ABSTRACT
BACKGROUND: Early diagnosis and treatment of human Immunodeficiency virus (HIV) is not only beneficial for the people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLHA) but for the public and society as well. The study was aimed to identify the factors associated with late presentation to HIV/AIDS care. MATERIALS AND METHODS: A facility-based unmatched case-control (1:1) study along with in-depth qualitative assessment was conducted at an ART Plus center at a district hospital, Udupi, southern India. A sample of 320 HIV patients (160 cases and 160 controls) was selected randomly between February and July 2014. Information regarding the patients were collected using an interviewer-administered semi-structured questionnaire. The qualitative component was assessed by in-depth interviews of 4 health professionals and 12 HIV-positive patients who were late for HIV care. The quantitative data were analyzed using Statistical Package for the Social Sciences (SPSS) version 15.0. The technique of thematic analysis was adopted for the analysis of qualitative data. RESULTS: HIV-positive individuals who lived with families [odds ratio (OR) = 5.11], the patients having non-AIDS comorbidities [OR= 2.19, 95% confidence interval (CI): 1.09-4.40], the patients who perceived fear of losing family [OR = 5.00, 95% CI: 2.17-11.49], the patients who perceived fear that their status will be ruined in the community [OR= 2.00, 95% CI: 1.01-3.97], the patients who perceived fear of side effects of ART medications [OR = 4.3, 95% CI: 2.65-11.33], the patients who perceived fear of losing confidentiality [OR = 4.94, 95% CI: 2.54-9.59], the patients those who lack information available on government services [OR = 4.12, 95% CI: 2.127-8.005], and the patients who consumed alcohol [OR= 3.52, 95% CI: 1.83-6.77] were found to be independently associated with the late presentation to HIV/AIDS care after adjusting for all known confounders in a multivariable analysis. The qualitative summary showed that the perceived HIV stigma, inadequate health education, lack of awareness on available government services, psychological problems, alcohol use, asymptomatic conditions, and financial problems are major barriers to access care early for the late presenters. CONCLUSION: The identified factors can be utilized for the formulation of policies and interventions by promoting early diagnoses and addressing special concerns such as stigma, disclosure, health education, and awareness.
Subject(s)
Delayed Diagnosis , Fear , HIV Infections/diagnosis , HIV Infections/psychology , Social Stigma , AIDS Serodiagnosis/statistics & numerical data , Adult , Case-Control Studies , Female , Health Knowledge, Attitudes, Practice , Health Services Accessibility , Humans , India , Interviews as Topic , Male , Middle Aged , Qualitative Research , Socioeconomic Factors , Surveys and QuestionnairesABSTRACT
SETTING: Conventional methods for the identification of mycobacteria are slow and labour intensive. DNA amplification methods offer rapid sensitive and specific diagnosis. OBJECTIVE: To determine the feasibility of an in-house polymerase chain reaction (PCR) method to detect Mycobacterium tuberculosis in clinical samples. DESIGN: The present study focused mainly on diagnosing extra-pulmonary tuberculosis (EPTB) using an in-house PCR method in 465 clinical samples. This study also compared the efficacy of a standard phenol-chloroform (PC) extraction procedure and the guanidine thiocyanate with diatomaceous silica (GTCS) method of DNA extraction and purification. A subsample of patients was used for the validation of results based on the final diagnosis. RESULTS: Among 373 patients with suspected EPTB, 75 specimens were positive by PCR, four by microscopy and six by culture. Of the 25 PCR-positive patients, 95% had a final diagnosis of TB. Globally, the GTCS method was found to be superior to the PC method for DNA extraction and removal of inhibitors from clinical specimens. CONCLUSION: The DNA amplification method was found to be significantly more sensitive and rapid compared to culture and microscopy for a reliable final diagnosis of EPTB.
Subject(s)
Polymerase Chain Reaction/economics , Polymerase Chain Reaction/methods , Tuberculosis/diagnosis , DNA, Bacterial/isolation & purification , Feasibility Studies , Guanidines , Humans , Mycobacterium tuberculosis/genetics , Nucleic Acid Amplification Techniques , Specimen Handling , Sri Lanka , ThiocyanatesABSTRACT
Previous measurements of the birefringence of sapphire and magnesium fluoride have been extended to their respective limits of transparency, revealing anomalous dispersion effects at short wavelengths, which are qualitatively discussed. Possible practical applications to Lyot filters and quarter-wave plates for Lyman-alpha are indicated.
ABSTRACT
Measurements of the ordinary and extraordinary refractive indices of synthetic quartz in the vacuum uv down to 1440 A are reported as deduced from the determination of the orders of interference fringes in a thin parallel plate.
ABSTRACT
Measurements of the birefringence of sapphire, magnesium fluoride, and synthetic quartz from 3000 A to 1500 A are reported and are followed by a discussion of the methods of achromatizing quarter-wave plates and of linearizing the path retardation of a multiwave plate against wavelength (equichromatic wave plates).
