Uptake and acceptability of antenatal HIV testing: randomised controlled trial of different methods of offering the test

Simpson, Wendy; Johnstone, Frank D.; Boyd, Fiona M; Goldberg, David J.; Hart, Graham; Prescott, R. J.

doi:10.1136/bmj.316.7127.262

Cited by 126 publications

(115 citation statements)

References 23 publications

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“…Many studies have demonstrated missed opportunities for earlier HIV diagnosis [33][34][35]. Others have identified strategies to improve uptake of HIV testing [36][37][38]. 'UK National Guidelines for HIV Testing 2008' were introduced with the aim of increasing HIV testing in a wider range of healthcare settings and reducing the number of patients diagnosed late with HIV [39].…”

Section: Discussionmentioning

confidence: 99%

Immunosuppression among HIV‐1‐positive patients attending for care: experience from two large HIV centres in the United Kingdom

et al. 2010

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The aim of the study was to describe the prevalence of and examine the factors associated with immunosuppression (CD4o200 cells/mL) among HIV-infected patients attending two large inner London treatment centres. MethodsPatients attending for care who had a CD4 count o200 cells/mL during a 6-month period (1 January to 30 June 2007) were identified from the UK national CD4 surveillance database. Corresponding case notes were reviewed and factors associated with the most recent immunosuppressive episode examined. Patients either previously had a CD4 count 4200 cells/mL at any time under follow-up which had decreased (group A) or never had a CD4 count 4200 cells/mL (group B; late presenters). ResultsOf 4589 patients, 10.2% (467) had at least one CD4 count o200 cells/mL. In group A (60.1% of patients), 70.4% were not receiving antiretroviral therapy (ART) at the time at which the CD4 count fell to o200 cells/mL. Reasons included: treatment interruption (TI; 32.6%), patient declined ART (20.2%), infrequent attendance (19.1%), physician delay in offer (23.1%) and transient CD4 cell count decrease (3.9%). Among those receiving ART, one in three had poor adherence. In group B, 92.3% had started ART after presentation: most had recently started and were responding virologically. AIDS-defining diagnoses occurred in the year preceding the decrease in CD4 cell count in 12.6% of patients in group A and 33.3% of those in group B. ConclusionThe majority of patients became immunosuppressed while under care. Our findings suggest that, in addition to strategies aimed at earlier diagnosis, there are further opportunities to reduce severe immunosuppression in patients already attending for HIV care. IntroductionPatients with advanced HIV disease and low CD4 cell counts continue to be a major concern for HIV healthcare providers. Higher rates of disease progression to AIDS and death and poor immunological recovery among individuals starting antiretroviral therapy (ART) with CD4 counts o200 cells/mL are routinely described [1][2][3]. A Health Protection Agency (HPA) analysis showed that, in 2006, of 48 731 HIV-infected adults accessing care in England, Wales and Northern Ireland, an estimated 19% had CD4 counts o200 cells/mL and 52% of patients initiated ART with CD4 counts below that recommended by national guidelines applicable at that time (CD4o200 cells/mL) [4][5][6]. Late diagnosis of HIV infection continues to contribute significantly to the burden of immunosuppression among HIV-infected cohorts, with important health and cost implications [7][8][9][10][11][12][13]. However, late presentation accounts for only a proportion of the unexpectedly high number of patients starting ART with low CD4 cell counts. Analysis of data for patients enrolled in the longitudinal UK Collaborative HIV Cohort Study (UK CHIC) shows that, despite having presented early, 34% of HIV-infected individuals subsequently initiated ART with CD4 counts o200 cells/mL [14]. A British HIV Association (BHIVA) audit of first-line ART in patients in the UK and Ire...

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Section: Discussionmentioning

confidence: 99%

Immunosuppression among HIV‐1‐positive patients attending for care: experience from two large HIV centres in the United Kingdom

et al. 2010

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“…The first challenge is the most urgent and basic, as health professionals represent a key factor in screening. In fact, the choice of whether to have a screening test performed is greatly influenced by the personal attitude of the health professionals offering the screening (245). In addition, health professionals who have limited knowledge and thus are unable to inform patients may ultimately affect the choice (248).…”

Section: Universal Serology Screeningmentioning

confidence: 99%

Diagnosis and Management of Human Cytomegalovirus Infection in the Mother, Fetus, and Newborn Infant

2002

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Human cytomegalovirus (HCMV) is the leading cause of congenital viral infection and mental retardation. HCMV infection, while causing asymptomatic infections in most immunocompetent subjects, can be transmitted during pregnancy from the mother with primary (and also recurrent) infection to the fetus. Hence, careful diagnosis of primary infection is required in the pregnant woman based on the most sensitive serologic assays (immunoglobulin M [IgM] and IgG avidity assays) and conventional virologic and molecular procedures for virus detection in blood. Maternal prognostic markers of fetal infection are still under investigation. If primary infection is diagnosed in a timely manner, prenatal diagnosis can be offered, including the search for virus and virus components in fetal blood and amniotic fluid, with fetal prognostic markers of HCMV disease still to be defined. However, the final step for definite diagnosis of congenital HCMV infection is detection of virus in the blood or urine in the first 1 to 2 weeks of life. To date, treatment of congenital infection with antiviral drugs is only palliative both prior to and after birth, whereas the only efficacious preventive measure seems to be the development of a safe and immunogenic vaccine, including recombinant, subunit, DNA, and peptide-based vaccines now under investigation. The following controversial issues are discussed in the light of the most recent advances in the field: the actual perception of the problem; universal serologic screening before pregnancy; the impact of correct counseling on decision making by the couple involved; the role of prenatal diagnosis in ascertaining transmission of virus to the fetus; the impact of preconceptional and periconceptional infections on the prevalence of congenital infection; and the prevalence of congenitally infected babies born to mothers who were immune prior to pregnancy compared to the number born to mothers undergoing primary infection during pregnancy

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“…Down syndrome), the neonate 111 (e.g. congenital hearing impairment) or the mother, which may also affect the baby 112 (e.g. HIV status).…”

Section: Introductionmentioning

confidence: 99%

Rapid testing for group B streptococcus during labour: a test accuracy study with evaluation of acceptability and cost-effectiveness

Daniels

Gray²,

Pattison³

et al. 2009

Health Technol Assess

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How to obtain copies of this and other HTA programme reports An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable CD-ROM is also available (see below).Printed copies of HTA monographs cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our Despatch Agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment programmeT he Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects. First is the commissioned route. Suggestions for research are actively sought from people working in t...

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Uptake and acceptability of antenatal HIV testing: randomised controlled trial of different methods of offering the test

Cited by 126 publications

References 23 publications

Immunosuppression among HIV‐1‐positive patients attending for care: experience from two large HIV centres in the United Kingdom

Immunosuppression among HIV‐1‐positive patients attending for care: experience from two large HIV centres in the United Kingdom

Diagnosis and Management of Human Cytomegalovirus Infection in the Mother, Fetus, and Newborn Infant

Rapid testing for group B streptococcus during labour: a test accuracy study with evaluation of acceptability and cost-effectiveness

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