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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.

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.

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.

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) continue to be a significant public health concern in the United States. It disproportionately affects persons in the Deep South of the United States, specifically African Americans. This is a descriptive report of an Emergency Department (ED)-based HIV screening program in the Deep South using the 2006 Centers for Disease Control and Prevention (CDC) recommendations for rapid testing and opt-out consent. Between May 2008 and March 2010, patients presenting for medical care to the ED Monday through Friday between 10 AM: and 10 PM: were approached for HIV screening. Patients were eligible for screening if they were 18 or older, had no previous history of positive HIV tests, were English-Speaking, and were not incarcerated, medically unstable, or otherwise able to decline testing. All patients were tested using the OraQuick® rapid HIV 1/2 antibody test. Patients with non-reactive results were referred to community anonymous testing sites for further testing. Patients with reactive results had confirmatory Western blot and CD4 counts drawn and were brought back to the ED for disclosure of the results. All patients with confirmed HIV positive via reactive Western blot were referred to the hospital-based infectious disease clinic or county health department. We tested 7,616 patients out of 8,922 approached. The overall test acceptance rate was 85.4%. 91.0% of patients tested were African American. The most common reason for refusal was recent HIV test. 1.7% of patients tested were confirmed HIV positive via Western blot. 95.2% of patients testing HIV positive were African American. The average CD4 count for patients testing positive was 276 cells/μl, with 42.0% of patients having CD4 counts ≤200 μl, consistent with an AIDS diagnosis. 88.4% of patients who had reactive oral swabs returned for Western blot results and 75.0% of patients attended their first clinic visit. We have been able to successfully carry out an ED-based HIV screening program in a resource-poor urban teaching facility in the Deep South. We define our success based on our relatively high test acceptance rate and high rate of attendance at first clinic visit. Our patient population has a relatively high undocumented HIV prevalence and are at advanced stage of disease at the time of diagnosis.

This study aimed to investigate whether endorsement of “difficulty coping” questions on two self-report measures would be affected by whether or not women had to put their name on the questionnaires. In addition, a small survey of mental health professionals was conducted to see what they thought the study would find. Women (n = 211) attending maternal and child health clinics completed two self-report measures of mood and experience of motherhood. Women were either asked to write their name on the forms and were told that the project officer would check their forms once completed (“named” condition) or asked not to put their name on the forms and that the forms would not be looked at (“anonymous” condition). Perinatal mental health professionals (n = 44) completed an anonymous survey asking them what they considered the study would find. Most health professionals (77.3%) expected that the anonymous condition would result in more “honest” responding by women—that is, there would be a higher rate of women admitting to not coping in the anonymous condition. To the contrary, however, this was not found. There were no differences between the rates of endorsement of “not currently coping” by women in the two conditions, a finding only expected by 13.6% of the professionals. There was a small, but statistically significant, difference in women reporting whether they had a prior history of difficulty coping, with more women in the named condition endorsing this. Rates of postnatal distress or depression, based upon responses to self-report mood or similar questionnaires, are unlikely to be affected by whether participants are required to put their name on the measures or not or whether they anticipate that their responses will be scrutinized. This is an unexpected finding by a sample of mental health professionals interested in the perinatal mental health field, and thus, the study has “new knowledge” significance.

The objective of this study was to describe human papillomavirus (HPV) prevalence in South Wales in relation to age, cytology and social deprivation. This was an unlinked, prospective, anonymous, population-based study. DNA was purified from 1911 liquid-based cytology samples (mean age 37.7 years, cytology 93.2% negative, social deprivation average score 17.9) using quality assured techniques and the presence of virus determined by PCR-Enzyme Immuno Assay (PCR-EIA). 209 (10.9%) samples contained high-risk (HR) HPV infection of which 36.4% had multiple HR-HPV types. The most frequent HR types were HPV 16 (19.6%), HPV 35 (9.5%), HPV 66 (9.2%), HPV 59 (8.5%) and HPV 56 (7.6%). There was a strong association between HPV infection and cytological abnormality. Significantly more HR-HPV infections were detected in women under the age of 30 years (68.9% of all HR-HPV infections Fisher's exact test P=0.0001) compared to 30 years and above. There was no difference in HPV prevalence between different socioeconomic groups. The data presented suggest a different HPV type distribution in South Wales in comparison to that reported for other populations.

OBJECTIVE: HIV testing remains a central strategy for HIV prevention for its ability to link those who test positive to treatment and support. In Canada, national guidelines have recently changed as part of standard primary care to recommend voluntary HIV testing for those aged 16–64 years. Using results from a nationally representative survey, we examined individual and jurisdictional factors associated with voluntary testing. METHODS: A total of 2,139 participants were sampled using a regionally stratified, two-stage recruitment process. English or French interviews (by phone or online) were conducted during May 2011. Voluntary testing was defined as testing at least once for reasons other than blood donation, insurance purposes, immigration screening or research participation. Weighted logistic regression analysis (including socio-demographic, sexual activity, HIV/AIDS knowledge and jurisdictional factors of HIV prevalence and anonymous testing availability) were conducted for the overall sample, and stratified by sex. RESULTS: Twenty-nine percent (29%) of survey participants reported at least one lifetime voluntary HIV test. For the full-sample model, the following were associated with increased odds of testing: age

Since the beginning of the registration of HIV, in Kiev there were registered a total 13,500 cases of HIV, 1,5 thousands people died. Under medical supervision in Kiev there are 9697 people with HIV, including the 1790 people who are in the stage of AIDS. Among vulnerable groups particularly distinguished IDU. During 2013 the number tested for HIV among this group is 3900 people. Infection level among them is 19.5 %. Identified by year of HIV-positive injecting drug users - 752. Enrollment rate in 2013 is 64 %. The majority (70.6 %) from infected IDU’s have III –IV clinical stage of disease. The assistance of non-governmental social organizations is critical. With the number of employees in the region of NGOs involved in the implementation of measures to combat HIV / AIDS in the region, the 5 most productive organizations are supported by the administration of Kyiv regional Clinical Hospital № 5 by allocating space for activities. Based cabinets anonymous HIV testing within the network Kyiv City AIDS Center and sites of ART also established cooperation with AIDS-service NGOs that implement preventive work with vulnerable groups and provide social support for persons living with HIV. Social workers allocated by the rooms required for their activity. Other NGOs engaged in addressing transition to the offices of anonymous testing people, who were positive in a testing in community centers, the mobile clinic or while. Results cooperation center and HIV service NGOs in Kiev: • Of the 932 patients, who were appointed ART, 894 patients (95.9 %) under the guidance of social workers • Percentage of adults and children with HIV known to be on ART at 12 months after initiation of ART- 86.43 % • Percentage of HIV -infected persons who received outpatient examination at the end of the year among the total number of HIV-infected persons who are under medical supervision 82% • Since 2009 increased the percentage of HIV -infected with TB who received treatment for TB and HIV, including through implementation of measures of social support persons with a triple problem of injecting drug users, HIV, TB

Despite the magnitude of the HIV epidemic in India, few centers exist that provide anonymous HIV testing that is also accompanied by adequate counseling and referral. This study describes the trends in demographic profiles, HIV serostatus, and risk factors among 1,745 male and female clients who accessed an anonymous counseling and testing center in Chennai, India from 1994 to 1998. The prevalence of HIV in this sample was 51%, indicating that the clinic is successful in its outreach to at-risk individuals. The increasing number of clients over time suggests that this clinic has been well-received by the community. Correlates of being HIV-positive included occasional condom use, being married, being referred by an HIV-positive sex partner, working as a truck driver or migrant, or having a spouse in these professions. The success of this clinic serves as a model for similar centers in India, and points to the widespread need for anonymous testing and counseling.

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

Background: The increased use of human biological material for cell-based research and clinical interventions poses risks to the privacy of patients and donors, including the possibility of re-identification of individuals from anonymized cell lines and associated genetic data. These risks will increase as technologies and databases used for re-identification become affordable and more sophisticated. Policies that require ongoing linkage of cell lines to donors’ clinical information for research and regulatory purposes, and existing practices that limit research participants’ ability to control what is done with their genetic data, amplify the privacy concerns. Discussion: To date, the privacy issues associated with cell-based research and interventions have not received much attention in the academic and policymaking contexts. This paper, arising out of a multi-disciplinary workshop, aims to rectify this by outlining the issues, proposing novel governance strategies and policy recommendations, and identifying areas where further evidence is required to make sound policy decisions. The authors of this paper take the position that existing rules and norms can be reasonably extended to address privacy risks in this context without compromising emerging developments in the research environment, and that exceptions from such rules should be justified using a case-by-case approach. In developing new policies, the broader framework of regulations governing cell-based research and related areas must be taken into account, as well as the views of impacted groups, including scientists, research participants and the general public. Summary: This paper outlines deliberations at a policy development workshop focusing on privacy challenges associated with cell-based research and interventions. The paper provides an overview of these challenges, followed by a discussion of key themes and recommendations that emerged from discussions at the workshop. The paper concludes that privacy risks associated with cell-based research and interventions should be addressed through evidence-based policy reforms that account for both well-established legal and ethical norms and current knowledge about actual or anticipated harms. The authors also call for research studies that identify and address gaps in understanding of privacy risks.

The paper examines the controversy surrounding legislative proposals in New York State that would require amending the public health law's stringent confidentiality provisions; the legislation calls for “unblinding” the results of a 7-year old statewide HIV seroprevalence study that tests newborns for HIV antibodies in order to track the incidence of HIV infection among parturient women. The pivotal point is made that mandatory disclosure of the test results is tantamount to mandatory testing of the mother, since presence (or absence) of HIV antibodies conclusively reveals the mother's HIV status. The author presents the history of the epidemiological study and documents the ongoing discussion of mandatory testing, within the medical, bioethical and public health community. Citing numerous papers, including the report of the Subcommittee, on Newborn Screening of the New York State AIDS Advisory Council, the author — a member of both the council and its subcommittee—argues against the principle of mandatory testing in general and “unblinding” of the seroprevalence survey in particular. Besides making a strong argument from the ethical viewpoint, the paper provides ample medical data to support the argument that mandatory testing of newborns is poor public health policy that would be essentially ineffectual in the effort to stem the spread of HIV.

This essay argues that informed consent remains desirable for both moral and practical reasons in regard to HIV testing by physicians. At the very least, respect for consent preserves patient control over treatment and affords the opportunity for education about the nature of HIV-related disorders. Nevertheless, there do appear to be circumstances under which involuntary testing may occur especially when health care workers may have become occupationally exposed to risk of HIV infection. To eliminate conflicts between health workers and their patients, however, it is desirable to work to eliminate the stigmatizing and discriminatory effects of HIV infection that can induce persons to resist testing.