BACKGROUND: We evaluated changing HIV testing coverage and prevalence rates before and after expanding city-wide antiretroviral therapy (ART) programs in Lusaka, Zambia. METHODS: We conducted serial cross-sectional surveys on the University Teaching Hospital medical ward to assess HIV prevalence among inpatients of unknown status in 2003 and 2006. Willing participants received counseling and dual HIV rapid tests. We compared the proportion of inpatients receiving their test results in 2003 (off-the-ward testing) to 2006 (on-the-ward). RESULTS: In 2003, none of 103 inpatients knew their HIV status or took ART; 99.0% (102/103) agreed to testing. In 2006, 49.3% (99 of 201) patients knew they were HIV-infected and were on ART; of those with unknown status, 98.0% (100/102) agreed to testing. In 2003, only 54.9% (56/102) received post-test counseling and 98.2% (55/56) learned their status. In 2006, 99.0% (99/100) received post-test counseling and 99.1% (98 of 99) learned their status. In 2003, 62.8% (64 of 102) of status-unknown inpatients who agreed to testing were seropositive by dual rapid test, compared to 48.0% (48 of 100) of status-unknown inpatients in 2006. When including inpatients who already knew their seropositive status plus those unknowns who tested seropositive, the proportion of inpatients that was seropositive in 2006 was 73.1% (147 of 201), higher than in 2003. CONCLUSIONS: After ART program expansion, inpatients in 2006 were far more likely than their 2003 counterparts to know their HIV status and to be taking ART. In both years, 63-73% of medical inpatients were HIV-infected and 98.5% of inpatients agreed to testing. On-the-ward testing in 2006 avoided the 2003 problem of patient discharge before learning of their test results. Hospital-based HIV testing is an essential clinical service in high prevalence settings and can serve further as a surveillance system to help track the community impact of outpatient AIDS services in Africa.
BACKGROUND: We evaluated changing HIV testing coverage and prevalence rates before and after expanding city-wide antiretroviral therapy (ART) programs in Lusaka, Zambia. METHODS: We conducted serial cross-sectional surveys on the University Teaching Hospital medical ward to assess HIV prevalence among inpatients of unknown status in 2003 and 2006. Willing participants received counseling and dual HIV rapid tests. We compared the proportion of inpatients receiving their test results in 2003 (off-the-ward testing) to 2006 (on-the-ward). RESULTS: In 2003, none of 103 inpatients knew their HIV status or took ART; 99.0% (102/103) agreed to testing. In 2006, 49.3% (99 of 201) patients knew they were HIV-infected and were on ART; of those with unknown status, 98.0% (100/102) agreed to testing. In 2003, only 54.9% (56/102) received post-test counseling and 98.2% (55/56) learned their status. In 2006, 99.0% (99/100) received post-test counseling and 99.1% (98 of 99) learned their status. In 2003, 62.8% (64 of 102) of status-unknown inpatients who agreed to testing were seropositive by dual rapid test, compared to 48.0% (48 of 100) of status-unknown inpatients in 2006. When including inpatients who already knew their seropositive status plus those unknowns who tested seropositive, the proportion of inpatients that was seropositive in 2006 was 73.1% (147 of 201), higher than in 2003. CONCLUSIONS: After ART program expansion, inpatients in 2006 were far more likely than their 2003 counterparts to know their HIV status and to be taking ART. In both years, 63-73% of medical inpatients were HIV-infected and 98.5% of inpatients agreed to testing. On-the-ward testing in 2006 avoided the 2003 problem of patient discharge before learning of their test results. Hospital-based HIV testing is an essential clinical service in high prevalence settings and can serve further as a surveillance system to help track the community impact of outpatientAIDS services in Africa.
Authors: Neil A Martinson; Tanvier Omar; Glenda E Gray; Jacobus S Vermaak; Maria Badicel; Elias Degiannis; Jan Steyn; James A McIntyre; Martin Smith Journal: Trans R Soc Trop Med Hyg Date: 2006-06-30 Impact factor: 2.184
Authors: Blanca Samayoa; Matthew Robert Anderson; Karla Patricia Alonso Pacheco; Carol Lee; Alicia Pittard; Alex Soltren; Ingrid Barrios Matos; Eduardo Arathoon Journal: J Int Assoc Physicians AIDS Care (Chic) Date: 2010-09-14
Authors: K Pallangyo; A Håkanson; L Lema; E Arris; I Mteza; K Pålsson; E Yangi; F Mhalu; G Biberfeld; S Britton Journal: AIDS Date: 1992-09 Impact factor: 4.177
Authors: Rhoda K Wanyenze; Cecilia Nawavvu; Alice S Namale; Bernard Mayanja; Rebecca Bunnell; Betty Abang; Gideon Amanyire; Nelson K Sewankambo; Moses R Kamya Journal: Bull World Health Organ Date: 2008-04 Impact factor: 9.408
Authors: M Melbye; E K Njelesani; A Bayley; K Mukelabai; J K Manuwele; F J Bowa; S A Clayden; A Levin; W A Blattner; R A Weiss Journal: Lancet Date: 1986-11-15 Impact factor: 79.321
Authors: S Ole-Nguyaine; J A Crump; G S Kibiki; K Kiang; J Taylor; W Schimana; J A Bartlett; J F Shao; J D Hamilton; N M Thielman Journal: Ann Trop Med Parasitol Date: 2004-03
Authors: I Sikazwe; M A Elafros; C M Bositis; O K Siddiqi; I J Koralnik; L Kalungwana; W H Theodore; J F Okulicz; M J Potchen; G L Birbeck Journal: HIV Med Date: 2015-07-22 Impact factor: 3.180
Authors: Tendai Munthali; Patrick Musonda; Paul Mee; Sehlulekile Gumede; Ab Schaap; Alwyn Mwinga; Caroline Phiri; Nathan Kapata; Charles Michelo; Jim Todd Journal: Health Res Policy Syst Date: 2017-06-13