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Ellis JD, Dunn KE, Huhn AS. Harm Reduction for Opioid Use Disorder: Strategies and Outcome Metrics. Am J Psychiatry 2024; 181:372-380. [PMID: 38706335 DOI: 10.1176/appi.ajp.20230918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Tweet: The authors discuss harm reduction strategies and associated outcome metrics in relation to the ongoing opioid crisis.
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Affiliation(s)
- Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore
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2
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Forthal S, Choi S, Yerneni R, Macinski S, Levey W, Kerwin J, Ahadzi M, Fish D, Anderson BJ, Neighbors C. Impact of supportive housing health homes program on medicaid utilization for persons diagnosed with HIV (PDWH). AIDS Care 2023; 35:1885-1890. [PMID: 36524897 PMCID: PMC10272282 DOI: 10.1080/09540121.2022.2158302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
ABSTRACTUnstable housing among persons diagnosed with HIV (PDWH) has been consistently linked to poor HIV-related care engagement. We examined the relationship between enrollment in a supportive housing program and health care utilization (use of outpatient services, emergency department (ED) visits, and hospitalizations) for a group of unstably housed, Medicaid and Health Homes (HH)-enrolled PDWH in New York State. We analyzed monthly longitudinal data consisting of linked supportive housing data, HH data, and Medicaid claims from New York State (excluding New York City) between 2012 and 2017 using time series models. Participants who had at least six consecutive months of supportive housing at month t had 20% higher odds of using an outpatient service, 19% lower odds of visiting the ED, and 24% lower odds of being hospitalized compared to those with less than six consecutive months of supportive housing after adjusting for covariates. Supportive housing may promote better medical management by increasing outpatient visits among chronically homeless PDWH.
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Affiliation(s)
- Sarah Forthal
- Department of Data Science, Partnership to End Addiction, New York, NY, USA
| | - Sugy Choi
- Department of Data Science, Partnership to End Addiction, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Rajeev Yerneni
- Department of Data Science, Partnership to End Addiction, New York, NY, USA
| | - Sarah Macinski
- AIDS Institute, New York State Department of Health, Albany, New York
| | - Wendy Levey
- AIDS Institute, New York State Department of Health, Albany, New York
| | - Joseph Kerwin
- AIDS Institute, New York State Department of Health, Albany, New York
| | - Martina Ahadzi
- Office of Health Insurance Programs, New York State Department of Health, Albany, New York
| | - Douglas Fish
- Office of Health Insurance Programs, New York State Department of Health, Albany, New York
| | - Bridget J. Anderson
- AIDS Institute, New York State Department of Health, Albany, New York
- New York State Center for Community Health, Department of Health, Albany, New York
| | - Charles Neighbors
- Department of Data Science, Partnership to End Addiction, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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Gouse I, Walters S, Miller-Archie S, Singh T, Lim S. Evaluation of New York/New York III permanent supportive housing program. EVALUATION AND PROGRAM PLANNING 2023; 97:102245. [PMID: 36764060 DOI: 10.1016/j.evalprogplan.2023.102245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/05/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
In 2005, the city and state of New York launched New York/New York III (NY/NY III), a permanent supportive housing program for individuals experiencing homelessness or at risk of homelessness with complex medical and behavioral health issues. This review paper summarizes a decade of findings (2007-2017) from the NY/NY III evaluation team, to analyze this program's impact on various housing and health outcomes. The evaluation team linked NY/NY III eligible persons with administrative data from two years pre- and two years post-eligibility and compared housing and health outcomes between placed and unplaced groups using propensity score analysis. Placement into NY/NY III housing was associated with improved physical and mental health outcomes, increased housing stability, and statistically significant cost savings per person after one year of placement. The evaluation team recommends that municipalities invest in supportive housing as a means for mitigating homelessness and improving health outcomes in this vulnerable population.
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Affiliation(s)
- Isabel Gouse
- Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, 42-09 28th St, 7th Floor, Queens, NY 11101, USA.
| | - Sarah Walters
- Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, 42-09 28th St, 7th Floor, Queens, NY 11101, USA
| | - Sara Miller-Archie
- Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, 42-09 28th St, 7th Floor, Queens, NY 11101, USA
| | - Tejinder Singh
- Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, 42-09 28th St, 7th Floor, Queens, NY 11101, USA
| | - Sungwoo Lim
- Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, 42-09 28th St, 7th Floor, Queens, NY 11101, USA
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López JD, Qiao Q, Presti RM, Hammer RA, Foraker RE. The impact of neighborhood socioeconomic status on retention in care and viral suppression among people living with HIV. AIDS Care 2022; 34:1383-1389. [PMID: 35164602 DOI: 10.1080/09540121.2022.2040724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Our study combined publicly available neighborhood socioeconomic status (nSES) data from the U.S. Census and clinical data to investigate the relationships between nSES, retention in care (RIC) and viral suppression (VS). Data from 2275 patients were extracted from 2009 to 2015 from a midwestern infectious diseases clinic. RIC was defined as patients who kept ≥ 3 visits and VS as an average viral load <200 copies/mL during their index year of study. Logistic regression models provided estimates for neighborhood-level and patient-level variables. In multivariable models, patients living in zip codes with low disability rates (1.50, 1.30-1.70), who wereolder (1.02, 1.01-1.03), and receiving antiretroviral therapy (ART; 3.81, 3.56-4.05) were more likely to have RIC, while those who were unemployed (0.72, 0.45-0.98) and self-reported as BIPOC (0.79, 0.64-0.97) were less likely to have RIC. None of the nSES variables were significantly associated with VS in multivariable models, yet older age (1.05, 1.04-1.05) and self-reported as BIPOC (1.68, 1.36-2.09) were modestly associated with VS, and receiving ART (6.14, 5.86-6.42) was a strong predictor of VS. In multivariable models, nSES variables were independently predictive more than of patient-level variables, for RIC but not VS.
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Affiliation(s)
- Julia D López
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO, USA
| | - Qisha Qiao
- Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Rachel M Presti
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO, USA
| | - Rachel A Hammer
- Department of Plant and Microbial Biology, North Carolina State University, Raleigh, NC, USA
| | - Randi E Foraker
- Department of Internal Medicine, Institute for Informatics, Washington University School of Medicine, Saint Louis, MO, USA
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5
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Zhao Y, Shannon K, Buxton JA, Ti L, Genovy TA, Braschel M, Deering K. The prevalence and social-structural correlates of housing status among women living with HIV in Vancouver, Canada. BMC Public Health 2022; 22:1804. [PMID: 36138356 PMCID: PMC9502613 DOI: 10.1186/s12889-022-14113-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 08/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background Women living with HIV (WLWH) experience numerous social and structural barriers to stable housing, with substantial implications for access to health care services. This study is the first to apply the Canadian Definition of Homelessness (CDOH), an inclusive national guideline, to investigate the prevalence and correlates of housing status among WLWH in Metro Vancouver, Canada. Methods Our study utilized data from a longitudinal open cohort of cisgender and trans WLWH aged 14 years and older, in 2010–2019. Cross-sectional descriptive statistics of the prevalence of housing status and other social and structural variables were summarized for the baseline visits. Bivariate and multivariable logistic regression analyses were conducted using generalized linear mixed models (GLMM) for repeated measures to investigate the relationship between social and structural correlates and housing status among WLWH. Results The study included 336 participants with 1930 observations over 9 years. Housing status derived from CDOH included four categories: unsheltered, unstable, supportive housing, and stable housing (reference). Evidence suggested high levels of precarious housing, with 24% of participants reporting being unsheltered, 47% reporting unstable housing, 11.9% reporting supportive housing, and 16.4% reporting stable housing in the last six months at baseline. According to the multivariable models, living in the Downtown Eastside (DTES) neighbourhood of Metro Vancouver, hospitalization, physical/sexual violence, and stimulant use were associated with being unsheltered, compared to stable housing; DTES residence, hospitalization, and physical/sexual violence were associated with unstable housing; DTES residence and stimulant use were associated with living in supportive housing. Conclusion Complex social-structural inequities are associated with housing instability among WLWH. In addition to meeting basic needs for living, to facilitate access to housing among WLWH, housing options that are gender-responsive and gender-inclusive and include trauma- and violence-informed principles, low-barrier requirements, and strong connections with supportive harm reduction services are critical.
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Affiliation(s)
- Yinong Zhao
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Kate Shannon
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Jane A Buxton
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Lianping Ti
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.,British Columbia Centre On Substance Use, Vancouver, Canada
| | - Theresa A Genovy
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Melissa Braschel
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Kathleen Deering
- Faculty of Medicine, University of British Columbia, Vancouver, Canada. .,Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada.
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Fernandez SB, Lopez C, Ibarra C, Sheehan DM, Ladner RA, Trepka MJ. Examining Barriers to Medication Adherence and Retention in Care among Women Living with HIV in the Face of Homelessness and Unstable Housing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11484. [PMID: 36141757 PMCID: PMC9517674 DOI: 10.3390/ijerph191811484] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
Despite advances in biomedical treatments, women living with HIV (WLH) who experience homelessness and housing instability suffer suboptimal HIV outcomes, even when linked to treatment. The purpose of this study was to explore experiences of housing instability among WLH and to understand its role in their ability to adhere to antiretroviral medication and remain retained in care. Sixteen women who were linked to Ryan White Program HIV care in South Florida participated in in-depth interviews. The findings focus around four larger themes: difficulty storing medication, privacy- and stigma-related issues, inconsistent access to medication and health care disruptions, and competing and unmet physical and mental health needs. Findings underscore the importance of strategies that are responsive to the disruption of routines and are sensitive to privacy issues in shared dwelling spaces; the proactive inquiry of behavioral and environmental considerations when prescribing antiretroviral medication; and the identification and treatment of comorbid conditions. This study provides evidence for strategies to facilitate self-management and improve modifiable system realities to augment larger-level policy and funding shifts that are critically needed to end the epidemic among vulnerable populations living with HIV.
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Affiliation(s)
- Sofia B. Fernandez
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL 33199, USA
| | - Cindy Lopez
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL 33199, USA
| | - Cynthia Ibarra
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
| | - Diana M. Sheehan
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL 33199, USA
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, FL 33199, USA
| | | | - Mary Jo Trepka
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL 33199, USA
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
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Molecular Epidemiology of Individuals Experiencing Unstable Housing or Living Homeless at HIV Diagnosis: Analysis of HIV Surveillance Data in King County, Washington. AIDS Behav 2022; 26:3459-3468. [PMID: 35445995 DOI: 10.1007/s10461-022-03689-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/01/2022]
Abstract
We examined patterns of genetic clustering among individuals diagnosed with HIV between 2010 and 2018 using data from King County, Washington's National HIV Surveillance System. Among 2,371 individuals newly diagnosed with HIV, 231 (10%) experienced unstable housing or were living homeless at the time of diagnosis. Among the 1,658 (70%) people with an available HIV-1 pol gene sequence, 1,071 (65%) were identified to be part of 296 genetic clusters. In our analysis, housing status was not associated with genetic clustering (OR 1.02; 95%CI:0.75,1.39). After adjusting for demographic and behavioral factors, people who were living homeless at HIV diagnosis had 35% lower odds of being identified as part of a genetic cluster (AOR 0.65; 95%CI:0.44,0.95) compared to people with stable housing. Our findings highlight that people experiencing unstable housing are disproportionately burdened by HIV, and that within this population in King County, being in a genetic cluster is predominantly associated with substance use.
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Berthaud V, Johnson L, Jennings R, Chandler-Auguste M, Osijo A, Baldwin MT, Matthews-Juarez P, Juarez P, Wilus D, Tabatabai M. The effect of homelessness on viral suppression in an underserved metropolitan area of middle Tennessee: potential implications for ending the HIV epidemic. BMC Infect Dis 2022; 22:144. [PMID: 35144557 PMCID: PMC8830956 DOI: 10.1186/s12879-022-07105-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] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A wealth of scientific evidence supports the effectiveness of HIV prophylaxis and treatment. Homelessness is strongly associated with the health status and viral suppression among underserved populations and can undermine the national plan to eliminate HIV by 2030. This retrospective observational study examined the extent in which homelessness affects HIV treatment in an underserved urban area of Middle Tennessee in 2014-2019. RESULTS Among 692 HIV-seropositive patients, the proportion of homeless patients increased from 13.5% in 2014 to 27.7% in 2019, thrice the national average for HIV-seropositive people (8.4%) and twice that of HIV positive patients who are participating in Ryan White programs nationwide (12.9%). Our findings suggest that homeless patients were half as likely to achieve viral suppression as compared to those who had a permanent/stable home [OR 0.48 (0.32-0.72), p-value < 0.001]. CONCLUSION Our study indicates that homelessness may play an important role in viral suppression among persons living with HIV/AIDS in Middle Tennessee.
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Affiliation(s)
- Vladimir Berthaud
- Division of Infectious Diseases, Meharry Community Wellness Center, Meharry Medical College, Nashville, TN, USA.
| | - Livette Johnson
- Division of Infectious Diseases, Meharry Community Wellness Center, Meharry Medical College, Nashville, TN, USA
| | - Ronda Jennings
- Division of Infectious Diseases, Meharry Community Wellness Center, Meharry Medical College, Nashville, TN, USA
| | - Maxine Chandler-Auguste
- Division of Infectious Diseases, Meharry Community Wellness Center, Meharry Medical College, Nashville, TN, USA
| | - Abosede Osijo
- Division of Infectious Diseases, Meharry Community Wellness Center, Meharry Medical College, Nashville, TN, USA
| | - Marie T Baldwin
- Division of Infectious Diseases, Meharry Community Wellness Center, Meharry Medical College, Nashville, TN, USA
| | | | - Paul Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA
| | - Derek Wilus
- School of Graduate Studies and Research, Meharry Medical College, Nashville, TN, USA
| | - Mohammad Tabatabai
- School of Graduate Studies and Research, Meharry Medical College, Nashville, TN, USA
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Koenig LJ, Higa DH, Leighton CA, Roland KB, DeLuca JB, Mizuno Y. Toward An Enhanced Understanding of HIV Patient Navigation as a Health Care Intervention: An Analysis of Navigation in Practice. AIDS Behav 2021; 25:4044-4054. [PMID: 33772697 DOI: 10.1007/s10461-021-03244-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 01/17/2023]
Abstract
Patient navigation is a promising strategy for improving health among persons with multiple barriers to HIV care, yet little is known about navigation's core components. From 24 systematically identified navigation studies, we abstracted navigators' activities, grouped activities into 20 thematic activity categories, and ordered them by frequency. Subsequently, Principal Components Analysis of activity categories was used identify independent clusters. Accompaniment characterized 71% of navigation programs; ≥ half included health education (58%), collaboration/coordination (58%), linkage-to-care (54%), transportation support (54%), service referrals (50%) and instrumental support (50%). Five unique components (comprising 13 activity categories) were identified: (1) services beyond office, (2) health education and relationship building, (3) accompaniment and instrumental support, (4) locating patients and tracking information, and (5) beyond HIV care. Navigators who located patients or tracked information were less likely to provide accompaniment or instrumental support (r = - 0.60, p = 0.002). Findings can enhance precision in developing, describing, evaluating and improving navigation programs.
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Affiliation(s)
- Linda J Koenig
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS US8-5, Atlanta, GA, 30329, USA.
| | - Darrel H Higa
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS US8-5, Atlanta, GA, 30329, USA
| | - Carolyn A Leighton
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS US8-5, Atlanta, GA, 30329, USA
| | - Katherine B Roland
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS US8-5, Atlanta, GA, 30329, USA
| | - Julia B DeLuca
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS US8-5, Atlanta, GA, 30329, USA
| | - Yuko Mizuno
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS US8-5, Atlanta, GA, 30329, USA
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Kerman N, Polillo A, Bardwell G, Gran-Ruaz S, Savage C, Felteau C, Tsemberis S. Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review. Drug Alcohol Depend 2021; 228:109052. [PMID: 34601279 DOI: 10.1016/j.drugalcdep.2021.109052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/14/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Harm reduction is a central tenet of Housing First. As the intervention has been shown to stably house people experiencing chronic homelessness across the lifespan with complex behavioural health needs, it is critical to understand the harm reduction outcomes and practices in Housing First. METHODS A systematic review following PRISMA guidelines was conducted of five databases: PsycINFO, MEDLINE, Embase, CINAHL, and Google Scholar. Harm reduction outcomes and practices in Housing First were examined in four domains: substance-related harms, viral health, sexual health, and harm reduction service use. RESULTS A total of 35 articles were included in the review, 23 of which examined harm reduction outcomes and 12 of which investigated harm reduction practices in Housing First. Harm reduction outcome studies focused mostly on nonspecific substance use problems, with Housing First being found to have minimal effects in this domain. More severe harms, such as delirium tremens and substance use-related deaths, have been minimally explored, though preliminary evidence is promising. Viral health, sexual health, and harm reduction service use outcomes were the focus of few studies. Research on harm reduction practices highlighted that Housing First providers experience both flexibility and ambiguity in their work using a harm reduction approach, and the importance of empathetic working relationships for engagement in harm reduction work. CONCLUSIONS Harm reduction outcomes in Housing First remain underexamined and any conclusions of the intervention's impacts in this domain would be premature. Effective harm reduction practices in Housing First require strong working relationships between staff and tenants.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, M6J 1H4, Canada.
| | - Alexia Polillo
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, M6J 1H4, Canada; University of Toronto, Department of Psychiatry, 250 College Street, 8th Floor, Toronto, Ontario, M5T 1R8, Canada
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9, Canada; University of British Columbia, Department of Medicine, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Sophia Gran-Ruaz
- University of Ottawa, School of Psychology, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, Ontario, K1N 6N5, Canada
| | - Cathi Savage
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada
| | - Charlie Felteau
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada
| | - Sam Tsemberis
- Pathways Housing First Institute, 1328 2nd Street, Santa Monica, CA, 90403, United States
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11
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Fletcher-Hildebrand S, Alimezelli H, Carr T, Lawson K, Ali A, Groot G. Understanding the impact of a residential housing programme for people living with HIV/AIDS: a realist evaluation protocol. BMJ Open 2021; 11:e044522. [PMID: 33820789 PMCID: PMC8030488 DOI: 10.1136/bmjopen-2020-044522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Housing instability and homelessness are significant barriers to medical treatment for people living with HIV/AIDS. For these individuals, lack of stable housing and stigma is associated with insufficient access to care, poor adherence to medication and higher cost burdens to the healthcare system. This protocol reports on the efforts to evaluate Sanctum V.1.0, a hospice and transitional care home for adults with HIV/AIDS in Saskatoon, Saskatchewan, Canada. The current project was developed out of a need to identify how Sanctum V.1.0 produces varying programme outcomes to assist in endeavours to replicate the programme in other geographic locations. METHODS AND ANALYSIS A realist evaluation will be conducted to explore how and why Sanctum V.1.0 is successful or unsuccessful, in which circumstances and for whom. Rather than explore the degree to which a programme is effective, realist evaluations seek to uncover mechanisms that explain processual links between programme inputs and outcomes. The completed first phase of the project involved the development of an initial realist programme theory. Phases 2 and 3 will consist of methods to test, refine and validate the initial theory using various data sources. ETHICS AND DISSEMINATION Ethics approval was obtained from the institutional review board at the University of Saskatchewan on 2 July 2020. Results will be disseminated according to stakeholders' desires.
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Affiliation(s)
| | - Hubert Alimezelli
- Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Tracey Carr
- Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Karen Lawson
- Psychology, University of Saskatchewan College of Arts and Science, Saskatoon, Saskatchewan, Canada
| | - Anum Ali
- Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Gary Groot
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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12
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Aquino G, Byrne M, Dorsey K, Siegel M, Mitchell O, Grant S, Fox A, Lum G, Allston A, Monroe A, Doshi R. Examining Retention in HIV Care and HIV Suppression on Housing Services Intake at a Washington, DC Community Based Organization. J Community Health 2021; 46:861-868. [PMID: 33507489 DOI: 10.1007/s10900-020-00959-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
In Washington, DC, 2% of residents are living with HIV, with 15.3% of them experiencing homelessness. Additionally, over half of DC-area renters are paying over 30% of their income for housing. The primary objective of this study was to describe HIV outcomes at initial intake at Housing Counseling Services (HCS). This retrospective study included adults with HIV completing HCS intake between 2015 and 2018 and linked HCS data with DC Department of Health (DOH) HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA) surveillance data. Proportions of individuals with retention in care (RIC) and viral suppression (VS) were compared across client subgroups using chi-square or rank sum tests. The sample of 734 participants was mostly male (67%), Non-Hispanic Black (89%), had MSM as the HIV transmission risk factor (44%) and had rental housing (60%). Most participants (634/734, 86%) were RIC at HCS intake. A majority of participants (477/621 or 77%) had VS at intake. Older age was associated with VS (p = 0.0007). Homeless individuals (with intake from the street) were less likely to be VS (4.8% vs. 11.1%, p < 0.0045). Our results suggest that PWH who have unstable housing or who are homeless may need additional support services for maintaining RIC and VS, as the proportion meeting those benchmarks was not at goal when they sought services at HCS.
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Affiliation(s)
- Gabrielle Aquino
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Morgan Byrne
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA
| | - Kerri Dorsey
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA.,District of Columbia Department of Health, Washington, DC, USA
| | | | | | - Sherita Grant
- District of Columbia Department of Health, Washington, DC, USA
| | - Anthony Fox
- District of Columbia Department of Health, Washington, DC, USA
| | - Garrett Lum
- District of Columbia Department of Health, Washington, DC, USA
| | - Adam Allston
- District of Columbia Department of Health, Washington, DC, USA
| | - Anne Monroe
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA.
| | - Rupali Doshi
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA.,District of Columbia Department of Health, Washington, DC, USA
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13
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Viral Rebound Among Persons With Diagnosed HIV Who Achieved Viral Suppression, United States. J Acquir Immune Defic Syndr 2021; 84:133-140. [PMID: 32084054 DOI: 10.1097/qai.0000000000002321] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Some persons who achieve viral suppression may later experience viral rebound, potentially putting them at risk for transmitting HIV. We estimate the prevalence of, and describe factors associated with, viral rebound among adults with diagnosed HIV in the United States who had ≥2 viral load tests in a 12-month period. SETTING The Medical Monitoring Project is an annual cross-sectional survey about the experiences and needs of adults with diagnosed HIV sampled from the National HIV Surveillance System. METHODS We analyzed interview and medical record data from 3 Medical Monitoring Project cycles spanning June 2015-May 2018. We analyzed viral load results from the 12-month period before the interview among persons with ≥2 viral load tests who achieved viral suppression. Data were weighted based on known probabilities of selection, adjusted for patient nonresponse, and poststratified to known population totals from the National HIV Surveillance System. RESULTS Among those with ≥2 viral load tests who achieved viral suppression, 7.5% demonstrated viral rebound. In multivariable analyses, viral rebound was higher among non-Hispanic blacks, persons ages 18-39, persons with public insurance, persons recently experiencing homelessness, persons with higher numbers of viral load tests, persons who missed HIV care appointments, and persons with suboptimal adherence to antiretroviral therapy. CONCLUSIONS Viral rebound varied by sociodemographic and clinical characteristics. HIV providers can monitor persons at greatest risk for viral rebound and link patients with ancillary services or evidence-based interventions to help them remain virally suppressed. Our findings can inform strategies and interventions implemented under the Ending the HIV Epidemic initiative.
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14
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Housing Subsidies and Housing Stability are Associated with Better HIV Medical Outcomes Among Persons Who Experienced Homelessness and Live with HIV and Mental Illness or Substance Use Disorder. AIDS Behav 2020; 24:3252-3263. [PMID: 32180090 DOI: 10.1007/s10461-020-02810-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Among 958 applicants to a supportive housing program for low-income persons living with HIV (PLWH) and mental illness or a substance use disorder, we assessed impacts of housing placement on housing stability, HIV care engagement, and viral suppression. Surveillance and administrative datasets provided medical and residence information, including stable (e.g., rental assistance, supportive housing) and unstable (e.g., emergency shelter) government-subsidized housing. Sequence analysis identified a "quick stable housing" pattern for 67% of persons placed by this program within 2 years, vs. 28% of unplaced. Compared with unplaced persons not achieving stable housing quickly, persons quickly achieving stable housing were more likely to engage in care, whether placed (per Poisson regression, ARR: 1.14;95% CI 1.09-1.20) or unplaced (1.19;1.13-1.25) by this program, and to be virally suppressed, whether placed (1.22;1.03-1.44) or unplaced (1.26, 1.03-1.56) by this program. Housing programs can help homeless PLWH secure stable housing quickly, manage their infection, and prevent transmission.
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15
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Spector AL, Quinn KG, McAuliffe TL, DiFranceisco W, Bendixen A, Dickson-Gomez J. Health-related quality of life and related factors among chronically homeless adults living in different permanent supportive housing models: a cross-sectional study. Qual Life Res 2020; 29:2051-2061. [PMID: 32222931 DOI: 10.1007/s11136-020-02482-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Permanent supportive housing (PSH) is an effective intervention to improve residential stability and reduce the utilization of costlier healthcare services for the chronically homeless. However, there has been little focus on health-related quality of life (HRQL) once they enter PSH, and the potential influence of other factors including the PSH model. Study results can shed light on the HRQL of the PSH population and inform strategies to improve PSH program effectiveness in this area. METHODS In this cross-sectional study, survey methods were used to assess the HRQL of PSH residents in the Chicago metropolitan area. The survey also included questions on socio-demographics, health behaviors, housing and neighborhood characteristics, and housing satisfaction. The SF-36 was used to obtain physical (PCS) and mental component summary (MCS) scores for HRQL. Other variables were selected using the Wilson and Cleary HRQL model. Statistical analyses included summary statistics, bivariate analyses, and fully adjusted linear regression models. RESULTS The study sample included 855 adults currently in PSH. The sample was predominantly African American men with an average age of 53 years. Mean scores for PCS and MCS were 39.4 and 46.1, respectively, (out of 100). In adjusted analyses, older age and being on disability were associated with worse PCS. Having HIV was associated with better PCS. Being non-Hispanic Black, living in fixed-sited housing, and being in PSH for longer durations were associated with better MCS. More depressive symptoms was associated with worse PCS and MCS. CONCLUSION While both aspects of the PSH model (housing configuration and service provision) were initially associated with HRQL in unadjusted analyses, housing configuration was the only PSH model variable that remained significant once accounting for other factors. Depressive symptomology and the social environment also appear to be important correlates of HRQL and are potential areas to target in PSH programs.
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Affiliation(s)
- Antoinette L Spector
- Department of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
| | - Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2701 N. Summit Ave., Milwaukee, WI, 53202, USA
| | - Timothy L McAuliffe
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2701 N. Summit Ave., Milwaukee, WI, 53202, USA
| | - Wayne DiFranceisco
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2701 N. Summit Ave., Milwaukee, WI, 53202, USA
| | | | - Julia Dickson-Gomez
- Department of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.,Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2701 N. Summit Ave., Milwaukee, WI, 53202, USA
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16
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Griffin A, Dempsey A, Cousino W, Avery L, Phillips H, Egwim E, Cheever L. Addressing disparities in the health of persons with HIV attributable to unstable housing in the United States: The role of the Ryan White HIV/AIDS Program. PLoS Med 2020; 17:e1003057. [PMID: 32119661 PMCID: PMC7051042 DOI: 10.1371/journal.pmed.1003057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Amy Griffin and co-authors discuss unstable housing and the response to HIV/AIDS in the United States.
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Affiliation(s)
- Amy Griffin
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, United States of America
| | - Antigone Dempsey
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, United States of America
| | - Wendy Cousino
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, United States of America
| | - Latham Avery
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, United States of America
| | - Harold Phillips
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, United States of America
| | - Emeka Egwim
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, United States of America
| | - Laura Cheever
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, United States of America
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17
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HIV Sero-Status Non-disclosure Among HIV-Infected Opioid-Dependent Individuals: The Roles of HIV-Related Stigma, Risk Behavior, and Social Support. J Community Health 2020; 44:112-120. [PMID: 30043195 DOI: 10.1007/s10900-018-0560-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
HIV sero-status disclosure among people living with HIV (PLWH) is an important component of preventing HIV transmission to sexual partners. Due to various social, structural, and behavioral challenges, however, many HIV-infected opioid-dependent patients do not disclose their HIV status to all sexual partners. In this analysis, we therefore examined non-disclosure practices and correlates of non-disclosure among high-risk HIV-infected opioid-dependent individuals. HIV-infected opioid-dependent individuals who reported HIV-risk behaviors were enrolled (N = 133) and assessed for HIV disclosure, risk behaviors, health status, antiretroviral therapy (ART) adherence, HIV stigma, social support and other characteristics. Multivariable logistic regression was used to identify significant correlates of non-disclosure. Overall, 23% reported not disclosing their HIV status to sexual partners, who also had high levels of HIV risk: sharing of injection equipment (70.5%) and inconsistent condom use (93.5%). Independent correlates of HIV non-disclosure included: being virally suppressed (aOR 0.19, p = 0.04), high HIV-related stigma (aOR 2.37, p = 0.03), and having multiple sex partners (aOR 5.87, p = 0.04). Furthermore, a significant interaction between HIV-related stigma and living with family/friends suggests that those living with family/friends were more likely to report not disclosing their HIV status when higher levels of perceived stigma was present. Our findings support the need for future interventions to better address the impact of perceived stigma and HIV disclosure as it relates to risk behaviors among opioid-dependents patients in substance abuse treatment settings.
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18
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Stanic A, Rybin D, Cannata F, Hohl C, Brody J, Gaeta J, Bharel M. The impact of the housing status on clinical outcomes and health care utilization among individuals living with HIV. AIDS Care 2019; 33:1-9. [PMID: 31766866 DOI: 10.1080/09540121.2019.1695728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The lack of stable housing can impair access and continuity of care for patients living with human immunodeficiency virus (HIV). This study investigated the relationship between housing status assessed at multiple time points and several core HIV-related outcomes within the same group of HIV patients experiencing homelessness. Patients with consistently stable housing (CSH) during the year were compared to patients who lacked CSH (non-CSH group). The study outcomes included HIV viral load (VL), CD4 counts, and health care utilization. Multivariable and propensity weighted analyses were used to assess outcomes adjusting for potential group differences. Of 208 patients, 88 (42%) had CSH and 120 (58%) were non-CSH. Patients with CSH had significantly higher proportion of VL suppression and higher mean CD4 counts. The frequency of nurse visits in the CSH group was less than a half of that in the non-CSH group. Patients with CSH were less likely to be admitted to the medical respite facility, and if admitted, their length of stay was about a half of that for the non-CSH group. Our study findings show that patients with CSH had significantly better HIV virologic control and immune status as well as improved health care utilization.
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Affiliation(s)
- Anela Stanic
- Department of Pharmacy Practice, MCPHS University, Boston, MA, USA.,Boston Health Care for the Homeless Program, Boston, MA, USA
| | - Denis Rybin
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Francis Cannata
- Department of Pharmacy Practice, MCPHS University, Boston, MA, USA
| | - Carole Hohl
- Boston Health Care for the Homeless Program, Boston, MA, USA
| | - Jennifer Brody
- Boston Health Care for the Homeless Program, Boston, MA, USA
| | - Jessie Gaeta
- Boston Health Care for the Homeless Program, Boston, MA, USA
| | - Monica Bharel
- Boston Health Care for the Homeless Program, Boston, MA, USA
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19
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HIV-Related Stigma, Motivation to Adhere to Antiretroviral Therapy, and Medication Adherence Among HIV-Positive Methadone-Maintained Patients. J Acquir Immune Defic Syndr 2019; 80:166-173. [PMID: 30383588 DOI: 10.1097/qai.0000000000001891] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Opioid agonist therapies with methadone are associated with higher levels of adherence to antiretroviral therapy (ART); yet, no studies have explored factors associated with optimal ART levels in HIV-positive patients on methadone maintenance treatment, including explanatory pathways using mediation analysis. SETTING Participants included 121 HIV-positive, methadone-maintained patients who reported HIV-risk behaviors and were taking ART. METHODS Participants were assessed using an audio computer-assisted self-interview. Multivariable logistic regression was used to identify significant correlates and PROCESS macro to test the explanatory pathway (ie, mediational effect) for optimal ART adherence. RESULTS Among 121 participants, almost 40% reported suboptimal adherence to ART. Optimal ART adherence was significantly associated with being virally suppressed [adjusted odds ratio (aOR) = 6.470, P = 0.038], higher motivation to adhere to ART (aOR = 1.171, P = 0.011), and lower anticipated HIV-related stigma (aOR = 0.384, P = 0.015). Furthermore, results revealed an indirect effect of motivation on the relationship between HIV stigma and ART adherence (effect = -0.121, P = 0.043), thus supporting the mediation effect. CONCLUSIONS Our findings underscore the complexities surrounding ART adherence, even in patients on methadone maintenance treatment. These findings provide insights on how to more effectively intervene to optimize HIV treatment outcomes, including HIV treatment-as-prevention initiatives, in methadone-maintained patients.
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20
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Supportive Housing Promotes AIDS-Free Survival for Chronically Homeless HIV Positive Persons with Behavioral Health Conditions. AIDS Behav 2019; 23:776-783. [PMID: 30684098 DOI: 10.1007/s10461-019-02398-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We assessed the influence of supportive housing, incarceration, and health service use on markers of HIV infection for people living with HIV and serious mental illness or substance use disorder (SUD) participating in a New York City supportive housing program (NY III). Using matched administrative data from 2007 to 2014, we compared survivor time without AIDS, achievement of undetectable viral load, and maintenance of viral suppression between NY III tenants (n = 696), applicants placed in other supportive housing programs (n = 333), and applicants not placed in supportive housing (n = 268). Inverse probability of treatment weights were applied to Cox proportional hazards regression models to account for confounding of observed variables. Individuals not placed in supportive housing had a significantly greater risk of death or AIDS diagnosis than NY III tenants [adjusted hazard ratio = 1.84 (1.40, 2.44), p < 0.001]. Incarceration and outpatient SUD treatment were significantly associated with negative short-term outcomes (time to undetectable viral load) but positive long-term outcomes (time to death or AIDS diagnosis). Supportive housing, SUD treatment, and incarceration were associated with prolonged survival without AIDS among supportive housing applicants living with HIV.
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21
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Viral suppression among HIV-infected methadone-maintained patients: The role of ongoing injection drug use and adherence to antiretroviral therapy (ART). Addict Behav 2018; 85:88-93. [PMID: 29879611 DOI: 10.1016/j.addbeh.2018.05.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Methadone maintenance therapy (MMT) is associated with improved virologic outcomes, yet no studies have explored factors associated with viral suppression in HIV-infected patients on MMT. Given the critical role of sustained viral suppression in maximizing benefits of antiretroviral therapy (ART), we sought to assess factors associated with viral suppression in patients stabilized on MMT. METHODS A sample of 133 HIV-infected, methadone-maintained patients who reported HIV-risk behaviors were assessed using an audio-computer assisted self-interview (ACASI). Multivariable logistic regression was used to identify significant correlates of viral suppression. RESULTS Among all participants, self-reported HIV risk behaviors were highly prevalent and over 80% had achieved viral suppression. Independent correlates of viral suppression were: having optimal adherence to ART (aOR = 4.883, p = .009), high CD4 count (aOR = 2.483, p = .045), and ongoing injection drug use (aOR = 0.081, p = .036). Furthermore, results revealed a significant interaction effect that involved optimal ART adherence and injection of drug use on viral suppression (aOR = 2.953, p = .029). CONCLUSION Overall, our findings highlight unaddressed HIV-related treatment challenges faced by certain group of methadone-maintained patients. These findings have significant implications for the HIV treatment as prevention efforts and, thus, indicate the need for comprehensive efforts to promote viral suppression in this risk population.
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22
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Saag MS, Benson CA, Gandhi RT, Hoy JF, Landovitz RJ, Mugavero MJ, Sax PE, Smith DM, Thompson MA, Buchbinder SP, Del Rio C, Eron JJ, Fätkenheuer G, Günthard HF, Molina JM, Jacobsen DM, Volberding PA. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2018 Recommendations of the International Antiviral Society-USA Panel. JAMA 2018; 320:379-396. [PMID: 30043070 PMCID: PMC6415748 DOI: 10.1001/jama.2018.8431] [Citation(s) in RCA: 440] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Importance Antiretroviral therapy (ART) is the cornerstone of prevention and management of HIV infection. Objective To evaluate new data and treatments and incorporate this information into updated recommendations for initiating therapy, monitoring individuals starting therapy, changing regimens, and preventing HIV infection for individuals at risk. Evidence Review New evidence collected since the International Antiviral Society-USA 2016 recommendations via monthly PubMed and EMBASE literature searches up to April 2018; data presented at peer-reviewed scientific conferences. A volunteer panel of experts in HIV research and patient care considered these data and updated previous recommendations. Findings ART is recommended for virtually all HIV-infected individuals, as soon as possible after HIV diagnosis. Immediate initiation (eg, rapid start), if clinically appropriate, requires adequate staffing, specialized services, and careful selection of medical therapy. An integrase strand transfer inhibitor (InSTI) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) is generally recommended for initial therapy, with unique patient circumstances (eg, concomitant diseases and conditions, potential for pregnancy, cost) guiding the treatment choice. CD4 cell count, HIV RNA level, genotype, and other laboratory tests for general health and co-infections are recommended at specified points before and during ART. If a regimen switch is indicated, treatment history, tolerability, adherence, and drug resistance history should first be assessed; 2 or 3 active drugs are recommended for a new regimen. HIV testing is recommended at least once for anyone who has ever been sexually active and more often for individuals at ongoing risk for infection. Preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and appropriate monitoring is recommended for individuals at risk for HIV. Conclusions and Relevance Advances in HIV prevention and treatment with antiretroviral drugs continue to improve clinical management and outcomes for individuals at risk for and living with HIV.
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Affiliation(s)
| | | | - Rajesh T Gandhi
- Massachusetts General Hospital and Harvard Medical School, Boston
| | - Jennifer F Hoy
- The Alfred Hospital and Monash University, Melbourne, Australia
| | | | | | - Paul E Sax
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Susan P Buchbinder
- San Francisco Department of Public Health and University of California San Francisco
| | - Carlos Del Rio
- Emory University Rollins School of Public Health and School of Medicine, Atlanta, Georgia
| | - Joseph J Eron
- University of North Carolina at Chapel Hill School of Medicine
| | - Gerd Fätkenheuer
- University Hospital of Cologne, Department I of Internal Medicine, Cologne, Germany, and German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Huldrych F Günthard
- University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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