ABSTRACT
Objective: Operational research for sexually transmitted disease (STD) service was conducted to: 1) create the potential for systematic care: to assess and monitor for HIV and STI; 2) create the linkage among OB-GYN, Medicine and Pediatric Departments of Siriraj Hospital; 3) cervical cancer screening in HIV-infected females by Pap smear once a year; 4) create a system file for collection of STI data of the unit; 5) promote HIV counseling, disclosure and keep records; 6) promote condom usage and reduce risk behaviors of HIV-infected females continuously. Methods: HIV positive females attending STD Clinic, Department of Obstetrics & Gynecology, Siriraj Hospital were enrolled in to the study during March 1, 2005 to September 1, 2006. The procedures include: 1) provide STI testing/treatment, risk-reduction and HIV disclosure counseling, provision of free condoms, and cervical cancer screening at least once a year; 2) develop standardized procedures and data collection tools and strengthen data management; 3) refer women from different departments to the STI clinic for screening; 4) provide training in risk reduction counseling and HIV disclosure counseling. Results: Most of the primary visits were check-up. Chlamydial infection was 2.1% (year 2005). GC infection was 0.5% (year 2005). Abnormal Pap was significantly related to low CD4 count. L-SIL = 9.3%; H-SIL = 26.8%. Among the participants, 10.4% had CD4 count <200. Conclusion: Early detection and treatment of STI is 30%. Early detection of cervical cancer and treatment were increased. Access to ARV for HIV-1 PMTCT was also increased. Cross sectional analysis will show more realistic data since the follow up visit may be a group who came to receive condoms which could be missed as high condom use rate. KPI of success in good clinical tracer include increased condom use and CD4 count, decrease STI, opportunistic infection, and viral load.
ABSTRACT
The objective of this study was to estimate HIV disclosure rates and identify factors that predict non-disclosure in Thai women who tested HIV positive during pregnancy or at delivery. This was a cohort study evaluating the implementation of prevention of mother-to-child HIV transmission programs at two Bangkok hospitals in 1999-2003. All HIV-infected women who delivered during the study period were enrollment eligible. Thai-language questionnaires were used to collect baseline data before discharge from the hospital. At the 1 and 4 month follow-up visits, women were asked if they had disclosed their HIV status. Of the 799 women who enrolled, 647 (81.0%) completed follow-up at 1 and 4 months. Four hundred fifty-three (70.0%) women disclosed their status by 1 month. Of the 194 women who had not disclosed by 1 month, 48 (24.7%) had disclosed their status by 4 months. An independent increased odds of non-disclosure by 1 month was associated with not having a partner tested for HIV (OR=5.83, 95% CI=3.19-9.08) or not knowing if the partner was ever tested for HIV (OR=1 3.02, 95% Cl=5.26-32.28), first learning of HIV positive status during delivery (OR=6.84, 95% CI=2.36-19.81) or after delivery (OR=3.14, 95% CI=1.57-6.26) and having >2 lifetime sexual partners (OR=1.71, 95% CI=1.04-2.82). Not living with a partner every day was associated with non-disclosure by 4 months in those women who had not disclosed by 1 month (OR=2.28, 95% CI=1.43-3.64). Despite high rates of disclosure by 1 month, 22.6% of women still had not disclosed their HIV status to their partners by 4 months. The benefits of disclosure warrant effective interventions targeted at women at risk for non-disclosure.