Achieving Universal HIV Screening in Prenatal Care in the United States: Provider Persistence Pays Off

Anderson, John E.; Koenig, Linda J.; Lampe, Margaret A.; Wright, Renee; Leiss, Jack K.; Saul, Janet

doi:10.1089/apc.2005.19.247

Cited by 29 publications

(12 citation statements)

References 9 publications

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“…Patient acceptability of routine HIV tests is higher when providers encourage HIV tests and believe HIV testing benefits the patient. 28,[32][33][34] Provider education about their role in HIV status determination and associated patient benefits should accompany implementation of routine opt-out HIV testing.…”

Section: Discussionmentioning

confidence: 99%

HIV Status Determination Among Tuberculosis Patients From California During 2008

Kong

Watt

Marks

et al. 2013

Journal of Public Health Management and Practice

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Context-Human immunodeficiency virus (HIV) infection complicates care and contributes to poor outcomes among tuberculosis (TB) patients. The Centers for Disease Control and Prevention recommends that providers test all TB patients for HIV.Objective-We assessed completeness of HIV status determination among TB patients and identified key gaps in adherence.Design-We conducted a retrospective review of public health charts to determine the HIV status for all TB patients reported in California during 2008. We then used logistic regression to determine the factors associated with a known (positive or negative) HIV status. A random sample of TB patients was selected for secondary review to characterize the timing of HIV status determination and the providers who had opportunity to test for HIV. Setting-California TB programs. Participants-All TB patients reported from California in 2008.Main Outcome Measures-Proportion of patients with a known HIV status, adjusted odds ratios for having a known HIV status, proportion of patients with a known HIV status before TB diagnosis, and proportion of patients diagnosed with TB by different provider types.Results-Only 1752 (66%) of 2667 TB patients had a known HIV status. Having a known HIV status was strongly associated with those aged between 15 and 44 years and being managed with any public provider involvement. Of 292 patients in the random sample, 12 patients (4%) had a This also presents a gap in TB management and public health TB control. Human immunodeficiency virus infection is a risk factor for death with TB, 5-9 TB recurrence, 10 and acquired TB drug resistance with intermittent therapy. 11-13 Thus, HIV status determination is needed to identify TB patients who should receive daily directly observed TB therapy and highly active antiretroviral therapy to prevent poor TB outcomes. 14-17 Human immunodeficiency virus status determination is also needed for TB programs to link HIVinfected TB patients to HIV care services and to identify HIV-infected contacts, who are at increased risk for progression to disease. 18 Ensuring complete HIV status determination among patients is part of TB programs' broader responsibility to monitor and ensure the quality of all TB-related activities. However, the decision to test patients for HIV ultimately rests with the provider. Although TB programs can directly implement routine HIV testing for patients in public TB clinics, they have less influence over the care given by private providers. Therefore, public health efforts to ensure complete HIV status determination must consider the provider types involved in TB care and target interventions appropriately. HHS Public AccessWe conducted an evaluation of TB patients reported from California in 2008 to (1) assess completeness of HIV status determination, (2) identify factors associated with having a known HIV status, (3) characterize providers who have opportunity to test for HIV during TB care, and (4) provide recommendations to increase HIV status determination completeness. Me...

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Section: Discussionmentioning

confidence: 99%

HIV Status Determination Among Tuberculosis Patients From California During 2008

Kong

Watt

Marks

et al. 2013

Journal of Public Health Management and Practice

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“…Multiple studies have supported the approach of routine testing (opt-out) for increased uptake of HIV testing among pregnant women [8-10]. Even though the 'opt out' strategy for HIV testing was a national policy for a number of years in Zambia, it was not operational in facilities.…”

Section: Introductionmentioning

confidence: 99%

Increasing the uptake of prevention of mother-to-child transmission of HIV services in a resource-limited setting

Torpey¹,

Kabaso²,

Kasonde³

et al. 2010

BMC Health Serv Res

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BackgroundAs in other resource limited settings, the Ministry of Health in Zambia is challenged to make affordable and acceptable PMTCT interventions accessible and available. With a 14.3% HIV prevalence, the MOH estimates over one million people are HIV positive in Zambia. Approximately 500,000 children are born annually in Zambia and 40,000 acquire the infection vertically each year if no intervention is offered. This study sought to review uptake of prevention of mother-to-child (PMTCT) services in a resource-limited setting following the introduction of context-specific interventions.MethodsInterventions to improve PMTCT uptake were introduced into 38 sites providing PMTCT services in Zambia in July 2005. Baseline and follow up service data were collected on a monthly basis through September 2008. Data was checked for internal and external consistency using logic built into databases used for data management. Data audits were conducted to determine accuracy and reliability. Trends were analyzed pre- and post- intervention.ResultsUptake among pregnant women increased across the 13 quarters (39 months) of observation, particularly in the case of acceptance of counseling and HIV testing from 45% to 90% (p value = 0.00) in the first year and 99% by year 3 (p value = 0.00). Receipt of complete course of antiretroviral (ARV) prophylaxis increased from 29% to 66% (p = 0.00) in the first year and 97% by year 3 (p value = 0.00). There was also significant improvement in the percentage of HIV positive pregnant women referred for clinical care.ConclusionsUptake of PMTCT services in resource-limited settings can be improved by utilizing innovative alternatives to mitigate the effects of human resource shortage such as by providing technical assistance and mentorship beyond regular training courses, integrating PMTCT services into existing maternal and child health structures, addressing information gaps, mobilizing traditional and opinion leaders and building strong relationships with the government. These health system based approaches provide a sustainable improvement in the capacity and uptake of services.

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“…[11][12][13][14][15] These studies report a wide range of HIV testing acceptance rates (33%-86%), with the highest acceptance rates occurring in obstetrical settings. 11,12,[14][15][16] Patient-related factors associated with refusing testing in these studies included: non-English speaking, older age, higher level of education, Asian or white race. 11,12,14 We are aware of only one published study examining routine HIV testing in the primary care setting.…”

Section: Introductionmentioning

confidence: 99%

Routine Opt-Out HIV Testing in an Urban Community Health Center

Cunningham

Doran

DeLuca³

et al. 2009

AIDS Patient Care and STDs

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Undiagnosed HIV infection remains a significant public health problem. To address this, the Centers for Disease Control and Prevention revised testing recommendations, calling for routine opt-out HIV screening among adults in health care settings. However, these recommendations have not been widely implemented in primary care settings. We examined acceptability of opt-out HIV testing in an urban community health center and factors associated with accepting testing. From July 2007 to March 2008, physicians or a designated HIV tester approached patients presenting for primary care visits during 52 clinical sessions at an urban community health center. Patients were told they "would be tested for HIV unless they declined testing." Enzyme-linked immunosorbent assays, which required venipuncture, were used to test for HIV infection. We extracted demographic, clinical, and visit characteristics from medical records and examined associations between these characteristics and accepting HIV testing using logistic regression. Of 300 patients, 35% agreed to HIV testing, with no new HIV infections detected. Common reasons for declining testing were perceived low risk (54.4%) and self-reported HIV testing previously (45.1%). Younger age (adjusted odds ratio [AOR] = 0.97, 95% confidence interval [CI] = 0.96-0.99), Hispanic ethnicity (AOR = 1.78, 95% CI = 1.01-3.14), and having another blood test during the visit (AOR = 6.36, 95% CI = 3.58-11.28) were independently associated with accepting HIV testing. This study questions whether expanding HIV testing by conducting routine opt-out HIV testing in primary care settings is an acceptable strategy. It is important to understand how various testing strategies may affect HIV testing rates. In addition, further exploration of patients' reasons for declining HIV testing in these settings is warranted.

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Achieving Universal HIV Screening in Prenatal Care in the United States: Provider Persistence Pays Off

Cited by 29 publications

References 9 publications

HIV Status Determination Among Tuberculosis Patients From California During 2008

HIV Status Determination Among Tuberculosis Patients From California During 2008

Increasing the uptake of prevention of mother-to-child transmission of HIV services in a resource-limited setting

Routine Opt-Out HIV Testing in an Urban Community Health Center

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