Voluntary Counseling And Testing Clinics Research Articles

Temporal and Spatial Trends in HIV Positivity Rate for VCT Clinics - China, 2015-2022.

Human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) clinics play a critical role in identifying and diagnosing HIV cases. This study aimed to describe the trend of HIV positivity rate (HPR) among Chinese VCT clinics between 2015 and 2022. This study utilized data from the China Information System for Disease Control and Prevention to analyze the trend in the HPR for VCT clinics from 2015 to 2022. The HPR was calculated by dividing the number of newly-reported HIV cases by the number of HIV tests, multiplied by 100%. To identify temporal and spatial trends in the HPR, we employed joinpoint regression analysis and the Getis-Ord hotspot analysis. From 2015 to 2022, VCT clinics in China performed a total of 22,075,386 HIV tests, leading to the identification of 260,353 HIV cases, resulting in a HPR of 1.18%. The HPR consistently declined over the study period, with an average annual percent change (AAPC) of -7.5% (95% confidence interval: -12.6%, -2.2%, P<0.05). The number of HPR hotspots also decreased from 41 in 2015 to 23 in 2022. These HPR hotspots were primarily located in Yunnan, Sichuan, Guangdong, and Guangxi provincial-level administrative divisions (PLADs). Among the 31 PLADs, 16 showed a significant decrease in HPR during the study period (AAPC<0, PAAPC<0.05). VCT clinics in China have played a significant role in identifying HIV cases. The declining HPR observed in these clinics may indicates the progress has been made in some degree in mitigating HIV among high-risk populations. Therefore, it is crucial to further improving the utilization of VCT clinics for HIV testing.

Factors related to delayed initiation of antiretroviral therapy among patients with clinically eligible HIV-infected

Background: Human Immunodeficiency Virus (HIV), namely a virus that reduces the ability of the human immune system, so that sufferers are susceptible to various diseases, the wider scope of ARV administration certainly has a positive impact in reducing mortality and morbidity, improving the quality of life of patients with HIV and AIDS.Purpose: To determine the factors associated with delayed initiation of antiretroviral therapy in Human Immunodeficiency Virus patients at the VCT (Voluntary Counseling and Testing) Clinic of Pringsewu Hospital in 2022.Method: This type of quantitative research, using a cross sectional design. The population of this study were HIV positive patients at the Pringsewu Regional General Hospital Clinic, Lampung for the year 2022, namely 174 patients, using the side total technique. Univariate data analysis, bivariate with chi square and multivariate with multiple logistic regression tests.Results: The result showed that the factors associated with delayed initiation of antiretroviral therapy in Human Immunodeficiency Virus patients at the VCT Clinic at Pringsewu General Hospital in 2022 were Socioeconomic Status (p value=0.009), education level (p value=0.001, opportunistic infections (p value= 0.001), HIV/AIDS Stigma (p value=0.003), and Access (p value=0.018). The most dominant factor associated with delayed initiation of antiretroviral therapy in patients with Human Immunodeficiency Virus infection was access (95% CI, p=0.027 and OR; 3.738).Conclusion: Antiretroviral therapy (ARV) delays in PLWHA are strongly influenced by low socioeconomic status, low education level, presence of opportunistic infections, positive stigma and remote access to healthcare services.Suggestion: Management at the hospital's VCT clinic is suggested to make guidelines or standardized services, educate about the importance of ARVs, provide motivation, and carry out consistent control of ARV therapy. The management always promotes the importance of awareness and adherence in carrying out ARV therapy which will have many benefits in improving quality of life, healthy behavior, and extending life span.

HIV Prevalence and Factors Influencing the Uptake of Voluntary HIV Counseling and Testing among Older Clients of Female Sex Workers in Liuzhou and Fuyang Cities, China, 2016-2017: A Cross-Sectional Study.

Objective To compare the prevalence of HIV and associated factors for participating HIV voluntary counseling and testing (VCT) among older clients of female sex workers (CFSWs) in Liuzhou City and Fuyang City in China. Methods A cross-sectional study was conducted and the study employed 978 male CFSWs, aged 50 years and above from October 2016 to December 2017. All participants were required to complete a questionnaire and provide blood samples for HIV testing. Multivariate logistic regression analysis was used to analyze the influential factors of using VCT program and tested for HIV. Results The HIV infection prevalence rate was 1.2% and 0.5%, while 52.3% and 54.6% participants had ever utilized VCT service and tested for HIV in Liuzhou City and Fuyang City, respectively. The older CFSWs who ever heard of VCT program were more likely to uptake VCT program in both cities (ORLiuzhou = 2.224, ORFuyang = 2.421). Participants, whose marital status was married or cohabiting (ORLiuzhou = 0.548, ORFuyang = 0.495), who have stigma against individuals who are living with HIV/AIDS (ORLiuzhou = 0.273, ORFuyang = 0.371), whose monthly income is more than 500 yuan (ORLiuzhou = 0.622, ORFuyang = 0.600), and whose age is more than 60 years old (ORLiuzhou = 0.639, ORFuyang = 0.554), were less likely to visit VCT clinics. Those who are worried about HIV-infected participants were more likely to utilize VCT services in Fuyang City (AOR = 1.838, 95%CI : 1.146‐2.948). Conclusion Combine strategy will be needed to promote the utilization of VCT service, based on the socioeconomic characteristics of older male CFSWs in different cities of China.

Mutu Pelayanan Voluntary Counseling and Testing (VCT) di Klinik VCT Puskesmas Puger dari Perspektif Provider

Voluntary Counseling and Testing (VCT) is an entry point to help everyone in utilizing services related to HIV-AIDS prevention, care, support and treatment. Puger Primary Health Care is a primary health care located in the work area with the highest number of HIV-AIDS sufferers in Jember Regency, experiencing a decrease in client visits, and there are some management services that are still not in accordance with VCT guidelines. This study aimed to describe the quality of VCT services at the VCT Clinic Puger Primary Health Care from the perspective of provider. This study was descriptive study using questionnaire, documentation study, and observation. The study respondents were 7 VCT clinic officers. The results indicated that in input parameter showed a lack of human resources, insufficient funding, lack of availability and material conditions that meet the VCT guidelines. In planning indicators related to the human resources, improvements of infrastructure facilities had not been written in the POA, the job description was sufficient based on duties and competences of staff and there were coordination, supervision and evaluation. In the dimensions of technical competence, access to services, efficiency, human relations, continuity and safety of VCT clinics in good categories, but sufficient and less categories for dimensions of effectiveness and comfort dimensions.

Repeat HIV Testing and Incident Rates among Individuals Attending Voluntary Counseling and Testing Clinics in Wuxi, China: A Retrospective Study

ObjectiveWe aimed to elucidate the rates of repeat HIV testing and incident HIV diagnosis, and baseline CD4+ T cell count among individuals attending HIV voluntary counseling and testing (VCT) clinics in Wuxi, China. MethodsA repeat HIV testing within 12 months was recorded if individuals had their first test with negative results, during 2013-2014 and retested within 12 months. An incident HIV diagnosis was recorded if individuals had their first test with negative results, during 2013-2015 and had a subsequent positive result at any point by the end of 2015. Data on HIV testing and diagnosis among individuals attending 32 VCT clinics from 2013 to 2015 and HIV diagnosis from other clinical services in Wuxi, China, were retrieved. A multivariate logistic regression model was used to analyze factors associated with repeat HIV testing. Cox regression was used to evaluate factors associated with incident HIV diagnosis. ResultsFrom 2013 to 2014, 11,504 individuals tested HIV negative at their first recorded test, with 655 (5.7%) retesting within 12 months. Higher repeat HIV testing within 12 months was associated with male gender [adjusted odds ratio (aOR) = 1.7, 95% confidence interval (CI): 1.4-2.2], risk behaviors [commercial heterosexual behaviors (aOR = 1.4, CI: 1.1-1.6), male-male sexual behaviors (aOR = 3.7, CI: 2.7-4.9)], injection drug use (aOR = 9.9, CI: 6.5-15.1), and having taken HIV tests previously (aOR = 2.0, CI: 1.6-2.4). From 2013 to 2015, 1,088 individuals tested negative on HIV test at their visit and at ≥ 2 subsequent tests; of them 30 had incident HIV diagnosis. The overall rate of incident HIV diagnosis among all VCT individuals was 1.6 (95% CI: 1.1-2.1) per 100 person-years. Incident HIV diagnosis was associated with male gender [adjusted hazard ratio (aHR) = 8.5, 95% CI: 1.9-38.1], attending hospital-based VCT clinics (aHR = 7.8, 95% CI: 1.1-58.3), and male-male sexual behavior (aHR = 8.4, 95% CI: 1.5-46.7). Individuals diagnosed at VCT clinics had higher CD4+ T cell count compared with those diagnosed at other clinical services (median 407 vs. 326 copies/mm3, P = 0.003). ConclusionVCT individuals in Wuxi, China, had a low repeat HIV testing rate and high HIV incidence. VCT-clinic-based interventions aimed at increasing repeat HIV testing are needed to detect more cases at an earlier stage, especially among individuals at high risk for HIV infection such as men who have sex with men.

Profil pasien baru HIV di poliklinik VCT BRSU Tabanan Bali pada tahun 2009 sampai 2017

Background: HIV infection is a disease that currently becomes a global problem. Bali is one of the provinces in Indonesia with very high HIV infection new case. Badan Rumah Sakit Umum (BRSU) Tabanan is one of the leading hospitals in Tabanan. Based on data in Voluntary Counseling and Testing (VCT) clinic in BRSU Tabanan, new diagnosed HIV patients are increasing from year to year, so research about new diagnosed HIV patient profile is needed. This research is a descriptive research. Methods: The research design used in this study is cross-sectional study. Population and sample in this study were all newly diagnosed patients with HIV infection in BRSU Tabanan VCT clinic from 2009 to 2017 with a total of 872 people were obtained by total sampling. Secondary data were then processed statistically using statistical software. Results: From this research obtained that new case is the most in the year 2016 (18,5%). With the most patient in age 30 – 39 years old age group (34,9%), male (60.1%), still in employment (22.4%), still living (93.9%), and predicted risk factor heterosexual (93,7%). When the sample is diagnosed HIV most of the patient in stadium 3 (53,6%), with the most clinical sign is weight loss more than 10% in one month (50,2%), and opportunistic infection Candidiasis (55.6%). Conclusions: In an attempt to reduce spreading of HIV, education about transmitted sexual disease and reproduction health are important, especially in high-risk groups.Â

Factors that lead to changes in sexual behaviours after a negative HIV test: protocol for a prospective cohort study in Kinshasa.

BackgroundConsidering the high percentage of couples in which one or both members are HIV negative, the frequency of transmission among non-regular partners and the probabilities of non-disclosure, attention should be paid to people getting a negative HIV test at the Voluntary Counseling and Testing (VCT). Research has shown that a negative HIV test may be followed by a change in sexual behaviours. In Sub-Saharan Africa, where most HIV infections occur, there are few studies that have analysed the factors associated with changes in sexual risk behaviours after a negative HIV test at the VCT clinic. The aim of this project is to evaluate the specific factors associated with changes in sexual behaviours, three months after a negative result in an HIV test, and to analyse the effect of counseling and testing on HIV-related knowledge of participants in an outpatient centre of Kinshasa (Democratic Republic of Congo).Methods and designProspective cohort study from December 2014 until March 2016. People 15–60 year old that received VCT at Monkole Hospital (Kinshasa) were followed three months after they got a negative HIV test. In a face-to-face interview, participants replied to a baseline and a follow-up research questionnaire on HIV-related knowledge, attitudes and behaviours. At follow-up respondents were also offered a new HIV test and additional HIV counseling. Four hundred and fifteen participants completed the baseline questionnaire and 363 (87 %) came back for their 3-month follow up.DiscussionThis is the first longitudinal study in the DRC that evaluates the factors associated with changes in sexual behaviours after a negative HIV test at the VCT. Participants attending the VCT services within a clinical setting are a good study population as they can be good transmitters of preventive information for other people with no access to health facilities.

Prevalence of intimate partner violence in heterosexual men attending HIV voluntary counsel and test clinics and related factors in Shanghai

To understand prevalence of intimate partner violence(IPV)in heterosexual men(HM)attending HIV voluntary counseling and testing(VCT)clinics and related factors in Shanghai. All the HM attending two VCT clinics in Shanghai during March-August, 2015 were recruited to participate in a cross-sectional survey with questionnaire interview and blood test for HIV. IPV was evaluated by using the questionnaire developed by WHO Multi-Country Study on Women' s Health and Domestic Violence against Women. A total of 327 participants were recruited, their average age was 29.4 years(s∶6.1). Among them 60.2%(197/327)were aged 26-35, 57.8%(189/327)never married, 78.8%(260/327)had educational level of ≥college degree, 49.5%(162/327)were not local residents; 72.2%(236/327)had steady female partners, 72.2%(236/327)had 2 or more female partners in the past year, 6.1%(20/327)reported being diagnosed with sexually transmitted disease(STD). 1.8%(6/327)were tested to be HIV-positive. 28.4%(93/327)had IPV behaviors against heterosexual partners. Multivariate logistic regression analysis indicated that IPV behavior against heterosexual partners was significantly associated with experience of commercial sex(aOR=2.19, 95%CI: 1.16-4.15)and witness of domestic violence in early life(aOR=3.19; 95%CI: 1.58-6.45). IPV prevalence was relatively high in HM attendants in VCT clinics in Shanghai and IPV intervention is needed to conduct in VCT clinics. Multivariate regression analysis showed that the factors associated with IPV behaviors included having sex with female sex workers and the witness of domestic violence between parents. Future research is needed to further explore the association between IPV and HIV infection.

Analysis of Inputs in the Sexually Transmitted Infection Screening with Voluntary Counselling and Testing Program for Female Prisoners at Class II A Jail, in Malang

Background: The increasing incidences of Sexually Transmitted Infection (STI) and Human Immonodeficiency Virus (HIV) infection are becoming serious public health concerns in Indonesia and other countries. These issues are of concern that call for close attention not only for general public but also for male and female prisoners. As studies have shown the prevalences of HIV and syphilis were 1.1% and 5.1% in male prisoners, respectively, 6% and 8.5% in female prisoners. For those reasons, at some jails Voluntary Counseling and Testing (VCT) have been provided for HIV/AIDS control and prevention. The success of the screening program with VCT would depend on the provision of supplies, equipment, infrastructure, health personnel, and fund. This study aimed to analyze the adequacy of various inputs in the STI screening program with VCT for prisoners at the Class II A female jail, in Malang, East Java.Subjects and Method: This was a qualitative study with evaluation approach. This study was conducted at the Class II A female jail, in Malang, East Java. The study applied CIPP (Context, Input, Process, Product) evaluation model. Key informants for this study included health personnels at the Class II A female jail clinics, in Malang, East Java, the STI mobile health care team from Arjuno Community Health Center Malang, and female prisoners, who were known as Warga Binaan Pemasyarakatan (WBP)Results: Average monthly visits at the VCT clinic were 21 female prisoners, which amounted to only a few of the total number of female prisoners. The health care team involved in the STI screening with VCT program, included skilled health personnel from the jail and the mobile STI team from Arjuno Community Health Center, Malang. The sources of fund for these programs came from the International as well as domestic funding agencies. The International funding came from the Global Fund. The domestic funding came from the Ministry of Law and Human Civil Rights, and the Municipality Health Office Malang, which provided reagents and medicine. Supplies, equipments, and infrastructure, were provided by Arjuno Community Health Center Malang and the Class II A female jail clinics, in Malang. The laboratory was provided by the health center. The reagents were sufficiently provided by the municipality health office, although there was a supply delay in February 2016.Conclusion: Inputs of the STI screening with VCT program at the Class II A female jail clinics, in Malang, East Java, which included supplies, equipment, infrastructure, health personnel, and funding, are sufficiently provided. Keywords: analysis, input, screening, STI, VCTCorrespondence: Rosyidah Alfitri. Diploma III School of Midwifery, Dr. Soepraoen Hospital, Malang. Email: elfitri.mafaza@gmail.com.Journal of Epidemiology and Public Health (2016), 1(2): 118-124https://doi.org/10.26911/jepublichealth.2016.01.02.05

Internet-Facilitated, Voluntary Counseling and Testing (VCT) Clinic-Based HIV Testing among Men Who Have Sex with Men in China

ObjectiveTo explore the feasibility of using Internet outreach to encourage men who have sex with men (MSM) to get tested for HIV at voluntary counseling and testing (VCT) clinics in Beijing and Urumqi, China.MethodsFrom June to August 2007, two volunteers contacted MSM using instant messaging, online chat rooms, mobile phone, and e-mail (active recruitment). Banners with study information were put at the front pages of three major Chinese gay websites (passive recruitment). Those contacted were offered a modest financial incentive to seek HIV testing at existing VCT clinics. Those who subsequently sought HIV testing services at VCT clinics and provided informed consent completed a questionnaire and a blood draw to test for HIV and syphilis.ResultsA total of 3,332 MSM were contacted and 429 attended VCT clinics. One out of every 4 men that were recruited through instant messaging actually went for HIV testing, while the recruitment yields for online gay chat rooms, mobile phone contact, and email were 1∶6, 1∶10, and 1∶140, respectively. The majority of participants (80%, 317/399) reported being motivated to seek HIV testing out of concern for their health, and only 3% (11/399) reported being motivated by the financial incentive. Active recruitment tend to recruit MSM who are younger (X2 = 11.400, P = 0.001), never tested for HIV (X2 = 4.281, P = 0.039), tested less often (X2 = 5.638, P = 0.018).ConclusionInternet outreach is a promising way to encourage MSM to seek HIV testing at existing VCT clinics. Active recruitment can target MSM who are younger, never tested for HIV and tested less often.

VCT clinic HIV burden and its link with HIV care clinic at the University of Gondar hospital

BackgroundVoluntary Counselling and Testing (VCT) is an important component of any HIV/AIDS control and prevention activities. VCT makes people aware of their HIV serostatus and enables early identification of those who need care. It is an important link to HIV care and support. The main aim of this study is to describe the HIV burden at VCT and define the relationship between the VCT Center and the HIV Chronic Care Clinic of the University of Gondar (UoG) Hospital.MethodsIt is a record based descriptive study undertaken by using data collected by health professionals at the VCT center and the HIV chronic care clinic of the UoG Hospital. Patient data collected from 2005/06 to 2008/09 was investigated. Analysis was carried out using the SPSS version 16.0.ResultsA total of 19,168 people were tested for HIV and a prevalence of 25.4% was obtained. 4298 HIV positive people were referred to the HIV chronic care clinic but only 27% actually registered at the clinic. Chi-square analyses showed residence, age and time of VCT visit showed significant relations with hospital care attendance.ConclusionThe overall HIV prevalence is high. The data obtained at the HIV care clinic regarding patients’ clinical conditions at acceptance were incomplete. Improvements are required on the link between VCT and HIV care and documentation of data.

Voluntary counseling and testing (VCT) for HIV/AIDS: A study of the knowledge, awareness and willingness to pay for VCT among students in tertiary institutions in Enugu State Nigeria

To examine the level of awareness of youths to voluntary counseling and testing and willingness to pay for this service, and to explore reasons for underutilization of this service. A cross sectional study was carried out among undergraduate students of two tertiary institutions in Enugu Nigeria using pre-tested interviewer administered questionnaire. Information was collected from 250 respondents per institution. Analysis was done using SPSS computer software package. Most of the respondents (64%) have heard about VCT and 70.6% of the students obtained their information from the mass media (P<0.05) while a minority (3.8%) heard from families. 76.6% of respondents believe VCT can provide useful information on HIV/AIDS and VCT is obtainable mainly in teaching hospitals (78.5%) and to a lesser extent in government hospitals (9.8%) and NGOs (8.8%), while being almost non existent in private hospitals (2.9%). 81% of the respondents did not attend VCT while only 19% attended. The reasons for non attendance were that majority of the students (45.7%) were unaware of the services (P<0.05), indifferent to VCT (20.0%), (12.8%) felt it was costly and (13.3%) were afraid of discovering their HIV status. About 50% of the respondents were willing to pay for VCT and the mean willingness to pay was $3.2 (N370). Out of those willing to pay, 46% of them are willing to pay ($2.6) N300 while 34% and 20% are willing to pay $3.4 (N400) and $4.3 (N500), respectively (P<0.05). Among those not willing to pay, 67.6% of them think it should be free (P<0.05). Males and people with higher knowledge of VCT stated higher WTP values than females and those with less knowledge of VCT. Log OLS also showed that a higher level in the University was positively related to WTP. The high knowledge of VCT does not reflect on the attendance at VCT clinics. Respondents seem ignorant about where the services can be obtained and they believe VCT should be free or adequately subsidized. The cost of VCT is much higher than the mean WTP and governments should take this into consideration when subsidies are being considered. More VCT centers should be created and widely publicized in various communities.

HIV voluntary counseling and testing: an experience from India

Despite proof of voluntary counseling and testing (VCT) effectiveness in HIV disease prevention and management, there are limited reports on experience with pre- and post-HIV-test counseling in developing countries. In view of this, we aimed to bring to the fore the voluntary counseling and testing experience at a tertiary healthcare center. The present study was conducted at the voluntary counseling and testing center of a tertiary healthcare center and the National HIV Reference Center. Participants were 1169 men and 581 females attending the VCT clinic from February 2005 to March 2006. Odds ratios were calculated for each of the variable to analyze the strength of association with HIV sero-status. Out of 1750 patients, 322 (27.5%) males and 156 females (26.9%) tested HIV-positive. HIV-sero-positivity was observed to be associated to participant age (~1.5 for 25–44 yrs age group), marital status (2.3 times in married patients), primary or lower education level (1.5 times), citing spouse death/HIV-infected spouse as the reason for seeking VCT (2.2 times) and reporting a history of risk behavior as reason for getting tested. This study aims to evaluate the effectiveness of existing client initiated voluntary counseling and testing facility in the light of a recent recommendation by WHO/UNAIDS for the implementation of provider initiated voluntary counseling services. Through this study, we could also highlight socio-demographic factors, like education and age, and reasons stated by participants for seeking VCT, which were associated with HIV-positive status and put an individual at a higher risk of HIV infection.

Efficacy and Acceptability of Rapid, Point-of-Care HIV Testing in Two Clinical Settings in Ghana

This study assessed the efficacy and acceptability of two rapid point-of-care HIV assays used in a voluntary counseling and testing (VCT) and a tuberculosis (TB) clinic in Kumasi, Ghana. Over a 4-week period in 2007, 95 individuals attending the VCT clinic and 35 patients with newly diagnosed TB were offered a rapid HIV test. Rates of return for positive results and attendance at the HIV clinic were compared with 471 individuals (395 attending the VCT clinic and 76 patients with TB), tested during an 8-week period 6 months earlier using standard testing procedures. All patients offered a rapid test in each clinic underwent testing, compared to 93% of VCT clients and 40% of TB patients offered a test 6 months earlier. In the rapid testing period, 37%, 60%, and 3% of the VCT clients and 26%, 74% and 0% of the TB patients had positive, negative, or indeterminate serology, respectively. There were no discordant results following retesting of patients with a positive test. All patients attending either the VCT or TB clinics who tested positive for HIV with the point-of-care test returned to the HIV clinic for care, while only 64% and 95%, respectively, of the patients previously testing positive had returned for follow-up. Both clients and staff showed high levels of satisfaction with the rapid testing procedure. In conclusion, rapid point-of-care testing in both of these settings was successful in improving diagnosis of HIV infection and engaging those testing positive in a clinical care program.

From HIV diagnosis to treatment: evaluation of a referral system to promote and monitor access to antiretroviral therapy in rural Tanzania

BackgroundIndividuals diagnosed with HIV in developing countries are not always successfully linked to onward treatment services, resulting in missed opportunities for timely initiation of antiretroviral therapy, or prophylaxis for opportunistic infections. In collaboration with local stakeholders, we designed and assessed a referral system to link persons diagnosed at a voluntary counselling and testing (VCT) clinic in a rural district in northern Tanzania with a government-run HIV treatment clinic in a nearby city.MethodsTwo-part referral forms, with unique matching numbers on each side were implemented to facilitate access to the HIV clinic, and were subsequently reconciled to monitor the proportion of diagnosed clients who registered for these services, stratified by sex and referral period. Delays between referral and registration at the HIV clinic were calculated, and lists of non-attendees were generated to facilitate tracing among those who had given prior consent for follow up.Transportation allowances and a "community escort" from a local home-based care organization were introduced for patients attending the HIV clinic, with supportive counselling services provided by the VCT counsellors and home-based care volunteers. Focus group discussions and in-depth interviews were conducted with health care workers and patients to assess the acceptability of the referral procedures.ResultsReferral uptake at the HIV clinic averaged 72% among men and 66% among women during the first three years of the national antiretroviral therapy (ART) programme, and gradually increased following the introduction of the transportation allowances and community escorts, but declined following a national VCT campaign. Most patients reported that the referral system facilitated their arrival at the HIV clinic, but expressed a desire for HIV treatment services to be in closer proximity to their homes. The referral forms proved to be an efficient and accepted method for assessing the effectiveness of the VCT clinic as an entry point for ART.ConclusionThe referral system reduced delays in seeking care, and enabled the monitoring of access to HIV treatment among diagnosed persons. Similar systems to monitor referral uptake and linkages between HIV services could be readily implemented in other settings.

Risk factors of HIV infection and prevalence of co-infections among men who have sex with men in Beijing, China

To investigate risk factors related to HIV infection and the prevalence of selected infections, especially sexually transmitted infections (STI) among men who have sex with men (MSM). A cross-sectional study including questionnaire and blood sample collection. Between January 2005 and December 2006, 753 MSM were recruited through the voluntary counselling and testing (VCT) clinic at the Chaoyang District Centers for Disease Control and Prevention in Beijing. Sera samples were collected and tested for HIV, syphilis, Chlamydia trachomatis, Ureaplasma urealyticum, Toxoplasma gondii, and hepatitis C virus (HCV). Statistical analyses were performed to identify factors related to HIV and STI, as well as other co-infections. The prevalence of HIV-1 infection among MSM attending the VCT clinic was 2.1%. Among all MSM, 7.0% had syphilis, 5.6% Chlamydia, 4.4% U. urealyticum, 2.5% T. gondii and 0.8% HCV (13.8% had one or more). Among HIV-negative MSM, 13.3% had one of these infections, whereas among HIV-positive MSM, 93.8% had serological evidence of one or more co-infections (P < 0.0001). Individuals with HIV infection were significantly more likely to have had more male sex partners or to report frequent receptive anal sex in the past 6 months. Serological evidence of infection with any of five STI or HIV-relevant conditions was far higher in HIV-infected than HIV-uninfected MSM. Co-infection in HIV-positive men was most frequent with syphilis. Our data suggest that strategies for HIV/AIDS and STI prevention and control among MSM should be synchronized.

Voluntary counselling and testing: uptake, impact on sexual behaviour, and HIV incidence in a rural Zimbabwean cohort

To examine the determinants of uptake of voluntary counselling and testing (VCT) services, to assess changes in sexual risk behaviour following VCT, and to compare HIV incidence amongst testers and non-testers. Prospective population-based cohort study of adult men and women in the Manicaland province of eastern Zimbabwe. Demographic, socioeconomic, sexual behaviour and VCT utilization data were collected at baseline (1998-2000) and follow-up (3 years later). HIV status was determined by HIV-1 antibody detection. In addition to services provided by the government and non-governmental organizations, a mobile VCT clinic was available at study sites. Lifetime uptake of VCT increased from under 6% to 11% at follow-up. Age, increasing education and knowledge of HIV were associated with VCT uptake. Women who took a test were more likely to be HIV positive and to have greater HIV knowledge and fewer total lifetime partners. After controlling for demographic characteristics, sexual behaviour was not independently associated with VCT uptake. Women who tested positive reported increased consistent condom use in their regular partnerships. However, individuals who tested negative were more likely to adopt more risky behaviours in terms of numbers of partnerships in the last month, the last year and in concurrent partnerships. HIV incidence during follow-up did not differ between testers and non-testers. Motivation for VCT uptake was driven by knowledge and education rather than sexual risk. Increased sexual risk following receipt of a negative result may be a serious unintended consequence of VCT. It should be minimized with appropriate pre- and post-test counselling.

The cost of a rapid-test VCT clinic in South Africa.

Demand for HIV voluntary counselling and testing (VCT) will increase as HIV prevention and treatment scale up in South Africa. Understanding the cost of delivering VCT will inform funding decisions. To determine the cost per client completing VCT (pretest counselling, testing and post-test counselling) in a non-research- based programme using rapid-test technology. One year of expenditure and output data were collected retrospectively as part of the PANCEA (Prevent AIDS: Network for Cost-Effectiveness Analysis) study. Market prices were determined for donated resources. An urban, church-based, non-profit organisation that offers rapid-test VCT services in KwaZulu-Natal, South Africa. Financial expenditure for the 2002/2003 fiscal year was 39,761 dollars (calculated using an average conversion rate for July 2003, which was 0.133). Using market prices for donated resources, the economic cost for the year was estimated at 67,248 dollars. Six hundred and sixty-two clients completed VCT, resulting in financial expenditure of 60.06 dollars per client and an economic cost of 101.58 dollars per client. Financial expenditures and economic costs per client decreased over the year by 66% because expenses remained stable as more clients were served. The cost of providing VCT services was higher than previously reported, but declined with expanding scale.

Women's barriers to HIV-1 testing and disclosure: Challenges for HIV-1 voluntary counselling and testing

In view of the ever-increasing HIV/AIDS epidemic in sub-Saharan Africa, the expansion of HIV-1 voluntary counselling and testing (VCT) as an integral part of prevention strategies and medical research is both a reality and an urgent need. As the availability of HIV-1 VCT grows two limitations need to be addressed, namely: low rates of HIV-1 serostatus disclosure to sexual partners and negative outcomes of serostatus disclosure. Results from a study among men, women and couples at an HIV-1 VCT clinic in Dar es Salaam, Tanzania are presented. The individual, relational and environmental factors that influence the decision to test for HIV-1 and to share test results with partners are described. The most salient barriers to HIV-1 testing and serostatus disclosure described by women include fear of partners' reaction, decision-making and communication patterns between partners, and partners' attitudes towards HIV-1 testing. Perception of personal risk for HIV-1 is the major factor driving women to overcome barriers to HIV-1 testing. The implications of findings for the promotion of HIV-1 VCT programmes, the implementation of partner notification policies and the development of post-test support services are discussed.