Implementation Of HIV Screening Research Articles

Influence of sickle cell disease on susceptibility to HIV infection.

People with sickle cell disease (SCD) are reported to have low rates of HIV infection, slower progression to AIDS and lower HIV-associated mortality compared to the general population. Mechanisms of potential resistance to HIV in SCD are incompletely understood. We retrospectively reviewed the Transfusion Safety Study to compare HIV status between people with SCD and other congenital anemias who were routinely exposed to blood products during the high-risk period before HIV screening implementation. Non-SCD congenital anemia diagnosis was associated with a higher risk of HIV acquisition compared to SCD (OR 13.1 95%CI 1.6–108.9). In addition, we prospectively enrolled 30 SCD cases and 30 non-SCD controls to investigate potential mechanisms of resistance to HIV in SCD. CCR5 and CCR7 expression was lower and CD4 expression was higher on CD4+ T cells from SCD cases compared to controls. Surface expression of CD4+ T cell CXCR4, CD38 and HLA-DR did not differ between the groups. SCD CD4+ T cells were not less susceptible to HIV infection than controls. Levels of multiple cytokines were elevated in the SCD plasma, but SCD plasma compared to control plasma did not inhibit HIV infection of target cells. In conclusion, our epidemiological data support people with SCD being resistant to HIV infection. Potential mechanisms include lower CD4+ T cell expression of CCR5 and CCR7, balanced by increased CD4 expression and cytokine levels, which did not result in in vitro resistance to HIV infection. Further study is needed to define the risk and pathophysiology of HIV in persons with SCD.

An expanded HIV screening strategy in the Emergency Department fails to identify most patients with undiagnosed infection: insights from a blinded serosurvey

ABSTRACTScreening for HIV in Emergency Departments (EDs) is recommended to address the problem of undiagnosed HIV. Serosurveys are an important method for estimating the prevalence of undiagnosed HIV and can provide insight into the effectiveness of an HIV screening strategy. We performed a blinded serosurvey in an ED offering non-targeted HIV screening to determine the proportion of patients with undiagnosed HIV who were diagnosed during their visit. The study was conducted in a high-volume, urban ED and included patients who had blood drawn for clinical purposes and had sufficient remnant specimen to undergo deidentified HIV testing. Among 4752 patients not previously diagnosed with HIV, 1403 (29.5%) were offered HIV screening and 543 (38.7% of those offered) consented. Overall, undiagnosed HIV was present in 12 patients (0.25%): six among those offered screening (0.4%), and six among those not offered screening (0.2%). Among those with undiagnosed HIV, two (16.7%) consented to screening and were diagnosed during their visit. Despite efforts to increase HIV screening, more than 80% of patients with undiagnosed HIV were not tested during their ED visit. Although half of those with undiagnosed HIV were missed because they were not offered screening, the yield was further diminished because a substantial proportion of patients declined screening. To avoid missed opportunities for diagnosis in the ED, strategies to further improve implementation of HIV screening and optimize rates of consent are needed.

Analysis of Primary Health-Care Resource Preparedness for Implementation of Maternal HIV Screening in Indonesia's Urban Areas

The Indonesian goverment's minimum service standard (MSS) indicator stipulates that 100% of pregnant women in the country must undergo HIV checks. in 2017, however only 7% of pregnant women underwent such checks. The same condition applies to Depok City, where in 2016 only 3.6% of pregnant women were screened. Because 86.6% antenatal examinations are done within primary-care facilities, this study has to analyzed the preparedness of primary health-care resources in the implementation of HIV screening for pregnant women. The research used qualitative method with in-depth interview, FGD and document review. The Study found that human resource workers trained in HIV programs were not available at every Public Health Center (PHC) and private primary health-care (PPHC) had no such workers were trained on HIV. Roughly half (17 of 35) of PHCs Primary health care capable of HIV screening for maternal. No PPHC facilities especially inpendent midwife practice had such capabilities The number of reagents was found to be inadequate at the PHCs, and no reagents at all were found at prprivate care facilities. Counselling media was found to be lacking at both types of primary care facilities. Conclusion the implementation of HIV screening in primary health care facilities is not yet ready according to the MSS. Regulations that require PPHC facilities to be capable of HIV screening and government support for the availability of resources (especially training and reagents) are require for the achievement of the MSS.

Experiences Implementing a Routine HIV Screening Program in Two Federally Qualified Health Centers in the Southern United States.

The southern United States is highly affected by HIV, and community health centers play a key role in addressing the health-care needs of residents of southern cities. In 2012, Southside Medical Care Services ("Southside") in Atlanta, Georgia, and Central Care Community Health Center ("Central Care") in Houston, Texas, began comprehensive programs for routine HIV screening and linkage to HIV care. We examined patient-level testing outcomes using medical record-derived data. We also compared the total number of HIV tests and HIV-positive tests in the most recent 12 months of the program with the number of HIV tests and HIV-positive tests during the 12 months prior to the program start. Southside saw 52,437 eligible patients from June 2012 through April 2014; 41,720 (80%) were offered an HIV test, 11,092 (27% of those offered a test) were tested, 75 (0.7% of those tested) had a positive result, and 74 (99% of those with a positive result) were linked to HIV care. Compared with the 12 months prior to the start of routine HIV screening implementation, Southside's routine HIV screening program conducted 5,955 more HIV tests (733% increase) and had 31 more patients who tested positive (238% increase). Central Care saw 22,658 eligible patients from July 2012 to April 2014; 10,904 (48%) were offered an HIV test, 9,909 (91% of those offered a test) were tested, 52 (0.5% of those tested) had a positive result, and 41 (79% of those with a positive result) were linked to HIV care. Compared with the 12 months before routine HIV screening was implemented, Central Care's routine HIV screening program conducted 4,559 more HIV tests (618% increase) and had 36 more patients who tested positive (600% increase). Southside and Central Care effectively implemented routine HIV screening programs that dramatically increased their testing volume while also linking the majority of HIV-positive patients to care. Other community health centers should consider similar programs.

Implementing Routine HIV Screening in Three Chicago Hospitals: Lessons Learned.

This study describes routine HIV screening implementation and outcomes in three hospitals in Chicago, Illinois. Retrospective data from three hospitals were examined, and routine testing procedures, testing volume, reactive test results, and linkage-to-care outcomes were documented. From January 2012 through March 2014, 40,788 HIV tests were administered at the three hospitals: 18,603 (46%) in the emergency department (ED), 7,546 (19%) in the inpatient departments, and 14,639 (36%) in outpatient clinics. The screened patients varied from 1% to 22% of the total eligible patient population across hospitals. A total of 297 patients tested positive for HIV for a seropositivity rate of 0.7%; 129 (43%) were newly diagnosed and 168 (57%) were previously diagnosed, with 64% of those previously diagnosed out of care at the time of screening. The inpatient areas had the highest seropositivity rate (0.6%). The percentage of newly diagnosed patients overall who were linked to care was 77%. Of newly diagnosed patients, 51% had ≥ 1 missed opportunity for testing (with a mean of 3.8 visits since 2006), and 30% of patients with missed opportunities were late testers (baseline CD4+ counts <200 cells per cubic millimeter). Routine screening is an essential tool for identifying new infections and patients with known infection who are out of care. Hospitals need to provide HIV screening in inpatient and outpatient settings--not just EDs--to decrease missed opportunities. Routine screening success will be driven by how notification and testing are incorporated into the normal medical flow, the level of leadership buy-in, the ability to conduct quality assurance, and local testing laws.

Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trial

Many people with HIV are undiagnosed. Early diagnosis saves lives and reduces onward transmission. We assessed whether an education programme promoting rapid HIV testing in general practice would lead to increased and earlier HIV diagnosis. In this cluster randomised controlled trial in Hackney (London, UK), general practices were randomly assigned (1:1) to offer either opt-out rapid HIV testing to newly registering adults or continue usual care. All practices were invited to take part. Practices were randomised by an independent clinical trials unit statistician with a minimisation program, maintaining allocation concealment. Neither patients nor investigators were masked to treatment allocation. The primary outcome was CD4 count at diagnosis. Secondary outcomes were rate of diagnosis, proportion with CD4 count less than 350 cells per μL, and proportion with CD4 count less than 200 cells per μL. This study is registered with ClinicalTrials.gov, number ISRCTN63473710. 40 of 45 (89%) general practices agreed to participate: 20 were assigned to the intervention group (44 971 newly registered adult patients) and 20 to the control group (38 464 newly registered adult patients), between April 19, 2010, and Aug 31, 2012. Intervention practices diagnosed 32 people with HIV versus 14 in control practices. Mean CD4 count at diagnosis was 356 cells per μL (SD 254) intervention practices versus 270 (SD 257) in control practices (adjusted difference of square root CD4 count 3·1, 95% CI -1·2 to 7·4; p=0·16);); in a pre-planned sensitivity analysis excluding patients diagnosed via antenatal care, the difference was 6·4 (95% CI, 1·2 to 11·6; p=0·017). Rate of HIV diagnosis was 0·30 (95% CI 0·11 to 0·85) per 10 000 patients per year in intervention practices versus 0·07 (0·02 to 0·20) in control practices (adjusted ratio of geometric means 4·51, 95% CI 1·27 to 16·05; p=0·021). 55% of patients in intervention practices versus 73% in control practices had CD4 count less than 350 cells per μL (risk ratio 0·75, 95% CI 0·53 to 1·07). 28% versus 46% had CD4 count less than 200 cells per μL (0·60, 0·32 to 1·13). All patients diagnosed by rapid testing were successfully transferred into specialist care. No adverse events occurred. Promotion of opt-out rapid testing in general practice led to increased rate of diagnosis, and might increase early detection, of HIV. We therefore recommend implementation of HIV screening in general practices in areas with high HIV prevalence. UK Department of Health, NHS City and Hackney.

The role of nurses in HIV screening in health care facilities: A systematic review.

To examine nurse-driven HIV screening in various health care settings in terms of its impact on test offering, acceptance and delivery rates, nursing responsibilities, staff perceptions and long-term implementation. Systematic review. The systematic review conducted in September 2014 adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Two independent reviewers extracted and summarised the eligible studies using a standardised form. All studies published from 2004 to 2014 that explored nurse-driven HIV screening practice in health care facilities in countries with comparable concentrated HIV epidemics were included. MEDLINE, EBSCO CINAHL. Overall, 30 quantitative, qualitative and mixed methods studies fulfilled the eligibility criteria. The studies showed a trend in higher test offering, better acceptance and higher delivery rates with the implementation of nurse-driven HIV screening. However, among the 23 studies (77%) that evaluated these aims, only 13 studies (56%) had a control group, and 4 studies (17%) were randomised controlled trials (RCT) in few centres (i.e., 1 or 2). In 2 studies that compared nurse-driven HIV test offering to physician intervention, the participation of nurses was higher than that of physicians (85% vs. 54%, p<0.001; 47% vs. 28%, p<0.05). In a third study, the intervention of a dedicated nurse increased the test offering from 96.5% to 99.5% (OR=7.27, 95% CI=1.02-316.9). Acceptance rates increased with the nurse intervention in 2 RCTs (75% vs. 71%, p=0.025; 45% vs. 19%, p<0.05) and in a cohort study (74.8% vs. 84.3%, OR=1.82, 95% CI=1.14-2.88), whereas it decreased in 2 other studies. The testing rates increased in 7 out of 10 studies, with a maximum absolute increase of 65.9%. Nurse-driven HIV screening was evaluated at the time of routine HIV screening implementation in 27 studies (90%) and provided nurses with new responsibilities in 9 studies (30%). The few studies (23%) that explored how health care professionals, including nurses, perceived the strategy showed that this approach was well received. However, several operational barriers, such as lack of time, prevented its long-term implementation. The review supports the implementation of nurse-driven HIV screening. However, the evaluation of the impact of the nurse approach by RCTs was scarce, calling for additional research to better evaluate the impact of the nursing profession's contribution to HIV screening. Moreover, the perceptions of nurses and health care staff were seldom evaluated and require further exploration to improve nurse-driven HIV screening implementation.

Opportunities for earlier HIV diagnosis in a pediatric ED

ObjectivesEmergency department (ED) HIV screening is recommended but challenging to implement and of uncertain effectiveness in pediatric EDs (PEDs). We sought to determine whether there were opportunities for earlier HIV diagnosis in the PED for a cohort of young adults diagnosed with HIV. MethodsThis retrospective cohort study reviewed PED records of a group of young adults receiving HIV care in an urban hospital setting. Pediatric ED visits were selected for review if they took place after the patient's estimated time of HIV acquisition and before their eventual diagnosis. Charts were reviewed to determine whether HIV infection was suspected and whether testing was offered. ResultsAmong a cohort of HIV-positive young adults, only 3 (3.6%; 95% confidence interval, 0.9-10.8) of 84 were seen in the PED during the time they were undiagnosed but likely to be infected with HIV. Among these subjects, there was no documentation that HIV testing was offered or refused nor was there documented suspicion of HIV. ConclusionsThere are opportunities for earlier diagnosis of HIV in PEDs, affirming the importance of HIV screening implementation in these settings. However, PEDs are unlikely to have the same frequency of contact with undiagnosed individuals as do adult EDs. Alternative methods of accessing at-risk adolescent populations must be identified.

Accès au don du sang des hommes ayant des relations sexuelles avec des hommes et impact sur le risque de transmission du VIH par transfusion : tour d’horizon international

As far back as 1983, in many countries, men who have sex with men were permanently excluded from blood donation because of their high risk of HIV infection. Since the implementation of HIV screening of blood donations in 1985, there has been a remarkable improvement in the viral safety of the blood supply due to improvements in donor selection and continuous progress in screening assays, including nucleic acid amplification testing. Despite, these improvements and the strong pressure of certain associations of the civil society, only few countries reduced the deferral duration for men who have sex with men. Studies that have assessed the impact of a modification of the permanent deferral measure on the HIV residual risk showed that a reduction in the deferral duration generates an additional risk. Even if this risk is tiny, is it acceptable to expose the blood product recipients to an additional risk? Nevertheless, these studies do not take into account an important parameter that is the probable better compliance of men who have sex with men with a temporary exclusion. The most recent studies agree to conclude that an alternative to the permanent exclusion of all men who have sex with men could consist in authorizing the donation from 12-month abstinent men who have sex with men, as some countries did already. This measure would allow covering widely the window period for the men having recently taken risks or for those whose partners would have taken risks, under the essential condition of an improvement of the donor compliance.

332: A Survey of Provider Opinions Regarding Implementing Rapid HIV Testing in the Emergency Department of a Safety Net Hospital

It is estimated that 1 in 4 HIV-positive people in the United States are unaware of their positive status. Centers for Disease Control and Prevention (CDC) in November 2006 changed their recommendations to advise more widespread HIV testing, including the adoption of screening programs at all points of contact with the health care system. Despite the revised guidelines and the availability of rapid HIV testing, implementation of HIV screening in emergency departments (EDs) is not widespread.

Incorporating the CDC Recommendations for Adolescent HIV Screening into Practice

The Centers for Disease Control and Prevention has issued revised recommendations for HIV testing that contain significant changes for adolescents and adults, namely that all patients ages 13 through 64 years should be offered routine, opt-out HIV screening without separate written consent or prevention counseling. This article elucidates the role of nurse practitioners caring for adolescent patients and provides a “to do” list for HIV screening implementation (including testing procedures, the consent process, confidentiality, communication of test results, insurance coverage, and links to legal and referral resources). Although this article includes issues unique to adolescents, the adult practitioner will also find it to be a useful guide for implementation.