Prevalence Pattern and Determinants of Disclosure of HIV Status in an Anti Retroviral Therapy Clinic in the Niger Delta Region of Nigeria.

BACKGROUND: In order to advance the extent of self-disclosure of HIV sero-status in Nigeria, we evaluated the prevalence, pattern and determinants of disclosure of HIV status amongst adult patients in a hospital in the Niger Delta. MATERIALS AND METHODS: In a three month cross sectional study undertaken in March 2012, the demographic and clinical data as well as HIV sero-status disclosure frequency and pattern were obtained using a pre-tested questionnaire from consenting HIV infected adults attending the Anti-Retroviral Therapy Clinic in the Niger Delta. Independent determinants of HIV disclosure to current sexual partner were determined using an unconditional logistic model. P<0.05 was considered statistically significant. RESULTS: A total of 260 patients were studied out of which 184(71%) were females. Disclosure to current sexual partner was found to be 62.0% and students had the least disclosure rate. Majority of study participants preferred to disclose to family members (57%) than past sexual partner (2.5%) or friend (4.9%). Although HIV disclosure was significantly associated with male sex, living with sexual partner, partner being HIV positive; the only independent determinants of HIV disclosure were partner being on ART (OR-12.7, 95% CI 1.2-132.7) and being currently married (OR-8.8, 95% CI 2.1-36.8). CONCLUSION: The results of our study suggest low rate of HIV status disclosure among HIV infected patients in the Niger Delta. We found that receiving ART and being currently married promoted disclosure. There is need for clinicians and policy makers to foster disclosure of HIV sero-status in Nigeria especially among HIV infected students and unmarried sexual partners.

Prevalence pattern and determinants of disclosure of HIV status in an anti retroviral therapy clinic in the Niger delta region of Nigeria

Background: In order to advance the extent of self-disclosure of HIV sero-status in Nigeria, we evaluated the prevalence, pattern and determinants of disclosure of HIV status amongst adult patients in a hospital in the Niger Delta. Materials and Methods: In a three month cross sectional study undertaken in March 2012, the demographic and clinical data as well as HIV sero-status disclosure frequency and pattern were obtained using a pre-tested questionnaire from consenting HIV infected adults attending the Anti-Retroviral Therapy Clinic in the Niger Delta. Independent determinants of HIV disclosure to current sexual partner were determined using an unconditional logistic model. P<0.05 was considered statistically significant. Results: A total of 260 patients were studied out of which 184(71%) were females. Disclosure to current sexual partner was found to be 62.0% and students had the least disclosure rate. Majority of study participants preferred to disclose to family members (57%) than past sexual partner (2.5%) or friend (4.9%). Although HIV disclosure was significantly associated with male sex, living with sexual partner, partner being HIV positive; the only independent determinants of HIV disclosure were partner being on ART (OR-12.7,95% CI 1.2-132.7)and being currently married (OR-8.8,95% CI 2.1-36.8). Conclusion: The results of our study suggest low rate of HIV status disclosure among HIV infected patients in the Niger Delta. We found that receiving ART and being currently married promoted disclosure. There is need for clinicians and policy makers to foster disclosure of HIV sero-status in Nigeria especially among HIV infected students and unmarried sexual partners

Outcome of partner notification in patients diagnosed with genital warts attending a provincial clinic in East Anglia, England.

We retrospectively reviewed partner notification of patients diagnosed with first episode genital warts seen in the genitourinary (GU) medicine clinic, Great Yarmouth, UK, from January 2005 to December 2008. Of 947 patients diagnosed with genital warts, 486 (51.3%) were men, median age 25 years; 461 (48.7%) were women, median age 21 years and the partner notification index was 32.9%. In our cohort, 310 patients 33.2% reported having had a casual partner that could not be traced. The median relationship duration of partners whose contact attended was nine months and those whose contact did not attend was two months, (χ(2) = 49.72, P < 0.0001). The odds ratio (OR) of a contact attending after seeing a health adviser was 2.94 (95% confidence interval [CI] = 1.79-4.86). In our cohort 35.6% of contacts whose partners saw a health adviser attended compared with 15.7% of contacts whose partner did not see a health adviser (χ(2) = 19.7, P < 0.0001). Among the contacts 26% had genital warts, 28% had another sexually transmitted infection (STI) and 12% had both genital warts and another STI. The low partner notification index was associated with the reported casual partnerships seen in the cohort. Partner notification was enhanced when patients saw a health adviser.

Anglian Genitourinary Medicine Audit Group -- cervical cytology screening in HIV-positive women.

Immunosuppressed HIV-infected women are at risk of developing cervical cytological abnormalities and should have routine annual cervical cytology smears performed as recommended by the National Health Services Cervical Screening Programme (NHSCSP). In the Anglian Genitourinary Medicine Audit Group review of practice of cervical cytology smears, only 55.5% of clinics met the NHSCSP standards. The mean age of the 173 women in the cohort was 35.8 +/- 8.1, range 16-66 years. Seventy-eight percent of clinics performed cervical cytology screening in women under the age of 25 years. High-grade cervical cytological abnormality (moderate dyskariosis and above) was seen in 9.5% of the cohort and 39.5% had low-grade lesions (borderline and mild dyskariosis). One patient, a 41-year-old black African on highly active antiretroviral therapy with HIV-1 RNA level <50 copies/mL and a CD4 count of 240 cells/mm(3) had invasive cervical cancer requiring hysterectomy. The expected mean number of cervical cytology smears for the cohort was 3.29 and the calculated performed mean cervical cytology smear was 1.9 (P = 0.0001), a statistically significant difference. Asylum dispersal among 69.5% black Africans in the cohort contributed to some of the clinics not meeting the NHSCSP standards.

Indinavir use: associated reversible hair loss and mood disturbance.

We present the case of a 55-year-old heterosexual man who had a generalized alopecia and mood changes associated with the antiretroviral protease inhibitor; indinavir within 6 months of use. This was reversed within 3 months of change of therapy to the protease inhibitor, nelfinavir with demonstrable changes in his Hospital Anxiety and Depression (HAD) scale scores.

Quality and resource management in genitourinary medicine service delivery.

Quality and efficiency are the hallmarks of appropriate resource utilization. Performance indicators in the UK facilitate measurement of efficiency of sexual health services. These parameters include consultant ratio per unit population served, sessional requirement of service providers, duration of wait before an appointment, duration of wait in the clinic setting before being seen and the locality prevalence of gonorrhoea per 100,000 of the catchment population aged 16-64. In a survey of these standards in the Bure Clinic in Great Yarmouth where one consultant physician serves a population of 250,000-320,000, providing 6-7 outpatient sessions a week, with inpatient commitment for HIV/AIDS, 31.4% of patients waited over 2 weeks before being seen in the Genitourinary Medicine (GUM) Clinic. Over 57.5% of the patients surveyed had waited more than one week before their appointment. This had been in an environment of prevailing local high incidence of gonorrhoea--a marker of sexual ill health--from 1996-1998 (>25 per 100,000 in those aged 16-64). This defect in optimum access is inimical to early case detection, contact tracing, and intervention for appropriate behaviour modification and truncation of infectivity.