Trends in HIV testing and recording of HIV status in the UK primary care setting: a retrospective cohort study 1995-2005

Objectives: To provide nationally representative data on trends in HIV testing in primary care and to estimate the proportion of diagnosed HIV positive individuals known to general practitioners (GPs). Methods: We undertook a retrospective cohort study between 1995 and 2005 of all general practices contributing data to the UK General Practice Research Database (GPRD), and data on persons accessing HIV care (Survey of Prevalent HIV Infections Diagnosed). We identified all practice-registered patients where an HIV test or HIV positive status is recorded in their general practice records. HIV testing in primary care and prevalence of recorded HIV positive status in primary care were estimated. Results: Despite 11-fold increases in male testing and 19-fold increases in non-pregnant female testing between 1995 and 2005, HIV testing rates remained low in 2005 at 71.3 and 61.2 tests per 100 000 person years for males and females, respectively, peaking at 162.5 and 173.8 per 100 000 person years at 25–34 years of age. Inclusion of antenatal tests yielded a 129-fold increase in women over the 10-year period. In 2005, 50.7% of HIV positive individuals had their diagnosis recorded with a lower proportion in London (41.8%) than outside the capital (60.1%). Conclusion: HIV testing rates in primary care remain low. Normalisation of HIV testing and recording in primary care in antenatal testing has not been accompanied by a step change in wider HIV testing practice. Recording of HIV positive status by GPs remains low and GPs may be unaware of HIV-related morbidity or potential drug interactions

Primary care consultations and costs among HIV-positive individulas in UK primary care 1995-2005: a cohort study

Objectives: To investigate the role of primary care in the management of HIV and estimate primary care-associated costs at a time of rising prevalence. Methods: Retrospective cohort study between 1995 and 2005, using data from general practices contributing data to the UK General Practice Research Database. Patterns of consultation and morbidity and associated consultation costs were analysed among all practice-registered patients for whom HIV-positive status was recorded in the general practice record. Results: 348 practices yielded 5504 person-years (py) of follow-up for known HIV-positive patients, who consult in general practice frequently (4.2 consultations/py by men, 5.2 consultations/py by women, in 2005) for a range of conditions. Consultation rates declined in the late 1990s from 5.0 and 7.3 consultations/py in 1995 in men and women, respectively, converging to rates similar to the wider population. Costs of consultation (general practitioner and nurse, combined) reflect these changes, at £100.27 for male patients and £117.08 for female patients in 2005. Approximately one in six medications prescribed in primary care for HIV-positive individuals has the potential for major interaction with antiretroviral medications. Conclusion: HIV-positive individuals known in general practice now consult on a similar scale to the wider population. Further research should be undertaken to explore how primary care can best contribute to improving the health outcomes of this group with chronic illness. Their substantial use of primary care suggests there may be potential to develop effective integrated care pathways

An integrated study of microstructural, geochemical, and seismic properties of the lithospheric mantle above the Kerguelen plume (Indian Ocean)

International audiencePeridotite xenoliths brought up to the surface by the volcanism of the Kerguelen Islands represent a mantle that has been affected by a high degree of partial melting followed by intense melt percolation above the Kerguelen plume. These xenoliths are therefore particularly suitable to investigate effects of melt-rock interaction on crystallographic fabrics (lattice-preferred orientation (LPO)) of peridotite minerals and on the LPO-induced seismic properties of peridotites above a mantle plume. We have studied a suite of 16 ultramafic samples representative of different degrees of partial melting and magma-rock interaction among which the protogranular harzburgites are the least metasomatised xenoliths and dunites are the ultimate stage of metasomatism. Olivine LPO is characterized by high concentration of [010] axes perpendicular to the foliation and [100] axes close to the lineation or distributed in the foliation plane in harzburgites, whereas the high concentration of [100] axes is parallel to the lineation and [010] axes is perpendicular to the assumed foliation in dunites. Olivine LPO in harzburgites is interpreted as being due to a deformation regime in axial compression or transpression. The fabric strength of olivine decreases progressively from protogranular to poikilitic harzburgites and finally to dunites, for which it remains nevertheless significant (J index 3.8). Seismic properties calculated from LPO of minerals indicate that metasomatism at higher melt/rock ratio lowers the P wave velocities. The most significant difference between harzburgites and dunites corresponds to the distribution of S wave anisotropy. Harzburgites display the maximum of anisotropy within the foliation plane and the minimum of anisotropy perpendicular to the foliation plane, whereas the lowest anisotropy is parallel to the lineation for dunites. These modifications of seismic properties as a result of metasomatic processes may induce seismic heterogeneities in the mantle above the Kerguelen plume. In addition, assuming a lithospheric mantle primarily harzburgitic and structured with a horizontal foliation, the seismic properties calculated for the Kerguelen xenoliths reconcile the rather high anisotropy evidenced by the horizontally propagating surface waves with the apparent isotropy revealed by the absence of splitting of vertically propagating teleseismic SKS waves recorded by the GEOSCOPE Kerguelen station

La agroindustria para el desarrollo argentino: para una política de Estado

El documento «La agroindustria para el desarrollo argentino: aportes para una política de Estado», es el resultado de una reflexión colectiva de ex secretarios de agricultura de gobiernos, de distintos signos políticos, que gobernaron la Argentina desde el retorno democrático en diciembre de 1983. En él hemos volcado nuestras experiencias y las lecciones aprendidas cuando estuvimos al frente de la entones Secretaria de Agricultura, Ganadería y Pesca. El propósito de este ejercicio es la identificación de los temas que consideramos prioritarios en la formulación, y adopción, de políticas de Estado que favorezcan y sostengan un vigoroso desarrollo agropecuario y agroindustrial, basado en una coordinación virtuosa del aprovechamiento de los recursos naturales, la capacidad empresarial y la tecnología, en función de criterios que concilien los objetivos de crecimiento económico y de equidad social. Es decir, que nuestro objetivo es aportar al fortalecimiento del bien común en la sociedad argentina.Academia Nacional de Agronomía y Veterinari

Where do we diagnose HIV infection? Monitoring new diagnoses made in nontraditional settings in England, Wales and Northern Ireland.

OBJECTIVES: The objectives of the study were to describe 10-year trends in HIV diagnosis setting and to explore predictors of being diagnosed outside a sexual health clinic (SHC). METHODS: Analyses of national HIV surveillance data were restricted to adults (aged ≥ 15 years) diagnosed in 2005-2014 in England, Wales and Northern Ireland. Logistic regression identified factors associated with diagnosis outside an SHC (2011-2014). RESULTS: Between 2005 and 2014, 63 599 adults were newly diagnosed with HIV infection; 83% had a diagnosis setting reported. Most people were diagnosed in SHCs (69%) followed by: medical admissions/accident and emergency (A&E; 8.6%), general practice (6.4%), antenatal services (5.5%), out-patient services (3.6%), infectious disease units (2.7%) and other settings (4.0%). The proportion of people diagnosed outside SHCs increased from 2005 to 2014, overall (from 27% to 32%, respectively) and among men who have sex with men (MSM) (from 14% to 21%) and black African men (from 25% to 37%) and women (from 39% to 52%) (all trend P < 0.001). Median CD4 increased across all settings, but was highest in SHCs (384 cells/μL) and lowest in medical admissions/A&E (94 cells/μL). Predictors of being diagnosed outside SHCs included: acquiring HIV through heterosexual contact [adjusted odds ratio (aOR) 1.99; 95% confidence interval (CI) 1.81-2.18] or injecting drug use (aOR: 3.28; 95% CI: 2.56-4.19; reference: MSM), being diagnosed late (< 350 cells/μL) (aOR: 2.55; 95% CI: 2.36-2.74; reference: diagnosed promptly) and being of older age at diagnosis (35-49 years: aOR: 1.60; 95% CI: 1.39-1.83; ≥ 50 years: aOR: 2.48; 95% CI: 2.13-2.88; reference: 15-24 years). CONCLUSIONS: The proportion of HIV diagnoses made outside SHCs has increased over the past decade in line with evolving HIV testing guidelines. However, the rate of late diagnosis remains high, indicating that further expansion of testing is necessary, as many people may have had missed opportunities for earlier diagnosis

Situation of HIV infections and STIs in the United Kingdom in 2007.

In the United Kingdom (UK) in 2007, an estimated 77,400 persons were living with human immunodeficiency virus (HIV) of whom 28% are unaware of their infection. A total of 7,734 persons were newly diagnosed with HIV infection in 2007, of which 31% were diagnosed late. This highlights the need for wider HIV testing, especially in those areas with a high diagnosed prevalence, as recommended in recent national guidelines. Among newly diagnosed cases of HIV in 2007, 41% acquired their infection through sex between men (four in five of whom acquired their infection in the UK) and 55% through heterosexual contact (four in five of whom acquired their infection abroad, mainly in sub-Saharan Africa). Young persons aged 16 to 24 years are disproportionally affected by sexually transmitted diseases (STIs) accounting for 65% of genital chlamydia infections, 50% of cases of genital warts and 50% of cases of gonorrhoea that were diagnosed in 2007

Eustatic change modulates exhumation in the Japanese Alps

The exhumation of bedrock is controlled by the interplay between tectonics, surface processes, and climate. The highest exhumation rates of centimeters per year are recorded in zones of highly active tectonic convergence such as the Southern Alps of New Zealand or the Himalayan syntaxes, where high rock uplift rates combine with very active surface processes. Using a combination of different thermochronometric systems including trapped-charge thermochronometry, we show that such rates also occur in the Hida Mountain Range, Japanese Alps. Our results imply that centimeter per year rates of exhumation are more common than previously thought. Our thermochronometry data allow the development of time series of exhumation rate changes at the time scale of glacial-interglacial cycles, which show a fourfold increase in baseline rates to rates of ~10 mm/yr within the past ~65 k.y. This increase in exhumation rate is likely explained by knickpoint propagation due to a combination of very high precipitation rates, climatic change, sea-level fall, range-front faulting, and moderate rock uplift. Our data resolve centimeter-scale sub-Quaternary exhumation rate changes, which show that in regions with horizontal convergence, coupling between climate, surface processes, and tectonics can exert a significant and rapid effect on rates of exhumatio

The success of HIV combination prevention: The Dean Street model

The 56 Dean Street combination prevention model, a strong engagement with the LGBTQI community and flexible services adapted to users’ changing needs led to an 80% drop in HIV diagnoses in gay, bisexual and other men who have sex with men (GBMSM) from 2015 to 2017. We describe the service changes at 56 Dean Street since 2012 which resulted in an increase in the frequency of HIV testing, the introduction of pre-exposure prophylaxis, earlier HIV diagnosis and a shorter time to viral suppression in those living with HIV. This model could be adapted to deliver similar results in those settings of high HIV prevalence among GBMSM and where access to technological innovation in healthcare and engagement with the community can be achieved