HIV rapid testing in community and outreach sites: results of a demonstration project in Italy

BMC Public Health

2018 18:748

Published: 18 June 2018mob

Abstract

Background

Globally the access to HIV testing has greatly increased over the past 30 years. Nonetheless, a high proportion of people living with HIV remains undiagnosed, even in resource rich countries. To increase the proportion of people aware of their HIV serostatus and their access to medical care, several strategies have been proposed including HIV rapid test programs offered outside health facilities. The aim of this project was to evaluate the feasibility and efficacy of the HIV rapid testing offered in community and outreach settings in Italy.

Methods

We conducted a national demonstration project on HIV rapid tests offered in community and outreach settings, including nongovernmental organization (NGO) facilities, primary care services for migrants and low-threshold services or mobile units for drug users (DU services). HIV rapid test on oral fluid (OraQuick®; Orasure Technologies) was anonymously offered to eligible people who presented themselves at the selected sites. Those with reactive results were referred to a specialized outpatient unit for confirmatory testing and medical care.

Results

Over a period of six months a total of 2949 tests were performed and 45.2% of individuals tested had not been previously tested. Overall 0.9% (27/2949) of tested people had a preliminary positive test. In NGO facilities the positivity rate was 1%. All subjects who performed their confirmatory test were confirmed as positive. In services for migrants the positivity rate was 0.5 and 80% were referred to care (with 1 false positive test). In DU services we observed the highest positivity rate (1.4%) but the lowest linkage to care (67%), with 1 false positive test.

Conclusion

Our project showed that the offering of an HIV rapid testing program in community and outreach settings in Italy is feasible and that it may reach people who have never been tested before, while having a significant yield in terms of new HIV diagnoses as well.

New evidence supports HIV screening in young adulthood

Science Daily, December 19, 2017

A new study suggests that the most beneficial age for a one-time screening HIV test of the general population would be age 25.

The report — led by researchers at Massachusetts General Hospital  working with the U.S. Centers for Disease Control and Prevention (CDC) and the Massachusetts Department of Public Health — will be published in the Journal of Adolescent Health and has been issued online.

HIV and hepatitis pre and post test discussion in Victoria: consultation report

Australian Research Centre in Sex, Health and Society, La Trobe University, Nov 2017

In February 2017, the Australian Research Centre in Sex, Health and Society (ARCSHS) at La Trobe University initiated a consultation which aimed to describe best practice in HIV, hepatitis B and hepatitis C pre and post test discussion in the Victorian context.

Building on existing evidence, and guided by the National Testing Policies, the purpose of this consultation was to better understand the components of a quality testing encounter in the era of elimination, with particular emphasis on the non-medical needs of people around the time of testing and diagnosis.

The focus of this consultation was to identify best practice in pre and post test discussion for HIV, hepatitis B and hepatitis C. A range of health and community providers and researchers discussed the fundamentals of best practice at length, and provided a great many insights into the components of quality testing services.
Importantly, most participants acknowledged that while best practice is a valuable notion, it is not attainable in all health care settings. Best practice, therefore, needs to be flexible enough to be able to fit into any setting where HIV, hepatitis B or hepatitis C testing may occur.

 

People who use drugs require prioritisation not exclusion in efforts to eliminate Hepatitis C

6th International Symposium on Hepatitis Care in Substance Users,  6th Sept 2017

An international conference bringing together hepatitis C experts from around the world is today calling for strategies to prioritise people who use drugs, saying hepatitis C elimination is impossible without them.

“The number of people around the world dying from hepatitis C is increasing. We have the tools to reverse this trend, to eliminate this disease and save millions of lives. But it will not happen until people who use drugs become a focus of our efforts,” said Associate Professor Jason Grebely, President of the International Network of Hepatitis C in Substance Users (INHSU), the convenors of the conference.

 

Contraception for women living with violence

Children by Choice, Last modified on: 22 May 2017

Contraceptive use is often compromised for women living with violence. 

Contraceptive options that are safe and appropriate for one woman may not work for another. If you’re working with women experiencing violence, it’s important to explore each woman’s unique circumstances and draw on her own knowledge to assess the degree of comfort and safety with her contraceptive options.

Important factors to consider include whether the perpetrator is likely to:

  • Monitor the woman’s Medicare or prescription records through her MyGov account;
  • Restrict or monitor access to health care professionals;
  • Monitor menstruation and fertility patterns;
  • Engage in severe physical assaults;
  • Be actively searching for the use of contraceptive drugs or devices; and/or
  • Engage in rape and other forms of sexual assault.

This guide is not intended to replace a full medical consultation with a professional, but does provide a starting point for thinking further about which contraceptive options might be safest and most appropriate given an individual patient’s or client’s circumstances.

  • Read more here
  • Download full resource (PDF) here 

 

Impact of Cigarette Smoking and Smoking Cessation on Life Expectancy Among People With HIV

J Infect Dis. (2016) 214 (11):1672-1681.doi: 10.1093/infdis/jiw430

Abstract

Background. In the United States, >40% of people infected with human immunodeficiency virus (HIV) smoke cigarettes.

Methods. We used a computer simulation of HIV disease and treatment to project the life expectancy of HIV-infected persons, based on smoking status. We used age- and sex-specific data on mortality, stratified by smoking status. The ratio of the non-AIDS-related mortality risk for current smokers versus that for never smokers was 2.8, and the ratio for former smokers versus never smokers was 1.0–1.8, depending on cessation age. Projected survival was based on smoking status, sex, and initial age. We also estimated the total potential life-years gained if a proportion of the approximately 248 000 HIV-infected US smokers quit smoking.

Results. Men and women entering HIV care at age 40 years (mean CD4+T-cell count, 360 cells/µL) who continued to smoke lost 6.7 years and 6.3 years of life expectancy, respectively, compared with never smokers; those who quit smoking upon entering care regained 5.7 years and 4.6 years, respectively. Factors associated with greater benefits from smoking cessation included younger age, higher initial CD4+ T-cell count, and complete adherence to antiretroviral therapy. Smoking cessation by 10%–25% of HIV-infected smokers could save approximately 106 000–265 000 years of life.

Conclusions. HIV-infected US smokers aged 40 years lose >6 years of life expectancy from smoking, possibly outweighing the loss from HIV infection itself. Smoking cessation should become a priority in HIV treatment programs.

Full text (open access) here