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Vo-Quang E, Vignier N, Adenis A, Adriouch L, Lucarelli A, Guarmit B, Nacher M. Tackling a worrisome rate of lost to follow-up among migrants with hepatitis B in French Guiana. Infect Dis Now 2024; 54:104974. [PMID: 39255907 DOI: 10.1016/j.idnow.2024.104974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/22/2024] [Accepted: 09/04/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVES Management of Hepatitis B virus (HBV)-infected patients, whether they are receiving treatment or not, necessitates long-term follow-up. This study evaluated the rate of lost to follow-up (LTFU) among HBV-infected patients and the feasibility of a callback strategy to re-engage these patients in HBV care. PATIENTS AND METHODS We conducted a retrospective study involving HBV-infected patients attending the outpatient clinic at Cayenne Hospital, French Guiana. LTFU was defined as patients who had not attended the clinic for more than 18 months. A callback strategy was implemented to re-engage LTFU patients in HBV care. RESULTS Between 1st January 2015 and 31st December 2018, 203 HBV-infected patients were referred to the outpatient clinic; 95/203 (46.8 %) were LTFU, resulting in a crude LTFU rate of 2.6 (95 % CI, 2.1-3.2) per 100 person-years. At baseline, patients aged 30-40 years (aOR, 0.48; 95 %CI, 0.24-0.95) and those who initiated treatment (aOR, 0.26; 95 %CI, 0.10-0.60) were less likely to be LTFU. Through application of the callback strategy, 55/95 (58 %) patients were successfully contacted, and 46/55 (84 %) attended the outpatient clinic for a liver assessment. The EASL criteria for treatment eligibility were met by 3/46 (4 %) patients. Compared to non-LTFU patients, LTFU patients were more likely to be in informal employment (p = 0.03) and to be receiving state medical assistance (p < 0.01), and had lower levels of knowledge about their condition (p < 0.01). CONCLUSIONS The callback strategy to re-engage LTFU patients in HBV care is feasible and effectively identifies those eligible for antiviral therapy.
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Affiliation(s)
- E Vo-Quang
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Comité de coordination de la lutte contre l'infection par le VIH, COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
| | - N Vignier
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Comité de coordination de la lutte contre l'infection par le VIH, COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Service Hôpital de jour adulte, HDJA, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Sorbonne Université, Inserm UMR 1136, Department of social epidemiology, Paris, France; Université Sorbonne Paris Nord, UFR SMBH, Faculté de médecine, Bobigny, France
| | - A Adenis
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Comité de coordination de la lutte contre l'infection par le VIH, COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana; DFR Santé, Université de Guyane, Cayenne, French Guiana; Centre de ressources biologiques CRB Amazonie, Centre hospitalier de Cayenne, Cayenne, French Guiana
| | - L Adriouch
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - A Lucarelli
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Comité de coordination de la lutte contre l'infection par le VIH, COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - B Guarmit
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - M Nacher
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana; DFR Santé, Université de Guyane, Cayenne, French Guiana
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2
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Gutiérrez-Velilla E, Robles-García R, Sánchez-Sosa JJ, Ávila-Ríos S, Caballero-Suárez NP. Brief Telephonic Motivational Interviewing for People Living with HIV with Follow-up Problems. J Clin Psychol Med Settings 2024; 31:493-500. [PMID: 38265700 DOI: 10.1007/s10880-023-09993-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/25/2024]
Abstract
Motivational interviewing (MI)-based interventions can be effective for people living with HIV (PLWHIV) with medical follow-up problems. This study aimed to assess the stage of motivation to attend medical appointments of PLWHIV with medical follow-up problems and to evaluate a single telephone session MI intervention directed to engage them in care. The change in stage was evaluated before and after the intervention, and attending medical appointments was monitored for six months. Thirty-nine PLWHIV participated; 51.3% were in precontemplation/contemplation and 49.7% in preparation/action stage. Most (excluding those in the action stage from the beginning) (n = 22, 71.0%) advanced to another stage after the intervention (z = - 4.235, p < .001), and most did not miss the following appointments. Brief and remote MI interventions could be useful in low-resource settings, especially for those in the early stages of change, to explore motivations related with missing medical appointments.
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Affiliation(s)
- E Gutiérrez-Velilla
- Centro de Investigación en Enfermedades Infecciosas del Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de Mexico, México
| | - R Robles-García
- Centro de Investigación en Salud Mental Global, Dirección de Investigaciones Epidemiológicas y Psicosociales del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de Mexico, México
| | - J J Sánchez-Sosa
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de Mexico, México
| | - S Ávila-Ríos
- Centro de Investigación en Enfermedades Infecciosas del Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de Mexico, México
| | - N P Caballero-Suárez
- Centro de Investigación en Enfermedades Infecciosas del Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de Mexico, México.
- Centro de Investigación en Enfermedades Infecciosas (CIENI), Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Sección XVI, 14080, Tlalpan, Mexico City, Mexico.
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3
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Gutiérrez-Velilla E, Piñeirúa-Menéndez A, Ávila-Ríos S, Caballero-Suárez NP. Clinical Follow-Up in People Living with HIV During the COVID-19 Pandemic in Mexico. AIDS Behav 2022; 26:2798-2812. [PMID: 35190942 PMCID: PMC8860257 DOI: 10.1007/s10461-022-03626-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/04/2022]
Abstract
Clinical follow-up in people living with HIV (PLWH) has individual and public health implications. The objectives of this study were to measure variables related to follow-up failures, identify self-reported reasons to maintain adequate follow-up or for having follow-up failures, and know how the pandemic influenced patients' clinical follow-up. Participants were PLWH receiving HIV-health care at a hospital-based clinic in Mexico City which became an exclusive COVID-19 health service. Participants completed a telephone semi-structured interview and online psychological questionnaires. Lower educational and socioeconomic level, longer times of transportation to the clinic, being attended by different doctors, detectable viral load, having previous dropouts, inadequate antiretroviral adherence, and less HIV knowledge were related to follow-up failures. COVID-19 had a significant negative impact, but it also had positive repercussions for patients with adequate follow-up. These results could help develop effective psychosocial programs and improve healthcare in institutions to facilitate patient retention.
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Affiliation(s)
- Ester Gutiérrez-Velilla
- Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Ciudad de México, Mexico
| | | | - Santiago Ávila-Ríos
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Ciudad de México, Mexico
| | - Nancy Patricia Caballero-Suárez
- Centro de Investigación en Enfermedades Infecciosas (CIENI) del Instituto Nacional de Enfermedades Respiratorias (INER), Ciudad de México, Mexico.
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4
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Baseline and Process Factors of Anti-Retroviral Therapy That Predict Loss to Follow-up Among People Living with HIV/AIDS in China: A Retrospective Cohort Study. AIDS Behav 2022; 26:1126-1137. [PMID: 34698955 DOI: 10.1007/s10461-021-03466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
We explored the predictors and predictive models of loss to follow-up (LTFU) during the first year of anti-retroviral therapy (ART). LTFU was defined as the failure to visit the clinic for antiretroviral drugs for ≥ 90 days after the last missed scheduled visit. Based on the electronic medical records of 5953 patients who were HIV positive and began ART between 2016 and 2019 in China, the LTFU rate was 7.24 (95% confidence interval 6.49-7.97) per 100 person-years during the first year of ART. ART baseline factors were associated with LTFU, but were non-optimal predictors. A model including ART process-related factors such as follow-up behaviors and physical health status had an area under the receiver operating characteristic curve of 73.4% for predicting LTFU. Therefore, the medical records of follow-up visits can be used to identify patients with a high risk of LTFU and allow interventions to be implemented proactively.
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Mittler JE, Murphy JT, Stansfield SE, Peebles K, Gottlieb GS, Abernethy NF, Reid MC, Goodreau SM, Herbeck JT. Large benefits to youth-focused HIV treatment-as-prevention efforts in generalized heterosexual populations: An agent-based simulation model. PLoS Comput Biol 2019; 15:e1007561. [PMID: 31846456 PMCID: PMC6938382 DOI: 10.1371/journal.pcbi.1007561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 12/31/2019] [Accepted: 11/23/2019] [Indexed: 01/05/2023] Open
Abstract
Predominantly heterosexual HIV-1 epidemics like those in sub-Saharan Africa continue to have high HIV incidence in young people. We used a stochastic, agent-based model for age-disparate networks to test the hypothesis that focusing uptake and retention of ART among youth could enhance the efficiency of treatment as prevention (TasP) campaigns. We used the model to identify strategies that reduce incidence to negligible levels (i.e., < 0.1 cases/100 person-years) 20-25 years after initiation of a targeted TasP campaign. The model was parameterized using behavioral, demographic, and clinical data from published papers and national reports. To keep a focus on the underlying age effects we model a generalized heterosexual population with average risks (i.e., no MSM, no PWIDs, no sex workers) and no entry of HIV+ people from other regions. The model assumes that most people (default 95%, range in variant simulations 60-95%) are "linkable"; i.e., could get linked to effective care given sufficient resources. To simplify the accounting, we assume a rapid jump in the number of people receiving treatment at the start of the TasP campaign, followed by a 2% annual increase that continues until all linkable HIV+ people have been treated. Under historical scenarios of CD4-based targeted ART allocation and current policies of untargeted (random) ART allocation, our model predicts that viral replication would need to be suppressed in 60-85% of infected people at the start of the TasP campaign to drive incidence to negligible levels. Under age-based strategies, by contrast, this percentage dropped by 18-54%, depending on the strength of the epidemic and the age target. For our baseline model, targeting those under age 30 halved the number of people who need to be treated. Age-based targeting also minimized total and time-discounted AIDS deaths over 25 years. Age-based targeting yielded benefits without being highly exclusive; in a model in which 60% of infected people were treated, ~87% and ~58% of those initiating therapy during a campaign targeting those <25 and <30 years, respectively, fell outside the target group. Sensitivity analyses revealed that youth-focused TasP is beneficial due to age-related risk factors (e.g. shorter relationship durations), and an age-specific herd immunity (ASHI) effect that protects uninfected adolescents entering the sexually active population. As testing rates increase in response to UNAIDS 90-90-90 goals, efforts to link all young people to care and treatment could contribute enormously to ending the HIV epidemic.
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Affiliation(s)
- John E. Mittler
- Department of Microbiology, University of Washington, Seattle, WA, United States of America
| | - James T. Murphy
- Department of Microbiology, University of Washington, Seattle, WA, United States of America
- Department of Anthropology, University of Washington, Seattle, WA, United States of America
| | - Sarah E. Stansfield
- Department of Anthropology, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Kathryn Peebles
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Geoffrey S. Gottlieb
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Neil F. Abernethy
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States of America
- Department of Health Services, University of Washington, Seattle, WA, United States of America
| | - Molly C. Reid
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Steven M. Goodreau
- Department of Anthropology, University of Washington, Seattle, WA, United States of America
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, United States of America
| | - Joshua T. Herbeck
- Department of Global Health, University of Washington, Seattle, WA, United States of America
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Teeraananchai S, Kerr SJ, Ruxrungtham K, Avihingsanon A, Chaivooth S, Teeraratkul A, Bhakeecheep S, Ongwandee S, Thanprasertsuk S, Law MG. Loss to follow-up and associated factors of patients in the National AIDS Program in Thailand. Antivir Ther 2019; 23:529-538. [PMID: 29583122 DOI: 10.3851/imp3233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Loss to follow-up (LTFU) is a crucial indicator to evaluate the effectiveness of HIV care and treatment programmes. We assessed the LTFU rate and associated factors of Thai HIV-infected patients who enrolled in the National AIDS Program (NAP) for two periods: prior to (pre-ART) and after starting ART (ART-patients). METHODS Thai HIV patients aged ≥15 years enrolled in NAP from 2008 to 2014. Vital status was ascertained by linkage with the National Death Registry. Competing risk models were used to calculate the adjusted sub-distribution hazards (aSHR) for LTFU for pre-ART and ART-patients, with death considered as a competing risk. RESULTS A total of 157,026 patients registered in care and were included in analyses. The cumulative incidence of LTFU in pre-ART patients at 1 year was 10.2%, whereas in ART-patients it was 12.8%. Among pre-ART patients, younger age (<30 versus ≥45 years, aSHR 1.60, 95% CI 1.49, 1.72), less advanced HIV stage (aSHR 1.29, 95% CI 1.21, 1.37) and higher CD4+ T-cell count (≥350 versus <100, aSHR 6.31, 95% CI 5.74, 6.95) had a higher chance of LTFU. ART-patients with high baseline CD4+ T-cell count (CD4 ≥350 versus CD4 <50, aSHR 2.06, 95% CI 1.97, 2.15) and non-advanced HIV stage had increased risk of LTFU. CONCLUSIONS Our findings provide new evidence of the LTFU rate in Thai HIV-infected patients in NAP. Emphasis needs to be placed on improving follow-up in all patients with higher CD4+ T-cell counts. LTFU will be important to monitor as programmes move to commence ART regardless of CD4+ T-cell count.
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Affiliation(s)
- Sirinya Teeraananchai
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Kirby Institute, University of New South Wales, Sydney, Australia
| | - Stephen J Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kiat Ruxrungtham
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suchada Chaivooth
- The HIV/AIDS, Tuberculosis and Infectious Diseases Program, National Health Security Office (NHSO), Bangkok, Thailand
| | | | - Sorakij Bhakeecheep
- The HIV/AIDS, Tuberculosis and Infectious Diseases Program, National Health Security Office (NHSO), Bangkok, Thailand
| | | | | | - Matthew G Law
- Kirby Institute, University of New South Wales, Sydney, Australia
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7
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Alaei A, Nautiyal N, Mishkin K, Saifuddin Karimov D, Saidi D, Alaei K. Factors associated with linkage to care for HIV patients in Tajikistan. Int J STD AIDS 2018; 29:1183-1189. [PMID: 29945541 DOI: 10.1177/0956462418779658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is a growing human immunodeficiency virus (HIV) epidemic in Tajikistan. This paper presents factors associated with linkage to HIV care among people aged 15 years and older in Tajikistan. This retrospective cross-sectional study used the Tajikistan Ministry of Health HIV registry data from patients diagnosed with HIV at age 15 years or older from 2000 to 2016. Chi squared tests and logistic regression models tested factors associated with linkage to care. A multivariable logistic regression model examined effect modifications. While linkage to care had an overall increase from 2000 to 2016, the odds of linkage were lower among certain sub-groups including among people in Dushanbe, men, people engaging in sex work, injection drug users, and older people. Regional differences exist with linkage to care, occurring least frequently in Dushanbe. While access to care and quality of care have increased significantly over time, findings suggest that linkage to care is low, especially in the capital city where many services are provided. Evaluation focusing on acceptability of HIV services should be undertaken to understand why certain people do not link with services. Additional research about the types of barriers to linking with HIV care is needed to increase linkage to HIV care.
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Affiliation(s)
- Arash Alaei
- 1 Institute for International Health and Education, University of Albany, Albany, NY, USA
| | - Nisheet Nautiyal
- 2 Department of Biostatistics, Yale University, New Haven, CT, USA
| | - Kathryn Mishkin
- 3 Global Institute for Health and Human Rights, University at Albany, State University of New York, Albany, NY, USA
| | - D Saifuddin Karimov
- 4 Republican AIDS Center, Tajikistan Ministry of Health, Dushanbe, Tajikistan
| | - Dilshod Saidi
- 4 Republican AIDS Center, Tajikistan Ministry of Health, Dushanbe, Tajikistan
| | - Kamiar Alaei
- 3 Global Institute for Health and Human Rights, University at Albany, State University of New York, Albany, NY, USA.,5 Rockefeller College, University at Albany, State University of New York, Albany, NY, USA
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Bet GMDS, Souza GHDAD, Croda J, Correa ME, de Sales RO, Santos RADS, Viebrantz Enne Sgarbi R, Yassuda RTS, Coimbra Motta-Castro AR, Pompílio MA, Simionatto S. Treatment Outcomes of Brazilian Inmates with Treponema pallidum and Human Immunodeficiency Virus Infection: A Prospective Cohort Study. Am J Trop Med Hyg 2018; 98:1603-1608. [PMID: 29737273 DOI: 10.4269/ajtmh.17-0592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A prospective cohort study was conducted to evaluate the incidence and treatment outcomes of syphilis and human immunodeficiency virus (HIV) in inmates from Central Brazil. In 2013, 3,363 inmates from 12 prisons in the state of Mato Grosso do Sul were recruited, and 1,614 remained incarcerated after 1 year. The inmates were interviewed, and blood samples were collected for serological testing for Treponema pallidum and HIV infections. Inmates infected with T. pallidum or HIV within the first year were assessed for treatment using prison medical record data, based on Venereal Disease Research Laboratory test results, HIV-1 viral load, and CD4 counts. Acquired syphilis was identified in 5.8% (N = 95) of the inmates and 74% (N = 70) of them demonstrated poor treatment outcomes after 1 year. Multivariate analysis revealed that not reporting a stable partner was a risk factor for failure of syphilis treatment. Twenty-five patients had HIV (1.5%) and among those, 13 (52%) had an HIV-1 viral load > 200 copies/mL after 1 year. The incidence of T. pallidum and HIV infections was 0.5% (N = 9). The poor treatment outcomes of syphilis and HIV within Brazilian prisons demonstrate the inadequacy of public health programs. Although the incidence of these infections within the prison population is low, new cases still occur. Our results reinforce the significance of screening programs during prison admission for early detection and treatment of sexually transmitted infections.
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Affiliation(s)
| | | | - Júlio Croda
- Faculdade de Medicina (FAMED), Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil.,Instituto Penal de Campo Grande, Agência Estadual de Administração do Sistema Penitenciário (Agepen), Mato Grosso do Sul, Campo Grande, Brazil
| | - Maísa Estopa Correa
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Romário Oliveira de Sales
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Ruthe Aline da Silva Santos
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Renata Viebrantz Enne Sgarbi
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Renata Terumi Shiguematsu Yassuda
- Instituto Penal de Campo Grande, Agência Estadual de Administração do Sistema Penitenciário (Agepen), Mato Grosso do Sul, Campo Grande, Brazil
| | - Ana Rita Coimbra Motta-Castro
- Laboratório de Imunologia Clínica, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil.,Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
| | - Maurício Antônio Pompílio
- Faculdade de Medicina (FAMED), Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Simone Simionatto
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
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De Boni RB, Peratikos MB, Shepherd BE, Grinsztejn B, Cortés C, Padgett D, Gotuzzo E, Belaunzarán-Zamudio PF, Rebeiro PF, Duda SN, McGowan CC. Is substance use associated with HIV cascade outcomes in Latin America? PLoS One 2018; 13:e0194228. [PMID: 29543857 PMCID: PMC5854364 DOI: 10.1371/journal.pone.0194228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/09/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The HIV care cascade has improved in Latin America over the last decade. However, the influence of alcohol and noninjected drug use (NIDU) on cascade outcomes is mostly unknown. This study estimated the association of alcohol and NIDU with retention in care, loss to follow up (LTFU), and virologic failure (VF). METHODS Individuals ≥18 years attending routine HIV clinic visits and completing the Rapid Screening Tool (RST; evaluating NIDU and ART adherence in 7-day recall period) during 2012-13 were followed up to 2015 in the Caribbean, Central and South America network for HIV epidemiology. Adjusted odds ratios (aOR) were calculated for the association of alcohol consumption and NIDU with retention in care by logistic regression; adjusted hazard ratios (aHR) were estimated for the associations with LTFU and VF by Cox regression. RESULTS Among 3604 individuals, the proportions retained in care for one year were 84%, 79%, 72%, and 69% for patients reporting non-use, alcohol use, NIDU, and both alcohol and NIDU, respectively. For the same patient groups, the proportions LTFU over 18 months were 6%, 8%, 12%, and 13%, respectively. There were 1901 patients (53%) with HIV RNA results; VF proportions were similar between users and nonusers (ranging from 14-16%). After controlling for age, sex, study site, HIV transmission mode, time on ART, AIDS status, and CD4 count, neither alcohol use (aOR = 1.1, CI = 0.9-1.4; aHR = 1.0, CI = 0.8-1.3) nor NIDU (aOR = 1.3, CI = 0.9-1.8; aHR = 1.4, CI = 0.9-2.1) were significantly associated with retention or VF, respectively. However, both alcohol use (aHR = 1.2, CI = 1.02-1.4) and NIDU (aHR = 1.3, CI = 1.00-1.8) were associated with increased LTFU. CONCLUSION Alcohol use and NIDU in a 7-day recall period increased the risk of being LTFU during the next 18 months, highlighting the need for routine screening and targeted interventions to keep these individuals in care and on ART.
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Affiliation(s)
- Raquel B. De Boni
- Instituto Nacional de Infectologia Evandro Chagas- FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Bryan E. Shepherd
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas- FIOCRUZ, Rio de Janeiro, Brazil
| | - Claudia Cortés
- Fundación Arriaran–Facultad de Medicina Universidad de Chile, Santiago, Chile
| | - Denis Padgett
- Instituto Hondureno de Seguridad Social and Hospital Escuela, Tegucigalpa, Honduras
| | | | - Pablo F. Belaunzarán-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Peter F. Rebeiro
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Stephany N. Duda
- Vanderbilt University Medical Center, Nashville, TN, United States of America
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10
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Gerenutti M, Martinez AMV, Bergamaschi CDC. The Effectiveness of a Pharmaceutical Care Model on Adherence to Antiretroviral Therapy: A SAME-Based Cohort Study in Brazil. Adv Pharm Bull 2017; 7:469-472. [PMID: 29071230 PMCID: PMC5651069 DOI: 10.15171/apb.2017.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/21/2017] [Accepted: 07/16/2017] [Indexed: 12/15/2022] Open
Abstract
Purpose: To verify the effectiveness of a pharmaceutical care model developed by the Specialized Municipal Assistance Service in Sorocaba, Brazil, on adherence to ART among patients infected with HIV. Methods: A cohort study compared adherence to ART in two groups of patients: intervention group (patients assisted with pharmaceutical care, n=130) and non-intervention group (patients attended by the habitual dispensing process, n=229). Antiretroviral adherence was measured by the number of pharmacy refill records in a six-month period. The relationship between the use of other drugs for the treatment of opportunistic infections and the adherence rate in the intervention group and the correlation between adherence and viral load and CD4 lymphocytes were also assessed. Results: Higher adherence rates were observed in the intervention group (p<0.05). The use of others drugs did not influence adherence to ART (p=0.30). There was a positive correlation between adherence and the percentage of patients in the intervention group with undetectable viral loads (p=0.0004) and higher levels of CD4 lymphocytes (p=0.0024). Conclusion: The pharmaceutical care model developed by the SAME improved patient adherence to ART as well as clinical outcomes.
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Affiliation(s)
- Marli Gerenutti
- Department of Pharmaceutical Sciences, Universidade de Sorocaba (UNISO), Sorocaba, Brazil
| | - Adriana Michel Vieira Martinez
- Department of Pharmaceutical Sciences, Universidade de Sorocaba (UNISO), Sorocaba, Brazil
- Specialized Municipal Assistance Service (SAME) in HIV/AIDS, Sorocaba, Brazil
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Mendes LC, Ralla SM, Vigani AG. Loss to follow-up in anti-HCV-positive patients in a Brazilian regional outpatient clinic. ACTA ACUST UNITED AC 2016; 49:e5455. [PMID: 27580006 PMCID: PMC5007075 DOI: 10.1590/1414-431x20165455] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/07/2016] [Indexed: 02/06/2023]
Abstract
Loss to follow-up (LF), which refers to patients who started care but voluntary stopped it, is a problem for patients with chronic disease. We aimed to estimate the rate of LF among patients seropositive for hepatitis C virus (HCV) and identify possible demographic and lifestyle risk factors associated with LF. From January 2009 through December 2012, 1010 anti-HCV-positive patients were included in the study. Among participants, 223 (22.1%) met the case definition for LF (more than 1-year elapsed since the last clinical appointment). Among 787 patients who remained in follow-up, 372 (47.2%) were discharged after undetectable HCV RNA, 88 (11.1%) were transferred (and remained on regular follow-up at the destination), and 25 (3.1%) died. According to univariate analysis, male gender, absence of a life partner, black race, psychiatric illness, previous alcohol abuse, previous or current recreational drug use, and previous or current smoking were significantly associated with LF. In multivariate analysis, absence of a life partner (adjusted odds ratio (AOR)=1.44; 95% confidence interval (95%CI)=1.03–2.02), black race (AOR=1.81, 95%CI=1.12–2.89), psychiatric illness (AOR=1.77, 95%CI=1.14–2.73), and the presence of at least one lifestyle risk factor (pertaining to substance abuse) (AOR=1.95, 95%CI=1.29–2.94) were independently associated with LF. Our study provides an estimate of the incidence of LF among anti-HCV-positive patients and identifies risk factors associated with this outcome. In addition, these results can help clinicians recognize patients at risk for LF, who require additional support for the continuity of care.
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Affiliation(s)
- L C Mendes
- Universidade Estadual de Campinas, Campinas, SP, Brasil.,Ambulatório Municipal de Hepatites Virais, Campinas, SP, Brasil
| | - S M Ralla
- Ambulatório Municipal de Hepatites Virais, Campinas, SP, Brasil
| | - A G Vigani
- Universidade Estadual de Campinas, Campinas, SP, Brasil.,Ambulatório Municipal de Hepatites Virais, Campinas, SP, Brasil
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Sgarbi RVE, Carbone ADSS, Paião DSG, Lemos EF, Simionatto S, Puga MAM, Motta-Castro ARC, Pompilio MA, Urrego J, Ko AI, Andrews JR, Croda J. A Cross-Sectional Survey of HIV Testing and Prevalence in Twelve Brazilian Correctional Facilities. PLoS One 2015; 10:e0139487. [PMID: 26466312 PMCID: PMC4605759 DOI: 10.1371/journal.pone.0139487] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/13/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Prior studies have reported higher HIV prevalence among prisoners than the general population in Brazil, but data have been derived from single prisons. The aim of this study was to evaluate HIV testing practices, prevalence and linkage to care among inmates in a network of 12 prisons. METHODS We administered a questionnaire to a population-based sample of inmates from 12 prisons in Central-West Brazil and collected sera for HIV and syphilis testing from January to December 2013. We evaluated factors associated with HIV testing and infection using multivariable logistic regression models. Six months after HIV testing, we assessed whether each HIV-infected prisoner was engaged in clinical care and whether they had started antiretroviral therapy. RESULTS We recruited 3,362 inmates, of whom 2,843 (85%) were men from 8 prisons, and 519 (15%) were women from 4 prisons. Forty-five percent of participants reported never having been tested for HIV previously. In multivariable analysis, the variables associated with previous HIV testing were lack of a stable partner (adjusted odds ratio [AOR]: 1.38; 95% CI: 1.18-1.60), completed more than four years of schooling (AOR 1.40; 95% CI: 1.20-1.64), history of previous incarceration (AOR: 1.68; 95% CI: 1.43-1.98), history of mental illness (AOR 1.52; 95% CI: 1.31-1.78) and previous surgery (AOR 1.31; 95% CI: 1.12-1.52). Fifty-four (1.6%) of all participants tested positive for HIV; this included 44 (1.54%) men and 10 (1.92%) women. Among male inmates, HIV infection was associated with homosexuality (AOR 6.20, 95% CI: 1.73-22.22), self-report of mental illness (AOR 2.18, 95% CI: 1.13-4.18), history of sexually transmitted infections (AOR 3.28, 95% CI: 1.64-6.56), and syphilis sero-positivity (AOR 2.54, 95% CI: 1.20-5.39). Among HIV-infected individuals, 34 (63%) were unaware of their HIV status; only 23 of these 34 (68%) newly diagnosed participants could be reached at six month follow-up, and 21 of 23 (91%) were engaged in HIV care. CONCLUSIONS HIV testing rates among prison inmates are low, and the majority of HIV-infected inmates were unaware of their HIV diagnosis. Incarceration can be an opportunity for diagnosis and treatment of HIV among vulnerable populations who have poor access to health services, but further work is needed on transitional HIV care for released inmates.
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Affiliation(s)
| | | | | | | | - Simone Simionatto
- Faculty of Ambiental and Biological Sciences, Federal University of Grande Dourados, Brazil
| | | | - Ana Rita Coimbra Motta-Castro
- Department of Biochemical Pharmacy, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Oswaldo Cruz Foundation, Campo Grande, Brazil
| | | | - Juliana Urrego
- Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Albert I. Ko
- Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, Connecticut, United States of America
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Jason R. Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Julio Croda
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil
- Oswaldo Cruz Foundation, Campo Grande, Brazil
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Hoffmann M, MacCarthy S, Batson A, Crawford-Roberts A, Rasanathan J, Nunn A, Silva LA, Dourado I. Barriers along the care cascade of HIV-infected men in a large urban center of Brazil. AIDS Care 2015; 28:57-62. [PMID: 26291264 DOI: 10.1080/09540121.2015.1062462] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Global and national HIV/AIDS policies utilize the care cascade to emphasize the importance of continued engagement in HIV services from diagnosis to viral suppression. Several studies have documented barriers that men experience in accessing services at specific stages of care, but few have analyzed how these barriers operate along the care cascade. Brazil offers a unique setting for analyzing barriers to HIV care because it is a middle-income country with a large HIV epidemic and free, universal access to HIV/AIDS services. Semi-structured interviews were conducted in 2011 with HIV-infected men (n = 25) receiving care at the only HIV/AIDS state reference center in Salvador, Brazil, the third largest city in the country. Interviews were transcribed and coded for analysis. Researchers identified barriers to services along the care cascade: health service-related obstacles (poor-quality care, lengthy wait times, and drug supply problems); psychosocial and emotional challenges (fear of disclosure and difficulty accepting HIV diagnosis); indirect costs (transportation and absenteeism at work or school); low perceived risk of HIV; and toxicity and complexity of antiretroviral drug (ARV) regimens. The stages of the care cascade interrupted by each barrier were also identified. Most barriers affected multiple, and often all, stages of care, while toxicity and complexity of ARV regimens was only present at a single care stage. Efforts to eliminate more prevalent barriers have the potential to improve care continuity at multiple stages. Going forward, assessing the relative impact of barriers along one's entire care trajectory can help tailor improvements in service provision, facilitate achievement of viral suppression, and improve access to life-saving testing, treatment, and care.
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Affiliation(s)
- Michael Hoffmann
- a Brown University School of Public Health and the Miriam Hospital , 121 South Main St. Suite 810, Providence , RI 02912 , USA
| | - Sarah MacCarthy
- b RAND Corporation , 1776 Main Street, Santa Monica , CA 90407 , USA
| | - Ashley Batson
- a Brown University School of Public Health and the Miriam Hospital , 121 South Main St. Suite 810, Providence , RI 02912 , USA
| | - Ann Crawford-Roberts
- c Icahn School of Medicine at Mount Sinai , 1428 Madison Ave, New York , NY 10029 , USA
| | - Jennifer Rasanathan
- d Department of Family and Social Medicine , Montefiore Medical Center , 111 East 210th Street, Bronx , NY 10467 , USA
| | - Amy Nunn
- a Brown University School of Public Health and the Miriam Hospital , 121 South Main St. Suite 810, Providence , RI 02912 , USA
| | - Luis Augusto Silva
- e Institute of Collective Health, Federal University of Bahia , Rua Basilio da Gama, s/n - Campus Universitario Canela, Salvador , Bahia , Brazil
| | - Ines Dourado
- e Institute of Collective Health, Federal University of Bahia , Rua Basilio da Gama, s/n - Campus Universitario Canela, Salvador , Bahia , Brazil
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