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Alvis-Estrada JP, Azmitia-Rugg A, Sobalvarro-Stolz X, Romo-Dueñas D, Díaz F, Martínez A, Morales RE, Chang LR, Vega N, Araúz AB, Ávila-Montes G. Evaluation of rapid antiretroviral initiation strategy in a cohort of newly diagnosed people living with HIV in Panama, 2018-2019. AIDS Care 2024:1-8. [PMID: 38991109 DOI: 10.1080/09540121.2024.2373397] [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: 02/16/2024] [Accepted: 06/21/2024] [Indexed: 07/13/2024]
Abstract
Antiretroviral therapy (ART) has been adopted as a form of HIV treatment and prevention. This study assesses rapid ART initiation using clinical outcomes such as viral load (VL) and CD4+ T lymphocytes count. Over the course of one year, the progress of newly diagnosed people living with HIV who started ART early in a hospital in Panama City was followed. The evaluation of early initiation of ART in achieving viral suppression (VL <200 copies/ml) was analyzed using descriptive statistics. Additionally, the cost difference between early (first 7 days) and late initiation of ART was evaluated from the perspective of the service provider. In total, 209 people were followed up during the study; 85% were male, 70% started ART on same day from hospital arrival, 80% had suppressed viral load at 6 months, and the median count of CD4 increased from 285 (IQR: 166-429) to 509 (IQR: 373-696) over 12 months. Starting ART early led to a 42% increase for the provider in terms of staffing costs; however, the clients had the opportunity to decrease absenteeism in daily activities. The results reveal that early initiation of ART generates clinical and economic benefits for the person in treatment.
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Affiliation(s)
- Juan Pablo Alvis-Estrada
- Juan Pablo Alvis-Estrada, Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Andrés Azmitia-Rugg
- Andrés Azmitia-Rugg, Center for Disease Control and Prevention (CDC) Central America Region, Guatemala City, Guatemala
| | - Ximena Sobalvarro-Stolz
- Ximena Soblavarro-Stolz, Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Daniela Romo-Dueñas
- Daniela Romo-Dueñas, Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Félix Díaz
- Félix Diaz, Hospital Santo Tomás, Panama City, Panama
| | - Alexander Martínez
- Alexander Martinez, Instituto Conmemorativo Gorgas de Estudios en Salud, Panama City, Panama
| | - Rosa Elena Morales
- Rosa Elena Morales, Center for Disease Control and Prevention (CDC) Central America Region, Guatemala City, Guatemala
| | - Lissette Raquel Chang
- Lissette Raquel Chang, Center for Disease Control and Prevention (CDC) Central America Region, Panama City, Panama
| | - Natalia Vega
- Natalia Vega, Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Ana Belén Araúz
- Ana Belén Araúz, Instituto Conmemorativo Gorgas de Estudios en Salud, Panama City, Panama
| | - Gustavo Ávila-Montes
- Gustavo Ávila-Montes, Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
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Algarin AB, Lara MV, Chapin-Bardales J, Baruch-Dominguez R, Sanchez TH, Hernandez-Avila M, Smith LR. Examining Geographical Differences in the HIV Care Continuum Among Men Who Have Sex with Men in Mexico. AIDS Behav 2023; 27:772-782. [PMID: 36156172 PMCID: PMC9511456 DOI: 10.1007/s10461-022-03809-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/30/2022]
Abstract
We analyzed data collected by the Encuesta de Sexo Entre Hombres study from 15,233 Mexican men who have sex with men (MSM) between May-July 2017 to examine differences in the HIV care continuum. Data were stratified into 6 geographical regions. Prevalence ratios assessed associations between region and care outcomes. Among participants never testing HIV positive (n = 13,583), 66.1% had ever been tested and 43.0% in the past year. Among HIV-positive persons (n = 1,650), 83.9% reported counseling post-diagnosis, 61.9% timely linkage to care, 42.4% timely CD4/viral load results, 38.2% timely access to antiretroviral therapy (ART), and 87.7% were currently on ART. The Ciudad de México /Estado de México region had significantly superior care continuum outcomes in ever and recent HIV testing, linkage to care, CD4/viral load results, and current ART use. Understanding geographical variations in HIV care for MSM in Mexico is one important step to inform efforts for ending HIV/AIDS by 2030 in Latin America.
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Affiliation(s)
- Angel B Algarin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, 92093-0507, La Jolla, CA, USA
| | | | | | | | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | | | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, 92093-0507, La Jolla, CA, USA.
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Correa-Salazar C, Braverman-Bronstein A, Bilal U, Groves AK, Page KR, Amon JJ, Vera A, Ballesteros L, Martínez-Donate A. The impact of social violence on HIV risk for women in Colombia: A concurrent mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001571. [PMID: 36963089 PMCID: PMC10021609 DOI: 10.1371/journal.pgph.0001571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/01/2023] [Indexed: 02/26/2023]
Abstract
Gender, violence, and migration structurally impact health. The Venezuelan humanitarian crisis comprises the largest transnational migration in the history of the Americas. Colombia, a post-conflict country, is the primary recipient of Venezuelans. The Colombian context imposes high levels of violence on women across migration phases. There is little information on the relationship between violence and HIV risk in the region and how it impacts these groups. Evidence on how to approach the HIV response related to Venezuela's humanitarian crisis is lacking. Our study seeks to 1) understand how violence is associated with newly reported HIV/AIDS case rates for women in Colombian municipalities; and 2) describe how social violence impacts HIV risk, treatment, and prevention for Venezuelan migrant and refugee women undergoing transnational migration and resettlement in Colombia. We conducted a concurrent mixed-methods design. We used negative binomial models to explore associations between social violence proxied by Homicide Rates (HR) at the municipality level (n = 84). The also conducted 54 semi-structured interviews with Venezuelan migrant and refugee women and key informants in two Colombian cities to expand and describe contextual vulnerabilities to HIV risk, prevention and care related to violence. We found that newly reported HIV cases in women were 25% higher for every increase of 18 homicides per 100,000, after adjusting for covariates. Upon resettlement, participants cited armed actors' control, lack of government accountability, gender-based violence and stigmatization of HIV as sources of increased HIV risk for VMRW. These factors impose barriers to testing, treatment and care. Social violence in Colombian municipalities is associated with an increase in newly reported HIV/AIDS case rates in women. Violence hinders Venezuelan migrant and refugee women's access and engagement in available HIV prevention and treatment interventions.
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Affiliation(s)
- Catalina Correa-Salazar
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Ariela Braverman-Bronstein
- Epidemiology and Biostatistics Department, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Usama Bilal
- Epidemiology and Biostatistics Department, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Ali K. Groves
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Kathleen R. Page
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Joseph J. Amon
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Alejandra Vera
- Corporación Mujer Denuncia y Muévete NGO, Cúcuta, Colombia
| | | | - Ana Martínez-Donate
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, United States of America
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Divino F, Nacher M, Pereira RDS, Peiter P. Vulnerability of the HIV cascade of care in an Amazonian town: A qualitative study. Front Public Health 2023; 10:1110330. [PMID: 36761327 PMCID: PMC9905674 DOI: 10.3389/fpubh.2022.1110330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/27/2022] [Indexed: 01/27/2023] Open
Abstract
The HIV care cascade spans from diagnosis to patient linkage and retention in health services for treatment. Brazil has made substantial efforts to optimize the cascade of care. However, despite these advances, there are striking regional differences and difficulties from testing to treatment, particularly in the north and northeast regions, often reflecting social inequalities. Oiapoque, a highly affected city in the state of Amapá, shares its borders with an overseas European territory-French Guiana. The objective of this study was to get a clearer picture of the different components of the HIV care cascade in the municipality of Oiapoque. The study was exploratory and qualitative, involving the mapping of health structures in the research area and interviews with the responsible healthcare professionals working in the municipality. Patients are vulnerable at several levels, including mobility limitations, mismatched information that affects the linkage and retention of treatment, an absence of infectious disease doctors, an absence of user autonomy, missed appointments, dropouts, and abandonment of care. We found that the five recommended steps in the continuum of care for people living with HIV all had weak points or were non-existent or unavailable. These results will be fundamental to rethink the municipality's actions and the strategies of the Unified Health System SUS for the HIV epidemic in these border regions of the Amazon.
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Affiliation(s)
- Flavia Divino
- Laboratório de Doenças Parasitarias, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil,Centre d'Investigation Clinique Antilles–Guyane (Inserm CIC 1424) Pôle Guyane, Université de Guyane, Cayenne, French Guiana,*Correspondence: Flavia Divino ✉
| | - Mathieu Nacher
- Laboratório de Doenças Parasitarias, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil,Centre d'Investigation Clinique Antilles–Guyane (Inserm CIC 1424) Pôle Guyane, Université de Guyane, Cayenne, French Guiana
| | - Rafael dos Santos Pereira
- Laboratório de Doenças Parasitarias, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paulo Peiter
- Laboratório de Doenças Parasitarias, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Grieb SMD, Velez M, Corty EW, Saxton RE, Flores-Miller A, Shah HS, Page KR. HIV-related stigma among Spanish-speaking Latinos in an emerging immigrant city following the Solo Se Vive Una Vez social marketing campaign. PLoS One 2022; 17:e0274888. [PMID: 36201494 PMCID: PMC9536543 DOI: 10.1371/journal.pone.0274888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
HIV-related stigma exacerbates Latino immigrants' risk of HIV infection and delayed care. Following the implementation of the social marketing campaign Sólo Se Vive Una Vez (You Only Live Once) to increase HIV testing that addressed stigmatizing beliefs, we conducted a survey among Latinos in Baltimore, Maryland (N = 357). The aims of this paper are to 1) characterize the sociodemographic characteristics, HIV-related stigma beliefs, and testing behaviors of the survey respondents by campaign exposure, and 2) model the effects of Vive exposure on stigma beliefs and testing behaviors. Comparing post-campaign survey respondents exposed and unexposed to the campaign to survey findings previously obtained and reported before the campaign implementation, respondents to the post-Vive survey continued to hold high levels of stigma beliefs, and compared to the pre-Vive survey sample, were more likely to hold four or more stigmatizing beliefs (from the six survey items). Among the post-Vive survey respondents, those for whom religion was important or very important had an increased odds of 1.6 of holding four or more stigmatizing beliefs. Survey respondents who were exposed to the campaign, however, had an increased odds of 2.25 of reporting ever having been tested for HIV. Our findings demonstrate the importance of the changing social context in addressing stigma within emerging immigrant communities and highlight the critical role of religious leaders in efforts to address HIV-related stigma.
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Affiliation(s)
- Suzanne M. Dolwick Grieb
- Center for Child and Community Health Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Matthew Velez
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Edward W. Corty
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ronald E. Saxton
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Alejandra Flores-Miller
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Harita S. Shah
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Kathleen R. Page
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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HIV Care Disengagement and Antiretroviral Treatment Discontinuation in Mexico: A Qualitative Study Based on the Ecological Model Among Men Who Have Sex With Men. J Assoc Nurses AIDS Care 2022; 33:468-477. [PMID: 35608885 DOI: 10.1097/jnc.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT In 2018, 24% of Mexican men living with HIV were disengaged from HIV care, which impedes their use of antiretroviral treatment (ART). To identify HIV care disengagement and/or ART discontinuation factors using an ecological framework, we conducted 22 semi-structured interviews with men who have sex with men from the HIV state clinic of Tabasco, Mexico. HIV care disengagement was attributed to interpersonal, organizational, and community factors, whereas ART discontinuation was attributed to intrapersonal and interpersonal factors. Intrapersonal factors were burden of ART, substance use, mental health problems, and feeling well or ill. Interpersonal factors included family stigma or support, and partner discouragement. Factors at the organizational level were HIV care-related: inconvenient follow-ups, negative provider interactions, and reentry obstacles; and work-related: absences, work stigma, and travel. Community factors were social stigma and economic means. Interventions should target multiple levels of interdependent factors, distinguishing between HIV care disengagement and ART discontinuation factors.
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Wirtz AL, Page KR, Stevenson M, Guillén JR, Ortíz J, López JJ, Ramírez JF, Quijano C, Vela A, Moreno Y, Rigual F, Case J, Hakim AJ, Hladik W, Spiegel PB. HIV Surveillance and Research for Migrant Populations: Protocol Integrating Respondent-Driven Sampling, Case Finding, and Medicolegal Services for Venezuelans Living in Colombia. JMIR Res Protoc 2022; 11:e36026. [PMID: 35258458 PMCID: PMC8941430 DOI: 10.2196/36026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Epidemiologic research among migrant populations is limited by logistical, methodological, and ethical challenges, but it is necessary for informing public health and humanitarian programming. OBJECTIVE We describe a methodology to estimate HIV prevalence among Venezuelan migrants in Colombia. METHODS Respondent-driven sampling, a nonprobability sampling method, was selected for attributes of reaching highly networked populations without sampling frames and analytic methods that permit estimation of population parameters. Respondent-driven sampling was modified to permit electronic referral of peers via SMS text messaging and WhatsApp. Participants complete sociobehavioral surveys and rapid HIV and syphilis screening tests with confirmatory testing. HIV treatment is not available for migrants who have entered Colombia through irregular pathways; thus, medicolegal services integrated into posttest counseling provide staff lawyers and legal assistance to participants diagnosed with HIV or syphilis for sustained access to treatment through the national health system. Case finding is integrated into respondent-driven sampling to allow partner referral. This study is implemented by a local community-based organization providing HIV support services and related legal services for Venezuelans in Colombia. RESULTS Data collection was launched in 4 cities in July and August 2021. As of November 2021, 3105 of the target 6100 participants were enrolled, with enrollment expected to end by February/March 2022. CONCLUSIONS Tailored methods that combine community-led efforts with innovations in sampling and linkage to care can aid in advancing health research for migrant and displaced populations. Worldwide trends in displacement and migration underscore the value of improved methods for translation to humanitarian and public health programming. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/36026.
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Affiliation(s)
- Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kathleen R Page
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Megan Stevenson
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | | | | | | | | | | | | | | | - James Case
- Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Avi J Hakim
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Paul B Spiegel
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Ferrer P, Bastias C, Beltrán C, Afani A. Diagnosis of HIV infection using mass community rapid testing in Santiago, Chile. JOURNAL OF CLINICAL VIROLOGY PLUS 2022. [DOI: 10.1016/j.jcvp.2022.100064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Diaz A, Grand M, Torrado J, Salazar F, Zócalo Y, Bia D. Aortic Pressure Levels and Waveform Indexes in People Living With Human Immunodeficiency Virus: Impact of Calibration Method on the Differences With Respect to Non-HIV Subjects and Optimal Values. Front Cardiovasc Med 2022; 8:772912. [PMID: 35004887 PMCID: PMC8733318 DOI: 10.3389/fcvm.2021.772912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/30/2021] [Indexed: 12/03/2022] Open
Abstract
Background: There are scarce and controversial data on whether human immunodeficiency virus (HIV) infection is associated with changes in aortic pressure (aoBP) and waveform-derived indexes. Moreover, it remains unknown whether potential differences in aoBP and waveform indexes between people living with HIV (PLWHIV) and subjects without HIV (HIV-) would be affected by the calibration method of the pressure waveform. Aims: To determine: (i) whether PLWHIV present differences in aoBP and waveform-derived indexes compared to HIV- subjects; (ii) the relative impact of both HIV infection and cardiovascular risk factors (CRFs) on aoBP and waveform-derived indexes; (iii) whether the results of the first and second aims are affected by the calibration method. Methods: Three groups were included: (i) PLWHIV (n = 86), (ii) HIV- subjects (general population; n = 1,000) and (iii) a Reference Group (healthy, non-exposed to CRFs; n = 398). Haemodynamic parameters, brachial pressure (baBP; systolic: baSBP; diastolic: baDBP; mean oscillometric: baMBPosc) and aoBP and waveform-derived indexes were obtained. Brachial mean calculated (baMBPcalc=baDBP+[baSBP-baDBP]/3) pressure was quantified. Three waveform calibration schemes were used: systolic-diastolic, calculated (baMBPcalc/baDBP) and oscillometric mean (baMBPosc/baDBP). Results: Regardless of CRFs and baBP, PLWHIV presented a tendency of having lower aoBP and waveform-derived indexes which clearly reached statistical significance when using the baMBPosc/baDBP or baMBPcalc/baDBP calibration. HIV status exceeded the relative weight of other CRFs as explanatory variables, being the main explanatory variable for variations in central hemodynamics when using the baMBPosc/baDBP, followed by the baMBPcalc/baDBP calibration. Conclusions: The peripheral waveform calibration approach is an important determinant to reveal differences in central hemodynamics in PLWHIV.
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Affiliation(s)
- Alejandro Diaz
- Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Investigación en Ciencias de la Salud (IICS), Universidad Nacional del Centro de la Provincia de Buenos Aires (UNICEN), Tandil, Argentina
| | - Marina Grand
- Instituto de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina.,Hospital Dr. Héctor M. Cura, Olavarría, Argentina
| | - Juan Torrado
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Federico Salazar
- Servicio de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Yanina Zócalo
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Universidad de la República, Montevideo, Uruguay
| | - Daniel Bia
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Universidad de la República, Montevideo, Uruguay
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Zitko P, Hojman M, Sabato S, Parenti P, Cuini R, Calanni L, Contarelli J, Teran R, Araujo V, Bakolis I, Chaverri J, Morales M, Arauz AB, Moncada W, Thormann M, Beltrán C. Antiretroviral therapy use in selected countries in Latin America during 2013-2017: results from the Latin American Workshop in HIV Study Group. Int J Infect Dis 2021; 113:288-296. [PMID: 34563708 DOI: 10.1016/j.ijid.2021.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To document antiretroviral use in Latin America during the last decade. METHODS We collected indicators from 79 HIV health care centres in 14 Latin American Spanish-speaking countries for 2013-2017. Indicators were analysed by age, sex and other characteristics and weighted by the estimated people under care (PUC) population in each country. RESULTS We gathered information on 116 299 PUC. One-third belonged to centres reporting a shortage of at least one antiretroviral therapy (ART) drug for >30 days during 2017. At end 2017, 95.1% of PUC were receiving ART. During 2013-2017, 45 329 people living with HIV were admitted to 39 centres. ART initiated during the first year after admission increased from 76.7% in 2013 to 83.8% in 2017. In 35 centres across the study period, 71.7% of PUC started ART with tenofovir disoproxil fumarate and lamivudine, and zidovudine use decreased. The third most common ART drug, EFV, reached 64.8%. Raltegravir and other alternatives increased annually to almost 10% of total use in 2017. CONCLUSIONS Initial ART in Latin America is not based on the most recent scientific evidence and recommendations; use of drugs with higher efficacy and safety profiles and guarantee of ART availability continues to be a public health challenge.
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Affiliation(s)
- Pedro Zitko
- Hospital Barros Luco Trudeau, Santiago Chile; Department of Health Services and Population Research, IoPPN, King's College London
| | - Martin Hojman
- Hospital General de Agudos "Bernardino Rivadavia", Ciudad de Buenos Aires, Argentina.
| | - Sofía Sabato
- Fundación del Centro de Estudios Infectológicos (FUNCEI), Ciudad de Buenos Aires, Argentina
| | - Pablo Parenti
- Hospital Provincial del Centenario, Rosario, Santa Fe, Argentina
| | - Rosana Cuini
- Hospital Teodoro Alvarez- Ciudad de Buenos Aires, Argentina
| | | | - Jorge Contarelli
- Centro de Estudio y Tratamiento Infectológico, La Plata, Provincia de Buenos Aires, Argentina
| | | | | | - Ioannis Bakolis
- Departments of Biostatistics and Health Informatics & Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Jorge Chaverri
- Hospital Dr. Rafaél Ángel Calderón Guardia, San José de Costa Rica, Costa Rica
| | | | | | - Wendy Moncada
- Instituto Nacional Cardiopulmonar, Tegucigalpa, Honduras
| | - Mónica Thormann
- Hospital Salvador Bienvenido Gautier, Santo Domingo, Dominican Republic
| | - Carlos Beltrán
- Hospital Barros Luco Trudeau, Santiago Chile; Department of Health Services and Population Research, IoPPN, King's College London
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Scales to Assess Knowledge, Motivation, and Self-Efficacy for HIV PrEP in Colombian MSM: PrEP-COL Study. AIDS Res Treat 2021; 2021:4789971. [PMID: 34540289 PMCID: PMC8443363 DOI: 10.1155/2021/4789971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/19/2021] [Accepted: 08/06/2021] [Indexed: 12/18/2022] Open
Abstract
Objective We evaluated the construct validity Spanish version of knowledge, stigma, norms, and self-efficacy scales regarding PrEP in MSM. Methods Sample of 287 MSM. Exploratory confirmatory factor analysis and item response theory were used to validate the constructs. Correlations and confidence interval-based estimation of relevance analyses were conducted to correlate the scales with willingness and intention to use PrEP. Results Attitude, stigma, and descriptive and subjective norms scales showed good construct validity and were related to intention and willingness to use PrEP. However, the knowledge scale and self-efficacy scales require further refinement. Conclusions The study provides useful information for assessing information, motivation, and self-efficacy related to PrEP use. Our results could be used to test the scales and the theoretical model in other contexts to confirm their usefulness.
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Arenas-Suarez NE, Cuervo LI, Avila EF, Duitama-Leal A, Pineda-Peña AC. The impact of immigration on tuberculosis and HIV burden between Colombia and Venezuela and across frontier regions. CAD SAUDE PUBLICA 2021; 37:e00078820. [PMID: 34076096 DOI: 10.1590/0102-311x00078820] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/17/2020] [Indexed: 11/21/2022] Open
Abstract
Historically, human migrations have determined the spread of many infectious diseases by promoting the emergence of temporal outbreaks between populations. We aimed to analyze health indicators, expenditure, and disability caused by tuberculosis (TB) and HIV/AIDS burden under the Colombian-Venezuelan migration flow focusing on the Northeastern border. A retrospective study was conducted using TB and HIV/AIDS data since 2009. We consolidated a database using official reports from the Colombian Surveillance System, World Health Organization, Indexmundi, the Global Health Observatory, IHME HIV atlas, and Joint United Nations Programme on HIV/AIDS (UNAIDS). Disability metrics regarding DALYs (disability adjusted life years) and YLDs (years lived with disability), were compared between countries. Mapping was performed on ArcGIS using official migration data of Venezuelan citizens. Our results indicate that TB profiles from Colombia and Venezuela are identical in terms of disease burden, except for an increase in TB incidence in the Colombian-Venezuelan border departments in recent years, concomitantly with the massive Venezuelan immigration since 2005. We identified a four-fold underfunding for the TB program in Venezuela, which might explain the low-testing rates for cases of multidrug-resistant TB (67%) and HIV/AIDS (60%), as well as extended hospital stays (150 days). We found a significant increase in DALYs of HIV/AIDS patients in Venezuela, specifically, 362.35 compared to 265.37 observed in Colombia during 2017. This study suggests that the Venezuelan massive migration and program underfunding might exacerbate the dual burden of TB and HIV in Colombia, especially towards the Colombian-Venezuelan border.
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Affiliation(s)
- Nelson Enrique Arenas-Suarez
- Faculdad de Ciencias, Universidad Antonio Nariño, Bogotá, Colombia.,Facultad de Ciencias Agropecuarias, Universidad de Cundinamarca, Fusagasugá, Colombia
| | - Laura I Cuervo
- Faculdad de Ciencias, Universidad Antonio Nariño, Bogotá, Colombia
| | - Edier F Avila
- Facultad de Ciencias Agropecuarias, Universidad de Cundinamarca, Fusagasugá, Colombia
| | | | - Andrea Clemencia Pineda-Peña
- Departamento de Biología Molecular e Inmunología, Fundación Instituto de Inmunología de Colombia, Bogotá, Colombia.,Facultad de Ciencias Agropecuarias, Universidad de Ciencias Aplicadas y Ambientales, Bogotá, Colombia
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13
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Munson AJ, Davis DA, Barrington C. 'There are no other options for us because of who we are': employment and retention in care among gay and bisexual men and transgender women living with HIV in Guatemala. CULTURE, HEALTH & SEXUALITY 2021; 23:608-623. [PMID: 32208919 DOI: 10.1080/13691058.2020.1718212] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 01/15/2020] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to improve understanding of the relationship between employment and retention in HIV care among gay and bisexual men and transgender women in Guatemala. We interviewed gay and bisexual men (n = 18) and transgender women (n = 9) receiving care at HIV clinics in three Guatemalan cities. Thematic coding and narrative analysis were used to describe employment experiences and identify employment factors that enabled or hindered retention within the broader context of participants' lives. Employment types ranged from formal, salaried positions to informal jobs; several participants were unemployed. Intersecting stigma related to HIV status, sexual orientation and gender identity reduced participants' ability to find and maintain stable, adequately compensated work. Job opportunities were particularly limited for transgender women due to discrimination related to gender identity. Among gay and bisexual men, discrimination related to HIV was the most salient barrier to employment. Three main employment-related determinants of retention were identified: work schedule, relationships with employers, and income. HIV care and treatment services should be strategically located and have flexible hours tailored to the employment schedules and needs of key populations living with HIV. Social protection programmes are needed to foster quality employment opportunities that facilitate attendance at HIV care appointments.
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Affiliation(s)
- Alexandra J Munson
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Dirk A Davis
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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14
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Pereira-Morales AJ, Acero Torres D, Moreno Zapata M, Moreno Sierra P, Astaiza Hurtado J. Design and Development of a Risk Classification Instrument for Virological Failure in HIV, Using Psychosocial Determinants of Health: Preliminary Evidence from a South American Country. AIDS Behav 2021; 25:623-633. [PMID: 32889660 DOI: 10.1007/s10461-020-03025-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Predictive approaches in HIV to estimate a patient's risk to present with relevant health outcomes, such as hospitalizations and AIDS-related death, long before they happen, could be highly useful. We aimed to develop a risk classification instrument for virological failure through a scoring system that identifies patients with a low, medium, and high risk after six months of ART treatment. A case-control design was implemented through 355 HIV-positive Colombian adults who were assessed using the designed instrument. The variables with independent predictive values were selected using logistic regression analysis, and the diagnostic performance of the prediction score was evaluated using the area under the curve. The prediction score included relevant psychosocial and biological risk factors, some of them modifiable variables like substance use and low health literacy. The area under the curve value for the total prediction score was 0.85 (CI 0.80-0.90). Therefore, this instrument could be a valuable tool to identify at-risk patients of virological failure. In low and middle-income countries, the associated risk factors of virological failure are little known. Assessing such risk would lead to make individualized decisions regarding the patient's management and minimize the chance of non-desirable outcomes.
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Affiliation(s)
- Angela J Pereira-Morales
- Sociedad Integral de Especialistas en Salud (SIES Salud IPS), Bogotá, Colombia.
- PhD Program in Public Health, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Diana Acero Torres
- Sociedad Integral de Especialistas en Salud (SIES Salud IPS), Bogotá, Colombia
| | - Mary Moreno Zapata
- Sociedad Integral de Especialistas en Salud (SIES Salud IPS), Bogotá, Colombia
| | - Pedro Moreno Sierra
- Sociedad Integral de Especialistas en Salud (SIES Salud IPS), Bogotá, Colombia
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15
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The HIV epidemic in Colombia: spatial and temporal trends analysis. BMC Public Health 2021; 21:178. [PMID: 33478434 PMCID: PMC7818909 DOI: 10.1186/s12889-021-10196-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 01/07/2021] [Indexed: 02/08/2023] Open
Abstract
Background Colombia has the fourth highest incidence rate of HIV/AIDS among all Latin American countries and it has been increasing since the 1980s. However, the number of studies that addresses this trend is limited. Here, we employed spatial and temporal trend analyses to study the behaviour of the epidemic in the Colombian territory. Methods Our sample included 72,994 cases of HIV/AIDS and 21,898 AIDS-related deaths reported to the National Ministry of Health between 2008 and 2016. We employed the joinpoint regression model to analyse the annual HIV/AIDS incidence and AIDS mortality rates. In the spatial analysis, we used univariate autocorrelation techniques and the Kernel density estimator. Results While the HIV/AIDS incidence had an increasing trend in Colombia, the AIDS mortality rate was stable. HIV/AIDS incidence and AIDS mortality showed a downward trend in the 0–14 age group. An upward trend was observed for HIV/AIDS incidence in people older than 15 years and with the highest trend in the 65 years and above group. AIDS mortality showed an increasing trend among people aged 65 years or older. The comparison between the sexes showed an upward trend of HIV/AIDS incidence in all age groups and AIDS-mortality rates in 65 years and above in men, while in women, the incidence was upward among those aged 45 years and above, and concerning the AIDS-mortality rate in the 45–64 group. The high–high clusters of HIV/AIDS incidence and AIDS mortality were located in the Andean and Caribbean regions. Conclusion Our study found an upward trend in HIV/AIDS incidence and a stable trend in the AIDS mortality rate in Colombia. The downward trend in HIV/AIDS incidence and AIDS mortality rate in the 0–14 age group reflects the downwards mother-to-child HIV transmission. The upward trend in HIV/AIDS incidence in older women and AIDS mortality in younger women rates, compared with men, may be due to late diagnosis and treatment. The Caribbean and the ‘coffee belt’ regions were the most impacted by the HIV epidemic, most likely due to sexual tourism. Our results provide crucial information that may help Colombian health authorities fight HIV transmission. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10196-y.
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16
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Chandler CJ, Bukowski LA, Sang JM, Harpel CK, Castellanos E, Stall RD, Egan JE. Barriers and facilitators to past six-month HIV testing among men who have sex with men in Belize. Int J STD AIDS 2020; 31:1300-1307. [PMID: 32981427 DOI: 10.1177/0956462420947574] [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] [Indexed: 11/15/2022]
Abstract
Prevalence of HIV in Belize is high, and men who have sex with men (MSM) are disproportionately impacted by HIV. HIV testing is critical in curbing the epidemic; however, little is known about factors associated with testing among MSM in Belize. Working with a non-governmental organization in a large, urban city within Belize, snowball sampling was applied to recruit Belizean MSM to complete a self-administered survey. Multivariable logistic regression analysis was employed to understand associations with HIV screening behavior. Access to healthcare, HIV knowledge, and reporting having heard of Section 53 of the Criminal Code of Belize (once outlawing same-sex sexual behavior), but not experiencing any negative impact from Section 53 were significantly positively associated with having received an HIV test in the past six months. Healthcare maltreatment (lifetime), depression symptomology, and shame were significantly negatively associated with having received a HIV test in the past six months. Findings suggest that multiple factors associated with stigma and discrimination negatively affect testing strategies among MSM in Belize.
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Affiliation(s)
- Cristian J Chandler
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Yale University Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Leigh A Bukowski
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan M Sang
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Caroline K Harpel
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erika Castellanos
- Collaborative Network of Persons Living with HIV in Belize (C-NET), Belize City, Belize
- Global Actions for Trans Equality, Amsterdam, Netherlands
| | - Ronald D Stall
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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17
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Ribeiro LCS, Freitas MIDF, Tupinambás U, Lana FCF. Late diagnosis of Human Immunodeficiency Virus infection and associated factors. Rev Lat Am Enfermagem 2020; 28:e3342. [PMID: 32876290 PMCID: PMC7458569 DOI: 10.1590/1518-8345.4072.3342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/26/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE to analyze the occurrence of late diagnosis of infection by the Human Immunodeficiency Virus and its associated factors. METHOD this is an epidemiological, cross-sectional and analytical study, carried out with 369 people followed-up by Specialized Assistance Services, undergoing anti-retroviral treatment, and interviewed by means of a questionnaire. Univariate analysis was performed using Pearson's chi-square test or Fisher's exact test and Kruskall-Wallis test, and multivariate analysis using the ordinal logistic regression model of proportional odds. RESULTS the occurrence of 59.1% for late diagnosis of the infection was observed; the probability of later diagnosis is greater among people who have a steady partnership, when compared to those who do not; with increasing age, particularly above 35 years old; among those with lower schooling; for those who seek the health services to have an HIV test when they feel sick; and for those who test HIV less often or never do it after sex without a condom with a steady partner. CONCLUSION the knowledge on the high proportion of late diagnosis and its associated factors verified in this study make the planning and implementation of new policies and strategies aimed at the timely diagnosis of the infection imperative.
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Affiliation(s)
| | | | - Unaí Tupinambás
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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18
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Leyva-Moral JM, Dominguez-Cancino KA, Guevara-Vasquez GM, Edwards JE, Palmieri PA. Faculty Attitudes About Caring for People Living With HIV/AIDS: A Comparative Study. J Nurs Educ 2020; 58:712-717. [PMID: 31794038 DOI: 10.3928/01484834-20191120-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 09/04/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND People living with HIV/AIDS (PLHIV) experience stigma and discrimination. Negative attitudes of nursing faculty about caring for PLHIV can adversely affect student perceptions and their nursing care. The study purpose was to describe nursing faculty attitudes and beliefs about caring for PLHIV. METHOD The HPASS (Healthcare Provider HIV/AIDS Stigma Scale), Spanish version, was delivered to nursing faculty in Colombia and Peru. RESULTS The HPASS was completed by 98 nursing faculty. The overall mean score was 2.41 (SD = 0.69), with subscale scores: stereotypes, 2.55 (SD = 0.84); discrimination, 2.28 (SD = 0.74); and prejudices, 2.41 (SD = 0.63). Peruvian faculty had the highest scores, statistically correlated with the importance of religion, whereas Colombia had the lowest. CONCLUSION Nursing faculty attitudes toward PLHIV were slightly positive in Colombia to slightly negative in Peru; however, both countries had negative stereotypes. Knowledge deficiencies about HIV persist and attitudes appear to be influenced by culture and religion. [J Nurs Educ. 2019;58(12):712-717.].
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19
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Robles MA, Ortiz AY, Zaldivar Y, Castillo J, Gondola J, Mewa JC, Moreno A, Burgos R, Chavarria O, Castillero O, Gonzalez C, Pascale JM, Martínez AA. Evolution of late presentation to care and advanced HIV in newly HIV diagnosed subjects in the Republic of Panama: 2012-2017. Int J STD AIDS 2020; 31:791-799. [PMID: 32487001 DOI: 10.1177/0956462419890761] [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: 11/17/2022]
Abstract
Most of the information on clinical factors related to HIV infection is focused on key populations and young people. Therefore, there is little information on clinical factors related to HIV infection in older persons (>45 years old). In this study, data on CD4 lymphocyte counts were analyzed on adults who are linked to care and have their first CD4 cell count done from different regions of the Republic of Panama from 2012 to 2017. Samples were grouped according to late presentation status, region of origin in the country, year, gender, and age groups. Factors associated with late presentation to care and advanced HIV were assessed on each group by multivariable logistic regression. Late presentation to care was observed in 71.6% of the evaluated subjects, and advanced HIV in 54.5%. Late presentation was associated with males (adjusted odds ratio [AOR] = 1.3, 95% confidence interval [CI]=1.1-1.6, p = 0.03), age greater than 45 years old (AOR = 2.3 CI= 1.8-2.9, p < 0.001), and being from regions where antiretroviral clinics are not well instituted (AOR = 2.1, CI = 1.6-2.7, p < 0.001). Despite an increase in subjects linked to care with a CD4 test performed over the years, late presentation remained constant. Therefore, prevention policies must be reformulated. Promotion of routine HIV testing, accessibility among all population groups, installation of antiretroviral clinics, and implementation of programs as rapid initiation of antiretroviral therapy should be rolled out nationally.
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Affiliation(s)
- Maria A Robles
- Department of Research in Genomics and Proteomics, Gorgas Memorial Institute for Health Studies, Panama, Republic of Panama
| | - Alma Y Ortiz
- Department of Research in Genomics and Proteomics, Gorgas Memorial Institute for Health Studies, Panama, Republic of Panama
| | - Yamitzel Zaldivar
- Department of Research - Surveillance and Biological Risk 3, Gorgas Memorial Institute for Health Studies, Panama, Republic of Panama
| | - Jorge Castillo
- Department of Research in Genomics and Proteomics, Gorgas Memorial Institute for Health Studies, Panama, Republic of Panama
| | - Jessica Gondola
- Department of Research in Genomics and Proteomics, Gorgas Memorial Institute for Health Studies, Panama, Republic of Panama
| | - Juan C Mewa
- Department of Research in Genomics and Proteomics, Gorgas Memorial Institute for Health Studies, Panama, Republic of Panama
| | - Ambar Moreno
- Department of Research in Genomics and Proteomics, Gorgas Memorial Institute for Health Studies, Panama, Republic of Panama
| | - Ramon Burgos
- Department of Research in Genomics and Proteomics, Gorgas Memorial Institute for Health Studies, Panama, Republic of Panama
| | - Oris Chavarria
- Department of Research in Genomics and Proteomics, Gorgas Memorial Institute for Health Studies, Panama, Republic of Panama
| | - Omar Castillero
- Department of Research in Genomics and Proteomics, Gorgas Memorial Institute for Health Studies, Panama, Republic of Panama
| | - Claudia Gonzalez
- Department of Research in Genomics and Proteomics, Gorgas Memorial Institute for Health Studies, Panama, Republic of Panama.,Departament of Microbiology and Immunology, University of Panama, Panama, Republic of Panama
| | - Juan M Pascale
- Department of Research in Genomics and Proteomics, Gorgas Memorial Institute for Health Studies, Panama, Republic of Panama.,Departament of Microbiology and Immunology, University of Panama, Panama, Republic of Panama
| | - Alexander A Martínez
- Department of Research in Genomics and Proteomics, Gorgas Memorial Institute for Health Studies, Panama, Republic of Panama
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20
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Barrow GJ, Fairley M, Brandeau ML. Optimizing Interventions Across the HIV Care Continuum: A Case Study Using Process Improvement Analysis. OPERATIONS RESEARCH FOR HEALTH CARE 2020; 25:100258. [PMID: 33014699 PMCID: PMC7528976 DOI: 10.1016/j.orhc.2020.100258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
UNAIDS' 90-90-90 goal for 2020 is for 90% of HIV-infected people to know their status, 90% of infected individuals to receive antiretroviral therapy (ART), and 90% of those on ART to achieve viral suppression. To achieve these ambitious goals, effective care delivery programs are needed. In this paper we present a case study showing how HIV care can be improved by viewing the patient care process as a production process and applying methods of process improvement analysis. We examine the continuum of HIV care at a hospital-based HIV clinic in Kingston, Jamaica. We perform qualitative analysis to identify key programmatic, personnel, and clinical areas for process improvement. We then perform quantitative analysis. We develop a stochastic model of the care process which we use to evaluate the effects of potential process improvements on the number of patients who receive ART and the number who achieve viral suppression. We also develop a model for optimal investment of a fixed budget among interventions aimed at improving the care cascade and we use the model to determine the optimal investment among three interventions that the clinic could invest in. By viewing the patient care process as a production process and applying qualitative and quantitative process improvement analysis, our case study illustrates how clinics can identify the best ways to maximize clinical outcomes. Our methods are generalizable to other HIV care clinics as well as to clinics that provide care for other chronic conditions (e.g., diabetes, hepatitis B, or opioid use disorder).
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Affiliation(s)
- Geoffrey J. Barrow
- Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica
| | - Michael Fairley
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Margaret L. Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
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21
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Tattsbridge J, Wiskin C, de Wildt G, Clavé Llavall A, Ramal-Asayag C. HIV understanding, experiences and perceptions of HIV-positive men who have sex with men in Amazonian Peru: a qualitative study. BMC Public Health 2020; 20:728. [PMID: 32429863 PMCID: PMC7238527 DOI: 10.1186/s12889-020-08745-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV-related incidence and mortality is increasing across Peru, with highest mortality rates recorded in the Amazonian region of Loreto. This epidemic is concentrated in men who have sex with men, a population with 14% HIV treatment adherence despite free national provision. This study investigates barriers and facilitators to following healthcare advice through experiences and perceptions of HIV-positive men who have sex with men and healthcare professionals in Loreto. METHODS Twenty qualitative interviews with HIV-positive men who have sex with men and one focus group with HIV-specialist healthcare professionals were conducted in Loreto, January-February 2019. Interviews were transcribed per verbatim. Thematic content analysis and deviant case analysis were used. RESULTS A culture of isolation and discrimination was identified, propagated by poor public knowledge surrounding HIV transmission and treatment. Employment potential was hampered and 7/20 patients had suicidal thoughts post-diagnosis. Barriers to care included: shame, depression, travel cost/times, a preference for traditional plant-based medicine and side-effects of antiretroviral therapy. Facilitators included: education, family and clinic support, disease acceptance and lifestyle changes. CONCLUSION More effective, focussed community education and workplace discrimination investigations are recommended to reduce stigma and increase adherence to treatment in this population.
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Affiliation(s)
- Jasmine Tattsbridge
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Connie Wiskin
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Gilles de Wildt
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Anna Clavé Llavall
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - César Ramal-Asayag
- Department of Infectious Diseases, Regional Hospital of Loreto, Iquitos, Peru.,Department of Clinical Sciences, Universidad Nacional de la Amazonia Peruana, Iquitos, Peru
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22
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Morando N, Vaulet MLG, Melgar A, Fermepin MR, Casco R, Pando MDLÁ. Incorporation of the rapid HIV test in a sexually-transmitted disease clinic in Buenos Aires: Dramatic increase in the frequency of HIV diagnosis. Rev Argent Microbiol 2020; 52:272-277. [PMID: 32273129 DOI: 10.1016/j.ram.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/11/2019] [Accepted: 12/10/2019] [Indexed: 11/30/2022] Open
Abstract
Improving access to diagnosis constitutes a key step in the control of the Human immunodeficiency virus (HIV)/AIDS epidemic. Rapid testing is increasingly gaining interest as a powerful diagnostic tool to achieve this goal. The purpose of this study was to implement the rapid HIV test (RHT) in a clinical setting in order to evaluate its effectiveness in increasing HIV diagnosis and patient linkage to the healthcare system. The RHT was offered to all patients attending a sexually-transmitted disease clinic in the City of Buenos Aires between March and December 2015. A total of 593 RHT were performed. The implementation of the RHT yielded an increase in frequency of diagnosis from 6.9% to 31.4% (p<0.001). The first steps of the care cascade showed high retention rates around 90%. RHT yielded an HIV prevalence of 6.3% (95% CI: 4.2-8.5) in this population. HIV prevalence tended to be higher in individuals with no previous HIV testing (p=0.09). Linkage to the healthcare system was associated with a higher probability of having been tested for HIV (p=0.008). The incorporation of the RHT resulted in a high retention of patients and an increase in both frequency of diagnosis and results reception when compared to the classic methodology.
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Affiliation(s)
- Nicolas Morando
- CONICET-Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Paraguay 2155, CABA, Argentina
| | - María Lucía Gallo Vaulet
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Cátedra de Microbiología Clínica, Inmunología y Virología Clínica, Junín 954, CABA, Argentina
| | - Asunta Melgar
- Universidad de Buenos Aires, Hospital de Clínicas "José de San Martín", Programa de Enfermedades de Transmisión Sexual, Av. Córdoba 2351, CABA, Argentina
| | - Marcelo Rodríguez Fermepin
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Cátedra de Microbiología Clínica, Inmunología y Virología Clínica, Junín 954, CABA, Argentina
| | - Ricardo Casco
- Universidad de Buenos Aires, Hospital de Clínicas "José de San Martín", Programa de Enfermedades de Transmisión Sexual, Av. Córdoba 2351, CABA, Argentina
| | - María de Los Ángeles Pando
- CONICET-Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Paraguay 2155, CABA, Argentina.
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Crabtree‐Ramírez B, Belaunzarán‐Zamudio PF, Cortes CP, Morales M, Sued O, Sierra‐Madero J, Cahn P, Pozniak A, Grinsztejn B. The HIV epidemic in Latin America: a time to reflect on the history of success and the challenges ahead. J Int AIDS Soc 2020; 23:e25468. [PMID: 32115884 PMCID: PMC7049674 DOI: 10.1002/jia2.25468] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/02/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Brenda Crabtree‐Ramírez
- Departamento de InfectologíaInstituto Nacional de Ciencias Médicas y Nutrición, Salvador ZubiránTlalpanMexico
| | - Pablo F Belaunzarán‐Zamudio
- Departamento de InfectologíaInstituto Nacional de Ciencias Médicas y Nutrición, Salvador ZubiránTlalpanMexico
| | | | | | - Omar Sued
- Fundación HuéspedInvestigaciones ClínicasBuenos AiresArgentina
| | - Juan Sierra‐Madero
- Departamento de InfectologíaInstituto Nacional de Ciencias Médicas y Nutrición, Salvador ZubiránTlalpanMexico
| | - Pedro Cahn
- Fundación HuéspedInvestigaciones ClínicasBuenos AiresArgentina
| | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust and Imperial College LondonLondonUK
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro ChagasFundacao Oswaldo CruzRio de JaneiroBrazil
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24
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Bayer AM, Mallma P, Cárcamo CP, Díaz DA, Chirre M, Sánchez H, García PJ, Gorbach PM. ¿ Te Recurseas? Mapping, Enumerating, and Describing Male and Transwomen Sex Workers in Venue-Based and Virtual Spaces in Lima, Peru. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:567-583. [PMID: 31815534 PMCID: PMC7751898 DOI: 10.1521/aeap.2019.31.6.567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
HIV disproportionately affects men who have sex with men and transwomen in Latin America. Globally, efforts to map, enumerate, and describe male and transwomen sex workers (MTSWs) are limited. We mapped and described venue- and non-venue-based MTSWs and enumerated venuebased MTSWs in Lima, Peru's capital. With venue-based MTSWs, we identified and described the venues, SWs, and clients and enumerated the SWs. With non-venue-based MTSWs, we described SW offerings and SWs. Male SWs (MSWs) are concentrated downtown, with many moving online. Transwomen SWs (TSWs) are spread across metropolitan Lima, with fewer online. At venues, there are more TSWs than MSWs, TSWs reported more HIV and sexual risk behaviors, and MSWs had more female partners. Non-venue-based MSWs used condoms less than venue-based MSWs. Results support systematic efforts to describe hard-to-reach MTSWs and their different types of partners, all of whom have unique, differing needs for HIV/ STI education, prevention, testing, and care services.
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Affiliation(s)
- Angela M Bayer
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patricia Mallma
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - César P Cárcamo
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - David A Díaz
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Miguel Chirre
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Patricia J García
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
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Leyva-Moral JM, Loayza-Enriquez BK, Palmieri PA, Guevara-Vasquez GM, Elias-Bravo UE, Edwards JE, Feijoo-Cid M, Davila-Olano LY, Rodriguez-Llanos JR, Leon-Jimenez FE. Adherence to antiretroviral therapy and the associated factors among people living with HIV/AIDS in Northern Peru: a cross-sectional study. AIDS Res Ther 2019; 16:22. [PMID: 31462291 PMCID: PMC6714391 DOI: 10.1186/s12981-019-0238-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/21/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adherence to antiretroviral therapy (ART) is the most important factor for therapeutic failure and the development of resistance. Peru has achieved moderate progress in meeting the 90-90-90 targets, but only 60% of PLHIV receiving ART are virally suppressed. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles, evaluating the clinical management strategies, and analyzing the relationships between the variables and adherence of PLHIV managed at a regional HIV clinic in Lambayeque Province (Northern Peru). METHODS This was a cross-sectional study with 180 PLHIV adults, non-randomly but consecutively selected with self-reported ART compliance (78.2% of the eligible population). The PLHIV profile (PLHIV-Pro) and the Simplified Medication Adherence Questionnaire (SMAQ) were used to collect sociodemographic information, clinical variables, and data specific to ART adherence. Descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was performed with the Mann-Whitney test, Chi square test, and Yates correction. RESULTS The 180 PLHIV sample included 78.9% men, 49.4% heterosexual, 45% with a detectable HIV-1 viral load less than 40 copies/ml, 58.3% not consistently adherent, and only 26.1% receiving Tenofovir + Lamivudine + Efavirenz. Risk factors significant for non-adherence included concurrent tuberculosis, discomfort with the ART regime, and previous pauses in ART. Multivariate analysis of nested models indicated having children is a protector factor for adherence. CONCLUSIONS Self-reported adherence appeared to be low and the use of first-line therapy is not being prescribed homogeneously. Factors associated with nonadherence are both medical and behavioral, such as having tuberculosis, pausing ART, or experiencing discomfort with ART. The Peruvian government needs to update national technical standards, monitor medication availability, and provide education to health care professionals in alignment with evidence-based guidelines and international recommendations. Instruments to measure adherence need to be developed and evaluated for use in Latin America.
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Affiliation(s)
- Juan M. Leyva-Moral
- Departament d’Infermeria, Facultat de Medicina, Universitat Autonoma de Barcelona, Avda. Can Domenech, Building M. Office M3/211, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
- Center for Health Sciences Research, Universidad María Auxiliadora, Av. Canto Bello 431, San Juan de Lurigancho, Lima, Lima 15408 Peru
- Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autonoma de Barcelona, Avda. Can Domenech, Building M. Office M3/211, 08193 Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Blanca K. Loayza-Enriquez
- Department of Research, Hospital Regional Lambayecue, Pro. Augusto B. Leguia Nro. 100 (Esquina con Av. Progreso N. 110-120), Chiclayo, Lambayeque 14101 Peru
- School of Nursing, Universidad Nacional Pedro Ruiz Gallo, Av. Juan XXIII 391, Lambayeque, Chiclayo 14013 Peru
| | - Patrick A. Palmieri
- Center for Health Sciences Research, Universidad María Auxiliadora, Av. Canto Bello 431, San Juan de Lurigancho, Lima, Lima 15408 Peru
- College of Health Sciences, Universidad Norbert Wiener, Av. Arequipa 444, Lima, Lima 15046 Peru
- Evidence-Based Health Care South America: A Joanna Briggs Institute Affiliated Group, Universidad María Auxiliadora, Av. Canto Bello 431, San Juan de Lurigancho, Lima, Lima 15408 Peru
- Doctor of Health Sciences Program, College of Graduate Health Studies, A. T. Still University, 800 West Jefferson Street, Kirksville, MO 63501 USA
| | - Genesis M. Guevara-Vasquez
- Department of Research, Hospital Regional Lambayecue, Pro. Augusto B. Leguia Nro. 100 (Esquina con Av. Progreso N. 110-120), Chiclayo, Lambayeque 14101 Peru
- Evidence-Based Health Care South America: A Joanna Briggs Institute Affiliated Group, Universidad María Auxiliadora, Av. Canto Bello 431, San Juan de Lurigancho, Lima, Lima 15408 Peru
| | - Ursula E. Elias-Bravo
- Coordinator HIV/AIDS Unit, Department of Nursing, Hospital Regional Lambayeque, Pro. Augusto B. Leguía Nro. 100 (Esquina con Av. Progreso N. 110-120), Chiclayo, Lambayeque 14101 Peru
| | - Joan E. Edwards
- Center for Global Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
| | - María Feijoo-Cid
- Departament d’Infermeria, Facultat de Medicina, Universitat Autonoma de Barcelona, Avda. Can Domenech, Building M. Office M3/211, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Lucy Y. Davila-Olano
- Midwife, Department of Obstetrics, Hospital Regional Lambayeque, Pro. Augusto B. Leguia Nro. 100 (Esquina con Av. Progreso N. 110-120), Chiclayo, Lambayeque 14101 Peru
| | - Juan R. Rodriguez-Llanos
- Department of Medicine, Hospital Regional Lambayeque, Pro. Augusto B. Leguia Nro. 100 (Esquina con Av. Progreso N. 110-120), Chiclayo, Lambayeque 14101 Peru
| | - Franco E. Leon-Jimenez
- School of Medicine, Universidad Santo Toribio Mogrovejo, Av. San Josemaría Escriva de Balaguer 855, Chiclayo, Lambayeque 14101 Peru
- Department of Medicine, Hospital Regional Lambayeque, Lambayeque, Pro. Augusto B. Leguia Nro. 100 (Esquina con Av. Progreso N. 110-120), Chiclayo, Lambayeque 14101 Peru
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Tan RKJ, Wong CS. Mobilizing civil society for the HIV treatment cascade: a global analysis on democracy and its association with people living with HIV who know their status. J Int AIDS Soc 2019; 22:e25374. [PMID: 31379133 PMCID: PMC6680091 DOI: 10.1002/jia2.25374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/21/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Civil society organizations (CSOs) play an essential role in the global HIV/AIDS response. Past studies have described the beneficial role of CSOs in meeting the United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, but have not explored how political conditions, which influence the ability of CSOs to organize, have an impact on the cascade. This study explores the relationship between measures of democracy and its association with diagnosis rates among people living with HIV (PLHIV). METHODS This study analyses 2016 data derived from the Economist Intelligence Unit's Democracy Index (EIUDI), UNAIDS country estimates for PLHIV and PLHIV who knew their status in 2016, World Bank's 2016 data on nominal gross domestic product (GDP) per capita and country population, HIV Justice Network's 2016 data on HIV criminalization, and country-level estimates for PLHIV, PLHIV who know their status, and expenditure on HIV prevention from other independent sources. An estimated HIV prevalence variable was constructed by dividing the estimated PLHIV population with the total population of a country. Analyses were limited to countries with available data on PLHIV who know their status (n = 111). RESULTS Of the 111 countries in the analytic sample, the mean democracy index score was 5.93 (of the 10), median estimated HIV prevalence was 0.20% (IQR 0.10-0.65), median GDP per capita (in thousands, US dollar) was 4.88 (IQR 2.11-13.79), and mean PLHIV who know their status is 67.12%. Preliminary analysis on the five component measures of the EIUDI revealed multicollinearity, and thus the composite democracy index score was used as the measure for democracy. Multivariate linear regression analyses revealed that democracy index scores (β = 2.10, SE = 1.02, p = 0.04) and GDP per capita (in thousands; β = 0.34. SE = 0.11, p < 0.01) were positively associated with diagnosis rates among PLHIV, controlling for country-level expenditure on HIV prevention, HIV criminalization laws and estimated HIV prevalence. CONCLUSIONS Results indicate that higher levels of democracy were positively associated with rates of diagnosis among PLHIV. Further analyses following wider implementation of universal testing and treatment is warranted, as well as the need for further research on the mechanisms through which political cultures specifically influence rates of diagnosis among PLHIV.
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Affiliation(s)
- Rayner KJ Tan
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | - Chen Seong Wong
- National Centre for Infectious DiseasesSingapore
- Department of MedicineYong Loo Lin School of MedicineNational University of SingaporeSingapore
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Edeza A, Galarraga O, Novak D, Mayer K, Rosenberger J, Mimiaga M, Biello K. The role of sexual risk behaviors on PrEP awareness and interest among men who have sex with men in Latin America. Int J STD AIDS 2019; 30:542-549. [PMID: 30722750 DOI: 10.1177/0956462419825944] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Latin America, men who have sex with men (MSM) remain disproportionately impacted by HIV. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool and has been FDA approved in the United States since 2012, but no Latin American state, with the recent exception of Brazil, has implemented PrEP guidelines. We carried out a multinational online survey of MSM in Latin America (n = 22698) in 2012 to assess whether MSM at highest risk of HIV acquisition (i.e., those engaging in condomless anal sex [CAS; n = 2606] and transactional sex [n = 1488]) had higher levels of awareness of PrEP, PrEP use and interest in participating in a PrEP trial. After adjusting for demographic and psychosocial characteristics including depressive symptoms, hazardous alcohol use, childhood sexual abuse, and sexual compulsivity, transactional sex and CAS were associated with increased PrEP awareness (aOR = 1.29, 95% CI: 1.05-1.59, p < .001 and aOR = 1.22, 95% CI: 1.11-1.34, p < .001, respectively) and PrEP trial interest (aOR = 1.45, 95% CI: 1.25-1.71, p < .001 and aOR = 1.74, 95% CI: 1.57-1.95, p < .001, respectively). Findings demonstrate substantial awareness of and interest in PrEP among MSM with behavioral risk factors for HIV in Latin America, suggesting that this region is primed for PrEP implementation, which has been slow.
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Affiliation(s)
- Alberto Edeza
- 1 Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Omar Galarraga
- 2 Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - David Novak
- 3 OLB Research Institute, Cambridge, MA, USA
| | - Kenneth Mayer
- 4 The Fenway Institute, Boston, MA, USA.,5 Department of Infectious Disease, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joshua Rosenberger
- 6 College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Matthew Mimiaga
- 1 Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.,4 The Fenway Institute, Boston, MA, USA.,7 Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Katie Biello
- 1 Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.,4 The Fenway Institute, Boston, MA, USA.,7 Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Alzate Angel JC, Pericàs JM, Taylor HA, Benach J. Systemic Factors and Barriers That Hamper Adequate Data Collection on the HIV Epidemic and Its Associated Inequalities in Countries With Long-Term Armed Conflicts: Lessons From Colombia. Am J Public Health 2018; 108:1341-1344. [PMID: 30138065 PMCID: PMC6137797 DOI: 10.2105/ajph.2018.304505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 11/04/2022]
Abstract
Although advances in treatment and diagnosis have transformed HIV into a chronic disease in high-income countries, a spectrum of structural, political, sociocultural, and health system barriers hamper early diagnosis and timely treatment of HIV in many middle- and low-income countries. In most Latin American countries, in spite of the great improvement in access to antiretroviral therapy, a large proportion of individuals infected with HIV do not know their status. In Colombia, the Joint United Nations Programme on HIV/AIDS currently estimates a much larger number of HIV cases than the number reported by Colombian authorities. Potential reasons for underdiagnosis and underreporting include sociocultural factors such as social stigma, restrictions in access to health care, a lack of public health research and robust surveillance systems, and the particular recent history and social situation related to the armed conflict the country has suffered through for several decades. Lessons from Colombia may be helpful in monitoring, understanding, and tackling the HIV epidemic in countries with long-term armed conflicts.
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Affiliation(s)
- Juan C Alzate Angel
- Juan C. Alzate Angel is with the Clinical Research Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia. Juan M. Pericàs is with ISGlobal, Hospital Clínic de Barcelona, University of Barcelona, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain. Holly A. Taylor is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Joan Benach is with the Health Inequalities Research Group, Department of Political and Social Sciences, Universitat Pompeu Fabra, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona
| | - Juan M Pericàs
- Juan C. Alzate Angel is with the Clinical Research Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia. Juan M. Pericàs is with ISGlobal, Hospital Clínic de Barcelona, University of Barcelona, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain. Holly A. Taylor is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Joan Benach is with the Health Inequalities Research Group, Department of Political and Social Sciences, Universitat Pompeu Fabra, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona
| | - Holly A Taylor
- Juan C. Alzate Angel is with the Clinical Research Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia. Juan M. Pericàs is with ISGlobal, Hospital Clínic de Barcelona, University of Barcelona, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain. Holly A. Taylor is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Joan Benach is with the Health Inequalities Research Group, Department of Political and Social Sciences, Universitat Pompeu Fabra, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona
| | - Joan Benach
- Juan C. Alzate Angel is with the Clinical Research Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia. Juan M. Pericàs is with ISGlobal, Hospital Clínic de Barcelona, University of Barcelona, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain. Holly A. Taylor is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Joan Benach is with the Health Inequalities Research Group, Department of Political and Social Sciences, Universitat Pompeu Fabra, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona
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Burden of HIV-associated histoplasmosis compared with tuberculosis in Latin America: a modelling study. THE LANCET. INFECTIOUS DISEASES 2018; 18:1150-1159. [PMID: 30146320 DOI: 10.1016/s1473-3099(18)30354-2] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/04/2018] [Accepted: 05/25/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Fungal infections remain a major contributor to the opportunistic infections that affect people living with HIV. Among them, histoplasmosis is considered neglected, often being misdiagnosed as tuberculosis, and is responsible for numerous deaths in Latin America. The objective of this study was to estimate the burden of HIV-associated histoplasmosis compared with tuberculosis in Latin American countries. METHODS For this modelling study, we estimated prevalence of previous exposure to Histoplasma capsulatum, HIV-associated histoplasmosis annual incidence, and number of deaths in 2012 in Latin American countries based on historical histoplasmin skin test studies in the general population, with an antigen dilution level of more than 1/10. Studies were identified in a literature search. Data on HIV-associated tuberculosis were extracted from the WHO notifications and outcomes tables and data on people living with HIV were extracted from the UNAIDS report for the year 2012. We systematically propagated uncertainty throughout all the steps of the estimation process. FINDINGS Among 1310 articles identified as of June 1, 2015, 24 articles were included in the study, representing 129 histoplasmin skin test studies led in the general population of Latin American countries. For the year 2012, we estimated a range of 6710 (95% CI 5680-7867) to 15 657 (13 254-18 357) cases of symptomatic HIV-associated histoplasmosis in Latin America. Hotspot areas for histoplasmosis prevalence (>30%) and incidence (>1·5 cases per 100 people living with HIV) were Central America, the northernmost part of South America, and Argentina. According to realistic scenarios, we estimated a range of 671 (95% CI 568-787) to 9394 (7952-11 014) deaths related to histoplasmosis, compared with 5062 (3777-6405) deaths related to tuberculosis reported in Latin America. INTERPRETATION Our estimates of histoplasmosis incidence and deaths are high and consistent with published data. For the first time, the burden of histoplasmosis is estimated to be equivalent in incidence and even higher in deaths when compared with tuberculosis among people living with HIV in Latin America. FUNDING None.
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Sued O, Cassetti I, Cecchini D, Cahn P, de Murillo LB, Weiss SM, Mandell LN, Soni M, Jones DL. Physician-delivered motivational interviewing to improve adherence and retention in care among challenging HIV-infected patients in Argentina (COPA2): study protocol for a cluster randomized controlled trial. Trials 2018; 19:396. [PMID: 30041703 PMCID: PMC6056946 DOI: 10.1186/s13063-018-2758-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 06/25/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND "Challenging" HIV-infected patients, those not retained in treatment, represent a critical focus for positive prevention, as linkage to care, early initiation of antiretroviral therapy, adherence and retention in treatment facilitate viral suppression, thus optimizing health and reducing HIV transmission. Argentina was one of the first Latin American countries to guarantee HIV prevention, diagnosis and comprehensive care services, including antiretroviral medication, which removed cost and access as barriers. Yet, dropout occurs at every stage of the HIV continuum. An estimated 110,000 individuals are HIV-infected in Argentina; of these, 70% have been diagnosed and 54% were linked to care. However, only 36% have achieved viral suppression and 31% of those diagnosed delayed entry to care. To achieve meaningful reductions in HIV infection at the community level, innovative strategies must be developed to re-engage patients. Motivational Interviewing (MI) is a patient-centered approach and has been used by therapists in Central and South America to enhance motivation and commitment in substance use and risk reduction. Our pilot feasibility study utilized culturally tailored MI in physicians to target patients not retained in treatment in public and private clinics in Buenos Aires, Argentina. Results demonstrated that a physician-based MI intervention was feasible and effective in enhanced and sustained patient adherence, viral suppression, and patient-physician communication and attitudes about treatment among these patients at 6 and 9 months post baseline. METHODS/DESIGN This clinical trial seeks to extend these findings in public and private clinics in four urban population centers in Argentina, in which clinics (n = 6 clinics, six MDs per clinic site) are randomized to experimental (physician MI Intervention) (n = 3) or control (physician Standard of Care) (n = 3) conditions in a 3:3 ratio. Using a cluster randomized clinical trial design, the study will test the effectiveness of a physician-based MI intervention to improve and sustain retention, adherence, persistence, and viral suppression among "challenging" patients (n = 420) over 24 months. DISCUSSION Results are anticipated to have significant public health implications for the implementation of MI to re-engage and retain patients in HIV treatment and care and improve viral suppression through high levels of medication adherence. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02846350 . Registered on 1 July 2016.
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Affiliation(s)
- Omar Sued
- Fundación Huésped, Pasaje Angel Peluffo 3932, C1202ABB Buenos Aires, Argentina
| | | | | | - Pedro Cahn
- Fundación Huésped, Pasaje Angel Peluffo 3932, C1202ABB Buenos Aires, Argentina
| | - Lina Bofill de Murillo
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL USA
| | - Stephen M. Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL USA
| | - Lissa N. Mandell
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL USA
| | - Manasi Soni
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL USA
| | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL USA
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Semple SJ, Pines HA, Strathdee SA, Vera AH, Rangel G, Magis-Rodriguez C, Patterson TL. Uptake of a Partner Notification Model for HIV Among Men Who Have Sex With Men and Transgender Women in Tijuana, Mexico. AIDS Behav 2018; 22:2042-2055. [PMID: 29159592 DOI: 10.1007/s10461-017-1984-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Undiagnosed HIV infection is common among men who have sex with men (MSM) and transgender women (TW) in Latin America. We examined uptake of a partner notification (PN) model among MSM and TW in Tijuana, Mexico. Forty-six HIV-positive MSM/TW enrolled as index patients, and reported 132 MSM/TW sexual partners for PN. Of notified partners (90/132), 39% declined eligibility screening or participation, 39% tested for HIV, and of those 28% were newly-diagnosed HIV-positive. Partners who were seen by the index patient more than once in the past 4 months and those who primarily had sex with the index patient in one of their homes were more likely to be notified via PN (76% vs. 50%; p = 0.01 and 86% vs. 64%, p = 0.02, respectively). Lower than expected PN uptake was associated with problems identifying index patients, obtaining reliable partner contact information, and engaging notified partners.
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Pereira MF, Luz E, Netto EM, Barbosa MHF, Brites C. Low variation in initial CD4 cell count in a HIV referral center, in Salvador, Brazil, from 2002 to 2015. Braz J Infect Dis 2018; 22:245-247. [PMID: 29883585 PMCID: PMC9425651 DOI: 10.1016/j.bjid.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/21/2018] [Accepted: 05/01/2018] [Indexed: 11/30/2022] Open
Abstract
Early initiation of antiretroviral therapy increases the likelihood of effective immune restoration, quality of life, and greater life expectancy for HIV-infected individuals. We evaluated the evolution of mean CD4+ cells count at diagnosis of HIV/AIDS in Salvador, Brazil from 2002 to 2015. We identified HIV/AIDS patients older than 18 years with diagnosis of HIV infection from 2002 to 2015, who had their first laboratory evaluation at Complexo Hospitalar Prof. Edgard Santos, Federal University of Bahia. Initial mean CD4+ cells count and age, over time were evaluated. A total of 1801 patients randomly selected individuals were included in the analysis. Overall mean CD4+ count at diagnosis in the whole period was 279 ± 265, varying from 191 in 2015 to 334 in 2011. There was no improvement in the immunological status at diagnosis from 2002 to 2015. In addition, a higher frequency of CD4+ cells count < 200 cells/mL in the last two years was observed. This suggests that the adopted strategies for early diagnosis of HIV/AIDS in Salvador, Brazil, are still ineffective.
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Affiliation(s)
- Marcela Fonseca Pereira
- Universidade Federal da Bahia, Faculdade de Medicina, Complexo Hospitalar Professor Edgard Santos, LAPI - Laboratório de Pesquisa em Infectologia, Salvador, BA, Brazil
| | - Estela Luz
- Universidade Federal da Bahia, Faculdade de Medicina, Complexo Hospitalar Professor Edgard Santos, LAPI - Laboratório de Pesquisa em Infectologia, Salvador, BA, Brazil
| | - Eduardo Martins Netto
- Universidade Federal da Bahia, Faculdade de Medicina, Complexo Hospitalar Professor Edgard Santos, LAPI - Laboratório de Pesquisa em Infectologia, Salvador, BA, Brazil
| | - Manoel Henrique Fonseca Barbosa
- Universidade Federal da Bahia, Faculdade de Medicina, Complexo Hospitalar Professor Edgard Santos, LAPI - Laboratório de Pesquisa em Infectologia, Salvador, BA, Brazil
| | - Carlos Brites
- Universidade Federal da Bahia, Faculdade de Medicina, Complexo Hospitalar Professor Edgard Santos, LAPI - Laboratório de Pesquisa em Infectologia, Salvador, BA, Brazil.
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Dolwick Grieb SM, Shah H, Flores-Miller A, Zelaya C, Page KR. HIV-Related Stigma Among Spanish-speaking Latinos in an Emerging Immigrant Receiving City. J Immigr Minor Health 2018; 19:868-875. [PMID: 27678505 DOI: 10.1007/s10903-016-0497-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HIV-related stigma has been associated with a reluctance to test for HIV among Latinos. This study assessed community HIV-related stigma within an emerging Latino immigrant receiving city. We conducted a brief survey among a convenience sample of 312 Spanish-speaking Latinos in Baltimore, Maryland. HIV-related stigma was assessed through six items. Associations between stigma items, socio-demographic characteristics, and HIV testing history were considered. Gender, education, and religiosity were significantly associated with stigmatizing HIV-related beliefs. For example, men were 3.4 times more likely to hold more than three stigmatizing beliefs than women, and were also twice as likely as women to report feeling hesitant to test for HIV for fear of people's reaction if the test is positive. These findings can help inform future stigma interventions in this community. In particular, we were able to distinguish between drivers of stigma such as fear and moralistic attitudes, highlighting specific actionable items.
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Affiliation(s)
- Suzanne M Dolwick Grieb
- Center for Child and Community Health Research, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Mason F. Lord Center Tower Suite 4200, Baltimore, MD, 21224, USA.
| | - Harita Shah
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Carla Zelaya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathleen R Page
- Bureau of HIV/STD Services, Baltimore City Health Department, Baltimore, MD, USA
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Prochazka M, Otero L, Konda KA, González-Lagos E, Echevarría J, Gotuzzo E. Patient-nominated supporters as facilitators for engagement in HIV care in a referral hospital in Peru: A retrospective cohort study. PLoS One 2018; 13:e0195389. [PMID: 29617437 PMCID: PMC5884557 DOI: 10.1371/journal.pone.0195389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 03/21/2018] [Indexed: 11/19/2022] Open
Abstract
Patient-nominated supporters can potentially improve the continuum of HIV care. We retrospectively determined factors associated with having a patient-nominated supporter among people living with HIV (PLWH), and its association with retention in care and viral suppression. We analysed registries of adults evaluated by social workers (n = 1345) at a referral hospital in Peru between 2011–2014. Nondisclosure of HIV status was associated with lacking supporters (aPR: 5.41, 95% CI: 3.83–7.64). Retention in care was 76.4% and 34.2% after one and two years of enrolment, respectively. PLWH with supporters were more likely to be retained in care after two years (aRR = 1.36, 95% CI: 1.02–1.81), but not after one year (aRR = 1.10, 95% CI: 0.98–1.23) compared to PLWH without supporters. Having supporters who were parents or friends was associated with an increased probability of being retained in care after one and two years of enrolment. Viral suppression after one year of enrolment was 58.7%. Having a supporter was not associated with viral suppression (aRR = 1.18, 95% CI: 0.99–1.41), but PLWH with supporters were more likely to have viral load measurements (p = 0.005). Patient-nominated supporters appear beneficial for engagement in HIV care; these benefits may be related to the nature of their relationship with PLWH.
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Affiliation(s)
- Mateo Prochazka
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Carlos Vidal Layseca School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru
- * E-mail:
| | - Larissa Otero
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Alberto Hurtado School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kelika A. Konda
- Carlos Vidal Layseca School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, Division of Infectious Diseases and Center for World Health, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California, United States of America
| | - Elsa González-Lagos
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Alberto Hurtado School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Echevarría
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Alberto Hurtado School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Infectious, Tropical and Dermatological Diseases, Hospital Cayetano Heredia, Ministry of Health, Lima, Peru
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Alberto Hurtado School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Infectious, Tropical and Dermatological Diseases, Hospital Cayetano Heredia, Ministry of Health, Lima, Peru
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Horyniak D, Strathdee SA, West BS, Meacham M, Rangel G, Gaines TL. Predictors of injecting cessation among a cohort of people who inject drugs in Tijuana, Mexico. Drug Alcohol Depend 2018; 185:298-304. [PMID: 29482055 PMCID: PMC5889739 DOI: 10.1016/j.drugalcdep.2017.12.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Little is known about the cessation of injecting drug use (IDU) among people who inject drugs (PWID) in low and middle-income settings, where access to effective interventions for reducing drug use (e.g., opioid substitution treatment; OST), may be limited. We measured the incidence and identified predictors of IDU cessation among a cohort of PWID in Tijuana, Mexico. METHODS Data were drawn from 621 participants in Proyecto El Cuete IV, a prospective cohort of PWID recruited in 2011 and interviewed biannually to 2016. A multivariable Extended Cox model was constructed to identify socio-demographic, drug use, risk environment and health-related predictors of IDU cessation (no IDU for ≥six months). RESULTS 141 participants (23%) reported at least one IDU cessation event during follow-up. The crude IDU cessation rate was 7.3 per 100 person-years (95% Confidence Interval [CI]: 6.2-8.7). IDU cessation was negatively associated with injecting at least daily on average and heroin/methamphetamine co-injection in the past six months, and positively associated with testing HIV positive at baseline, being on methadone maintenance therapy in the past six months, and recent arrest. Concern for personal safety was also independently associated with IDU cessation. CONCLUSIONS The rate of IDU cessation among PWID in Tijuana was low. These findings underscore the importance of expansion of services including OST to help reduce drug use and facilitate IDU cessation for those who wish to do so. In this setting, interventions addressing individual-level economic barriers as well as broader social and structural barriers to harm reduction services are integral.
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Affiliation(s)
- Danielle Horyniak
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States,Behaviours and Health Risks Program, Burnet Institute, Melbourne, VIC, 3004, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Steffanie A. Strathdee
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States
| | - Brooke S. West
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States
| | - Meredith Meacham
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, 94143, United States
| | - Gudelia Rangel
- United States-Mexico Border Health Commission, Tijuana, BC, 22320, Mexico
| | - Tommi L. Gaines
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States,Correspondence: Tommi L. Gaines, Division of Global Public Health, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, Phone: 858-246-0600,
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Galea JT, Wong M, Muñoz M, Valle E, Leon SR, Díaz Perez D, Kolevic L, Franke M. Barriers and facilitators to antiretroviral therapy adherence among Peruvian adolescents living with HIV: A qualitative study. PLoS One 2018; 13:e0192791. [PMID: 29447226 PMCID: PMC5813958 DOI: 10.1371/journal.pone.0192791] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/30/2018] [Indexed: 12/23/2022] Open
Abstract
AIDS deaths among adolescents are increasing globally. This qualitative study investigated the barriers and facilitators to cART adherence among Peruvian adolescents living with HIV. Guided by a social ecological model, we analyzed transcripts from 24 psychosocial support groups for HIV-positive adolescents aged 13–17 years and 15 individual, in-depth interviews with cART providers and caregivers to identify the barriers and facilitators to cART adherence at the individual, family/caregiver and hospital levels. Most barriers and facilitators to cART adherence clustered at the individual and family/caregiver levels, centering on support provided to adolescents; history of declining health due to suboptimal cART adherence; side effects from antiretroviral drugs; and cART misinformation. Interventions to support adolescent HIV cART adherence should begin at the individual and family/caregiver levels and include an educational component. No adolescent living with HIV should die from AIDS in an era of accessible cART.
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Affiliation(s)
- Jerome T. Galea
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Socios En Salud, Lima, Peru
- * E-mail:
| | | | | | | | | | | | | | - Molly Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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Stuart RM, Fraser‐Hurt N, Kerr CC, Mabusela E, Madi V, Mkhwanazi F, Pillay Y, Barron P, Muzah B, Matsebula T, Gorgens M, Wilson DP. The City of Johannesburg can end AIDS by 2030: modelling the impact of achieving the Fast-Track targets and what it will take to get there. J Int AIDS Soc 2018; 21:e25068. [PMID: 29359533 PMCID: PMC5810342 DOI: 10.1002/jia2.25068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION In 2014, city leaders from around the world endorsed the Paris Declaration on Fast-Track Cities, pledging to achieve the 2020 and 2030 HIV targets championed by UNAIDS. The City of Johannesburg - one of South Africa's metropolitan municipalities and also a health district - has over 600,000 people living with HIV (PLHIV), more than any other city worldwide. We estimate what it would take in terms of programmatic targets and costs for the City of Johannesburg to meet the Fast-Track targets, and demonstrate the impact that this would have. METHODS We applied the Optima HIV epidemic and resource allocation model to demographic, epidemiological and behavioural data on 26 sub-populations in Johannesburg. We used data on programme costs and coverage to produce baseline projections. We calculated how many people must be diagnosed, put onto treatment and maintained with viral suppression to achieve the 2020 and 2030 targets. We also estimated how treatment needs - and therefore fiscal commitments - could be reduced if the treatment targets are combined with primary HIV prevention interventions (voluntary medical male circumcision (VMMC), an expanded condom programme, and comprehensive packages for female sex workers (FSW) and young females). RESULTS If current programmatic coverage were maintained, Johannesburg could expect 303,000 new infections and 96,000 AIDS-related deaths between 2017 and 2030 and 769,000 PLHIV by 2030. Achieving the Fast-Track targets would require an additional 135,000 diagnoses and 232,000 people on treatment by 2020 (an increase in around 80% over 2016 treatment numbers), but would avert 176,000 infections and 56,500 deaths by 2030. Assuming stable ART unit costs, this would require ZAR 29 billion (USD 2.15 billion) in cumulative treatment investments over the 14 years to 2030. Plausible scale-ups of other proven interventions (VMMC, condom distribution and FSW strategies) could yield additional reductions in new infections (between 4 and 15%), and in overall treatment investment needs. Scaling up VMMC in line with national targets is found to be cost-effective in the medium term. CONCLUSIONS The scale-up in testing and treatment programmes over this decade has been rapid, but these efforts must be doubled to reach 2020 targets. Strategic investments in proven interventions will help Johannesburg achieve the treatment targets and be on track to end AIDS by 2030.
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Affiliation(s)
- Robyn M Stuart
- Department of Mathematical SciencesUniversity of CopenhagenCopenhagenDenmark
- Burnet InstituteMelbourneAustralia
| | | | - Cliff C Kerr
- Burnet InstituteMelbourneAustralia
- School of PhysicsUniversity of SydneySydneyAustralia
| | - Emily Mabusela
- Department of HealthGauteng ProvinceJohannesburgSouth Africa
| | - Vusi Madi
- Department of HealthGauteng ProvinceJohannesburgSouth Africa
| | - Fredrika Mkhwanazi
- Department of HealthJohannesburg Health DistrictJohannesburgSouth Africa
| | - Yogan Pillay
- National Department of HealthPretoriaSouth Africa
| | - Peter Barron
- School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | | | | | - David P Wilson
- Burnet InstituteMelbourneAustralia
- Monash UniversityMelbourneAustralia
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The challenges of ending AIDS in Asia: outcomes of the Thai National AIDS Universal Coverage Programme, 2000–2014. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30323-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vasquez AL, Errea RA, Hoces D, Echevarria J, González-Lagos E, Gotuzzo E. Missed opportunities for HIV control: Gaps in HIV testing for partners of people living with HIV in Lima, Peru. PLoS One 2017; 12:e0181412. [PMID: 28806412 PMCID: PMC5555572 DOI: 10.1371/journal.pone.0181412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 06/30/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Based on the hypothesis that HIV programs struggle to deliver health services that harmonize necessities of treatment and prevention, we described the outcomes of routinely provided HIV testing to partners of people living with HIV (PLWH) through a secondary analysis of routine data collected at a public hospital in Lima, Peru. Methods Among PLWH enrolled in the study center’s HIV program between 2005 and 2014, we identified index cases (IC): PLWH who reported a unique partner not previously enrolled. We grouped partners according to their HIV status as reported by IC and collected data on HIV testing, clinical characteristics and admissions. The main outcome was the frequency of HIV testing among partners with reported unknown/seronegative HIV status. Results Out of 1586 PLWH who reported a unique partner at enrollment, 171 had a previously enrolled partner, leaving 1415 (89%) IC. HIV status of the partner was reported as unknown in 571 (40%), seronegative in 325 (23%) and seropositive in 519 (37%). Out of 896 partners in the unknown/seronegative group, 72 (8%) had HIV testing, 42/72 (58%) tested within three months of IC enrollment. Among the 49/72 (68%) who tested positive for HIV, 33 (67%) were enrolled in the HIV program. The proportion in WHO clinical stage IV was lower in enrolled partners compared to IC (37% vs 9%, p = 0.04). Non-tested partners (824) were likely reachable by the hospital, as 297/824 (36%) of their IC were admitted in the study center at least once, 51/243 (21%) female IC had received pregnancy care at the study center, and 401/692 (64%) of IC on antiretroviral therapy had achieved viral suppression, implying frequent visits to the hospital for pill pick-up. Conclusion In this setting, HIV testing of partners of PLWH was suboptimal, illustrating missed opportunities for HIV control. Integration of HIV strategies in primarily clinical-oriented services is a challenging need.
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Affiliation(s)
- Ana L. Vasquez
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- * E-mail:
| | - Renato A. Errea
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daniel Hoces
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Echevarria
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departmento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Cayetano Heredia, Lima, Peru
| | - Elsa González-Lagos
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departmento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Cayetano Heredia, Lima, Peru
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Braga LP, Mendicino CCP, Reis EA, Carmo RA, Menezes de Pádua CA. Effectiveness of second-line antiretroviral therapy: the impact of drug switches. AIDS Care 2017; 29:1585-1588. [PMID: 28490196 DOI: 10.1080/09540121.2017.1322680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Including antiretroviral drug switches as a measure of ART failure could be more suitable than conventional measures to evaluate health outcomes in "real-world" settings. This is part of a historical cohort of HIV-infected adults who initiated ART from 2001-2005, and were followed up for a maximum of five years in three HIV/AIDS centers in Belo Horizonte, Brazil. Follow-up information included data from 2001-2010. All patients switched from first-line ART were included. Second-line ART effectiveness was measured as the time-to-ART failure. Failure was defined simulating two scenarios: (1) Clinical, immunological and virological failure (scenario 1); and scenario 1 plus ART switches (scenario 2). Descriptive analysis, Kaplan-Meier curves, log-rank test, and Cox proportional hazards model were performed. We identified 119 eligible patients; most had protease inhibitor (PI)-based regimens prescribed as second-line. The incidence of failure was different for the two scenarios (29.4% vs. 54.6% for scenario 1 and 2, respectively; p < 0.001). The main identifiers of failure were increase in viral load (31.1%) for scenario 1 and ART switches (42.8%) for scenario 2. Median duration on second-line ART was 36.8 vs. 19.8 months for scenario 1 and 2, respectively. In the Cox analysis of scenario 2, increased risk was found for patients given PI-based second-line regimens (HR = 2.26; 95% CI: 1.09-3.17). There is a high incidence of ART failure associated with PI-based regimens when ART switches are considered as an indicator of failure. This demonstrates the impact of ART switches in representing lack of ART effectiveness.
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Affiliation(s)
- Letícia Penna Braga
- a Department of Social Pharmacy, Faculty of Pharmacy , Federal University of Minas Gerais , Belo Horizonte , Brazil
| | | | - Edna Afonso Reis
- b Department of Statistics , Exact Sciences Institute, Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Ricardo Andrade Carmo
- c Municipal Health Division , Infectious Disease Reference Center, CTR/DIP Orestes Diniz, Federal University of Minas Gerais , Belo Horizonte , Brazil
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Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross-sectional online survey. J Int AIDS Soc 2017. [PMID: 28406270 PMCID: PMC5515028 DOI: 10.7448/ias.20.01/21372] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION HIV and syphilis testing rates remain low among men who have sex with men (MSM) in low- and middle-income countries (LMICs). Community engagement has been increasingly used to promote HIV testing among key populations in high-income countries, often in settings with stronger civil society. This study aimed to assess socio-demographic, behavioural, and community engagement factors associated with HIV and syphilis testing among MSM in China. METHODS MSM ≥16 years old who had condomless sex in the past three months were recruited nationwide to complete a cross-sectional online survey in November 2015. Data were collected on socio-demographics, sexual behaviours, HIV testing, syphilis testing, and community engagement in sexual health. We defined community engagement in sexual health using six items assessing awareness and advocacy of sexual health programmes. The underlying factor structure of a 6-item community engagement scale was determined through exploratory factor analysis. Univariate and multivariable logistic regressions identified correlates of HIV and syphilis testing. RESULTS 1189 MSM were recruited. 54% (647/1189) of men had ever tested for HIV and 30% (354/1189) had ever tested for syphilis. Factor analysis suggested three levels of community engagement (minimal, moderate, and substantial) and this model explained 79.5% of observed variance. A quarter (26%, 312/1189) reported none to minimal engagement, over one half (54%, 644/1189) reported moderate engagement, and a fifth (20%, 233/1189) reported substantial engagement. Multivariable logistic regression showed that MSM with greater community engagement in sexual health were more likely to have ever tested for HIV (substantial vs. no engagement: aOR 7.91, 95% CI 4.98-12.57) and for syphilis (substantial vs. no engagement: aOR 5.35, 95% CI 3.16-9.04). CONCLUSION HIV and syphilis testing are suboptimal among MSM in China. Community engagement may be useful for promoting testing in China and should be considered in intervention development and delivery. Further research is needed to better understand the role of LMIC community engagement in HIV interventions.
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Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross-sectional online survey. J Int AIDS Soc 2017; 20:21372. [PMID: 28406270 DOI: 10.7448/ias.20.01.21372] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION HIV and syphilis testing rates remain low among men who have sex with men (MSM) in low- and middle-income countries (LMICs). Community engagement has been increasingly used to promote HIV testing among key populations in high-income countries, often in settings with stronger civil society. This study aimed to assess socio-demographic, behavioural, and community engagement factors associated with HIV and syphilis testing among MSM in China. METHODS MSM ≥16 years old who had condomless sex in the past three months were recruited nationwide to complete a cross-sectional online survey in November 2015. Data were collected on socio-demographics, sexual behaviours, HIV testing, syphilis testing, and community engagement in sexual health. We defined community engagement in sexual health using six items assessing awareness and advocacy of sexual health programmes. The underlying factor structure of a 6-item community engagement scale was determined through exploratory factor analysis. Univariate and multivariable logistic regressions identified correlates of HIV and syphilis testing. RESULTS 1189 MSM were recruited. 54% (647/1189) of men had ever tested for HIV and 30% (354/1189) had ever tested for syphilis. Factor analysis suggested three levels of community engagement (minimal, moderate, and substantial) and this model explained 79.5% of observed variance. A quarter (26%, 312/1189) reported none to minimal engagement, over one half (54%, 644/1189) reported moderate engagement, and a fifth (20%, 233/1189) reported substantial engagement. Multivariable logistic regression showed that MSM with greater community engagement in sexual health were more likely to have ever tested for HIV (substantial vs. no engagement: aOR 7.91, 95% CI 4.98-12.57) and for syphilis (substantial vs. no engagement: aOR 5.35, 95% CI 3.16-9.04). CONCLUSION HIV and syphilis testing are suboptimal among MSM in China. Community engagement may be useful for promoting testing in China and should be considered in intervention development and delivery. Further research is needed to better understand the role of LMIC community engagement in HIV interventions.
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Granich R, Gupta S, Hall I, Aberle-Grasse J, Hader S, Mermin J. Status and methodology of publicly available national HIV care continua and 90-90-90 targets: A systematic review. PLoS Med 2017; 14:e1002253. [PMID: 28376085 PMCID: PMC5380306 DOI: 10.1371/journal.pmed.1002253] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/03/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In 2014, the Joint United Nations Program on HIV/AIDS (UNAIDS) issued treatment goals for human immunodeficiency virus (HIV). The 90-90-90 target specifies that by 2020, 90% of individuals living with HIV will know their HIV status, 90% of people with diagnosed HIV infection will receive antiretroviral treatment (ART), and 90% of those taking ART will be virally suppressed. Consistent methods and routine reporting in the public domain will be necessary for tracking progress towards the 90-90-90 target. METHODS AND FINDINGS For the period 2010-2016, we searched PubMed, UNAIDS country progress reports, World Health Organization (WHO), UNAIDS reports, national surveillance and program reports, United States President's Emergency Plan for AIDS Relief (PEPFAR) Country Operational Plans, and conference presentations and/or abstracts for the latest available national HIV care continuum in the public domain. Continua of care included the number and proportion of people living with HIV (PLHIV) who are diagnosed, on ART, and virally suppressed out of the estimated number of PLHIV. We ranked the described methods for indicators to derive high-, medium-, and low-quality continuum. For 2010-2016, we identified 53 national care continua with viral suppression estimates representing 19.7 million (54%) of the 2015 global estimate of PLHIV. Of the 53, 6 (with 2% of global burden) were high quality, using standard surveillance methods to derive an overall denominator and program data from national cohorts for estimating steps in the continuum. Only nine countries in sub-Saharan Africa had care continua with viral suppression estimates. Of the 53 countries, the average proportion of the aggregate of PLHIV from all countries on ART was 48%, and the proportion of PLHIV who were virally suppressed was 40%. Seven countries (Sweden, Cambodia, United Kingdom, Switzerland, Denmark, Rwanda, and Namibia) were within 12% and 10% of achieving the 90-90-90 target for "on ART" and for "viral suppression," respectively. The limitations to consider when interpreting the results include significant variation in methods used to determine national continua and the possibility that complete continua were not available through our comprehensive search of the public domain. CONCLUSIONS Relatively few complete national continua of care are available in the public domain, and there is considerable variation in the methods for determining progress towards the 90-90-90 target. Despite bearing the highest HIV burden, national care continua from sub-Saharan Africa were less likely to be in the public domain. A standardized monitoring and evaluation approach could improve the use of scarce resources to achieve 90-90-90 through improved transparency, accountability, and efficiency.
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Affiliation(s)
- Reuben Granich
- International Association of Providers of AIDS Care, Washington, D.C., United States of America
| | - Somya Gupta
- International Association of Providers of AIDS Care, Washington, D.C., United States of America
| | - Irene Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John Aberle-Grasse
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shannon Hader
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jonathan Mermin
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Bayer AM, Díaz CM, Chiappe M, Baker AN, Egoavil MS, Pérez-Lu JE, Gorbach PM, García PJ. The odyssey of linking to and staying in HIV care among male sex workers in Peru. JOURNAL OF HIV AND AIDS 2017; 3:10.16966/2380-5536.134. [PMID: 29202049 PMCID: PMC5708583 DOI: 10.16966/2380-5536.134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In Peru, there is little information about the HIV care continuum. Therefore, we conducted a study to describe the HIV care continuum among male sex workers (MSWs) in Lima. METHODS We applied close-ended surveys with 209 MSWs about their engagement in the HIV care continuum and open-ended surveys with 34 MSWs who are people living with HIV (PLHIV) to explore their linkage to and retention in HIV care. RESULTS Of 209 MSWs, only 71% (n=148) reported a lifetime HIV test and 56% (n=116) of all MSWs received confirmatory HIV test results. Of the 34 MSWs who are PLHIV, 76% had received HIV care at least once, but only 59% were currently in care, 50% were currently taking ART(antiretroviral therapy) and an even lower 32% had been on ART for 6 months or more. The primary reason for non-linkage to HIV care is the multiple visits to link at the Ministry of Health (MOH). Remaining in care was also challenging, particularly at non-governmental organizations (NGOs). CONCLUSIONS Substantial barriers linking to and remaining in HIV care result in significant delays in linkage and high proportions of PLHIV that remain unlinked or become unstably linked following initial linkage. Urgent implementation science research is needed to facilitate linkage to HIV care and strengthen retention in HIV care post-linkage.
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Affiliation(s)
- Angela M Bayer
- David Geffen School of Medicine, University of California, Los Angeles, 10833 LeConte Ave, CHS 12-105, Los Angeles, CA 90095 and School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Chanelle M Díaz
- Leonard M. Miller School of Medicine, University of Miami, 1600 NW 10th Ave #1140, Miami, FL 33136
| | - Marina Chiappe
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima, Peru
| | - Amira N Baker
- David Geffen School of Medicine, University of California, Los Angeles, 10833 LeConte Ave, CHS 12-105, Los Angeles, CA 90095
| | - Miguel S Egoavil
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima, Peru
| | - José E Pérez-Lu
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima, Peru
| | - Pamina M Gorbach
- Fielding School of Public Health, University of California, Los Angeles, 10833 LeConte Ave, CHS 41-295, Los Angeles, CA 90095
| | - Patricia J García
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima, Peru
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Kay ES, Batey DS, Mugavero MJ. The HIV treatment cascade and care continuum: updates, goals, and recommendations for the future. AIDS Res Ther 2016; 13:35. [PMID: 27826353 PMCID: PMC5100316 DOI: 10.1186/s12981-016-0120-0] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/31/2016] [Indexed: 11/10/2022] Open
Abstract
The HIV care continuum is a framework that models the dynamic stages of HIV care. The continuum consists of five main steps, which, at the population level, are depicted cross-sectionally as the HIV treatment cascade. These steps include diagnosis, linkage to care (LTC), retention in care (RiC), adherence to antiretroviral therapy (ART), and viral suppression. Although the HIV treatment cascade is represented as a linear, unidirectional framework, persons living with HIV (PLWH) often experience the care continuum in a less streamlined fashion, skip steps altogether, or even exit the continuum for a period of time and regress to an earlier stage. The proportion of PLWH decreases at each successive step of the cascade, beginning with an estimated 86% who are diagnosed and dropping dramatically to approximately 30% of PLWH who are virally suppressed in the United States (US). In this current issues review, we describe each step in the cascade, discuss targeted interventions that address weak points in the continuum, review domestic and international policies that help shape and direct HIV care strategies, and conclude with recommendations and future directions for HIV providers and policymakers. While we primarily examine issues related to domestic HIV care in the US, we also discuss international applications of the continuum in order to provide broader context.
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Levison JH, Alegría M. Shifting the HIV Training and Research Paradigm to Address Disparities in HIV Outcomes. AIDS Behav 2016; 20 Suppl 2:265-72. [PMID: 27501811 PMCID: PMC5003775 DOI: 10.1007/s10461-016-1489-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Tailored programs to diversify the pool of HIV/AIDS investigators and provide sufficient training and support for minority investigators to compete successfully are uncommon in the US and abroad. This paper encourages a shift in the HIV/AIDS training and research paradigm to effectively train and mentor Latino researchers in the US, Latin America and the Caribbean. We suggest three strategies to accomplish this: (1) coaching senior administrative and academic staff of HIV/AIDS training programs on the needs, values, and experiences unique to Latino investigators; (2) encouraging mentors to be receptive to a different set of research questions and approaches that Latino researchers offer due to their life experiences and perspectives; and (3) creating a virtual infrastructure to share resources and tackle challenges faced by minority researchers. Shifts in the research paradigm to include, retain, and promote Latino HIV/AIDS researchers will benefit the scientific process and the patients and communities who await the promise of HIV/AIDS research.
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Affiliation(s)
- Julie H Levison
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA, 02114, USA.
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Margarita Alegría
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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48
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Bernabò N, Greco L, Mattioli M, Barboni B. A scientometric analysis of reproductive medicine. Scientometrics 2016. [DOI: 10.1007/s11192-016-1969-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chow JY, Konda KA, Borquez A, Caballero P, Silva-Santisteban A, Klausner JD, Cáceres CF. Peru's HIV care continuum among men who have sex with men and transgender women: opportunities to optimize treatment and prevention. Int J STD AIDS 2016; 27:1039-1048. [PMID: 27099168 DOI: 10.1177/0956462416645727] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/29/2016] [Indexed: 01/23/2023]
Abstract
The HIV epidemic in Peru is concentrated in men who have sex with men (MSM) and transgender women (TW), who have an estimated prevalence > 10%, while the overall population prevalence remains < 1%. Because MSM and TW account for >60% of new infections, it is crucial to understand the full HIV continuum of care for these key populations. We performed a review of the peer-reviewed scientific and grey literature to determine the proportion of HIV-infected MSM and TW in Peru who are diagnosed, linked to and retained in care, are taking antiretroviral therapy (ART), and who have attained virologic suppression. Of the estimated 613,080 MSM and TW in Peru in 2015, approximately 63,981 are HIV-infected. Only 24.0% of HIV-infected MSM and TW are aware of their diagnosis, 15.6% are retained in care, 13.6% are on ART, and 12.0% have achieved adequate virologic control. The largest drop-off in the HIV care continuum occurs at the first step: diagnosis of HIV. Improving HIV serostatus awareness among MSM and TW is crucial to controlling Peru's HIV epidemic. In the era of 'treatment as prevention', understanding the full HIV care continuum may help guide efforts to curb transmission and reduce HIV-related morbidity and mortality.
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Affiliation(s)
- Jeremy Y Chow
- Division of Infectious Diseases, University of California, Los Angeles, CA, USA
| | - Kelika A Konda
- Division of Infectious Diseases, University of California, Los Angeles, CA, USA Center for Interdisciplinary Studies in Sexuality, AIDS and Society, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Annick Borquez
- Department of Infectious Disease Epidemiology, Imperial College London, UK Division of Global Public Health, University of California, San Diego, CA, USA
| | | | - Alfonso Silva-Santisteban
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Division of Infectious Diseases, University of California, Los Angeles, CA, USA
| | - Carlos F Cáceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
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50
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Labhardt ND, Ringera I, Lejone TI, Masethothi P, Thaanyane T, Kamele M, Gupta RS, Thin K, Cerutti B, Klimkait T, Fritz C, Glass TR. Same day ART initiation versus clinic-based pre-ART assessment and counselling for individuals newly tested HIV-positive during community-based HIV testing in rural Lesotho - a randomized controlled trial (CASCADE trial). BMC Public Health 2016; 16:329. [PMID: 27080120 PMCID: PMC4832467 DOI: 10.1186/s12889-016-2972-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/19/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Achievement of the UNAIDS 90-90-90 targets in Sub-Sahara Africa is challenged by a weak care-cascade with poor linkage to care and retention in care. Community-based HIV testing and counselling (HTC) is widely used in African countries. However, rates of linkage to care and initiation of antiretroviral therapy (ART) in individuals who tested HIV-positive are often very low. A frequently cited reason for non-linkage to care is the time-consuming pre-ART assessment often requiring several clinic visits before ART-initiation. METHODS This two-armed open-label randomized controlled trial compares in individuals tested HIV-positive during community-based HTC the proposition of same-day community-based ART-initiation to the standard of care pre-ART assessment at the clinic. Home-based HTC campaigns will be conducted in catchment areas of six clinics in rural Lesotho. Households where at least one individual tested HIV positive will be randomized. In the standard of care group individuals receive post-test counselling and referral to the nearest clinic for pre-ART assessment and counselling. Once they have started ART the follow-up schedule foresees monthly clinic visits. Individuals randomized to the intervention group receive on the spot point-of-care pre-ART assessment and adherence counselling with the proposition to start ART that same day. Once they have started ART, follow-up clinic visits will be less frequent. First primary outcome is linkage to care (individual presents at the clinic at least once within 3 months after the HIV test). The second primary outcome is viral suppression 12 months after enrolment in the study. We plan to enrol a minimum of 260 households with 1:1 allocation and parallel assignment into both arms. DISCUSSION This trial will show if in individuals tested HIV-positive during community-based HTC campaigns the proposition of same-day ART initiation in the community, combined with less frequent follow-up visits at the clinic could be a pragmatic approach to improve the care cascade in similar settings. TRIAL REGISTRATION NCT02692027 , registered February 21, 2016.
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Affiliation(s)
- Niklaus Daniel Labhardt
- />Clinical Research Unit, Medical Services and Diagnostics, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- />University of Basel, Basel, Switzerland
| | - Isaac Ringera
- />SolidarMed, Swiss Organization for Health in Africa, Premium House #224, Kingsway, P.O.Box 0254, Maseru West, 105 Lesotho
| | - Thabo Ishmael Lejone
- />SolidarMed, Swiss Organization for Health in Africa, Premium House #224, Kingsway, P.O.Box 0254, Maseru West, 105 Lesotho
| | - Phofu Masethothi
- />SolidarMed, Swiss Organization for Health in Africa, Premium House #224, Kingsway, P.O.Box 0254, Maseru West, 105 Lesotho
| | - T’sepang Thaanyane
- />SolidarMed, Swiss Organization for Health in Africa, Premium House #224, Kingsway, P.O.Box 0254, Maseru West, 105 Lesotho
| | - Mashaete Kamele
- />SolidarMed, Swiss Organization for Health in Africa, Premium House #224, Kingsway, P.O.Box 0254, Maseru West, 105 Lesotho
| | - Ravi Shankar Gupta
- />District Health Management Team Butha-Buthe, Ministry of Health of Lesotho, Butha-Buthe, Lesotho
| | - Kyaw Thin
- />Research Coordination Unit, Room Number 326, Ministry of Health of Lesotho, Maseru, Lesotho
| | - Bernard Cerutti
- />Faculty of Medicine, UDREM, University of Geneva, 1 Rue Michel Servet, 1211 Geneva, Switzerland
| | - Thomas Klimkait
- />Department of Biomedicine – Petersplatz, Molecular Virology, University of Basel, Basel, Switzerland
| | - Christiane Fritz
- />SolidarMed, Swiss Organization for Health in Africa, Premium House #224, Kingsway, P.O.Box 0254, Maseru West, 105 Lesotho
| | - Tracy Renée Glass
- />Clinical Research Unit, Medical Services and Diagnostics, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- />University of Basel, Basel, Switzerland
- />Biostatistics Department, Epidemiology and Public Health Unit, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box 4002, Basel, Switzerland
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