Voluntary Counseling And Testing Research Articles

Implementing a provider-initiated testing and counselling (PITC) intervention in Cape town, South Africa: a process evaluation using the normalisation process model

BackgroundProvider-initiated HIV testing and counselling (PITC) increases HIV testing rates in most settings, but its effect on testing rates varies considerably. This paper reports the findings of a process evaluation of a controlled trial of PITC for people with sexually transmitted infections (STI) attending publicly funded clinics in a low-resource setting in South Africa, where the trial results were lower than anticipated compared to the standard Voluntary Counselling and Testing (VCT) approach.MethodThis longitudinal study used a variety of qualitative methods, including participant observation of project implementation processes, staff focus groups, patient interviews, and observation of clinical practice. Data were content analysed by identifying the main influences shaping the implementation process. The Normalisation Process Model (NPM) was used as a theoretical framework to analyse implementation processes and explain the trial outcomes.ResultsThe new PITC intervention became embedded in practice (normalised) during a two-year period (2006 to 2007). Factors that promoted the normalising include strong senior leadership, implementation support, appropriate accountability mechanisms, an intervention design that was responsive to service needs and congruent with professional practice, positive staff and patient perceptions, and a responsive organisational context. Nevertheless, nurses struggled to deploy the intervention efficiently, mainly because of poor sequencing and integration of HIV and STI tasks, a focus on HIV education, tension with a patient-centred communication style, and inadequate training on dealing with the operational challenges. This resulted in longer consultation times, which may account for the low test coverage outcome.ConclusionLeadership and implementation support, congruent intervention design, and a responsive organisational context strengthened implementation. Poor compatibility with nurse skills on the level of the clinical consultation may have contributed to limiting the size of the trial outcomes. A close fit between the PITC intervention design and clinical practices, as well as appropriate training, are needed to ensure sustainability of the programme. The use of a theory-driven analysis promotes transferability of the results, and the findings are therefore relevant to the implementation of HIV testing and to the design and evaluation of complex interventions in other settings.Trial registrationCurrent controlled trials ISRCTN93692532

Socio‐economic determinants of HIV testing and counselling: a comparative study in four African countries

Research indicates that individuals tested for HIV have higher socio-economic status than those not tested, but less is known about how socio-economic status is associated with modes of testing. We compared individuals tested through provider-initiated testing and counselling (PITC), those tested through voluntary counselling and testing (VCT) and those never tested. Cross-sectional surveys were conducted at health facilities in Burkina Faso, Kenya, Malawi and Uganda, as part of the Multi-country African Testing and Counselling for HIV (MATCH) study. A total of 3659 clients were asked about testing status, type of facility of most recent test and socio-economic status. Two outcome measures were analysed: ever tested for HIV and mode of testing. We compared VCT at stand-alone facilities and PITC, which includes integrated facilities where testing is provided with medical care, and prevention of mother-to-child transmission (PMTCT) facilities. The determinants of ever testing and of using a particular mode of testing were analysed using modified Poisson regression and multinomial logistic analyses. Higher socio-economic status was associated with the likelihood of testing at VCT rather than other facilities or not testing. There were no significant differences in socio-economic characteristics between those tested through PITC (integrated and PMTCT facilities) and those not tested. Provider-initiated modes of testing make testing accessible to individuals from lower socio-economic groups to a greater extent than traditional VCT. Expanding testing through PMTCT reduces socio-economic obstacles, especially for women. Continued efforts are needed to encourage testing and counselling among men and the less affluent.

Reproductive health service utilization and associated factors among adolescents (15–19 years old) in Gondar town, Northwest Ethiopia

BackgroundThe utilization of reproductive health services is an important component in preventing adolescents from different sexual and reproductive health problems. It plays a vital role in safeguarding youth in Sub-Saharan African countries including Ethiopia, which accounts for a high proportion of the region’s new HIV infections as well as maternal and infant mortality ratios. Due to this, assessing adolescent reproductive health service utilization and associated factors has its own contribution in achieving the national Millennium Development Goals (MDG), especially goals 4 to 6.MethodsA community based cross-sectional study was conducted from April 5–19, 2012, in 4 randomly selected administrative areas of Gondar town. A total of 1290 adolescents aged 15–19 were interviewed using a pre-tested and structured questionnaire. Data were entered in to the EPI INFO version 3.5.3 statistical software and analyzed using an adapted SPSS version 20 software package. Logistic regression was done to identify possible factors associated with family planning (FP), and voluntary counseling and testing (VCT) service utilization.ResultsOut of the total participants, 79.5% and 72.2% utilized FP and VCT services, respectively. In addition, among sexually experienced adolescents, 68.1% and 88.4% utilized contraceptive methods and VCT service during their first sexual encounter, respectively. Educational status, discussion with family/relatives, peer groups, sexual partners and teachers were significantly associated with FP service utilization. Also, adolescents who had a romantic sexual relationship, and those whose last sexual relationship was long-term, were about 6.5 times (Adjusted Odds Ratio [AOR] = 6.5, 95% CI: 1.23, 34.59), and about 3 times (AOR = 3, 95% CI: 1.02, 8.24) more likely to utilize FP services than adolescents who had no romantic relationship or long-term sexual relationship, respectively. In addition, the variables significantly associated with VCT service utilization were: participants who had secondary education and above, schooling attendance, co- residence with both parents, parental communication, discussion of services with peer groups, health workers, and perception of a risk of HIV/AIDS.ConclusionsThe majority of the adolescents were utilizing FP and VCT service in Northwest Ethiopia. But among the sexually experienced adolescents, utilization of FP at first sexual intercourse and VCT service were found to be low. Educational status, schooling attendance, discussion of services, type of sexual relationship and perception of risk were important factors affecting the utilization of FP and VCT services. Building life skill, facilitating parent to child communication, establishing and strengthening of youth centers and school reproductive health clubs are important steps to improve adolescents’ reproductive health (RH) service utilization.

Knowledge, attitude and practice towards voluntary counseling and testing among university students in North West Ethiopia: a cross sectional study

BackgroundVoluntary counseling and testing (VCT) is one among different approaches which have been implemented as an attempt to slow the spread of HIV infection and minimize its impact at the individual, family and society level. VCT is perceived to be an effective strategy in risk reduction among sexually active young people like tertiary level students. Ethiopia as a country with high burden of HIV started responding to the epidemic by preparing and updating guidelines on VCT. The objective of this study was to assess the level of knowledge, attitude and practice of Voluntary Counseling and Testing (VCT) for HIV among university students in North West Ethiopia.MethodsA cross sectional study was conducted from February to May 2010 using a stratified sampling method to enroll students from different faculties into the study. A total of 330 university students filled in a self-administered questionnaire with response rate of 97.3%. Main outcome measures included level of knowledge, attitude and practice of VCT for HIV. A chi-square test was used to determine an association between a number of independent factors and dependant variables.ResultAbout 66.1% of the study participants were males with a mean age of 20 years. Majority (75.6%) of the respondents were Orthodox with 63% reported living in urban areas before joining the university. From the study participants 86.3% were knowledgeable on VCT, 73.3% had positive attitude towards VCT for HIV and 61.8% had had VCT for HIV in the past. Previous residence before joining the university, level of education, sex and religion were among the sociodemographic variables that showed statistically significant association with the one or more of the outcome variables. Fear of positive results, stigma and discrimination following the positive results were reported as main barriers for VCT uptake.ConclusionThe findings reveal important barriers for VCT uptake and suggest strategies to reduce stigma and discrimination.

Estimation on the HIV-1 incidence among high risk groups using the pooling RNA technique

To timely identify the HIV-1 infection in window-period and to estimate the HIV-1 incidence among people who came for voluntary counseling and testing (VCT) service as well as men who have sex with men (MSM), respectively. HIV antibody negative samples that were determined by screening tests between January and October 2012, were collected and tested with pooling HIV-1 RNA testing technique (2-staged pooling by 50:1, 10:1). Positive cases were followed-up for HIV antibody testing while HIV incidence was calculated under Ron Brookmeyer' s method, among VCT and MSM populations. Among 1400 HIV antibody negative samples of VCT, two showed HIV-1 RNA positive during the antibody window period with the HIV-1 incidence as 1.87% per year (95% CI: 1.23%-2.65% ). Among 500 HIV antibody negative samples from MSM population, two showed HIV-1 RNA positive in the antibody window period, with HIV-1 incidence as 5.31% per year (95% CI: 3.52%-7.45% ). Pooling HIV-1 RNA testing seemed a powerful tool for HIV antibody testing in the window-period. Measures should be taken to strengthen the HIV diagnostic programs among MSM and other high risk groups,during the HIV antibody window-period. More frequent detection approach as pooling HIV-1 RNA testing might be a good choice.

The relationship between sexual violence and human immunodeficiency virus (HIV) infection among women using voluntary counseling and testing services in South Wollo Zone, Ethiopia

BackgroundGender based violence affects the health and wellbeing of women across the world on an epidemic scale. While women remain more vulnerable to both sexual violence and risk of HIV infection, they are less able to access health and other welfare services than men. These vulnerabilities are further compounded by social factors, including the low status of women in many communities and their lack of decision-making power, both within the household and in wider society. The objective of this study was to assess the relationship between sexual violence and HIV infection among clients of voluntary counseling and testing (VCT) services in South Wollo Zone, Ethiopia.MethodologyA facility based cross sectional study was conducted using quantitative methods on a sample of 647 people living in seven selected districts of South Wollo Zone, Amhara Regional State.ResultsThe study revealed that sexual violence is significantly associated with the risk of HIV infection. The prevalence of lifetime sexual violence, lifetime partner violence, and last 12 months partner violence were 34.6%, 32.3% and 10.5% respectively. Both partner violence and lifetime sexual violence by another perpetrator were associated with HIV. The overall prevalence of HIV among VCT users was 21.5%. Both before (crude analysis) and after the results were adjusted for selected variables, women who experienced sexual violence in the last 12 months by their intimate partner or by another perpetrator is significantly associated with their HIV status. The chances of having HIV was 1.97 times higher among women victims who have a history of lifetime partner violence when compared with women who are not victims; crude odds ratio (COR) = 1.97, 95% Confidence Interval (CI), (1.34 - 2.90).ConclusionThe study revealed that sexual violence is significantly associated with the risk of HIV infection. Empowerment of women can be used as an important tool to reduce both sexual violence and HIV. More importantly policy issues must be set by all actors to take action on the mediating variables that interacted with violence to aggravate the transmission of HIV.

Importance of the Media in Scaling-Up HIV Testing in Kenya

The main objective of this study was to examine the association between media exposure and voluntary counseling and testing (VCT), and factors that influenced VCT among Kenyan women and men. Retrospective cross-sectional data from Kenya Demographic and Health Survey 2003 were used, adjusting for weights and strata to account for survey complex design. The study sample comprised women aged 15 to 49 ( n = 8,050) and men aged 15 to 54 ( n = 3,539). Among those who read newspapers/magazines almost every day, fewer women (15%) had been tested for HIV than men (31%), p < .001. Among women, those who read newspapers/magazines at least once a week (adjusted odds ratio [AOR] = 1.29, p < .001) and almost every day (AOR = 1.3, p < .001) were more likely to be tested than those who did not read at all. Among men, this was nonsignificant. However, those who read newspapers/magazines almost every day (AOR = 1.14, p < .05) were more likely to be tested than those who did not read at all. Significant odds of being tested for HIV were observed among men who watched television almost every day (AOR = 1.21, p < .001) versus women (AOR = 1.07, p < .05) compared with those who did not watch television at all. Results suggest a need to increase HIV messages in all media to scaling-up HIV testing in Kenya.

Profil sociodémographique, biologique et clinique de patients suivis dans un Centre de conseil et dépistage volontaire du VIH en zone rurale dans la province du Bas-Congo (RDC) 2006–2011

AIDS remains a public health problem in the Democratic Republic of Congo (DRC). However, there is little information on the medical situation of the disease in rural areas. The objective of this study is to describe the HIV infection in a rural zone in the province of Bas-Congo, DRC. The medical records of patients with a diagnosis of HIV/AIDS, followed in the centre of voluntary counselling and testing (VCT) of the general hospital Nsona-Nkulu in the city of Mbanza-Ngungu, DRC, from January 2006 to June 2011, were retrospectively reviewed. Socio-demographic profile, laboratory data and mode of detection were analyzed. During this study, 167 patients were identified as HIV positive (112 females and 54 males). The majority of patients were aged between 30 and 44 years and two out of three patients were not married; 77.3% had primary schooling. Testing for HIV was performed in 78% of patients during an episode of illness. Screening for unprotected sex was a rare event (0.7%). Co-infection with tuberculosis was present in 32% of our patients while 26% had shingles and 44.5% had sexually transmitted infection. Smoking was found slightly (14%) and alcoholism was reported in 37% of patients. Weight loss greater than 10% was found in 61% of patients. Over 80% of people tested positive for HIV were in later stages (stages 3 and 4). This study demonstrates that HIV infection remains a serious public health problem in rural zone. The factors militating for the use of awareness program for preventive measures need to be urgently addressed.

Factors Affecting Late Presentation for HIV/AIDS Care in Southwest Ethiopia: A Case Control Study

Late presentation for HIV/AIDS care may occur either as a result of late testing for HIV or delayed presentation to HIV care after getting tested. Identificat ion of different risk factors associated with late HIV/AIDS care is essential to target interventions aimed at favoring early entrance into HIV/AIDS care. Therefo re, the objective of this study was to assess factors associated with late presentation for HIV/AIDS care in Jimma town, Southwest Ethiopia. Institution based unmatched case-control study triangulated with qualitative method was conducted at Jimma University Specialized Hospital and Jimma Health Center. A samp le of 103 cases and 206 controls were selected using a consecutive sampling technique. Purposively, selected health workers working in an Anti Retroviral Therapy clinic and selected HIV positive indiv iduals who were attending an Anti Retroviral Therapy clinic for the first time were included in an in-depth interview. The primary statistical methodology used was logistic regression analysis and all analyses were performed using the Statistical Package for Social Sciences software fo r windows version 16. Qualitative data were analy zed using thematic analysis and triangulated with quantitative findings. The following were correlated with increased risk of delayed HIV/AIDS care: Those who were divorced or separated (AOR=3.7, CI: 1.3-10.4), could formally read and write (AOR=3.7, CI: 1.6-8.7), perceived HIV as curable (AOR= 2.7, CI: 1.3-5.4), got tested by voluntary counseling and testing (VCT) (AOR=2.5, CI: 1.2-5.4), had symptoms of HIV at time of d iagnosis (AOR= 4.9, CI: 2.3-10.9), had chronic health problems (AOR= 2.7, CI: 1.2-5.9), had contact with a commercial sex worker (AOR= 3.00, CI: 1.4-6.5) and alcohol users (AOR= 3.8, CI: 1.8-7.9) as compared with their counterparts. The qualitative findings also showed that HIV stigma, non disclosure, low awareness, substance use, having contact with commercial sex workers, and poor lin kage after HIV testing were the major barriers for late presentation for HIV/AIDS care. In this study being separated or divorced, being educated, having signs and symptoms of HIV at diagnosis, having chronic health problems and having behavioral problems upon HIV d iagnosis were risk factors for late HIV/AIDS care. So, efforts to reduce late initiat ion of HIV/AIDS care should focus on addressing these risk factors.

P4.036 Condom Use Among Female Sex Workers (FSWs) Increased Through Drop In Center (DIC) Based Service Delivery Approach in Bangladesh

BackgroundThe HIV prevalence in Bangladesh remains low (< 1%) among FSWs. Since June 2008, with the funding supports from the Global Fund, Save the Children gradually scaled up essential services...

Assessing factors influencing university students to uptake voluntary counselling and testing (VCT) of human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS)

This research sought to establish factors that influence students at a university in Tanzania to go for voluntary counselling and testing (VCT) of human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The study adopted a case study design done under an interpretivist paradigm and employed a qualitative research approach. Sixty seven respondents were selected by using purposive and snowball samplings. Primary data was obtained from semi-structured interviews and focus group discussions. Secondary data was obtained from documentary reviews of reports at the university in which the study was carried out. Data was analysed by using content analysis. It was found that university students recommended VCT services to other people but would not go themselves because of fear of the consequences of HIV positive results such as stigmatization, isolation and stress. Students also do not go for VCT because they are unsure about confidentiality issues, and they have a misunderstanding of benefits of HIV testing and peer pressure. Few students went for VCT as they were influenced by factors such as marriage, the need to know their statuses, encouragement from different organisations and the great role that is played by peer educators. The study concluded that until an effective treatment for HIV/AIDS is discovered and availed to the affected individuals and communities, VCT remains the major strategy for the reduction of the disease. University students’ attitudes towards VCT play an indispensable role towards the attainment of the services. The study recommends that sensitization about HIV/AIDS VCT be increased so that students may be able to break the bond of terror and go for HIV testing in order to access life prolonging drugs earlier if they are HIV positive. More HIV/AIDS programmes such as seminars which are related to VCT should be frequently done in universities. Key words: Human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS), voluntary counselling and testing, university students.

Knowledge, attitudes, and behaviors regarding HIV among first time attenders of voluntary counseling and testing services in Italy

BackgroundThis study assess knowledge, attitudes, and practices regarding Human Immunodeficiency Virus (HIV) testing and counseling services and the predictor characteristics of these outcomes among individuals who presented for the first time to Voluntary Counseling and Testing (VCT) public services.MethodsA sample of 244 subjects in the geographic area of Naples (Italy) received a self-administered anonymous questionnaire about socio-demographic characteristics, knowledge, attitudes relating to HIV infection, and practices relating to access to VCT service.ResultsOnly 25% correctly identified the main modes of transmission and the main preventative measures of HIV and this knowledge was significantly higher in who had had more than one sexual partner and have not always used a condom during the intercourse in the last year, in those who have received information about HIV/AIDS through physician, and in those who have received middle school or lower educational level. The perceived risk of contracting HIV/AIDS was significantly higher in respondents of lower age, in those who perceived a better personal health status, and in those unmarried. Only 20.9% reported that they had received the HIV test and males and those who visited a physician or participated in preventive activities about HIV/AIDS were significantly more likely to have had an HIV test.ConclusionsThis study supports the need to disseminate information and interventions to this population.

Are healthcare workers at higher risk of HIV infection than the general population in Burkina Faso?

In order to assess the HIV prevalence in healthcare workers (HCWs) in Burkina Faso, we conducted a national survey in 97 health facilities from urban and rural areas. Of 1570 HCWs who agreed to participate, 1013 (64·5%) provided a urine sample for HIV testing. The crude prevalence of HIV in HCWs was 3·5% (95% CI 2·3-4·6). HIV prevalence was 0·7% in students and trainees, 3·8% in nurses and midwives, 4·5% in administrative workers, and 4·6% in laboratory workers. After age and area standardization, men from the Demographic Health Survey (DHS) had a similar HIV prevalence (2·3%, 95% CI 1·4-2·9) as male HCWs (2·5%, 95% CI 1·1-4·0), while female HCWs were more infected (4·5%, 95% CI 2·5-6·0) than women from the DHS (2·1%, 95% CI 1·3-2·4). A voluntary counselling and testing (VCT) programme should be specifically implemented and adapted for female HCWs.

Voluntary HIV testing and risky sexual behaviours among health care workers: a survey in rural and urban Burkina Faso

BackgroundVoluntary counselling and testing (VCT) together with a safe sexual behaviour is an important preventive strategy in the control of HIV. Although Health care workers (HCWs) are critical in the response to HIV, little is known about VCT and high risk behaviours (HRB) among this group in West Africa. This study aims to assess the prevalence of VCT and HRB among HCWs in Burkina Faso.MethodsWe collected data through a questionnaire in urban areas (Ouagadougou and Bobo-Dioulasso) and rural areas (Poni and Yatenga) among HCWs from 97 health care facilities. Urine samples were collected, screened for HIV using a Calypte® test kit and confirmed by Western Blot. Multiple logistic regression analysis was performed to identify factors associated with the use of VCT services and with high-risk sex behaviour.ResultsAbout 92.5% of eligible HCWs participated (1570 out of 1697). Overall, 38.2% of them (34.6% of women and 42.6% of men) had ever used VCT services. About 40% of HCWs reported that fear of knowing the test result was the main reason for not doing the HIV test. Male HCWs (p = 0.001), laboratory workers (p < 0.001), those having two years or more experience (p = 0.03), and those who had multiple partners (p = 0.001) were more likely to have tested for HIV. One fifth of HCWs reported multiple partners. Of these, thirteen percent did not use condoms. HCWs who had multiple partners were significantly more likely to be men, single, living in rural areas, and under the age of 29 years.ConclusionVCT was still very low among HCWs in Burkina Faso, while HRB was high.These findings suggest that ‘HCW-friendly’ VCT centres should be implemented, securing confidentiality among colleagues. In addition, refreshment courses on HIV risk reduction, counselling and testing are certainly required during the professional career of HCWs.

A suicide risk screening scale for HIV-infected persons in the immediate post-diagnosis period

Background. The risk of suicidal tendencies in HIV-infected persons appears high and may parallel the increasing prevalence of suicidal behaviour in South Africa.Objective. To construct a brief suicide risk screening scale (SRSS) as a self-administered instrument to screen for suicidal ideation in recently diagnosed HIV-infected persons.Methods. An SRSS was developed, drawing 14 items from two established screening tests, and assessed using a sample of 150 HIV-infected consenting adults identified at a voluntary counselling and testing (VCT) clinic at an academic district level hospital in Durban, South Africa. Participants returned three weeks after their initial assessment for a re-assessment.Results. The internal consistency of the SRSS was good (Cronbach’s alpha, 0.87), and its sensitivity (81%) was higher than its specificity (47%). The findings suggest that, despite certain limitations, the SRSS may be a valuable screening tool for suicidal ideation at VCT clinics.Conclusion. Screening for suicide risk and possible suicidal behaviour in HIV-positive persons may form a routine aspect of comprehensive patient care at VCT clinics to assist with effective prevention and treatment.

Voluntary Counseling and Testing in the Pediatric Ward of Mzuzu Central Hospital, Northern Malawi

ObjectivesA voluntary counseling and testing (VCT) program to screen for human immunodeficiency virus (HIV) has been implemented in areas of high HIV prevalence; however, such services are not readily available to children in the clinics of sub-Saharan Africa. The objective of this study was to investigate the relationship between the clinical symptoms of children and HIV infection status. MethodsA cross-sectional study of children and their caregivers was conducted at a clinic in northern Malawi, a country with a high prevalence of HIV infection. A total of 85 (48.6%) pediatric patients and 82 (46.7%) caregivers were recruited in the study. The HIV VCT services were provided based on the principle of three C’s (consent, counseling, and confidential). ResultsThe prevalence rates of HIV infection were 16.5% for children and 25.9% for their caregivers. In those children, 74.0% and 65.3% of HIV infections may be attributable to malnutrition and sepsis, respectively. Caregivers were mainly motivated to accept the VCT service or agree to have their children receive the test because they wanted to know their own HIV status (81.7%) and the status of their children (78.0%). ConclusionWhen a child shows symptoms of malnutrition and sepsis, the clinic should recommend VCT to caregivers in order to help them learn about their own as well as their child’s HIV status. After discussing factors that affect the advantages, disadvantages, limitations, and acceptability of offering routine VCT services, it is concluded that a standard approach to identify HIV infections in hospitalized children is urgently needed.

Predictors of HIV Serodiscordance among Couples in Southwestern Ethiopia

With transmission of HIV occurring mainly through heterosexual contact, it is paramount to identify serodiscordant couples and implement preventive strategies that will protect the negative partner. The burden of serodiscordance and its predictors in Ethiopia is not clearly understood due to the dearth of data. To assess the prevalence and predictors of HIV serodiscordance among couples tested in Jimma University Specialized Hospital (JUSH) Voluntary Counseling and Testing (VCT) center. The study employed a case-control study design conducted at VCT center of JUSH in all registered serodiscordant couples and seroconcordant couples that were selected from the registered clients in the period from 2003 to 2010. A pretested structured questionnaire was used for data collection using medical chart abstraction. Data were entered, cleaned, and coded using Statistical Package of Social Sciences (SPSS) version 16. The prevalence of serodiscordance in the study population was found to be 8.4%. Male and female discordants accounted for 5.8% (137) and 2.6% (62), respectively. Rare use of condom (adjusted odds ratio [AOR] = 7.2; 95% confidence interval [CI] = 1.59-32.54) and active tuberculosis (TB) at enrollment (AOR= 17.7; 95% CI = 2.3-139.2) were significantly found to be the predictors of serodiscordance. The prevalence of serodiscordance in the study area was found to be low, but it contributes to a clinically significant population that mandates implementation of preventive strategy. Sero-positive individuals who use condoms rarely should be encouraged to have their partners tested, and the association between active TB and serodiscordance underscores the need for further study.

A suicide risk screening scale for HIV-infected persons in the immediate post-diagnosis period

Background. The risk of suicidal tendencies in HIV-infected persons appears high and may parallel the increasing prevalence of suicidal behaviour in South Africa. Objective. To construct a brief suicide risk screening scale (SRSS) as a self-administered instrument to screen for suicidal ideation in recently diagnosed HIV-infected persons. Methods. An SRSS was developed, drawing 14 items from two established screening tests, and assessed using a sample of 150 HIV-infected consenting adults identified at a voluntary counselling and testing (VCT) clinic at an academic district level hospital in Durban, South Africa. Participants returned three weeks after their initial assessment for a re-assessment. Results. The internal consistency of the SRSS was good (Cronbach’s alpha, 0.87), and its sensitivity (81%) was higher than its specificity (47%). The findings suggest that, despite certain limitations, the SRSS may be a valuable screening tool for suicidal ideation at VCT clinics. Conclusion. Screening for suicide risk and possible suicidal behaviour in HIV-positive persons may form a routine aspect of comprehensive patient care at VCT clinics to assist with effective prevention and treatment.

Assessment of Voluntary Counselling and Testing Uptake Among Adults in Osun State Nigeria

In Nigeria less than 10% of people infected with Human Immunodeficiency Virus are aware of their HIV status. This poses a great challenge to effective control of the spread of the disease. The study assessed the uptake of Voluntary Counselling and Testing (VCT) among adults of reproductive age in Osun State, Nigeria. Respondents from three Local Government Areas of Osun State were selected for the study which employed a descriptive cross-sectional design. An interviewer-administered, semi-structured questionnaire was used to elicit information from 720 male and female respondents of reproductive age group. The data were analyzed using SPSS version 15 and the results were analyzed using descriptive and inferential statistics. The results showed that only 17.9% of the respondents had ever accessed VCT. The commonest reasons reported for accessing it were the desire to know their HIV status (36.4%), doctor’s request sequel to being sick (24.8%) and ante-natal care screening (22.5%), among others. Respondents with tertiary education were more likely to access VCT. Eighty two percent (82%) of the respondents had never accessed VCT before. The study concluded that adults of reproductive age in Osun State had poor uptake of VCT and those with tertiary education were more likely to access the services. Continuous media education, social marketing of VCT, building more testing sites in rural areas and scaling-up of the services in routine medical and obstetric care, can help to improve the uptake.

Community Based Promotion on VCT Acceptance among Rural Migrants in Shanghai, China

ObjectiveVoluntary counseling and testing (VCT) plays an important integral role in response to the HIV/AIDS epidemic. However, VCT service has not been effectively utilized among rural migrants, a high risk group in China. In this study, we developed a community based intervention to examine if community mobilization with comprehensive VCT is more effective than current HIV preventions with routine VCT service in promoting VCT acceptability among rural migrants in Shanghai, China.MethodsA comprehensive intervention with community mobilization and comprehensive VCT services including community-based VCT and mobile VCT was implemented during 2007–2009. Three communities in Minhang District of Shanghai were randomly selected and were designed to receive community mobilization and comprehensive VCT, traditional VCT and none intervention, respectively. After 24 months intervention, effects were evaluated by comparing outcome indicators between the baseline (2,690 participants) and follow-up surveys (1,850 participants).FindingsA substantial increase in VCT acceptance was observed among community mobilization group (94.9% vs. 88.5%, P<0.001), whereas the reverse effect was seen in the traditional VCT group (86.1% vs. 94.6%, P<0.001) and control group (69.0% vs. 91.7%, P<0.001). Rural migrants from community mobilization group were more likely to accept VCT (OR = 2.91, 95% CI 1.69–4.97). Rural migrants from community mobilization group also showed significant increase in HIV/AIDS knowledge, positive attitude towards HIV positive individuals and condom use.ConclusionCommunity mobilization with comprehensive VCT has significant impact on promotion of VCT acceptance and utilization among rural migrants in Shanghai. These findings provide evidence to support community mobilization as a suitable strategy for VCT promotion among rural migrants in Shanghai, China.