scholarly journals Digitising point of care HIV test results to accurately measure, and improve performance towards, the UNAIDS 90-90-90 targets

2019 ◽  
Author(s):  
Nisha Jacob ◽  
Brian Rice ◽  
Emma Kalk ◽  
Alexa Heekes ◽  
Jennie Morgan ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Testing ◽  
Point Of Care ◽  
Linkage To Care ◽  
Hiv Care ◽  
Western Cape ◽  
Newly Diagnosed ◽  
Cross Sectional ◽  
Hiv Test ◽  
Testing Data

AbstractIntroductionHigh rates of pre-treatment loss to care among persons diagnosed with HIV persist. Linkage to care can be improved through active digitally-based surveillance. Currently, record-keeping for HIV diagnoses in South Africa is paper-based. Aggregated testing data are reported routinely, and only discordant findings result in a specimen being tested at a laboratory and digitised.MethodsThe Western Cape Province in South Africa has a Provincial Health Data Centre (PHDC) where person-level routine data are consolidated in a single database, leveraging the existence of a unique patient identifier. To facilitate improved surveillance, a pre-carbonated point-of-care test (PoCT) form was piloted, where one copy was routed to the centralised laboratory and digitised for PHDC inclusion. We evaluated the utility of the intervention using cross-sectional and retrospective cohort analyses, as well as comparisons with reported aggregate data.ResultsFrom May 2017 to June 2018, 11337 digitised point-of-care HIV testing records were linked to the PHDC. Overall, 96% of records in the aggregate dataset were digitised, with 97% linked to the PHDC. Of those tested, 79% were female (median age 27 years). Linkage demonstrated that 51.3% of patients testing HIV-positive were retesting. Of those truly newly diagnosed, 81% were linked to HIV care and 25% were initiated on antiretroviral therapy immediately.ConclusionDigitisation of PoCT results is feasible and provides individuated HIV testing data to assist in linkage to care and in differentiating newly diagnosed patients from positive patients retesting. Actionable and accurate data can improve the measurement of performance towards the UNAIDS 90-90-90 targets.

scholarly journals Same-Day CD4 Testing to Improve Uptake of HIV Care and Treatment in South Africa: Point-of-Care Is Not Enough

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Bruce A. Larson ◽  
Kathryn Schnippel ◽  
Alana Brennan ◽  
Lawrence Long ◽  
Thembi Xulu ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Testing ◽  
Point Of Care ◽  
Linkage To Care ◽  
Retention In Care ◽  
Baseline Period ◽  
Hiv Care ◽  
Hiv Positive ◽  
Care And Treatment ◽  
Cd4 Testing

Background. We evaluated whether a pilot program providing point-of-care (POC), but not rapid, CD4 testing (BD FACSCount) immediately after testing HIV-positive improved retention in care.Methods. We conducted a retrospective record review at the Themba Lethu Clinic in Johannesburg, South Africa. We compared all walk-in patients testing HIV-positive during February, July 2010 (pilot POC period) to patients testing positive during January 2008–February 2009 (baseline period). The outcome for those with a≤250cells/mm3when testing HIV-positive was initiating ART<16weeks after HIV testing.Results. 771 patients had CD4 results from the day of HIV testing (421 pilots, 350 baselines). ART initiation within 16 weeks was 49% in the pilot period and 46% in the baseline period. While all 421 patients during the pilot period should have been offered the POC test, patient records indicate that only 73% of them were actually offered it, and among these patients only 63% accepted the offer.Conclusions. Offering CD4 testing using a point-of-care, but not rapid, technology and without other health system changes had minor impacts on the uptake of HIV care and treatment. Point-of-care technologies alone may not be enough to improve linkage to care and treatment after HIV testing.

Observational study of the populations accessing rapid point-of-care HIV testing in Winnipeg, Manitoba, Canada, through a retrospective chart review of site records

2017 ◽  
Vol 94 (3) ◽  
pp. 194-199 ◽  
Author(s):  
James Blain Johnston ◽  
Joss N Reimer ◽  
John L Wylie ◽  
Jared Bullard
Keyword(s):  
Viral Load ◽  
Hiv Testing ◽  
Clinical Outcomes ◽  
Point Of Care ◽  
Age Groups ◽  
Linkage To Care ◽  
Hiv Positive ◽  
Hiv Status ◽  
Viral Load Suppression ◽  
Hiv Test

ObjectivesHIV point-of-care testing (POCT) has been available in Manitoba since 2008. This study evaluated the effectiveness of POCT at identifying individuals with previously unknown HIV status, its effects on clinical outcomes and the characteristics of the populations reached.MethodsA retrospective database review was conducted for individuals who received HIV POCT from 2011 to 2014. Time to linkage to care and viral load suppression were compared between individuals who tested positive for HIV using POCT and controls identified as positive through standard screening. Testing outcomes for labouring women with undocumented HIV status accessing POCT during labour were also assessed.Results3204 individuals received POCT (1055 females (32.9%) and 2149 males (67.1%)), being the first recorded HIV test for 2205 (68.8%). Males were more likely to be targeted with POCT as their first recorded HIV test (adjusted OR (AOR) 1.40). Between the two main test sites (Main Street Project (MSP) and Nine Circles Community Health Centre), MSP tested relatively fewer males (AOR 0.79) but a higher proportion of members of all age groups over 30 years old (AOR 1.83, 2.51 and 3.64 for age groups 30–39, 40–49 and >50, respectively). There was no difference in time to linkage to care (p=0.345) or viral load suppression (p=0.405) between the POCT and standard screening cohorts. Of 215 women presenting in labour with unknown HIV status, one was identified as HIV positive.ConclusionsPOCT in Manitoba has been successful at identifying individuals with previously unknown HIV-positive status. Demographic differences between the two main testing sites support that this intervention is reaching unique populations. Given that we observed no significant difference in time to clinical outcomes, it is reasonable to continue using POCT as a targeted intervention.MeSH termsHIV infection; rapid HIV testing; vertical infectious disease transmission; community outreach; service delivery; marginalised populations.

scholarly journals The Changing Demographics of Women Living with HIV/AIDS in Southern Alberta from 1982 to 2006

2012 ◽  
Vol 23 (2) ◽  
pp. e36-e40
Author(s):  
Liana Hwang ◽  
Jesse Raffa ◽  
Michael John Gill
Keyword(s):  
Hiv Testing ◽  
Hiv Infections ◽  
Hiv Care ◽  
Screening Methods ◽  
Newly Diagnosed ◽  
Female Population ◽  
Opt Out ◽  
Hiv Test ◽  
Southern Alberta ◽  
The Impact

INTRODUCTION: Women account for a growing proportion of HIV infections in Canada. This has implications with respect to prevention, diagnosis and treatment.OBJECTIVE: To describe the female population presenting for HIV care in southern Alberta and to examine the impact of opt-out pregnancy screening.METHODS: A retrospective review of demographic and clinical characteristics of all patients presenting to the Southern Alberta HIV Clinic (SAC) care program from 1982 to 2006, was performed.RESULTS: The proportion of newly diagnosed patients who were female increased from 7.5% before 1998 to 21.5% after 1998. Women were more likely to be from vulnerable populations, such as intravenous drug users (31.3% versus 13.7%, P<0.001), aboriginals/Métis (21.5% versus 8.7%, P<0.001), blacks (28.9% versus 4.9%, P<0.001) and immigrants (36.6% versus 14.7%, P<0.001). Heterosexual intercourse was the main risk factor for HIV acquisition (43.7%). Women were less likely than men to have requested HIV testing (20.9% versus 37.8%, P<0.001). Opt-out pregnancy screening accounted for 12.7% of HIV-positive tests in women, following its introduction in 1998. Of the women diagnosed by pregnancy screening, 62.1% were from HIV-endemic countries. There was an association between reason for testing and CD4 count at presentation; women who requested their HIV test had higher median CD4 counts than those diagnosed because of illness (478 cells/mL, interquartile range [IQR]=370 cells/mL versus 174 cells/mL, IQR=328 cells/mL, P<0.001) or pregnancy screening (478 cells/mL, IQR=370 cells/mL versus 271 cells/mL, IQR=256 cells/mL, P=0.001).CONCLUSIONS: Women were less likely than men to have requested HIV testing and were more likely to be diagnosed by population-based screening methods. Women, especially vulnerable groups, account for a growing number and proportion of newly diagnosed HIV infections in Alberta. The implications of expanded screening in this population merit further consideration.

scholarly journals Parents Support Implementation of HIV Testing and Counseling at School: Cross-Sectional Study with Parents of Adolescent Attending High School in Gauteng and North West Provinces, South Africa

2016 ◽  
Vol 2016 ◽  
pp. 1-9
Author(s):  
Sphiwe Madiba ◽  
Mathildah Mokgatle
Keyword(s):  
South Africa ◽  
High School ◽  
Hiv Testing ◽  
Household Survey ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
North West ◽  
Hiv Testing And Counseling ◽  
Hiv Test ◽  
Testing And Counseling

Background. A formative assessment of the implementation of HIV testing and counseling (HTC) at school showed high acceptability and willingness to test among learners. However, the success of the proposed HTC depends on the support and acceptability of key stakeholders, including the parents. The aim of the study was to assess the opinions and acceptability of the implementation of HTC at school among parents of adolescents in high school.Methods. This was a cross-sectional household survey conducted with parents of adolescents attending high schools in educational districts in North West and Gauteng provinces, South Africa.Results. A total of 804 parents participated, and 548 (68.3%) were biological mothers, 85 (10.6%) were fathers, and the remaining were other relatives including grandmothers. Almost all (n=742, 92.9%) parents were in support of implementation and provision of HTC at school, 701 (87.7%) would allow their children to be tested at school, 365 (46%) felt that parental consent was not needed to test at school, and 39.4% preferred to receive the HIV test results with their children.Conclusion. Parents accept the roll-out of an HTC program at school and have a role to play in supporting children who test positive for HIV.

The cost of HIV testing at five district health facilities intervented poct model to confirmation HIV detected

2021 ◽  
Vol 05 (02) ◽  
pp. 84-92
Author(s):  
Viet Nga Nguyen ◽  
◽  
Thi Hien Ho ◽  
Thanh Long Nguyen
Keyword(s):  
Hiv Testing ◽  
Cost Allocation ◽  
Point Of Care ◽  
Cross Sectional Study ◽  
Confirmatory Test ◽  
District Health ◽  
Cross Sectional ◽  
Hiv Test ◽  
Keywords Hiv ◽  
The Cost

Objective: HIV testing is the only method to confirm people infected with HIV. There are many models providing HIV testing services. HIV testing cost is an important component for the investment and strategic direction of policies and programs on HIV. This paper describes HIV testing costs of HIV confirmatory testing by using three rapid diagnostic tests at district level (POCT- Point of Care testing). Methods: cross-sectional study design was employed, costs are calculated using the cost-allocation method based on the proportion of resources used for the personnel, investment such as infrastructure and equipments, routine operational costs including test kits and consumable supplies, administration and training, fuel costs using for HIV testing in the laboratory, transporting the sample to province for HIV positived confirmation and HIV confirmatory test at the province. Five district health centers (DHC) thực hiện mô hình can thiệp POCT HIV were studied, HIV tests were conducted for 4,636 clients in 2016. Results : 201 HIV positive cases were detected; after implementing the POCT model to confirm HIV status at these five DHCs, the cost per HIV screening test case is 7,4 USD on average; and cost per an HIV comfirmatory test is 206,8 USD. Conclusion: Applying the POCT model of HIV helps reducethe cost of HIV testing because of saving cost for sample transportion and implementing confirm HIV detected more in provincal standard laboratory. It should be expanded to use especially limitted resource settings in Vietnam Keywords: HIV, HIV test, POCT, cost

scholarly journals Point-of-Care HIV Testing and Linkage in an Urban Cohort in the Southern US

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Anne Zinski ◽  
Sarah M. Dougherty ◽  
Ashutosh Tamhane ◽  
Kelly L. Ross-Davis ◽  
James L. Raper
Keyword(s):  
Primary Care ◽  
Hiv Testing ◽  
Point Of Care ◽  
Linkage To Care ◽  
Hiv And Aids ◽  
Hiv Care ◽  
Race And Gender ◽  
Linkage Rate ◽  
The Us ◽  
And Gender

The Southern states experience the highest rates of HIV and AIDS in the US, and point-of-care (POC) testing outside of primary care may contribute to status awareness in medically underserved populations in this region. To evaluate POC screening and linkage to care at an urban south site, analyses were performed on a dataset of 3,651 individuals from an integrated rapid-result HIV testing and linkage program to describe this test-seeking cohort and determine trends associated with screening, results, and linkage to care. Four percent of the population had positive results. We observed significant differences by test result for age, race and gender, reported risk behaviors, test location, and motivation for screening. The overall linkage rate was 86%, and we found significant differences for clients who were linked to HIV care versus persons whose linkage could not be confirmed with respect to race and gender, location, and motivation. The linkage rate for POC testing that included a comprehensive intake visit and colocated primary care services for in-state residents was 97%. Additional research on integrated POC screening and linkage methodologies that provide intake services at time of testing is essential for increasing status awareness and improving linkage to HIV care in the US.

scholarly journals Early HIV Diagnosis Leads to Significantly Decreased Costs in the First 2 Years of HIV Care in an Urban Charity Hospital in New Orleans

2017 ◽  
Vol 16 (6) ◽  
pp. 527-530 ◽  
Author(s):  
Jason Halperin ◽  
Morgan Katz ◽  
Ishani Pathmanathan ◽  
Leann Myers ◽  
Nicholas Van Sickels ◽  
...  
Keyword(s):  
Linkage To Care ◽  
Hiv Care ◽  
Newly Diagnosed ◽  
Inclusion Criteria ◽  
Hiv Diagnosis ◽  
Total Cost ◽  
Hiv Rna ◽  
Charity Hospital ◽  
Median Total Cost ◽  
Hiv Test

We undertook a retrospective cohort study of patients with a positive HIV test in the emergency department who were then linked to care. Inpatient, outpatient, and emergency costs were collected for the first 2 years after HIV diagnosis. Fifty-six patients met the inclusion criteria; they were predominantly uninsured (73%) and African American (89%). The median total cost for a newly diagnosed patient over the first 2 years was US$36 808, driven predominantly by outpatient costs of US$17 512. Median inpatient and total costs were significantly different between the lowest (<200 cells/mm3) and highest (>499 cells/mm3) CD4 count categories (US$21 878 vs US$6607, P <.05; US$61 378 vs US$18 837, P <.05, respectively). Total costs were significantly different between viral load categories <100 000 HIV-RNA copies/mL and ≥100 000 HIV-RNA copies/mL (US$28 219 vs US$49 482, P <.05). Costs were significantly lower among patients diagnosed earlier in their disease. Decreased cost is another factor supporting early diagnosis and linkage to care for patients with HIV.

scholarly journals Clients’ perceptions and satisfaction with HIV counselling and testing: A cross-sectional study in 56 HCT sites in South Africa

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Gladys Matseke ◽  
Karl Peltzer ◽  
Neo Mohlabane
Keyword(s):  
South Africa ◽  
Hiv Testing ◽  
Client Satisfaction ◽  
Cross Sectional Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Staff Attitude ◽  
Hiv Test ◽  
Hiv Counselling And Testing ◽  
Study Participants

Background: Client satisfaction serves as a predictor for acceptance of HIV counselling and testing (HCT) services. Therefore, the study of clients’ perception and satisfaction may offer insights on how to improve HCT programmes. Aim and setting: The aim of this study was to assess clients’ satisfaction with HCT as well as describe perceived barriers to and facilitators of HIV testing by HCT clients in South Africa.Methods: A cross-sectional survey was conducted through interviews with 498 clients purposefully selected at the end of an HCT visit at 56 HCT sites throughout the country. Results: All the 498 study participants had tested for HIV with 98.8% receiving their results. Most (88.2%) reported testing for HIV before. The vast majority (75.5%) of clients reported that they had decided to be tested for HIV by themselves. High levels of satisfaction with HCT service (89.8%), low levels (27.7%) of difficulty in making the decision to have an HIV test and high levels of perceived confidentiality (94.6%) of the HIV test results were reported in this study. The most cited perceived barrier to HIV testing was lack of awareness about the HCT service (98%), while staff attitudes (37%), confidentiality (29.6%) and privacy (23.6%) were perceived facilitators. In multivariate logistic regression, staff attitude was significantly associated with client satisfaction (p < 0.05).Conclusion: High levels of client satisfaction with HCT services were observed. Various barriers to and facilitators of – including staff attitude – HCT were identified which can help guide the improvement of HCT services in South Africa.

scholarly journals Evaluation of the Utility of Point-of-Care HIV Testing on a Canadian Internal Medicine Inpatient Unit

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Lawrence Lau ◽  
Beverly Wudel ◽  
Eugene Lee ◽  
Majid Darraj ◽  
Quinlan Richert ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Point Of Care ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Inpatient Unit ◽  
Cross Sectional ◽  
Hiv Test ◽  
Undiagnosed Hiv ◽  
Acceptable Method ◽  
Routine Hiv Testing

Point-of-care (POC) HIV testing has been shown to be an acceptable method for increasing HIV testing uptake. To date, no studies have examined the use of POC testing for routine HIV screening on the medicine inpatient unit. A prospective cross-sectional study was conducted over a three-month period in July, August, and October 2016 to evaluate the prevalence of undiagnosed HIV and the attitudes towards routine POC HIV testing. Patients admitted directly to medicine inpatient teaching units at a tertiary hospital in Winnipeg, Canada, were approached for participation. The POC HIV test was administered at the bedside. Reactive and indeterminate tests were confirmed with standard serological HIV testing. Participants were given a questionnaire regarding their attitudes towards POC testing on the unit. Although no cases of previously undiagnosed HIV were identified during the study period, only 35% of participants were found to have ever had HIV testing previously. The majority of participants were satisfied with the POC testing experience and would choose to have the POC testing again. Overall, the low rate of outpatient testing highlights the need for routine HIV testing on an inpatient basis.

scholarly journals 1273. Routine Opt-out HIV Screening and Detection of HIV Infection Among Emergency Department Patients

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S388-S388
Author(s):  
Nada Fadul ◽  
Ciarra Dortche ◽  
Richard Baltaro ◽  
Tim Reeder
Keyword(s):  
Emergency Department ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Medical Center ◽  
Linkage To Care ◽  
Hiv Care ◽  
Hiv Positive ◽  
Newly Diagnosed ◽  
Opt Out ◽  
Post Test

Abstract Background The Southeastern United States bears a disproportionate burden of HIV infection, accounting for nearly half of all new cases. The Centers for Disease Control and Prevention released routine opt-out testing recommendations in 2006. Our emergency department collaborated with our infectious diseases clinic (ECU-ID) to implement suggested guidelines among adults since March 2017. Methods Our primary aim was to implement routine, opt-out HIV testing in the Vidant Medical Center Emergency Department (ED) for patients between 18 and 65 years of age who have blood work completed, and have not had a test documented in the electronic medical record (EMR) in the last year. A secondary aim was to successfully link HIV-positive patients to care at ECU-ID or preferred clinic. Methods defining programmatic success included developing nurse directed opt-out ordering protocol, integrating testing into normal ED workflow, utilizing the existing EMR to prompt testing, and hiring a linkage coordinator to initiate post-test counseling and linkage-to-care. Results Since March 2, 2017, a total of 7,109 HIV tests were performed; an average of 592 monthly tests conducted compared with a previous average of 10 stat tests. Testing increased 5,820% compared with 2015. Of the 21 HIV-positive patients found, 16 were newly diagnosed. Among those newly diagnosed, 14 (87.5%) were linked to care; and among the five known positives, two (40%) were linked to care. Reasons why patients could not be linked included incarceration, refusal to link to care, and re-location. Conclusion Joined with the implementation of a routinized ED HIV testing program, a seamless process was developed to link persons found to be positive in the ED to HIV care services; therefore, establishing a systems-level prevention model. Future plans include expanding testing to adolescents and utilizing similar methods to integrate Hepatitis C testing. Disclosures All Authors. Gilead Sciences, Inc.: Grant Investigator, Grant recipient and Salary.

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