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Epalza C, Domínguez-Rodríguez S, Cervantes E, Jiménez de Ory S, Frick MA, Fortuny C, Soler-Palacín P, Prieto-Tato L, Sainz T, Carreras-Abad C, Montero Alonso M, de Zárraga Fernández MA, Ocampo A, Rojo P, Navarro ML. Factors associated with late presentation for HIV care in adolescents in Spain. HIV Med 2022; 23:1195-1201. [PMID: 36178091 DOI: 10.1111/hiv.13407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Late presenters (LP) for HIV care are associated with higher morbidity and mortality rates. Our aim was to describe the characteristics associated with LP among adolescents in Spain. Identification of particular features may help in the design of strategies for improvement. METHODS Late-presenting adolescents diagnosed at 12-19 years of age and enrolled in the Spanish paediatric and adult HIV/AIDS cohorts (CoRIS-CoRISpe) from 2004 to 2019 were selected. LP were defined as those presenting with CD4 count <350 cells/mm3 or an AIDS-defining event in the 6 months following HIV diagnosis. Confirmed low CD4 count in the next 3 months and before antiretroviral treatment initiation defined confirmed LP (cLP). RESULTS Of 410 adolescents newly diagnosed with HIV, 303 (73.9%) had available data for assessing late presentation. Of these, 34.7% were LP and 23.7% were cLP. The median CD4 count for cLP was 235 cells/mm3 (interquartile range 122-285). In a multivariable analysis, adolescents at the highest risk of late presentation were early adolescents (age 12-14 years; odds ratio [OR] 6.50; 95% confidence interval [CI] 2.61-18.2), middle adolescents (age 15-17 years; OR 1.85; 95% CI 0.92-3.59), and adolescents born abroad (OR 1.71; 95% CI 0.97-3.00), particularly those of African origin (OR 3.08; 95% CI 1.38-6.79). CONCLUSIONS One-quarter of adolescents presented late for HIV care in Spain. Early adolescents, middle adolescents, and those born abroad presented a sevenfold, twofold, and twofold higher risk of being cLP, respectively. Enhancing the awareness of HIV risk and the access to care, especially for younger and foreign adolescents, could help reduce late presentation and tackle the adolescent HIV epidemic.
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Affiliation(s)
- Cristina Epalza
- Paediatric Infectious Diseases Unit. Department of Paediatrics, Hospital Universitario 12 de Octubre, Madrid. Universidad Complutense de Madrid, Spain.,Paediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
| | - Sara Domínguez-Rodríguez
- Paediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Eloisa Cervantes
- Paediatric Infectious Diseases Unit. Department of Paediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Santiago Jiménez de Ory
- Grupo de Enfermedades Infecciosas en la Población Pediátrica, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón Madrid, Madrid, Spain.,CIBER de Enfermedades Infecciosas (CIBERInfec), Instituto de Salud Carlos III, Madrid, Spain
| | - Marie Antoinette Frick
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain.,Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Infantil Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Clàudia Fortuny
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Sant Joan de Déu, Barcelona, Spain.,CIBER en Epidemiología y Salud Pública, CIBERESP, Spain.Departament de Pediatria, Universitat de Barcelona Facultat de Medicina, Barcelona, Spain
| | - Pere Soler-Palacín
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain.,Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Infantil Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Luis Prieto-Tato
- Paediatric Infectious Diseases Unit. Department of Paediatrics, Hospital Universitario 12 de Octubre, Madrid. Universidad Complutense de Madrid, Spain.,Paediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
| | - Talía Sainz
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain.,CIBER de Enfermedades Infecciosas (CIBERInfec), Instituto de Salud Carlos III, Madrid, Spain.,Department of Pediatrics. Hospital Universitario La Paz - IdiPAZ Research Institute. Universidad Autónoma de Madrid, Spain
| | - Clara Carreras-Abad
- Paediatric Infectious Diseases Unit. Department of Paediatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marta Montero Alonso
- Unidad de Enfermedades Infecciosas, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | | | - Antonio Ocampo
- Unidad de Enfermedades Infecciosas. Servicio de Medicina Interna, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Pablo Rojo
- Paediatric Infectious Diseases Unit. Department of Paediatrics, Hospital Universitario 12 de Octubre, Madrid. Universidad Complutense de Madrid, Spain.,Paediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
| | - Maria Luisa Navarro
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain.,CIBER de Enfermedades Infecciosas (CIBERInfec), Instituto de Salud Carlos III, Madrid, Spain.,Pediatric Infectious Disease Unit, Department of Pediatrics, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). UCM, Madrid, Spain
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Msukwa MT, MacLachlan EW, Gugsa ST, Theu J, Namakhoma I, Bangara F, Blair CL, Payne D, Curran KG, Arons M, Namachapa K, Wadonda N, Kabaghe AN, Dobbs T, Shanmugam V, Kim E, Auld A, Babaye Y, O'Malley G, Nyirenda R, Bello G. Characterising persons diagnosed with HIV as either recent or long-term using a cross-sectional analysis of recent infection surveillance data collected in Malawi from September 2019 to March 2020. BMJ Open 2022; 12:e064707. [PMID: 36153024 PMCID: PMC9511604 DOI: 10.1136/bmjopen-2022-064707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/09/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In Malawi, a recent infection testing algorithm (RITA) is used to characterise infections of persons newly diagnosed with HIV as recent or long term. This paper shares results from recent HIV infection surveillance and describes distribution and predictors. SETTING Data from 155 health facilities in 11 districts in Malawi were pooled from September 2019 to March 2020. PARTICIPANTS Eligible participants were ≥13 years, and newly diagnosed with HIV. Clients had RITA recent infections if the rapid test for recent infection (RTRI) test result was recent and viral load (VL) ≥1000 copies/mL; if VL was <1000 copies/mL the RTRI result was reclassified as long-term. Results were stratified by age, sex, pregnancy/breastfeeding status and district. RESULTS 13 838 persons consented to RTRI testing and 12 703 had valid RTRI test results and VL results after excluding clients not newly HIV-positive, RTRI negative or missing data (n=1135). A total of 12 365 of the 12 703 were included in the analysis after excluding those whose RTRI results were reclassified as long term (n=338/784 or 43.1%). The remainder, 446/12 703 or 3.5%, met the definition of RITA recent infection. The highest percentage of recent infections was among breastfeeding women (crude OR (COR) 3.2; 95% CI 2.0 to 5.0), young people aged 15-24 years (COR 1.6; 95% CI 1.3 to 1.9) and persons who reported a negative HIV test within the past 12 months (COR 3.3; 95% CI 2.6 to 4.2). Factors associated with recent infection in multivariable analysis included being a non-pregnant female (adjusted OR (AOR) 1.4; 95% CI 1.2 to 1.8), a breastfeeding female (AOR 2.2; 95% CI 1.4 to 3.5), aged 15-24 years (AOR 1.6; 95% CI 1.3 to 1.9) and residents of Machinga (AOR 2.0; 95% CI 1.2 to 3.5) and Mzimba (AOR 2.4; 95% CI 1.3 to 4.5) districts. CONCLUSIONS Malawi's recent HIV infection surveillance system demonstrated high uptake and identified sub-populations of new HIV diagnoses with a higher percentage of recent infections.
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Affiliation(s)
- Malango T Msukwa
- Department of Global Health, I-TECH, University of Washington, Lilongwe, Malawi
| | - Ellen W MacLachlan
- Department of Global Health, I-TECH, University of Washington, Seattle, Washington, USA
| | - Salem T Gugsa
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Joe Theu
- Department of Global Health, I-TECH, University of Washington, Lilongwe, Malawi
| | - Ireen Namakhoma
- Department of Global Health, I-TECH, University of Washington, Lilongwe, Malawi
| | - Fred Bangara
- Department of Global Health, I-TECH, University of Washington, Lilongwe, Malawi
| | - Christopher L Blair
- Department of Global Health, I-TECH, University of Washington, Lilongwe, Malawi
| | - Danielle Payne
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Kathryn G Curran
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa Arons
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Khumbo Namachapa
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Central Region, Malawi
| | - Nellie Wadonda
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | | | - Trudy Dobbs
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Evelyn Kim
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Andrew Auld
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Yusuf Babaye
- Department of Global Health, I-TECH, University of Washington, Lilongwe, Malawi
| | - Gabrielle O'Malley
- Department of Global Health, I-TECH, University of Washington, Seattle, Washington, USA
| | - Rose Nyirenda
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Central Region, Malawi
| | - George Bello
- Department of Global Health, I-TECH, University of Washington, Lilongwe, Malawi
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Ickowicz S, Dong H, Ti L, Nolan S, Fairbairn N, Barrios R, Milloy MJ. Behavioural, social and structural-level risk factors for developing AIDS among HIV-positive people who use injection drugs in a Canadian setting, 1996-2017. AIDS Care 2020; 32:1262-1267. [PMID: 32476442 DOI: 10.1080/09540121.2020.1772955] [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: 10/24/2022]
Abstract
People who use injection drugs (PWID) experience high rates of HIV acquisition and, as a result of lower rates of optimal access and adherence to combination antiretroviral therapy (ART), experience worse HIV treatment outcomes than other key affected populations. However, the incidence and risk factors for the development of AIDS among HIV-positive PWID have not been completely described. We used data from a community-recruited prospective cohort of HIV-positive PWID in Vancouver, Canada, a setting with universal no-cost ART and a comprehensive clinical monitoring registry. We used multivariable extended Cox models to identify factors associated with time to AIDS. Between 1996 and 2017, 396 participants, including 140 (35.4%) women, were followed for a median of 39.0 months (interquartile range: 16.6-76.2), among whom 165 (41.7%) developed AIDS. In a multivariable model, homelessness (Adjusted Hazard Ratio [AHR] = 1.76 (1.18-2.61)) and injection drug use within the preceding six months (AHR = 1.74 (1.17-2.58)) were independently associated with a higher risk of developing AIDS. Despite widespread scale-up of programmes to improve ART utilization, significant risk factors for the development of AIDS remain among HIV-positive PWID in this setting.
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Affiliation(s)
- S Ickowicz
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada
| | - H Dong
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada
| | - L Ti
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - S Nolan
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - N Fairbairn
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - R Barrios
- BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada.,Faculty of Medicine, School of Population and Public Health, Vancouver, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
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Factores psicosociales asociados a la realización de la prueba diagnóstica del VIH en estudiantes universitarios colombianos. ACTA COLOMBIANA DE PSICOLOGIA 2020. [DOI: 10.14718/acp.2020.23.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Los objetivos de esta investigación fueron: (a) relacionar el riesgo sexual, los conocimientos y las actitudes hacia la prueba del VIH con su realización en estudiantes universitarios colombianos; y (b) describir las barreras percibidas en aquellos que no sela habían realizado, identificando las diferencias según el sexo. Se llevó a cabo un estudio transversal en el que particip- aron 1057 estudiantes colombianos, y en el que se utilizó el Cuestionario Confidencial sobre Vida Sexual Activa (CCVSA), el test Barreras Hacia la Prueba del VIH, la Escala de Actitudes hacia el VIH-Sida y un cuestionario ad hoc de conocimien- tos sobre la prueba. Los estudiantes que se realizaron la prueba (n = 214) reportaron una edad inferior de iniciación sexual (p < .01), un número superior de parejas sexuales (p = .01) y un menor uso de condón en la primera (p = .02) y la última (p = .04) relación sexual, así como mayores conocimientos sobre la prueba del VIH (p < .001). Las principales barreras estuvieron relacionadas con la baja percepción del riesgo de la enfermedad (29.8 %), la confianza en las parejas sexuales (29.2 %) y la falta de ofrecimiento de la prueba (25.2 %). En conclusión, la realización de la prueba está relacionada con la exposición a conductas sexuales de riesgo y con los conocimientos, mas no con las actitudes hacia la prueba. La identi- ficación de los factores psicosociales vinculados podría contribuir al diseño de intervenciones orientadas a la prevención y al tratamiento oportuno de la enfermedad.
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Gutiérrez-Velilla E, Quezada-Juárez FJ, Pérez-Sánchez IN, C Iglesias M, Reyes-Terán G, Caballero-Suárez NP. Identifying risk factors for HIV-positive test results in walk-in and hospitalized patients in a Mexico City HIV clinic: a descriptive study. Int J STD AIDS 2019; 30:569-576. [PMID: 30813862 DOI: 10.1177/0956462419828604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to analyze risk factors for HIV-positive tests in walk-in users and in hospitalized patients in a Mexico City hospital. We undertook a cross-sectional study based on routine HIV testing and counseling service data in adults undergoing an HIV test from January 2015 to July 2017. Multivariate analysis was performed to determine risk factors for walk-in and hospitalized patients. The results showed that 2040 people tested during the period; hospitalized patients were more likely to test HIV-positive than walk-in users (18 versus 15%; p < 0.05). HIV risk factors for hospitalized patients included being men who have sex with men (MSM) (adjusted odds ratio [aOR] 7.2, 95% CI 2.0-26.5), divorced (aOR 4.4, 95% CI 1.3-14.4), having 3-5 lifetime sexual partners (aOR 2.7, 95% CI 1.0-7.4), and being in the emergency room (aOR 3.6, 95% CI 1.1-11.3), intensive care (aOR 27.2, 95% CI 3.4-217.2), or clinical pneumology wards (aOR 33.4, 95% CI 9.7-115.2). In the walk-in group, HIV risk factors included being male (aOR 2.8, 95% CI 1.3-5.9), being MSM (aOR 4.3, 95% CI 2.0-9.5), having sex while using drugs (aOR 2.3, 95% CI 1.3-4.0), being referred by a physician for testing (aOR 3.2, 95% CI 1.6-6.3), and perceiving oneself at risk (aOR 3.8, 95% CI 2.3-6.3). Differential risk factors found among hospitalized patients and walk-in testers can be helpful in designing better HIV testing strategies to increase early diagnosis and linkage to care.
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Affiliation(s)
- Ester Gutiérrez-Velilla
- 1 Departamento de Investigación en Enfermedades Infecciosas (CIENI), Instituto Nacional de Enfermedades Respiratorias (INER), Mexico City, Mexico
| | - Francisco J Quezada-Juárez
- 1 Departamento de Investigación en Enfermedades Infecciosas (CIENI), Instituto Nacional de Enfermedades Respiratorias (INER), Mexico City, Mexico
| | - Ivonne N Pérez-Sánchez
- 1 Departamento de Investigación en Enfermedades Infecciosas (CIENI), Instituto Nacional de Enfermedades Respiratorias (INER), Mexico City, Mexico.,2 Consejo Nacional de Ciencia y Tecnología (CONACYT), Mexico City, Mexico
| | - Maria C Iglesias
- 1 Departamento de Investigación en Enfermedades Infecciosas (CIENI), Instituto Nacional de Enfermedades Respiratorias (INER), Mexico City, Mexico
| | - Gustavo Reyes-Terán
- 1 Departamento de Investigación en Enfermedades Infecciosas (CIENI), Instituto Nacional de Enfermedades Respiratorias (INER), Mexico City, Mexico
| | - Nancy P Caballero-Suárez
- 1 Departamento de Investigación en Enfermedades Infecciosas (CIENI), Instituto Nacional de Enfermedades Respiratorias (INER), Mexico City, Mexico
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