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Stangl AL, Singh D, Windle M, Sievwright K, Footer K, Iovita A, Mukasa S, Baral S. A systematic review of selected human rights programs to improve HIV-related outcomes from 2003 to 2015: what do we know? BMC Infect Dis 2019; 19:209. [PMID: 30832599 PMCID: PMC6399958 DOI: 10.1186/s12879-019-3692-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/08/2019] [Indexed: 01/05/2023] Open
Abstract
Background Repressive legal environments and widespread human rights violations act as structural impediments to efforts to engage key populations at risk of HIV infection in HIV prevention, care, and treatment efforts. The identification and scale-up of human rights programs and rights-based interventions that enable coverage of and retention in evidence-based HIV prevention and treatment approaches is crucial for halting the epidemic. Methods We conducted a systematic review of studies that assessed the effectiveness of human rights interventions on improving HIV-related outcomes between 1/1/2003–28/3/2015 per PRISMA guidelines. Studies of any design that sought to evaluate an intervention falling into one of the following UNAIDS’ key human rights program areas were included: HIV-related legal services; monitoring and reforming laws, policies, and regulations; legal literacy programs; sensitization of lawmakers and law enforcement agents; and training for health care providers on human rights and medical ethics related to HIV. Results Of 31,861 peer-reviewed articles and reports identified, 23 were included in our review representing 15 different populations across 11 countries. Most studies (83%) reported a positive influence of human rights interventions on HIV-related outcomes. The majority incorporated two or more principles of the human rights-based approach, typically non-discrimination and accountability, and sought to influence two or more elements of the right to health, namely availability and acceptability. Outcome measures varied considerably, making comparisons between studies difficult. Conclusion Our review revealed encouraging evidence of human rights interventions enabling a comprehensive HIV response, yet critical gaps remain. The development of a research framework with standardized indicators is needed to advance the field. Promising interventions should be implemented on a larger scale and rigorously evaluated. Funding for methodologically sound evaluations of human rights interventions should match the demand for human rights-based and structural approaches to protect those most vulnerable from HIV infection. Electronic supplementary material The online version of this article (10.1186/s12879-019-3692-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne L Stangl
- Department of Global Health, Youth and Development, International Center for Research on Women, 1120 20th St. NW Suite 500N, Washington, DC, 20036, USA.
| | - Devaki Singh
- Department of Global Health, Youth and Development, International Center for Research on Women, 1120 20th St. NW Suite 500N, Washington, DC, 20036, USA
| | - Michael Windle
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Kirsty Sievwright
- Department of Global Health, Youth and Development, International Center for Research on Women, 1120 20th St. NW Suite 500N, Washington, DC, 20036, USA
| | - Katherine Footer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Alexandrina Iovita
- Human Rights Division, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Stella Mukasa
- Department of Global Health, Youth and Development, International Center for Research on Women, 1120 20th St. NW Suite 500N, Washington, DC, 20036, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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Nobles AL, Dreisbach CN, Keim-Malpass J, Barnes LE. "Is this a STD? Please help!": Online Information Seeking for Sexually Transmitted Diseases on Reddit. PROCEEDINGS OF THE ... INTERNATIONAL AAAI CONFERENCE ON WEBLOGS AND SOCIAL MEDIA. INTERNATIONAL AAAI CONFERENCE ON WEBLOGS AND SOCIAL MEDIA 2018; 2018:660-663. [PMID: 30984474 PMCID: PMC6460917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Increasing incidence of sexually transmitted diseases (STDs) has prompted the public health and technology communities to innovate new measures to understand how individuals use Internet resources to attain relevant information, particularly for sensitive or stigmatized conditions. The purpose of this study is to examine recent health information seeking and needs of the r/STD community, a subreddit focused exclusively on STDs. We found that the majority of posts crowd-source information about intermediate, non-reportable STDs such as human papillomavirus (HPV). Crowdsourced information in this community focused on symptoms, treatment, as well as the social and emotional aspects of sexual health such as fear of misdiagnosis. From our analysis, it is clear that online communities focused on discussion of health symptoms have the ripe potential to influence information-seeking behavior and consumer action.
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Affiliation(s)
- Alicia L Nobles
- Department of Systems and Information Engineering, University of Virginia
| | - Caitlin N Dreisbach
- Department of Systems and School of Nursing, University of Virginia
- Department of Systems and Data Science Institute, University of Virginia
| | | | - Laura E Barnes
- Department of Systems and Information Engineering, University of Virginia
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Abstract
One of the four national HIV prevention goals is to incorporate combinations of effective, evidence-based approaches to prevent HIV infection. In fields of public health, techniques that alter environment and affect choice options are effective. Structural approaches may be effective in preventing HIV infection. Existing frameworks for structural interventions were lacking in breadth and/or depth. We conducted a systematic review and searched CDC's HIV/AIDS Prevention Research Synthesis Project's database for relevant interventions during 1988-2013. We used an iterative process to develop the taxonomy. We identified 213 structural interventions: Access (65%), Policy/Procedure (32%), Mass Media (29%), Physical Structure (27%), Capacity Building (24%), Community Mobilization (9%), and Social Determinants of Health (8%). Forty percent targeted high-risk populations (e.g., people who inject drugs [12%]). This paper describes a comprehensive, well-defined taxonomy of structural interventions with 7 categories and 20 subcategories. The taxonomy accommodated all interventions identified.
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Assessment: A Core Function for Implementing Effective Interventions in Sexually Transmitted Disease Control Programs. Sex Transm Dis 2016; 43:S3-7. [PMID: 26779686 DOI: 10.1097/olq.0000000000000285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Assessment is a core function in sexually transmitted disease (STD) prevention and control programs. Assessment is more than reviewing case report data; it includes taking into consideration an array of data of various sources and types to be able to respond to emerging disease threats, align human and financial resources, and plan for the future. In this article, we outline key assessment domains, data sources, activities, and methods for STD programs. We present an illustrative case study of how assessment can be used to identify effective interventions for STD control.
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Frimpong JA, D'Aunno T, Helleringer S, Metsch LR. Spillover effects of HIV testing policies: changes in HIV testing guidelines and HCV testing practices in drug treatment programs in the United States. BMC Public Health 2016; 16:666. [PMID: 27473519 PMCID: PMC4966765 DOI: 10.1186/s12889-016-3322-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 07/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine the extent to which state adoption of the Centers for Disease Control and Prevention (CDC) 2006 revisions to adult and adolescent HIV testing guidelines is associated with availability of other important prevention and medical services. We hypothesized that in states where the pretest counseling requirement for HIV testing was dropped from state legislation, substance use disorder treatment programs would have higher availability of HCV testing services than in states that had maintained this requirement. METHODS We analyzed a nationally representative sample of 383 opioid treatment programs from the 2005 and 2011 National Drug Abuse Treatment System Survey (NDATSS). Data were collected from program directors and clinical supervisors through telephone surveys. Multivariate logistic regression models were used to measure associations between state adoption of CDC recommended guidelines for HIV pretest counseling and availability of HCV testing services. RESULTS The effects of HIV testing legislative changes on HCV testing practices varied by type of opioid treatment program. In states that had removed the requirement for HIV pretest counseling, buprenorphine-only programs were more likely to offer HCV testing to their patients. The positive spillover effect of HIV pretest counseling policies, however, did not extend to methadone programs and did not translate into increased availability of on-site HCV testing in either program type. CONCLUSIONS Our findings highlight potential positive spillover effects of HIV testing policies on HCV testing practices. They also suggest that maximizing the benefits of HIV policies may require other initiatives, including resources and programmatic efforts that support systematic integration with other services and effective implementation.
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Affiliation(s)
- Jemima A Frimpong
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 600 West 168th Street, New York, NY, 10032, USA.
| | - Thomas D'Aunno
- Robert F. Wagner Graduate School of Public Service, New York University, 295 Lafayette Street, New York, NY, 10012, USA
| | - Stéphane Helleringer
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
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Felsen UR, Bellin EY, Cunningham CO, Zingman BS. Unknown HIV Status in the Emergency Department: Implications for Expanded Testing Strategies. J Int Assoc Provid AIDS Care 2015; 15:313-9. [PMID: 25999330 DOI: 10.1177/2325957415586261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The authors sought to determine the prevalence of unknown HIV status among emergency department (ED) patients, how it has changed over time, and whether it differs according to patient characteristics. METHODS The authors used electronic medical record data to identify whether HIV status was known or unknown among patients aged ≥13 seen in the ED of a large, urban medical center between 2006 and 2011. The authors used multivariate logistic regression to identify the characteristics associated with unknown HIV status. RESULTS The prevalence of unknown HIV status decreased each year, from 87.7% in 2006 to 74.9% in 2011 (P < .001). Characteristics associated with unknown HIV status included being nonblack, in the youngest and oldest age-groups, and nonpublically insured. Compared to men, women without prior pregnancy were equally likely to have unknown HIV status, but women with prior pregnancy were significantly less likely to have unknown HIV status. CONCLUSION The prevalence of unknown HIV status is decreasing, but in 2011 75% of ED patients aged ≥13 still had unknown status, and it was associated with specific patient characteristics. Understanding the trends in the prevalence of unknown HIV status and how it is associated with patient characteristics should inform the design and implementation of expanded HIV-testing strategies.
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Affiliation(s)
- Uriel R Felsen
- Division of Infectious Diseases, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Eran Y Bellin
- Division of Infectious Diseases, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Chinazo O Cunningham
- Division of Infectious Diseases, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Barry S Zingman
- Division of Infectious Diseases, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
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Lazariu V, Parker MM, Leung SYJ, McVoy M, Gieryic S, Rowe KA, Ortega-Peluso C, Anderson BJ, McNutt LA, Smith LC. New York State 2010 HIV testing law: an evaluation of testing rates using laboratory data. J Acquir Immune Defic Syndr 2015; 68 Suppl 1:S10-4. [PMID: 25545488 DOI: 10.1097/qai.0000000000000391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As of September 2010, New York State (NYS) Public Health Law mandates the offer of HIV testing to all persons aged 13-64 years receiving hospital or primary care services. Changes in the number of HIV tests 13 months before and after law enactment were assessed using HIV test volume data from 166 laboratories holding NYS permits to conduct HIV testing on specimens originating in NYS. Compared with the pre-enactment baseline, overall HIV testing volume increased by 13% following enactment, with the volume of conventional and rapid HIV screening tests increasing by 12.0% and 13.7%, respectively. These data suggest that testing law is having an impact consistent with the legislative intent to increase HIV testing in NYS. Monitoring should be continued to assess testing trends across a variety of health care venues to identify and address additional barriers to HIV testing access.
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Affiliation(s)
- Victoria Lazariu
- *New York State Department of Health, AIDS Institute, Albany, NY; †Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY; and ‡Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, NY
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Rosen DL, Golin CE, Grodensky CA, May J, Bowling JM, DeVellis RF, White BL, Wohl DA. Opt-out HIV testing in prison: informed and voluntary? AIDS Care 2014; 27:545-54. [PMID: 25506799 DOI: 10.1080/09540121.2014.989486] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
HIV testing in prison settings has been identified as an important mechanism to detect cases among high-risk, underserved populations. Several public health organizations recommend that testing across health-care settings, including prisons, be delivered in an opt-out manner. However, implementation of opt-out testing within prisons may pose challenges in delivering testing that is informed and understood to be voluntary. In a large state prison system with a policy of voluntary opt-out HIV testing, we randomly sampled adult prisoners in each of seven intake prisons within two weeks after their opportunity to be HIV tested. We surveyed prisoners' perception of HIV testing as voluntary or mandatory and used multivariable statistical models to identify factors associated with their perception. We also linked survey responses to lab records to determine if prisoners' test status (tested or not) matched their desired and perceived test status. Thirty-eight percent (359/936) perceived testing as voluntary. The perception that testing was mandatory was positively associated with age less than 25 years (adjusted relative risk [aRR]: 1.45, 95% confidence interval [CI]: 1.24, 1.71) and preference that testing be mandatory (aRR: 1.81, 95% CI: 1.41, 2.31) but negatively associated with entry into one of the intake prisons (aRR: 0.41 95% CI: 0.27, 0.63). Eighty-nine percent of prisoners wanted to be tested, 85% were tested according to their wishes, and 82% correctly understood whether or not they were tested. Most prisoners wanted to be HIV tested and were aware that they had been tested, but less than 40% understood testing to be voluntary. Prisoners' understanding of the voluntary nature of testing varied by intake prison and by a few individual-level factors. Testing procedures should ensure that opt-out testing is informed and understood to be voluntary by prisoners and other vulnerable populations.
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Affiliation(s)
- David L Rosen
- a Department of Medicine , University of North Carolina , Chapel Hill , NC , USA
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Huy NV, Khuyen LT, Ha PN. Factors associated with HIV testing among male motorbike taxi drivers in urban Vietnam. Glob Public Health 2014; 10 Supppl 1:S56-69. [PMID: 25415855 DOI: 10.1080/17441692.2014.981832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Using the Attitude-Skills-Knowledge (ASK) model, this study examined the prevalence of, and factors associated with, human immunodeficiency virus (HIV) testing among male motorbike taxi drivers (MMTDs). In a cross-sectional design, using quantitative approaches, 291 MMTDs were recruited from 135 sites across 13 districts in Hanoi, Vietnam, for a face-to-face interview. Applying the ASK model modified as a central theory, logistic regression was used to identify determinants of HIV testing. Although many MMTDs engaged in multiple risk behaviours for HIV, only 20.6% had been tested for HIV during the past 12 months. The tested model included one factor of the ASK model, HIV prevention knowledge (adjusted odds ratio [AOR] = 4.76; 95% confidence interval [CI] = 2.12-10.7) and five additional factors: being married (AOR = 3.13; 95% CI = 1.25-4.78), preferring sex with men or with both men and women (AOR = 8.72; 95% CI = 1.48-51.5), having lower number of lifetime sex partners (AOR = 0.66; 95% CI = 0.49-0.88), higher number of past year sex partners (AOR = 2.97: 95% CI = 1.21-7.31) and discussing condom use when having sex with partners (AOR = 0.08; 95% CI = 0.01-7.31). This modified ASK model provided better fit than the ASK model, as it explained more variance in HIV testing (47 vs. 29.8%). Recognising factors associated with HIV testing among MMTDs enables us to create suitable public health intervention strategies.
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Affiliation(s)
- Nguyen Van Huy
- a Department of Health Management and Organization, Institute for Preventive Medicine and Public Health , Hanoi Medical University , Hanoi , Vietnam
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Fleckenstein JR, Cox DW. The association of an open relationship orientation with health and happiness in a sample of older US adults. SEXUAL AND RELATIONSHIP THERAPY 2014. [DOI: 10.1080/14681994.2014.976997] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Worthington CA, Calzavara LM, White SJ, Allman D, Tyndall MW. Individual and jurisdictional factors associated with voluntary HIV testing in Canada: Results of a national survey, 2011. ACTA ACUST UNITED AC 2014; 106:e4-9. [PMID: 25955665 DOI: 10.17269/rcsp.106.4625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/25/2014] [Accepted: 10/13/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE HIV testing remains a central strategy for HIV prevention for its ability to link those who test positive to treatment and support. In Canada, national guidelines have recently changed as part of standard primary care to recommend voluntary HIV testing for those aged 16-64 years. Using results from a nationally representative survey, we examined individual and jurisdictional factors associated with voluntary testing. METHODS A total of 2,139 participants were sampled using a regionally stratified, two-stage recruitment process. English or French interviews (by phone or online) were conducted during May 2011. Voluntary testing was defined as testing at least once for reasons other than blood donation, insurance purposes, immigration screening or research participation. Weighted logistic regression analysis (including socio-demographic, sexual activity, HIV/AIDS knowledge and jurisdictional factors of HIV prevalence and anonymous testing availability) were conducted for the overall sample, and stratified by sex. RESULTS Twenty-nine percent (29%) of survey participants reported at least one lifetime voluntary HIV test. For the full-sample model, the following were associated with increased odds of testing: age <60 years, female sex, sexual minority status, perceived HIV knowledge, casual sex partner in previous year, and living in a higher-prevalence jurisdiction. For men, the strongest factor related to testing was sexual minority status (OR = 5.15, p < 0.001); for women, it was having a casual sex partner in the previous year (OR = 2.57, p = 0.001). For both men and women, residing in a jurisdiction with lower HIV prevalence decreased odds of testing. DISCUSSION Sex differences should be considered when designing interventions to increase testing uptake. Jurisdictional factors, including HIV prevalence and testing modality, should be investigated further.
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Wright PB, Booth BM, Curran GM, Borders TF, Ounpraseuth ST, Stewart KE. Correlates of HIV testing among rural African American cocaine users. Res Nurs Health 2014; 37:466-77. [PMID: 25346379 DOI: 10.1002/nur.21629] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2014] [Indexed: 11/06/2022]
Abstract
Andersen's Revised Behavioral Model of Health Services Use (RBM) was used as a framework in this correlational cross-sectional study to examine factors associated with HIV testing among a sample of 251 rural African American cocaine users. All participants reported using cocaine and being sexually active within the past 30 days. Independent variables were categorized according to the RBM as predisposing, enabling, need, or health behavior factors. Number of times tested for HIV (never, one time, two to four times, five or more times) was the outcome of interest. In ordered logistic regression analyses, HIV testing was strongly associated with being female, of younger age (predisposing factors); having been tested for sexually transmitted diseases or hepatitis, ever having been incarcerated in jail or prison (enabling factors); and having had one sex partner the past 30 days (health behavior factor). Other sexual risk behaviors, drug use, health status, and perception of risk were not associated with HIV testing. Our findings confirm the importance of routine testing in all healthcare settings rather than risk-based testing.
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Affiliation(s)
- Patricia B Wright
- College of Nursing, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 529, Little Rock, AR, 72205
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Sanchez TH, Sullivan PS, Rothman RE, Brown EH, Fitzpatrick LK, Wood AF, Hernandez PI, Nunn AS, Serota ML, Moreno-Walton L. A Novel Approach to Realizing Routine HIV Screening and Enhancing Linkage to Care in the United States: Protocol of the FOCUS Program and Early Results. JMIR Res Protoc 2014; 3:e39. [PMID: 25093431 PMCID: PMC4129189 DOI: 10.2196/resprot.3378] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/16/2014] [Accepted: 06/09/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The United States health care system remains far from implementing the Centers for Disease Control and Prevention's recommendation of routine human immunodeficiency virus (HIV) screening as part of health care for adults. Although consensus for the importance of screening has grown, innovations in implementing routine screening are still lacking. HIV on the Frontlines of Communities in the United States (FOCUS) was launched in 2010 to provide an environment for testing innovative approaches to routine HIV screening and linkage to care. OBJECTIVE The strategy of the FOCUS program was to develop models that maximize the use of information systems, fully integrate HIV screening into clinical practice, transform basic perceptions about routine HIV screening, and capitalize on emerging technologies in health care settings and laboratories. METHODS In 10 of the most highly impacted cities, the FOCUS program supports 153 partnerships to increase routine HIV screening in clinical and community settings. RESULTS From program launch in 2010 through October 2013, the partnerships have resulted in a total of 799,573 HIV tests and 0.68% (5425/799,573) tested positive. CONCLUSIONS The FOCUS program is a unique model that will identify best practices for HIV screening and linkage to care.
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Kuo I, Magnus M, Phillips G, Castel A, Opoku J, Peterson J, Jia Y, West T, Greenberg A. HIV testing among heterosexuals at elevated risk for HIV in the District of Columbia: has anything changed over time? AIDS Behav 2014; 18 Suppl 3:333-9. [PMID: 24057933 DOI: 10.1007/s10461-013-0616-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The District of Columbia launched a routine HIV testing initiative in 2006. We examined HIV testing behaviors among heterosexuals at risk for HIV over time using CDC National HIV Behavioral Surveillance data from Washington, DC for the heterosexual cycles from 2006 to 2007 (Cycle 1) and 2010 (Cycle 2). Past year and past 2-year HIV testing across study cycles were compared using Chi square tests. Weighted multivariable logistic regression identified correlates of past year testing. The majority of participants across both cycles were black and female. Cycle 1 participants were significantly more likely to have ≥4 partners in the past year, casual sex partners, and have anal sex at last sexual encounter (p < 0.05). Lifetime testing was high, and individuals from Cycle 2 versus Cycle 1 were more likely to have been tested in the past 2 years. There were no significant differences in past year testing or being offered the HIV test at last health care visit by cycle. Independent correlates of past year testing were seeing a health care provider in the past year and using condoms at last vaginal sex. In conclusion, although past year testing did not differ between the two data collection years, the proportion of heterosexuals testing in the past 2 years was higher in Cycle 2 versus Cycle 1, suggesting successful expansion of HIV testing between the two time periods.
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Affiliation(s)
- Irene Kuo
- The George Washington University School of Public Health and Health Services, 2100-W Pennsylvania Avenue NW, 8th Floor, Washington, DC, 20037, USA,
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Rifampin monoresistant tuberculosis and HIV comorbidity in California, 1993-2008: a retrospective cohort study. AIDS 2013; 27:2615-22. [PMID: 23842135 DOI: 10.1097/01.aids.0000432445.07437.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Rifampin monoresistant tuberculosis (RMR-TB) is increasingly identified because of scale-up of rapid molecular tests. The longitudinal association of RMR-TB, multidrug-resistant TB (MDR-TB), and HIV/AIDS is incompletely described. METHODS We examined clinical characteristics and treatment outcomes of patients with RMR-TB, isoniazid monoresistant TB (IMR-TB), MDR-TB, and drug-susceptible TB during a 16-year period (1993-2008) in California. TB cases were cross-matched with the state HIV/AIDS registry, and HIV prevalence denominators modeled using nonparametric backcalculation. RESULTS Of 42,582 TB cases, 178 (0.4%), 3469 (8.1%), and 635 (1.5%) were RMR-TB, IMR-TB, and MDR-TB, respectively. From the pre-HAART (1993-1996) to HAART (2005-2008) era, RMR-TB rates declined rapidly (12.0 vs. 0.5 per 100,000) among patients with HIV infection. The proportion of patients for whom rifampin resistance indicated RMR-TB (rather than MDR-TB) decreased from 31% [95% confidence interval (CI) 26-38%] to 11% (95% CI 5-19%). In multivariate analysis controlling for HIV coinfection and other covariates, patients with RMR-TB were twice as likely to die as patients with drug-sensitive TB (relative risk 1.94, 95% CI 1.40-2.69). CONCLUSION RMR-TB/HIV rates declined substantially over time in association with improved TB control and HIV control in California. Mortality among patients with RMR-TB was high, even after adjusting for HIV status.
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Fitz Harris LF, Taylor AW, Zhang F, Borkowf CB, Arthur BC, Jacques-Carroll L, Wang SA, Nesheim SR. Factors Associated with Human Immunodeficiency Virus Screening of Women During Pregnancy, Labor and Delivery, United States, 2005–2006. Matern Child Health J 2013; 18:648-56. [DOI: 10.1007/s10995-013-1289-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Assessing the impact of a community-wide HIV testing scale-up initiative in a major urban epidemic. J Acquir Immune Defic Syndr 2012; 61:23-31. [PMID: 22739134 DOI: 10.1097/qai.0b013e3182632960] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Bronx, one of 5 boroughs in New York City (NYC), bears a high burden of HIV. We evaluated the impact of HIV testing initiatives in the Bronx, including the 2008 The Bronx Knows campaign. METHODS We used data from an annual telephone survey representative of NYC adults to compare 2005 and 2009 estimates of HIV testing prevalence among Bronx residents and to identify correlates of testing. We used NYC HIV surveillance data to evaluate changes in the percentage of persons concurrently being diagnosed with HIV and AIDS, an indicator of delayed HIV diagnosis. RESULTS Between 2005 and 2009, relative increases of 14% and 32% were found in the proportion of Bronx adults who have ever been HIV tested and who have been tested in the past year, respectively (P < 0.001). The largest increases were among those aged 24-44 years, men, non-Hispanic blacks and Hispanics, and those with low income or education, nonheterosexual identity, a personal doctor/provider, or health insurance. Factors independently associated with being recently tested included black or other race, Hispanic ethnicity, and bisexual identity. The proportion concurrently diagnosed with HIV and AIDS fell 22% from 2005 to 2009, and decreases generally occurred among subgroups experiencing increases in testing. CONCLUSION Community-wide testing in the Bronx increased the proportion of people with known HIV status and reduced the proportion with delayed diagnoses.
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Rizza SA, MacGowan RJ, Purcell DW, Branson BM, Temesgen Z. HIV screening in the health care setting: status, barriers, and potential solutions. Mayo Clin Proc 2012; 87:915-24. [PMID: 22958996 PMCID: PMC3538498 DOI: 10.1016/j.mayocp.2012.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 06/27/2012] [Accepted: 06/29/2012] [Indexed: 10/27/2022]
Abstract
Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.
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Affiliation(s)
| | - Robin J. MacGowan
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - David W. Purcell
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Bernard M. Branson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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