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Reporting of AIDS cases began right from the inception of national AIDS programmes in the Eastern Mediterranean Region. HIV surveillance was initiated with ad hoc serological surveys of selected groups of population. However, these surveys suffered from statistical bias. To minimize this bias, sentinel surveillance was introduced in two groups:patients with sexually transmitted diseases and antenatal clinic attendants. Apart from surveillance, many other population groups are being tested for HIV, mainly for case-finding. As HIV surveillance has an important role in AIDS prevention and control, adequate attention should be paid to its improvement, including the use of unlinked anonymous testing and the participation of the private sector

To reopen the economy safely during the COVID-19 pandemic, governments need the capability to proactively identify new and often asymptomatic infections, as well as contact tracing. Policymakers and public health professionals need a sampling-testing method that can achieve broad population coverage without overwhelming medical workers. We observe that COVID-19 high-risk groups are located in the hubs and cliques of our geo-social network, formed by the close encounters of people during daily life. These individuals are the de facto “canary in a coal mine”. We propose that nations offer free and anonymous testing service to them. With open-source computer algorithms and datasets, only a small fraction of the population selected for COVID-19 testing can cover the majority of high-exposure-risk individuals. A 0.3% sampled testing for a megacity covers 3/4 of its entire population. A 3% sampled testing for a rural town covers 3/4 of its entire population. With government oversight and public consent, this approach can serve each province/state or city/township for decentralized daily testing planning. However, to protect privacy, we recommend constructing the geo-social network of anonymized cellphones, not named individuals. This infrastructure should be dismantled once the pandemic is largely over. This can be achieved by policymakers, health workers, and engineers together in solidarity.

In 2015, WHO and UNAIDS released new guidance recommending that countries transition from conducting antenatal clinic (ANC) unlinked anonymous testing (ANC-UAT) for tracking HIV prevalence trends among pregnant women to using ANC routine testing (ANC-RT) data, which are more consistent and economic to collect. This transition could pose challenges for distinguishing whether changes in observed prevalence are due to a change in underlying population prevalence or due to a change in the testing approach. We compared the HIV prevalence measured from ANC-UAT and ANCRT in 15 countries that had both data sources in overlapping years. We used linear mixed-e effects model (LMM) to estimate the RT-to-UAT calibration parameter as well as other unobserved quantities. We summarized the results at different levels of aggregation (e.g., country, urban, rural, and province). Based on our analysis, the HIV prevalence measured by ANC-UAT and ANC-RT data are consistent in most countries. Therefore, if large discrepancy is observed between ANC-UAT and ANC-RT at the same location, we recommend that people should be cautious and investigate the reason. For countries that lack information to estimate the calibration parameter, we propose an informative prior distribution of mean 0 and standard deviation 0.2 for the RT-to-UAT calibration parameter.

Background Owing to the continuous increase in the number of new human immunodeficiency virus (HIV) infection in Korea, public health centers (PHCs) have performed anonymous tests since 1989. No study has examined the patterns of anonymous HIV testing performed at PHCs and the characteristics of HIV infection detected in those tests. We aimed to assess the influence of anonymous HIV testing on Korea’s national HIV surveillance. Methods HIV screening test data from 253 PHCs over a 16-year period were classified into 13 groups based on reason for testing. For anonymous HIV test takers (Anonymous), the HIV positivity per 10,000 tests was calculated, as repetitions could not be distinguished. Those with suspected HIV infection voluntarily underwent HIV testing and revealed their identity (Suspected). HIV prevalence was calculated as the number of HIV-positive persons per 10,000 test takers. Analyses were performed using chi-square and Cochran-Armitage trend test with SAS 9.4. Results Approximately 400,000 HIV screening tests were performed at PHCs annually, which remained unchanged in the past 10 years. The proportion of anonymous testing increased from Conclusions Anonymous and Suspected, which were driven by similar motives, impacted each other. Increase in HIV prevalence among the suspected led to a higher HIV prevalence among all test takers in PHCs and higher proportions of HIV infection nationwide, which could be attributed to the increase in the number of anonymous tests performed in PHCs. HIV positivity among the anonymous and HIV prevalence among the suspected are key indexes of the national HIV surveillance in Korea.

Objective Although studies have shown inconsistent results in terms of prevalence of eating disorders, the Eating Attitudes Test (EAT-26) was used to screen students for abnormal eating behaviors. The results of the self-reported EAT-26 and body frame, as well as the efficacy of using self-administered questionnaires (SAQs) were examined to detect eating disorders in new college students. Results An anonymous questionnaire (EAT-26) was provided to 7738 new students; 4552 (58.8%) responders were included in the final analysis. Semi-structured interviews were conducted for 131 (1.7%) students. Among them, 6 students showed a high EAT-26 score, but were not diagnosed with an eating disorder based on the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Three students were diagnosed with an eating disorder using SCID-I, but their EAT-26 scores were below the threshold. From these results, in a non-clinical population, findings on EAT-26 do not agree with those on SCID-I in terms of the diagnosis of eating disorders, and this battery is not appropriate for detecting eating disorders.

BackgroundWomen and girls are relatively under-represented across the HIV treatment cascade. Two conditions unique to women, pregnancy and cervical cancer/dysplasia, share a common acquisition mode with HIV. This scoping review aimed to explore HIV testing practices in voluntary termination of pregnancy (TOP) and colposcopy services.MethodsThe scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We searched articles published up to 20 December 2020 using three electronic databases (PubMed/Medline, Embase, Google Scholar) and including the keywords “HIV Testing”, “Abortion, Induced”, “Colposcopy”, “HIV screen*” and “termination of pregnancy”.ResultsA total of 1496 articles were identified, of which 55 met the inclusion criteria. We included studies providing background HIV prevalence in addition to prevalence in the study population and studies of women seeking TOP rather than presenting with TOP complications. This limited our review to high-income, low HIV prevalence settings. We observed two study phases: studies pre-antiretroviral therapy (ART) using unlinked anonymous testing data and examining HIV risk factors associated with positive HIV tests and studies post-ART using routine testing data and exploring HIV testing uptake. HIV prevalence was estimated at >0.2% in most TOP settings and >1% (range 1.7%–11.4%) in colposcopy services. Many TOP providers did not have local HIV testing policies and HIV testing was not mentioned in many specialist guidelines. Testing uptake was 49%–96% in TOP and 23%–75% in colposcopy services.ConclusionGiven the estimated HIV prevalence of >0.1% among women attending TOP and colposcopy services, HIV testing would be economically feasible to perform in high-income settings. Explicit testing policies are frequently lacking in these two settings, both at the local level and in specialist guidelines. Offering HIV testing regardless of risk factors could normalise testing, reduce late HIV presentation and create an opportunity for preventive counselling.

BackgroundPre-travel testing programs are being implemented around the world to curb COVID-19 and its variants from incoming travelers. A common approach is a single pre-travel test, 72 hours before departure, such as in Hawaii; however this raises concerns for those who are incubating or those infected after pre-travel testing or during transit. We need a rapid method to assess the effectiveness of pre-travel testing programs, and we use Hawaii as our case study.MethodsWe invited travelers departing from Kahului main airport at the end of their visit to Maui (major tourist destination among the Hawaiian islands) and performed COVID-19 PCR testing. Eligible participants needed a negative pre-travel test and a Hawaiian stay ≤ 14 days. We designed for anonymous testing at the end of travel so that travel plans would be unaffected, and we aimed for ≥ 70% study participation.ResultsAmong consecutive eligible travelers, 282 consented and 111 declined to participate, leading to a 72% (67-76%, 95% confidence interval) participation rate. Among 281 tested participants, two were positive with COVID-19, with an estimated positivity rate of 7 cases per 1,000 travelers. The top states of residence are California (58%) and Washington (21%). The mean length of stay was 7.7 ± 0.2 days. Regarding pre-travel testing, 87% had non-nasopharyngeal tests and 66% had self-administered tests.ConclusionsThis positivity rate leads to an estimated 17-30 infected travelers arriving daily to Maui in November-December 2020, and an estimated 52-70 infected travelers arriving daily to Hawaii during the same period. These counts surpass the Maui District Health Office’s projected ability to accommodate 10 infected visitors daily in Maui; therefore, an additional mitigation layer for travelers is recommended. This rapid field study can be replicated widely in airports to assess effectiveness of pre-travel programs and can be expanded to evaluate COVID-19 importation and its variants.

The HIV epidemic has not yet ended, and there are ever more challenges: the recent Italian National Plan of Interventions against HIV and AIDS (Piano Nazionale di Interventi Contro HIV e AIDS (PNAIDS) 2017-2019) was hailed for its comprehensiveness. Its likelihood of success across the HIV care continuum was therefore assessed. Awareness interventions are sporadic and continue to miss high risk populations; if effectively implemented, the prescriptive detail in PNAIDS may help address this. Combined prevention needs greater focus and investment. However, there has been recent progress: free anonymous testing is available at multiple settings although improvements to provide access to key vulnerable populations are needed. Clinical management is available to a high standard across the country, with some areas for improvement in ensuring equality of access. Long-term management of people living with HIV is often effective, but discrepancies exist across regions and settings of care. It is recommended to enable implementation of PNAIDS as a matter of urgency, develop integrated awareness and testing interventions for STIs and HIV, make condoms free for high-risk populations, and develop a network of multidisciplinary services for long-term holistic care of people living with HIV.

Biochemical testing in urine is a powerful new tool in the investigation of non-adherence to cardiovascular medications Drug testing using liquid chromatography tandem mass spectrometry (LC-MS-MS) is the mainstay of the laboratory test but may be subject to pre-analytical factors that could impact on test results. The stability of cardiovascular medications in urine is one such factor that has not been fully explored in non-adherence testing and has the potential to result in patients appearing falsely non-adherent to their therapy. The stability of 29 cardiovascular medications in patients' urine samples were assessed at room temperature (RT) and at -80°C using a LC-MS-MS screening method. All drugs and drug metabolites were found to be stable under the storage conditions studied. The findings imply that the medication stability in urine samples does not have any impact on non-adherence results and thus allowing samples to be taken and transported without the need for specialist sample handling procedures. The stability of cardiovascular drugs in urine samples will allow adherence testing to be utilized more widely into routine clinics and research.

Routine infectious diseases screening of Sudanese pregnant women has been patchy due to scarcity of healthcare resources and social stigma. We sought to determine the seroprevalence of HIV, hepatitis B, and syphilis among pregnant women attending antenatal care (ANC) at El Obeid Maternity Hospital in western Sudan. We also explored the association between these infections and a set of socio-demographic and maternal variables. Unlinked anonymous testing for HIV-1/2 antibodies, hepatitis B surface antigen, and Treponema pallidum antibodies was performed on residual blood samples collected during routine ANC (August 2016–March 2017). Seroprevalence of HIV was 1.13% (5/444; 95% CI 0.37–2.61%), hepatitis B 2.93% (13/444; 95% CI 1.57–4.95%), and syphilis 7.43% (33/444; 95% CI 5.17–10.28%). On bivariate analysis, there were no statistically significant associations between hepatitis B, syphilis, or a composite outcome including any of the three infections and age, stage of pregnancy, gravidity, parity, previous mode of delivery, history of blood transfusion, or husband polygamy. Urgent action is needed to scale up routine maternal screening for HIV, hepatitis B, and syphilis on an opt-out basis. Further research into the socio-demographic and behavioural determinants of these infections as well as their clinical outcomes is needed.

Classroom questioning is a common teaching and learning strategy in postgraduate nurse education. Technologies such as audience response systems (ARS) may offer advantage over traditional approaches to classroom questioning. However, despite being available since the 1960s, ARSs are still considered novel in many postgraduate nurse education classroom settings. This article aims to explicate the attitudes of postgraduate nursing students in an Irish academic teaching hospital towards classroom questioning (CQ) and the use of ARSs as an alternative to traditional CQ techniques. The results of this small-scale study demonstrate that ARSs have a role to play in CQ in the postgraduate setting, being regarded by students as beneficial to learning, psychological safety and classroom interaction.

Objectives In Estonia, a network of anonymous and free of charge HIV testing sites has been operating since 1988. Services are provided by health care organizations and financed by the National Institute for Health Development from the state budget. The objective of this analysis was to assess anonymous HIV testing in Estonia from 2005 to 2015. Methods We used data collected from the National Institute for Health Development's annual reports, Health Board and Estonian Health Insurance Fund. Results In Estonia, more than 200 000 HIV-tests are performed annually, and of these approximately 5-6% are within anonymous HIV testing sites. The percentage tested with rapid tests in anonymous testing sites has increased from 15% in 2010 to 53% in 2015. Furthermore, up to 65% of all newly diagnosed HIV-cases have been detected in these sites. The proportion of HIV-positive tests has decreased from 3.8% to 0.5% in anonymous testing sites and from 0.3% to 0.1% in general health care. Simultaneously, the cost of detecting one new HIV case has increased almost six times. Conclusions This analysis reveals that anonymous HIV testing services are well accepted by the general population as well as vulnerable populations. The positivity rate among those tested in anonymous testing sites remains higher than among all people tested, showing that the sites reach more of those who are at higher risk of HIV. In the light of decreasing positivity rate, more attention should be paid to people with higher HIV risk and increasing access to testing in community based settings.

Quality of sleep is one of the prerequisites of health and life and work performance. During the anonymous testing by applying Pittsburgh scale, it was analyzed quality of sleep of the students of the University of Novi Sad. A total of 576 people. Results show that the quality of sleep is the best with the students of the Faculty of Sport. Students of the Faculty of Medicine have the shortest sleep, but quality of sleep is rated good. The duration of sleep is the longest with the students of the Faculty of Philosophy, and the quality is lower than in the other study groups.

Identifying undiagnosed HIV infection is necessary for the elimination of HIV transmission in the United States. The present study evaluated the efficacy of 3 community-based approaches for uncovering undiagnosed HIV among heterosexuals at high-risk (HHR), who are mainly African American/Black and Hispanic. Heterosexuals comprise 24% of newly reported HIV infections in the United States, but experience complex multilevel barriers to HIV testing. We recruited African American/Black and Hispanic HHR in a discrete urban area with both elevated HIV prevalence and poverty rates. Approaches tested were (1) respondent-driven sampling (RDS) and confidential HIV testing in 2 sessions (n = 3116); (2) RDS and anonymous HIV testing in one session (n = 498); and (3) venue-based sampling (VBS) and HIV testing in a single session (n = 403). The main outcome was newly diagnosed HIV infection. RDS with anonymous testing and one session reached HHR with less HIV testing experience and more risk factors than the other approaches. Furthermore, RDS with anonymous (4.0%) and confidential (1.0%) testing yielded significantly higher rates of newly diagnosed HIV than VBS (0.3%). Thus peer-referral approaches were more efficacious than VBS for uncovering HHR with undiagnosed HIV, particularly a single-session/anonymous strategy, and have a vital role to play in efforts to eliminate HIV transmission.

Background In British Columbia (BC), three testing options are available: nominal, non-nominal and anonymous. Little is known, however, about the factors that influence the acceptability of the different testing strategies, particularly among young men, a group with disproportionately low HIV testing rates. Methods We draw on data from in-depth, semi-structured interviews with 45 young men (18–30) in Vancouver, BC, in order to identify the factors that influence the acceptability of different HIV testing options. Results Most participants described not being aware that there were options other than nominal testing available in Vancouver. Upon learning about non-nominal and anonymous testing options, participants described seeing the value of non-nominal testing, insofar as it safeguards their privacy while at the same time providing a pathway to HIV-related health care for those who test positive. Many were concerned, however, that anonymous testing would present challenges to treatment and care for those who test positive. Others expressed concerns about the implications for public health not having access to accurate and up-to-date information about the ‘state’ of the HIV epidemic. Nevertheless, while participants did not tend to describe anonymous testing as something they would opt for in the future, almost all of the participants felt offering anonymous testing as an option is an important strategy to reduce barriers for key groups of young men (e.g., those living in rural communities). Conclusion Based on our results, offering non-nominal and anonymous HIV testing represents an important step in increasing the accessibility of HIV testing for some groups of young men who found these approaches both acceptable and preferable (e.g., over nominal testing). However, within our sample, participants were not aware that anonymous and non-nominal testing were available. Developing clear and easy-to-understand communication strategies about the different approaches to testing may enhance opportunities for uptake of these approaches. Disclosure No significant relationships.

Summary: In this paper we build on work investigating the feasibility of human immunodeficiency virus (HIV) testing in emergency departments (EDs), estimating the prevalence of hepatitis B, C and HIV infections among persons attending two inner-London EDs, identifying factors associated with testing positive in an ED. We also undertook molecular characterisation to look at the diversity of the viruses circulating in these individuals, and the presence of clinically significant mutations which impact on treatment and control.Blood-borne virus (BBV) testing in non-traditional settings is feasible, with emergency departments (ED) potentially effective at reaching vulnerable and underserved populations. We investigated the feasibility of BBV testing within two inner-London EDs. Residual samples from biochemistry for adults (⩾18 years) attending The Royal Free London Hospital (RFLH) or the University College London Hospital (UCLH) ED between January and June 2015 were tested for human immunodeficiency virus (HIV)Ag/Ab, anti-hepatitis C (HCV) and HBsAg. PCR and sequence analysis were conducted on reactive samples. Sero-prevalence among persons attending RFH and UCLH with residual samples (1287 and 1546), respectively, were 1.1% and 1.0% for HBsAg, 1.6% and 2.3% for anti-HCV, 0.9% and 1.6% for HCV RNA, and 1.3% and 2.2% for HIV. For RFH, HBsAg positivity was more likely among persons of blackvs.white ethnicity (odds ratio 9.08; 95% confidence interval 2.72–30), with anti-HCV positivity less likely among females (0.15, 95% CI 0.04–0.50). For UCLH, HBsAg positivity was more likely among non-white ethnicity (13.34, 95% CI 2.20–80.86 (Asian); 8.03, 95% CI 1.12–57.61 (black); and 8.11, 95% CI 1.13–58.18 (other/mixed)). Anti-HCV positivity was more likely among 36–55 year oldsvs.⩾56 years (7.69, 95% CI 2.24–26.41), and less likely among females (0.24, 95% CI 0.09–0.65). Persons positive for HIV-markers were more likely to be of blackvs.white ethnicity (4.51, 95% CI 1.63–12.45), and less likely to have one ED attendance (0.39, 95% CI 0.17–0.88), or female (0.12, 95% CI 0.04–0.42). These results indicate that BBV-testing in EDs is feasible, providing a basis for further studies to explore provider and patient acceptability, referral into care and cost-effectiveness.

Summary Objectives The re-emergence of the HIV epidemic among men who have sex with men (MSM) represents a serious health issue. This study aimed to assess the HIV prevalence among MSM in a very low prevalence population of a large city. Methods A public campaign to raise awareness of HIV infection and to provide access to anonymous testing was conducted in places frequented by MSM and through a mobile phone application. No identity information was requested from individuals contacting the call centre, and anonymous and free HIV testing was offered proactively. Those who agreed to have a test were provided a code number, which was used in blood sampling procedures. Results Of 1200 subjects who contacted the call centre, 197 consented to undergo HIV testing and visited the laboratory to give a blood sample. Twenty-five subjects were found to have a reactive ELISA result on two different occasions plus a positive Western blot test result. Thus, the HIV prevalence in this group of MSM was 12.7%. Conclusions MSM remain a high risk group for HIV infection in a low prevalence setting, and thus represent a key target population for diagnostic and therapeutic interventions.

Hintergrund Die Mitteilung schlechter medizinischer Nachrichten stellt fur Patienten und Arzte gleichermasen eine belastende Situation dar, die zu Hurden in der Arzt-Patienten-Kommunikation fuhren kann. Der Fragebogen „measure of patients’ preferences“ (MPP-D, validierte deutsche Fassung) wurde zur Untersuchung der Kommunikationspraferenzen von Patienten bei der Mitteilung schlechter medizinischer Nachrichten entwickelt.

Gay, bisexual, and other men who have sex with men (MSM) have adapted their sexual practices over the course of the HIV/AIDS epidemic based on available data and knowledge about HIV. This study sought to identify and compare patterns in condom use among gay, bisexual, and other MSM who were tested for HIV at a community-based testing site in Montreal, Canada. Results showed that while study participants use condoms to a certain extent with HIV-positive partners and partners of unknown HIV status, they also make use of various other strategies such as adjusting to a partner's presumed or known HIV status and viral load, avoiding certain types of partners, taking PEP, and getting tested for HIV. These findings suggest that MSM who use condoms less systematically are not necessarily taking fewer precautions but may instead be combining or replacing condom use with other approaches to risk reduction.

In China, some health departments and gay community-based organizations have begun to offer home-based HIV testing kits in order to augment test uptake among men who have sex with men (MSM). However, HIV test preferences and motivations for home-testing among MSM in China are not well understood. The HIV testing preferences of 803 MSM throughout China were evaluated using single-item assessment and a discrete choice experiment (DCE). In both the single-item assessment and DCE, participants expressed strong preference for free and anonymous testing by health professionals. Both approaches also indicated that naïve testers most prefer home testing. However, among previous testers, the single-item assessment indicated that "home" was the most preferred testing location (vs. hospital or clinic), while the DCE indicated that "home" was the least preferred testing location after controlling for anonymity. HIV home-testing may have limited appeal to previously tested Chinese MSM if anonymity is not maintained.

INTRODUCTION:The objectives of this study was to investigate and compare levels of acceptability of pre-marital HIV testing; and intention to sero-sort future marital and its associated factors among unmarried adults in two cities in Cameroon. METHODS:A population-based survey was conducted simultaneously in the cities of Kumba and Buea, located in the Southwest region of Cameroon. Data were collected from September to October 2016 by trained interviewers who administered questionnaires to eligible and consenting unmarried adults aged 21-35 years. Data were weighted and logistic regression analyses performed to identify significant predictors. The level of statistical significance was set at p< = 0.05. RESULTS:A total of 1,406 respondents (767 in Kumba and 639 in Buea) participated in the study. In the pooled sample, the median age of respondents was 26 years (IQR = 23-29) and over half (54.8%) were males. Over 90% of respondents in both cities indicated their willingness to accept pre-marital HIV testing. Respondents who had previously tested for HIV in Kumba (AOR = 7.87; 95%CI, 4.02-15.44) were significantly more likely to accept premarital HIV testing than those who had never tested for HIV. In Kumba, older age (AOR = 0.42; 95%CI, 0.18-0.96) and those unemployed (AOR = 0.22; 95% CI, 0.06-0.76) were significantly less likely to accept pre-marital HIV testing. In Buea males (AOR = 0.64 95% CI, 0.45-0.89) who would test HIV negative would be significantly less likely to accept to marry an HIV positive partner. In Buea, respondents who indicated a moderate risk of contracting HIV (AOR = 1.71; 95%CI, 1.09-2.66, p = 0.018) were significantly more likely to accept to marry an HIV positive partner. The major limitation of the study was that a hypothetical situation was used to ask respondents about their willingness to accept pre-marital HIV testing rather than actual HIV test acceptance. CONCLUSIONS:Most respondents expressed their willingness to undergo pre-marital HIV testing. However, majority of respondents who would test HIV negative would refuse to marry their partner who tests HIV positive. These findings suggest that interventions to reduce HIV infection and fight against stigma and discrimination should be reinforced at community level.

Purpose The American Academy of Pediatrics recommends substance use screening in adolescent primary care. Many studies of substance use prevalence and screening tool validation are conducted under research protocols that differ from routine clinical screening in context, consequences, and privacy implications. Methods This study is a secondary analysis drawing from two projects focused on adolescent primary care patients, aged 12–17, conducted nearly contemporaneously in a Federally Qualified Health Center system. The first project conducted anonymous research interviews with patients (N = 525), while the other tracked routine clinical screening as part of a larger service implementation project (N = 5,971). Both projects assessed substance use with the CRAFFT screening tool. Results Rates of substance use disclosure and substance use problems were over three and four times higher, respectively, in the anonymous research interview sample compared to rates found in routine clinical screening (p values Conclusions Routine clinical screening may underestimate substance use among adolescents.

A large proportion of people who are HIV positive do not know their serostatus because facility-based provider-initiated HIV testing and counseling, and voluntary counseling and testing, have not been efficiently implemented in China. Therefore, a new HIV testing strategy must be developed to improve testing services so that more HIV infections can be detected earlier. In this study, we established an anonymous internet-aided urine-based HIV testing service for men who have sex with men (MSM) from 1 April 2016 to 20 January 2017. In total, 3092 urine sample collection packs were distributed by grassroots organizations to MSM; 1977 (69.3%) packs were mailed back to the laboratory; and 1911 (96.7%) eligible samples were tested for HIV antibody. The rate of HIV antibody positivity was 7.1% (135/1901), excluding 10 previously-identified HIV infections. Of those tested, 65.4% (1243/1901) participants obtained their results from our website, 94 (69.6%) of 135 newly-identified urine HIV antibody-positive participants were contacted by CDC staff, and 61.7% (58/94) reported undergoing blood HIV antibody confirmation testing after learning of their urine HIV antibody test results. Of those who were tested for venous HIV antibody, 84.5% (49/58) reported being confirmed HIV antibody positive. Thirty-six of the newly diagnosed participants were successfully referred to a hospital to receive antiretroviral therapy. The rate of confirmed HIV antibody positivity was estimated to be 72.8-89.2 times of that of routine HIV antibody testing. In conclusion, this approach offers an alternative efficient HIV testing strategy to identify HIV positive persons in vulnerable populations.

To assess the roles of pre- and posttest counselling as an approach to HIV prevention, the experience of Anonymous Counselling Office of Vladivostok in 2014-2015 was reviewed. Materials and methods: Examined were 796 questionnaires obtained from persons who wished to pass anonymous testing for HIV. Of them, 63 persons were found to be HIV-positive. Most of the HIV cases were working-class men aged 31-40 years and showing risky behavioral patterns, including injection drug use and unprotected heterosexual contacts. Results: The data suggest that at the stage of pretest counselling it is necessary to develop trustful and easy relationships with patients in order to foster their commitment to health care and motivation for changing behavioral patterns and to enhance preventive interventions in the general population.

To compare non-commercial DICOM toolkits for their de-identification ability in removing a patient's personal health information (PHI) from a DICOM header.Ten DICOM toolkits were selected for de-identification tests. Tests were performed by using the system's default de-identification profile and, subsequently, the tools' best adjusted settings. We aimed to eliminate fifty elements considered to contain identifying patient information. The tools were also examined for their respective methods of customization.Only one tool was able to de-identify all required elements with the default setting. Not all of the toolkits provide a customizable de-identification profile. Six tools allowed changes by selecting the provided profiles, giving input through a graphical user interface (GUI) or configuration text file, or providing the appropriate command-line arguments. Using adjusted settings, four of those six toolkits were able to perform full de-identification.Only five tools could properly de-identify the defined DICOM elements, and in four cases, only after careful customization. Therefore, free DICOM toolkits should be used with extreme care to prevent the risk of disclosing PHI, especially when using the default configuration. In case optimal security is required, one of the five toolkits is proposed.aEuro cent Free DICOM toolkits should be carefully used to prevent patient identity disclosure.aEuro cent Each DICOM tool produces its own specific outcomes from the de-identification process.aEuro cent In case optimal security is required, using one DICOM toolkit is proposed.

The Department of Defense Serum Repository (DoDSR) contains a growing archive of sera from service members collected to perform medical surveillance, clinical diagnosis, and epidemiologic studies to identify, prevent, and control diseases associated with military service. The specimens are a mandatory collection under DoD and U.S. regulations and do not include informed consent for uses beyond force health protection. Any use of the specimens for research requires deidentification of the samples and must be approved by Institutional Review Boards. However, as expansion of the DoDSR is contemplated, ethical considerations of sample collection, storage, and use must be carefully reconsidered. Other similar programs for research use of specimens collected for public health purpose are also undergoing similar reviews. It is recommended that at a minimum, service members are informed of the potential storage and use of their specimens and are allowed to opt out of additional use, or a broad informed consent is provided. The DoDSR provides a tremendous resource to the DoD and global health community, and to ensure its continued existence and improvement, the DoD must stay consistent with all principles of research ethics.

Background: Analysis of anonymous pooled urine samples from street urinals has been used to demonstrate time-trends in the detection of classical recreational drugs and novel psychoactive substances (NPS). Aim: This study aimed to expand this to undertake a geographical trend analysis of classical recreational drugs/NPS across UK. Methods: Samples of anonymous pooled urine were collected from street urinals that had been in place for one night in April 2014 in nine cities across the UK. Collected samples were then analysed for the presence of recreational drugs, NPS anabolic steroids using high-performance liquid chromatography coupled to high-resolution accurate mass full-scan mass spectrometry and gas chromatography coupled to electron impact ionization mass spectrometry operating in selected ion monitoring and full-scan modes. Results: Ten classical recreational drugs, nine NPS and four anabolic steroids were detected across the nine cities; the range of detection was from 1 in Leeds to 14 in London. The most common classical drugs were cocaine (9 cities) and 3,4-methylenedioxy-methamphetamine (8 cities); the most common NPS was 4-methylmethcathinone (5 cities). In addition there was variation in the detection of NPS, with methylhexaneamine detected only in Bristol and London, piperazines (3-trifluoromethylphenylpiperazine and 1-benzylpiperazine) and pentedrone only detected in Birmingham and the cathinone methylone only detected in London. Conclusions: There is variability in the detection of classical recreational drugs, NPS and anabolic steroids across UK, likely reflecting variation in their use. This technique can be used to supplement drug use surveys to determine geographical and time trends in the use of these substances. This is important to ensure appropriate targeting of drug-related interventions.

We evaluated Amsterdam HIV Testing Week (HTW) 2016 regarding its primary goals of raising awareness and prompting HIV testing. Participating services offered free, anonymous HIV testing, with a focus on reaching men who have sex with men (MSM) and people with a non-western migration background. Sociodemographic characteristics, HIV testing history, intention to test regularly, beliefs about personal risk and severity of HIV, and perceived social norms regarding HIV testing and people living with HIV were assessed among all who tested. A community quick scan assessed awareness of Amsterdam HTW 2016 and attitudes and intentions regarding HIV testing. Of 806 people tested, 59.6% (405/679) belonged to key populations. None tested HIV-positive and 37.6% intended to test regularly in the future. The community quick scan found moderate awareness of Amsterdam HTW 2016. Awareness was highest among recent testers and HIV-positive MSM and not associated with HIV testing attitudes and intentions. People tested during Amsterdam HTW 2016 were from key populations and/or were not (adequately) reached via traditional testing approaches. The contribution of the Amsterdam HTW approach to raising awareness and prompting HIV testing in key populations may benefit from focusing on HIV-negative individuals who have not been tested recently.

A recurring problem with the study of sexual fantasy is that of social desirability bias. Study participants may report fantasies that are consistent with general societal expectations of fantasy content, as opposed to themes characterized by their actual fantasies. The wide availability of erotic material on the Internet, however, facilitates the study of sexual fantasy narratives as they are anonymously expressed and viewed online. By extracting approximately 250,000 text-based erotic fantasies from a user-generated website, we sought to examine "real-world" sexual fantasies, determine the themes that were typical of these narratives, and explore the relationship between themes and story popularity (as assessed by story views per day). A principal components analysis identified 20 themes that commonly occurred across the massive corpus, and a path analysis revealed that these themes played a significant role in predicting the popularity of the sexual fantasy narratives. In particular, the empirically identified themes reflecting familial words (e.g., mother, father) and colloquial sexual words (e.g., cock, fuck) were predictive of story popularity. Other themes identified included those not obviously erotic, such as those consisting of words reflecting domesticity (e.g., towel, shower) and colors (e.g., brown, blue). By analyzing a sexual fantasy corpus of unprecedented size, this study offers unique insight into both the content of sexual fantasies and the popularity of that content.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2017-05-02T20:16:35Z No. of bitstreams: 1 artigo 26. 2016.pdf: 151225 bytes, checksum: d9a98b86d845ce6c087b08e1d2023164 (MD5) Made available in DSpace on 2017-05-02T20:16:35Z (GMT). No. of bitstreams: 1 artigo 26. 2016.pdf: 151225 bytes, checksum: d9a98b86d845ce6c087b08e1d2023164 (MD5) This study aimed to identify incentives and barriers to HIV testing in men who have sex with men (MSM). This was a cross-sectional study of MSM who had lived at least three months in greater metropolitan Fortaleza, Ceará State, Brazil, 2010. The study recruited 391 men ≥ 18 years of age who reported sexual relations with men in the previous six months, using Respondent Driven Sampling. Personal network and socio-demographic data were collected and HIV testing was offered, analyzed with RDSAT 6.0 and Stata 11.0. The majority were young (40.3%), had 5 to 11 years of schooling (57.3%), were single (85.1%), had low income (37.6%), and 58.1% had tested for HIV some time in life. Incentive to test: certainty of not being infected (34.1%) and the exposure to national campaign Fique Sabendo [Know your Status] (34%). Barriers: trust in partner(s) (21%) and fear of discrimination if tested positive (20.3%). Policies should be developed to ensure test confidentiality and communication campaigns focusing on information gaps and encouragement for testing. Rio de Janeiro

Anonymous group research carried out at companies is important and principal because it points out deficiencies in the company culture, possibilities for further company development, and it secures more trust from employees. We have focused on the priorities within the value hierarchy of the employees at a company which produces structures from reinforced concrete. The cohort of employees underwent two rounds of anonymous testing. The Test of Colour Semantic Differential (TCSD) was used for the purposes of the study. The results are not to be applied generally as every company has its individual needs.

Objective: HIV prevalence data collected from routine HIV testing of pregnant women at antenatal clinics (ANC-RT) are potentially available from all facilities that offer testing services to pregnant women and can be used to improve estimates of national and subnational HIV prevalence trends. We develop methods to incorporate these new data source into the Joint United Nations Programme on AIDS Estimation and Projection Package in Spectrum 2017. Methods: We develop a new statistical model for incorporating ANC-RT HIV prevalence data, aggregated either to the health facility level (site-level) or regionally (census-level), to estimate HIV prevalence alongside existing sources of HIV prevalence data from ANC unlinked anonymous testing (ANC-UAT) and household-based national population surveys. Synthetic data are generated to understand how the availability of ANC-RT data affects the accuracy of various parameter estimates. Results: We estimate HIV prevalence and additional parameters using both ANC-RT and other existing data. Fitting HIV prevalence using synthetic data generally gives precise estimates of the underlying trend and other parameters. More years of ANC-RT data should improve prevalence estimates. More ANC-RT sites and continuation with existing ANC-UAT sites may improve the estimate of calibration between ANC-UAT and ANC-RT sites. Conclusion: We have proposed methods to incorporate ANC-RT data into Spectrum to obtain more precise estimates of prevalence and other measures of the epidemic. Many assumptions about the accuracy, consistency, and representativeness of ANC-RT prevalence underlie the use of these data for monitoring HIV epidemic trends and should be tested as more data become available from national ANC-RT programs.

Objectives Chlamydia prevalence in the general population is a potential outcome measure for the evaluation of chlamydia control programmes. We carried out a pilot study to determine the feasibility of using a postal survey for population-based chlamydia prevalence monitoring. Methods Postal invitations were sent to a random sample of 2000 17-year-old to 18-year-old women registered with a general practitioner in two pilot areas in England. Recipients were randomised to receive either a self-sampling kit (n=1000), a self-sampling kit and offer of £5 voucher on return of sample (n=500) or a self-sampling kit on request (n=500). Participants returned a questionnaire and self-taken vulvovaginal swab sample for unlinked anonymous Chlamydia trachomatis testing. Non-responders were sent a reminder letter 3 weeks after initial invitation. We calculated the participation rate (number of samples returned/number of invitations sent) and cost per sample returned (including cost of consumables and postage) in each group. Results A total of 155/2000 (7.8%) samples were returned with consent for testing. Participation rates varied by invitation group: 7.8% in the group who were provided with a self-sampling kit, 14% in the group who were also offered a voucher and 1.0% in the group who were not sent a kit. The cost per sample received was lowest (£36) in the group who were offered both a kit and a voucher. Conclusions The piloted survey methodology achieved low participation rates. This approach is not suitable for population-based monitoring of chlamydia prevalence among young women in England. Study registration number (UKCRN ID 10913).

Background In low-income countries (LICs), HIV sentinel surveillance surveys (HIV-SSS) are recommended in between two demographic and health surveys, due to low-cost than the latter. Using the classical unlinked anonymous testing (UAT), HIV-SSS among pregnant women raised certain ethical and financial challenges. We therefore aimed at evaluating how to use prevention of mother-to-child transmission of HIV (PMTCT) routine data as an alternative approach for HIV-SSS in LICs. Methods A survey conducted through 2012 among first antenatal-care attendees (ANC1) in the ten regions of Cameroon. HIV testing was performed at PMTCT clinics as-per the national serial algorithm (rapid test), and PMTCT site laboratory (PMTCT-SL) performances were evaluated by comparison with results of the national reference laboratory (NRL), determined as the reference standard. Results Acceptance rate for HIV testing was 99%, for a total of 6521 ANC1 (49 · 3% aged 15–24) enrolled nationwide. Among 6103 eligible ANC1, sensitivity (using NRL testing as the reference standard) was 81 · 2%, ranging from 58 · 8% (South region) to 100% (West region); thus implying that 18 · 8% HIV-infected ANC1 declared HIV-negative at the PMTCT-SL were positive from NRL-results. Specificity was 99 · 3%, without significant disparity across sites. At population-level, this implies that every year in Cameroon, ~2,500 HIV-infected women are wrongly declared seronegative, while ~1,000 are wrongly declared seropositive. Only 44 · 4% (16/36) of evaluated laboratories reached the quality target of 80%. Conclusions The study identified weaknesses in routine PMTCT HIV testing. As Cameroon transitions to using routine PMTCT data for HIV-SSS among pregnant women, there is need in optimizing quality system to ensure robust routine HIV testing for programmatic and surveillance purposes. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2119-5) contains supplementary material, which is available to authorized users.

In 1983, Huntington disease (HD) became the first disease to be mapped to a previously unknown location on chromosome 4. This discovery meant that we could now identify whether some individuals at risk for HD would develop HD in the future using a method called linkage testing. Testing was first offered through research protocols designed to assess whether testing could be done safely in this population. Testing guidelines were soon developed by the Huntington's Disease Society of America and the International Huntington Association in collaboration with the World Federation of Neurology. The gene for HD was found in 1993, allowing for direct gene testing for the mutant HTT allele. This chapter will discuss the development of guidelines and recent revisions to the guidelines, prenatal testing, and testing in three complicated situations: (1) the testing of minors; (2) anonymous testing; and (3) testing individuals at 25% risk. Studies examining the outcomes of predictive testing will also be discussed. Outcome studies have shown that testing can be done safely in the context of testing protocols that include neurologic examinations, pretest counseling, psychiatric/psychologic assessment, results in person, and available follow-up support. It appears that anxiety and depression prior to testing are better predictors of psychologic status after testing than the test result itself.

Background Psoriasis is a disease of enormous socio-economic impact. Despite approval of numerous highly efficient and costly therapies, a minor proportion of severely affected patients actually receives sufficient treatment. Objective To investigate whether addictions are associated with psoriasis and to develop evidence-based recommendations for dermatologists in their daily clinical practice in order to improve medical assessment of psoriasis and patients’ quality of life. Patients and Methods Psoriasis patients at the University Department of Dermatology were asked to fill out a paper-based self-reported anonymous questionnaire with 92 questions of validated screening tests for the six most common addictions in Germany (alcohol, nicotine, drugs and illegal drugs, gambling, food). Body weight and height as well as current Psoriasis Area and Severity Index (PASI) were documented as well. Results Between October 2015 and February 2016, 102 patients (65 males, 37 females; mean age 49.7 years (SD 13.4), range 18–83 years) participated in the study. Fifty-seven of the 102 patients showed addictive behaviour. Of these, 23.8% were high-risk drinkers, 41% regular smokers, 11% at risk of drug abuse, 4.1% at risk of food dependency and 19% compulsive gamblers. Compared with the general population, these results are significantly higher for alcohol abuse (P < 0.005), nicotine (P < 0.001) and gambling (P < 0.001). Body mass index was significantly higher in the study population (P < 0.001). Conclusion Addictions and gambling are more prevalent in patients with psoriasis compared with the general population. Respective screening measures are recommended in daily practice for doctors treating psoriasis patients, and PeakPASI is suggested as a score to document patients’ lifetime highest PASI. Parallel to new drug approvals and even more detailed insights into the pathomechanism of psoriasis, public health strategies and interdisciplinary approaches are essential for a general sustained psoriasis treatment.

International audience; In France, several successive changes in anti-hepatitis B virus (HBV) vaccination policies occurred since 1982. We estimated the incidence and prevalence of HBV infection according to years of birth 1960 to 1994 in a large sentinel cohort to evaluate the epidemiology of HBV during vaccination policy changes. A retrospective cohort study included data from all HIV, HBV and hepatitis C virus (HCV) screening facilities in Grand Lyon. From 2005 to 2010, all 57113 individuals with complete HBV serologic status were enrolled. Survival analyses modeled separately various ages in each birth cohort. The proportion of immunized individuals increased in birth cohorts 1978 to 1984 (up to 58.3% (95% confidence interval (CI), 43.3-68.2 at age 15). In post-1985 birth cohorts, this proportion decreased to 19.5% (95% CI, 15.5-24) in birth cohort 1987 at age 15. Probability of past or current HBV infection increased constantly in birth cohorts 1960 to 1967, up to 12% (95% CI, 10.4-14) at age 30, then decreased gradually in birth cohorts 1968 to 1991, down to 0.9% (95% CI, 0.7-1.2) at age 17.5. In post-1991 cohorts, the probability of HBV infection increased again, up to 2.5% (95% CI, 1.7-3.6) at age 17.5. HBV incidence fluctuated between 5 and 8 per 1000 person-years in pre-1986 birth cohorts, decreased to 2.1 (95% CI, 1.5-2.7) in birth cohorts 1986 to 1991 but rebounded to 5 (95% CI, 3.5-7.1) in post-1991 birth cohorts. HBV incidence was remarkably high in young adults with noticeable variations concomitantly to vaccination policy changes. A dramatic decline in immunization rate was temporally associated with a sharp rebound of infection after withdrawal of systematic adolescent vaccination in 1998.

The communication of bad medical news represents a burdening situation for both patients and physicians which may lead to hurdles in their communication. The questionnaire Measure of Patients' Preferences (MPP-D, validated German translation) was developed to investigate patients' preferences regarding the communication of bad news.The preferences regarding the communication of bad news among patients with prostate cancer was assessed.Anonymous survey, where approximately 70 office-based urologists were asked to distribute the MPP-D questionnaire to about 20 of their patients with prostate cancer. In addition, information on social demographics was retrieved in order to investigate the influence on communication preferences.In total, 709 questionnaires were evaluated (50 % return). The majority of patients had clear preferences concerning privacy of the setting, completeness, and unambiguity of information provided and assessment of their subjective information needs. Larger individual differences were observed regarding preferences for emotional support offered by the physician and involvement of family which was also influenced by age and education of the patients.This is the first large, multicenter survey of prostate cancer patients in Germany regarding their preferences for communication of bad news. The results confirm previous reports on the importance of cultural affiliation, age, and education as influencing factors.

This study aimed to identify incentives and barriers to HIV testing in men who have sex with men (MSM). This was a cross-sectional study of MSM who had lived at least three months in greater metropolitan Fortaleza, Ceará State, Brazil, 2010. The study recruited 391 men ≥ 18 years of age who reported sexual relations with men in the previous six months, using Respondent Driven Sampling. Personal network and socio-demographic data were collected and HIV testing was offered, analyzed with RDSAT 6.0 and Stata 11.0. The majority were young (40.3%), had 5 to 11 years of schooling (57.3%), were single (85.1%), had low income (37.6%), and 58.1% had tested for HIV some time in life. Incentive to test: certainty of not being infected (34.1%) and the exposure to national campaign Fique Sabendo [Know your Status] (34%). Barriers: trust in partner(s) (21%) and fear of discrimination if tested positive (20.3%). Policies should be developed to ensure test confidentiality and communication campaigns focusing on information gaps and encouragement for testing. Resumo: Identificar os incentivos e as barreiras aos testes de HIV entre homens que fazem sexo com homens (HSH). Estudo transversal entre HSH que residiram pelo menos três meses na região metropolitana de Fortaleza, Ceará, Brasil, em 2010. Foram recrutados 391 homens, ≥ 18 anos, que relataram sexo com homens nos últimos seis meses, utilizando Respondent Driven Sampling. Coletados os dados: rede social, sociodemográficos e oferecido o teste de HIV e analisados pelo RDSAT 6.0 e Stata 11.0. A maioria era jovem (40,3%), de 5 a 11 anos de escolaridade (57,3%), solteira (85,1%), baixa renda (37,6%), 58,1% testaram para o HIV alguma vez na vida. Incentivos ao teste: certeza de não estar infectado (34,1%) e campanha nacional Fique Sabendo (34%). Barreiras: confiar no(s) parceiro(s) (21%) e medo de discriminação se o resultado for positivo (20,3%). Políticas que assegurem a confidencialidade dos testes e campanhas de comunicação voltadas às lacunas de informação e incentivo ao teste devem ser desenvolvidas. Resumen: Identificar los incentivos y las barreras a los test de VIH entre hombres que practican sexo con hombres (HSH). Estudio transversal entre HSH que residieron por lo menos tres meses en la región metropolitana de Fortaleza, Ceará, Brasil, en 2010. Fueron reclutados 391 hombres, ≥ 18 años, que relataron sexo con hombres en los últimos seis meses, utilizando Respondent Driven Sampling. Datos recogidos: red social, sociodemográficos y ofrecido el test de VIH y analizados por el RDSAT 6.0 y Stata 11.0. La mayoría era joven (40,3%), de 5 a 11 años de escolaridad (57,3%), soltero (85,1%), baja renta (37,6%), 58,1% se hicieron pruebas del VIH alguna vez en la vida. Incentivos al test: certeza de no estar infectado (34,1%) y campaña nacional Fique Sabendo (34%). Barreras: confiar en el compañero (s) (21%) y miedo a la discriminación si el resultado fuera positivo (20,3%). Se deben desarrollar políticas que aseguren la confidencialidad de los test, así como campañas de comunicación, dirigidas a las lagunas de información sobre este asunto, además de incentivos a la realización del test.

Background Prevention of mother-to-child transmission of HIV (PMTCT) programs collect socio-demographic and HIV testing information similar to that collected by unlinked anonymous testing sero-surveillance (UAT) in antenatal settings. Zimbabwe evaluated the utility of PMTCT data in replacing UAT. Methods A UAT dataset was created by capturing socio-demographic, testing practices from the woman’s booking-card and testing remnant blood at a laboratory from 1 June to 30 September 2012. PMTCT data were collected retrospectively from ANC registers. UAT and PMTCT data were linked by bar-code labels that were temporarily affixed to the ANC register. A questionnaire was used to obtain facility-level data at 53 sites. Results Pooled HIV prevalence was 15.8 % (95 % CI 15.3–16.4) among 17,349 women sampled by UAT, and 16.3 % (95 % CI 15.8 %–16.9 %) among 17,150 women in PMTCT datasets for 53 sites. Pooled national percent-positive agreement (PPA) was 91.2 %, and percent-negative agreement (PNA) was 98.7 % for 16,782 women with matched UAT and PMTCT data. Based on UAT methods, overall median prevalence was 12.9 % (Range 4.0 %–19.4 %) among acceptors and refusers of HIV test in PMTCT compared to 12.5 % ((Range 3.4 %–19.5 %) among acceptors in ANC registers. There were variations in prevalence by site. Conclusion Although, there is no statistical difference between pooled HIV prevalence in UAT compared to PMTCT program, the overall PPA of 91.2 % and PNA of 98.7 % fall below World Health Organisation (WHO) benchmarks of 97.6 % and 99.6 % respectively. Zimbabwe will need to strengthen quality assurance (QA) of rapid HIV testing and data collection practices. Sites with good performance should be prioritised for transitioning. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1425-2) contains supplementary material, which is available to authorized users.

OBJECTIVES To assess the extent of nondisclosure of known HIV status among sexual health clinic attendees and to quantify the impact of nondisclosure on estimates of undiagnosed HIV prevalence and of the proportion of patients remaining undiagnosed on leaving the clinic. METHODS Serum samples from the unlinked anonymous survey of clinic attendees' archive were tested for antiretrovirals. Estimates of undiagnosed HIV were adjusted using the findings. RESULTS Antiretrovirals were detected in 27% of samples taken from 'previously undiagnosed' attendees, who did not have an HIV test but were HIV positive as detected by unlinked anonymous testing, indicating nondisclosure; 24% of such samples from MSM had antiretrovirals present compared with 32% of heterosexual men and women. Antiretrovirals were detected in 33% of samples from London clinics and in 21% from non-London clinics. Following adjustment, the estimated prevalence of undiagnosed HIV decreased nonsignificantly from 3.04% (95% confidence interval 2.71-3.41) to 2.66% (2.35-3.01) among men who have sex with men (MSM), 0.31% (0.26-0.37) to 0.30% (0.25-0.36) in heterosexual men and 0.40% (0.35-0.46) to 0.37% (0.32-0.43) in women; 7% of MSM who do not have an HIV test at a clinic visit will be infected with HIV and remain unaware of their infection. CONCLUSION Nondisclosure of HIV status to healthcare professionals occurs among clinic attendees. Adjustment for nondisclosure results in a small, nonsignificant decrease in the prevalence of undiagnosed HIV estimated from the unlinked anonymous survey in sexual health clinics. Testing the population of MSM not having an HIV test remains a priority as levels of undiagnosed HIV are high.

Chlamydia prevalence in the general population is a potential outcome measure for the evaluation of chlamydia control programmes. We carried out a pilot study to determine the feasibility of using a postal survey for population-based chlamydia prevalence monitoring.Postal invitations were sent to a random sample of 2000 17-year-old to 18-year-old women registered with a general practitioner in two pilot areas in England. Recipients were randomised to receive either a self-sampling kit (n=1000), a self-sampling kit and offer of £5 voucher on return of sample (n=500) or a self-sampling kit on request (n=500). Participants returned a questionnaire and self-taken vulvovaginal swab sample for unlinked anonymous Chlamydia trachomatis testing. Non-responders were sent a reminder letter 3 weeks after initial invitation. We calculated the participation rate (number of samples returned/number of invitations sent) and cost per sample returned (including cost of consumables and postage) in each group.A total of 155/2000 (7.8%) samples were returned with consent for testing. Participation rates varied by invitation group: 7.8% in the group who were provided with a self-sampling kit, 14% in the group who were also offered a voucher and 1.0% in the group who were not sent a kit. The cost per sample received was lowest (£36) in the group who were offered both a kit and a voucher.The piloted survey methodology achieved low participation rates. This approach is not suitable for population-based monitoring of chlamydia prevalence among young women in England.(UKCRN ID 10913).

Large-scale aggregate analyses of anonymized data can yield valuable results and insights that address public health challenges and provide new avenues for scientific discovery. These methods can extend our knowledge and provide new tools for enhancing health and wellbeing. However, they raise questions about how to best address potential threats to privacy while reaping benefits for individuals and to society as a whole. The use of machine learning to make leaps across informational and social contexts to infer health conditions and risks from nonmedical data provides representative scenarios for reflections on directions with balancing innovation and regulation.

Linking clinical and phenotype variables across data sets will both power precision medicine studies and introduce new privacy risks

Since the late 1980s, human immunodeficiency virus (HIV) sentinel serosurveillance among pregnant women attending select antenatal clinics (ANCs) based on unlinked anonymous testing (UAT) has provided invaluable information for tracking HIV prevalence and trends and informing global and national HIV models in most countries with generalized HIV epidemics. However, increased coverage of HIV testing, prevention of mother-to-child transmission (PMTCT), and antiretroviral therapy has heightened ethical concerns about UAT. PMTCT programs now routinely collect demographic and HIV testing information from the same pregnant women as serosurveillance and therefore present an alternative to UAT-based ANC serosurveillance. This paper reports on the evolution and current direction of the global approach to HIV surveillance among pregnant women attending ANCs, including the transition away from traditional UAT-based serosurveillance and toward new guidance from the World Health Organization and the Joint United Nations Programme on HIV/AIDS on the implementation of surveillance among pregnant women attending ANCs based on routine PMTCT program data.