监管场所中艾滋病检测政策的应用

在监狱及其他监管场所羁押的罪犯和违法犯罪人员是艾滋病的高危人群,对他们开展艾滋病病毒(HIV)抗体检测,对于及时发现和治疗HIV感染者和病人,预防进一步传播具有重要作用。但在开展强制检测、自愿咨询检测之间存在激烈的争论,世界卫生组织主张开展自愿咨询检测,但美国、南非、澳大利亚等国都曾经或正在实行强制检测。     

艾滋病抗病毒治疗政策和策略分析与思考

目的把握艾滋病抗病毒治疗政策和策略现状,分析存在的问题,为调整完善艾滋病抗病毒治疗机制提供建议。方法采用文献回顾、数据资料收集和现场调查的方法。结果中国制定落实了艾滋病病人免费抗病毒治疗的政策和策略,建立了医疗机构和疾病预防控制机构服务相结合的治疗模式,探索建立了免费抗病毒治疗的药品供应、经费保障机制,将抗病毒治疗药品纳入城镇职工基本医疗保险支付范围,推动了抗病毒治疗工作的迅速开展,明显降低了病人的病死率。当前抗病毒治疗工作面临治疗服务规模和能力有限、治疗药品供应和管理机制不能适合治疗发展需要、治疗与现行基本医疗保障体系脱节、流动人口异地治疗办法尚不完善等问题。结论需要进一步健全以定点医疗机构为依托的抗病毒治疗服务体系,结合医改重建满足治疗需求的免费抗病毒治疗药品供应保障机制,将抗病毒治疗纳入现行的医疗保障范围,加快探索异地抗病毒治疗的办法     

艾滋病临床检测中存在的问题和解决方法

实验室检测是艾滋病病毒(Humani mmunodeficiency virus,HIV)感染者/艾滋病(Acquiredi mmu-nodeficiency syndrome,AIDS)病人诊断的主要依据。各个时期均可通过血清HIV抗体的检测来进行诊断,但是在HIV抗体结果不确定或是HIV感染的"窗口期"时,要依靠核酸检测、抗原检测进行辅助诊断。另外,CD4+T细胞的检测和核酸检测在HIV感     

宛城区艾滋病自愿咨询检测结果分析

艾滋病自愿咨询检测(VCT)不仅可以尽早发现、及时治疗和预防艾滋病病毒(HIV)感染,为受检者提供心理支持,而且还可以减少高危人群的高危性行为,预防HIV传播。南阳市宛城区艾滋病疫情主要是1995年前后经非法采供血传播引起,2004年8~9月份对全区既往有偿供血员进行普查登记及HIV检     

浙江省艾滋病自愿咨询检测求询者的动态变化分析

目的对比2008年和2009年浙江省艾滋病自愿咨询检测(VCT)数据,探索今后VCT工作的方向。方法通过下载艾滋病综合防治数据信息管理系统中,检测咨询信息管理定时统计的数据、2008年和2009年不同类型的求询者的数量和艾滋病病毒(HIV)阳性者的数量,利用卡方检验进行统计学分析。结果 2008年共完成咨询检测73 918人次,2009年共完成咨询检测81 386人次。求询者中有非婚异性性行为史者有上升趋势,2008年占46.98%(34 730/73 918),2009年占49.12%(39 977/81 386),两年对比差异有统计学意义(P<0.05)。2008年和2009年分别经VCT发现HIV感染者255人和331人,感染者中以男男性行为者、非婚异性性行为者、配偶/固定性伴HIV阳性者为主,注射吸毒史(P<0.05)、有非婚异性性行为史者(P<0.05)和有男男性行为史者对比,差异有统计学意义(P<0.05)。结论要对大众进行宣传艾滋病VCT服务,特别是针对具有男男性行为、非婚异性性行为、配偶/固定性伴HIV阳性的人群要加强宣传。     

北京市朝阳区艾滋病自愿咨询检测情况分析

目的调查北京市朝阳区艾滋病自愿咨询检测（VCT）人群的社会人口学特征和艾滋病病毒（HIV）感染状况,有针对性地制定朝阳区艾滋病健康教育和高危干预措施。方法对2007年6月-2008年9月,朝阳区疾病预防控制中心艾滋病VCT门诊求询者的调查结果进行分析。结果868名求询者接受咨询和血清HIV抗体检测,以20～40岁男性青壮年为主,占89.9%;男女比例7.19∶1;未婚占68.9%。求询原因以发生危险性行为为主,占86.3%。HIV抗体阳性41例,感染率为4.7%,以性途径感染为主（75.6%）,22人通过同性性行为感染。结论朝阳区艾滋病的传播以性途径为主,求询者以年轻、未婚和高学历男性为主,HIV感染在男男性行为人群（MSM）中检出率较高。因此,应对男性青壮年、MSM人群进行广泛的艾滋病健康教育,加强针对MSM人群的行为干预措施。     

江西省艾滋病自愿咨询检测现状分析

目的更好地做好江西省艾滋病防治工作。方法采用描述性方法分析江西省艾滋病自愿咨询检测(VCT)现状。结果从事艾滋病咨询工作的专职人员较少。接受检测后咨询及转介服务人数占检测前咨询人数的比例分别为5.22%、1.39%。接受检测的人以20~29岁人数最多,其次30~39岁。萍乡、南昌市检测初筛阳性构成比较高,分别为39.13%、26.09%。结论建立健全VCT服务网络,提高咨询服务质量。广泛开展对目标人群的VCT服务宣传和外展活动,有效开展VCT服务,遏制艾滋病的传播。     

山东省艾滋病自愿咨询检测现状分析

目的为了解山东省艾滋病自愿咨询检测(VCT)门诊的建设情况,以及艾滋病咨询、检测工作现状,探讨影响高危人群接受艾滋病VCT服务的因素,为VCT工作的广泛开展提供有价值的信息。方法采用观察法、问卷调查、深入访谈及关键人物座谈进行调查。结果共调查了全省134个艾滋病自愿咨询检测点,其中81.9%的VCT点有专用、保密的咨询室;84.3%的门诊有HIV抗体筛查检测实验室;90%的门诊可以提供艾滋病热线电话咨询。76%的门诊现场开展了一定的工作,但检测前后咨询开展的很少。咨询室的可及性和保密性、人员配备、宣传工作及其他工作还存在问题。结论全省各地市艾滋病VCT门诊室的硬、软件建设均存在不足,尤其咨询人员缺乏,要充分认识VCT工作的重要性和紧迫性,创造条件促进VCT工作的广泛开展。     

Sex differences in HIV testing in Ghana, and policy implications

HIV testing and counseling (HTC) is the primary gateway to all systems of AIDS-related care. This study describes sex differences in the use of HTC from data of the National AIDS/STI Control Program (NACP) over four years (2007-2010), across the 10 regions of Ghana. HTC data from NACP were from diagnostic centers (DCs), know your status campaigns (KYS) and prevention of mother-to-child transmission (PMTCT) sites across the country. Data highlight significantly greater use of HTC by females than males. From 2007 to 2010, females comprised 58.2% of all those using HIV testing at DCs and KYS, and this proportion rose to 75.9% when PMTCT data were included. The female: male testing ratio ranged from 6.2 in 2007 to 2.8 in 2010, suggesting a recent increase in male testing. The NACP data also indicate that females are more likely than males to test positive for HIV, suggesting either better catchment of HIV positive females, or potentially, a higher HIV epidemic among females than males. While the magnitude of the sex differences in testing varies by year and location, the data provide consistent evidence of lower male use of testing. Rigorous examination of HTC utilization rates, with closer attention to male use of testing, deserves closer policy attention.     

HIV testing practices in Jamaica

OBJECTIVES: Prevention programmes often promote HIV testing as one possible strategy for combating the spread of the disease. The objectives of the present study were to examine levels of HIV testing practices in a large sample of Jamaicans and the relationships among HIV testing, sociodemographic variables and HIV-related behaviours. METHODS: A total of 1800 persons, aged 15-49 years, were surveyed between May and August 2004 using a household-level, interviewer-administered questionnaire. The questionnaire included HIV-related knowledge, attitudinal and behavioural items. For the present analyses, data from 1558 sexually experienced persons were examined. RESULTS: Approximately 38% of the sexually experienced sample reported a history of HIV testing. Hierarchical logistic regression analyses revealed that adults, females, persons with post-high school education and married persons were more likely to report previous HIV testing. Also, those who had attended an HIV/AIDS education workshop or discussion and those who reported knowing persons living with HIV/AIDS were more likely to report previous testing. However, HIV testing was not associated with condom use or with the number of sexual partners. CONCLUSIONS: The lack of significant findings establishing a relationship between testing and risky sexual behaviours should not negate the importance of HIV testing. Being informed regarding personal HIV serostatus is one of the first steps in self-protection. Effective messages and programmes promoting HIV testing need to be developed and implemented in Jamaica, in order to educate people about how to assess their level of risk with respect to contracting HIV infection.     

Routine, voluntary HIV testing in Durban, South Africa: correlates of HIV infection

Background

Routine HIV testing is increasingly recommended in resource‐limited settings. Our objective was to evaluate factors associated with a new diagnosis of HIV infection in a routine HIV testing programme in South Africa.

Methods

We established a routine HIV testing programme in an out‐patient department in Durban, South Africa. All registered adults were offered a rapid HIV test; we surveyed a sample of tested patients.

Results

During the 12‐week study, 1414 adults accepted HIV testing. Of those, 463 (32.7%) were HIV‐infected. Seven hundred and twenty (50.9%) were surveyed. Compared with married women, unmarried men were at the highest risk of HIV [odds ratio (OR) 6.84; 95% confidence interval (CI) 3.45–23.55], followed by unmarried women (OR 5.90; 95% CI 3.25–10.70) and married men (OR 4.00; 95% CI 2.04–7.83). Age 30–39 years (compared with ≥50 years; OR 5.10; 95% CI 2.86–9.09), no prior HIV test (OR 1.45; 95% CI 1.07–2.27) and an imperfect HIV knowledge score (OR 2.32; 95% CI 1.24–4.35) were also associated with HIV infection.

Conclusion

In a routine HIV testing programme in South Africa, rates of previously undiagnosed HIV were highest among men, young and unmarried patients, and those with poorer HIV knowledge. Better interventions are needed to improve HIV knowledge and decrease HIV risk behaviour.     

Distance to testing sites and its association with timing of HIV diagnosis*

Early HIV diagnosis enables prompt treatment initiation, thereby contributing to decreased morbidity, mortality, and transmission. We aimed to describe the association between distance from residence to testing sites and HIV disease stage at diagnosis. Using HIV surveillance data, we identified all new HIV diagnoses made at publicly funded testing sites in central North Carolina during 2005–2013. Early-stage HIV was defined as acute HIV (antibody-negative test with a positive HIV RNA) or recent HIV (normalized optical density <0.8 on the BED assay for non-AIDS cases); remaining diagnoses were considered post-early-stage HIV. Street distance between residence at diagnosis and (1) the closest testing site and (2) the diagnosis site was dichotomized at 5 miles. We fit log-binomial models using generalized estimating equations to estimate prevalence ratios (PR) and robust 95% confidence intervals (CI) for post-early-stage diagnoses by distance. Models were adjusted for race/ethnicity and testing period. Most of the 3028 new diagnoses were black (N?=?2144; 70.8%), men who have sex with men (N?=?1685; 55.7%), and post-early-stage HIV diagnoses (N?=?2010; 66.4%). Overall, 1145 (37.8%) cases traveled <5 miles for a diagnosis. Among cases traveling ≥5 miles for a diagnosis, 1273 (67.6%) lived <5 miles from a different site. Residing ≥5 miles from a testing site was not associated with post-early-stage HIV (adjusted PR, 95% CI: 0.98, 0.92–1.04), but traveling ≥5 miles for a diagnosis was associated with higher post-early HIV prevalence (1.07, 1.02–1.13). Most of the elevated prevalence observed in cases traveling ≥5 miles for a diagnosis occurred among those living <5 miles from a different site (1.09, 1.03–1.16). Modest increases in post-early-stage HIV diagnosis were apparent among persons living near a site, but choosing to travel longer distances to test. Understanding reasons for increased travel distances could improve accessibility and acceptability of HIV services and increase early diagnosis rates.     

Factors associated with uptake of home-based HIV counselling and testing and HIV care services among identified HIV-positive persons in Masaka,Uganda

We investigated uptake of home-based HIV counselling and testing (HBHCT) and HIV care services post-HBHCT in order to inform the design of future HBHCT programmes. We used data from an open-label cluster-randomised controlled trial which had demonstrated the effectiveness of a post-HBHCT counselling intervention in increasing linkage to HIV care. HBHCT was offered to adults (≥18 years) from 28 rural communities in Masaka, Uganda; consenting HIV-positive care naïve individuals were enrolled and referred for care. The trial's primary outcome was linkage to HIV care (clinic-verified registration for care) six months post-HBHCT. Random effects logistic regression was used to investigate factors associated with HBHCT uptake, linkage to care, CD4 count receipt, and antiretroviral therapy (ART) initiation; all analyses of uptake of post-HBHCT services were adjusted for trial arm allocation. Of 13,455 adults offered HBHCT, 12,100 (89.9%) accepted. HBHCT uptake was higher among men [adjusted odds ratio (aOR) 1.20, 95% confidence interval (CI)?=?1.07–1.36] than women, and decreased with increasing age. Of 551 (4.6%) persons who tested HIV-positive, 205 (37.2%) were in care. Of those not in care, 302 (87.3%) were enrolled in the trial and of these, 42.1% linked to care, 35.4% received CD4 counts, and 29.8% initiated ART at 6 months post-HBHCT. None of the investigated factors was associated with linkage to care. CD4 count receipt was lower in individuals who lived ≥30?min from an HIV clinic (aOR 0.60, 95%CI?=?0.34–1.06) versus those who lived closer. ART initiation was higher in older individuals (≥45 years versus <25 years, aOR 2.14, 95% CI?=?0.98–4.65), and lower in single (aOR 0.60, 95% CI?=?0.28–1.31) or divorced/separated/widowed (aOR 0.47, 95% CI?=?0.23–0.93) individuals versus those married/cohabiting. HBHCT was highly acceptable but uptake of post-HBHCT care was low. Other than post-HBHCT counselling, this study did not identify specific issues that require addressing to further improve linkage to care.     

Risk factors associated with resistance to HIV testing among transwomen in Brazil

Transwomen are a high-risk population for HIV/AIDS worldwide. However, many transwomen do not test for HIV. This study aimed to identify factors associated with resistance to HIV testing among transwomen in Fortaleza/CE. A cross-sectional study was conducted between August and December 2008 with a sample of 304 transwomen recruited through respondent-driven sampling. Data analysis utilized Respondent-Driven Sampling Analysis Tool and SPSS 11.0. Univariate, bivariate, and multivariate analyses examined risk factors associated with resistance to HIV testing. Less than 18 years of age (OR?=?4.221; CI?=?2.419–7.364), sexual debut before 10 years of age (OR?=?6.760; CI?=?2.996–15.256), using illegal drugs during sex (OR?=?2.384; CI?=?1.310–4.339), experience of discrimination (OR?=?3.962; CI?=?1.540–10.195) and a belief that the test results were not confidential (OR?=?3.763; CI?=?2.118–6.688) are independently associated with resistance to testing. Intersectoral and targeted strategies aimed at encouraging the adoption of safer sexual behaviors and testing for HIV among transwomen are required.     

桂林市2008～2010年艾滋病自愿咨询及检测情况分析

目的了解艾滋病自愿咨询及检测人群的HIV感染分布情况,有针对性地开展艾滋病健康教育。方法由经过专业技术培训的医护人员对2008年1月至2010年12月在我院艾滋病咨询及免费检测门诊（VCT门诊）的1232例求询者进行HIV抗体（ELISA法）初筛检测,并对确诊试验阳性的患者情况进行分析。结果1232例求询者中75例HIV阳性（6．09％）。75例HIV阳性患者中男性49例,女性26例,其中外省流动人口3例。年龄3～78岁,其中21～40岁者39例（52．0％）。结论艾滋病的发病仍保持低流行状态,应加强对高危人群的检测及健康教育干预,更好的预防和控制艾滋病传播。     

Perceptions of door-to-door HIV counselling and testing in Botswana

Prevalence of HIV infection in Botswana is among the highest in the world, at 23.9% of 15 – 49-year-olds. Most HIV testing is conducted in voluntary counselling and testing centres or medical settings. Improved access to testing is urgently needed. This qualitative study assessed and documented community perceptions about the concept of door-to-door HIV counselling and rapid testing in two of the highest-prevalence districts of Botswana.

Community members associated many positive benefits with home-based, door-to-door HIV testing, including convenience, confidentiality, capacity to increase the number of people tested, and opportunities to increase knowledge of HIV transmission, prevention and care through provision of correct information to households. Community members also saw the intervention as increasing opportunities to engage and influence family members and to role model positive behaviours. Participants also perceived social risks and dangers associated with home-based testing including the potential for conflict, coercion, stigma, and psychological distress within households. Community members emphasised the need for individual and community preparation, including procedures to protect confidentiality, provisions for psychological and social support, and links to appropriate services for HIV-positive persons.