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The Influence & Effects Of Community HIV Testing for the African Communities in Leicester

Posted on September 18, 2012 by | 3 Comments

A special research report by Diana Inegbenebor of African Health Policy Network, and Celia Fisher, of Leicestershire AIDS Support Services

Leicester City has almost the most diverse population for a city in England, with predictions that there will be no ethnic majority by 2012. There are many different African communities in the city, this increases the challenges for HIV awareness, HIV testing and prevention interventions as there are many different aspects and cultural differences to consider. Leicester City has an above average number of people with diagnosed HIV, with a current prevalence of 3.2 per 1000.

This is the 7th highest rate in England. In this context LASS (Leicestershire AIDS Support Service) launched its Rapid HIV testing service in June 2009, supported by a Clinical Governance Group.

The uptake of testing within the African communities was low during the first year of the Rapid HIV testing service compared to the uptake from other communities in Leicester. The Community tester volunteer project was initiated to empower African communities with knowledge about HIV and the skills to deliver Rapid HIV testing as community volunteers in association with LASS. Groups of people from different African communities have taken the Rapid HIV testing training, with a total of 28 of these community volunteers completing the training to 1st September 2011. The benefit of the community tester approach is that each person trained understands their community and can adapt and tailor an approach as necessary.

This research report is focused on the effects of the LASS Community Rapid Testing training with different African communities in Leicester and the influence of trained community testing volunteers on the uptake of HIV testing. Key objectives are:

  • To compare the uptake of POCT HIV testing in the different African communities before and after the LASS community HIV tester project was initiated.
  • To determine the cost benefits and savings of using Rapid HIV tests delivered in the communities in non-clinical settings and by non-clinical volunteers.
  • To find out the motivation for people volunteering to become testers, keeping in mind the training includes an HIV test for each person.
  • To provide recommendations about using and evolving the community tester model in what will become a resource limited environment.

A literature review was undertaken to determine what information is available about Community HIV Testing models. The review summarises evidence sourced 3 from Medline/Pub med, Global  Health/Global Health Archive, Cochrane, and Google scholar. Review of material about Rapid HIV Testing reiterates the effectiveness of HIV rapid test kits in early detection of HIV especially for use in the community. There are models of practice for using volunteers in HIV prevention and care work. A study in Zambia looked at the role of community volunteers in voluntary counselling and testing.  They concluded that community volunteers, with approved training and on-going supervision can play a major role to provide counselling and testing services of quality. Research into “training to test” shows that volunteer testing programmes have been tried and proved successful in other countries.

Analysis of the uptake of Rapid HIV testing by people from African communities is compared between 2 periods – before and after the community tester project was started. The analysis clearly shows the effectiveness of focused interventions with 100% increase in uptake over similar periods of time. The benefits of focused interventions alongside accessible HIV testing are evident – in particular taking HIV testing out to the community, with significant numbers of people getting tested at these events. The trained community testing volunteers understand the benefits of being tested and have a significant effect on the acceptability of testing in the communities. There are more tests carried out in the office based setting after these interventions, with 3 new diagnoses in one period due to these influences.

The experience with the different communities highlights that it is important for HIV to be openly discussed to enable people to have the confidence to get tested. When communities are openly talking about HIV and the benefits of testing more people will get tested. The community testing volunteer approach gives an ideal opportunity for people to practice sharing strong messages about HIV and HIV testing.

Results from the qualitative research show that people who have been trained to test were generally very satisfied with the knowledge they had accrued from the training course, and were willing to take what they had learned to their communities, to educate and empower others. People are motivated by doing things for their community. In this model the testing is encapsulated in a ‘bigger’ outcome for the individual.

The effect of the community tester model increases the confidence within the community generally as they have access to new skills and knowledge. The majority of people in each African community here in Leicester have direct experience of people living with HIV, whether locally or back home.  LASS have anecdotal reports of people using their up to date HIV knowledge globally: being able to provide clarity and facts for a person who knows mainly myths. Others are planning to use these skills when they return to their country – as they can now deliver with confidence.

The community testing model using volunteers is cost effective. Comparison of the cited potential cost savings to those of the Community testing model delivered by LASS, immediately highlight the benefits of using this model:

Potential cost savings for 8 new diagnoses are between £2.24 million and £2.88 million with between £7,840 and £14,000 spent to achieve this delivering 556 tests.

Recommendations from the research are as follows;

  • Take the model into different communities and continue to evaluate the benefits.
  • Deliver HIV testing in different community settings on a regular basis to increase accessibility and acceptability, in particular using the outreach van.
  • Research to consider and evaluate the benefits of community HIV testing volunteer training in local communities and with their global connections.
  • Initiate research into how community testing and involvement of people in seeing their blood make the positive result affects acceptance of diagnosis and onward management of HIV. This recommendation is based on observations during the research for already diagnosed HIV positive people.
  • Develop the community volunteer tester model to include testing for other health conditions, for example Hepatitis.

The authors would like to acknowledge the involvement of community testing volunteers and all those involved in organising and delivering the interventions.

Download the full report here.

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World AIDS Day 2011: LASS In The News – ITV1 Julie’s Real Story and Our Free Rapid HIV Testing Service!

Posted on December 1, 2011 by | Comments Off

We are pleased publish our local advert to promote HIV testing, in our office location in Leicester Town Centre, on Regent Road.

This advert speaks with 15 languages internationally.  This advert cost marginally and considerably less than the Governments 1987 “Tombstone” Advert.

Our message is clear, it is better to know your own HIV status and you can get a HIV test at LASS, and have the result within a minute!

Our team of volunteers have specialist training to provide a free and confidential test, we also have a fantastic support team to provide after-care and further information if required.  We also have established network links so we can refer to more specialist agencies all around Leicester, Leicestershire and Rutland so you can be sure to get expert advice for your needs.

We also have a support group called LhivE, a group of people from Leicester, Leicestershire & Rutland who are living with HIV.  Living with HIV brings a whole set of its own issues and LhivE demonstrate that people living with HIV can lead fulfilling and safe lives with choices.

We hope you like our new advert and hope that you’ll feel comfortable to contact us if you would like a free and confidential test.

The city of Leicester has the fastest-rising HIV rate in the east Midlands and the sixth-highest in the country.

Meanwhile, in 2009/10, national research demonstrated that community testing was effective in delivering tests to those at risk, preventing late diagnosis and thereby reducing onward transmission. As there was no such community testing service in Leicester, we set about creating one!

It is the training of our volunteers which makes the project unique as a method of engaging with specific African communities which are considered to have a high need.  As well as delivering courses to train volunteers to carry out tests among Zimbabwean and Congolese community groups, we also provide a safe and confidential place for people to receive a test.

Our volunteers have created a 50-second advert promoting the value of knowing your HIV status in 15 languages.

We have delivered more than 400 tests, more than half of which are to the BME communities in the region.  While the first phase of the project involved delivering tests only from our building, funding has ensured  we can use our van to take testing to more venues across Leicester, Leicestershire & Rutland.

We were delighted to be highly commended by the Charity Awards, the UK charity sector’s most prestigious awards scheme earlier this year, after being short-listed in the Healthcare & Medical Research category.   This means we have been judged to be of the best 32 Charities in the whole country. Our sincere thanks go to all our service users, volunteers, staff and people in partner organisations who are the real reason we have achieved such a magnificent accolade. Community based HIV testing and our advertisement for this service were the basis of for our application.

WIDESPREAD TESTING IS URGENTLY NEEDED – Health Protection Agency.

The Health Protection Agency (HPA) predicts that unless more focus is given to HIV prevention and routine testing, more people could become infected.

It is 30 years since the first case of HIV was formally diagnosed, and since then there have been several major breakthroughs in medical treatment resulting in longer life expectancy for those infected by the virus.

But some medical experts now believe because of the success of anti viral drugs in prolonging the lives of carriers, it has led to complacency.

HPA figures show that in the last three decades 115,000 people have been diagnosed with HIV in the UK alone, with 27,000 people having gone on to develop full-blown Aids – and 20,000 of those having since died.

We need a complete and wholesome approach to treating HIV and most importantly help prevent its spread – Dr Rupert Whitaker, a long-standing HIV survivor

But what is worrying the medical profession and campaign pressure groups is that, despite all the medical advances over the last three decades, the number of HIV cases in the UK is expected to rise next year to 100,000 and some of those cases will be people who do not yet realise they have been infected by the virus.

Dr Valerie Delpech, Head of HIV surveillance at the HPA, believes widespread testing is urgently needed to help get new cases diagnosed.

“It is so crucial when treating someone who is HIV positive as quickly as possible. That way their lives can be prolonged considerably,” she said.

“Provided someone is tested within the early stages of infection, so they have only had HIV for a short time, and they receive effective medication followed up by effective therapy, then their life expectancy is very good.

“In fact we can safely say HIV is no longer a life threatening illness but a chronic life long condition which if treated correctly can mean people can live to their normal life expectancy.”

LASS are registered for JustTextGiving which enables supporters to make donations of up to £10 by text message.

It’s easy to donate to LASS, and it takes no time at all, simply text: “LASS25 £10″ to 70070.  (You can change the amount of your donation to: £1, £2, £3, £4 or £5 if you prefer) and you’ll receive a text message receipt, and the chance to add Gift Aid by text or in web form.  More details are available from this link.

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HIV Diagnosis Progress Hampered by Inaccurate Online Information

Posted on October 21, 2011 by | Comments Off

Inaccurate and out-of-date online information about HIV is hampering efforts to improve early diagnosis rates, the National Aids Trust (NAT) has warned.

National AIDS Trust have set up HIVaware.org.uk, run in partnership with Durex.The charity carried out an audit of websites featuring information on HIV and other sexual health issues and found that much information was incorrect or out of date.

NAT chief executive Deborah Jack told GPonline.com that information about symptoms in particular was often inaccurate and represented a ‘missed opportunity’ to improve early diagnosis rates.

‘Given that we know that the majority of new infections are from people who are themselves undiagnosed – many of them at an early stage of infection – this is a real missed opportunity to educate people,’ she said.

‘There is no information about what the most common symptoms are what someone should do if they experience symptoms after putting themselves at risk.’

She said websites often stated that many people have no symptoms of HIV infection for years, even though 70%-90% of people have some symptoms during sero-conversion.

HIVaware.org.uk, will also be contacting publishers of inaccurate online information ‘to identify the content that needs updating and make suggestions as to how it can be improved’.

Ms Jack said the most common area where information was out of date is around testing. A number of sites state that laboratories can only test for HIV antibodies, whereas they can now test for antigens and nearly all clinics use these tests, she said.

Websites also inaccurately stated that there is no point in taking a test for at least three months and that patients need to wait for your test to be sent off to a laboratory to get your results, she said. In fact, antigen tests provide accurate results from four weeks after potential infection and point of care tests, which provide results in 20 minutes, are now being used in a number of settings.

Original Article by Tom Moberly at GPOnline.com

Are you interested in having a HIV test?  We offer a completely free and confidential rapid HIV test and you’ll get the results within 60 seconds from a simple finger prick test. We use the Insti HIV test produced by BioLytical laboratories. The test is 99.96% accurate from 90 days post contact for detecting HIV 1 and 2 antibodies. We also have a mobile testing van which is often out in communities providing mobile rapid HIV tests. Appointments are not always necessary, if you would like a test, please contact us on 0116 2559995

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Increase In Life Expectancy for People Living With HIV

Posted on October 12, 2011 by | Comments Off

People with HIV have a 15 years longer life expectancy thanks to improved treatments over the past 13 years, according to a new study published on the British Medical Journal website.

Researchers found that the life expectancy of these patients improved significantly between 1996 and 2008, and that earlier diagnosis and timely treatment can increase life expectancy.   HIV infection has become a chronic disease with a good prognosis if treatment begins sufficiently early in the course of the disease and the patient sticks to antiretroviral treatment. However life expectancy for people with the disease is lower than that of the general population.

Researchers led by Dr Margaret May of the University of Bristol’s School of Social and Community Medicine set out to estimate life expectancy of people treated for HIV infection and compare it with that of the UK general population.

They used data from the UK Collaborative HIV Cohort (UK CHIC) study, which in 2001 began collating routine data on HIV positive people attending some of the UK’s largest clinical centres since January 1996.  Patients included in the analysis were aged 20 years and over and started treatment with antiretroviral therapy with at least three drugs between 1996 and 2008.

The researchers studied data on 17,661 patients, of whom 1,248 (7%) died between 1996 and 2008.   Their analysis shows that life expectancy for an average 20-year-old infected with HIV increased from 30 years to almost 46 between the periods 1996-9 and 2006-8.

The findings also show that life expectancy for women treated for HIV is ten years’ higher than for men. During the period 1996 -2008, life expectancy was 40 years for male patients and 50 years for female patients compared with 58 years for men and nearly 62 years for women in the general UK population.   The point at which a person started treatment had an impact on their life expectancy, as the researchers also found that starting antiretroviral therapy later than guidelines suggest, resulted in up to 15 years loss of life.

Doctors use a test to count the number of CD4 cells in one cubic millimetre of blood. A normal CD4 count in a healthy, HIV-negative adult is usually between 600 and 1,200 CD4 cells/mm3.   The researchers found that life expectancy was 38 years, 41 years and 53 years in those starting antiretroviral therapy with CD4 counts less than 100, 100-199 and 200-350/mm3 cells respectively.

The improvement in life expectancy since 1996 was likely to be due to several factors, they say, including a greater proportion of patients with high CD4 counts, better antiretroviral therapy, more effective drugs, and an upward trend in the UK population life expectancy.

They conclude: “Life expectancy in the HIV-positive population has significantly improved in the UK between 1996 and 2008 and we should expect further improvements for patients starting antiretroviral therapy now with improved modern drugs and new guidelines recommending earlier treatment.  There is a need to identify HIV-positive individuals early in the course of disease in order to avoid the very large negative impact that starting antiretroviral therapy at a CD4 count below 200 cells/mm3 has on life expectancy.”

Dr Mark Gompels, lead clinician and co-author, North Bristol NHS Trust, said “These results are very reassuring news for current patients and will be used to counsel those recently found to be HIV-positive.”   In an accompanying editorial, researchers in Boston argue that, although these gains are encouraging, they have not been seen in everyone with HIV.

Nevertheless, this study “serves as an urgent call to increase awareness of the effectiveness of current HIV treatments in patients and providers,” they say. “In turn this should increase rates of routine HIV screening, with timely linkage to care and uninterrupted treatment. As these factors improve, the full benefits of treatment for all HIV infected people can be realised.”

The study also finds that women with HIV could expect to live a decade longer than men with HIV, perhaps because women are tested for HIV during pregnancy and are likely to start treatment earlier.

The data
  • Data on 17,661 patients, of whom 1,248 (7%) died between 1996 and 2008
  • Life expectancy for the average 20-year-old with HIV increased from 30 to almost 46 years between the periods 1996-9 and 2006-8
  • Life expectancy for women treated for HIV was 10 years’ higher than for men
  • Starting anti-retroviral therapy later than guidelines suggest resulted in up to 15 years’ loss of life
Dr. Anthony Fauci explains how advances in treatment research have dramatically increased the life expectancy for those infected with HIV.

The Terrence Higgins Trust says people at risk should get tested now.  Figures suggest more than 80,000 UK are living with HIV, and about 25% are unaware they have the infection however, it’s good news for people with HIV, their families and friends.

Sir Nick Partridge (CEO of THT) said: “It also demonstrates why it’s so much better to know if you have HIV. Late diagnosis and late treatment mean an earlier grave, so if you’ve been at risk for HIV, get tested now.   Of course, it’s not just length of life that’s important, but quality of life too, and having HIV can still severely damage your life’s chances.   While so much has changed 30 years on from the start of the epidemic, condoms continue to be the best way to protect yourself and your partner from HIV in the first place.”

Are you interested in having a HIV test?  We offer a completely free and confidential rapid HIV test and you’ll get the results within 60 seconds from a simple finger prick test. We use the Insti HIV test produced by BioLytical laboratories. The test is 99.96% accurate from 90 days post contact for detecting HIV 1 and 2 antibodies. We also have a mobile testing van which is often out in communities providing mobile rapid HIV tests. Appointments are not always necessary, if you would like a test, please contact us on 0116 2559995

Original Articles via BBC News and the British Medical Journal

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THT Asks Government to Legalise and Regulate HIV Home Testing Kits

Posted on October 10, 2011 by | Comments Off

Almost two-thirds of people would consider using HIV home testing kits if they were legally available and regulated, according to a survey.

The poll, by Terrence Higgins Trust (THT), comes as the charity urged the Government to legalise and regulate home testing in a bid to cut the number of cases of undiagnosed HIV in the UK.

The sale of HIV home testing kits is currently illegal in the UK. While they can be bought over the internet, THT says they are unregulated, often of poor quality and do not direct users to places where they can get support.

Of 490 people surveyed who have not tested HIV-positive, 63% said they would consider using the kits if they were legalised and 51% thought legalisation would make them test more often.

Among gay men, one of the groups most at risk of HIV in the UK, 60% thought legalisation would make them test themselves more often.

In 2009, 22,200 people were estimated to be living with undiagnosed HIV in the UK.

Lisa Power, policy director for THT, said: “Reducing undiagnosed HIV is a major challenge. A quarter of those with HIV in the UK remain undiagnosed, and so are more likely to pass the virus on. One way to bring this number down is by increasing the opportunities for people to test outside of traditional settings.”

A spokeswoman for the Department of Health said: “We are considering our current policy on HIV home testing and whether we need to repeal the current regulations.

“Key to any repeal will be the availability of a quality-assured testing kit suitable for home use. We are working with the THT and others in taking forward our review.

“HIV testing is widely available from open-access NHS sexual health clinics. Our advice is clear – if you think you might be at risk from HIV, contact your local sexual health service or your GP for a test.”

Original Article by the Press Association

The Terence Higgins Trust policy document: HIV and Sexual Health: 12 things the Government can do was launched a few days ago, at this year’s Conservative Party Conference. The document, which includes a section on home testing, is available to download from here www.tht.org.uk/12things.

Are you interested in having a HIV test?  We offer a completely free and confidential rapid HIV test and you’ll get the results within 60 seconds from a simple finger prick test. We use the Insti HIV test produced by BioLytical laboratories. The test is 99.96% accurate from 90 days post contact for detecting HIV 1 and 2 antibodies. We also have a mobile testing van which is often out in communities providing mobile rapid HIV tests. Appointments are not always necessary, if you would like a test, please contact us on 0116 2559995

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HIV Treatment at 500 CD4 Level Would Put Half of Patients in Need of ART Within a Year of Seroconversion

Posted on September 28, 2011 by | Comments Off

Raising the CD4 cell threshold for the initiation of antiretroviral therapy to 500 cells/mm3 would mean that almost 50% of patients would need to start HIV treatment within a year of their infection with HIV, investigators from an international study of seroconverters report in the October 15th edition of Clinical Infectious Diseases.

A threshold of 350 cells/mm3 would result in approximately a third of patients starting therapy within a year of infection with the virus.

Large numbers of patients with HIV are diagnosed late and the investigators comment: “Our findings provide strong support for public health campaigns to encourage early HIV infection diagnosis and testing.”

US HIV treatment guidelines now recommend that patients should start antiretroviral therapy when their CD4 cell count falls below 500 cells/mm3. European guidelines endorse treatment at a CD4 threshold of 350 cells/mm3, as do World Health Organization (WHO) guidelines for middle- and low-income countries.

The earlier initiation of HIV therapy appears to have several advantages. For instance, the results of observational studies suggest that it reduces the risk of both HIV-related and non-HIV-related illnesses. Moreover, prompt therapy may also have public health benefits, significantly reducing the risk of onward HIV transmission.

But raising the CD4 cell threshold for the initiation of therapy will have cost implications for health systems, many of which are already struggling. An accurate understanding of the length of time between infection with HIV and a fall in CD4 cell count low enough to merit therapy is needed to assist planning.

Investigators from the CASCADE (Using Concerted Action on AIDS and Death In Europe) study analysed the medical records of 18,495 individuals with a known date of HIV seroconversion to predict the amount of time between infection with the virus and a fall in CD4 cell count to below 500, 350 and 200 cells/mm3. They also calculated the proportion of patients who would reach these CD4 cell count thresholds one, two and five years after infection with HIV.

Most of the patients (78%) were men and were infected with HIV through sex with another man (55%). Median age at the time of serconversion was 30 years.

The median length of follow-up was 3.74 years.

According to the investigators’ calculations, median CD4 cell counts one, two and five years after infection with HIV were 510 cells/mm3, 460 cells/mm3 and 315 cells/mm3, respectively.

If guidelines recommended HIV therapy at a CD4 cell count of 500 cells/mm3, then 48% of individuals would need to start treatment within a year of seroconversion. This compared to 26% of patients if the threshold was 350 cells/mm3 and 9% of individuals if the level was 200 cells/mm3.

The estimated median times between seroconversion and a drop in CD4 cell count to below 500, 350 and 200 cells/mm3 were 1.19, 4.19 and 7.93 years respectively.

However, CD4 cell loss differed according to individual patient characteristics. Older age was associated with a lower CD4 cell count at the time of seroconversion and faster loss of CD4 cells during follow-up (p < 0.001). In addition, individuals infected with HIV via injecting drug use or heterosexual contact had a steeper CD4 cell count decrease than gay men (p < 0.001).

The investigators calculated the time between seroconversion and a fall in CD4 cell count to the study thresholds for three groups of patients.

For heterosexual women aged 25 to 30, the median times between seroconversion and a fall in CD4 cell count below 500, 350 and 200 cells/mm3 were 10.71, 5.66 and 1.63 years respectively.

The times for gay men aged 30 to 35 years were 0.95, 3.94 and 7.67 years, and 0.04, 4.08 and 9.15 years for heterosexual men in the same age group.

“These data signify a substantial increase in the number of individuals who require treatment within the first 5 years after becoming infected following the recent changes in [US and WHO] guidelines,” write the authors. “These estimates…will be essential to health care planners estimating the additional costs of increasing the CD4 cell count threshold for cART (combination antiretroviral therapy) initiation.”

The investigations add: “Our data urgently call for a campaign to encourage early HIV testing to ensure that infected individuals receive a diagnosis of HIV infection and access care well before they reach the CD4 cell count threshold at which treatment is indicated.”

Original Article by Michael Carter at NAM

The following video features an excellent 3D animation which explains the HIV replication process very clearly.  Available from Dr Rufus Rajadurai YouTube page

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Mobile Testing Units Show Success in Linking People to HIV Care

Posted on September 23, 2011 by | Comments Off

Linkage to facility-based HIV care from a mobile testing unit is feasible, South African researchers report in the advance online edition of the Journal of Acquired Immune Deficiency Syndromes.

In a stratified random sample of 192 newly diagnosed individuals who had received CD4 test results, linkage to care was best among those who were ART eligible, Darshini Govindasamy and colleagues found.

The lower the CD4 cell count the greater the linkage to care: all of those with CD4 counts at or under 200 cells/mm3, two-thirds of those with CD4 counts of 201-350 cells/mm3 and a third of those with CD4 counts over 350 cells/mm3 linked to care.

An estimated two million people died as a result of HIV/AIDS in sub-Saharan Africa in 2008. South Africa now has the largest ART programme in the world, yet half of those in need of treatment do not get it. And a large number of those who do present for care, present late with low CD4 cell counts increasing their risk of early death.

In South Africa traditional HIV counselling and testing (HCT) sites at stationary facilities have increased and consequently so have the numbers tested. Yet this has not resulted in increased numbers on treatment and in care.

Transport costs, being male and having a low CD4 cell count have been well documented as the primary barriers of non-linkage to care.

Successful early diagnosis of HIV has to be accompanied by strategies that assure timely linkage to care and treatment so improving health outcomes.

Mobile testing units offer several advantages: people are often tested at an earlier stage of HIV; it is easier for hard-to-reach and high-risk populations to test; and they are cost-effective. However, maintaining on-going HIV care may prove difficult, requiring referral to stationery facilities.

The authors note no studies have looked at the performance of mobile testing units in linking people diagnosed with HIV to care at public health facilities.

The authors chose to look at whether disease progression as defined by CD4 cell count had an effect on access to care and the associated barriers in a nurse-run, counsellor-supported mobile testing unit.

From August 2008 until December 2009 those diagnosed for the first time with HIV were identified retrospectively from the mobile unit records. Those who got a CD4 cell count were prospectively followed from April to June 2010 to determine linkage to HIV care.

The unit, in the Cape Metropolitan region, Western Cape, South Africa, provides free HCT services to underserved communities.

Along with free client-initiated HCT free screening for other chronic conditions including high blood pressure, diabetes and obesity as well as TB is offered. The population is predominantly black Xhosa-speaking Africans.

Following rapid testing and a positive result and CD4 testing individuals are given detailed referral letters to help their access to care. Individuals are called when results of CD4 counts are available (within 72 hours). Those with no contact number are followed up by home visit or letter. Counselling is provided and patients are encouraged to go to clinics for either pre-ART care or to start ART as appropriate.

Of the 6738 records, overall prevalence of new diagnosis was 6.9% (463), of which 376 met the study’s inclusion criteria.

Because of a higher proportion of patients with CD4 counts at or above 350 cells/mm3 the authors took one-third of patients from this cohort (76), together with all 36 individuals with CD4 cell counts at or below 200 cells/mm3, and the 80 patients with CD4 counts between 201 and 350 cells/mm3.

Of the sample 27% (43) did not get their CD4 test result. Being female, having a CD4 cell count at or under 350 cells/mm3 and having a cellphone improved the likelihood of getting a CD4 count result. These results echo recent studies in South Africa showing a high loss to follow-up prior to receiving a CD4 test result; highlighting the critical need for point of care CD4 testing in both mobile and stationary facilities.

Of the 145 (73%) remaining individuals 10 refused to participate and 56 could not be traced in spite of previously having been contacted and receiving their CD4 counts.

52.5% (49) linked to care, including 100% of those ART-eligible. While the sample size is small, note the authors, the results are considerably higher than in studies of stationary facilities, where rates of post-diagnosis linkage to care varied from 30% to 80% among the ART-eligible.

Over 70% said that the mobile unit’s referral letter helped them access care at a public health facility.

Nonetheless over 30% of those eligible to start ART still had not started two months after their diagnosis but were still in the ART screening process. These results support other studies in sub-Saharan Africa also showing a delay in starting ART after diagnosis.

Having a higher CD4 count, no TB symptoms, not having disclosed and being employed increased the risks of not accessing care.

Not being able to access public health facilities was the most common barrier reported (41%) to linking to care. Other barriers included: 13% worried about ART toxicity and side effects and 9% fearing stigma and disclosure.

Extending hours and opening on the weekends at public facilities and setting up workplace programmes with mobile units could improve linkage to care for the employed, note the authors.

Limitations include the small sample size; the inability to track over 40% of eligible study participants in spite of persistent follow-up so potentially biasing the findings; and incorrect contact information. The study was undertaken 6-18 months after HIV diagnosis makingfollow-up especially challenging.

Strengths include validation of self-reported linkage to HIV care; trained bilingual counsellors assured minimal respondent bias; no incentives were given for participation.

The authors note HIV services at the mobile unit and public health facilities were free so their findings can be generalised to similar settings.

The authors conclude that while linkage to care was best among those ART-eligible, there is an urgent need to design interventions to improve linkage to care for the employed.

Original Article by Carole Leach-Lemens at Nam

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LASS offer a completely free and confidential rapid HIV test and you’ll get the results within 60 seconds from a simple finger prick test.  We use the Insti HIV test produced by BioLytical laboratories.  The test is 99.96% accurate from 90 days post contact for detecting HIV 1 and 2 antibodies.  We also have a mobile testing van which is often out in communities providing mobile rapid HIV tests.  Appointments are not always necessary, if you would like a test, please contact us on 0116 2559995

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LASS – An Investors in People Organisation

Posted on September 20, 2011 by | 1 Comment


  • Excellent strategy, well communicated.
  • Excellent and trusted leadership.
  • Excellent coaching and mentoring across the organisation.

These are just three of the positive statements used to describe Leicestershire AIDS Support Services by Investors in People after our recent assessment.  We are proud to announce that we are now officially recognised as an investor in people organisation.

Three years ago, LASS underwent a diagnostic review against the Investors in People Standard. The findings have been used to help shape a series of changes in support of a strategic review, implemented by our Chief Executive Officer, Jenny Hand.

The revised strategy has made a significant difference to LASS, both in direction and culturally.  Work has been done to create robust performance measures and to improve communications.  As a result there is clear understanding amongst staff and volunteers of the strategic direction of LASS and there is close co-operation and support between departments.

Within the past three years, we have also set up Well For Living, a Social Enterprise in order to expand beyond our current boundaries and to generate income that is not dependent on Government or local authority funding streams.

In order to achieve Investors in People accreditation, LASS was required to meet 39 mandatory evidence requirements which we did and three more in addition.

We are committed to Investors in People because people are at the heart of everything that we do, our success depends on employees, volunteers, service users and members alike.  We chose Investors in People because the framework for accreditation is focused on engagement with people, training and development, and communication.

We are keen to maintain a high standard of work and ensure our employees and volunteers continually work toward professional development.  Investors in People have national credibility and their revised standard really reflects the needs of a charity such as LASS.

During the last three years the changes to the organisation have meant a significant investment in people development. Our strategy has laid down a clear direction and focus for us and, with the training and development, has enabled staff and volunteers to be confident in influencing how our services are delivered.  For example In 2009 LASS successfully introduced a rapid HIV testing programme that can be administered confidentially on site at The Michael Wood Centre, or via our mobile testing which is taken out to communities.

Many of our staff and volunteers are involved in helping people rebuild their lives once they have been diagnosed as HIV positive. This requires a great deal of positive thinking and encouragement and the same skills are utilised in supporting each other.

We have become a top performing voluntary organisation and were recently shortlisted for “National Charity of the Year 2011” competing against large national charities.  We were recognised by the Charities Aid Foundation as:
“One of the best charities in the Country; a small charity punching well above its weight.”

Investment in staff and volunteer development has been a crucial factor in helping the organisation become so successful. We still have to resolve difficulties in getting to those `hard to reach` areas, but we are very creative and recently held a football tournament where we were able to provide rapid HIV tests to people who would not normally come forward for testing.

Our volunteers have also created an advert promoting the value of knowing your HIV status and this informs the audience using 15 languages.  It’s this work that got us nominated to the Charity Awards this year and a lasting “Highly Commended” status from them.  We always look for opportunities to improve, and welcome ideas and feedback.

Investors in People is an assessment to good standards and working practice.  We believe we can continue to “punch above our weight” and we welcome the opportunity to do so, right now and in the future.

We thank our many volunteers, service users and partner organisations who had a part to play in ensuring we continually improve and perform well.

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Door-To-Door Compulsory HIV Testing on the Table

Posted on September 14, 2011 by | 2 Comments

The Zimbabwe government says it is considering drastic measures of door-to-door HIV testing campaigns for every citizen in the country in a move to try and eliminate new HIV infections.

This has been revealed by Health and Child Welfare minister, Dr Henry Madzorera.

He spoke on Thursday at the closing ceremony of the four-day second national conference on HIV and Aids held in Harare.

“This conference marks a significant milestone in ending this global injustice and the beginning of the road for Zimbabwe to reach the target of reducing MTCT (mother-to-child transmission) to less than five percent by 2015. We must actively promote HIV testing and counselling until every Zimbabwean knows their HIV status. This is the starting point of elimination. With the need for each of us to know their HIV status, we must be innovative and embrace new approaches such as the know your HIV status campaigns through door-to door testing,” he said.

Dr Madzorera said all pregnant women should have access to antenatal care, HIV testing and counselling.

Speaking to journalist after the conference, Dr Madzorera said the door-to-door campaign strategy was a way forward in eliminating HIV and Aids.

“The way we test HIV should be (like) the way we test malaria and other diseases. When we get to that stage, then we will conquer,” he said.

The director of the TB and Aids unit in the Ministry of Health and Child Welfare Dr Owen Mugurungi said the nation should be brave enough, innovative and accept strategies like the door-to-door testing.

Speaking in June, at the United Nations General Assembly High Level Meeting on HIV & AIDS, Dr. Henry Madzorera, Zimbabwe’s Minister of Health & Child Welfare highlighted Zimbabwe’s achievements in the fight against HIV/AIDS over the years,  the current status of HIV/AIDS in Zimbabwe, and the challenges that still remain ahead.

Dr. Madzorera indicated that due to the Zimbabwe government’s commitment towards fighting HIV/AIDS, HIV prevalence had dropped from a high of over 29% in 1999, to the current level of 13.7%.  The decline in prevalence has also been accompanied by a decline in incidence.  He also highlighted Zimbabwe’s progress thus far towards achieving universal access to HIV/AIDS resources, noting that the country now provides 77% coverage for the nearly 593 000 Zimbabweans in need of various HIV/AIDS resources and services.

Zimbabwe recently adopted the new World Health Organization treatment guidelines which recommend starting antiretroviral therapy (ART) at CD4 counts of 350, instead of the previous 200.  Adoption of this new standard meant an immediate rise in the number of people in need of treatment.

Dr. Madzorera pointed out that Zimbabwe has seen an increase in access to care for children, with the number of children accessing ARV drugs doubling in the past two years alone.

After crediting Zimbabwe’s  home-grown multi-currency financial environment for recent progress made in the purchase of antiretroviral drugs, CD4 counti machines, HIV test kits, blood its, and the funding of outreach campaigns, Dr. Madzorera pointed out that the country’s pursuit of universal access to care and services for its HIV/AIDS patients is set to benefit from the recently developed results-based Zimbabwe National HIV and AIDS Strategic Plan for 2011 to 2015 (ZNASP II).  Dr. Madzorera pointed that amongst other things, the plan prioritizes Prevention of Mother to Child Transmission (PMTCT) as well as Male circumcision (MC).

Original Articles (including a full 3 hour video webcast) from Zimdiaspotra.com and Hivaidszimbabwe.org

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Lords Warn About “Woefully Inadequate Government Policies On HIV/AIDS

Posted on September 1, 2011 by | 1 Comment

A House of Lords Select Committee today published a damning report on HIV in the UK, warning that the current priority given to HIV and Aids treatment by policy makers is ‘woefully inadequate’, and revealing that over 100,000 people in the UK will be living with the disease by next year. The Lords Select Committee on HIV and Aids in the UK also warned that the total cost of treatment would soon top £1 billion per year, and called for all new patients at GPs’ surgeries to be tested for the illness on an opt-out basis.

As the Select Committee published its report, the Terrence Higgins Trust (THT) released a new plan to help policy makers deal more effectively with HIV. THT said that the plan, ‘Tackling the Spread of HIV in the UK’, would help to bring down the disease’s transmission, and reduce the financial burden on the NHS by concentrating on four actions: halving undiagnosed and late diagnosed infections within three years; increasing the number of people living with HIV taking effective treatment from half to two-thirds in three years; identifying people who persistently take risks that expose them to HIV, and supporting them to change; and increasing HIV awareness.

The Terrence Higgins Trust said it would continue to campaign within the gay community.

THT’s Executive Director of Health Improvement, Genevieve Edwards, told So So Gay she was sure that it was possible to reduce transmission by improving early diagnosis and awareness. ‘Increasing the number of people on treatment is quite do-able, if you think that a quarter of people with HIV aren’t diagnosed,’ she said. ‘Many of those people have already gone past the point at which they should receive treatment. If we can start people on the right treatment sooner, that would go an awfully long way to achieving the target.’

Edwards welcomed the Lords’ recommendation that new patients at GPs’ clinics should be tested on an opt-out basis, especially in areas where infection is more common. ‘This has been done in ante-natal screening, and that’s been one of the big successes in the UK. Very few babies are born with HIV as a result of that campaign, because women who are diagnosed with HIV during pregnancy can be offered the right sort of treatment. So when you’re in an area of high HIV prevalence, this makes sense.’

The Lords Select Committee launched its report to coincide with the 25th anniversary of the iconic ‘Don’t Die of Ignorance’ campaign, which was run by the Committee’s Chairman, Lord Fowler – as the then Health Secretary. As the report was published, Fowler pointed out that although HIV was now more survivable than it was in the 1980s, it remained a serious problem and not enough was being done to improve awareness; one recent survey had found that a quarter of young people had received no information about HIV in the classroom.

‘In the last 25 years the development of new drugs has dramatically reduced the death toll,’ he said. ‘But that should not encourage a false sense of security. Serious medical and mental health problems remain for many with HIV. People can now live with HIV, but all of those infected would prefer to be without a disease which can cut short life and cast a shadow over their everyday life.’

Edwards echoed Fowler’s warning about the consequences of infection, but warned against a return to ‘Don’t Die of Ignorance’ style scare tactics. ‘Our evidence shows that scare tactics – not just for HIV, incidentally, but for all public health areas – don’t work. People tend to look away, or immediately think it’s aimed at someone else. So while that sort of direct campaign in the 1980s was hugely influential, it wouldn’t have the same impact today. We’ve learned that we need to find different ways to get that message across.

‘Of course, we have to be absolutely clear about the reality of living with HIV in the UK. Treatments have come a long way, and they’re enormously better than they were. But it’s not without consequence. I think we’re very clear about that. On the one hand, you don’t want to scaremonger; but you have to balance that against being honest about the realities.’

Fowler agreed, and said that improved treatment alone would not help. ‘Prevention must be the key policy,’ he added. ‘One essential message remains the same as in the 1980s: the more the partners, the greater the risk. Protect yourself. Use a condom.’

Original Article by Andy Wasley at sosogay.org

LASS offer a completely free and confidential rapid HIV test and you’ll get the results within 60 seconds from a simple finger prick test.  We use the Insti HIV test produced by BioLytical laboratories.  The test is 99.96% accurate from 90 days post contact for detecting HIV 1 and 2 antibodies.  Appointments are not always necessary, if you would like a test, please contact us on 0116 2559995

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