Correspondence
Food Action Network, the Food First Information and Action Network, La Via Campesina, ACT UP, the Landless People’s Movement, or the many other movements respected by governments and the UN agencies. There is also no indication of how empowered communities—as partners of the movement—will become empowered. The need is not for a new social movement; it is for recognition, inclusion, coordination, and strengthening of existing social movements. The Lancet should rather call on public health practitioners and existing social movements to come together to jointly act against the structural drivers of health inequality and to protect equitable health systems. Such a move is urgent, and politically wise. We declare that we have no competing interests.
*Claudio Schuftan, David Legge, David Sanders, Sarojini Nadimpally [email protected] People’s Health Movement, Ho Chi Minh City 70000, Vietnam (CS); La Trobe University, Melbourne, Australia (DL); University of Western Cape, Cape Town, South Africa (DS); and Jan Swasthya Abhiyan, New Delhi, India (SN) 1
2 3 4
Horton R, Beaglehole R, Bonita R, Raeburn J, McKee M, Wall S. From public to planetary health: a manifesto. Lancet 2014; 383: 847. Horton R. Offline: four principles of social medicine. Lancet 2013; 382: 192. Stiglitz J. Globalization and its discontents. New York: Allen Lane, 2002. Moodie R, Stuckler D, Monteiro C, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol and ultra-processed food and drink industries. Lancet 2013; 381: 670–79.
Opt-out HIV testing in adult critical care units This online publication has been corrected. The corrected version first appeared at thelancet.com on May 16, 2014
1460
The Lancet has previously emphasised the public health importance of early diagnosis of HIV infection and the impetus to roll out community HIV testing initiatives to prevent transmission and late diagnosis. 1 However, there are many missed opportunities for testing of patients already in hospital, with high rates of missed testing opportunities reported
in UK hospitals.1 To address this issue, we have introduced an opt-out HIV testing strategy in the adult critical care setting at The Royal London Hospital, London, UK. National and international guidance already supports opt-out HIV testing in medical settings where local HIV prevalence exceeds two per 1000 individuals.1,2 HIV-related opportunistic infections result in critical care admissions for patients with undiagnosed HIV.3 In these life-threatening situations, prompt HIV diagnosis is paramount to guide appropriate treatment. A UKbased study showed that 18–30% of patients admitted to intensive care qualified for testing according to UK HIV testing guidelines, yet only 5% were actually tested.4 We introduced a universal opt-out HIV testing initiative in the adult critical care unit to increase diagnosis in critically ill patients and reduce morbidity and mortality in a high prevalence setting (local prevalence is 6·25 per 1000 individuals).5 We offered opt-out HIV testing to all nonelective patients admitted to the adult critical care unit and patients unable to consent were tested under a best interests principle on the basis of the high local HIV prevalence. For the first 6 months (from October, 2012, to April, 2013) of the initiative: 465 (52%) of 899 adults admitted to the critical care unit had an HIV test (46 percentage points higher than in the 6 month period before the initiative when the testing rate was 6%, p
Food Action Network, the Food First Information and Action Network, La Via Campesina, ACT UP, the Landless People’s Movement, or the many other movements respected by governments and the UN agencies. There is also no indication of how empowered communities—as partners of the movement—will become empowered. The need is not for a new social movement; it is for recognition, inclusion, coordination, and strengthening of existing social movements. The Lancet should rather call on public health practitioners and existing social movements to come together to jointly act against the structural drivers of health inequality and to protect equitable health systems. Such a move is urgent, and politically wise. We declare that we have no competing interests.
*Claudio Schuftan, David Legge, David Sanders, Sarojini Nadimpally [email protected] People’s Health Movement, Ho Chi Minh City 70000, Vietnam (CS); La Trobe University, Melbourne, Australia (DL); University of Western Cape, Cape Town, South Africa (DS); and Jan Swasthya Abhiyan, New Delhi, India (SN) 1
2 3 4
Horton R, Beaglehole R, Bonita R, Raeburn J, McKee M, Wall S. From public to planetary health: a manifesto. Lancet 2014; 383: 847. Horton R. Offline: four principles of social medicine. Lancet 2013; 382: 192. Stiglitz J. Globalization and its discontents. New York: Allen Lane, 2002. Moodie R, Stuckler D, Monteiro C, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol and ultra-processed food and drink industries. Lancet 2013; 381: 670–79.
Opt-out HIV testing in adult critical care units This online publication has been corrected. The corrected version first appeared at thelancet.com on May 16, 2014
1460
The Lancet has previously emphasised the public health importance of early diagnosis of HIV infection and the impetus to roll out community HIV testing initiatives to prevent transmission and late diagnosis. 1 However, there are many missed opportunities for testing of patients already in hospital, with high rates of missed testing opportunities reported
in UK hospitals.1 To address this issue, we have introduced an opt-out HIV testing strategy in the adult critical care setting at The Royal London Hospital, London, UK. National and international guidance already supports opt-out HIV testing in medical settings where local HIV prevalence exceeds two per 1000 individuals.1,2 HIV-related opportunistic infections result in critical care admissions for patients with undiagnosed HIV.3 In these life-threatening situations, prompt HIV diagnosis is paramount to guide appropriate treatment. A UKbased study showed that 18–30% of patients admitted to intensive care qualified for testing according to UK HIV testing guidelines, yet only 5% were actually tested.4 We introduced a universal opt-out HIV testing initiative in the adult critical care unit to increase diagnosis in critically ill patients and reduce morbidity and mortality in a high prevalence setting (local prevalence is 6·25 per 1000 individuals).5 We offered opt-out HIV testing to all nonelective patients admitted to the adult critical care unit and patients unable to consent were tested under a best interests principle on the basis of the high local HIV prevalence. For the first 6 months (from October, 2012, to April, 2013) of the initiative: 465 (52%) of 899 adults admitted to the critical care unit had an HIV test (46 percentage points higher than in the 6 month period before the initiative when the testing rate was 6%, p
