Indicator condition-guided HIV testing with an electronic prompt in primary healthcare: a before and after evaluation of an intervention

2019 ◽  
Vol 95 (4) ◽  
pp. 238-243 ◽  
Author(s):  
Laia Cayuelas Redondo ◽  
Marina Ruíz ◽  
Belchin Kostov ◽  
Ethel Sequeira ◽  
Pablo Noguera ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Primary Healthcare ◽  
Hiv Infections ◽  
Hiv Test ◽  
Younger Patient ◽  
Before And After ◽  
New Diagnosis ◽  
The Impact ◽  
Test Request ◽  
Made In

ObjectiveIndicator condition (IC)-guided HIV testing is a strategy for the diagnosis of patients with HIV. The aim of this study was to assess the impact on the proportion of HIV tests requested after the introduction of an electronic prompt instructing primary healthcare (PHC) physicians to request an HIV test when diagnosing predefined IC.MethodsA prospective interventional study was conducted in 2015 in three PHC centres in Barcelona to assess the number of HIV test requests made during the implementation of an electronic prompt. Patients aged 18–65 years without HIV infection and with a new diagnosis of predefined IC were included. The results were compared with preprompt (2013) and postprompt data (2016).ResultsDuring the prompt period, 832 patients presented an IC (median age 41.6 years [IQR 30–54], 48.2% female). HIV tests were requested in 296 individuals (35, 6%) and blood tests made in 238. Four HIV infections were diagnosed (positivity rate 1.7%, 95% CI 0.5% to 4.4%). The number of HIV tests requested based on IC increased from 12.6% in 2013 to 35.6% in 2015 (p<0.001) and fell to 17.9% after removal of the prompt in 2016 (p<0.001). Younger patient age (OR 0.97, 95% CI 0.96 to 0.98), birth outside Spain (OR 1.53, 95% CI 1.06 to 2.21) and younger physician age (OR 0.97, 95% CI 0.96 to 0.99) were independent predictive factors for an HIV test request during the prompt period. The electronic prompt (OR 3.36, 95% CI 2.70 to 4.18) was the factor most closely associated with HIV test requests. It was estimated that 10 (95% CI 3.0 to 26.2) additional new cases would have been diagnosed if an HIV test had been performed in all patients presenting an IC.ConclusionsA significant increase in HIV test requests was observed during the implementation of the electronic prompt. The results suggest that this strategy could be useful in increasing IC-guided HIV testing in PHC centres.

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 An Electronic Alert for HIV Screening in the Emergency Department Increases Screening but not the Diagnosis of HIV

2014 ◽  
Vol 05 (01) ◽  
pp. 299-312 ◽  
Author(s):  
N. Liu ◽  
J. Sperling ◽  
R. Green ◽  
S. Clark ◽  
D. Vawdrey ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Hiv Testing ◽  
Intervention Group ◽  
Hiv Screening ◽  
Intervention Period ◽  
Post Intervention ◽  
Hiv Test ◽  
The Impact ◽  
Post Intervention Group

SummaryObjective: Based on US. Centers for Disease Control and Prevention recommendations, New York State enacted legislation in 2010 requiring healthcare providers to offer non-targeted human immunodeficiency virus (HIV) testing to all patients aged 13–64. Three New York City adult emergency departments implemented an electronic alert that required clinicians to document whether an HIV test was offered before discharging a patient. The purpose of this study was to assess the impact of the electronic alert on HIV testing rates and diagnosis of HIV positive individuals.Methods: During the pre-intervention period (2.5–4 months), an electronic “HIV Testing” order set was available for clinicians to order a test or document a reason for not offering the test (e.g., patient is not conscious). An electronic alert was then added to enforce completion of the order set, effectively preventing ED discharge until an HIV test was offered to the patient. We analyzed data from 79,786 visits, measuring HIV testing and detection rates during the pre-intervention period and during the six months following the implementation of the alert.Results: The percentage of visits where an HIV test was performed increased from 5.4% in the pre-intervention period to 8.7% (p<0.001) after the electronic alert. After the implementation of the electronic alert, there was a 61% increase in HIV tests performed per visit. However, the percentage of patients testing positive per total patients-tested was slightly lower in the post-intervention group than the pre-intervention group (0.48% vs. 0.55%), but this was not significant. The number of patients-testing positive per total-patient visit was higher in the post-intervention group (0.04% vs. 0.03%).Conclusions: An electronic alert which enforced non-targeted screening was effective at increasing HIV testing rates but did not significantly increase the detection of persons living with HIV. The impact of this electronic alert on healthcare costs and quality of care merits further examination.Citation: Schnall R, Liu N, Sperling J, Green R, Clark S, Vawdrey D. An electronic alert for HIV screening in the emergency department increases screening but not the diagnosis of HIV. Appl Clin Inf 2014; 5: 299–312 http://dx.doi.org/10.4338/ACI-2013-09-RA-0075

scholarly journals Missed Opportunities for HIV Diagnosis

2016 ◽  
Vol 16 (1) ◽  
pp. 14-17 ◽  
Author(s):  
Asia Downing ◽  
Julia B. Garcia-Diaz
Keyword(s):  
Hiv Testing ◽  
Study Cohort ◽  
Health Issues ◽  
Hiv Diagnosis ◽  
Missed Opportunities ◽  
Change Behavior ◽  
Positive Individual ◽  
Hiv Test ◽  
Multiple Health ◽  
Made In

It has been previously shown that patients may present for multiple health issues in the years preceding their initial HIV diagnosis. This retrospective cohort study analyzed the data of patients with a new HIV diagnosis, at Ochsner Health System between January 1, 2011, and December 31, 2012. The primary end point was missed opportunities, the number of healthcare visits these patients made in the 2 years prior to being diagnosed with HIV. The 125 patients in the study cohort had 649 healthcare visits during which an HIV test was not performed. These missed opportunities are the key to capturing the undiagnosed and unaware HIV-positive individual. Primary care is an ideal setting to conduct HIV testing for those who have access to regular health care. However, nontraditional providers should also be encouraged to conduct HIV testing regardless of their ability to provide treatment because evidence shows that knowledge of the diagnosis may change behavior.

scholarly journals DAMPAK MEA TERHADAP INVESTASI, EKSPOR-IMPOR DAN PENGGUNAAN TENAGA KERJA INDONESIA

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Nur Khasanah ◽  
Prihartini Budi Astuti ◽  
Ika Neni Kristanti
Keyword(s):  
Economic Integration ◽  
Secondary Data ◽  
Economic Community ◽  
Foreign Investors ◽  
Before And After ◽  
The Government ◽  
Asean Economic Community ◽  
The Impact ◽  
Sample Pair ◽  
Made In

This research attempts to analyze the effects of the economic integration of the ASEAN Economic Community (AEC) which was implemented since 2015. The impact analyzed is focused on investments made in Indonesia, both investments made by foreign investors and domestic investors. Another thing that was also highlighted in this study was the flow of exports and imports. This was also investigated because one of the policies contained in the agreement of the ASEAN economic community was the elimination of international trade barriers. In addition to the two things above, researchers also analyzed the influence of the ASEAN economic community on the use oflabor in Indonesia. The data analyzed in this study are secondary data obtained from the relevant agencies. The method used in this study is a different sample pair test. This method is used because the research conducted is comparing the conditions of investment, export-import and use of labor in Indonesia before and after the economic integration of the ASEAN Economic Community. At the end of this study, researchers will provide recommendations to the government regarding what should be done by the government to optimize investment activities, exports and use of local labor in Indonesia.

scholarly journals Solidarity and HIV Testing Willingness During the COVID-19 Epidemic: A Study Among Men Who Have Sex With Men in China

2021 ◽  
Vol 9 ◽  
Author(s):  
Hang Lyu ◽  
Yi Zhou ◽  
Wencan Dai ◽  
Shihan Zhen ◽  
Shanzi Huang ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Hiv Testing ◽  
Social Cohesion ◽  
Online Survey ◽  
Principal Component ◽  
Community Connectedness ◽  
Hiv Test ◽  
Testing Uptake ◽  
Sex With Men ◽  
The Impact

Background: Solidarity, such as community connectedness and social cohesion, may be useful in improving HIV testing uptake among men who have sex with men (MSM). This study aimed to evaluate the impact of solidarity on HIV testing before the coronavirus disease 2019 (COVID-19) and HIV testing willingness during COVID-19 among MSM in China.Materials and Methods: An online survey was conducted to collect sociodemographic, sexual behavioral, and solidarity items' information from the participants. We first used factor analysis to reveal the principal component of the solidarity items and then used logistic regression to study the impact of solidarity on HIV testing, by adjusting the possible confounding factors, such as age and education.Results: Social cohesion and community connectedness were revealed by the factor analysis. MSM with high community connectedness were more willing to undergo HIV testing before the epidemic adjusted by age [odds ratio (OR): 1.07, 95% CI: 1.01–1.13]. The community connectedness was also related to the willingness of HIV testing during the epidemic, with adjustments of 1.09 (95% CI: 1.03–1.15). People who did not test for HIV before the COVID-19 epidemic were more willing to have the HIV test during the epidemic, which was correlated with the community connectedness, and the OR value was 1.14 (95%: 1.03–1.25).Conclusion: A high level of community connectedness helped to increase the HIV testing rate before COVID-19 and the willingness of HIV testing during the epidemic among MSM. Strategies can strengthen the role of the community in the management and service of MSM.

scholarly journals The Impact of HIV Knowledge and Attitudes on HIV Testing Acceptance among Patients in an Emergency Department in the Eastern Cape, South Africa

2019 ◽  
Author(s):  
Sofia Ryan ◽  
Elizabeth Hahn ◽  
Aditi Rao ◽  
George Mwinnyaa ◽  
John Black ◽  
...  
Keyword(s):  
South Africa ◽  
Emergency Department ◽  
Hiv Testing ◽  
Eastern Cape ◽  
Hiv Knowledge ◽  
Knowledge And Attitudes ◽  
Knowledge And Beliefs ◽  
Hiv Test ◽  
Undiagnosed Hiv ◽  
The Impact

Abstract Background: Transmission of HIV in South Africa continues to be high due to a large proportion of individuals living with undiagnosed HIV. Uptake of HIV testing is influenced by a multitude of factors including the patient’s knowledge and beliefs about HIV. Methods: This study sought to quantify the impact of knowledge and attitudes on HIV testing acceptance in an emergency department by co-administering a validated HIV knowledge and attitudes survey to patients who were subsequently offered HIV testing. Results: During the study period 223 patients were interviewed and offered HIV testing. Individuals reporting more negative overall attitudes (p = 0.006), higher levels of stigma to HIV testing (p<0.001), and individuals who believed their test was confidential (p<0.001) were more likely to accept an HIV test. Conclusions: Interventions focused on improving patient perceptions around testing confidentiality will likely have the greatest impact on testing acceptance in the emergency department.

scholarly journals HIV testing by public health centers and municipalities, and new HIV cases during the COVID-19 pandemic in Japan

2020 ◽  
Author(s):  
Keisuke Ejima ◽  
Yoshiki Koizumi ◽  
Nao Yamamoto ◽  
Molly Rosenberg ◽  
Christina Ludema ◽  
...  
Keyword(s):  
Public Health ◽  
Hiv Testing ◽  
Health Centers ◽  
Added Value ◽  
Sensitivity Analyses ◽  
Related Data ◽  
Time Restrictions ◽  
Hiv Test ◽  
Aids Diagnosis ◽  
The Impact

AbstractBackgroundDuring the COVID-19 outbreak, medical resources were primarily allocated to COVID-19, which might have reduced facility capacity for HIV testing. Further, people may have opted against HIV testing during this period to avoid COVID-19 exposure. We investigate the influence of the COVID-19 pandemic on HIV testing and its consequences in Japan.MethodsWe analysed quarterly HIV/AIDS-related data from 2015 to the second quarter of 2020 using an anomaly detection approach. The data included the number of consultations that public health centers received, the number of HIV tests performed by public health centers or municipalities, and the number of newly reported HIV cases with and without AIDS diagnosis. As sensitivity analyses, we performed the same analysis for two subgroups: men who have sex with men (MSM) and non-Japanese.FindingsThe number of HIV tests (9,584 vs. 35,908 in the year-before period) and consultations (11,689 vs. 32,565) performed by public health centers significantly declined in the second quarter of 2020, while the proportion of HIV cases with AIDS diagnosis among all HIV cases (36·2% vs. 26·4%) significantly increased after removing the trend and seasonality effects. The number of HIV cases without AIDS diagnosis numerically decreased (166 vs. 217), although the reduction was not significant. We confirmed similar trend for the MSM and non-Japanese groups.InterpretationThe current HIV testing system including public health centers misses more HIV cases at the early phase of the infection during the pandemic. Given that the clear epidemiological picture of HIV incidence during the pandemic is still uncertain, continuously monitoring the situation as well as securing sufficient test resources using self-test is essential.FundingJapan Society for the Promotion of Science, Japan Science and Technology Agency, Japan Agency for Medical Research and Development.Research in contextEvidence before this studyBefore this study, we searched PubMed, Medline, and Google Scholar on Oct 12, 2020, for articles investigated the number of HIV test and HIV cases during the COVID-19 pandemic in Japan, using the search terms “novel coronavirus” or “SARS-CoV-2”, and “HIV” or “AIDS”, and “Japan”, with no time restrictions. We found no published work relevant to our study.Added value of this studyDuring the COVID-19 pandemic in Japan, the public health centers and municipalities temporarily suspended facility-based HIV testing to concentrate their limited resources to COVID-19 testing. We investigated the impact of the COVID-19 pandemic on the number of HIV tests in public health centers and municipalities, and on the number of HIV cases with and without AIDS diagnosis. We confirmed that the number of the test declined in the second quarter (April to June) of 2020, and the proportion of HIV with AIDS diagnosis among all HIV cases increased during the same period.Implications of all the available evidenceProviding sufficient HIV testing opportunities even during the pandemic, when facility-based testing is challenging, is necessary for better clinical and public health outcomes. Self-testing and home specimen collection (e.g. dried blood spot or oral fluid test) could be a key to fill the gap between the need for HIV testing and the constraints related to the COVID-19 outbreak.

scholarly journals Continuing education on child development for primary healthcare professionals: a prospective before-and-after study

2014 ◽  
Vol 132 (4) ◽  
pp. 211-218 ◽  
Author(s):  
Amira Consuêlo Melo Figueiras ◽  
Rosana Fiorini Puccini ◽  
Edina Mariko Koga Silva
Keyword(s):  
Child Development ◽  
Continuing Education ◽  
Education Program ◽  
Primary Healthcare ◽  
Healthcare Professionals ◽  
Before And After ◽  
The Impact ◽  
Children's Development ◽  
Before And After Study ◽  
Children’S Development

CONTEXT AND OBJECTIVE: Children's developmental disorders are often identified late by healthcare professionals working in primary care. The aim of this study was to assess the impact of a continuing education program on child development, on the knowledge and practices of these professionals.DESIGN AND SETTING: Prospective single-cohort study (before-and-after study), conducted in the city of Belém, Pará , Brazil.METHODS: Two hundred and twenty-one professionals working in primary healthcare (82.2%) participated in a continuing education program on child development and were assessed before and after implementation of the program through tests on their knowledge of child development, consisting of 19 questions for physicians and 14 for nurses, and questionnaires on their professional practices.RESULTS: One to three years after the program, the mean number of correct answers in the tests had increased from 11.5 to 14.3 among physicians in the Healthy Family Program (Programa Família Saudável, PFS); 13.0 to 14.3 among physicians in Municipal Health Units (Unidades Municipais de Saúde, UMS); 8.3 to 10.0 among PFS nurses; and 7.8 to 9.4 among UMS nurses. In interviews with mothers attended by these professionals before the program, only 21.7% reported that they were asked about their children's development, 24.7% reported that the professional asked about or observed their children's development and 11.1% received advice on how to stimulate them. After the program, these percentages increased to 34.5%, 54.2% and 30.3%, respectively.CONCLUSIONS: Professionals who participated in the program showed improved performance regarding child development knowledge and practices.

Sexually transmitted disease rates before and after HIV testing

1998 ◽  
Vol 9 (5) ◽  
pp. 291-293 ◽  
Author(s):  
Nigel George ◽  
John Green ◽  
Siobhan Murphy
Keyword(s):  
Hiv Testing ◽  
Sexually Transmitted Disease ◽  
Transmitted Disease ◽  
Hiv Positive ◽  
Negative Test ◽  
Negative Test Result ◽  
Sexually Transmitted ◽  
Hiv Test ◽  
Before And After ◽  
Test Result

Summary: The aim of the study was to evaluate the effect of having an HIV-positive or negative test result on sexual risk behaviour before and after the test. Longitudinal retrospective case-note survey identifying new episodes of sexually transmitted disease (STD) infections in 114 subjects testing HIV positive and 114 matched negatives were examined at the Genitourinary Medicine Department, St Mary's Hospital, Paddington, London. Across the whole sample in the year after HIV testing the number of cases of new STD infections was 40% of the number of cases in the year prior to HIV testing. There was no association between serostatus and incidence of STD infections before and after HIV testing. Of those testing negative, 5.3% were identified as having a new infection in the year after the HIV test, while amongst those testing positive there was a rate of new STDs of 2.6%. In conclusion, there was no evidence that having a negative test result increased the risk of acquisition of new STDs. Rates of new STD infections amongst seropositives in the year after HIV testing were low.

scholarly journals Strengthening Visceral Leishmaniasis Diagnosis Capacity to Improve Access to Care in Kenya: The Example of Marsabit County

2022 ◽  
Vol 2 ◽  
Author(s):  
Dziedzom K. de Souza ◽  
Albert Picado ◽  
Paul R. Bessell ◽  
Abduba Liban ◽  
Davis Wachira ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Public Health Problem ◽  
Diagnosis And Treatment ◽  
Road Map ◽  
Kala Azar ◽  
Before And After ◽  
Facility Placement ◽  
New Diagnosis ◽  
The Impact ◽  
New Facilities

BackgroundVisceral leishmaniasis (VL), also known as kala-azar, is a neglected tropical disease (NTD) that is fatal if not treated early. The WHO targets the elimination of VL as a public health problem in its 2030 NTD road map. However, improving access to VL diagnosis and treatment remains a major challenge in many VL-endemic countries. Kenya is endemic for VL and is among the top 6 high-disease burden countries in the world.MethodsFIND, through its activities in improving the diagnosis of VL and supporting the elimination of the disease in Kenya, has worked with various county ministries of health (MOH) and central MOH over the last couple of years. FIND’s activities in Marsabit county started in 2018. In this work, we present the implementation of activities and the impacts in Marsabit county. We reviewed the data for 2017 and 2019 outbreaks (before and after the implementation of FIND’s activities) and assessed the importance of improving access and community sensitization to VL diagnosis. We assessed the contribution of each facility to the total distance traveled from a perspective of location optimization.ResultsThere was a sharp increase in the number of people tested in the 2017 outbreak compared to the 2019 outbreak. In 2017, 437 people were tested compared to 2,338 in 2019. The county reported 234 and 688 VL cases in 2017 and 2019, respectively. The data revealed a shift in the demographic structures of cases toward the younger population (mean age in 2017 was 17.6 years and 15.3 years in 2019), with more female cases reported in 2019 compared to 2017. In 2017, 44.4% were 10 years of age or under. In 2019, the proportion 10 years or below was 52.2%. The addition of two new diagnosis facilities in 2018 resulted in a decrease in the distance traveled by confirmed VL cases from 28.1 km in 2017 to 10.8 km in 2019. Assessing the impact of facility placement indicated the most optimal facilities to provide VL diagnostic services and minimize the distance traveled by patients. Adding new facilities reduces the travel distance until a point where the addition of a new facility provides no additional impact.ConclusionThe results from this study indicate the need to carefully consider the placement of health facilities in improving access to VL diagnosis and treatment and could serve as an investment case in deciding when to stop adding new facilities in a particular setting. Extending the activities in Kenya to other VL-endemic countries in East Africa will contribute significantly toward the elimination of the disease, addressing the needs of marginalized populations and leaving no one behind.

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