المؤلفون: Ramirez-Avila, Lynn, Regan, Susan, Chetty, Senica, Giddy, Janet, Ross, Douglas, Katz, Jeffrey N., Freedberg, Kenneth A., Losina, Elena, Walensky, Rochelle P., Bassett, Ingrid V.

المصدر: International Journal of STD & AIDS; Sep2015, Vol. 26 Issue 10, p704-709, 6p, 1 Chart, 1 Graph

مصطلحات موضوعية: DIAGNOSIS of HIV infections, HIV infections, THERAPEUTICS, HIV infection transmission, HIV-positive persons, HEALTH

مصطلحات جغرافية: DURBAN (South Africa)

مستخلص: The HIV public health messages in South Africa have increased. Our objective was to evaluate changes over time in HIV testing behaviour, prevalence and knowledge. We prospectively enrolled adults (≥18 years) prior to HIV testing at one urban and one peri-urban outpatient department in Durban, South Africa. A baseline questionnaire administered before testing included the number of prior HIV tests and four knowledge items. We used test results to estimate previously undiagnosed HIV prevalence among those tested. We assessed linear trends over enrollment. From November 2006 to August 2010, 5229 subjects enrolled and 4877 (93%) were HIV tested and had results available. Subjects reporting prior testing over time increased, from 13% in study year 1 to 42% in year 4 (linear trend p < 0.001). The HIV prevalence among those tested declined steadily and significantly over time, from 64% of enrollees in study year 1 to 39% in the final year (linear trend p < 0.001). The percentage of subjects who recognised that medicine can help people with HIV live longer increased from 80% in study year 1 to 96% in study year 4. Rates of HIV testing have increased and prevalence among those tested has decreased in outpatients in Durban, South Africa. [ABSTRACT FROM AUTHOR]

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المؤلفون: Bassett, Ingrid V., Giddy, Janet, Chaisson, Christine E., Ross, Douglas, Bogart, Laura M., Coleman, Sharon M., Govender, Tessa, Robine, Marion, Erlwanger, Alison, Freedberg, Kenneth A., Katz, Jeffrey N., Walensky, Rochelle P., Losina, Elena

المصدر: BMC Infectious Diseases; 2013, Vol. 13 Issue 1, p1-9, 9p, 2 Diagrams, 2 Charts

مصطلحات موضوعية: HIV-positive persons, HIV infections, CLINICAL trials, CD4 lymphocyte count

مصطلحات جغرافية: DURBAN (South Africa)

مستخلص: Background: Despite increases in HIV testing, only a fraction of people newly diagnosed with HIV infection enter the care system and initiate antiretroviral therapy (ART) in South Africa. We report on the design and initial enrollment of a randomized trial of a health system navigator intervention to improve linkage to HIV care and TB treatment completion in Durban, South Africa. Methods/Design: We employed a multi-site randomized controlled trial design. Patients at 4 outpatient sites were enrolled prior to HIV testing. For all HIV-infected participants, routine TB screening with sputum for mycobacterial smear and culture were collected. HIV-infected participants were randomized to receive the health system navigator intervention or usual care. Participants in the navigator arm underwent a baseline interview using a strengths-based case management approach to assist in identifying barriers to entering care and devising solutions to best cope with perceived barriers. Over 4 months, participants in the navigator arm received scheduled phone and text messages. The primary outcome of the study is linkage and retention in care, assessed 9 months after enrollment. For ART-eligible participants without TB, the primary outcome is 3 months on ART as documented in the medical record; participants co-infected with TB are also eligible to meet the primary outcome of completion of 6 months of TB treatment, as documented by the TB clinic. Secondary outcomes include mortality, receipt of CD4 count and TB test results, and repeat CD4 counts for those not ART-eligible at baseline. We hypothesize that a health system navigator can help identify and positively affect modifiable patient factors, including self-efficacy and social support, that in turn can improve linkage to and retention in HIV and TB care. Discussion: We are currently evaluating the clinical impact of a novel health system navigator intervention to promote entry to and retention in HIV and TB care for people newly diagnosed with HIV. The details of this study protocol will inform clinicians, investigators, and policy makers of strategies to best support HIV-infected patients in resource-limited settings. [ABSTRACT FROM AUTHOR]

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المؤلفون: Regan, Susan, Losina, Elena, Chetty, Senica, Giddy, Janet, Walensky, Rochelle P., Ross, Douglas, Holst, Helga, Katz, Jeffrey N., Freedberg, Kenneth A., Bassett, Ingrid V.

المصدر: PLoS ONE; Apr2013, Vol. 8 Issue 4, p1-7, 7p

مصطلحات موضوعية: HIV infections, THERAPEUTICS, DISEASE prevalence, MEDICAL statistics, COMMUNICABLE diseases, CLINICAL epidemiology, VIRUS diseases

مصطلحات جغرافية: DURBAN (South Africa), SOUTH Africa

مستخلص: Background: Routine screening for HIV infection leads to early detection and treatment. We examined patient characteristics associated with repeated screening in a high prevalence country. Methods: We analyzed data from a cohort of 5,229 adults presenting for rapid HIV testing in the outpatient departments of 2 South African hospitals from November 2006 to August 2010. Patients were eligible if they were ≥18 years, reported no previous diagnosis with HIV infection, and not pregnant. Before testing, participants completed a questionnaire including gender, age, HIV testing history, health status, and knowledge about HIV and acquaintances with HIV. Enrollment HIV test results and CD4 counts were abstracted from the medical record. We present prevalence of HIV infection and median CD4 counts by HIV testing history (first-time vs. repeat). We estimated adjusted relative risks (ARR’s) for repeat testing by demographics, health status, and knowledge of HIV and others with HIV in a generalized linear model. Results: Of 4,877 participants with HIV test results available, 26% (N = 1258) were repeat testers. Repeat testers were less likely than first-time testers to be HIV-infected (34% vs. 54%, p<0.001). Median CD4 count was higher among repeat than first-time testers (201/uL vs. 147/uL, p<0.001). Among those HIV negative at enrollment (N = 2,499), repeat testing was more common among those with family or friends living with HIV (ARR 1.50, 95% CI: 1.33–1.68), women (ARR: 1.24, 95% CI: 1.11–1.40), and those self-reporting very good health (ARR: 1.28, 95% CI: 1.12–1.45). Conclusions: In this high prevalence setting, repeat testing was common among those undergoing HIV screening, and was associated with female sex, lower prevalence of HIV infection, and higher CD4 counts at diagnosis. [ABSTRACT FROM AUTHOR]

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المؤلفون: Losina, Elena, Bassett, Ingrid V., Giddy, Janet, Chetty, Senica, Regan, Susan, Walensky, Rochelle P., Ross, Douglas, Scott, Callie A., Uhler, Lauren M., Katz, Jeffrey N., Holst, Helga, Freedberg, Kenneth A.

المصدر: PLoS ONE; 2010, Vol. 5 Issue 3, p1-8, 8p

مصطلحات موضوعية: HIGHLY active antiretroviral therapy, HIV infections, TEST interpretation, PUBLIC health, DISEASE risk factors, TUBERCULOSIS, CHEST diseases

مصطلحات جغرافية: DURBAN (South Africa), SOUTH Africa

مستخلص: Background: Although loss to follow-up after antiretroviral therapy (ART) initiation is increasingly recognized, little is known about pre-treatment losses to care (PTLC) after an initial positive HIV test. Our objective was to determine PTLC in newly identified HIV-infected individuals in South Africa. Methodology/Principal Findings: We assembled the South African Test, Identify and Link (STIAL) Cohort of persons presenting for HIV testing at two sites offering HIV and CD4 count testing and HIV care in Durban, South Africa. We defined PTLC as failure to have a CD4 count within 8 weeks of HIV diagnosis. We performed multivariate analysis to identify factors associated with PTLC. From November 2006 to May 2007, of 712 persons who underwent HIV testing and received their test result, 454 (64%) were HIV-positive. Of those, 206 (45%) had PTLC. Infected patients were significantly more likely to have PTLC if they lived ≥10 kilometers from the testing center (RR = 1.37; 95% CI: 1.11-1.71), had a history of tuberculosis treatment (RR = 1.26; 95% CI: 1.00-1.58), or were referred for testing by a health care provider rather than self-referred (RR = 1.61; 95% CI: 1.22-2.13). Patients with one, two or three of these risks for PTLC were 1.88, 2.50 and 3.84 times more likely to have PTLC compared to those with no risk factors. Conclusions/Significance: Nearly half of HIV-infected persons at two high prevalence sites in Durban, South Africa, failed to have CD4 counts following HIV diagnosis. These high rates of pre-treatment loss to care highlight the urgent need to improve rates of linkage to HIV care after an initial positive HIV test. [ABSTRACT FROM AUTHOR]

: Copyright of PLoS ONE is the property of Public Library of Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)