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Thomas E, Ekperi L, LeBlanc TT, Adams EE, Wilt GE, Molinari NA, Carbone EG. Vulnerabilities Associated with Post-disaster Declines in HIV-testing: Decomposing the Impact of Hurricane Sandy. PLOS CURRENTS 2018; 10:ecurrents.dis.e735c842bab99a2f564cc9a502394bbe. [PMID: 30210933 PMCID: PMC6108781 DOI: 10.1371/currents.dis.e735c842bab99a2f564cc9a502394bbe] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Using Interrupted Time Series Analysis and generalized estimating equations, this study identifies factors that influence the size and significance of Hurricane Sandy's estimated impact on HIV testing in 90 core-based statistical areas from January 1, 2011 to December 31, 2013. METHODS Generalized estimating equations were used to examine the effects of sociodemographic and storm-related variables on relative change in HIV testing resulting from Interrupted Time Series analyses. RESULTS There is a significant negative relationship between HIV prevalence and the relative change in testing at all time periods. A one unit increase in HIV prevalence corresponds to a 35% decrease in relative testing the week of the storm and a 14% decrease in relative testing at week twelve. Building loss was also negatively associated with relative change for all time points. For example, a one unit increase in building loss at week 0 corresponds with an 8% decrease in the relative change in testing (p=0.0001) and a 2% at week twelve (p=0.001). DISCUSSION Our results demonstrate that HIV testing can be negatively affected during public health emergencies. Communities with high percentages of building loss and significant HIV disease burden should prioritize resumption of testing to support HIV prevention.
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Affiliation(s)
- Erin Thomas
- Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response, Office of the Director, Office of Science and Public Health Practice (OSPHP)
| | - Linda Ekperi
- Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response, Division of State and Local Readiness, Applied Science and Evaluation Branch (ASEB)
| | - Tanya Telfair LeBlanc
- Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response, Division of State and Local Readiness, Applied Science and Evaluation Branch (ASEB)
| | - Erica Elaine Adams
- Centers for Disease Control and Prevention, Office of the Director, Division of Toxicology and Human Health Sciences, Geospatial Research, Analysis, and Services Program (GRASP)
| | - Grete E Wilt
- Centers for Disease Control and Prevention, Office of the Director, Division of Toxicology and Human Health Sciences, Geospatial Research, Analysis, and Services Program (GRASP)
| | - Noelle-Angelique Molinari
- Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response, Division of State and Local Readiness, Applied Science and Evaluation Branch (ASEB)
| | - Eric G Carbone
- Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response, Office of the Director, Office of Science and Public Health Practice (OSPHP)
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Merchant RC, Liu T, Clark MA, Carey MP. Facilitating HIV/AIDS and HIV testing literacy for emergency department patients: a randomized, controlled, trial. BMC Emerg Med 2018; 18:21. [PMID: 29986662 PMCID: PMC6038177 DOI: 10.1186/s12873-018-0172-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/26/2018] [Indexed: 11/17/2022] Open
Abstract
Background Although this has not been fully studied, videos and pictorial brochures might be equivalent methods of delivering HIV/AIDS and HIV testing information to emergency departments (ED) patients. It also is not known how well or for how long such knowledge is retained, if this information should be tailored according to patient health literacy, and if retention of this knowledge impacts future HIV testing behavior. Methods We will conduct a multi-site, randomized, controlled, longitudinal trial among 600 English- and 600 Spanish-speaking 18–64-year-old ED patients to investigate these questions. We will stratify our sample within language (English vs. Spanish) by health literacy level (lower vs. higher) and randomly assign patients to receive HIV/AIDS and HIV testing information by video or pictorial brochure. All patients will be tested for HIV in the ED. At 12-months post-enrollment, we will invite participants to be tested again for HIV. As primary aims, we will compare the efficacy of pictorial brochures and videos in improving short-term (in ED) HIV/AIDS and HIV testing knowledge and retaining this knowledge over 12 months. We will determine if and how short-term improvement and longer-term retention of knowledge interacts with information delivery mode (pictorial brochure or video), patient health literacy level (lower or higher), and language (English or Spanish). As secondary aims, using the Information-Motivation-Behavioral Skills (IMB) model as a heuristic framework, we will measure constructs from the IMB model relevant to our study, and assess their impact on HIV re-testing behavior; we will also examine the moderating influences of information delivery mode, language, and health literacy level. In addition, we will explore simplified screening strategies to identify ED patients with lower health literacy as ways to implement a tailored approach to HIV/AIDS and HIV testing information delivery in EDs. Discussion Study findings will guide ED-based delivery of HIV/AIDS and HIV testing information; that is, whether delivery modes (video or pictorial brochure) should be selected for patients by language and/or health literacy level. The results also will inform EDs when, how, and for whom information needs to be provided for those undergoing testing again for HIV within a one-year period. Trial registration ClinicalTrials.gov Identifier: NCT02284451. Posted November 6, 2014. Electronic supplementary material The online version of this article (10.1186/s12873-018-0172-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, 02906, USA
| | - Melissa A Clark
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Ave, Providence, RI, 02906, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, 02906, USA
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Bruhn R, Moreno E, Sabino EC, Ferreira NAF, Carneiro-Proietti ABF, Lopes MED, Sampaio D, Loureiro P, Custer B, Goncalez TT. Self-reported historic human immunodeficiency virus (HIV) testing in a Brazilian blood donor HIV case-control study. Transfusion 2016; 56:2857-2867. [PMID: 27716930 DOI: 10.1111/trf.13792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/06/2016] [Accepted: 06/28/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND There has been increased worldwide emphasis on the many benefits of human immunodeficiency virus (HIV) serostatus awareness for both infection prevention and improved treatment outcomes. Previous studies indicate that donors may use blood donation to be tested; the objectives of this analysis were to assess, among donors with previously undisclosed risk behavior in the 12 months before donation, the frequency of those who have previously been tested for HIV and the demographic and behavioral factors associated with such testing. STUDY DESIGN AND METHODS In this secondary analysis from an HIV case-control study of blood donors in Brazil, we analyzed the response to the question, "Other than blood donation, have you ever been tested for HIV?" Demographic and disclosed risk behaviors associated with previous testing were determined. RESULTS The study included 341 HIV-positive cases and 791 HIV-negative controls (1:2 case/control ratio). Overall, 31% of blood donors (40% of cases and 26% of controls) reported having been tested for HIV outside of blood donation. History of HIV testing varied according to sex, HIV status, and reported sexual risk behavior. CONCLUSION Although it is encouraging that previous testing was more frequent in donors with acknowledged sexual risk behavior in Brazil, 60% still had not been tested for HIV outside of the blood donation setting. Educating donors on the importance of not using blood centers as a means to get tested for HIV in Brazil, especially if they engage in higher risk behaviors, and seeking alternate testing venues instead could improve the safety of donated blood.
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Affiliation(s)
- Roberta Bruhn
- Blood Systems Research Institute, Epidemiology, San Francisco, California
| | - Elizabeth Moreno
- Fundação Hemominas/Hemocentro de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ester C Sabino
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, Brazil.,Department of Infectious Disease, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Divaldo Sampaio
- Fundação Hemope/Hemocentro de Pernambuco, Recife, Pernambuco, Brazil
| | - Paula Loureiro
- Fundação Hemope/Hemocentro de Pernambuco, Recife, Pernambuco, Brazil.,University of Pernambuco, FCM, Fundação Hemope, Recife, Pernambuco, Brazil
| | - Brian Custer
- Blood Systems Research Institute, Epidemiology, San Francisco, California
| | - Thelma T Goncalez
- Blood Systems Research Institute, Epidemiology, San Francisco, California
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Williams MV, Derose KP, Aunon F, Kanouse DE, Bogart LM, Griffin BA, Haas AC, Collins DO. Church-Based HIV Screening in Racial/Ethnic Minority Communities of California, 2011-2012. Public Health Rep 2016; 131:676-684. [PMID: 28123208 DOI: 10.1177/0033354916662641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Community-based human immunodeficiency virus (HIV) testing at religious congregations has been proposed as a potentially effective way to increase screening among disproportionately affected populations, such as those self-identifying as African American and Latino. Although congregations may provide reach into these communities, the extent to which church-based HIV testing alleviates access barriers, identifies new cases, and reaches people at increased risk for HIV is not well documented. We examined the results of an HIV testing program that was conducted as part of a larger intervention aimed at reducing HIV stigma at five churches in Los Angeles County, California, in 2011-2012. HIV screening identified one positive result in 323 tests but reached a substantial proportion of people who had not been tested before, including many who lacked health insurance. Although this approach may not be an efficient way to identify cases of previously unknown HIV infection, it could help achieve universal testing goals.
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Affiliation(s)
| | | | | | | | - Laura M Bogart
- Harvard Medical School and Boston Children's Hospital, Boston, MA, USA
| | | | | | - Deborah Owens Collins
- Department of Health and Human Services, City of Long Beach, Physician Services Bureau, Long Beach, CA, USA
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Felsen UR, Bellin EY, Cunningham CO, Zingman BS. Unknown HIV Status in the Emergency Department: Implications for Expanded Testing Strategies. J Int Assoc Provid AIDS Care 2015; 15:313-9. [PMID: 25999330 DOI: 10.1177/2325957415586261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The authors sought to determine the prevalence of unknown HIV status among emergency department (ED) patients, how it has changed over time, and whether it differs according to patient characteristics. METHODS The authors used electronic medical record data to identify whether HIV status was known or unknown among patients aged ≥13 seen in the ED of a large, urban medical center between 2006 and 2011. The authors used multivariate logistic regression to identify the characteristics associated with unknown HIV status. RESULTS The prevalence of unknown HIV status decreased each year, from 87.7% in 2006 to 74.9% in 2011 (P < .001). Characteristics associated with unknown HIV status included being nonblack, in the youngest and oldest age-groups, and nonpublically insured. Compared to men, women without prior pregnancy were equally likely to have unknown HIV status, but women with prior pregnancy were significantly less likely to have unknown HIV status. CONCLUSION The prevalence of unknown HIV status is decreasing, but in 2011 75% of ED patients aged ≥13 still had unknown status, and it was associated with specific patient characteristics. Understanding the trends in the prevalence of unknown HIV status and how it is associated with patient characteristics should inform the design and implementation of expanded HIV-testing strategies.
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Affiliation(s)
- Uriel R Felsen
- Division of Infectious Diseases, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Eran Y Bellin
- Division of Infectious Diseases, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Chinazo O Cunningham
- Division of Infectious Diseases, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Barry S Zingman
- Division of Infectious Diseases, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
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6
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Chappuis M, Pauti MD, Tomasino A, Fahet G, Cayla F, Corty JF. Knowledge of HIV and hepatitis B and C status among people living in extreme poverty in France, in 2012. Med Mal Infect 2015; 45:72-7. [PMID: 25660328 DOI: 10.1016/j.medmal.2015.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 09/08/2014] [Accepted: 01/14/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE "Médecins du Monde" healthcare centers receive individuals living in extremely precarious conditions for primary health care; 94% of these are foreigners. These medical consultations are an opportunity to discuss their serological status and to offer them screening tests. PATIENTS AND METHOD Two standardized questionnaires were implemented in all healthcare centers in 2000. The medical record covers knowledge of HIV and hepatitis B and C status. RESULTS 41,033 consultations were given in 2012 in the 20 healthcare centers, for 23,181 patients. Only 29% of the patients knew their hepatitis status and 35% their HIV status. 42% of French patients were unaware of their HIV status compared to 67% of foreign patients. The lack of knowledge of foreign patients' HIV status was more frequent among men and in age classes<20 and>60 years of age. Patients from non-EU Europe, the Middle East, and Asia were significantly more likely to be unaware of their HIV status compared to people from Sub-Saharan Africa and Oceania/America. The rate of foreigners not having undergone screening remained stable, regardless of the duration of residence in France. CONCLUSION These results highlight the need to develop specific prevention projects among immigrant populations in precarious situations.
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Affiliation(s)
- M Chappuis
- Médecins du Monde, 62, rue Marcadet, 75018 Paris, France.
| | - M-D Pauti
- Médecins du Monde, 62, rue Marcadet, 75018 Paris, France
| | - A Tomasino
- Médecins du Monde, 62, rue Marcadet, 75018 Paris, France
| | - G Fahet
- Observatoire régional de la santé de Midi Pyrénées, 37, allées Jules-Guesde, 31073 Toulouse cedex, France
| | - F Cayla
- Observatoire régional de la santé de Midi Pyrénées, 37, allées Jules-Guesde, 31073 Toulouse cedex, France
| | - J-F Corty
- Médecins du Monde, 62, rue Marcadet, 75018 Paris, France
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Durall PS, Enciso R, Rhee J, Mulligan R. Attitude toward rapid HIV testing in a dental school clinic. SPECIAL CARE IN DENTISTRY 2014; 35:29-36. [PMID: 25329819 DOI: 10.1111/scd.12096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Detection of HIV infection provides an opportunity for transmission reduction and lifesaving treatment strategies. This study examined patients' willingness to take a routine, rapid oral HIV test if offered at a dental school clinic. For fifteen days in 2011, an anonymous survey containing demographic information and willingness to be tested questions was offered to all patients awaiting treatment. A total of 383 of 443 people approached, answered the questionnaire (40.2% Hispanic, 27.2% Caucasian, and 19.3% African American) with 58.8% indicating that they had been previously tested for HIV (as compared to the California mean of 39.2%). Patients were highly likely to participate (84.0% of Hispanics, 63.6% of Caucasians, 80.0% of African Americans and 66.7% of Asians) in a free HIV rapid test when given the opportunity. Of respondents never tested before, 62.6% reported a willingness to be tested in this study. HIV screening in a dental clinic during routine visits may allow new undiagnosed cases to be detected with subsequent referral into medical treatment.
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Affiliation(s)
- Piedad Suarez Durall
- Assistant Professor of Clinical Dentistry and Section Chair of Geriatrics and Special Patients, Division of Dental Public Health and Pediatric Dentistry, Ostrow School of Dentistry, University of Southern California, Los Angeles, California
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8
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Felsen UR, Bellin EY, Cunningham CO, Zingman BS. Development of an electronic medical record-based algorithm to identify patients with unknown HIV status. AIDS Care 2014; 26:1318-25. [PMID: 24779521 DOI: 10.1080/09540121.2014.911813] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Individuals with unknown HIV status are at risk for undiagnosed HIV, but practical and reliable methods for identifying these individuals have not been described. We developed an algorithm to identify patients with unknown HIV status using data from the electronic medical record (EMR) of a large health care system. We developed EMR-based criteria to classify patients as having known status (HIV-positive or HIV-negative) or unknown status and applied these criteria to all patients seen in the affiliated health care system from 2008 to 2012. Performance characteristics of the algorithm for identifying patients with unknown HIV status were calculated by comparing a random sample of the algorithm's results to a reference standard medical record review. The algorithm classifies all patients as having either known or unknown HIV status. Its sensitivity and specificity for identifying patients with unknown status are 99.4% (95% CI: 96.5-100%) and 95.2% (95% CI: 83.8-99.4%), respectively, with positive and negative predictive values of 98.7% (95% CI: 95.5-99.8%) and 97.6% (95% CI: 87.1-99.1%), respectively. Using commonly available data from an EMR, our algorithm has high sensitivity and specificity for identifying patients with unknown HIV status. This algorithm may inform expanded HIV testing strategies aiming to test the untested.
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Affiliation(s)
- Uriel R Felsen
- a Division of Infectious Diseases , Montefiore Medical Center , Bronx , NY , USA
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9
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Social Determinants of Health Associated with Self-Reported HIV Testing among Women. IRANIAN JOURNAL OF PUBLIC HEALTH 2013; 42:436-42. [PMID: 23785685 PMCID: PMC3684732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 03/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND There currently is lack of knowledge about HIV testing practices in Iran. The purpose of this pilot study was to evaluate the prevalence of self-reported HIV testing and its associated factors among women. METHODS This cross-sectional study was conducted in Sanandaj City, located in the west of Iran, in 2012. Data were collected using self-administered questionnaire including demographics characteristics and the main outcome variable was self-reported HIV testing. The univariate and multivariate logistic regression models using STATA software was used for data analysis. RESULTS A total of 1200 women were interviewed during the study (Response rate=87.5%). The mean age was 29.67 years (SD: 7.01 years), 49% were aged 28 years or younger, 39.2% were single, 16.9% were pregnant and 60% did not have academic education. The proportion of women that were HIV-tested was, 32.1% (CI 95%: 29.2%, 35.0%). HIV testing was associated with younger age, knowledge of HIV/AIDS, household wealth, pregnancy, academic education, occupation and duration time of occupation, rating of quality of health services and substance use history in her husband. CONCLUSION The self-reported HIV testing rate among our sample women is 32.1%, lower than the HIV testing rate in other studies. Therefore, interventions to expand HIV testing and increase awareness of HIV risk are urgently needed in Iran.
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10
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Jain S, Lowman ES, Kessler A, Harper J, Rumoro DP, Smith KY, Purim-Shem-Tov Y, Kessler HA. Seroprevalence Study Using Oral Rapid HIV Testing in a Large Urban Emergency Department. J Emerg Med 2012; 43:e269-75. [DOI: 10.1016/j.jemermed.2012.02.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 10/03/2011] [Accepted: 02/13/2012] [Indexed: 11/25/2022]
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Merchant RC, Waxman MJ, Maher JG, Clark MA, Celada MT, Liu T, Simmons EM, Beckwith CG, Mayer KH. Patient and clinician ethical perspectives on the 2006 Centers for Disease Control and prevention HIV testing methods. Public Health Rep 2012; 127:318-29. [PMID: 22547863 DOI: 10.1177/003335491212700312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES CDC 2006 recommendations for new HIV testing methods in U.S. health-care settings (opt-out approach, general medical consent, and optional prevention counseling) have been the subject of a public ethical debate. Ethical concerns might limit their implementation and affect expanded HIV screening efforts. We compared clinicians' and patients' perspectives on the ethical concerns raised about, justifications provided in support of, and preferences for the 2006 CDC-recommended HIV testing methods for the U.S. health-care setting, in contrast with the 2001 CDC-recommended HIV testing methods (opt-in approach, specific written consent, and mandatory prevention counseling). METHODS We conducted a non-inferiority trial and survey of 249 clinicians and random samples of 1,013 of their patients at three emergency departments and three ambulatory care clinics at university-affiliated hospitals in Rhode Island from June to December 2007. RESULTS Clinicians found the 2006 CDC HIV testing methods to be more ethically concerning than the 2001 testing methods (i.e., ethically inferior), while patients had few ethical concerns. In regard to ethical justifications cited for the 2006 CDC HIV testing methods, clinicians were more supportive of the ethical justifications cited for using an opt-out approach and general medical consent, while patients were more supportive of the justifications for optional HIV prevention counseling. Clinicians showed a relatively greater preference for the opt-out approach and use of general medical consent, while patients had a relatively greater preference for optional HIV prevention counseling. CONCLUSIONS Clinicians and their patients hold divergent ethical perspectives on CDC's 2006 HIV testing methods. The results indicate an opportunity to review not only these but also future HIV testing recommendations, as well as how they are presented for implementation.
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Affiliation(s)
- Roland C Merchant
- Brown University, Alpert Medical School, Department of Emergency Medicine, Providence, RI, USA.
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Batey DS, Hogan VL, Cantor R, Hamlin CM, Ross-Davis K, Nevin C, Zimmerman C, Thomas S, Mugavero MJ, Willig JH. Short communication routine HIV testing in the emergency department: assessment of patient perceptions. AIDS Res Hum Retroviruses 2012; 28:352-6. [PMID: 21790474 DOI: 10.1089/aid.2011.0074] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The CDC released revised HIV testing guidelines in 2006 recommending routine, opt-out HIV testing in acute care settings including emergency departments (ED). Patient attitudes have been cited as a barrier to implementation of routine HIV testing in the ED. We assessed patients' perceptions of HIV testing in the ED through a contextual qualitative approach. The study was conducted during a 72-h period. All adults presenting to the ED without life-threatening trauma or psychiatric crisis completed a standardized questionnaire. The questionnaire explored HIV testing history, knowledge of testing resources, and qualitative items addressing participant perceptions about advantages and disadvantages to ED testing. After completion of the interview, participants were offered a free, confidential, rapid HIV test. Among 329 eligible individuals approached, 288 (87.5%) completed the initial interview. Participants overwhelmingly (n=247, 85.8%) reported support for testing and identified increased knowledge (41%), prevention (12.5%), convenience (11.8%), and treatment (4.9%) among the advantages. Fear and denial about one's HIV status, reported by <5% of patients, were identified as the most significant barriers to ED testing. Bivariate analysis determined race and ethnicity differences between individuals completing the interview and those who refused (p<0.05). Among individuals consenting for testing (n=186, 64.6%), no positives were detected. Most patients support HIV testing in the ED, noting knowledge of status, prevention, convenience, and linkage to early treatment as distinct advantages. These data are of particular benefit to decision makers considering the addition of routine HIV testing in EDs.
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Affiliation(s)
- D. Scott Batey
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Victoria L. Hogan
- School of Medicine, Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ryan Cantor
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christopher M. Hamlin
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kelly Ross-Davis
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christa Nevin
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cindy Zimmerman
- School of Medicine, Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shakira Thomas
- School of Medicine, Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael J. Mugavero
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - James H. Willig
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
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Rigal L, Rouessé C, Collignon A, Domingo A, Deniaud F. Facteurs liés à l’absence de proposition de dépistage du VIH-sida et des hépatites B et C aux immigrés en situation de précarité. Rev Epidemiol Sante Publique 2011; 59:213-21. [DOI: 10.1016/j.respe.2011.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 11/26/2010] [Accepted: 01/05/2011] [Indexed: 10/18/2022] Open
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Carrizosa CM, Blumberg EJ, Hovell MF, Martinez-Donate AP, Garcia-Gonzalez G, Lozada R, Kelley NJ, Hofstetter CR, Sipan CL. Determinants and prevalence of late HIV testing in Tijuana, Mexico. AIDS Patient Care STDS 2010; 24:333-40. [PMID: 20438374 DOI: 10.1089/apc.2009.0138] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Timely diagnosis of HIV is essential to improve survival rates and reduce transmission of the virus. Insufficient progress has been made in effecting earlier HIV diagnoses. The Mexican border city of Tijuana has one of the highest AIDS incidence and mortality rates in all of Mexico. This study examined the prevalence and potential correlates of late HIV testing in Tijuana, Mexico. Late testers were defined as participants who had at least one of: (1) an AIDS-defining illness within 1 year of first positive HIV test; (2) a date of AIDS diagnosis within 1 year of first positive HIV test; or (3) an initial CD4 cell count below 200 cells per microliter within 1 year of first positive HIV test. Medical charts of 670 HIV-positive patients from two HIV/AIDS public clinics in Tijuana were reviewed and abstracted; 362 of these patients were interviewed using a cross-sectional survey. Using multivariate logistic regression, we explored potential correlates of late HIV testing based on the Behavioral Ecological Model. From 342 participants for whom late testing could be determined, the prevalence of late testing was 43.2%. Multivariate logistic regression results (n = 275) revealed five significant correlates of late testing: "I preferred not to know I had HIV" (adjusted odds ratio [AOR] = 2.78, 1.46-5.31); clinic (AOR = 1.90, 1.06-3.41); exposure to peers engaging in high-risk sexual behavior (AOR = 1.14, 1.02-1.27); stigma regarding HIV-infected individuals (AOR = 0.65, 0.47-0.92); and stigma regarding HIV testing (AOR = 0.66, 0.45-0.97). These findings may inform the design of interventions to increase timely HIV testing and help reduce HIV transmission in the community at large.
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Affiliation(s)
- Claudia M. Carrizosa
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California
| | - Elaine J. Blumberg
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California
| | - Melbourne F. Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California
| | - Ana P. Martinez-Donate
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Gregorio Garcia-Gonzalez
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 20, Tijuana, Baja California, Mexico
| | - Remedios Lozada
- Programa Estatal de VIH/ITS Baja California Norte, Palacio Federal Piso 3, Centro Civico, Mexicali, Baja California, Mexico
| | - Norma J. Kelley
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California
| | - C. Richard Hofstetter
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California
| | - Carol L. Sipan
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California
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Merchant RC, Freelove SM, Langan TJ, Clark MA, Mayer KH, Seage GR, DeGruttola VG. The relationship of reported HIV risk and history of HIV testing among emergency department patients. Postgrad Med 2010; 122:61-74. [PMID: 20107290 DOI: 10.3810/pgm.2010.01.2100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Among a random sample of emergency department (ED) patients, we sought to determine the extent to which reported risk for human immunodeficiency virus (HIV) is related to ever having been tested for HIV. METHODS A random sample of patients (aged 18-64 years) from an adult, urban, northeastern United States, academic ED were surveyed about their history of ever having been tested for HIV and their reported HIV risk behaviors. A reported HIV risk score was calculated from the survey responses and divided into 4 levels, based on quartiles of the risk scores. Pearson's X(2) testing was used to compare HIV testing history and level of reported HIV risk. Logistic regression models were created to investigate the association between level of reported HIV risk and the outcome of ever having been tested for HIV. RESULTS Of the 557 participants, 62.1% were female. A larger proportion of females than males (71.4% vs 60.6%; P < 0.01) reported they had been tested for HIV. Among the 211 males, 11.4% reported no HIV risk, and among the 346 females, 10.7% reported no HIV risk. The proportion of those who had been tested for HIV was greater among those reporting any risk compared with those reporting no risk for females (75.4% vs 37.8%; P < 0.001), but not for males (59.9% vs 66.7%; P < 0.52). However, certain high-risk behaviors, such as a history of injection-drug use, were associated with prior HIV testing for both genders. In the logistic regression analyses, there was no relationship between increasing level of reported HIV risk and a history of ever having been tested for HIV for males. For females, a history of ever having been tested was related to increasing level of reported risk, but not in a linear fashion. CONCLUSIONS The relationship between reported HIV risk and history of testing among these ED patients was complex and differed by gender. Among these patients, having greater risk did not necessarily mean a higher likelihood of ever having been tested for HIV.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA.
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