Data from: Missed opportunities for earlier diagnosis of HIV in patients that presented with advanced HIV disease: a retrospective cohort study

OBJECTIVE: To quantify and characterize missed opportunities for earlier HIV diagnosis in patients diagnosed with advanced HIV. DESIGN: A retrospective observational cohort study. SETTING: A central tertiary medical center in Israel. MEASURES: The proportion of patients with advanced HIV, the proportion of missed opportunities to diagnose them earlier, and the rate of clinical indicator diseases (CIDs) in those patients RESULTS: Between 2010-2015, 356 patients were diagnosed with HIV, 118 (33.4 %) were diagnosed late, 57 (16%) with advanced HIV disease. Old age (OR=1.45 [95% CI 1.16-1.74]) and being heterosexual (OR=2.65 [95% CI 1.21-5.78]) were significant risk factors for being diagnosed late. All patients with advanced disease had at least one CID that did not lead to an HIV test in the 5 years prior to AIDS diagnosis. The median time between CID and AIDS diagnosis was 24 month (IQR 10-30). 60% of CIDs were missed by a general practitioner and 40% by a specialist. CONCLUSIONS: Missed opportunities to early diagnosis of HIV occur both in primary and secondary care. Lack of national guidelines, lack of knowledge regarding CIDs and communication barriers with patients may contribute to HIV late diagnosis. 'Strengths and limitations of this study' This study shows for the first time rate and reasons for missed opportunities to diagnose HIV in a low prevalence country like Israel. This study may shed light on the reasons why primary care physicians or specialists are missing to diagnose HIV earlier. Nonexistence of clear national guidelines for HIV testing and ignoring HIV clinically indicator diseases are major reasons for missed diagnosis of HIV. This study was carried out in one center and may not reflect the picture in the all country; Also, the total number of patients is low and this may limit generability of the stud

Attitudes, perceptions and knowledge among men who have sex with men towards the blood donation deferral policy in Israel

<div><p>Background</p><p>Men who have sex with men (MSM) are permanently deferred from donating blood in Israel. Pressure to change this policy exists, despite data showing higher prevalence and incidence of HIV in MSM. A survey was conducted to evaluate current knowledge, attitudes, perceptions and compliance if deferral was changed.</p><p>Study design and methods</p><p>Anonymous survey was published in a gay-oriented website, collecting demographic information, history of blood donation, attitudes, knowledge and compliance with permanent versus temporary deferral. Responses were analyzed given 1 point for every "yes" response (0–7 points). Student’s t-test was applied to compare differences between continuous variables. Correlations were described with the Pearson correlation coefficient.</p><p>Results</p><p>Responses from 492 MSM were analyzed. Average age was 31±9 years. 76% donated blood at least once, mostly for social solidarity (score of 3.2 on 1–5 scale). Tests seeking or protest scores were 1.7 and 1.6, respectively. 66% were unaware of the higher risk of HIV transmission by MSM, or the potential to infect 3 recipients. Knowledge regarding HIV transmission by blood positively correlated with knowledge regarding other routes of HIV transmission (r = 0.11; p = 0.03), age (r = 0.10; p = 0.04), and higher rate of non-compliance with the current deferral policy (OR = 1.9; p = 0.02). Activism for LGBT rights was associated with lower risk for non-adherence (OR = 0.5; p = 0.03). If temporary deferral is introduced 66% will comply with the new policy, but 23% will continue to donate as long as MSM deferral policy is in place.</p><p>Conclusion</p><p>A high proportion of MSM do not comply with the current lifetime deferral. This may partially change if temporary deferral is introduced.</p></div

Reasons for blood donation.

<p>In this figure the reasons for blood donation according to their importance for the individual donor is shown.</p

Parameters associated with non-compliance—univariate by logistic regression.

<p>Parameters associated with non-compliance—univariate by logistic regression.</p

Parameters associated with non-compliance—multivariate model by logistic regression.

<p>Parameters associated with non-compliance—multivariate model by logistic regression.</p

Demographic characteristics.

<p>Demographic characteristics.</p

Participants flow diagram.

<p>Participants flow diagram.</p

Comparing Patient Perspectives on Diabetes Management to the Deficit-Based Literature in an Ethnic Minority Population: A Mixed-Methods Study

Marginalized racial/ethnic minorities have disproportionately high rates of type 2 diabetes prevalence, complications and mortality. Researchers and policymakers have typically addressed these disparities using a deficit-based discourse focused on individual/cultural deficiencies or failure. A mixed-methods study was used to compare the deficit discourse to the perspectives of adults with diabetes in the Arab minority in Israel, using data from 10 focus groups (5 men&rsquo;s, 5 women&rsquo;s) and 296 quantitative in-person surveys. Both qualitative and quantitative data were triangulated. In addition, multivariable regression models tested associations between diabetes management perspectives and participant characteristics. Contrary to the deficit-based characterizations of patients as fatalistic and unknowledgeable, participants viewed diabetes as a chronic disease with serious complications. They expressed more support for patient responsibility in diabetes management than for passive fatalism, and were less fatalistic as educational level and adequacy of diabetes self-care training increased. The impact of social/environmental barriers and changing cultural norms on lifestyle behaviors was highlighted. Over 95% used prescription medications for diabetes management, although 35% reported economic barriers. The deficit discourse is not well-aligned with Arab patients&rsquo; evolving perceptions and needs, and has deflected attention from the socioeconomic/structural determinants of health, and the healthcare system&rsquo;s responsibility to provide effective, culturally-relevant diabetes services