Routine Voluntary HIV Testing in Durban, South Africa: The Experience From an Outpatient Department
Identifieur interne : 001955 ( Pmc/Corpus ); précédent : 001954; suivant : 001956Routine Voluntary HIV Testing in Durban, South Africa: The Experience From an Outpatient Department
Auteurs : Ingrid V. Bassett ; Janet Giddy ; Jacques Nkera ; Bingxia Wang ; Elena Losina ; Zhigang Lu ; Kenneth A. Freedberg ; Rochelle P. WalenskySource :
- Journal of acquired immune deficiency syndromes (1999) [ 1525-4135 ] ; 2007.
Abstract
To evaluate the yield of a routine voluntary HIV testing program compared with traditional provider-referred voluntary counseling and testing (VCT) in a hospital-affiliated outpatient department (OPD) in Durban, South Africa.
In a prospective 14-week “standard of care” period, we compared OPD physician logs documenting patient referrals to the hospital VCT site with HIV test registers to measure patient completion of HIV test referral. The standard of care period was followed by a 12-week intervention during which all patients who registered at the OPD were given an educational intervention and offered a rapid HIV test at no charge as part of routine care.
During the standard of care period, OPD physicians referred 435 patients aged ≥18 years for HIV testing; 137 (31.5%) of the referred patients completed testing at the VCT site within 4 weeks. Among those tested, 102 (74.5%) were HIV infected. During the intervention period, 1414 adults accepted HIV testing and 1498 declined. Of those tested, 463 (32.7%, 95% confidence interval: 30.3 to 35.3) were HIV infected. Routine HIV testing in the OPD identified 39 new HIV cases per week compared with 8 new cases per week with standard of care testing based on physician referral to a VCT site (
Routine voluntary HIV testing in an OPD in South Africa leads to significantly higher rates of detection of HIV disease. This strategy should be implemented more widely in high HIV prevalence areas where treatment is available.
Url:
DOI: 10.1097/QAI.0b013e31814277c8
PubMed: 17667332
PubMed Central: 2140230
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PMC:2140230Le document en format XML
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<author><name sortKey="Bassett, Ingrid V" sort="Bassett, Ingrid V" uniqKey="Bassett I" first="Ingrid V." last="Bassett">Ingrid V. Bassett</name>
<affiliation><nlm:aff id="A1"> Division of Infectious Disease, Massachusetts General Hospital, Boston, MA</nlm:aff>
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<author><name sortKey="Giddy, Janet" sort="Giddy, Janet" uniqKey="Giddy J" first="Janet" last="Giddy">Janet Giddy</name>
<affiliation><nlm:aff id="A2"> McCord Hospital, Durban, South Africa</nlm:aff>
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<author><name sortKey="Nkera, Jacques" sort="Nkera, Jacques" uniqKey="Nkera J" first="Jacques" last="Nkera">Jacques Nkera</name>
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<author><name sortKey="Wang, Bingxia" sort="Wang, Bingxia" uniqKey="Wang B" first="Bingxia" last="Wang">Bingxia Wang</name>
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<affiliation><nlm:aff id="A4"> Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, MA;</nlm:aff>
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<author><name sortKey="Freedberg, Kenneth A" sort="Freedberg, Kenneth A" uniqKey="Freedberg K" first="Kenneth A." last="Freedberg">Kenneth A. Freedberg</name>
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<affiliation><nlm:aff id="A4"> Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, MA;</nlm:aff>
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<affiliation><nlm:aff id="A5"> Harvard Center for AIDS Research (CFAR), Boston, MA</nlm:aff>
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<author><name sortKey="Walensky, Rochelle P" sort="Walensky, Rochelle P" uniqKey="Walensky R" first="Rochelle P." last="Walensky">Rochelle P. Walensky</name>
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<affiliation><nlm:aff id="A3"> Division of General Medicine, Massachusetts General Hospital, Boston, MA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A5"> Harvard Center for AIDS Research (CFAR), Boston, MA</nlm:aff>
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<affiliation><nlm:aff id="A6"> Division of Infectious Disease, Brigham and Women’s Hospital, Boston, MA.</nlm:aff>
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<author><name sortKey="Bassett, Ingrid V" sort="Bassett, Ingrid V" uniqKey="Bassett I" first="Ingrid V." last="Bassett">Ingrid V. Bassett</name>
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<author><name sortKey="Giddy, Janet" sort="Giddy, Janet" uniqKey="Giddy J" first="Janet" last="Giddy">Janet Giddy</name>
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<author><name sortKey="Nkera, Jacques" sort="Nkera, Jacques" uniqKey="Nkera J" first="Jacques" last="Nkera">Jacques Nkera</name>
<affiliation><nlm:aff id="A2"> McCord Hospital, Durban, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Wang, Bingxia" sort="Wang, Bingxia" uniqKey="Wang B" first="Bingxia" last="Wang">Bingxia Wang</name>
<affiliation><nlm:aff id="A3"> Division of General Medicine, Massachusetts General Hospital, Boston, MA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Losina, Elena" sort="Losina, Elena" uniqKey="Losina E" first="Elena" last="Losina">Elena Losina</name>
<affiliation><nlm:aff id="A3"> Division of General Medicine, Massachusetts General Hospital, Boston, MA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A4"> Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, MA;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Lu, Zhigang" sort="Lu, Zhigang" uniqKey="Lu Z" first="Zhigang" last="Lu">Zhigang Lu</name>
<affiliation><nlm:aff id="A3"> Division of General Medicine, Massachusetts General Hospital, Boston, MA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Freedberg, Kenneth A" sort="Freedberg, Kenneth A" uniqKey="Freedberg K" first="Kenneth A." last="Freedberg">Kenneth A. Freedberg</name>
<affiliation><nlm:aff id="A1"> Division of Infectious Disease, Massachusetts General Hospital, Boston, MA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A3"> Division of General Medicine, Massachusetts General Hospital, Boston, MA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A4"> Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, MA;</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A5"> Harvard Center for AIDS Research (CFAR), Boston, MA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Walensky, Rochelle P" sort="Walensky, Rochelle P" uniqKey="Walensky R" first="Rochelle P." last="Walensky">Rochelle P. Walensky</name>
<affiliation><nlm:aff id="A1"> Division of Infectious Disease, Massachusetts General Hospital, Boston, MA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A3"> Division of General Medicine, Massachusetts General Hospital, Boston, MA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A5"> Harvard Center for AIDS Research (CFAR), Boston, MA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A6"> Division of Infectious Disease, Brigham and Women’s Hospital, Boston, MA.</nlm:aff>
</affiliation>
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<imprint><date when="2007">2007</date>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title>
<p id="P1">To evaluate the yield of a routine voluntary HIV testing program compared with traditional provider-referred voluntary counseling and testing (VCT) in a hospital-affiliated outpatient department (OPD) in Durban, South Africa.</p>
</sec>
<sec id="S2"><title>Design and Methods</title>
<p id="P2">In a prospective 14-week “standard of care” period, we compared OPD physician logs documenting patient referrals to the hospital VCT site with HIV test registers to measure patient completion of HIV test referral. The standard of care period was followed by a 12-week intervention during which all patients who registered at the OPD were given an educational intervention and offered a rapid HIV test at no charge as part of routine care.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">During the standard of care period, OPD physicians referred 435 patients aged ≥18 years for HIV testing; 137 (31.5%) of the referred patients completed testing at the VCT site within 4 weeks. Among those tested, 102 (74.5%) were HIV infected. During the intervention period, 1414 adults accepted HIV testing and 1498 declined. Of those tested, 463 (32.7%, 95% confidence interval: 30.3 to 35.3) were HIV infected. Routine HIV testing in the OPD identified 39 new HIV cases per week compared with 8 new cases per week with standard of care testing based on physician referral to a VCT site (<italic>P</italic>
< 0.0001).</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">Routine voluntary HIV testing in an OPD in South Africa leads to significantly higher rates of detection of HIV disease. This strategy should be implemented more widely in high HIV prevalence areas where treatment is available.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">100892005</journal-id>
<journal-id journal-id-type="pubmed-jr-id">21821</journal-id>
<journal-id journal-id-type="nlm-ta">J Acquir Immune Defic Syndr</journal-id>
<journal-title>Journal of acquired immune deficiency syndromes (1999)</journal-title>
<issn pub-type="ppub">1525-4135</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">17667332</article-id>
<article-id pub-id-type="pmc">2140230</article-id>
<article-id pub-id-type="doi">10.1097/QAI.0b013e31814277c8</article-id>
<article-id pub-id-type="manuscript">NIHMS33900</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Routine Voluntary HIV Testing in Durban, South Africa: <italic>The Experience From an Outpatient Department</italic>
</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Bassett</surname>
<given-names>Ingrid V.</given-names>
</name>
<degrees>MD</degrees>
<xref rid="A1" ref-type="aff">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Giddy</surname>
<given-names>Janet</given-names>
</name>
<degrees>MBChB</degrees>
<xref rid="A2" ref-type="aff">†</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nkera</surname>
<given-names>Jacques</given-names>
</name>
<degrees>MD</degrees>
<xref rid="A2" ref-type="aff">†</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Wang</surname>
<given-names>Bingxia</given-names>
</name>
<degrees>PhD</degrees>
<xref rid="A3" ref-type="aff">‡</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Losina</surname>
<given-names>Elena</given-names>
</name>
<degrees>PhD</degrees>
<xref rid="A3" ref-type="aff">‡</xref>
<xref rid="A4" ref-type="aff">§</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lu</surname>
<given-names>Zhigang</given-names>
</name>
<degrees>MD</degrees>
<xref rid="A3" ref-type="aff">‡</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Freedberg</surname>
<given-names>Kenneth A.</given-names>
</name>
<degrees>MD, MSc</degrees>
<xref rid="A1" ref-type="aff">*</xref>
<xref rid="A3" ref-type="aff">‡</xref>
<xref rid="A4" ref-type="aff">§</xref>
<xref rid="A5" ref-type="aff">||</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Walensky</surname>
<given-names>Rochelle P.</given-names>
</name>
<degrees>MD</degrees>
<degrees>MPH</degrees>
<xref rid="A1" ref-type="aff">*</xref>
<xref rid="A3" ref-type="aff">‡</xref>
<xref rid="A5" ref-type="aff">||</xref>
<xref rid="A6" ref-type="aff">¶</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>*</label>
Division of Infectious Disease, Massachusetts General Hospital, Boston, MA</aff>
<aff id="A2"><label>†</label>
McCord Hospital, Durban, South Africa</aff>
<aff id="A3"><label>‡</label>
Division of General Medicine, Massachusetts General Hospital, Boston, MA</aff>
<aff id="A4"><label>§</label>
Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, MA;</aff>
<aff id="A5"><label>||</label>
Harvard Center for AIDS Research (CFAR), Boston, MA</aff>
<aff id="A6"><label>¶</label>
Division of Infectious Disease, Brigham and Women’s Hospital, Boston, MA.</aff>
<author-notes><corresp id="FN1">Correspondence to: Ingrid V. Bassett, MD, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114 (e-mail: <email>ibassett@partners.org</email>
)</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>9</day>
<month>11</month>
<year>2007</year>
</pub-date>
<pub-date pub-type="ppub"><day>1</day>
<month>10</month>
<year>2007</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>17</day>
<month>12</month>
<year>2007</year>
</pub-date>
<volume>46</volume>
<issue>2</issue>
<fpage>181</fpage>
<lpage>186</lpage>
<abstract><sec id="S1"><title>Objective</title>
<p id="P1">To evaluate the yield of a routine voluntary HIV testing program compared with traditional provider-referred voluntary counseling and testing (VCT) in a hospital-affiliated outpatient department (OPD) in Durban, South Africa.</p>
</sec>
<sec id="S2"><title>Design and Methods</title>
<p id="P2">In a prospective 14-week “standard of care” period, we compared OPD physician logs documenting patient referrals to the hospital VCT site with HIV test registers to measure patient completion of HIV test referral. The standard of care period was followed by a 12-week intervention during which all patients who registered at the OPD were given an educational intervention and offered a rapid HIV test at no charge as part of routine care.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">During the standard of care period, OPD physicians referred 435 patients aged ≥18 years for HIV testing; 137 (31.5%) of the referred patients completed testing at the VCT site within 4 weeks. Among those tested, 102 (74.5%) were HIV infected. During the intervention period, 1414 adults accepted HIV testing and 1498 declined. Of those tested, 463 (32.7%, 95% confidence interval: 30.3 to 35.3) were HIV infected. Routine HIV testing in the OPD identified 39 new HIV cases per week compared with 8 new cases per week with standard of care testing based on physician referral to a VCT site (<italic>P</italic>
< 0.0001).</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">Routine voluntary HIV testing in an OPD in South Africa leads to significantly higher rates of detection of HIV disease. This strategy should be implemented more widely in high HIV prevalence areas where treatment is available.</p>
</sec>
</abstract>
<kwd-group><kwd>Africa</kwd>
<kwd>HIV</kwd>
<kwd>HIV testing</kwd>
<kwd>screening</kwd>
<kwd>urgent care</kwd>
</kwd-group>
<contract-num rid="AI1">K23 AI068458-01</contract-num>
<contract-sponsor id="AI1">National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID</contract-sponsor>
</article-meta>
</front>
</pmc>
</record>
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