Suchergebnisse

Background The aim of this study was to assess perceptions of health professionals involved in HIV testing policy and practice in national settings across the WHO European Region regarding the delivery of HIV test results, post-test discussion and referral to specialist HIV services as recommended in authoritative guidelines. Methods: An online self-report survey was completed by a convenience sample of 338 respondents (response rate 34.1%) from 55 countries. Respondents worked with non-government organisations (49.4%), health services (32.8%), non-health service government agencies (6.2%) or other organisations (11.5%; e.g. prisons, education and research, international development). Results: Experts' perceptions indicate that delivery of HIV-positive test results and related post-test discussion in their country generally corresponded to recommendations. However, results pointed to a significant gap perceived by experts between recommendations and the practice of delivering HIV-negative test results. Fewer respondents thought that suitable time is taken to deliver a negative HIV-test result (54.1%) than a positive result (73.1%). Also, fewer respondents thought there was a procedure for referral to specialist treatment, care and support services for people receiving a HIV-negative test result (34.9%) than for people receiving an HIV-positive test result (86.2%). Experts also reported low perceived use of communication technologies (i.e. telephone, email, text messaging, a secure website) for delivering HIV test results. Conclusions: This expert survey offers new insight into perceived HIV post-test practices in almost all national settings across the WHO European Region. The findings provide valuable guidance for future HIV testing guidelines for the WHO European Region. Journal compilation

Background: Interest in research on migrant health is increasing. The aim of this study is to review sample characteristics, study design, and outcomes (participation and retention rate) of longitudinal studies of the health of migrant populations, and to evaluate whether there are differences in outcomes related to study populations and methodology. Methods: A literature search of prospective longitudinal studies on migrants' health was performed in Medline and Web of Science, with 545 articles retrieved. Key informants were contacted when needed. After identification, screening, and eligibility, nine articles were included. Results: The most commonly studied topics were occupational and mental health (44.4%). Two studies had sample sizes of >5000 subjects, and 4 studies recruited families. One study targeted undocumented workers. Study duration was 2 years in 4 studies with 1 follow up wave. Two studies collected biological samples, and 2 used incentives. Higher participation (PR) and retention (RR) rates were found in studies of families, studies of groups perceived to be at high risk, studies where the researchers had close community ties, and studies where complete contact information had been obtained by the researchers. Lower PR and RR were associated with large time delays between waves and targeting irregular workers. Respondent driven sampling (RDS) was successful in reaching hidden populations. Conclusions: Identification of documented migrants through governmental records, early follow up, use of a variety of strategies (including digital technologies) to locate participants and maintaining personal relationships are the main factors influencing PR and RR. It is essential to consider them when planning research and to foresee and plan for the difficulties that might arise during a longitudinal study.

Purpose of the studyOur aim was to evaluate factors associated with progression to AIDS/death in HIV‐infected naïve pts initiating cART with low CD4 counts.MethodsAdult HIV‐infected ARV‐naïve pts with CD4 <200 who initiated NNRTI or PI‐containing regimens between 1998 and 2009, were included. Primary end point was progression to AIDS (a first episode or a new AIDS‐defining condition in pts with prior AIDS) or death. Kaplan‐Meier curves were used to determine progression‐free survival and multivariate Cox regression models were used to identify independent predictive factors of progression to AIDS/death.Summary of resultsWe included 1427 patients (80% men, median age 38 years, 25% IDU, 37% AIDS, 20% HCV) between 1998 and 2009. At baseline (BL), median (range) CD4 and viral load (VL) was 77 (1–199) cells/µL and 170,000 (19–8,750,000) copies/mL, respectively. After a median follow‐up 4.6 years, 70% of pts reached CD4>200/µL, 65.2% reached undetectable VL and 268 (19%) pts progressed to AIDS/death during follow‐up. The probability of AIDS/death at 5 years was 76%, 34%, 3% and 3%, in pts with BL CD4<100/VL>5 log and CD4<200/VL detectable during FU, BL CD4<100/ VL>5 log and CD4<200/VL undetectable during FU, BL CD4<100 and/or VL>5 log and CD4>200/VL undetectable during FU and BL CD4>100/ VL<5 log and CD4>200/VL undetectable during FU, respectively. In the multivariate analysis, several variables were associated with AIDS/death: CD4< 200 during FU (HR 10.89, p<0.001), detectable VL during FU (HR 3.49, p<0.001), age>50 years (HR 1.75, p=0.001), prior AIDS (HR 1.71, p<0.001) and BL VL>5 log (HR 1.45, p=0.011). If only pts without prior AIDS (n=895) were analyzed, the variables independently associated with AIDS/death were: CD4<200 during FU (HR 9.90, p<0.001), detectable VL during FU (HR 2.78, p<0.001) and BL VL>5 log (HR 1.62, p=0.016).ConclusionsIn immunosuppressed patients initiating cARV therapy, not reaching CD4>200/µL during FU was the strongest variable associated with progression to AIDS/death. VL at BL and mainly at follow up also played a role in patient outcome.