Routine, rapid HIV testing.
ABSTRACT HIV testing identifies HIV-positive persons, allowing for reduced future HIV transmission while simultaneously providing policy makers with surveillance data to inform policy planning. If current costs of HIV testing were reduced, these funds could be redirected to increase testing rates or to expand treatment. The cost of testing is lowered and impact increased if noninvasive (oral and urine), rapid-testing modalities are utilized, pretest counseling uses cost-efficient counseling methods (e.g., video, pamphlets, small group discussions), and opt-out consent strategies are implemented while posttest counseling is more narrowly targeted to HIV-positive persons. Rather than relying on one international standard, customizing HIV testing procedures to local environments may be more efficient and effective. In the United States, laboratories with substantial HIV testing revenues are likely to be most resistant to altering current practices. However, AIDS researchers, policy makers, and advocates may dramatically influence the epidemic's course by encouraging flexibility and innovation in HIV-testing guidelines.
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ABSTRACT: Controlled studies show that HIV risk reduction counseling significantly increases condom use, reduces unprotected sex and prevents sexually transmitted infections. Nevertheless, without evidence of reducing HIV incidence, these interventions are generally discarded. One trial, the EXPLORE study, was designed to test whether ten sessions of risk reduction counseling could impact HIV incidence among men who have sex with men in six US cities. Based on epidemiologic models to define effective HIV vaccines, a 35 % reduction in HIV incidence was set a priori as the benchmark of success in this behavioral intervention trial. Results demonstrated a significant effect of the intervention, with more than a 35 % reduction in HIV incidence observed during the initial 12-18 months following counseling. Over an unprecedented 48-month follow-up, however, the effect of counseling on HIV incidence declined to 18 %. The current review examined how the scientific literature has thus far judged the outcomes of the EXPLORE study as well as the policy implications of these judgments. We identified 127 articles that cited the EXPLORE study since its publication. Among articles that discuss the HIV incidence outcomes, 20 % judged the intervention effective and 80 % judged the intervention ineffective. The overwhelmingly negative interpretation of the EXPLORE study outcomes is reflected in public policies and prevention planning. We conclude that using a vaccine standard to define success led to a broad discrediting of the benefits of behavioral counseling and, ultimately, adversely impacted policies critical to the field of HIV prevention.AIDS and Behavior 08/2013; 18(4). DOI:10.1007/s10461-013-0603-0 · 3.49 Impact Factor
Journal of HIV/AIDS & Social Services 04/2008; 7(1):1-6. DOI:10.1080/15381500802092912
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ABSTRACT: This paper describes the changes in Human Immundodeficiency virus (HIV) testing rates in Autonomous Province (AP) Vojvodina, Serbia since 2000 and compares provider-initiated with client-initiated HIV testing. Between 2000 and 2008, 66,327 HIV screening tests were reported from AP Vojvodina. During this time HIV testing rates increased from 1.2 per 1,000 inhabitants in 2000, to 7.7 per 1,000 inhabitants in 2008. The results showed an increase in testing as a consequence of increased mandatory testing of surgical patients as well as an upsurge in the use of Voluntary Counselling and Testing (VCT). Pregnant women that were tested represented less than 5% of the overall sample population. Public health efforts in AP Vojvodina to increase HIV testing rates lead to a continuous increase in testing rates, but with different limitations. HIV testing in low prevalence middle income countries could be highly affected by procurement difficulties, low motivation of medical professionals to initiate testing, and opportunities for testing limited to large towns and cities.The Journal of Infection in Developing Countries 11/2013; 7(11):844-50. DOI:10.3855/jidc.2743 · 1.27 Impact Factor