1261. Alarming High Rate of HIV Detected by Testing and Prevention Opportunities: Observations From the Largest HIV Program in Liberia

Abstract Background HIV/AIDS remains one of the world’s most significant public health challenges. Sub-Saharan Africa is home to only 12% of the world’s population, yet accounts for 71% of the global burden of HIV infection. While the HIV prevalence among reproductive aged Liberians (age 15–49 years) is estimated at 1.9%. As the critical first step in HIV disease management is detection of cases, it is important to optimize HIV testing particularly among high-risk groups. Identifying these high-risk groups for HIV infection also provides information on prevention opportunities. We report on 5 year HIV testing data at a tertiary hospital in Monrovia, Liberia stratified by age and gender. Methods A single-center academic hospital-based retrospective analysis of HIV testing data over a period of 5 years (January 2014 to December 2018) obtained from the Infectious Disease Center (IDC) of John F. Kennedy Medical Center in Monrovia, Liberia. The IDC has a peer-led counseling program on site and offers HIV testing daily. Data on the study population (all individuals screened for HIV disease at the center) was extracted from ledgers and registries within the IDC. The following information was collected on all participants: age, sex, and pregnancy status. Positive test results are reported as simple proportions of either all patients or all individuals tested within the category reported. Results Over the 5-year study period, 41,343 individuals were screened for HIV disease including 2 key demographics - 7875 individuals aged 15–24 years and 24,913 pregnant women. 4,066 individuals were diagnosed with HIV (a case detection rate of 10%), and ranged from 7% (909/12821) in 2018 to 13% (678/5079) in 2014. Case detection rates for individuals aged 15–24 were 7%, 5%, 4%, 6% and 3% for years 2014, 2015, 2016, 2017 and 2018, respectively. From 2014–2018, 2–3% of all pregnant women tested were diagnosed with HIV infection. Almost three-quarters (74%) of diagnosed cases were subsequently enrolled in an HIV clinic. Conclusion A peer-led HIV testing program is effective in HIV case detection, with young individuals (aged 15–24 years) and pregnant women having higher case detection rates than expected. These findings highlight opportunities for HIV prevention targeting these high-risk groups. Disclosures All authors: No reported disclosures.

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Circumcision in men and the prevention of HIV infection: a 'meta-analysis' revisited

International Journal of STD & AIDS ◽

10.1258/0956462001915480 ◽

2000 ◽

Vol 11 (3) ◽

pp. 137-142 ◽

Cited By ~ 49

Author(s):

Nigel O'Farrell ◽

Matthias Egger

Keyword(s):

Systematic Review ◽

High Risk ◽

Hiv Infection ◽

Male Circumcision ◽

Odds Ratio ◽

Meta Analysis ◽

Risk Groups ◽

Sub Saharan Africa ◽

Effect Model ◽

Increased Risk

There is debate on the role of male circumcision in HIV transmission. Most case-control and cohort studies from Africa have shown an association between a lack of circumcision and an increased risk of HIV infection in men. The evidence is conflicting, however, with cross-sectional surveys from Tanzania and Rwanda either showing no relationship or an association in the opposite direction. A recent review and meta-analysis of the literature concluded that the risk of HIV infection was lower in uncircumcised men (combined odds ratio 0.94, 95% confidence interval 0.89 to 0.99). However, the analysis was performed by simply pooling the data from 33 diverse studies, which is an inappropriate method for combining studies. We re-analysed the data, stratifying by study, and found that an intact foreskin was associated with an increased risk of HIV infection: combined odds ratio 1.43 (1.32 to 1.54) with a fixed effect model and 1.67 (1.25 to 2.24) with a random effect model. There was significant between-study heterogeneity (P < 0.0001) which was partly explained by stronger associations in studies in high-risk groups. The results from this re-analysis thus support the contention that male circumcision may offer protection against HIV infection, particularly in high-risk groups where genital ulcers and other STDs 'drive' the HIV epidemic. A systematic review is required to clarify this issue. Such a review should be based on an extensive search for relevant studies, published and unpublished, and should include a careful assessment of the design and methodological quality of studies. Much emphasis should be given to the exploration of possible sources of heterogeneity. In view of the continued high prevalence and incidence of HIV in many countries in sub-Saharan Africa, the question of whether circumcision could contribute to prevent infections is of great importance, and a sound systematic review of the available evidence should be performed without delay.

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Spatial patterns of leprosy in a hyperendemic state in Northern Brazil, 2001-2012

Revista de Saúde Pública ◽

10.1590/s0034-8910.2015049005866 ◽

2015 ◽

Vol 49 (0) ◽

Cited By ~ 12

Author(s):

Lorena Dias Monteiro ◽

Francisco Rogerlândio Martins-Melo ◽

Aline Lima Brito ◽

Carlos Henrique Alencar ◽

Jorg Heukelbach

Keyword(s):

High Risk ◽

Spatial Patterns ◽

Detection Rate ◽

Disease Risk ◽

Late Diagnosis ◽

Control Measures ◽

Case Detection ◽

Detection Rates ◽

Case Detection Rate ◽

Brazilian State

ABSTRACT OBJECTIVE To describe the spatial patterns of leprosy in the Brazilian state of Tocantins. METHODS This study was based on morbidity data obtained from the Sistema de Informações de Agravos de Notificação (SINAN – Brazilian Notifiable Diseases Information System), of the Ministry of Health. All new leprosy cases in individuals residing in the state of Tocantins, between 2001 and 2012, were included. In addition to the description of general disease indicators, a descriptive spatial analysis, empirical Bayesian analysis and spatial dependence analysis were performed by means of global and local Moran’s indexes. RESULTS A total of 14,542 new cases were recorded during the period under study. Based on the annual case detection rate, 77.0% of the municipalities were classified as hyperendemic (> 40 cases/100,000 inhabitants). Regarding the annual case detection rate in < 15 years-olds, 65.4% of the municipalities were hyperendemic (10.0 to 19.9 cases/100,000 inhabitants); 26.6% had a detection rate of grade 2 disability cases between 5.0 and 9.9 cases/100,000 inhabitants. There was a geographical overlap of clusters of municipalities with high detection rates in hyperendemic areas. Clusters with high disease risk (global Moran’s index: 0.51; p < 0.001), ongoing transmission (0.47; p < 0.001) and late diagnosis (0.44; p < 0.001) were identified mainly in the central-north and southwestern regions of Tocantins. CONCLUSIONS We identified high-risk clusters for transmission and late diagnosis of leprosy in the Brazilian state of Tocantins. Surveillance and control measures should be prioritized in these high-risk municipalities.

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Emergencies in HIV-positive patients

Oxford Handbook of Acute Medicine ◽

10.1093/med/9780199230921.003.08 ◽

2010 ◽

pp. 479-505

Author(s):

Punit S. Ramrakha ◽

Kevin P. Moore ◽

Amir Sam

Keyword(s):

Hiv Infection ◽

Hiv Testing ◽

Hiv Positive ◽

Hiv Disease ◽

Primary Hiv Infection ◽

Clinical Indicator ◽

Factors Influencing ◽

Neurological Conditions

Emergency presentations of HIV infection 480 Factors influencing presentation in HIV disease 482 HIV testing 484 Clinical indicator diseases for adult HIV infection 486 Primary HIV infection (PHI) 487 Acute neurological conditions in HIV-positive patients: assessment 488 Acute neurological conditions in HIV-positive patients: investigations 490...

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Incorporating Rapid HIV Testing into Partner Counseling and Referral Services

Public Health Reports ◽

10.1177/00333549081230s315 ◽

2008 ◽

Vol 123 (3_suppl) ◽

pp. 126-135 ◽

Cited By ~ 10

Author(s):

Elin B. Begley ◽

Alexandra M. Oster ◽

Binwei Song ◽

Linda Lesondak ◽

Kelly Voorhees ◽

...

Keyword(s):

High Risk ◽

Hiv Infection ◽

Hiv Testing ◽

The United States ◽

High Risk Population ◽

Newly Diagnosed ◽

Infected People ◽

Rapid Hiv Testing ◽

Undiagnosed Hiv ◽

Locating Information

Objectives. Partner counseling and referral services (PCRS) provide a unique opportunity to decrease transmission of human immunodeficiency virus (HIV) by notifying sex and drug-injection partners of HIV-infected individuals of their exposure to HIV. We incorporated rapid HIV testing into PCRS to reduce barriers associated with conventional HIV testing and identify undiagnosed HIV infection within this high-risk population. Methods. From April 2004 through June 2006, HIV-infected people (index clients) were interviewed, and their partners were notified of their potential exposure to HIV and offered rapid HIV testing at six sites in the United States. The numbers of index clients participating and the numbers of partners interviewed and tested were compared by site. Descriptive and bivariate analyses were performed. Results. A total of 2,678 index clients were identified, of whom 779 (29%) provided partner locating information. A total of 1,048 partners were elicited, of whom 463 (44%) were both interviewed and tested for HIV. Thirty-seven partners (8%) were newly diagnosed with HIV. The number of index clients interviewed to identify one partner with newly diagnosed HIV infection ranged from 10 to 137 at the participating sites. Conclusions. PCRS provides testing and prevention services to people at high risk for HIV infection. Incorporating rapid HIV testing into PCRS and identifying previously undiagnosed infections likely confer individual and public health benefits. Further evaluation is needed to determine the best methods of identifying partners with previously unrecognized HIV infection.

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Late diagnosis of human immunodeficiency virus infections in high-risk groups in Karachi, Pakistan

International Journal of STD & AIDS ◽

10.1177/0956462418785264 ◽

2018 ◽

Vol 29 (14) ◽

pp. 1400-1406

Author(s):

Zahra Hasan ◽

Sharaf Shah ◽

Rumina Hasan ◽

Shoaib Rao ◽

Manzoor Ahmed ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

High Risk ◽

Early Diagnosis ◽

Hiv Infection ◽

Hiv Infections ◽

Risk Groups ◽

Newly Diagnosed ◽

Immunodeficiency Virus ◽

Hiv 1

Human immunodeficiency virus (HIV) infection prevalence in Pakistan has been increasing in high-risk groups, including people who inject drugs (PWID) and transgender hijra sex workers (TG-HSWs) nationwide. Effective control of HIV requires early diagnosis of the infection. We investigated recency of HIV infections in newly-diagnosed cases in PWID and TG-HSWs. This was an observational study with convenience sampling. Overall, 210 HIV-positive subjects comprising an equal number of PWID and TG-HSWs were included. Antibody avidity was tested using the Maxim HIV-1 Limiting Antigen Avidity (LAg) EIA (Maxim Biomedical, Inc. Rockville, Maryland, USA). The mean age of study subjects was 29.5 years: PWID, 28.5 years and TG-HSWs, 30.4 years. Study subjects were married, 27%, or unmarried. Eighteen percent of individuals had recently-acquired HIV infections: 19% of PWID and 17% of TG-HSWs. Eighty-two percent of individuals had long-term HIV infections: 81% of PWID and 83% of TG-HSWs. This is the first study identification of recent HIV-1 infections in Pakistan. We show that most newly-diagnosed HIV patients in the high-risk groups studied had long-term infections. There is an urgent need for intervention in these groups to facilitate early diagnosis and treatment of HIV infection to reduce transmission in Pakistan.

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1630. Voluntary HIV Testing and Self-Realization of Risk of HIV Infection Among Young Men-Who-Have-Sex-with-Men in the Miami-Dade Area

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1494 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S595-S595

Author(s):

Hampton Ocon ◽

Samir Sabbag

Keyword(s):

Public Health ◽

High Risk ◽

Hiv Infection ◽

Hiv Testing ◽

Hiv Risk ◽

Perceived Risk ◽

Health Initiatives ◽

History Of ◽

Sex With Men ◽

Public Health Initiatives

Abstract Background According to the Centers for Disease Control and Prevention, Miami-Dade County has the highest rate of new HIV diagnoses in the Nation. So far, a large focus of public health initiatives has been spreading awareness of HIV testing locations, but this form of voluntary testing relies on individuals realizing that they are at risk of HIV infection in the first place. Consequently, a major obstacle to encouraging young men-who-have-sex-with-men (YMSM) to test themselves for HIV is their own self-perceived risk of having an undetected infection. Methods In an effort to better understand the discordance between high-risk sexual behavior and HIV testing among this high-risk population, YMSM (18–24) were surveyed through smartphone applications that facilitate sexual encounters in the Miami-Dade area (eg Grindr, Scruff). Users were asked about their history of condomless anal intercourse (CAI), their HIV testing habits, and whether or not they believe it possible that they are currently infected with HIV. An analysis of the relationship between CAI and self-perception of possible HIV infection was performed using Cochran-Mantel–Haenszel testing. Results Of the 843 eligible responses, 667 reported a history of voluntary HIV testing while 176 had never voluntarily tested. 726 respondents reported a history of CAI and 131 of these have never voluntarily tested. Of the 843 total participants, 1.6% were in the highest HIV risk group, which is those who have engaged in CAI with an exchange/casual partner, have never voluntarily tested for HIV, and have no self-perceived risk of being currently infected. According to data analysis, YMSM who have engaged in CAI but have never been tested for HIV were not more likely to have a self-perceived possibility of infection when compared with those who have voluntarily tested (P < 0.595). Conclusion This suggests that many high-risk YMSM are not voluntarily testing themselves for HIV not because they do not have access to testing, but rather because they do not perceive themselves as being possibly infected in the first place. Therefore, in addition to increasing access to HIV testing, new public health initiatives must be designed to facilitate YMSM understanding their own personal HIV risk. Disclosures All authors: No reported disclosures.

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Comparação da Aplicação da EER Hema-Obs a 250 Gestações da Consulta de Hematologia-Obstetrícia do Centro Hospitalar São João, Portugal Versus EER Galit Sarig a 90 Gestações no Rambam Health Care Campus, Israel

Acta Médica Portuguesa ◽

10.20344/amp.5200 ◽

2015 ◽

Vol 28 (2) ◽

pp. 189

Author(s):

Ana Salselas ◽

Inês Pestana ◽

Francisco Bischoff ◽

Mariana Guimarães ◽

Joaquim Aguiar Andrade

Keyword(s):

High Risk ◽

Risk Stratification ◽

Pregnant Women ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Characteristic Curve ◽

Risk Groups ◽

Low Risk ◽

Very High ◽

Receiver Operating

Introduction: Pregnant women with thromboembolic diseases, previous thrombotic episodes or thrombophilia family history were supervised in a multidisciplinary Obstetrics/ Hematology consultation in Centro Hospitalar São João EPE, Porto, Portugal. For the evaluation and medication of these women, a risk stratification scale was used. Purposes: The aim of this study was to validate a Risk Stratification Scale and thromboprophylaxis protocol by means of comparing it with a similar scale, developed and published by Sarig. Material and Methods: We have compared: The distribution, by risk groups, obtained through the application of the two scales on pregnant women followed at Centro Hospitalar São João, Porto, Portugal, consultation; the sensibility and specificity for each one of the scales (DeLong scale, applied to Receiver Operating Characteristic) curves; the outcomes in pregnancies followed in Hospital São João, Porto, Portugal Results: According to our Hema-Obs risk stratification scale, 29% were allocated to low-risk, 47% to high-risk and 24% to very-high-risk groups. According to Galit Sarig risk stratification scale, 24% were considered low-risk, 53% moderate, 16% high-risk and 7% as very high-risk group. In our study we observed 9% of spontaneous abortions, in comparison with 18% in the Galit Sarig cohort. From the application of Receiver Operating Characteristic curve to both risk stratification scales, the results of the calculated areas were 58,8% to our Hema-Obs risk stratification scale and 38,7% to Galit Sarig risk stratification scale, with a Delong test significancie of p = 0.0006. Conclusions: We concluded that Hema-Obs risk stratification scale is an effective support for clinical monitoring of therapeutic strategies.

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Attitudes to HIV testing in general practice

International Journal of STD & AIDS ◽

10.1258/0956462981922188 ◽

1998 ◽

Vol 9 (5) ◽

pp. 263-267 ◽

Cited By ~ 15

Author(s):

D J Kellock ◽

K E Rogstad

Keyword(s):

Hiv Infection ◽

Hiv Testing ◽

Vertical Transmission ◽

Risk Groups ◽

Antibody Testing ◽

Local Study ◽

Sexually Transmitted ◽

Patient Groups ◽

High Level ◽

Hiv Antibody Testing

Summary: Newer therapies for the treatment of HIV infection and the effectiveness of zidovudine in reducing vertical transmission mean that it is becoming increasingly important to diagnose HIV infection earlier. General practitioners (GPs) attending a local study day on sexually transmitted diseases (STDs) were asked about their likelihood of raising the subject of HIV antibody testing, and their anxiety when doing so, for different patient groups. A high level of anxiety was found when raising this topic in certain patient groups, and a proportion of GPs would never discuss HIV testing, even in very high-risk groups. No respondents were aware that vertical transmission could be reduced by antiretroviral drug therapy. These data advocate that the barriers to raising the issue of HIV testing and the methods of reducing GPs' anxiety associated with it, need to be addressed.

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