Late diagnosis of HIV infection and its associated factors in Jiading District of Shanghai between 1998 and 2022 / 上海预防医学

ObjectiveTo investigate the late diagnosis of HIV infection and associated factors in Jiading District between 1998 and 2022， and to provide the information for the development of AIDS prevention and control strategy. MethodsInformation of newly reported HIV/AIDS cases in Jiading District between 1998 and 2022 were obtained from the National Information System for Comprehensive AIDS Prevention and Control. Logistic regression was used to explore the associated factors of late diagnosis of HIV infection. ResultsIn total， 809 HIV/AIDS cases was newly reported， 324 of which were late diagnosis with the overall rate of late diagnosis of 40.1%. Despite an increased tendency from 2016 to 2018， the rate of late diagnosis showed a downward trend from 1998 to 2015. The late diagnosis rate was 29.5% in 2015. From 2016 to 2022， the average rate was 34.9%. The average age of cases with a late diagnosis was 44.8±14.6 years old. Age groups over 50 had the highest risk，at 57.7%， accounting for 35.8% of all cases of late diagnosis. All age groups older than 30（OR=1.37‒3.50） had a higher rate of late diagnosis than the group between age 21 and 30. In comparison to patients at VCT clinic， the rate of late diagnosis among sexually transmitted disease （STD） outpatients （OR=2.23， 95%CI：1.42‒3.49） and other clinical patients （OR=2.75， 95%CI：1.88‒4.01） was higher. ConclusionThe late diagnosis rate of HIV infection is relatively high in Jiading District. AIDS education and prevention activities should be strengthened among people aged over 50 years. For early detection of HIV infection， VCT clinic platform’s function should be fully utilized. Medical institutions should pay attention to HIV testing in patients.

Repeat HIV Testing and Incident Rates among Individuals Attending Voluntary Counseling and Testing Clinics in Wuxi, China: A Retrospective Study / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>We 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.</p><p><b>METHODS</b>A 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.</p><p><b>RESULTS</b>From 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).</p><p><b>CONCLUSION</b>VCT 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.</p>

Gestão e processos de trabalho nos Centros de Testagem e Aconselhamento de Porto Alegre-RS na perspectiva de seus aconselhadores / Management and work processes in Voluntary Counseling and Testing Services in Porto Alegre city, Brazil, in the perspective of their counselors

O estudo objetivou avaliar o trabalho nos Centros de Testagem e Aconselhamento (CTAs) do município de Porto Alegre-RS na perspectiva de seus aconselhadores. Tratou-se de pesquisa qualitativa envolvendo a realização de seis grupos focais com 13 aconselhadoras dos três CTAs do município. Os relatos foram submetidos à análise de conteúdo qualitativa, resultando na categoria temática central Conjugações entre gestão e processos de trabalho nos CTAs. Na visão das aconselhadoras, os serviços são essenciais para o diagnóstico e a prevenção em HIV/Aids e contribuem muito para a efetivação dos atendimentos nessa área. Contudo, os serviços estariam vivendo uma crise quanto ao seu papel, em função da expansão do aconselhamento e da testagem anti-HIV para a rede básica de saúde. Essas mudanças trouxeram angústias e incertezas, principalmente pela falta de diálogo com as esferas gestoras e pela ausência de diretrizes claras para o trabalho no contexto das novas políticas nacionais. Os achados também evidenciaram a preocupação com a qualidade e a forma como o aconselhamento será realizado na Atenção Básica, bem como a necessidade de mais profissionais para o atendimento em HIV/Aids e de consultas com especialidades médicas. Acredita-se que estratégias de gestão participativa poderiam contribuir no redirecionamento da atuação dos CTAs, fortalecendo o matriciamento da testagem e do aconselhamento em HIV e reforçando os CTAs na atenção de maior complexidade e como formadores de recursos humanos na área.

This qualitative study aimed to assess the work in Voluntary Counseling and Testing Services (VCT) in Porto Alegre, Brazil in the perspective of their counselors. It was conducted six focus groups with 13 counselors from the three VCT services in the city. Qualitative content analysis of the reports resulted in a central theme named Joining management and work processes in the VCT services. Counselors have emphasized that services are essential for HIV/AIDS diagnosis and prevention, and contributed significantly to effective healthcare. However, VCT services were facing a crisis regarding its role in the healthcare system since counseling and HIV testing activities were being extended as a responsibility of primary health care. These changes have brought anxiety and uncertainness among counselors, especially because the poor relationships with management levels and the lack of clear guidelines in the new policy context. Findings also pointed out counselors' concerns about the quality of counseling offered in the primary health care services, the lack of professionals to HIV/AIDS healthcare and the lack of medical specialist appointments. We endorsed that participatory management strategies could help to redirect VCT services activities, strength the matrix support testing and counseling for HIV and value these services as specialized healthcare providers and human resources reference for training in the area.

HIV/AIDS atigma: main barrier to VCT and other health services in four suburban villages in National Capital District, Papua New Guinea

The HIV/AIDS stigma, fear and discrimination have been linked with poor participation in Voluntary Counselling and Testing (VCT) programs. Cultural factors, attitudes and behaviours strongly influence the spread of HIV/AIDS and these have been extensively studied in several sub-Sahara African countries. Similar studies in Papua New Guinea are scanty. This study investigates the extents of HIV/AIDS-Stigma, fear, discrimination and other psychological factors as barriers to the access of VCT and other services in four suburban villages in the National Capital District, Papua New Guinea. The study sites were Baruni, Hanuabada, Pari and Kilakila villages. A semi-structured questionnaire comprising of closed and open ended questions was administered to respondents selected randomly. Groups were selected for focus group discussions. Gender stratification was used to ensure that views of both men and women were equally represented. A total of 333 respondents comprising of 166 (49.8%) males, and 167 (50.2 %) females participated in the survey. Self-stigmatization as a major barrier to VCT was indicated by 90.7% of all the respondents. Gender based differences were not statistically significant. Discrimination by relatives and friends was indicated by 74.8% respondents; 79.0% of respondents would discriminate HIV/AIDS-infected people. A total of 42.0% respondents indicated the possibility of rejection from close relationships. The likelihood of dismissal from workplace was indicated by 68.5% of respondents. Lack of support from health providers (67.0%) and fear of HIV test result (61.6%) were other barriers to VCT indicated by respondents. This study recommends the need to heighten awareness of VCT and to eliminate stigma and fear in order to control the HIV/AIDS pandemic.

Whole blood clotting time: Variation of practice in coagulation laboratory, members of Thailand national external quality assessment scheme.

Objective: To collect the necessary data for a perspective of Whole Blood Clotting Time (WBCT) practice in Thailand. Methods: In March 2007, 124 questionnaires were sent to laboratory members of the Thailand National External Quality Assessment Scheme (Thailand NEQAS) to obtain essential information about the WBCT practice. Results: From a dispatch of 124 questionnaires, 120 (96.77%) were returned. There were 101 (84.1%) hospitals performing WBCT in the laboratories and the mean number of WBCTs performed was 16.17 times/month. Eighty nine laboratories (88.11%) used the modified Lee-White methods. Seventy four laboratories (73.26%) used snake bite and other animal bites as the indication for WBCT. Thirty three laboratories (34.37%) had problems performing the WBCT. Conclusion: The WBCT methods among the practice of the Thailand NEQAS laboratory members were as various as problems concerning WBCT throughout Thailand. Their practice needs to be improved and standardized by proper education. It also emphasizes the need for an appropriate guidelines for WBCT in Thailand.

Risk-based assessment does not distinguish between recent and chronic HIV-1 infection in Rio de Janeiro, Brazil

This study investigated the risk factors associated with recent and chronic HIV infections among individual attending a voluntary counseling and testing (VCT) site in Rio de Janeiro, Brazil. In a cross-sectional study, recent HIV infections were detected by the sensitive/less-sensitive test, using Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS) strategy, and compared to chronic HIV infection and HIV negative individuals. Seroincidence was estimated and risk factors associated with recent and chronic infections were assessed using multinomial logistic regression. Among the 7,379 individuals tested between June 2006 and April 2007, the overall prevalence and incidence of HIV infection were 7.5 percent; and 1.39/100 PY, respectively. In multivariate analysis, having a HIV positive steady partner was a risk factor for recent and for chronic HIV infection for MSM, heterosexual male and women. No differences in risk factors for recent and chronic infections were found between MSM and heterosexual males. Among women, chronic infected individuals were more likely than HIV negatives to be older. Recently HIV infected women were more likely than HIV negatives to be less educated; and more likely than HIV negatives and chronically infected to report having more partners. Routinely used risk-based assessment in testing centers in Brazil lack sensitivity to distinguish between recent and chronic infections, particularly among MSM and heterosexual males. Steady relationships and serosorting may be playing a key role in maintaining the HIV epidemics in Brazil.

Development of a computer-aided for voluntary counseling and test / 中华疾病控制杂志

Objective This study aims at developing a computer aid for performing HIV/AIDS counseling and test,so as to standardize VCT operating procedures and help frontline counselors provide high quality VCT service.Methods Rapid prototyping was employed in which primitive VCT standard operation procedure (SOP) and prototype software were generated through literature reviews,counseling case studies and expert panel activities first and then refined through consecutive rounds of piloting at various VCT settings.Results A pragmatic SOP and computer-aid for performing routine VCT services were put forward.It consists of 5 main application modules including performing counseling,making appointment,managing data,developing counseling skill and setting system parameters.Conclusions Our study suggests that standardization and computerization of complex VCT service is feasible and the system we had produced provides a new means for improving the service.

Computer-aided voluntary counseling and test:a pilot trial / 中华疾病控制杂志

Objective This study aimed at soliciting preliminary data about the feasibility and effectiveness of a computer-aids for HIV/AIDS voluntary counseling and test (VCT) developed by ourselves and inform further refinement and evaluation of the software.Methods Informant qualitative interviews,structured questionnaires and audio-recorded counseling cases were used in gathering data.Pre-and post-intervention statistical comparisons of quantitative data and expert reviews of qualitative materials were performed in deriving evaluation outcomes.Results Application of the software increased per episode counseling time from 5.55 minutes to 10.73 minutes;coverage of critical counseling components by over 1.5 folds;and successful memory of core knowledge items from 40.51% to 86.34%.Most participating counselors and clients perceive the software as feasible and effective.Conclusions The software put forth merits further researches.

A qualitative study on voluntary counseling and testing(VCT)for HIV/AIDS among migrants in Minhang district of Shanghai / 中国艾滋病性病

Objective To understand the knowledge,attitudes and impact factors related to voluntary counseling and testing(VCT)for HIV/AIDS among migrants in Minhang district of Shanghai.Method Using a convenience sampling strategy,74 migrants,27 key informants and 20 community service providers were selected to participate in in-depth interviews and focus group discussions.Results Most migrants were young,less educated and poorly aware of HIV prevention.Only one third of the migrants heard of VCT,but few of them knew where to seek VCT or had any personal VCT experience.Nearly half of the interviewees took a negative attitude towards those who participated in VCT service.The main factors influencing the participation in VCT service among the migrants were the knowledge of VCT,having risk behavior and perception,supportive environments and availability of HIV/VCT services.Conclusions There is an urgent need to promote extensive health education about HIV/VCT,adopt flexible and available approaches to VCT service and provide appropriate care following the HIV test among migrants.

Current situation of HIV/AIDS voluntary counseling and testing in Jiangxi province / 中国艾滋病性病

Objective To analyze the current situation of voluntary counseling and testing(VCT) and improve HIV/AIDS prevention and control in Jiangxi province.Method VCT services in the province were analyzed using descriptive methodology.Result The province is in shortage of full time VCT workers.Of the individuals receiving pre-testing counseling,those receiving post-testing counseling and receiving referral counseling accounted for 5.22% and 1.39%,respectively.The individuals receiving tests mostly were aged 20-29 years,and a little less were aged 30-39 years.Higher positive rates of HIV screening tests were found in Pingxiang and Nanchang cities,accounting for 39.13% and 26.09%,respectively.Conclusion To improve VCT service and contain the spread of HIV/AIDS in this province,it is necessary to establish VCT networks,upgrade quality of counseling service and publicize VCT and its outreach activities among target population.