Search

Mother-to-child-transmission (MTCT) of HIV still remains a significant route of new HIV infection in children in Malawi and Nigeria, despite the introduction of Prevention-of-Mother-to-Child-Transmission (PMTCT) of HIV programmes in both countries. A critical literature review, based on the findings from 12 primary research articles, explores the reasons for the inadequacy and failure of PMTCT. Findings show socioeconomic and sociocultural factors as the biggest barriers to the success of PMTCT programmes. Other factors include: limited male involvement, the organization of PMTCT and health workers' inefficiency. In conclusion, PMTCT programmes will remain inefficient unless these factors are addressed. There is an urgent need to strengthen PMTCT programmes by stakeholders through a collaborative strategic effort to ensure high PMTCT programme uptake in Malawi and Nigeria, in order to eliminate HIV/AIDS in children.

Tujuan dari penelitian ini untuk mengeksplorasi secara mendalam motivasi WPS di sepanjang ruas jalan Stasiun Poncol untuk mengikuti VCT.Jenis penelitian ini adalah penelitian kualitatif, menggunakan metode studi kasus tunggal dengan single level analysis. Populasi pada penelitian ini adalah WPS di sepanjang ruas jalan Stasiun Poncol dengan sampel bertujuan sebanyak 14 orang. Teknik pengumpulan data dengan menggunakan wawancara mendalam, observasi, dan dokumentasi. Teknik analisis data dengan menggunakan model imersi/kristalisasi.Kesimpulan dari penelitian ini adalah WPS di sepanjang ruas jalan Stasiun Poncol memiliki motivasi yang rendah untuk mengikuti VCT dikarenakan adanya anggapan dari WPS bahwa dirinya tidak berisiko HIV/AIDS, VCT bukan kebutuhan utama untuk WPS, adanya anggapan kurang penting tentang VCT, dan kurangnya motivasi eksternal untuk VCT.Saran bagi WPS dapat lebih memahami pentingnya VCT. Saran bagi lembaga pelayanan kesehatan dapat memberikan layanan mobile VCT kembalipada WPS jalanan dan meningkatkan kerjasama antar lembaga. Saran bagi peneliti lain diharapkan adanya penelitian lanjutan dengan kajian yang lebih dalam.

Background: Voluntary counselling and testing (VCT) is one of the nine strategies recommended for prevention and control of HIV globally. In this study, we assessed the awareness and utilisation of VCT services among residents of the Lower Manya Krobo Municipality (LMKM) in the Eastern Region of Ghana.Methods: A population-based descriptive cross-sectional survey was conducted with 200 participants, aged between 18 and 55 years. Participants were recruited using cluster and simple random techniques to take part in the survey. Data was analysed descriptively, as well as using regression analysis approach.Results: Ninety-one percent of the respondents surveyed were aware of VCT services for HIV/AIDS. Seventy percent (70 %) have used VCT service in the last 12 months prior to the survey. Of this proportion, 97% were satisfied with the quality of VCT services offered and indicated their willingness to recommend the service to others. Participants desire to know their HIV status (40%), referral by health workers (25%), and participants who wanted to get married (11%) were the main reasons for increased uptake. Participants who had formal education, primary (OR = 1.8 (95% CI 1.25-2.84)), junior high school (OR = 2.3 (95% CI 1.54-3.37)), senior high school (OR = 2.8 (95% CI 1.73-4.78)), and tertiary (OR = 3.4 (95% CI 1.98-8.42)), had increased chance of using VCT service compared with participants who had no education (p < 0.001). Reasons for non-utilisation of VCT service were lack of awareness of the VCT service in the area (32%), fear of being stigmatised (53 %), and the belief that HIV/AIDS cannot be cured and therefore the lack of need (5%).Conclusions: Although awareness and utilisation of VCT service rates were reportedly high, more efforts need to be done in order to increase awareness and promote utilisation. HIV/AIDS educational campaign programmes need to be strongly pursued, with emphasis on the benefits of VCT services. This has the potential of reducing stigma and increase utilisation. [ABSTRACT FROM AUTHOR]

Migrants, particularly from low- and middle-income countries, are at a heightened risk of adverse HIV outcomes. HIV testing may improve these outcomes. We reviewed and synthesised studies into migrants and HIV testing (outcome variable), published between January 1997 and April 2014. Papers using quantitative, qualitative and mixed methods designs, and samples with adult (≥18 years) migrants from low- and middle-income countries in high-income countries were included in the paper. Of 3155 papers retrieved, 31 met the inclusion criteria and are included in the review. A large number of barriers and facilitators to HIV testing were identified across the individual, social and structural levels. A number of study design and methodological issues, however, inhibited a comprehensive synthesis. There is no doubt that addressing HIV testing in migrants in high-income countries is complex; however, it has important implications for individual, community and population health, and a strong, empirically based response is warranted. [ABSTRACT FROM AUTHOR]

Background: A provider-initiated counselling and testing (PICT) strategy replaced the voluntary counselling and testing (VCT) strategy with respect to the provision of human immunodeficiency virus (HIV) counselling and testing (HCT) in KwaZulu-Natal province with the aim of increasing the uptake of HIV services. VCT depended on clients requesting HCT, whereas HCT is routinely offered to all persons utilising health facilities, regardless of the reason for the visit with the provision of PICT. This study reports on the feasibility and early outcomes of using the PICT strategy in KwaZulu-Natal. Method: Health workers were trained to provide PICT to patients presenting at the outpatient department (OPD) of two public health institutions in KwaZulu-Natal from December 2010 to May 2011. Data on the offering and uptake of HIV services were recorded and analysed using univariate and multivariate analysis to compare HCT uptake and other systematic barriers before and after the introduction of PICT. Results: A significant change in the uptake of HCT after the introduction of PICT at both sites (p = 0.242 and p = 0.224) and in the uptake of HIV testing (p = 0.062 and p = 0.224) was not observed. PICT offering was weakest at the OPDs (p < 0.001), and was solely provided by counsellors (85.5%). Few (29.2%) clients were screened for tuberculosis. Immunological and clinical staging was performed on 29.8% and 1.0% of HIV-positive patients, respectively. The linkage to prevention services was low with 12.2% of clients referred for further care. Conclusion: PICT implementation and integration with other services faces human resource, infrastructural and conceptual barriers, and is not currently feasible at OPDs. The urgent provision of operational guidance and training for providers is needed. [ABSTRACT FROM AUTHOR]

Background: With transmission of HIV occurring mainly through heterosexual contact, it is paramount to identify serodiscordant couples and implement preventive strategies that will protect the negative partner. The burden of serodiscordance and its predictors in Ethiopia is not clearly understood due to the dearth of data.Objective: To assess the prevalence and predictors of HIV serodiscordance among couples tested in Jimma University Specialized Hospital (JUSH) Voluntary Counseling and Testing (VCT) center.Methods: The study employed a case-control study design conducted at VCT center of JUSH in all registered serodiscordant couples and seroconcordant couples that were selected from the registered clients in the period from 2003 to 2010. A pretested structured questionnaire was used for data collection using medical chart abstraction. Data were entered, cleaned, and coded using Statistical Package of Social Sciences (SPSS) version 16.Results: The prevalence of serodiscordance in the study population was found to be 8.4%. Male and female discordants accounted for 5.8% (137) and 2.6% (62), respectively. Rare use of condom (adjusted odds ratio [AOR] = 7.2; 95% confidence interval [CI] = 1.59-32.54) and active tuberculosis (TB) at enrollment (AOR= 17.7; 95% CI = 2.3-139.2) were significantly found to be the predictors of serodiscordance.Conclusion: The prevalence of serodiscordance in the study area was found to be low, but it contributes to a clinically significant population that mandates implementation of preventive strategy. Sero-positive individuals who use condoms rarely should be encouraged to have their partners tested, and the association between active TB and serodiscordance underscores the need for further study. [ABSTRACT FROM AUTHOR]

Rapid HIV voluntary counselling and testing (RVCT) is an alternative method of standard HIV voluntary counselling and testing (SVCT). Less is known about whether RVCT improves the receipt rate of HIV test results among clients who seek HIV counselling and testing. We aimed to evaluate effectiveness of RVCT on result receipt rate. We conducted a comprehensive search of databases containing Medline, EBSCO, Web of science, and Cochrane library to identify studies published up to August 2012. Reviewers extracted information independently. Risk of bias was evaluated with Cochrane Collaboration’s tool for assessing study quality. Five randomised controlled trials were included and analysed for the result receipt rate using a random-effects model. The pooled receipt rate of HIV test results in the RVCT was significantly higher than in the SVCT (RR = 1.74, 95% CI = 1.47–2.07). Our results suggest RVCT as a favourable method to increase the receipt of HIV test results. Only two included studies assessed the modification of risk behaviour after HIV-CT in a different manner; also, the sample size was small in the current meta-analysis. In future research, it is necessary to confirm the effect of RVCT on disinhibition of post-test risk behaviour. [ABSTRACT FROM PUBLISHER]

Introduction Little is known about HIV testing, HIV infection and sexual behaviour among bathhouse patrons in China. This study aims to assess differences in HIV prevalence and high‐risk sexual behaviours between repeat and first‐time testers among men who have sex with men (MSM) attending bathhouse in Tianjin, China. Methods Between March 2011 and September 2012, a HIV voluntary counselling and testing station was established in a gay bathhouse, which provided HIV testing and conducted a survey among participants recruited through snowball sampling. Differences in demographic and high‐risk sexual behaviours between repeat and first‐time testers were assessed using the chi‐square test. Univariate and multivariate logistic regression analyses were conducted to identify predictors for HIV infection. Results Of the 1642 respondents, 699 (42.6%) were repeat testers and 943 (57.4%) were first‐time testers. Among repeat testers, a higher proportion were men aged 18 to 25, single, better educated, had a history of STIs and worked as male sex workers or “money boys” (MBs). Repeat testers were less likely to report having unprotected anal intercourse in the past six months. The overall HIV prevalence was 12.4% (203/1642). There was no difference in HIV prevalence between repeat (11.2%, 78/699) and first‐time (13.3%, 125/943) testers. The HIV prevalence increased with age among first‐time testers (χtrend2=9.816, p=0.002). First‐time MB testers had the highest HIV prevalence of 34.5%. Conclusions MSM attending bathhouse had an alarmingly high HIV infection rate, particularly in MB. Targeted interventions are urgently needed especially focusing on older MSM and MBs.

The prevalence of HIV infection is substantially higher in mentally ill individuals than in the general population. Despite this, HIV testing is not yet standard practice among the mentally ill population, and many mental health settings do not encourage HIV testing. This paper discusses provider-initiated HIV counselling and testing (PICT) and some of the ethical dilemmas associated with it, on the basis that PICT may be used to increase the number of mentally ill persons tested for HIV. The authors conclude that PICT should be promoted to all psychiatric admissions and mentally ill individuals receiving outpatient services, and that this is within the parameters of existing policies and legislations in South Africa.

BACKGROUND: HIV is still an enormous global burden and it is also causing loss of huge health care workers (HCWs) on the already limited human resource capacity in health care services in Sub-Saharan Africa. Variety of methods of accelerating HIV testing is required to increase the rate of HIV testing and expand treatment services. Therefore, this study was aimed to find out the prevalence, feasibility and options of HIV self-testing practices in Ethiopia. METHODS: A cross-sectional study design triangulated with qualitative method was conducted from February to May, 2012. The data was collected using a semi-structured pretested questionnaire and in-depth interview, at government and private health centers or clinics and hospitals. During the data collection all the available healthcare workers (HCWs) which encompass the internship students including: Medical, Health Officer, Nurses, Midwives and Laboratory students, and health professionals working in the selected health institutions were involved. RESULTS: A total of 307 HCWs were included in the analysis and we found that 288(94.4%) of them were ever tested for HIV, of which majority 203 (70.5%) were tested by themselves though 244(80%) of the HCWs had motivation or interest to be tested by themselves. Generally, of the ever tested only 85(29.5%) were tested by the help of health care providers/counselors other than self. Regarding the place where the HCWs had the test, majority 136 (69.4%) tested by themselves at the health facility and the rest were tested at their home, office, market and church. The main reason stated for self-testing was the need for confidentiality for the test result, which was mentioned by 205(82%). Moreover, 35(14.0%) claims lack of time to access the ordinary counseling and testing services. CONCLUSION: This study depicts high rate of HIV self-testing practice among HCWs. This shows that HIV self-testing can be considered as one pillar to increase the HIV-testing services and a means for the HIV prevention and control policy, through increasing HIV testing uptake and awareness of HIV status. However, the implementation may require the role of different stakeholders and decision makers with further study to extend the options.

We implement virtual clinical integration of next-generation perovskite detectors into common x-ray imaging devices. This was achieved by performing Monte Carlo (MC) optimisation of the design and benchmarking of low cost, high spatial resolution, direct conversion perovskite crystal x-ray flat panel imagers for a next generation of breast-, MV-, and kV-cone beam CT detectors. Semiconductor methylammonium lead bromide perovskite crystals energy deposition efficiencies calculated in TOPAS were benchmarked against four common detector materials for twelve detector crystal thicknesses between 40 to 15 mm and ten beam energies ranging from 20 keV to 6 MeV. Based on these simulations, Koning's dedicated breast CT, and Varian's Truebeam kV- and MV-cone beam CT systems were designated as suitable applications for perovskite detectors. System specific Fastcat hybrid MC cone beam CT image simulation was subsequently used to optimise the perovskite detector design and conduct virtual clinical trials. Device-specific optimal perovskite crystal thicknesses were calculated to be 0.30, 0.86, and 1.99 mm for Koning breast CT and Truebeam kV- and MV-cone beam CT systems, respectively. Replacing the current detectors on these machines with low cost perovskite crystal detectors could be advantageous as it would simultaneously yield 12.1%, 9.5% and 86.1% improvements in detective quantum efficiency as well as increases in contrast to noise ratio in brain, lung, and bone tissues., (Creative Commons Attribution license.)

Anecdotal evidence and published data suggest that many patients are lost in the transition from voluntary counselling and testing (VCT) to antiretroviral treatment (ART) initiation. This study aimed to identify the proportion of patients who fail to proceed from VCT to ART initiation within six months. Records of all patients who tested HIV positive at two VCT centres in South Africa, from 1 April 2009 to 30 June 2009, were selected for the study. Patients eligible for ART were identified, based on their CD4+ count ≤ 200 cells/mm3. An electronic patient database (SOZO) was used to track patients and determine whether they had attended pre-ART visits and whether they commenced ART. Patients were regarded as lost to initiation on ART if there was no proof that they attended pre-ART visits or finally accessed treatment within six months. More than half 63.9% (n=360) of the patients eligible for treatment at the two VCT centres did not commence ART within a period of six months. The majority of patients lost to initiation on ART (52.6 %) were lost before collecting their CD4+ count results. Evidently a high percentage of patients in need of ART is not receiving treatment and the majority of these patients are lost early in the process. These results suggest a need for urgent intervention to improve ART uptake. [ABSTRACT FROM AUTHOR]

Mother-to-child-transmission (MTCT) of HIV still remains a significant route of new HIV infection in children in Malawi and Nigeria, despite the introduction of Prevention-of-Mother-to-Child-Transmission (PMTCT) of HIV programmes in both countries. A critical literature review, based on the findings from 12 primary research articles, explores the reasons for the inadequacy and failure of PMTCT. Findings show socioeconomic and sociocultural factors as the biggest barriers to the success of PMTCT programmes. Other factors include: limited male involvement, the organization of PMTCT and health workers' inefficiency. In conclusion, PMTCT programmes will remain inefficient unless these factors are addressed. There is an urgent need to strengthen PMTCT programmes by stakeholders through a collaborative strategic effort to ensure high PMTCT programme uptake in Malawi and Nigeria, in order to eliminate HIV/AIDS in children. [ABSTRACT FROM AUTHOR]

HIV self-testing (HIVST) is an emerging HIV testing strategy intended to address challenges of increasing access to preliminary knowledge of serostatus. It offers the potential for tests and testing to reach more people than previously possible, including those who do not seek testing in facilities. With approval of an HIV self-test kit in the USA, increasing evidence from public pilot programs in sub-Saharan Africa showing high acceptability and feasibility, and evidence of the informal sale of rapid HIV test kits in the private sector, options for individuals to access HIV self-testing, as well as consumer-demand, appear to be increasing. More recently WHO and UNAIDS have explored self-testing as an option to achieving greater HIV testing coverage to support global treatment targets. However, for resource-limited settings, technological development, diagnostic device regulation and quality assurance policies are lagging behind. This commentary will examine regulatory and policy issues with HIVST, given its increased prominence as a potential part of the global HIV/AIDS response. [ABSTRACT FROM AUTHOR]

Voluntary counseling and testing (VCT) is a major component of HIV prevention and care. VCT is also perceived to be an effective strategy in risk reduction among sexually active young people [1]. A recent study in Cameroon reported an HIV prevalence of 3.2% [2] among youths aged 15-24 and an estimated 4.3 to 5.9 million young people in the same age group living with HIV [3]. The Cameroonian government has done a lot to reduce the incidence of HIV infection [4]. However, the Global AIDS epidemic report 2008 indicated that only 16% of the Cameroonian population aged 15-49 knew their HIV status [5]. Another study in Cameroon showed that awareness and use of centres offering VCT for HIV were very low [6]. The aim of this study was to evaluate the use of VCT services among high school students in the Tiko health distrit (THD).

In Ukraine, only 28 % of HIV-infected individuals are aware of their HIV status. Expansion of voluntary HIV counseling and testing (VCT) in primary and specialty health care settings holds promise for increasing the number of people who know their HIV status and can access care. To build capacity among health care providers to deliver VCT, we conducted two-day trainings on basic HIV knowledge and on VCT procedures in the Odessa region of Ukraine. The training program was developed by local trainers in collaboration with faculty from the US Southeast AIDS Training and Education Center and was delivered in the clinical settings where trainees worked ( n = 392). We assessed training effectiveness in terms of change in knowledge among clinician trainees, comparing HIV specialists and nonspecialists and those working in urban and rural clinical settings. All else being equal, compared with their urban HIV-specialist peers, trainees who were rural nonspecialists demonstrated significantly greater increases in general HIV knowledge scores. This effort demonstrates that brief, on-site training programs support the expansion of VCT by increasing the knowledge and skills of rural nonspecialist clinicians to levels equal with urban HIV specialists. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about HIV testing, HIV infection and sexual behaviour among bathhouse patrons in China. This study aims to assess differences in HIV prevalence and high-risk sexual behaviours between repeat and first-time testers among men who have sex with men (MSM) attending bathhouse in Tianjin, China. Methods: Between March 2011 and September 2012, a HIV voluntary counselling and testing station was established in a gay bathhouse, which provided HIV testing and conducted a survey among participants recruited through snowball sampling. Differences in demographic and high-risk sexual behaviours between repeat and first-time testers were assessed using the chi-square test. Univariate and multivariate logistic regression analyses were conducted to identify predictors for HIV infection. Results: Of the 1642 respondents, 699 (42.6%) were repeat testers and 943 (57.4%) were first-time testers. Among repeat testers, a higher proportion were men aged 18 to 25, single, better educated, had a history of STIs and worked as male sex workers or “money boys” (MBs). Repeat testers were less likely to report having unprotected anal intercourse in the past six months. The overall HIV prevalence was 12.4% (203/1642). There was no difference in HIV prevalence between repeat (11.2%, 78/699) and first-time (13.3%, 125/943) testers. The HIV prevalence increased with age among first-time testers (χtrend2=9.816, p=0.002). First-time MB testers had the highest HIV prevalence of 34.5%. Conclusions: MSM attending bathhouse had an alarmingly high HIV infection rate, particularly in MB. Targeted interventions are urgently needed especially focusing on older MSM and MBs. [ABSTRACT FROM AUTHOR]

Background: Despite the introduction of free antiretroviral therapy (ART), the use of voluntary counselling and testing (VCT) services remains persistently low in many African countries. This study investigates how prior experience of HIV and VCT, and knowledge about HIV and ART influence VCT use in rural Tanzania. Methods: In 2006-7, VCT was offered to study participants during the fifth survey round of an HIV community cohort study that includes HIV testing for research purposes without results disclosure, and a questionnaire covering knowledge, attitudes and practices around HIV infection and HIV services. Categorical variables were created for HIV knowledge and ART knowledge, with "good" HIV and ART knowledge defined as correctly answering at least 4/6 and 5/7 questions about HIV and ART respectively. Experience of HIV was defined as knowing people living with HIV, or having died from AIDS. Logistic regression methods were used to assess how HIV and ART knowledge, and prior experiences of HIV and VCT were associated with VCT uptake, with adjustment for HIV status and socio-demographic confounders. Results: 2,695/3,886 (69%) men and 2,708/5,575 women (49%) had "good" HIV knowledge, while 613/3,886 (16%) men and 585/5575 (10%) women had "good" ART knowledge. Misconceptions about HIV transmission were common, including through kissing (55% of women, 43% of men), or mosquito bites (42% of women, 34% of men). 19% of men and 16% of women used VCT during the survey. After controlling for HIV status and socio-demographic factors, the odds of VCT use were lower among those with poor HIV knowledge (aOR = 0.5; p = 0.01 for men and aOR = 0.6; p < 0.01 for women) and poor ART knowledge (aOR = 0.8; p = 0.06 for men, aOR = 0.8; p < 0.01 for women), and higher among those with HIV experience (aOR = 1.3 for men and aOR = 1.6 for women, p < 0.01) and positive prior VCT experience (aOR = 2.0 for all men and aOR = 2.0 for HIV-negative women only, p < 0.001). Conclusions: Two years after the introduction of free ART in this setting, misconceptions regarding HIV transmission remain rife and knowledge regarding treatment is worryingly poor, especially among women and HIV-positive people. Further HIV-related information, education and communication activities are urgently needed to improve VCT uptake in rural Tanzania. [ABSTRACT FROM AUTHOR]

Background: To endorse involvement in voluntary HIV counseling and testing (VCT), it is essential to recognize factors that influence people in deciding whether to access VCT services and their underlying route factors. Theory of planned behavior (TPB) constitutes a proficient framework for predicting behaviors and intentions. Objective: The aim of the study reported here was to assess the predicting ability of TPB in determining the intended use of VCT services among health professionals in Jimma, southwest Ethiopia. Methods: This was an institution-based cross-sectional quantitative study of a sample of 336 health professionals in 12 selected districts of Jimma, southwest Ethiopia between February 5 to March 28, 2012. Data were collected using structured questionnaire self-administered by the study participants. A hierarchal multivariable linear regression model was used to predict the role of TPB constructs that can influence the intention to use VCT services. Results: The constructs of TPB explained the variability in intention to use VCT by 27% (R2 adjusted = 0.27). The standardized regression coefficients showed that the strongest predictor of intention to use VCT was subjective norms (β = 0.32, P , 0.0005) followed by attitude (β = 0.21, P , 0.002). Perceived behavioral control was not a significant predictor of intention to use VCT among the study group (P = 0.12). Conclusion: The study revealed the possibility of describing the intention to use VCT among health professionals using TPB, with perceived social pressure being the leading predictor. In light of this, health intervention programs should be designed to develop health professionals' ability to resist norms that oppose the use of VCT and to change community-held norms against VCT use, provided they help individuals develop a positive attitude toward the services. [ABSTRACT FROM AUTHOR]

Background: Voluntary counselling and testing (VCT) together with a safe sexual behaviour is an important preventive strategy in the control of HIV. Although Health care workers (HCWs) are critical in the response to HIV, little is known about VCT and high risk behaviours (HRB) among this group in West Africa. This study aims to assess the prevalence of VCT and HRB among HCWs in Burkina Faso. Methods: We collected data through a questionnaire in urban areas (Ouagadougou and Bobo-Dioulasso) and rural areas (Poni and Yatenga) among HCWs from 97 health care facilities. Urine samples were collected, screened for HIV using a Calypte® test kit and confirmed by Western Blot. Multiple logistic regression analysis was performed to identify factors associated with the use of VCT services and with high-risk sex behaviour. Results: About 92.5% of eligible HCWs participated (1570 out of 1697). Overall, 38.2% of them (34.6% of women and 42.6% of men) had ever used VCT services. About 40% of HCWs reported that fear of knowing the test result was the main reason for not doing the HIV test. Male HCWs (p = 0.001), laboratory workers (p < 0.001), those having two years or more experience (p = 0.03), and those who had multiple partners (p = 0.001) were more likely to have tested for HIV. One fifth of HCWs reported multiple partners. Of these, thirteen percent did not use condoms. HCWs who had multiple partners were significantly more likely to be men, single, living in rural areas, and under the age of 29 years. Conclusion: VCT was still very low among HCWs in Burkina Faso, while HRB was high.These findings suggest that 'HCW-friendly' VCT centres should be implemented, securing confidentiality among colleagues. In addition, refreshment courses on HIV risk reduction, counselling and testing are certainly required during the professional career of HCWs. [ABSTRACT FROM AUTHOR]

The accession of volume of arterial blood and thereby the increment of offered exploitable oxygen in the treatment of extremity has become obvious as one of the line of supposed treatment mechanism vacuumcompression therapy (VCT). These increments were quantified with the usage of three older, so far not analyzed experiments that show the effectiveness of vacuum compression therapy. It was proved that vacuum-compression therapy can get the constant increment of the fresh oxygenated blood in volumes up to 100 ml/min into the treated extremity during the treatment procedure. It means the increase by 50 % of the offer of oxygen for the treated extremity. However it has become apparent that if the technical conditions of the procedure are not optimal, the specific increment of the offer of oxygen induced by administration of VCT persists but is distinctly lower. These experimental conclusions support the purposefulness and efficiency of the vacuum-compression therapy (VCT) in its standard classic form but they support the need of development and the usage of improved methods and new technical tools for performing this highly effective physical-treatment therapy for which the scanning of the response of the treated extremity on the treatment and the feedback impedance control of the optimal values of the biotrophic procedure's parameters will be characteristic. These new systems will be possibly considered the higher generation of classic VCT. They are called "computer controlled peripheral bipolar barotherapy, CC-PBBT (Computer Control Peripheral Bipolar Barotherapy). [ABSTRACT FROM AUTHOR]

Copyright of Fire Ecology is the property of Springer Nature 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.)

This qualitative study aimed to assess the work in Voluntary Counseling and Testing Services (VCT) in Porto Alegre, Brazil in the perspective of their counselors. It was conducted six focus groups with 13 counselors from the three VCT services in the city. Qualitative content analysis of the reports resulted in a central theme named Joining management and work processes in the VCT services. Counselors have emphasized that services are essential for HIV/AIDS diagnosis and prevention, and contributed significantly to effective healthcare. However, VCT services were facing a crisis regarding its role in the healthcare system since counseling and HIV testing activities were being extended as a responsibility of primary health care. These changes have brought anxiety and uncertainness among counselors, especially because the poor relationships with management levels and the lack of clear guidelines in the new policy context. Findings also pointed out counselors' concerns about the quality of counseling offered in the primary health care services, the lack of professionals to HIV/AIDS healthcare and the lack of medical specialist appointments. We endorsed that participatory management strategies could help to redirect VCT services activities, strength the matrix support testing and counseling for HIV and value these services as specialized healthcare providers and human resources reference for training in the area. [ABSTRACT FROM AUTHOR]

Background: Despite the recognition of stigma as a hindrance to public health treatment and prevention there are gaps in evidence on the relationship between HIV stigma and VCT services utilization in Nigeria. The purpose of this study was to examine a community's perceptions, feelings and attitudes towards people living with HIV/AIDS and how this is associated with access to utilization of voluntary counselling and treatment in Nigeria. Methods: A cross-sectional random study of Nigerians, using a mixed-method approach was carried out in two distinct ethnic areas of the country. Both quantitative and qualitative methods (mixed-methods) were used to collect data in Osun State (Yoruba ethnic group) in the South-West and Imo State (Igbo ethnic group) in the South East. Multivariate logistic regression was the model used to examine the association of interest. Results: It is shown that Nigerian public attitudes to HIV/AIDS and those infected with the disease are negative. The markers for stigma on the overall stigma index are significant predictors of utilization of voluntary counselling and testing. As the sum of negative feelings increases, there is less likelihood to using voluntary counselling and testing (VCT) and vice versa. Conclusions: Current national efforts at addressing the AIDS pandemic can only be successful when the issue of AIDS is de-stigmatized and is made a critical part of those efforts. One way to do this is through well-designed messages that should be posted in the media, community halls, health centers and other public places aimed at humanizing the disease and those affected and infected by it. [ABSTRACT FROM AUTHOR]

Background: Voluntary Counseling and Testing (VCT) is the key entry point to prevention, care, treatment and support services, where people learn whether they are infected or not and to understand the implications of their HIV status and make informed choices for the future. Methods: A cross sectional study design was done among 753 students drawn from selected departments in Debre Markos University, Ethiopia, using multi-stage sampling technique. Self-administered questionnaire was used to estimate the prevalence of VCT service utilization and to assess associated factors. Data were entered and analyzed using SPSS version 16. Results: 711 students were participated in the study, of whom, 521 were males. Majority (93.8%) were within the age range of 15 to 24 years. The mean age was 21.5 (3.2±); most of the respondents (91.6%) were single. Majority (81.4%) heard about the confidential VCT service, and their major sources of information were mass media (73.3%) and health workers (71.1%). The study revealed that 58.5% of the study participants had undergone voluntary counseling and testing. It was shown that VCT service utilization was significantly associated with availability of ART drug in VCT site, heard presence of confidentiality, perceived stigma, risk perception and knowledge about HIV. Conclusion: The major factors identified for increased VCT service utilization were knowledge about availability of ART drug in VCT site, information about confidentiality, absence of perceived stigma, higher risk perception and knowledge about HIV. Therefore, actions targeting on these predictors are necessary to effectively enhance the use of the VCT services utilization. [ABSTRACT FROM AUTHOR]

Introduction: HIV is still an enormous global burden and it is also causing loss of huge health care workers (HCWs) on the already limited human resource capacity in health care services in Sub-Saharan Africa. Variety of methods of accelerating HIV testing is required to increase the rate of HIV testing and expand treatment services. Therefore, this study was aimed to find out the prevalence, feasibility and options of HIV self-testing practices in Ethiopia. Methods: A cross-sectional study design triangulated with qualitative method was conducted from February to May, 2012. The data was collected using a semi-structured pretested questionnaire and in-depth interview, at government and private health centers or clinics and hospitals. During the data collection all the available healthcare workers (HCWs) which encompass the internship students including: Medical, Health Officer, Nurses, Midwives and Laboratory students, and health professionals working in the selected health institutions were involved. Results: A total of 307 HCWs were included in the analysis and we found that 288(94.4%) of them were ever tested for HIV, of which majority 203 (70.5%) were tested by themselves though 244(80%) of the HCWs had motivation or interest to be tested by themselves. Generally, of the ever tested only 85(29.5%) were tested by the help of health care providers/counselors other than self. Regarding the place where the HCWs had the test, majority 136 (69.4%) tested by themselves at the health facility and the rest were tested at their home, office, market and church. The main reason stated for self-testing was the need for confidentiality for the test result, which was mentioned by 205(82%). Moreover, 35(14.0%) claims lack of time to access the ordinary counseling and testing services. Conclusion: This study depicts high rate of HIV self-testing practice among HCWs. This shows that HIV self-testing can be considered as one pillar to increase the HIV-testing services and a means for the HIV prevention and control policy, through increasing HIV testing uptake and awareness of HIV status. However, the implementation may require the role of different stakeholders and decision makers with further study to extend the options. [ABSTRACT FROM AUTHOR]

Background: Voluntary HIV Counseling and Testing (VCT) forms one of the cornerstones of HIV prevention strategies. It is imperative to understand HIV testing correlates and their theoretical underpinnings in order to promote VCT uptake. The aim of this study was to predict the intention to VCT and associated factors among health professionals in Jimma zone, Ethiopia using the theory of planned behavior. Methods: An institution based cross-sectional quantitative study among a sample of 336 health professionals in 12 selected districts of Jimma, Ethiopia was conducted in 2012. The constructs and principles of the theory of planned behavior (TPB) were measured. Data were collected using structured questionnaire on self administered basis. A multivariable linear regression model was used to predict the role of independent variables/TPB constructs on the intention to use VCT using SPSS version 16.0. Results: The components of TPB independently explained the variance in intention to VCT by 30.3%. Both components of TPB and socio-demographic characteristic in the final model explained 32.7% of variance in the intention to use VCT services. Significant proportions (33.0%) of the respondents have never been tested for HIV. The respective indirect components of the TPB predicted the direct components. The strongest predictors of intention to VCT were subjective norm (ß=0.39, p<0.001) and attitude (ß= 0.19, p<0.001) whereas, none of the socio-demographic variables were significantly predicted the intention to use VCT. Past VCT experience did not have significant statistical association with VCT use intention. Conclusions: Behavioral intention to use VCT was a function of attitude and perceived social pressure. Demographic related social determinants were not barriers for VCT use intention. Most health workers test their blood by themselves. Strategies to empower health professionals on social pressure resistance and programs targeted at changing negative attitude on VCT use can enhance intention of health professionals to use VCT. [ABSTRACT FROM AUTHOR]

Voluntary counselling and HIV testing (VCT) has been associated with decreased human immunodeficiency virus (HIV) risk behaviour, but in South Africa, which has the largest HIV/acquired immune deficiency syndrome (AIDS) epidemic in the world, uptake of VCT remains low. HIV/AIDS-associated stigma has been identified as a barrier to HIV testing. This study explored changes in stigma, and VCT access in a peri-urban South African community with high HIV prevalence, following education and research interventions, as well as the introduction of a wide-scale antiretroviral therapy (ART) programme. Two cross-sectional community surveys assessing HIV knowledge, attitudes and uptake of VCT services were conducted. The first survey was performed in 2004 prior to the implementation of a community-based HIV awareness and education campaign, HIV prevention research studies and the introduction of an ART programme. The second survey was performed in 2008 after a three-year education programme, the implementation of HIV-related research studies and following the scale-up of the ART programme. The same study design was used in both the 2004 and 2008 surveys: 10% of households were randomly selected and all residents aged ≥ 14 years were invited to complete a self-administered questionnaire. Overall basic knowledge of HIV/AIDS increased from 2004 to 2008 (p=0.04) and stigmatisation towards HIV-positive individuals decreased over the same time period (p<0.001). Increasing knowledge score was significantly associated with a lower stigma score (p<0.001). Decreasing stigma score was associated with knowing someone who was HIV infected (p<0.001), or who had died from HIV/AIDS (p=0.04). The proportion of participants who had undergone HIV testing increased from 2004 to 2008 (40 vs. 70%, respectively) and, in particular, VCT increased from 26 to 43%. In adjusted analysis, participants who had undergone HIV testing were more likely to have a higher HIV knowledge score (p=0.02) and a lower stigma score (p=0.09). A reduction in levels of HIV/AIDS-associated stigma was noted in a community burdened with high HIV prevalence, as was an increase in reported VCT. These findings may be the result of a number of interventions including a wide-spread and targeted education campaign, and the “normalisation” of HIV through the availability of ART. Given the role of HIV/AIDS-associated stigma in influencing choices to access HIV testing, and the benefits associated with HIV testing, interventions to reduce stigma in communities affected by this disease should be encouraged. [ABSTRACT FROM PUBLISHER]

Involvement of male partners may increase adherence to and improve outcomes of programs to prevent mother-to-child HIV transmission (PMTCT). Greater understanding of factors impeding male voluntary HIV counseling and testing (VCT) is needed. A cross-sectional study was conducted in Tshwane, South Africa. Semi-structured interviews were completed with men whose partners had recently been pregnant. Of 124 men who participated, 94% believed male HIV testing was important, but 40% had never been tested. Of those tested, 32% were tested during the pregnancy, while 37% were tested afterward. Fifty-eight percent of men reported that their female partners had disclosed their test results during pregnancy. A man's likelihood of testing during pregnancy was associated with prior discussion of testing in PMTCT, knowing the female partner had tested, and her disclosure of the test result (all p<0.05). In terms of increasing male-partner HIV testing rates, 74% of the men reported they would respond favorably to a written invitation for VCT from their partners. Based on themes that emerged during the interviews, six partner invitation cards to encourage male involvement in PMTCT were designed. Responses to the cards were elicited from 158 men and 409 women. One invitation card framed by the themes of fatherhood and the baby was selected by 41% of men and 31% of women as the most likely for women undergoing PMTCT to bring to their male partners and the most successful at encouraging men to be tested. In conclusion, this study found that a substantial proportion of men whose partners were recently pregnant had never been tested themselves; of those who had tested, most had done so only after the pregnancy. Encouraging partner communication and clinic attendance using an invitation card could facilitate increased male testing and participation in PMTCT. [ABSTRACT FROM PUBLISHER]

In Ethiopia, most HIV-affected couples are in serodiscordant relationships and must weigh any childbearing desires against the risk of transmitting the virus to a partner or child. This analysis investigates the relationship between HIV diagnosis and fertility intentions among couple voluntary counseling and testing (VCT) clients in Ethiopia and whether this relationship differs between men and women. Data come from the Ethiopia Voluntary Counseling and Testing Integrated with Contraceptive Services (VICS) study, which collected information from men and women attending VCT at eight public sector health facilities in the Oromia region of Ethiopia. VCT clients were asked about their fertility intentions before (pre-test) and after (post-test) receiving their HIV test results. Sex-stratified logistic regression was used to find characteristics, such as the couple's HIV status, associated with ceasing to desire children between pre-test and post-test versus desiring children at both time points. Women belonging to serodiscordant couples were much more likely to cease desiring children than women in HIV-concordant couples, regardless of whether the woman (aOR=11.08, p<0.001) or her partner (aOR=9.97, p=0.001) was HIV+. Only HIV+ men in serodiscordant relationships were more likely to stop desiring children than men in HIV-concordant couples (aOR=12.10, p<0.001). Serodiscordant couples would benefit from family planning services or referrals during VCT to help meet their reproductive needs. [ABSTRACT FROM PUBLISHER]

The purpose of this study was to assess the prevalence of, and the factors associated with HIV testing and pre- and post-test counselling (PPTC) in Colombia. Cross-sectional data from the National Health Survey carried out during 2007 were analysed. Data were gathered from records of 29,760 individuals between the ages of 18 and 69 from the main regions of the country. Only 19.7% of the sample had taken an HIV test. Men, people with no education, those not affiliated with the health-care system, residents of rural areas and those aged older than 65 were less likely to have been tested for HIV; 42% of those tested did not receive pre-test counselling and 56.9% received no report of the results. Considering the low prevalence of HIV testing among the Colombian population, it is necessary to design and apply guidelines for HIV screening in all health-care settings and to conduct targeted testing in high-risk sub-populations. A national norm of PPTC in those who undergo HIV testing should be examined. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the use of voluntary counseling and testing (VCT) services for HIV by high school students in the Tiko health district (THD), Cameroon. A cross sectional descriptive, analytical study was conducted using a pre-established questionnaire among high school students in the Tiko health district where a multi stage sampling method was used. A total of 474 students were included in the study. Among them, 350 (73.8%) had heard about VCT, 136 (27.8%) had undergone VCT and 329 (69.4%) were willing to undergo VCT. The use of VCT services was positively associated with age (p<0.001), sex (p<0.001), school (p<0.001), sexual activity (p=0.001), attitude (p=0.001) towards and knowledge of VCT (p<0.001). Knowledge of VCT among the students was high but the use of VCT services was low. We recommend that free screening for HIV should be offered in secondary schools of THD. [ABSTRACT FROM AUTHOR]

Introduction The current UNAIDS goal towards virtual ending or elimination of infants acquiring HIV by 2015 is perhaps the most achievable goal to date. Yet, models show that delivery of antiretroviral compounds alone will not suffice to achieve this goal, and a broader community-based approach to pregnancy, families and HIV is needed. Such an approach would highlight the important role of men in reproduction. Although early studies have shown it is cost-effective to include males, very few interventions have proceeded to involve men. Methods This review utilized systematic review techniques to explore the literature on effective interventions for the inclusion of men in the prevention of HIV to infants. A key word search of literature sources generated 248 studies for hand sorting and interrogation. Of these, 13 were found to contain some information on involvement of males in some form of provision. Data were abstracted from these and form the basis of this review. Results Background descriptive studies painted a picture of low male involvement, poor male inclusion and barriers to engagement at all stages. Yet, pregnancy intentions among men affected by HIV are high and the importance of fathers to family functioning - from relationships, through conception, pregnancy and parenting - is well established. Search strategies for interventions for males in HIV and pregnancy were used to generate studies of sufficient quality to inform strategies on the future of male involvement. Of the 317,434 papers on pregnancy and HIV, only 4178 included the term male (paternal or father). When these were restricted to intervention studies, only 248 remained for hand sorting, generating 13 studies of relevance for data extraction. The results show that all these interventions were concentrated around male partner HIV testing. In general, male partner testing was low and was amenable to change by offering voluntary counselling and testing (VCT) information, providing couple-based testing facilities and encouraging male attendance. All interventions used indirect approaches to men via their pregnant spouse. Non-health facility (clinic or hospital)-based provision (such as testing facilities in the community in bars and churches) were more effective than healthcare facilities in attracting male participation. Conclusions In conclusion, the review showed that approaches to men are limited to HIV testing with little innovative planning and provision for male treatment and care. As such, initiatives run the risk of alienating rather than including males. Direct approaches and the provision of male-specific facilities and benefits should be explored. [ABSTRACT FROM AUTHOR]

Studies show reduced HIV risk behaviors after couple voluntary counseling and testing (VCT), either resulting from the couple counseling process or the type of people it attracts. A total of 1858 sexually active individual VCT clients in partnerships were compared to 866 sexually experienced couple VCT participants with multilevel logistic regression. Sexually experienced couple VCT clients were also compared to those couple VCT clients who never had sex. Among sexually experienced participants in partnerships, women, non-premarital testers, and those who felt at risk for HIV were less likely to attend couple VCT than individual VCT. Among couple VCT clients, sexually inexperienced individuals were more likely to be: testing for the first time, premarital testers, and more educated than those who were sexually experienced. Couple VCT's effectiveness might partly result from who it attracts. Addressing the diverse needs of a heterogeneous testing population is a programmatic challenge for couple VCT in Ethiopia. [ABSTRACT FROM AUTHOR]

A venue-based HIV prevention study which included Voluntary Counseling and Testing (VCT) was conducted in three diverse areas of Kenya-Malindi, Nanyuki and Rachounyo. Aims of the study were to: (1) assess the acceptability of VCT for the general population, men who have sex with men (MSM), and injecting drug users (IDUs) within the context of a venue-based approach; (2) determine if there were differences between those agreeing and not agreeing to testing; and (3) study factors associated with being HIV positive. Approximately 98% of IDUs and 97% of MSM agreed to VCT, providing evidence that populations with little access to services and whose behaviors are stigmatized and often considered illegal in their countries can be reached with needed HIV prevention services. Acceptability of VCT in the general population ranged from 60% in Malindi to 48% in Nanyuki. There were a few significant differences between those accepting and declining testing. Notably in Rachuonyo and Malindi those reporting multiple partners were more likely to accept testing. There was also evidence that riskier sexual behavior was associated with being HIV positive for both men in Rachounyo and women in Malindi. Overall HIV prevalence was higher among the individuals in this study compared to individuals sampled in the 2008-2009 Kenya Demographic and Health Survey, indicating the method is an appropriate means to reach the highest risk individuals including stigmatized populations. [ABSTRACT FROM AUTHOR]

Summary: Among HIV-infected adults attending non-governmental organization voluntary counseling and testing (VCT) sites in Uganda that provide a nine-month course of isoniazid preventive treatment (IPT), we report on loss to follow-up (LTFU) and its associated risk factors. The design was a retrospective cohort study of program data spanning a three year period (2006–2008). A total of 586 IPT patients were enrolled of whom 335 (57.1%) were females with a mean age of 34 years. Of those starting IPT, 341 (58.1%) were lost to follow-up, 197 (33.6%) completed IPT, 29 (4.9%) were discontinued and 19 (3.2%) died. The return rates at one, three, five and seven months were 78.0% (457), 62.1% (364), 52.9% (310) and 33.6% (197) respectively. Being less than 30 years of age, widowed, separated, or divorced were found to be associated with a higher risk of loss to follow-up. Sudden improvement in retention on IPT was observed between the years 2006 and 2007, although causes of the improvement are poorly understood hence the need for more research. At non-governmental VCT sites in Uganda, six out of ten individuals enrolled on IPT are lost to follow-up and efforts to reduce this attrition including systems strengthening might play a critical role in the success of IPT programs. [Copyright &y& Elsevier]

Abstract: Many forestry and earth science applications require spatially detailed forest height data sets. Among the various remote sensing technologies, lidar offers the most potential for obtaining reliable height measurement. However, existing and planned spaceborne lidar systems do not have the capability to produce spatially contiguous, fine resolution forest height maps over large areas. This paper describes a Landsat–lidar fusion approach for modeling the height of young forests by integrating historical Landsat observations with lidar data acquired by the Geoscience Laser Altimeter System (GLAS) instrument onboard the Ice, Cloud, and land Elevation (ICESat) satellite. In this approach, “young” forests refer to forests reestablished following recent disturbances mapped using Landsat time-series stacks (LTSS) and a vegetation change tracker (VCT) algorithm. The GLAS lidar data is used to retrieve forest height at sample locations represented by the footprints of the lidar data. These samples are used to establish relationships between lidar-based forest height measurements and LTSS–VCT disturbance products. The height of “young” forest is then mapped based on the derived relationships and the LTSS–VCT disturbance products. This approach was developed and tested over the state of Mississippi. Of the various models evaluated, a regression tree model predicting forest height from age since disturbance and three cumulative indices produced by the LTSS–VCT method yielded the lowest cross validation error. The R2 and root mean square difference (RMSD) between predicted and GLAS-based height measurements were 0.91 and 1.97m, respectively. Predictions of this model had much higher errors than indicated by cross validation analysis when evaluated using field plot data collected through the Forest Inventory and Analysis Program of USDA Forest Service. Much of these errors were due to a lack of separation between stand clearing and non-stand clearing disturbances in current LTSS–VCT products and difficulty in deriving reliable forest height measurements using GLAS samples when terrain relief was present within their footprints. In addition, a systematic underestimation of about 5m by the developed model was also observed, half of which could be explained by forest growth that occurred between field measurement year and model target year. The remaining difference suggests that tree height measurements derived using waveform lidar data could be significantly underestimated, especially for young pine forests. Options for improving the height modeling approach developed in this study were discussed. [Copyright &y& Elsevier]

Disclosure of HIV status after HIV voluntary counseling and testing has important implications for the spread of the HIV epidemic and the health of individuals who are HIV positive. Here, we use individual and couples level data for currently married respondents from an ongoing longitudinal study in rural Malawi to (1) examine the extent of HIV status disclosure by HIV serostatus; (2) identify reasons for not sharing one's HIV status with a spouse; and (3) evaluate the reliability of self-reports of HIV status disclosure. We find that disclosure of HIV status is relatively common among rural Malawians, where most have shared their status with a spouse, and many disclose to others in the community. However, there are significant differences in disclosure patterns by HIV status and gender. Factors associated with non-disclosure are also gendered, where women who perceive greater HIV/AIDS stigma and HIV positive are less likely to disclose HIV status to a spouse, and men who are worried about HIV infection from extramarital partners are less likely to disclose their HIV status to a spouse. Finally, we test the reliability of self-reported HIV status disclosure and find that self-reports of HIV-positive men are of questionable reliability. [ABSTRACT FROM AUTHOR]

Despite the availability of large funds and considerable efforts to improve access to antiretroviral therapy (ART), coverage of treatment with ART remains low in Democratic Republic of the Congo (DRC). We identified the bottlenecks for adults' access to ART in a semi-rural health zone in DRC, compared ART coverage in the urban and rural area and described the outcomes and yield of different HIV testing settings. An operational model was used to examine bottlenecks in the flow of patients. The study period covered the start of the HIV care programme in April 2006, until December 2008. An estimated 505 People Living With HIV/AIDS (PLWHA), of whom 201 were in need of ART, lived in the health zone. The proportion of PLWHA in need of ART who were actually receiving ART was estimated at 53%. About 6451 adults were tested for HIV, 266 of them were HIV-positive and 163 accessed the HIV care programme. About 106 of the 126-159 eligible patients initiated ART. The main bottleneck was situated at HIV detection. Access to the HIV care programme for the patients testing HIV-positive was identified as the second biggest bottleneck. About 41% of the PLWHA identified in urban areas accessed the HIV care programme, versus 11% of the rural PLWHA, showing a serious inequity. The tuberculosis (TB) programme detected 75% of the total estimated 92 co-infected patients of the health zone. Only 13% of women testing positive in the Prevention of Mother-To-Child Transmission programme accessed the HIV care programme, showing that this bottleneck is greatly accentuated in this specific group. By testing all pregnant women and all TB patients in the health zone, 28% of all PLWHA could potentially be detected in a period of 33 months, showing its great potential in settings with a relatively low HIV prevalence. [ABSTRACT FROM AUTHOR]

Based on our previous qualitative exploration, this research presents the second phase in our study of factors associated with utilization of a free HIV VCT clinic in Jinan City, Northern China, by female sex workers (FSWs). A total of 970 FSWs from entertainment venues were interviewed and prospectively followed to determine who ultimately sought and received VCT at the clinic, compared to those who did not. Simple and multiple logistic regressions were performed on factors drawn from the Ecological Perspective, hypothesized to be associated with utilization of testing at the VCT clinic. Despite 69% of FSWs expressing willingness to attend the VCT clinic, only 11% were actually tested. The multiple logistic regression model that provided best goodness of fit included the covariates of willingness to attend the VCT clinic (Adjusted OR 3.13, 95% CI: 1.62-6.59), low perceived HIV infection risk (Adjusted OR 0.64, 95% CI: 0.35-1.11), low fear of FSWs status disclosure in the clinic (Adjusted OR 0.55, 95% CI: 0.31-0.94) and influence of acquaintances (Adjusted OR 0.52, 95% CI: 0.29-0.89) and peers (Adjusted OR 2.45, 95% CI: 1.40-4.50). This is the first study in China to follow FSWs longitudinally to measure factors related to VCT utilization. The low utilization of VCT services by participants in our study is similar to prior reports throughout China. FSWs' access to VCT service is associated with intrapersonal, institutional, and particularly, interpersonal factors. Based on these findings, we recommend emphasis on confidentiality of services, VCT education for influential peers, and introduction of HIV rapid testing on site. [ABSTRACT FROM AUTHOR]

In Cayenne, French Guiana, 80% of HIV-positive patients followed at the hospital are migrants. Behavioural information is crucial for optimising HIV testing for this vulnerable group. Predictors of ignorance of the existence of free voluntary counselling and testing (VCT) centre and willingness to get tested were investigated in 2006 among 398 migrants from Haiti, Guyana, Suriname and Brazil using a structured questionnaire. Only 27% of migrants knew simultaneously about the existence of free VCT, its localisation and its operating hours. Factors associated with ignorance of the existence of free VCT centre were birthplace in Haiti, being in French Guiana for less than three years, not thinking one's birth country as strongly affected by HIV and not thinking to be personally at risk for HIV. Factors independently associated with willingness to get tested were thinking to be at risk for HIV, birthplace in Brazil and Haiti, having a high-integration level and fear of suffering if HIV test was positive. In order to improve testing among migrants, the accessibility of testing facilities and the knowledge of their whereabouts and operating hours must be improved to promote the desired behaviour among the majority of migrants which is often willing to do the test. [ABSTRACT FROM AUTHOR]

Low CD4 count at antiretroviral therapy initiation is common both in developed and developing countries. Active voluntary counseling and testing (VCT) center with integrated CD4 count service may facilitate early HIV testing and CD4 count measurement.We analyzed data from clients who had HIV testing at our VCT center between June 1, 2006 to May 31, 2009. HIV testing was provided through routine VCT, health check-up, nutrition, and sexual health services. CD4 count measurement was available in the clinic. The first CD4 count and duration between HIV diagnosis and the first CD4 count measurement were extracted from the database along with available demographic data.Among 19,525 Thai clients who had HIV testing, 2580 clients (13.2%) were tested HIV positive for the first time. CD4 count measurement was performed in 73.3% of HIV-positive clients and 91.4% of these occurred within the first month of HIV diagnosis. Median first CD4 count was 287.0 (IQR = 114.0-434.3) cells per cubic millimeter, 62% had CD4 count <350 cells per cubic millimeter.As HIV programs are moving toward earlier initiation of antiretroviral therapy, efforts are needed to promote “early HIV testing” among general population with different levels of HIV risks and to enhance “early CD4 count measurement” after HIV diagnosis. [ABSTRACT FROM AUTHOR]