1
|
Palacio-Vieira J, Moreno-Fornés S, Díaz Y, Aceitón J, Bruguera A, Nomah DK, Llibre JM, Knobel H, Chivite I, Miro JM, Domingo P, Suanzes P, Fanjul F, Navarro G, Macorigh L, Mera A, Casabona J, Imaz A, Reyes-Urueña J. Who is lost to follow-up in HIV care? Assessment of care retention over time and the impact of COVID-19. Longitudinal analysis of the PISCIS cohort. HIV Med 2023; 24:965-978. [PMID: 36990962 DOI: 10.1111/hiv.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/08/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION People living with HIV who are lost to follow-up have a greater risk of health deterioration, mortality, and community transmission. OBJECTIVE Our aim was to analyse both how rates of loss to follow-up (LTFU) changed between 2006 and 2020 and how the COVID-19 pandemic affected these rates in the PISCIS cohort study of Catalonia and the Balearic Islands. METHODS We analysed socio-demographic and clinical characteristics of LTFU yearly and with adjusted odds ratios to assess the impact of these determinants on LTFU in 2020 (the year of COVID-19). We used latent class analysis to categorize classes of LTFU based on their socio-demographic and clinical characteristics at each year. RESULTS In total, 16.7% of the cohort were lost to follow-up at any time in the 15 years (n = 19 417). Of people living with HIV who were receiving follow-up, 81.5% were male and 19.5% were female; of those who were lost to follow-up, 79.6% and 20.4% were male and female, respectively (p < 0.001). Although rates of LTFU increased during COVID-19 (1.11% vs. 0.86%, p = 0.024), socio-demographic and clinical factors were similar. Eight classes of people living with HIV who were lost to follow-up were identified: six for men and two for women. Classes of men (n = 3) differed in terms of their country of birth, viral load (VL), and antiretroviral therapy (ART); classes of people who inject drugs (n = 2) differed in terms of VL, AIDS diagnosis, and ART. Changes in rates of LTFU included higher CD4 cell count and undetectable VL. CONCLUSIONS The socio-demographic and clinical characteristics of people living with HIV changed over time. Although the circumstances of the COVID-19 pandemic increased the rates of LTFU, the characteristics of these people were similar. Epidemiological trends among people who were lost to follow-up can be used to prevent new losses of care and to reduce barriers to achieve Joint United Nations Programme on HIV/AIDS 95-95-95 targets.
Collapse
Affiliation(s)
- Jorge Palacio-Vieira
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
| | - Sergio Moreno-Fornés
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
| | - Yesika Díaz
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
| | - Jordi Aceitón
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
| | - Andreu Bruguera
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
| | - Daniel K Nomah
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
| | - Josep M Llibre
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Iván Chivite
- Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - José M Miro
- Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- CIBERINFEC. Instituto de Salud Carlos III, Madrid, Spain
| | | | - Paula Suanzes
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | - Jordi Casabona
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
| | - Arkaitz Imaz
- HIV and STI Unit, Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Juliana Reyes-Urueña
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
| |
Collapse
|
2
|
Izquierdo R, Rava M, Moreno-García E, Blanco JR, Asensi V, Cervero M, Curran A, Rubio R, Iribarren JA, Jarrín I. HIV medical care interruption among people living with HIV in Spain, 2004-2020. AIDS 2023; 37:1277-1284. [PMID: 36939068 DOI: 10.1097/qad.0000000000003552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVE We estimated the incidence rate of HIV medical care interruption (MCI) and its evolution over a 16-year-period, and identified associated risk factors among HIV-positive individuals from the Cohort of the Spanish AIDS Research Network in 2004-2020. DESIGN We included antiretroviral-naive individuals aged at least 18 years at enrolment, recruited between January 1, 2004, and August 30, 2019, and followed-up until November 30, 2020. METHODS Individuals with any time interval of at least 15 months between two visits were defined as having a MCI. We calculated the incidence rate (IR) of having at least one MCI and used multivariable Poisson regression models to identify associated risk factors. RESULTS Of 15 274 individuals, 5481 (35.9%) had at least one MCI. Of those, 2536 (46.3%) returned to HIV care after MCI and 3753 (68.5%) were lost to follow-up at the end of the study period. The incidence rate (IR) of MCI was 7.2/100 person-years (py) [95% confidence interval (CI): 7.0-7.4]. The annual IR gradually decreased from 20.5/100 py (95% CI: 16.4-25.6) in 2004 to 4.9/100 py (95% CI: 4.4-5.5) in 2014, a slight increase was observed between 2015 and 2018, reaching 9.3/100 py (95% CI: 8.6-10.2) in 2019. Risk factors for MCI included younger age, lower educational level, having contracted HIV infection through injecting drug use or heterosexual intercourse, having been born outside of Spain, and CD4 + cell count >200 cell/μl, viral load <100 000 and co-infection with hepatitis C virus at enrolment. CONCLUSIONS Around a third of individuals had at least one MCI during the follow-up. Identified predictors of MCI can help health workers to target and support most vulnerable individuals.
Collapse
Affiliation(s)
- Rebeca Izquierdo
- National Center for Epidemiology, Instituto de Salud Carlos III
- Centre of Biomedical Research for Infectious Diseases (CIBERINFEC), Madrid
| | - Marta Rava
- National Center for Epidemiology, Instituto de Salud Carlos III
- Centre of Biomedical Research for Infectious Diseases (CIBERINFEC), Madrid
| | | | | | - Víctor Asensi
- Infectious Diseases - HIV Unit, Internal Medicine, Hospital Universitario Central de Asturias, Oviedo University School of Medicine, Translational Research in Infective Pathology Lab, ISPA-FINBA
| | - Miguel Cervero
- Internal Medicine Department, Hospital Universitario Severo Ochoa, Leganés
| | - Adrian Curran
- Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona
| | - Rafael Rubio
- HIV Unit, Internal Medicine Department, Biomedical Research Institute Imas12, Hospital Universitario 12 de Octubre. Medicine Department. Universidad Complutense de Madrid, Madrid
| | - José Antonio Iribarren
- Department of Infectious Diseases, Donostia University Hospital, IIS Biodonostia, San Sebastián, Spain
| | - Inmaculada Jarrín
- National Center for Epidemiology, Instituto de Salud Carlos III
- Centre of Biomedical Research for Infectious Diseases (CIBERINFEC), Madrid
| |
Collapse
|
3
|
Valencia J, Troya J, Lazarus JV, Cuevas G, Alvaro-Meca A, Torres-Machado J, Escobar I, Cañamares I, Ryan P. Effectiveness of an HIV care model integrated into addiction care based on medication-assisted treatment for HIV-positive people who use drugs. AIDS Care 2022; 34:1297-1304. [PMID: 34482777 DOI: 10.1080/09540121.2021.1967853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Our objective was to evaluate the effectiveness of initiated or reinitiated antiretroviral therapy (ART) in HIV-positive active drug users receiving integrated HIV and addiction care in a harm reduction setting. We performed a study of HIV-positive persons who use drugs (PWUD) in a harm reduction unit in Madrid, Spain. Participants received HIV care integrated into addiction care and received at least one dose of observed ART based on medication-assisted treatment between January 2013 and December 2019. Individuals newly diagnosed with HIV (n = 13) had a greater median CD4 cell count at baseline were less likely to be late presenters, had a greater CD4 cell count increase, and were less likely to have AIDS in comparison to those who were aware of their HIV status (n = 87) at initiation or reinitiation of ART. The overall VS was 73% in the intention-to-treat (ITT) analysis and 92.4% in the modified intention-to-treat (mITT) analysis. People who were engaged in OST, people with >90% adherence to ART, and older people were positively associated with VS in the multivariate analysis. An HIV care model integrated into a harm reduction facility demonstrated a high uptake of HIV treatment, retention in care, improvement in adherence, and achievement of VS.
Collapse
Affiliation(s)
- Jorge Valencia
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain.,Harm Reduction Unit "SMASD", Addictions and Mental Health Department, Madrid, Spain
| | - Jesús Troya
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Guillermo Cuevas
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Alejandro Alvaro-Meca
- Unit of Preventive Medicine and Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Juan Torres-Machado
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Ismael Escobar
- Pharmacy Department, University Hospital Infanta Leonor, Madrid, Spain
| | - Irene Cañamares
- Pharmacy Department, University Hospital Infanta Leonor, Madrid, Spain
| | - Pablo Ryan
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain
| |
Collapse
|
4
|
Palacio-Vieira J, Reyes-Urueña JM, Imaz A, Bruguera A, Force L, Llaveria AO, Llibre JM, Vilaró I, Borràs FH, Falcó V, Riera M, Domingo P, de Lazzari E, Miró JM, Casabona J. Strategies to reengage patients lost to follow up in HIV care in high income countries, a scoping review. BMC Public Health 2021; 21:1596. [PMID: 34454444 PMCID: PMC8403456 DOI: 10.1186/s12889-021-11613-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background Despite remarkable achievements in antiretroviral therapy (ART), losses to follow-up (LTFU) might prevent the long-term success of HIV treatment and might delay the achievement of the 90–90-90 objectives. This scoping review is aimed at the description and analysis of the strategies used in high-income countries to reengage LTFU in HIV care, their implementation and impact. Methods A scoping review was done following Arksey & O′Malley’s methodological framework and recommendations from Joanna Briggs Institute. Peer reviewed articles were searched for in Pubmed, Scopus and Web of Science; and grey literature was searched for in Google and other sources of information. Documents were charted according to the information presented on LTFU, the reengagement procedures used in HIV units in high-income countries, published during the last 15 years. In addition, bibliographies of chosen articles were reviewed for additional articles. Results Twenty-eight documents were finally included, over 80% of them published in the United States later than 2015. Database searches, phone calls and/or mail contacts were the most common strategies used to locate and track LTFU, while motivational interviews and strengths-based techniques were used most often during reengagement visits. Outcomes like tracing activities efficacy, rates of reengagement and viral load reduction were reported as outcome measures. Conclusions This review shows a recent and growing trend in developing and implementing patient reengagement strategies in HIV care. However, most of these strategies have been implemented in the United States and little information is available for other high-income countries. The procedures used to trace and contact LTFU are similar across reviewed studies, but their impact and sustainability are widely different depending on the country studied. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11613-y.
Collapse
Affiliation(s)
- Jorge Palacio-Vieira
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Badalona, Spain. .,CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain. .,Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
| | - Juliana Maria Reyes-Urueña
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Badalona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain.,Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Arkaitz Imaz
- HIV and STI Unit, Department of Infectious Diseases, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Andreu Bruguera
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Badalona, Spain.,Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Luis Force
- Internal Medicine, Hospital de Mataró-Consorci Sanitari del Maresme, Mataró, Spain
| | - Amat Orti Llaveria
- Internal Medicine, Hospital Verge de la Cinta de Tortosa, Tortosa, Spain
| | - Josep M Llibre
- Infectious Diseases and "Fight AIDS" Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | | | | | - Vicenç Falcó
- Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | - Josep M Miró
- HIV/AIDS Unit. Hospital Clinic, Barcelona, Spain
| | - Jordi Casabona
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Badalona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain.,Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | | |
Collapse
|
5
|
Vivancos MJ, Moreno S. Las pérdidas de seguimiento de las personas con infección por VIH: un punto débil en el continuo de cuidados. Enferm Infecc Microbiol Clin 2019; 37:359-360. [DOI: 10.1016/j.eimc.2019.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 11/28/2022]
|