Uptake of HIV testing in a busy South London GU medicine clinic--will we reach targets set in the National Strategy and are we testing those at risk?

We audited the practice of offering, and the uptake of, an HIV antibody test in new genitourinary medicine clinic attenders. We aimed to determine if we have reached targets set in the National Strategy for Sexual Health and HIV for 2006. We also aimed to determine whether patients at higher risk of acquiring HIV infection reached these targets. We found that nearly all patients were offered an HIV test (94.7%) and uptake was 60.5%, demonstrating that we have already reached our target. However, in this audit, the 60% uptake targets were not met by patients at increased risk of HIV, with 52.9% uptake in men who have sex with men and 50% uptake in Black Africans.

Post-exposure prophylaxis for human immunodeficiency virus: knowledge and experience of junior doctors.

OBJECTIVE: To assess the level of knowledge and experience of post-exposure prophylaxis (PEP) against human immunodeficiency virus (HIV) among junior doctors. METHODS: A questionnaire was sent to all junior doctors working in two major teaching hospitals in London. RESULTS: Most junior doctors had heard of PEP (93%) but fewer were aware that it reduced the rate of HIV transmission (76%). Only a minority of doctors (8%) could name the drugs recommended in recent national guidelines and a significant proportion (43%) could not name any. Almost one third (29%) did not know within what period PEP should be administered. This was despite the fact that the majority of respondents (76%) had experienced high risk exposure to potentially infective material at some stage in their careers and that a significant proportion (18%) had sought advice about PEP following potential exposures. CONCLUSIONS: This study demonstrates that the junior hospital doctors in our survey had inadequate knowledge of PEP against HIV despite being at risk of occupational exposure.

Cytomegalovirus pp65 antigenaemia as an indicator of end-organ disease in AIDS.

We aim to assess the usefulness of the cytomegalovirus (CMV) pp65 antigenaemia test, also called the CMV direct antigen test (DAT), in the management of patients with advanced human immunodeficiency virus (HIV) infection; we studied all patients who had pp65 assays between 8 September 1995 and 30 August 1996. Twenty-three patients had 31 tests. The mean CD4 cell count was 20/mm3. The tests were negative in 16 patients, of whom 12 have not developed CMV end-organ disease after a mean follow up of 114 days (range 14-269 days), whilst the remaining 4 patients had previously treated CMV disease. Eleven patients had positive tests: 4 had active CMV disease, 2 subsequently developed CMV retinitis, 2 died within a fortnight of multi-drug resistant tuberculosis (MDR-TB), one was lost to follow up and 2 have remained disease-free. This test has a positive predictive value of 43% and a negative predictive value of 94%, Fisher's exact test P=0.03. The pp65 antigenaemia assay can be performed in a standard virology laboratory avoiding the problems associated with polymerase chain reaction (PCR), a result is available within 5 h, and it is semi-quantifiable. However, a large prospective study is required to determine the comparative value and roles of the pp65 antigenaemia assay and DNA PCR in the management of CMV disease, especially with regard to the use of primary prophylaxis and pre-emptive therapy.

Female genital mutilation.

PIP: Female genital mutilation is perhaps currently the most dangerous traditional practice in terms of health. An estimated 100 million women worldwide have undergone this procedure, most commonly performed between the ages of 4 and 10 years old by a traditional birth attendant. In one study, acute complications occurred in 39% of procedures. Hemorrhage and infection leading to gangrene, septicemia, or tetanus are the main causes of mortality. Late complications are estimated to occur in 37% of women. Chronic pelvic inflammatory disease and dysmenorrhea occur in 14-65%. Persistence of female genital mutilation is based, in part, on cultural beliefs about women, a perceived need to reduce sexual desire, and assurance of virginity and marriageability. Women who do not comply face social ostracism. In 1982, the World Health Organization recommended that female genital mutilation should not be carried out by any health professional under any circumstances. Although legislation outlawing the practice is important, it may be unenforceable in many areas. Key to the eradication of this practice are attitudinal changes through the education of both men and women and improvements in women's status.^ieng