Download or read book Screening for HIV Systematic Review to Update the U S Preventive Services Task Force Recommendation written by U. S. Department of Health and Human Services and published by Createspace Independent Pub. This book was released on 2013-04-17 with total page 184 pages. Available in PDF, EPUB and Kindle. Book excerpt: The purpose of this report is to update a previous systematic review commissioned by the U.S. Preventive Services Task Force (USPSTF) on screening for asymptomatic HIV infection in nonpregnant adults and adolescents. In 2005, based on the earlier evidence review, the USPSTF recommended screening all adolescents and adults at increased risk for HIV infection (grade A recommendation). The USPSTF based its recommendation on the high yield of screening in these patients, good evidence that standard and rapid HIV screening tests accurately detect HIV infection, and good evidence that identification and treatment of unsuspected HIV infection at immunologically advanced stages of disease with antiretroviral therapy (ART) and other interventions results in marked reduction in risk of progression to acquired immunodeficiency syndrome (AIDS) and AIDS-related clinical events and mortality. Although the USPSTF found ART associated with short-term adverse events and increased risk of long-term cardiovascular events, it determined that estimated benefits greatly outweighed harms. The USPSTF made no recommendation for or against routinely screening for HIV in adolescents and adults not at increased risk for HIV infection (grade C recommendation). Because of the lower prevalence of HIV infection in persons not at increased risk, the USPSTF determined that benefits from screening would be smaller than screening in higher-risk populations, resulting in a close balance between potential benefits and harms, including false-positive results, labeling, anxiety, and adverse events associated with ART and other interventions. Importantly, the USPSTF found insufficient evidence to estimate benefits from screening in persons at less immunologically advanced stages of disease or effects of screening and subsequent interventions on risk of HIV transmission. In 2006, the Centers for Disease Control and Prevention (CDC) issued its revised guideline recommending routine voluntary HIV screening of all persons ages 13 to 64 years, unless the prevalence of undiagnosed HIV infection has been documented to be less than 0.1 percent. The CDC also recommended that testing be performed on an opt-out basis without a requirement for pretest prevention counseling, in order to reduce barriers to screening. A key reason for the differences between the CDC and USPSTF recommendations is evidence showing that 20 to 26 percent of patients with HIV infection report no risk factors, suggesting that any screening strategy based on risk factor identification will miss an important proportion of infected persons. Other reasons for the differences between the CDC and USPSTF recommendations include greater weight placed by the CDC on studies showing reductions in self-reported risky behaviors following diagnosis of HIV infection, acceptance of modeling studies to estimate effects of HIV diagnosis and reductions in risky behaviors on transmission risk, and greater weight placed on studies showing acceptable incremental cost-effectiveness ratios for screening versus no screening in very low-prevalence populations. The USPSTF subsequently commissioned a focused update of its 2005 report with the studies included in the CDC guideline, but found insufficient evidence to change its C recommendation on screening in persons not at higher risk. The USPSTF found methodological shortcomings in the studies showing reduced risky behaviors following HIV diagnosis, which made estimations of reductions in transmission risk unreliable. This report updates the prior USPSTF review on the benefits and harms of HIV screening in nonpregnant adolescents and adults, focusing on key research gaps identified in the earlier review. This report also addresses areas not addressed in the prior USPSTF review, including effects of different screening methods on uptake, CD4 count at diagnosis, linkage to followup care, and harms, in order to help inform optimal screening strategies.

Download or read book Screening for HIV written by and published by . This book was released on 2012 with total page 176 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: A 2005 U.S. Preventive Services Task Force (USPSTF) review found good evidence that HIV screening tests are accurate and that identification of undiagnosed HIV infection and treatment of immunologically advanced disease is associated with substantial clinical benefits. However, it found insufficient evidence to estimate effects of diagnosis and subsequent interventions on transmission risks, or to estimate clinical benefits of antiretroviral treatment in patients with less immunologically advanced disease. PURPOSE: To systematically update the 2005 USPSTF review on benefits and harms of screening for HIV infection in adolescents and adults, focusing on research gaps identified in the prior review. DATA SOURCES: We searched the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the second quarter of 2012) and Ovid MEDLINE (2004 through June 2012) and manually reviewed reference lists. STUDY SELECTION: We selected randomized trials and observational studies that compared different HIV screening strategies and reported clinical outcomes; the uptake, yield, or harms of screening; CD4 counts at diagnosis; or rates of linkage to care. We also selected randomized trials and observational studies that reported the effects of starting antiretroviral therapy (ART) at different CD4 count thresholds and long-term harms associated with ART, and randomized trials and observational studies that reported the effects of screening and subsequent interventions on risky behaviors and transmission risk. DATA EXTRACTION: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. DATA SYNTHESIS (RESULTS): No study directly evaluated effects of screening for HIV infection versus no screening on clinical outcomes, or compared effects of repeat screening versus one-time screening. Evidence from studies comparing effects of different HIV screening strategies on the uptake or yield of screening, CD4 count at diagnosis, linkage to care, or harms associated with screening is too limited to draw reliable conclusions. New evidence provides strong evidence for effectiveness of earlier initiation of ART, including a subgroup analysis from a randomized trial that found initiation of ART at CD4 counts 0.250 109 cells/L associated with markedly increased risk of death or acquired immunodeficiency syndrome (AIDS) events compared with initiation at CD4 counts0.350 109 cells/L after a mean of 18 months (hazard ratio, 5.3 [95% CI, 1.3 to 9.6]). Large, fair-quality cohort studies also consistently found initiation of ART at CD4 counts of 0.350 to 0.500 109 cells/L associated with decreased risk of mortality and clinical events compared with delayed initiation. New evidence from good-quality cohort studies confirm a small increase in risk of long-term cardiovascular events associated with certain antiretroviral drugs. Although direct clinical evidence showing that changes in risky behaviors as a result of screening or subsequent interventions reduces transmission risk remains unavailable, there is now strong evidence from a randomized trial as well as consistent evidence from multiple observational studies that ART use is associated with an approximately 10- to 20-fold reduction in risk of sexual transmission of HIV infection. LIMITATIONS: Only English-language articles were included. Observational studies were included. Studies conducted in resource-poor or high-prevalence settings were included, but might be of limited applicability to general screening in the United States. CONCLUSIONS: Prior studies have shown that HIV screening is accurate, targeted screening misses a substantial proportion of cases, and treatments are effective at improving clinical outcomes in patients with advanced immunodeficiency. New evidence indicates that ART reduces risk of AIDS-defining events and mortality in persons with less advanced immunodeficiency and reduces sexual transmission. More research is needed to understand effects of different screening strategies on the uptake and yield of screening, harms, CD4 count at diagnosis, and linkage to care.

Download or read book Screening for HIV in Pregnant Women written by and published by . This book was released on 2012 with total page 99 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: A 2005 U.S. Preventive Services Task Force (USPSTF) review found good evidence that prenatal HIV screening is accurate and can lead to interventions that reduce the risk of mother-to-child transmission. PURPOSE: To systematically update the 2005 USPSTF review on benefits and harms of prenatal HIV screening, focusing on research gaps previously identified and new evidence on treatments. DATA SOURCES: We searched MEDLINE (2004 to June 2012) and the Cochrane Library Database (2005 to the second quarter of 2012) and manually reviewed reference lists. STUDY SELECTION: We selected randomized trials and cohort studies of pregnant women that reported risk of mother-to-child transmission or maternal or infant harms associated with prenatal HIV screening or antiretroviral therapy during pregnancy. We also selected studies that reported the yield of repeat prenatal screening or the positive predictive values and harms associated with rapid versus standard HIV testing during pregnancy. DATA EXTRACTION: Two reviewers abstracted and confirmed study details and quality using predefined criteria, based on methods developed by the USPSTF. DATA SYNTHESIS (RESULTS): No study directly evaluated effects of prenatal screening for HIV infection versus no screening on risk of mother-to-child transmission or maternal or infant clinical outcomes. One fair-quality, large cohort study (0.7% HIV prevalence) found rapid testing during labor associated with a positive predictive value of 90 percent. New cohort studies of nonbreastfeeding women in the United States and Europe confirm that full-course combination antiretroviral therapy reduces risk of mother-to-child transmission (

Download or read book Screening for HIV in Pregnant Women Systematic Review to Update the U S Preventive Services Task Force Recommendation written by U. S. Department of Health and Human Services and published by Createspace Independent Pub. This book was released on 2013-04-17 with total page 106 pages. Available in PDF, EPUB and Kindle. Book excerpt: The purpose of this report is to update a previous evidence review commissioned by the U.S. Preventive Services Task Force (USPSTF) on screening for asymptomatic HIV infection in pregnant women, including adolescents. In 2005, based on the earlier review, the USPSTF recommended that clinicians screen all pregnant women for HIV (grade A recommendation). Although the USPSTF found no studies that directly evaluated prenatal HIV screening versus no screening on risk of mother-to-child transmission or other clinical outcomes, it found good evidence that prenatal testing is accurate and acceptable to women and that treatment with recommended interventions (combination antiretrovirals, elective Cesarean delivery in women with viral loads greater than 1,000 copies/mL near the time of delivery, and avoidance of breastfeeding) is associated with major reductions in risk of mother-to-child transmission (from 14% to 25% in untreated women to 1% to 2% with treatment). The USPSTF concluded that benefits of treatments in reducing perinatal transmission substantially outweighed short-term harms, though evidence on long-term maternal or infant harms associated with screening and subsequent interventions was limited. The current report will be used by the USPSTF to update its 2005 recommendation on prenatal HIV screening. This update focuses on newer evidence on the accuracy and acceptability of rapid versus standard testing, the effectiveness of newer antiretroviral regimens for reducing mother-to-child transmission, long-term maternal outcomes following use of antiretroviral regimens during pregnancy, and maternal and infant harms associated with use of antiretroviral medications. Because perinatal practices and interventions related to prevention of HIV infection are substantially impacted by the availability of resources, the report will emphasize evidence applicable to typical practice in the United States. A major goal of prenatal screening for HIV is to reduce the risk of mother-to-child transmission through subsequent interventions. Other important goals are to improve long-term clinical outcomes in HIV-infected women, facilitate early identification of infected newborns, help women to make more informed future reproductive choices, and reduce risk of horizontal transmission through effects on risky behaviors. Using the methods developed by the USPSTF, the USPSTF and the Agency for Healthcare Research and Quality (AHRQ) determined the scope and key questions for this review. Investigators created an analytic framework with the key questions and patient populations, interventions, and outcomes reviewed. The target population for HIV screening was pregnant women without signs or symptoms of HIV infection. Key Questions include: Key Question 1. What are the benefits of HIV screening versus no screening in asymptomatic pregnant women on maternal or child morbidity, mortality, or quality of life or rates of mother-to-child transmission? Key Question 2a. What is the yield (number of new diagnoses) of repeat HIV screening in asymptomatic pregnant women? Key Question 2b. What are the adverse effects (including false-positive results and anxiety) of rapid versus standard HIV testing in asymptomatic pregnant women? Key Question 3a. What is the effectiveness of newer antiretroviral regimens for reducing mother-to- child transmission? Key Question 3b. What are the effects of antiretroviral regimens in pregnant, HIV-positive women on long-term maternal morbidity, mortality, or quality of life? Key Question 3c. What are the harms (including longer-term harms) to the mother or child associated with antiretroviral therapy during pregnancy?

Download or read book Screening for Human Immunodeficiency Virus written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-06-22 with total page 36 pages. Available in PDF, EPUB and Kindle. Book excerpt: This report updates an evidence synthesis commissioned by the U.S. Preventive Services Task Force (USPSTF) and completed in March 2005, on screening for unsuspected human immunodeficiency virus (HIV) using HIV antibody (Ab) tests in non-pregnant adolescents (aged 13 to 18 years old) and adults. This brief update was requested by the USPSTF to determine whether there is sufficient new evidence to justify revision of recommendations based on the 2005 evidence synthesis. A key reason for this update is the release in September 2006 of revised Centers for Disease Control and Prevention (CDC) recommendations advising routine voluntary HIV screening of most U.S. adolescents and adults. The 2005 USPSTF recommendations differ from the revised CDC recommendations in that they do not recommend for or against routine screening non-pregnant adults and adolescents who do not report risk factors and are not in high-prevalence (greater than 1%) or other high-risk settings. Staff at the CDC have indicated that the agency's expanded screening recommendations are based primarily on new evidence as to the effects of HIV screening on transmission risk. This report focuses on new or “breakthrough” evidence that could affect the 2005 USPSTF recommendations regarding routine screening of low- or average-risk adults and adolescents. This update reviews new evidence on HIV screening not included in the 2005 evidence synthesis. It focuses on evidence in non-pregnant, adults and adolescents who do not report risk factors and are evaluated in lower-prevalence (less than 1%), low-risk clinical settings (referred to in this report as 'low-risk' persons), because this is the population for which the USPSTF and the 2006 CDC recommendations are discordant. In the 2005 evidence review, we identified several key areas where additional evidence could strengthen the case for screening in low-risk populations. These include gaps in the research regarding uncertainties about the acceptability of routine voluntary screening in low-risk persons; the yield of targeted versus universal screening and optimal methods of risk assessment in low-risk settings; the impact on test uptake and follow-up of abbreviated or streamlined counseling methods and newer testing or sampling methods; and the effects of screening on HIV transmission rates. We therefore focused on studies that could help fill in these gaps. We also evaluated new evidence on the cost-effectiveness of routine HIV screening and studies on the frequency of testing.

Download or read book Screening for Human Immunodeficiency Virus written by Roger Chou and published by . This book was released on 2007 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This report updates an evidence synthesis commissioned by the U.S. Preventive Services Task Force (USPSTF) and completed in March 2005, on screening for unsuspected human immunodeficiency virus (HIV) using HIV antibody (Ab) tests in non-pregnant adolescents (aged 13 to 18 years old) and adults. This brief update was requested by the USPSTF to determine whether there is sufficient new evidence to justify revision of recommendations based on the 2005 evidence synthesis. A key reason for this update is the release in September 2006 of revised Centers for Disease Control and Prevention (CDC) recommendations advising routine voluntary HIV screening of most U.S. adolescents and adults. The 2005 USPSTF recommendations differ from the revised CDC recommendations in that they do not recommend for or against routine screening non-pregnant adults and adolescents who do not report risk factors and are not in high-prevalence (>1%) or other high-risk settings. Staff at the CDC have indicated that the agency's expanded screening recommendations are based primarily on new evidence as to the effects of HIV screening on transmission risk. This report focuses on new or "breakthrough" evidence that could affect the 2005 USPSTF recommendations regarding routine screening of low- or average-risk adults and adolescents.

Download or read book Screening for HIV Infection in Pregnant Women written by Shelley Selph and published by . This book was released on 2019 with total page 109 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: A 2012 systematic review on HIV screening for the U.S. Preventive Services Task Force (USPSTF) found strong evidence that antiretroviral therapy (ART) greatly decreases the risk of mother-to-child HIV transmission but that use of ART may be associated with increased risk of preterm delivery. The USPSTF previously found HIV screening tests to be highly accurate. PURPOSE: To systematically update the 2012 USPSTF review on HIV screening in pregnancy, focusing on research gaps identified in the prior review. DATA SOURCES: We searched the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and MEDLINE (2012 to June 2018) and manually reviewed reference lists, with surveillance through January 25, 2019. STUDY SELECTION: We selected randomized, controlled trials (RCTs) and cohort studies of pregnant women that reported risk of mother-to-child transmission or maternal or infant harms associated with prenatal HIV screening or ART during pregnancy. DATA EXTRACTION: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. DATA SYNTHESIS (RESULTS): We identified no studies on the benefits or harms of prenatal HIV screening versus no screening, or on the yield of repeat versus one-time screening or screening at different intervals. One new RCT and five new cohort studies were consistent with the 2012 USPSTF review in finding combination ART highly effective at reducing the risk of mother-to-child transmission of HIV infection, especially if started early in pregnancy (rate of mother-to-child transmission

Download or read book Screening for HIV Infection in Asymptomatic Nonpregnant Adolescents and Adults written by Roger Chou and published by . This book was released on 2019 with total page 121 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: A 2012 systematic review on HIV screening for the U.S. Preventive Services Task Force (USPSTF) found strong evidence that antiretroviral therapy (ART) is associated with improved clinical outcomes in persons with CD4+ T helper cell (CD4) counts less than 500 cells/mm3 and substantially decreases risk of HIV transmission, with certain antiretroviral agents potentially associated with long-term cardiovascular harms. The USPSTF previously found HIV screening tests to be highly accurate. PURPOSE: To systematically update the 2012 USPSTF review on screening for HIV in adolescents and adults, focusing on research gaps identified in the prior review. DATA SOURCES: We searched the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and MEDLINE (2012 to June 2018) and manually reviewed reference lists, with surveillance through January 2019. STUDY SELECTION: Randomized, controlled trials (RCTs) and controlled observational studies on benefits and harms of screening versus no screening and on the yield of screening at different intervals; the effects of earlier versus later initiation of ART; and long-term (≥2 years) harms of ART. DATA EXTRACTION: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. DATA SYNTHESIS (RESULTS): We did not identify any studies on benefits or harms of HIV screening versus no screening, or on the yield of repeat versus one-time screening or of screening at different intervals. Two new RCTs conducted completely or partially in low-resource settings found initiation of ART in persons with CD4 counts greater than 500 cells/mm3 associated with lower risk of composite clinical outcomes (mortality, AIDS-defining events, or serious non-AIDS events) (relative risk [RR], 0.44 [95% confidence interval (CI), 0.31 to 0.63] and RR, 0.57 [95% CI, 0.35 to 0.95]); early initiation of ART was not associated with increased risk of cardiovascular events. A large observational study also found initiation of ART in persons in high-resource settings with CD4 counts greater than 500 cells/mm3 to be associated with reduced risk of mortality or AIDS events, although the magnitude of effect was smaller. New evidence regarding the association between abacavir use and increased risk of cardiovascular events was inconsistent, and certain antiretroviral regimens were associated with increased risk of long-term neuropsychiatric, renal, hepatic, and bone adverse events. LIMITATIONS: Only English-language articles were included. Observational studies were included. Studies conducted in resource-poor settings were included, which might limit applicability to general screening in the United States. CONCLUSIONS: New evidence extends effectiveness of ART to asymptomatic persons with CD4 counts greater than 500 cells/mm3. Certain ART regimens may be associated with long-term cardiovascular, neuropsychiatric, hepatic, renal, or bone harms, but early initiation of ART is not associated with increased risk of cardiovascular events. Research is needed to inform optimal screening intervals.

Download or read book Colorectal Cancer Screening written by Joseph Anderson, MD and published by Springer Science & Business Media. This book was released on 2011-04-23 with total page 210 pages. Available in PDF, EPUB and Kindle. Book excerpt: Colorectal Cancer Screening provides a complete overview of colorectal cancer screening, from epidemiology and molecular abnormalities, to the latest screening techniques such as stool DNA and FIT, Computerized Tomography (CT) Colonography, High Definition Colonoscopes and Narrow Band Imaging. As the text is devoted entirely to CRC screening, it features many facts, principles, guidelines and figures related to screening in an easy access format. This volume provides a complete guide to colorectal cancer screening which will be informative to the subspecialist as well as the primary care practitioner. It represents the only text that provides this up to date information about a subject that is continually changing. For the primary practitioner, information on the guidelines for screening as well as increasing patient participation is presentedd. For the subspecialist, information regarding the latest imaging techniques as well as flat adenomas and chromoendoscopy are covered. The section on the molecular changes in CRC will appeal to both groups. The text includes up to date information about colorectal screening that encompasses the entire spectrum of the topic and features photographs of polyps as well as diagrams of the morphology of polyps as well as photographs of CT colonography images. Algorithms are presented for all the suggested guidelines. Chapters are devoted to patient participation in screening and risk factors as well as new imaging technology. This useful volume explains the rationale behind screening for CRC. In addition, it covers the different screening options as well as the performance characteristics, when available in the literature, for each test. This volume will be used by the sub specialists who perform screening tests as well as primary care practitioners who refer patients to be screened for colorectal cancer.

Download or read book Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection written by World Health Organization and published by . This book was released on 2016 with total page 429 pages. Available in PDF, EPUB and Kindle. Book excerpt: These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 consolidated guidelines on the use of antiretroviral drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. It is being published in a changing global context for HIV and for health more broadly.

Download or read book HIV Screening and Access to Care written by Institute of Medicine and published by National Academies Press. This book was released on 2011-01-22 with total page 96 pages. Available in PDF, EPUB and Kindle. Book excerpt: More than 200,000 people in the United States living with HIV/AIDS do not know they are infected. The Institute of Medicine's Committee on HIV Screening and Access to Care held a workshop and reviewed literature to explore barriers and facilitators to more widespread HIV testing. This book contains the committee's conclusions.

Download or read book HIV Screening and Access to Care written by Institute of Medicine and published by National Academies Press. This book was released on 2011-04-21 with total page 114 pages. Available in PDF, EPUB and Kindle. Book excerpt: Increased HIV screening may help identify more people with the disease, but there may not be enough resources to provide them with the care they need. The Institute of Medicine's Committee on HIV Screening and Access to Care concludes that more practitioners must be trained in HIV/AIDS care and treatment and their hospitals, clinics, and health departments must receive sufficient funding to meet a growing demand for care.

Download or read book Finding What Works in Health Care written by Institute of Medicine and published by National Academies Press. This book was released on 2011-07-20 with total page 267 pages. Available in PDF, EPUB and Kindle. Book excerpt: Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines. Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process. In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain. Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.

Download or read book Consolidated guidelines on HIV prevention testing treatment service delivery and monitoring written by World Health Organization and published by World Health Organization. This book was released on 2021-07-16 with total page 592 pages. Available in PDF, EPUB and Kindle. Book excerpt: These consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring bring together existing and new clinical and programmatic recommendations across different ages, populations and settings, bringing together all relevant WHO guidance on HIV produced since 2016. It serves as an update to the previous edition of the consolidated guidelines on HIV. These guidelines continue to be structured along the continuum of HIV care. Information on new combination prevention approaches, HIV testing, ARV regimens and treatment monitoring are included. There is a new chapter on advanced HIV disease that integrates updated guidance on the management of important HIV comorbidities, including cryptococcal disease, histoplasmosis and tuberculosis. The chapter on general HIV care, contains a new section on palliative care and pain management, and up to date information on treatment of several neglected tropical diseases, such as visceral leishmaniasis and Buruli ulcer. New recommendations for screening and treating of cervical pre-cancer lesions in women living with HIV are also addressed in this chapter. Guidance on service delivery was expanded to help the implementation and strengthening the HIV care cascade. Importantly, this guidance emphasizes the need for differentiated approaches to care for people who are established on ART, such as reduced frequency of clinic visits, use of multi-month drug dispensing and implementation of community ART distribution. The adoption of these efficiencies is essential to improve the quality of care of people receiving treatment and reduce the burden on health facilities, particularly in resource limited settings.

Download or read book Screening for Syphilis in Nonpregnant Adolescents and Adults written by Amy Cantor and published by . This book was released on 2016 with total page 82 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: In 2004, the U.S. Preventive Services Task Force recommended routine screening for syphilis infection in asymptomatic persons at increased risk of infection, and recommended against screening in those not at increased risk. PURPOSE: To update a prior systematic review on screening for syphilis infection in asymptomatic, nonpregnant adolescents and adults for the U.S. Preventive Services Task Force. DATA SOURCES: Cochrane Central Register of Controlled Trials (to March 2016) and Cochrane Database of Systematic Reviews (to March 2016), MEDLINE (January 2004 to March 2016), and reference lists. STUDY SELECTION: English-language trials and observational studies of screening effectiveness, test accuracy, and screening harms. DATA EXTRACTION: One investigator abstracted details about study design, patient population, setting, screening method, followup, and results. Two investigators independently applied prespecified criteria to rate study quality. Discrepancies were resolved through consensus. DATA SYNTHESIS: Four observational studies conducted outside the United States evaluated detection rates using specific screening intervals among men who have sex with men (MSM) or persons living with HIV. Higher rates of detection were reported for early syphilis in MSM living with HIV (8.1% vs. 3.1%; p=0.001), newly acquired syphilis in MSM living with HIV (7.3 cases [95% CI, 5.2 to 9.9] vs. 2.8 cases [95% CI, 1.8 to 4.0] per 1,000 patient-years; p0.05); early latent syphilis in MSM (1.7% vs. 0.4%; p=0.008); and early syphilis in higher-risk MSM (53% vs. 16%; p=0.001) when screening every 3 months compared with 6 or 12 months. Three diagnostic accuracy studies found that treponemal or nontreponemal tests are accurate screening tests for syphilis in asymptomatic persons (sensitivity 85% and specificity >91% for nontreponemal and treponemal tests in most studies) but require confirmatory testing. Two studies of the accuracy of reverse sequence testing indicated that using an automated treponemal test for initial screening resulted in a higher rate of false-reactive tests compared with using the Rapid Plasma Reagin test as an initial test in a low prevalence U.S. population (0.6% vs. 0.0%; p=0.03) and a higher prevalence Canadian population (0.26% vs. 0.13%), but both methods also identified additional positive tests that would not have been identified using conventional methods. LIMITATIONS: No studies addressed the effectiveness of screening, the effectiveness of risk assessment instruments, or the adverse effects of screening. No studies were specifically conducted in adolescents. Only screening tests and methods cleared by the U.S. Food and Drug Administration for current clinical practice were included to determine diagnostic accuracy. CONCLUSIONS: Observational data from four studies demonstrate improved detection of syphilis infection among MSM or men living with HIV who are screened every 3 months compared with 6 or 12 months. Screening with treponemal or nontreponemal tests is accurate for detecting syphilis in asymptomatic persons but requires confirmatory testing. Further research is needed to understand the impact of screening for syphilis on clinical outcomes; effective screening strategies, including reverse sequence screening, in various patient populations; and harms of screening.

Download or read book WHO consolidated guidelines on tuberculosis Module 2 written by World Health Organization and published by World Health Organization. This book was released on 2021-03-22 with total page 68 pages. Available in PDF, EPUB and Kindle. Book excerpt: The WHO consolidated guidelines on tuberculosis. Module 2: screening – systematic screening for tuberculosis disease is an updated and consolidated summary of WHO recommendations on systematic screening for tuberculosis (TB) disease, containing 17 recommendations for populations in which TB screening should be conducted and tools to be used for TB screening. TB screening is strongly recommendations for household and close contacts of individuals with TB, people living with HIV, miners exposed to silica dust, and prisoners. In addition, screening is conditionally recommended for people with risk factors for TB attending health care, and for communities with risk factors for TB and limited access to care (e.g. homeless, urban poor, refugees, migrants). General population screening is recommended in high-burden settings (0.5% prevalence or higher). Symptoms, chest radiography (CXR), and molecular WHO-recommended rapid diagnostic tests for TB are recommended as screening tools for all adults eligible for screening. Computer-aided detection programmes are recommended as alternatives to human interpretation of CXR in settings where trained personnel are scarce. For people living with HIV, C-reactive protein is also a good screening tool. This guideline document is accompanied by an operational handbook, the WHO operational handbook on tuberculosis. Module 2: screening – systematic screening for tuberculosis disease, that presents principles of screening, steps in planning and implementing a screening programme, and algorithm options for screening different populations.

Download or read book Guidelines on Hepatitis B and C Testing written by World Health Organization and published by World Health Organization. This book was released on 2017 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Testing and diagnosis of hepatitis B (HBV) and C (HCV) infection is the gateway for access to both prevention and treatment services, and is a crucial component of an effective response to the hepatitis epidemic. Early identification of persons with chronic HBV or HCV infection enables them to receive the necessary care and treatment to prevent or delay progression of liver disease. Testing also provides an opportunity to link people to interventions to reduce transmission, through counselling on risk behaviors and provision of prevention commodities (such as sterile needles and syringes) and hepatitis B vaccination. These are the first WHO guidelines on testing for chronic HBV and HCV infection and complement published guidance by WHO on the prevention, care and treatment of chronic hepatitis C and hepatitis B infection. These guidelines outline the public health approach to strengthening and expanding current testing practices for HBV and HCV, and are intended for use across age groups and populations.