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Arnaiz-Villena A, Juarez I, Vaquero-Yuste C, Lledo T, Martin-Villa JM, Suarez-Trujillo F. Complex Interactions between the Human Major Histocompatibility Complex (MHC) and Microbiota: Their Roles in Disease Pathogenesis and Immune System Regulation. Biomedicines 2024; 12:1928. [PMID: 39200390 PMCID: PMC11352054 DOI: 10.3390/biomedicines12081928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/19/2024] [Accepted: 08/19/2024] [Indexed: 09/02/2024] Open
Abstract
The relationship between microbiota and the immune system is complex and characterized by the ways in which microbiota directs immune function interactions, both innate and acquired and also keeps activating the immune system throughout an individual's life. In this respect, the human Major Histocompatibility Complex (MHC, referred to as HLA in humans) plays a crucial role and is also established in self-defense against microbes by presenting microbial-derived peptides to the immune cells. However, this assumption has some unclear aspects that should be investigated. For example, how is the microbiota shaped by microbe species diversity, quantity and functions of the immune system, as well as the role and molecular mechanisms of the HLA complex during this process. There are autoimmune diseases related to both HLA and specific microbiota changes or alterations, many of which are mentioned in the present review. In addition, the HLA peptide presenting function should be put in a framework together with its linkage to diseases and also with HLA compatibility necessary for transplants to be successful. These are still quite an enigmatically statistical and phenomenological approach, but no firm pathogenic mechanisms have been described; thus, HLA's real functioning is still to be fully unveiled. After many years of HLA single-genes studies, firm pathogenesis mechanisms underlying disease linkage have been discovered. Finally, microbiota has been defined as conformed by bacteria, protozoa, archaea, fungi, and viruses; notwithstanding, endogenous viral sequences integrated into the human genome and other viral particles (obelisks) recently found in the digestive mucosa should be taken into account because they may influence both the microbiome and the immune system and their interactions. In this context, we propose to integrate these microbial-genetic particle components into the microbiome concept and designate it as "microgenobiota".
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Affiliation(s)
- Antonio Arnaiz-Villena
- Department of Immunology, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (I.J.); (C.V.-Y.); (T.L.); (J.M.M.-V.); (F.S.-T.)
- Instituto de Investigacion Sanitaria Gegorio Marañon, 28009 Madrid, Spain
| | - Ignacio Juarez
- Department of Immunology, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (I.J.); (C.V.-Y.); (T.L.); (J.M.M.-V.); (F.S.-T.)
- Instituto de Investigacion Sanitaria Gegorio Marañon, 28009 Madrid, Spain
| | - Christian Vaquero-Yuste
- Department of Immunology, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (I.J.); (C.V.-Y.); (T.L.); (J.M.M.-V.); (F.S.-T.)
- Instituto de Investigacion Sanitaria Gegorio Marañon, 28009 Madrid, Spain
| | - Tomás Lledo
- Department of Immunology, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (I.J.); (C.V.-Y.); (T.L.); (J.M.M.-V.); (F.S.-T.)
- Instituto de Investigacion Sanitaria Gegorio Marañon, 28009 Madrid, Spain
| | - José Manuel Martin-Villa
- Department of Immunology, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (I.J.); (C.V.-Y.); (T.L.); (J.M.M.-V.); (F.S.-T.)
- Instituto de Investigacion Sanitaria Gegorio Marañon, 28009 Madrid, Spain
| | - Fabio Suarez-Trujillo
- Department of Immunology, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (I.J.); (C.V.-Y.); (T.L.); (J.M.M.-V.); (F.S.-T.)
- Instituto de Investigacion Sanitaria Gegorio Marañon, 28009 Madrid, Spain
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Martin-Iguacel R, Pedersen C, Llibre JM, Søndergaard J, Jensen J, Omland LH, Johansen IS, Obel N, Rasmussen LD. Primary health care: an opportunity for early identification of people living with undiagnosed HIV infection. HIV Med 2019; 20:404-417. [PMID: 31016849 DOI: 10.1111/hiv.12735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES We aimed to determine the fraction of HIV-diagnosed individuals who had primary health care (PHC) contacts 3 years prior to HIV diagnosis and whether the risk of HIV diagnosis and degree of immunodeficiency were associated with the frequency of visits or procedures performed. METHODS We used data from national registries to conduct a population-based nested case-control study. Cases were individuals diagnosed with HIV infection in Denmark from 1998 to 2016. Population controls were extracted from the general population matched 13:1 on gender and age. We used conditional logistic regression. As there was a statistically significant interaction, analyses were further stratified by gender and Danish/non-Danish origin. RESULTS We identified 2784 cases and 36 192 controls. Ninety-three per cent of cases and 88% of controls attended PHC at least once in the 3 years prior to diagnosis, with a higher median number of visits to PHC (NVPC) for cases. We found a statistically significant positive association between NVPC and risk of subsequent HIV diagnosis in men and non-Danish women. A U-shaped association between NVPC and risk of HIV diagnosis among Danish women. No substantial association between NVPC and degree of immunodeficiency was found. Risk of HIV diagnosis and degree of immunodeficiency were weakly associated with type of procedures performed. CONCLUSIONS For most HIV-infected individuals, there seem to be many opportunities for earlier diagnosis in PHC. In men and non-Danish women, the risk of HIV diagnosis but not the degree of immunodeficiency was related to NVPC. The results suggest that the type of medical procedure performed cannot not be used as a guide by the primary physician to indicate which patients to test.
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Affiliation(s)
- R Martin-Iguacel
- Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark
| | - C Pedersen
- Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark
| | - J M Llibre
- Fight AIDS Foundation, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
| | - J Søndergaard
- Department of Public Health, The Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - J Jensen
- Department of Internal Medicine, Kolding Sygehus, Kolding, Denmark
| | - L H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - I S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark
| | - N Obel
- Fight AIDS Foundation, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
| | - L D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark
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Matulionytė R, Žagminas K, Balčiūnaitė E, Matulytė E, Paulauskienė R, Bajoriūnienė A, Ambrozaitis A. Routine HIV testing program in the University Infectious Diseases Centre in Lithuania: a four-year analysis. BMC Infect Dis 2019; 19:21. [PMID: 30616558 PMCID: PMC6322331 DOI: 10.1186/s12879-018-3661-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 12/26/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND HIV transmission remains a major concern in Eastern Europe, and too many people are diagnosed late. Expanded testing strategies and early and appropriate access to care are required. Infectious disease departments might be targets for expanded HIV testing owing to the intense passage of key patient populations that carry indicators of HIV disease. Our objective was to evaluate the feasibility and clinical effectiveness of a fully integrated, opt-out routine, rapid HIV testing program. METHODS A retrospective four-year study of a screening program was conducted from 2010 through 2014. The program was divided into two periods: from 2010 to 2012 (pilot study) and from 2013 to 2014. The pilot study consisted of routine HIV testing of patients aged 18-55 that were hospitalized in one department. In the second period, all inpatients aged 18-65 were eligible. Targeted testing was conducted in the other inpatient department during the pilot study and the outpatient department during both periods. RESULTS During the pilot study, 2203 patients were hospitalized, 1314 (59.6%) were eligible, 954 (72.6%) were tested, and 3 (0.31%) were newly diagnosed HIV-positive. In the second period, 4911 patients were hospitalized, 3727 (75.9%) were eligible, 3303 (88.6%) were tested, and 7 (0.21%) were HIV-positive. In total, 2800 targeted tests were performed, and 4 (0.14%) patients tested positive with newly discovered HIV. All 14 newly diagnosed patients were provided with care. Comparing cumulative groups of routine and targeted testing, the HIV prevalence was 0.23% vs. 0.14% (p = 0.40) and was above the reported cost-effectiveness threshold of 0.1% (p = 0.012). A lower proportion of advanced disease and a higher proportion of heterosexually transmitted infection were found in the routine testing group. CONCLUSION Routine HIV testing in admissions of infectious diseases is acceptable, feasible, sustainable and clinically effective. Compared to targeted testing, routine testing helped to discover more patients in earlier stages and those with heterosexually transmitted HIV infection.
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Affiliation(s)
- Raimonda Matulionytė
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Kęstutis Žagminas
- Institute of Health Sciences, Vilnius University, Vilnius, Lithuania
| | - Eglė Balčiūnaitė
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Elžbieta Matulytė
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Rasutė Paulauskienė
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Almina Bajoriūnienė
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Arvydas Ambrozaitis
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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Pottie K, Lotfi T, Kilzar L, Howeiss P, Rizk N, Akl EA, Dias S, Biggs BA, Christensen R, Rahman P, Magwood O, Tran A, Rowbotham N, Pharris A, Noori T, Pareek M, Morton R. The Effectiveness and Cost-Effectiveness of Screening for HIV in Migrants in the EU/EEA: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081700. [PMID: 30096905 PMCID: PMC6121945 DOI: 10.3390/ijerph15081700] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/19/2018] [Accepted: 08/01/2018] [Indexed: 01/08/2023]
Abstract
Migrants, defined as individuals who move from their country of origin to another, account for 40% of newly-diagnosed cases of human immunodeficiency virus (HIV) in the European Union/European Economic Area (EU/EEA). Populations at high risk for HIV include migrants, from countries or living in neighbourhoods where HIV is prevalent, and those participating in high risk behaviour. These migrants are at risk of low CD4 counts at diagnosis, increased morbidity, mortality, and onward transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of HIV testing strategies in migrant populations and to estimate their effect on testing uptake, mortality, and resource requirements. Following a systematic overview, we included four systematic reviews on the effectiveness of strategies in non-migrant populations and inferred their effect on migrant populations, as well as eight individual studies on cost-effectiveness/resource requirements. We assessed the certainty of our results using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The systematic reviews reported that HIV tests are highly accurate (rapid test >90% sensitivity, Western blot and ELISA >99% sensitivity). A meta-analysis showed that rapid testing approaches improve the access and uptake of testing (risk ratio = 2.95, 95% CI: 1.69 to 5.16), and were associated with a lower incidence of HIV in the middle-aged women subgroup among marginalised populations at a high risk of HIV exposure and HIV related stigma. Economic evidence on rapid counselling and testing identified strategic advantages with rapid tests. In conclusion, community-based rapid testing programmes may have the potential to improve uptake of HIV testing among migrant populations across a range of EU/EEA settings.
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Affiliation(s)
- Kevin Pottie
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada.
- Departments of Family Medicine & Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Tamara Lotfi
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Lama Kilzar
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Pamela Howeiss
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Nesrine Rizk
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Elie A Akl
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut 1107 2020, Lebanon.
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Sonia Dias
- National School of Public Health, Centro de Investigação em Saúde Pública & GHTM/IHMT, Universidade Nova de Lisboa, 2825-149 Caparica, Portugal.
| | - Beverly-Ann Biggs
- Department of Medicine/RMH at the Doherty Institute, The University of Melbourne Vic Australia, Parkville 3010, Australia.
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark.
- Department of Rheumatology, Odense University Hospital, 5000 Odense, Denmark.
| | - Prinon Rahman
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada.
| | - Olivia Magwood
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada.
| | - Anh Tran
- NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia.
| | - Nick Rowbotham
- NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia.
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control, 16973 Solna, Sweden.
| | - Teymur Noori
- European Centre for Disease Prevention and Control, 16973 Solna, Sweden.
| | - Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 7RH, UK.
| | - Rachael Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia.
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5
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Gargallo-Bernad C, Sangrós-González FJ, Arazo-Garcés P, Martínez-Álvarez R, Malo-Aznar C, Gargallo-Bernad A, Ballester-Luna A, Cabrero-Pascual LE, Gil-Orna P, Abadía-Gallego VJ, Torres-Peña I, Ordiz-Suárez H. Missed opportunities in the diagnosis of human immunodeficiency virus infection in the Region of Aragon. Late diagnosis importance. Enferm Infecc Microbiol Clin 2018; 37:100-108. [PMID: 29724618 DOI: 10.1016/j.eimc.2018.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/11/2018] [Accepted: 03/24/2018] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Late Diagnosis (LD) of Human Immunodeficiency Virus (HIV) infection (CD4 lymphocytes <350/μl at diagnosis of the disease), deteriorates the condition of those affected and increases the probability of transmission. The objective of the present study was to analyse the prevalence of LD, to identify missed diagnostic opportunities (MDO) and to find out which level of the health care delivery system they took place. METHODS Retrospective, observational and descriptive study of the population diagnosed with infection of HIV/AIDS in the period 2011-2015 in Aragon. MDO were identified during the 3 years prior to diagnosis of the disease in all levels of the health care delivery system as well as frequentation of consultations. The indicator conditions (IC) that generated more MDO were analysed according to the latest recommendations for early diagnosis of HIV in the health care setting. RESULTS 435 newly diagnosed HIV/AIDS cases were analysed. 45.1% were diagnosed in Primary Healthcare (PH). 49.4% presented criteria of LD and 61.1% were infected through heterosexual contact. The majority of MDO (68.5%) were given in PH. The IC that generated the most MDO were seborrheic dermatitis/exanthema (19.4%) and fever of unknown origin (10.3%). However, the IC that were associated with higher LD were pneumonia acquired in the community and unjustified weight loss. CONCLUSION In Aragon, prevalence of LD is high, the main route of infection is heterosexual and most of MDO go unnoticed in PH. The dissemination of current guidelines for requesting IC guided HIV testing and HIV screening across the preoperative period will result in an effective measure to decrease the LD.
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Affiliation(s)
| | | | - Piedad Arazo-Garcés
- Servicio de Enfermedades Infecciosas, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Rosa Martínez-Álvarez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - Alba Ballester-Luna
- Servicio de Medicina Interna, Hospital Ernest Lluch Martín, Calatayud, Zaragoza, España
| | | | - Pablo Gil-Orna
- Servicio de Urgencias, Hospital Universitario Miguel Servet, Zaragoza, España
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6
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Fakoya I, Álvarez-Del Arco D, Copas AJ, Teixeira B, Block K, Gennotte AF, Volny-Anne A, Bil JP, Touloumi G, Del Amo J, Burns FM. Factors Associated With Access to HIV Testing and Primary Care Among Migrants Living in Europe: Cross-Sectional Survey. JMIR Public Health Surveill 2017; 3:e84. [PMID: 29109072 PMCID: PMC5696579 DOI: 10.2196/publichealth.7741] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 12/31/2022] Open
Abstract
Background There is a heavy and disproportionate burden of human immunodeficiency virus (HIV) infection among migrant communities living in Europe. Despite this, the published evidence related to HIV testing, prevention, and treatment needs for migrants is sparse. Objective The aim of this study was to identify the factors associated with access to primary care and HIV testing among migrant groups living in Europe. Methods A Web-based survey (available in 14 languages) was open to all people aged 18 years and older, living outside their country of birth in the World Health Organization (WHO) European area. Community organizations in 9 countries promoted the survey to migrant groups, focusing on those at a higher risk of HIV (sub-Saharan Africans, Latin Americans, gay or bisexual men, and people who inject drugs). Multivariable analysis examined factors associated with access to primary care and previous history of an HIV test. Results In total, 559 women, 395 heterosexual men, and 674 gay or bisexual men were included in the analysis, and 68.1% (359/527) of women, 59.5% (220/371) of heterosexual men, and 89.6% (596/664) of gay or bisexual men had tested for HIV. Low perceived risk was the reason given for not testing by 62.3% (43/69) of gay or bisexual men and 83.3% (140/168) of women and heterosexual men who reported never having tested for HIV. Access to primary care was >60% in all groups. Access to primary care was strongly positively associated with living in Northern Europe compared with Southern Europe (women: adjusted odds ratio, aOR 34.56 [95% CI 11.58-101]; heterosexual men: aOR 6.93 [95% CI 2.49-19.35], and gay or bisexual men: aOR 2.53 [95% CI 1.23-5.19]), whereas those with temporary residency permits were less likely to have access to primary care (women: aOR 0.41 [95% CI 0.21-0.80] and heterosexual men: aOR 0.24 [95% CI 0.10-0.54] only). Women who had experience of forced sex (aOR 3.53 [95% CI 1.39-9.00]) or postmigration antenatal care (aOR 3.07 [95% CI 1.55-6.07]) were more likely to have tested for HIV as were heterosexual men who had access to primary care (aOR 3.13 [95% CI 1.58-6.13]) or reported “Good” health status (aOR 2.94 [95% CI 1.41-5.88]). Conclusions Access to primary care is limited by structural determinants such as immigration and health care policy, which varies across Europe. For those migrants who can access primary care and other health services, missed opportunities for HIV testing remain a barrier to earlier testing and diagnosis for migrants in Europe. Clinicians should be aware of these potential structural barriers to HIV testing as well as low perception of HIV risk in migrant groups.
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Affiliation(s)
- Ibidun Fakoya
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Débora Álvarez-Del Arco
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.,Biomedical Research Network on Epidemiology and Public Health, Faculty of Political Science and Sociology, Universidad Complutense de Madrid, Madrid, Spain
| | - Andrew J Copas
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom
| | | | - Koen Block
- European AIDS Treatment Group, Brussels, Belgium
| | - Anne-Francoise Gennotte
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | | | - Janneke P Bil
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands.,Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunology Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Giota Touloumi
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Julia Del Amo
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.,Biomedical Research Network on Epidemiology and Public Health, Faculty of Political Science and Sociology, Universidad Complutense de Madrid, Madrid, Spain
| | - Fiona M Burns
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom.,Royal Free London National Health Service Foundation Trust, London, United Kingdom
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7
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Henriquez-Camacho C, Villafuerte-Gutierrez P, Pérez-Molina JA, Losa J, Gotuzzo E, Cheyne N. Opt-out screening strategy for HIV infection among patients attending emergency departments: systematic review and meta-analysis. HIV Med 2016; 18:419-429. [PMID: 28000338 DOI: 10.1111/hiv.12474] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES International health agencies have promoted nontargeted universal (opt-out) HIV screening tests in different settings, including emergency departments (EDs). We performed a systematic review and meta-analysis to assess the testing uptake of strategies (opt-in targeted, opt-in nontargeted and opt-out) to detect new cases of HIV infection in EDs. METHODS We searched the Pubmed and Embase databases, from 1984 to April 2015, for opt-in and opt-out HIV diagnostic strategies used in EDs. Randomized controlled or quasi experimental studies were included. We assessed the percentage of positive individuals tested for HIV infection in each programme (opt-in and opt-out strategies). The mean percentage was estimated by combining studies in a random-effect meta-analysis. The percentages of individuals tested in the programmes were compared in a random-effect meta-regression model. Data were analysed using stata version 12. Quality assessments were performed using the Newcastle-Ottawa Scale. RESULTS Of the 90 papers identified, 28 were eligible for inclusion. Eight trials used opt-out, 18 trials used opt-in, and two trials used both to detect new cases of HIV infection. The test was accepted and taken by 75 155 of 172 237 patients (44%) in the opt-out strategy, and 73 581 of 382 992 patients (19%) in the opt-in strategy. The prevalence of HIV infection detected by the opt-out strategy was 0.40% (373 cases), that detected by the opt-in nontargeted strategy was 0.52% (419 cases), and that detected by the opt-in targeted strategy was 1.06% (52 cases). CONCLUSIONS In this meta-analysis, the testing uptake of the opt-out strategy was not different from that of the opt-in strategy to detect new cases of HIV infection in EDs.
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Affiliation(s)
- C Henriquez-Camacho
- Infectious Diseases Department, Internal Medicine Unit, Hospital Universitario Fundacion Alcorcon, Madrid, Spain
| | | | - J A Pérez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Ramón y Cajal, Madrid, Spain
| | - J Losa
- Infectious Diseases Department, Internal Medicine Unit, Hospital Universitario Fundacion Alcorcon, Madrid, Spain
| | - E Gotuzzo
- Alexander von Humboldt Tropical Medicine Institute, Lima, Peru
| | - N Cheyne
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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8
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Rich JD, Beckwith CG, Macmadu A, Marshall BDL, Brinkley-Rubinstein L, Amon JJ, Milloy MJ, King MRF, Sanchez J, Atwoli L, Altice FL. Clinical care of incarcerated people with HIV, viral hepatitis, or tuberculosis. Lancet 2016; 388:1103-1114. [PMID: 27427452 PMCID: PMC5504684 DOI: 10.1016/s0140-6736(16)30379-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The burden of HIV/AIDS and other transmissible diseases is higher in prison and jail settings than in the non-incarcerated communities that surround them. In this comprehensive review, we discuss available literature on the topic of clinical management of people infected with HIV, hepatitis B and C viruses, and tuberculosis in incarcerated settings in addition to co-occurrence of one or more of these infections. Methods such as screening practices and provision of treatment during detainment periods are reviewed to identify the effect of community-based treatment when returning inmates into the general population. Where data are available, we describe differences in the provision of medical care in the prison and jail settings of low-income and middle-income countries compared with high-income countries. Structural barriers impede the optimal delivery of clinical care for prisoners, and substance use, mental illness, and infectious disease further complicate the delivery of care. For prison health care to reach the standards of community-based health care, political will and financial investment are required from governmental, medical, and humanitarian organisations worldwide. In this review, we highlight challenges, gaps in knowledge, and priorities for future research to improve health-care in institutions for prisoners.
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Affiliation(s)
- Josiah D Rich
- Department of Medicine, Brown University, Providence, RI, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | - Curt G Beckwith
- Department of Medicine, Brown University, Providence, RI, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, USA
| | - Alexandria Macmadu
- The Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine and Center for Health Equity Research, University of North Carolina, Chapel Hill, NC, USA
| | - Joseph J Amon
- Health and Human Rights Division, Human Rights Watch, New York City, NY, USA
| | - M-J Milloy
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Maximilian R F King
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Jorge Sanchez
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Lima, Peru; Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Frederick L Altice
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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Reyes-Urueña J, Breveglieri M, Furegato M, Fernàndez-López L, Agusti C, Casabona J. Heterogeneity of community-based voluntary, counselling and testing services for HIV in Europe: the HIV-COBATEST survey. Int J STD AIDS 2016; 28:28-38. [PMID: 26672004 DOI: 10.1177/0956462415623402] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study reports the first EU-wide survey of community-based voluntary counselling and testing services (CBVCTs), with the following aims: to assess the current availability of CBVCTs and how the concept of CBVCT is understood; to describe CBVCT modalities and strategies; and to measure the use of rapid tests within CBVCTs. A cross-sectional survey was conducted in two different key informant groups: HIV/AIDS National Focal Points (NFPs) and CBVCTs from the EU and European Free Trade Association (EFTA) countries. A definition of CBVCTs was reached. Descriptive and correspondence analyses were performed. The COBATEST survey was answered by NFPs from 25 of the 32 EU/EFTA countries (response rate of 78.1%), and by 55 CBVCTs in 22 different countries. CBVCTs were functioning in nearly all the responding countries, but only 56% explicitly included them in their national strategic plans. In those that had CBVCTs, the NFPs often lacked reliable information on CBVCTs. In general, CBVCTs in Europe are focused mainly on men who have sex with men, are primarily peer-driven and highly communitarised, whereas CBVCTs targeting other at-risk populations are more medicalised. In addition, the oral test is under-used and in general test performance is highly medicalised. Results show that there is a wide heterogeneity of CBVCTs in Europe, which is varied and highly medicalised. The data provided in this study in conjunction with other deliverables produced by the COBATEST project should contribute to the development of standardised indicators to enable comparisons over time and eventually improve the effectiveness of CBVCTs across Europe.
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Affiliation(s)
- Juliana Reyes-Urueña
- 1 Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain
| | - Michele Breveglieri
- 2 Service for International Social and Health Relations, Verona Local Health Authority n. 20 of the Veneto Region, Italy.,3 Arcigay Italian LGBT Association, Bologna, Italy
| | - Martina Furegato
- 2 Service for International Social and Health Relations, Verona Local Health Authority n. 20 of the Veneto Region, Italy.,4 HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, England
| | - Laura Fernàndez-López
- 1 Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain.,5 CIBER Epidemiologia y Salud Pública (CIBERESP), Spain.,6 Sciences Research Institute of the "Germans Trias i Pujol" Foundation (IGTP), Badalona, Spain
| | - Cristina Agusti
- 1 Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain.,5 CIBER Epidemiologia y Salud Pública (CIBERESP), Spain.,6 Sciences Research Institute of the "Germans Trias i Pujol" Foundation (IGTP), Badalona, Spain
| | - Jordi Casabona
- 1 Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain.,5 CIBER Epidemiologia y Salud Pública (CIBERESP), Spain.,6 Sciences Research Institute of the "Germans Trias i Pujol" Foundation (IGTP), Badalona, Spain.,7 Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine, Universidad Autonoma de Barcelona, Bellaterra Cerdanyola, Spain
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10
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Leber W, Anderson J, Griffiths C. HIV testing in Europe: how can primary care contribute? Sex Transm Infect 2016; 91:464-5. [PMID: 26487771 DOI: 10.1136/sextrans-2015-052229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Werner Leber
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Jane Anderson
- Homerton Sexual Health Services, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
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Montoy JCC, Dow WH, Kaplan BC. Patient choice in opt-in, active choice, and opt-out HIV screening: randomized clinical trial. BMJ 2016; 532:h6895. [PMID: 26786744 PMCID: PMC4718971 DOI: 10.1136/bmj.h6895] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY QUESTION What is the effect of default test offers--opt-in, opt-out, and active choice--on the likelihood of acceptance of an HIV test among patients receiving care in an emergency department? METHODS This was a randomized clinical trial conducted in the emergency department of an urban teaching hospital and regional trauma center. Patients aged 13-64 years were randomized to opt-in, opt-out, and active choice HIV test offers. The primary outcome was HIV test acceptance percentage. The Denver Risk Score was used to categorize patients as being at low, intermediate, or high risk of HIV infection. STUDY ANSWER AND LIMITATIONS 38.0% (611/1607) of patients in the opt-in testing group accepted an HIV test, compared with 51.3% (815/1628) in the active choice arm (difference 13.3%, 95% confidence interval 9.8% to 16.7%) and 65.9% (1031/1565) in the opt-out arm (difference 27.9%, 24.4% to 31.3%). Compared with active choice testing, opt-out testing led to a 14.6 (11.1 to 18.1) percentage point increase in test acceptance. Patients identified as being at intermediate and high risk were more likely to accept testing than were those at low risk in all arms (difference 6.4% (3.4% to 9.3%) for intermediate and 8.3% (3.3% to 13.4%) for high risk). The opt-out effect was significantly smaller among those reporting high risk behaviors, but the active choice effect did not significantly vary by level of reported risk behavior. Patients consented to inclusion in the study after being offered an HIV test, and inclusion varied slightly by treatment assignment. The study took place at a single county hospital in a city that is somewhat unique with respect to HIV testing; although the test acceptance percentages themselves might vary, a different pattern for opt-in versus active choice versus opt-out test schemes would not be expected. WHAT THIS PAPER ADDS Active choice is a distinct test regimen, with test acceptance patterns that may best approximate patients' true preferences. Opt-out regimens can substantially increase HIV testing, and opt-in schemes may reduce testing, compared with active choice testing. FUNDING, COMPETING INTERESTS, DATA SHARING This study was supported by grant NIA 1RC4AG039078 from the National Institute on Aging. The full dataset is available from the corresponding author. Consent for data sharing was not obtained, but the data are anonymized and risk of identification is low.Trial registration Clinical trials NCT01377857.
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Affiliation(s)
- Juan Carlos C Montoy
- Department of Emergency Medicine, University of California, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - William H Dow
- School of Public Health, University of California, 239 University Hall #7360, University of California, Berkeley, CA 94720-7360, USA
| | - Beth C Kaplan
- Department of Emergency Medicine, University of California, 1001 Potrero Ave, San Francisco CA 94143, USA
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Deblonde J, Sasse A, Del Amo J, Burns F, Delpech V, Cowan S, Levoy M, Keith L, Pharris A, Amato-Gauci A, Noori T. Restricted access to antiretroviral treatment for undocumented migrants: a bottle neck to control the HIV epidemic in the EU/EEA. BMC Public Health 2015; 15:1228. [PMID: 26654427 PMCID: PMC4676131 DOI: 10.1186/s12889-015-2571-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 12/04/2015] [Indexed: 12/20/2022] Open
Abstract
Background In the European Union/European Economic Area (EU/EEA), migrants from high-endemic countries are disproportionately affected by HIV. Between 2007 and 2012, migrants represented 39 % of reported HIV cases. There is growing evidence that a significant proportion of HIV acquisition among migrant populations occurs after their arrival in Europe. Discussion Migrants are confronted with multiple risk factors that shape patterns of population HIV susceptibility and vulnerability, which simultaneously affect HIV transmission. Undocumented migrants incur additional risks for contracting HIV due to limited access to adequate health care services, protection and justice, alongside insecure housing and employment conditions. All EU/EEA countries have ratified a number of international and regional human rights instruments that enshrine access to health care as a human right that should be available to everyone without discrimination. From a clinical and public health perspective, early HIV care and treatment is associated with viral suppression, improved health outcomes and reductions in transmission risks. A current challenge of the HIV epidemic is to reach the highest proportion of overall viral suppression among people living with HIV in order to impact on HIV transmission. Although the majority of EU/EEA countries regard migrants as an important sub-population for their national responses to HIV, and despite the overwhelming evidence of the individual and public health benefits associated with HIV care and treatment, a significant number of EU/EEA countries do not provide antiretroviral treatment to undocumented migrants. Summary HIV transmission dynamics in migrant populations depend on the respective weight of all risk and vulnerability factors to which they are exposed, which act together in a synergistic way. People who are not linked to HIV care will continue to unwillingly contribute to the on-going transmission of HIV. Following the recommendations of the European Union Agency for Fundamental Rights, ensuring access to HIV-care for all sub-populations, including undocumented migrants, would fulfil the human rights of those populations and also strengthen the control of HIV incidence among those not currently able to access HIV care.
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Affiliation(s)
- Jessika Deblonde
- Scientific Institute of Public Health, Epidemiology of Infectious Diseases, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium.
| | - André Sasse
- Scientific Institute of Public Health, Epidemiology of Infectious Diseases, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium.
| | - Julia Del Amo
- Institute of Health Carlos III, National Center for Epidemiology, C/Sinesio Delgado 6, 28029, Madrid, Spain.
| | - Fiona Burns
- University College London, Research Department of Infection & Population Health, London, WC1E 6JB, UK. .,Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
| | - Valerie Delpech
- Public Health England, PHIV & STI Department, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - Susan Cowan
- Statens Serum Institut, Department of Infectious Medicine Epidemiology, Artillerivej 5, 2300, Copenhagen S, Denmark.
| | - Michele Levoy
- PICUM- Platform for International Cooperation on Undocumented Migrants, Rue du Congrès 37-41 / 5, Brussels, 1000, Belgium.
| | - Lilana Keith
- PICUM- Platform for International Cooperation on Undocumented Migrants, Rue du Congrès 37-41 / 5, Brussels, 1000, Belgium.
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control, Surveillance and Response Support Unit, Tomtebodavagen 11A, 171 83, Stockholm, Sweden.
| | - Andrew Amato-Gauci
- European Centre for Disease Prevention and Control, Office of the Chief Scientist, Tomtebodavagen 11A, 171 83, Stockholm, Sweden.
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Surveillance and Response Support Unit, Tomtebodavagen 11A, 171 83, Stockholm, Sweden.
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Saracino A, Lorenzini P, Lo Caputo S, Girardi E, Castelli F, Bonfanti P, Rusconi S, Caramello P, Abrescia N, Mussini C, Monno L, d'Arminio Monforte A. Increased risk of virologic failure to the first antiretroviral regimen in HIV-infected migrants compared to natives: data from the ICONA cohort. Clin Microbiol Infect 2015; 22:288.e1-8. [PMID: 26551839 DOI: 10.1016/j.cmi.2015.10.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/08/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
Migrant and Italian HIV-infected patients (n = 5773) enrolled in the ICONA cohort in 2004-2014 were compared for disparities in access to an initial antiretroviral regimen and/or risk of virologic failure (VF), and determinants of failure were evaluated. Variables associated with initiating antiretroviral therapy (ART) were analysed. Primary endpoint was time to failure after at least 6 months of ART and was defined as: VF, first of two consecutive virus loads (VL) >200 copies/mL; treatment discontinuation (TD) for any reason; and treatment failure as confirmed VL >200 copies/mL or TD. A Poisson multivariable analysis was performed to control for confounders. Migrants presented significantly lower CD4 counts and more frequent AIDS events at baseline. When adjusting for baseline confounders, migrants presented a lower likelihood to begin ART (odds ratio 0.80, 95% confidence interval (CI) 0.67-0.95, p 0.012). After initiating ART, the incidence VF rate was 6.4 per 100 person-years (95% CI 4.8-8.5) in migrants and 2.7 in natives (95% CI 2.2-3.3). Multivariable analysis confirmed that migrants had a higher risk of VF (incidence rate ratio 1.90, 95% CI 1.25-2.91, p 0.003) and treatment failure (incidence rate ratio 1.16, 95% CI 1.01-1.33, p 0.031), with no differences for TD. Among migrants, variables associated with VF were age, unemployment and use of a boosted protease inhibitor-based regimen versus nonnucleoside reverse transcriptase inhibitors. Despite the use of more potent and safer drugs in the last 10 years, and even in a universal health care setting, migrants living with HIV still present barriers to initiating ART and an increased risk of VF compared to natives.
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Affiliation(s)
- A Saracino
- Clinic of Infectious Diseases, University of Bari, Bari, Italy.
| | - P Lorenzini
- Clinical Department, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - S Lo Caputo
- Santissima Annunziata Hospital, Firenze, Italy
| | - E Girardi
- Department of Epidemiology, National Institute for Infectious Diseases 'L. Spallanzani,' IRCCS, Rome, Italy
| | - F Castelli
- University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | - P Bonfanti
- Department of Infectious Diseases, Azienda Ospedaliera Lecco, Lecco, Italy
| | - S Rusconi
- Department of Infectious Disease, L. Sacco University Hospital, University of Milan, Milan, Italy
| | - P Caramello
- Infectious and Tropical Diseases Unit I, Department of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy
| | - N Abrescia
- Department of Infectious Diseases, Cotugno Hospital, Naples, Italy
| | - C Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - L Monno
- Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - A d'Arminio Monforte
- Clinic of Infectious Diseases, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
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14
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Chocarro Martínez A, Ochoa Sangrador C, Brezmes Valdivieso MP, Martín Gómez C. [Human immunodeficiency virus screening in primary care: Acceptance by physicians and patients]. Enferm Infecc Microbiol Clin 2014; 33:426-8. [PMID: 25444361 DOI: 10.1016/j.eimc.2014.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 08/22/2014] [Accepted: 10/06/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Angel Chocarro Martínez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Virgen de la Concha, Zamora, España.
| | | | | | - Cristina Martín Gómez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Virgen de la Concha, Zamora, España
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15
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Flanigan J. Non-culpable ignorance and HIV criminalisation. JOURNAL OF MEDICAL ETHICS 2014; 40:798-801. [PMID: 25190732 DOI: 10.1136/medethics-2012-101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this essay, I argue that any legal framework that addresses sexual transmission of HIV should be sensitive to the way that culpability can be mitigated by moral and factual ignorance. Though it is wrong to transmit HIV, public officials should be wary of criminalising transmission because people with HIV may be excused if they suffer from blameless moral or factual ignorance. I begin with the widely shared premise that blameless ignorance about one's HIV status is an excuse for sexual transmission of infections. I then extend this premise to other kinds of non-moral ignorance about HIV. Next, I argue that blameless moral ignorance also excuses transmission of HIV. There is some evidence of significant blameless non-moral and moral ignorance about HIV transmission. In these cases, transmission is excused. In light of the presence of moral and non-moral ignorance about HIV, I conclude that public health officials should encourage moral deliberation about HIV transmission and also that criminal penalties for HIV transmission are unwarranted even in some cases of knowing or intentional transmission.
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16
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Reisen CA, Zea MC, Bianchi FT, Poppen PJ, del Río González AM, Romero RAA, Pérez C. HIV testing among MSM in Bogotá, Colombia: the role of structural and individual characteristics. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2014; 26:328-344. [PMID: 25068180 PMCID: PMC4121962 DOI: 10.1521/aeap.2014.26.4.328] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study used mixed methods to examine characteristics related to HIV testing among men who have sex with men (MSM) in Bogotá, Colombia. A sample of 890 MSM responded to a computerized quantitative survey. Follow-up qualitative data included 20 in-depth interviews with MSM and 12 key informant interviews. Hierarchical logistic set regression indicated that sequential sets of variables reflecting demographic characteristics, insurance coverage, risk appraisal, and social context each added to the explanation of HIV testing. Follow-up logistic regression showed that individuals who were older, had higher income, paid for their own insurance, had had a sexually transmitted infection, knew more people living with HIV, and had greater social support were more likely to have been tested for HIV at least once. Qualitative findings provided details of personal and structural barriers to testing, as well as inter-relationships among these factors. Recommendations to increase HIV testing among Colombian MSM are offered.
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Abstract
BACKGROUND Describing the undiagnosed HIV-infected population is essential for guiding HIV screening policy, implementing interventions, and resource planning. METHODS We used French national HIV surveillance data and a back-calculation approach to estimate the number of undiagnosed HIV-infected individuals in France and the distribution of time since HIV infection among undiagnosed individuals. We also used data on CD4⁺ cell count decline to assess the CD4⁺ cell count distribution among undiagnosed individuals. RESULTS We estimated that 29,000 [95% confidence interval (CI): 24,200-33,900] individuals were living with undiagnosed HIV infection at the end of 2010. Of these, 28.7% (95% CI: 27.1-30.4) were infected less than a year ago, 16.4% (95% CI: 15.0-17.8) more than 5 years ago, and 59.6% (95% CI: 59.2-59.8) were eligible for antiretroviral treatment (CD4⁺ cell count less than 500 cells/μl) according to the 2010 French guidelines. Men represented 70.0% of the undiagnosed HIV-infected individuals and had lower CD4⁺ cell counts than women. The numbers of undiagnosed infections in MSM, non-French national heterosexuals, and French national heterosexuals were similar (9200, 9300, 10,000, respectively). However, because of differences in group size, undiagnosed HIV prevalence varied significantly between these groups (2.95, 0.36, 0.03%, respectively; P less than 0.001). CONCLUSION Our findings suggest that many undiagnosed HIV-infected individuals were eligible for treatment and, thus, lack of HIV diagnosis is a lost chance for them; many more heterosexuals than MSM will need to be tested to find those undiagnosed; and universal screening of men may be cost-effective, especially in the areas most affected by the epidemic, such as the Paris region.
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Abstract
HIV infection in Western Europe is mainly concentrated among men who have sex with men, heterosexuals who acquired HIV from sub-Saharan African countries, and in people who inject drugs. The rate of newly diagnosed cases of HIV has remained roughly stable since 2004 whereas the number of people living with HIV has slowly increased due to new infections and the success of antiretroviral therapy in prolonging life. An ageing population is gradually emerging that will require additional care. There are large differences across countries in HIV testing rates, proportions of people who present to care with low CD4+ cell counts, accessibility to treatment and care, and rates of retention once in care. Improved collection of HIV surveillance data will benefit countries and help to understand their epidemic better. However, social inequalities experienced by people with HIV still remain in some regions and urgently need to be addressed.
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Affiliation(s)
- Fumiyo Nakagawa
- Research Department of Infection and Population Health, UCL Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | - Andrew N. Phillips
- Research Department of Infection and Population Health, UCL Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | - Jens D. Lundgren
- Copenhagen HIV Programme (CHIP), Department of Infectious Disease (8632), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
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Terlikbayeva A, Zhussupov B, Primbetova S, Gilbert L, Atabekov N, Giyasova G, Ruziev M, Soliev A, Saliev D, El-Bassel N. Access to HIV counseling and testing among people who inject drugs in Central Asia: strategies for improving access and linkages to treatment and care. Drug Alcohol Depend 2013; 132 Suppl 1:S61-4. [PMID: 23916319 PMCID: PMC3858676 DOI: 10.1016/j.drugalcdep.2013.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 07/04/2013] [Accepted: 07/05/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION As a population profoundly affected by the HIV epidemic and in critical need of linkages to HIV treatment and care, PWID in Central Asia remain largely underserved. This paper provides an overview of the current state of HIV testing and counseling in Central Asia for PWID, identifies main barriers leading to gaps in service delivery, and discusses implications for improving strategies that promote HIV testing for PWID. METHODS We reviewed a number of sources for this paper including unpublished government reports, published papers, and Ministries of Health of Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan country progress reports to the UN General Assembly Special Session on HIV/AIDS (UNGASS) for 2012. RESULTS Between 29 and 65% of PLWH in some Central Asian countries have been tested for HIV in the last 12 months. The rates have been increasing in the recent years but still are relatively low. Stigma, discrimination, human rights violations, and repressive legislation are barriers to HTC for people who inject drugs (PWID). CONCLUSION The use of innovative evidence-based HTC models, such as community mobile-vans, self-testing at home, and rapid HIV testing among PWID in Central Asia are discussed and recommendations given regarding amendments in legislation and scaling up of existing community-based pilot projects to support HIV testing among PWID in CA.
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Affiliation(s)
- Assel Terlikbayeva
- Global Health Research Center of Central Asia, Columbia University School of Social Work, Kazakhstan.
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Hoyos J, Belza MJ, Fernández-Balbuena S, Rosales-Statkus ME, Pulido J, de la Fuente L. Preferred HIV testing services and programme characteristics among clients of a rapid HIV testing programme. BMC Public Health 2013; 13:791. [PMID: 23987230 PMCID: PMC3765864 DOI: 10.1186/1471-2458-13-791] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 08/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the current context of diversity and coexistence of HIV testing approaches, limited information exists on test recipient's views of HIV testing services and programme attributes that could ease the testing process and make it more appealing for at risk individuals who don't know their HIV status. This study analyzed ratings given to different testing sites and programme characteristics that might facilitate testing. METHODS We analyzed data from 3120 persons attending a mobile HIV testing programme located on a central street in the gay district of Madrid. RESULTS 64% were men (of which, 55% had had sex with other men), 59.5% were <30 years, 35.4% foreigners, 50.6% had a university degree,71.7% a regular employment, 59.3% reported multiple partners and inconsistent condom use and 56.5% had been tested for HIV. Non Governmental Organizations and specific HIV/STI centres received the maximum rating from over 60% of participants, followed by self-testing (38.9%). Pharmacies (20.8%) and hospital emergency departments (14.2%) were the worst valued testing sites. Over 80% gave the highest rating to having immediate test results, not needing a previous appointment, and free testing, while less than 50% gave the maximum rating to privacy and anonymity. CONCLUSIONS HIV testing services that don't require an appointment, based on free tests with rapid results are most valued by a young, not socially marginalized but high risk sexual exposure population. On the contrary, issues traditionally highly valued by health care providers or AIDS social organizations (privacy and anonymity) are much less valued.
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Affiliation(s)
- Juan Hoyos
- CIBER Epidemiology and Public Health (CIBERESP), C/Monforte de Lemos, nº 35, 28029 Madrid, Spain.
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Alvarez-Del Arco D, Monge S, Caro-Murillo AM, Ramírez-Rubio O, Azcoaga-Lorenzo A, Belza MJ, Rivero-Montesdeoca Y, Noori T, Del Amo J. HIV testing policies for migrants and ethnic minorities in EU/EFTA Member States. Eur J Public Health 2013; 24:139-44. [PMID: 23921295 PMCID: PMC3901314 DOI: 10.1093/eurpub/ckt108] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: In the context of an European Centre for Disease Prevention and Control (ECDC) research project, our objective was to describe current recommendations regarding HIV testing and counselling targeting migrants and ethnic minorities in the European Union/European Economic Area/European Free Trade Association (EU/EEA/EFTA) Member States. Methods: An on-line survey was conducted among 31 EU/EEA/EFTA Member States. The survey inquired on the existence of specific HIV testing and counselling recommendations or policies for migrants and/or ethnic minorities and the year of their publication. Additionally, we performed a review of national recommendations, guidelines or any other policy documents retrieved from an Internet search through the different countries’ competent bodies. Results: Twenty-nine (94%) country representatives responded the survey, and 28 documents from 27 countries were identified. National guidelines on HIV testing are heterogeneous and tailored, according to the epidemiological situation. Twenty-two countries identify migrants and four countries identify ethnic minorities as particularly vulnerable to HIV. Sixteen countries explicitly recommend offering an HIV test to migrants/ethnic minorities. Guidelines especially target people originating from HIV endemic countries, and benefits of HIV early detection are highlighted. HIV testing is not mandatory in any country, but some countries overtly facilitate this practice. Conclusion: Benefits of HIV testing in migrants and ethnic minorities, at both individual and community levels are recognized by many countries. In spite of this, not all countries identify the need to test these groups.
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Champenois K, Cousien A, Cuzin L, Le Vu S, Deuffic-Burban S, Lanoy E, Lacombe K, Patey O, Béchu P, Calvez M, Semaille C, Yazdanpanah Y. Missed opportunities for HIV testing in newly-HIV-diagnosed patients, a cross sectional study. BMC Infect Dis 2013; 13:200. [PMID: 23638870 PMCID: PMC3652743 DOI: 10.1186/1471-2334-13-200] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 04/19/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In France, 1/3 HIV-infected patients is diagnosed at an advanced stage of the disease. We describe missed opportunities for earlier HIV testing in newly-HIV-diagnosed patients. METHODS Cross sectional study. Adults living in France for ≥1 year, diagnosed with HIV-infection ≤6 months earlier, were included from 06/2009 to 10/2010. We collected information on patient characteristics at diagnosis, history of HIV testing, contacts with healthcare settings, and occurrence of HIV-related events 3 years prior to HIV diagnosis. During these 3 years, we assessed whether or not HIV testing had been proposed by the healthcare provider upon first contact in patients notifying that they were MSM or had HIV-related conditions. RESULTS 1,008 newly HIV-diagnosed patients (mean age: 39 years; male: 79%; MSM: 53%; diagnosed with an AIDS-defining event: 16%). During the 3-year period prior to HIV diagnosis, 99% of participants had frequented a healthcare setting and 89% had seen a general practitioner at least once a year. During a contact with a healthcare setting, 91/191 MSM (48%) with no HIV-related conditions, said being MSM; 50 of these (55%) did not have any HIV test proposal. Only 21% (41/191) of overall MSM who visited a healthcare provider received a test proposal. Likewise, 299/364 patients (82%) who sought care for s had a missed opportunity for HIV testing. CONCLUSIONS Under current screening policies, missed opportunities for HIV testing remain unacceptably high. This argues in favor of improving risk assessment, and HIV-related conditions recognition in all healthcare facilities.
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Affiliation(s)
- Karen Champenois
- ATIP-Avenir Inserm: Modélisation, Aide à la Décision, et Coût-Efficacité en Maladies Infectieuses, 152 rue du professeur Yersin, Loos 59120, France.
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Hoyos Miller J, Fernández-Balbuena S, Belza Egozcue MJ, García de Olalla P, Pulido Manzanero J, Molist Señe G, de la Fuente de Hoz L. Time devoted to pre- and post-HIV test counselling in different health services according to participants of a rapid testing program in Madrid, Spain. Enferm Infecc Microbiol Clin 2013; 32:82-6. [PMID: 23582196 DOI: 10.1016/j.eimc.2013.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 01/14/2013] [Accepted: 02/05/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The role of pre- and post-test counselling in new HIV testing strategies to reduce delayed diagnosis has been debated. Data on time devoted to counselling are scarce. One approach to this problem is to explore patients' views on the time devoted to counselling by venue of their last HIV test. METHODS We analysed data from 1568 people with a previous HIV test who attended a mobile HIV testing program in Madrid between May and December 2008. RESULTS The majority (71%) were men (48% had had sex with other men), 51% were <30 years, 40% were foreigners, 56% had a university degree, and 40% had the most recent HIV test within the last year. As regards pre-test counselling, 30% stated they were told only that they would receive the test; 26.3% reported <10 min; 20.4% about 10 min; and 24.2%, 15 min or more. For post-test counselling: 40.2% stated they were told only that the test was negative; 24.9% reported 2-6 min; 16.4% about 10 min; and 18.5%, 15 min or more. The percentage of participants who reported no counselling time was higher among those tested in general health services: primary care, hospital settings and private laboratories (over 40% in pre-test, over 50% in post-test counselling). Women received less counselling time than men in almost all settings. CONCLUSION Policies to expand HIV testing in general health services should take this current medical behaviour into account. Any mention of the need for counselling can be a barrier to expansion, because HIV is becoming less of a priority in developed countries. Oral consent should be the only requirement.
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Affiliation(s)
- Juan Hoyos Miller
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Sonia Fernández-Balbuena
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
| | - María José Belza Egozcue
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | | | - Jose Pulido Manzanero
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Gemma Molist Señe
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis de la Fuente de Hoz
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
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Berg RC. Predictors of never testing for HIV among a national online sample of men who have sex with men in Norway. Scand J Public Health 2013; 41:398-404. [DOI: 10.1177/1403494813483216] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: HIV testing among persons at risk of infection has become a cornerstone in prevention and control of the HIV/AIDS epidemic. Understanding factors related to HIV testing is thus fundamental for informing prevention and testing initiatives. Aims: This study aims to identify prevalence of, and factors that are associated with, HIV testing. Methods: This study analysed data from 2011 HIV-negative and untested MSM collected in a national, online survey. Results: More than a third (35.3%) of MSM had never received an HIV test result. Multivariate logistic regression results showed that compared with men ever tested, untested men were younger (odds ratio, OR 0.95), closeted about same sex attractions (OR 3.84), had low educational level (OR 0.47), low HIV transmission and testing knowledge (OR 0.98), did not believe that HIV testing is free (OR 0.27), had never taken a test for sexually transmitted infection (OR 0.08), and had not engaged in sex abroad in the past year (OR 0.69). Conclusions: These results underscore the urgency in efforts to reduce testing delay among especially young MSM and point to the need for additional public health resources and prevention marketing efforts to be directed towards increasing awareness of HIV testing.
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Affiliation(s)
- Rigmor C. Berg
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
- School of Public Health, University of Texas Houston, Houston, USA
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25
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Aebi-Popp K, Mulcahy F, Rudin C, Hoesli I, Gingelmaier A, Lyons F, Thorne C. National Guidelines for the prevention of mother-to-child transmission of HIV across Europe - how do countries differ? Eur J Public Health 2013; 23:1053-8. [DOI: 10.1093/eurpub/ckt028] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Johnson M, Afonina L, Haanyama O. The challenges of testing for HIV in women: experience from the UK and other European countries. Antivir Ther 2013; 18 Suppl 2:19-25. [DOI: 10.3851/imp2637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 10/26/2022]
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Manirankunda L, Loos J, Debackaere P, Nöstlinger C. "It is not easy": challenges for provider-initiated HIV testing and counseling in Flanders, Belgium. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2012; 24:456-468. [PMID: 23016506 DOI: 10.1521/aeap.2012.24.5.456] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study identified physicians' HIV testing practices and their barriers toward implementing provider-initiated HIV testing and counseling (PITC) for Sub-Saharan African migrants (SAM) in Flanders, Belgium. In-depth interviews were conducted on a purposive sample of 20 physicians (ten GPs and ten internists). GPs performed mainly patient-initiated tests, while internists carried out tests based on disease indicators and risk behavior. For the most part, World Health Organization (WHO) guidelines were not followed. Study participants were not in favor of implementing PITC. Reasons included lack of information on the HIV epidemic among SAM, fear of stigmatizing patients, perceiving testing as unethical for undocumented patients, questionable relevance of pre-test counseling, lack of expertise in discussing sexuality, language barriers, lack of time, and the absence of a national or regional HIV testing policy. Implementing PITC will require appropriate training of service providers. Also, supporting policies should be developed with the participation of stakeholders encouraging "normalization" of HIV testing.
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Flowers P, Knussen C, Li J, McDaid L. Has testing been normalized? An analysis of changes in barriers to HIV testing among men who have sex with men between 2000 and 2010 in Scotland, UK. HIV Med 2012; 14:92-8. [PMID: 22934820 PMCID: PMC3561706 DOI: 10.1111/j.1468-1293.2012.01041.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2012] [Indexed: 01/04/2023]
Abstract
OBJECTIVES This paper examines changes in barriers to HIV testing amongst gay men. We compared data collected in 2000 and 2010 to assess changes in HIV testing behaviours, in community-level perceptions of barriers to HIV testing, and in the relative contributions of barrier measures. METHODS Cross-sectional surveys were conducted within the commercial gay scene in Glasgow with good response rates (78% and 62%) using a form of time and location sampling. RESULTS Major changes in HIV testing behaviours were observed between 2000 and 2010 (30.6% increase in testing within previous year). At the community level, the perceived benefits of testing [t (1284) = -8.46; P < 0.001] and the norm for HIV testing [t (1236) = -11.62; P < 0.001] increased; however, other perceived barriers did not change (fear of a positive result, clinic-related barriers and attitudes to sex with HIV-positive men). Multinomial logistic regression showed that fear of a positive test result remained a key barrier to HIV testing; however, a significant fear × year of survey interaction indicated that fear played a lesser role in differentiating those who had never been tested from those who had been tested in 2010 than it had in 2000. CONCLUSIONS These findings suggest the partial normalization of HIV testing. While some barriers have reduced, other key barriers remain important. Interventions should be designed and evaluated that attend to both the biomedical and the psychosocial aspects of HIV testing (e.g. the meaning of positive test results, the sexual exclusion of positive men, and HIV-related stigma).
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Affiliation(s)
- P Flowers
- Department of Psychology and Allied Health Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
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Søgaard OS, Lohse N, Østergaard L, Kronborg G, Røge B, Gerstoft J, Sørensen HT, Obel N. Morbidity and risk of subsequent diagnosis of HIV: a population based case control study identifying indicator diseases for HIV infection. PLoS One 2012; 7:e32538. [PMID: 22403672 PMCID: PMC3293814 DOI: 10.1371/journal.pone.0032538] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 01/31/2012] [Indexed: 12/12/2022] Open
Abstract
Background Early identification of persons with undiagnosed HIV infection is an important health care issue. We examined associations between diseases diagnosed in hospitals and risk of subsequent HIV diagnosis. Methods In this population-based case control study, cases were persons with incident HIV infection diagnosed in Denmark between 1 January 1995 and 1 June 2008. Risk-set sampling was used to identify 19 age- and gender-matched population controls for each HIV case, using the HIV diagnosis date as the index date for both cases and controls. Prior hospital diagnoses obtained from Danish medical databases were first categorized into 22 major disease categories (excluding AIDS-defining diseases except tuberculosis) and then subdivided into 161 subcategories, allowing us to examine specific diseases as potential HIV indicators by conditional logistic regression. Results The study included 2,036 HIV cases and 35,718 controls. Persons with the following disease categories had a high risk of HIV diagnosis during the subsequent 5-year period: sexually transmitted infections and viral hepatitis (adjusted odds ratio [aOR] = 12.3, 95% CI: 9.60–15.7), hematological diseases (aOR = 4.28, 3.13–5.85), lower respiratory tract infections (aOR = 3.98, 3.14–5.04)), CNS infections (aOR = 3.44, 1.74–6.80), skin infections (aOR = 3.05, 2.47–3.75), other infections (aOR = 4.64, 3.89–5.54), and substance abuse (aOR = 2.60, 2.06–3.29). Several specific diseases were associated with aORs >20 including syphilis, hepatitis A, non “A” viral hepatitis, herpes zoster, candida infection, endocarditis, thrombocytopenia, and opioid abuse. Conclusions Targeted testing for HIV in patients diagnosed with diseases associated with HIV may lead to earlier treatment and thereby reduced morbidity, mortality and HIV transmission.
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Affiliation(s)
- Ole S Søgaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark.
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30
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Waters L, Sabin CA. Late HIV presentation: epidemiology, clinical implications and management. Expert Rev Anti Infect Ther 2012; 9:877-89. [PMID: 21973300 DOI: 10.1586/eri.11.106] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Late presentation of HIV is common and is associated with several adverse outcomes including an increased risk of clinical progression, blunted immune recovery on highly active antiretroviral therapy and a greater risk of drug toxicity. Late presenters may have higher rates of poor adherence, exacerbated by the same factors that contribute to their late diagnosis, such as lack of knowledge about HIV and the benefits of highly active antiretroviral therapy. We review the definitions of, risk factors for and subsequent impact of late presentation. Evidence regarding how and when to start antiretroviral therapy, and with which agents, will be discussed, as well as issues surrounding vaccination and opportunistic infection prophylaxis for individuals with a low CD4 count. Finally, strategies to increase HIV testing uptake to reduce late presentation will be summarized.
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Affiliation(s)
- Laura Waters
- St Stephens Research, St Stephens Centre, Chelsea & Westminster Hospital, 369 Fulham Road, London, UK
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Lorenc T, Marrero-Guillamón I, Llewellyn A, Aggleton P, Cooper C, Lehmann A, Lindsay C. HIV testing among men who have sex with men (MSM): systematic review of qualitative evidence. HEALTH EDUCATION RESEARCH 2011; 26:834-46. [PMID: 21873612 DOI: 10.1093/her/cyr064] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We conducted a systematic review of qualitative evidence relating to the views and attitudes of men who have sex with men (MSM) concerning testing for HIV. Studies conducted in high-income countries (Organisation for Economic Co-operation and Development members) since 1996 were included. Seventeen studies were identified, most of gay or bisexual men. Data were analysed using a thematic analysis methodology. The uncertainty of unknown HIV status is an important motive for testing; however, denial is also a common response to uncertainty. Fear of the consequences of a positive HIV test is widespread and may take several forms. A sense of responsibility towards oneself or one's partner may be a motive for testing. The perception of stigma, from other gay men or from the wider culture, is a barrier to testing. Gay and other MSM have clear preferences regarding testing services, particularly for those that are community based, include non-judgemental and gay-positive service providers, and offer a high degree of confidentiality.
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Affiliation(s)
- Theo Lorenc
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, University of London, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Lapostolle A, Massari V, Chauvin P. Time since the last HIV test and migration origin in the Paris metropolitan area, France. AIDS Care 2011; 23:1117-27. [PMID: 21500026 PMCID: PMC3472401 DOI: 10.1080/09540121.2011.554522] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In France, the newly diagnosed infection rate was 372/100,000 for African immigrants versus 6/100,000 for the French-born population in 2008. In addition, people from sub-Saharan countries were at higher risk for late diagnosis than native-born French despite their more frequent use of HIV testing. The purpose of this study was to compare the mean time since the last HIV test according to migration origin. This study used data from the SIRS (a French acronym for health, inequalities, and social ruptures) cohort, which, in 2005, included 3023 households representative of the greater Paris area. HIV testing uptake and the time since the last test were studied in relation to socio-economic factors, psychosocial characteristics, and migration origin. Multivariate ANOVA analyses were performed using Stata 10. People from sub-Saharan Africa were more likely to have been tested in their lifetime (78.51%) than those of French (56.19%) or Maghreb (39.74%) origin (p<0.0000). The mean time, in years, since the last HIV test was shorter among sub-Saharan immigrants and Maghreb immigrants (2.15 and 2.53 years, respectively) than among native-born French (4.84 years) (F=12.67; p<0.0000). These differences remained significant even after adjusting for gender, age, number of steady relationships, time lived in France, and difficulty reading and/or writing French (F=5.73; p=0.0007). A gender analysis revealed the same pattern for both sexes, with greater differences in the mean duration by migration origin for women. These results and recent epidemiological data seem to show that since the early 2000s, measures aimed at increasing HIV testing and decreasing late diagnosis in sub-Saharan immigrants have been effective.
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Deblonde J, Meulemans H, Callens S, Luchters S, Temmerman M, Hamers FF. HIV testing in Europe: mapping policies. Health Policy 2011; 103:101-10. [PMID: 21794943 DOI: 10.1016/j.healthpol.2011.06.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 06/20/2011] [Accepted: 06/20/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES In the absence of treatment and in the context of discrimination, HIV testing was embedded within exceptional procedures. With increasing treatment effectiveness, early HIV diagnosis became important, calling for the normalization of testing. National HIV testing policies were mapped to explore the characteristics and variations across European countries. METHODS Key informants within the health authorities of all EU/EEA countries were questioned on HIV testing policies, which were assessed within a conceptual framework and the level of exceptionalism and normalization was scored based on defined attributes. RESULTS Twenty-four out of 31 countries participated in the survey. Policies tended to support confidential voluntary testing, informed consent, and counselling. In the majority of countries, specific groups were targeted for provider-initiated testing. Taking together all attributes of HIV testing, 14 countries obtained a high score for exceptionalism, while only 3 achieved a high score on normalization. Italy, Lithuania and Romania had primarily exceptional procedures; Norway leant more towards normalization; Netherlands, the United Kingdom, and Denmark scored high in both. CONCLUSIONS In most EU/EEA countries, policies are integrating HIV testing in health care settings, through voluntary and targeted testing strategies. Current HIV testing policies exhibited a high level of exceptionalism with varying degrees of normalization. Further research should compare HIV testing policies with practices.
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Affiliation(s)
- Jessika Deblonde
- Ghent University, International Centre for Reproductive Health, De Pintelaan 185 P3, 9000 Ghent, Belgium.
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Hemminki E, Regushevskaya E, Rüütel K, Barros H, Niemiec T, Nikula M, Kuusio H, Deblonde J. Is HIV testing normal or special? Opinions of health professionals in four European countries in 2008. AIDS Care 2011; 24:91-9. [DOI: 10.1080/09540121.2011.592819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Elina Hemminki
- a Department of Children, Young People and Families and Public Health, National Institute for Health and Welfare (THL) , University of Helsinki , Helsinki , Finland
| | - Elena Regushevskaya
- a Department of Children, Young People and Families and Public Health, National Institute for Health and Welfare (THL) , University of Helsinki , Helsinki , Finland
| | - Kristi Rüütel
- b Infectious Diseases and Drug Abuse Prevention Department , National Institute for Health Development , Tallinn , Estonia
| | - Henrique Barros
- c Department of Hygiene & Epidemology , University of Porto Medical School , Porto , Portugal
| | | | - Minna Nikula
- a Department of Children, Young People and Families and Public Health, National Institute for Health and Welfare (THL) , University of Helsinki , Helsinki , Finland
| | - Hannamaria Kuusio
- e Service System Department , National Institute for Health & Welfare , Helsinki , Finland
| | - Jessika Deblonde
- f International Centre for Reproductive Health , Ghent University , Ghent , Belgium
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Yazdanpanah Y, Sloan CE, Charlois-Ou C, Le Vu S, Semaille C, Costagliola D, Pillonel J, Poullié AI, Scemama O, Deuffic-Burban S, Losina E, Walensky RP, Freedberg KA, Paltiel AD. Routine HIV screening in France: clinical impact and cost-effectiveness. PLoS One 2010; 5:e13132. [PMID: 20976112 PMCID: PMC2956760 DOI: 10.1371/journal.pone.0013132] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 09/05/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In France, roughly 40,000 HIV-infected persons are unaware of their HIV infection. Although previous studies have evaluated the cost-effectiveness of routine HIV screening in the United States, differences in both the epidemiology of infection and HIV testing behaviors warrant a setting-specific analysis for France. METHODS/PRINCIPAL FINDINGS We estimated the life expectancy (LE), cost and cost-effectiveness of alternative HIV screening strategies in the French general population and high-risk sub-populations using a computer model of HIV detection and treatment, coupled with French national clinical and economic data. We compared risk-factor-based HIV testing ("current practice") to universal routine, voluntary HIV screening in adults aged 18-69. Screening frequencies ranged from once to annually. Input data included mean age (42 years), undiagnosed HIV prevalence (0.10%), annual HIV incidence (0.01%), test acceptance (79%), linkage to care (75%) and cost/test (€43). We performed sensitivity analyses on HIV prevalence and incidence, cost estimates, and the transmission benefits of ART. "Current practice" produced LEs of 242.82 quality-adjusted life months (QALM) among HIV-infected persons and 268.77 QALM in the general population. Adding a one-time HIV screen increased LE by 0.01 QALM in the general population and increased costs by €50/person, for a cost-effectiveness ratio (CER) of €57,400 per quality-adjusted life year (QALY). More frequent screening in the general population increased survival, costs and CERs. Among injection drug users (prevalence 6.17%; incidence 0.17%/year) and in French Guyana (prevalence 0.41%; incidence 0.35%/year), annual screening compared to every five years produced CERs of €51,200 and €46,500/QALY. CONCLUSIONS/SIGNIFICANCE One-time routine HIV screening in France improves survival compared to "current practice" and compares favorably to other screening interventions recommended in Western Europe. In higher-risk groups, more frequent screening is economically justifiable.
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Affiliation(s)
- Yazdan Yazdanpanah
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Tourcoing, France.
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Antinori A, Johnson M, Moreno S, Rockstroh JK, Yazdanpanah Y. Introduction to late presentation for HIV treatment in Europe. Antivir Ther 2010; 15 Suppl 1:1-2. [PMID: 20442454 DOI: 10.3851/imp1521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This publication is based on the proceedings of a meeting of European HIV experts convened in Windsor, UK, in March 2009. The meeting reviewed data in four key topics affecting the late presentation of HIV patients in Europe: the definition and epidemiology of late presentation, its medical and societal consequences, the need for earlier HIV testing and strategies for management of late-presenting patients. Each topic is discussed in detail here. A concluding article presents recommendations in each topic that were developed at the meeting to address the continuing challenge represented by late presentation for HIV treatment.
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Warwick Z. Barriers to the implementation of the UK HIV testing guidelines in secondary care: how many are medical? Int J STD AIDS 2010; 21:205-6. [PMID: 20215628 DOI: 10.1258/ijsa.2009.009269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A survey of consultants in Plymouth Teaching Hospital was performed to identify barriers to HIV testing in secondary care. Testing practices were compared with those recommended by the UK HIV testing guidelines and barriers to testing described.
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Affiliation(s)
- Z Warwick
- Genitourinary Medicine Department, Plymouth Hospitals NHS Trust, Plymouth, UK.
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Deblonde J, De Koker P, Hamers FF, Fontaine J, Luchters S, Temmerman M. Barriers to HIV testing in Europe: a systematic review. Eur J Public Health 2010; 20:422-32. [PMID: 20123683 DOI: 10.1093/eurpub/ckp231] [Citation(s) in RCA: 235] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the European Union (EU) and neighbouring countries, HIV/AIDS, of all infectious diseases, has one of the highest morbidity and mortality rates. An estimated 30% of people living with HIV are unaware of their infection, and may therefore not benefit from timely treatment or may transmit HIV to others, unknowingly. Evidence shows that opportunities are being missed to diagnose HIV infections in EU Member States, particularly in regular health care settings. There is a need to better understand the barriers to HIV testing and counselling with the aim to contribute to the decrease of the number of undiagnosed people. METHODS A systematic review of literature on HIV testing barriers in Europe was conducted, applying a free text strategy with a set of search terms. RESULTS A total of 24 studies published in international peer-reviewed journals and meeting the review's eligibility criteria were identified. Fourteen studies report on barriers at the level of the patient; six on barriers at health care provider level and seven on institutional barriers referring to the policy level. The barriers described are centralized around low-risk perception; fear and worries; accessibility of health services, reluctance to address HIV and to offer the test; and scarcity of financial and well trained human resources. CONCLUSIONS Some barriers to HIV testing and counselling have been illustrated in the literature. Nevertheless, there is lack of structured information on barriers considering (i) legal, administrative and financial factors, (ii) attitudes and practices of health care providers and (iii) perception of patients. Such data is critical to improve effectiveness of HIV testing and counselling.
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Affiliation(s)
- Jessika Deblonde
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium.
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Yazdanpanah Y, Lange J, Gerstoft J, Cairns G. Earlier testing for HIV – how do we prevent late presentation? Antivir Ther 2010; 15 Suppl 1:17-24. [DOI: 10.3851/imp1526] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Partridge DG, Collini P, McKendrick MW. HIV testing: the boundaries. A survey of HIV testing practices and barriers to more widespread testing in a British teaching hospital. Int J STD AIDS 2009; 20:427-8. [PMID: 19451332 DOI: 10.1258/ijsa.2008.008467] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A survey of HIV testing practices among registrars of all admitting specialties within Sheffield Teaching Hospitals National Health Service Trust was performed in 2007. Respondents from most specialties tested patients for HIV infrequently and several barriers were identified, which prevented testing even when the diagnosis was considered.
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Affiliation(s)
- D G Partridge
- Department of Infectious Diseases, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
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Madeddu G, Rezza G, Mura MS. Trends in the European HIV/AIDS epidemic: a perspective from Italy. Expert Rev Anti Infect Ther 2009; 7:25-36. [PMID: 19622055 DOI: 10.1586/14787210.7.1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The HIV/AIDS epidemic represents one of the major public-health challenges in present days. Despite the relevant improvement in the prognosis of HIV disease following the introduction of highly active antiretroviral therapy (HAART), numerous new challenges are progressively emerging as patient characteristics evolve. In this article, we give an insight into more actual topics in the HIV/AIDS epidemic in Italy and Europe, including recent epidemiological trends, emerging drug resistance and non-B-subtype circulation, the lights and shadows of HAART and the potential of HARRT to reduce sexual transmission of HIV.
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Affiliation(s)
- Giordano Madeddu
- Department of Infectious Diseases, University of Sassari, Via De Nicola 1, 07100 Sassari, Italy.
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