Supervised oral HIV self-testing is accurate in rural KwaZulu-Natal, South Africa.

OBJECTIVES: To achieve UNAIDS 90-90-90 targets, alternatives to conventional HIV testing models are necessary in South Africa to increase population awareness of their HIV status. One of the alternatives is oral mucosal transudates-based HIV self-testing (OralST). This study describes implementation of counsellor-introduced supervised OralST in a high HIV prevalent rural area. METHODS: Cross-sectional study conducted in two government-run primary healthcare clinics and three Médecins Sans Frontières-run fixed-testing sites in uMlalazi municipality, KwaZulu-Natal. Lay counsellors sampled and recruited eligible participants, sought informed consent and demonstrated the use of the OraQuick(™) OralST. The participants used the OraQuick(™) in front of the counsellor and underwent a blood-based Determine(™) and a Unigold(™) rapid diagnostic test as gold standard for comparison. Primary outcomes were user error rates, inter-rater agreement, sensitivity, specificity and predictive values. RESULTS: A total of 2198 participants used the OraQuick(™) , of which 1005 were recruited at the primary healthcare clinics. Of the total, 1457 (66.3%) were women. Only two participants had to repeat their OraQuick(™) . Inter-rater agreement was 99.8% (Kappa 0.9925). Sensitivity for the OralST was 98.7% (95% CI 96.8-99.6), and specificity was 100% (95% CI 99.8-100). CONCLUSION: This study demonstrates high inter-rater agreement, and high accuracy of supervised OralST. OralST has the potential to increase uptake of HIV testing and could be offered at clinics and community testing sites in rural South Africa. Further research is necessary on the potential of unsupervised OralST to increase HIV status awareness and linkage to care.

Treating 4,000 diabetic patients in Cambodia, a high-prevalence but resource-limited setting: a 5-year study.

BACKGROUND: Despite the worldwide increasing burden of diabetes, there has been no corresponding scale-up of treatment in developing countries and limited evidence of program effectiveness. In 2002, in collaboration with the Ministry of Health of Cambodia, Médecins Sans Frontières initiated an outpatient program of subsidized diabetic care in two hospital-based chronic disease clinics in rural settings. We aimed to describe the outcomes of newly and previously diagnosed diabetic patients enrolled from 2002 to 2008. METHODS: We calculated the mean and proportion of patients who met the recommended treatment targets, and the drop from baseline values for random blood glucose (RBG), hemoglobin A1c (HbA1c), blood pressure (BP), and body mass index (BMI) at regular intervals. Analysis was restricted to patients not lost to follow-up. We used the t test to compare baseline and subsequent paired values. RESULTS: Of 4404 patients enrolled, 2,872 (65%) were still in care at the time of the study, 24 (0.5%) had died, and 1,508 (34%) were lost to follow-up. Median age was 53 years, 2,905 (66%) were female and 4,350 (99%) had type 2 diabetes. Median (interquartile range (IQR)) follow-up was 20 months (5 to 39.5 months). A total of 24% (51/210) of patients had a HbA1c concentration of <7% and 35% (709/1,995) had a RBG <145 mg/dl within 1 year. There was a significant drop of 109 mg/dl (95% confidence interval (CI) 103.1 to 114.3) in mean RBG (P < 0.001) and a drop of 2.7% (95% CI 2.3 to 3.0) in mean HbA1c (P < 0.001) between baseline and month 6. In all, 45% (327/723) and 62% (373/605) of patients with systolic or diastolic hypertension at baseline, respectively, reached = 130/80 mm Hg within 1 year. There was a drop of 13.5 mm Hg (95% CI 12.1 to 14.9) in mean systolic blood pressure (SBP) (P < 0.001), and a drop of 11.7 mm Hg (95% CI 10.8 to 12.6) in mean diastolic blood pressure (DBP) (P < 0.001) between baseline and month 6. Only 22% (90/401) patients with obesity at baseline lowered their BMI <27.5 kg/m2 after 1 year. Factors associated with loss to follow-up were male sex, age >60 years, living outside the province, normal BMI on admission, high RBG on last visit, and coming late for the last consultation. CONCLUSION: Significant and clinically important improvements in glycemia and BP were observed, but a relatively low proportion of diabetic patients reached treatment targets. These results and the high loss to follow-up rate highlight the challenges of delivering diabetic care in rural, resource-limited settings.

A randomized controlled trial on the effectiveness of ear acupuncture plus structured counseling as compared to structured counseling alone in decreasing cigarette stick consumption among patients consulting in the Out Patient Department of the Philippine General Hospital

Cigarette smoking is considered to be the single most preventable cause of premature death and the most important challenge in primary care. The epidemic is already killing 20,000 Filipinos every year with the number of smoking-related deaths likely to rise steeply over the next few years. In other countries, ear acupuncture is a therapy frequently offered for this purpose. Uncontrolled studies with acupuncture have reported smoking cessation rates as high as 95 percent. There were no local studies found in the literature Objectives: The general objective of this study was to compare the effectiveness of ear acupuncture plus structured counseling versus structured counseling alone in decreasing mean cigarette stick consumption among smokers consulting in the Family Medicine Clinic. Design: This was an open randomized controlled trial of adult smokers in the contemplation and planning stage of quitting smoking and consulting in the Family Medicine Out-patient Clinic. Ear acupuncture plus structured counseling or structured counseling alone were compared as to the mean cigarette sticks consumed per day at the end of two weeks, one month, two months and three months, as well as compared as to the quit rate at the end of the three months. Intervention: The structured counseling involved a patient-centered, brief but extensive health education and goal-setting. This was given to both the control and the treatment groups. The treatment group received additional six sessions of ear acupuncture treatment. Results: In terms of demographic profile and intention to quit at baseline, there were no significant differences between the two groups (p value.05) except with regards to gender differences (p value=.02). The average number of sticks consumed per day decreased in both groups after two weeks, one month, two months and three months, but with greater decrease in mean cigarette stick consumption in the treatment group across all follow-up periods (p=.01). Quit rate at the end of three months was found to be higher in the structured counseling plus ear acupuncture group (40 percent) as compared to structured counseling alone group (18 percent) but this was not statistically significant (p value.05) No ear acupuncture complications were found in the treatment group at the end of the three month observation period. Conclusion: Structured counseling and ear acupuncture, alone and in combination, is effective in decreasing the mean cigarette stick consumption per day. But the combination of structured counseling plus ear acupuncture is more effective in decreasing cigarette consumption than structured counseling alone among adult smokers consulting in the Family Medicine Out-patient Clinic. This can be a new strategy for smoking cessation for our Filipino patients.