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Muttai H, Guyah B, Musingila P, Achia T, Miruka F, Wanjohi S, Dande C, Musee P, Lugalia F, Onyango D, Kinywa E, Okomo G, Moth I, Omondi S, Ayieko C, Nganga L, Joseph RH, Zielinski-Gutierrez E. Development and Validation of a Sociodemographic and Behavioral Characteristics-Based Risk-Score Algorithm for Targeting HIV Testing Among Adults in Kenya. AIDS Behav 2021; 25:297-310. [PMID: 32651762 PMCID: PMC7846530 DOI: 10.1007/s10461-020-02962-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
To inform targeted HIV testing, we developed and externally validated a risk-score algorithm that incorporated behavioral characteristics. Outpatient data from five health facilities in western Kenya, comprising 19,458 adults ≥ 15 years tested for HIV from September 2017 to May 2018, were included in univariable and multivariable analyses used for algorithm development. Data for 11,330 adults attending one high-volume facility were used for validation. Using the final algorithm, patients were grouped into four risk-score categories: ≤ 9, 10-15, 16-29 and ≥ 30, with increasing HIV prevalence of 0.6% [95% confidence interval (CI) 0.46-0.75], 1.35% (95% CI 0.85-1.84), 2.65% (95% CI 1.8-3.51), and 15.15% (95% CI 9.03-21.27), respectively. The algorithm's discrimination performance was modest, with an area under the receiver-operating-curve of 0.69 (95% CI 0.53-0.84). In settings where universal testing is not feasible, a risk-score algorithm can identify sub-populations with higher HIV-risk to be prioritized for HIV testing.
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Affiliation(s)
- Hellen Muttai
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya.
| | - Bernard Guyah
- School of Public Health, Maseno University, Kisumu, Kenya
| | - Paul Musingila
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
| | - Thomas Achia
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
| | - Fredrick Miruka
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
| | | | - Caroline Dande
- University of California at San Francisco, Kisumu, Kenya
| | - Polycarp Musee
- Elizabeth Glaser Pediatric AIDS Foundation, Homa Bay, Kenya
| | | | | | | | - Gordon Okomo
- Homa Bay County Department of Health, Homa Bay, Kenya
| | - Iscah Moth
- Homa Bay County Department of Health, Homa Bay, Kenya
| | | | | | - Lucy Nganga
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
| | - Rachael H Joseph
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
| | - Emily Zielinski-Gutierrez
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
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Leblanc J, Hejblum G, Costagliola D, Durand-Zaleski I, Lert F, de Truchis P, Verbeke G, Rousseau A, Piquet H, Simon F, Pateron D, Simon T, Crémieux AC. Targeted HIV Screening in Eight Emergency Departments: The DICI-VIH Cluster-Randomized Two-Period Crossover Trial. Ann Emerg Med 2017; 72:41-53.e9. [PMID: 29092761 DOI: 10.1016/j.annemergmed.2017.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/09/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE This study compares the effectiveness and cost-effectiveness of nurse-driven targeted HIV screening alongside physician-directed diagnostic testing (intervention strategy) with diagnostic testing alone (control strategy) in 8 emergency departments. METHODS In this cluster-randomized, 2-period, crossover trial, 18- to 64-year-old patients presenting for reasons other than potential exposure to HIV were included. The strategy applied first was randomly assigned. During both periods, diagnostic testing was prescribed by physicians following usual care. During the intervention periods, patients were asked to complete a self-administered questionnaire. According to their answers, the triage nurse suggested performing a rapid test to patients belonging to a high-risk group. The primary outcome was the proportion of new diagnoses among included patients, which further refers to effectiveness. A secondary outcome was the intervention's incremental cost (health care system perspective) per additional diagnosis. RESULTS During the intervention periods, 74,161 patients were included, 16,468 completed the questionnaire, 4,341 belonged to high-risk groups, and 2,818 were tested by nurses, yielding 13 new diagnoses. Combined with 9 diagnoses confirmed through 97 diagnostic tests, 22 new diagnoses were established. During the control periods, 74,166 patients were included, 92 were tested, and 6 received a new diagnosis. The proportion of new diagnoses among included patients was higher during the intervention than in the control periods (3.0 per 10,000 versus 0.8 per 10,000; difference 2.2 per 10,000, 95% CI 1.3 to 3.6; relative risk 3.7, 95% CI 1.4 to 9.8). The incremental cost was €1,324 per additional new diagnosis. CONCLUSION The combined strategy of targeted screening and diagnostic testing was effective.
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Affiliation(s)
- Judith Leblanc
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris, Paris, France; Université Paris Saclay-Université Versailles St Quentin, INSERM UMR 1173, Garches, France.
| | - Gilles Hejblum
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique UMRS 1136, Paris, France
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique UMRS 1136, Paris, France
| | - Isabelle Durand-Zaleski
- Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu, URC Eco Île-de-France, Paris, France, and Université Paris Diderot, Univ Paris 07, INSERM, ECEVE, UMR 1123, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Santé publique, Créteil, France
| | - France Lert
- Université Paris Sud, Univ Paris 11, INSERM, Centre for Research in Epidemiology and Population Health, U 1018, Villejuif, France
| | - Pierre de Truchis
- Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Infectious Diseases Department, Garches, France
| | - Geert Verbeke
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium, and UHasselt, Hasselt, Belgium
| | - Alexandra Rousseau
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Unit of East of Paris, Paris, France
| | - Hélène Piquet
- Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Emergency Department, Paris, France
| | - François Simon
- Assistance Publique-Hôpitaux de Paris, Hôpital St Louis, Microbiology Department, INSERM U941, Paris, France
| | - Dominique Pateron
- Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Emergency Department, Paris, France
| | - Tabassome Simon
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Department of Clinical Pharmacology and Clinical Research Platform of East of Paris, and Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR 1148, Paris, France
| | - Anne-Claude Crémieux
- Université Paris Saclay-Université Versailles St Quentin, INSERM UMR 1173, Garches, France; Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Infectious Diseases Department, Université Paris Diderot, Univ Paris 07, Paris, France
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Adekeye OA, Abara WE, Xu J, Lee JM, Rust G, Satcher D. HIV Screening Rates among Medicaid Enrollees Diagnosed with Other Sexually Transmitted Infections. PLoS One 2016; 11:e0161560. [PMID: 27556925 PMCID: PMC4996516 DOI: 10.1371/journal.pone.0161560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 08/08/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction Approximately 20 million new sexually transmitted infections (STIs) are diagnosed yearly in the United States costing the healthcare system an estimated $16 billion in direct medical expenses. The presence of other STIs increases the risk of HIV transmission. The Centers for Disease Control and Prevention (CDC) has long recommended routine HIV screening for individuals with a diagnosed STI. Unfortunately, HIV screening prevalence among STI diagnosed patients are still sub-optimal in many healthcare settings. Objective To determine the proportion of STI-diagnosed persons in the Medicaid population who are screened for HIV, examine correlates of HIV screening, and to suggest critical intervention points to increase HIV screening in this population. Methods A retrospective database analysis was conducted to examine the prevalence and correlates of HIV screening among participants. Participant eligibility was restricted to Medicaid enrollees in 29 states with a primary STI diagnosis (chlamydia, gonorrhea, and syphilis) or pelvic inflammatory disease claim in 2009. HIV-positive persons were excluded from the study. Frequencies and descriptive statistics were conducted to characterize the sample in general and by STI diagnosis. Univariate and multivariate logistic regression were performed to estimate unadjusted odds ratios and adjusted odds ratio respectively and the 95% confidence intervals. Multivariate logistic regression models that included the independent variables (race, STI diagnosis, and healthcare setting) and covariates (gender, residential status, age, and state) were analyzed to examine independent associations with HIV screening. Results About 43% of all STI-diagnosed study participants were screened for HIV. STI-diagnosed persons that were between 20–24 years, female, residing in a large metropolitan area and with a syphilis diagnosis were more likely to be screened for HIV. Participants who received their STI diagnosis in the emergency department were less likely to be screened for HIV than those diagnosed in a physician’s office. Conclusion This study showed that HIV screening prevalence among persons diagnosed with an STI are lower than expected based on the CDC’s recommendations. These suboptimal HIV screening prevalence present “missed opportunities” for HIV screening in at-risk populations. Measures and incentives to increase HIV screening among all STI-diagnosed persons are vital to the timely identification of HIV infection, linkage to HIV care, and mitigating further HIV transmission.
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Affiliation(s)
- Oluwatoyosi A. Adekeye
- Department of Community Health and Preventive Medicine, Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America
- * E-mail:
| | - Winston E. Abara
- Department of Community Health and Preventive Medicine, Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Junjun Xu
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Joel M. Lee
- Department of Health Policy and Management, The University of Georgia, Athens, Georgia, United States of America
| | - George Rust
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - David Satcher
- Department of Community Health and Preventive Medicine, Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America
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Leblanc J, Rousseau A, Hejblum G, Durand-Zaleski I, de Truchis P, Lert F, Costagliola D, Simon T, Crémieux AC. The impact of nurse-driven targeted HIV screening in 8 emergency departments: study protocol for the DICI-VIH cluster-randomized two-period crossover trial. BMC Infect Dis 2016; 16:51. [PMID: 26831332 PMCID: PMC4736610 DOI: 10.1186/s12879-016-1377-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2010, to reduce late HIV diagnosis, the French national health agency endorsed non-targeted HIV screening in health care settings. Despite these recommendations, non-targeted screening has not been implemented and only physician-directed diagnostic testing is currently performed. A survey conducted in 2010 in 29 French Emergency Departments (EDs) showed that non-targeted nurse-driven screening was feasible though only a few new HIV diagnoses were identified, predominantly among high-risk groups. A strategy targeting high-risk groups combined with current practice could be shown to be feasible, more efficient and cost-effective than current practice alone. METHODS/DESIGN DICI-VIH (acronym for nurse-driven targeted HIV screening) is a multicentre, cluster-randomized, two-period crossover trial. The primary objective is to compare the effectiveness of 2 strategies for diagnosing HIV among adult patients visiting EDs: nurse-driven targeted HIV screening combined with current practice (physician-directed diagnostic testing) versus current practice alone. Main secondary objectives are to compare access to specialist consultation and how early HIV diagnosis occurs in the course of the disease between the 2 groups, and to evaluate the implementation, acceptability and cost-effectiveness of nurse-driven targeted screening. The 2 strategies take place during 2 randomly assigned periods in 8 EDs of metropolitan Paris, where 42 % of France's new HIV patients are diagnosed every year. All patients aged 18 to 64, not presenting secondary to HIV exposure are included. During the intervention period, patients are invited to fill a 7-item questionnaire (country of birth, sexual partners and injection drug use) in order to select individuals who are offered a rapid test. If the rapid test is reactive, a follow-up visit with an infectious disease specialist is scheduled within 72 h. Assuming an 80 % statistical power and a 5 % type 1 error, with 1.04 and 3.38 new diagnoses per 10,000 patients in the control and targeted groups respectively, a sample size of 140,000 patients was estimated corresponding to 8,750 patients per ED and per period. Inclusions started in June 2014. Results are expected by mid-2016. DISCUSSION The DICI-VIH study is the first large randomized controlled trial designed to assess nurse-driven targeted HIV screening. This study can provide valuable information on HIV screening in health care settings. TRIAL REGISTRATION ClinicalTrials.gov: NCT02127424 (29 April 2014).
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Affiliation(s)
- Judith Leblanc
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris (CRC-Est), F75012, Paris, France. .,Université Paris Saclay - Université Versailles Saint-Quentin, Doctoral School of Public Health (EDSP), UMR 1173, F92380, Garches, France.
| | - Alexandra Rousseau
- AP-HP, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Unit of East of Paris (URC-Est), F75012, Paris, France.
| | - Gilles Hejblum
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
| | - Isabelle Durand-Zaleski
- AP-HP, Hôpital Hôtel-Dieu, URC Eco Île-de-France, F75004, Paris, France. .,Université Paris Diderot, Univ Paris 07, INSERM, ECEVE, UMR 1123, F75019, Paris, France. .,AP-HP, Hôpital Henri-Mondor, Santé publique, F94010, Créteil, France.
| | - Pierre de Truchis
- AP-HP, Hôpital Raymond-Poincaré, Infectious Disease Department, F92380, Garches, France.
| | - France Lert
- Université Paris Sud, Univ Paris 11, INSERM, Centre for research in Epidemiology and population health, U 1018, F94800, Villejuif, France.
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
| | - Tabassome Simon
- AP-HP, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Department of clinical pharmacology and Clinical Research Center of East of Paris (CRC-Est), F75012, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR 1148, F75018, Paris, France.
| | - Anne-Claude Crémieux
- AP-HP, Hôpital Raymond-Poincaré, Infectious Disease Department, F92380, Garches, France. .,Université Versailles Saint-Quentin, UMR 1173, F92380, Garches, France.
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Haukoos JS, Hopkins E, Bucossi MM, Lyons MS, Rothman RE, White DA, Al-Tayyib AA, Bradley-Springer L, Campbell JD, Sabel AL, Thrun MW. Brief report: Validation of a quantitative HIV risk prediction tool using a national HIV testing cohort. J Acquir Immune Defic Syndr 2015; 68:599-603. [PMID: 25585300 PMCID: PMC4357562 DOI: 10.1097/qai.0000000000000518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Routine screening is recommended for HIV detection. HIV risk estimation remains important. Our goal was to validate the Denver HIV Risk Score using a national cohort from the Centers for Disease Control and Prevention. Patients of 13 years and older were included, 4,830,941 HIV tests were performed, and 0.6% newly diagnosed infections were identified. Of all visits, 9% were very low risk (HIV prevalence = 0.20%), 27% low risk (HIV prevalence = 0.17%), 41% moderate risk (HIV prevalence = 0.39%), 17% high risk (HIV prevalence = 1.19%), and 6% very high risk (HIV prevalence = 3.57%). The Denver HIV Risk Score accurately categorized patients into different HIV risk groups.
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Affiliation(s)
- Jason S. Haukoos
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Emily Hopkins
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Meggan M. Bucossi
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Michael S. Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Richard E. Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Douglas A.E. White
- Department of Emergency Medicine, Alameda County Medical Center, Oakland, CA
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA
| | - Alia A. Al-Tayyib
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
- Denver Public Health, Denver, Colorado
| | | | - Jonathon D. Campbell
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO
| | - Allison L. Sabel
- Department of Patient Safety and Quality, Denver Health Medical Center, Denver, CO
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Mark W. Thrun
- Denver Public Health, Denver, Colorado
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
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Matković Puljić V, Kosanović Ličina ML, Kavić M, Nemeth Blažić T. Repeat HIV testing at voluntary testing and counseling centers in Croatia: successful HIV prevention or failure to modify risk behaviors? PLoS One 2014; 9:e93734. [PMID: 24705595 PMCID: PMC3976312 DOI: 10.1371/journal.pone.0093734] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 03/07/2014] [Indexed: 11/18/2022] Open
Abstract
HIV testing plays a critical role in preventing the spread of the virus and identifying infected individuals in need of care. Voluntary counseling and testing centers (VCTs) not only conduct testing but they also provide counseling. Since a proportion of people who test negative for HIV on their previous visit will return for retesting, the frequency of retesting and the characteristics of those who retest may provide insights into the efficacy of testing and counseling strategies. In this cross-sectional, retrospective study of 1,482 VCT clients in Croatia in 2010, 44.3% had been tested for HIV before. The rate of repeat HIV testing is lower in Croatia than in other countries. Men who have sex with men (MSM) clients, those with three or more sexual partners in the last 12 months, consistent condom users with steady partners, and intravenous drug users were more likely to be repeat testers. This finding suggests that clients presenting for repeat HIV testing are those who self-identify as being at a higher risk of infection. Our data showed that testing positive for HIV was not associated with repeat testing. However, the effects of repeat testing on HIV epidemiology needs to be explored.
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Affiliation(s)
- Vlatka Matković Puljić
- University Hospital for Infectious Diseases, Dr. Fran Mihaljević, Zagreb, Croatia
- * E-mail:
| | | | - Marija Kavić
- University Hospital for Infectious Diseases, Dr. Fran Mihaljević, Zagreb, Croatia
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Haukoos JS, Hopkins E, Bender B, Sasson C, Al-Tayyib AA, Thrun MW. Comparison of enhanced targeted rapid HIV screening using the Denver HIV risk score to nontargeted rapid HIV screening in the emergency department. Ann Emerg Med 2013; 61:353-61. [PMID: 23290527 PMCID: PMC4730951 DOI: 10.1016/j.annemergmed.2012.10.031] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 10/11/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE A clinical prediction tool, the Denver HIV Risk Score, was recently developed to help identify patients with increased probability of undiagnosed HIV infection. Our goal was to compare targeted rapid HIV screening using the Denver HIV Risk Score to nontargeted rapid HIV screening in an urban emergency department (ED) and urgent care. METHODS We used a prospective, before-after design at an urban medical center with an approximate annual census of 110,000 visits. Patients aged 13 years or older were eligible for screening. Targeted HIV screening of patients identified as high-risk by nurses using the Denver HIV Risk Score during medical screening was compared to nontargeted HIV screening offered by medical screening nurses during 2 separate 4-month time periods. The primary outcome was newly diagnosed HIV-infected patients. RESULTS 28,506 patients presented during the targeted phase, 1,718 were identified as high-risk, and 551 completed HIV testing. Of these, 7 (1.3%, 95% confidence interval [CI] 0.5% to 2.6%) were newly diagnosed with HIV infection. 29,510 patients presented during the nontargeted phase and 3,591 completed HIV testing. Of these, 7 (0.2%, 95% CI 0.1% to 0.4%) were newly diagnosed with HIV infection. Targeted HIV screening was significantly associated with identification of newly diagnosed HIV infection when compared to nontargeted screening, adjusting for patient demographics and payer status (relative risk [RR] 10.4, 95% CI 3.4 to 32.0). CONCLUSION Targeted HIV screening using the Denver HIV Risk Score was strongly associated with new HIV diagnoses when compared to nontargeted screening. Although both HIV screening methods identified the same absolute number of newly diagnosed patients, significantly fewer tests were required during the targeted phase to achieve the same effect.
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Affiliation(s)
- Jason S Haukoos
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA.
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McNaghten AD, Valverde EE, Blair JM, Johnson CH, Freedman MS, Sullivan PS. Routine HIV testing among providers of HIV care in the United States, 2009. PLoS One 2013; 8:e51231. [PMID: 23341880 PMCID: PMC3544875 DOI: 10.1371/journal.pone.0051231] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 10/31/2012] [Indexed: 12/05/2022] Open
Abstract
In 2006, CDC recommended HIV screening as part of routine medical care for all persons aged 13-64 years. We examined adherence to the recommendations among a sample of HIV care providers in the US to determine if known providers of HIV care are offering routine HIV testing in outpatient settings. Data were from the CDC's Medical Monitoring Project Provider Survey, administered to physicians, nurse practitioners and physician assistants from June-September 2009. We assessed bivariate associations between testing behaviors and provider and practice characteristics and used multivariate regression to determine factors associated with offering HIV screening to all patients aged 13-64 years. Sixty percent of providers reported offering HIV screening to all patients 13 to 64 years of age. Being a nurse practitioner (aOR = 5.6, 95% CI = 2.6-11.9) compared to physician, age<39 (aOR = 1.9, 95% CI = 1.0-3.5) or 39-49 (aOR = 2.1, 95% CI = 1.4-3.3) compared with ≥50 years, and black race (aOR = 2.6, 95% CI = 1.2-6.0) compared with white race was associated with offering testing to all patients. Providers with low (aOR = 0.2, 95% CI = 0.1-0.3) or medium (aOR = 0.4, 95% CI = 0.2-0.6) HIV-infected patient loads were less likely to offer HIV testing to all patients compared with providers with high patient loads. Many providers of HIV care are still conducting risk-based rather than routine testing. We found that provider profession, age, race, and HIV-infected patient load were associated with offering HIV testing. Health care providers should use patient encounters as an opportunity to offer routine HIV testing to patients as outlined in CDC's revised recommendations for HIV testing in health care settings.
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Affiliation(s)
- A D McNaghten
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Desai M, Desai S, Sullivan AK, Mohabeer M, Mercey D, Kingston MA, Thng C, McCormack S, Gill ON, Nardone A. Audit of HIV testing frequency and behavioural interventions for men who have sex with men: policy and practice in sexual health clinics in England. Sex Transm Infect 2013; 89:404-8. [PMID: 23300336 DOI: 10.1136/sextrans-2012-050679] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND National guidance recommends targeted behavioural interventions and frequent HIV testing for men who have sex with men (MSM). We reviewed current policy and practice for HIV testing and behavioural interventions (BI) in England to determine adherence to guidance. METHODS 25 sexual health clinics were surveyed using a semistructured audit asking about risk ascertainment for MSM, HIV testing and behavioural intervention policies. Practice was assessed by reviewing the notes of the first 40 HIV-negative MSM aged over 16 who attended from 1 June 2010, in a subset of 15 clinics. RESULTS 24 clinics completed the survey: 18 (75%) defined risk for MSM and 17 used unprotected anal intercourse (UAI) as an indication of high risk. 21 (88%) offered one or more structured BI. Of 598 notes reviewed, 199 (33%) MSM reported any UAI. BI, including safer sex advice, was offered to and accepted by 251/598 (42%) men. A low proportion of all MSM (52/251: 21%) accepted a structured one-to-one BI as recommended by national guidance and uptake was still low among higher risk MSM (29/107: 27%). 92% (552/598) of men had one or more HIV test over a 1-year period. CONCLUSIONS In 2010, the number of HIV tests performed met the national minimum standard but structured behavioural interventions were being offered to and accepted by only a small proportion of MSM, including those at a higher risk of infection. Reasons for not offering behavioural interventions to higher risk MSM, whether due to patient choice, a lack of staff training or resource shortage, need to be investigated and addressed.
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Affiliation(s)
- Monica Desai
- HIV & STI Department, Health Protection Agency, London, UK.
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Rosenberg ES, Delaney KP, Branson BM, Spaulding AC, Sullivan PS, Sanchez TH. Re: "Derivation and validation of the Denver Human Immunodeficiency Virus (HIV) risk score for targeted HIV screening". Am J Epidemiol 2012; 176:567-8; author reply 568-9. [PMID: 22899828 DOI: 10.1093/aje/kws305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Brown LB, Miller WC, Kamanga G, Kaufman JS, Pettifor A, Dominik RC, Nyirenda N, Mmodzi P, Mapanje C, Martinson F, Cohen MS, Hoffman IF. Predicting partner HIV testing and counseling following a partner notification intervention. AIDS Behav 2012; 16:1148-55. [PMID: 22120879 DOI: 10.1007/s10461-011-0094-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Provider-assisted methods of partner notification increase testing and counseling among sexual partners of patients diagnosed with HIV, however they are resource-intensive. The sexual partners of individuals enrolled in a clinical trial comparing different methods of HIV partner notification were analyzed to identify who was unlikely to seek testing on their own. Unconditional logistic regression was used to identify partnership characteristics, which were assigned a score based on their coefficient in the final model, and a risk score was calculated for each participant. The risk score included male partner sex, relationship duration 6-24 months, and index education > primary. A risk score of ≥ 2 had a sensitivity of 68% and specificity of 78% in identifying partners unlikely to seek testing on their own. A risk score to target partner notification can reduce the resources required to locate all partners in the community while increasing the testing yield compared to patient-referral.
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Affiliation(s)
- Lillian B Brown
- Department of Epidemiology, CB#7435, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599-7435, USA.
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12
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Haukoos JS, Lyons MS, Lindsell CJ, Hopkins E, Bender B, Rothman RE, Hsieh YH, Maclaren LA, Thrun MW, Sasson C, Byyny RL. Derivation and validation of the Denver Human Immunodeficiency Virus (HIV) risk score for targeted HIV screening. Am J Epidemiol 2012; 175:838-46. [PMID: 22431561 DOI: 10.1093/aje/kwr389] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Targeted screening remains an important approach to human immunodeficiency virus (HIV) testing. The authors aimed to derive and validate an instrument to accurately identify patients at risk for HIV infection, using patient data from a metropolitan sexually transmitted disease clinic in Denver, Colorado (1996-2008). With multivariable logistic regression, they developed a risk score from 48 candidate variables using newly identified HIV infection as the outcome. Validation was performed using an independent population from an urban emergency department in Cincinnati, Ohio. The derivation sample included 92,635 patients; 504 (0.54%) were diagnosed with HIV infection. The validation sample included 22,983 patients; 168 (0.73%) were diagnosed with HIV infection. The final score included age, gender, race/ethnicity, sex with a male, vaginal intercourse, receptive anal intercourse, injection drug use, and past HIV testing, and values ranged from -14 to +81. For persons with scores of <20, 20-29, 30-39, 40-49, and ≥50, HIV prevalences were 0.31% (95% confidence interval (CI): 0.20, 0.45) (n = 27/8,782), 0.41% (95% CI: 0.29, 0.57) (n = 36/8,677), 0.99% (95% CI: 0.63, 1.47) (n = 24/2,431), 1.59% (95% CI: 1.02, 2.36) (n = 24/1,505), and 3.59% (95% CI: 2.73, 4.63) (n = 57/1,588), respectively. The risk score accurately categorizes patients into groups with increasing probabilities of HIV infection.
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Affiliation(s)
- Jason S Haukoos
- Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Mail Code 0108, Denver, CO 80204, USA.
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13
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Mohajer MA, Lyons M, King E, Pratt J, Fichtenbaum CJ. Internal medicine and emergency medicine physicians lack accurate knowledge of current CDC HIV testing recommendations and infrequently offer HIV testing. ACTA ACUST UNITED AC 2012; 11:101-8. [PMID: 22337704 DOI: 10.1177/1545109711430165] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the knowledge and attitudes of residents and attendings in emergency medicine (EM) and internal medicine (IM) about HIV. METHODS An electronic anonymous 41-question survey of IM and EM physicians at the University of Cincinnati Academic Health Center. RESULTS The survey was completed by 232 physicians (71.6%). EM residents were more likely to routinely offer HIV testing compared to IM residents (60.7% vs. 27.8%, P = 0.0009). Overall, there was no difference in offering HIV testing by sex (32% vs. 35.6%) or by residents versus attendings (33.8% vs. 33.3%). Only 70 physicians (30.9%) were aware of current CDC recommendations of HIV screening with attendings more knowledgeable than residents (41.7% vs. 26%, P = 0.017). CONCLUSION EM and IM residents and attendings fail to offer HIV testing or assess for HIV transmission risk factors with sufficient frequency. There is also a gap in knowledge of the current CDC recommendations.
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Affiliation(s)
- Mayar Al Mohajer
- 1Department of Internal Medicine, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
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14
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HIV, Sexual Health, and Psychosocial Issues Among Older Adults Living with HIV in North America. AGEING INTERNATIONAL 2011. [DOI: 10.1007/s12126-011-9111-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Lee BE, Plitt S, Fenton J, Preiksaitis JK, Singh AE. Rapid HIV tests in acute care settings in an area of low HIV prevalence in Canada. J Virol Methods 2010; 172:66-71. [PMID: 21192977 DOI: 10.1016/j.jviromet.2010.12.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/16/2010] [Accepted: 12/22/2010] [Indexed: 11/25/2022]
Abstract
Rapid HIV testing has the potential to improve medical care and reduce the transmission of infection. In this study, rapid HIV testing was performed on serum samples in acute care settings in five hospitals from urban and rural regions using the INSTI™ HIV-1/HIV-2 Rapid Antibody Test (bioLytical Laboratories, Richmond, British Columbia). Parallel standard HIV antibody tests were performed at the provincial reference laboratory. Patient demographics, indication for testing and risk behaviours were collected. From April 30, 2007 and November 23, 2009, 1708 individuals were tested: 875 (50.3%) tests in pregnant women, 730 (42%) in source individuals in blood and body fluid exposures and 119 (5.8%) in acutely ill persons. Twenty-five (1.4%) samples were reactive by rapid HIV testing, of which 13 were reactive previously and 1 was a false reactive. Sensitivity of the rapid HIV test compared to standard HIV testing was 100%, specificity was 99.9%, the positive predictive value was 96% and the negative predictive value was 100%. The median time from specimen collection to availability of the rapid HIV result varied by site and ranged from 54 min to 1h 42 min. In this study, the INSTI™ HIV-1 Rapid Antibody test identified reactive and non-reactive samples with similar accuracy to the conventional testing algorithm and provided a reliable way to perform rapid HIV testing in acute care settings.
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Affiliation(s)
- Bonita E Lee
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada
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16
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Abstract
OBJECTIVE To develop and validate an easy-to-use prediction model for HIV acquisition among men who have sex with men (MSM). METHODS We developed prediction models using medical records data from an STD clinic (2001-2008) and validated these models using data from the control arm of Project Explore, an HIV prevention trial (1999-2003). RESULTS Of 1903 MSM who tested for HIV more than once in the development sample, 101 acquired HIV over 6.7 years of follow-up. Annual HIV incidence was 2.57% (95% confidence interval [CI]: 2.09%, 3.12%). During 4 years of follow-up of 2081 Project Explore control arm participants, 144 acquired HIV for an incidence of 2.32% (95% CI: 1.96%, 2.73%). A prediction model that included variables indicating use of methamphetamine or inhaled nitrites in the prior 6 months, unprotected anal intercourse with a partner of positive or unknown HIV status in the prior year, > or =10 male sex partners in the prior year, and current diagnosis or history of bacterial sexually transmitted infection was well calibrated overall (expected-observed ratio = 1.01; 95% CI: 0.97, 1.05) and had modest discriminatory accuracy at 1 year (area under the receiver-operator characteristic curve = 0.67; 95% CI: 0.60, 0.75) and at 4 years (area under the receiver-operator characteristic curve = 0.66; 95% CI: 0.61, 0.71). Over 4 years, cumulative incidence ranged from 3.9% to 14.3% for groups of men defined by the prediction model. CONCLUSIONS A new risk score was predictive of HIV acquisition and could assist providers in counseling MSM and in targeting intensified prevention to MSM at greatest risk for HIV infection. Its accuracy requires further evaluation.
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Freeman AE, Sattin RW, Miller KM, Dias JK, Wilde JA. Acceptance of rapid HIV screening in a southeastern emergency department. Acad Emerg Med 2009; 16:1156-64. [PMID: 20053236 DOI: 10.1111/j.1553-2712.2009.00508.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective was to assess the acceptance of an emergency department (ED) human immunodeficiency virus (HIV) screening program based on the Centers for Disease Control and Prevention (CDC) recommendations for routine HIV screening in health care settings. METHODS Rapid HIV screening was offered on an opt-out basis to patients aged 13 to 64 years presenting to the ED by trained HIV counselors. Patients were excluded if they had a history of HIV, were physically or mentally incapacitated, did not understand their right to opt-out, or did not speak English or Spanish. Statistical analyses, including logistic regression, were performed to assess the associations between the demographics of patients offered testing and their test acceptance or refusal. RESULTS From March 2008 to January 2009, a total of 5,080 (91%) of the 5,585 patients offered the HIV test accepted, and 506 (9%) refused. White and married patients were less likely to accept testing than those who were African American and unmarried (p < 0.001). Adult patients were almost twice as likely to accept testing as pediatric patients (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.50 to 2.53). As age increased among pediatric patients, testing refusal decreased (OR = 0.71; 95% CI = 0.59 to 0.85), and as age increased among adult patients, testing refusal increased (OR = 1.17; 95% CI = 1.12 to 1.22). Two percent of persons accepting the test were considered high risk. Males were more likely to report high-risk behavior than females (OR = 1.83; 95% CI = 1.23 to 2.72). CONCLUSIONS The opt-out approach results in high acceptance of routine HIV screening. Widespread adoption of the CDC's recommendations, although feasible, will require significant increases in resources.
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Affiliation(s)
- Arin E Freeman
- Department of Emergency Medicine, School of Medicine, Medical College of Georgia, Augusta, GA, USA.
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18
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Patel VL, Yoskowitz NA, Kaufman DR, Shortliffe EH. Discerning patterns of human immunodeficiency virus risk in healthy young adults. Am J Med 2008; 121:758-64. [PMID: 18724961 PMCID: PMC2597652 DOI: 10.1016/j.amjmed.2008.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 04/22/2008] [Accepted: 04/23/2008] [Indexed: 10/21/2022]
Abstract
Previous research has questioned the effectiveness of existing methods to identify individuals at high risk for contracting and transmitting human immunodeficiency virus and other sexually transmitted diseases. Thus, new approaches are needed to provide these individuals with risk-reduction strategies. We review our research on young adults' sexual decision making by using theories and methods from social and cognitive sciences. Four patterns of condom use and associated levels of risks and beliefs were identified. These patterns suggest value in targeting intervention strategies to individuals at different levels of risk. The findings also imply that the monogamous population may be at higher risk for infection than they realize. Primary-care physicians are the first line of contact for many individuals in the health care system and may be in the best position to screen for at-risk individuals. Given the time demands and other barriers, easy-to-use, evidence-based guidelines for such screening are needed. We propose such guidelines for primary-care physicians to use in identifying an individual's risk, from which custom-tailored intervention strategies can be developed.
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Affiliation(s)
- Vimla L Patel
- HIV Center for Clinical and Behavioral Studies, NYS Psychiatric Institute, New York City, NY, USA.
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19
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Millen JC, Arbelaez C, Walensky RP. Implications and impact of the new US Centers for Disease Control and prevention HIV testing guidelines. Curr Infect Dis Rep 2008; 10:157-63. [PMID: 18462591 PMCID: PMC3513386 DOI: 10.1007/s11908-008-0027-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Of the 1.2 million Americans estimated to be living with HIV in the United States, approximately 250,000 are unaware of their diagnosis and therefore unable to access clinical care and life-sustaining treatment. The revised 2006 US Centers for Disease Control and Prevention's guidelines for HIV testing recommend universal, routine, and voluntary HIV screening in public and private health care settings for all adults and adolescents between 13 and 64 years old. These major revisions present new challenges for health care providers, hospitals, government agencies, and community advocacy groups. In this review, we discuss the important issues in diverse care venues such as opt-out testing, consent and confidentiality, barriers to treatment, and financial impact. The implications of the revised recommendations for HIV testing are addressed in the context of a fragmented, overstressed, underfunded US health care system.
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Affiliation(s)
- Jennifer C Millen
- Department of Emergency Medicine, Brigham and Women's Hospital, Neville House, 2nd Floor, 75 Francis Street, Boston, MA 02115, USA.
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20
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Population prevalence of reported and unreported HIV and related behaviors among the household adult population in New York City, 2004. AIDS 2008; 22:281-7. [PMID: 18097231 DOI: 10.1097/qad.0b013e3282f2ef58] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surveillance for HIV likely underestimates infection among the general population: 25% of US residents are estimated to be unaware of their HIV infection. OBJECTIVE To determine the prevalence of HIV infection and risk behaviors among New York City (NYC) adults and compare these with surveillance findings. METHODS The NYC Health and Nutrition Examination Survey (HANES) provided the first opportunity to estimate population-based HIV prevalence among NYC adults. It was conducted in 2004 among a representative sample of adults > 20 years. Previously reported HIV infection was identified from the NYC HIV/AIDS Surveillance Registry. A blinded HIV serosurvey was conducted on archived blood samples of 1626 NYC HANES participants. Data were used to estimate prevalence for HIV infection, unreported infections, high-risk activities, and self-perceived risk. RESULTS Overall, 18.1% engaged in one or more risky sexual/needle-use behaviors, of which 92.2% considered themselves at low or no risk of HIV or another sexually transmitted disease. HIV occurred in 21 individuals (prevalence 1.4%; 95% confidence interval (CI), 0.8-2.5]; one infection (5%; 95% CI, 0.7-29.9) was not reported previously and possibly undiagnosed. HIV infection was significantly elevated in those with herpes simplex virus 2 (4%), men who have sex with men (14%), and needle-users (21%) (P < 0.01). CONCLUSIONS Among NYC adults, HIV prevalence was consistent with surveillance findings overall. The proportion of unreported HIV was less than estimated nationally, but findings were limited by sample size. Most adults with risky behaviors perceived themselves to be at minimal risk, highlighting the need for risk reduction and routine HIV screening.
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21
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Obstetrician–Gynecologists' Knowledge and Practice Regarding Human Immunodeficiency Virus Screening. Obstet Gynecol 2007; 110:1019-26. [DOI: 10.1097/01.aog.0000267200.70965.a5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Gerstein W. One patient, many lessons. South Med J 2007; 100:865-6. [PMID: 17902284 DOI: 10.1097/smj.0b013e3181484462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Smith R, Zetola NM, Klausner JD. Beyond the end of exceptionalism: integrating HIV testing into routine medical care and HIV prevention. Expert Rev Anti Infect Ther 2007; 5:581-9. [PMID: 17678423 DOI: 10.1586/14787210.5.4.581] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In September 2006, the US CDC issued new guidelines for HIV testing. These guidelines were designed not only to simplify and expand HIV testing but also to integrate testing into routine medical care in the USA. The nationwide implementation of these guidelines is currently facing several political and legal barriers. In this article, we examine the origins of current patient-driven and risk-based HIV testing in the USA and highlight shortcomings of this strategy. We then demonstrate how the changing HIV epidemic in the USA requires routine HIV screening at all points of contact in the medical system in order to control the HIV epidemic and how novel testing strategies could increase the yield of testing in these settings.
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Affiliation(s)
- Rachel Smith
- School of Medicine, University of California, San Francisco, CA, USA.
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24
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Lyss SB, Branson BM, Kroc KA, Couture EF, Newman DR, Weinstein RA. Detecting Unsuspected HIV Infection With a Rapid Whole-Blood HIV Test in an Urban Emergency Department. J Acquir Immune Defic Syndr 2007; 44:435-42. [PMID: 17224850 DOI: 10.1097/qai.0b013e31802f83d0] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Sheryl B Lyss
- National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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25
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Greenwald JL. Routine rapid HIV testing in hospitals: another opportunity for hospitalists to improve care. J Hosp Med 2006; 1:106-12. [PMID: 17219480 DOI: 10.1002/jhm.66] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention recommends routinely offering HIV testing to inpatients at hospitals with an HIV seroprevalence rate of greater than 1% or an AIDS diagnosis rate of greater than 1.0 per 1000 discharges. This recommendation has not been widely adopted, perhaps because of one of several barriers: the cost of implementing a counseling and testing program; the logistics of HIV counseling and testing on a hospital ward particularly with respect to privacy; concern about the follow-up of HIV test results necessitating patients to return after discharge; and the cultural mindset of screening as an outpatient modality complicated by the fear of raising the possibility of HIV testing and therefore eliciting a negative reaction from a patient who has not requested it. PURPOSE This article focuses on these barriers and some possible solutions, emphasizing the role of FDA-approved rapid HIV tests, which may decrease follow-up issues for HIV testing programs. It also considers hospitalists, given their frontline status and ability to coordinate the multidisciplinary services and system-wide approach required to implement such a program, as leaders in this area.
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Liddicoat RV, Losina E, Kang M, Freedberg KA, Walensky RP. Refusing HIV testing in an urgent care setting: results from the "Think HIV" program. AIDS Patient Care STDS 2006; 20:84-92. [PMID: 16475889 DOI: 10.1089/apc.2006.20.84] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Efforts to increase HIV case identification through routine, voluntary HIV testing are hindered by high refusal rates. Our objective was to identify patients most likely to refuse routine HIV testing. We developed a new HIV testing program at four Massachusetts urgent care centers. Patients were asked if they were interested in routine HIV testing. We performed analyses to assess differences in characteristics between those who refused testing and those who accepted it. Data were available for 9129/10,354 (88%) patients offered routine HIV testing from January to December 2002. Of these 9129 patients, 67% refused testing. In the crude analysis, HIV test refusal was associated with female gender, white race, older age, and higher educational level. In multivariate analysis, non-English-speaking patients who were Hispanic, Haitian, and other race were more likely to refuse testing than their English-speaking counterparts. Among all patients, "not at risk" and "already tested" were the most common reasons for test refusal. Two thirds of patients refused routine HIV testing when it was offered in a statewide urgent care-based program. If routine HIV testing programs are to be successful, strategies must be developed to increase HIV test acceptance among patients most likely to refrain from testing.
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Affiliation(s)
- Rebecca V Liddicoat
- Department of Medicine, Greater Los Angeles Veterans Affairs, Los Angeles, California 90073, USA.
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27
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Pincus JM, Crosby SS, Losina E, King ER, LaBelle C, Freedberg KA. Acute Human Immunodeficiency Virus Infection in Patients Presenting to an Urban Urgent Care Center. Clin Infect Dis 2003; 37:1699-704. [PMID: 14689354 DOI: 10.1086/379772] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2003] [Accepted: 08/14/2003] [Indexed: 11/03/2022] Open
Abstract
Acute infection with human immunodeficiency virus (HIV) is often accompanied by a flu-like illness, and early identification and treatment may help control the infection and prevent transmission. We enrolled patients who presented to an urban urgent care center with any symptoms of a viral illness and any recent potential risk for HIV infection, and we tested them for acute HIV infection using enzyme-linked immunosorbent and RNA assays. Of 499 patients enrolled over a 1-year period, acute HIV infection was diagnosed in 5 (1.0%; 95% confidence interval [CI], 0.1%-1.9%), and chronic HIV infection was diagnosed in 6 (1.2%; 95% CI, 0.2%-2.2%). There were no false-positive results of the RNA assay. No signs or symptoms reliably distinguished patients with acute HIV infection from those who were HIV uninfected. Given the importance of this diagnosis, testing for acute HIV infection using RNA and antibody assays should be offered to all patients in similar settings with viral symptoms and any risk factors for HIV infection.
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Affiliation(s)
- Jonathan M Pincus
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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Tao G, Branson BM, Anderson LA, Irwin KL. Do physicians provide counseling with HIV and STD testing at physician offices or hospital outpatient departments? AIDS 2003; 17:1243-7. [PMID: 12819527 DOI: 10.1097/00002030-200305230-00017] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Guoyu Tao
- Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Phillips KA, Bayer R, Chen JL. New Centers for Disease Control and Prevention's guidelines on HIV counseling and testing for the general population and pregnant women. J Acquir Immune Defic Syndr 2003; 32:182-91. [PMID: 12571528 DOI: 10.1097/00126334-200302010-00010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We review two new HIV counseling and testing guidelines by the U.S. Centers for Disease Control and Prevention. The guidelines, which address the general population and pregnant women, reflect an important shift in the goals and methods of counseling and testing that has widespread implications. The guidelines' defining characteristic is the greater emphasis on increasing the numbers of people knowing their HIV status while maintaining the historical focus on extensive pretest counseling and consent procedures. We discuss the policy and practice implications by evaluating five factors: 1) Will the guidelines be adopted? 2) Will at-risk and infected individuals be identified for counseling and testing? 3) Will health care providers offer counseling and testing and patients accept counseling and testing, obtain their test results, seek treatment, and change risky behaviors? 4) Will the guidelines be relatively cost-effective? 5) Will the guidelines be compatible with ethical standards?
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Affiliation(s)
- Kathryn A Phillips
- University of California at San Francisco, San Francisco, California 94143, USA.
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Fennema H, van den Hoek A, van der Heijden J, Batter V, Stroobant A. Regional differences in HIV testing among European patients with sexually transmitted diseases: trends in the history of HIV testing and knowledge of current serostatus. AIDS 2000; 14:1993-2001. [PMID: 10997405 DOI: 10.1097/00002030-200009080-00016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine trends in (1) HIV testing and knowledge of current serostatus and (2) clinic-visits of aware HIV-infected patients and (3) to determine associates of incident HIV infection among patients with sexually transmitted disease (STD) in 15 countries participating in a European Community anonymous HIV seroprevalence survey. METHODS Demographics, STD diagnosis, self-reported history of HIV tests and current HIV test results were collected for patients diagnosed with one of 12 pre-selected STDs. Incident HIV infections were determined among patients who reported prior HIV-negative test results. RESULTS Between June 1990 and December 1996, 66560 STD patients were tested for HIV. Of these, 1581 (2.4%) reported a prior HIV-positive test. Of 41727 (62%) patients who reported no previous HIV test, 611 (1.4%) were HIV infected. Of 20785 (31%) patients who reported a prior HIV-negative test, 213 (1.0%) were HIV infected. Of 2467 (4%) patients without prior HIV test data available 123 (4.9%) were HIV infected. Overall, 63% of HIV-seropositive patients was aware of their HIV infection. Over time, the proportion of aware HIV-seropositive patients increased in some exposure categories in south and central Europe. Among the 11684 patients who reported dates of prior HIV-negative tests, 108 HIV infections were found. Compared with the north, HIV incidence was higher in the central region [odds ratio (OR), 1.23; 95% confidence interval (CI), 0.71-2.12] and in the south (OR, 4,39; 95% CI, 2.80-6.88) in all exposure categories except homosexual men. CONCLUSIONS Two-thirds of patients with an STD had never been tested for HIV. Of all HIV infections found, 32% were undiagnosed, indicating missed opportunities for counselling, safe sex education and referral for treatment. HIV testing should be routinely offered to all STD patients.
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Affiliation(s)
- H Fennema
- Municipal Health Service, Division of Public Health and Environment, Amsterdam, The Netherlands.
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