Simplifying Consent for HIV Testing Is Associated with an Increase in HIV Testing and Case Detection in Highest Risk Groups, San Francisco January 2003–June 2007

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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SIMPLIFYING CONSENT INCREASES HIV TESTING AND NEW CASE DETECTION: THE SAN FRANCISCO EXPERIENCE

American Journal of Public Health ◽

10.2105/ajph.2009.173591 ◽

2009 ◽

Vol 99 (11) ◽

pp. 1924-1924 ◽

Cited By ~ 5

Author(s):

Nicola M. Zetola ◽

Jeffrey D. Klausner ◽

Mitchell H. Katz

Keyword(s):

Hiv Testing ◽

San Francisco ◽

Case Detection

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Operational Research to Assess the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Health Facilities in Harare, Zimbabwe

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6020094 ◽

2021 ◽

Vol 6 (2) ◽

pp. 94

Author(s):

Pruthu Thekkur ◽

Kudakwashe C. Takarinda ◽

Collins Timire ◽

Charles Sandy ◽

Tsitsi Apollo ◽

...

Keyword(s):

Hiv Testing ◽

Treatment Outcomes ◽

Real Time ◽

Treatment Success ◽

Health Facilities ◽

Case Detection ◽

Monthly Data ◽

Hiv Services ◽

Tb Treatment ◽

Set Up

When COVID-19 was declared a pandemic, there was concern that TB and HIV services in Zimbabwe would be severely affected. We set up real-time monthly surveillance of TB and HIV activities in 10 health facilities in Harare to capture trends in TB case detection, TB treatment outcomes and HIV testing and use these data to facilitate corrective action. Aggregate data were collected monthly during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data extracted for the pre-COVID-19 period (March 2019–February 2020). Monthly reports were sent to program directors. During the COVID-19 period, there was a decrease in persons with presumptive pulmonary TB (40.6%), in patients registered for TB treatment (33.7%) and in individuals tested for HIV (62.8%). The HIV testing decline improved in the second 6 months of the COVID-19 period. However, TB case finding deteriorated further, associated with expiry of diagnostic reagents. During the COVID-19 period, TB treatment success decreased from 80.9 to 69.3%, and referral of HIV-positive persons to antiretroviral therapy decreased from 95.7 to 91.7%. Declining trends in TB and HIV case detection and TB treatment outcomes were not fully redressed despite real-time monthly surveillance. More support is needed to transform this useful information into action.

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Unsafe Injection Is Associated with Higher HIV Testing after Bayesian Adjustment for Unmeasured Confounding

Archives of Iranian Medicine ◽

10.34172/aim.2020.113 ◽

2020 ◽

Vol 23 (12) ◽

pp. 848-855

Author(s):

Soodabeh Navadeh ◽

Ali Mirzazadeh ◽

Willi McFarland ◽

Phillip Coffin ◽

Mohammad Chehrazi ◽

...

Keyword(s):

Hiv Testing ◽

San Francisco ◽

Expert Opinion ◽

Bias Analysis ◽

Hiv Knowledge ◽

Persons Who Inject Drugs ◽

Adjusted Risk ◽

Unmeasured Confounder ◽

Unsafe Injection ◽

Insufficient Knowledge

Background: To apply a novel method to adjust for HIV knowledge as an unmeasured confounder for the effect of unsafe injection on future HIV testing. Methods: The data were collected from 601 HIV-negative persons who inject drugs (PWID) from a cohort in San Francisco. The panel-data generalized estimating equations (GEE) technique was used to estimate the adjusted risk ratio (RR) for the effect of unsafe injection on not being tested (NBT) for HIV. Expert opinion quantified the bias parameters to adjust for insufficient knowledge about HIV transmission as an unmeasured confounder using Bayesian bias analysis. Results: Expert opinion estimated that 2.5%–40.0% of PWID with unsafe injection had insufficient HIV knowledge; whereas 1.0%–20.0% who practiced safe injection had insufficient knowledge. Experts also estimated the RR for the association between insufficient knowledge and NBT for HIV as 1.1-5.0. The RR estimate for the association between unsafe injection and NBT for HIV, adjusted for measured confounders, was 0.96 (95% confidence interval: 0.89,1.03). However, the RR estimate decreased to 0.82 (95% credible interval: 0.64, 0.99) after adjusting for insufficient knowledge as an unmeasured confounder. Conclusion: Our Bayesian approach that uses expert opinion to adjust for unmeasured confounders revealed that PWID who practice unsafe injection are more likely to be tested for HIV – an association that was not seen by conventional analysis.

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HIV Testing Patterns and Unrecognized HIV Infection Among Young Asian and Pacific Islander Men Who Have Sex With Men in San Francisco

AIDS Education and Prevention ◽

10.1521/aeap.2005.17.6.540 ◽

2005 ◽

Vol 17 (6) ◽

pp. 540-554 ◽

Cited By ~ 41

Author(s):

Tri D. Do ◽

Sanny Chen ◽

Willi McFarland ◽

Gina M. Secura ◽

Stephanie K. Behel ◽

...

Keyword(s):

Hiv Infection ◽

Hiv Testing ◽

San Francisco ◽

Pacific Islander ◽

Asian And Pacific Islander ◽

Sex With Men ◽

Testing Patterns

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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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Success of active tuberculosis case detection among high-risk groups in urban slums in Pakistan

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.14.0001 ◽

2014 ◽

Vol 18 (9) ◽

pp. 1099-1104 ◽

Cited By ~ 12

Author(s):

R. Fatima ◽

E. Qadeer ◽

D. A. Enarson ◽

J. Creswell ◽

R. Stevens ◽

...

Keyword(s):

High Risk ◽

Risk Groups ◽

Active Tuberculosis ◽

Urban Slums ◽

Case Detection ◽

Tuberculosis Case

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ScreenTB: a tool for prioritising risk groups and selecting algorithms for screening for active tuberculosis

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.19.0284 ◽

2020 ◽

Vol 24 (4) ◽

pp. 367-375

Author(s):

C. R. Miller ◽

E. M. H. Mitchell ◽

N. Nishikiori ◽

A. Zwerling ◽

K. Lönnroth

Keyword(s):

Health Care Access ◽

Planning Process ◽

Cost Effective ◽

Risk Groups ◽

Local Context ◽

Diagnostic Tools ◽

Case Detection ◽

Online Tool ◽

Screening Programs ◽

Care Access

SETTING AND OBJECTIVES: There is an urgent need to improve tuberculosis (TB) case detection globally. This would require greater focus on the implementation of TB screening programs. However, to be productive, cost-effective, and ethical, TB screening efforts should be tailored to their local context, targeted to the populations most likely to benefit and utilizing diagnostic tools with sufficient accuracy.DESIGN AND RESULTS: We have developed an online tool, ScreenTB to help National TB Programmes (NTPs) and their partners plan TB screening activities by modeling the potential outcomes of screening programs, including yield of TB cases diagnosed (true- and false-positives), costs, and cost-effectiveness, specific to the populations screened and the diagnostic algorithms used. In Myanmar, ScreenTB was used to assist the NTP in prioritizing risk groups for screening efforts and selecting appropriate screening algorithms to maximize case detection and minimize false-positive diagnoses.CONCLUSION: The ScreenTB tool can help facilitate the prioritization of risk groups for screening and the selection of appropriate screening algorithms. This is useful when used as part of a larger planning process that considers feasibility of screening, vulnerability of risk groups, potential impact of screening on TB transmission, human rights implications of screening and equity in health care access.

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