HIV Counseling and Testing Thomas J. Coates, PhD Michael and Sue Steinberg Professor of Global AIDS...
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Transcript of HIV Counseling and Testing Thomas J. Coates, PhD Michael and Sue Steinberg Professor of Global AIDS...
HIV Counseling and Testing
Thomas J. Coates, PhDMichael and Sue Steinberg Professor of Global AIDS Research
Director, UCLA Center for World Health
Varieties of Community HCT ModalitiesFacility-based
Mobile
House-to-house
Index
Self-testing
Workplace
School
Church
5
VCT: Historical Perspectives: 1985Antibody tests licensed
(protect the blood supply)
Anonymous testing the norm
Had to include pre- and post-test counseling
Strong testing campaigns in the US
Not so much in Europe
6
VCT: Historical Perspectives: 1985$70m allocated for AIDS research
Ryan White refused entry to middle school
Rock Hudson dies at UCLA
First AIDS conference in Atlanta
hosted by WHO and CDC
7
VCT: Historical Perspectives: 1986Reagan says “AIDS” for the first time and vows to make
AIDS a priority (thank you Elizabeth Taylor)
National Minority AIDS Council formed
First panel of AIDS quilt sewn
HIV is named
8
VCT: Historical Perspectives: 1987Global Program on AIDS launched at WHO
AZT approved
ACT UP founded by Larry Kramer
First National Conference on HIV and Communities of Color in New York
First candidate vaccine tested
9
VCT: Historical Perspectives: 1987CDC testing guidelines released
Ray house burned in Florida
Western Blot test approved
Liberace dies of AIDS
10
VCT: Historical Perspectives: 1989Precursor to the Ryan White Care Act
funded by Congress
100,000 reported AIDS cases in the US
12
VCT: Historical Perspectives: 1990Ryan White dies
Ryan White Care Act passed by Congress
HIV prevention counseling model adopted by the CDC--client-centered approach
13
VCT: Historical Perspectives: 1991HOPWA enacted
CDC recommends restrictions on HIV+ health care workers
First National Skills Building Conference hosted by NAPWA
Magic Johnson announces that he has AIDS
14
VCT: Historical Perspectives: 19928th International Conference on AIDS moved from
Boston to Amsterdam
AIDS is the #1 cause of death for men 25-44
15
VCT: Historical Perspectives: 19928th International Conference on AIDS moved from
Boston to Amsterdam
AIDS is the #1 cause of death for men 25-44
16
VCT: Historical Perspectives: 1993President Clinton establishes the
Office of National AIDS Policy at The White House
CDC establishes the community planning process to better target local prevention efforts
Philadelphia released
Angels in America receives the Tony
Case definition of AIDS expanded (<200 CD4)
17
VCT: Historical Perspectives: 1994AIDS is the leading cause of death
for all Americans 25-44
Randy Shilts and Peter Zamora die
AZT recommended for pregnant HIV+ women to prevent mother-to-child transmission of HIV
NIH addresses the appropriate inclusion of women and minorities in HIV clinical research
18
VCT: Historical Perspectives: 1995Greg Louganis discloses that he has HIV
Eric Lynn Wright (Eazy-E) dies one month after being diagnosed with HIV
500,000 cases of AIDS reported in the US
First White House Conference on AIDS convened
19
VCT: Historical Perspectives: 1996HAART unveiled at Vancouver AIDS Conference
Number of reported AIDS cases declines for the first time in the US
UNAIDS formed
AIDS Memorial Quilt covers the entire Mall in DC
Ryan White Care Act reauthorized
20
VCT: Historical Perspectives: 1997AIDS deaths decline
Combination therapy approved by FDA
UNAIDS estimates 30m people with HIV worldwide
Clinton establishes goal of HIV vaccine in 10 years
21
VCT: Historical Perspectives: 1998African-Americans account for 49% of AIDS-related
deaths; AIDS related mortality 10x that of whites and 3x that of Latinos
Clinton announces a special package of initiatives aimed at HIV in minority communities; Minority AIDS Initiative
passed by Congress with $156m
Shalala announces that needle exchange programs are effective
The Supremes say that the ADA covers people with HIV
22
VCT: Historical Perspectives: 1999WHO announces that AIDS is the 4th biggest killer
worldwide; 33m infected; 16m have died
VaxGen vaccine trial starts in Thailand
Clinton announces new global initiative for HIV
23
VCT: Historical Perspectives: 2000United Nations Security Council discusses AIDS as a
global security issue (#1 for any health issue)
Durban AIDS Conference
Clinton announces Executive Order to permit developing countries to import generic drugs
Global AIDS and Relief Act of 2000
Ryan White Care Act reauthorized
We announce the results of our study of HCT
24
VCT: Historical Perspectives: 2001UN Secretary Kofi Annan calls for the global AIDS fund
“war chest”
US Secretary of State Colin Powell reaffirms that HIV/AIDS is a national security threat
First Annual National Black AIDS Awareness Day in the US
World Trade Organization announces DOHA Agreement to allow developing countries to buy or manufacture
generics
25
VCT: Historical Perspectives: 2002UNAIDS reports that women comprise about half of all
adults living with HIV/AIDS worldwide
HIV is leading cause of death worldwide among those aged 15-59
Approval of OraQuick rapid HIV-1 Antibody Test by FDA; first rapid test to use finger prick
26
VCT: Historical Perspectives: 20033 by 5 Initiative announced by WHO
South Africa announces new antiretroviral treatment programs
William J. Clinton Presidential Foundation secures price reductions for HIV/AIDS drugs to benefit
developing nations
27
VCT: Historical Perspectives: 2004Global Fund holds first Partnership Forum in Bangkok
with 400 participating dleegates
UNAIDS launches the Global Coalition on Women and AIDS
PEPFAR, President Bush’s Emergency Plan for AIDS Relief, begins first round of funding
OraQuick Rapid HIV-1 Antibody Test approved for use with oral fluid by FDA
28
VCT: Historical Perspectives: 2005World Economic Forum in Davos priorities include a
focus on addressing HIV/AIDS in Africa
First Annual National Asian and Pacific Islander HIV/AIDS Awareness Day in the United States
Ranbaxy is the first Indian drug manufacturer to gain US FDA approval to produce generic antiretrovirals for
PEPFAR
29
VCT: Historical Perspectives: 2006First Annual National HIV/AIDS Awareness Day in the
US
CDC recommends routine HIV in health care settings
First Annual National Women and Girls HIV/AIDS Awareness Day in the US
30
VCT: Historical Perspectives: 2007President Bush calls on Congress to reauthorize
PEPFAR at $30b over 5 years
WHO and UNAIDS issue guidance recommending ‘provider initiated’ HIV testing in health care settings
WHO and UNAIDS recommend that male circumcision should always be considered as part of a comprehensive
HIV prevention package
31
VCT: Historical Perspectives: 2008US Congress reauthorizes PEPFAR for 5 years at up to
$48b
17th International AIDS Conference
”Universal Action Now” in Mexico City
First Annual National Gay Men’s HIV/AIDS Awareness Day in the United States
CDC releases new HIV incidence estimates for the US, showing that the US epidemic is worst than thought
32
VCT: Historical Perspectives: 2009
Newly elected President Obama calls for the first ever National HIV/AIDS Strategy
The Obama Administration lifts HIV travel and immigration ban by removing regulatory barriers to entry
US Congress eliminates long-standing statutory ban on the use of Federal funding for needle exchange in the US
33
VCT: Historical Perspectives: 2010
Obama Administration releases first comprehensive HIV/AIDS strategy for the US
South African investigators announce the results of CAPRISA004 showing that the use of a microbicide gel
reduces risk of HIV infection by 39%
iPrEx shows that the daily dose of a Truvada reduced risk of acquiring HIV among MSM by 43%
34
VCT: Historical Perspectives: 2011
HHS launches the 12 Cities Project to focus resources on the areas with the highest AIDS burden in the country
Secretary Clinton and President Obama announce the goal of an AIDS-free generation
HPTN 052 demonstrates the importance of treatment as prevention
Elizabeth Taylor dies
35
VCT: Historical Perspectives: 2012
FDA approves OraQuick In-Home Test
The first rapid over-the-counter rapid test that can be bought over the counter and read at home
Truvada approved for PrEP
36
Varieties of Community HCT ModalitiesAcceptance of Testing
Mobile—87%
House-to-house—80%
Index—88%
Self-testing—87%
Workplace—67%
School—62%
37
Principles of HIV Counseling and Testing
Screening donor blood and cellular products
Diagnosis of HIV infection (sensitivity and specificity)
Human rights (confidential, counseling, informed consent)
Confidentiality
Anonymous testing
Routine testing
38
Community HCT Modalities
Increased testing uptake—RR=10.65 (6.27-18.08)
Proportion of first-time testers—RR=1.23 (1.06-1.42)
Proportion of testers CD4 > 350—1.42 (1.16-1.74)
Lower positivity rate—RR=0.59 (0.37-0.96)
40