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PubMed1997

On-site, rapid HIV testing with same-day results and counseling.

BACKGROUND: New rapid HIV antibody tests have allowed provision of results and result-specific counseling on the day on initial visit, and have the potential to increase the efficiency of HIV counseling and testing. METHODS: To evaluate the use of rapid testing with same-day results in public clinics, the Single Use Diagnostic System HIV-1 rapid assay was used for a 3-month period at an anonymous testing clinic and a sexually transmitted disease (STD) clinic in Dallas, Texas. Non-reactive rapid test results were reported as HIV-negative. Reactive results were reported as 'preliminary positive'. These procedures were compared with standard testing during a baseline period, with respect to number of clients receiving results and post-test counseling, client satisfaction, counselor acceptance, cost and effectiveness at reducing HIV risk. RESULTS: Rapid testing resulted in an increase in the number of persons learning their serostatus: a 4% increase for uninfected and a 16% increase for infected clients at the Anonymous Testing Clinic; a 210% increase for uninfected patients and a 23% increase for infected patients at the STD clinic. Rapid testing resulted in a cost saving of US$ 11 per test in both the anonymous and STD clinics. Of those previously tested, 88% responded that they preferred the rapid test. In the year following initial HIV test, clients tested with rapid and standard procedures were equally likely to return to the clinic with a new STD (odds ratio, 0.97; 95% confidence interval, 0.7-1.4). CONCLUSIONS: Rapid, on-site HIV testing was feasible, preferred by clients, and, resulted in significant improvement in the number of persons learning their serostatus, without increasing the costs or decreasing the effectiveness of counseling and testing.

Counseling↗

PubMedDate not supplied

Testing for human immunodeficiency virus in chemical dependence treatment programs.

This article examines the issue of testing for human immunodeficiency virus (HIV) in chemical dependence treatment programs. Three types of treatment programs are considered: 21- to 28-day inpatient, eight-week outpatient, and methadone maintenance. Through discussion by groups of chemical dependence treatment providers, recommendations are made in regard to issues of who to test, when to test, confidential versus anonymous testing, charting policies, informed consent, elements of pre- and posttest counseling, and the duty to warn others.

Acquired Immunodeficiency Syndrome↗

PubMed1990

Evaluation of a hospital admission HIV antibody voluntary screening program.

Voluntary screening for the presence of human immunodeficiency virus (HIV) is recommended by the healthcare profession. The optimal settings to accomplish screening have not been established. We evaluated an admission HIV screening program in a large private hospital to assess advantages and disadvantages in this setting. In a three-month study period, 4,535 of 8,868 patients (51%) admitted to the hospital agreed to HIV testing. Serum specimens from 500 patients who refused testing were blindly, anonymously tested. The seroprevalence of the patients agreeing to (0.26%) and refusing (0.60%) testing was not statistically different (p = .12). There were 12 HIV cases discovered; ten (83%) of these were known to be in a high-risk group at the time of admission. Eighty-five percent of patients interviewed were in favor of this screening program. Difficulties associated with confidentiality or consent were not evident. Calculated charges of testing for each HIV case discovery was $14,550. There was no evidence that this screening program provided for a more effective infection control policy to prevent nosocomial HIV transmission. A hospital admission HIV screening program can be implemented, can meet with favorable patient opinion and can detect previously unknown HIV-positive patients. Hospitals are an efficient and practical setting for HIV testing. The benefit of this program appears to be greater for the patient than hospital or healthcare worker. Cost-benefit analyses will identify optimal candidates to be screened in different hospital populations.

Attitude to Health↗

PubMed2000

Prevalence of detectable abnormal prion protein in persons incubating vCJD: plausible incubation periods and cautious inference.

BACKGROUND: Both small and large variant Creutzfeldt Jakob disease (vCJD) epidemics are consistent with the current observed incidence. Uncertainty in vCJD projections could potentially be reduced by incorporating information on the prevalence of the infectious agent in persons incubating vCJD. The prospect of vCJD prevalence studies has been raised by detection of abnormal prion protein, thought to be the infectious agent, in appendices and tonsils removed from vCJD patients. Although unlinked anonymous testing of stored operative tissues for abnormal prion protein is very appealing, the design and interpretation of such prevalence studies is complicated by the lack of information on how early in the incubation period of vCJD the abnormal prion protein becomes detectable. METHODS: We simulate a range of vCJD epidemics, consistent with the limited available information on the incidence of vCJD, to illustrate some of the potential problems encountered when interpreting the results from prevalence studies of detectable abnormal prion protein. We assume plausible incubation period distributions and dietary exposure patterns. RESULTS: We demonstrate, in the context of our simulated epidemics, that prevalence studies of detectable abnormal prion protein would require the testing of tens of thousands of operative specimens and, even then, that unlinked anonymous testing positives would be unexpected.

Animals↗

PubMed1967

Use of thiosemicarbazone and para-nitrobenzoic acid in screening tests for anonymous mycobacteria.

In screening for anonymous mycobacteria the use of thiosemicarbazone (10mug./ml.) may give rise to false positive results. Although these can usually be overcome by further tests, additional time and effort is required, which seriously limits the value of thiosemicarbazone as a true screening agent. Para-nitrobenzoic acid (500 mug./ml.) has proved more satisfactory in our hands; no false positive results have been obtained and it has the additional advantage that strains of M. kansasii (usually thiosemicarbazone sensitive) are resistant to para-nitrobenzoic acid.

Animals↗

PubMed1989

Epidemiology of human T-cell leukaemia/lymphoma virus type 1 (HTLV-1) infections in a subpopulation of Afro-Caribbean origin in England.

Epidemiological studies on neurological diseases in residents of Afro-Caribbean origin in the West Midlands region of England have identified eight patients with tropical spastic paraparesis (TSP), all of whom were found to be infected with human T-cell leukaemia/lymphoma virus type 1 (HTLV-1). The husband of one of the patients with TSP was also infected with HTLV-1 and had a T-cell lymphoma. In addition, six asymptomatic HTLV-1-infected first-degree relatives of the TSP patients have been found. By anonymous testing of over 700 sera obtained from individuals of Afro-Caribbean, African, or Asian ethnic origin, seven HTLV-1-infected individuals were detected, who were all immigrants from the Caribbean. Overall, these numbers yielded a seroprevalence of HTLV-1 infections of 3.4% among the immigrant population of Afro-Caribbean origin, which is comparable with the prevalence of HTLV-1 in Jamaica in an equivalent age and sex cohort. Sera were tested for HTLV-1 antibody by means of three different procedures: passive particle agglutination test (Serodia), indirect enzyme-labeled immunosorbent assay (ELISA; Dupont), and indirect immunofluorescence test (in-house, using HTLV-1-infected MT2 cells). The results of all three tests correlated very well with each other. HTLV-1 antibody titres in TSP patients were on the whole significantly higher than those of asymptomatic carriers, but some of the apparently healthy first-degree relatives and one anonymously tested individual had titres as high as most of the TSP patients.

Black or African American↗

PubMedDate not supplied

Evaluation of the unlinked anonymous prevalence monitoring programme for HIV in England and Wales: science, ethics and health policy.

BACKGROUND: The Unlinked Anonymous Prevalence Monitoring Programme for HIV in England and Wales was set up in 1989 and has been operational for over a decade. This paper describes a wide-ranging evaluation of the programme encompassing different perspectives and approaches: epidemiological, ethical, social scientific and economic. MATERIAL AND METHODS: Epidemiological and ethical evaluation by critical review of the literature. Evaluation of the public's views on unlinked anonymous testing of blood by questions inserted into the Omnibus National Survey carried out by the Office for National Statistics. Evaluation of the views of planners of HIV/AIDS services by telephone questionnaire survey. Economic analysis by costing of the programme. RESULTS: Epidemiologically the programme's results contribute to the jigsaw of knowledge about HIV. The ethical debate has shifted with time, and moral justification for the programme was more valid at its inception than now. The majority of the public was unaware of unlinked anonymous testing of blood for HIV, and 25-30% disagreed with the policy. Local planners of HIV services found the programme generally useful. There are concerns about the programme's hidden costs and funding. CONCLUSIONS: To improve awareness and respect autonomy information leaflets, explaining opting out of testing, should be handed to all individuals at centres where the programme is operational. Data from the programme should be fed back quicker to local planners, and the programme's funding needs reappraisal. Further research on patients' views is indicated. Generic conclusions include the need for a definition of 'public health emergency', and establishment of a national healthcare ethics committee.

Bioethical Issues↗

PubMed1989

HIV testing in antenatal clinics: the impact on women.

One hundred and fifty-five women attending antenatal clinics in an inner city area where the rate of AIDS reporting is high were interviewed to examine the acceptability of different modes and purposes of antenatal HIV testing. Eighty-two per cent of women felt the test should be available in antenatal clinics, but only 48% reported that they themselves would take the test. Seventy-four per cent would accept anonymous testing. Potential anxiety levels surrounding the HIV test were significantly higher than for other (currently routine) tests in antenatal clinics. The implications of these findings for policy are discussed.

AIDS Serodiagnosis↗

PubMed1993

The prevalence of human retroviral infections in female patients attending a central London sexually transmitted disease clinic: 1985-1990.

OBJECTIVES: To determine the prevalence of infection with HIV-1, HIV2, HTLV-1 and HTLV-2 in female attenders at a central London sexually transmitted disease clinic in an 8 week period in 1989-1990, and compare it with similar samples studied between 1985 and 1987. DESIGN: Anonymous testing of serum samples from consecutive female patients having routine serological investigation for syphilis. Testing was for clinically important retroviruses, Hepatitis B core antibodies (anti-HBc), and p24 and reverse transcriptase (RT) antigens. Age (in 5 year bands), nationality (in broad geographical zones), diagnosis on the day of presentation, and history of intravenous drug usage were recorded for each patient. Annual gonorrhoea rates were analysed from 1981 to 1990. SETTING: Outpatients of the department of genitourinary medicine. PATIENTS: A total of 850 females attending consecutively and having routine syphilis serology. MAIN RESULTS: The prevalence of anti-HIV-1 in female attenders in 1989-1990 was 0.35% (3/850). Prevalence in the same clinic has remained statistically unchanged since the first female cases were identified in 1986. No cases of HIV-2, HTLV-1 or HTLV-2 were identified, and no early HIV-1 infection evidenced by the presence of p24 or RT antigenaemia was found. Female gonorrhoea rates continued to decline but other STD monthly/annual rates have remained unchanged. CONCLUSIONS: Over the last 5 years prevalence of HIV-1 infection in females in our clinic has remained unchanged and other retroviral infections have remained absent. However, the unaltered rates of other genital infections, their potential role in the heterosexual spread of HIV-1 infection, and the lack of evidence for any major changes in female sexual behaviour suggests there is a need to remain vigilant. This work complements the MRC multicentre, unlinked, genitourinary medicine clinic, anonymous testing programme, and our group will continue to apply this simple methodology to specimens from female attenders to contribute to the surveillance of the evolving HIV-1 epidemic.

Adolescent↗

PubMedDate not supplied