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Tumwegamire A, Fatch R, Emenyonu NI, Lodi S, Muyindike WR, Kekibiina A, Adong J, Ngabirano C, Beesiga B, Marson K, Golabi N, Kamya M, Chamie G, Hahn JA. Association between smoking and lack of HIV virological suppression in a cross-sectional study of persons with HIV on antiretroviral therapy in Uganda. PLoS One 2024; 19:e0300508. [PMID: 38507431 PMCID: PMC10954112 DOI: 10.1371/journal.pone.0300508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 02/28/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Smoking and alcohol use frequently co-occur and are the leading causes of preventable death in sub-Saharan Africa (SSA) and are common among people living with HIV (PLWH). While alcohol use has been shown to be associated with reduced adherence to antiretroviral treatment (ART), which may affect HIV viral suppression, the independent effect of smoking on HIV outcomes in SSA is unknown. We aimed to 1) describe the prevalence of current smoking and correlates of smoking; 2) assess the association of smoking with viral suppression, adjusting for level of alcohol use; 3) explore the relationship between smoking and CD4 cell count <350 cells/mm3, among participants who are virally suppressed. METHODS We analyzed data from the Drinkers Intervention to Prevent Tuberculosis (DIPT) and the Alcohol Drinkers' Exposure to Preventive Therapy for TB (ADEPTT) studies conducted in Southwest Uganda. The studies enrolled PLWH who were on ART for at least 6 months and co-infected with latent tuberculosis and dominated with participants who had unhealthy alcohol use. Current smoking (prior 3 months) was assessed by self-report. Alcohol use was assessed using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C, modified for prior 3 months) and phosphatidylethanol (PEth), an alcohol biomarker. We used logistic regression to estimate the cross-sectional association between smoking and lack of virological suppression (≥40 copies/ml), adjusting for level of alcohol use and other covariates, and to examine the association between smoking and CD4 cell counts among PLWH with viral suppression. RESULTS Of the 955 participants enrolled from 2017 to 2021 who had viral load (VL) results, 63% were men, median age was 40 years (interquartile range [IQR] 32-47), 63% engaged in high/very high-risk alcohol use (AUDIT-C≥6 or PEth≥200 ng/mL), and 22% reported smoking in the prior 3 months. Among 865 participants (91%) with viral suppression and available CD4 count, 11% had a CD4 cell count <350 cells/mm3. In unadjusted and adjusted analyses, there was no evidence of an association between smoking and lack of virological suppression nor between smoking and CD4 count among those with viral suppression. CONCLUSIONS The prevalence of smoking was high among a study sample of PLWH in HIV care with latent TB in Southwest Uganda in which the majority of persons engaged in alcohol use. Although there was no evidence of an association between smoking and lack of virological suppression, the co-occurrence of smoking among PLWH who use alcohol underscores the need for targeted and integrated approaches to reduce their co-existence and improve health.
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Affiliation(s)
- Adah Tumwegamire
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robin Fatch
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, United States of America
| | - Nneka I. Emenyonu
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, United States of America
| | - Sara Lodi
- Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Winnie R. Muyindike
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Allen Kekibiina
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Julian Adong
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Christine Ngabirano
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brian Beesiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Kara Marson
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, United States of America
| | - Nakisa Golabi
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, United States of America
| | - Moses Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Gabriel Chamie
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, United States of America
| | - Judith A. Hahn
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States of America
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Kerr J, Smith A, Nzama N, Bullock NAA, Chandler C, Osezua V, Johnson K, Rozema I, Metzger IW, Harris LM, Bond K, LaPreze D, Rice BM. Systematic Review of Neighborhood Factors Impacting HIV Care Continuum Participation in the United States. J Urban Health 2024; 101:31-63. [PMID: 38093034 PMCID: PMC10897076 DOI: 10.1007/s11524-023-00801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 01/07/2024]
Abstract
Social determinants have been increasingly implicated in accelerating HIV vulnerability, particularly for disenfranchised communities. Among these determinants, neighborhood factors play an important role in undermining HIV prevention. However, there has been little research comprehensively examining the impact of neighborhood factors on HIV care continuum participation in the US. To address this, we conducted a systematic review (PROSPERO registration number CRD42022359787) to determine neighborhood factors most frequently associated with diminished HIV care continuum participation. Peer-reviewed studies were included if published between 2013 - 2022, centralized in the US, and analyzed a neighborhood factor with at least one aspect of the HIV care continuum. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Study quality was guided by LEGEND (Let Evidence Guide Every New Decision) evaluation guidelines. Systematic review analysis was conducted using Covidence software. There were 3,192 studies identified for initial screening. Forty-four were included for review after eliminating duplicates, title/abstract screening, and eligibility assessment. Social and economic disenfranchisement of neighborhoods negatively impacts HIV care continuum participation among persons living with HIV. In particular, five key neighborhood factors (socioeconomic status, segregation, social disorder, stigma, and care access) were associated with challenged HIV care continuum participation. Race moderated relationships between neighborhood quality and HIV care continuum participation. Structural interventions addressing neighborhood social and economic challenges may have favorable downstream effects for improving HIV care continuum participation.
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Affiliation(s)
- Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA.
| | - Adrienne Smith
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Nqobile Nzama
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Nana Ama Aya Bullock
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Cristian Chandler
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Victory Osezua
- Public Health Program, Gwynedd Mercy University, Gwynedd Valley, PA, USA
| | - Karen Johnson
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Isabel Rozema
- University of Louisville Health, Louisville, KY, USA
| | - Isha W Metzger
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Lesley M Harris
- Kent School of Social Work and Family Science, University of Louisville, Louisville, KY, USA
| | - Keosha Bond
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY, USA
| | - Dani LaPreze
- Kornhauser Health Sciences Library, University of Louisville, Louisville, KY, USA
| | - Bridgette M Rice
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
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Filippone P, Serrano S, Campos S, Freeman R, Cluesman SR, Israel K, Amos B, Cleland CM, Gwadz M. Understanding why racial/ethnic inequities along the HIV care continuum persist in the United States: a qualitative exploration of systemic barriers from the perspectives of African American/Black and Latino persons living with HIV. Int J Equity Health 2023; 22:168. [PMID: 37649049 PMCID: PMC10466874 DOI: 10.1186/s12939-023-01992-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Racial/ethnic inequities along the HIV care continuum persist in the United States despite substantial federal investment. Numerous studies highlight individual and social-level impediments in HIV, but fewer foreground systemic barriers. The present qualitative study sought to uncover and describe systemic barriers to the HIV care continuum from the perspectives of African American/Black and Latino persons living with HIV (PLWH) with unsuppressed HIV viral load, including how barriers operated and their effects. METHODS Participants were African American/Black and Latino PLWH with unsuppressed HIV viral load (N = 41). They were purposively sampled for maximum variability on key indices from a larger study. They engaged in semi-structured in-depth interviews that were audio-recorded and professionally transcribed. Data were analyzed using directed content analysis. RESULTS Participants were 49 years old, on average (SD = 9), 76% were assigned male sex at birth, 83% were African American/Black and 17% Latino, 34% were sexual minorities (i.e., non-heterosexual), and 22% were transgender/gender-nonbinary. All had indications of chronic poverty. Participants had been diagnosed with HIV 19 years prior to the study, on average (SD = 9). The majority (76%) had taken HIV medication in the six weeks before enrollment, but at levels insufficient to reach HIV viral suppression. Findings underscored a primary theme describing chronic poverty as a fundamental cause of poor engagement. Related subthemes were: negative aspects of congregate versus private housing settings (e.g., triggering substance use and social isolation); generally positive experiences with health care providers, although structural and cultural competency appeared insufficient and managing health care systems was difficult; pharmacies illegally purchased HIV medication from PLWH; and COVID-19 exacerbated barriers. Participants described mitigation strategies and evidenced resilience. CONCLUSIONS To reduce racial/ethnic inequities and end the HIV epidemic, it is necessary to understand African American/Black and Latino PLWH's perspectives on the systemic impediments they experience throughout the HIV care continuum. This study uncovers and describes a number of salient barriers and how they operate, including unexpected findings regarding drug diversion and negative aspects of congregate housing. There is growing awareness that systemic racism is a core determinant of systemic barriers to HIV care continuum engagement. Findings are interpreted in this context.
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Affiliation(s)
- Prema Filippone
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Samantha Serrano
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Stephanie Campos
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Robin Freeman
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Sabrina R Cluesman
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Khadija Israel
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Brianna Amos
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Charles M Cleland
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA
| | - Marya Gwadz
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA.
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Bourdeau B, Shade SB, Koester KA, Rebchook GM, Steward WT, Agins BM, Myers JJ, Phan SH, Matosky M. Rapid start antiretroviral therapies for improved engagement in HIV care: implementation science evaluation protocol. BMC Health Serv Res 2023; 23:503. [PMID: 37198586 DOI: 10.1186/s12913-023-09500-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND In 2020, the Health Resources and Services Administration's HIV/AIDS Bureau funded an initiative to promote implementation of rapid antiretroviral therapy initiation in 14 HIV treatment settings across the U.S. The goal of this initiative is to accelerate uptake of this evidence-based strategy and provide an implementation blueprint for other HIV care settings to reduce the time from HIV diagnosis to entry into care, for re-engagement in care for those out of care, initiation of treatment, and viral suppression. As part of the effort, an evaluation and technical assistance provider (ETAP) was funded to study implementation of the model in the 14 implementation sites. METHOD The ETAP has used implementation science methods framed by the Dynamic Capabilities Model integrated with the Conceptual Model of Implementation Research to develop a Hybrid Type II, multi-site mixed-methods evaluation, described in this paper. The results of the evaluation will describe strategies associated with uptake, implementation outcomes, and HIV-related health outcomes for patients. DISCUSSION This approach will allow us to understand in detail the processes that sites to implement and integrate rapid initiation of antiretroviral therapy as standard of care as a means of achieving equity in HIV care.
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Affiliation(s)
- Beth Bourdeau
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA.
| | - Starley B Shade
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Kimberly A Koester
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Greg M Rebchook
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Wayne T Steward
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce M Agins
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Janet J Myers
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Son H Phan
- Division of Policy and Data, Health Resources and Services Administration HIV/AIDS Bureau, Rockville, MD, USA
| | - Marlene Matosky
- Division of Policy and Data, Health Resources and Services Administration HIV/AIDS Bureau, Rockville, MD, USA
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Soogun AO, Kharsany ABM, Zewotir T, North D, Ogunsakin RE. Identifying Potential Factors Associated with High HIV viral load in KwaZulu-Natal, South Africa using Multiple Correspondence Analysis and Random Forest Analysis. BMC Med Res Methodol 2022; 22:174. [PMID: 35715730 PMCID: PMC9206247 DOI: 10.1186/s12874-022-01625-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/27/2022] [Indexed: 12/02/2022] Open
Abstract
Background Sustainable Human Immunodeficiency Virus (HIV) virological suppression is crucial to achieving the Joint United Nations Programme of HIV/AIDS (UNAIDS) 95–95-95 treatment targets to reduce the risk of onward HIV transmission. Exploratory data analysis is an integral part of statistical analysis which aids variable selection from complex survey data for further confirmatory analysis. Methods In this study, we divulge participants’ epidemiological and biological factors with high HIV RNA viral load (HHVL) from an HIV Incidence Provincial Surveillance System (HIPSS) sequential cross-sectional survey between 2014 and 2015 KwaZulu-Natal, South Africa. Using multiple correspondence analysis (MCA) and random forest analysis (RFA), we analyzed the linkage between socio-demographic, behavioral, psycho-social, and biological factors associated with HHVL, defined as ≥400 copies per m/L. Results Out of 3956 in 2014 and 3868 in 2015, 50.1% and 41% of participants, respectively, had HHVL. MCA and RFA revealed that knowledge of HIV status, ART use, ARV dosage, current CD4 cell count, perceived risk of contracting HIV, number of lifetime HIV tests, number of lifetime sex partners, and ever diagnosed with TB were consistent potential factors identified to be associated with high HIV viral load in the 2014 and 2015 surveys. Based on MCA findings, diverse categories of variables identified with HHVL were, did not know HIV status, not on ART, on multiple dosages of ARV, with less likely perceived risk of contracting HIV and having two or more lifetime sexual partners. Conclusion The high proportion of individuals with HHVL suggests that the UNAIDS 95–95-95 goal of HIV viral suppression is less likely to be achieved. Based on performance and visualization evaluation, MCA was selected as the best and essential exploration tool for identifying and understanding categorical variables’ significant associations and interactions to enhance individual epidemiological understanding of high HIV viral load. When faced with complex survey data and challenges of variables selection in research, exploratory data analysis with robust graphical visualization and reliability that can reveal divers’ structures should be considered. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01625-6.
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Affiliation(s)
- Adenike O Soogun
- School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Westville Campus, Durban, South Africa. .,Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
| | - Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
| | - Delia North
- School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
| | - Ropo Ebenezer Ogunsakin
- Biostatistics Unit, Discipline of Public Health Medicine, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Lekas HM, Lewis C, Lunden S, Olender SA, Rosen-Metsch L. Single Room Occupancy Residence: Processes Linking Housing to Not Engaging in HIV Outpatient Care. AIDS Behav 2021; 25:2644-2656. [PMID: 33743114 DOI: 10.1007/s10461-021-03225-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/28/2022]
Abstract
Homelessness and housing instability undermine engagement in medical care, adherence to treatment and health among persons with HIV/AIDS. However, the processes by which unstable and unsafe housing result in adverse health outcomes remain understudied and are the focus of this manuscript. From 2012 to 2014, we conducted qualitative interviews among inpatients with HIV disengaged from outpatient care (n = 120). We analyzed the content of the interviews with participants who reported a single room occupancy (SRO) residence (n = 44), guided by the Health Lifestyle Theory. Although SROs emerged as residences that were unhygienic and conducive to drug use and violence, participants remained in the SRO system for long periods of time. This generated experiences of living instability, insecurity and lack of control that reinforced a set of tendencies (habitus) and behaviors antithetical to adhering to medical care. We called for research and interventions to transform SROs into housing protective of its residents' health and wellbeing.
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Affiliation(s)
- Helen-Maria Lekas
- Division of Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Bldg. 35, Orangeburg, NY, USA.
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
| | - Crystal Lewis
- Division of Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Bldg. 35, Orangeburg, NY, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Sara Lunden
- Benjamin N. Cardoso School of Law, Yeshiva University, New York, NY, USA
| | - Susan Aileen Olender
- Division of Infectious Disease, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa Rosen-Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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The HIV Care Continuum in Small Cities of Southern New England: Perspectives of People Living with HIV/AIDS, Public Health Experts, and HIV Service Providers. AIDS Behav 2021; 25:897-907. [PMID: 33001353 DOI: 10.1007/s10461-020-03049-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
The HIV care continuum (HCC), comprised of five steps (screening, linkage to care, treatment initiation, retention, and viral suppression), is used to monitor treatment delivery to people living with HIV (PLWH). The HCC has primarily focused on large urban or metropolitan areas where the situation may differ from that in smaller cities. Three themes (i.e., knowledge, stigma, stability) that shaped HCC outcomes were identified from analysis of two qualitative studies involving HIV service providers, public health experts, and PLWH in smaller cities of southern New England. The findings suggest that enhancing HCC outcomes require a multiprong approach that targets both the individual and organizational levels and includes interventions to increase health literacy, staff communication skills, universal screening to assess patients' religiosity/spirituality and supplemental service needs. Interventions that further ensure patient confidentiality and the co-location and coordination of HIV and other healthcare services are particularly important in smaller cities.
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8
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Viral Rebound Among Persons With Diagnosed HIV Who Achieved Viral Suppression, United States. J Acquir Immune Defic Syndr 2021; 84:133-140. [PMID: 32084054 DOI: 10.1097/qai.0000000000002321] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Some persons who achieve viral suppression may later experience viral rebound, potentially putting them at risk for transmitting HIV. We estimate the prevalence of, and describe factors associated with, viral rebound among adults with diagnosed HIV in the United States who had ≥2 viral load tests in a 12-month period. SETTING The Medical Monitoring Project is an annual cross-sectional survey about the experiences and needs of adults with diagnosed HIV sampled from the National HIV Surveillance System. METHODS We analyzed interview and medical record data from 3 Medical Monitoring Project cycles spanning June 2015-May 2018. We analyzed viral load results from the 12-month period before the interview among persons with ≥2 viral load tests who achieved viral suppression. Data were weighted based on known probabilities of selection, adjusted for patient nonresponse, and poststratified to known population totals from the National HIV Surveillance System. RESULTS Among those with ≥2 viral load tests who achieved viral suppression, 7.5% demonstrated viral rebound. In multivariable analyses, viral rebound was higher among non-Hispanic blacks, persons ages 18-39, persons with public insurance, persons recently experiencing homelessness, persons with higher numbers of viral load tests, persons who missed HIV care appointments, and persons with suboptimal adherence to antiretroviral therapy. CONCLUSIONS Viral rebound varied by sociodemographic and clinical characteristics. HIV providers can monitor persons at greatest risk for viral rebound and link patients with ancillary services or evidence-based interventions to help them remain virally suppressed. Our findings can inform strategies and interventions implemented under the Ending the HIV Epidemic initiative.
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Mohammed DY, Koumoulos LM, Martin E, Slim J. Annual and durable HIV retention in care and viral suppression among patients of Peter Ho Clinic, 2013-2017. PLoS One 2020; 15:e0244376. [PMID: 33373385 PMCID: PMC7771864 DOI: 10.1371/journal.pone.0244376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives To determine rates of annual and durable retention in medical care and viral suppression among patients enrolled in the Peter Ho Clinic, from 2013–2017. Methods This is a retrospective review of medical record data in an urban clinic, located in Newark, New Jersey, a high prevalence area of persons living with HIV. Viral load data were electronically downloaded, in rolling 1-year intervals, in two-month increments, from January 1, 2013 to December 31, 2019. Three teams were established, and every two months, they were provided with an updated list of patients with virologic failure. Retention and viral suppression rates were first calculated for each calendar-year. After patients were determined to be retained/suppressed annually, the proportion of patients with durable retention and viral suppression were calculated in two, three, four, five and six-year periods. Descriptive statistics were used to summarize sample characteristics by retention in care, virologic failure and viral suppression with Pearson Chi-square; p-value <0.05 was statistically significant. Multiple logistic regression models identified patient characteristics associated with retention in medical care, virologic failure and suppression. Results As of December 31, 2017, 1000 (57%) patients were retained in medical care of whom 870 (87%) were suppressed. Between 2013 and 2016, decreases in annual (85% to 77%) and durable retention in care were noted: two-year (72% to 70%) and three-year (63% to 59%) periods. However, increases were noted for 2017, in annual (89%) and durable retention in the two-year period (79%). In the adjusted model, when compared to current patients, retention in care was less likely among patients reengaging in medical care (adjusted Odds Ratio (aOR): 0.77, 95% CI: 0.61–0.98) but more likely among those newly diagnosed from 2014–2017 (aOR: 1.57, 95% CI: 1.08–2.29), compared to those in care since 2013. A higher proportion of patients re-engaging in medical care had virologic failure than current patients (56% vs. 47%, p < 0.0001). As age decreased, virologic failure was more likely (p<0.0001). Between 2013 and 2017, increases in annual (74% to 87%) and durable viral suppression were noted: two-year (59% to 73%) and three-year (49% to 58%) periods. Viral suppression was more likely among patients retained in medical care up to 2017 versus those who were not (aOR: 5.52, 95% CI: 4.08–7.46). Those less likely to be suppressed were 20–29 vs. 60 years or older (aOR: 0.52, 95% CI: 0.28–0.97), had public vs. private insurance (aOR: 0.29, 95% CI: 0.15–0.55) and public vs. private housing (aOR: 0.59, 95% CI: 0.40–0.87). Conclusions Restructuring clinical services at this urban clinic was associated with improved viral suppression. However, concurrent interventions to ensure retention in medical care were not implemented. Both retention in care and viral suppression interventions should be implemented in tandem to achieve an end to the epidemic. Retention in care and viral suppression should be measured longitudinally, instead of cross-sectional yearly evaluations, to capture dynamic changes in these indicators.
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Affiliation(s)
- Debbie Y. Mohammed
- Department of Nursing, William Paterson University, Wayne, New Jersey, United States of America
- Division of Infectious Diseases, Saint Michael’s Medical Center, Newark, New Jersey, United States of America
- * E-mail:
| | - Lisa Marie Koumoulos
- Department of Nursing, William Paterson University, Wayne, New Jersey, United States of America
- Department of Quality, Palisades Medical Center, Hackensack Meridian Health, North Bergen, New Jersey, United States of America
| | - Eugene Martin
- Department of Pathology and Laboratory Medicine, Rutgers-Robert Wood Johnson Medical School, Somerset, New Jersey, United States of America
| | - Jihad Slim
- Division of Infectious Diseases, Saint Michael’s Medical Center, Newark, New Jersey, United States of America
- New York Medical College, Valhalla, New York, United States of America
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Elgalib A, Al-Wahaibi A, Shah S, Al-Habsi Z, Al-Fouri M, Lau R, Al-Kindi H, Al-Rawahi B, Al-Abri S. Predictors of virologic failure among people living with HIV in Oman: a national study from the Middle East. Int J STD AIDS 2020; 32:239-245. [DOI: 10.1177/0956462420956850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We conducted a cross-sectional analysis to determine HIV virologic failure and its associated factors among Omani people living with HIV who are on ART for > 6 months. Patients (n = 1427) were identified from a central national HIV surveillance dataset. Two-thirds (67%) of patients were male, and the median age was 39 years (IQR, 32-48 years). Out of 1427 patients, 14.4% had virologic failure (HIV viral load [VL] ≥ 200 copies/ml). The multivariate analysis showed that patients aged 25-49 years (adjusted odds ratio [aOR]: 1.76, 95% CI: 1.01-3.08) were significantly more likely to fail treatment, compared to those aged ≥ 50 years. Besides, having “Other” HIV risk factor (compared to heterosexuals, aOR: 1.82, 95% CI: 1.02-3.24) and receiving HIV care outside the capital Muscat (compared to those cared for in Muscat, aOR: 1.73, 95% CI: 1.11-2.7) were independently associated with virologic failure. HIV viral suppression (85.6%) in Oman is encouraging; however, further strategies, mainly targeting patients who are young (<50 years), those not disclosing their HIV risk factor and those attending HIV treatment centres outside Muscat, are required to enhance HIV treatment outcome in Oman.
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Affiliation(s)
- Ali Elgalib
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Adil Al-Wahaibi
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Samir Shah
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Zeyana Al-Habsi
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Maha Al-Fouri
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Richard Lau
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Hanan Al-Kindi
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Bader Al-Rawahi
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Muscat, Oman
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11
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Housing Subsidies and Housing Stability are Associated with Better HIV Medical Outcomes Among Persons Who Experienced Homelessness and Live with HIV and Mental Illness or Substance Use Disorder. AIDS Behav 2020; 24:3252-3263. [PMID: 32180090 DOI: 10.1007/s10461-020-02810-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Among 958 applicants to a supportive housing program for low-income persons living with HIV (PLWH) and mental illness or a substance use disorder, we assessed impacts of housing placement on housing stability, HIV care engagement, and viral suppression. Surveillance and administrative datasets provided medical and residence information, including stable (e.g., rental assistance, supportive housing) and unstable (e.g., emergency shelter) government-subsidized housing. Sequence analysis identified a "quick stable housing" pattern for 67% of persons placed by this program within 2 years, vs. 28% of unplaced. Compared with unplaced persons not achieving stable housing quickly, persons quickly achieving stable housing were more likely to engage in care, whether placed (per Poisson regression, ARR: 1.14;95% CI 1.09-1.20) or unplaced (1.19;1.13-1.25) by this program, and to be virally suppressed, whether placed (1.22;1.03-1.44) or unplaced (1.26, 1.03-1.56) by this program. Housing programs can help homeless PLWH secure stable housing quickly, manage their infection, and prevent transmission.
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12
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Chandran A, Edmonds A, Benning L, Wentz E, Adedimeji A, Wilson TE, Blair-Spence A, Palar K, Cohen M, Adimora A. Longitudinal Associations Between Neighborhood Factors and HIV Care Outcomes in the WIHS. AIDS Behav 2020; 24:2811-2818. [PMID: 32170507 PMCID: PMC7483905 DOI: 10.1007/s10461-020-02830-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Identifying structural determinants affecting HIV outcomes is important for informing interventions across heterogeneous geographies. Longitudinal hierarchical generalized mixed-effects models were used to quantify the associations between changes in certain structural-level factors on HIV care engagement, medication adherence, and viral suppression. Among women living with HIV in the WIHS, ten-unit increases in census-tract level proportions of unemployment, poverty, and lack of car ownership were inversely associated with viral suppression and medication adherence, while educational attainment and owner-occupied housing were positively associated with both outcomes. Notably, increased residential stability (aOR 5.68, 95% CI 2.93, 9.04) was positively associated with HIV care engagement, as were unemployment (aOR: 1.59, 95% CI 1.57, 1.60), lack of car ownership (aOR 1.14, 95% CI 1.13, 1.15), and female-headed households (aOR 1.23, 95% CI 1.22, 1.23). This underscores the importance of understanding neighborhood context, including factors that may not always be considered influential, in achieving optimal HIV-related outcomes.
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Affiliation(s)
- Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew Edmonds
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eryka Wentz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adebola Adedimeji
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, State University of New York, Downstate Health Sciences University, School of Public Health, Brooklyn, NY, USA
| | - Amanda Blair-Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DC, USA
| | - Kartika Palar
- Division of HIV, Infectious Disease and Global Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Mardge Cohen
- Cook County Health and Hospital System, Chicago, IL, USA
| | - Adaora Adimora
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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13
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Abstract
: As policies built on 'Undetectable = Untransmittable' become more popular, use of durable viral suppression (DVS) as an outcome in analyses is increasing. We identified a case series of recent HIV-related publications that study the DVS outcome. The majority did not distinguish between a definition of DVS and the operationalization of that definition. Clearer discussion of DVS, including a formal definition, is needed to ensure better comparability across studies and ultimately better public health outcomes.
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14
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Zhong Y, Beattie CM, Rojas J, Farquhar XP, Brown PA, Wiewel EW. Enrollment Length, Service Category, and HIV Health Outcomes Among Low-Income HIV-Positive Persons Newly Enrolled in a Housing Program, New York City, 2014-2017. Am J Public Health 2020; 110:1068-1075. [PMID: 32437285 DOI: 10.2105/ajph.2020.305660] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate the impact of duration and service category on HIV health outcomes among low-income adults living with HIV and enrolled in a housing program in 2014 to 2017.Methods. We estimated relative risk of engagement in care, viral suppression, and CD4 improvement for 561 consumers at first and second year after enrollment to matched controls through the New York City HIV surveillance registry, by enrollment length (enrolled for more than 1 year or not) and service category (housing placement assistance [HPA], supportive permanent housing [SPH], and rental assistance [REN]).Results. The SPH and REN consumers were enrolled longer and received more services, compared with HPA consumers. Long-term SPH and REN consumers had better engagement in care, viral suppression, and CD4 count than controls at both first and second year after enrollment, but the effect did not grow bigger from year 1 to 2. HPA consumers did not have better outcomes than controls regardless of enrollment length.Conclusions. Longer enrollment with timely housing placement and a higher number and more types of services are associated with better HIV health outcomes for low-income persons living with HIV with unmet housing needs.
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Affiliation(s)
- Yaoyu Zhong
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Christopher M Beattie
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - John Rojas
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - X Pamela Farquhar
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Paul A Brown
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Ellen W Wiewel
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
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15
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Griffin A, Dempsey A, Cousino W, Avery L, Phillips H, Egwim E, Cheever L. Addressing disparities in the health of persons with HIV attributable to unstable housing in the United States: The role of the Ryan White HIV/AIDS Program. PLoS Med 2020; 17:e1003057. [PMID: 32119661 PMCID: PMC7051042 DOI: 10.1371/journal.pmed.1003057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Amy Griffin and co-authors discuss unstable housing and the response to HIV/AIDS in the United States.
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Affiliation(s)
- Amy Griffin
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, United States of America
| | - Antigone Dempsey
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, United States of America
| | - Wendy Cousino
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, United States of America
| | - Latham Avery
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, United States of America
| | - Harold Phillips
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, United States of America
| | - Emeka Egwim
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, United States of America
| | - Laura Cheever
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, United States of America
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