158 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0427 Infectious Disease
Success Story of Provider Initiated Testing and Coun- seling at Various Departments in Mwala District Hospi- tal
Muthoni Catherine MUBURI1, Elizabeth MUBURI1 Mwala District Hospital, Kenya1
Background: In the HIV epidemic, Kenya is ranked fourth in the world. Provider in- itiated testing and counseling (PITC) was rolled out in Kenya in 2005. The greatest challenge has been the poor uptake by the health care providers since most lack the necessary skills and knowledge to carry out the testing and counseling. In Mwala dis- trict a study carried out showed that the uptake of voluntary counseling and testing (VCT) amongst the locals was particularly poor because of the stigma associated with the disease. Many people were afraid to be seen walking into a VCT centre. This creat- ed a gap in HIV testing and counseling in the district. As of 2012, 53% of all Kenyans living with HIV were not aware of their status. With the help of a local organization, several staff members of Mwala District Hospital underwent training on HIV testing and counseling. With the knowledge and skills acquired the staff members were in a position to offer the service appropriately at a departmental level.
Methods: A retrospective study was undertaken. Records of all patients tested in the period of January 2013-February 2014 were analyzed. The departments involved were - outpatient, inpatient, wounds and laboratory.
Results: Of the 12,364 patients treated during that period-4179 patients were tested at the outpatient deportment; 35 patients were tested at the wounds department ; 176 patients were tested at the Laboratory department; 169 patients were tested as inpatients. A total of 843 people were tested at the VCT centre during the same peri- od.88 patients out of the 4559 patients tested positive.
Conclusion: PITC should be an integral part of healthcare delivery at all healthcare facilities. PITC should be embraced by all health care providers.
PS 0430 Infectious Disease
Diagnosis and Management of Appendicitis in HIV-In- fected Patients
Kumiko KITAOKA1, Koichi TOKUUYE1 Tokyo Medical University, Japan1
Background: Appendicitis is a common abdominal emergency and traditionally clas- sifi ed as surgical condition. Previous studies have suggested possible increased risk of appendicitis and special etiological features among HIV-positive patients. However, no prior study has evaluated what clinical variables are important in predicting severity of appendicitis, and deciding whether surgical intervention is indicated among HIV-posi- tive patients.
Methods: We retrospectively studied 323 patients diagnosed with appendicitis at our university hospital from 2007 to 2012.
Results: Of 323 appendicitis patients, fourteen (13 male, 1 female) have been diag- nosed with HIV infection (4.6%). In HIV-positive group, six patients were surgically treated (42.9% v 68.2% OR 0.33, P<0.05), and four patients were diagnosed with complicated appendicitis (28.6% v 37.9% OR 0.66, P=0.34). No mortality was ob- served. Appendicolithiasis was identifi ed in only four HIV-positive patients (28.6% v 47.8% OR 0.42, P=0.11). The HIV-positive patients with complicated appendicitis had lower WBC count (median, 6.8 vs 14.2 cells/mL) and lower CD4 count (median, 222 vs 571 x106 /l) than HIV-positive patients with uncomplicated appendicitis
Conclusions: Of 14 HIV-positive patients, eight patients were treated non-operatively and there was no associated mortality. Among HIV-positive patients, complicated appendicitis has been observed more with lower CD4 count patients. The lower CD4 count should alert clinicians for possibility of complicated appendicitis.
PS 0431 Infectious Disease
Partner Characteristics Predicting HIV-1 Set Point in Sexually Acquired HIV-1 among African Seroconverters
Njeri Rahab MBUGUA1, Asunta Wagura WAGURA2, Elizabeth Ann BUKUSI1 Kenya Medical Research Institute, Kenya1, Kenya Network of Women Living with HIV/AIDS, Kenya2 Background: Plasma HIV-1 RNA set point is an important predictor of HIV-1 disease progression. We hypothesized that inoculum size and HIV-1 exposure prior to HIV-1 transmission may modulate set point. We evaluated predictors of set point among 141 African HIV-1 seroconverters and their HIV-1-infected study partners.
Methods: We compared characteristics of seroconverters and their HIV-1-infected partners and HIV-1 set point. Data were from a clinical trial of genital HSV-2 suppres- sion with acyclovir to reduce HIV-1 transmission in HIV-1 serodiscordant couples with HIV-1 transmission linkage assigned through virus sequencing. Our analysis includes data from all transmissions including those with transmission linkage to the HIV-1-in- fected “source partner” and those that were not linked to their HIV-1-infected study partner
Results: n multivariable analysis, higher plasma HIV-1 in source partners was associ- ated with higher seroconverter set point ( + 0.44 log10 copies/ml per log(10) source partner plasma HIV-1, p < 0.001). In addition, bacterial vaginosis (BV) among female source partners near the time of infection was associated with higher set point in their male seroconverters ( + 0.49 log(10), p = 0.04). Source partner characteristics associated with lower set point included male circumcision ( - 0.63 log(10), p = 0.03) and assignment to acyclovir ( - 0.44 log10, p = 0.02). The proportion of variation in set point explained by plasma HIV-1 RNA of the source partner, after controlling for other factors, was 0.06. Source partner plasma HIV-1 level is the most signifi cant predictor of seroconverter set point, possibly refl ecting characteristics of the transmitted virus.
Conclusions: Acyclovir use, BV among women source partners, and circumcision among male source partners may alter the set point by affecting transmitted virus inoculum in the source partners’ genital compartment.
PS 0432 Infectious Disease
Predictors of Consistent Condom Use among Female Sex Workers (FSWs),
Njeri Rahab MBUGUA1, Asunta Wagura WAGURA2, Elizabeth Ann BUKUSI4 Kenya Medical Research Institute, Kenya1, Kenya Network of Women Living with HIV/AIDS, Kenya2, Kenyatta National Hospital, Kenya3, Nairobi University, Kenya4
Background: We evaluated predictors of consistent condom use among female sex workers (FSWs), a core group for controlling the spread of HIV.
Methods: In an analysis of data collected in 2004-2005 from 140 Kenyan FSWs who completed questionnaires administered during a baseline study visit and three bimonthly follow-up visits, we used a case-crossover design to identify predictors of consistent condom use during all coital acts in the preceding 2 weeks, overall and by partner type.
Results: Participants (n=140) completed the baseline visit and 390 bimonthly fol- low-up visits. Alcohol use during sex was negatively associated with consistent con- dom use with helping partners (defi ned as regular sex partners to whom the woman could go for help or support if needed) (adjusted odds ratio [AOR], 2.6, 95% confi - dence interval [CI] 1.0-6.5) but not associated with condom use with other partners.
Coital frequency was associated with condom use with other partners only. Women who reported 1-5 (AOR 11.0, 95% CI 4.3-28.3) or 6-9 recent coital acts (AOR 3.8, 95% CI 1.7-8.8) with other partners were more likely to report consistent condom use with those partners than were women who reported =10 acts. Having a recent part- ner delay payment was inversely associated with consistent condom use with helping, other, or all partners.
Conclusions: Correlates of consistent condom use differed by partner type. By using a case-crossover design, we were able to identify potentially modifi able factors asso- ciated with consistent condom use by FSWs who used condoms consistently with a given partner type during some periods but not others.
