The document discusses the need to scale up rapid HIV testing in order to meet UNPD targets and increase testing coverage, as current testing rates among at-risk groups like MSM are low. It reviews evidence that rapid HIV testing can increase testing rates and yield higher proportions of undiagnosed cases. The document also examines issues around introducing rapid HIV testing services and the policy changes needed to support expanded access to rapid testing.
Optimal HIV testing strategies to achieve high levels of HIV diagnosis in Sou...Carmen Figueroa
This document discusses optimal HIV testing strategies to achieve high levels of HIV diagnosis in South Africa. It summarizes that while South Africa has made progress towards diagnosing 90% of HIV cases by 2020, testing gaps remain, particularly for men, youth, and key populations. The document outlines using an agent-based model to assess the efficiency and cost-effectiveness of various testing strategies, such as home-based testing, mobile testing, and targeted testing of sex workers and partners of diagnosed individuals. Preliminary findings suggest strategies like assisted partner notification and testing sex workers and men who have sex with men could be highly cost-effective in increasing diagnoses and reducing undiagnosed cases.
This presentation on research about HIV self-testing in Australia was given by A/Prof Rebecca Guy, The Kirby Institute, at the AFAO Members Forum - May 2015.
Representatives from the Philadelphia Department of Public Health (PDPH) presented an update on their strategic plan for sexual health at the February 2015 meeting of the Philadelphia Ryan White Part A Planning Council.
Cost of testing per new HIV diagnosis as a metric for monitoring cost-effecti...Carmen Figueroa
This document analyzes the cost-effectiveness of additional HIV testing programs in southern Africa beyond core testing through mathematical modeling. It finds that using the cost-per-new-HIV-diagnosis as a metric, additional testing programs for men are likely cost-effective if the cost is below $585 per diagnosis. However, additional testing programs for women are unlikely to be cost-effective. The analysis is based on simulating 1000 scenarios of HIV epidemics and testing programs in southern Africa to examine outcomes and costs over 50 years.
Health-related effects of government tobacco control policies: What's the evi...Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control on health-related outcomes. Click here for access to the audio recording: https://youtu.be/oMBERrVazGY
Steven J. Hoffman, Director of Global Strategy Lab and Associate Professor of Law at the University of Ottawa and Charlie Tan, MD Candidate, Michael G. DeGroote School of Medicine, McMaster University, led the session and presented findings from their latest BMC Public Health review:
Hoffman SJ, & Tan C. (2015). Overview of systematic reviews on the health-related effects of government tobacco control policies. BMC Public Health, 15(744).
The global tobacco epidemic is a major public health problem that continues to deepen, with nearly 1 billion smokers worldwide in 2012. Government interventions are critical to addressing the global tobacco epidemic as it is the leading cause of preventable death, resulting in approximately 6 million unnecessary deaths per year. This review examines the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control (FCTC), supporting the implementation of this international treaty on the tenth anniversary of it entering into force. This webinar highlighted factors that contribute to the effectiveness of government tobacco control policies as well as implications for practice.
Reducing sitting time at work: What's the evidence?Health Evidence™
Health Evidence hosted a 60 minute webinar examining the effectiveness of workplace interventions for reducing sitting at work. Click here for access to the audio recording for this webinar: https://youtu.be/psmac6jkbMM
Dr. Nipun Shrestha, MBBS, MPH, Postgraduate Student at Victoria University led the session and presented findings from his recent Cochrane review:
Shrestha N, Kukkonen-harjula KT, Verbeek JH, Ijaz S, Hermans V, & Bhaumik S. (2016). Workplace interventions for reducing sitting at work. Cochrane Database of Systematic Reviews, 2016(3), Art. No.: CD010912.
http://healthevidence.org/view-article.aspx?a=workplace-interventions-reducing-sitting-work-28404
Office work has become sedentary in nature. Increased sitting has been linked to increase in cardiovascular disease, obesity and overall mortality. This review examines the impact of workplace interventions to reduce sitting at work. Two cross-over randomized control trials, 11 cluster randomized trials and 4 controlled before-and-after studies, including 2180 participants are included in this review. Findings suggest that sit-stand desks may decrease workplace sitting. This webinar examined the effectiveness and components of interventions that reduce sitting at work.
Optimal HIV testing strategies to achieve high levels of HIV diagnosis in Sou...Carmen Figueroa
This document discusses optimal HIV testing strategies to achieve high levels of HIV diagnosis in South Africa. It summarizes that while South Africa has made progress towards diagnosing 90% of HIV cases by 2020, testing gaps remain, particularly for men, youth, and key populations. The document outlines using an agent-based model to assess the efficiency and cost-effectiveness of various testing strategies, such as home-based testing, mobile testing, and targeted testing of sex workers and partners of diagnosed individuals. Preliminary findings suggest strategies like assisted partner notification and testing sex workers and men who have sex with men could be highly cost-effective in increasing diagnoses and reducing undiagnosed cases.
This presentation on research about HIV self-testing in Australia was given by A/Prof Rebecca Guy, The Kirby Institute, at the AFAO Members Forum - May 2015.
Representatives from the Philadelphia Department of Public Health (PDPH) presented an update on their strategic plan for sexual health at the February 2015 meeting of the Philadelphia Ryan White Part A Planning Council.
Cost of testing per new HIV diagnosis as a metric for monitoring cost-effecti...Carmen Figueroa
This document analyzes the cost-effectiveness of additional HIV testing programs in southern Africa beyond core testing through mathematical modeling. It finds that using the cost-per-new-HIV-diagnosis as a metric, additional testing programs for men are likely cost-effective if the cost is below $585 per diagnosis. However, additional testing programs for women are unlikely to be cost-effective. The analysis is based on simulating 1000 scenarios of HIV epidemics and testing programs in southern Africa to examine outcomes and costs over 50 years.
Health-related effects of government tobacco control policies: What's the evi...Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control on health-related outcomes. Click here for access to the audio recording: https://youtu.be/oMBERrVazGY
Steven J. Hoffman, Director of Global Strategy Lab and Associate Professor of Law at the University of Ottawa and Charlie Tan, MD Candidate, Michael G. DeGroote School of Medicine, McMaster University, led the session and presented findings from their latest BMC Public Health review:
Hoffman SJ, & Tan C. (2015). Overview of systematic reviews on the health-related effects of government tobacco control policies. BMC Public Health, 15(744).
The global tobacco epidemic is a major public health problem that continues to deepen, with nearly 1 billion smokers worldwide in 2012. Government interventions are critical to addressing the global tobacco epidemic as it is the leading cause of preventable death, resulting in approximately 6 million unnecessary deaths per year. This review examines the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control (FCTC), supporting the implementation of this international treaty on the tenth anniversary of it entering into force. This webinar highlighted factors that contribute to the effectiveness of government tobacco control policies as well as implications for practice.
Reducing sitting time at work: What's the evidence?Health Evidence™
Health Evidence hosted a 60 minute webinar examining the effectiveness of workplace interventions for reducing sitting at work. Click here for access to the audio recording for this webinar: https://youtu.be/psmac6jkbMM
Dr. Nipun Shrestha, MBBS, MPH, Postgraduate Student at Victoria University led the session and presented findings from his recent Cochrane review:
Shrestha N, Kukkonen-harjula KT, Verbeek JH, Ijaz S, Hermans V, & Bhaumik S. (2016). Workplace interventions for reducing sitting at work. Cochrane Database of Systematic Reviews, 2016(3), Art. No.: CD010912.
http://healthevidence.org/view-article.aspx?a=workplace-interventions-reducing-sitting-work-28404
Office work has become sedentary in nature. Increased sitting has been linked to increase in cardiovascular disease, obesity and overall mortality. This review examines the impact of workplace interventions to reduce sitting at work. Two cross-over randomized control trials, 11 cluster randomized trials and 4 controlled before-and-after studies, including 2180 participants are included in this review. Findings suggest that sit-stand desks may decrease workplace sitting. This webinar examined the effectiveness and components of interventions that reduce sitting at work.
Partners Demonstration Project - HIV self testing update - Feb 2015SlidesShare_Foxtrot
The Partners Demonstration Project is studying the use of antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) to prevent HIV among heterosexual couples in Kenya and Uganda. An ancillary study is evaluating the acceptability of HIV self-testing among individuals using PrEP in Kenya. Preliminary findings show high uptake of self-testing, with 96% of expected tests reported as used. Qualitative feedback indicates self-testing reduces anxiety and empowers individuals. Continued research will provide more data on experiences with self-testing and its potential as a cost-effective component of PrEP programs.
Operational research to increase the efficiency of ART initiation in AfricaSydney Rosen
RapIT tested a single-visit ART initiation approach that significantly increased the proportion of patients starting ART within 90 days compared to standard of care. However, it relied on expensive point-of-care tests. SLATE aims to evaluate a simplified algorithm without these tests to determine immediate ART eligibility and initiate treatment in a single visit, with the goals of increasing prompt ART uptake and evaluating its costs and patient outcomes compared to standard care. If successful, SLATE could help standardize a fast, effective, and low-cost ART initiation model to strengthen the testing to treatment cascade.
The document summarizes Peel Public Health's journey towards becoming more evidence-informed in decision making. It outlines how they initially lacked library services and staff skills in finding and applying research evidence. Over two years, they improved library services and provided training to build capacity. This included hiring librarians, gaining access to databases, and promoting pre-appraised research evidence sources like Health-Evidence.ca to help staff apply evidence more efficiently. The document provides examples and resources to help other organizations on their similar evidence-informed decision making journeys.
Decision aids for people facing health treatment or screening decisions: What...Health Evidence™
This webinar discussed a Cochrane review on the effectiveness of patient decision aids. It found that compared to usual care, decision aids improve patient knowledge by 13%, accuracy of risk perceptions by 82%, and the match between patient values and the health choices made by 51%. Decision aids may also reduce the use of discretionary treatments or screening by up to 20% and 14% respectively. While decision aids are effective, they are not being widely used in practice. The webinar provided an overview of the evidence on decision aids and highlighted their potential for improving shared decision making.
The Kenya HIV Testing Services Guidelines 2015Cheryl Johnson
The document provides guidelines for HIV Testing Services in Kenya. It outlines the background of HIV testing in Kenya since the first diagnosis over 30 years ago. It notes that testing approaches have evolved from expensive laboratory tests requiring complex procedures to more simplified point-of-care testing kits, resulting in more Kenyans knowing their status. The guidelines aim to ensure quality services are provided to all clients accessing health facilities for HIV services. It emphasizes updated guidance on HIV Testing Services in line with current knowledge and the country's 90-90-90 strategy to identify people living with HIV so they can access treatment.
HIV self-testing among transgender women in San Francisco - a pilotCheryl Johnson
This pilot study explored the acceptability and feasibility of HIV self-testing among 50 transgender women in San Francisco. The results showed that HIV self-testing was found to be feasible and acceptable, with 88% returning for a follow up at least once and 72% returning at 3 months. Participants reported that using the self-test kits was easy and the instructions were clear. However, the women noted that the current price of self-test kits is too high and free or low-cost options would be needed to make self-testing a realistic option. There was also interest in enhancing opportunities for partner testing and linking self-testing to social and resource support.
This document provides an agenda and overview for the HSG 2016 conference. It summarizes the conference attendance numbers, recognizes sponsors and award recipients, and thanks outgoing and welcomes new board members. It highlights the HSG's strategic plan and 2016 accomplishments including clinical trials. Speakers discuss the future of HD care including education, coordinated care models, and improving access. The future of HD clinical trials is outlined including new recruitment strategies, quantitative disease models, virtual visits, objective measures, digital biomarkers from smartphones, and the need for new measurement classes.
This presentation was given at the Global Symposium on Health System Research in November 2010. The authors are L P Singh, Olakunle Alonge, Anubhav Agarwal,
Kayhan Natiq, S D Gupta and David Peters.
Where are we on HIV testing services - the achievements and the gapsCheryl Johnson
This document discusses achievements and gaps in HIV testing services globally. It finds that approximately 17 million people with HIV still do not know their status, and linkage to treatment after testing is suboptimal. While over 150 million people received HIV testing in 2014, nearly half of all people with HIV remain undiagnosed globally, with lower testing rates among men, adolescents, and key populations. The document calls for new approaches to testing like self-testing and lay providers, as well as improving quality, coverage, and focus on missing populations and areas with ongoing high risk.
HIV self-testing and linkage in Africa. The document summarizes a presentation on HIV self-testing research in Africa. It discusses (1) the need for HIV self-testing in Africa due to low testing rates and knowledge of HIV status, (2) completed and ongoing studies of HIV self-testing in various African countries, and (3) priorities for future research including improving accuracy, evaluating new models for linkage to care, and assessing implementation in different populations and settings.
1) HIV self-testing has potential to increase testing among men who have sex with men (MSM) by providing privacy and convenience. However, questions remain about its impact on linkage to care, risk behavior, and accuracy.
2) Studies show high acceptability of HIV self-testing among MSM, but optimal distribution methods and support for interpretation and counseling are still unclear.
3) While early research found little evidence of harm, more data is needed on how self-testing may influence sexual behavior and accuracy given the test's window period. Effective instruction and support strategies could help address these issues.
Improving the HIV Cascade of Services in VietnamSC SC
The document discusses Vietnam's response to the HIV epidemic and improving their cascade of services. It outlines Vietnam's cascade and findings from provincial rapid assessments. Key findings include that many PLHIV are not seeking testing or linking to care after testing positive, ART initiation is not growing in many sites, and coordination of services is fragmented. The cascade framework is being used to identify gaps where interventions can have the most impact, like increasing testing and linkage to care and reducing viral loads through sustained ART. Investments in applying the cascade approach at local levels can substantially improve the performance of Vietnam's HIV response system.
Thailand experiences on PrEP and HIV self-testingCheryl Johnson
Thailand has piloted PrEP and HIV self-testing programs targeting at-risk groups. PrEP is available through research studies and hospitals on a self-pay basis, though challenges remain around registration and inclusion in national healthcare. Several PrEP demonstration projects have enrolled hundreds of MSM and transgender individuals. HIV self-testing research includes an online counseling and supervised self-testing program, as well as oral fluid testing pilots, but legal and test kit issues remain regarding over-the-counter use in Thailand. Overall the document outlines Thailand's experiences with emerging HIV prevention methods.
John de Wit, (NCHSR) argues that strengthening HIV prevention approaches will benefit significantly from drawing on behaviour change science. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
Innovations in Community-based Diagnosis and Treatment of Acute Malnutrition ...CORE Group
This document summarizes a research study conducted in Aweil South County, South Sudan to assess whether community health workers with low literacy could effectively treat severe acute malnutrition (SAM) using simplified tools and protocols. The study found that the health workers were able to implement the protocol and treat 310 malnourished children in the community with 75.6% cured and treatment outcomes meeting international standards. This demonstrates that with appropriate training and adapted tools, low-literacy community health workers can successfully treat uncomplicated SAM cases in their communities.
This document summarizes a study enhancing HIV care and treatment for people who inject drugs in Kenya. The study uses respondent-driven sampling to identify people who inject drugs for rapid HIV testing and point-of-care CD4 testing. Those with CD4 counts under 350 are linked to antiretroviral therapy through peer case managers. The study aims to evaluate this intervention, model its impact on community viral load, and assess its cost-effectiveness. Preliminary results show the combination of rapid testing and point-of-care CD4 testing effectively identifies HIV-positive people who inject drugs and links them to treatment. Linkage to care through peer case managers has proven very effective for initiating antiretroviral therapy.
Cost-effectiveness of an early awareness campaign for colorectal cancerEEPRU
1) A cost-effectiveness analysis was conducted on an early awareness campaign for colorectal cancer using data from a pilot campaign in England. The campaign was estimated to lead to an increase in colorectal cancer diagnoses and a decrease in cancer deaths, but also increased costs to the healthcare system.
2) A mathematical model predicted that over a lifetime, the campaign would result in 404 additional quality-adjusted life years at an incremental cost-effectiveness ratio of £13,496 per QALY gained compared to no campaign.
3) Uncertainty analysis found the cost-effectiveness was sensitive to assumptions about the duration and magnitude of increased symptomatic presentation following the campaign. Further research is needed on the long-
The document discusses using HIV program data to evaluate gaps and disparities in linkage to care. It provides examples of how Louisiana measures linkage, retention, and viral suppression, and presents continuum of care data for the state overall and by region, race/ethnicity, and testing site. Linkage to care rates for newly diagnosed individuals are shown to be improving over time but still vary between regions and community-based organizations. The document encourages evaluating one's own agency's linkage data and identifying opportunities for the State HIV Program to provide more useful data support.
This document proposes a clinical trial to evaluate the accuracy of the QikTech One-Step HIV I/II/O Saliva Test compared to a conventional blood test. The trial would enroll 250+ individuals across medical centers in Tijuana, Mexico. Participants would receive both tests, and positive results would undergo further confirmatory testing. If found to be accurate, the saliva test could provide a simpler alternative for HIV screening in Mexico and be commercialized in the country. The proposed trial outlines inclusion criteria, sample collection processes, testing procedures, statistical analysis plans, and anticipated outcomes of increased access to rapid and flexible HIV detection tools.
LT Labs (STD Rapid Test) delivers home HIV test kits to worldwide consumers those are highly reliable and quality tested and authenticated. Check : http://stdrapidtest.com
This document provides information about HIV testing and the implications of test results. It discusses the various types of HIV tests including rapid tests, ELISA, and Western blot. A positive test result means antibodies to HIV have been detected, while a negative result means antibodies were not detected, though the person could still be in the window period. Interpretation of results and the need for counseling before and after testing is emphasized. Symptoms of infection and potential complications are outlined. Treatment involves antiretroviral drugs to suppress the virus and medications to prevent opportunistic infections.
Partners Demonstration Project - HIV self testing update - Feb 2015SlidesShare_Foxtrot
The Partners Demonstration Project is studying the use of antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) to prevent HIV among heterosexual couples in Kenya and Uganda. An ancillary study is evaluating the acceptability of HIV self-testing among individuals using PrEP in Kenya. Preliminary findings show high uptake of self-testing, with 96% of expected tests reported as used. Qualitative feedback indicates self-testing reduces anxiety and empowers individuals. Continued research will provide more data on experiences with self-testing and its potential as a cost-effective component of PrEP programs.
Operational research to increase the efficiency of ART initiation in AfricaSydney Rosen
RapIT tested a single-visit ART initiation approach that significantly increased the proportion of patients starting ART within 90 days compared to standard of care. However, it relied on expensive point-of-care tests. SLATE aims to evaluate a simplified algorithm without these tests to determine immediate ART eligibility and initiate treatment in a single visit, with the goals of increasing prompt ART uptake and evaluating its costs and patient outcomes compared to standard care. If successful, SLATE could help standardize a fast, effective, and low-cost ART initiation model to strengthen the testing to treatment cascade.
The document summarizes Peel Public Health's journey towards becoming more evidence-informed in decision making. It outlines how they initially lacked library services and staff skills in finding and applying research evidence. Over two years, they improved library services and provided training to build capacity. This included hiring librarians, gaining access to databases, and promoting pre-appraised research evidence sources like Health-Evidence.ca to help staff apply evidence more efficiently. The document provides examples and resources to help other organizations on their similar evidence-informed decision making journeys.
Decision aids for people facing health treatment or screening decisions: What...Health Evidence™
This webinar discussed a Cochrane review on the effectiveness of patient decision aids. It found that compared to usual care, decision aids improve patient knowledge by 13%, accuracy of risk perceptions by 82%, and the match between patient values and the health choices made by 51%. Decision aids may also reduce the use of discretionary treatments or screening by up to 20% and 14% respectively. While decision aids are effective, they are not being widely used in practice. The webinar provided an overview of the evidence on decision aids and highlighted their potential for improving shared decision making.
The Kenya HIV Testing Services Guidelines 2015Cheryl Johnson
The document provides guidelines for HIV Testing Services in Kenya. It outlines the background of HIV testing in Kenya since the first diagnosis over 30 years ago. It notes that testing approaches have evolved from expensive laboratory tests requiring complex procedures to more simplified point-of-care testing kits, resulting in more Kenyans knowing their status. The guidelines aim to ensure quality services are provided to all clients accessing health facilities for HIV services. It emphasizes updated guidance on HIV Testing Services in line with current knowledge and the country's 90-90-90 strategy to identify people living with HIV so they can access treatment.
HIV self-testing among transgender women in San Francisco - a pilotCheryl Johnson
This pilot study explored the acceptability and feasibility of HIV self-testing among 50 transgender women in San Francisco. The results showed that HIV self-testing was found to be feasible and acceptable, with 88% returning for a follow up at least once and 72% returning at 3 months. Participants reported that using the self-test kits was easy and the instructions were clear. However, the women noted that the current price of self-test kits is too high and free or low-cost options would be needed to make self-testing a realistic option. There was also interest in enhancing opportunities for partner testing and linking self-testing to social and resource support.
This document provides an agenda and overview for the HSG 2016 conference. It summarizes the conference attendance numbers, recognizes sponsors and award recipients, and thanks outgoing and welcomes new board members. It highlights the HSG's strategic plan and 2016 accomplishments including clinical trials. Speakers discuss the future of HD care including education, coordinated care models, and improving access. The future of HD clinical trials is outlined including new recruitment strategies, quantitative disease models, virtual visits, objective measures, digital biomarkers from smartphones, and the need for new measurement classes.
This presentation was given at the Global Symposium on Health System Research in November 2010. The authors are L P Singh, Olakunle Alonge, Anubhav Agarwal,
Kayhan Natiq, S D Gupta and David Peters.
Where are we on HIV testing services - the achievements and the gapsCheryl Johnson
This document discusses achievements and gaps in HIV testing services globally. It finds that approximately 17 million people with HIV still do not know their status, and linkage to treatment after testing is suboptimal. While over 150 million people received HIV testing in 2014, nearly half of all people with HIV remain undiagnosed globally, with lower testing rates among men, adolescents, and key populations. The document calls for new approaches to testing like self-testing and lay providers, as well as improving quality, coverage, and focus on missing populations and areas with ongoing high risk.
HIV self-testing and linkage in Africa. The document summarizes a presentation on HIV self-testing research in Africa. It discusses (1) the need for HIV self-testing in Africa due to low testing rates and knowledge of HIV status, (2) completed and ongoing studies of HIV self-testing in various African countries, and (3) priorities for future research including improving accuracy, evaluating new models for linkage to care, and assessing implementation in different populations and settings.
1) HIV self-testing has potential to increase testing among men who have sex with men (MSM) by providing privacy and convenience. However, questions remain about its impact on linkage to care, risk behavior, and accuracy.
2) Studies show high acceptability of HIV self-testing among MSM, but optimal distribution methods and support for interpretation and counseling are still unclear.
3) While early research found little evidence of harm, more data is needed on how self-testing may influence sexual behavior and accuracy given the test's window period. Effective instruction and support strategies could help address these issues.
Improving the HIV Cascade of Services in VietnamSC SC
The document discusses Vietnam's response to the HIV epidemic and improving their cascade of services. It outlines Vietnam's cascade and findings from provincial rapid assessments. Key findings include that many PLHIV are not seeking testing or linking to care after testing positive, ART initiation is not growing in many sites, and coordination of services is fragmented. The cascade framework is being used to identify gaps where interventions can have the most impact, like increasing testing and linkage to care and reducing viral loads through sustained ART. Investments in applying the cascade approach at local levels can substantially improve the performance of Vietnam's HIV response system.
Thailand experiences on PrEP and HIV self-testingCheryl Johnson
Thailand has piloted PrEP and HIV self-testing programs targeting at-risk groups. PrEP is available through research studies and hospitals on a self-pay basis, though challenges remain around registration and inclusion in national healthcare. Several PrEP demonstration projects have enrolled hundreds of MSM and transgender individuals. HIV self-testing research includes an online counseling and supervised self-testing program, as well as oral fluid testing pilots, but legal and test kit issues remain regarding over-the-counter use in Thailand. Overall the document outlines Thailand's experiences with emerging HIV prevention methods.
John de Wit, (NCHSR) argues that strengthening HIV prevention approaches will benefit significantly from drawing on behaviour change science. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
Innovations in Community-based Diagnosis and Treatment of Acute Malnutrition ...CORE Group
This document summarizes a research study conducted in Aweil South County, South Sudan to assess whether community health workers with low literacy could effectively treat severe acute malnutrition (SAM) using simplified tools and protocols. The study found that the health workers were able to implement the protocol and treat 310 malnourished children in the community with 75.6% cured and treatment outcomes meeting international standards. This demonstrates that with appropriate training and adapted tools, low-literacy community health workers can successfully treat uncomplicated SAM cases in their communities.
This document summarizes a study enhancing HIV care and treatment for people who inject drugs in Kenya. The study uses respondent-driven sampling to identify people who inject drugs for rapid HIV testing and point-of-care CD4 testing. Those with CD4 counts under 350 are linked to antiretroviral therapy through peer case managers. The study aims to evaluate this intervention, model its impact on community viral load, and assess its cost-effectiveness. Preliminary results show the combination of rapid testing and point-of-care CD4 testing effectively identifies HIV-positive people who inject drugs and links them to treatment. Linkage to care through peer case managers has proven very effective for initiating antiretroviral therapy.
Cost-effectiveness of an early awareness campaign for colorectal cancerEEPRU
1) A cost-effectiveness analysis was conducted on an early awareness campaign for colorectal cancer using data from a pilot campaign in England. The campaign was estimated to lead to an increase in colorectal cancer diagnoses and a decrease in cancer deaths, but also increased costs to the healthcare system.
2) A mathematical model predicted that over a lifetime, the campaign would result in 404 additional quality-adjusted life years at an incremental cost-effectiveness ratio of £13,496 per QALY gained compared to no campaign.
3) Uncertainty analysis found the cost-effectiveness was sensitive to assumptions about the duration and magnitude of increased symptomatic presentation following the campaign. Further research is needed on the long-
The document discusses using HIV program data to evaluate gaps and disparities in linkage to care. It provides examples of how Louisiana measures linkage, retention, and viral suppression, and presents continuum of care data for the state overall and by region, race/ethnicity, and testing site. Linkage to care rates for newly diagnosed individuals are shown to be improving over time but still vary between regions and community-based organizations. The document encourages evaluating one's own agency's linkage data and identifying opportunities for the State HIV Program to provide more useful data support.
This document proposes a clinical trial to evaluate the accuracy of the QikTech One-Step HIV I/II/O Saliva Test compared to a conventional blood test. The trial would enroll 250+ individuals across medical centers in Tijuana, Mexico. Participants would receive both tests, and positive results would undergo further confirmatory testing. If found to be accurate, the saliva test could provide a simpler alternative for HIV screening in Mexico and be commercialized in the country. The proposed trial outlines inclusion criteria, sample collection processes, testing procedures, statistical analysis plans, and anticipated outcomes of increased access to rapid and flexible HIV detection tools.
LT Labs (STD Rapid Test) delivers home HIV test kits to worldwide consumers those are highly reliable and quality tested and authenticated. Check : http://stdrapidtest.com
This document provides information about HIV testing and the implications of test results. It discusses the various types of HIV tests including rapid tests, ELISA, and Western blot. A positive test result means antibodies to HIV have been detected, while a negative result means antibodies were not detected, though the person could still be in the window period. Interpretation of results and the need for counseling before and after testing is emphasized. Symptoms of infection and potential complications are outlined. Treatment involves antiretroviral drugs to suppress the virus and medications to prevent opportunistic infections.
This document provides an overview of laboratory diagnosis of AIDS, including:
1) The structure of HIV and the humoral and cellular immune response to HIV are described.
2) Diagnosis of AIDS involves antibody detection using screening tests like ELISA and confirmatory tests like Western blot. Antigen detection tests like p24 antigen capture and PCR are also used.
3) Laboratory monitoring of anti-retroviral therapy includes measuring CD4+ T cell counts, HIV RNA levels, and testing for HIV drug resistance.
1. Specific tests for diagnosing HIV infection include detecting viral antigens like p24, isolating the live virus, detecting viral nucleic acids through PCR, and detecting antibodies through ELISA and Western blot tests.
2. ELISA and rapid tests are used as initial screening tests to detect antibodies, while Western blot is a supplemental test used to confirm positive ELISA results.
3. In addition to specific tests, nonspecific tests like complete blood counts can provide clues about HIV infection by detecting signs of immune deficiency like low CD4+ T cell and platelet counts.
This document discusses cestodes (tapeworms) and provides information on their morphology, life cycles, and diseases they cause in humans. It describes the general characteristics of cestodes, including their segmented, tape-like shape and lack of digestive system. It separates cestodes into two main groups - pseudophyllidean and cyclophyllidean - and provides differences between them. Specific tapeworms discussed include Diphyllobothrium latum, Taenia solium, Taenia saginata, and Echinococcus granulosus. The larval forms and life cycles of these tapeworms are described, as well as the diseases they can cause, such as cysticercosis and hydat
Phillip Keen, (NAPWA) discusses the background, goals and objectives of NAPWA's billboard and web campaign encouraging people with HIV to get up to date about treatments. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
Colorectal screening evidence & colonoscopy screening guidelines Health Evidence™
Health Evidence hosted a 90 minute webinar examining colorectal cancer screening: benefits and harms, effective screening methods, and screening guidelines.Click here for access to the audio recording for this webinar: https://www.youtube.com/watch?v=JqOV-KHCBq8
Donna Fitzpatrick-Lewis, MSW, Senior Research Coordinator at the McMaster Evidence Review and Synthesis Centre and Dr. Maria Bacchus, Associate Professor of Medicine, Faculty of Medicine University of Calgary, and member of the Canadian Task Force on Preventive Health Care led the session. Donna presented the findings of the Synthesis Centre’s latest review and Dr. Bacchus presented findings from the Task Force’s latest guidelines:
Fitzpatrick-Lewis, D., Usman, A., Warren, R., Kenny, M., Rice, M., Bayer, A., Ciliska, D., Sherifali, D., Raina, P. Screening for colorectal cancer. Ottawa: Canadian Task Force on Preventive Health Care; 2015. Available: http://canadiantaskforce.ca/files/crc-screeningfinal2.pdf
Bacchus, C. M., Dunfield, L., Gorber, S. C., Holmes, N. M., Birtwhistle, R., Dickinson, J. A., Lewin, G., Singh, H., Klarenbach, S., Mai, V., Tonelli, M. (2016). Recommendations on screening for colorectal cancer in primary care. Canadian Medical Association Journal, cmaj-151125.
Among men and women, colorectal cancer is the second and third most common cause of cancer related death, respectively. Colorectal cancer screening guidelines, developed by the Canadian Task Force on Preventive Health Care, are based on a systematic review synthesizing evidence on the benefits and harms of screening, and the characteristics of effective screening tests. The guidelines, developed from the review, outline screening recommendations for adults aged 50 and older who are asymptomatic and not at high risk for colorectal cancer. This webinar provided a high level overview of the systematic review that informed these recommendations, followed by an overview of the recent Canadian screening guidelines.
Partners Demonstration Project - HIV self testing update - Feb 2015Cheryl Johnson
The Partners Demonstration Project is studying the use of antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) to prevent HIV among heterosexual couples in Kenya and Uganda. An ancillary study is evaluating the acceptability of HIV self-testing among individuals using PrEP in Kenya. Preliminary findings show high uptake of self-testing, with 96% of expected tests reported as used. Qualitative feedback indicates self-testing reduces anxiety and empowers individuals. Continued research will provide more data on experiences with self-testing and its potential as a cost-effective component of PrEP programs.
Rapid oral swab hepatitis C screening in a community-based settingCDC NPIN
This study evaluated the use of rapid oral swab hepatitis C (HCV) screening in community settings in New York City. 503 subjects at high risk of HCV underwent rapid oral swab testing and standard blood testing. The rapid test results agreed with blood tests in 97.5% of cases. Staff preferred the rapid test due to ease of use and reduced safety risks. Rapid testing could increase HCV screening and linkage to care in non-clinical settings but ensuring follow up for confirmatory testing remains a challenge.
1. The document discusses eliminating unnecessary healthcare costs through high value care, which aims to improve quality while reducing costs. It notes that about 1/3 of healthcare spending is wasteful.
2. Common sources of excess costs include unnecessary services, tests, procedures, missed prevention opportunities, and inefficient care delivery. Physicians play a key role in addressing over-ordering that contributes to waste.
3. Clinical scenarios are presented to illustrate how using evidence-based guidelines and decision support tools can help providers order only appropriate and necessary tests or imaging to maximize benefits and minimize harms to patients as well as reduce costs.
This document discusses monitoring and evaluation concepts for family planning programs. It begins by outlining session objectives related to applying M&E frameworks, indicators, and issues to family planning programs from a post-Cairo perspective. It then provides an overview of topics to be covered including family planning frameworks, implications of the Cairo agenda, indicators like contraceptive prevalence and unmet need, monitoring quality of care, and linkages between family planning and HIV. The document reviews conceptual frameworks for understanding factors influencing fertility and family planning supply. It discusses applying these frameworks for M&E by examining inputs, outputs, outcomes, and impacts. Specific indicators, data sources, and issues related to monitoring quality of care, contraceptive prevalence, unmet need,
Implementation science aims to study methods to promote the uptake of evidence-based practices into routine healthcare. It focuses on evaluating the process of implementation and its impact on the targeted evidence-based practice. Implementation studies commonly employ mixed quantitative and qualitative methods to evaluate the process, formative outcomes, and summative impact of implementation strategies. Key outcomes include measures of adoption rates, fidelity, costs and sustainability of implementing evidence-based practices into real-world healthcare settings.
Costing HIV testing Services Understand and Using Data for decision makingCarmen Figueroa
This document discusses costing and informing policy for HIV testing services in South Africa. It notes that HIV testing is a national priority and gap analysis showed a 25% testing gap. Research was conducted on the feasibility, acceptability, and usability of different testing modalities. Data shows increased testing could help close gaps in reaching the first 90 target of the UNAIDS 90-90-90 goals. Cost-benefit analyses are in progress to show benefits of increased testing outweigh costs. National HIV testing policies and guidelines from 2010 and 2016 outline facility-based and community-based testing modalities, including client-initiated counseling and testing, provider-initiated counseling and testing, and HIV self-screening.
NZP+ supports HIV self-testing as a way to increase testing rates and knowledge of HIV status, but has some concerns that need addressing first. For self-testing to be effective, voluntary and confidential testing kits must provide clear information, and support mechanisms should be in place. Communities like NZP+ will need to generate demand for testing, advocate for treatment access, and support linkage to care. Self-testing has potential benefits if implemented properly with community engagement and focus on linkage to care, but risks harm without these elements.
Philadelphia Department of Public Health HIV Prevention ActivitiesOffice of HIV Planning
Coleman Terrell of the Philadelphia Department of Public Health presented on the PDPH's HIV Prevention Activities at the Philadelphia HIV Prevention Planning Group's December 2014 meeting.
1) The document describes a webinar presented by the National Collaborating Centre Methods and Tools (NCCMT) on the ROBINS-I tool for assessing risk of bias in non-randomized studies.
2) The webinar provided an overview of ROBINS-I, including its development process, contributors, key features such as the seven bias domains and signaling questions, and how it can be used to make risk of bias assessments.
3) Attendees of the webinar were given information on how to access the presentation and recording afterward on the NCCMT website.
1) Around 1.5 million Kenyans are living with HIV, with about 500,000 not yet initiated on treatment. HIV self-testing (ST) is being implemented to help reach the 90:90:90 goal.
2) ST was included in national guidelines in 2009 but is just now being rolled out. Acceptability studies found 72% of Kenyans would use ST kits. ST can reach populations like men and youth who haven't previously tested.
3) A pilot with 16 pharmacies in major cities will help inform a wider private sector rollout of ST in Kenya, scheduled for the end of April 2017. Procurement of WHO-prequalified ST kits and public sector distribution will then begin.
This document provides summaries from several presentations about driving progress in health care through research supported by the National Institute for Health Research (NIHR) in the UK. The first presentation introduces the NIHR and its role in supporting different types of health care research. The second presentation describes a clinical academic fellowship funded by the NIHR and the research and career development it enabled. The third presentation summarizes a large clinical trial called DRAFFT that compared wire fixation and plate fixation for distal radius fractures and found wires to be as effective and cost less, leading to a change in practice. The last presentation discusses the experience of patients who participate in research and how it can benefit the NHS.
Join Dr. Sarah Neil-Sztramko, Knowledge Translation Advisor, and Dr. Maureen Dobbins, Scientific Director, to learn how the NCCMT quickly pivoted to meet decision makers’ needs for high-quality synthesized evidence during the COVID-19 pandemic. The presentation will include an overview of how rigorous review methods were adapted to the ever-changing COVID-19 evidence landscape and provide time for discussion and questions from webinar participants.
Reviews from the Rapid Evidence Service are available here: https://www.nccmt.ca/res, and a pre-print article describing methods is available here: https://www.researchsquare.com/articl....
Learning Objectives:
By the end of this webinar, you will:
1. Learn about the methods for conducting rigorous rapid reviews in the face of quickly evolving evidence.
2. Apply knowledge of the strengths and limitations of rapid reviews to decision making.
3. Gain tools and resources to apply to rapid reviews in your own work.
This document discusses quality improvement approaches to patient safety in medicines optimization. It provides an overview of quality improvement science and outlines several key principles, including using small tests of change and repeated PDSA cycles to drive continuous learning and improvement over time. The document also discusses using a collaborative approach to improvement that engages both staff and patients in the process.
Phillip Keen (Kirby Institute) discusses the successes and challenges of community-based HIV testing.
This presentation was given at the AFAO National HIV Forum, 17 October 2014.
Similar to Rapid HIV Testing & Scaling Up Testing (20)
This presentation on AFAO's recent work with Culturally and Linguistically Diverse (CALD) communities was given by Michael Frommer at the SiREN Symposium in Perth, June 2016.
The document outlines a four-phase activity to develop culturally appropriate online health resources for Aboriginal and Torres Strait Islander communities as well as several CALD populations in Australia. The activity will be overseen by ASHM and involves auditing existing resources, consulting with communities, developing new resources, distributing and promoting them, and evaluating their uptake. Key steps include establishing advisory committees, reviewing current resources, holding workshops to prioritize new materials, subcontracting organizations to create resources, and measuring the impact through surveys and web analytics. The goal is to prevent blood-borne viruses and sexually transmitted infections among these at-risk communities through improved health education.
The document discusses changes to the structure and priorities of AFAO for 2016/17. Due to funding changes, AFAO's international program will expand while its domestic program shrinks. Some staff will leave and the organization will restructure accordingly. Key priorities will include leadership and communications, advocacy, coordination, policy, capacity building, and international work. The organization will need to work smarter with its reduced capacity by collaborating with other community organizations.
This presentation on key strategies for addressing HIV among people from CALD communities and people who travel to high prevalence countries was given by Corie Gray from Curtin University and CoPAHM at AFAO'S HIV and Mobility Forum on 30 May 2016.
This presentation on a directory of HIV health promotion programs and resources that engage with people from CALD communities was given by Jill Sergeant from AFAO at AFAO'S HIV and Mobility Forum on 30 May 2016.
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Drawing upon HIV surveillance data and the Seroconversion Study, this presentation explores reasons for late diagnosis of HIV and barriers to testing among gay men and other MSM in Australia. The presentation was given by Phillip Keen from the Kirby Institute at AFAO's National Gay Men's HIV Health Promotion Conference in April 2016.
This document provides a summary of a directory of health promotion programs and resources for HIV and culturally and linguistically diverse (CALD) communities. The directory aims to support organizations working with CALD communities on HIV-related issues. It includes summaries of program activities, objectives, outcomes, evaluation details, downloads, and contact information for each listing. The feedback on the directory was positive, noting it is a valuable resource for research and ideas. Recommendations include organizations using the resource, updating it regularly, and holding a forum to further build capacity and identify programs for national support.
A report on findings from the AHOD Temporary Resident Access Study, which looked at access to HIV treatments for people not eligible for Medicare. This presentation was given at the AFAO Community Hub at the ASHM 2015 conference.
Lea Narciso from SA Health discusses the changing epidemic in South Australia, which now includes an increasing number of people born overseas, and the government's policy response. This presentation was given at the AFAO Community Hub at the ASHM 2015 conference.
This Report Card provides an overview of national momentum on HIV and mobility, highlighting areas with strong momentum and areas that are limited. This presentation was given at the AFAO Community Hub at the ASHM 2015 conference.
ComePrepd is the Queensland AIDS Councils (QuAC) new campaign for pre-exposure prophylaxis (PrEP) which aims to encourage open discussion in the gay community. This presentation discusses the design of the campaign and its various stages. This presentation was given at the AFAO Community Hub at the ASHM 2015 conference.
Alison Coelho from the Centre for Culture, Ethnicity and Health describes a program which partnered with faith & community leaders around preventing BBV/STI transmission in migrant and refugee communities. This presentation was given at the AFAO Community Hub at the ASHM 2015 conference.
An overview of how the 2 Spirits Program at the Queensland AIDS Council adapts a western health promotion framework into a cultural framework to engage Aboriginal & Torres Strait Islander communities around HIV and sexual health. This presentation was given at the AFAO Community Hub at the ASHM 2015 conference.
This presentation on the priorities and challenges for the HIV response in Aboriginal and Torres Strait Islander communities was given by Michael Costello-Czok (Executive Officer – Anwernekenhe National HIV Alliance - ANA) at the AFAO Members Forum - May 2015.
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This document discusses using systems approaches to better understand peer-based programs for HIV and HCV. It summarizes work done with various organizations representing people who use drugs, gay men, people living with HIV, sex workers, and others. Systems approaches were used to develop more sophisticated theories of how peer-based programs work and influence communities. System dynamics maps showed how interventions engage with communities. Key functions and draft indicators were identified to demonstrate influence and help programs evaluate their work and influence on communities and policies. The document provides an overview of the Understanding What Works & Why (W3) project which aims to help answer questions about program influence and effectiveness using systems approaches.
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Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
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Chemotherapy
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Learning objectives:
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2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
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3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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Unit 4: MRA 103T Regulatory affairs
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Rapid HIV Testing & Scaling Up Testing
1. Rapid HIV Testing
&
Scaling Up Testing
Phillip Keen
phillip@napwa.org.au
May 2012
2. Overview
• Why rapid HIV testing?
• Where to now on rapid HIV testing
• National HIV Testing Policy Review
• Scaling up testing
3. UNPD Targets
• Need to scale up testing coverage and
frequency:
New technologies (eg. rapid HIV testing)
Reorienting existing testing services
New models for marketing & providing
testing
Community/peer-based
Outreach
(Home?)
4. Testing Coverage among MSM
• There is still scope for benefit from increased testing
coverage and frequency
o Testing coverage low in broad-based MSM samples:
• e-Male Survey (2008)
– 23.8% never tested
– Among men who had tested, 31% had not tested in previous
year
• PASH Survey (2009)
– 15.2% never tested
• Adam (2012), NCHSR
5. Testing Frequency
• Real testing frequency v’s self-report data
o Guy et al (2010):
• Less than 40% of MSM retested after I year
• Less than 20% of highly sexually active men retested after six
months
• Late HIV diagnoses
o Approximately 14% of diagnoses among MSM are late
diagnoses
• Most have never previously tested, others have not
tested for a long time.
6. Rapid HIV Testing in other Settings
• Pedrana (2011): Rapid HIV Testing & Community-
Based Testing services:
o High proportion of never previously tested
o High positive yields
o High consumer satisfaction with rapid HIV testing
o High workforce satisfaction with rapid HIV testing
o Staffing models incorporating non-clinical staff in
community based testing services
8. HIV Testing Policy Review
•Support for rapid HIV testing for use at point of care:
• Limited to use as screening tests
• Confirmatory testing required for reactive rapid test results
• May be considered for:
• High risk populations (eg. gay men)
• Hard to reach populations and individuals (who are resistant to
conventional testing) and
9. False Positives to True Positives
Test Specificity
Positive Yield 99.5% 99.8%
1.5% 1:3 1:7.5
(MSM in VPCNSS)
(5 FP per 1000 tests) (2 FP per 1000 tests)
1.0%
(Males @MSHC, 2009) 1:2 1:5
0.1%
(Females @MSHC, 2009) 5:1 2:1
0.025%
(All females tested in Victoria, 20:1 8:1
2004)
10. Community based testing
• Scope for non-clinical staff to administer rapid
tests:
• If State/Territory health department endorses organisation
• Staff must attend accredited training and achieve certification
• Service must have access to clinical support and
venepuncture, and a relationship with a laboratory approved by
the National Association of Testing Authorities (NATA)
11.
12. What Now?
• Policy support for rapid testing at POC, but:
• No TGA licensed tests
• No Medicare funding for rapid test kits or
procedures
13. Community Organisations
• What models for rapid testing make sense locally?
• Establish a new community based testing service?
• What planning needed?
• Partner with other services to offer rapid testing?
• Incorporate peer-based workers to some parts of testing
services?
• Identify services well-placed to introduce rapid HIV testing
and start talking to them
• Liaison with funders and other stakeholders to plan for the
14. HIV Educators & Counsellors
• Peer Educators & TreatAware Officers:
• Community Awareness about rapid HIV testing
• Limitations and benefits of rapid testing
• Participate in rapid testing service delivery
• Very different role for most
• What selection & training?
• Counsellors:
• Different issues in context of rapid HIV testing – e.g. anxiety while
16. Marketing
• Increasing HIV testing rates will be needed to
reach new HIV Prevention and Targets
• Introducing rapid HIV testing represents an
opportunity to re-frame HIV testing
17.
18.
19.
20.
21.
22.
23. Home Testing
• Home testing was not supported in the recent
Australian HIV Testing Policy review
• UK: House of Lords Select Committee on HIV
in the UK recommendations:
o Legalise home testing
o Establish a quality control system
o THT supports the above
24. Home Testing
• USA:
Orasure application to FDA for home sales
Study of home users found 93% sensitivity
v's 99.3% when used by trained testers
Expert panel unanimously supported
approving home sales
FDA decision expected soon
25. Outreach Testing
• Was not considered in detail in policy review
• Outreach testing trial may start soon in
Sydney
• Community HIV sector doesn't have a well-
developed position on outreach testing.
27. Clinical Staff
• Should rapid testing be introduced?
• New procedures
• Training & staffing – clinicians or nurses?
• Relationship with NATA-approved laboratory
28. Policymakers
• Planning
• How and where should rapid testing be introduced to complement
existing testing services?
• NSW Health Model - Point of Care Testing Working Group:
• ASHM
• Clinical & social research
• Community orgs
• Sexual health clinic director
• Counsellor
29. Policymakers II
• Funding
• Public sexual health clinics and specialist community based testing
services may be best placed to offer rapid HIV testing - but
State/Territory funding covers most costs of public sexual health
clinics and would need to for new community based testing services
• Cost barriers to introducing rapid testing in all
settings until there is Medicare funding
• Public clinics: Currently some HIV testing costs recouped from
Medicare
30. Policymakers III
• Funding support for trials of rapid HIV testing
• Trials are underway in public sexual health
settings
• Test performance (sensitivity, specificity, NPV & PPV)
• Acceptability to clients
• Feasibility issues in clinics
• Any impact on testing frequency?
31. Researchers
• Tracking changes in testing patterns in the
context of rapid testing
• Understanding the impact of rapid HIV testing
on gay men’s sexual cultures
32. CD4 at start of cART (closest CD4
with 6 months prior)
Prior to 1 Jan
2006
1 Jan 2006
onwards Overall
Total 1882 427 2309
Mean 327.9 324.0 327.1
SD 242.4 193.5 234.1
Median 288.5 294 290
25th 150 200 160
75th 450 422 445
n (%) n (%) n (%)
250-349 347 (18.4) 101 (23.6) 448 (19.4)
<250 787 (41.8) 161 (37.7) 948 (41.1)
>=350 748 (39.7) 165 (38.6) 913 (39.5)
33. CD4 Decline Following
Seroconversion
• CASCADE Study (Europe n. = 18,495)
CD4 Level Median time following
Seroconversion
500 1.19 years
350 4.19 years
200 7.93 years
34. Treatments Uptake Needed
• Rapid increases in treatments uptake occurred
1996-1998 (20% > 70%)
Year Estimated Proportion Population Additional
Population on ARVs not on ARVs needed if
90%
2010 21,391 70% 6,417 4,278
2011 22,391 70% 6,717 4,478
35. Challenges
• Costs of access
• Costs of multiple medications / management
interventions
• Complexity of access to prescriber / dispensing
arrangements
• Dr concerns re adherence
• Dr concerns re lifelong treatment commitments
• Concern re impact of side effects
• Other Patient barriers
36. Increased cost sharing
• 1. Lower rates of drug treatment / selective Rx
• 2. Diminished adherence among existing pts
• 3. More frequent discontinuation of therapy
• 4. Affect likelihood of pt to seek care
• Summary point
• For each 10% increase in cost
sharing, prescription drug spending decreases
37. Issues – Pt involvement
• 35% started treatment within a year of
diagnosis
• Majority waiting more than a year btwn
diagnosis and initiating
• Reasons
• 47% - Dr’s decision to wait*
• 27% - Pt Unsure about starting
• *Age split: Under 50 – 52% / Over 50 - 18%
38. Issues - Access
• Access has costs
• PBS drugs have pt contributions $35.40 /
$5.80 per script
• Safety net $1281.30 / $324.00
• Pt experience survey – PCR (ABS) 2009
• 9.7 % delay or reject filling a script (general
pop)
39. HIV population
• 30% live below poverty line
• 40% rely on a govt benefit
• Chronic disease management increasingly
complex within the ageing population
• Medicare not covering cost of most non
medical treatments, or increasingly newer
procedures
40. Issues - Access
• Chronic Illness
• - regardless of income levels spending up to
30% of household income on medications
• Plhiv (Futures 6) (n = 1100)
• - 42% report major source of income as Govt
support
• 31% report living below poverty line levels
41. Issues - Access
• BGF Survey (2010)
• PLHIV respondents struggling to access
treatment
• 46% - HIV medications
• 60% - Other prescribed medications
• Hardship requires people to make decisions
between care and basic living expenses
42. Patient Concerns
• Concern about side effects
• Lifelong treatment
• Lack of readiness
• Pt perception ARV are bad for you
• Dislike of taking (Reminder)
• Commencing Rx means health has declined
• Impact on lifestyle
43. Issues – Pt Attitudes
• 70%(ATLIS) to 80% (Futures) of treating
population believe that ARVs mean better
prospects for themselves
• 39% (ATLIS) & 30% (Futures)- Negative beliefs
such as “harmful” and impacts outweighing
benefit to QOL.
• Reminder of status / fear of disclosure
(includes access issues to care / drugs)
44. Psychological barriers
“Commencing was terrifying. I was scared and the night before I
started I was a mess. Initial physical reaction was minimal so that was
a relief. Changing meds is also a scary thought which I am trying to
avoid” (ARCSHS Tracking Changes, 2011)
“I had thought it would be difficult for me to commence meds since this
would be an acknowledgment of the progression of my HIV. However
since starting my meds I have found that a lot of small irritating
conditions have cleared up and my overall health is significantly
improved. I'm just grateful every day that the meds exist!” (ARCSHS
Tracking Changes, 2011)
45. What are the outcomes
• Therapeutic Treatment coverage and
maintenance will improve individual health
• Secondary prevention impacts will follow
• Dynamics across other Strategies and within
the BBVSS framework benefits shared
• As fast as knowledge is acquired it must be
applied (NHMRC Research Translation goal)
46. ROI
• Base policy options on evidence base of
current data + the value of treatments to
community
• Environment of community acceptability with
drive to resolve barriers or disincentives for
individuals
• National Strategy could be adapted to this
expansive vision
47. Economic analysis
• NSW – 50% Gay + men initiated Treatment at
diagnosis then minimum 10 % - up to 22% of
new infections would be averted
• $14,000 annually on HIV therapy
• One infection over a lifetime costs Govt
$700,000
• Data build to show nationally if a program
targets people who would otherwise have not
received therapy, it would be cost effective,
48. Success of Test and Treat in San Francisco? Reduced Time to Virologic
Suppression, Decreased Community Viral Load,
and Fewer New HIV Infections, 2004-2009
M Das, P Chu, G-M Santos, S Scheer, W McFarland, E Vittinghoff, G Colfax
Minimum, Most Recent, Maximum CVL and Newly
Diagnosed and Reported HIV cases
49. Where can we do more?
Testing
Treatments uptake
Community Mobilisation
PrEP + PEP
Targeting Primary Infection
Targeting Late HIV
Diagnoses
Specific actions to reduce
heterosexual transmissions
50. HIV diagnoses, 2006 --
2010, by HIV exposure
category
Source: State and Territory health authorities
51. Newly diagnosed HIV among men who report an exposure other than
sex with men, 2001 – 2010, by year and HIV exposure category
80
60
Num be r 40
20
0
Y ear
Source: State and Territory health authorities
52. Newly diagnosed HIV among women, 2001 – 2010, by year
and HIV exposure category
Source: State and Territory health authorities
53. Reducing Heterosexual
Transmissions
• Diagnosing
o Expand ASHM mentoring project
o Clinical markers (eg oral candidiasis)
o Populations focus – people from high prevalence
countries & partners
o Clusters (swingers)
• Serodiscordant couples
54. Peer base
• Community information
• Informed by community
• Drivers / influence
• Nuances
• Sophisticated (Persistence/ Resilience)
• Strength of peer ownership / partnership
• Acceptability / thresholds of tolerance &
55. Community Mobilisation
• Gay community
o High profile social marketing initiatives to suggest a period
of concerted community action
o Seek support from gay community leadership
• Disproportionate contributions to new diagnoses
from:
o Men in serodicordant relationships
o Sexually adventurous men
56. Targeting Late HIV Diagnoses
• NAPWA believes there is scope to reduce late
HIV diagnoses among MSM, heterosexuals
and CALD.
57. CD4+ cell count at HIV diagnosis,
2001 – 2010, by year
Click to edit the outline
text format
Second Outline
Level
Third Outline
Level
Fourth Outline
Level
Fifth
Outline
Level
Source: State and Territory health authorities
59. Late HIV Diagnoses Actions
• Reduce structural and psychological barriers
to testing
• Encourage primary health services to offer
testing to populations at increased risk.
o Low caseload GPs in areas of high HIV prevalence
– offer testing to MSM
o GPs and community health services working with
CALD populations at increased risk
60. Need data for targets
• Variable treatment patterns across sub groups
• Attitudes and beliefs are wide ranging and
complex
• Motivations and drivers critical
• Campaigns need to be diverse and different
mediums – websites, blogs and social media
61. Should we expect an initial
increase in HIV Diagnoses?
Population Undiagnosed Click to edit the outline
Undiagnosed
Size (10%) text format
(20%)
22,391 (1) 2,239 Second Outline
4,478
Level
Third Outline
•
Level
(1) Estimate of the number of people living with HIV in Australia as at
31/12/2010 plus 1,000 (estimated number of new diagnoses in 2011)
Fourth Outline
• Level
The estimates of the proportion of the PLHIV population that are
undiagnosed are from Mapping HIV Outcomes: Geographical and clinical
Fifth
forecasts of numbers of people living with HIV in Australia (NCHECR/NAPWA,
2010)
Outline
• If testing coverage and frequency increase, there may be anLevel
initial spike in
62. A package
• Targets disease prevention
• Targets access inequities
• Targets continuity of care
63. Targets are a package
• They bring other dynamics and roll on effects
• National HIV strategy links
• The momentum brings energy and focus
• Forward to future yrs and see results
• Health and well being of a population is what
fosters other secondary benefits, such as
prevention and broader BBVSS health
maintenance
64. Setting Targets
• Set targets based on the number of people it
will positively affect.
• Planning should be optimistic and lead with
positive frameworks for what you can do and
what potentials there are to truly transform
65. Targets and Reduced Diagnoses
Exposure Category 2010 Diagnoses 50% Reduction
Click to edit theReduction
80%
outline
MSM + MSM & IDU 621
text format
(311) 124
Heterosexual 289 Second Outline
145
IDU 25 Level
13
All Categories 1,043 Third Outline
Level
• An 80% reduction in MSM diagnoses and a 50% reduction
Fourth Outline
in heterosexual, IDU and other categories would result in
Level
approximately 335 annual diagnoses, which is a 68%
reduction overall on the 1,043 diagnoses in 2010.
Fifth
Outline
Level
66. Opportunities
• Emerging combination prevention options offer the best
chance in thirty years to drive infections down
• We have to seize the moment – ‘wait and see’ isn’t an option
• Signing up to ambitious (but not unrealistic) 2015 targets will
provide the galvanising factor
68. End here?
• End?
• Jo, following slides are in case you want to
keep them and move them back up into the
presentation
69. Implications
• Targeted sub groups may require varied
interventions
• Health maintenance not just understood as
clinical benefits
• Must be peer driven and focused
• Need to measure national against state
analysis
70. Treatments Uptake
• Reducing barriers to treatment
o Dispensing arrangements
o Co-payments
• Difficulties obtaining medication and co-payments
associated with stopping ARVs (ARCSHS Tracking
Changes, 2011)
• ATRAS and other Medicare Ineligibles
• Addressing Psychological barriers to initiating treatment
71. Self reporting
• Actual utilisation vs self reported levels
• - Both testing – but also treating, and
maintenance