1
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Teo AKJ, MacLean ELH, Fox GJ. Subclinical tuberculosis: a meta-analysis of prevalence and scoping review of definitions, prevalence and clinical characteristics. Eur Respir Rev 2024; 33:230208. [PMID: 38719737 PMCID: PMC11078153 DOI: 10.1183/16000617.0208-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/12/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND This scoping review aimed to characterise definitions used to describe subclinical tuberculosis (TB), estimate the prevalence in different populations and describe the clinical characteristics and treatment outcomes in the scientific literature. METHODS A systematic literature search was conducted using PubMed. We included studies published in English between January 1990 and August 2022 that defined "subclinical" or "asymptomatic" pulmonary TB disease, regardless of age, HIV status and comorbidities. We estimated the weighted pooled proportions of subclinical TB using a random-effects model by World Health Organization reported TB incidence, populations and settings. We also pooled the proportion of subclinical TB according to definitions described in published prevalence surveys. RESULTS We identified 29 prevalence surveys and 71 other studies. Prevalence survey data (2002-2022) using "absence of cough of any duration" criteria reported higher subclinical TB prevalence than those using the stricter "completely asymptomatic" threshold. Prevalence estimates overlap in studies using other symptoms and cough duration. Subclinical TB in studies was commonly defined as asymptomatic TB disease. Higher prevalence was reported in high TB burden areas, community settings and immunocompetent populations. People with subclinical TB showed less extensive radiographic abnormalities, higher treatment success rates and lower mortality, although studies were few. CONCLUSION A substantial proportion of TB is subclinical. However, prevalence estimates were highly heterogeneous between settings. Most published studies incompletely characterised the phenotype of people with subclinical TB. Standardised definitions and diagnostic criteria are needed to characterise this phenotype. Further research is required to enhance case finding, screening, diagnostics and treatment options for subclinical TB.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Both authors contributed equally
| | - Emily Lai-Ho MacLean
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Both authors contributed equally
| | - Greg J Fox
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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2
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Ahmed MH, Ahmed F, Abu-Median AB, Panourgia M, Owles H, Ochieng B, Ahamed H, Wale J, Dietsch B, Mital D. HIV and an Ageing Population-What Are the Medical, Psychosocial, and Palliative Care Challenges in Healthcare Provisions. Microorganisms 2023; 11:2426. [PMID: 37894084 PMCID: PMC10608969 DOI: 10.3390/microorganisms11102426] [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: 08/29/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
The continuing increase in patient numbers and improvement in healthcare provisions of HIV services in the UK, alongside the effectiveness of combined antiretroviral therapy (cART), has resulted in increasing numbers of the ageing population among people living with HIV (PLWH). It is expected that geriatricians will need to deal with many older people living with HIV (OPLWH) as life expectancy increases. Therefore, geriatric syndromes in OPLWH will be similar to the normal population, such as falls, cognitive decline, frailty, dementia, hypertension, diabetes and polypharmacy. The increase in the long-term use of cART, diabetes, dyslipidaemia and hypertension may lead to high prevalence of cardiovascular disease (CVD). The treatment of such conditions may lead to polypharmacy and may increase the risk of cART drug-drug interactions. In addition, the risk of developing infection and cancer is high. OPLWH may develop an early onset of low bone mineral density (BMD), osteoporosis and fractures. In this review, we have also provided potential psychosocial aspects of an ageing population with HIV, addressing issues such as depression, stigma, isolation and the need for comprehensive medical and psychosocial care through an interdisciplinary team in a hospital or community setting. OPLWH have a relatively high burden of physical, psychological, and spiritual needs and social difficulties, which require palliative care. The holistic type of palliative care that will improve physical, emotional and psychological wellbeing is discussed in this review.
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Affiliation(s)
- Mohamed H. Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
| | - Fatima Ahmed
- Tele-Geriatric Research Fellowship, Geriatric Division, Family Medicine Department, Michigan State University, East Lansing, MI 48824, USA
| | - Abu-Bakr Abu-Median
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester LE1 9BH, UK
| | - Maria Panourgia
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
| | - Henry Owles
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
| | - Bertha Ochieng
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester LE1 9BH, UK
| | - Hassan Ahamed
- Tele-Geriatric Research Fellowship, Geriatric Division, Family Medicine Department, Michigan State University, East Lansing, MI 48824, USA
| | - Jane Wale
- Department of Palliative Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
| | - Benjamin Dietsch
- Department of Palliative Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
| | - Dushyant Mital
- Department of HIV and Blood Borne Virus, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
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3
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Szychowiak P, Boulain T, Timsit JF, Elabbadi A, Argaud L, Ehrmann S, Issa N, Canet E, Martino F, Bruneel F, Quenot JP, Wallet F, Azoulay É, Barbier F. Clinical spectrum and prognostic impact of cancer in critically ill patients with HIV: a multicentre cohort study. Ann Intensive Care 2023; 13:74. [PMID: 37608140 PMCID: PMC10444715 DOI: 10.1186/s13613-023-01171-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/04/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Both AIDS-defining and non-AIDS-defining cancers (ADC/NADC) predispose people living with HIV (PLHIV) to critical illnesses. The objective of this multicentre study was to investigate the prognostic impact of ADC and NADC in PLHIV admitted to the intensive care unit (ICU). METHODS All PLHIV admitted over the 2015-2020 period in 12 university-affiliated ICUs in France were included in the study cohort. The effect of ADC and NADC on in-hospital mortality (primary study endpoint) was measured through logistic regression with augmented backward elimination of potential independent variables. The association between ADC/NADC and treatment limitation decision (TLD) during the ICU stay (secondary study endpoint) was analysed. One-year mortality in patients discharged alive from the index hospital admission (exploratory study endpoint) was compared between those with ADC, NADC or no cancer. RESULTS Amongst the 939 included PLHIV (median age, 52 [43-59] years; combination antiretroviral therapy, 74.4%), 97 (10.3%) and 106 (11.3%) presented with an active NADC (mostly lung and intestinal neoplasms) and an active ADC (predominantly AIDS-defining non-Hodgkin lymphoma), respectively. Inaugural admissions were common. Bacterial sepsis and non-infectious neoplasm-related complications accounted for most of admissions in these subgroups. Hospital mortality was 12.4% in patients without cancer, 30.2% in ADC patients and 45.4% in NADC patients (P < 0.0001). NADC (adjusted odds ratio [aOR], 7.00; 95% confidence interval [CI], 4.07-12.05) and ADC (aOR, 3.11; 95% CI 1.76-5.51) were independently associated with in-hospital death after adjustment on severity and frailty markers. The prevalence of TLD was 8.0% in patients without cancer, 17.9% in ADC patients and 33.0% in NADC patients (P < 0.0001)-organ failures and non-neoplastic comorbidities were less often considered in patients with cancer. One-year mortality in survivors of the index hospital admission was 7.8% in patients without cancer, 17.0% in ADC patients and 33.3% in NADC patients (P < 0.0001). CONCLUSIONS NADC and ADC are equally prevalent, stand as a leading argument for TLD, and strongly predict in-hospital death in the current population of PLHIV requiring ICU admission.
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Affiliation(s)
- Piotr Szychowiak
- Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, 14, Avenue de L'Hôpital, 45100, Orléans, France
| | - Thierry Boulain
- Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, 14, Avenue de L'Hôpital, 45100, Orléans, France
| | - Jean-François Timsit
- Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Universitaire Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandre Elabbadi
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Argaud
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Stephan Ehrmann
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Nahema Issa
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Emmanuel Canet
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Frédéric Martino
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de La Guadeloupe, Pointe-À-Pitre, France
| | - Fabrice Bruneel
- Réanimation et Unité de Surveillance Continue, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Jean-Pierre Quenot
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Dijon-Bourgogne, Dijon, France
| | - Florent Wallet
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Élie Azoulay
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Barbier
- Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, 14, Avenue de L'Hôpital, 45100, Orléans, France.
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4
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Phillips V, Quest TE, Higgins M, Marconi VC, Balthazar MS, Holstad M. A Cost-Effective Analysis of Motivational Interviewing with Palliative Care Versus Usual Care: Results from the Living Well Project. AIDS Behav 2023; 27:1259-1268. [PMID: 36334215 PMCID: PMC10832615 DOI: 10.1007/s10461-022-03862-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/08/2022]
Abstract
Little is known about the impact of early palliative care (EPC) combined with motivational interviewing (MI) for persons living with AIDS (PWA). We compared the cost and quality-adjusted life-years (QALYs) of EPC + MI (n = 61) versus usual care (UC) (n = 60) for patients with AIDS, not on antiretroviral medications, enrolled into the Living Well Project trial. Data on clinic, emergency department, and hospital visits were collected through self-report and billing records. Risk-adjusted average annual health care costs were estimated using a generalized linear model with a gamma log-link function. QALYs were calculated using the SF-12v2. Cost-effectiveness was defined as cost per QALY gained. Estimated intervention costs were $165 per participant. EPC + MI reduced costs by 33% (AOR = 0.67; CI 95%: 0.15, 0.93). QALYs did not differ between groups. Results suggest EPC + MI for PWA is cost-saving and maintains quality of life compared to UC due to reduced hospital and ED costs.
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Affiliation(s)
- Victoria Phillips
- Department of Health Policy and Management, Rollins School of Public Health of Emory University, Atlanta, Georgia.
- Rollins School of Public Health of Emory University, 1518 Clifton Road, Room 614, 30322, Atlanta, GA, USA.
| | - Tammie E Quest
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Melinda Higgins
- Office of Research, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Vincent C Marconi
- Department of Infectious Disease, Emory University School of Medicine, Atlanta, Georgia
| | - Monique S Balthazar
- Georgia State University Byrdine F. Lewis College of Nursing and Health Professions, Atlanta, Georgia
| | - Marcia Holstad
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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5
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Gaillet A, Azoulay E, de Montmollin E, Garrouste-Orgeas M, Cohen Y, Dupuis C, Schwebel C, Reignier J, Siami S, Argaud L, Adrie C, Mourvillier B, Ruckly S, Forel JM, Timsit JF. Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort. Crit Care 2023; 27:108. [PMID: 36915207 PMCID: PMC10012467 DOI: 10.1186/s13054-023-04325-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/17/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE Despite antiviral therapy (ART), 800,000 deaths still occur yearly and globally due to HIV infection. In parallel with the good virological control and the aging of this population, multiple comorbidities [HIV-associated-non-AIDS (HANA) conditions] may now be observed. METHODS HIV adult patients hospitalized in intensive care unit (ICU) from all the French region from university and non-university hospital who participate to the OutcomeRea™ database on a voluntary basis over a 24-year period. RESULTS Of the 24,298 stays registered, 630 (2.6%) were a first ICU stay for HIV patients. Over time, the mean age and number of comorbidities (diabetes, renal and respiratory history, solid neoplasia) of patients increased. The proportion of HIV diagnosed on ICU admission decreased significantly, while the median duration of HIV disease as well as the percentage of ART-treated patients increased. The distribution of main reasons for admission remained stable over time (acute respiratory distress > shock > coma). We observed a significant drop in the rate of active opportunistic infection on admission, while the rate of active hemopathy (newly diagnosed or relapsed within the last 6 months prior to admission to ICU) qualifying for AIDS increased-nonsignificantly-with a significant increase in the anticancer chemotherapy administration in ICU. Admissions for HANA or non-HIV reasons were stable over time. In multivariate analysis, predictors of 60-day mortality were advanced age, chronic liver disease, past chemotherapy, sepsis-related organ failure assessment score > 4 at admission, hospitalization duration before ICU admission > 24 h, AIDS status, but not the period of admission. CONCLUSION Whereas the profile of ICU-admitted HIV patients has evolved over time (HIV better controlled but more associated comorbidities), mortality risk factors remain stable, including AIDS status.
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Affiliation(s)
- Antoine Gaillet
- Medical Intensive Care Unit, Henri Mondor University Hospital, APHP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France. .,IAME UMR 1137, INSERM, Paris University, 75018, Paris, France.
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, APHP, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Etienne de Montmollin
- IAME UMR 1137, INSERM, Paris University, 75018, Paris, France.,Medical Intensive Care Unit, Paris Diderot University/Bichat University Hospital, APHP, Paris, France
| | - Maité Garrouste-Orgeas
- Medical Unit, French-British Hospital Institute Levallois-Perret, Levallois-Perret, France
| | - Yves Cohen
- Medical-Surgical Intensive Care Unit, Avicenne University Hospital, Paris Seine Saint-Denis Hospital Network, APHP, Bobigny, France
| | - Claire Dupuis
- Medical Intensive Care Unit, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Nutrition Humaine Unit, INRAe, CRNH Auvergne, Clermont Auvergne University, 63000, Clermont-Ferrand, France
| | - Carole Schwebel
- Medical ICU, Albert Michallon University Hospital, Grenoble 1 University, Grenoble, France
| | - Jean Reignier
- Medical ICU, Nantes University Hospital, Nantes, France
| | - Shidasp Siami
- Polyvalent ICU, Sud Essonne Dourdan-Etampes Hospital, Dourdan, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France
| | | | - Bruno Mourvillier
- Medical Intensive Care Unit, Reims University Hospital, Reims, France
| | - Stéphane Ruckly
- IAME UMR 1137, INSERM, Paris University, 75018, Paris, France
| | - Jean-Marie Forel
- Medical ICU, Hôpital Nord University Hospital, Marseille, France
| | - Jean-Francois Timsit
- IAME UMR 1137, INSERM, Paris University, 75018, Paris, France. .,Medical Intensive Care Unit, Paris Diderot University/Bichat University Hospital, APHP, Paris, France.
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6
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Advanced HIV disease and health-related suffering-exploring the unmet need of palliative care. Lancet HIV 2023; 10:e126-e133. [PMID: 36427522 PMCID: PMC7614396 DOI: 10.1016/s2352-3018(22)00295-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/24/2022]
Abstract
With more than 38 million people living with HIV worldwide, the scale-up of antiretroviral therapy ensures nearly 28 million of them receive regular treatment. However, a substantial number of deaths still occur every year from AIDS-related complications, with approximately 680 000 deaths in 2021. Of the estimated 56·8 million people globally in need of palliative care in 2020, only 7 million can access services. Providing palliative care services can help alleviate health-related suffering, such as pain and disease-related symptoms, and improve wellbeing. This Viewpoint discusses the unrealised potential of palliative care in individuals with advanced HIV disease. Key areas of training for health-care workers include appropriate sensitisation, training in palliative care, and effective communication. Advance care planning supports both the individual and their family and is therefore of crucial importance. Integration of palliative care in HIV programmes is needed to address health-related suffering, particularly for advanced HIV disease.
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7
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Qama E, Rubinelli S, Diviani N. Factors influencing the integration of self-management in daily life routines in chronic conditions: a scoping review of qualitative evidence. BMJ Open 2022; 12:e066647. [PMID: 36585140 PMCID: PMC9809267 DOI: 10.1136/bmjopen-2022-066647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Self-management of chronic diseases is regarded as dynamic experience which is always evolving and that requires constant adjustment. As unexpected and new shifts in diseases occur, patients tend to abandon acquired behaviours calling into question their sustainability over time. Developing a daily self-management routine as a response to lifestyle changes is considered to facilitate self-management performance. However, fitting self-management recommendations in one's daily life activities is a constant challenge. In this review, we describe the performance of self-management routines within daily settings in people living with chronic conditions with the aim of identifying factors that challenge its integration in daily life. DESIGN Scoping review. DATA SOURCES We searched PubMed, Web of Science, CINAHL and PsycINFO on February 2022. ELIGIBILITY CRITERIA We included qualitative studies on self-management experience, in English, with adult participants, original and peer-reviewed, and depicting the performance of self-management activities in one's own environment. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened titles and abstracts. After agreement, one reviewer screened the full text of relevant articles and extracted the data. The data were synthesised and analysed thematically. PRISMA Extension for Scoping Reviews checklist was used for reporting the steps. RESULTS Twenty-two studies were included. The thematic analysis brought up two overreaching themes. The first one is the Environment support with three subthemes: family and cultural norms; health professionals and guiding communication; and society and disease perceptions. The second theme is comprehension gap with two subthemes: reading the body and applying information. CONCLUSIONS The integration of self-management requirements in a daily routine is affected by the patients' inability to apply disease knowledge in different context and by the challenge of understanding body symptoms and predicting body reactions in advance.
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Affiliation(s)
- Enxhi Qama
- Person-centered Healthcare & Health Communication Group, Swiss Paraplegic Research, Nottwil, Switzerland
- University of Lucerne, Lucerne, Switzerland
| | - Sara Rubinelli
- Person-centered Healthcare & Health Communication Group, Swiss Paraplegic Research, Nottwil, Switzerland
- University of Lucerne, Lucerne, Switzerland
| | - Nicola Diviani
- Person-centered Healthcare & Health Communication Group, Swiss Paraplegic Research, Nottwil, Switzerland
- University of Lucerne, Lucerne, Switzerland
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8
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Okyere J, Mensah ABB, Kissah-Korsah K. Covid-19 Front-Liners: Experiences of Palliative Care Providers in a Tertiary Hospital. SAGE Open Nurs 2022; 8:23779608221132172. [PMID: 36267052 PMCID: PMC9577064 DOI: 10.1177/23779608221132172] [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: 07/08/2022] [Revised: 09/17/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction In “normal” times, palliative care (PC) service delivery is confronted with
many challenges thereby making access to care difficult. Now, we are in the
era of COVID-19 where the healthcare ecology is radically changed. During
this process of radical transformation, there are some ramification of
COVID-19 on PC service delivery. Yet, there is a paucity of empirical
evidence to support this claim. Objective We explored PC providers’ perspectives on delivering PC services in the era
of COVID-19. Methods Using an exploratory descriptive qualitative approach, we conducted
face-to-face and telephone interviews with seven PC service providers at
Korle Bu Teaching Hospital, Ghana. Haase's adaptation of Colaizzi's method
was employed as the analysis strategy. Results Two main themes emerged: ramifications and adaptations. The ramifications of
COVID-19 on PC service delivery included changes in care relationship,
perceived increased responsibilities, psychological distress, shortage of
medicines, and treatment delays. In an attempt to mitigate the challenges
posed by COVID-19 on PC service delivery, the following mechanisms
adaptations were made: halting of service provision, resorting to
tele-consultation, adopting shift system and reducing number of
appointments, and adoption of infection prevention and control
strategies. Conclusions Our results indicate that COVID-19 has substantial ramification of PC service
delivery. In conclusion, priority should be given to the training of
healthcare workers on emergency preparedness for future pandemics. Also,
continuous professional development would be needed in order build PC
service providers’ skills and capacity to effectively utilize
tele-consultation in PC service delivery.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health,
University of
Cape Coast, Cape Coast, Ghana,Department of Nursing, College of Health Sciences,
Kwame Nkrumah
University of Science and Technology,
Kumasi, Ghana,Joshua Okyere, Department of Population and
Health, University of Cape Coast, University Post Office, Cape Coast, Ghana.
| | - Adwoa Bemah Boamah Mensah
- Department of Nursing, College of Health Sciences,
Kwame Nkrumah
University of Science and Technology,
Kumasi, Ghana
| | - Kwaku Kissah-Korsah
- Department of Population and Health,
University of
Cape Coast, Cape Coast, Ghana
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9
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Cluver LD, Sherr L, Toska E, Zhou S, Mellins CA, Omigbodun O, Li X, Bojo S, Thurman T, Ameyan W, Desmond C, Willis N, Laurenzi C, Nombewu A, Tomlinson M, Myeketsi N. From surviving to thriving: integrating mental health care into HIV, community, and family services for adolescents living with HIV. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:582-592. [PMID: 35750063 DOI: 10.1016/s2352-4642(22)00101-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 01/10/2023]
Abstract
Adolescents are a crucial generation, with the potential to bring future social and economic success for themselves and their countries. More than 90% of adolescents living with HIV reside in sub-Saharan Africa, where their mental health is set against a background of poverty, familial stress, service gaps, and an HIV epidemic that is now intertwined with the COVID-19 pandemic. In this Series paper, we review systematic reviews, randomised trials, and cohort studies of adolescents living with and affected by HIV. We provide a detailed overview of mental health provision and collate evidence for future approaches. We find that the mental health burden for adolescents living with HIV is high, contributing to low quality of life and challenges with adherence to antiretroviral therapy. Mental health provision is scarce, infrastructure and skilled providers are missing, and leadership is needed. Evidence of effective interventions is emerging, including specific provisions for mental health (eg, cognitive behavioural therapy, problem-solving, mindfulness, and parenting programmes) and broader provisions to prevent drivers of poor mental health (eg, social protection and violence prevention). We provide evidence of longitudinal associations between unconditional government grants and improved mental health. Combinations of economic and social interventions (known as cash plus care) could increase mental health benefits. Scalable delivery models include task sharing, primary care integration, strengthening families, and a pyramid of provision that differentiates between levels of need, from prevention to the care of severe disorders. A turning point has now been reached, from which complacency cannot persist. We conclude that there is substantial need, available frameworks, and a growing evidence base for action while infrastructure and skill acquisition is built.
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Affiliation(s)
- Lucie D Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Lorraine Sherr
- Institute of Global Health, University College London, London, UK
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Claude-Ann Mellins
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Columbia University Irving Medical Center, New York, NY, USA
| | - Olayinka Omigbodun
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Samuel Bojo
- Agency for Research and Development Initiative, Juba, South Sudan
| | - Tonya Thurman
- Highly Vulnerable Children Research Center, Cape Town, South Africa; Tulane University School of Public Health, New Orleans, LA, USA
| | - Wole Ameyan
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Chris Desmond
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Christina Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Amahle Nombewu
- Teen Advisory Group, University of Cape Town, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Noxolo Myeketsi
- Department of Information Systems, University of the Western Cape, Cape Town, South Africa
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10
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Kobayashi T, Salinas JL, Ten Eyck P, Chen B, Ando T, Inagaki K, Alsuhaibani M, Auwaerter PG, Molano I, Diekema DJ. Palliative care consultation in patients with Staphylococcus aureus bacteremia. Palliat Med 2021; 35:785-792. [PMID: 33757367 PMCID: PMC8436633 DOI: 10.1177/0269216321999574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Palliative care consultation has shown benefits across a wide spectrum of diseases, but the utility in patients with Staphylococcus aureus bacteremia remains unclear despite its high mortality. AIM To examine the frequency of palliative care consultation and factors associated with palliative care consult in Staphylococcus aureus bacteremia patients in the United States. DESIGN A population-based retrospective analysis using the Nationwide Inpatient Sample database in 2014, compiled by the Healthcare Costs and Utilization Project of the Agency for Healthcare Research and Quality. SETTING/SUBJECTS All inpatients with a discharge diagnosis of Staphylococcus aureus bacteremia (ICD-9-CM codes; 038.11 and 038.12). MEASUREMENTS Palliative care consultation was identified using ICD-9-CM code V66.7. Patients' baseline characteristics and outcomes were compared between those with and without palliative care consult. RESULTS A total of 111,320 Staphylococcus aureus bacteremia admissions were identified in 2014. Palliative care consult was observed in 8140 admissions (7.3%). Palliative care consultation was associated with advanced age, white race, comorbidities, higher income, teaching/urban hospitals, Midwest region, Methicillin-resistant Staphylococcus aureus bacteremia and the lack of echocardiogram. Palliative care consult was also associated with shorter but more expensive hospitalizations. Crude mortality was 53% (4314/8140) among admissions with palliative care consult and 8% (8357/10,3180) among those without palliative care consult (p < 0.001). CONCLUSIONS Palliative care consultation was infrequent during the management of Staphylococcus aureus bacteremia, and a substantial number of patients died during their hospitalizations without palliative care consult. Given the reported benefit in other medical conditions, palliative care consultation may have a role in Staphylococcus aureus bacteremia. Selecting patients who may benefit the most should be explored.
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Affiliation(s)
- Takaaki Kobayashi
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Jorge L Salinas
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Benjamin Chen
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Tomo Ando
- Division of Cardiology, Columbia University, New York, NY, USA
| | - Kengo Inagaki
- Division of Infectious Diseases, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mohammed Alsuhaibani
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Department of Pediatrics, College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Paul G Auwaerter
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ilonka Molano
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Division of Supportive and Palliative Care, University of Iowa, Iowa City, IA, USA
| | - Daniel J Diekema
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
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11
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Lyon ME, Caceres S, Scott RK, Benator D, Briggs L, Greenberg I, D'Angelo LJ, Cheng YI, Wang J. Advance Care Planning-Complex and Working: Longitudinal Trajectory of Congruence in End-of-Life Treatment Preferences: An RCT. Am J Hosp Palliat Care 2021; 38:634-643. [PMID: 33530701 DOI: 10.1177/1049909121991807] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
CONTEXT The effect of advance care planning (ACP) interventions on the trajectory of end-of-life treatment preference congruence between patients and surrogate decision-makers is unstudied. OBJECTIVE To identify unobserved distinctive patterns of congruence trajectories and examine how the typology of outcome development differed between ACP and controls. METHODS Multisite, assessor-blinded, intent-to-treat, randomized clinical trial enrolled participants between October 2013 to March 2017 from 5 hospital-based HIV clinics. Persons living with HIV(PLWH)/surrogate dyads were randomized to 2 weekly 60-minute sessions: ACP (1) ACP facilitated conversation, (2) advance directive completion; or Control (1) Developmental/relationship history, (2) Nutrition/Exercise. Growth Mixed Modeling was used for 18-month post-intervention analysis. FINDINGS 223 dyads (N = 449 participants) were enrolled. PLWH were 56% male, aged 22 to 77 years, and 86% African American. Surrogates were 56% female, aged 18 to 82 years, and 84% African American. Two latent classes (High vs. Low) of congruence growth trajectory were identified. ACP influenced the trajectory of outcome growth (congruence in all 5 AIDS related situations) by latent class. ACP dyads had a significantly higher probability of being in the High Congruence latent class compared to controls (52%, 75/144 dyads versus 27%, 17/62 dyads, p = 0.001). The probabilities of perfect congruence diminished at 3-months post-intervention but was then sustained. ACP had a significant effect (β = 1.92, p = 0.006, OR = 7.10, 95%C.I.: 1.729, 26.897) on the odds of being in the High Congruence class. CONCLUSION ACP had a significant effect on the trajectory of congruence growth over time. ACP dyads had 7 times the odds of congruence, compared to controls. Three-months post-intervention is optimal for booster sessions.
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Affiliation(s)
- Maureen E Lyon
- Division of Adolescent and Young Adult Medicine, 571630Children's National Hospital, Washington, District of Columbia (DC), USA.,Center for Translational Research/Children's Research Institute, Washington, DC, USA.,George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sarah Caceres
- Nova Southeastern University School of Nursing, Fort Lauderdale, FL, USA
| | - Rachel K Scott
- MedStar: Health Research Institute and Washington Hospital Center, Washington, DC, USA
| | - Debra Benator
- Washington DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Linda Briggs
- Respecting Choices, Coalition to Transform Advance Care Innovations, Washington, DC, USA
| | | | - Lawrence J D'Angelo
- Division of Adolescent and Young Adult Medicine, 571630Children's National Hospital, Washington, District of Columbia (DC), USA
| | | | - Jichuan Wang
- Center for Translational Research/Children's Research Institute, Washington, DC, USA.,George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Division of Biostatistics & Study Methodology, Center for Translational Research/Children's Research Institute, Washington, DC, USA
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12
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Grill KB, Wang J, Scott RK, Benator D, D'Angelo LJ, Lyon ME. What Do Adults With HIV Want? End-of-Life Care Goals, Values and Beliefs by Gender, Race, Sexual Orientation. Am J Hosp Palliat Care 2021; 38:610-617. [PMID: 33464114 DOI: 10.1177/1049909120988282] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We examined factors influencing end-of-life care preferences among persons living with HIV (PLWH). METHODS 223 PLWH were enrolled from 5 hospital-based clinics in Washington, DC. They completed an end-of-life care survey at baseline of the FACE™-HIV Advance Care Planning clinical trial. FINDINGS The average age of patients was 51 years. 56% were male, 66% heterosexual, and 86% African American. Two distinct groups of patients were identified with respect to end-of-life care preferences: (1) a Relational class (75%) who prioritized family and friends, comfort from church services, and comfort from persons at the end-of-life; and (2) a Transactional/Self-Determination class (25%) who prioritized honest answers from their doctors, and advance care plans over relationships. African Americans had 3x the odds of being in the Relational class versus the Transactional/Self-determination class, Odds ratio = 3.30 (95% CI, 1.09, 10.03), p = 0.035. Males were significantly less likely to be in the relational latent class, Odds ratio = 0.38 (CI, 0.15, 0.98), p = 0.045. Compared to non-African-Americans, African-American PLWH rated the following as important: only taking pain medicines when pain is severe, p = 0.0113; saving larger doses for worse pain, p = 0.0067; and dying in the hospital, p = 0.0285. PLWH who were sexual minorities were more afraid of dying alone, p = 0.0397, and less likely to only take pain medicines when pain is severe, p = 0.0091. CONCLUSION Integrating culturally-sensitive palliative care services as a component of the HIV care continuum may improve health equity and person-centered care.
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Affiliation(s)
| | - Jichuan Wang
- Division of Biostatistics and Study Methodology, Center for Translational Research at Children's National Hospital, Washington, DC, USA.,George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rachel K Scott
- MedStar Health Research Institute and Washington Hospital Center, Washington, DC, USA
| | - Debra Benator
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Washington DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Lawrence J D'Angelo
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Division of Adolescent and Young Adult Medicine, 571630Children's National Hospital, Washington, DC, USA
| | - Maureen E Lyon
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Division of Adolescent and Young Adult Medicine, 571630Children's National Hospital, Washington, DC, USA.,Center for Translational Research/Children's National Research Institute at 571630Children's National Hospital, Washington, DC, USA
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13
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Lyon ME, Squires L, Scott RK, Benator D, Briggs L, Greenberg I, D'Angelo LJ, Cheng YI, Wang J. Effect of FAmily CEntered (FACE®) Advance Care Planning on Longitudinal Congruence in End-of-Life Treatment Preferences: A Randomized Clinical Trial. AIDS Behav 2020; 24:3359-3375. [PMID: 32399799 PMCID: PMC7699823 DOI: 10.1007/s10461-020-02909-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Trial tested effect of advance care planning on family/surrogates' understanding of patients' end-of-life treatment preferences longitudinally. A multisite, assessor-blinded, intent-to-treat, parallel-group, randomized controlled clinical trial in five hospital-based HIV clinics enrolled 449 participants aged 22 to 77 years during October 2013-March 2017. Patients living with HIV/family dyads were randomized at 2:1 ratio to 2 weekly ~ 60-min sessions either ACP (n = 155 dyads)-(1) ACP facilitated conversation, (2) Advance directive completion; or Control (n = 68 dyads)-(1) Developmental/relationship history, (2) Nutrition/exercise tips. ACP families/surrogates were more likely to accurately report patients' treatment preferences at Time 1 (T1) and 12 months post-intervention (T2) compared to controls, experiencing high congruence longitudinally (high→high transition), [63·6% vs 37·7% (difference = 25·9%, 95% CI: 11·3%, 40·4%, χ2 = 11·52, p = 0·01)], even as patients' preferences changed over time. ACP families/surrogates had eight times the odds of controls of having an excellent understanding of patients' treatment preferences (Adjusted Odds Ratio 7.91, 95%CI: 3.08, 20.3). Conversations matter.
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Affiliation(s)
- Maureen E Lyon
- Division of Adolescent and Young Adult Medicine, Children's National, Center for Translational Research/Children's Research Institute, Washington, DC, USA.
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Division of Adolescent and Young Adult Medicine at Children's National Health System, Center for Translational Research/Children's Research Institute, 111 Michigan Avenue, N.W., Room M7658, Washington, DC, 20010-2970, USA.
| | - Leah Squires
- Washington DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Rachel K Scott
- MedStar: Health Research Institute and Washington Hospital Center, Washington, DC, USA
| | - Debra Benator
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Washington DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Linda Briggs
- Respecting Choices, Coalition to Transform Advance Care Innovations, Washington, DC, USA
| | | | - Lawrence J D'Angelo
- Division of Adolescent and Young Adult Medicine, Children's National, Center for Translational Research/Children's Research Institute, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Yao Iris Cheng
- Division of Biostatistics & Study Methodology, Center for Translational Research/Children's Research Institute, Washington, DC, USA
| | - Jichuan Wang
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Division of Biostatistics & Study Methodology, Center for Translational Research/Children's Research Institute, Washington, DC, USA
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14
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Gilliams EA, Ammirati RJ, Nguyen MLT, Shahane AA, Farber EW, Marconi VC. Increased Retention in Care After a Palliative Care Referral Among People Living With HIV. J Acquir Immune Defic Syndr 2020; 84:78-84. [PMID: 31923086 DOI: 10.1097/qai.0000000000002296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early palliative care addresses biopsychosocial needs for people living with HIV in an outpatient setting. We sought to describe patients referred to a palliative care program and compare the medical outcomes of emergency department (ED) visits, hospitalizations, primary care visits, and viral load suppression among patients enrolled in the program, to patients who did not enroll (no-show group). SETTING We completed a retrospective cohort study at an urban, academically affiliated HIV primary care clinic. METHODS Data were collected from electronic medical records. Descriptive statistics characterized patient demographics at baseline, comorbidities, and reasons for referral to palliative care. Viral load suppression, rates of ED visits, hospitalizations, primary care visits, and retention in care were compared between the palliative and no-show groups. RESULTS The most common reasons for referral were chronic pain management and medication/appointment adherence. Median percent of viral load measurements suppressed increased over time, but did not differ statistically between groups (pre: 28.6% and 15.5%, post: 70.8% and 50.0%, palliative and no-show groups, respectively). Median rates of ED visits and hospitalizations were low and were not impacted by palliative care. Rates of primary care visit attendance remained stable in the palliative group (4.6/year) but declined in the no-show group (3.5/year), P < 0.05. Retention in care improved significantly after the palliative intervention (palliative: 85.4%-96.1%, no-show: 94.4%-82.5%), and at high and low palliative engagement, suggesting a threshold effect of the intervention. CONCLUSION Outpatient early palliative care is a promising intervention that might impact retention in HIV care.
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Affiliation(s)
- Elizabeth A Gilliams
- Department of Medicine, Emory University School of Medicine, Atlanta, GA.,Currently, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rachel J Ammirati
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Minh L T Nguyen
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Amit A Shahane
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA.,Currently, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA; and
| | - Eugene W Farber
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA.,Department of Global Health, Rollins School of Public Health, Atlanta, GA
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15
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Nair M, Kumar P, Mahajan R, Harshana A, Richardson K, Moreto-Planas L, Burza S. Lived experiences of palliative care among people living with HIV/AIDS: a qualitative study from Bihar, India. BMJ Open 2020; 10:e036179. [PMID: 33020082 PMCID: PMC7537445 DOI: 10.1136/bmjopen-2019-036179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study aimed to assess the lived experiences of palliative care among critically unwell people living with HIV/AIDS (PLHA), caregivers and relatives of deceased patients. It also aimed to understand the broader palliative care context in Bihar. DESIGN This was an exploratory, qualitative study which used thematic analysis of semistructured, in-depth interviews as well as a focus group discussion. SETTING All interviews took place in a secondary care hospital in Patna, Bihar which provides holistic care to critically unwell PLHA. PARTICIPANTS We purposively selected 29 participants: 10 critically unwell PLHA, 5 caregivers of hospitalised patients, 7 relatives of deceased patients who were treated in the secondary care hospital and 7 key informants from community-based organisations. RESULTS Critically ill PLHA emphasised the need for psychosocial counselling and opportunities for social interaction in the ward, as well as a preference for components of home-based palliative care, even though they were unfamiliar with actual terms such as 'palliative care' and 'end-of-life care'. Critically unwell PLHA generally expressed preference for separate, private inpatient areas for end-of-life care. Relatives of deceased patients stated that witnessing patients' deaths caused trauma for other PLHA. Caregivers and relatives of deceased patients felt there was inadequate time and space for grieving in the hospital. While both critically ill PLHA and relatives wished that poor prognosis be transparently disclosed to family members, many felt it should not be disclosed to the dying patients themselves. CONCLUSIONS Despite expected high inpatient fatality rates, PLHA in Bihar lack access to palliative care services. PLHA receiving end-of-life care in hospitals should have a separate dedicated area, with adequate psychosocial counselling and activities to prevent social isolation. Healthcare providers should make concerted efforts to inquire, understand and adapt their messaging on prognosis and end-of-life care based on patients' preferences.
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Affiliation(s)
- Mohit Nair
- Medecins Sans Frontieres, New Delhi, Delhi, India
| | - Pragya Kumar
- Community & Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | | | | | | | | | - Sakib Burza
- Medecins Sans Frontieres, New Delhi, Delhi, India
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16
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Alexander CS, Raveis VH, Karus D, Carrero-Tagle M, Lee MC, Pappas G, Lockman K, Brotemarkle R, Memiah P, Mulasi I, Hossain BM, Welsh C, Henley Y, Piet L, N'Diaye S, Murray R, Haltiwanger D, Smith CR, Flynn C, Redfield R, Silva CL, Amoroso A, Selwyn P. Early Use of the Palliative Approach to Improve Patient Outcomes in HIV Disease: Insights and Findings From the Care and Support Access (CASA) Study 2013-2019. Am J Hosp Palliat Care 2020; 38:332-339. [PMID: 32851870 DOI: 10.1177/1049909120951129] [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: 11/15/2022] Open
Abstract
Young men of color who have sex with men (yMSM) living with human immunodeficiency virus (HIV) in syndemic environments have been difficult-to-retain in care resulting in their being at-risk for poor health outcomes despite availability of effective once-daily antiretroviral treatment (ART). Multiple methods have been implemented to improve outcomes for this cohort; none with sustainable results. Outpatient HIV staff themselves may be a contributing factor. We introduced multidisciplinary staff to the concept of using a palliative approach early (ePA) in outpatient HIV care management to enable them to consider the patient-level complexity of these young men. Young MSM (18-35 years of age) enrolled in and cared for at the intervention site of the Care and Support Access Study (CASA), completed serial surveys over 18 months. Patients' Global and Summary quality of life (QoL) increased during the study at the intervention site (IS) where staff learned about ePA, compared with patients attending the control site (CS) (p=.021 and p=.018, respectively). Using serial surveys of staff members, we found that in the era of HIV disease control, outpatient staff are stressed more by environmental factors than by patients' disease status seen historically in the HIV epidemic. A Community Advisory Panel of HIV stakeholders contributed to all phases of this study and altered language used in educational activities with staff members to describe the patient cohort.
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Affiliation(s)
- Carla S Alexander
- Institute of Human Virology, 12264University of Maryland School of Medicine, Baltimore, MD, USA
| | - Victoria H Raveis
- Psychosocial Research Unit on Health, Aging and Community, 70241New York University, New York, NY, USA
| | - Daniel Karus
- Psychosocial Research Unit on Health, Aging and Community, 70241New York University, New York, NY, USA
| | - Monique Carrero-Tagle
- Psychosocial Research Unit on Health, Aging and Community, 70241New York University, New York, NY, USA
| | - Mei Ching Lee
- 12265University of Maryland School of Nursing, Baltimore, MD, USA
| | | | | | | | - Peter Memiah
- Institute of Human Virology, 12264University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ila Mulasi
- Institute of Human Virology, 12264University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Christopher Welsh
- Department of Psychiatry, 12264University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Leslie Piet
- Johns Hopkins Home Health, Baltimore, MD, USA
| | | | - Renard Murray
- Institute of Human Virology, 12264University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Colin Flynn
- Maryland Department of Health and Human Services Prevention, Baltimore, MD, USA
| | | | - Caroline L Silva
- Institute of Human Virology, 12264University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anthony Amoroso
- Institute of Human Virology, 12264University of Maryland School of Medicine, Baltimore, MD, USA
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17
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Catalan J, Ridge D, Cheshire A, Hedge B, Rosenfeld D. The Changing Narratives of Death, Dying, and HIV in the United Kingdom. QUALITATIVE HEALTH RESEARCH 2020; 30:1561-1571. [PMID: 32507074 PMCID: PMC7411528 DOI: 10.1177/1049732320922510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Death and infection were closely linked from the start of the HIV epidemic, until successful treatments became available. The initial impact of mostly young, gay men dying from HIV was powerful in shaping UK responses. Neoliberal discourses developed at the same time, particularly focusing on how citizens (rather than the state) should take responsibility to improve health. Subsequently "successful ageing" became an allied discourse, further marginalising death discussions. Our study reflected on a broad range of meanings around death within the historical UK epidemic, to examine how dying narratives shape contemporary HIV experiences. Fifty-one participants including people living with HIV, professionals, and activists were recruited for semistructured interviews. Assuming a symbolic interactionist framework, analysis highlighted how HIV deaths were initially experienced as not only traumatic but also energizing, leading to creativity. With effective antiretrovirals, dying changed shape (e.g., loss of death literacy), and better integration of palliative care was recommended.
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Affiliation(s)
- Jose Catalan
- South Kensington and Chelsea
Mental Health Centre, London, United Kingdom
| | - Damien Ridge
- University of Westminster, London,
United Kingdom
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18
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Chayama KL, Ng C, McNeil R. Addressing treatment and care needs of older adults living with HIV who use drugs. J Int AIDS Soc 2020; 23:e25577. [PMID: 32851790 PMCID: PMC7449948 DOI: 10.1002/jia2.25577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Older adults living with HIV (OALHIV; ≥50 years) who use drugs face unique needs and challenges that compromise their health and wellbeing due to the structural and environmental barriers they experience, in addition to being disproportionately affected by comorbidities. Nevertheless, research on this population is limited and work is needed to tailor and optimize their care and services. The purpose of this commentary is to address the key research gaps pertaining to OALHIV who use drugs. DISCUSSION We identified four key research gaps specific to OALHIV who use drugs. Gap 1: Increased understanding of how older adults manage HIV alongside comorbidities in the context of substance use is critical to optimize their care management. Gap 2: More information on the geriatric characteristics of OALHIV who use drugs and the need and role of harm reduction in geriatric care is necessary for the provision of appropriate and effective care. Gap 3: Greater knowledge around the adoption of harm reduction and case manager approaches in various care facilities is essential to ensure equitable access to care for OALHIV who use drugs. Gap 4: Improved understanding of barriers to high-quality palliative care among OALHIV who use drugs is important to enhance quality of life across their life course. CONCLUSIONS Addressing the identified gaps in literature will lead to a more fulsome understanding of the issues encountered by OALHIV who use drugs and inform the development and implementation of strategies that address disparities at the intersection of HIV, substance use and ageing.
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Affiliation(s)
- Koharu Loulou Chayama
- British Columbia Centre on Substance UseVancouverBCCanada
- Department of Experimental MedicineFaculty of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Cara Ng
- British Columbia Centre on Substance UseVancouverBCCanada
| | - Ryan McNeil
- British Columbia Centre on Substance UseVancouverBCCanada
- General Internal MedicineSchool of MedicineYale UniversityNew HavenCTUSA
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19
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Jackson BS, Nunes Goncalves J, Pretorius E. Comparison of pathological clotting using haematological, functional and morphological investigations in HIV-positive and HIV-negative patients with deep vein thrombosis. Retrovirology 2020; 17:14. [PMID: 32571345 PMCID: PMC7310079 DOI: 10.1186/s12977-020-00523-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients infected with the human immunodeficiency virus (HIV) are more prone to systemic inflammation and pathological clotting, and many may develop deep vein thrombosis (DVT) as a result of this dysregulated inflammatory profile. Coagulation tests are not routinely performed unless there is a specific reason. METHODS We recruited ten healthy control subjects, 35 HIV negative patients with deep vein thrombosis (HIV negative-DVT), and 13 HIV patients with DVT (HIV positive-DVT) on the primary antiretroviral therapy (ARV) regimen-emtricitabine, tenofovir and efavirenz. Serum inflammatory markers, haematological results, viscoelastic properties using thromboelastography (TEG) and scanning electron microscopy (SEM) of whole blood (WB) were used to compare the groups. RESULTS The DVT patients (HIV positive and HIV negative) had raised inflammatory markers. The HIV positive-DVT group had anaemia in keeping with anaemia of chronic disorders. DVT patients had a hypercoagulable profile on the TEG but no significant difference between HIV negative-DVT and HIV positive-DVT groups. The TEG analysis compared well and supported our ultrastructural results. Scanning electron microscopy of DVT patient's red blood cells (RBCs) and platelets demonstrated inflammatory changes including abnormal cell shapes, irregular membranes and microparticle formation. All the ultrastructural changes were more prominent in the HIV positive-DVT patients. CONCLUSIONS Although there were trends that HIV-positive patients were more hypercoagulable on functional tests (viscoelastic profile) compared to HIV-negative patients, there were no significant differences between the 2 groups. The sample size was, however, small in number. Morphologically there were inflammatory changes in patients with DVT. These ultrastructural changes, specifically with regard to platelets, appear more pronounced in HIV-positive patients which may contribute to increased risk for hypercoagulability and deep vein thrombosis.
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Affiliation(s)
- Brandon S Jackson
- Department of Surgery, University of Pretoria, Pretoria, 0007, South Africa
| | | | - Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, Private Bag X1 Matieland, 7602, South Africa.
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21
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Azoulay É, de Castro N, Barbier F. Critically Ill Patients With HIV: 40 Years Later. Chest 2019; 157:293-309. [PMID: 31421114 DOI: 10.1016/j.chest.2019.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/25/2019] [Accepted: 08/04/2019] [Indexed: 01/27/2023] Open
Abstract
The development of combination antiretroviral therapies (cARTs) in the mid-1990s has dramatically modified the clinical presentation of critically ill, HIV-infected patients. Most cART-treated patients aging with controlled HIV replication are currently admitted to the ICU for non-AIDS-related events, mostly bacterial pneumonia and exacerbation of comorbidities, variably affected by chronic HIV infection (COPD, cardiovascular diseases, or solid neoplasms). Today, Pneumocystis jirovecii pneumonia, cerebral toxoplasmosis, TB, and other severe opportunistic infections only occur in patients with unknown viral status, limited access to cART, viral resistance, or compliance issues. Acute respiratory failure, neurological disorders, and sepsis remain the main conditions that lead HIV-infected patients to the ICU, although admissions for liver diseases or acute kidney injury are increasing. Case fatality dropped substantially over the past decades, reaching figures of HIV-uninfected critically ill patients with similar demographic characteristics, comorbidities, and level of organ dysfunctions. Several other facets of critical care management have evolved in this population, including diagnostic procedures, cART management at the acute phase of critical illness, and ethical considerations. The goal of this narrative review was to depict the current evidence and emerging challenges for the management of critically ill, HIV-infected patients, almost 40 years following the onset of the AIDS epidemic.
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Affiliation(s)
- Élie Azoulay
- Medical Intensive Care Unit, Saint-Louis Hospital, APHP, Paris, France; ECSTRA, SBIM, and the Saint-Louis Hospital, APHP, Paris, France.
| | - Nathalie de Castro
- Department of Infectious Diseases, Saint-Louis Hospital, APHP, Paris, France
| | - François Barbier
- Medical Intensive Care Unit, La Source Hospital, CHR Orléans, Orléans, France
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Limardi S, Saunders R, Tasia Y, Hong PW. Integrating palliative care to improve the care of children living with HIV in Indonesia. PROGRESS IN PALLIATIVE CARE 2019. [DOI: 10.1080/09699260.2019.1646033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | | | - Poon Wing Hong
- Singapore Institute Technology, Director of Nursing, St Luke’s Elder Care, Singapore, Singapore
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23
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Justice AC, Akgün KM. What Does Aging with HIV Mean for Nursing Homes? J Am Geriatr Soc 2019; 67:1327-1329. [PMID: 31063666 PMCID: PMC6612581 DOI: 10.1111/jgs.15950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/27/2019] [Indexed: 12/17/2022]
Abstract
This editorial comments on the article by Miller et al.
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Affiliation(s)
- Amy C. Justice
- Medicine Service, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Kathleen M. Akgün
- Medicine Service, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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