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Mahmoud M, Ballouz T, Lahoud C, Adnan J, Habib PA, Saab R, Farhat H, Hussein ME, Rizk N. Late presentations and missed opportunities among newly diagnosed HIV patients presenting to a specialty clinic in Lebanon. Sci Rep 2024; 14:8296. [PMID: 38594292 PMCID: PMC11004126 DOI: 10.1038/s41598-024-55277-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/22/2024] [Indexed: 04/11/2024] Open
Abstract
Late presentation to medical care of individuals infected with the human immunodeficiency virus (HIV) is linked to poor outcomes and increased morbidity and mortality. Missed opportunities for a prompt diagnosis are frequently reported among late presenters. We aimed to estimate the proportion of late presenters and missed opportunities in diagnosis among newly diagnosed HIV-positive subjects presenting to a specialty clinic in Lebanon. This is a retrospective chart review of all newly diagnosed adult HIV-positive subjects presenting to clinic from 2012 to 2022. Demographic, laboratory, and clinical data were collected at initial HIV diagnosis or presentation to medical care. We defined late presentation as having a CD4 count < 350 or AIDS-defining event regardless of CD4 count. Advanced disease is defined as having a CD4 count below 200 cells/μL or the presence of an AIDS-defining illness, regardless of the CD4 count. A missed opportunity was defined as the presence of an indicator condition (IC) that suggests infection with HIV/AIDS during 3 years preceding the actual HIV diagnosis and not followed by a recommendation for HIV testing. The proportions for demographic, epidemiological, and clinical characteristics are calculated by excluding cases with missing information from the denominator. Our cohort included 150 subjects (92.7% males; 63.6% men who have sex with men (MSM); 33.3% heterosexuals; median age 30.5 years at diagnosis). 77 (51.3%) were late presenters and 53 (35.3% of all subjects, 68.8% of late presenters) had advanced HIV on presentation. Up to 76.5% of late presenters had a presentation with an HIV-related condition at a healthcare provider without getting HIV test within the previous 3 years. The most frequent ICs were weight loss, generalized lymphadenopathy, constitutional symptoms, and chronic idiopathic diarrhea. Overall mortality rate was 4% (6/150 individuals). All-cause mortality among those who presented with AIDS was 15.4% (6/39 subjects). In our setting, late presentations and missed opportunities for HIV diagnosis are common. In the Middle East, AIDS mortality remains high with a large gap in HIV testing. To effectively influence policies, comprehensive analyses should focus on estimating the preventable health and financial burdens of late HIV presentations. Another concern pertains to healthcare providers' attitudes and competencies.
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Affiliation(s)
- Maya Mahmoud
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Chloe Lahoud
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jana Adnan
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Paola Abi Habib
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Reem Saab
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Haya Farhat
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammad El Hussein
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nesrine Rizk
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut, 1107 2020, Lebanon.
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Saliba B, Kang M, Wells N, Mao L, Prestage G, Hammoud MA. Hiding in plain sight: highlighting the research gap on access to HIV and other sexual health services for underrepresented gay men in developed Western countries - insights from a scoping review with a focus on Arab men. Sex Health 2024; 21:NULL. [PMID: 38164800 DOI: 10.1071/sh23131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Strategies pertaining to HIV and sexual health for gay, bisexual, and other men who have sex with men (GBMSM) have shifted focus towards underrepresented subgroups within some developed Western countries. Although emerging research exists on some subgroups, limited attention has been given to the needs of Arab GBMSM in these contexts. Considering they are part of a large diaspora, understanding their access to services is crucial. This paper focuses on Arab GBMSM as a case study within a scoping review, highlighting their hidden status within the broader landscape of HIV and sexual health research for GBMSM in the West. METHODS A multi-method search strategy was employed, including searching four electronic databases using several terms within each of the following search topics: Arab, GBMSM, HIV and other sexual health services, and developed Western countries. RESULTS Of the 384 articles found, only one addressed the research question and met the inclusion criteria, revealing a stark scarcity of research on access to HIV and sexual health services for this population. CONCLUSIONS This review highlights a paucity of research on access to HIV and sexual health services for underrepresented GBMSM populations in developed Western countries. The literature indicates that, for Arab men, this may be due to a difficulty in participant recruitment and poor data collection efforts. By focusing on one hidden population, we aim to advocate for inclusive policies and interventions that promote equitable sexual health access for all. Addressing this research gap aligns with broader local and global HIV strategies to reduce disparities among underrepresented GBMSM populations.
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Affiliation(s)
- Bernard Saliba
- Kirby Institute, UNSW Sydney, Kensington, NSW, Australia; and School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Melissa Kang
- Specialty of General Practice, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | | | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Kensington, NSW, Australia
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Khorrami Z, Balooch Hasankhani M, Khezri M, Jafari-Khounigh A, Jahani Y, Sharifi H. Trends and projection of incidence, mortality, and disability-adjusted life years of HIV in the Middle East and North Africa (1990-2030). Sci Rep 2023; 13:13859. [PMID: 37620356 PMCID: PMC10449905 DOI: 10.1038/s41598-023-40743-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
Evidence shows a growing trend of the HIV epidemic in the Middle East and North Africa (MENA). We aimed to project the incidence, mortality, and disability-adjusted life years (DALY) in the region from 1990 to 2019 and assess its trend by 2025, and 2030. We extracted the HIV incidence, mortality, and DALY data from the Global Burden of Disease (GBD) and UNAIDS databases. The joinpoint regression model was used to examine changes in HIV trends. The trend changes were estimated by average annual percent change (AAPC). In most countries, an increasing trend was observed in HIV incidence, mortality, and DALY. Specifically, the highest growth in the annual incidence rate was related to Egypt (AAPC = 14.4, GBD) and Iran (AAPC = 9.6, UNAIDS). Notably, Qatar (AAPC = - 5.6, GBD), Bahrain (AAPC = - 3.3, GBD), and Somalia (AAPC = - 4.2, UNAIDS) demonstrated a significant reduction in incidence. Regarding mortality rates, Djibouti (AAPC = 24.2, GBD) and Iran (AAPC = 16.2, UNAIDS) exhibited a significant increasing pattern. Furthermore, the estimated increase in incidence by 2030 was most marked in Djibouti (985%) and Iran (174%). Iran (422%) and Egypt (339%) showed a prominent rise in mortality rates. GBD data showed 16 countries had an increasing pattern in DALY in both genders. According to age and period effects, there was a significant upward trend in incidence, mortality rates, and DALY. Findings highlighted the urgent need for improved prevention and treatment services, including expanding access to HIV testing, promoting safe practices, increasing antiretroviral therapy coverage, and supporting targeted interventions for high-risk populations.
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Affiliation(s)
- Zahra Khorrami
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No. 23, Paidarfard St., Pasdaran Ave., Tehran, Iran
| | - Mohammadreza Balooch Hasankhani
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehrdad Khezri
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Jafari-Khounigh
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yones Jahani
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Delabre RM, Moussa AB, Villes V, Elkhammas M, Ouarsas L, Castro Rojas Castro D, Karkouri M. Fear of stigma from health professionals and family/neighbours and healthcare avoidance among PLHIV in Morocco: results from the Stigma Index survey Morocco. BMC Public Health 2022; 22:1705. [PMID: 36076214 PMCID: PMC9454179 DOI: 10.1186/s12889-022-14010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Enacted or anticipated stigma among people living with HIV (PLHIV) can negatively impact healthcare engagement. We identified factors associated with having avoided HIV health services for fear of stigma among PLHIV in Morocco. Methods The Stigma Index survey was conducted in Morocco in March-June 2016. Factors associated with avoiding HIV testing and treatment services for fear of stigma by (A) health personnel or family/neighbours and (B) health personnel and family/neighbours compared to people who did not avoid health services for fear of stigma from either of the two sources were assessed using multinomial logistic regression models. Results Among 583 respondents, 280 (48.0%) were women and median number of years living with HIV was 5[IQR:2–7]. Half of the respondents reported avoiding health services for fear of stigma by health personnel and/or family/neighbours: (A) n = 228, 39.1% and (B) n = 68, 11.7%. After adjustment on perceived health status, not having had easy access to antiretroviral treatment ((A) aRR [95% CI] = 1.76[1.16; 2.68]; (B) 2.18[1.11; 4.27]), discrimination by PLHIV ((A) 1.87[1.12; 3.13]; (B) 3.35[1.63; 6.88]) and exclusion from social activities ((A) 1.70[1.10; 2.61]; (B) 2.63[1.39; 5.00]) were associated with having avoided health services for fear of stigma by health personnel or/and family/neighbours. Being female (2.85[1.48; 5.47]), not having been referred for an HIV test for suspected symptoms 3.47[1.67; 7.22], having discussed sexual/reproductive health with a health professional (4.56[2.38; 8.71]), and not having the feeling to influence decisions on local projects for PLHIV (3.47[1.37; 7.83], were associated with having avoided health services for fear of stigma by both sources. Conclusion Results suggest a cumulative effect of fear of stigma and discrimination among PLHIV in Morocco. PLHIV who have experienced discrimination may seek to avoid similar situations at the expense of their health. These results should inform multi-level interventions and broader advocacy efforts to reduce stigma and discrimination.
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Affiliation(s)
| | - Amal Ben Moussa
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France. .,Association de Lutte Contre le Sida, Casablanca, Morocco.
| | - Virginie Villes
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France
| | - Mohammed Elkhammas
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France.,Association de Lutte Contre le Sida, Casablanca, Morocco
| | - Lahoucine Ouarsas
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France.,Association de Lutte Contre le Sida, Casablanca, Morocco
| | - Daniela Castro Rojas Castro
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France.,Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | - Mehdi Karkouri
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France.,Association de Lutte Contre le Sida, Casablanca, Morocco
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Mohamed R, White TM, Lazarus JV, Salem A, Kaki R, Marrakchi W, Kheir SGM, Amer I, Ahmed FM, Khayat MA, Al-Abdullah N, Ali B, Sultan R, Alamri B, Abdulmajid A, Kooli I, Chakroun M, Madani TA, Esmat G, Cordie A. COVID-19 vaccine acceptance and associated factors among people living with HIV in the Middle East and North Africa region. South Afr J HIV Med 2022; 23:1391. [PMID: 36101660 PMCID: PMC9452923 DOI: 10.4102/sajhivmed.v23i1.1391] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/18/2022] [Indexed: 11/22/2022] Open
Abstract
Background Identifying coronavirus disease 2019 (COVID-19) vaccine acceptance and associated factors among people living with HIV (PLHIV) in the Middle East and North Africa region is important to meet the need for broad-scale vaccination against COVID-19. Objectives To investigate the COVID-19 vaccine acceptance rate and factors among PLHIV in the Middle East and North Africa region. Method An online cross-sectional survey was conducted among PLHIV currently living in Egypt, Tunisia and Saudi Arabia between March 2021 and August 2021. Results Of the 540 respondents, 19.3% reported already being vaccinated against COVID-19 (n = 104), 32.0% responded ‘definitely yes’ (n = 173), and 13.3% responded ‘probably yes’ (n = 72) for intention to receive a COVID-19 vaccine, with an overall COVID-19 vaccine acceptance rate of 64.6% among PLHIV in the region. The most significant predictors of COVID-19 vaccine acceptance included feeling less worried about COVID-19 transmission post-vaccination (221.0% higher odds), and believing the disease is vaccine-preventable (160.0% higher odds). Reported barriers to COVID-19 vaccine acceptance include concerns about vaccine effectiveness and belief that HIV medications protect against COVID-19 transmission, living in a rural area and reporting less-frequent engagement with HIV care. Nine out of 10 participants reported that the chances of them getting COVID-19 vaccine would increase if given adequate information and if their doctor recommended it. Conclusion Findings of the study can help researchers, health officials, and other health system actors understand the predictors and barriers to COVID-19 vaccine acceptance reported by PLHIV. This understanding could inform the future planning of interventions tailored to PLHIV.
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Affiliation(s)
- Rahma Mohamed
- Endemic Medicine Department, Kasr Alaini School of Medicine, Cairo University Hospitals, Cairo, Egypt
- Kasr Al-Aini HIV and Viral Hepatitis Fighting Group, Kasr Alaini School of Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Trenton M. White
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Amany Salem
- Department of Public Health, Kasr Alaini School of Medicine, Cairo University, Cairo, Egypt
| | - Reham Kaki
- Department of Infectious Disease, Infection Control and Environmental Health, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wafa Marrakchi
- Infectious Diseases Department, Faculty of Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Sara G. M Kheir
- Disease Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Ibrahim Amer
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt
| | - Fida M Ahmed
- Department of Infectious Disease, Infection Control and Environmental Health, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maie A Khayat
- Department of Infectious Disease, Infection Control and Environmental Health, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Batool Ali
- Department of Infectious Diseases, East Jeddah General Hospital, Jeddah, Saudi Arabia
| | - Roaa Sultan
- Department of Infectious Diseases, East Jeddah General Hospital, Jeddah, Saudi Arabia
| | - Bandar Alamri
- Department of Infectious Diseases, East Jeddah General Hospital, Jeddah, Saudi Arabia
| | - Anouf Abdulmajid
- Department of Infectious Diseases, East Jeddah General Hospital, Jeddah, Saudi Arabia
| | - Ikbal Kooli
- Infectious Diseases Department, Faculty of Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Mohamed Chakroun
- Infectious Diseases Department, Faculty of Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Tariq A. Madani
- Department of Infectious Disease, Infection Control and Environmental Health, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Gamal Esmat
- Endemic Medicine Department, Kasr Alaini School of Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Ahmed Cordie
- Endemic Medicine Department, Kasr Alaini School of Medicine, Cairo University Hospitals, Cairo, Egypt
- Kasr Al-Aini HIV and Viral Hepatitis Fighting Group, Kasr Alaini School of Medicine, Cairo University Hospitals, Cairo, Egypt
- Infectious Diseases Department, Armed Forces College of Medicine, Cairo, Egypt
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6
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Bozicevic I, Sharifi H, Haghdoost A, Sabry A, Hermez J. Availability of HIV surveillance data in key populations in the countries of the World Health Organization Eastern Mediterranean Region. Int J Infect Dis 2022; 121:211-216. [PMID: 35533830 PMCID: PMC9174059 DOI: 10.1016/j.ijid.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To present an assessment of key components and results of HIV surveillance activities relevant for understanding HIV epidemics in the countries of the World Health Organization (WHO) Eastern Mediterranean Region among key populations (KPs), which include men who have sex with men (MSM), sex workers, people who inject drugs and transgender people. METHODS We examined HIV surveillance data submitted by the National AIDS Programmes of all 22 countries of the WHO Eastern Mediterranean Region via an online database hosted by the WHO since 2011. We also examined journal articles available on PubMed and technical reports on surveillance activities. RESULTS Recent (i.e., since 2017) estimates of HIV indicators from integrated bio-behavioral surveys (IBBS) were available from only four countries (Lebanon, Morocco, Somalia, and Tunisia) and population size estimates from two (Afghanistan and Morocco). IBBS indicated an increase in HIV prevalence among KPs in Pakistan, among people who inject drugs and female sex workers in Tunisia, and among MSM in Lebanon. Information on size estimations of KPs was available from 11 countries, and population size estimation data since 2017 had been collected in only Afghanistan and Morocco. CONCLUSION Although some countries have been able to progressively expand HIV strategic information systems, there were still few or no HIV data on KPs in almost a third of the countries.
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Affiliation(s)
- Ivana Bozicevic
- World Health Organization Collaborating Centre for HIV Strategic Information, University of Zagreb School of Medicine, Zagreb, Croatia,Corresponding author: Phone : +385 99 450 51 55.
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - AliAkbar Haghdoost
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmed Sabry
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Joumana Hermez
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
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He S, Ke XJ, Wu Y, Kong XY, Wang Y, Sun HQ, Xia DZ, Chen GH. The stigma of patients with chronic insomnia: a clinical study. BMC Psychiatry 2022; 22:449. [PMID: 35790932 PMCID: PMC9254637 DOI: 10.1186/s12888-022-04091-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/24/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The objective of this study was to explore the stigma and related influencing factors in individuals with chronic insomnia disorder (CID). METHODS A total of 70 CID patients and 70 healthy controls (CON) were enrolled in the study. All subjects completed the assessments of sleep, emotion, and cognition. Their stigma and life quality were measured using the Chronic Stigma Scale and the 36-Item Short-Form Health Survey (SF-36). RESULTS The ratio of individuals with stigma was significantly different between CID and CON groups (C2 = 35.6, p < 0.001). Compared with the CON group, the CID group had higher scores for total stigma (U = 662.0, p < 0.001), internalized stigma (U = 593.0, p < 0.001), enacted stigma (U = 1568.0, p < 0.001), PSQI (U = 2485.0, p < 0.001) and HAMD-17 (U = 69.5, p < 0.001) as well as lower scores for MoCA-C (U = 3997.5, p < 0.001) and most items of SF-36. Partial correlation analysis showed that different items of the Chronic Stigma Scale were positively correlated with illness duration, PSQI and HAMD-17 scores, while negatively correlated with one or more items of the SF-36. Multivariate regression analysis showed that illness duration and the Mental Health domain of the SF-36 were independent risk factors for one or more items of stigma in CID patients. CONCLUSION Patients with CID have an increased risk of stigma. Moreover, illness duration and Mental Health may be primary factors related to stigma.
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Affiliation(s)
- Shuo He
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Xue-Jia Ke
- grid.477985.00000 0004 1757 6137Department of Geriatrics, Hefei First People’s Hospital, Hefei, 230092 China
| | - Yan Wu
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Xiao-Yi Kong
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Yun Wang
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Hui-Qin Sun
- Department of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000, Chaohu, China.
| | - Deng-Zhi Xia
- Department of Outpatient, The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000, Chaohu, China.
| | - Gui-Hai Chen
- Department of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000, Chaohu, China.
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Mugisa B, Sabry A, Hutin Y, Hermez J. HIV epidemiology in the WHO Eastern Mediterranean region: a multicountry programme review. Lancet HIV 2022; 9:e112-e119. [PMID: 35120632 DOI: 10.1016/s2352-3018(21)00320-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Worldwide, HIV incidence, and mortality has decreased since 2010; however, in the WHO Eastern Mediterranean region, trends continue to increase. We reviewed the regional progress to understand determinants of this situation and inform strategies to accelerate the response. METHODS We conducted a multicountry programme review of 22 countries in the WHO Eastern Mediterranean region from Jan 1, 2010 to Dec 31, 2020. We extracted data from WHO's global AIDS monitoring system, UNAIDS estimates, and country reports regarding incident cases, policy uptake, and antiretrovirals used. We analysed data to describe incidence, testing practices, treatment coverage, and mortality to identify bottlenecks leading to persisting incidence and mortality. FINDINGS Due to COVID-19 disruptions, the volume of HIV testing in 2020 halved to 3·0 million tests compared with 2019 with 8017 people living with HIV identified (0·27% positivity yield). In comparison with a 0·18% positivity yield from the 6·5 million tests in 2019. HIV tests were done in migrants (59·6%), groups at low risk (38·9%), and key populations (1·5%). Diagnoses with advanced disease increased from 27·3% in 2017 to 37·0% in 2019. In 2019, among 52 318 people on treatment, only 2888 (6%) received optimised regimens as per WHO recommendations. The number of people on treatment increased from 19 000 in 2010 with a coverage of 8% to 110 000 in 2020 with a coverage of 25%. Late diagnoses and suboptimal regimens could explain the increase in mortality from 9600 in 2010 to 17 000 in 2020. INTERPRETATION In the Eastern Mediterranean region, inefficient testing and suboptimal treatment lead to underdiagnosis, persisting transmission, late treatment, and rising mortality. The HIV epidemic is growing faster than the response. A change in thinking is needed to test groups at high risk, transition to optimised treatment, and deliver patient-centred services that maximise retention. FUNDING World Health Organization.
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Affiliation(s)
- Bridget Mugisa
- Department of Communicable Diseases Prevention and Control, World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt.
| | - Ahmed Sabry
- Department of Communicable Diseases Prevention and Control, World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Yvan Hutin
- Department of Communicable Diseases Prevention and Control, World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Joumana Hermez
- Department of Communicable Diseases Prevention and Control, World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Ahmed A, Dujaili JA, Jabeen M, Umair MM, Chuah LH, Hashmi FK, Awaisu A, Chaiyakunapruk N. Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan. Front Pharmacol 2022; 12:807446. [PMID: 35153763 PMCID: PMC8832364 DOI: 10.3389/fphar.2021.807446] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/20/2021] [Indexed: 01/30/2023] Open
Abstract
Background: With the increased availability of safe antiretroviral therapy (ART) in recent years, achieving optimal adherence and patient retention is becoming the biggest challenge for people living with HIV (PLWH). Care retention is influenced by several socioeconomic, socio-cultural, and government policies during the COVID-19 pandemic. Therefore, we aim to explore barriers and facilitators to adherence to ART among PLWH in Pakistan in general and COVID-19 pandemic related in particular. Methods: Semi-structured interviews were conducted among 25 PLWH from December 2020 to April 2021 in the local language (Urdu) at the ART centre of Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Interviews were audio-recorded in the local Urdu language, and bilingual expert (English, Urdu) transcribed verbatim, coded for themes and sub-themes, and analyzed using a phenomenological approach for thematic content analysis. Results: Stigma and discrimination, fear of HIV disclosure, economic constraints, forgetfulness, religion (Ramadan, spiritual healing), adverse drug reactions, lack of social support, alternative therapies, and COVID-19-related lock-down and fear of lesser COVID-19 care due to HIV associated stigma were identified as barriers affecting the retention in HIV care. At the same time, positive social support, family responsibilities, use of reminders, the beneficial impact of ART, and initiation of telephone consultations, courier delivery, and long-term delivery of antiretrovirals during COVID-19 were identified as facilitators of HIV retention. Conclusion: Improving adherence and retention is even more challenging due to COVID-19; therefore, it requires the integration of enhanced access to treatment with improved employment and social support. HIV care providers must understand these reported factors comprehensively and treat patients accordingly to ensure the continuum of HIV care. A coordinated approach including different stakeholders is required to facilitate patient retention in HIV care and consequently improve the clinical outcomes of PLWH.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Department of Pharmacy, Quaid-I-Azam University, Islamabad, Pakistan
- *Correspondence: Ali Ahmed, ; Juman Abdulelah Dujaili, ; Ahmed Awaisu,
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- *Correspondence: Ali Ahmed, ; Juman Abdulelah Dujaili, ; Ahmed Awaisu,
| | - Musarat Jabeen
- ART Centre, Pakistan Institute of Medical Sciences (PIMS) Hospital, Islamabad, Pakistan
| | - Malik Muhammad Umair
- National AIDS Control Programme, National Institute of Health, Islamabad, Pakistan
| | - Lay-Hong Chuah
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
| | - Furqan Khurshid Hashmi
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, Pakistan
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
- *Correspondence: Ali Ahmed, ; Juman Abdulelah Dujaili, ; Ahmed Awaisu,
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
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10
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Abi Zeid Daou C, Rizk N, Mirza FG, Lakissian Z, Banat R, Chahine E, Sharara-Chami R. A review of prenatal HIV screening practices among physicians at a tertiary care center in Lebanon: is it culture? AIDS Care 2020; 33:1255-1261. [PMID: 33345579 DOI: 10.1080/09540121.2020.1861180] [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: 10/22/2022]
Abstract
HIV remains one of the major causes of mortality and morbidity among women of reproductive age; given the risk of vertical transmission to the fetus, timely prevention, monitoring and management are imperative (Melaku et al. [2014]. Causes of death among females-investigating beyond maternal causes: A community-based longitudinal study. BMC Research Notes, 7(1), 629. https://doi.org/10.1186/1756-0500-7-629). Most HIV studies in Lebanon focus on men who have sex with men, people diagnosed with sexually transmitted infections, intravenous (IV) drug users, and people infected by blood transfusion products Ministry of Public Health [2017]. National AIDS Control Program in Lebanon. https://www.moph.gov.lb/en/Pages/2/4000/aids#/en/Pages/2/4000/aids; Shaheen [2014]. Around 3,750 HIV/AIDS cases in Lebanon. The Daily Star. https://www.dailystar.com.lb/News/Lebanon-News/2014/Dec-02/279570-around-3750-hivaidscases-in-lebanon.ashx). We conducted a retrospective review of women who delivered at a tertiary academic hospital in Beirut between January 2016-Decemeber 2017 to assess prenatal HIV screening practices. In total, 1500 charts were randomly selected and reviewed: 137 (9%) women were screened for HIV, 2 (1.5%) tested positive. Odds rations were calculated for screening in relation to religion, parity, previous abortions, and mode of delivery: none were significant. No one was tested for Gonorrhoea and Chlamydia; 1250 (93.8%) were tested for Hepatitis B, 27 (1.9%) for Hepatitis C, 7 (0.5%) for HSV and, 74(5.3%) for Syphilis. Barriers to screening may include: Lack of consensus on mandated screening policy, HIV stigma, physician and patient prejudice and misconception of risk and, financial barriers as health insurance does not cover HIV screening.
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Affiliation(s)
- Christophe Abi Zeid Daou
- Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Nesrine Rizk
- Department of Internal Medicine, Division of Infectious Diseases, AUBMC, Beirut, Lebanon
| | - Fadi G Mirza
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, AUBMC, Beirut, Lebanon
| | | | - Rim Banat
- Department of Pediatric and Adolescent Medicine, AUBMC, Beirut, Lebanon
| | - Elsa Chahine
- School of Medicine, American University of Beirut, Beirut, Lebanon
| | - Rana Sharara-Chami
- Department of Pediatric and Adolescent Medicine, AUBMC, Beirut, Lebanon.,Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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11
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Torres TS, Cox J, Marins LMS, Bezerra DRB, Veloso VG, Grinsztejn B, Luz PM. A call to improve understanding of Undetectable equals Untransmittable (U = U) in Brazil: a web-based survey. J Int AIDS Soc 2020; 23:e25630. [PMID: 33156556 PMCID: PMC7646361 DOI: 10.1002/jia2.25630] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Currently, the slogan "Undetectable = Untransmittable" (U = U), launched to disseminate scientific evidence on how people living with HIV (PLHIV) on antiretroviral treatment with suppressed viral load cannot transmit HIV to their sexual partners, is still challenged by individuals with differential acceptance across populations. In this study, we documented the perceived accuracy of U = U in Brazil in three different groups: PLHIV, HIV-negative/unknown cisgender gay/bisexual men who have sex with men (GBM) and HIV-negative/unknown other populations (POP). METHODS Adult (age ≥ 18y) Brazilians were recruited during October 2019 to complete a web-based survey advertised on Grindr, Facebook and WhatsApp. Perceived accuracy of U = U was assessed with the question: "With regards to HIV-positive individuals transmitting HIV through sexual contact, how accurate do you believe the slogan U = U is?" Response options ranged from 1 (Completely inaccurate) to 4 (Completely accurate) plus a fifth option (I don't know what "undetectable" means). Participants' characteristics were described according to perceived accuracy of U = U. Logistic regression models assessed the factors associated with perceived accuracy of U = U (completely accurate vs. partially accurate/inaccurate or completely inaccurate) by group. RESULTS Of 2311 individuals accessing the questionnaire, 1690 (73.1%) met inclusion/exclusion criteria and completed it. Of these, 347 (20.5%) were PLHIV, 785 (46.4%) GBM and 558 (33.0%) POP. More PLHIV perceived U = U as completely accurate (79.0%), compared to 44.2% GBM and 17.2% POP (p < 0.001). Among PLHIV, Black identity was associated with decreased odds of perceiving U = U as completely accurate while having a steady partner was associated with increased odds. Among GBM, being gay, having middle/higher income, being a resident of state capital metropolitan areas and ever testing for HIV were associated with increased odds. Lastly, among POP, ever testing for HIV increased the odds of perceiving U = U as completely accurate. CONCLUSIONS There was a significant difference in perceived accuracy of U = U across population groups. Accurate understanding of the slogan needs to be promoted in more vulnerable populations such as PLHIV of Black identity and GBM of lower income to maximize individual and societal prevention benefits. Moreover, broader understating of U = U among the general population can help decrease societal stigma towards PLHIV.
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Affiliation(s)
- Thiago S Torres
- Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroBrazil
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational HealthFaculty of MedicineMcGill UniversityMontrealCanada
- Research InstituteMcGill University Health CentreMontrealCanada
| | - Luana MS Marins
- Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroBrazil
| | - Daniel RB Bezerra
- Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroBrazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroBrazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroBrazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroBrazil
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