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Biomedical subjects

Bernard M Branson

Publications and source records attributed to Bernard M Branson.

At least 19 recordsLinked to original sources
PubMed2007

Detecting unsuspected HIV infection with a rapid whole-blood HIV test in an urban emergency department.

OBJECTIVE: To evaluate and compare HIV screening and provider-referred diagnostic testing as strategies for detecting undiagnosed HIV infection in an urban emergency department (ED). METHODS: From January 2003 through April 2004, study staff offered HIV screening with rapid tests to ED patients regardless of risks or symptoms. ED providers could also refer patients for diagnostic testing. Patients aged 18 to 54 years without known HIV infection were eligible. RESULTS: Of 4849 eligible patients approached for screening, 2824 (58%) accepted and were tested; 414 (95%) of 436 provider-referred patients accepted and were tested. Thirty-five (1.2%) screened patients and 48 (11.6%) provider-referred patients were infected with HIV (P < 0.001). Of these, 18 (51%) screened patients and 24 (50%) referred patients reported no traditional risk factors; 27 (77%) screened patients and 38 (79%) referred patients entered HIV care. Of HIV-infected patients with CD4 cell counts available, 14 (45%) of 31 screened patients and 37 (82%) of 45 provider-referred patients had <200 cells/microL (P < 0.001). CONCLUSIONS: ED screening detects HIV infection and links to care patients who may not be tested through risk- or symptom-based strategies. The diagnostic yield was higher among provider-referred patients, but screening detected patients earlier in the course of disease.

Adolescent↗
PubMed2006

Rapid HIV antibody testing in the New York State Anonymous HIV Counseling and Testing Program: experience from the field.

OBJECTIVES: To assess rapid and conventional HIV test use, client satisfaction, and counselors' comfort. METHODS: At 61 HIV test sites in New York State, we compared HIV test use during the first 6 months of rapid testing in 2003 with the same time period in 2002. We administered surveys to clients at each site during the first 30 days of rapid testing and to counselors before and after training and after 12 weeks of using rapid tests in the field. RESULTS: Almost all (1249 [96.5%] of 1294) clients surveyed selected rapid over conventional HIV testing. During the evaluation period, 6187 HIV tests were reported, 1667 (36.9%) more than during the same period in 2002. All 5771 (100%) of 5771 clients received their rapid HIV test results compared with 333 (85.8%) of 388 clients (P < 0.0001) who had elected conventional testing. After performing rapid testing for 12 weeks, 32 (80%) of 40 trained counselors reported feeling "very comfortable" delivering reactive rapid test results compared with 14 (35%) of 40 trained counselors (P < 0.001) before training. CONCLUSIONS: Rapid testing presents a key opportunity to increase the number of people undergoing HIV testing and the proportion receiving their test results.

AIDS Serodiagnosis↗
PubMed2006

Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings.

These recommendations for human immunodeficiency virus (HIV) testing are intended for all health-care providers in the public and private sectors, including those working in hospital emergency departments, urgent care clinics, inpatient services, substance abuse treatment clinics, public health clinics, community clinics, correctional health-care facilities, and primary care settings. The recommendations address HIV testing in health-care settings only. They do not modify existing guidelines concerning HIV counseling, testing, and referral for persons at high risk for HIV who seek or receive HIV testing in nonclinical settings (e.g., community-based organizations, outreach settings, or mobile vans). The objectives of these recommendations are to increase HIV screening of patients, including pregnant women, in health-care settings; foster earlier detection of HIV infection; identify and counsel persons with unrecognized HIV infection and link them to clinical and prevention services; and further reduce perinatal transmission of HIV in the United States. These revised recommendations update previous recommendations for HIV testing in health-care settings and for screening of pregnant women (CDC. Recommendations for HIV testing services for inpatients and outpatients in acute-care hospital settings. MMWR 1993;42[No. RR-2]:1-10; CDC. Revised guidelines for HIV counseling, testing, and referral. MMWR 2001;50[No. RR-19]:1-62; and CDC. Revised recommendations for HIV screening of pregnant women. MMWR 2001;50[No. RR-19]:63-85). Major revisions from previously published guidelines are as follows: For patients in all health-care settings HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Persons at high risk for HIV infection should be screened for HIV at least annually. Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings. For pregnant women HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women. HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women.

AIDS Serodiagnosis↗
PubMed2006

A meta-analysis of the effectiveness of alternative HIV counseling and testing methods to increase knowledge of HIV status.

BACKGROUND: Alternatives to conventional HIV counseling and testing (HIV-CT) have been used to improve receipt of HIV test results. OBJECTIVES: To determine the effectiveness of alternative HIV-CT methods on the receipt of HIV test results. METHODS: Studies were identified by a systematic search of the literature using English-language databases from 1990 to 2005. Studies were included if they used an alternative method for HIV-CT, reported the receipt of HIV test results and had a comparison group. Pooled effect sizes [risk ratios (RR)] were calculated using a random effects model. RESULTS: Seventeen effect sizes (k) were included n = 21 096). Alternative HIV-CT methods included rapid testing (k = 12), oral fluid testing (k = 2), home testing (k = 1), and telephone post-test counseling (k = 2). All alternatives except for oral fluid testing significantly increased receipt of results compared with conventional testing. In stratified analysis, rapid testing was most effective [RR, 1.80; 95% confidence interval (CI), 1.46-2.22] followed by telephone post-test counseling (RR, 1.38. 95% CI, 1.24-1.47). CONCLUSIONS: There is strong evidence that clients are substantially more likely to receive their HIV test results with rapid testing than with conventional tests or other alternatives. Therefore, to increase knowledge of HIV status, rapid testing is preferable in settings with low rates of return for test results.

AIDS Serodiagnosis↗
PubMed2006

Performance of an oral fluid rapid HIV-1/2 test: experience from four CDC studies.

OBJECTIVE: To evaluate the performance of a rapid HIV antibody test used with whole blood and oral fluid in settings where the test is likely to be used. DESIGN: In four separate studies, we compared the accuracy of the rapid test performed on whole blood and oral fluid specimens with the results of conventional HIV tests. METHODS: Oral fluid and whole blood from persons of unknown HIV status recruited from clinics, labor and delivery units, and outreach venues were tested with the OraQuick Advance rapid HIV-1/2 antibody test. Sensitivity and specificity were compared with results of the enzyme immunoassay (EIA) and Western blot algorithm used by the study sites. RESULTS: OraQuick sensitivity was 99.7% with whole blood and 99.1% with oral fluid from 327 persons who were HIV antibody positive by the conventional algorithm. OraQuick specificity was 99.9% with whole blood and 99.6% with oral fluid from 12 010 HIV-negative persons; EIA specificity was 99.7%. A cluster of 16 false-positive oral fluid tests occurred in one study, in which specificity was lower (99.0%) than in the other three studies (99.6-99.8%). CONCLUSIONS: In diverse settings in four studies, the OraQuick test showed high sensitivity and specificity for HIV antibody in whole blood and oral fluid specimens. Slightly more false-positive and false-negative results occurred with oral fluid than with whole blood, but performance with both specimen types was similar to, or better than, that of conventional EIAs.

AIDS Serodiagnosis↗
PubMed2006

Comparison of HIV type 1 incidence observed during longitudinal follow-up with incidence estimated by cross-sectional analysis using the BED capture enzyme immunoassay.

The BED capture enzyme immunoassay (BED CEIA) for recent infection was developed for the estimation of HIV-1 incidence in a population from a single cross-sectional survey. To evaluate performance, we applied the assay to specimen sets obtained from a longitudinal cohort study, the AIDSVAX B/B vaccine trial, in which there was an independent and conventional measure of observed incidence. The BED CEIA was performed on specimens obtained during follow-up for seroconversion conducted every 6 months for 3 years. There was excellent agreement between the observed and BED-estimated incidence for all the intervals. The cumulative, annualized incidence observed in the cohort was 3.10 new infections per 100 person-years (95% CI, 2.57-3.63). The corresponding BED-estimated incidence was 2.91 (2.30-3.53). We also estimated the effect of varied prevalence on a fixed incidence. Because some specimens from persons with longer-term infection are classified as recent by the assay, this can inflate the incidence estimate. We quantify this effect and discuss potential mitigation by excluding certain specimens on clinical grounds, by relying on trend differences rather than absolute incidence estimates, by secondary confirmatory testing, or by analytic adjustments for misclassification. Cross-sectional HIV incidence estimation circumvents many of the drawbacks associated with longitudinal cohort studies, but there are test-specific limitations that should be considered in the design of population surveys.

Algorithms↗
PubMed2005

Choosing HIV Counseling and Testing Strategies for Outreach Settings: A Randomized Trial.

BACKGROUND: In surveys, clients have expressed preferences for alternatives to traditional HIV counseling and testing. Few data exist to document how offering such alternatives affects acceptance of HIV testing and receipt of test results. OBJECTIVES: This randomized controlled trial compared types of HIV tests and counseling at a needle exchange and 2 bathhouses to determine which types most effectively ensured that clients received test results. METHODS: Four alternatives were offered on randomly determined days: (1) traditional test with standard counseling, (2) rapid test with standard counseling, (3) oral fluid test with standard counseling, and (4) traditional test with choice of written pretest materials or standard counseling. RESULTS: Of 17,010 clients offered testing, 7014 (41%) were eligible; of those eligible, 761 (11%) were tested: 324 at the needle exchange and 437 at the bathhouses. At the needle exchange, more clients accepted testing (odds ratio [OR] = 2.3; P < 0.001) and received results (OR = 2.6; P < 0.001) on days when the oral fluid test was offered compared with the traditional test. At the bathhouses, more clients accepted oral fluid testing (OR = 1.6; P < 0.001), but more clients overall received results on days when the rapid test was offered (OR = 1.9; P = 0.01). CONCLUSIONS: Oral fluid testing and rapid blood testing at both outreach venues resulted in significantly more people receiving test results compared with traditional HIV testing. Making counseling optional increased testing at the needle exchange but not at the bathhouses.

AIDS Serodiagnosis↗
PubMed2005

Outcomes of offering rapid point-of-care HIV testing in a sexually transmitted disease clinic.

BACKGROUND: Delays in receipt of positive HIV test results and in entry into HIV care are common problems in clinics; in public venues, up to 33% of patients with negative results and 25% of those with positive results never learn their results. METHODS: Patients aged 18 years or older at an urban sexually transmitted disease (STD) clinic were offered rapid HIV testing between October 1999 and August 2000. Specimens were tested using the rapid Single Use Diagnostic System for HIV-1 (SUDS; Abbott/Murex, Norcross, GA), and results were confirmed by conventional enzyme immunoassay and Western blot (WB) analysis. Trained health educators performed all HIV counseling, phlebotomy, and rapid testing. RESULTS: Of 1977 eligible patients, 1581 (80%) agreed to HIV testing; of these, 1372 (87%) accepted rapid testing and 1357 (99%) received same-visit results and posttest counseling. Thirty-seven (2.7%) were HIV-positive as confirmed by WB analysis. One of these HIV-positive participants died, but the remaining 36 went to their first clinic appointment. CONCLUSION: Rapid HIV testing was acceptable and feasible in this STD clinic and facilitated entry of newly identified HIV-infected patients into health care.

AIDS Serodiagnosis↗
PubMed2005

Surveillance for HIV-1 incidence using tests for recent infection in resource-constrained countries.

Over the past few years, several assays have been developed for the purpose of estimating HIV-1 incidence from cross-sectional population surveys. The tests detect features of the evolving virological or immunological response to HIV-1 infection that distinguish recent from established infection. Surveillance programmes that collect specimens from population surveys for HIV-1 prevalence can apply some of these tests to the same specimen sets to estimate incidence. We describe these tests and discuss the principle and strategy for implementation of a testing programme for recent infection in surveillance settings. Test-specific prerequisites, such as calibration, validation, and quality assurance, and other test-specific performance characteristics that may influence interpretation, epidemiological considerations that may guide application, and practical operational considerations for implementation in surveillance settings are considered. When properly and judiciously applied, the capacity to estimate incidence from existing programmes that conduct surveillance for prevalent HIV-1 infection will enhance the capacity for more precise and timely analysis of the dynamics of the epidemic and the effectiveness of public health interventions.

AIDS Serodiagnosis↗
PubMed2005

Rapid HIV testing. Wait time reduced from days to minutes.

Recent breakthroughs in technology have produced tests for HIV antibody that are highly accurate and easy to use and can give a preliminary result in 20 minutes or less. These rapid HIV tests will be used increasingly in labor and delivery wards, emergency departments, urgent care centers, and the primary care office. They have unique applications for healthcare worker exposures, military operations, public health venues, and developing countries. In this article, Drs Keenan, Keenan, and Branson discuss the advantages and limitations of rapid HIV testing in various settings.

AIDS Serodiagnosis↗
PubMed2004

Incidence immunoassay for distinguishing recent from established HIV-1 infection in therapy-naive populations.

OBJECTIVE: To identify a specific marker of recent HIV-1 infection. DESIGN: The humoral immune response in individuals recently infected with HIV-1 was followed by analysing the antibody isotype-specific response generated to HIV-1 antigens in sequential samples collected during and following seroconversion. METHODS: Antibody isotype-specific HIV-1 Western blots were analysed to identify interactions indicative of recent HIV-1 infection. These responses were further quantified using an antibody isotype-specific enzyme-linked immunoabsorbent assay based on recombinant HIV-1 antigens. RESULTS: During maturation of the immune response to HIV-1 infection, a rapid and enduring IgG1 isotype response was seen to all the major proteins transcribed by env, gag and pol. An early transient peak of IgG3 reactivity to p24 was observed over an interval of approximately 1-4 months following HIV-1 infection. The presence of IgG3 reactivity to p24 permitted established infection to be distinguished from recently infected individuals during this time period. CONCLUSION: An assay for anti-p24 IgG3 reactivity would provide an estimate of the incidence of HIV infection that may be applicable for epidemiological surveys as well as for monitoring new infections during vaccine trials and for managing treatment programmes.

Acute Disease↗
PubMed2004

Rapid HIV-1 testing during labor: a multicenter study.

CONTEXT: Timely testing of women in labor with undocumented human immunodeficiency virus (HIV) status could enable immediate provision of antiretroviral prophylaxis. OBJECTIVES: To determine the feasibility and acceptance of rapid HIV testing among women in labor and to assess rapid HIV assay performance. DESIGN, SETTING, AND PATIENTS: The Mother-Infant Rapid Intervention At Delivery (MIRIAD) study implemented 24-hour counseling and voluntary rapid HIV testing for women in labor at 16 US hospitals from November 16, 2001, through November 15, 2003. A rapid HIV-1 antibody test for whole blood was used. MAIN OUTCOME MEASURES: Acceptance of HIV testing; sensitivity, specificity, and predictive value of the rapid test; time from blood collection to patient notification of results. RESULTS: There were 91,707 visits to the labor and delivery units in the study, 7381 of which were by eligible women without documentation of HIV testing. Of these, 5744 (78%) women were approached for rapid HIV testing and 4849 (84%) consented. HIV-1 test results were positive for 34 women (prevalence = 7/1000). Sensitivity and specificity of the rapid test were 100% and 99.9%, respectively; positive predictive value was 90% compared with 76% for enzyme immunoassay (EIA). Factors independently associated with higher test acceptance included younger age, being black or Hispanic, gestational age less than 32 weeks, and having had no prenatal care. Lower acceptance was associated with being admitted between 4 pm and midnight, particularly on Friday nights, but this may be explained in part by fewer available personnel. Median time from blood collection to patient notification of result was 66 minutes (interquartile range, 45-120 minutes), compared with 28 hours for EIA (P<.001). CONCLUSIONS: Rapid HIV testing is feasible and delivers accurate and timely test results for women in labor. It provides HIV-positive women prompt access to intrapartum and neonatal antiretroviral prophylaxis, proven to reduce perinatal HIV transmission, and may be particularly applicable to higher-risk populations.

AIDS Serodiagnosis↗
PubMed2004

Virological evaluation of the 'Ottawa case' indicates no evidence for HIV-1 superinfection.

An HIV-1 infected man who experienced rapid disease progression and poor response to therapy after starting a new sexual relationship with an infected partner is known as the 'Ottawa superinfection case'. Subsequent analysis of viral sequences of protease, reverse transcriptase, Gag p17, and Env V3 provided no evidence for the acquisition of genetically divergent viruses before disease progression or drug resistance during virological failure of combination therapy. Whether HIV-1 superinfection contributes to disease progression or the spread of drug-resistant HIV-1 remains unknown.

Antiretroviral Therapy, Highly Active↗
PubMed2003

Do physicians provide counseling with HIV and STD testing at physician offices or hospital outpatient departments?

OBJECTIVES: To estimate the frequency of HIV/sexually transmitted disease (STD) counseling among patients tested for HIV or STD infection at physician offices and hospital outpatient departments and to describe the factors associated with HIV/STD counseling in private settings in the USA. DESIGN: Cross-sectional study of patients served by physicians in private settings in the USA. METHODS: We analyzed 1997-1998 data from two representative national surveys of ambulatory care visits in private settings by persons aged 18-64 years. RESULTS: During 1997-1998, 12.7 million ambulatory care visits included HIV or STD testing. HIV/STD counseling was documented in 35% of all visits and in 28% of visits by pregnant women at the time HIV or STD tests were done. Counseling was less common when only HIV tests (21%) or STD tests (37%) alone were carried out than when both HIV and STD tests (50%) were performed. Counseling was more common (65%) if the patient's reason for visit was related to HIV, STD, or genitourinary complaints than if the visit was for other reasons. CONCLUSIONS: Private physicians often counseled about HIV/STD when testing patients with symptoms. The proportion of other visits in which counseling accompanied HIV or STD tests was variable. This suggests the need for a better understanding of the reasons why clinicians in private settings decide whether to counsel patients about HIV and STD when they order testing, barriers to offering counseling, and interventions to increase counseling when appropriate.

Adolescent↗
PubMed2003

Overcoming barriers to HIV testing: preferences for new strategies among clients of a needle exchange, a sexually transmitted disease clinic, and sex venues for men who have sex with men.

OBJECTIVE: To determine strategies to overcome barriers to HIV testing among persons at risk. METHODS: We developed a survey that elicited testing motivators, barriers, and preferences for new strategies among 460 participants at a needle exchange, three sex venues for men who have sex with men, and a sexually transmitted disease clinic. RESULTS: Barriers to testing included factors influenced by individual concern (fear and discrimination); by programs, policies, and laws (named reporting and inability to afford treatment); and by counseling and testing strategies (dislike of counseling, anxiety waiting for results, and venipuncture). The largest proportions of participants preferred rapid testing strategies, including clinic-based testing (27%) and home self-testing (20%); roughly equal proportions preferred oral fluid testing (18%), urine testing (17%), and standard blood testing (17%). One percent preferred home specimen collection. Participants who had never tested before were significantly more likely to prefer home self-testing compared with other strategies. Blacks were significantly more likely to prefer urine testing. CONCLUSIONS: Strategies for improving acceptance of HIV counseling and testing include information about access to anonymous testing and early treatment. Expanding options for rapid testing, urine testing, and home self-testing; providing alternatives to venipuncture; making pretest counseling optional; and allowing telephone results disclosure may encourage more persons to learn their HIV status.

Adult↗
PubMed2003

Cost comparison of three HIV counseling and testing technologies.

BACKGROUND: In the United States, more than 2 million human immunodeficiency virus (HIV) antibody tests are performed annually at publicly funded HIV counseling and testing (CT) clinics. Clients do not receive results from one third of these tests because of low return rates. New rapid-testing technologies may improve receipt of results, but no study has systematically analyzed the costs of these newer technologies compared with the standard protocol. OBJECTIVE: To estimate and compare the economic costs associated with three HIV CT protocols: the standard protocol and the one-step and two-step rapid protocols. METHODS: A cost analysis model was developed in 2002 to calculate the intervention costs for HIV CT services with the standard CT protocol and the one-step and two-step rapid-test protocols for a hypothetical client in a publicly funded HIV clinic. Sensitivity analyses were performed to ascertain the effects of uncertainty in the model parameters. RESULTS: The one-step rapid protocol was generally the least expensive of the three protocols. The standard protocol cost less than the two-step protocol per HIV-positive client notified of his or her HIV status, but cost more per HIV-negative client. The sensitivity analysis indicated overlap in the cost estimates for HIV-negative clients, reflecting the generally similar costs of the three testing protocols. Taking into account HIV seroprevalence, the two-step rapid protocol would be less expensive than the standard protocol for most publicly funded testing programs in the United States. CONCLUSIONS: Rapid test protocols offer economic advantages as well as convenience, compared to the standard testing protocol. The cost estimates presented here should prove helpful to HIV program managers and other public health decision makers who need information on these counseling and testing technologies.

AIDS Serodiagnosis↗