Routine HIV testing in health care settings: the deterrent factors to maximal implementation in sub-Saharan Africa.
ABSTRACT The sub-Saharan region of Africa is the most severely affected HIV/AIDS region in the world. The population of this region accounts for 67% of all people living with HIV/AIDS and 72% of all AIDS-related deaths. As international collaboration makes access to HIV treatment more widely available in this region the need to increase the population's awareness of its serostatus becomes greater. The incorporation of provider-initiated HIV testing and counseling (routine HIV testing model) as part of a routine medical care would not only increase the population's serostatus awareness but also lead to a better understanding of HIV prevention and treatment and ultimately, increased utilization of available HIV/AIDS prevention programs on a much larger scale. This mini-review summarizes some important regional, sociocultural, economic, legal, and ethical issues that may be deterrent factors to maximal implementation and integration of provider initiated HIV testing and counseling as part of routine medical care in the sub-Saharan African region.
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ABSTRACT: This paper proposes a digital hysteresis-modulation technique based on switching-time prediction. Sampling controlled variables several times within a switching period, it ensures a dynamic performance comparable to that obtainable with analog hysteresis modulation. Compared to conventional digital hysteresis modulation, it avoids frequency jitter since it predicts switching transitions. Compared to hysteresis modulation based on the detection of the zero crossing of current errors, it avoids external analog circuits. Compared to pulsewidth-modulation (PWM) techniques, it ensures faster dynamic response. These advantages are obtained at the expense of increased signal-processing requirements and of control complexity. Switching-frequency stabilization and synchronization with an external clock can be obtained extending the techniques proposed for analog hysteresis modulations. The proposed predictive algorithm does not require knowledge of load parameters and only a rough estimation of the inductor value, which can be easily self-adjusted. The proposed solution is suited for high-performance current (or sliding-mode) control where the digital hardware has enough computational power to allow multiple samples within a switching period. The proposed modulation technique has been applied to a sliding-mode control of a single-phase uninterruptible power supply (UPS). Experimental results confirm the effectiveness of the proposed approach.IEEE Transactions on Industry Applications 06/2006; 42(3-42):763 - 769. DOI:10.1109/TIA.2006.873665 · 2.05 Impact Factor
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ABSTRACT: As efficacy trials of antiretroviral pre-exposure prophylaxis (PrEP) continue, a growing literature has begun anticipating the potential challenges of implementing PrEP for HIV prevention. These efforts coincide with a shift toward combination interventions for preventing HIV, which integrate biomedical, behavioral, and structural components. The optimal implementation of PrEP would exemplify this combination model, incorporating not only PrEP drugs, but also HIV testing, safety screening, behavioral interventions addressing adherence and risk behavior, and long-term monitoring. Efforts to plan for PrEP implementation therefore present an opportunity to advance the science of implementation and delivery in HIV prevention, in order to better address the challenges of scaling up combination approaches. We review the published and unpublished literature on PrEP implementation, organizing themes into five categories: scientific groundwork, regulatory and policy groundwork, stakeholder and infrastructure groundwork, delivery, and long-term monitoring. The lessons from PrEP planning can benefit the scale-up of future combination interventions.Current HIV/AIDS Reports 11/2010; 7(4):210-9. DOI:10.1007/s11904-010-0062-4
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ABSTRACT: Routine opt-out provider-initiated HIV testing and counseling (PITC) remains underutilized in sub-Saharan Africa. By selectively targeting clients who either volunteer or have clinical indications of HIV disease, standard approaches to HIV counseling and testing are presumed more cost-efficient than PITC. One thousand two hundred twenty-one patients aged 15– 49 years were seen by 22 practitioners in a mobile clinic in southern Zambia. A random sample of physicians was assigned to administer PITC, whereas the remaining practitioners offered standard non- PITC (ie, voluntary or diagnostic). Questionnaires assessed patient demographics and attitudes toward HIV. HIV detection rates were stratified by referral type, demographics, and HIV-related knowledge and attitudes. HIV prevalence was 10.6%. Infection rates detected using PITC [11.1%; 95% confidence interval (CI): 8.8% to 13.5%] and standard non-PITC (10.0%; 95% CI: 7.5% to 12.5%) did not significantly differ (odds ratio = 1.01; 95% CI: 0.67 to 1.52; P = 0.95). Patients who did not request testing or demonstrate clinical indicators of HIV did not have significantly higher HIV prevalence than those who did (odds ratio = 0.83; 95% CI: 0.55 to 1.24; P = 0.36). Implementation of PITC was highly acceptable and produced a 3-fold increase in patients tested per practitioner compared with standard non-PITC (114 vs. 34 patients per practitioner, respectively). PITC detected a comparable HIV infection rate as a standard non-PITC approach among rural adults seeking primary care services. Widespread implementation of PITC may therefore lead to significantly more cases of HIV detected.JAIDS Journal of Acquired Immune Deficiency Syndromes 01/2011; 56(1):e9-32. DOI:10.1097/QAI.0b013e3181fdb629 · 4.39 Impact Factor