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Peer Reviewed

Title: Preventing transfusion-transmitted HIV infection in Latin America and the Caribbean: issues associated with blood donor interviews and sex between men.
Author: Alonso M; Mazin R; Md RM; Cruz JR
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 May 1;51 Suppl 1:S67-72.
Abstract: BACKGROUND: Blood-borne transmission is the most efficient route for acquiring HIV infection, particularly through transfusion. Availability of noninfectious blood units for hemotherapy is a necessary condition for efficient functioning of health services. They have the obligation to ensure that the blood supply is safe, which includes interviewing potential donors to ascertain whether they might be at risk of being HIV infected. The interview procedures demand that blood services staff inquire potential blood donors about sexual practices associated to HIV transmission. Assumptions and misconceptions may unnecessary exclude adequate donors. METHODS: Review of published and unpublished country reports in Latin America regarding blood safety and deferral criteria related to same sexual behavior among males. RESULTS: An analysis of criteria for deferral of potential blood donors shows inconsistencies that may impact the necessary safe blood supply. CONCLUSIONS: The blood donor deferral criteria should be revised according to relevant epidemiological evidence and social legitimacy. Personnel in blood banks and hemotherapy services should be educated to conduct appropriate interviews for accepting or deferring potential donors. Potential donors and the public should be knowledgeable for them to understand the reasons why some individuals may be deferred. Health authorities should work to reduce the stigma associated with HIV, prioritize building strong and meaningful partnerships with civil society, and engage diverse sectors in the national AIDS response.
Language: English
Keywords:
LATIN AMERICA | CARIBBEAN | RESEARCH REPORT | MEN HAVING SEX WITH MEN | HIV INFECTIONS | HIV TRANSMISSION | BLOOD DONORS | SAFETY | STIGMA | HOMOSEXUALS | BLOOD TRANSFUSION | Americas | Developing Countries | Sex Behavior | Behavior | Viral Diseases | Diseases | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Public Health | Social Problems | Sociocultural Factors | Treatment
Document Number: 341318

2.
Peer Reviewed

Title: Quality of obstetric care in public-sector facilities and constraints to implementing emergency obstetric care services: evidence from high- and low-performing districts of Bangladesh.
Author: Anwar I; Kalim N; Koblinsky M
Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):139-55.
Abstract: This study explored the quality of obstetric care in public-sector facilities and the constraints to programming comprehensive essential obstetric care (EOC) services in rural areas of Khulna and Sylhet divisions, relatively high- and low-performing areas of Bangladesh respectively. Quality was explored by physically inspecting all public-sector EOC facilities and the constraints through in-depth interviews with public-sector programme managers and service providers. Distribution of the functional EOC facilities satisfied the United Nation's minimum criteria of at least one comprehensive EOC and four basic EOC facilities for every 500,000 people in Khulna but not in Sylhet region. Human-resource constraints were the major barrier for maternal health. Sanctioned posts for nurses were inadequate in rural areas of both the divisions; however, deployment and retention of trained human resources were more problematic in rural areas of Sylhet. Other problems also plagued care, including unavailability of blood in rural settings and lack of use of evidence-based techniques. The overall quality of care was better in the EOC facilities of Khulna division than in Sylhet. 'Context' of care was also different in these two areas: the population in Sylhet is less literate, more conservative, and faces more geographical and sociocultural barriers in accessing services. As a consequence of both care delivered and the context, more normal vaginal and caesarian-section deliveries were carried out in the public-sector EOC facilities in the Khulna region, with the exception of the medical college hospitals. To improve maternal healthcare, there is a need for a human-resource plan that increases the number of posts in rural areas and ensures availability. All categories of maternal healthcare providers also need training on evidence-based techniques. While the centralized push system of management has its strengths, special strategies for improving the response in the low-performing areas is urgently warranted.
Language: English
Keywords:
BANGLADESH | RURAL AREAS | RESEARCH REPORT | OBSTETRICS | EMERGENCY SERVICES | IMPLEMENTATION | MATERNAL HEALTH SERVICES | QUALITY OF HEALTH CARE | OBSTACLES | HEALTH FACILITIES | PUBLIC SECTOR | HUMAN RESOURCES | BLOOD SUPPLY | SAFE MOTHERHOOD | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration | Maternal-Child Health Services | Primary Health Care | Health Services Evaluation | Program Evaluation | Macroeconomic Factors | Economic Factors | Equipment and Supplies | Medical Procedures | Maternal Health
Document Number: 341937

Title: Laboratory challenges in the scaling up of HIV, TB, and malaria programs: The interaction of health and laboratory systems, clinical research, and service delivery.
Author: Birx D; de Souza M; Nkengasong JN
Source: American Journal of Clinical Pathology. 2009 Jun;131(6):849-51.
Abstract: Strengthening national health laboratory systems in resource-poor countries is critical to meeting the United Nations Millennium Development Goals. Despite strong commitment from the international community to fight major infectious diseases, weak laboratory infrastructure remains a huge rate-limiting step. Some major challenges facing laboratory systems in resource-poor settings include dilapidated infrastructure; lack of human capacity, laboratory policies, and strategic plans; and limited synergies between clinical and research laboratories. Together, these factors compromise the quality of test results and impact patient management. With increased funding, the target of laboratory strengthening efforts in resource-poor countries should be the integrating of laboratory services across major diseases to leverage resources with respect to physical infrastructure; types of assays; supply chain management of reagents and equipment; and maintenance of equipment.
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | HIV INFECTIONS | TUBERCULOSIS | MALARIA | LABORATORY | NEEDS | INTEGRATED PROGRAMS | HUMAN RESOURCES | LOGISTICS | TRAINING ACTIVITIES | STANDARDS | QUALITY CONTROL | Viral Diseases | Diseases | Infections | Parasitic Diseases | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Economic Factors | Programs | Organization and Administration | Management | Training Programs | Education | Research Methodology
Document Number: 341768

Peer Reviewed

Title: Political feasibility of scaling-up five evidence-informed HIV interventions in Pakistan: a policy analysis.
Author: Buse K; Lalji N; Mayhew SH; Imran M; Hawkes SJ
Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 2):ii37-ii42.
Abstract: Background: Drawing on policy theories, an assessment was made of the perceived political feasibility of scaling-up five evidence-based interventions to curb Pakistan's HIV epidemic: needle and syringe exchange programmes; targeted behaviour change communication; sexual health care for male and transgender sex workers; sexual and reproductive health care for female sex workers; and promoting and protecting the rights of those at greatest risk. Method: A questionnaire was emailed to 40 stakeholders and completed by 22. They expressed their level of agreement with 15 statements for each intervention (related to variables associated with policy success). Semi-structured interviews were conducted with 12 respondents. Results: The interventions represent considerable change from the status quo, but are perceived to respond to widely acknowledged problems. These perceptions, held by the HIV policy elite, need to be set in the context of the prevailing view that the AIDS response is not warranted given the small and concentrated nature of the epidemic and that the interventions do not resonate closely with values held by society. The interventions were perceived to be evidence-based, supported by at least one donor and subject to little resistance from frontline staff as they will be implemented by contracted non-government organisations. The results were mixed in terms of other factors determining political feasibility, including the extent to which interventions are easy to explain, exhibit simple technical features, require few additional funds, are supported and not opposed by powerful stakeholders. Conclusion: The interventions stand a good chance of being implemented although they depend on donor support. The prospects for scaling them would be improved by ongoing policy analysis and strengthening of domestic constituencies among the target groups.
Language: English
Keywords:
PAKISTAN | RESEARCH REPORT | THEORETICAL MODELS | KAP SURVEYS | POLICYMAKERS | IV DRUG USERS | SEX WORKERS | HIV PREVENTION | BEHAVIOR CHANGE COMMUNICATION | POLICY DEVELOPMENT | HEALTH POLICY | INTERVENTIONS | CAPACITY BUILDING | SEXUALLY TRANSMITTED DISEASE PREVENTION | SYRINGE | NEEDLE SHARING | SOCIAL POLICY | Developing Countries | Asia, Southern | Asia | Research Methodology | Surveys | Sampling Studies | Studies | Administrative Personnel | Organization and Administration | Drug Use and Abuse | Behavior | Sex Behavior | HIV Infections | Viral Diseases | Diseases | Communication Programs | Communication | Behavior Change | Planning | Policy | Political Factors | Sociocultural Factors | Programs | Program Sustainability | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Risk Behavior
Document Number: 340114

Title: Seroprevalence of human immunodeficiency virus and syphilis in blood donors of Delhi [letter]
Author: Ekadashi R; Langer S
Source: Indian Journal of Medical Microbiology. 2009 Apr-Jun;27(2):167-8.
Abstract: Transfusion of blood and blood products is a life saving measure that benefits numerous patients worldwide. At the same time it is an important mode of infection to the recipients. In up to 15% of the total patients infected with human immunodeficiency virus (HIV), blood transfusion has been the route of transmission. Syphilis positivity varies from 0.8% in voluntary donors to more than 15% in paid commercial donors. Although HIV infection has been reported in all groups of blood donors in Delhi, it is particularly high among replacement donors. Concealing the medical history by professional or replacement donors pose a great threat to safe blood supply. Problems are also due to the prevalence of asymptomatic carriers in the society, blood donations during the window period, genetic variability in the viral strains and laboratory errors. Only few reports are available regarding the trend of HIV seropositivity and syphilis serology, particularly in blood donors from northern India. In this study, we aimed to assess the prevalence and trend of HIV and syphilis over 4 years, 2004-2007, among blood donors of Central Delhi. A total of 13,672 blood units were collected from blood donors during the period from January 1 2004 to December 31 2007 at the blood bank of Delhi Heart and Lung Institute in New Delhi, India. This is a tertiary care level hospital super specializing in heart and lung ailments. Blood donors were either replacement or voluntary. Care was taken to exclude professional donors by taking appropriate history and examination. (excerpt)
Language: English
Keywords:
INDIA | CRITIQUE | BLOOD DONORS | HIV TRANSMISSION | SYPHILIS | HIV | LABORATORY PROCEDURES | SCREENING | SAFETY | PREVENTION AND CONTROL | Asia, Southern | Asia | Developing Countries | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Public Health
Document Number: 341204

Title: A test that won't die: the serologic test for syphilis [editorial]
Author: Katz LM
Source: Transfusion. 2009 Apr;49(4):617-9.
Abstract: We (the blood community and the regulators) are unable to articulate an answer to the question "how safe is safe enough?" for the set of blood safety measures we have already implemented.We must address this fundamental policy issue to establish priorities for our menu of potential future threats and interventions and to move solutions through development and deploy them with the urgency their importance demands. The experience of four decades with no recognized transfusion-transmitted syphilis, during which we have implemented a manylayered approach to blood safety addressing a substantial proportion of the risk of T. pallidum infection in the donor base, suggests that the time is ripe to reconsider the use of STS. (excerpt)
Language: English
Keywords:
IOWA | CRITIQUE | RECOMMENDATIONS | CLINICAL RESEARCH | BLOOD DONORS | SYPHILIS | TESTING | SEROCONVERSION | BLOOD TRANSFUSION | SEXUALLY TRANSMITTED DISEASE PREVENTION | United States of America | North America | Americas | Developed Countries | Research Methodology | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Measurement | Immunity | Immune System | Physiology | Biology | Treatment
Document Number: 331247

Title: Intrinsic clotting factors in dependency of age, sex, body mass index, and oral contraceptives: definition and risk of elevated clotting factor levels.
Author: Luxembourg B; Schmitt J; Humpich M; Glowatzki M; Seifried E; Lindhoff-Last E
Source: Blood Coagulation and Fibrinolysis. 2009 Jul 17;
Abstract: Elevated clotting factors have been demonstrated to be a risk factor for venous thromboembolism (VTE). The aim of our study was to investigate the impact of age, sex, body mass index, and oral contraceptives on the clotting factor activities of factors VIII, IX, XI, and XII and their impact on the cutoff definition and risk of VTE associated with elevated clotting factors. Factor VIII, IX, XI, and XII activities were measured in 499 blood donors and 286 patients with VTE. Age and body mass index predicted significantly and independently the clotting factor activities of factors VIII, IX, and XI, whereas use of oral contraceptives predicted factor IX, XI, and XII levels. Percentiles of clotting factor activities, which are often used for the cutoff definition of elevated clotting factors, varied due to the effect of age, body mass index, and oral contraceptives. The adjusted odds ratios for VTE were 10.3 [95% confidence interval (CI) 5.1-20.7], 6.1 (95% CI 3.1-12.0), and 3.3 (95% CI 1.9-5.8) for elevated factors VIII, IX, and XI, respectively. Furthermore, our study demonstrates for the first time that elevated factor XII is associated with an increased risk of VTE (adjusted odds ratio 2.9, 95% CI 1.6-5.3).
Language: English
Keywords:
GERMANY | RESEARCH REPORT | CLIENTS | BLOOD DONORS | AGE FACTORS | BODY WEIGHT | ORAL CONTRACEPTIVES | THROMBOEMBOLISM | RISK FACTORS | Europe, Central | Europe | Developed Countries | Program Activities | Programs | Organization and Administration | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Characteristics | Demographic Factors | Population | Physiology | Biology | Contraceptive Methods | Contraception | Family Planning | Embolism | Vascular Diseases | Diseases
Document Number: 342216

Peer Reviewed

Title: Evaluation of simple rapid HIV assays and development of national rapid HIV test algorithms in Dar es Salaam, Tanzania.
Author: Lyamuya EF; Aboud S; Urassa WK; Sufi J; Mbwana J; Ndugulile F; Massambu C
Source: BMC Infectious Diseases. 2009;9:19.
Abstract: BACKGROUND: Suitable algorithms based on a combination of two or more simple rapid HIV assays have been shown to have a diagnostic accuracy comparable to double enzyme-linked immunosorbent assay (ELISA) or double ELISA with Western Blot strategies. The aims of this study were to evaluate the performance of five simple rapid HIV assays using whole blood samples from HIV-infected patients, pregnant women, voluntary counseling and testing attendees and blood donors, and to formulate an alternative confirmatory strategy based on rapid HIV testing algorithms suitable for use in Tanzania. METHODS: Five rapid HIV assays: Determine HIV-1/2 (Inverness Medical), SD Bioline HIV 1/2 3.0 (Standard Diagnostics Inc.), First Response HIV Card 1-2.0 (PMC Medical India Pvt Ltd), HIV1/2 Stat-Pak Dipstick (Chembio Diagnostic System, Inc) and Uni-Gold HIV-1/2 (Trinity Biotech) were evaluated between June and September 2006 using 1433 whole blood samples from hospital patients, pregnant women, voluntary counseling and testing attendees and blood donors. All samples that were reactive on all or any of the five rapid assays and 10% of non-reactive samples were tested on a confirmatory Inno-Lia HIV I/II immunoblot assay (Immunogenetics). RESULTS: Three hundred and ninety samples were confirmed HIV-1 antibody positive, while 1043 were HIV negative. The sensitivity at initial testing of Determine, SD Bioline and Uni-Gold was 100% (95% CI; 99.1-100) while First Response and Stat-Pak had sensitivity of 99.5% (95% CI; 98.2-99.9) and 97.7% (95% CI; 95.7-98.9), respectively, which increased to 100% (95% CI; 99.1-100) on repeat testing. The initial specificity of the Uni-Gold assay was 100% (95% CI; 99.6-100) while specificities were 99.6% (95% CI; 99-99.9), 99.4% (95% CI; 98.8-99.7), 99.6% (95% CI; 99-99.9) and 99.8% (95% CI; 99.3-99.9) for Determine, SD Bioline, First Response and Stat-Pak assays, respectively. There was no any sample which was concordantly false positive in Uni-Gold, Determine and SD Bioline assays. CONCLUSION: An alternative confirmatory HIV testing strategy based on initial testing on either SD Bioline or Determine assays followed by testing of reactive samples on the Determine or SD Bioline gave 100% sensitivity (95% CI; 99.1-100) and 100% specificity (95% CI; 96-99.1) with Uni-Gold as tiebreaker for discordant results.
Language: English
Keywords:
TANZANIA | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | URBAN POPULATION | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | BLOOD DONORS | HIV TESTING | TIME FACTORS | GOVERNMENT PROGRAMS | HEALTH SERVICES EVALUATION | VOLUNTARY COUNSELING AND TESTING | RELIABILITY | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Population Dynamics | Programs | Organization and Administration | Program Evaluation | Measurement
Document Number: 330705

10.

11.
Peer Reviewed

Title: Maternal health in Gujarat, India: a case study.
Author: Mavalankar DV; Vora KS; Ramani KV; Raman P; Sharma B; Upadhyaya M
Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):235-48.
Abstract: Gujarat state of India has come a long way in improving the health indicators since independence, but progress in reducing maternal mortality has been slow and largely unmeasured or documented. This case study identified several challenges for reducing the maternal mortality ratio, including lack of the managerial capacity, shortage of skilled human resources, non-availability of blood in rural areas, and infrastructural and supply bottlenecks. The Gujarat Government has taken several initiatives to improve maternal health services, such as partnership with private obstetricians to provide delivery care to poor women, a relatively-short training of medical officers and nurses to provide emergency obstetric care (EmOC), and an improved emergency transport system. However, several challenges still remain. Recommendations are made for expanding the management capacity for maternal health, operationalization of health facilities, and ensuring EmOC on 24/7 (24 hours a day, seven days a week) basis by posting nurse-midwives and trained medical officers for skilled care, ensuring availability of blood, and improving the registration and auditing of all maternal deaths. However, all these interventions can only take place if there are substantially-increased political will and social awareness.
Language: English
Keywords:
INDIA | RESEARCH REPORT | CASE STUDIES | MATERNAL HEALTH | MATERNAL HEALTH SERVICES | HEALTH SERVICES ADMINISTRATION | OBSTETRICS | EMERGENCY SERVICES | TRANSPORTATION | MATERNAL MORTALITY | BLOOD SUPPLY | HUMAN RESOURCES | TRAINING PROGRAMS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Health | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Management | Organization and Administration | Medicine | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Equipment and Supplies | Medical Procedures | Education
Document Number: 341932

12.
Peer Reviewed

Title: Improving maternal survival in South Asia--what can we learn from case studies?
Author: McPake B; Koblinsky M
Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):93-107.
Abstract: Technical interventions for maternal healthcare are implemented through a dynamic social process. Peoples' behaviours--whether they be planners, managers, providers, or potential users--influence the outcomes. Given the complexity and unpredictability inherent in such dynamic processes, the proposed cause-and-effect relationships in any one context cannot be directly transferred to another. While this is true of all health services, its importance is magnified in maternal healthcare because of the need to involve multiple levels of the health system, multiple types of care providers from the highly skilled specialist to community-level volunteers, and multiple technical interventions, without the ability to measure significant change in the outcome, the maternal mortality ratio. Patterns can be followed however, in terms of outcomes in response to interventions. From these case studies of implementation of maternal health programmes across five states of India, Pakistan, and Bangladesh, some patterns stand out and seem to apply virtually everywhere (e.g., failure of systems to post staff in difficult areas) while others require more data to understand the observed patterns (e.g., response to financial incentives for improving maternal health systems; instituting available accessible safe blood). The patterns formed can provide guidance to programme managers as to what aspects of the process to track and micro-manage, to policy-makers as to what features of a context may particularly influence impacts of alternative maternal health strategies, and to governments more broadly as to the factors shaping dynamic responses that might themselves warrant intervention.
Language: English
Keywords:
ASIA, SOUTHERN | CRITIQUE | CASE STUDIES | MATERNAL MORTALITY | MATERNAL HEALTH SERVICES | CHILDBIRTH | BLOOD SUPPLY | HUMAN RESOURCES | FINANCIAL ACTIVITIES | INCENTIVES | HEALTH SERVICES ADMINISTRATION | HEALTH POLICY | Asia | Developing Countries | Studies | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Equipment and Supplies | Medical Procedures | Medicine | Economic Factors | Policy | Political Factors | Sociocultural Factors | Management | Organization and Administration
Document Number: 341940

13.

Title: Qualitative evaluation of a peer-based needle syringe programme in Vietnam.
Author: Ngo AD; Schmich L; Higgs P; Fischer A
Source: International Journal on Drug Policy. 2009 Mar;20(2):179-82.
Abstract: BACKGROUND: Harm reduction has been identified as an important HIV prevention strategy for injecting drug users (IDUs) in Vietnam. However, to date only small geographically limited formal needle syringe programmes (NSPs) have been implemented; and little attention has been given to assessing the effectiveness of the piloted models. Using data from a qualitative evaluation of an NSP in northern Vietnam, this paper assesses the effectiveness of the intervention, examines barriers to the NSP, and documents lessons which can be applied to replicate and scale up interventions across Vietnam. METHODS: Data were gathered using key informant interviews, focus group discussions, in-depth interviews, observation and intercept interviews with IDUs and other project stakeholders. IDUs were introduced to the evaluation by peer educators (PEs). RESULTS: The project contributed to a shift toward safe injecting practices and safe disposal of used needles and syringes (N&S) among IDUs. Collection of used N&S positively influenced community attitudes toward PEs and IDUs. Reduced community discrimination, achieved as a result of project advocacy activities, encouraged IDU to access free needle syringes and other project services provided by PEs. Resistance from the local government officials and community members was turned into support for the programme through intensive advocacy activities. The project highlighted the importance of involving law enforcement in the programme and promoted a public health approach toward working with IDU. However, periodic police campaigns against drug use continued to be an obstacle to successful programme implementation and demonstrated the need for continued efforts to address the issue. CONCLUSION: Programme success is dependent upon community support. Resistance to NSPs can be overcome through a programme of intensive advocacy with community stakeholders including; local government, mass organizations, local residents, IDUs and their families. Garnering the support of law enforcement officials requires a sustained effort.
Language: English
Keywords:
VIETNAM | RESEARCH REPORT | QUALITATIVE RESEARCH | INTERVIEWS | IV DRUG USERS | SYRINGE | COMMUNITY PARTICIPATION | EVALUATION | PROGRAM EFFECTIVENESS | Asia, Southeastern | Asia | Developing Countries | Research Methodology | Data Collection | Drug Use and Abuse | Behavior | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Organization and Administration | Program Evaluation | Programs
Document Number: 330570

15.
Title: Confirming the presence of HTLV-1 infection and the absence of HTLV-2 in blood donors from Arequipa, Peru.
Author: Quispe NC; Feria EB; Santos-Fortuna Ede L; Caterino-de-Araujo A
Source: Revista Do Instituto De Medicina Tropical De Sao Paulo. 2009 Jan-Feb;51(1):25-9.
Abstract: Epidemiological studies conducted in Peru disclosed HTLV-1 to be prevalent in different ethnic groups, and found HTLV-2 in some Amazonian Indians and in men who have sex with men. No data concerning HTLV-1/2 infection in blood donors from Arequipa, a highlands region in southern Peru, is available. We searched for the presence of HTLV-1 and HTLV-2 antibodies in 2,732 serum samples obtained from blood donors from this geographic area. HTLV-1/2-specific antibodies were detected using an enzyme-linked immunosorbent assay (ELISA) and were confirmed by Western blot (WB). Reactive sera had their blood bags discarded from donation, and the demographic characteristics of the donors were analyzed. Thirty-five sera (1.2%) were HTLV seroreactive by ELISA, and 25 were confirmed HTLV-1-positive by WB. One serum disclosed HTLV-positivity, and the remaining nine serum samples showed indeterminate results by WB; three of which had an HTLV-1 indeterminate Gag profile. The median age of HTLV-positive individuals was 34.6 years; 27 were male and eight were female. All individuals were from southern Peru: 27 from Arequipa, five from Puno, and three from Cuzco. HTLV co-positivity with hepatitis B (five sera) and syphilis (one serum) were detected. Previous transfusion and tattooing were observed in two and one individuals, respectively. No serum was positive for HTLV/HIV co-infection. This study confirmed, for the first time, HTLV-1 infection and the absence of HTLV-2 infection in blood donors from Arequipa, Peru and suggests vertical transmission as the major route of HTLV-1 transmission and acquisition in this geographic region.
Language: English
Keywords:
PERU | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | BLOOD DONORS | RURAL POPULATION | PREVALENCE | BLOOD TRANSFUSION | HIV INFECTIONS | VIRAL DISEASES | TATTOOS | SYPHILIS | HEPATITIS | Developing Countries | South America, Western | South America | Latin America | Americas | Research Methodology | Diseases | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Characteristics | Demographic Factors | Population | Measurement | Treatment | Culture | Sociocultural Factors | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections
Document Number: 331252

16.
Peer Reviewed

Title: Study of blood-transfusion services in Maharashtra and Gujarat States, India.
Author: Ramani KV; Mavalankar DV; Govil D
Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):259-70.
Abstract: Blood-transfusion services are vital to maternal health because haemorrhage and anaemia are major causes of maternal death in South Asia. Unfortunately, due to continued governmental negligence, blood-transfusion services in India are a highly-fragmented mix of competing independent and hospital-based blood-banks, serving the needs of urban populations. This paper aims to understand the existing systems of blood-transfusion services in India focusing on Maharashtra and Gujarat states. A mix of methodologies, including literature review (including government documents), analysis of management information system data, and interviews with key officials was used. Results of analysis showed that there are many managerial challenges in blood-transfusion services, which calls for strengthening the planning and monitoring of these services. Maharashtra provides a good model for improvement. Unless this is done, access to blood in rural areas may remain poor.
Language: English
Keywords:
INDIA | EVALUATION REPORT | BLOOD TRANSFUSION | EMERGENCY SERVICES | MATERNAL MORTALITY | BLOOD SUPPLY | SAFETY | HEALTH SERVICES ADMINISTRATION | ORGANIZATION AND ADMINISTRATION | BLOOD DONORS | MONITORING | TRAINING PROGRAMS | Asia, Southern | Asia | Developing Countries | Evaluation | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Demographic Factors | Population | Equipment and Supplies | Public Health | Management | Education
Document Number: 341930

17.

18.

Peer Reviewed

Title: Increase in clinical prevalence of AIDS implies increase in unsafe medical injections.
Author: Reid S
Source: International Journal of STD and AIDS. 2009 May;20(5):295-9.
Abstract: A mass action model developed by the World Health Organization (WHO) estimates that the re-use of contaminated syringes for medical care accounted for 2.5% of HIV infections in sub-Saharan Africa in 2000. The WHO's model applies the population prevalence of HIV infection rather than the clinical prevalence to calculate patients' frequency of exposure to contaminated injections. This approach underestimates iatrogenic exposure risks when progression to advanced HIV disease is widespread. This sensitivity analysis applies the clinical prevalence of HIV to the model and re-evaluates the transmission efficiency of HIV in injections. These adjustments show that no less than 12-17%, and up to 34-47%, of new HIV infections in sub-Saharan Africa may be attributed to medical injections. The present estimates undermine persistent claims that injection safety improvements would have only a minor impact on HIV incidence in Africa.
Language: English
Keywords:
AFRICA, SUB SAHARAN | CRITIQUE | ESTIMATION TECHNIQUES | ADULTS | WHO | HIV INFECTIONS | PREVALENCE | HIV TRANSMISSION | NEEDLE PIERCING | NEEDLE SHARING | SAFETY | SYRINGE | Africa | Developing Countries | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Viral Diseases | Diseases | Measurement | Risk Behavior | Behavior | Public Health | Health | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 341816

19.

Title: Dengue virus antibodies in blood donors from an endemic area.
Author: Rodriguez Rodriguez D; Garza Rodriguez M; Chavarria AM; Ramos-Jimenez J; Rivera MA; Tamez RC; Farfan-Ale J; Rivas-Estilla AM
Source: Transfusion Medicine. 2009 Jun;19(3):125-31.
Abstract: We evaluated the incidence of anti-Dengue virus (DENV) antibodies and dengue viremia in a region of Mexico with a high prevalence of dengue. DENV is the most important arthropod-borne virus in terms of human morbidity and mortality in America We tested 800 blood donors from a tertiary care teaching hospital that provides care in Northeast Mexico, to identify anti-DENV IgM and IgG antibodies by enzyme-linked immunosorbent assay (ELISA) and DENV genome by reverse transcription polymerase chain reaction (RT-PCR). In addition, routine tests for donors including Brucella, Hepatitis C virus (HCV), Venereal Disease Research Laboratory (VDRL), HIV-1 and HBsAg identification were performed. We found that 59% of donors were reactive for anti-DENV IgG and none of them had reported recent DENV infection; however, 16 (2%) were reactive for anti-DENV IgM antibodies. None of them were viremic at the time of donation. Routine tests showed that the prevalence of anti-Brucella was 0.71%, anti-HCV 0.71%, anti-HIV-1-2 0.14%, HBsAg 0.14% and VDRL test 0.57%. Although DENV transmission by blood transfusion had not been confirmed in Mexico, the finding of a high prevalence of anti-DENV IgM-positive donors with asymptomatic manifestations and the recent viremia reported in blood donors suggests that this route of transmission might be possible.
Language: English
Keywords:
MEXICO | RESEARCH REPORT | TESTING | PREVALENCE | DENGUE | BLOOD DONORS | BLOOD TRANSFUSION | ANTIBODIES | TRANSMISSION | North America | Americas | Developing Countries | Measurement | Research Methodology | Viral Diseases | Diseases | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Treatment | Immunologic Factors | Immunity | Immune System | Physiology | Biology | Infections
Document Number: 342973

20.

Title: The WHO/PEPFAR collaboration to prepare an operations manual for HIV prevention, care, and treatment at primary health centers in high-prevalence, resource-constrained settings: defining laboratory services.
Author: Spira T; Lindegren ML; Ferris R; Habiyambere V; Ellerbrock T
Source: American Journal of Clinical Pathology. 2009 Jun;131(6):887-94.
Abstract: The expansion of HIV/AIDS care and treatment in resource-constrained countries, especially in sub-Saharan Africa, has generally developed in a top-down manner. Further expansion will involve primary health centers where human and other resources are limited. This article describes the World Health Organization/President's Emergency Plan for AIDS Relief collaboration formed to help scale up HIV services in primary health centers in high-prevalence, resource-constrained settings. It reviews the contents of the Operations Manual developed, with emphasis on the Laboratory Services chapter, which discusses essential laboratory services, both at the center and the district hospital level, laboratory safety, laboratory testing, specimen transport, how to set up a laboratory, human resources, equipment maintenance, training materials, and references. The chapter provides specific information on essential tests and generic job aids for them. It also includes annexes containing a list of laboratory supplies for the health center and sample forms.
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | WHO | HIV PREVENTION | CARE AND SUPPORT | TREATMENT | PRIMARY HEALTH CARE | HEALTH FACILITIES | PROCEDURES | LABORATORY | LABORATORY EXAMINATIONS AND DIAGNOSES | TESTING | QUALITY CONTROL | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Health Services | Delivery of Health Care | Health | Medical Procedures | Medicine | Organization and Administration | Equipment and Supplies | Examinations and Diagnoses | Measurement | Research Methodology
Document Number: 341765

21.

Title: Seroprevalence of HIV/HBV coinfection in Malian blood donors.
Author: Tounkara A; Sarro YS; Kristensen S; Dao S; Diallo H
Source: Journal of the International Association of Physicians in AIDS Care. 2009 Jan-Feb;8(1):47-51.
Abstract: A cross-sectional study was conducted to assess the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and their coinfection among blood donors at the National Blood Transfusion Center in Bamako, Mali, from November 2001 to July 2002. Enzyme-linked immunosorbent assay techniques with reagents from Bio-Rad (France) were used to test the blood samples. 11,592 blood donors were tested for HIV and HBV surface antigens. The prevalence of HIV was 4.5% and the prevalence of HBV was 14.9%. The HIV/HBV coinfection rate was only 1.13% in this population. The coinfection rate was unexpectedly low in this blood donor population where monoinfection with HIV or HBV prevalence was high.
Language: English
Keywords:
MALI | RESEARCH REPORT | BLOOD DONORS | HIV INFECTIONS | INFECTIONS | LABORATORY PROCEDURES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Viral Diseases | Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses
Document Number: 331329

22.

Title: Human immunodeficiency virus-1 genotypic drug resistance among volunteer blood donors in Yunnan, China.
Author: Tu YQ; Wang MJ; Yao J; Zhu XM; Pan PL; Xing WG; Zhang GH; Yang RG; Zheng YT; Jiang Y
Source: Transfusion. 2009 Sep;49(9):1865-73.
Abstract: BACKGROUND: Drug resistance profiles of human immunodeficiency virus-1 (HIV-1) in treatment-naive infections have been reported in developed countries. However, little is known in developing countries, including China, especially in treatment-naive volunteer blood donors. STUDY DESIGN AND METHODS: Fifty-two HIV-1-positive samples of blood donors were collected from 2005 to 2006 in Yunnan, China. Recent and long-term infections were distinguished by the HIV-1 subtypes B, E, and D immunoglobulin G-capture enzyme immunoassay assay. The nucleotide sequences of pol genes were amplified and sequenced. Phylogenetic tree and drug resistance analyses were performed. RESULTS: Of 49 samples successfully analyzed, circulating strains were circulating recombinant form (CRF)08_BC (51.0%), CRF07_BC (24.5%), CRF01_AE (20.4%), and B (4.1%). No protease inhibitors (PI) major drug resistance mutation (DRM) was detected. Six samples (12.2%) displayed seven minor PI DRMs. Nine samples (18.4%) displayed 10 nucleoside reverse transcriptase inhibitor DRMs, and DRMs to nonnucleoside reverse transcriptase inhibitors were present in one sample (2.0%). There was only one sample of the 49 (2.0%) in which the DRMs were of sufficient magnitude to result in a clinical change to drug susceptibility, but even in this sample, the clinical effect of these DRMs was predicted to be low. Significant differences were not observed between the long-term and recent infected population. Differences in DRMs were not observed between peripheral blood mononuclear cells and plasma within an individual. CONCLUSIONS: CRF_BC was the dominant subtype circulating in HIV-1-infected donors in Yunnan. Prevalence of genotypic drug resistances among donors in Yunnan was low in this study. Surveillance on HIV-1 infections among blood donors should be continued in China.
Language: English
Keywords:
CHINA | RESEARCH REPORT | RETROSPECTIVE STUDIES | BLOOD DONORS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL DRUGS | DRUG RESISTANCE | IMMUNOGLOBULIN ALTERATIONS | LABORATORY PROCEDURES | Asia, Eastern | Asia | Developing Countries | Studies | Research Methodology | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Treatment | Hematological Effects | Hemic System | Physiology | Biology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses
Document Number: 342906

23.

Peer Reviewed

Title: Modelling the transmission of HIV and HCV among injecting drug users in Rawalpindi, a low HCV prevalence setting in Pakistan.
Author: Vickerman P; Platt L; Hawkes S
Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 2):ii23-ii30.
Abstract: Background: In 2007, a survey in Rawalpindi found the prevalence of hepatitis C virus (HCV) in injecting drug users (IDUs) to be low (17%), despite widespread needle/ syringe sharing. This analysis uses modelling to explore hypotheses for the low prevalence of HCV to project the future HIV/HCV epidemic and to estimate the impact of a generic intervention. Methods: An HIV/HCV transmission model was developed and parameterised using data from Rawalpindi. By incorporating different assumptions about the relative frequency/importance of needle/syringe sharing events among "strangers" and people they have shared with before, and undertaking extensive uncertainty analyses to fit the model for each scenario, the validity of different hypotheses for the low HCV prevalence was determined. Model fits were used to project the future HIV/HCV epidemic and the impact of reducing needle/syringe sharing among different IDU subgroups. Results: The model projections suggest that the low HCV prevalence in Rawalpindi is probably due to most HIV/HCV transmissions occurring in a small IDU subgroup that shares needles/syringes frequently with strangers, with most needle/syringe sharing incidents being low risk. Projections suggest that the prevalence of HIV in IDUs will increase to 5-12% by 2015, and the prevalence of HCV will increase if HIV increases HCV transmission. Moderate reductions in needle/syringe sharing (.40%) could reduce the number of HCV/HIV infections (,45%) if all IDUs are reached, although less impact is achieved if high-risk IDUs are not reached. Conclusions: Despite many needle/syringe sharing events possibly being low risk in Rawalpindi, the model projects that the prevalence of HIV/HCV in IDUs is likely to increase. This highlights the importance of intervening in this low prevalence setting.
Language: English
Keywords:
PAKISTAN | RESEARCH REPORT | KAP SURVEYS | MATHEMATICAL MODEL | EPIDEMIOLOGIC METHODS | IV DRUG USERS | HIV TRANSMISSION | HEPATITIS | INFECTION TRANSMISSION | PREVALENCE | NEEDLE SHARING | SYRINGE | RISK ASSESSMENT | Developing Countries | Asia, Southern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Theoretical Models | Drug Use and Abuse | Behavior | HIV Infections | Viral Diseases | Diseases | Infections | Measurement | Risk Behavior | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Evaluation
Document Number: 340116

24.

Title: Novel way to 'cut' the risk of HIV transmission.
Source: Expert Review of Medical Devices. 2008 Sep;5(5):549.
Abstract: Adult male circumcision has recently been endorsed as a strategy for HIV prevention and an innovative device is being considered for this purpose. HIV/AIDS continues to spread in sub-Saharan Africa at an epidemic rate and previous studies into the benefit of circumcision within that area were halted when the NIH considered it unethical to withhold the procedure from the men acting as controls. Some communities in Africa link circumcision, or the lack of it, to rites of passage and religious and tribal identity. However, the recent recommendation by the WHO has been accompanied by an increase in men voluntarily seeking the procedure. The current 'free-hand' technique used in Africa takes approximately 20-30 min and requires suturing. Recently, attention has been drawn to a device currently only available in China that may provide a faster and safer alternative. (excerpt)
Language: English
Keywords:
AFRICA, SUB SAHARAN | CRITIQUE | RECOMMENDATIONS | PILOT PROJECTS | MEN | MALE CIRCUMCISION | HIV PREVENTION | TIME FACTORS | PROCEDURES | SURGICAL EQUIPMENT | APPROPRIATE TECHNOLOGY | Africa | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Population Dynamics | Organization and Administration | Equipment and Supplies | Technology | Economic Factors
Document Number: 328821

25.
Title: Progress toward strengthening blood transfusion services--14 countries, 2003-2007.
Author: Centers for Disease Control and Prevention (CDC)
Source: MMWR. Morbidity and Mortality Weekly Report. 2008 Nov 28;57(47):1273-7.
Abstract: Nearly all persons transfused with human immunodeficiency virus (HIV)-infected blood become infected, and blood transfusions are a substantial source of HIV transmission in sub-Saharan Africa, especially among women and children. Since 2004, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has provided technical and financial support to strengthen national blood transfusion services in 14 countries in Africa and the Caribbean with high prevalence of HIV infection. PEPFAR has supported efforts to improve blood supply adequacy and safety by providing policy guidance, strengthening laboratory infrastructure, and enhancing blood donor recruitment and retention practices. To assess the progress made by these countries with PEPFAR support, CDC analyzed data collected by national blood transfusion services in the 14 countries during 2003-2007. This report summarizes the results of that analysis, which found that 1) national policies had been established in 12 of the 14 countries; 2) the number of whole blood units collected had increased in all 14 countries; 3) the percentage of collections from voluntary, non-remunerated donors had increased; and 4) the percentage of collected blood units reactive for HIV had decreased in 13 of the 14 countries. Since the start of the PEPFAR initiative, progress toward improving safe and adequate supplies of blood has been made in the 14 countries with high prevalence of HIV infection.
Language: English
Keywords:
AFRICA | PROGRESS REPORT | EVALUATION INDEXES | BLOOD DONORS | POLICYMAKERS | WORLD AIDS DAY | BLOOD TRANSFUSION | CAPACITY BUILDING | PERFORMANCE IMPROVEMENT | FOREIGN AID | TECHNICAL ASSISTANCE | SAFETY | STANDARDS | QUALITY CONTROL | HIV TESTING | Developing Countries | Quantitative Evaluation | Evaluation | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Administrative Personnel | Organization and Administration | International Cooperation | Political Factors | Sociocultural Factors | Treatment | Program Sustainability | Programs | Management | Financial Activities | Economic Factors | Public Health | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses
Document Number: 329841

26.

Peer Reviewed

Title: Seroprevalence of HHV-8, CMV, and EBV among the general population in Ghana, West Africa.
Author: Adjei AA; Armah HB; Gbagbo F; Boamah I; Adu-Gyamfi C; Asare I
Source: BMC Infectious Diseases. 2008;8:111.
Abstract: BACKGROUND: Human herpesvirus 8 (HHV-8), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) are prevalent in Africa, but less common elsewhere and the modes of transmission are still subject to debate. Generally, they rarely cause disease in the immunocompetent host but are highly oncogenic when associated with immunosuppression. Although the high prevalence of HHV-8, CMV and EBV has been well documented in Africa, such data are sparse from Ghana. METHODS: Serum samples from 3275 HIV-seronegative healthy blood donors and 250 HIV-AIDS patients were tested for antibodies specific for HHV-8, CMV and EBV by IgG ELISA assays. Differences in seropositivity rates by gender and age were evaluated using the Chi-square test with Yates correction. RESULTS: Of the 3275 HIV-seronegative healthy blood donors tested, 2573 (78.6%) were males and 702 (21.4%) were females, with ages ranging from 18 to 65 years (median 32.6; mean 31.2; mode 30). Of the 250 HIV-AIDS patients tested, 140 (56%) were males and 110 (44%) were females, with ages ranging from 17 to 64 years (median 30.8; mean 30.3; mode 28). Among the HIV-seronegative healthy blood donors, overall seroprevalence of HHV-8, CMV and EBV was 23.7%, 77.6% and 20.0%, respectively. Among the HIV-AIDS patients, overall seroprevalence of HHV-8, CMV and EBV was 65.6%, 59.2% and 87.2%, respectively. The seroprevalence of HHV-8 (p < 0.005) and EBV (p < 0.001) was statistically significantly higher in HIV-AIDS patients compared to HIV-seronegative healthy blood donors. There was no statistically significant difference (p = 0.24) between CMV seroprevalence in HIV-AIDS patients and HIV-seronegative healthy blood donors. Age and gender were not independent determinants (p > 0.05) for all three infections among HIV-seronegative healthy blood donors and HIV-AIDS patients in Ghana. CONCLUSION: The results presented herein indicate that HHV-8, CMV and EBV infections are hyperendemic in both HIV-seronegative and HIV-seropositive Ghanaians, and suggest primarily a horizontal route of transmission of these three viral infections in Ghana.
Language: English
Keywords:
GHANA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CASE CONTROL STUDIES | PERSONS LIVING WITH HIV/AIDS | BLOOD DONORS | PREVALENCE | HERPES GENITALIS | VIRAL DISEASES | AIDS | COMPLICATIONS | EPIDEMICS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Studies | Persons Living With HIV/AIDS | HIV Infections | Diseases | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections
Document Number: 328606

27.

Title: The prevalence of HBV, HCV and HIV infections among blood donors in Izmir, Turkey [letter]
Author: Afsar I; Gungor S; Sener AG; Yurtsever SG
Source: Indian Journal of Medical Microbiology. 2008 Jul-Sep;26(3):288-9.
Abstract: The evaluation of the data of the prevalence of the transfusion transmitted infections (TTIs), Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human immunodeficiency virus (HIV), among blood donors permits an assessment of the acquisition of the infections in the blood donor population and consequently the safety of the collected donations. It also gives an idea for the epidemiology of these infections in the community. [1] Therefore, the purpose of the present study was to determine the prevalence of serological markers of HBV, HCV and HIV in the population of blood donors in Izmir, Turkey. (excerpt)
Language: English
Keywords:
TURKEY | CRITIQUE | PREVALENCE | EVALUATION | HEPATITIS | HIV INFECTIONS | INFECTIONS | BLOOD DONORS | BLOOD TRANSFUSION | LABORATORY PROCEDURES | SCREENING | RISK FACTORS | Developing Countries | Europe, Southeastern | Europe | Measurement | Research Methodology | Viral Diseases | Diseases | Blood Supply | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Treatment | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Biology
Document Number: 328535

28.
Title: [HIV in Mexican blood donors and estimated transfusional risk] VIH en donadores mexicanos de sangre y el riesgo calculado de la transfusion.
Author: Arreguin V; Alvarez P; Simon JI; Valderrama JA; Macias AE
Source: Revista de Investigacion Clinica. 2008 Jul-Aug;60(4):278-83.
Abstract: OBJECTIVE: To determine the HIV seroprevalence in Mexican blood donors and the residual risk of transfusion. MATERIAL AND METHODS: The seroprevalence was determined in a sample of first-time blood donors at one hospital center in Mexico City, from 2003 to 2007. To estimate the seroprevalence reported in Mexican blood donors, we reviewed recent papers. To determine the positive likelihood ratio (LR+) of the EIA test the specificity was calculated against the western-blot result. To infer the residual risk, the incident infections were assumed to be 1.8 times more frequent for first-time donors. RESULTS: We analyzed 29,318 donors; 66 were reactive to HIV by EIA (225/100,000; 95% Confidence Interval: 171 to 279/100,000), but western-blot confirmed only 5 (prevalence = 17/100,000 donors; 95% CI: 2 to 32/100,000). The maximal residual risk was inferred to be 6.2 per million, or about 6.8 per year. The LR+ of the EIA test was calculated to be 476. The Bayesian analysis estimated that the disease is present in only 7.5% donors with a reactive EIA. Published reports in medical literature do not inform confirmatory tests for Mexican donors. DISCUSSION: The residual risk for HIV had been calculated to be about 100 per million of blood donors. Although we inferred that the risk had been overestimated by not performing confirmatory tests, the results are a call for action as the risk is still several times higher than the one reported in industrialized countries.
Language: Spanish
Keywords:
MEXICO | RESEARCH REPORT | LABORATORY PROCEDURES | PERSONS LIVING WITH HIV/AIDS | BLOOD DONORS | BLOOD TRANSFUSION | RISK FACTORS | RISK ASSESSMENT | North America | Americas | Developing Countries | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Blood Supply | Equipment and Supplies | Treatment | Biology | Evaluation
Document Number: 330322

29.

Title: Prevalence of infections, HIV risk behaviors and factors associated with HIV infection among male injecting drug users attending a needle/syringe exchange program in Dhaka, Bangladesh.
Author: Azim T; Chowdhury EI; Reza M; Faruque MO; Ahmed G; Khan R; Rahman M; Pervez MM; Jana S; Strathdee SA
Source: Substance Use and Misuse. 2008 Dec;43(14):2124-44.
Abstract: Injecting drug users (IDU) in Bangladesh are at the early stages of an HIV epidemic. To understand the dynamics of the HIV epidemic, male IDU (n = 561) were recruited from the needle/syringe exchange program in Dhaka in 2002, who underwent a risk-behavior survey and were tested for HIV, syphilis, hepatitis C, and hepatitis B. Correlates of HIV infection were determined by conducting bivariate and multiple regression analyses. The median age of the IDU was 35 years, 39.6% had no formal education, approximately half were married and/or living with their regular sex partner and 26% were currently homeless. The median age at first injection was 29 years. HIV was detected in 5.9% of the IDU and homelessness was the only factor independently associated with HIV (OR = 5.5). Urgent measures must be undertaken to prevent escalation of the HIV epidemic. The study's limitations are noted.
Language: English
Keywords:
BANGLADESH | RESEARCH REPORT | PREVALENCE | MEN | IV DRUG USERS | HOMELESS PERSONS | RISK BEHAVIOR | RISK FACTORS | HIV INFECTIONS | HEPATITIS | SYPHILIS | SYRINGE | Developing Countries | Asia, Southern | Asia | Measurement | Research Methodology | Demographic Factors | Population | Drug Use and Abuse | Behavior | Residence Characteristics | Population Distribution | Geographic Factors | Health | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 330532

30.

Peer Reviewed

Title: Hexamethylbisacetamide and disruption of human immunodeficiency virus type 1 latency in CD4+ T cells.
Author: Choudhary SK; Archin NM; Margolis DM
Source: Journal of Infectious Diseases. 2008;197:1162-1170.
Abstract: Novel therapeutic approaches are needed to attack persistent proviral human immunodeficiency type 1 (HIV-1) infection. Hexamethylbisacetamide (HMBA), a hybrid bipolar compound, induces expression of the HIV-1 promoter in the long terminal repeat (LTR) region in a Tat-independent manner but mimics the effect of Tat, overcoming barriers to LTR expression and increasing the processivity of LTR transcription complexes. We studied alterations in cellular factors and their LTR occupancy induced by HMBA in models of latent HIV-1 infection. We measured the induction of viral outgrowth by HMBA in resting CD4+ T cells from aviremic HIV-1-infected donors. HMBA induced outgrowth of HIV-1 from resting CD4+ T cells recovered from aviremic patients treated with antiretroviral therapy (ART). HMBA triggered cyclin-dependent kinase 9 (CDK9) recruitment to the LTR, a key factor in the induction of efficient HIV-1 expression, via an unexpected interaction with the transcription factor Sp1. The availability of Sp1 andSp1 DNA binding sites were necessary for HMBA-induced CDK9 recruitment and LTR expression. HMBA signaling via both protein kinase C micro and phosphatidylinositol 3-kinase appeared to contribute to LTR induction. The novel mechanism through which HMBA disrupts latent HIV-1 infection involves 2 cellular kinases that may be therapeutically exploited to induce expression of persistent proviral HIV-1. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | NORTH CAROLINA | RESEARCH REPORT | LABORATORY PROCEDURES | PERSONS LIVING WITH HIV/AIDS | BLOOD DONORS | BLOOD | ANTIBODIES | ANTIRETROVIRAL THERAPY | Developed Countries | North America | Americas | Laboratory Examinations and Diagnoses |