Repeat voluntary HIV counseling and testing (VCT), sexual risk behavior and HIV incidence in Rakai, Uganda.
ABSTRACT We examined the effects of repeat Voluntary HIV counseling and testing (VCT) on sexual risk behaviors and HIV incidence in 6,377 initially HIV-negative subjects enrolled in a prospective STD control for HIV prevention trial in rural Rakai district, southwestern Uganda. Sixty-four percent accepted VCT, and of these, 62.2% were first time acceptors while 37.8% were repeat acceptors. Consistent condom use was 5.8% in repeat acceptors, 6.1% in first time acceptors and 5.1% in non-acceptors. A higher proportion of repeat acceptors (15.9%) reported inconsistent condom use compared to first-time acceptors (12%) and non-acceptors (11.7%). Also, a higher proportion of repeat acceptors (18.1%) reported 2+ sexual partners compared to first-time acceptors (14.1%) and non-acceptors (15%). HIV incidence rates were 1.4/100 py (person-years) in repeat acceptors, 1.6/100 py in first time acceptors and 1.6/100 py in non-acceptors. These data suggest a need for intensive risk-reduction counseling interventions targeting HIV-negative repeat VCT acceptors as a special risk group.
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ABSTRACT: Heineken begon in 2001 als één van de eerste multinationale bedrijven met het verstrekken van gratis hiv-behandelingen aan werknemers en hun familieleden in de Afrikaanse landen waar de brouwerij actief is. Er was weinig ervaring met dit soort programma’s op de werkvloer. Dit betekende dat verschillende problemen moesten worden opgelost met de steun van partnerorganisaties. Het is mogelijk om door vrijwillig testen seropositieve werknemers en hun familieleden te identificeren. Daarna kan een behandelingsprogramma worden aangeboden dat goede resultaten oplevert. Omdat dit gezondheidsverstrekking is door de eigen, particuliere gezondheidsdienst van het bedrijf, kunnen zich specifieke problemen voordoen zoals: hoe zorg je dat mensen toegang krijgen tot goedkope medicijnen? Stefaan van der Borght concludeert dat kwaliteitsbewaking van het medisch handelen op een innovatieve manier werd opgelost, namelijk door teleconferenties en een elektronisch patiëntendossier dat in real time zichtbaar is voor klinische mentors.
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ABSTRACT: Despite efforts to promote HIV counseling and testing (HCT) - among couples, few couples know their own or their partners' HIV status. We assessed trends in HCT uptake among married individuals in Rakai district, southwestern Uganda. We analysed data for 21,798 married individuals aged 15-49 years who were enrolled into the Rakai Community Cohort Study (RCCS) between 2003 and 2009. Married individuals were interviewed separately but were retrospectively linked to their partners at analysis. All participants had serologic samples obtained for HIV testing, and had the option of receiving HCT together (couples' HCT) or separately (individual HCT). Individuals were categorized as concordant HIV-positive if both partners had HIV; concordant HIV-negative if both did not have HIV; or HIV-discordant if only one of the partners had HIV. We used chi2 tests to assess linear trends in individual and couples' HCT uptake in the entire sample and conducted multinomial logistic regression on a sub-sample of 10,712 individuals to assess relative risk ratios (RRR) and 95% Confidence Intervals (95%CI) associated with individual and couples' HCT uptake. Analysis was done using STATA version 11.0. Uptake of couples' HCT was 27.2% in 2003/04, 25.1% in 2005/06, 28.5% in 2006/08 and 27.8% in 2008/09 (chi2 for trend = 2.38; P = 0.12). Uptake of individual HCT was 57.9% in 2003/04, 60.2% in 2005/06, 54.0% in 2006/08 and 54.4% in 2008/09 (chi2 for trend = 8.72; P = 0.003). The proportion of couples who had never tested increased from 14.9% in 2003/04 to 17.8% in 2008/09 (chi2 for trend = 18.16; P < 0.0001). Uptake of couples' HCT was significantly associated with prior HCT (Adjusted [Adj.] RRR = 6.80; 95%CI: 5.44, 8.51) and being 25-34 years of age (Adj. RRR = 1.81; 95% CI: 1.32, 2.50). Uptake of individual HCT was significantly associated with prior HCT (Adj. RRR = 6.26; 95%CI: 4.24, 9.24) and the female partner being HIV-positive (Adj. RRR = 2.46; 95%CI: 1.26, 4.80). Uptake of couples' HCT remained consistently low (below 30%) over the years, while uptake of individual HCT declined over time. These findings call for innovative strategies to increase demand for couples' HCT, particularly among younger couples and those with no prior HCT.BMC Public Health 07/2013; 13(1):618. DOI:10.1186/1471-2458-13-618 · 2.32 Impact Factor