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Chavez JV, Ewart LD, Ilyas O, Ghanooni D, Diaz JE, Atkins L, Ramos R, Garayua AH, Stewart A, Horvath KJ, Hirshfield S, Carrico AW. I was like sh*t this is gonna hurt': Implementing Self-Sampling of Dried Blood Spots to Measure HIV Viral Load. RESEARCH SQUARE 2024:rs.3.rs-4132978. [PMID: 38645181 PMCID: PMC11030538 DOI: 10.21203/rs.3.rs-4132978/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Sexual minority men (SMM) with HIV who use stimulants may experience greater difficulties with antiretroviral therapy adherence which amplifies risk for unsuppressed HIV viral load (VL). Remote monitoring of VL could support efforts to rapidly respond to sub-optimal adherence. Methods This qualitative study enrolled 24 SMM with HIV who use stimulants to examine experiences with two different dried blood spots (DBS) self-sampling devices (i.e., Tasso-M20 vs. HemaSpot HD) to measure VL. Participants were asked to complete self-sampling of DBS using both devices, and then participated in a 45-minute semi-structured interview. Interviews focused on ease of use, device preference, experiences with receiving and mailing kits, and barriers to participating in research. A thematic analysis was conducted to analyze interviews transcripts. Results Twenty-two participants (92%) returned the Tasso-M20 and 21 (88%) returned the Hemaspot HD devices. Among the 22 participants that completed qualitative interviews, twenty-three codes were identified and collapsed within seven themes. Preferences for devices were based on convenience, pain and prior experiences with finger-pricking technology. Participants emphasized that clearer instructions with contingency plans for self-sampling of DBS would improve the user experience with self-sampling of DBS. Intersectional stigma (e.g., HIV, sexual minority status, and substance use) was noted as an important consideration in implementing self-sampling of DBS. Promoting decision making, or the option to choose sampling method based on personal preferences, may improve engagement and likelihood of DBS completion. Conclusions Findings will guide the broader implementation of self-sampling of DBS to optimize VL monitoring in SMM with HIV who use stimulants.
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Howarth AR, Apea V, Michie S, Morris S, Sachikonye M, Mercer CH, Evans A, Delpech VC, Sabin C, Burns FM. Associations with sub-optimal clinic attendance and reasons for missed appointments among heterosexual women and men living with HIV in London. AIDS Behav 2022; 26:3620-3629. [PMID: 35536520 PMCID: PMC9550732 DOI: 10.1007/s10461-022-03681-x] [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] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Abstract
Poor engagement in HIV care is associated with poorer health outcomes and increased mortality. Our survey examined experiential and circumstantial factors associated with clinic attendance among women (n = 250) and men (n = 106) in London with heterosexually-acquired HIV. While no associations were found for women, among men, sub-optimal attendance was associated with insecure immigration status (25.6% vs. 1.8%), unstable housing (32.6% vs. 10.2%) and reported effect of HIV on daily activities (58.7% vs. 40.0%). Among women and men on ART, it was associated with missing doses of ART (OR = 2.96, 95% CI:1.74-5.02), less belief in the necessity of ART (OR = 0.56, 95% CI:0.35-0.90) and more concern about ART (OR = 3.63, 95% CI:1.45-9.09). Not wanting to think about being HIV positive was the top reason for ever missing clinic appointments. It is important to tackle stigma and the underlying social determinants of health to improve HIV prevention, and the health and well-being of people living with HIV.
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Affiliation(s)
- A R Howarth
- Institute for Global Health, University College London, London, UK.
- UCL Institute for Global Health, Mortimer Market Centre, off Capper Street, WC1E 6JB, London, UK.
| | - V Apea
- Barts Health NHS Trust, London, UK
| | - S Michie
- Centre for Behaviour Change, University College London, London, UK
| | - S Morris
- Department of Applied Health Research, University College London, London, UK
| | | | - C H Mercer
- Institute for Global Health, University College London, London, UK
| | - A Evans
- Royal Free London NHS Foundation Trust, London, UK
| | | | - C Sabin
- Institute for Global Health, University College London, London, UK
| | - F M Burns
- Institute for Global Health, University College London, London, UK
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Whiteley LB, Olsen EM, Haubrick KK, Odoom E, Tarantino N, Brown LK. A Review of Interventions to Enhance HIV Medication Adherence. Curr HIV/AIDS Rep 2021; 18:443-457. [PMID: 34152554 DOI: 10.1007/s11904-021-00568-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Adherence to antiretroviral treatment (ART) is crucial for the successful treatment of HIV. Unfortunately, it is estimated that 45% of persons living with HIV (PLWH) have poor adherence to ART. To provide health care professionals and PLWH with effective tools for supporting adherence, researchers have investigated the effectiveness of psychosocial interventions to enhance adherence to ART. In this paper, interventional studies, systematic reviews, and meta-analyses that examine ART adherence interventions for PLWH are reviewed. RECENT FINDINGS There is great variability among interventions in terms of quality, sample, measures, and outcome characteristics. Despite a diverse and wide-ranging assortment of ART adherence interventions, consistent lessons have been learned. Interventions that focus on individual and interpersonal factors have been effective for improving ART adherence; however, the improvement in adherence tends to be short-lived. Additionally, interventions are most successful when tailored to those at risk for poor adherence. Finally, theory-based interventions are more likely to be effective than non-theory-based interventions. A variety of individual-level psychological interventions have been shown to be effective in improving ART adherence in the short term. Digital and mobile interventions have the potential to improve dissemination and implementation of these evidence-based interventions and could be used to extend intervention effects. Future interventions that address issues of accessibility, inequality, structural and institutional barriers to ART adherence should also be tested and prioritized. Implementation science frameworks can be used to assess and address issues of accessibility and systematic barriers to care.
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Affiliation(s)
- Laura B Whiteley
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Elizabeth M Olsen
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kayla K Haubrick
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Enyonam Odoom
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | | | - Larry K Brown
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
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4
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Howarth AR, Apea V, Michie S, Morris S, Sachikonye M, Mercer CH, Evans A, Delpech VC, Sabin C, Burns FM. The association between use of chemsex drugs and HIV clinic attendance among gay and bisexual men living with HIV in London. HIV Med 2021; 22:641-649. [PMID: 33949070 DOI: 10.1111/hiv.13103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 11/27/2020] [Accepted: 03/02/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To investigate the association between chemsex drug use and HIV clinic attendance among gay and bisexual men in London. METHODS A cross-sectional survey of adults (> 18 years) diagnosed with HIV for > 4 months, attending seven London HIV clinics (May 2014 to August 2015). Participants self-completed an anonymous questionnaire linked to clinical data. Sub-optimal clinic attenders had missed one or more HIV clinic appointments in the past year, or had a history of non-attendance for > 1 year. RESULTS Over half (56%) of the 570 men who identified as gay or bisexual reported taking recreational drugs in the past 5 years and 71.5% of these men had used chemsex drugs in the past year. Among men reporting chemsex drug use (past year), 32.1% had injected any drugs in the past year. Sub-optimal clinic attenders were more likely than regular attenders to report chemsex drug use (past year; 46.9% vs. 33.2%, P = 0.001), injecting any drugs (past year; 17.1% vs. 8.9%, P = 0.011) and recreational drug use (past 5 years; 65.5% vs. 48.8%, P < 0.001). One in five sub-optimal attenders had missed an HIV clinic appointment because of taking recreational drugs (17.4% vs. 1.8%, P < 0.001). In multivariable logistic regression, chemsex drug use was significantly associated with sub-optimal clinic attendance (adjusted odds ratio = 1.71, 95% confidence interval: 1.10-2.65, P = 0.02). CONCLUSIONS Our findings highlight the importance of systematic assessment of drug use and development of tools to aid routine assessment. We suggest that chemsex drug use should be addressed when developing interventions to improve engagement in HIV care among gay and bisexual men.
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Affiliation(s)
- A R Howarth
- Institute for Global Health, University College London, London, UK
| | - V Apea
- Barts Health NHS Trust, London, UK
| | - S Michie
- Centre for Behaviour Change, University College London, London, UK
| | - S Morris
- Department of Applied Health Research, University College London, London, UK
| | | | - C H Mercer
- Institute for Global Health, University College London, London, UK
| | - A Evans
- Royal Free London NHS Foundation Trust, London, UK
| | | | - C Sabin
- Institute for Global Health, University College London, London, UK
| | - F M Burns
- Institute for Global Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
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5
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Niasse F, Varloteaux M, Diop K, Ndiaye SM, Diouf FN, Mbodj PB, Niang B, Diack A, Cames C. Adherence to ready-to-use food and acceptability of outpatient nutritional therapy in HIV-infected undernourished Senegalese adolescents: research-based recommendations for routine care. BMC Public Health 2020; 20:695. [PMID: 32414346 PMCID: PMC7227087 DOI: 10.1186/s12889-020-08798-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/28/2020] [Indexed: 01/05/2023] Open
Abstract
Background Ready-to-use food (RUF) is increasingly used for nutritional therapy in HIV-infected individuals. However, practical guidance advising nutrition care to HIV-infected adolescents is lacking, so that little is known about the acceptability of such therapy in this vulnerable population. This study assesses the overall acceptability and perception of a RUF-based therapy and risk factors associated with sub-optimal RUF intake in HIV-infected undernourished adolescents in Senegal. Methods Participants 5 to 18 years of age with acute malnutrition were enrolled in 12 HIV clinics in Senegal. Participants were provided with imported RUF, according to WHO prescription weight- and age-bands (2009), until recovery or for a maximum of 9–12 months. Malnutrition and recovery were defined according to WHO growth standards. Adherence was assessed fortnightly by self-reported RUF intake over the period. Sub-optimal RUF intake was defined as when consumption of the RUF provision was < 50%. RUF therapy acceptability and perceptions were assessed using a structured questionnaire at week 2 and focus group discussions (FGDs) at the end of the study. Factors associated with sub-optimal RUF intake at week 2 were identified using a stepwise logistic regression model. Results We enrolled 173 participants, with a median age of 12.5 years (Interquartile range: 9.5–14.9), of whom 61% recovered from malnutrition within the study period. Median follow-up duration was 66 days (21–224). RUF consumption was stable, varying between 64 and 57% of the RUF provided, throughout the follow-up. At week 2, sub-optimal RUF intake was observed in 31% of participants. Dislike of the taste of RUF (aOR = 5.0, 95% CI: 2.0–12.3), HIV non-disclosure (5.1, 1.9–13.9) and food insecurity (2.8, 1.1–7.2) were the major risk factors associated with sub-optimal RUF intake at week 2. FGDs showed that the need to hide from others to avoid sharing and undesirable effects were other constraints on RUF feeding. Conclusions This study revealed several factors reducing the acceptability and adherence to RUF therapy based on WHO guidelines in HIV-infected adolescents. Tailoring prescription guidance and empowering young patients in their care are crucial levers for improving the acceptability of RUF-based therapy in routine care. Trial registration ClinicalTrials.gov identifier: NCT03101852, 04/04/2017.
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Affiliation(s)
- Fatou Niasse
- Comité national de lutte contre le sida (CNLS), Dakar, Sénégal
| | - Marie Varloteaux
- Institut de recherche pour le développement (IRD), UMI233 TransVIHmi, INSERM U1175, Université de Montpellier, 911 Av Agropolis, 34394, Montpellier, France
| | - Karim Diop
- Centre régional de recherche et de formation à la prise en charge clinique (CRCF), Dakar, Sénégal.,Division de lutte contre le sida et les infections sexuellement transmissibles (DLSI), Ministère de la santé et de l'action sociale, Dakar, Sénégal
| | - Sidy Mokhtar Ndiaye
- Centre régional de recherche et de formation à la prise en charge clinique (CRCF), Dakar, Sénégal
| | | | | | - Babacar Niang
- Centre Hospitalier National Universitaire d'Enfants Albert Royer, Dakar, Sénégal
| | - Aminata Diack
- Centre Hospitalier National Universitaire d'Enfants Albert Royer, Dakar, Sénégal
| | - Cecile Cames
- Institut de recherche pour le développement (IRD), UMI233 TransVIHmi, INSERM U1175, Université de Montpellier, 911 Av Agropolis, 34394, Montpellier, France.
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Elliott JC, Critchley L, Feaster DJ, Hasin DS, Mandler RN, Osorio G, Rodriguez AE, Del Rio C, Metsch LR. The roles of heavy drinking and drug use in engagement in HIV care among hospitalized substance using individuals with poorly controlled HIV infection. Drug Alcohol Depend 2019; 201:171-177. [PMID: 31234013 PMCID: PMC6677390 DOI: 10.1016/j.drugalcdep.2019.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Substance use can reduce care engagement for individuals with HIV. However, little is known as to whether heavy drinkers differ from drug users. This study compares heavy drinkers, drug users, and those drinking heavily and using drugs on their HIV care engagement. METHODS HIV-infected adult inpatients (n = 801; 67% male; 78% Black) from 11 urban hospitals across the United States participated in a multisite clinical trial to improve patient engagement in HIV care and virologic outcomes. All participants drank heavily and/or used drugs, and had poorly controlled HIV. Participants reported care history at baseline. We compared heavy drinkers, drug users, and those both drinking heavily and using drugs (reference group) on their engagement in care. RESULTS Heavy drinkers reported lowest rates of lifetime HIV care, AOR = 0.59 (95% CI = 0.36, 0.97). Groups did not differ in recent care, prescription of HIV medication, medical mistrust, or patient-provider relationship. Drug users evidenced the best medication adherence, AOR = 2.38 (95% CI = 1.33, 4.23). Exploratory analyses indicated that drinkers had lower initial care engagement, but that it increased more rapidly with duration of known HIV infection, with similar rates of recent care. Drinkers had the lowest CD4 counts (B=-0.28, p < 0.0001), but no difference in viral load. CONCLUSIONS Heavy drinkers were least likely to have ever been in HIV care. More research is needed to determine why heavy drinkers evidence the lowest initial care engagement and current CD4 counts, and whether drinking intervention early in infection may increase HIV care engagement.
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Affiliation(s)
- Jennifer C Elliott
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, Box 123, New York, NY, 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Box 123, New York, NY, 10032, USA.
| | - Lacey Critchley
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 N.W. 14th Street, Miami, Florida, 33136 USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 N.W. 14th Street, Miami, Florida, 33136 USA
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, Box 123, New York, NY, 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Box 123, New York, NY, 10032, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168(th) St, New York, NY, 10032, USA
| | - Raul N Mandler
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd, Bethesda, MD 20952, Room B1-W30, Bethesda, MD, USA
| | - Georgina Osorio
- Mount Sinai St. Luke's and Mount Sinai West, Icahn School of Medicine at Mount Sinai, 440 West 114th Street, 6th floor (Clark Building), New York, NY, 10025, USA
| | - Allan E Rodriguez
- Division of Infectious Diseases, Miller School of Medicine, University of Miami, 1120 NW 14th Street Suite 856, Miami, FL, 33136, USA
| | | | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W 168(th) St, New York, NY, 10032, USA
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Fakoya I, Álvarez‐Del Arco D, Monge S, Copas AJ, Gennotte A, Volny‐Anne A, Wengenroth C, Touloumi G, Prins M, Barros H, Darling KEA, Prestileo T, Del Amo J, Burns FM. HIV testing history and access to treatment among migrants living with HIV in Europe. J Int AIDS Soc 2018; 21 Suppl 4:e25123. [PMID: 30027686 PMCID: PMC6053481 DOI: 10.1002/jia2.25123] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/16/2018] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Migrants are overrepresented in the European HIV epidemic. We aimed to understand the barriers and facilitators to HIV testing and current treatment and healthcare needs of migrants living with HIV in Europe. METHODS A cross-sectional study was conducted in 57 HIV clinics in nine countries (Belgium, Germany, Greece, Italy, The Netherlands, Portugal, Spain, Switzerland and United Kingdom), July 2013 to July 2015. HIV-positive patients were eligible for inclusion if they were as follows: 18 years or older; foreign-born residents and diagnosed within five years of recruitment. Questionnaires were completed electronically in one of 15 languages and linked to clinical records. Primary outcomes were access to primary care and previous negative HIV test. Data were analysed using random effects logistic regression. Outcomes of interest are presented for women, heterosexual men and gay/bisexual men. RESULTS A total of 2093 respondents (658 women, 446 heterosexual men and 989 gay/bisexual men) were included. The prevalence of a previous negative HIV test was 46.7%, 43.4% and 82.0% for women, heterosexual and gay/bisexual men respectively. In multivariable analysis previous testing was positively associated with: receipt of post-migration antenatal care among women, permanent residency among heterosexual men and identifying as gay rather than bisexual among gay/bisexual men. Access to primary care was found to be high (>83%) in all groups and was strongly associated with country of residence. Late diagnosis was common for women and heterosexual men (60.8% and 67.1%, respectively) despite utilization of health services prior to diagnosis. Across all groups almost three-quarters of people on antiretrovirals had an HIV viral load <50 copies/mL. CONCLUSIONS Migrants access healthcare in Europe and while many migrants had previously tested for HIV, that they went on to test positive at a later date suggests that opportunities for HIV prevention are being missed. Expansion of testing beyond sexual health and antenatal settings is still required and testing opportunities should be linked with combination prevention measures such as access to PrEP and treatment as prevention.
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Affiliation(s)
- Ibidun Fakoya
- Institute for Global HealthUniversity College LondonLondonUnited Kingdom
| | | | - Susana Monge
- Department of Health and Socio‐medical SciencesUniversity of AlcaláAlcalá de HenaresMadrid
| | - Andrew J Copas
- Institute for Global HealthUniversity College LondonLondonUnited Kingdom
| | | | | | | | - Giota Touloumi
- Department of Hygiene, Epidemiology& Medical StatisticsMedical SchoolNational and Kapodistrian University of AthensAthensGreece
| | - Maria Prins
- Academic Medical CentreUniversity of AmsterdamAmsterdamthe Netherlands
- Public Health Service of Amsterdamthe Netherlands
| | | | | | - Tullio Prestileo
- Unit for Infectious Diseases and Assistance, Coordination and Territorial Integration for Migrants’ EmergencyCivico‐ Benfratelli HospitalPalermoItaly
| | - Julia Del Amo
- National Centre of EpidemiologyInstituto de Salud Carlos IIIMadridSpain
| | - Fiona M Burns
- Institute for Global HealthUniversity College LondonLondonUnited Kingdom
- Royal Free London NHS Foundation TrustLondonEngland
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Gómez CA, Tat SA, Allen D, Gordon D, Browe D. What Will It Take to End the HIV/AIDS Epidemic? Linking the Most Disenfranchised Into Care Through Outreach. AIDS Patient Care STDS 2017; 31:122-128. [PMID: 28282248 DOI: 10.1089/apc.2016.0241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The 2015 National HIV/AIDS Strategy renewed its goal of increasing access to care for people living with HIV/AIDS (PLWHA) and called for an increased focus on linkage to care efforts. As many PLWHA face multiple barriers to care and live on the margins of society, adoption of intensive outreach activities is necessary to engage the most disenfranchised PLWHA into care and to ultimately end the HIV epidemic. The Bay Area Network for Positive Health (BANPH), comprising 12+ agencies, established a network outreach model for our linkage-to-care project to engage the hardest-to-reach populations in the San Francisco Bay Area. During the years 2010-2013, BANPH agencies conducted street outreach, analyzed internal tracking systems to identify out-of-care individuals and individuals experiencing tenuous care, and surveyed participants using Apple iPod Touch devices. During the 3-year project, BANPH agencies engaged 602 out-of-care PLWHA and linked 440 to care. On average, outreach workers made 10 contact attempts with a client to link them to care. Sixty-three percent of participants were linked to care on an average of 56 days after initial contact. Factors, including lack of case management, lack of transportation, competing concerns, substance abuse, and HIV stigma, were significantly associated with linkage-to-care outcomes. Intensive outreach efforts could help to reduce barriers to care for hard-to-reach PLWHA, but these efforts require a tremendous amount of time and resources. A network outreach model could help facilitate sharing of limited resources and increase regional outreach capacity for linkage-to-care programs.
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Affiliation(s)
- Cynthia A. Gómez
- Health Equity Institute, San Francisco State University, San Francisco, California
| | - Susana A. Tat
- Health Equity Institute, San Francisco State University, San Francisco, California
| | - Debra Allen
- Health Equity Institute, San Francisco State University, San Francisco, California
| | - Danielle Gordon
- Health Equity Institute, San Francisco State University, San Francisco, California
| | - Dennis Browe
- Health Equity Institute, San Francisco State University, San Francisco, California
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Howarth A, Apea V, Michie S, Morris S, Sachikonye M, Mercer C, Evans A, Delpech V, Sabin C, Burns F. REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BackgroundAntiretroviral therapy (ART) benefits individuals living with human immunodeficiency virus (HIV) through reduced morbidity and mortality, and brings public health gains through a reduction in HIV transmission. People living with human immunodeficiency virus (PLWH) need to know their HIV status and engage in HIV care in order for these individual and public health benefits to be realised.ObjectiveTo explore, describe and understand HIV outpatient attendance in PLWH, in order to develop cost-effective interventions to optimise engagement in care.DesignA mixed-methods study incorporating secondary analysis of data from the UK Collaborative HIV Cohort (UK CHIC) study and primary data collection.MethodsPhase 1 – an engagement-in-care (EIC) algorithm was developed to categorise patients as in care or out of care for each month of follow-up. The algorithm was used in group-based trajectory analysis to examine patterns of attendance over time and of the association between the proportion of months in care before ART initiation and post-ART mortality and laboratory test costs. Phase 2 – a cross-sectional survey was conducted among patients attending seven London HIV clinics. Regular attenders (all appointments attended in past year), irregular attenders (one or more appointments missed in past year) and non-attenders (recent absence of ≥ 1 year) were recruited. A ‘retention risk tool’ was developed to identify those at risk of disengaging from care. Individual in-depth interviews and focus groups were conducted with PLWH. Phase 3 – key informant interviews were conducted with HIV service providers. Interventions were developed from the findings of phases 2 and 3.ResultsPlots from group-based trajectory analysis indicated that four trajectories best fitted the data. Higher EIC is associated with reduced mortality but the association between EIC before starting ART, and post-ART mortality [relative hazard (RH) per 10% increase in EIC 0.29, 95% confidence interval (CI) 0.18 to 0.47] was attenuated after adjustment for fixed covariates and post-ART cluster of differentiation 4 counts and viral loads (RH 0.74, 95% CI 0.42 to 1.30). Small differences were found in pre-ART EIC and the costs of post-ART lab tests. The final model for the retention risk tool included age at diagnosis, having children, recreational drug use, drug/alcohol dependency, insufficient money for basic needs and use of public transport to get to the clinic. Quantitative and qualitative data showed that a range of psychological, social and economic issues were associated with disengagement from care. The negative impact of stigma on attendance was highlighted. Interventions were proposed that support a holistic approach to care including peer support, address stigma by holding clinics in alternative locations and involve training staff to encourage attendance.ConclusionsThe study shows the adverse health impacts of disengaging from HIV care and demonstrates the importance of the wider health and social context in managing HIV effectively. Although phase 1 analysis was based on UK data, phases 2 and 3 were limited to London. The interventions proposed are supported by the data but their cost-effectiveness requires testing. Future research is needed to evaluate the interventions, to validate our retention risk tool across populations and settings, and to fully analyse the economic costs of disengaging from HIV care.FundingThe National Institute for Health Research Health Services and Delivery Research programme. The UK CHIC study is funded by the Medical Research Council UK (grant numbers G0000199, G0600337, G0900274 and M004236).
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Affiliation(s)
- Alison Howarth
- Research Department of Infection and Population Health, University College London, London, UK
| | - Vanessa Apea
- The Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Steve Morris
- Department of Applied Health Research, University College London, London, UK
| | | | - Catherine Mercer
- Research Department of Infection and Population Health, University College London, London, UK
| | - Amanda Evans
- Royal Free London NHS Foundation Trust, London, UK
| | | | - Caroline Sabin
- Research Department of Infection and Population Health, University College London, London, UK
| | - Fiona Burns
- Research Department of Infection and Population Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
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10
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Bolsewicz K, Debattista J, Vallely A, Whittaker A, Fitzgerald L. Factors associated with antiretroviral treatment uptake and adherence: a review. Perspectives from Australia, Canada, and the United Kingdom. AIDS Care 2015; 27:1429-38. [PMID: 26641139 DOI: 10.1080/09540121.2015.1114992] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
International focus on reducing onward HIV transmission emphasizes the need for routine HIV testing and early uptake of antiretroviral treatment (ART). Strategic targets have been set for 2020 to achieve the goal of 90% of people infected with HIV diagnosed, 90% of identified cases on treatment, and 90% of persons on treatment virally suppressed (90-90-90). It is vital to understand the complexity of factors influencing a person's treatment decisions over time and the context which may enable better adherence. In this paper we present findings from the review of published and gray literature (2003-2013) on the documented factors associated with treatment initiation and adherence in the general adult population of Australia, Canada, and the UK. A framework developed by Begley, McLaws, Ross, and Gold [2008. Cognitive and behavioural correlates of non-adherence to HIV anti-retroviral therapy: Theoretical and practical insight for clinical psychology and health psychology. Clinical Psychologist, 12(1), 9-17] in Australia was adapted to summarize the findings. A systematic database search using keywords and a set of inclusion criteria yielded 17 studies (Australia = 6; Canada = 8; UK = 3). In addition 11 reports were included in the review. We found that a person's abilities and motivations (intrapersonal factors, reported in 7 studies) to start and continue ART are influenced by a host of interconnected factors spanning relationship (interpersonal, 3 studies) and broader structural (extrapersonal, 15 studies) factors that are situated within social determinants of health. People therefore evaluate various costs and benefits of starting and staying on treatment, in which biomedical concerns play an important yet often subsidiary role. In this review the economic barriers to care were found to be significant and under-reported, highlighting the persistent health inequities in terms of access to services. Our understanding of the context around people's use of ART remains poor. Qualitative social research within HIV-positive communities is urgently needed to capture people's lived experiences and may address some of this deficit in understanding.
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Affiliation(s)
- K Bolsewicz
- a School of Public Health, University of Queensland , Herston , Australia
| | - J Debattista
- b Metro North Public Health Unit, Metro North Hospital & Health Service , Windsor , Australia
| | - A Vallely
- c Public Health Interventions Research Group, The Kirby Institute, UNSW.,d Australian Institute of Tropical Health & Medicine, James Cook University , Cairns , Australia
| | - A Whittaker
- e School of Social Science, Faculty of Arts , Monash University , Melbourne , Victoria , Australia
| | - L Fitzgerald
- a School of Public Health, University of Queensland , Herston , Australia
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Kupprat SA, Halkitis PN, Pérez-Figueroa R, Solomon TM, Ashman T, Kingdon MJ, Levy MD. Age- and education-matched comparison of aging HIV+ men who have sex with men to general population on common neuropsychological assessments. J Health Psychol 2015; 20:1175-85. [PMID: 24265296 PMCID: PMC4451431 DOI: 10.1177/1359105313509844] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Little is known about the impact of HIV and aging on cognitive functioning. This New York City cross-sectional study of aging HIV-positive gay and bisexual men assessed their neuropsychological state. Working memory and verbal abstract reasoning were relatively intact. After 55 years of age, attention abilities were impaired. Executive function impairment was present regardless of age and education. Results suggest the need for HIV-specific norms, and the use of neuropsychological assessments (i.e. baseline and over time) as a cost-effective way to assess HIV-related cognitive decline in developed and under-developed countries.
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Johnson M, Samarina A, Xi H, Valdez Ramalho Madruga J, Hocqueloux L, Loutfy M, Fournelle MJ, Norton M, Van Wyk J, Zachry W, Martinez M. Barriers to access to care reported by women living with HIV across 27 countries. AIDS Care 2015; 27:1220-30. [PMID: 26168817 PMCID: PMC4673574 DOI: 10.1080/09540121.2015.1046416] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Increased access to successful antiretroviral therapy (ART) is necessary in order to achieve an AIDS-free generation. Importantly, slightly over half of the people living with HIV are women. Small studies have described many barriers to accessing treatment and care among women living with HIV. This cross-sectional, non-interventional, epidemiological study assessed the prevalence of barriers to accessing care for women living with HIV across 27 countries, divided into four global regions. HIV-positive women attending routine clinical visits were offered the opportunity to participate in the study. Data describing the study sites and demographic characteristics of the participating women were collected. Participating women filled out questionnaires including the Barriers to Care Scale (BACS) questionnaire, on which they reported the extent to which they found each of the 12 potential barriers to accessing health care problematic. A total of 1931 women living with HIV were included in the study: 760 from Western Europe and Canada (WEC), 532 from Central and Eastern Europe (CEE), 519 from Latin America (LA), and 120 from China. The mean age of participating women was 40.1 ± 11.4 years. A total of 88.2% were currently taking ART. A total of 81.8% obtained HIV treatment under a government health plan. The most prevalent barrier to care was community HIV/AIDS stigma. Community HIV/AIDS knowledge, lack of supportive/understanding work environments, lack of employment opportunities, and personal financial resources were also highly prevalent barriers to accessing care. These findings indicate that, more than 30 years after the start of the AIDS epidemic, stigma is still a major issue for women living with HIV. Continued efforts are needed to improve community education on HIV/AIDS in order to maximize access to health care among women living with HIV.
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Affiliation(s)
| | - Anna Samarina
- b Saint-Petersburg City HIV Centre , Petersburg , Russia
| | - He Xi
- c Guangzhou Eight People's Hospital , Yuexiu District , Guangzhou , China
| | | | - Laurent Hocqueloux
- e Centre Hospitalier Régional d'Orléans - La Source, Service des Maladies Infectieuses et Tropicales, Orléans , France
| | - Mona Loutfy
- f Women's College Research Institute , University of Toronto, Toronto , Canada
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Christopoulos KA, Riley ED, Tulsky J, Carrico AW, Moskowitz JT, Wilson L, Coffin LS, Falahati V, Akerley J, Hilton JF. A text messaging intervention to improve retention in care and virologic suppression in a U.S. urban safety-net HIV clinic: study protocol for the Connect4Care (C4C) randomized controlled trial. BMC Infect Dis 2014; 14:718. [PMID: 25551175 PMCID: PMC4323139 DOI: 10.1186/s12879-014-0718-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/15/2014] [Indexed: 11/22/2022] Open
Abstract
Background Few data exist on the use of text messaging as a tool to promote retention in HIV care and virologic suppression at the clinic level in the United States. We describe the protocol for a study designed to investigate whether a text messaging intervention that supports healthy behaviors, encourages consistent engagement with care, and promotes antiretroviral persistence can improve retention in care and virologic suppression among patients in an urban safety-net HIV clinic in San Francisco. Methods/Design Connect4Care (C4C) is a single-site, randomized year-long study of text message appointment reminders vs. text message appointment reminders plus thrice-weekly supportive, informational, and motivational text messages. Eligible consenting patients are allocated 1:1 to the two arms within strata defined by HIV diagnosis within the past 12 months (i.e. “newly diagnosed”) vs. earlier. Study participants must receive primary care at the San Francisco General Hospital HIV clinic, speak English, possess a cell phone and be willing to send/receive up to 25 text messages per month, a have viral load >200 copies/μL, and be either new to the clinic or have a history of poor retention. The primary efficacy outcome is virologic suppression at 12 months and the key secondary outcome, which will also be examined as a mediator of the primary outcome, is retention in HIV care, as operationalized by kept and missed primary care visits. Process outcomes include text message response rate and percent of time in study without cell phone service. Generalized estimating equation log-binomial models will be used for intent to treat, per protocol, and mediation analyses. An assessment of the cost and cost-effectiveness of the intervention is planned along with a qualitative evaluation of the intervention. Discussion Findings from this study will provide valuable information about the use of behavioral-theory based text messaging to promote retention in HIV care and virologic suppression, further elucidate the challenges of using texting technology with marginalized urban populations, and help guide the development of new mobile health strategies to improve HIV care cascade outcomes. Trial registration NCT01917994 Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0718-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katerina A Christopoulos
- HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, 995 Potrero Avenue, 4th Floor, San Francisco, CA, 94110, USA.
| | - Elise D Riley
- HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, 995 Potrero Avenue, 4th Floor, San Francisco, CA, 94110, USA.
| | - Jacqueline Tulsky
- HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, 995 Potrero Avenue, 4th Floor, San Francisco, CA, 94110, USA.
| | - Adam W Carrico
- School of Nursing, University of California San Francisco, San Francisco, CA, USA.
| | - Judith T Moskowitz
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Leslie Wilson
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA.
| | - Lara S Coffin
- HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, 995 Potrero Avenue, 4th Floor, San Francisco, CA, 94110, USA.
| | - Veesta Falahati
- Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Jordan Akerley
- HIV Services, The Shanti Project, San Francisco, CA, USA.
| | - Joan F Hilton
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
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Servin AE, Muñoz FA, Zúñiga ML. Healthcare provider perspectives on barriers to HIV-care access and utilisation among Latinos living with HIV in the US-Mexico border. CULTURE, HEALTH & SEXUALITY 2014; 16:587-599. [PMID: 24592920 PMCID: PMC4451060 DOI: 10.1080/13691058.2014.886131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Latinos living with HIV residing in the US-Mexico border region frequently seek care on both sides of the border. Given this fact, a border health perspective to understanding barriers to care is imperative to improve patient health outcomes. This qualitative study describes and compares experiences and perceptions of Mexican and US HIV care providers regarding barriers to HIV care access for Latino patients living in the US-Mexico border region. In 2010, we conducted in-depth qualitative interviews with HIV care providers in Tijuana (n = 10) and San Diego (n = 9). We identified important similarities and differences between Mexican and US healthcare provider perspectives on HIV care access and barriers to service utilisation. Similarities included the fact that HIV-positive Latino patients struggle with access to ART medication, mental health illness, substance abuse and HIV-related stigma. Differences included Mexican provider perceptions of medication shortages and US providers feeling that insurance gaps influenced medication access. Differences and similarities have important implications for cross-border efforts to coordinate health services for patients who seek care in both countries.
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Affiliation(s)
- Argentina E. Servin
- Center on Gender Equity and Health, Division of Global Public Health, School of Medicine, University of California, San Diego, USA
| | - Fátima A. Muñoz
- Division of Global Public Health, School of Medicine, University of California, San Diego, USA
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Christopoulos KA, Massey AD, Lopez AM, Geng EH, Johnson MO, Pilcher CD, Fielding H, Dawson-Rose C. "Taking a half day at a time:" patient perspectives and the HIV engagement in care continuum. AIDS Patient Care STDS 2013; 27:223-30. [PMID: 23565926 DOI: 10.1089/apc.2012.0418] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The HIV treatment continuum, or "cascade," outlines key benchmarks in the successful treatment of HIV-infected individuals. However, the cascade fails to capture important dimensions of the patient experience in that it has been constructed from a provider point of view. In order to understand meaningful steps in the HIV care cascade for individuals diagnosed with HIV through expanded, more routine testing, we conducted in-depth interviews (n=34) with three groups of individuals: those diagnosed with HIV in the emergency department/urgent care clinic who linked to HIV care and exhibited 100% appointment adherence in the first 6 months of HIV care; those diagnosed in the emergency department/urgent care clinic who linked to HIV care and exhibited sporadic appointment adherence in the first 6 months of HIV care, and; hospitalized patients with no outpatient HIV care for at least 6 months. This last group was chosen to supplement data from in-care patients. The engagement in care process was defined by a changing perspective on HIV, one's HIV identity, and the role of health care. The linkage to care experience laid the groundwork for subsequent retention. Interventions to support engagement in care should acknowledge that patient concerns change over time and focus on promoting shifts in perspective.
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Affiliation(s)
- Katerina A. Christopoulos
- HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California
| | - Amina D. Massey
- HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California
| | - Andrea M. Lopez
- HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California
| | - Elvin H. Geng
- HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California
| | - Mallory O. Johnson
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California
| | - Christopher D. Pilcher
- HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California
| | - Hegla Fielding
- HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California
| | - Carol Dawson-Rose
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California
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Hermes A, Squires K, Fredrick L, Martinez M, Pasley M, Trinh R, Norton M. Meta-analysis of the safety, tolerability, and efficacy of lopinavir/ritonavir-containing antiretroviral therapy in HIV-1-infected women. HIV CLINICAL TRIALS 2013. [PMID: 23195669 DOI: 10.1310/hct1306-308] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Women comprise ≯50% of HIV-infected patients, yet safety, tolerability, and efficacy data in women taking antiretrovirals (ARVs) are limited. Lopinavir/ ritonavir (LPV/r)-anchored regimens are globally the most widely prescribed HIV-1 protease inhibitor regimens. The objective was to investigate the safety and efficacy of LPV/r-based therapy in women. METHODS A database query yielded all available data in HIV-1-infected subjects receiving LPV/r-based triple-ARV regimens from randomized clinical trials lasting ≥48 weeks from Abbott or Abbott-supported AIDS Clinical Trials Group studies. Efficacy (HIV-1 RNA levels, CD4+ T-cell counts) and safety and tolerability (treatment discontinuation, treatment-related adverse events [AE], and clinical laboratory abnormalities) at 48 weeks were assessed for total women, women by age (≥50, <50 years) and body mass index (BMI; <25, ≥25 to <30, ≥30 kg/m2), and sex. RESULTS Nine hundred ninety-two women initiated LPV/r-based therapy (of whom 79.2% were ARV-naïve), with 83.6% completing 48 weeks of treatment. There were 75.5% of women who achieved a threshold of HIV RNA <400 copies/mL by intent-to-treat, non-completer equals failure (ITT, NC = F) analysis, with a mean ± SE CD4+ T-cell count increase of 191.6 ± 4.92 cells/mm3 from baseline. Women aged ≥50 versus <50 years had higher incidence of moderate-to-severe treatment-related AEs and certain laboratory abnormalities, better virologic response (HIV RNA <400 copies/mL by ITT, NC = F), similar immunologic responses, and similar overall incidence of treatment discontinuations. Higher incidences of certain moderate-to-severe treatment-related AEs and laboratory abnormalities occurred in women with BMI ≥30 kg/m2; however, no effect of BMI on efficacy or discontinuation was observed. CONCLUSIONS LPV/r-based regimens were efficacious and well-tolerated in women without marked differences based on age and BMI categories evaluated.
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Affiliation(s)
- A Hermes
- Abbott Laboratories, Abbott Park, IL, USA.
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