2014. Data were collected on sociodemographic and behavioral characteristics, including previous receipt of couples’ HCT. HIV testing data were obtained from the Rakai Community Cohort Study. We conducted multivariable logistic regression analysis to identify correlates that are independently associated with previous receipt of couples’ HCT. Data analysis was conducted using STATA (statistical software, version 11.2. Results: Of the 2,135 married individuals enrolled, the majority (n=1,783, 83.5% had been married for five or more years while (n=1,460, 66% were in the first-order of marriage. Ever receipt of HCT was almost universal (n=2,020, 95%; of those ever tested, (n=846, 41.9% reported that they had ever received couples’ HCT. There was no significant difference in previous receipt of couples’ HCT between low (n=309, 43.9%, middle (n=295, 41.7%, and high (n=242, 39.7% HIV prevalence settings (p=0.61. Marital order was not significantly associated with previous receipt of couples’ HCT. However, marital duration [five or more years vis-à-vis 1–2 years: adjusted odds ratio (aOR: 1.06; 95% confidence interval (95% CI: 1.04–1.08] and
Gollub, Erica L; Morrow, Kathleen M; Mayer, Kenneth H; Koblin, Beryl A; Peterside, Pamela Brown; Husnik, Marla J; Metzger, David S
New intervention models are needed for HIV prevention among drug-using women. The Women Fighting Infection Together (Women FIT) feasibility study enrolled 189 women in three U.S. cities (Providence, New York, Philadelphia) with drug-using histories, who also reported risky sexual behavior. Eligible women had participated previously in a yearlong study of HIV Counseling and Testing (HIV-CT) and limited case management. Two thirds of the sample were black, most were unemployed, and about two thirds reported prior or current crack use. Women were randomized into two groups. In one group, women participated in a manualized, four-session, peer-led, interactive group intervention that stressed body knowledge, woman-initiated HIV/sexually transmitted infection (HIV/STI) prevention, including a focus on women's health (reproductive health screening, sexual violence, self-breast examination, STI signs, symptoms), which aimed to increase comfort with and pride in their bodies. Control group women received HIV-CT enriched by female condom counseling. Outcomes included study retention, session attendance and ratings, changes in knowledge, and use of protection methods. The study successfully retained 95% of the participants for a 2-month follow-up. Positive assessments from participants and peer leaders exceeded preset thresholds for success. Pre-post changes in body knowledge (p women than the control women. The body empowerment model deserves further elaboration in interventions focusing on women at high risk of HIV/STI acquisition.
CIANELLI, ROSINA; FERRER, LILIAN; MCELMURRY, BEVERLY J.
Socio-cultural factors and HIV-related misinformation contribute to the increasing number of Chilean women living with HIV. In spite of this, and to date, few culturally specific prevention activities have been developed for this population. The goal of the present study was to elicit the perspectives of low-income Chilean women regarding HIV and relevant socio-cultural factors, as a forerunner to the development of a culturally appropriate intervention. As part of a mixed-methods study, fifty low-income Chilean women participated in a survey and twenty were selected to participate in prevention, in-depth interviews. Results show evidence of widespread misinformation and misconceptions related to HIV/AIDS. Machismo and marianismo offer major barriers to prevention programme development. Future HIV prevention should stress partner communication, empowerment and improving the education of women vulnerable to HIV. PMID:18432428
Teitelman, Anne M.; Bevilacqua, Amanda W.; Jemmott, Loretta Sweet
Background: Women and adolescent girls bear a significant burden of the global HIV pandemic. Both behavioral and biomedical prevention approaches have been shown to be effective. In order to foster the most effective combination HIV-prevention approaches for women and girls, it is imperative to understand the unique biological, social, and structural considerations that increase vulnerability to acquiring HIV within this population. Primary Study Objective: The purpose of this article is to propose novel ideas for personalized biobehavioral HIV prevention for women and adolescent girls. The central argument is that we must transcend unilevel solutions for HIV prevention toward comprehensive, multilevel combination HIV prevention packages to actualize personalized biobehavioral HIV prevention. Our hope is to foster transnational dialogue among researchers, practitioners, educators, and policy makers toward the actualization of the proposed recommendations. Methods: We present a commentary organized to review biological, social, and structural factors that increase vulnerability to HIV acquisition among women and adolescent girls. The overview is followed by recommendations to curb HIV rates in the target population in a sustainable manner. Results: The physiology of the lower female reproductive system biologically increases HIV risk among women and girls. Social (eg, intimate partner violence) and structural (eg, gender inequality) factors exacerbate this risk by increasing the likelihood of viral exposure. Our recommendations for personalized biobehavioral HIV prevention are to (1) create innovative mechanisms for personalized HIV risk—reduction assessments; (2) develop mathematical models of local epidemics; (3) prepare personalized, evidence-based combination HIV risk—reduction packages; (4) structure gender equity into society; and (5) eliminate violence (both physical and structural) against women and girls. Conclusions: Generalized programs and
Brawner, Bridgette M; Teitelman, Anne M; Bevilacqua, Amanda W; Jemmott, Loretta Sweet
Women and adolescent girls bear a significant burden of the global HIV pandemic. Both behavioral and biomedical prevention approaches have been shown to be effective. In order to foster the most effective combination HIV-prevention approaches for women and girls, it is imperative to understand the unique biological, social, and structural considerations that increase vulnerability to acquiring HIV within this population. The purpose of this article is to propose novel ideas for personalized biobehavioral HIV prevention for women and adolescent girls. The central argument is that we must transcend unilevel solutions for HIV prevention toward comprehensive, multilevel combination HIV prevention packages to actualize personalized biobehavioral HIV prevention. Our hope is to foster transnational dialogue among researchers, practitioners, educators, and policy makers toward the actualization of the proposed recommendations. We present a commentary organized to review biological, social, and structural factors that increase vulnerability to HIV acquisition among women and adolescent girls. The overview is followed by recommendations to curb HIV rates in the target population in a sustainable manner. The physiology of the lower female reproductive system biologically increases HIV risk among women and girls. Social (eg, intimate partner violence) and structural (eg, gender inequality) factors exacerbate this risk by increasing the likelihood of viral exposure. Our recommendations for personalized biobehavioral HIV prevention are to (1) create innovative mechanisms for personalized HIV risk-reduction assessments; (2) develop mathematical models of local epidemics; (3) prepare personalized, evidence-based combination HIV risk-reduction packages; (4) structure gender equity into society; and (5) eliminate violence (both physical and structural) against women and girls. Generalized programs and interventions may not have universal, transnational, and crosscultural
... NIAID's Biomedical HIV Prevention Research Communication Messages SUMMARY: In compliance with the... Collection: Title: Pretesting of NIAID's Biomedical HIV Prevention Research Communication Messages. Type of... biomedical HIV prevention research. The primary objectives of the pretests are to (1) Assess audience...
L.M. Kleijn; Dr. P.D.D.M. Roelofs; Dr. H.S. Miedema; Dr. M.N. Wagener; E.C.M. van Gorp
People living with HIV (PLWH) face various workrelated problems, such as stigma and physical difficulties. Health care professionals can help improve the employment situation of PLWH. Nurses who work in HIV care play a central role in the care of PLWH in the Netherlands. The aim of this
Sau, Mealiny Sokun; Balamane, Maya; Lurie, Mark; Harwell, Joseph; Welle, Emily; Mean, Chhivun; Cu-Uvin, Susan
Elimination of pediatric HIV requires a robust program for the prevention of mother-to-child transmission (PMTCT). The goal of this study was to assess the implementation of these services in Cambodia. This prospective study was conducted in Bantey Meanchey at 2 sites. Staff reviewed daily clinic and laboratory registration logs to gather data on PMTCT service access among antenatal women. A total of 12 140 pregnant women received antenatal care. Only 4034 (33.2%) received pre-HIV test counseling. Of which 3407 (84.5%) received an HIV test. Eighteen (94.7%) of 19 women testing HIV-seropositive received triple-combination antiretroviral (ARV) medication. Fifteen HIV-exposed infants were delivered during the study. One infant tested HIV positive and is on ARV medication. Acceptance for HIV testing was high among women who received pretest counseling. An increase in the number of counselors may improve the rates of HIV testing. Follow-up mechanisms targeting mother-baby pairs should focus on increasing timely service uptake in the public sector. © The Author(s) 2015.
Eaton, Lisa A; Kalichman, Seth C; Kenny, David A; Harel, Ofer
Project EXPLORE - a large-scale, behavioral intervention tested among men who have sex with men (MSM) at-risk for HIV infection - was generally deemed as ineffective in reducing HIV incidence. Using novel and more precise data analytic techniques we reanalyzed Project EXPLORE by including both direct and indirect paths of intervention effects. Data from 4296 HIV-negative MSM who participated in Project EXPLORE, which included 10 sessions of behavioral risk reduction counseling completed from 1999 to 2005, were included in the analysis. We reanalyzed the data to include parameters that estimate the over-time effects of the intervention on unprotected anal (UA) sex and the over-time effects of the intervention on HIV status mediated by UA sex simultaneously in a single model. We found the indirect effect of intervention on HIV infection through UA sex to be statistically significant up through 12-month post-intervention, OR = 0.83, 95% CI = 0.72-0.95. Furthermore, the intervention significantly reduced UA sex up through 18-month post-intervention, OR = 0.79, 95% CI = 0.63-0.99. Our results reveal effects not tested in the original model that offer new insight into the effectiveness of a behavioral intervention for reducing HIV incidence. Project EXPLORE demonstrated that when tested against an evidence-based, effective control condition can result in reductions in rates of HIV acquisition at one year follow-up. Findings highlight the critical role of addressing behavioral risk reduction counseling in HIV prevention.
Johns, Benjamin; Doroshenko, Olena; Tarantino, Lisa; Cowley, Peter
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.
Ruzagira, Eugene; Baisley, Kathy; Kamali, Anatoli; Biraro, Samuel; Grosskurth, Heiner
Home-based HIV counselling and testing (HBHCT) has the potential to increase HIV testing uptake in sub-Saharan Africa (SSA), but data on linkage to HIV care after HBHCT are scarce. We conducted a systematic review of linkage to care after HBHCT in SSA. Five databases were searched for studies published between 1st January 2000 and 19th August 2016 that reported on linkage to care among adults newly identified with HIV infection through HBHCT. Eligible studies were reviewed, assessed for risk of bias and findings summarised using the PRISMA guidelines. A total of 14 studies from six countries met the eligibility criteria; nine used specific strategies (point-of-care CD4 count testing, follow-up counselling, provision of transport funds to clinic and counsellor facilitation of HIV clinic visit) in addition to routine referral to facilitate linkage to care. Time intervals for ascertaining linkage ranged from 1 week to 12 months post-HBHCT. Linkage ranged from 8.2% [95% confidence interval (CI), 6.8-9.8%] to 99.1% (95% CI, 96.9-99.9%). Linkage was generally lower (80%) if additional strategies were used. Only one study assessed linkage by means of a randomised trial. Five studies had data on cotrimoxazole (CTX) prophylaxis and 12 on ART eligibility and initiation. CTX uptake among those eligible ranged from 0% to 100%. The proportion of persons eligible for ART ranged from 16.5% (95% CI, 12.1-21.8) to 77.8% (95% CI, 40.0-97.2). ART initiation among those eligible ranged from 14.3% (95% CI, 0.36-57.9%) to 94.9% (95% CI, 91.3-97.4%). Additional linkage strategies, whilst seeming to increase linkage, were not associated with higher uptake of CTX and/or ART. Most of the studies were susceptible to risk of outcome ascertainment bias. A pooled analysis was not performed because of heterogeneity across studies with regard to design, setting and the key variable definitions. Only few studies from SSA investigated linkage to care among adults newly diagnosed with HIV through
Full Text Available Background: Commercial sex plays an increasingly important role in China’s growing HIV and sexually transmitted infection (STI epidemics. In China, street-based sex workers (SSWs are a subgroup of female sex workers with a particularly high risk of HIV/STI infections but are neglected in responses to HIV. This study assesses changes in HIV voluntary counseling and testing (VCT utilization and high-risk sexual behaviors following a three-month HIV preventive intervention among SSWs in Chongqing, China. Methods: A three-month intervention was conducted by a team of peer educators, outreach workers from community-based organizations and health professionals. It mainly included distribution of free pamphlets and condoms and delivery of onsite and clinic-based VCT. Cross-sectional surveys were conducted prior to (n = 100 and immediately following (n = 112 the intervention to assess its impact. In-depth interviews were conducted among 12 SSWs after the intervention to further explore potential barriers to HIV prevention. Results: The intervention significantly increased SSWs’ participation in VCT (from 2.0%–15.2%, P < 0.001. Despite participants’ improved HIV-related knowledge level (from 24.0%–73.2%, P < 0.001, there were minimal changes in the levels of condom use with clients. Qualitative research revealed that fear of police arrest and stigma were the main barriers to VCT utilization. Low condom use was associated with family financial constraints, inadequate power in condom negotiation, low awareness and misconceptions of HIV infection risks. Conclusion: HIV intervention improved VCT utilization and knowledge but we did not observe an increase in condom use after this short intervention. SSWs faced substantial economic, social and environmental barriers to VCT utilization and condom use.
Young, Sean D
The recent availability of "big data" from social media and mobile technologies provides promise for development of new tools and methods to address the HIV epidemic. This manuscript presents recent work in this growing area of bioinformatics, digital epidemiology, and disease modeling, describes how it can be applied to address HIV prevention, and presents issues that need to be addressed prior to implementing a mobile technology big-data approach to HIV prevention. Copyright © 2014 Elsevier Inc. All rights reserved.
HIV thereby impacting HIV prevention. Effects of Stigma on HIV Prevention. Prevention of HIV is hampered by stigma in many ways. Due to stigma some people and governments have chosen to withhold information about preventing the transmission of HIV and have supported laws and policies that make the victims of.
Snyder, Hannah; Yeldandi, Vijay V.; Kumar, G. Prem; Liao, Chuanhong; Lakshmi, Vemu; Gandham, Sabitha R.; Muppudi, Uma; Oruganti, Ganesh; Schneider, John A.
In India, men who have sex with men (MSM) and truck drivers are high-risk groups that often do not access HIV testing due to stigma and high mobility. This study evaluated a field testing package (FTP) that identified HIV positive participants through video pre-test counseling, OraQuick oral fluid HIV testing, and telephonic post-test counseling…
The purpose of this study was to develop a core HIV/AIDS knowledge assessment (CHAKA) for students enrolled in counseling-related degree programs. Although there are studies that examined counseling HIV/AIDS knowledge, the instruments that were used were limited in ways that may compromise the accuracy of the inferences that were made. This study…
This podcast provides an overview of CDC's HIV prevention capacity building efforts with community-based organizations and health departments. Created: 7/29/2010 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Date Released: 7/29/2010.
Sep 3, 2017 ... Keywords: Faith-based organisations, HIV prevention strategies, systematic review. DOI: https://dx.doi.org/10.4314/ahs.v17i3.18. Cite as: Ochillo MA, Teijlingen EV, Hind M. Influence of faith-based organisations on HIV prevention strategies in Africa: a systematic review. .... Business Source Complete. 3. 12.
countries through the process of designing and implementing HIV/AIDS prevention trials. Activities include offering researchers a series of short courses on epidemiology and randomized controlled trials; building training capacity for HIV/AIDS prevention trials at two African universities and a nongovernmental organization.
The various CBOs can be partners in HIV/AIDS prevention, patient care/support and control programs. They may facilitate efforts to curb the spread of HIV through the expansion of awareness creation and prevention initiatives and also provide patient care and support. The kebele may act as forum for community initiatives ...
Kalichman, Seth C
... of New South Wales, Australia Rise Goldstein, Center for HIV Identiﬁcation, Prevention, and Treatment Services, Department of Psychiatry University of California, Los Angeles Lauren K. Gooden,...
Wang, Yuan; Guo, Jian; Lu, Wenli
Rapid HIV voluntary counselling and testing (RVCT) is an alternative method of standard HIV voluntary counselling and testing (SVCT). Less is known about whether RVCT improves the receipt rate of HIV test results among clients who seek HIV counselling and testing. We aimed to evaluate effectiveness of RVCT on result receipt rate. We conducted a comprehensive search of databases containing Medline, EBSCO, Web of science, and Cochrane library to identify studies published up to August 2012. Reviewers extracted information independently. Risk of bias was evaluated with Cochrane Collaboration's tool for assessing study quality. Five randomised controlled trials were included and analysed for the result receipt rate using a random-effects model. The pooled receipt rate of HIV test results in the RVCT was significantly higher than in the SVCT (RR = 1.74, 95% CI = 1.47-2.07). Our results suggest RVCT as a favourable method to increase the receipt of HIV test results. Only two included studies assessed the modification of risk behaviour after HIV-CT in a different manner; also, the sample size was small in the current meta-analysis. In future research, it is necessary to confirm the effect of RVCT on disinhibition of post-test risk behaviour. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Gahagan, Jacqueline C; Fuller, Janice L; Delpech, Valerie C; Baxter, Larry N; Proctor-Simms, E Michelle
Nova Scotia, as a small province in Atlantic Canada, provides health care professionals and policy analysts with unique challenges for developing and implementing a strategy for accessible and acceptable HIV counselling and testing. Despite universal health care in Canada, barriers and challenges persist in relation to HIV counselling and testing programs and services in Nova Scotia. It is therefore necessary to examine the unique circumstances in the provision of programs and services in Nova Scotia prior to the possibility of adopting international HIV counselling and testing standards and guidelines being implemented in other jurisdictions. Nova Scotia's provincial strategy on HIV/AIDS promotes a harm-reduction approach for different populations in various service settings, recognizing the diverse circumstances and experiences of people living in Nova Scotia. By contrast, the Centers for Disease Control (CDC) recommended strategy promotes opt-out testing and in some instances alters the requirement of informed consent. As the Public Health Agency of Canada (PHAC) revises the national HIV counselling and testing policies, it is imperative to address the unique characteristics of Nova Scotia's provision of services, and how divergent strategies have the potential to address or compound the barriers to access that exist in this province's communities.
Kamali, Anatoli; Price, Matt A; Lakhi, Shabir; Karita, Etienne; Inambao, Mubiana; Sanders, Eduard J; Anzala, Omu; Latka, Mary H; Bekker, Linda-Gail; Kaleebu, Pontiano; Asiki, Gershim; Ssetaala, Ali; Ruzagira, Eugene; Allen, Susan; Farmer, Paul; Hunter, Eric; Mutua, Gaudensia; Makkan, Heeran; Tichacek, Amanda; Brill, Ilene K; Fast, Pat; Stevens, Gwynn; Chetty, Paramesh; Amornkul, Pauli N; Gilmour, Jill
HIV epidemiology informs prevention trial design and program planning. Nine clinical research centers (CRC) in sub-Saharan Africa conducted HIV observational epidemiology studies in populations at risk for HIV infection as part of an HIV prevention and vaccine trial network. Annual HIV incidence ranged from below 2% to above 10% and varied by CRC and risk group, with rates above 5% observed in Zambian men in an HIV-discordant relationship, Ugandan men from Lake Victoria fishing communities, men who have sex with men, and several cohorts of women. HIV incidence tended to fall after the first three months in the study and over calendar time. Among suspected transmission pairs, 28% of HIV infections were not from the reported partner. Volunteers with high incidence were successfully identified and enrolled into large scale cohort studies. Over a quarter of new cases in couples acquired infection from persons other than the suspected transmitting partner.
Full Text Available HIV epidemiology informs prevention trial design and program planning. Nine clinical research centers (CRC in sub-Saharan Africa conducted HIV observational epidemiology studies in populations at risk for HIV infection as part of an HIV prevention and vaccine trial network. Annual HIV incidence ranged from below 2% to above 10% and varied by CRC and risk group, with rates above 5% observed in Zambian men in an HIV-discordant relationship, Ugandan men from Lake Victoria fishing communities, men who have sex with men, and several cohorts of women. HIV incidence tended to fall after the first three months in the study and over calendar time. Among suspected transmission pairs, 28% of HIV infections were not from the reported partner. Volunteers with high incidence were successfully identified and enrolled into large scale cohort studies. Over a quarter of new cases in couples acquired infection from persons other than the suspected transmitting partner.
Kamali, Anatoli; Price, Matt A.; Lakhi, Shabir; Karita, Etienne; Inambao, Mubiana; Sanders, Eduard J.; Anzala, Omu; Latka, Mary H.; Bekker, Linda-Gail; Kaleebu, Pontiano; Asiki, Gershim; Ssetaala, Ali; Ruzagira, Eugene; Allen, Susan; Farmer, Paul; Hunter, Eric; Mutua, Gaudensia; Makkan, Heeran; Tichacek, Amanda; Brill, Ilene K.; Fast, Pat; Stevens, Gwynn; Chetty, Paramesh; Amornkul, Pauli N.; Gilmour, Jill
HIV epidemiology informs prevention trial design and program planning. Nine clinical research centers (CRC) in sub-Saharan Africa conducted HIV observational epidemiology studies in populations at risk for HIV infection as part of an HIV prevention and vaccine trial network. Annual HIV incidence ranged from below 2% to above 10% and varied by CRC and risk group, with rates above 5% observed in Zambian men in an HIV-discordant relationship, Ugandan men from Lake Victoria fishing communities, men who have sex with men, and several cohorts of women. HIV incidence tended to fall after the first three months in the study and over calendar time. Among suspected transmission pairs, 28% of HIV infections were not from the reported partner. Volunteers with high incidence were successfully identified and enrolled into large scale cohort studies. Over a quarter of new cases in couples acquired infection from persons other than the suspected transmitting partner. PMID:25602351
Mutchler, Matt G; McDavitt, Bryce; Ghani, Mansur A; Nogg, Kelsey; Winder, Terrell J A; Soto, Juliana K
Biomedical HIV prevention strategies, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), represent new opportunities to reduce critically high HIV infection rates among young black men who have sex with men (YBMSM). We report results of 24 dyadic qualitative interviews (N=48), conducted in Los Angeles, CA, exploring how YBMSM and their friends view PrEP and PEP. Interviews were analyzed using a grounded theory approach. Participants had widely divergent levels of knowledge about these prevention methods. Misconceptions and mistrust regarding PrEP were common, and concerns were expressed about PrEP-related stigma and the potential for gossip among peers who might assume a person on PrEP was HIV-positive. Yet participants also framed PrEP and PEP as valuable new options within an expanded "tool kit" of HIV prevention strategies that created possibilities for preventing new HIV infections, dating men with a different HIV status, and decreased anxiety about exposure to HIV. We organized themes around four main areas: (1) information and misinformation about biomedical HIV prevention; (2) expectations about PrEP, sexual behavior, and stigma; (3) gossip, disclosure, and "spreading the word" about PrEP and PEP; and (4) the roles of PrEP and PEP in an expanded HIV prevention tool kit. The findings suggest a need for guidance in navigating the increasingly complex array of HIV-prevention options available to YBMSM. Such "prevention navigation" could counter misconceptions and address barriers, such as stigma and mistrust, while helping YBMSM make informed selections from among expanded HIV prevention options.
Fasula, Amy M; Fogel, Catherine I; Gelaude, Deborah; Carry, Monique; Gaiter, Juarlyn; Parker, Sharon
Incarcerated women are a critical population for targeted HIV/STI prevention programming; however, there is a dearth of evidence-based, genderspecific behavioral interventions for this population. Systematically adapting existing evidence-based interventions (EBIs) can help fill this gap. We illustrate the adaptation of the HIV/STI prevention EBI, Project Safe, for use among incarcerated women and delivery in prisons. Project POWER, the final adapted intervention, was developed using formative research with prison staff and administration, incarcerated and previously incarcerated women, and input of community advisory boards. Intervention delivery adaptations included: shorter, more frequent intervention sessions; booster sessions prior to and just after release; facilitator experience in prisons and counseling; and new videos. Intervention content adaptations addressed issues of empowerment, substance use, gender and power inequity in relationships, interpersonal violence, mental health, reentry, and social support. This illustration of the adaption process provides information to inform additional efforts to adapt EBIs for this underserved population.
McCreary, Linda L; Kaponda, Chrissie P N; Davis, Kristina; Kalengamaliro, Mary; Norr, Kathleen F
Behavioral change interventions using peer group leaders are effective and widely used, but few studies have examined how being a peer group leader affects the leaders. This study describes how participants felt being a peer group leader affected their lives. This descriptive qualitative study interviewed 18 experienced peer group leaders who had conducted a multisession human immunodeficiency virus (HIV) prevention peer group intervention in rural Malawi. We used inductive content analysis and comparisons within and between cases. Three major themes were identified. All leaders said they experienced personal changes in their knowledge, attitudes, or HIV prevention behaviors. They described interacting with family, neighbors, and friends, and speaking at church or community meetings, to discuss HIV prevention issues. They increased their self-efficacy to engage others in sensitive HIV prevention issues, developed a self-identity as a change agent, and came to be recognized in their community as trustworthy advisors about HIV and acquired immunodeficiency syndrome. These three themes, taken together, form the meta-theme of psychological empowerment. Being a peer group leader empowered the leaders as change agents for HIV prevention and had impacts in the community after the intervention ended, potentially increasing the long-term effectiveness and cost effectiveness of peer group interventions. Healthcare workers and community volunteers who led HIV prevention sessions continued HIV prevention activities in the community and workplace after the program ended. Training health workers as volunteer HIV prevention leaders offers a strategy to bring HIV prevention to limited-resource settings, despite health worker shortages. © 2013 Sigma Theta Tau International.
Full Text Available Behavioral interventions can prevent the transmission of HIV and sexually transmitted infections. This systematic review and meta-analysis assesses the effectiveness and quality of available evidence of HIV prevention interventions for people living with HIV in high-income settings. Searches were conducted in MEDLINE, EMBASE, PsycINFO, and CDC Compendium of Effective Interventions. Interventions published between January, 1998 and September, 2015 were included. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE. Forty-six articles and 63 datasets involving 14,096 individuals met inclusion criteria. Included articles were grouped by intervention type, comparison group and outcome. Few of these had high or moderate quality of evidence and statistically significant effects. One intervention type, group-level health education interventions, were effective in reducing HIV/STI incidence when compared to attention controls. A second intervention type, comprehensive risk counseling and services, was effective in reducing sexual risk behaviors when compared to both active and attention controls. All other intervention types showed no statistically significant effect or had low or very low quality of evidence. Given that the majority of interventions produced low or very low quality of evidence, researchers should commit to rigorous evaluation and high quality reporting of HIV intervention studies.
Ciann Wilson; Vanessa Oliver; Sarah Flicker; Native Youth Sexual Health Network; Tracey Prentice; Randy Jackson; June Larkin; Jean-Paul Restoule; Claudia Mitchell
This article explores the ways in which (a) Indigenous youth involved in an HIV intervention took up and reclaimed their cultures as a project of defining ‘self’, and (b) how Indigenous ‘culture’ can be used as a tool for resistance, HIV prevention and health promotion. Data were drawn from the Taking Action Project: Using arts-based approaches to develop Aboriginal youth leadership in HIV prevention. ‘By youth, for youth’ HIV education and awareness workshops were facilitated in six Indigeno...
Dagnan, N'cho Simplice; Tiembré, Issaka; Bi Vroh, Joseph Benié; Diaby, Badara; Zengbe-Acray, Pétronille; Attoh-Touré, Harvey; Adjoua, Didier; Ekra, Kouadio Daniel; Tagliante-Saracino, Janine
In Côte d'Ivoire, HIV testing and counselling has been identified as a priority in the National 2006-2010 AIDS Strategic Plan, which is designed to evaluate the prevalence of HIV in rural areas measured by means of a mobile strategy. We conducted a cross-sectional descriptive and analytical study from 1st April, 2007 to 31st March 2008 in six rural areas of Côte d'Ivoire: Dabou, San Pedro, Abengourou, Tanda, Daloa, and Soubré*. The study population consisted of subjects attending the mobile voluntary counselling and testing units. The mean prevalence of HIV infection in this study was 5.30%. The mean prevalence rate in men was 5.26%, with a peak of 7.55% in the 30-34 years age-group. The mean prevalence rate in women was 5.35%, with a peak of 6.59% in the same age-group. Type HIV-1 was predominant (84.2% of the total). The most affected area was Dabou, with a rate three times higher (15.83%) than the average rate observed during the study. More educated people (university level) presented 3.5-fold (for men) or 6-fold (for women) higher infection rates than illiterate people. Although 100% of people who tested positive received a medical or community referral according to their specific needs, only 62.1% were first-line referred for medical care. In the light of the results of this study, we believe that community mobilization must be redirected to the most severely affected populations to facilitate earlier diagnosis. Actions such as training and prevention based on communication to encourage changes of behaviour should therefore be priorities in the national counselling and testing programme.
Full Text Available HIV counseling and testing (HCT has been prioritized as one of the prevention strategies for HIV/AIDS, and promoted as an essential tool in scaling up and improving access to treatment, care and support especially in community settings. Home-based HCT (HBHCT is a model that has consistently been found to be highly acceptable and has improved HCT coverage and uptake in low- and middle-income countries since 2002. It involves trained lay counselors going door-to-door offering pre-test counseling and providing HCT services to consenting eligible household members. Currently, there are few studies reporting on the quality of HBHCT services offered by lay counselors especially in Sub-Saharan Africa, including South Africa. This is a quantitative descriptive sub-study of a community randomized trial (Good Start HBHCT trial which describes the quality of HBHCT provided by lay counselors. Quality of HBHCT was measured as scores comparing observed practice to prescribed protocols using direct observation. Data were collected through periodic observations of HCT sessions and exit interviews with clients. Counselor quality scores for pre-test counseling and post-test counseling sessions were created to determine the level of quality. For the client exit interviews a continuous score was created to assess how satisfied the clients were with the counseling session. A total of 196 (3% observational assessments and 406 (6% client exit interviews were completed. Overall, median scores for quality of counseling and testing were high for both HIV-negative and HIV-positive clients. For exit interviews all 406 (100% clients had overall satisfaction with the counseling and testing services they received, however 11% were concerned about the counselor keeping their discussion confidential. Of all 406 clients, 393 (96.8% intended to recommend the service to other people. In ensuring good quality HCT services, ongoing quality assessments are important to monitor
Magasana, Vuyolwethu; Zembe, Wanga; Tabana, Hanani; Naik, Reshma; Jackson, Debra; Swanevelder, Sonja; Doherty, Tanya
HIV counseling and testing (HCT) has been prioritized as one of the prevention strategies for HIV/AIDS, and promoted as an essential tool in scaling up and improving access to treatment, care and support especially in community settings. Home-based HCT (HBHCT) is a model that has consistently been found to be highly acceptable and has improved HCT coverage and uptake in low- and middle-income countries since 2002. It involves trained lay counselors going door-to-door offering pre-test counseling and providing HCT services to consenting eligible household members. Currently, there are few studies reporting on the quality of HBHCT services offered by lay counselors especially in Sub-Saharan Africa, including South Africa. This is a quantitative descriptive sub-study of a community randomized trial (Good Start HBHCT trial) which describes the quality of HBHCT provided by lay counselors. Quality of HBHCT was measured as scores comparing observed practice to prescribed protocols using direct observation. Data were collected through periodic observations of HCT sessions and exit interviews with clients. Counselor quality scores for pre-test counseling and post-test counseling sessions were created to determine the level of quality. For the client exit interviews a continuous score was created to assess how satisfied the clients were with the counseling session. A total of 196 (3%) observational assessments and 406 (6%) client exit interviews were completed. Overall, median scores for quality of counseling and testing were high for both HIV-negative and HIV-positive clients. For exit interviews all 406 (100%) clients had overall satisfaction with the counseling and testing services they received, however 11% were concerned about the counselor keeping their discussion confidential. Of all 406 clients, 393 (96.8%) intended to recommend the service to other people. In ensuring good quality HCT services, ongoing quality assessments are important to monitor quality of HCT
Cianelli, Rosina; Ferrer, Lilian; McElmurry, Beverly J
Socio-cultural factors and HIV-related misinformation contribute to the increasing number of Chilean women living with HIV. In spite of this, and to date, few culturally specific prevention activities have been developed for this population. The goal of the present study was to elicit the perspectives of low-income Chilean women regarding HIV and relevant socio-cultural factors, as a forerunner to the development of a culturally appropriate intervention. As part of a mixed-methods study, fifty low-income Chilean women participated in a survey and twenty were selected to participate in prevention, in-depth interviews. Results show evidence of widespread misinformation and misconceptions related to HIV/AIDS. Machismo and marianismo offer major barriers to prevention programme development. Future HIV prevention should stress partner communication, empowerment and improving the education of women vulnerable to HIV.
Full Text Available There is a substantial burden of HIV infection among older children in sub-Saharan Africa, the majority of whom are diagnosed after presentation with advanced disease. We investigated the provision and uptake of provider-initiated HIV testing and counselling (PITC among children in primary health care facilities, and explored health care worker (HCW perspectives on providing HIV testing to children.Children aged 6 to 15 y attending six primary care clinics in Harare, Zimbabwe, were offered PITC, with guardian consent and child assent. The reasons why testing did not occur in eligible children were recorded, and factors associated with HCWs offering and children/guardians refusing HIV testing were investigated using multivariable logistic regression. Semi-structured interviews were conducted with clinic nurses and counsellors to explore these factors. Among 2,831 eligible children, 2,151 (76% were offered PITC, of whom 1,534 (54.2% consented to HIV testing. The main reasons HCWs gave for not offering PITC were the perceived unsuitability of the accompanying guardian to provide consent for HIV testing on behalf of the child and lack of availability of staff or HIV testing kits. Children who were asymptomatic, older, or attending with a male or a younger guardian had significantly lower odds of being offered HIV testing. Male guardians were less likely to consent to their child being tested. 82 (5.3% children tested HIV-positive, with 95% linking to care. Of the 940 guardians who tested with the child, 186 (19.8% were HIV-positive.The HIV prevalence among children tested was high, highlighting the need for PITC. For PITC to be successfully implemented, clear legislation about consent and guardianship needs to be developed, and structural issues addressed. HCWs require training on counselling children and guardians, particularly male guardians, who are less likely to engage with health care services. Increased awareness of the risk of HIV infection
Tabana, Hanani; Nkonki, Lungiswa; Hongoro, Charles; Doherty, Tanya; Ekström, Anna Mia; Naik, Reshma; Zembe-Mkabile, Wanga; Jackson, Debra; Thorson, Anna
There is growing evidence concerning the acceptability and feasibility of home-based HIV testing. However, less is known about the cost-effectiveness of the approach yet it is a critical component to guide decisions about scaling up access to HIV testing. This study examined the cost-effectiveness of a home-based HIV testing intervention in rural South Africa. Two alternatives: clinic and home-based HIV counselling and testing were compared. Costs were analysed from a provider's perspective for the period of January to December 2010. The outcome, HIV counselling and testing (HCT) uptake was obtained from the Good Start home-based HIV counselling and testing (HBHCT) cluster randomised control trial undertaken in KwaZulu-Natal province. Cost-effectiveness was estimated for a target population of 22,099 versus 23,864 people for intervention and control communities respectively. Average costs were calculated as the cost per client tested, while cost-effectiveness was calculated as the cost per additional client tested through HBHCT. Based on effectiveness of 37% in the intervention (HBHCT) arm compared to 16% in control arm, home based testing costs US$29 compared to US$38 per person for clinic HCT. The incremental cost effectiveness per client tested using HBHCT was $19. HBHCT was less costly and more effective. Home-based HCT could present a cost-effective alternative for rural 'hard to reach' populations depending on affordability by the health system, and should be considered as part of community outreach programs.
Full Text Available Most HIV infections in Africa are acquired by married/cohabiting adults and WHO recommends couple's voluntary HIV counseling and testing (CVCT for prevention. The handover from NGO-sponsored weekend CVCT to government-sponsored services in routine weekday antenatal care (ANC and individual voluntary testing and counseling (VCT services in Zambia's two largest cities from 2009-2015 is described.Government clinic counselors were trained to provide CVCT, and along with community health workers they promoted CVCT services in their clinic and surrounding areas. When client volume exceeded the capacity of on-duty staff in ANC and VCT, non-governmental organization (NGO subsidies were offered for overtime pay.Implementation of routine CVCT services varied greatly by clinic and city. The 12 highest volume clinics were examined further, while 13 clinics had CVCT numbers that were too low to warrant further investigation. In Lusaka, the proportion of pregnant women whose partners were tested rose from 2.6% in 2009 to a peak of 26.2% in 2012 and 24.8% in 2015. Corresponding reports in Ndola were 2.0% in 2009, 17.0% in 2012 and 14.5% in 2015. Obstacles to CVCT included: limited space and staffing, competing priorities, record keeping not adapted for couples, and few resources for promotion and increasing male involvement. Conflicting training models for 'partner testing' with men and women separately vs. CVCT with joint post-test counseling led to confusion in reporting to district health authorities.A focused and sustained effort will be required to reach a meaningful number of couples with CVCT to prevent heterosexual and perinatal HIV transmission. Establishing targets and timelines, funding for dedicated and appropriately trained staff, adoption of standardized data recording instruments with couple-level indicators, and expansion of community and clinic-based promotions using proven models are recommended.
Inambao, Mubiana; Kilembe, William; Canary, Lauren A; Czaicki, Nancy L; Kakungu-Simpungwe, Matilda; Chavuma, Roy; Wall, Kristin M; Tichacek, Amanda; Pulerwitz, Julie; Thior, Ibou; Chomba, Elwyn; Allen, Susan A
Most HIV infections in Africa are acquired by married/cohabiting adults and WHO recommends couple's voluntary HIV counseling and testing (CVCT) for prevention. The handover from NGO-sponsored weekend CVCT to government-sponsored services in routine weekday antenatal care (ANC) and individual voluntary testing and counseling (VCT) services in Zambia's two largest cities from 2009-2015 is described. Government clinic counselors were trained to provide CVCT, and along with community health workers they promoted CVCT services in their clinic and surrounding areas. When client volume exceeded the capacity of on-duty staff in ANC and VCT, non-governmental organization (NGO) subsidies were offered for overtime pay. Implementation of routine CVCT services varied greatly by clinic and city. The 12 highest volume clinics were examined further, while 13 clinics had CVCT numbers that were too low to warrant further investigation. In Lusaka, the proportion of pregnant women whose partners were tested rose from 2.6% in 2009 to a peak of 26.2% in 2012 and 24.8% in 2015. Corresponding reports in Ndola were 2.0% in 2009, 17.0% in 2012 and 14.5% in 2015. Obstacles to CVCT included: limited space and staffing, competing priorities, record keeping not adapted for couples, and few resources for promotion and increasing male involvement. Conflicting training models for 'partner testing' with men and women separately vs. CVCT with joint post-test counseling led to confusion in reporting to district health authorities. A focused and sustained effort will be required to reach a meaningful number of couples with CVCT to prevent heterosexual and perinatal HIV transmission. Establishing targets and timelines, funding for dedicated and appropriately trained staff, adoption of standardized data recording instruments with couple-level indicators, and expansion of community and clinic-based promotions using proven models are recommended.
Prokhorov, Alexander V; Wetter, David W; Padgett, Diana; de, Moor Carl; Le, Tao; Kitzman, Heather
The use of spit tobacco (ST) products is a serious public health problem in the United States. Use of ST is associated with increased risk of oral cancer, gastrointestinal neoplasms, and other deleterious effects. The prevalence of ST use among adolescents is high in many areas, especially in predominantly rural states (e.g., South Dakota, Montana). Community-wide efforts aimed at prevention and cessation of ST use among young people are needed. A total of 4089 clinicians and educators were surveyed in 1998 regarding their personal ST use and several other characteristics associated with ST prevention and cessation counseling. Educators reported significantly higher rates of ST use than did clinicians. The most prevalent barriers to ST counseling among clinicians were perceptions of patient resistance to referral to ST cessation programs and the lack of community services that effectively treat ST use. Lack of training was a major barrier to ST counseling among all educator subgroups. Although knowledge of the health effects of ST was fairly high among all subgroups, more than 10% of dentists and dental hygienists failed to report that ST use causes gum disease. Most clinicians believed that they should demonstrate leadership in efforts aimed at ST control; however, only 64% of dentists believed that repeated counseling attempts were necessary with patients who continued to use ST. Compared with clinicians, educators generally felt less obligated to provide ST counseling. Eighty percent of physicians reported counseling activities, but fewer than half of the dental professionals did. More than 75% of Drug Abuse Resistance Education (DARE) officers reported having delivered ST counseling, whereas only 4% of volunteer leaders did. Fewer than 50% of educators believed that the ST program they taught was effective. Training of various professionals in ST interventions may benefit from emphasizing different issues (reduction of personal ST use, knowledge, commitment
Limiting access to some methods of suicide, a strategy known as means restriction, is gaining support among mental-health researchers. Some suicides can be prevented, the logic goes, if it is more challenging for an impulsive individual to harm himself. But on most campuses, that strategy has not taken hold. Instead, counseling and education tend…
Lippman, Sheri A; Maman, Suzanne; MacPhail, Catherine; Twine, Rhian; Peacock, Dean; Kahn, Kathleen; Pettifor, Audrey
Community mobilizing strategies are essential to health promotion and uptake of HIV prevention. However, there has been little conceptual work conducted to establish the core components of community mobilization, which are needed to guide HIV prevention programming and evaluation. We aimed to identify the key domains of community mobilization (CM) essential to change health outcomes or behaviors, and to determine whether these hypothesized CM domains were relevant to a rural South African setting. We studied social movements and community capacity, empowerment and development literatures, assessing common elements needed to operationalize HIV programs at a community level. After synthesizing these elements into six essential CM domains, we explored the salience of these CM domains qualitatively, through analysis of 10 key informant in-depth-interviews and seven focus groups in three villages in Bushbuckridge. CM DOMAINS INCLUDE: 1) shared concerns, 2) critical consciousness, 3) organizational structures/networks, 4) leadership (individual and/or institutional), 5) collective activities/actions, and 6) social cohesion. Qualitative data indicated that the proposed domains tapped into theoretically consistent constructs comprising aspects of CM processes. Some domains, extracted from largely Western theory, required little adaptation for the South African context; others translated less effortlessly. For example, critical consciousness to collectively question and resolve community challenges functioned as expected. However, organizations/networks, while essential, operated differently than originally hypothesized - not through formal organizations, but through diffuse family networks. To date, few community mobilizing efforts in HIV prevention have clearly defined the meaning and domains of CM prior to intervention design. We distilled six CM domains from the literature; all were pertinent to mobilization in rural South Africa. While some adaptation of specific
Sheri A Lippman
Full Text Available Community mobilizing strategies are essential to health promotion and uptake of HIV prevention. However, there has been little conceptual work conducted to establish the core components of community mobilization, which are needed to guide HIV prevention programming and evaluation.We aimed to identify the key domains of community mobilization (CM essential to change health outcomes or behaviors, and to determine whether these hypothesized CM domains were relevant to a rural South African setting.We studied social movements and community capacity, empowerment and development literatures, assessing common elements needed to operationalize HIV programs at a community level. After synthesizing these elements into six essential CM domains, we explored the salience of these CM domains qualitatively, through analysis of 10 key informant in-depth-interviews and seven focus groups in three villages in Bushbuckridge.CM DOMAINS INCLUDE: 1 shared concerns, 2 critical consciousness, 3 organizational structures/networks, 4 leadership (individual and/or institutional, 5 collective activities/actions, and 6 social cohesion. Qualitative data indicated that the proposed domains tapped into theoretically consistent constructs comprising aspects of CM processes. Some domains, extracted from largely Western theory, required little adaptation for the South African context; others translated less effortlessly. For example, critical consciousness to collectively question and resolve community challenges functioned as expected. However, organizations/networks, while essential, operated differently than originally hypothesized - not through formal organizations, but through diffuse family networks.To date, few community mobilizing efforts in HIV prevention have clearly defined the meaning and domains of CM prior to intervention design. We distilled six CM domains from the literature; all were pertinent to mobilization in rural South Africa. While some adaptation of
Background/Objective: Sub-Saharan Africa is home to two-thirds of all people living with HIV/AIDS. Nigeria has the third highest population of People Living with HIV/AIDS (PLWHAs). Voluntary counselling and testing (VCT) is rapidly becoming an important component of HIV/AIDS prevention and care strategy.
Bell, Stephen A; Delpech, Valerie; Raben, Dorthe; Casabona, Jordi; Tsereteli, Nino; de Wit, John
In the context of a shift from exceptionalism to normalisation, this study examines recommendations/evidence in current pan-European/global guidelines regarding pre-test HIV testing and counselling practices in health care settings. It also reviews new research not yet included in guidelines. There
Rasmussen, M.B.; Rasmussen, J.B.; Nielsen, V.R.
was to describe vertical transmission of HIV in Denmark after the introduction of ART. MATERIALS AND METHODS: The study was a retrospective study of all HIV-infected women who gave birth in Denmark between 1 January 2000 and 31 May 2005 and their children. RESULTS: 83 HIV-infected women gave birth to 96 children...... during the study period. In 79% of the cases, the woman knew her HIV status at the beginning of her pregnancy. The median CD4 count before delivery was 447 x 10(6)/l, and in 76% of the cases the HIV-RNA was women delivered by Caesarean section. None of the children were...... breastfed. None of the children were infected during pregnancy, delivery or after birth. During the same period of time, 8 children were diagnosed with HIV in Denmark; they were born to mothers whose HIV infection was not diagnosed during pregnancy or delivery and therefore preventive treatment...
Following the fall of the Taliban in 2001, Afghanistan has entered a process of physical and political reconstruction. The an- nual per capita income...hospitals (Brazzaville, Point Noire , and Dolosie), establishing 3 integrated counseling and testing (CT) centers, training CT counselors, conducting an HIV...sion. Additionally, DHAPP has provided funds for the pur- chase of a TV and VCR so that films can be shown at training seminars and to prepare troops
Rhodes, Corinne M.; Chang, Yuchiao; Regan, Susan; Triant, Virginia A.
Importance The Human Immunodeficiency Virus (HIV) epidemic has evolved, with an increasing non-communicable disease (NCD) burden emerging and need for long-term management, yet there are limited data to help delineate the optimal care model to screen for NCDs for this patient population. Objective: The primary aim was to compare rates of NCD preventive screening in persons living with HIV/AIDS (PLWHA) by type of HIV care model, focusing on metabolic/cardiovascular disease (CVD) and cancer scr...
Abiodun, Olumide; Sotunsa, John; Ani, Franklin; Jaiyesimi, Ebunoluwa
The spread of HIV/AIDS among the reproductive age group particularly young adults is a major public health concern in Nigeria. Lifestyles of students on university campuses put them at increased risk of contracting the HIV. The aim of this study was to assess the level of HIV/AIDS knowledge and to investigate the factors that were correlated with the uptake of and willingness to take up HIV counseling and testing. A cross-sectional study of 1,250 university students selected by 2-stage random sampling technique using self-administered questionnaire. The participants consisted of 57.7% females and 42.3% males with ages ranging from 15 to 32 years and a mean of 19.13 ± 2.32 years. The awareness of HIV was universal. The knowledge about HIV/AIDS was very high with a mean score of 8.18 ± 1.60 out of 10; and 97.1% of participants having good knowledge of HIV/AIDS. The major source of HIV/AIDS information was the mass media. There was a significant difference in knowledge of HIV/AIDS by gender where male students had better knowledge about HIV/AIDS than females [t (1225) = 3.179, p = 0.002]. While 95% of the participants knew where to get an HIV test done, only 30.4% had tested for HIV within the six months preceding the study. However, 72.2% of them were willing to test for HIV. There was no significant association between demographic characteristics and having tested for HIV in the preceding six months but there was significant association between willingness to have an HIV test and the participants' age groups, sex, marital status and their knowledge of HIV/AIDS. Participants who were aged 21 years and above and had good knowledge about HIV were more willing to take an HIV test. Females were more willing to take an HIV test than males. The participants' knowledge about HIV /AIDS was quite good, the willingness to have HIV test done was high and the knowledge of a place where test can be done was nearly universal yet HIV testing was low. Innovative
Hamilton, Erica L.; Griffith, Sam B.; Jennings, Larissa; Dyer, Typhanye V.; Mayer, Kenneth; Wheeler, Darrell
Abstract Most U.S. investigators in the HIV Prevention Trials Network (HPTN) have been of majority race/ethnicity and sexual orientation. Research participants, in contrast, have been disproportionately from racial/ethnic minorities and men who have sex with men (MSM), reflecting the U.S. epidemic. We initiated and subsequently evaluated the HPTN Scholars Program that mentors early career investigators from underrepresented minority groups. Scholars were affiliated with the HPTN for 12–18 months, mentored by a senior researcher to analyze HPTN study data. Participation in scientific committees, trainings, protocol teams, and advisory groups was facilitated, followed by evaluative exit surveys. Twenty-six trainees have produced 17 peer-reviewed articles to date. Research topics typically explored health disparities and HIV prevention among black and Hispanic MSM and at-risk black women. Most scholars (81% in the first five cohorts) continued HIV research after program completion. Alumni reported program-related career benefits and subsequent funding successes. Their feedback also suggested that we must improve the scholars' abilities to engage new research protocols that are developed within the network. Mentored engagement can nurture the professional development of young researchers from racial/ethnic and sexual minority communities. Minority scientists can benefit from training and mentoring within research consortia, whereas the network research benefits from perspectives of underrepresented minority scientists. PMID:29145745
Lynch, H T; Lynch, J
Lynch syndrome is the most common hereditary form of colorectal cancer (CRC). Its natural history has been investigated extensively, so that highly targeted surveillance and management strategies, melded to its natural history, have proven effective in cancer control. Most important is the early age of onset of cancer (approximately 44 years), involving CRC and the several extracolonic cancers that are integral to the syndrome. With respect to CRC, approximately 70% of cases occur proximal to the splenic flexure. Synchronous and metachronous CRCs are extremely common. Full colonoscopy should be initiated when the patient is between the ages of 20 and 25, and because of the accelerated carcinogenesis of CRC, it should be performed every 1 to 2 years. The presence of initial CRC requires subtotal colectomy, given the mentioned increased frequency of metachronous cancer. Options available for germ-line mutation carriers, in addition to cancer screening, include prophylactic colectomy as well as prophylactic total abdominal hysterectomy and bilateral salpingo-oophorectomy. The discovery of mismatch repair germ-line mutations (most commonly MSH2 or MLH1) has added significantly to the recognition of this disease as well as to the search for high-risk individuals throughout families who, with genetic counseling, may become candidates for germ-line mutation testing. Clearly, hereditary nonpolyposis colorectal cancer provides an excellent opportunity for learning about the etio-pathogenesis of cancer at the molecular and clinical levels and how this knowledge might ultimately be exploited for cancer control. A search for chemoprevention agents, such as cyclo-oxygenase 2 inhibitors, as well as for putative environmental effects and how they may interact with the genetic component in CRC etiology should abet this entire cancer control process.
Avelin F Aghokeng
Full Text Available BACKGROUND: Increased access to HIV testing is essential in working towards universal access to HIV prevention and treatment in resource-limited countries. We here evaluated currently used HIV diagnostic tests and algorithms in Cameroon for their ability to correctly identify HIV infections. METHODS: We estimated sensitivity, specificity, and positive and negative predictive values of 5 rapid/simple tests, of which 3 were used by the national program, and 2 fourth generation ELISAs. The reference panel included 500 locally collected samples; 187 HIV -1 M, 10 HIV-1 O, 259 HIV negative and 44 HIV indeterminate plasmas. RESULTS: None of the 5 rapid assays and only 1 ELISA reached the current WHO/UNAIDS recommendations on performance of HIV tests of at least 99% sensitivity and 98% specificity. Overall, sensitivities ranged between 94.1% and 100%, while specificities were 88.0% to 98.8%. The combination of all assays generated up to 9% of samples with indeterminate HIV status, because they reacted discordantly with at least one of the different tests. Including HIV indeterminate samples in test efficiency calculations significantly decreased specificities to a range from 77.9% to 98.0%. Finally, two rapid assays failed to detect all HIV-1 group O variants tested, with one rapid test detecting only 2 out of 10 group O specimens. CONCLUSION: In the era of ART scaling-up in Africa, significant proportions of false positive but also false negative results are still observed with HIV screening tests commonly used in Africa, resulting in inadequate treatment and prevention strategies. Depending on tests or algorithms used, up to 6% of HIV-1 M and 80% of HIV-1 O infected patients in Cameroon do not receive ART and adequate counseling to prevent further transmission due to low sensitivities. Also, the use of tests with low specificities could imply inclusion of up to 12% HIV negative people in ART programs and increase budgets in addition to inconveniences
Full Text Available Young Latino immigrant men who have sex with men (MSM are at risk for HIV and for delayed diagnosis. A need exists to raise awareness about HIV prevention in this population, including the benefits of timely HIV testing. This project was developed through collaboration between University of WA researchers and Entre Hermanos, a community-based organization serving Latinos. Building from a community-based participatory research approach, the researchers developed a campaign that was executed by Activate Brands, based in Denver, Colorado. The authors (a describe the development of HIV prevention messages through the integration of previously collected formative data; (b describe the process of translating these messages into PSAs, including the application of a marketing strategy; (c describe testing the PSAs within the Latino MSM community; and (c determine a set of important factors to consider when developing HIV prevention messages for young Latino MSM who do not identify as gay.
Kim, Peter S; Read, Sarah W
HIV/AIDS is a global pandemic and is the leading infectious cause of death among adults. Although antiretroviral (ARV) therapy has dramatically improved the quality of life and increased the life expectancy of those infected with HIV, life-long suppressive treatment is required and a cure for HIV infection remains elusive; frequency of dosing and drug toxicity as well as the development of viral resistance pose additional limitations. Furthermore, preventative measures such as a vaccine or microbicide are urgently needed to curb the rate of new infections. The capabilities inherent to nanotechnology hold much potential for impact in the field of HIV treatment and prevention. This article reviews the potential for the multidisciplinary field of nanotechnology to advance the fields of HIV treatment and prevention. © 2010 John Wiley & Sons, Inc.
Newman, Peter A; Williams, Charmaine C; Massaquoi, Notisha; Brown, Marsha; Logie, Carmen
Black women bear a disproportionate burden of HIV/AIDS in North America. The purpose of this investigation was to explore Black Canadian women's perspectives on HIV risk and prevention. Four 90-minute focus groups (n=26) and six key informant interviews were conducted in Toronto with Black women of African and Caribbean descent and low socioeconomic status. Data analysis revealed a number of potent barriers to existing HIV preventive interventions: stigma, cultural disconnections, lack of engagement of Black religious institutions, and multiple intersecting forms of discrimination. Recommended HIV prevention opportunities included the Black church, mainstreaming, health care providers, and ethno-specific agencies. HIV prevention strategies for North American Black women, rather than focusing on HIV and individual risk behaviors, may benefit from a primary focus on social and structural factors (e.g., promoting gender equality, economic opportunity, women-controlled prevention technologies and combating racism in health care) thereby integrating HIV prevention into the larger context of community health and survival.
Marais, B J; Rabie, H; Cotton, M F
The human immunodeficiency virus (HIV) epidemic has had a major impact on the age and gender profile of adult tuberculosis (TB) patients, resulting in increased exposure of HIV-infected and uninfected children at a very young age. Young and/or HIV-infected children are extremely vulnerable to develop severe forms of TB following recent exposure and infection. There is an urgent need to implement safe and pragmatic strategies to prevent TB in children, especially in TB endemic areas where they suffer the greatest burden of disease. The management of TB in HIV-infected children poses multiple challenges, but recent advances in the implementation of prevention of mother to child transmission (PMTCT) strategies and HIV care of infants offer hope. These include HIV testing and access to PMTCT for all pregnant women, routine testing of all HIV exposed infants and rapid initiation of antiretroviral treatment irrespective of clinical or immunological disease staging. In addition, careful scrutiny for TB exposure should occur at every health care visit, with provision of isoniazid preventive therapy (IPT) following each documented exposure event. Knowing the HIV infection status of child TB suspects is essential to optimize case management. Although multiple difficulties remain, recent advances demonstrate that the management of children with TB and/or HIV can be vastly improved by well focused interventions using readily available resources. 2010 Elsevier Ltd. All rights reserved.
Oral Diseases – A Review. Etisiobi Ndiokwelu, Chika Ndiokwelu. Department of Preventive Dentistry, College of Medicine, University Of. Nigeria, Enugu Campus and Department of Dietetics,University of Nigeria Teaching Hospital,. Enugu. SUMMARY. There is a close relationship between diet, nutrition and dental health.
Patrone R. Risenga
Background: Perception forms the core of HIV Counselling and Testing (HCT use by young adults, because it is from these perceptions that young adults will decide to follow an HCT programme or not, depending on how they perceive the programme. HCT as an entry point in HIV and AIDS services should be accessible and young adults' perceptions towards the programme be promoted in order to assist them to develop positive perceptions towards the programme, which will enhance its uptake. Data sources: A literature search was undertaken using internet search engines, different journals, websites and electronic literature indexes. A sample of 60 documents met the criteria. The inclusion criterion was any article addressing perceptions in psychology, social sciences, nursing and education were reviewed. Review method: A concept analysis was conducted according to the steps of Rodger andKnafl (2000; Walker and Avant (2005 and Wilson (1963. Results: Perception has been defined as a constructive process that relies on a top-down processing. This entails that people make inferences about what they see and try to make a best guess as to what the object is all about. Attributes for perception were defined as intensity and physical dimension of stimulus, past experiences, and attention factors such as readiness to respond to the stimulus, motivation and emotional state of the subject. Consequences include increasedHCTuptake by young adults, a positive lifestyle, a reduction in the spreading of HIV and AIDS and lowered HIV statistics amongst young adults. Conclusion: The study findings related to HCT and perceptions paved the way towards a further understanding of HCT as an entry programme in HIV/AIDS services or programmes in relation to young adults. The ability of young adults to use their auditory senses to hear the nurses talk about HCT and HIV, the ability to see the attitudes displayed by HCT counsellors, and their perceptions with regard to lack of privacy, together with a
Wright, Nicola; Akhtar, Athfah; Tosh, Graeme E; Clifton, Andrew V
People with serious mental illness have rates of Human Immuno-deficiency Virus (HIV) infection higher than expected in the general population for the same demographic area. Despite this elevated prevalence, UK national strategies around sexual health and HIV prevention do not state that people with serious mental illness are a high risk group. However, a significant proportion in this group are sexually active and engage in HIV-risk behaviours including having multiple sexual partners, infrequent use of condoms and trading sex for money or drugs. Therefore we propose the provision of HIV prevention advice could enhance the physical and social well being of this population. To assess the effects of HIV prevention advice in reducing morbidity, mortality and preserving the quality of life in people with serious mental illness. We searched the Cochrane Schizophrenia Group's Trials Register (24 January, 2012), which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. There is no language, date, document type, or publication status limitations for inclusion of records in the register. We planned to include all randomised controlled trials focusing on HIV prevention advice versus standard care or comparing HIV prevention advice with other more focused methods of delivering care or information for people with serious mental illness. Review authors (NW, AC, AA, GT) independently screened search results and did not identify any studies that fulfilled the review's criteria. We did not identify any randomised studies that evaluated advice regarding HIV for people with serious mental illness. The excluded studies illustrate that randomisation of packages of care relevant to both people with serious mental illness and HIV risk are possible. Policy makers, clinicians, researchers and service users need to collaborate to produce guidance on how best to provide advice for people with serious mental illness in
Suthar, Amitabh B; Ford, Nathan; Bachanas, Pamela J; Wong, Vincent J; Rajan, Jay S; Saltzman, Alex K; Ajose, Olawale; Fakoya, Ade O; Granich, Reuben M; Negussie, Eyerusalem K; Baggaley, Rachel C
Effective national and global HIV responses require a significant expansion of HIV testing and counselling (HTC) to expand access to prevention and care. Facility-based HTC, while essential, is unlikely to meet national and global targets on its own. This article systematically reviews the evidence for community-based HTC. PubMed was searched on 4 March 2013, clinical trial registries were searched on 3 September 2012, and Embase and the World Health Organization Global Index Medicus were searched on 10 April 2012 for studies including community-based HTC (i.e., HTC outside of health facilities). Randomised controlled trials, and observational studies were eligible if they included a community-based testing approach and reported one or more of the following outcomes: uptake, proportion receiving their first HIV test, CD4 value at diagnosis, linkage to care, HIV positivity rate, HTC coverage, HIV incidence, or cost per person tested (outcomes are defined fully in the text). The following community-based HTC approaches were reviewed: (1) door-to-door testing (systematically offering HTC to homes in a catchment area), (2) mobile testing for the general population (offering HTC via a mobile HTC service), (3) index testing (offering HTC to household members of people with HIV and persons who may have been exposed to HIV), (4) mobile testing for men who have sex with men, (5) mobile testing for people who inject drugs, (6) mobile testing for female sex workers, (7) mobile testing for adolescents, (8) self-testing, (9) workplace HTC, (10) church-based HTC, and (11) school-based HTC. The Newcastle-Ottawa Quality Assessment Scale and the Cochrane Collaboration's "risk of bias" tool were used to assess the risk of bias in studies with a comparator arm included in pooled estimates. 117 studies, including 864,651 participants completing HTC, met the inclusion criteria. The percentage of people offered community-based HTC who accepted HTC was as follows: index testing, 88% of
Amitabh B Suthar
Full Text Available BACKGROUND: Effective national and global HIV responses require a significant expansion of HIV testing and counselling (HTC to expand access to prevention and care. Facility-based HTC, while essential, is unlikely to meet national and global targets on its own. This article systematically reviews the evidence for community-based HTC. METHODS AND FINDINGS: PubMed was searched on 4 March 2013, clinical trial registries were searched on 3 September 2012, and Embase and the World Health Organization Global Index Medicus were searched on 10 April 2012 for studies including community-based HTC (i.e., HTC outside of health facilities. Randomised controlled trials, and observational studies were eligible if they included a community-based testing approach and reported one or more of the following outcomes: uptake, proportion receiving their first HIV test, CD4 value at diagnosis, linkage to care, HIV positivity rate, HTC coverage, HIV incidence, or cost per person tested (outcomes are defined fully in the text. The following community-based HTC approaches were reviewed: (1 door-to-door testing (systematically offering HTC to homes in a catchment area, (2 mobile testing for the general population (offering HTC via a mobile HTC service, (3 index testing (offering HTC to household members of people with HIV and persons who may have been exposed to HIV, (4 mobile testing for men who have sex with men, (5 mobile testing for people who inject drugs, (6 mobile testing for female sex workers, (7 mobile testing for adolescents, (8 self-testing, (9 workplace HTC, (10 church-based HTC, and (11 school-based HTC. The Newcastle-Ottawa Quality Assessment Scale and the Cochrane Collaboration's "risk of bias" tool were used to assess the risk of bias in studies with a comparator arm included in pooled estimates. 117 studies, including 864,651 participants completing HTC, met the inclusion criteria. The percentage of people offered community-based HTC who accepted HTC
Galindo-Quintero, Jaime; Mueses-Marin, Hector Fabio; Montaño-Agudelo, David; Pinzón-Fernández, María Virginia; Tello-Bolívar, Inés Constanza; Alvarado-Llano, Beatriz Eugenia; Martinez-Cajas, Jorge Luis
HIV testing rates remain very low in Colombia, with only 20% of individuals at risk ever tested. In order to tackle this issue, the Corporacion de Lucha Contra el Sida (CLS) has implemented a multidisciplinary, provider-initiated, population-based HIV testing/counselling strategy named BAFI. In this report, we describe the experience of CLS at reaching populations from low socioeconomic backgrounds in 2008-2009. Two different approaches were used: one led by CLS and local health care providers (BAFI-1) and the other by CLS and community leaders (BAFI-2). Both approaches included the following: consented HIV screening test, a demographic questionnaire, self-reported HIV knowledge and behaviour questionnaires, pre- and posttest counselling, confirmatory HIV tests, clinical follow-up, access to comprehensive care and antiretroviral treatment. A total of 2085 individuals were enrolled in BAFI-1 and 363 in BAFI-2. The effectiveness indicators for BAFI-1 and BAFI-2, respectively, were HIV positive-confirmed prevalence = 0.29% and 3.86%, return rate for confirmatory results = 62.5% and 93.7%, return rate for comprehensive care = 83.3% and 92.8%, and ART initiation rate = 20% and 76.9%. Although more people were reached with BAFI-1, the community-led BAFI-2 was more effective at reaching individuals with a higher prevalence of behavioural risk factors for HIV infection. PMID:24592330
Galindo-Quintero, Jaime; Mueses-Marin, Hector Fabio; Montaño-Agudelo, David; Pinzón-Fernández, María Virginia; Tello-Bolívar, Inés Constanza; Alvarado-Llano, Beatriz Eugenia; Martinez-Cajas, Jorge Luis
HIV testing rates remain very low in Colombia, with only 20% of individuals at risk ever tested. In order to tackle this issue, the Corporacion de Lucha Contra el Sida (CLS) has implemented a multidisciplinary, provider-initiated, population-based HIV testing/counselling strategy named BAFI. In this report, we describe the experience of CLS at reaching populations from low socioeconomic backgrounds in 2008-2009. Two different approaches were used: one led by CLS and local health care providers (BAFI-1) and the other by CLS and community leaders (BAFI-2). Both approaches included the following: consented HIV screening test, a demographic questionnaire, self-reported HIV knowledge and behaviour questionnaires, pre- and posttest counselling, confirmatory HIV tests, clinical follow-up, access to comprehensive care and antiretroviral treatment. A total of 2085 individuals were enrolled in BAFI-1 and 363 in BAFI-2. The effectiveness indicators for BAFI-1 and BAFI-2, respectively, were HIV positive-confirmed prevalence = 0.29% and 3.86%, return rate for confirmatory results = 62.5% and 93.7%, return rate for comprehensive care = 83.3% and 92.8%, and ART initiation rate = 20% and 76.9%. Although more people were reached with BAFI-1, the community-led BAFI-2 was more effective at reaching individuals with a higher prevalence of behavioural risk factors for HIV infection.
Full Text Available HIV testing rates remain very low in Colombia, with only 20% of individuals at risk ever tested. In order to tackle this issue, the Corporacion de Lucha Contra el Sida (CLS has implemented a multidisciplinary, provider-initiated, population-based HIV testing/counselling strategy named BAFI. In this report, we describe the experience of CLS at reaching populations from low socioeconomic backgrounds in 2008-2009. Two different approaches were used: one led by CLS and local health care providers (BAFI-1 and the other by CLS and community leaders (BAFI-2. Both approaches included the following: consented HIV screening test, a demographic questionnaire, self-reported HIV knowledge and behaviour questionnaires, pre- and posttest counselling, confirmatory HIV tests, clinical follow-up, access to comprehensive care and antiretroviral treatment. A total of 2085 individuals were enrolled in BAFI-1 and 363 in BAFI-2. The effectiveness indicators for BAFI-1 and BAFI-2, respectively, were HIV positive-confirmed prevalence = 0.29% and 3.86%, return rate for confirmatory results = 62.5% and 93.7%, return rate for comprehensive care = 83.3% and 92.8%, and ART initiation rate = 20% and 76.9%. Although more people were reached with BAFI-1, the community-led BAFI-2 was more effective at reaching individuals with a higher prevalence of behavioural risk factors for HIV infection.
AJRH Managing Editor
Chairman, Board of Trustees, New HIV Vaccine and Microbicide Advocacy Society (NHVMAS). The research and development process for new. HIV prevention technologies is a global enterprise and most parts of Africa, have been actively involved in the identification and development of effective methods. The new tools ...
HIV-discordant couples: An emerging issue in prevention and treatment. G de Bruyn, N Bandezi, S Dladla, G Gray. Abstract. No Abstract Southern African Journal of HIV Medicine Vol. 7 (2) 2006: pp. 25-28. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.
Nigeria is scaling up prevention of mother-to-child transmission (PMTCT) of HIV interventions to primary health care centres (PHCs). This retrospective study of PMTCT was at two PHCs in Northwest Nigeria with the main outcome measure being HIV infection rate of exposed infants at 6 weeks of life. Of 10,289 women who ...
. 31 of infected are children under 15 years, 12 of them are infected from the mother. The analysis and research of HIV/AIDS epidemic situation and prevention of a prenatal transmission of the HIV on territory of republic was held. Thus 311 ...
Key findings: In Borana, HIV prevention endeavors were found to be coordinated by the zonal health department. Health extension workers, local teachers and youth groups were important agents facilitating HIV awareness creation activities at community level. However, these facilitators were not recognized as credible ...
... who can affect their peers only to a narrow, albeit crucial extent. The external environment thus remains adverse to HIV prevention. Keywords: development management, HIV/AIDS, multiple-case study, non-governmental organisations, public sector, social change, South Africa, strategic planning, youth. African Journal of ...
Adolescents are the only age group with growing AIDS-related morbidity and mortality in Eastern and Southern Africa, making HIV prevention research among this population an urgent priority. Structural deprivations are key drivers of adolescent HIV infection in this region. Biomedical interventions must be combined with ...
The World Health Organization estimates that 50% of the 30 million HIV infections worldwide occurred in young people between the ages of 15 and 24 years. In the United States, national statistics estimate that almost 40% of new HIV cases occur in youth ages 13-29 (Centers for Disease Control and Prevention, 2011). Therefore, a focus on preventing…
Healthcare workers are a priority group for HIV prevention trials because they constitute a large relatively healthy group at risk from blood-borne diseases ... to participate in designing, implementing and evaluating programs aimed at reducing the transmission of HIV and other infectious diseases in health personnel.
... challenges faced in the search for effective measures to control the HIV epidemic. We also emphasise the need to identify and develop HIV control strategies that reflect spatial and temporal variations in the local socio-economic and epidemiological context. The Zimbabwe Science News Volume 35 (1+ 2) 2001, pp. 27-42 ...
Lubogo, David; Ddamulira, John Bosco; Tweheyo, Raymond; Wamani, Henry
The HIV/AIDS health challenge continues to ravage many resource-constrained countries of the world. Approximately 75 % of all the global HIV/AIDS related deaths totaling 1.6 (1.4-1.9) million in 2012 occurred in sub-Saharan Africa, Uganda contributed 63,000 (52,000-81,000) to these deaths. Most of the morbidity and mortality associated with HIV/AIDS can be averted if individuals with HIV/AIDS have improved access to HIV care and treatment. The aim of this study therefore, was to explore the factors associated with access to HIV care services among HIV seropositive clients identified by a home based HIV counseling and testing program in Kumi district, eastern Uganda. In a cross sectional study conducted in February 2009, we explored predictor variables: socio-demographics, health facility and community factors related to access to HIV care and treatment. The main outcome measure was reported receipt of cotrimoxazole for prophylaxis. The majority [81.1 % (284/350)] of respondents received cotrimoxazole prophylaxis (indicating access to HIV care). The main factors associated with access to HIV care include; age 25-34 years (AOR = 5.1, 95 % CI: 1.5-17.1), male sex (AOR = 2.3, 95 % CI: 1.2-4.4), urban residence (AOR = 2.5, CI: 1.1-5.9) and lack of family support (AOR = 0.5, CI: 0.2-0.9). There was relatively high access to HIV care and treatment services at health facilities for HIV positive clients referred from the Kumi home based HIV counseling and testing program. The factors associated with access to HIV care services include; age group, sex, residence and having a supportive family. Stakeholders involved in providing HIV care and treatment services in similar settings should therefore consider these socio-demographic variables as they formulate interventions to improve access to HIV care services.
Kumar, SG Prem; Dandona, Rakhi; Schneider, John A; Ramesh, YK; Dandona, Lalit
Background HIV prevention programmes for truck drivers form part of the HIV control efforts, but systematic data on the outputs and cost of providing such services in India are not readily available for further planning and use of resources. Methods Detailed cost and output data were collected from written records and interviews for 2005–2006 fiscal year using standardized methods at six sampled HIV prevention programmes for truck drivers in the Indian state of Andhra Pradesh. The total economic cost for these programmes was computed and the relation of unit cost of services per truck driver with programme scale was assessed using regression analysis. Results A total of 120,436 truck drivers were provided services by the six programmes of which 55.9% were long distance truck drivers. The annual economic cost of providing services to a truck driver varied between programmes from US$ 1.52 to 4.56 (mean US$ 2.49). There was an inverse relation between unit economic cost of serving a truck driver and scale of the programme (R2 = 0.63; p = 0.061). The variation between programmes in the average number of contacts made by the programme staff with truck drivers was 1.3 times versus 5.8 times for contacts by peer educators. Only 1.7% of the truck drivers were referred by the programmes for counseling and HIV testing. Conclusion These data provide information for further planning of HIV prevention programmes for truck drivers and estimating the resources needed for such programmes. The findings suggest the need to strengthen the role of peer educators and increase referral of truck drivers for HIV testing. PMID:19457269
Full Text Available Abstract Background HIV prevention programmes for truck drivers form part of the HIV control efforts, but systematic data on the outputs and cost of providing such services in India are not readily available for further planning and use of resources. Methods Detailed cost and output data were collected from written records and interviews for 2005–2006 fiscal year using standardized methods at six sampled HIV prevention programmes for truck drivers in the Indian state of Andhra Pradesh. The total economic cost for these programmes was computed and the relation of unit cost of services per truck driver with programme scale was assessed using regression analysis. Results A total of 120,436 truck drivers were provided services by the six programmes of which 55.9% were long distance truck drivers. The annual economic cost of providing services to a truck driver varied between programmes from US$ 1.52 to 4.56 (mean US$ 2.49. There was an inverse relation between unit economic cost of serving a truck driver and scale of the programme (R2 = 0.63; p = 0.061. The variation between programmes in the average number of contacts made by the programme staff with truck drivers was 1.3 times versus 5.8 times for contacts by peer educators. Only 1.7% of the truck drivers were referred by the programmes for counseling and HIV testing. Conclusion These data provide information for further planning of HIV prevention programmes for truck drivers and estimating the resources needed for such programmes. The findings suggest the need to strengthen the role of peer educators and increase referral of truck drivers for HIV testing.
A new study from the BC Centre for Excellence in HIV/AIDS (BC-CfE) confirms that the benefits of highly active antiretroviral therapy (HAART) extend far beyond treatment and include dramatic secondary preventive benefits.
Sheri A Lippman
Full Text Available Building a successful combination prevention program requires understanding the community's local epidemiological profile, the social community norms that shape vulnerability to HIV and access to care, and the available community resources. We carried out a situational analysis in order to shape a comprehensive HIV prevention program that address local barriers to care at multiple contextual levels in the North West Province of South Africa.The situational analysis was conducted in two sub-districts in 2012 and guided by an adaptation of WHO's Strategic Approach, a predominantly qualitative method, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. Analysis began during fieldwork with nightly discussions of findings and continued with coding original textual data from the fieldwork notebooks and a select number of recorded interviews.We conducted over 200 individual and group interviews and gleaned four principal social barriers to HIV prevention and care, including: HIV fatalism, traditional gender norms, HIV-related stigma, and challenges with communication around HIV, all of which fuel the HIV epidemic. At the different levels of response needed to stem the epidemic, we found evidence of national policies and programs that are mitigating the social risk factors but little community-based responses that address social risk factors to HIV.Understanding social and structural barriers to care helped shape our comprehensive HIV prevention program, which address the four 'themes' identified into each component of the program. Activities are underway to engage communities, offer community-based testing in high transmission areas, community stigma reduction, and a positive health, dignity and prevention program for stigma reduction and improve communication skills. The situational analysis
Rosenberg, Nora E; Graybill, Lauren A; Wesevich, Austin; McGrath, Nuala; Golin, Carol E; Maman, Suzanne; Bhushan, Nivedita; Tsidya, Mercy; Chimndozi, Limbikani; Hoffman, Irving F; Hosseinipour, Mina C; Miller, William C
In sub-Saharan Africa couple HIV testing and counseling (CHTC) has been associated with substantial increases in safe sex, especially when at least one partner is HIV infected. However, this relationship has not been characterized in an Option B+ context. The study was conducted at the antenatal clinic at Bwaila District Hospital in Lilongwe, Malawi in 2016 under an Option B+ program. Ninety heterosexual couples with an HIV-infected pregnant woman (female-positive couples) and 47 couples with an HIV-uninfected pregnant woman (female-negative couples) were enrolled in an observational study. Each couple member was assessed immediately before and 1 month after CHTC for safe sex (abstinence or consistent condom use in the last month). Generalized estimating equations were used to model change in safe sex before and after CHTC and to compare safe sex between female-positive and female-negative couples. Mean age was 26 years among women and 32 years among men. Before CHTC, safe sex was comparable among female-positive couples (8%) and female-negative couples (2%) [risk ratio (RR): 3.7, 95% confidence interval (CI): 0.5 to 29.8]. One month after CHTC, safe sex was higher among female-positive couples (75%) than among female-negative couples (3%) (RR: 30.0, 95% CI: 4.3 to 207.7). Safe sex increased substantially after CTHC for female-positive couples (RR 9.6, 95% CI: 4.6 to 20.0), but not for female-negative couples (RR: 1.2, 95% CI: 0.1 to 18.7). Engaging pregnant couples in CHTC can have prevention benefits for couples with an HIV-infected pregnant woman, but additional prevention approaches may be needed for couples with an HIV-uninfected pregnant woman.
Fisher, William A; Kohut, Taylor; Fisher, Jeffrey D
The current analysis considers the HIV prevention research record in the social sciences. We do so with special reference to what has been termed "AIDS Exceptionalism"- departures from standard public health practice and prevention research priorities in favor of alternative approaches to prevention that, it has been argued, emphasize individual rights at the expense of public health protection. In considering this issue, we review the historical context of the HIV epidemic; empirically demonstrate a pattern of prevention research characterized by systematic neglect of prevention interventions for HIV-infected persons; and articulate a rationale for "Prevention for Positives," supportive prevention efforts tailored to the needs of HIV+ individuals. We then propose a social psychological conceptualization of processes that appear to have influenced developments in HIV prevention research and directed its focus to particular target populations. Our concluding section considers whether there are social and research policy lessons to be learned from the record of HIV prevention research that might improve our ability to addresses effectively, equitably, and in timely fashion future epidemics that play out, as HIV does, at the junction of biology and behavior. At the first quarter century of the AIDS epidemic, it is important to weigh our accomplishments against our failures in the fight against AIDS…Future historians will conclude that we cannot escape responsibility for our failure to use effective, scientifically proven strategies to control the AIDS epidemic…They will also likely regard as tragic those instances when we allowed scarce resources to be used to support ideologically driven "prevention" that only served a particular political agenda.Editorial: A Quarter Century of AIDS . American Journal of Public Health. (Stall & Mills, 2006, p. 961).
Sullivan, Patrick S; Grey, Jeremy A; Simon Rosser, Brian R
Technology-enabled HIV research and prevention has emerged in the past 10 years as an exciting dynamic field that offers great potential to help bring HIV prevention efforts to scale in key risk communities. Evolutions in technologies and in HIV epidemics suggest mutual opportunities to reach most at risk populations in novel ways. New technologies cannot completely replace interventions and services currently delivered by the people. However, we suggest that emerging technologies hold promise to bring services to scale and produce efficiencies in reaching rural populations of men who have sex with men (MSM), connecting with populations who are not reached in current urban outreach efforts, and providing services or research surveys that can be described algorithmically. Furthermore, the types of technologies (eg, internet-based, smartphone-based, text messaging) should be matched with both the content to be delivered and the technology usage patterns of target populations. We suggest several key principles and lessons learned that comprise a framework in which to consider the opportunities of technologies and HIV prevention and research. Future directions include improvement of data quality in online surveying, better characterization of biases, developing improved sampling approaches, working with funders to ensure compatibility of funding mechanisms and online research proposals, and promoting consensus approaches to the duplication and presentation of research and program evaluation results from online research. Given the current calls for comprehensive packages of prevention services for MSM, effective prevention might require an intentional combination of technology-enabled prevention services to achieve scale and strategic use of personally delivered package components in cases where non-algorithmic services, such as individualized counseling, are needed.
This podcast is based on the November 24, 2015 CDC Vital Signs report. Preexposure prophylaxis, or PrEP, is a daily medicine that can be used to prevent getting HIV. PrEP is for people who donât have HIV but who are at very high risk for getting it from sex or injection drug use. Unfortunately, many people who can benefit from PrEP arenât taking it. Created: 11/24/2015 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). Date Released: 11/24/2015.
Jessica E Haberer
Full Text Available Randomized clinical trials of oral antiretroviral pre-exposure prophylaxis (PrEP for HIV prevention have widely divergent efficacy estimates, ranging from 0% to 75%. These discrepancies are likely due to differences in adherence. To our knowledge, no studies to date have examined the impact of improving adherence through monitoring and/or intervention, which may increase PrEP efficacy, or reported on objective behavioral measures of adherence, which can inform PrEP effectiveness and implementation.Within the Partners PrEP Study (a randomized placebo-controlled trial of oral tenofovir and emtricitabine/tenofovir among HIV-uninfected members of serodiscordant couples in Kenya and Uganda, we collected objective measures of PrEP adherence using unannounced home-based pill counts and electronic pill bottle monitoring. Participants received individual and couples-based adherence counseling at PrEP initiation and throughout the study; counseling was intensified if unannounced pill count adherence fell to 80% adherence. Study limitations include potential shortcomings of the adherence measures and use of a convenience sample within the substudy cohort.The high PrEP adherence achieved in the setting of active adherence monitoring and counseling support was associated with a high degree of protection from HIV acquisition by the HIV-uninfected partner in heterosexual serodiscordant couples. Low PrEP adherence was associated with sexual behavior, alcohol use, younger age, and length of PrEP use. Please see later in the article for the Editors' Summary.
Lippman, Sheri A; Treves-Kagan, Sarah; Gilvydis, Jennifer M; Naidoo, Evasen; Khumalo-Sakutukwa, Gertrude; Darbes, Lynae; Raphela, Elsie; Ntswane, Lebogang; Barnhart, Scott
..., and the available community resources. We carried out a situational analysis in order to shape a comprehensive HIV prevention program that address local barriers to care at multiple contextual levels in the North West Province of South Africa...
Nagamatsu, Miyuki; Sato, Takeshi; Nakagawa, Aki; Saito, Hisako
We developed an extended HIV prevention program for students, parents, and school teachers, and then evaluated its effectiveness. The participants were 490 students, aged 13-14 years, attending four public junior high schools in Saga Prefecture, Japan. They were divided into two groups: control and intervention. All the students received group education by health professionals. In the control group, students received only two group education sessions given by health professionals. In the intervention group, there were three intervention components: parent education, teacher education, and student individual counseling by health professionals. Before and 3 months after the intervention, participants underwent evaluation of their frequency of communication about AIDS with parents or teachers, their knowledge of HIV/AIDS, and attitudes to sexual intercourse, self-esteem, and high-risk behavior. A total of 135 students (80 boys and 55 girls) from the intervention group and 236 students (115 boys and 121 girls) from the control group participated in the evaluation 3 months after intervention. Adolescents in the intervention group showed more positive changes than those in the control group from baseline to follow-up. Intervention had a significant impact on the frequency of communication about AIDS with teachers (p = 0.027) and HIV/AIDS knowledge among females (p = 0.023), and intervention also had a significant impact on refusal of sexual activity by males (p = 0.045). These findings suggest that effective prevention of HIV might be achieved by an expanded education program for students and teachers such as that described, and individual counseling that takes into consideration the sexual differences of Japanese adolescents.
Leitner, Thomas [Los Alamos National Laboratory; Campbell, Mary S [UNIV OF WASHINGTON; Mullins, James I [UNIV OF WASHINGTON; Hughes, James P [UNIV OF WASHINGTON; Wong, Kim G [UNIV OF WASHINGTON; Raugi, Dana N [UNIV OF WASHINGTON; Scrensen, Stefanie [UNIV OF WASHINGTON
HIV-1 sequencing has been used extensively in epidemiologic and forensic studies to investigate patterns of HIV-1 transmission. However, the criteria for establishing genetic linkage between HIV-1 strains in HIV-1 prevention trials have not been formalized. The Partners in Prevention HSV/HIV Transmission Study (ClinicaITrials.gov NCT00194519) enrolled 3408 HIV-1 serodiscordant heterosexual African couples to determine the efficacy of genital herpes suppression with acyclovir in reducing HIV-1 transmission. The trial analysis required laboratory confirmation of HIV-1 linkage between enrolled partners in couples in which seroconversion occurred. Here we describe the process and results from HIV-1 sequencing studies used to perform transmission linkage determination in this clinical trial. Consensus Sanger sequencing of env (C2-V3-C3) and gag (p17-p24) genes was performed on plasma HIV-1 RNA from both partners within 3 months of seroconversion; env single molecule or pyrosequencing was also performed in some cases. For linkage, we required monophyletic clustering between HIV-1 sequences in the transmitting and seroconverting partners, and developed a Bayesian algorithm using genetic distances to evaluate the posterior probability of linkage of participants sequences. Adjudicators classified transmissions as linked, unlinked, or indeterminate. Among 151 seroconversion events, we found 108 (71.5%) linked, 40 (26.5%) unlinked, and 3 (2.0%) to have indeterminate transmissions. Nine (8.3%) were linked by consensus gag sequencing only and 8 (7.4%) required deep sequencing of env. In this first use of HIV-1 sequencing to establish endpoints in a large clinical trial, more than one-fourth of transmissions were unlinked to the enrolled partner, illustrating the relevance of these methods in the design of future HIV-1 prevention trials in serodiscordant couples. A hierarchy of sequencing techniques, analysis methods, and expert adjudication contributed to the linkage
Cianelli, Rosina; Ferrer,Lilian; MCELMURRY, BEVERLY J.
Socio-cultural factors and HIV-related misinformation contribute to the increasing number of Chilean women living with HIV. In spite of this, and to date, few culturally specific prevention activities have been developed for this population. The goal of the present study was to elicit the perspectives of low-income Chilean women regarding HIV and relevant socio-cultural factors, as a forerunner to the development of a culturally appropriate intervention. As part of a mixed-methods study, fift...
Brooks, Ronald A; Kaplan, Rachel L; Lieber, Eli; Landovitz, Raphael J; Lee, Sung-Jae; Leibowitz, Arleen A
The purpose of this study was to identify factors that may facilitate or impede future adoption of preexposure prophylaxis (PrEP) for HIV prevention among gay and bisexual men in HIV-serodiscordant relationships. This qualitative study utilized semistructured interviews conducted with a multiracial/-ethnic sample of 25 gay and bisexual HIV-serodiscordant male couples (n=50 individuals) recruited from community settings in Los Angeles, CA. A modified grounded theory approach was employed to identify major themes relating to future adoption of PrEP for HIV prevention. Motivators for adoption included protection against HIV infection, less concern and fear regarding HIV transmission, the opportunity to engage in unprotected sex, and endorsements of PrEP's effectiveness. Concerns and barriers to adoption included the cost of PrEP, short- and long-term side effects, adverse effects of intermittent use or discontinuing PrEP, and accessibility of PrEP. The findings suggest the need for a carefully planned implementation program along with educational and counseling interventions in the dissemination of an effective PrEP agent.
Mustafa Alparslan BABAYIÐIT
Full Text Available Human Immune-deficiency Virus (HIV was first discovered in 1981 in the United States of America and the day of December 1, was announced as ?World AIDS Day? by WHO (World Health Organization. In Turkey, the first announcement of the people living with HIV was made in 1985. HIV/AIDS has killed more than 20 millions people and more than 16,000 people become newly infected each day since the first cases were diagnosed in 1981. It is estimated that 39.4 million people would have been infected with HIV at the end of 2004, with 4.9 million new cases that year. Sub-Saharan Africa is the worst-hit region, with 70 percent of all people living with HIV. In Africa alone, 10,000 people become infected each day. This year?s main theme is ?Women, Girls, HIV and AIDS,? which reflects a focus on how the effects of HIV/AIDS have significantly increased among women. Women now make up half of all people living with HIV worldwide with the number of 17,6 million. [TAF Prev Med Bull 2004; 3(11.000: 280-290
Maiorana, Andre; Koester, Kimberly A; Myers, Janet J; Lloyd, Karen C; Shade, Starley B; Dawson-Rose, Carol; Morin, Stephen F
Disclosure of HIV serostatus by HIV-infected individuals is considered a prevention strategy, under the assumption that disclosure will prompt risk reduction practices among sex partners. We examined patients' self-reports regarding disclosure messages they found relevant as part of prevention with positives (PwP) interventions in clinical settings. We conducted 52 in-depth interviews with patients participating in 13 PwP interventions. We found that the opportunity to reflect about living with HIV, explore fears of stigma and rejection, develop communication skills and strategies to disclose, and explore a sense of responsibility influenced patients' intention to disclose and their disclosure practices. PwP interventions need to include a combination of messages about disclosure strategies, stigma, and communication, as well as helping patients frame disclosure as a process that includes situations and interactions to consider post-disclosure. PwP disclosure counseling can help influence a shift in patients' risk towards safer sex practices.
Lazarus, Jeff; Shete, Priya B; Eramova, Irina
throughout Europe and central Asia has changed comorbidity and mortality patterns among people living with HIV/AIDS (PLWHA) as liver disease has increasingly replaced AIDS as the cause of death in PLWHA in western European countries. The average prevalence of HCV among PLWHA is 40 per cent, and much higher...... health issue. DESCRIPTION: In October 2006, the WHO Regional Office for Europe issued protocols for the clinical management of HIV/HCV and HIV/HBV coinfections. They include diagnostic algorithms adjusted for resource availability, and guidelines for the management of patients who do not yet need....... To expand access to hepatitis prevention and treatment, public awareness needs to be raised and national political leaders need to address hepatitis as a public health issue. Effective public health measures include price reductions for anti-hepatitis drugs; targeted testing, counselling and prevention...
Full Text Available Introduction: In recent years children and adolescents have emerged as a priority for HIV prevention and care services. We conducted a systematic review to investigate the acceptability, yield and prevalence of HIV testing and counselling (HTC strategies in children and adolescents (5 to 19 years in sub-Saharan Africa. Methods: An electronic search was conducted in MEDLINE, EMBASE, Global Health and conference abstract databases. Studies reporting on HTC acceptability, yield and prevalence and published between January 2004 and September 2014 were included. Pooled proportions for these three outcomes were estimated using a random effects model. A quality assessment was conducted on included studies. Results and discussion: A total of 16,380 potential citations were identified, of which 21 studies (23 entries were included. Most studies were conducted in Kenya (n=5 and Uganda (n=5 and judged to provide moderate (n=15 to low quality (n=7 evidence, with data not disaggregated by age. Seven studies reported on provider-initiated testing and counselling (PITC, with the remainder reporting on family-centred (n=5, home-based (n=5, outreach (n=5 and school-linked HTC among primary schoolchildren (n=1. PITC among inpatients had the highest acceptability (86.3%; 95% confidence interval [CI]: 65.5 to 100%, yield (12.2%; 95% CI: 6.1 to 18.3% and prevalence (15.4%; 95% CI: 5.0 to 25.7%. Family-centred HTC had lower acceptance compared to home-based HTC (51.7%; 95% CI: 10.4 to 92.9% vs. 84.9%; 95% CI: 74.4 to 95.4% yet higher prevalence (8.4%; 95% CI: 3.4 to 13.5% vs. 3.0%; 95% CI: 1.0 to 4.9%. School-linked HTC showed poor acceptance and low prevalence. Conclusions: While PITC may have high test acceptability priority should be given to evaluating strategies beyond healthcare settings (e.g. home-based HTC among families to identify individuals earlier in their disease progression. Data on linkage to care and cost-effectiveness of HTC strategies are needed to
Uccella, Ilaria; Petrelli, Alessio; Vescio, Maria Fenicia; De Carolis, Silvia; Fazioli, Cecilia; Pezzotti, Patrizio; Rezza, Gianni
Uptake of HIV tests is a challenging issue in vulnerable populations including immigrants, normally using standard diagnostic tools. Objectives of this study were to evaluate the acceptability of HIV rapid test; estimate the percentage of newly HIV diagnoses and evaluate knowledge, attitudes and perception (KAP) about HIV/AIDS and other STIs in a specific set of immigrants and vulnerable population in Rome (Italy). All immigrant and Italian people, aged 16-70 years, attending the infectious disease outpatient clinic of the National Institute for Health, Migration and Poverty (INMP) in Rome (Italy), during the period December 2012 to December 2013 were enrolled. HIV rapid testing was provided for free and patients were asked to fill in a questionnaire evaluating KAP about HIV/STIs. All patients with risky sexual behaviours or with a recent diagnosis of STIs were invited to come back after 3-6 months and a post-counselling questionnaire was offered. Out of the total sample, 99.2% (n = 825) accepted the "rapid test" and 10 new HIV diagnoses were found (1.22%; 95% CI 0.58%-2.22%). Three hundred and eighty-five participants (47%) answered the entry questionnaire and 58 (15%) completed the follow-up. Overall, we found high knowledge about HIV/AIDS; however, lower educational level and immigrant status were associated with poor knowledge about HIV, other STIs and prevention methods. Immigrants have lower perception of sexual risk and higher prejudice than Italians. Our study showed high acceptance of rapid test in this specific vulnerable population and this allowed to identify new HIV diagnoses in unaware people. Socioeconomic inequalities observed in the KAP questionnaire suggest the need for actions to support the reduction of cultural differences in knowledge of HIV/AIDS and for policies aimed at improving access to health services and preventions programmes of marginalized populations.
Finch, Stacia A; Weiley, Victoria; Ip, Edward H; Barkin, Shari
To measure impact of pediatricians' perceived self-efficacy and confidence on current practices and attitudes regarding four violence prevention (VP) topics (gun storage, gun removal, limiting exposure to media violence, discipline techniques) during health supervision for children ages 2-11. Random sample survey of American Academy of Pediatrics Fellows (n = 486; 53% response rate) providing health supervision for children ages 2-11. Participants surveyed about VP issues regarding: (1) current counseling practices for 2-5 and 6-11 year olds; (2) amount of time spent addressing; (3) confidence in addressing; and (4) perceived self-efficacy at changing patients' behaviors. Multivariate analyses explored relationships between pediatricians' perceived self-efficacy and confidence versus VP counseling frequency. VP topics were not routinely discussed during health supervision. Most pediatricians (64%) reported spending too little time addressing these topics. Although most pediatricians felt confident discussing and effective at changing behaviors regarding limiting exposure to media violence (89% vs. 50%) and discipline techniques (91% vs. 76%), they were less so for safe gun storage (54% vs. 35%) and gun removal (51% vs. 17%). Perceived self-efficacy was the mediating factor on self-reported VP counseling frequencies for all topics. Pediatricians reported spending insufficient time on VP counseling. Confidence and perceived self-efficacy levels varied by VP topic, but for all topics pediatricians felt more confident discussing than effective at changing behaviors. Since pediatricians' self-efficacy was related to counseling practices, boosting self-efficacy could ultimately improve counseling frequencies. Further research is needed to identify methods to build providers' perceived self-efficacy regarding these VP areas.
Weiley, Victoria; Ip, Edward H.; Barkin, Shari
Objective To measure impact of pediatricians’ perceived self-efficacy and confidence on current practices and attitudes regarding four violence prevention (VP) topics (gun storage, gun removal, limiting exposure to media violence, discipline techniques) during health supervision for children ages 2–11. Methods Random sample survey of American Academy of Pediatrics Fellows (n = 486; 53% response rate) providing health supervision for children ages 2–11. Participants surveyed about VP issues regarding: (1) current counseling practices for 2–5 and 6–11 year olds; (2) amount of time spent addressing; (3) confidence in addressing; and (4) perceived self-efficacy at changing patients’ behaviors. Multivariate analyses explored relationships between pediatricians’ perceived self-efficacy and confidence versus VP counseling frequency. Results VP topics were not routinely discussed during health supervision. Most pediatricians (64%) reported spending too little time addressing these topics. Although most pediatricians felt confident discussing and effective at changing behaviors regarding limiting exposure to media violence (89% vs. 50%) and discipline techniques (91% vs. 76%), they were less so for safe gun storage (54% vs. 35%) and gun removal (51% vs. 17%). Perceived self-efficacy was the mediating factor on self-reported VP counseling frequencies for all topics. Conclusions Pediatricians reported spending insufficient time on VP counseling. Confidence and perceived self-efficacy levels varied by VP topic, but for all topics pediatricians felt more confident discussing than effective at changing behaviors. Since pediatricians’ self-efficacy was related to counseling practices, boosting self-efficacy could ultimately improve counseling frequencies. Further research is needed to identify methods to build providers’ perceived self-efficacy regarding these VP areas. PMID:17554613
Romano, John L.; Netland, Jason D.
The theory of reasoned action and planned behavior (TRA/PB) is a model of behavior change that has been extensively studied in the health sciences but has had limited exposure in the counseling psychology literature. The model offers counseling psychologists a framework to conceptualize prevention research and practice. The model is important to…
Seenivasan, Subramani; Vaitheeswaran, Natarajan; Seetha, Viswanathan; Anbalagan, Selvaraj; Karunaianantham, Ramesh; Swaminathan, Soumya
To analyze the outcomes of Prevention of Parent to Child Transmission (PPTCT) of HIV program in an urban Southern Indian setting. Observational study. Anti-retroviral Therapy (ART) Centers/ Integrated Counseling and Testing Centers (ICTC) at four government Obstetrics Institutes in an urban area. 100 HIV-positive pregnant women and their infants delivered in the study centers. Triple drug ART to HIV-positive pregnant women was started for maternal indications only. Rest of the pregnant women were given single dose Nevirapine (200 mg) at the onset of labor. All infants were given single dose Nevirapine (2 mg/kg) prophylaxis, according to National AIDS Control Organization guidelines. Mothers were counseled regarding breastfeeding and artificial feeding, and the choice was left to them. Whole blood HIV 1 DNA PCR was done for all infants at 6 weeks of life. A second PCR was done at 6 months or 6 weeks after stopping breastfeeds. PCR-positive infants were started on ART, and were followed-up till18 months of life. Four infants were PCR-positive for HIV. All of them were breastfed. They were born to mothers of HIV stage 1 or 2 who were not on ART as CD4 counts were >350 cells/mm3. Among the mothers in Stage 3 or 4 or CD4 count <200 cells/mm3 and on ART, none of the infants was HIV-positive. The cumulative HIV-free survival at 18 months was 94%. Parent-to-child transmission rate in HIV was low with the currently used strategies. Triple drug ART to mother reduces mother-to-child transmission despite advanced maternal stage or low CD4 counts.
C.W. Njue (Carolyne)
textabstractThis thesis explores three topics concerning youth in Kenya: their knowledge and information needs regarding sexual and reproductive health including HIV/AIDS; their sexual risk behaviour; and HIV prevention efforts targeted at them. The data on which these studies are based were
Full Text Available Introduction: In 2010, two global networks of people living with HIV, the International Community of Women Living with HIV (ICW Global and the Global Network of People living with HIV (GNP + were invited to review a draft strategic framework for the global scale up of prevention of vertical transmission (PVT through the primary prevention of HIV and the prevention of unintended pregnancies among women living with HIV. In order to ensure recommendations were based on expressed needs of people living with HIV, GNP+ and ICW Global undertook a consultation amongst people living with HIV which highlighted both facilitators and barriers to prevention services. This commentary summarizes the results of that consultation. Discussion: The consultation was comprised of an online consultation (moderated chat-forum with 36 participants from 16 countries, an anonymous online e-survey (601 respondents from 58 countries, and focus-group discussions with people living with HIV in Jamaica (27 participants. The consultation highlighted the discrepancies across regions with respect to access to essential packages of PVT services. However, the consultation participants also identified common barriers to access, including a lack of trustworthy sources of information, service providers’ attitudes, and gender-based violence. In addition, participant responses revealed common facilitators of access, including quality counselling on reproductive choices, male involvement, and decentralized services. Conclusions: The consultation provided some understanding and insight into the participants’ experiences with and recommendations for PVT strategies. Participants agreed that successful, comprehensive PVT programming require greater efforts to both prevent primary HIV infection among young women and girls and, in particular, targeted efforts to ensure that women living with HIV and their partners are supported to avoid unintended pregnancies and to have safe, healthy
Grant, Robert M; Lama, Javier R; Anderson, Peter L; McMahan, Vanessa; Liu, Albert Y; Vargas, Lorena; Goicochea, Pedro; Casapía, Martín; Guanira-Carranza, Juan Vicente; Ramirez-Cardich, Maria E; Montoya-Herrera, Orlando; Fernández, Telmo; Veloso, Valdilea G; Buchbinder, Susan P; Chariyalertsak, Suwat; Schechter, Mauro; Bekker, Linda-Gail; Mayer, Kenneth H; Kallás, Esper Georges; Amico, K Rivet; Mulligan, Kathleen; Bushman, Lane R; Hance, Robert J; Ganoza, Carmela; Defechereux, Patricia; Postle, Brian; Wang, Furong; McConnell, J Jeff; Zheng, Jia-Hua; Lee, Jeanny; Rooney, James F; Jaffe, Howard S; Martinez, Ana I; Burns, David N; Glidden, David V
Antiretroviral chemoprophylaxis before exposure is a promising approach for the prevention of human immunodeficiency virus (HIV) acquisition. We randomly assigned 2499 HIV-seronegative men or transgender women who have sex with men to receive a combination of two oral antiretroviral drugs, emtricitabine and tenofovir disoproxil fumarate (FTC-TDF), or placebo once daily. All subjects received HIV testing, risk-reduction counseling, condoms, and management of sexually transmitted infections. The study subjects were followed for 3324 person-years (median, 1.2 years; maximum, 2.8 years). Of these subjects, 10 were found to have been infected with HIV at enrollment, and 100 became infected during follow-up (36 in the FTC-TDF group and 64 in the placebo group), indicating a 44% reduction in the incidence of HIV (95% confidence interval, 15 to 63; P=0.005). In the FTC-TDF group, the study drug was detected in 22 of 43 of seronegative subjects (51%) and in 3 of 34 HIV-infected subjects (9%) (P<0.001). Nausea was reported more frequently during the first 4 weeks in the FTC-TDF group than in the placebo group (P<0.001). The two groups had similar rates of serious adverse events (P=0.57). Oral FTC-TDF provided protection against the acquisition of HIV infection among the subjects. Detectable blood levels strongly correlated with the prophylactic effect. (Funded by the National Institutes of Health and the Bill and Melinda Gates Foundation; ClinicalTrials.gov number, NCT00458393.).
van Schalkwyk, Cari; Mndzebele, Sibongile; Hlophe, Thabo; Garcia Calleja, Jesus Maria; Korenromp, Eline L; Stoneburner, Rand; Pervilhac, Cyril
Swaziland's severe HIV epidemic inspired an early national response since the late 1980s, and regular reporting of program outcomes since the onset of a national antiretroviral treatment (ART) program in 2004. We assessed effectiveness outcomes and mortality trends in relation to ART, HIV testing and counseling (HTC), tuberculosis (TB) and prevention of mother to child transmission (PMTCT). Data triangulated include intervention coverage and outcomes according to program registries (2001-2010), hospital admissions and deaths disaggregated by age and sex (2001-2010) and population mortality estimates from the 1997 and 2007 censuses and the 2007 demographic and health survey. By 2010, ART reached 70% of the estimated number of people living with HIV/AIDS with CD4TB. All-cause child in-patient case fatality rates started to decrease from 2005-6. TB case notifications as well as rates of HIV/TB co-infection among notified TB patients continued a steady increase through 2010, while coverage of HIV testing and CPT for co-infected patients increased to above 80%. Against a background of high, but stable HIV prevalence and decreasing HIV incidence, we documented early evidence of a mortality decline associated with the expanded national HIV response since 2004. Attribution of impact to specific interventions (versus natural epidemic dynamics) will require additional data from future household surveys, and improved routine (program, surveillance, and hospital) data at district level.
Bautista-Arredondo, Sergio; Sosa-Rubí, Sandra G; Opuni, Marjorie; Kwan, Ada; Chaumont, Claire; Coetzee, Jenny; Condo, Jeanine; Dzekedzeke, Kumbutso; Galárraga, Omar; Martinson, Neil; Masiye, Felix; Nsanzimana, Sabin; Wamai, Richard; Wang'ombe, Joseph
Scaling up services to achieve HIV targets will require that countries optimize the use of available funding. Robust unit cost estimates are essential for the better use of resources, and information on the heterogeneity in the unit cost of delivering HIV services across facilities - both within and across countries - is critical to identifying and addressing inefficiencies. There is limited information on the unit cost of HIV prevention services in sub-Saharan Africa and information on the heterogeneity within and across countries and determinants of this variation is even more scarce. The "Optimizing the Response in Prevention: HIV Efficiency in Africa" (ORPHEA) study aims to add to the empirical body of knowledge on the cost and technical efficiency of HIV prevention services that decision makers can use to inform policy and planning. ORPHEA is a cross-sectional observational study conducted in 304 service delivery sites in Kenya, Rwanda, South Africa, and Zambia to assess the cost, cost structure, cost variability, and the determinants of efficiency for four HIV interventions: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT), voluntary medical male circumcision (VMMC), and HIV prevention for sex workers. ORPHEA collected information at three levels (district, facility, and individual) on inputs to HIV prevention service production and their prices, outputs produced along the cascade of services, facility-level characteristics and contextual factors, district-level factors likely to influence the performance of facilities as well as the demand for HIV prevention services, and information on process quality for HTC, PMTCT, and VMMC services. ORPHEA is one of the most comprehensive studies on the cost and technical efficiency of HIV prevention interventions to date. The study applied a robust methodological design to collect comparable information to estimate the cost of HTC, PMTCT, VMMC, and sex worker prevention services in
Hoyos Miller, Juan; Fernández-Balbuena, Sonia; Belza Egozcue, María José; García de Olalla, Patricia; Pulido Manzanero, Jose; Molist Señe, Gemma; de la Fuente de Hoz, Luis
The role of pre- and post-test counselling in new HIV testing strategies to reduce delayed diagnosis has been debated. Data on time devoted to counselling are scarce. One approach to this problem is to explore patients' views on the time devoted to counselling by venue of their last HIV test. We analysed data from 1568 people with a previous HIV test who attended a mobile HIV testing program in Madrid between May and December 2008. The majority (71%) were men (48% had had sex with other men), 51% were <30 years, 40% were foreigners, 56% had a university degree, and 40% had the most recent HIV test within the last year. As regards pre-test counselling, 30% stated they were told only that they would receive the test; 26.3% reported <10 min; 20.4% about 10 min; and 24.2%, 15 min or more. For post-test counselling: 40.2% stated they were told only that the test was negative; 24.9% reported 2-6 min; 16.4% about 10 min; and 18.5%, 15 min or more. The percentage of participants who reported no counselling time was higher among those tested in general health services: primary care, hospital settings and private laboratories (over 40% in pre-test, over 50% in post-test counselling). Women received less counselling time than men in almost all settings. Policies to expand HIV testing in general health services should take this current medical behaviour into account. Any mention of the need for counselling can be a barrier to expansion, because HIV is becoming less of a priority in developed countries. Oral consent should be the only requirement. Copyright © 2012 Elsevier España, S.L. All rights reserved.
Full Text Available Abstract Background There is an increasing trend toward international migration worldwide. With it comes a challenge for public health and public funded health care systems to meet the migrating population’s health needs. Men who have sex with men are a key population for HIV, contributing an estimated 42% of new HIV cases in Europe in 2013. HIV monitoring data suggest that foreign-born MSM are not only exposed to a high risk of HIV before migration but also while living in Sweden. The aim of this study is to examine HIV testing prevalence and uptake of HIV prevention interventions among foreign-born MSM living in Sweden. Methods A web survey available in English and Swedish was conducted from October 1 to October 30, 2013 via a Scandinavian Web community for Lesbian, Gay, Bisexual, Transgender and Intergender people. The web survey included modules on sociodemographics, condom use, sexual risk behaviour and HIV/STI testing experience. 244 eligible MSM participants born abroad and living in Sweden participated in the study. Descriptive and inferential analysis was performed. Results Half of the foreign-born MSM participants in this study had been tested for HIV during the last 12 months. Participants who had lived in Sweden less than or equal to 5 years were more likely to have been tested for HIV during the last 12 months. Having talked about HIV/STI with a prevention worker during the past year was associated with having been tested for HIV. Requested services among the majority of participants were HIV rapid test, anonymous HIV testing, HIV/STI testing outside of the health care setting and MSM-friendly clinics. Conclusion Efforts are needed to promote HIV testing among foreign-born MSM. Peer outreach, individual and group counselling may be preferred interventions to do so. In addition, it is critically important to increase HIV testing among foreign-born MSM who have lived in Sweden for more than five years. Further research should
van Schalkwyk, Cari; Mndzebele, Sibongile; Hlophe, Thabo; Garcia Calleja, Jesus Maria; Korenromp, Eline L.; Stoneburner, Rand; Pervilhac, Cyril
Introduction Swaziland’s severe HIV epidemic inspired an early national response since the late 1980s, and regular reporting of program outcomes since the onset of a national antiretroviral treatment (ART) program in 2004. We assessed effectiveness outcomes and mortality trends in relation to ART, HIV testing and counseling (HTC), tuberculosis (TB) and prevention of mother to child transmission (PMTCT). Methods Data triangulated include intervention coverage and outcomes according to program registries (2001-2010), hospital admissions and deaths disaggregated by age and sex (2001-2010) and population mortality estimates from the 1997 and 2007 censuses and the 2007 demographic and health survey. Results By 2010, ART reached 70% of the estimated number of people living with HIV/AIDS with CD4<350/mm3, with progressively improving patient retention and survival. As of 2010, 88% of health facilities providing antenatal care offered comprehensive PMTCT services. The HTC program recorded a halving in the proportion of adults tested who were HIV-infected; similarly HIV infection rates among HIV-exposed babies halved from 2007 to 2010. Case fatality rates among hospital patients diagnosed with HIV/AIDS started to decrease from 2005–6 in adults and especially in children, contrasting with stable case fatality for other causes including TB. All-cause child in-patient case fatality rates started to decrease from 2005–6. TB case notifications as well as rates of HIV/TB co-infection among notified TB patients continued a steady increase through 2010, while coverage of HIV testing and CPT for co-infected patients increased to above 80%. Conclusion Against a background of high, but stable HIV prevalence and decreasing HIV incidence, we documented early evidence of a mortality decline associated with the expanded national HIV response since 2004. Attribution of impact to specific interventions (versus natural epidemic dynamics) will require additional data from future
Geary, Cynthia Waszak; Burke, Holly McClain; Castelnau, Laure; Neupane, Shailes; Sall, Yacine Ba; Wong, Emily; Tucker, Heidi Toms
In 2002 MTV launched a global multicomponent HIV prevention campaign, "Staying Alive," reaching over 166 countries worldwide. An evaluation of this campaign focused on three diverse sites: Kathmandu, Nepal; São Paulo, Brazil; and Dakar, Senegal. Data were collected before and after campaign implementation through population-based household surveys. Using linear regression techniques, our evaluation examined the effects of campaign exposure on interpersonal communication about HIV and the effects of campaign exposure and interpersonal communication on beliefs about HIV prevention. We found a consistent positive effect of exposure on interpersonal communication across all sites, though there were differences among sites with regard to whom the respondent talked about HIV. We also found a consistent positive effect of exposure on HIV prevention beliefs across sites when interpersonal communication was simultaneously entered into the model. Finally, in two sites we found a relationship between interpersonal communication and HIV prevention beliefs, controlling for exposure, though again, the effects differed by the type of person the communication was with. These similar findings in three diverse sites provide ecological validity of the findings that "Staying Alive" promoted interpersonal communication and influenced young people's beliefs about HIV prevention in a positive way, evidence for the potential of a global media campaign to have an impact on social norms.
Akers, Aletha Y.; Davis, Esa M.; Foster, Lovie J. Jackson; Morrison, Penelope; Sucato, Gina; Miller, Elizabeth; Lee, MinJae
Objectives Little is known about prevention-focused counseling health providers deliver to parents of adolescents. This study compared parental report of discussions with their adolescents’ providers about a range of adolescent prevention topics. Methods Between June and November 2009, a questionnaire was provided to parents accompanying adolescents aged 11-18 on outpatient clinic visits. Parents indicated, anonymouslym which of 22 prevention topics they remembered discussing with their adolescent's provider. Hierarchical logistic regression models were used to identify correlates of parental recall. Results Among the 358 participants, 83% reported discussing at least one prevention topic. More parents reported discussing general prevention topics than mental health or high-risk topics (e.g. sex). Adolescent gender, visit type, having a usual source of care, and parental beliefs about their adolescents’ risk behaviors correlated with parental report of discussions about high-risk and mental health topics. Conclusion Most parents recalled discussing one or more topics with their adolescent's health provider. However, parental report of discussions about topics linked to significant adolescent morbidity was low. Practice implications Strategies to improve the frequency, timeliness and appropriateness of counseling services delivered to parents about adolescent preventive health are needed. Strategies that utilize decision support tools or patient education tools may be warranted. PMID:24238626
Ott, Mary A; Alexander, Andreia B; Lally, Michelle; Steever, John B; Zimet, Gregory D
Adolescents have had very limited access to research on biomedical prevention interventions despite high rates of HIV acquisition. One concern is that adolescents are a vulnerable population, and trials carry a possibility of harm, requiring investigators to take additional precautions. Of particular concern is preventive misconception, or the overestimation of personal protection that is afforded by enrolment in a prevention intervention trial. As part of a larger study of preventive misconception in adolescent HIV vaccine trials, we interviewed 33 male and female 16-19-year-olds who have sex with men. Participants underwent a simulated HIV vaccine trial consent process, and then completed a semistructured interview about their understanding and opinions related to enrolment in a HIV vaccine trial. A grounded theory analysis looked for shared concepts, and focused on the content and process of adolescent participants' understanding of HIV vaccination and the components of preventive misconception, including experiment, placebo and randomisation. Across interviews, adolescents demonstrated active processing of information, in which they questioned the interviewer, verbally worked out their answers based upon information provided, and corrected themselves. We observed a wide variety of understanding of research concepts. While most understood experiment and placebo, fewer understood randomisation. All understood the need for safer sex even if they did not understand the more basic concepts. Education about basic concepts related to clinical trials, time to absorb materials and assessment of understanding may be necessary in future biomedical prevention trials.
Phanuphak, Nittaya; Lo, Ying-Ru; Shao, Yiming; Solomon, Sunil Suhas; O'Connell, Robert J.; Tovanabutra, Sodsai; Chang, David; Kim, Jerome H.
Abstract An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost–benefit may help this decision process. PMID:26107771
Marutani, Miki; Miyazaki, Misako
This study explored the methods that are used by public health nurses to provide culturally sensitive health counseling to elderly Japanese farmers in order to motivate them to adopt healthy behaviors. Fourteen elderly farmers (eight men and six women) from three rural communities underwent health counseling and then changed their habits to prevent lifestyle-related diseases. Qualitative and inductive analyses were conducted to determine the effects of the culturally sensitive counseling. Five methods for providing culturally sensitive counseling were identified: (i) showing an interest in, and respect for, the local culture; (ii) stimulating the participants' awareness of the health risks inherited in their local cultural practices through the use of familiar examples; (iii) accepting and understanding the participants' ambivalence about their local culture; (iv) connecting the reasons for the participants to change their lifestyle with their local culture; and (v) adjusting the health-promoting behaviors of the participants to fit their local culture. Public health nurses should consider the pride that elderly farmers have in their background and their resistance to change and use these factors to point out the discrepancies in their lifestyle and promote more quality-of-life-oriented and practical self-care behaviors.
Chandler-Coley, Rasheeta; Ross, Henry; Ozoya, Oluwatobi; Lescano, Celia; Flannigan, Timothy
Media messages can facilitate the delivery of accurate information related to HIV and sexually transmitted infection. This study's purpose was to examine preexisting media campaigns from the iMPPACS study to assess age-, gender-, and culturally appropriate components identified by African American females who attend historically Black colleges/universities. In 3 separate focus group sessions, 31 Black female college students (M age = 20) viewed 4 vignettes and heard 3 audio-only clips, then ranked and commented on them based on perceived satisfaction with HIV prevention content and appropriateness of delivery. Conventional qualitative analysis using NVivo software was performed until saturation of content was achieved and themes derived. Six major themes emerged and were designated as (a) social media; (b) mirror image; (c) visually dynamic advertisements; (d) the real world; (e) people, place, things; and (f) HIV knowledge. Visually stimulating content (i.e., graphics) was found to be most appealing in marketing HIV prevention, with brief monologue/dialogue from scenarios that resemble daily life. Socially and culturally relevant HIV prevention messages are important to Black college female students. Participants recommended creating short audiovisual messages that encompass familiar contexts like dorm rooms and appealing graphics for HIV health promotion messages, such as emojis. Future audio-only prevention advertisements for this population should use recognizable voices (e.g., celebrities). Finally, messaging should be promoted on open and closed circuit social media platforms.
Spielberg, Freya; Kurth, Ann; Reidy, William; McKnight, Teka; Dikobe, Wame; Wilson, Charles
This article highlights findings from an evaluation that explored the impact of mobile versus clinic-based testing, rapid versus central-lab based testing, incentives for testing, and the use of a computer counseling program to guide counseling and automate evaluation in a mobile program reaching people of color at risk for HIV. The program's…
BACKGROUND: Coverage assessment of prevention of Pregnant Mother to Child Transmission (PMTCT) of HIV service is useful to measure the health system effort or performance of health service delivery function and to influence decisions. The objective of this study was to assess effective coverage level for prevention ...
Nov 2, 2012 ... Isoniazid preventive therapy (IPT) is recommended for the prevention of active TB in HIV-infected individuals, including pregnant women. However, there are few data regarding IPT use in the latter, with concern regarding the concurrent use of. IPT with nevirapine in pregnancy, as both treatments are ...
Tovar Cuevas, Luis Miguel; Arrivillaga Quintero, Marcela
The purpose of this study was to assess the prevalence of, and the factors associated with HIV testing and pre- and post-test counselling (PPTC) in Colombia. Cross-sectional data from the National Health Survey carried out during 2007 were analysed. Data were gathered from records of 29,760 individuals between the ages of 18 and 69 from the main regions in the country. Only 19.7% of the sample had taken an HIV test. Men, people with no education, not affiliated to the health-care sys...
L. T. Matthews
Full Text Available Background. Understanding HIV-infected patient experiences and perceptions of reproductive counseling in the health care context is critical to inform design of effective pharmaco-behavioral interventions that minimize periconception HIV risk and support HIV-affected couples to realize their fertility goals. Methods. We conducted semistructured, in-depth interviews with 30 HIV-infected women (with pregnancy in prior year and 20 HIV-infected men, all reporting serodiscordant partners and accessing care in Durban, South Africa. We investigated patient-reported experiences with safer conception counseling from health care workers (HCWs. Interview transcripts were reviewed and coded using content analysis for conceptual categories and emergent themes. Results. The study findings indicate that HIV-infected patients recognize HCWs as a resource for periconception-related information and are receptive to speaking to a HCW prior to becoming pregnant, but seldom seek or receive conception advice in the clinic setting. HIV nondisclosure and unplanned pregnancy are important intervening factors. When advice is shared, patients reported receiving a range of information. Male participants showed particular interest in accessing safer conception information. Conclusions. HIV-infected men and women with serodiscordant partners are receptive to the idea of safer conception counseling. HCWs need to be supported to routinely initiate accurate safer conception counseling with HIV-infected patients of reproductive age.
Hudson, C P
Networks of concurrent sexual partnerships may be the primary cause of epidemic spread of HIV-1 in parts of sub-Saharan Africa. This pattern of sexual behaviour increases the likelihood that individuals experiencing primary HIV-1 infection transmit the virus to other persons. Networks of concurrent partnerships are likely to be important in both the early ('epidemic') and late ('endemic') phases of HIV-1 transmission. Interventions should aim to break the sexual networks, whatever the stage of the epidemic. However, prevention of transmission in the endemic phase also requires a greater awareness of early clinical manifestations of HIV-1 infection in the general population. Such awareness, coupled with the availability of condoms and access to HIV-1 testing facilities, may reduce transmission in discordant couples.
In South Africa, the private sector has responded to the HIV epidemic by providing treatment in the form of highly active antiretroviral therapy (HAART). The private sector has paved the way for policy and treatment regimens, while the public sector has reviewed health-systems capacity and the political will to provide ...
Philpott, Sean; Heise, Lori; McGrory, Elizabeth; Paxton, Lynn; Hankins, Catherine
As new HIV prevention tools are developed, researchers face a number of ethical and logistic questions about how and when to include novel HIV prevention strategies and tools in the standard prevention package of ongoing and future HIV prevention trials. Current Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO) guidance recommends that participants in prevention trials receive 'access to all state of the art HIV risk reduction methods', and that decisions about adding new tools to the prevention package be made in consultation with 'all relevant stakeholders'. The guidance, however, leaves open questions of both process and implementation. In March 2009, the Global Campaign for Microbicides, UNAIDS and the Centers for Disease Control and Prevention convened a consultation to develop practical answers to these questions. Fifty-nine diverse participants, including researchers, ethicists, advocates and policymakers, worked to develop consensus criteria on when to include new HIV prevention tools in future trials. Participants developed a set of questions to guide decision-making, including: whether the method has been recommended by international bodies or adopted at a national level; the size of the effect and weight of the evidence; relevance to the trial population; whether the tool has been approved or introduced in the trial country; whether adding the tool might lead to trial futility; outstanding safety issues and status of the trial. Further work is needed to develop, implement and evaluate approaches to facilitate meaningful stakeholder participation in this deliberative process.
Lundgren, J D; Battegay, M; Behrens, G
BACKGROUND: Metabolic diseases are frequently observed in HIV-infected persons and, as the risk of contracting these diseases is age-related, their prevalence will increase in the future as a consequence of the benefits of antiretroviral therapy (ART). SUMMARY OF GUIDELINES: All HIV-infected pers......BACKGROUND: Metabolic diseases are frequently observed in HIV-infected persons and, as the risk of contracting these diseases is age-related, their prevalence will increase in the future as a consequence of the benefits of antiretroviral therapy (ART). SUMMARY OF GUIDELINES: All HIV......-infected persons should be screened at regular intervals for a history of metabolic disease, dyslipidaemia, diabetes mellitus, hypertension and alteration of body composition; cardiovascular risk and renal function should also be assessed. Efforts to prevent cardiovascular disease will vary in intensity depending...... on an individual's absolute risk of ischaemic heart disease and should be comprehensive in nature. Lifestyle interventions should focus on counselling to stop smoking, modify diet and take regular exercise. A healthy diet, exercise and maintaining normal body weight tend to reduce dyslipidaemia; if not effective...
Rhodes, Corinne M; Chang, Yuchiao; Regan, Susan; Triant, Virginia A
The Human Immunodeficiency Virus (HIV) epidemic has evolved, with an increasing non-communicable disease (NCD) burden emerging and need for long-term management, yet there are limited data to help delineate the optimal care model to screen for NCDs for this patient population. The primary aim was to compare rates of NCD preventive screening in persons living with HIV/AIDS (PLWHA) by type of HIV care model, focusing on metabolic/cardiovascular disease (CVD) and cancer screening. We hypothesized that primary care models that included generalists would have higher preventive screening rates. Prospective observational cohort study. Partners HealthCare System (PHS) encompassing Brigham & Women's Hospital, Massachusetts General Hospital, and affiliated community health centers. PLWHA age >18 engaged in active primary care at PHS. HIV care model categorized as infectious disease (ID) providers only, generalist providers only, or ID plus generalist providers. Odds of screening for metabolic/CVD outcomes including hypertension (HTN), obesity, hyperlipidemia (HL), and diabetes (DM) and cancer including colorectal cancer (CRC), cervical cancer, and breast cancer. In a cohort of 1565 PLWHA, distribution by HIV care model was 875 ID (56%), 90 generalists (6%), and 600 ID plus generalists (38%). Patients in the generalist group had lower odds of viral suppression but similar CD4 counts and ART exposure as compared with ID and ID plus generalist groups. In analyses adjusting for sociodemographic and clinical covariates and clustering within provider, there were no significant differences in metabolic/CVD or cancer screening rates among the three HIV care models. There were no notable differences in metabolic/CVD or cancer screening rates by HIV care model after adjusting for sociodemographic and clinical factors. These findings suggest that HIV patients receive similar preventive health care for NCDs independent of HIV care model.
Full Text Available BACKGROUND. “Project Protect” aims to find highly infectious individuals through screening for acute/recent infection cases and prevent HIV transmission in the risk networks of these cases through contact tracing of these networks` participants, distributing community alerts about risk of acute infection among them and accurate post-test counseling.METHODS. An ongoing pilot phase of the intervention began in Kriviy Rig and Lviv, Ukraine in November, 2011. Participants are recruited through: 1 screening for cases of acute/recent infection at voluntary counseling and testing (VCT sites and in partner organizations (including AIDS-Centers which conduct VCT; 2 visits to drug use venues, chain-referral and contact tracing. Genscreen ultra HIV Ag-Ab “special-tests” are used to detect cases of acute infection. Recent infection is defined as positive test result and preceding negative result within 6 months and/or age younger than 21 years old.RESULTS. In the two cities 173 respondents were recruited to the project, 118 special tests were done. No cases of acute infection and eleven cases of recent infection were found (8 injection drug users (IDUs with preceding negative result within 6 months, 2 IDUs younger than 21 recruited by project team; one non-IDU with preceding negative result within 6 months referred from AIDS-Center. Six recent cases were recruited through screening at VCT sites, 5 others through contact tracing. Psychologists conducted 41 interviews with recent infection cases and their risk networks` members; 176 community alert flyers were distributed to members of risk networks during the interview by psychologist, at the venue by social worker and by participants themselves; 3 drug use venues were visited by project team with concomitant HIV-testing of people present at the venue. CONCLUSIONS. Network tracing seems to be feasible and to help find recently infected people. Further research is needed to tell whether this
Full Text Available Behailu Merdekios1, Adebola A Adedimeji2 1College of Medicine and Health Sciences, Arba Minch University, Ethiopia; 2Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, New York, USA Background: In Ethiopia, Progress in Reducing Mother-to-Child-Transmission (PMTCT of human immunodeficiency virus (HIV is being curtailed by behavioral and cultural factors that continue to put unborn children at risk, and mother-to-child transmission is responsible for more than 90% of HIV infection in children. The objective of this study was to assess PMTCT services by examining knowledge about reducing vertical transmission among pregnant women. Methods: A multistaged sampling institution-based survey was conducted in 113 pregnant women in Arba Minch. Qualitative and quantitative data were obtained. Results: Of the 113 respondents, 89.4% were from Arba Minch, 43.4% were at least 25 years of age, 73.4% had formal education at primary level or above, 100% reported acceptance of voluntary counseling and testing, 92.0% were knowledgeable about mother-to-child transmission, and 90.3% were aware of the availability of the PMTCT service in the health facility. Of 74 HIV-positive women in PMTCT, only three (4.1% had had skilled birth attendants at delivery. There was an unacceptable degree of loss of women from PMTCT. Maternal educational level had a statistical association with income (P < 0.001 and voluntary counseling and testing for pregnant women (P < 0.05. Factors that determined use of PMTCT included culture, socioeconomic status, and fear of stigma and discrimination. Conclusion: In the area studied, intervention to reduce mother-to-child transmission of HIV is failing to reach its goal. This is an alarming discovery requiring quick reconsideration and strengthening of preventive strategies at all levels. Keywords: human immunodeficiency virus, mother-to-child transmission, pregnant women, Ethiopia
Liu, Y; Tang, H F; Ning, Z; Zheng, H; He, N; Zhang, Y Y
Objective: To understand the prevalence rates of HIV-syphilis and HIV-herpes simplex virus 2 (HSV-2) co-infections and related factors among men having sex with men (MSM) who had visited the voluntary HIV counseling and testing (VCT) clinics in Shanghai, China. Methods: 756 eligible MSM who attended the VCT clinics of Shanghai Municipality and Putuo district during March to August, 2015 were recruited to participate in a cross-sectional survey with questionnaire interview and blood testing for HIV, syphilis and HSV-2. Results: A total of 732 participants completed a valid questionnaire survey. The prevalence rates were 3.3 % (24/732) for HIV/Syphilis co-infection, 1.9 % (14/732) for HIV/HSV-2 co-infection, and 0.7 % (5/732) for HIV/Syphilis/HSV-2 co-infection, respectively. HIV prevalence appeared significantly higher among syphilis-infected participants (45.3 % , 24/53) than those without Syphilis (7.2 % , 61/679) (χ(2)=63.11, P Syphilis co-infection. Those participants who had high middle school or lower levels of education ( OR =6.87, 95 %CI : 1.86-25.42; OR =9.82, 95 %CI : 2.25-42.85) were under risk on HIV and HSV-2 co-infection. Conclusion: HIV/Syphilis and HIV/HSV-2 co-infection were seen among MSM who attended the VCT clinics in Shanghai that called for special attention, especially on migrants, those with low education or illicit drug users.
Galárraga, Omar; Wamai, Richard G; Sosa-Rubí, Sandra G; Mugo, Mercy G; Contreras-Loya, David; Bautista-Arredondo, Sergio; Nyakundi, Helen; Wang'ombe, Joseph K
We estimate costs and their predictors for three HIV prevention interventions in Kenya: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT) and voluntary medical male circumcision (VMMC). As part of the 'Optimizing the Response of Prevention: HIV Efficiency in Africa' (ORPHEA) project, we collected retrospective data from government and non-governmental health facilities for 2011-12. We used multi-stage sampling to determine a sample of health facilities by type, ownership, size and interventions offered totalling 144 sites in 78 health facilities in 33 districts across Kenya. Data sources included key informants, registers and time-motion observation methods. Total costs of production were computed using both quantity and unit price of each input. Average cost was estimated by dividing total cost per intervention by number of clients accessing the intervention. Multivariate regression methods were used to analyse predictors of log-transformed average costs. Average costs were $7 and $79 per HTC and PMTCT client tested, respectively; and $66 per VMMC procedure. Results show evidence of economies of scale for PMTCT and VMMC: increasing the number of clients per year by 100% was associated with cost reductions of 50% for PMTCT, and 45% for VMMC. Task shifting was associated with reduced costs for both PMTCT (59%) and VMMC (54%). Costs in hospitals were higher for PMTCT (56%) in comparison to non-hospitals. Facilities that performed testing based on risk factors as opposed to universal screening had higher HTC average costs (79%). Lower VMMC costs were associated with availability of male reproductive health services (59%) and presence of community advisory board (52%). Aside from increasing production scale, HIV prevention costs may be contained by using task shifting, non-hospital sites, service integration and community supervision. © The Author 2017. Published by Oxford University Press in association with The London School of
Huebner, David M; Davis, Mary C; Nemeroff, Carol J; Aiken, Leona S
A growing body of research implicates internalized homophobia--the internalization of society's antihomosexual sentiments by gay and lesbian people--as a factor contributing to HIV-related sexual risk behavior in gay and bisexual men. Although accumulating evidence links internalized homophobia and sexual risk behavior, no study has explored the impact of internalized homophobia on efforts to prevent these behaviors. This paper examines the effect of internalized homophobia on gay and bisexual men's awareness of participation in, and perceptions of programs offered by a community-based HIV prevention organization. In Study 1, 595 gay and bisexual men reported their levels of awareness of and participation in HIV prevention programming offered by one community organization. Internalized homophobia was negatively related to men's awareness of the services offered by the organization. However, among the men who were aware of at least one service, internalized homophobia did not further predict service utilization. Study 2 examined 89 gay and bisexual men who participated for a single session in a group-structured, community-based HIV preventive intervention. Pre- to immediate postintervention change in perceptions of condom use self-efficacy was inversely related to internalized homophobia. Internalized homophobia was also a significant negative predictor of the extent to which participants felt similar to and related well with other members of the group. Together, these findings suggest that internalized homophobia may pose multiple barriers to community-based HIV prevention efforts.
Thomas Obinchemti Egbe
Full Text Available Background. We determined the incidence of HIV seroconversion during the second and third trimesters of pregnancy and ad hoc potential cofactors associated with HIV seroconversion after having an HIV-negative result antenatally. We also studied knowledge of PMTCT among pregnant women in seven health facilities in Fako Division, South West Region, Cameroon. Method. During the period between September 12 and December 4, 2011, we recruited a cohort of 477 HIV-negative pregnant women by cluster sampling. Data collection was with a pretested interviewer-administered questionnaire. Sociodemographic information, knowledge of PMTCT, and methods of HIV prevention were obtained from the study population and we did Voluntary Counselling and Testing (VCT for HIV. Results. The incidence rate of HIV seroconversion during pregnancy was 6.8/100 woman-years. Ninety percent of the participants did not use condoms throughout pregnancy but had a good knowledge of PMTCT of HIV. Only 31.9% of participants knew their HIV status before the booking visit and 33% did not know the HIV status of their partners. Conclusion. The incidence rate of HIV seroconversion in the Fako Division, Cameroon, was 6.8/100 woman-years. No risk factors associated with HIV seroconversion were identified among the study participants because of lack of power to do so.
Egbe, Thomas Obinchemti; Tazinya, Rose-Mary Asong; Halle-Ekane, Gregory Edie; Egbe, Eta-Nkongho; Achidi, Eric Akum
We determined the incidence of HIV seroconversion during the second and third trimesters of pregnancy and ad hoc potential cofactors associated with HIV seroconversion after having an HIV-negative result antenatally. We also studied knowledge of PMTCT among pregnant women in seven health facilities in Fako Division, South West Region, Cameroon. During the period between September 12 and December 4, 2011, we recruited a cohort of 477 HIV-negative pregnant women by cluster sampling. Data collection was with a pretested interviewer-administered questionnaire. Sociodemographic information, knowledge of PMTCT, and methods of HIV prevention were obtained from the study population and we did Voluntary Counselling and Testing (VCT) for HIV. The incidence rate of HIV seroconversion during pregnancy was 6.8/100 woman-years. Ninety percent of the participants did not use condoms throughout pregnancy but had a good knowledge of PMTCT of HIV. Only 31.9% of participants knew their HIV status before the booking visit and 33% did not know the HIV status of their partners. The incidence rate of HIV seroconversion in the Fako Division, Cameroon, was 6.8/100 woman-years. No risk factors associated with HIV seroconversion were identified among the study participants because of lack of power to do so.
Gay, Cynthia L.; Cohen, Myron S.
More than 3 million people are now receiving antiretroviral therapy (ART) worldwide. Currently, the indications for ART depend primarily on CD4 count, blood viral burden, and clinical signs and symptoms suggesting advanced HIV disease. However, interest is increasing in ART’s preventive potential. Postexposure prophylaxis following both occupational and nonoccupational exposure to HIV is the standard-of-care in many settings. Observational and ecologic studies suggest that ART administered to...
Full Text Available This article explores the ways in which (a Indigenous youth involved in an HIV intervention took up and reclaimed their cultures as a project of defining ‘self’, and (b how Indigenous ‘culture’ can be used as a tool for resistance, HIV prevention and health promotion. Data were drawn from the Taking Action Project: Using arts-based approaches to develop Aboriginal youth leadership in HIV prevention. ‘By youth, for youth’ HIV education and awareness workshops were facilitated in six Indigenous communities across Canada, incorporating traditional and contemporary art forms to explore how youth perceived the links between structural inequality and HIV vulnerability. Over 100 youth participated, with 70 partaking in individual interviews to reflect on their experiences at the workshops. Interviews were audio-recorded, transcribed verbatim and analysed using NVivo software. Indigenous youth understood culture as a complex construct that included reconnecting to land, body, history, community and ceremony. For many youth, being Aboriginal and participating in cultural activities was seen as important for intergenerational healing, empowerment, health and combatting HIV. Youth spoke excitedly of their attempts to reclaim their languages and cultures despite barriers. They also understood art as a medium for self-expression and as an important site of cultural evolution. Our project demonstrates that the incorporation of culture within health strategies is important for effective HIV prevention amongst Indigenous youth. Reclaiming Indigenous cultures, languages and ceremonies may help to nurture future generations, diminish cycles of victimisation and combat hopelessness by reconnecting youth to stories of resistance and survival. Keywords: Indigenous youth, culture, HIV prevention, arts-based research
Metzger, David S; Woody, George E; O'Brien, Charles P
Drug use continues to be a major factor fueling the global epidemic of HIV infection. This article reviews the current literature on the ability of drug treatment programs to reduce HIV transmission among injection and noninjection drug users. Most data come from research on the treatment of opiate dependence and provide strong evidence on the effectiveness of medication-assisted treatment for reducing the frequency of drug use, risk behaviors, and HIV infections. This has been a consistent finding since the epidemic began among diverse populations and cultural settings. Use of medications other than methadone (such as buprenorphine/naloxone and naltrexone) has increased in recent years with promising data on their effectiveness as HIV prevention and as new treatment options for communities heavily affected by opiate use and HIV infection. However, few treatment interventions for stimulant abuse and dependence have shown efficacy in reducing HIV risk. The cumulative literature provides strong support of drug treatment programs for improving access and adherence to antiretroviral treatment. Drug users in substance abuse treatment are significantly more likely to achieve sustained viral suppression, making viral transmission less likely. Although there are challenges to implementing drug treatment programs for maximum impact, the scientific literature leaves no doubt about the effectiveness of drug treatment as an HIV prevention strategy.
Naomi E Stotland
Full Text Available Describe the attitudes, beliefs, and practices of U.S. obstetricians on the topic of prenatal environmental exposures.A national online survey of American Congress of Obstetricians and Gynecologists (ACOG fellows and 3 focus groups of obstetricians.We received 2,514 eligible survey responses, for a response rate of 14%. The majority (78% of obstetricians agreed that they can reduce patient exposures to environmental health hazards by counseling patients; but 50% reported that they rarely take an environmental health history; less than 20% reported routinely asking about environmental exposures commonly found in pregnant women in the U.S.; and only 1 in 15 reported any training on the topic. Barriers to counseling included: a lack of knowledge of and uncertainty about the evidence; concerns that patients lack the capacity to reduce harmful exposures; and fear of causing anxiety among patients.U.S. obstetricians in our study recognized the potential impact of the environment on reproductive health, and the role that physicians could play in prevention, but reported numerous barriers to counseling patients. Medical education and training, evidence-based guidelines, and tools for communicating risks to patients are needed to support the clinical role in preventing environmental exposures that threaten patient health.
Brown, E J; Simpson, E M
Adolescents are increasingly at risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection. The prolonged latency period, sometimes in excess of five years, and the incubation period of up to 10 years before the manifestation of symptoms, may foster adolescents' false sense of invincibility and denial as they often do not see the devastating effects of the disease in their peers until they are older. In turn, their practice of safer sex may be hindered and thereby contribute to the escalation of this public health crisis among sexually active adolescents. Prevention-focused recommendations were made in the USA as a result of this crisis. Recommendations were made to: (1) include STD/HIV education in the curricula of grades kindergarten to 12; (2) increase to at least 75% the proportion of primary care and mental health professionals who provide age-appropriate STD/HIV prevention counselling to adolescents; and (3) expand HIV prevention services to include age-appropriate HIV education curricula for students in grades 4-12 in 95% of schools. Yet, in the USA, the provision of school-based comprehensive STD/HIV education has been difficult to achieve owing to certain limitations and, in some instances, legal action. These limitations include: limited student access; restricted content; and the implementation of sporadic and/or brief educational programmes. Given these recommendations and the fact that adolescents are acquiring STDs and HIV infections at increasing rates, and despite the limitations and legal actions, do health care professionals not have an ethical obligation to provide adolescents with comprehensive STD/HIV prevention education? This ethical dilemma will be discussed using the ethical decision-making principles of 'autonomy' and 'beneficence', and a decision-making model proposed by Thompson and Thompson, and by Chally and Loric.
Full Text Available Background: HIV counselling and testing (HCT and knowledge about HIV have been key strategies utilised in the prevention and control of HIV/AIDS worldwide. HIV knowledge and uptake of HCT services in sub-Saharan Africa are still low. This study was conducted to determine factors associated with HCT and HIV/AIDS knowledge levels among a commuter population in Johannesburg, South Africa. Objective: To identify the factors associated with HCT uptake among the commuter population. Design: A simple random sampling method was used to select participants in a venue-based intercept survey at a taxi rank in the Johannesburg Central Business District. Data were collected using an electronic questionnaire. Logistic regression analysis assessed factors associated with HIV testing stratified by gender. Results: 1,146 respondents were interviewed, the maority (n=579, 50.5% were females and (n=780, 68.1% were over 25 years of age. Overall HCT knowledge was high (n=951, 83% with more females utilising HCT facilities. There was a significant difference in HIV testing for respondents living closer to and further away from health facilities. Slightly more than half of the respondents indicated stigma as one of the barriers for testing (n=594, 52%, p-value=0.001. For males, living with a partner (aOR: 1.68, 95% CI: 1.02–2.78, p-value: 0.041 and possessing a post-primary education were positively associated with testing (aOR: 2.00, 95% CI: 1.15–3.47, p-value: 0.014, whereas stigma and discrimination reduced the likelihood of testing (aOR: 0.40, 95% CI: 0.31–0.62, p-value: <0.001. For females, having one sexual partner (aOR: 2.65, 95% CI: 1.19–5.90, p-value: 0.017 and a low perceived benefit for HIV testing (aOR: 0.54, 95% CI: 0.30–0.96, p-value: 0.035 were associated with HIV testing. Conclusion: The overall HIV/AIDS knowledge was generally high. Gender-specific health education and HIV intervention programmes are needed for improved access to HCT services
Nlend, Anne Esther Njom; Ekani, Bernadette Bagfegue
The objective is to describe the trends of infant feedings choices in HIV context after infant feeding counseling. Descriptive retrospective study: Infant feeding counseling (IFC) sessions were offered to HIV pregnant women by the same team of counselors from April 2008 to December 2012. Counseling content was promoting either exclusive breastfeeding (EBF) or exclusive formula feeding (EFF) prior to 2010. Later on, versus EBF+ antiretroviral (ARV) drug given either to the mother or the infant or EFF was the gold standard. Mixed feeding was prohibited. Infants feeding were practices recorded at the first post natal visit. rate of EBF/ EFF per year and period. We included a total of 1114 live-born babies. During the five year the overall rate of EBF and EFF stood at 41% and 59% respectively. The rate of EBF/EFF was recorded as follow: varies from 25/75% in year one to 52/48% in year five(p ≤ 0.001). The rate of mixed was virtually cancelled during the same period, 3/237 (1.2%) in year one to period 1/165 (0.6%) in the latest period. In conclusion, in Yaoundé, there is a slight increase in breastfeeding rate among HIV exposed infants during the first two months of life. Further investigations are required to confirm this tendency and analyze the new features of breastfeeding practices.
Whaley, Kevin J; Mayer, Kenneth H
Human immunodeficiency virus (HIV) may be transmitted through either cell-free virions or leukocytes harboring intracellular HIV in bodily fluids. In recent years, the early initiation of combination antiretroviral therapy leading to virological suppression has resulted in decreased HIV transmission to uninfected partners. Additionally, the efficacy of primary chemoprophylaxis with oral or topical antiretroviral regimens containing tenofovir (with or without emtricitabine) has been demonstrated. However, the efficacy of these approaches may be compromised by suboptimal adherence, decreased drug concentrations in mucosal compartments in women, and genital inflammation. Furthermore, in vitro studies on the effects of tenofovir on cell-associated HIV transmission have produced conflicting results. Preclinical studies suggest that combination preventive approaches may be most effective in stopping the transmission of HIV after mucosal exposure. Since the development of antibodies were found to correlate with protection in the only effective HIV vaccine trial, the administration of preformed mucosal and systemic antibodies may inform the development of safe and effective antibody-based oral, topical, and/or systemic preexposure prophylaxis agents and provide guidance in the development of HIV vaccines that effectively block cell-associated HIV transmission. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: email@example.com.
Full Text Available Many attempts have been made or are ongoing for HIV prevention and HIV cure. Many successes are in the list, particularly for HIV drugs, recently proposed also for prevention. However, no eradication of infection has been achieved so far with any drug.Further, a residual immune dysregulation associated to chronic immune activation and incomplete restoration of B and T cell subsets, together with HIV DNA persistence in reservoirs, are still unmet needs of the highly active antiretroviral therapy (HAART, causing novel non-AIDS related diseases that account for a higher risk of death even in virologically suppressed patients. These ART unmet needs represent a problem, which is expected to increase by ART roll out. Further, in countries such as South Africa, where 6 millions of individuals are infected, ART appears unable to contain the epidemics. Regretfully, all the attempts at developing a preventative vaccine have been largely disappointing. However, recent therapeutic immunization strategies have opened new avenues for HIV treatment, which might be exploitable also for preventative vaccine approaches. For example, immunization strategies aimed at targeting key viral products responsible of virus transmission, activation and maintenance of virus reservoirs may intensify drug efficacy and lead to a functional cure providing new perspectives also for prevention and future virus eradication strategies. However, this approach imposes new challenges to the scientific community, vaccine developers and regulatory bodies, such as the identification of novel immunological and virological biomarkers to assess efficacy endpoints, taking advantage from the natural history of infection and exploiting lessons from former trials.This review will focus first on recent advancement of therapeutic strategies, then on the progresses made in preventative approaches, discussing concepts and problems for the way ahead for the development of vaccines for HIV treatment
Full Text Available Adolescent girls and young women who are at risk for unplanned pregnancy and sexually transmitted infection (STI, including HIV, are frequently counseled to use a hormonal contraceptive to protect against the former and condoms to protect against the latter, for exampe, American College of Obstetricians and Gynecologists, 2011. The present paper reviews the literature on multiple risk messages, compliance with this dual-use recommendation, predictors of dual use, and interventions developed to encourage dual use. Data indicate that simultaneous use of these two methods is not common, and that efforts to encourage dual use have not yielded promising results. An alternative is to recommend condom use alone, since condoms protect very well against STI and HIV, and quite well against pregnancy when used consistently and correctly. The availability of emergency contraception is relevant here. Research utilizing a randomized controlled trial is recommended.
Full Text Available Abuse of drugs, psychotropic substances, illegal drugs and other addictive substances (drugs among teenagers especially students to be a problem from time to time keeps going on and it seems difficult to be finalized. So also in Indonesia drug abuse prevention efforts at the level of the student and the student assessment has been a great school for education practitioners and also involving relevant agencies such as BNN, BKKBN, the health department and the police. On the other hand, the number of victims of drug abuse among adolescents from year-to-year increase. spiritual intelligence (SQ is low is one of the students to be drug users. Various approaches, models and techniques of counseling has been developed and implemented in schools in order to develop students' potential. Counseling logo is one of the counseling intervention model that was first introduced by Viktor Frankl who seek to build the spiritual dimension of human besides raceway and psychological dimensions, and assume that the meaning of life and a desire for meaningful is the primary motivation of men to achieve meaningful livelihoods (the meaningful life is wanted. This research aimed to develop the logo counseling to improving the lives meaning drug abuse prevention and to know the effectiveness of that model. This research uses research and development approach or R&D with seven essential steps, namely (1 research and information collecting, (2 planning, (3 developing preliminary from of product, (4 preliminary field testing and product revision, (5 main field test and product revision, (6 operational field test and product revision, and (7 dissemination implementation and institutionalization. The population of this research includes practitioners or school counselors, experts and both state, Junior High School, Senior High Scholl and vocational students in Bali Province. The results of research on the effect of counseling logo on the trend of drug abuse in students in
Du, Ping; Crook, Tonya; Whitener, Cynthia; Albright, Patsi; Greenawalt, Daphne; Zurlo, John
People living with human immunodeficiency virus (HIV)/AIDS (PLWHA) who continue high-risk behaviors may represent an important source for transmitting HIV infections. To identify factors associated with high-risk behaviors among PLWHA and to plan better HIV prevention intervention strategies in HIV care. A cross-sectional survey to assess HIV transmission risk behaviors including sexual practices, disclosure of HIV infection status to sexual partner(s), and injection drug use. Five HIV outpatient clinics serving diverse PLWHA in south central Pennsylvania. A total of 519 HIV-infected patients. Two high-risk behaviors that may increase HIV transmission risk: (1) any unsafe sexual behavior and (2) nondisclosure of HIV infection status to sexual partner(s). An unsafe sexual behavior was defined as inconsistent condom use, sex under the influence of alcohol or drugs, or exchange of sex for money. A subgroup analysis was performed to examine factors related to unprotected anal intercourse among sexually active men who have sex with men. About two-thirds of 519 HIV patients (65.7%) were sexually active, and nearly 50% of sexually active patients reported at least 1 unsafe sexual behavior. Nondisclosure of HIV infection status was reported by about 15% of the patients. Partners' characteristics including HIV infection status and the perceived partner behavior (ie, partner may have sex with other people) were significantly associated with unsafe sexual behaviors and with nondisclosure of HIV infection status. Non-Hispanic black males were more likely to withhold their HIV infection status from their sexual partner(s) (adjusted odds ratio = 4.51) than their white counterparts. In addition, the perceived partner sexual behavior was significantly related to unprotected anal intercourse among men who have sex with men (adjusted odds ratio = 2.00). High-risk sexual behaviors are commonly reported by PLWHA, and these behaviors may be influenced by their partners' characteristics
Tuberculosis (TB) is the second most common cause of death from infectious disease in the world after human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Immunosuppressed HIV-infected persons are highly susceptible to TB disease, and countries in sub-Saharan Africa have the highest TB incidence rates, primarily because of the HIV epidemic. In Zambia, the TB rate increased during 1984-2005 from approximately 100 cases per 100,000 population to 580 cases per 100,000 population. Much of this increase has been attributed to the high rate of coinfection with HIV; currently, an estimated 50%-70% of TB patients are infected with HIV (N. Kapata, Ministry of Health, Zambia, personal communication, 2008). In 2007, the World Health Organization (WHO) recommended that countries with high coinfection rates develop TB/HIV collaborative activities, including routine provider-initiated HIV testing and counseling (PITC) of TB patients in TB clinical settings, using an "opt-out" approach. This report summarizes results from a PITC pilot study conducted by the Zambian Ministry of Health, with assistance from the CDC Global AIDS Program Zambia, during September 2004-December 2006 with TB patients at three clinics in the Livingstone District in the Southern Province of Zambia. The results indicated that, among 4,148 persons who had TB diagnosed, 2,072 (50%) were tested for HIV; of these, 1,497 (72%) tested positive. These findings demonstrate the practicality and acceptance of PITC and HIV rapid testing and support the need to expand this program to TB clinical settings in Zambia and other countries with high rates of TB and HIV.
Quaife, Matthew; Eakle, Robyn; Cabrera Escobar, Maria A; Vickerman, Peter; Kilbourne-Brook, Maggie; Mvundura, Mercy; Delany-Moretlwe, Sinead; Terris-Prestholt, Fern
The development of antiretroviral (ARV)-based prevention products has the potential to substantially change the HIV prevention landscape; yet, little is known about how appealing these products will be outside of clinical trials, as compared with the existing options. We conducted a discrete choice experiment (DCE) to measure preferences for 5 new products among 4 important populations in the HIV response: adult men and women in the general population (aged 18 to 49 y), adolescent girls (aged 16 to 17 y), and self-identifying female sex workers (aged 18 to 49 y). We interviewed 661 self-reported HIV-negative participants in peri-urban South Africa, who were asked to choose between 3 unique, hypothetical products over 10 choice sets. Data were analyzed using multinomial, latent class and mixed multinomial logit models. HIV protection was the most important attribute to respondents; however, results indicate significant demand among all groups for multipurpose prevention products that offer protection from HIV infection, other STIs, and unwanted pregnancy. All groups demonstrated a strong preference for long-lasting injectable products. There was substantial heterogeneity in preferences within and across population groups. Hypothetical DCE data may not mirror real-world choices, and products will have more attributes in reality than represented in choice tasks. Background data on participants, including sensitive areas of HIV status and condom use, was self-reported. These results suggest that stimulating demand for new HIV prevention products may require a more a nuanced approach than simply developing highly effective products. No single product is likely to be equally attractive or acceptable across different groups. This study strengthens the call for effective and attractive multipurpose prevention products to be deployed as part of a comprehensive combination prevention strategy.
Prevention of MTCT of HIV will involve; (1) Prevention of transmission from an HIV infected mother to her infant. (2) Prevention of unintended pregnancies in HIV infected women. (3) Prevention of new infections in pregnant women and their partners. And (4) Provision of treatment, care and support to women infected with ...
Mamo, Tewodros; Moseman, E Ashley; Kolishetti, Nagesh; Salvador-Morales, Carolina; Shi, Jinjun; Kuritzkes, Daniel R; Langer, Robert; von Andrian, Ulrich
Currently, there is no cure and no preventive vaccine for HIV/AIDS. Combination antiretroviral therapy has dramatically improved treatment, but it has to be taken for a lifetime, has major side effects and is ineffective in patients in whom the virus develops resistance. Nanotechnology is an emerging multidisciplinary field that is revolutionizing medicine in the 21st century. It has a vast potential to radically advance the treatment and prevention of HIV/AIDS. In this review, we discuss the challenges with the current treatment of the disease and shed light on the remarkable potential of nanotechnology to provide more effective treatment and prevention for HIV/AIDS by advancing antiretroviral therapy, gene therapy, immunotherapy, vaccinology and microbicides. PMID:20148638
Objective: An HCT survey was carried out to ascertain barriers and facilitators for HIV testing in South Africa. Methods: A cross-sectional survey of 67 HCT-offering health facilities in 8 South African provinces was undertaken. Individuals (n = 489 who had not tested for HIV on the day of the site visit were interviewed on awareness of HCT services, HIV testing history and barriers to HIV testing. Frequencies were run to describe the sample characteristics, barriers and facilitators to HIV testing. Bivariate and multivariate logistic regression was usedt o identify the association between never tested for HIV with socio-demographics, awareness of HCT services and type of HCT facilities. Results: In all 18.1% participants never had an HIV test. Major barriers to HCT uptake comprise being scared of finding out one's HIV test result or what people may say, shyness or embarrassment, avoidance of divulging personal information to health workers and fear of death. In multivariate analysis the age group 55 years and older, and not being recommended to have an HIV test were associated with never had an HIV test. Potential facilitators for HIV testing include community or household HIV testing, providing incentives for those who test for HIV, mandatory HIV testing and disclosure of HIV status by those who test HIV positive. Conclusion: The benefits of HCT which include the reduction of HIV transmission, the availability of HIV care and treatment needs to be emphasized to enhance HCT uptake.
MacPhail, Catherine Lorne; Pettifor, Audrey; Coates, Tom; Rees, Helen
Reduced HIV risk behavior and increased use of care and support services have been demonstrated among adults accessing HIV voluntary counseling and testing (VCT). The impact of VCT on adolescents is, however, not known. Focus group discussions were held with adolescents and parents in two South African townships to establish the perceptions of and…
Ana Rita Diniz
Full Text Available Objectives: To review existing data on Pre-Exposure Prophylaxis (PrEP for prevention of HIV infection, including the role of medical male circumcision, oral administration of antiretroviral drugs and topical microbicides. Data Sources: PubMed and www.clinicaltrials.gov. Review Methods: Comprehensive review. Results: Medical male circumcision has been shown to prevent 48-60% of new HIV-1 infections. The efficacy rate of antiretroviral drugs given per os to prevent HIV infection varies in direct association with the adherence rate (62.2% in TDF2 study with 84% adherence; 44% in iPrEx study with <50% adherence; 48% in Bangkok study with 67% adherence; 67-75% in Partners PrEP study with 82% adherence; and 6% in FEM-PrEP study with 40% adherence. As for the use of topic microbicides, the CAPRISA 004 study showed 39% reduction in HIV infection using a 1% tenofovir gel. On the other hand, PRO2000 gel showed a modest reduction of 30% which was not statistically significant. Conclusions: The studies suggest that medical male circumcision is highly cost-effective at preventing HIV infection but requires careful communication strategies to be successful. PrEP using antiretroviral drugs is also very effective but it is highly dependent on the adherence rate. As for topical microbicides, 1% tenofovir gel is currently the only promising option.
Mary S Campbell
Full Text Available Characterization of viruses in HIV-1 transmission pairs will help identify biological determinants of infectiousness and evaluate candidate interventions to reduce transmission. Although HIV-1 sequencing is frequently used to substantiate linkage between newly HIV-1 infected individuals and their sexual partners in epidemiologic and forensic studies, viral sequencing is seldom applied in HIV-1 prevention trials. The Partners in Prevention HSV/HIV Transmission Study (ClinicalTrials.gov #NCT00194519 was a prospective randomized placebo-controlled trial that enrolled serodiscordant heterosexual couples to determine the efficacy of genital herpes suppression in reducing HIV-1 transmission; as part of the study analysis, HIV-1 sequences were examined for genetic linkage between seroconverters and their enrolled partners.We obtained partial consensus HIV-1 env and gag sequences from blood plasma for 151 transmission pairs and performed deep sequencing of env in some cases. We analyzed sequences with phylogenetic techniques and developed a Bayesian algorithm to evaluate the probability of linkage. For linkage, we required monophyletic clustering between enrolled partners' sequences and a Bayesian posterior probability of ≥ 50%. Adjudicators classified each seroconversion, finding 108 (71.5% linked, 40 (26.5% unlinked, and 3 (2.0% indeterminate transmissions, with linkage determined by consensus env sequencing in 91 (84%. Male seroconverters had a higher frequency of unlinked transmissions than female seroconverters. The likelihood of transmission from the enrolled partner was related to time on study, with increasing numbers of unlinked transmissions occurring after longer observation periods. Finally, baseline viral load was found to be significantly higher among linked transmitters.In this first use of HIV-1 sequencing to establish endpoints in a large clinical trial, more than one-fourth of transmissions were unlinked to the enrolled partner
Sophus, Amber I; Fujitani, Loren; Vallabhbhai, Samantha; Antonio, Jo Anna; Yang, Pua Lani; Elliott, Elyssa; Mitchell, Jason W
Partner-oriented services and Health Information and Communication technology (HICT) in the forms of mHealth (eg, smartphone applications), eHealth (eg, interactive websites), telemedicine, and social media play an important and growing role in HIV prevention. Accordingly, the present study sought to describe: (1) the primary and secondary HIV prevention services available in Hawai'i, (2) the prevention services that are available for gay male couples and partners, and (3) the prevention services that use HICT. Information about prevention services and use of HICT were obtained from websites and phone calls made to 19 organizations in the state, including the Hawai'i Department of Health. Overall, partner-oriented services were limited and only 1 couples-based service was currently being offered. Technology, namely social media, was used by 14 organizations, primarily to increase HIV awareness and advertise events. These findings may inform how best to adapt and better leverage the use of innovative technological tools to help expand access to HIV testing and counseling, sexual health education, and case management services for gay male couples and other MSM populations in the state.
Ron Levey, Ilana; Wang, Wenjuan
Despite the substantial investment for providing HIV counselling and testing (VCT) services in Zambia, there has been little effort to systematically evaluate the quality of VCT services provided by various types of health providers. This study, conducted in 2009, examines VCT in the public and private sectors including private for-profit and NGO/faith-based sectors in Copperbelt and Luapula. The study used five primary data collection methods to gauge quality of VCT services: closed-ended client interviews with clients exiting VCT sites; open-ended client interviews; interviews with facility managers; review of service statistics; and an observation of the physical environment for VCT by site. Over 400 clients and 87 facility managers were interviewed from almost 90 facilities. Sites were randomly selected and results are generalizable at the provincial level. The study shows concerning levels of underperformance in VCT services across the sectors. It reveals serious underperformance in counselling about key risk-reduction methods. Less than one-third of clients received counselling on reducing number of sexual partners and only approximately 5% of clients received counselling about disclosing test results to partners. In terms of client profiles, the NGO sector attracts the most educated clients and less educated Zambians seek VCT services at very low rates (7%). The private for-profit performs equally or sometimes better than other sectors even though this sector is not adequately integrated into the Zambian national response to HIV. The private for-profit sector provides VCT services on par in quality with the other sectors. Most clients did not receive counselling on partner reduction or disclosure of HIV test results to partners. In a generalized HIV epidemic where multiple concurrent sexual partners are a significant problem for transmitting the disease, risk-reduction methods and discussion should be a main focus of pre-test and post-test counselling
Full Text Available Children living with HIV who are not diagnosed in infancy often remain undiagnosed until they present with advanced disease. Provider-initiated testing and counselling (PITC in health facilities is recommended for high-HIV-prevalence settings, but it is unclear whether this approach is sufficient to achieve universal coverage of HIV testing. We aimed to investigate the change in community burden of undiagnosed HIV infection among older children and adolescents following implementation of PITC in Harare, Zimbabwe.Over the course of 2 years (January 2013-January 2015, 7 primary health clinics (PHCs in southwestern Harare implemented optimised, opt-out PITC for all attendees aged 6-15 years. In February 2015-December 2015, we conducted a representative cross-sectional survey of 8-17-year-olds living in the 7 communities served by the study PHCs, who would have had 2 years of exposure to PITC. Knowledge of HIV status was ascertained through a caregiver questionnaire, and anonymised HIV testing was carried out using oral mucosal transudate (OMT tests. After 1 participant taking antiretroviral therapy was observed to have a false negative OMT result, from July 2015 urine samples were obtained from all participants providing OMTs and tested for antiretroviral drugs to confirm HIV status. Children who tested positive through PITC were identified from among survey participants using gender, birthdate, and location. Of 7,146 children in 4,251 eligible households, 5,486 (76.8% children in 3,397 households agreed to participate in the survey, and 141 were HIV positive. HIV prevalence was 2.6% (95% CI 2.2%-3.1%, and over a third of participants with HIV were undiagnosed (37.7%; 95% CI 29.8%-46.2%. Similarly, among the subsample of 2,643 (48.2% participants with a urine test result, 34.7% of those living with HIV were undiagnosed (95% CI 23.5%-47.9%. Based on extrapolation from the survey sample to the community, we estimated that PITC over 2 years identified
Method: A self-administered questionnaire was used to collect data on demography, knowledge of HIV transmission and prevention, training on HIV transmission and prevention and teaching of students on HIV/AIDS. A composite scale for HIV knowledge was defined by pooling all scored knowledge variables based on 25 ...
van de Wijgert, Janneke; Coggins, Christiana
The development of topical microbicides for HIV prevention originated in response to the unabated spread of HIV despite the availability of an effective HIV prevention tool (condoms), as well as the lack of an effective HIV vaccine. Initially, hopes were pinned on existing over-the-counter
Epps, Patricia H.; Vallenari, Allison
This manual includes all necessary information for implementing the Champs program, which trains older elementary school students or middle/high school students to operate puppets to deliver an HIV/AIDS message to kindergarten through sixth graders. Relying on a peer approach, the Program provides scripted, prerecorded lessons intended to reach…
Hoban, Mary T.; Ottenritter, Nan W.; Gascoigne, Jan L.; Kerr, Dianne L.
This document presents the results of the National College Health Risk Behavior Survey (NCHRBS) conducted by the U.S. Centers for Disease Control (CDC) that pertain to HIV transmission. These results include sexual assault, alcohol and other drug use, and sexual behaviors. The survey was administered to a nationally representative random sample of…
Boot, J.; Rump, B.O.; Boucher, C.A.B.; Coul, E.L. Op de; Agtmael, M.A. van; Vijver, D.A. van de; Burger, D.M.; Fanoy, E.B.
The Netherlands has approximately 20,000 registered HIV-infected patients. The current HIV prevention policy consisting of condom use and active HIV testing does not effectively mitigate the HIV epidemic in all risk groups. In July of 2012, tenofovir/emtricitabine (TDF/FTC) was approved by the
Rosen, Raymond C; Catania, Joseph A; Ehrhardt, Anke A; Burnett, Arthur L; Lue, Tom F; McKenna, Kevin; Heiman, Julia R; Schwarcz, Sandy; Ostrow, David G; Hirshfield, Sabina; Purcell, David W; Fisher, William A; Stall, Ron; Halkitis, Perry N; Latini, David M; Elford, Jonathan; Laumann, Edward O; Sonenstein, Freya L; Greenblatt, David J; Kloner, Robert A; Lee, Jay; Malebranche, David; Janssen, Erick; Diaz, Rafael; Klausner, Jeffrey D; Caplan, Arthur L; Jackson, Graham; Shabsigh, Ridwan; Khalsa, Jag H; Stoff, David M
Recent reports have linked the use of phosphodiesterase type 5 (PDE-5) inhibitors with increased rates of high-risk sexual behavior and HIV transmission in some individuals. A National Institute of Mental Health (NIMH)-funded, multidisciplinary conference was convened to evaluate scientific research, clinical and ethical considerations, and public policy implications of this topic. Published and unpublished findings on effects of PDE-5 inhibitors on sexual behavior; published guidelines and management recommendations. Leading investigators in relevant disciplines (e.g., public health, epidemiology, medical ethics, urology, psychology) participated in a 2-day meeting, including representatives of government, scientific, and regulatory agencies (the Centers for Disease Control, Food and Drug Administration, NIMH, and the National Institute on Drug Abuse). Panelists provided critical reviews of substantive areas of research, followed by question and answer sessions on each topic. On the second day, working groups were convened to identify critical gaps and priorities in three major areas: (i) research and evaluation needs; (ii) prevention strategies and clinical management issues; and (iii) policy and prevention implications. Research needs and priorities were categorized into four specific areas: (i) basic and clinical/laboratory research; (ii) epidemiology and risk factors; (iii) social-behavioral processes and interventions; and (iv) prevention/policy and educational needs. Identified gaps in the available data include populations at risk (e.g., risk among heterosexuals, risk profiles among subpopulations of men who have sex with men) and the specific role of PDE-5 inhibitors in HIV seroconversion. Specific areas of emphasis were the need for safer sex counseling, comprehensive sexually transmitted infection (STI) screening and follow-up when indicated, avoidance of potentially dangerous drug interactions, and potential benefits of testosterone replacement for HIV
Mtenga, Sally M; Exavery, Amon; Kakoko, Deodatus; Geubbels, Eveline
Cumulative evidence indicates increasing HIV infection among married individuals. Voluntary Counselling and Testing for HIV (HCT) is known to be an effective intervention to induce safer sex behaviour and access to early treatment, care and support among married individuals, which are important for HIV prevention. In this context, knowledge of factors associated with HCT uptake among married individuals is critical in promoting the use of the services. This study therefore intended to identify the social cognitive factors associated with acceptance of HCT among married individuals. In a cross-sectional analytical study face to face questionnaires were administered among 200 randomly selected married individuals in Kinondoni district, Dar es Salaam Tanzania. The questionnaire included self-reported HCT, socio-demographic variables and social cognitive variables (attitude, subjective norms, perceived control and perceived risk). Logistic regression was used to identify the independent association of social cognitive predictors of HCT among married individuals. Nearly half (42%) of the respondents had never had HCT. Of the social cognitive constructs, the strongest predictor of HCT uptake was attitude (OR per additional score point = 1.07, 95% CI 1.04-1.10) followed by perceived behavioural control (OR = 1.04, 95% CI 1.02-1.06). Subjective norm and perceived risk were not associated with HCT uptake. Public health interventions targeting married individuals should be designed to enhance their positive attitude towards HCT and empower them to overcome barriers to the use of the services.
Préau, Marie; Lorente, Nicolas; Sagaon-Teyssier, Luis; Champenois, Karen; Gall, Jean Marie Le; Mabire, Xavier; Spire, Bruno; Mora, Marion; Yazdanpanah, Yazdan; Suzan, Marie
The aims of the study were to determine the level of satisfaction of men who have sex with men (MSM) participating in two community-based non-medicalized counseling and testing programs (ANRS-DRAG and ANRS-COM'TEST) offering HIV rapid tests (hereafter CBOffer), and to identify factors associated with satisfaction. Between 2009 and 2011, 436 participants voluntarily benefited from a CBOffer in the two programs. They completed self-administered questionnaires before and after testing. Psychosocial scores were constructed using principal component analyses to reflect the following dimensions: post-test satisfaction, avoidance of at-risk situations as a HIV risk-reduction strategy, and attitudes towards condom use. Logarithmic regression of the post-test satisfaction score was performed on these scores and on other selected explanatory variables, including the variable "self-identification as homosexual or bisexual". Post-test satisfaction ranged between 90-99 and below 90 for 50% and 25% of the participants, respectively. Post-test satisfaction with the CBOffer was independently associated with self-defined sexuality, meeting place for sexual partners, participants' attitudes about being HIV-positive, and condom use. The very high level of satisfaction was associated with both personal and socio-behavioral factors. Vulnerable MSM could be targeted better and, accordingly, could use this offer more frequently as a combined prevention tool.
Cawley, C; Wringe, A; Todd, J.; Gourlay, A; CLARK, B; Masesa, C; Machemba, R; Reniers, G; Urassa, M; Zaba, B
OBJECTIVES: To investigate the relative effectiveness of different HIV testing and counselling (HTC) services in improving HIV diagnosis rates and increasing HTC coverage in African settings. METHODS: Patient records from three HTC services [community outreach HTC during cohort study rounds (CO-HTC), walk-in HTC at the local health centre (WI-HTC) and antenatal HIV testing (ANC-HTC)] were linked to records from a community cohort study using a probabilistic record linkage algorithm. Character...
Cawley, Caoimhe; Wringe, Alison; Todd, Jim; Gourlay, Annabelle; Clark, Benjamin; Masesa, Clemens; Machemba, Richard; Reniers, Georges; Urassa, Mark; Zaba, Basia
Abstract Objectives To investigate the relative effectiveness of different HIV testing and counselling (HTC) services in improving HIV diagnosis rates and increasing HTC coverage in African settings. Methods Patient records from three HTC services [community outreach HTC during cohort study rounds (CO?HTC), walk?in HTC at the local health centre (WI?HTC) and antenatal HIV testing (ANC?HTC)] were linked to records from a community cohort study using a probabilistic record linkage algorithm. Ch...
Paredes i Carbonella, J J; Colomer Revueltab, C
To describe the application of participatory methodology in the prison setting for the determination of the most appropiate contents and methods of a HIV/AIDS prevention program. Community study in the Centro de Cumplimiento del Establecimiento Penitenciario in Valencia (1250 inmates) in Spain. The study was carried out in two phases: identification of key informants and collection of information. In the second phase, a community forum composed of the center's male and female inmates was created, personal interviews with convicted female prisoners were carried out and a self-administered questionnaire was distributed to the center's health professionals and management as well as to health promotion experts. Community forum. The following proposals for HIV/AIDS prevention were made by the male and female prisoners: a) those directed at the prisoners themselves: increasing preventive mesures in material used in injection and in sexual relationships; b) those directed at the prison management: increased distribution of condoms, safety razors and bleach and the introduction of sterile injection material. In the personal interviews, agreement on a future prevention program was high among the female inmates and the other key informants. Preferred measures were the acquisition of information on the mechanisms of HIV transmission and prevention and on the differences between HIV carriers and those suffering from AIDS and the acquisition of skills for disinfecting material used for drug injection and in negotiating the use of condoms with partners. The preferred methodology was based on groups that would allow for an interchange of experience and would deal with the difficulties of putting preventive measures into practice. The participation of the prison's inmates and staff supplied information that facilitated the design (choice of aims, measures, methods and resources) of an HIV prevention program adapted to the needs and preferences of all the interested parties.
Collier, Alizanne C; Van der Borght, Stefaan F M; Rinke de Wit, Tobias; Rinke de Wit, Tobias F; Richards, Sarah C; Feeley, Frank G
Heineken Breweries launched a workplace HIV/AIDS program at its Rwanda subsidiary in September 2001. By January 25, 2005, 736/2,595 eligible individuals had reported for counseling and HIV testing: 380/521 employees (72.9%), 254/412 spouses (61.7%), 99/1,517 children (6.5%), and 3/145 retired (2.0%). As a result, 109 HIV+ individuals were identified: 62 employees, 34 spouses, 12 children, and 1 retired. In September 2003 an anonymous HIV seroprevalence survey was performed with participation rates of 69.4% for employees, 58.2% for spouses, and 79.7% for adolescents. Using the survey result, the expected number of HIV+ employees was 71, which implies a program uptake of 87.1% (62/71) in this group. Of the identified 109 HIV+ beneficiaries, 42 were on highly active antiretroviral treatment (HAART). In November 2003 a qualitative study of awareness and health-seeking behavior of the Heineken Rwanda beneficiaries identified key principles contributing to the success of this program.
Leyna Germana H
Full Text Available Abstract Background Variability in stages of the HIV-1 epidemic and hence HIV-1 prevalence exists in different areas in sub-Saharan Africa. The purpose of this study was to investigate the magnitude of HIV-1 infection and identify HIV-1 risk factors that may help to develop preventive strategies in rural Kilimanjaro, Tanzania. Methods A cross-sectional study was conducted between March and May of 2005 involving all individuals aged between 15–44 years having an address in Oria Village. All eligible individuals were registered and invited to participate. Participants were interviewed regarding their demographic characteristics, sexual behaviors, and medical history. Following a pre-test counseling, participants were offered an HIV test. Results Of the 2 093 eligible individuals, 1 528 (73.0% participated. The overall age and sex adjusted HIV-1 prevalence was 5.6%. Women had 2.5 times higher prevalence (8.0% vs. 3.2% as compared to men. The age group 25–44 years, marriage, separation and low education were associated with higher risk of HIV-1 infection for both sexes. HIV-1 infection was significantly associated with >2 sexual partners in the past 12 months (women: Adjusted odds ratio [AOR], 2.5 (95%CI: 1.3–4.7, and past 5 years, [(men: AOR, 2.2 (95%CI:1.2–5.6; women: AOR, 2.5 (95%CI: 1.4–4.0], unprotected casual sex (men: AOR,1.8 95%CI: 1.2–5.8, bottled alcohol (Men: AOR, 5.9 (95%CI:1.7–20.1 and local brew (men: AOR, 3.7 (95%CI: 1.5–9.2. Other factors included treatment for genital ulcers and genital discharge in the past 1 month. Health-related complaints were more common among HIV-1 seropositive as compared to seronegative participants and predicted the presence of HIV-1 infection. Conclusion HIV-1 infection was highly prevalent in this population. As compared to our previous findings, a shift of the epidemic from a younger to an older age group and from educated to uneducated individuals was observed. Women and married or
Inzaule, Seth C.; Hamers, Raph L.; Calis, Job; Boerma, Ragna; Sigaloff, Kim; Zeh, Clement; Mugyenyi, Peter; Akanmu, Sulaimon; Rinke de Wit, Tobias F.
: The scale-up of antiretroviral prophylaxis to prevent mother-to-child transmission of HIV has significantly reduced new pediatric infections in sub-Saharan Africa. However, among infants who become HIV-infected despite prevent mother-to-child transmission, more than 50% have drug-resistant HIV.
Full Text Available This paper examines the ways in which HIV prevention is understood including “biomedical”, “behavioural”, “structural”, and “combination” prevention. In it I argue that effective prevention entails developing community capacity and requires that public health addresses people not only as individuals but also as connected members of groups, networks and collectives who interact (talk, negotiate, have sex, use drugs, etc. together. I also examine the evaluation of prevention programmes or interventions and argue that the distinction between efficacy and effectiveness is often glossed and that, while efficacy can be evaluated by randomized controlled trials, the evaluation of effectiveness requires long-term descriptive strategies and/or modelling. Using examples from a number of countries, including a detailed account of the Australian HIV prevention response, effectiveness is shown to be dependent not only on the efficacy of the prevention technology or tool but also on the responses of people – individuals, communities and governments – to those technologies. Whether a particular HIV prevention technology is adopted and its use sustained depends on a range of social, cultural and political factors. The paper concludes by calling on biomedical and social scientists to work together and describes a “social public health”.
... 30% of the HIV-infected women and 55% of the HIV-uninfected mothers were using mixed feeding, with no significant differences. Programmes for the prevention of motherto- child transmission of HIV should re-enforce counselling activities to address the issue of early weaning by HIV-infected women, and to support safe ...
Balfour, Louise; Wiebe, Stephanie A; Cameron, William D; Sandre, Daniella; Pipe, Andrew; Cooper, Curtis; Angel, Jonathan; Garber, Gary; Holly, Crystal; Dalgleish, Tracy L; Tasca, Giorgio A; MacPherson, Paul A
Cardiovascular disease (CVD) rates among people living with HIV/AIDS (PHAs) are high. Rates of cigarette smoking, a leading contributor to CVD among PHAs, are 40-70% (2-3 times higher than the general population). Furthermore, PHAs have high rates of depression (40-60%), a risk factor for smoking cessation relapse. The current pilot study examined the effectiveness of a specifically tailored 5-session smoking cessation counselling programme for PHAs, which addressed depression, in combination with Nicotine Replacement Therapy (NRT) in a cohort of PHA smokers (n = 50). At 6-month follow-up, 28% of participants demonstrated biochemically verified abstinence from smoking. This result compares favourably to other quit-smoking intervention studies, particularly given the high percentage of HIV+ smokers with depression. At study baseline, 52% of HIV+ smokers scored above the clinical cut-off for depression on the Centre for Epidemiological Studies - Depression (CES-D) scale. HIV+ smokers with depression at study baseline demonstrated quantitatively lower depression at 6-month follow-up with a large effect size (d = 1), though it did not reach statistical significance (p = .058). Furthermore, those with depression were no more likely to relapse than those without depression (p = .33), suggesting that our counselling programme adequately addressed this significant barrier to smoking cessation among PHAs. Our pilot study indicates the importance of tailored programmes to help PHAs quit smoking, the significance of addressing depressive symptoms, and the need for tailored counselling programmes to enhance quit rates among PHAs.
Cluver, Lucie Dale; Orkin, Frederick Mark; Meinck, Franziska; Boyes, Mark Edward; Sherr, Lorraine
Introduction Social protection is high on the HIV-prevention agenda for youth in sub-Saharan Africa. However, questions remain: How do unconditional cash transfers work? What is the effect of augmenting cash provision with social care? And can “cash plus care” social protection reduce risks for adolescents most vulnerable to infection? This study tackles these questions by first identifying mediated pathways to adolescent HIV risks and then examining potential main and moderating effects of social protection in South Africa. Methods This study was a prospective observational study of 3515 10-to-17-year-olds (56.7% female; 96.8% one-year retention). Within randomly selected census areas in four rural and urban districts in two South African provinces, all homes with a resident adolescent were sampled between 2009/2010 and 2011/2012. Measures included 1) potential structural drivers of HIV infection such as poverty and community violence; 2) HIV risk behaviours; 3) hypothesized psychosocial mediating factors; and 4) types of social protection involving cash and care. Using gender-disaggregated analyses, longitudinal mediation models were tested for potential main and moderating effects of social protection. Results Structural drivers were associated with increased onset of adolescent HIV risk behaviour (psocial protection were associated with reductions in HIV risk behaviour and psychosocial deprivations. In addition, cash social protection moderated risk pathways: for adolescent girls and boys experiencing more acute structural deprivation, social protection had the greatest associations with HIV risk prevention (e.g. moderation effects for girls: B=−0.08, psocial protection has the greatest prevention effects for the most vulnerable. Social protection comprising unconditional cash plus care was associated with reduced risk pathways through moderation and main effects, respectively. Our findings suggest the importance of social protection within a combination
Amy M. Hernandez
Full Text Available Hispanics are the fastest growing minority group in North Carolina with increasing incidence of HIV infection. Gender roles, cultural expectations, and acculturation of women may explain some of Hispanic women’s risks. The perspectives of Hispanic female immigrants and community-based providers were sought to identify services they offer, understand HIV risk factors, and support the adaptation of a best-evidence HIV behavioural intervention for Hispanic women. Two sets of focus groups were conducted to explicate risks and the opportunities to reach women or couples and the feasibility to conduct HIV prevention in an acceptable manner. Salient findings were that Hispanic female immigrants lacked accurate HIV/AIDS and STI knowledge and that traditional gender roles shaped issues surrounding sexual behaviour and HIV risks, as well as condom use, partner communication, and multiple sexual partnerships. Intervention implications are discussed such as developing and adapting culturally appropriate HIV prevention interventions for Hispanics that address gender roles and partner communication.
BARRIERS, FACILITATORS AND SOCIO-DEMOGRAPHIC CHARACTERISTICS ASSOCIATED WITH CONDOM USAGE AMONGST MALE HIV INTEGRATED COUNSELLING AND TESTING CENTRE ATTENDEES AT THE GOVERNMENT HOSPITAL OF THORACIC MEDICINE, AN HIV TERTIARY CARE CENTRE IN CHENNAI
Full Text Available Background: HIV is transmitted largely through sexual route which can be prevented by using condoms. The objectives of this study were to describe condom usage with various barriers, facilitators and to determine association between different socioeconomic characteristics among male Integrated Counselling and Testing Centre (ICTC attendees. Methods: This is a hospital based cross sectional study (n=300. Clients (18-45years attending ICTC for first time, between June-October ‘2010, were interviewed with structured questionnaire after obtaining informed consent. Description of demographic characteristics of respondents; univariate, multivariate logistic regression analyses were performed for estimation of association. Results: Among respondents, awareness of HIV and condom were 80% and 85.3% respectively; Knowledge of prevention from STI/HIV (97.7% was most common facilitator while forgetfulness after drinking alcohol (64.1% was most common barrier to use condom; Respondents who had education up to secondary or above level were more associated with condom usage (AOR 2.9,95%CI1.34-6.24, after adjusting for income compared to non educated respondents; considering less than Indian rupee (INR 3000 per month as reference category, there were association of condom usage among relatively higher income groups between INR.3000 to 5000 per month (AOR 2.6, 95%CI 1.38-5.0,adjusting education and income above INR5000 per month (AOR 2.85,95%CI1.37-5.9, adjusting education. Conclusions: Condom usage was independently associated with education and income level of respondents. Forgetfulness after drinking alcohol was main barrier; knowledge of prevention from HIV was main facilitator of condom usage. Dissemination of knowledge regarding facilitator of condom usage and implementation of Rapid Needs Assessment Tool for Condom Programming can encourage condom use.
Smerecnik, Chris M R; Ruiter, Robert A C
The present study examined the role of a number of cognitive beliefs (i.e. attitude, subjective norm, anticipated regret, and self-efficacy) in explaining the effects of fear appeal information on behavioral motivation. A randomized experiment with a 2 (threat: low versus high) × 2 (coping: low versus high) between-subjects design was used in the study. Undergraduates were exposed to one of four scenario messages that presented high or low threat information about HIV/AIDS combined with high or low coping information with regard to condom use in HIV prevention. Explorative analyses revealed that only anticipated regret qualified as a mediator of the effect of the fear appeal message on intention. High coping information was observed to increase anticipated regret, which increased the intention to use condoms. Anticipated regret mediated the coping-intention relationship. This finding furthers our understanding of the working mechanisms of fear appeals in HIV prevention.
Simon, Viviana; Ho, David D; Karim, Quarraisha Abdool
The HIV-1 pandemic is a complex mix of diverse epidemics within and between countries and regions of the world, and is undoubtedly the defining public-health crisis of our time. Research has deepened our understanding of how the virus replicates, manipulates, and hides in an infected person. Although our understanding of pathogenesis and transmission dynamics has become more nuanced and prevention options have expanded, a cure or protective vaccine remains elusive. Antiretroviral treatment has transformed AIDS from an inevitably fatal condition to a chronic, manageable disease in some settings. This transformation has yet to be realised in those parts of the world that continue to bear a disproportionate burden of new HIV-1 infections and are most a% ected by increasing morbidity and mortality. This Seminar provides an update on epidemiology, pathogenesis, treatment, and prevention interventions pertinent to HIV-1. PMID:16890836
Dokubo, E. Kainne; Shiraishi, Ray W.; Young, Peter W.; Neal, Joyce J.; Aberle-Grasse, John; Honwana, Nely; Mbofana, Francisco
Objective To determine factors associated with HIV status unawareness and assess HIV prevention knowledge and condom use among people living with HIV/AIDS (PLHIV) in Mozambique. Design Cross-sectional household-based nationally representative AIDS Indicator Survey. Methods Analyses focused on HIV-infected adults and were weighted for the complex sampling design. We identified PLHIV who had never been tested for HIV or received their test results prior to this survey. Logistic regression was used to assess factors associated with HIV status unawareness. Results Of persons with positive HIV test results (N = 1182), 61% (95% confidence interval [CI] 57–65%) were unaware of their serostatus. Men had twice the odds of being unaware of their serostatus compared with women [adjusted odds ratio (aOR) 2.05, CI 1.40–2.98]. PLHIV in the poorest wealth quintile were most likely to be unaware of their serostatus (aOR 3.15, CI 1.09–9.12) compared to those in the middle wealth quintile. Most PLHIV (83%, CI 79–87%) reported not using a condom during their last sexual intercourse, and PLHIV who reported not using a condom during their last sexual intercourse were more likely to be unaware of their serostatus (aOR 2.32, CI 1.57–3.43) than those who used a condom. Conclusions Knowledge of HIV-positive status is associated with more frequent condom use in Mozambique. However, most HIV-infected persons are unaware of their serostatus, with men and persons in the poorest wealth quintile being more likely to be unaware. These findings support calls for expanded HIV testing, especially among groups less likely to be aware of their HIV status and key populations at higher risk for infection. PMID:25222010
Full Text Available Daisy Maria Machado,1 Alexandre Machado de Sant’Anna Carvalho,2 Rachel Riera3 1Disciplina de Infectologia Pediátrica, Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2Universidade Federal do Rio de Janeiro, Rio de Janeiro, 3Disciplina de Medicina Baseada em Evidências, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil Abstract: Adolescents are a critical population that is disproportionately impacted by the HIV epidemic. More than 2 million adolescents between the age group of 10 and 19 years are living with HIV, and millions are at risk of infection. HIV risks are considerably higher among girls, especially in high-prevalence settings such as eastern and southern Africa. In addition to girls, there are other vulnerable adolescent subgroups, such as teenagers, who use intravenous (IV drugs, gay and bisexual boys, transgender youth, male sex workers, and people who fall into more than one of these categories. Pre-exposure prophylaxis (PrEP is a new intervention for people at high risk for acquiring HIV, with an estimated HIV incidence of >3%. Recent data from trials show evidence of the efficacy of PrEP as a powerful HIV prevention tool in high-risk populations, including men who have sex with men, HIV-1-serodiscordant heterosexual couples, and IV drug users. The reported efficacy in those trials of the daily use of oral tenofovir, alone or in combination with emtricitabine, to prevent HIV infection ranged from 44% to 75% and was heavily dependent on adherence. Despite the proven efficacy of PrEP in adult trials, concerns remain about its feasibility in real-life scenarios due to stigma, cost, and limited clinician experience with PrEP delivery. Recent studies are attempting to expand the inquiry into the efficacy of such HIV prophylaxis approaches in adolescent populations, but there are still many gaps in knowledge, and no
Attitudes and Practices on HIV Prevention among students of Higher Education Institutions in Ethiopia: The Case of Addis Ababa University. ... Data were collected using survey quantitative (questionnaire) and qualitative (FGDs), and subsequently, analysis of the data was made through the use of descriptive statistics ...
However, the reach of these interventions is still very limited in adolescent girls and young women (15–24 years) and the full realisation of the intervention mandates has not yet been achieved. The HIV prevention field has been criticised for the tendency to adopt a narrow focus. The Fast-Track Strategy offers a unique ...
Abstract. In this study we explored the level of awareness and practice on HIV prevention among married couples from selected communities in. Malawi. Methods. We carried out the study from October to December, 2008 in four communities, two each from Chiradzulu and Chikhwawa districts of. Malawi. We conducted ...
This paper examines the cultural and structural difficulties surrounding effective prevention of mother-to-child HIV transmission (PMTCT) in rural Lesotho. We argue for three strategies to improve PMTCT interventions: communitybased research and outreach, addressing cultural and structural dynamics, and working with the ...
members of the community were carried out. Data so collected were coded, categorized and summarized with an application of MAXQDA 10 qualitative data analysis software. Key findings: In Borana, HIV prevention endeavors were found to be coordinated by the zonal health department. Health extension workers, local ...
East African Medical Journal Vol. 77 No. 9 September 2000. ISONIAZID PROPHYLAXIS FOR TUBERCULOSIS PREVENTION AMONG HIV INFECTED POLICE OFFICERS IN DAR ES SALAAM. M. Bakari, MD, MMed, Lecturer and Specialist Physician, A. Moshi, MD, MMed, Specialist Physician, E.A. Aris, MD, MMed, ...
Background: Even though significant progress has been made in the roll-out and quality of the prevention of mother-to-child transmission of HIV (PMTCT) services in South Africa, the quality of patient data recording remains a challenge. Objectives: To assess PMTCT data completeness and accuracy at primary healthcare ...
Hohman, Melinda; Shillington, Audrey M.; Min, Jong Won; Clapp, John D.; Mueller, Kristin; Hovell, Melbourne
This study compared two groups of adolescents seeking help at HIV prevention drop-in agencies. The first group attended agencies in low-income Hispanic neighborhoods which recruited within the locale. The second group of youth attended agencies that recruited based upon a specific population--they targeted homeless and LGBQ youth. We explored the…
The implementation and evaluation of a peer education and support programme in secondary schools to prevent and reduce high-risk sexual behaviour amongst adolescents is discussed.The aims of the programme were to provide accurate information about HIV/AIDS, discuss and reconsider peer group norms, and ...
This volume is a guide to providing effective Human Immunodeficiency Virus (HIV) and substance abuse prevention services to runaway and homeless youth. The guide is based on current research and the best programs in this field. Chapters 1 and 2 summarize what is known about runaway and homeless youth, the services these youth require if they are…
... describes a condom promotion strategy to prevent HIV/STIs among highly vulnerable urban youth in a post-conflict, resource-constrained environment via the provision of both male and female condoms to nontraditional venues like music and photo shops, ice cream parlors, money exchange centers and beauty salons.
A relatively small number of African sites have the clinical and laboratory capacity to design, manage and carry out HIV/AIDS prevention trials. This project is based on the premise that many of the ... Journal supplement features 10 years of West African health systems research. In the wake of the devastating Ebola virus ...
Apr 27, 2016 ... IDRC-funded research is using mathematical modelling to influence local and national policies in China to reduce HIV transmission. Treatment as prevention Earlier research conducted under Modelling and controlling infectious diseases project showed that providing antiretroviral therapy (ART) to ...
Aug 21, 2014 ... Background: Even though significant progress has been made in the roll-out and quality of the prevention of mother-to-child transmission of HIV (PMTCT) services in South Africa, the quality of patient data recording remains a challenge. Objectives: To assess PMTCT data completeness and accuracy at ...
AJRH Managing Editor
Jigawa State, 3Federal Medical Centre Katsina, Katsina State.4Takai Comprehensive Health Centre, Takai, Kano State. 5Maternal ... Nigeria is scaling up prevention of mother-to-child transmission (PMTCT) of HIV interventions to primary health care centres. (PHCs). ..... stigma, inability to afford transport cost and long.
Background: The aim of infant-feeding counselling is to facilitate informed decision on method of feeding in the context of prevention of mother-to-child transmission of HIV. However, HIV-positive mothers are faced with uncertainty on how best to feed their infants. The question we asked for this research was: how does the ...
Background: Voluntary Counselling and Testing. (VCT) has become a cornerstone intervention in the fight against HIV. Current evidence suggests that it is cost-effective in changing behaviour and preventing. HIV infection. A number of studies have demonstrated some of the factors which are associated with both intention ...
Kalkım, Aslı; Dağhan, Şafak
The purpose of this research was to investigate the effect of an osteoporosis prevention program based on the Health Belief Model for women between the ages of 30 years and 45 years at risk of osteoporosis. This study was conducted with randomized control group pretest, post-test and follow-up trial. Intervention group (n = 37) and control group (n = 36) participated in the research. Data were collected using a sociodemographic data questionnaire, the Osteoporosis Knowledge Test, the Osteoporosis Health Belief Scale, the Osteoporosis Self-efficacy Scale, a monitoring form for estimated dairy calcium intake, and a monitoring form for estimated weekly exercise. Intervention program was composed of a 4-week education program and a 24-week counseling program. Data were collected pretest, post-test 15 days after the end of the education program, follow-up 1 after 3 months, and follow-up 2 after 6 months. Mann Whitney U test, chi-square test, Friedman test, Bonferroni test, two means test and Wilcoxon signed-rank test were used for statistical analysis. After the education and counseling program, a significant increase was seen in comparison with the control group in the mean scores of the intervention group on the Osteoporosis Knowledge Test and its subscales (p Belief Scale and its subscales (p Belief Model-based osteoporosis prevention education and counseling program conducted by nurses. Copyright © 2017. Published by Elsevier B.V.
Although substantial evidence supports oral preexposure prophylaxis with tenofovir disoproxil fumarate and emtricitabine (OPTF) for the primary prevention of HIV infection in certain settings, assessing whether other promising HIV prevention interventions are safe and effective as well as determining optimal prevention strategies necessitates research. However, given the established safety and efficacy of OPTF, it is necessary to determine when and how is it ethically acceptable to conduct this research, which is the focus of this review. Although they are somewhat intertwined, questions regarding OPTF in research can be considered in two broad categories: use in a comparison arm and as a standard of prevention. Major statements addressing these issues are described and recent literature directed at the particular issue of OPTF in research is reviewed and critiqued. There is now arguably a rebuttable presumption for the use of OPTF as a comparator or as part of the standard of prevention in much future HIV prevention research. However, making such determinations necessitates taking into account scientific considerations, the modality being evaluated, acceptability, adherence, and the local context. Doing so should be optimized by robust stakeholder engagement.
Spizzichino, L; Casella, P; Zaccarelli, M; Rezza, G; Venezia, S; Gattari, P
Between September 1993 and December 1995, 528 foreign individuals at risk of HIV infection attended the drug treatment centre located in the Santo Spirito Hospital in Rome, undergoing medical examination, HIV testing and counselling. The geographic distribution showed that the majority of the participants were from South America (40.0%), most of whom were transsexual sex workers (from Brazil or Columbia), and from North Africa (37.5%); all the individuals coming from Western and Eastern Europe and the USA were heroin users. The overall HIV prevalence was high (21.6%), though it varied by nationality, ranging from 5.1% among North Africans to 68.3% among Brazilian transsexuals. During the study period, 170 of the individuals returned for at least one follow-up visit. Three seroconversions occurred among the 118 initially HIV-negative immigrants who were retested, all three among the 26 HIV-negative Columbian transsexuals; the seroconversion rate within this group was 10.1 per 100 persons/years. During follow-up, there was no reduction observed in drug-related practices associated with HIV infection, yet a general increase in regular condom use was reported. The increasing number of foreign persons contacting our programme emphasizes the need for easy access to care and treatment for marginalized populations possibly engaging in behaviour at risk for HIV infection. Counselling strategies seem to be relatively effective in promoting safer sex among these population groups.
Shih, P; Worth, H; Travaglia, J; Kelly-Hanku, A
In his conceptualisation of pastoral power, Michel Foucault argues that modern healthcare practices derive a specific power technique from pastors of the early Christian church. As experts in a position of authority, pastors practise the care of others through implicitly guiding them towards thoughts and actions that effect self-care, and towards a predefined realm of acceptable conduct, thus having a regulatory effect. This qualitative study of healthcare workers from two Christian faith-based organisations in Papua New Guinea examines the pastoral rationalities of HIV prevention practices which draw together globally circulated modern medical knowledge and Christian teachings in sexual morality for implicit social regulation. Community-based HIV awareness education, voluntary counselling and testing services, mobile outreach, and economic empowerment programs are standardised by promoting behavioural choice and individual responsibility for health. Through pastoral rationalities of care, healthcare practices become part of the social production of negative differences, and condemn those who become ill due to perceived immorality. This emphasis assumes that all individuals are equal in their ability to make behavioural choices, and downplays social inequality and structural drivers of HIV risk that are outside individual control. Given healthcare workers' recognition of the structural drivers of HIV, yet the lack of language and practical strategies to address these issues, political commitment is needed to enhance structural competency among HIV prevention programs and healthcare workers. Copyright © 2017 Elsevier Ltd. All rights reserved.
Full Text Available Rapid HIV assays are the mainstay of HIV testing globally. Delivery of effective biomedical HIV prevention strategies such as antiretroviral pre-exposure prophylaxis (PrEP requires periodic HIV testing. Because rapid tests have high (>95% but imperfect specificity, they are expected to generate some false positive results.We assessed the frequency of true and false positive rapid results in the Partners PrEP Study, a randomized, placebo-controlled trial of PrEP. HIV testing was performed monthly using 2 rapid tests done in parallel with HIV enzyme immunoassay (EIA confirmation following all positive rapid tests.A total of 99,009 monthly HIV tests were performed; 98,743 (99.7% were dual-rapid HIV negative. Of the 266 visits with ≥1 positive rapid result, 99 (37.2% had confirmatory positive EIA results (true positives, 155 (58.3% had negative EIA results (false positives, and 12 (4.5% had discordant EIA results. In the active PrEP arms, over two-thirds of visits with positive rapid test results were false positive results (69.2%, 110 of 159, although false positive results occurred at <1% (110/65,945 of total visits.When HIV prevalence or incidence is low due to effective HIV prevention interventions, rapid HIV tests result in a high number of false relative to true positive results, although the absolute number of false results will be low. Program roll-out for effective interventions should plan for quality assurance of HIV testing, mechanisms for confirmatory HIV testing, and counseling strategies for persons with positive rapid test results.
Ndase, Patrick; Celum, Connie; Kidoguchi, Lara; Ronald, Allan; Fife, Kenneth H; Bukusi, Elizabeth; Donnell, Deborah; Baeten, Jared M
Rapid HIV assays are the mainstay of HIV testing globally. Delivery of effective biomedical HIV prevention strategies such as antiretroviral pre-exposure prophylaxis (PrEP) requires periodic HIV testing. Because rapid tests have high (>95%) but imperfect specificity, they are expected to generate some false positive results. We assessed the frequency of true and false positive rapid results in the Partners PrEP Study, a randomized, placebo-controlled trial of PrEP. HIV testing was performed monthly using 2 rapid tests done in parallel with HIV enzyme immunoassay (EIA) confirmation following all positive rapid tests. A total of 99,009 monthly HIV tests were performed; 98,743 (99.7%) were dual-rapid HIV negative. Of the 266 visits with ≥1 positive rapid result, 99 (37.2%) had confirmatory positive EIA results (true positives), 155 (58.3%) had negative EIA results (false positives), and 12 (4.5%) had discordant EIA results. In the active PrEP arms, over two-thirds of visits with positive rapid test results were false positive results (69.2%, 110 of 159), although false positive results occurred at HIV prevalence or incidence is low due to effective HIV prevention interventions, rapid HIV tests result in a high number of false relative to true positive results, although the absolute number of false results will be low. Program roll-out for effective interventions should plan for quality assurance of HIV testing, mechanisms for confirmatory HIV testing, and counseling strategies for persons with positive rapid test results.
Ahmed, Saeed; Schwarz, Monica; Flick, Robert J; Rees, Chris A; Harawa, Mwelura; Simon, Katie; Robison, Jeff A; Kazembe, Peter N; Kim, Maria H
To assess implementation of provider-initiated testing and counselling (PITC) for HIV in Malawi. A review of PITC practices within 118 departments in 12 Ministry of Health (MoH) facilities across Malawi was conducted. Information on PITC practices was collected via a health facility survey. Data describing patient visits and HIV tests were abstracted from routinely collected programme data. Reported PITC practices were highly variable. Most providers practiced symptom-based PITC. Antenatal clinics and maternity wards reported widespread use of routine opt-out PITC. In 2014, there was approximately 1 HIV test for every 15 clinic visits. HIV status was ascertained in 94.3% (5293/5615) of patients at tuberculosis clinics, 92.6% (30,675/33,142) of patients at antenatal clinics and 49.4% (6871/13,914) of patients at sexually transmitted infection clinics. Reported challenges to delivering PITC included test kit shortages (71/71 providers), insufficient physical space (58/71) and inadequate number of HIV counsellors (32/71) while providers from inpatient units cited the inability to test on weekends. Various models of PITC currently exist at MoH facilities in Malawi. Only antenatal and maternity clinics demonstrated high rates of routine opt-out PITC. The low ratio of facility visits to HIV tests suggests missed opportunities for HIV testing. However, the high proportion of patients at TB and antenatal clinics with known HIV status suggests that routine PITC is feasible. These results underscore the need to develop clear, standardised PITC policy and protocols, and to address obstacles of limited health commodities, infrastructure and human resources. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.
Short, R V
HIV infection is the greatest health crisis in human history. It continues to spread unchecked among the poor in the developing world because we have failed to design simple preventative methods that are available and affordable to those living on under Dollars 2 a day. Five new methods are discussed. (i) A natural microbicide. Intravaginal lime or lemon juice has been used for centuries as a traditional contraceptive. The juice can also kill HIV in the laboratory, but clinical trials are needed to see if vaginal application is acceptable, safe and effective. (ii) Intravaginal oestrogen. Monkeys can be protected from Simian immunodeficiency virus (SIV) infection by keratinizing the vagina with topical oestrogen. If women take the oral contraceptive pill vaginally it retains its contraceptive efficacy, and the oestrogen it contains should thicken the vagina and protect against HIV infection. Clinical trials are needed. (iii) Male circumcision. Removal of the inner foreskin removes the main site of HIV entry into the penis, resulting in a sevenfold reduction in susceptibility to infection. The practice needs to be promoted. (iv) Post-coital penile hygiene. Wiping the penis immediately after intercourse with lime or lemon juice or vinegar should kill the virus before it has had a chance to infect. A clinical trial of efficacy is needed. (v) PhotoVoice. Asking schoolchildren in developing countries to photograph their impressions of HIV/AIDS is a powerful way of getting them to discuss the subject openly, and develop their own preventative strategies.