Reduction of the risk of transfusion‐transmitted viral infection by nucleic acid amplification testing in the Western Cape of South Africa: a 5‐year review

Background and Objectives In October 2005, individual donation nucleic acid amplification testing (ID‐NAT) for HIV, HBV and HCV was introduced in the Western Cape Province of South Africa. After 5 years, the impact on HIV, HBV and HCV transmission risk was assessed. Materials and Methods A total of 649 745 donations were tested by ID‐NAT using the Ultrio assay on the Tigris instrument (Novartis Diagnostics) and for anti‐HIV, HBsAg and anti‐HCV (Abbott Prism). Initial reactive samples were repeated in duplicate. Discrepant repeat reactive samples were subjected to confirmatory assays. ID‐NAT nonrepeat reactive donations were further screened for occult HBV infection (OBI) by anti‐HBc assay. Results ID‐NAT yielded 6 HIV‐RNA‐positive donations in the anti‐HIV‐negative window period (WP) but only 2 were p24 Ag nonreactive (1:325 000). Mathematical modelling estimated a similar HIV transmission risk for lapsed and repeat donations, in the order of 3 per million. The WP risk for HBV was 13 per million. Eight acute (1:81 000) and 13 chronic OBI yield cases (1:50 000) were interdicted. There were significantly more anti‐HBc‐positive donors in the Ultrio initial reactive/nonrepeat reactive group (12%) than in an Ultrio nonreactive control group (6%). Conclusion ID‐NAT in the Western Cape Province of South Africa has contributed significantly to enhancing blood safety, particularly for HBV transmission risk and to a lesser extent for HIV. Anti‐HBc testing of NAT nonrepeat reactive donations seems useful in identifying a subgroup of donors with OBI who may be at risk of transmitting HBV.     

Effectiveness and feasibility study of routine HIV rapid testing in an urban methadone maintenance treatment program

Abstract

Background: Universal Human Immunodeficiency Virus (HIV) testing and treatment are strategies to decrease AIDS-related morbidity and mortality and to reduce HIV transmission. Objective: This study examined the feasibility and effectiveness of routine HIV rapid testing implemented in the largest New York City (NYC) Methadone Maintenance Treatment Program (MMTP). Methods: A routine HIV rapid testing program performed by medical providers without pretest counseling or the provision of incentives was compared to HIV rapid testing done by referral to HIV counselors with pretest counseling and incentives over the prior 12 months. Results: Routine HIV rapid testing proved feasible and effective when performed by the medical staff in the setting of a large urban MMTP. The program increased HIV testing in all genders, race/ethnicities, and ages. HIV-positive individuals were diagnosed and successfully linked to care. The elimination of HIV prevention counseling may have facilitated expanded testing. Conclusion: This study confirms that routine HIV rapid testing without HIV-prevention counseling or the provision of incentives for patients is feasible on a large scale in a busy, urban methadone clinic.     

Combining the ventilatory response to exercise and peak oxygen consumption is no better than peak oxygen consumption alone in predicting mortality in chronic heart failure

BACKGROUND: A low peak oxygen uptake (pVO(2)) and steep VE/VCO(2) slope are independently associated with a worse prognosis in patients with chronic heart failure (CHF). We wished to confirm whether combining these variables as a ratio would lead to a more accurate predictor of prognosis than using either alone. METHODS: 388 CHF patients completed a treadmill-based cardiopulmonary exercise test (CPET) to volitional exhaustion using a modified Bruce protocol. RESULTS: 212 CHF patients completed the CPET with a peak RER >or= 1.0. Of these, 48 patients died and one was transplanted during follow-up. In surviving patients, the median follow-up period was 42 months (IQR 34-49 months). The ratio VE/VCO(2) slope/pVO(2) was calculated for each individual and its ability to predict outcome compared with other variables. The Cox multivariable survival analysis showed that pVO(2) was the strongest independent predictor of mortality in CHF patients. CONCLUSION: Our study shows that the composite variable VE/VCO(2) slope/pVO(2) is a less effective prognosticator than pVO(2) alone in patients with CHF.     

Hepatitis E virus infection in Ghanaian blood donors – the importance of immunoassay selection and confirmation

Background and Objectives Hepatitis E virus (HEV) infection is emerging as a potential new threat to blood safety after several cases of transfusion–transmission were reported from non‐epidemic countries. On the basis of seroprevalence data, HEV is endemic in Ghana where poor sanitary conditions and regular flooding are prevalent. However, no data are available for HEV prevalence in blood donors. Materials and Methods Plasma samples from 239 Ghanaian blood donors were tested for anti‐HEV IgG and IgM by ELISA (two and three assays, respectively) and Western blot (recomLine) and for HEV‐RNA by RT‐qPCR. Results All donors were RNA negative. Results from the different serological assays were discrepant: reactivity in two of the three IgM assays was correlated with elevated IgM levels, but the discrepancies between IgG assays were unrelated to the donors’ IgG levels and more likely related to assay sensitivity. Fourteen samples (5·9%) were anti‐HEV IgM reactive and 11 samples (4·6%) anti‐HEV IgG reactive in at least two serological assays from different manufacturers. Conclusions (a) In the absence of accepted confirmatory assays, it is crucial to confirm anti‐HEV reactive samples with an alternative assay, especially when the population tested carries high levels of immunoglobulin M. (b) Although asymptomatic HEV infections are common in Ghanaian blood donors, currently, it does not seem to be a major risk to blood safety.     

Does rapid HIV testing result in an early diagnosis and reduce the waiting time for patients to receive medical care?

The implementation of rapid HIV testing in Brazil began in 2006 for specific groups, and from 2009 was extended to the Counseling and Testing Centers (CTC) in certain Brazilian capitals. The aim of this study was to compare two groups of individuals: those diagnosed with HIV infection by conventional testing and those diagnosed with rapid testing, with respect to: the waiting time before receiving medical care, the time of the first laboratory tests and the virological, immune and clinical status. This is a cross-sectional study to compare a group with individuals diagnosed by conventional testing (2006–2008) and another with those diagnosed by rapid testing (2010–2011).The median time between blood collection and diagnosis of HIV in the conventional test group was 76 days, while in the rapid test group 94.2% of the subjects received their results on the same day of blood collection (p?p?p?p?=?0.01). The introduction of rapid HIV testing as a diagnostic strategy has reduced the waiting times for medical care and laboratory tests and also allowed earlier diagnosis of HIV infection than with the conventional test.     

Pulsed Multifrequency Excitation and Spectrogram Eddy Current Testing (PMFES-ECT) for Nondestructive Evaluation of Conducting Materials

This paper presents a new method for nondestructive testing—a pulsed multifrequency excitation and spectrogram eddy current testing (PMFES-ECT), which is an extension of the multifrequency excitation and spectrogram eddy current testing. The new method uses excitation in the form of pulses repeated at a specified time, containing several periods of a waveform consisting of the sum of sinusoids with a selected frequency, amplitude and phase. This solution allows the maintenance of the advantages of multifrequency excitation and, at the same time, generates high energy pulses similar to those used in pulse eddy current testing (PECT). The effectiveness of the new method was confirmed by numerical simulations and the measurement of thin Inconel plates, consisting of notches manufactured by the electric-discharge method.     

A controlled trial to decrease the unnecessary use of diagnostic tests

A controlled trial evaluated a program to decrease the unnecessary use of inpatient testing by medical residents in a university medical center. The program included education, concurrent feedback, and resident participation in program planning. Using specific criteria for 7,891 chart audits of patients who had repeat tests within seven days, the authors measured change in testing among 44 residents in the first year and 43 in the second year. There were no significant differences related to the program. They conclude that substantial overuse of diagnostic tests did occur, that it varied from hospital to hospital, and that the program could not overcome powerful counteracting influences. Future studies, using control groups and chart audits, should evaluate interventions other than education. Received from the Section of General Medicine, Department of Medicine, and the Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Williams is a Henry J. Kaiser Family Foundation Faculty Scholar and Associate Professor of General Medicine. Dr. Eisenberg is Sol Katz Associate Professor of General Medicine and Chief of the Section of General Medicine. Supported primarily by a grant from Blue Cross of Greater Philadelphia. Additional support came from the National Fund for Medical Education (sponsored by the Prudential Insurance Corporation of America) and the National Health Care Management Center at the Leonard Davis Institute of Health Economics (Grant No. HS 02557, National Center for Health Services Research).     

Comparison of performance characteristics between new and reprocessed electrophysiology catheters

Objective Electrophysiology (EP) catheter reprocessing is widespread and previous studies have examined clinical performance, sterility and safety of these reprocessed devices. Here we compare the intrinsic engineering characteristics, electrical, mechanical and safety, between new and reprocessed devices. Materials and methods New (58 devices) and clinically used (five times)/reprocessed (165 devices) EP catheters from five manufacturers were employed to examine and compare catheter electrode continuity, electrode isolation, electrical leakage current, shaft torsion and stiffness characteristics as well as tip buckling and bond strengths. Results Electrode continuity, isolation and leakage currents for both new and reprocessed EP catheters were within acceptance criteria for electrode continuity (<30 Ω) and shaft electrical leakage (<0.5 mA) as well as electrode isolation (>200 Ω). In addition, reprocessed catheters were equivalent when compared with their new counterparts. While catheter shaft torque forces varied five fold amongst manufacturers, comparison between new and reprocessed devices within a manufacturer showed no significant differences. Likewise shaft stiffness showed no significant difference between new and reprocessed devices. Average tip buckling forces for all catheters were substantially below the acceptance criteria of 0.45 lb (between 0.04 and 0.1 lb) with differences between new and reprocessed catheters not being significant. All bond strengths for both new and reprocessed catheters exceeded the acceptance criteria specified in ISO 10555-1. Conclusions This study found that reprocessed EP catheters which had undergone five actual clinical use/reprocessing cycles met and exceeded acceptance criteria specified by industry standards as well as individual manufacturer’s criteria for both electrical and safety characteristics. We conclude that reprocessed EP catheters exhibit electrical, mechanical and safety characteristics which are equivalent to their new counterparts.     

The Dynamics of Repeat HIV Testing, and Interventions for Repeat HIV Testers

This paper attempts to better understand the dynamics of repeat HIV testing behavior. It suggests that different types of HIV risk dynamics characterize different types of repeat testers, and proposes a new set of alternatives to use to triage repeat testers for further intervention. Those for whom repeat testing is more optimal would be tested and counseled as usual (e.g., in the case of those originally tested during the window period), or would be tested and then referred to HIV prevention case management (e.g., in the case of chronic high-risk individuals). Those for whom repeat testing is less than optimal (e.g., the neurotic worried well those with information deficits prompting repeat testing) may or may not be tested, depending on the specifics of their situation, and would be provided with services to address the causes of their repeat testing and to reduce its occurrence.     

Why are People Getting Tested? Self-Reported Reasons for Seeking Voluntary Counseling and Testing at a Clinic in Chennai, India

VCT has been shown to be an important HIV risk reduction strategy; however, little is known about who attends VCT or why people seek VCT. A retrospective analysis was performed on charts of 6330 clients who attended VCT between 1994 and 2002 at Y.R. Gaitonde Centre for AIDS Research and Education, a non-governmental organization in Chennai, Tamil Nadu, India. Most clients reported more than one reason for attending VCT, and the most commonly reported reasons were risk behavior, having symptoms, having a current HIV-positive partner, and reconfirming a previous positive HIV test. Reasons varied by gender and over time, and the likelihood of testing positive for HIV varied by reason reported. Understanding why people seek VCT informs an understanding of knowledge and attitudes about HIV and HIV testing, which has implications for the development of education, outreach and other HIV prevention services.     

The UK National External Quality Assessment Scheme in Blood Group Serology. Compatibility testing 1979–1980

Seven proficiency tests in compatibility testing were issued in 1979 to 1980. In each exercise participants were required to test five sera, most of which contained alloantibodies, against three samples of red cells by three designated techniques, namely agglutination in saline at room temperature, agglutination in albumin at 37°C and the antiglobulin test at 37°C. Comparability was achieved by scoring of results. Incompatibilities were missed by 3.5 to 22% of participants in five exercises in which undiluted antibodies were issued. There was no significant improvement in performance over two years. Antibodies which were issued diluted, but detectable by antiglobulin test, were missed with high frequency.     

Extended Damage Detection and Identification in Aircraft Structure Based on Multifrequency Eddy Current Method and Mutual Image Similarity Assessment

In this paper, a novel approach to Non-Destructive Testing (NDT) of defective materials for the aircraft industry is proposed, which utilizes an approach based on multifrequency and spectrogram eddy current method combined with an image analysis method previously applied for general-purpose full-reference image quality assessment (FR IQA). The proposed defect identification method is based on the use of the modified SSIM4 image quality metric. The developed method was thoroughly tested for various locations, sizes, and configurations of defects in the examined structure. Its application makes it possible to not only determine the presence of cracks but also estimate their size.     

Over-the-counter human immunodeficiency virus self-test kits: time to explore their use for men who have sex with men in Brazil

Increasing access and frequency of human immunodeficiency virus testing are critical to stemming the epidemic. In Brazil's concentrated epidemic, human immunodeficiency virus prevalence in the men who have sex with men/transgender population far exceeds that in the general population, but testing rates fall below what is needed to ensure early detection and treatment. Over-the-counter human immunodeficiency virus self-testing kits, now available in stores in the U.S., have enormous potential to increase testing access and frequency and to facilitate early detection and treatment. With the advent of human immunodeficiency virus self-testing upon us, it is timely to engage the scientific community, government, and civil society in a dialog around how to best utilize this technology in Brazil. We summarize recent research on over-the-counter testing among men who have sex with men, raise potential questions and challenges to using self-tests, suggest implementation strategies, and outline a research agenda moving forward.