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Pokhrel D, Lang SG, Elder H, John B, Roosevelt KA, Klevens M, Randall LM, DeMaria A. Predictors of HIV Care Outcomes among Recently Out-of-Care Individuals in The Massachusetts Cooperative Re-engagement Controlled Trial Cohort. AIDS Behav 2024:10.1007/s10461-024-04457-1. [PMID: 39172186 DOI: 10.1007/s10461-024-04457-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/23/2024]
Abstract
A cohort of individuals in care for HIV infection who were identified as being recently out-of-care (OOC) was recruited for a trial using a data-to-care approach and an intervention to facilitate re-engagement and retention in care. This allowed for analysis of demographic and clinical characteristics correlated with recently being OOC, re-engagement, and successful retention in care and viral suppression. Recently OOC persons with HIV infection (PWH) were identified for enrollment in the Cooperative Re-engagement Controlled Trial (CoRECT). CoRECT employed a data-to-care strategy, using both clinical and surveillance data, and an active public health re-engagement intervention. We estimated relative risks (RRs), unadjusted and with multivariate log binomial regression models, to analyze associations between sociodemographic and clinical predictors of being OOC, re-engagement, retention in care, and viral suppression. Of the 630 OOC PWH enrolled in CoRECT, most were male (72.7%) and over 30 years old (91.3%). Almost 40.0% were Black non-Hispanic, 29.7% were non-US born, and 41.6% were men who have sex with men (MSM). Possible predictors of re-engagement, retention in care, and viral suppression included younger age, Hispanic race/ethnicity, birth in a US dependency, AIDS status, and HIV exposure mode. Viral suppression status within 1-year pre-enrollment was significantly associated with all outcomes: re-engagement (aRR 1.28), retention (aRR 1.72), viral suppression (aRR 1.81), and durable viral suppression (aRR 3.30). Findings elucidate factors associated with care engagement and continuity for recently OOC PWH which can be used to inform targeted re-engagement activities for priority populations and guide future data-to-care interventions.
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Affiliation(s)
- Dinesh Pokhrel
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA.
| | - Simona G Lang
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - Heather Elder
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - Betsey John
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - Kathleen A Roosevelt
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - Monina Klevens
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - Liisa M Randall
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - Alfred DeMaria
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
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Machavariani E, Miceli J, Altice FL, Neblett Fanfair R, Speers S, Nichols L, Jenkins H, Villanueva M. Using Data-To-Care Strategies to Optimize the HIV Care Continuum in Connecticut: Results From a Randomized Controlled Trial. J Acquir Immune Defic Syndr 2024; 96:40-50. [PMID: 38324241 PMCID: PMC11009056 DOI: 10.1097/qai.0000000000003391] [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: 09/27/2023] [Accepted: 12/18/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Re-engaging people with HIV who are newly out-of-care remains challenging. Data-to-care (D2C) is a potential strategy to re-engage such individuals. METHODS A prospective randomized controlled trial compared a D2C strategy using a disease intervention specialist (DIS) vs standard of care where 23 HIV clinics in 3 counties in Connecticut could re-engage clients using existing methods. Using a data reconciliation process to confirm being newly out-of-care, 655 participants were randomized to DIS (N = 333) or standard of care (N = 322). HIV care continuum outcomes included re-engagement at 90 days, retention in care, and viral suppression by 12 months. Multivariable regression models were used to assess factors predictive of attaining HIV care continuum outcomes. RESULTS Participants randomized to DIS were more likely to be re-engaged at 90 days (adjusted odds ratios [aOR] = 1.42, P = 0.045). Independent predictors of re-engagement at 90 days were age older than 40 years (aOR = 1.84, P = 0.012) and perinatal HIV risk category (aOR = 3.19, P = 0.030). Predictors of retention at 12 months included re-engagement at 90 days (aOR = 10.31, P < 0.001), drug injection HIV risk category (aOR = 1.83, P = 0.032), detectable HIV-1 RNA before randomization (aOR = 0.40, P = 0.003), and county (Hartford aOR = 1.74, P = 0.049; New Haven aOR = 1.80, P = 0.030). Predictors of viral suppression included re-engagement at 90 days (aOR = 2.85, P < 0.001), retention in HIV care (aOR = 7.07, P < 0.001), and detectable HIV-1 RNA prerandomization (aOR = 0.23, P < 0.001). CONCLUSIONS A D2C strategy significantly improved re-engagement at 90 days. Early re-engagement improved downstream benefits along the HIV care continuum like retention in care and viral suppression at 12 months. Moreover, other factors predictive of care continuum outcomes can be used to improve D2C strategies.
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Affiliation(s)
- Eteri Machavariani
- Department of Internal Medicine, Section of Infectious Disease, HIV/AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Janet Miceli
- Department of Internal Medicine, Section of Infectious Disease, HIV/AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Frederick L. Altice
- Department of Internal Medicine, Section of Infectious Disease, HIV/AIDS Program, Yale University School of Medicine, New Haven, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | | | - Suzanne Speers
- Connecticut Department of Public Health, Hartford, CT, USA
| | - Lisa Nichols
- Department of Internal Medicine, Section of Infectious Disease, HIV/AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Heidi Jenkins
- Connecticut Department of Public Health, Hartford, CT, USA
| | - Merceditas Villanueva
- Department of Internal Medicine, Section of Infectious Disease, HIV/AIDS Program, Yale University School of Medicine, New Haven, CT, USA
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Sousa B, Chiale S, Bryant H, Dulli L, Medrano T. Adopting Data to Care to Identify and Address Gaps in Services for Children and Adolescents Living With HIV in Mozambique. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300130. [PMID: 38443100 PMCID: PMC11057801 DOI: 10.9745/ghsp-d-23-00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/06/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The Data to Care (D2C) strategy uses multiple sources of complementary data on HIV clients and related services to identify individuals with gaps in HIV treatment. Although D2C has been widely used in the United States, there is no evidence on its use in other settings, such as countries most affected by the epidemic. STRATEGY IMPLEMENTATION The D2C strategy was implemented within the context of a project that provided community-based support to children and adolescents living with HIV (C/ALHIV) in Mozambique. A data tracking tool and a standard operating procedure manual for local partner community organizations and health care facilities were developed to support the effort. Project staff met with local project implementing partners to discuss and coordinate the intervention in pilot health facilities. STRATEGY PILOTING The project initiated a pilot D2C intervention in 2019, working with 14 health facilities across 5 additional districts within 1 province. COVida project data were compared with clinical data from facilities serving C/ALHIV. The D2C intervention identified gaps in HIV treatment for a substantial number of C/ALHIV, and targeted support services were provided to address those gaps. Viral load (VL) monitoring was added in March 2020. Before the intervention, 71% of C/ALHIV reported to be on HIV treatment by their caregivers were documented as on treatment in health facilities. Support interventions targeted those not on treatment, and this proportion increased to 96% within 1 year of implementation. Additionally, 12 months later, the proportion of C/ALHIV with a documented VL test increased from 52% to 72%. CONCLUSION Introducing the D2C pilot intervention was associated with substantial improvements in HIV treatment for C/ALHIV, including increased linkage to and continuity in treatment and increased VL testing. D2C may be a useful approach to improve health outcomes for C/ALHIV in settings outside of the United States.
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Irvine MK, Abdelqader F, Levin B, Thomas J, Avoundjian T, Peterson M, Zimba R, Braunstein SL, Robertson MM, Nash D. Study protocol for data to suppression (D2S): a cluster-randomised, stepped-wedge effectiveness trial of a reporting and capacity-building intervention to improve HIV viral suppression in housing and behavioural health programmes in New York City. BMJ Open 2023; 13:e076716. [PMID: 37451738 PMCID: PMC10351323 DOI: 10.1136/bmjopen-2023-076716] [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] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION With progress in the 'diagnose', 'link' and 'retain' stages of the HIV care continuum, viral suppression (VS) gains increasingly hinge on antiretroviral adherence among people with HIV (PWH) retained in care. The Centers for Disease Control and Prevention estimate that unsuppressed viral load among PWH in care accounts for 20% of onward transmission. HIV intervention strategies include 'data to care' (D2C)-using surveillance to identify out-of-care PWH for follow-up. However, most D2C efforts target care linkage, not antiretroviral adherence, and limit client-level data sharing to medical (versus support-service) providers. Drawing on lessons learnt in D2C and successful local pilots, we designed a 'data-to-suppression' intervention that offers HIV support-service programmes surveillance-based reports listing their virally unsuppressed clients and capacity-building assistance for quality-improvement activities. We aimed to scale and test the intervention in agencies delivering Ryan White HIV/AIDS Programme-funded behavioural health and housing services. METHODS AND ANALYSIS To estimate intervention effects, this study applies a cross-sectional, stepped-wedge design to the intervention's rollout to 27 agencies randomised within matched pairs to early or delayed implementation. Data from three 12-month periods (pre-implementation, partial implementation and full implementation) will be examined to assess intervention effects on timely VS (within 6 months of a report listing the client as needing follow-up for VS). Based on projected enrolment (n=1619) and a pre-implementation outcome probability of 0.40-0.45, the detectable effect size with 80% power is an OR of 2.12 (relative risk: 1.41-1.46). ETHICS AND DISSEMINATION This study was approved by the New York City Department of Health and Mental Hygiene's institutional review board (protocol: 21-036) with a waiver of informed consent. Findings will be disseminated via publications, conferences and meetings including provider-agency representatives. TRIAL REGISTRATION NUMBER NCT05140421.
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Affiliation(s)
- Mary K Irvine
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Faisal Abdelqader
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Jacinthe Thomas
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Tigran Avoundjian
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Meghan Peterson
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health, City University of New York, New York City, New York, USA
| | - Sarah L Braunstein
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - McKaylee M Robertson
- Institute for Implementation Science in Population Health, City University of New York, New York City, New York, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York City, New York, USA
- Department of Epidemiology and Biostatistics, City University of New York, New York City, New York, USA
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O’Shea J, Fanfair RN, Williams T, Khalil G, Brady KA, DeMaria A, Villanueva M, Randall LM, Jenkins H, Altice FL, Camp N, Lucas C, Buchelli M, Samandari T, Weidle PJ. The Cooperative Re-Engagement Controlled Trial (CoRECT): Durable Viral Suppression Assessment. J Acquir Immune Defic Syndr 2023; 93:134-142. [PMID: 36812382 PMCID: PMC10962216 DOI: 10.1097/qai.0000000000003178] [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: 12/14/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND A collaborative, data-to-care strategy to identify persons with HIV (PWH) newly out-of-care, combined with an active public health intervention, significantly increases the proportion of PWH re-engaged in HIV care. We assessed this strategy's impact on durable viral suppression (DVS). METHODS A multisite, prospective randomized controlled trial for out-of-care individuals using a data-to-care strategy and comparing public health field services to locate, contact, and facilitate access to care versus the standard of care. DVS was defined as the last viral load, the viral load at least 3 months before, and any viral load between the 2 were all <200 copies/mL during the 18-month postrandomization. Alternative definitions of DVS were also analyzed. RESULTS Between August 1, 2016-July 31, 2018, 1893 participants were randomized from Connecticut (n = 654), Massachusetts (n = 630), and Philadelphia (n = 609). Rates of achieving DVS were similar in the intervention and standard-of-care arms in all jurisdictions (all sites: 43.4% vs 42.4%, P = 0.67; Connecticut: 46.7% vs 45.0%, P = 0.67; Massachusetts: 40.7 vs 44.4%, P = 0.35; Philadelphia: 42.4% vs 37.3%, P = 0.20). There was no association between DVS and the intervention (RR: 1.01, CI: 0.91-1.12; P = 0.85) adjusting for site, age categories, race/ethnicity, birth sex, CD4 categories, and exposure categories. CONCLUSION A collaborative, data-to-care strategy, and active public health intervention did not increase the proportion of PWH achieving DVS, suggesting additional support to promote retention in care and antiretroviral adherence may be needed. Initial linkage and engagement services, through data-to-care or other means, are likely necessary but insufficient for achieving DVS for all PWH.
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Affiliation(s)
- Jesse O’Shea
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - George Khalil
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Alfred DeMaria
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA
| | | | - Liisa M. Randall
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA
| | - Heidi Jenkins
- Connecticut Department of Public Health, Hartford, CT
| | | | - Nasima Camp
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Crystal Lucas
- Philadelphia Department of Public Health, Philadelphia, PA
| | | | - Taraz Samandari
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Paul J. Weidle
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Mulatu MS, Carter JW, Flores SA, Benton S, Galindo CA, Johnson WD, Wilkes AL, Mbaka CK, Prather C. Expanding Data to Care Programs to Improve HIV Care Continuum Among Men Who Have Sex With Men and Transgender Persons: Key Processes and Outcomes From Project PrIDE, 2015-2019. Public Health Rep 2023; 138:43-53. [PMID: 35060402 PMCID: PMC9730178 DOI: 10.1177/00333549211058175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES During 2015-2019, five local and state health department jurisdictions implemented Data to Care (D2C) programs supported by Project PrIDE (Pre-exposure prophylaxis, Implementation, Data to Care, and Evaluation) to improve linkage or reengagement in HIV medical care among persons with HIV (PWH) who had gaps in care, particularly among men who have sex with men (MSM) and transgender persons. We describe findings from the cross-jurisdiction evaluation of the project. METHODS We conducted a qualitative analysis of the final progress reports submitted by PrIDE jurisdictions to the Centers for Disease Control and Prevention to identify key D2C activities implemented and challenges encountered. We also conducted descriptive analysis on aggregate quantitative data to summarize key D2C program outcomes. RESULTS PrIDE jurisdictions implemented multiple activities to build their D2C capacity, identify PWH who were not in care or virally suppressed, provide linkage/reengagement services, and monitor outcomes. Overall, 11 463 PWH were selected for follow-up, 45% of whom were MSM or transgender persons. Investigations were completed for 8935 (77.9%) PWH. Only 2323 (26.0%) PWH were confirmed not in care or virally suppressed; 1194 (51.4%) were subsequently linked/reengaged in care; among those, 679 (56.9%) were virally suppressed at last test. PrIDE jurisdictions identified data-related (eg, incomplete or delayed laboratory results), program capacity (eg, insufficient staff), and social and structural (eg, unstable housing) challenges that affected their D2C implementation. CONCLUSIONS PrIDE jurisdictions successfully enhanced their D2C capacity, reached priority populations who were not in care or virally suppressed, and improved their engagement in care and health outcomes. Data-related and non-data-related challenges limited the efficiency of D2C programs. Findings can help inform other D2C programs and contribute to national HIV prevention goals.
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Affiliation(s)
- Mesfin S. Mulatu
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jarvis W. Carter
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen A. Flores
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shaliondel Benton
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carla A. Galindo
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wayne D. Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aisha L. Wilkes
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cecily K. Mbaka
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia Prather
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Carey JW, Roland KB, Bessler PA, Tesfaye C, Randall LA, Frew PM. Overcoming Challenges to HIV Medical Care-seeking and Treatment Among Data-to-Care Program Clients in Baton Rouge and New Orleans, Louisiana. J Assoc Nurses AIDS Care 2023; 34:71-82. [PMID: 36524875 PMCID: PMC10988392 DOI: 10.1097/jnc.0000000000000375] [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] [Indexed: 12/23/2022]
Abstract
ABSTRACT Data to Care (D2C) uses US public health surveillance data to identify persons with diagnosed HIV who are not receiving adequate medical care. These persons are linked to care and ancillary social services through personalized outreach. We conducted semistructured interviews with 36 adults with HIV in Louisiana who were engaged for the first time or reengaged back into HIV care through D2C efforts. Before D2C program staff contact, nearly 40% were not contemplating HIV care. Program clients cited barriers to HIV care, including difficulties with appointment scheduling and transportation, health care service and drug costs, low motivation, and competing non-HIV health needs. Thirty-four of the 36 clients said that D2C staff helped them overcome these barriers. Clients also described psychosocial support from D2C staff. After receiving D2C program assistance, more than 90% of clients reported consistently receiving HIV medical care and taking medications. Our findings suggest that D2C staff successfully identified client needs and provided tailored assistance.
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Affiliation(s)
- James W. Carey
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention
| | | | | | - Casey Tesfaye
- Research Support Services, Incorporated, Evanston, Illinois
| | - Laura A. Randall
- Emory University, Atlanta, GA, and Merck and Co., Incorporated, Kenilworth, NJ
| | - Paula M. Frew
- Emory University, Atlanta, GA, and Merck and Co., Incorporated, Kenilworth, NJ
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Advancing data to care strategies for persons with HIV using an innovative reconciliation process. PLoS One 2022; 17:e0267903. [PMID: 35511958 PMCID: PMC9071117 DOI: 10.1371/journal.pone.0267903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 04/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background UN AIDS has set ambitious 95-95-95 HIV care continuum targets for global HIV elimination by 2030. The U.S. HIV Care Continuum in 2018 showed that 65% of persons with HIV(PWH) are virally suppressed and 58% retained in care. Incomplete care-engagement not only affects individual health but drives ongoing HIV transmission. Data to Care (D2C) is a strategy using public health surveillance data to identify and re-engage out-of-care (OOC) PWH. Optimization of this strategy is needed. Setting Statewide partnership with Connecticut Department of Public Health (CT DPH), 23 HIV clinics and Yale University School of Medicine (YSM). Our site was one of 3 participants in the CDC-sponsored RCT evaluating the efficacy of DPH-employed Disease Intervention Specialists (DIS) for re-engagement in care. Methods From 11/2016-7/2018, a data reconciliation process using public health surveillance and clinic visit data was used to identify patients eligible for randomization (defined as in-Care for 12 months and OOC for subsequent 6-months) to receive DIS intervention. Clinic staff further reviewed this list and designated those who would not be randomized based on established criteria. Results 2958 patients were eligible for randomization; 655 (22.1%) were randomized. Reasons for non-randomizing included: well patient [499 (16.9%)]; recent visit [946 (32.0%)]; upcoming visit [398 (13.5%)]. Compared to non-randomized patients, those who were randomized were likely to be younger (mean age 46.1 vs. 51.6, p < .001), Black (40% vs 35%)/Hispanic (37% vs 32.8%) [(p < .001)], have CD4<200 cells/ul (15.9% vs 8.5%, p < .001) and viral load >20 copies/ml (43.8% vs. 24.1%, 0<0.001). Extrapolating these estimates to a statewide HIV care continuum suggests that only 8.3% of prevalent PWH are truly OOC. Conclusions A D2C process that integrated DPH surveillance and clinic data successfully refined the selection of newly OOC PWH eligible for DIS intervention. This approach more accurately reflects real world care engagement and can help prioritize DPH resources.
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Higa DH, Crepaz N, Mullins MM, Adegbite-Johnson A, Gunn JKL, Denard C, Mizuno Y. Strategies to improve HIV care outcomes for people with HIV who are out of care. AIDS 2022; 36:853-862. [PMID: 35025818 PMCID: PMC10167711 DOI: 10.1097/qad.0000000000003172] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of five intervention strategies: patient navigation, appointment help/alerts, psychosocial support, transportation/appointment accompaniment, and data-to-care on HIV care outcomes among persons with HIV (PWH) who are out of care (OOC). DESIGN A systematic review with meta-analysis. METHODS We searched CDC's Prevention Research Synthesis (PRS) Project's cumulative HIV database to identify intervention studies conducted in the U.S., published between 2000 and 2020 that included comparisons between groups or prepost, and reported at least one relevant outcome (i.e. re-engagement or retention in HIV care, and viral suppression). Effect sizes were meta-analyzed using random-effect models to assess intervention effectiveness. RESULTS Thirty-nine studies reporting on 42 unique interventions met the inclusion criteria. Overall, intervention strategies are effective in improving re-engagement in care [odds ratio (OR) = 1.79;95% confidence interval (95% CI): 1.36-2.36, k = 14], retention in care (OR = 2.01; 95% CI: 1.64-2.64, k = 22), and viral suppression (OR = 2.50;95% CI: 1.87-3.34, k = 27). Patient navigation, appointment help/alerts, psychosocial support, and transportation/appointment accompaniment improved all three HIV care outcomes. Data-to-care improved re-engagement and retention but had insufficient evidence for viral suppression. CONCLUSION Several strategies are effective for improving HIV care outcomes among PWH who are OOC. More work is still needed for consistent definitions of OOC and HIV care outcomes, better reporting of intervention and cost data, and identifying how best to implement and scale-up effective strategies to engage and retain OOC PWH in care and reach the ending the HIV epidemic goals.
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Affiliation(s)
- Darrel H Higa
- Division of HIV Prevention, Centers for Disease Control and Prevention
| | - Nicole Crepaz
- Division of HIV Prevention, Centers for Disease Control and Prevention
| | - Mary M Mullins
- Division of HIV Prevention, Centers for Disease Control and Prevention
| | | | - Jayleen K L Gunn
- Division of HIV Prevention, Centers for Disease Control and Prevention
- U.S. Public Health Service
| | | | - Yuko Mizuno
- Division of HIV Prevention, Centers for Disease Control and Prevention
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Linthwaite B, Kronfli N, Marbaniang I, Ruppenthal L, Lessard D, Engler K, Lebouché B, Cox J. Increased reengagement of out-of-care HIV patients using Lost & Found, a clinic-based intervention. AIDS 2022; 36:551-560. [PMID: 34897240 PMCID: PMC8876436 DOI: 10.1097/qad.0000000000003147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 11/30/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Negative health outcomes associated with being out of HIV care (OOC) warrant reengagement strategies. We aimed to assess effectiveness of Lost & Found, a clinic-based intervention to identify and reengage OOC patients. METHODS Developed and delivered using implementation science, Lost & Found consists of two core elements: identification, operationalized through nurse validation of a real-time list of possible OOC patients; and contact, via nurse-led phone calls. It was implemented over a 12-month period (2018-2019) at the Chronic Viral Illness Service, McGill University Health Centre (CVIS-MUHC) during a type-II implementation-effectiveness hybrid pilot study. Descriptive outcomes of interest were identification as possibly OOC, OOC confirmation, contact, and successful reengagement. We present results from a pre-post analysis comparing overall reengagement to the year prior, using robust Poisson regression controlled for sex, age, and Canadian birth. Time to reengagement is reported using a Cox proportional hazards model. RESULTS Over half (56%; 1312 of 2354) of CVIS-MUHC patients were identified as possibly OOC. Among these, 44% (n = 578) were followed elsewhere, 19% (n = 249) engaged in care, 3% (n = 33) deceased, 2% (n = 29) otherwise not followed, and 32% (n = 423) OOC. Of OOC patients contacted (85%; 359/423), 250 (70%) reengaged and 40 (11%) had upcoming appointments; the remainder were unreachable, declined care, or missed given appointments. Pre-post results indicate people who received Lost & Found were 1.18 [95% confidence interval (CI) 1.02-1.36] times more likely to reengage, and reengaged a median 55 days (95% CI 14-98) sooner. CONCLUSION Lost & Found may be a viable clinic-based reengagement intervention for OOC patients. More robust evaluations are needed.
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Affiliation(s)
- Blake Linthwaite
- Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Nadine Kronfli
- Research Institute of the McGill University Health Centre (RI-MUHC)
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
| | - Ivan Marbaniang
- Department of Epidemiology, Biostatistics, and Occupational Health
| | - Luciana Ruppenthal
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
| | - David Lessard
- Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Kim Engler
- Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Bertrand Lebouché
- Research Institute of the McGill University Health Centre (RI-MUHC)
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Centre (RI-MUHC)
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
- Department of Epidemiology, Biostatistics, and Occupational Health
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11
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Koenig LJ, Flores SA, Mulatu MS. Project PrIDE in Context: Evolution of Evaluation in the Centers for Disease Control and Prevention's Multi-Jurisdictional HIV Prevention Demonstration Projects. EVALUATION AND PROGRAM PLANNING 2022; 90:102015. [PMID: 34625273 DOI: 10.1016/j.evalprogplan.2021.102015] [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: 06/09/2020] [Accepted: 12/17/2020] [Indexed: 06/13/2023]
Abstract
Over the past decade, CDC has been implementing a high-impact prevention (HIP) approach to HIV, directing funds towards activities with the greatest likelihood of reducing new infections and disparities. Corresponding to this shift, the Division of HIV/AIDS Prevention (DHAP) began funding a series of multi-site demonstration projects to provide extra support and evaluative capacity to select health departments to initiate new HIP programming, with the intention of ascertaining and sharing lessons with other health departments. In this paper, we provide context for the PrEP, Implementation, Data2Care, Evaluation (PrIDE) evaluation by describing the evolution of evaluation goals and activities across three prior demonstration projects, highlighting four areas of change: 1) integrated evaluation and program implementation; 2) local program evaluation in addition to cross-site performance monitoring; 3) prescriptive allocation of resources to support local program evaluation; and 4) expansion beyond single site program evaluation to identify effective cross-site programmatic strategies. Together, these changes reflect our own learning about achieving the greatest contribution from multi-site projects and set the stage for unique aspects of program evaluation within PrIDE. We describe these features, concluding with lessons learned from this most recent approach to structuring and supporting evaluation within CDC DHAP's health department demonstration projects.
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Affiliation(s)
- Linda J Koenig
- Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, United States.
| | - Stephen A Flores
- Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, United States.
| | - Mesfin S Mulatu
- Program Evaluation Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, United States.
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Abstract
Identifying evidence-based interventions that can optimize the re-engagement into care of people living with HIV is necessary to achieve and sustain HIV epidemic control. We conducted a systematic review of interventions for re-engagement into HIV care to examine the accumulated evidence and to identify similarities and differences across studies. Between January and March 2020, we searched MEDLINE, Embase, CINAHL, and PsycINFO databases for publications from 1996 to 2020. We screened 765 references and selected 125 publications for full-text review. For the nine included studies, the intervention centered on (1) integration of clinic and HIV surveillance data; (2) additional or different levels of support provided by healthcare workers; or (3) multi-component intervention. Irrespective of the interventions, mixed results were found for re-engagement into care or ART re-initiation. None of the studies led to an improvement in viral suppression. Re-engagement in HIV care is critical for longitudinal HIV and national program success. Standardizing definitions for out-of-care and re-engagement would facilitate the comparison of interventions. Rigorous study designs to assess strategies to enhance HIV re-engagement are warranted.
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Benbow ND, Mokotoff ED, Dombrowski JC, Wohl AR, Scheer S. The HIV Treat Pillar: An Update and Summary of Promising Approaches. Am J Prev Med 2021; 61:S39-S46. [PMID: 34686289 PMCID: PMC11107265 DOI: 10.1016/j.amepre.2021.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 01/22/2023]
Abstract
The Treat pillar of the Ending the HIV Epidemic in the U.S. plan calls for comprehensive strategies to enhance linkage to, and engagement in, HIV medical care to improve viral suppression among people with HIV and achieve the goal of 95% viral suppression by 2025. The U.S. has seen large increases in the proportion of people with HIV who have a suppressed viral load. Viral suppression has increased 41%, from 46% in 2010 to 65% in 2018. An additional increase of 46% is needed to meet the Ending the HIV Epidemic in the U.S. goal. The rate of viral suppression among those in care increased to 85% in 2018, highlighting the need to ensure sustained care for people with HIV. Greater increases in all steps along the HIV care continuum are needed for those disproportionately impacted by HIV, especially the young, sexual and racial/ethnic minorities, people experiencing homelessness, and people who inject drugs. Informed by systematic reviews and current research findings, this paper describes more recent promising practices that suggest an impact on HIV care outcomes. It highlights rapid linkage and treatment interventions; interventions that identify and re-engage people in HIV care through new collaborations among health departments, providers, and hospital systems; coordinated care and low-barrier clinic models; and telemedicine-delivered HIV care approaches. The interventions presented in this paper provide additional approaches that state and local jurisdictions can use to reach their local HIV elimination plans' goals and the ambitious Ending the HIV Epidemic in the U.S. Treat pillar targets by 2030.
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Affiliation(s)
- Nanette D Benbow
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | | | - Julia C Dombrowski
- Department of Medicine, University of Washington, Seattle, Washington; Public Health - Seattle & King County, Seattle, Washington
| | - Amy R Wohl
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California
| | - Susan Scheer
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, California
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Norkin SK, Benson S, Civitarese AM, Reich A, Chomsky Albright M, Convery C, Kasarskis IM, Cassidy-Stewart H, Howe K, Wang X, Golden MR, Khosropour CM, Glick SN, Kerani RP. Inadequate Engagement in HIV Care Among People With HIV Newly Diagnosed With a Sexually Transmitted Disease: A Multijurisdictional Analysis. Sex Transm Dis 2021; 48:601-605. [PMID: 33633070 PMCID: PMC9113732 DOI: 10.1097/olq.0000000000001381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A key challenge of HIV surveillance-based HIV care reengagement is locating people living with HIV (PLWH) who seem to be out of care to reengage them in care. Providing reengagement services to PLWH diagnosed with a sexually transmitted disease (STD)-individuals who are in jurisdiction and connected to the health care system-could be an efficient means of promoting HIV treatment and reducing HIV transmission. METHODS Early and late syphilis (ES/LS) and gonorrhea (GC) cases diagnosed in 2016 and 2017 in Louisiana, Michigan, Mississippi, Oregon, Rhode Island, and Texas were matched to each state's HIV surveillance data to determine the proportion of PLWH with these infections who (1) did not have evidence of a CD4 count or viral load in the prior ≥13 months (out of care) or (2) had a viral load ≥1500 copies/mL on their most recent HIV RNA test before STD diagnosis (viremic). RESULTS Previously diagnosed HIV infection was common among persons diagnosed with ES (n = 6942; 39%), LS (n = 4329; 27%), and GC (n = 9509; 6%). Among these ES, LS, and GC cases, 26% (n = 1543), 33% (n = 1113), and 29% (n = 2391) were out of HIV medical care or viremic at the time of STD diagnosis. CONCLUSIONS A large proportion of STD cases with prior HIV diagnosis are out of care or viremic. Integrating relinkage to care activities into STD partner services and/or the use of matching STD and HIV data systems to prioritize data to care activities could be an efficient means for relinking patients to care and promoting viral suppression.
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Affiliation(s)
- Sarah K Norkin
- From the Texas Department of State Health Services, Austin, TX
| | - Samantha Benson
- Health Services Research and Development, VA Puget Sound Healthcare System, Seattle, WA
| | | | - Amanda Reich
- From the Texas Department of State Health Services, Austin, TX
| | | | | | | | | | | | - Xueyan Wang
- Mississippi Department of Health, Jackson, MI
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15
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Koenig LJ, Flores SA, Mulatu MS. Project PrIDE in context: Evolution of evaluation in the centers for disease control and prevention's multi-jurisdictional HIV prevention demonstration projects. EVALUATION AND PROGRAM PLANNING 2021; 85:101905. [PMID: 33429164 DOI: 10.1016/j.evalprogplan.2020.101905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
Over the past decade, CDC has been implementing a high-impact prevention (HIP) approach to HIV, directing funds towards activities with the greatest likelihood of reducing new infections and disparities. Corresponding to this shift, the Division of HIV/AIDS Prevention (DHAP) began funding a series of multi-site demonstration projects to provide extra support and evaluative capacity to select health departments to initiate new HIP programming, with the intention of ascertaining and sharing lessons with other health departments. In this paper, we provide context for the PrEP, Implementation, Data2Care, Evaluation (PrIDE) evaluation by describing the evolution of evaluation goals and activities across three prior demonstration projects, highlighting four areas of change: 1) integrated evaluation and program implementation; 2) local program evaluation in addition to cross-site performance monitoring; 3) prescriptive allocation of resources to support local program evaluation; and 4) expansion beyond single site program evaluation to identify effective cross-site programmatic strategies. Together, these changes reflect our own learning about achieving the greatest contribution from multi-site projects and set the stage for unique aspects of program evaluation within PrIDE. We describe these features, concluding with lessons learned from this most recent approach to structuring and supporting evaluation within CDC DHAP's health department demonstration projects.
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Affiliation(s)
- Linda J Koenig
- Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, United States.
| | - Stephen A Flores
- Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, United States.
| | - Mesfin S Mulatu
- Program Evaluation Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 30329, United States.
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Skaathun B, Pho MT, Pollack HA, Friedman SR, McNulty MC, Friedman EE, Schmitt J, Pitrak D, Schneider JA. Comparison of effectiveness and cost for different HIV screening strategies implemented at large urban medical centre in the United States. J Int AIDS Soc 2020; 23:e25554. [PMID: 33119195 PMCID: PMC7594703 DOI: 10.1002/jia2.25554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Incident HIV infections persist in the United States (U.S.) among marginalized populations. Targeted and cost-efficient testing strategies can help in reaching HIV elimination. This analysis compares the effectiveness and cost of three HIV testing strategies in a high HIV burden area in the U.S. in identifying new HIV infections. METHODS We performed a cost analysis comparing three HIV testing strategies in Chicago: (1) routine screening (RS) in an inpatient and outpatient setting, (2) modified partner services (MPS) among networks of the recently HIV infected and diagnosed, and (3) a respondent drive sampling (RDS)-based social network (SN) approach targeting young African-American men who have sex with men. All occurred at the same academic medical centre during the following times: routine testing, 2011 to 2016; MPS, 2013 to 2016; SN: 2013 to 2014. Costs were in 2016 dollars and included personnel, HIV testing, training, materials, overhead. Outcomes included cost per test, HIV-positive test and new diagnosis. Sensitivity analyses were performed to assess the impact of population demographics. RESULTS The RS programme completed 57,308 HIV tests resulting in 360 (0.6%) HIV-positive tests and 165 new HIV diagnoses (0.28%). The MPS completed 146 HIV tests, resulting in 79 (54%) HIV-positive tests and eight new HIV diagnoses (5%). The SN strategy completed 508 HIV tests, resulting in 210 (41%) HIV-positive tests and 37 new HIV diagnoses (7.2%). Labour accounted for the majority of costs in all strategies. The estimated cost per new HIV diagnosis was $16,773 for the RS programme, $61,418 for the MPS programme and $15,683 for the SN testing programme. These costs were reduced for the RS and MPS strategies in sensitivity analyses limiting testing efficacy to the highest prevalence patient populations ($2,841 and $33,233 respectively). CONCLUSIONS The SN strategy yielded the highest proportion of new diagnoses, followed closely by the MPS programme. Both the SN strategy and RS programme were comparable in the cost per new diagnosis. A simultaneous approach that consists of RS in combination with SN testing may be most effective for identifying new HIV infections in settings with heterogeneous epidemics with both high rates of HIV prevalence and HIV testing.
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Affiliation(s)
- Britt Skaathun
- Department of Infectious Diseases and Global Public HealthUniversity of CaliforniaSan DiegoCAUSA
- Department of Public Health SciencesUniversity of ChicagoChicagoILUSA
- Chicago Center for HIV EliminationChicagoILUSA
| | - Mai T Pho
- Department of MedicineUniversity of ChicagoChicagoILUSA
| | - Harold A Pollack
- School of Social Service AdministrationUniversity of ChicagoChicagoILUSA
| | - Samuel R Friedman
- Department of Population HealthNew York University Medical SchoolNew YorkNYUSA
| | - Moira C McNulty
- Chicago Center for HIV EliminationChicagoILUSA
- Department of MedicineUniversity of ChicagoChicagoILUSA
| | | | | | - David Pitrak
- Department of MedicineUniversity of ChicagoChicagoILUSA
| | - John A Schneider
- Department of Public Health SciencesUniversity of ChicagoChicagoILUSA
- Chicago Center for HIV EliminationChicagoILUSA
- Department of MedicineUniversity of ChicagoChicagoILUSA
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Sachdev DD, Mara E, Hughes AJ, Antunez E, Kohn R, Cohen S, Scheer S. "Is a Bird in the Hand Worth 5 in the Bush?": A Comparison of 3 Data-to-Care Referral Strategies on HIV Care Continuum Outcomes in San Francisco. Open Forum Infect Dis 2020; 7:ofaa369. [PMID: 32995350 PMCID: PMC7505526 DOI: 10.1093/ofid/ofaa369] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/17/2020] [Indexed: 12/27/2022] Open
Abstract
Background Health departments utilize HIV surveillance data to identify people with HIV (PWH) who need re-linkage to HIV care as part of an approach known as Data to Care (D2C.) The most accurate, effective, and efficient method of identifying PWH for re-linkage is unknown. Methods We evaluated referral and care continuum outcomes among PWH identified using 3 D2C referral strategies: health care providers, surveillance, and a combination list derived by matching an electronic medical record registry to HIV surveillance. PWH who were enrolled in the re-linkage intervention received short-term case management for up to 90 days. Relative risks and 95% confidence intervals were calculated to compare proportions of PWH retained and virally suppressed before and after re-linkage. Durable viral suppression was defined as having suppressed viral loads at all viral load measurements in the 12 months after re-linkage. Results After initial investigation, 233 (24%) of 954 referrals were located and enrolled in navigation. Although the numbers of surveillance and provider referrals were similar, 72% of enrolled PWH were identified by providers, 16% by surveillance, and 12% by combination list. Overall, retention and viral suppression improved, although relative increases in retention and viral suppression were only significant among individuals identified by surveillance or providers. Seventy percent of PWH who achieved viral suppression after the intervention remained durably virally suppressed. Conclusions PWH referred by providers were more likely to be located and enrolled in navigation than PWH identified by surveillance or combination lists. Overall, D2C re-linkage efforts improved retention, viral suppression, and durable viral suppression.
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Affiliation(s)
- Darpun D Sachdev
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California, USA
| | - Elise Mara
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, California, USA
| | - Alison J Hughes
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, California, USA
| | - Erin Antunez
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California, USA
| | - Robert Kohn
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California, USA
| | - Stephanie Cohen
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California, USA
| | - Susan Scheer
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, California, USA
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18
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Buchbinder M, Blue C, Rennie S, Juengst E, Brinkley-Rubinstein L, Rosen DL. Practical and Ethical Concerns in Implementing Enhanced Surveillance Methods to Improve Continuity of HIV Care: Qualitative Expert Stakeholder Study. JMIR Public Health Surveill 2020; 6:e19891. [PMID: 32886069 PMCID: PMC7501574 DOI: 10.2196/19891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/24/2020] [Accepted: 07/14/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Retention in HIV care is critical to maintaining viral suppression and preventing further transmission, yet less than 50% of people living with HIV in the United States are engaged in care. All US states have a funding mandate to implement Data-to-Care (D2C) programs, which use surveillance data (eg, laboratory, Medicaid billing) to identify out-of-care HIV-positive persons and relink them to treatment. OBJECTIVE The purpose of this qualitative study was to identify and describe practical and ethical considerations that arise in planning for and implementing D2C. METHODS Via purposive sampling, we recruited 43 expert stakeholders-including ethicists, privacy experts, researchers, public health personnel, HIV medical providers, legal experts, and community advocates-to participate in audio-recorded semistructured interviews to share their perspectives on D2C. Interview transcripts were analyzed across a priori and inductively derived thematic categories. RESULTS Stakeholders reported practical and ethical concerns in seven key domains: permission and consent, government assistance versus overreach, privacy and confidentiality, stigma, HIV exceptionalism, criminalization, and data integrity and sharing. CONCLUSIONS Participants expressed a great deal of support for D2C, yet also stressed the role of public trust and transparency in addressing the practical and ethical concerns they identified.
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Affiliation(s)
- Mara Buchbinder
- Department of Social Medicine, Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Colleen Blue
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stuart Rennie
- Department of Social Medicine, Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Eric Juengst
- Department of Social Medicine, Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - David L Rosen
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Cross-Jurisdictional Data to Care: Lessons Learned in New York State and Florida. J Acquir Immune Defic Syndr 2020; 82 Suppl 1:S42-S46. [PMID: 31425394 DOI: 10.1097/qai.0000000000001974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data-to-Care (D2C) programming is an important strategy in locating and relinking persons with HIV who are not in care (NIC), back to care. However, Health Department D2C programs have found a large proportion of individuals who seem NIC are living outside of their jurisdiction. Jurisdictions are limited in ability to cross-communicate regarding such individuals. SETTING Two D2C programs [New York State (NYS) and Florida (FL)] funded through the Partnerships-for-Care Demonstration Project, partnered to conduct a feasibility pilot project to test cross-jurisdictional D2C reciprocity. METHODS Jurisdictions made efforts to set up infrastructure for cross-jurisdictional D2C, and NYS worked to identify persons reported in NYS presumed in need of linkage/relinkage efforts in FL using 3 years of NYS D2C program outcomes. RESULTS One hundred forty NYS NIC individuals were presumed to need linkage/relinkage efforts in FL. However, case dispositions for these individuals were not able to be advanced beyond determining HIV care status due to 4 critical challenges: (1) Local legal and regulatory permissibility for sharing identifiable HIV surveillance information outside of a specific jurisdiction varies; (2) Electronic infrastructure in place does not support public health follow-up of individuals who are not within a jurisdiction's HIV surveillance system; (3) An individual's verifiable current residence is not easily attained; and (4) Roles, responsibilities, and case prioritization within each state, and across jurisdictions vary and require clear delineation. CONCLUSIONS Although programmatic challenges during this D2C feasibility pilot project were unsurmountable for NYS and FL, potential solutions presented may facilitate broader national cross-jurisdictional D2C reciprocity.
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Data to Care Opportunities: An Evaluation of Persons Living With HIV Reported to Be "Current to Care" Without Current HIV-Related Labs. J Acquir Immune Defic Syndr 2020; 82 Suppl 1:S20-S25. [PMID: 31425391 DOI: 10.1097/qai.0000000000001973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data to care (D2C) is an effective strategy using HIV surveillance data to link/relink persons living with HIV into medical care. However, some appearing to be not in care (NIC) report being in care (persons "current to care"). SETTING New York State's Expanded Partner Services (ExPS) D2C program has identified many persons reported as "current to care." This evaluation describes these persons after 24 months of follow-up and identifies HIV-related laboratory-based testing patterns and results to determine whether this cohort could benefit from further programmatic intervention. METHODOLOGY Data from ExPS assignments from September 2013 to May 2016 were used. Persons "current to care" were compared with persons NIC on demographics, subsequent HIV-related laboratory-based testing, and viral load suppression status. Persons "current to care" receiving subsequent HIV-related laboratory-based testing were compared with those who did not receive HIV-related labs. RESULTS Persons "current to care" significantly differed from persons NIC on demographics and subsequent HIV-related laboratory-based testing (82% of persons "current to care" had subsequent HIV-related labs, versus 99% of those NIC who were relinked to care). Persons "current to care" were more likely to be virally suppressed at their subsequent lab than persons NIC who were relinked to care (72% vs. 47%). Minor differences were noted for persons "current to care" receiving subsequent HIV-related labs compared with those who did not. CONCLUSIONS Persons "current to care" reflect a unique cohort who might benefit from further programmatic intervention. Although most received additional HIV-related labs, some were without labs for the duration of follow-up.
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Buchbinder M, Blue C, Juengst E, Brinkley-Rubinstein L, Rennie S, Rosen DL. Expert stakeholders' perspectives on a Data-to-Care strategy for improving care among HIV-positive individuals incarcerated in jails. AIDS Care 2020; 32:1155-1161. [PMID: 32160760 DOI: 10.1080/09540121.2020.1737641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Data-to-Care (D2C) uses surveillance data (e.g., laboratory, Medicaid billing) to identify out-of-care HIV-positive persons to re-link them to care. Most US states are implementing D2C, yet few studies have explored stakeholders' perspectives on D2C, and none have addressed these perspectives in the context of D2C in jail. This article reports findings from qualitative, semi-structured interviews conducted with expert stakeholders regarding their perspectives on the ethical challenges of utilizing D2C to understand and improve continuity of care among individuals incarcerated in jails. Participants included 47 professionals with expertise in ethics and privacy, public health and HIV care, the criminal justice system, and community advocacy. While participants expressed a great deal of support for extending D2C to jails, they also identified many possible risks. Stakeholders discussed many issues specific to D2C in jails, such as heightened stigma in the jail setting, the need for training of jail staff and additional non-medical community-based resources, and the high priority of this vulnerable population. Many experts suggested that the actual likelihood of benefits and harms would depend on contextual details. Implementation of D2C in jails may require novel strategies to minimize risk of disclosing out-of-care patients' HIV status.
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Affiliation(s)
- Mara Buchbinder
- Department of Social Medicine, Center for Bioethics, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Colleen Blue
- Institute for Global Health and Infectious Diseases, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Eric Juengst
- Department of Social Medicine, Center for Bioethics, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, Center for Health Equity Research, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Stuart Rennie
- Department of Social Medicine, Center for Bioethics, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - David L Rosen
- Division of Infectious Diseases, Department of Medicine, UNC Chapel Hill, School of Medicine, Chapel Hill, NC, USA
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Sweeney P, DiNenno EA, Flores SA, Dooley S, Shouse RL, Muckleroy S, Margolis AD. HIV Data to Care-Using Public Health Data to Improve HIV Care and Prevention. J Acquir Immune Defic Syndr 2019; 82 Suppl 1:S1-S5. [PMID: 31425388 PMCID: PMC11288579 DOI: 10.1097/qai.0000000000002059] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND "Data to Care" (D2C) is a public health strategy that uses surveillance and other data to improve continuity of HIV care for persons with HIV (PWH) by identifying those who are in need of medical care or other services and facilitating linkage to these services. The primary goal of D2C is to increase the number of PWH who are engaged in care and virally suppressed. METHODS Data to Care can be implemented using several approaches. Surveillance-based D2C is usually initiated by health departments, using HIV surveillance and other data to identify those not in care. Health care providers may also initiate D2C by identifying patients who may have fallen out of care and working collaboratively with health departments to investigate, locate, and relink the patients to medical care or other needed services. RESULTS Although D2C is a relatively new strategy, health department D2C programs have reported both promising results (eg, improved surveillance data quality and successful linkage to or re-engagement in care for PWH) and challenges (eg, incomplete or inaccurate data in surveillance systems, barriers to data sharing, and limitations of existing data systems). CONCLUSIONS Data to Care is expected to enable health departments to move closer toward achieving national HIV prevention goals. However, additional information on appropriate implementation practices at each step of the D2C process is needed. This JAIDS Special Supplement explores how CDC funding to state health departments (eg, technical assistance and demonstration projects), and partnerships across federal agencies, are advancing our knowledge of D2C.
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Affiliation(s)
- Patricia Sweeney
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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23
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Dombrowski JC, Galagan SR, Ramchandani M, Dhanireddy S, Harrington RD, Moore A, Hara K, Eastment M, Golden MR. HIV Care for Patients With Complex Needs: A Controlled Evaluation of a Walk-In, Incentivized Care Model. Open Forum Infect Dis 2019; 6:ofz294. [PMID: 31341930 PMCID: PMC6641789 DOI: 10.1093/ofid/ofz294] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/21/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND New approaches are needed to provide care to persons with HIV who do not engage in conventionally organized HIV clinics. The Max Clinic in Seattle, Washington, is a walk-in, incentivized HIV care model located in a public health STD clinic that provides care in collaboration with a comprehensive HIV primary care clinic (the Madison Clinic). METHODS We compared outcomes in the first 50 patients enrolled in Max Clinic and 100 randomly selected matched Madison Clinic control patients; patients in both groups were virally unsuppressed (viral load [VL] >200 copies/mL) at baseline. The primary outcome was any VL indicating viral suppression (≥1 VL <200 copies/mL) during the 12 months postbaseline. Secondary outcomes were continuous viral suppression (≥2 consecutive suppressed VLs ≥60 days apart) and engagement in care (≥2 medical visits ≥60 days apart). We compared outcomes in the 12 months pre- and postbaseline and used generalized estimating equations to compare changes in Max vs control patients, adjusting for unstable housing, substance use, and psychiatric disorders. RESULTS Viral suppression improved in both groups pre-to-post (20% to 82% Max patients; P < .001; and 51% to 65% controls; P = .04), with a larger improvement in Max patients (adjusted relative risk ratio [aRRR], 3.2; 95% confidence interval [CI], 1.8-5.9). Continuous viral suppression and engagement in care increased in both groups but did not differ significantly (continuous viral suppression: aRRR, 1.5; 95% CI, 0.5-5.2; engagement: aRRR, 1.3; 95% CI, 0.9-1.9). CONCLUSIONS The Max Clinic improved viral suppression among patients with complex medical and social needs.
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Affiliation(s)
- Julia C Dombrowski
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Public Health – Seattle & King County HIV/STD Program, Seattle, Washington
| | - Sean R Galagan
- Department of Global Health, University of Washington, Seattle, Washington
| | - Meena Ramchandani
- Department of Medicine, University of Washington, Seattle, Washington
- Public Health – Seattle & King County HIV/STD Program, Seattle, Washington
| | | | | | - Allison Moore
- Public Health – Seattle & King County HIV/STD Program, Seattle, Washington
| | - Katie Hara
- Social Work, Harborview Medical Center, Seattle, Washington
| | - Mckenna Eastment
- Department of Medicine, University of Washington, Seattle, Washington
| | - Matthew R Golden
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Public Health – Seattle & King County HIV/STD Program, Seattle, Washington
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Phillips TK, Myer L. Shifting to the long view: engagement of pregnant and postpartum women living with HIV in lifelong antiretroviral therapy services. Expert Rev Anti Infect Ther 2019; 17:349-361. [PMID: 30978126 DOI: 10.1080/14787210.2019.1607296] [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: 12/31/2022]
Abstract
Introduction: The advent of policies promoting lifelong antiretroviral therapy (ART) for all pregnant and postpartum women living with HIV has shifted focus from short-term prevention of mother-to-child transmission (PMTCT) to lifelong engagement in ART services. However, disengagement from care threatens the long-term treatment and prevention benefits of lifelong ART. Areas covered: A framework for considering the unique aspects of ART for pregnant and postpartum women is presented along with a review of the literature on maternal engagement in care in sub-Saharan Africa and a discussion of potential interventions to sustain engagement in lifelong ART. Expert opinion: Engaging women and mothers in ART services for life is critical for maternal health, PMTCT, and prevention of sexual transmission. Evidence-based interventions exist to support engagement in care but most focus on periods of mother-to-child transmission risk. In the long term, life transitions and health-care transfers are inevitable. Thus, interventions that can reach beyond a single facility or provide a bridge between health services should be prioritized. Multicomponent interventions will also be essential to address the numerous intersecting barriers to sustained engagement in ART services.
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Affiliation(s)
- Tamsin K Phillips
- a Division of Epidemiology & Biostatistics and Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Landon Myer
- a Division of Epidemiology & Biostatistics and Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
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25
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Udeagu C, Huang J, Eason L, Pickett L. Health department-HIV clinic integration of data and human resources to re-engage out of care HIV-positive persons into clinical care in a New York City locale. AIDS Care 2019; 31:1420-1426. [PMID: 30821484 DOI: 10.1080/09540121.2019.1587373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We describe an enhanced data to care (eD2C) initiative combining New York City (NYC) Department of Health and Mental Hygiene (DOHMH) HIV surveillance data and a collaborating HIV clinic records to identify and re-engage into care persons living with HIV (PLWH), and presumed to be out of care (OOC). DOHMH identified presumed-OOC persons who lacked recent HIV-related laboratory test reports (e.g., viral load, CD4) in the NYC surveillance registry, and whose last laboratory reports were from the collaborating clinic. The clinic then obtained the current care status of the presumed-OOC persons per their medical record system. The final list of persons deemed to be OOC by DOHMH and clinic were given to a clinic patient navigator and DOHMH disease intervention specialist (DIS) for re-engagement in care efforts. The initiative was a pilot effort aimed at reducing the inefficiencies (e.g., persons current with care, but deemed to be OOC) inherent in routine data to care (rD2C), using surveillance data or clinic medical records alone. Significantly, fewer PLWH, presumed to be OOC in eD2C than DOHMH rD2C were found to be current with care (2% vs. 16%, P = <.001). After adjusting for significant characteristics, time since OOC and years since HIV diagnosis, the odds of re-engaging in HIV care were significantly higher among eD2C (aOR: 2172.31; 95% CI: 1171.23-4044.36) than the rD2C group. We demonstrated the feasibility of leveraging DOHMH and HIV clinic data and human resources to potentially gain efficiencies in efforts to re-engage and retain PLWH in HIV care.
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Affiliation(s)
- C Udeagu
- Epidemiology and Field Services Program, Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene , Long Island City , NY , USA
| | - J Huang
- Epidemiology and Field Services Program, Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene , Long Island City , NY , USA
| | - L Eason
- Epidemiology and Field Services Program, Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene , Long Island City , NY , USA
| | - L Pickett
- Epidemiology and Field Services Program, Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene , Long Island City , NY , USA
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26
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Xia Q, Seyoum S, Wiewel EW, Torian LV, Braunstein SL. Reduction in Gaps in High CD4 Count and Viral Suppression Between Transgender and Cisgender Persons Living With HIV in New York City, 2007-2016. Am J Public Health 2018; 109:126-131. [PMID: 30495998 DOI: 10.2105/ajph.2018.304748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To compare trends in HIV outcomes for cisgender and transgender persons living with HIV (PLWH) in New York City.Methods. We used HIV surveillance data for the analysis. We based CD4 count on the last measurement in a calendar year and defined viral suppression as the last viral load being less than or equal to 200 copies per milliliter in the calendar year.Results. The estimated number of PLWH increased from 73 415 in 2007 to 83 299 in 2016, including 606 transgender persons (0.8%) in 2007 and 1054 transgender persons (1.3%) in 2016. The proportion with CD4 count of 500 cells per cubic millimeter or more increased from 38% in 2007 to 61% in 2016 among cisgender persons versus 32% to 60% among transgender persons. The proportion with a suppressed viral load increased from 52% in 2007 to 80% in 2016 among cisgender persons versus 42% to 73% among transgender persons.Conclusions. Among PLWH in New York City, CD4 count and viral suppression improved during 2007 to 2016, with larger improvements among transgender persons, leading to narrower gaps. However, continuing efforts to improve HIV outcomes among transgender PLWH are needed to further eliminate disparities, particularly in viral suppression.
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Affiliation(s)
- Qiang Xia
- All of the authors are with the Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Selam Seyoum
- All of the authors are with the Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Ellen W Wiewel
- All of the authors are with the Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Lucia V Torian
- All of the authors are with the Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Sarah L Braunstein
- All of the authors are with the Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
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27
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Ikeda DJ, Hollander L, Weigl S, Sawicki SV, Belanger DR, West NY, Brey Magnani N, Wells CG, Gordon P, Morne J, Agins BD. The Facility-Level HIV Treatment Cascade: Using a Population Health Tool in Health Care Facilities to End the Epidemic in New York State. Open Forum Infect Dis 2018; 5:ofy254. [PMID: 30386808 PMCID: PMC6202506 DOI: 10.1093/ofid/ofy254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/18/2018] [Indexed: 11/12/2022] Open
Abstract
Background The HIV treatment cascade is a tool for characterizing population-level gaps in HIV care, yet most adaptations of the cascade rely on surveillance data that are ill-suited to drive quality improvement (QI) activities at the facility level. We describe the adaptation of the cascade in health care organizations and report its use by HIV medical providers in New York State (NYS). Methods As part of data submissions to the NYS Department of Health, sites that provide HIV medical care in NYS developed cascades using facility-generated data. Required elements included data addressing identification of people living with HIV (PLWH) receiving any service at the facility, linkage to HIV medical care, prescription of antiretroviral therapy (ART), and viral suppression (VS). Sites also submitted a methodology report summarizing how cascade data were collected and an improvement plan identifying care gaps. Results Two hundred twenty-two sites submitted cascades documenting the quality of care delivered to HIV patients presenting for HIV- or non-HIV-related services during 2016. Of 101 341 PLWH presenting for any medical care, 75 106 were reported as active in HIV programs, whereas 21 509 had no known care status. Sites reported mean ART prescription and VS rates of 94% and 80%, respectively, and 60 distinct QI interventions. Conclusions Submission of facility-level cascades provides data on care utilization among PLWH that cannot be assessed through traditional HIV surveillance efforts. Moreover, the facility-level cascade represents an effective tool for identifying care gaps, focusing data-driven improvement efforts, and engaging frontline health care providers to achieve epidemic control.
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Affiliation(s)
- Daniel J Ikeda
- New York State Department of Health AIDS Institute, New York, New York.,HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California
| | - Leah Hollander
- New York State Department of Health AIDS Institute, New York, New York
| | - Susan Weigl
- New York State Department of Health AIDS Institute, New York, New York
| | - Steven V Sawicki
- New York State Department of Health AIDS Institute, New York, New York
| | - Daniel R Belanger
- New York State Department of Health AIDS Institute, New York, New York
| | - Nova Y West
- New York State Department of Health AIDS Institute, New York, New York
| | | | | | - Peter Gordon
- Division of Infectious Diseases, Department of Medicine, Columbia University, New York, New York
| | - Johanne Morne
- New York State Department of Health AIDS Institute, New York, New York
| | - Bruce D Agins
- New York State Department of Health AIDS Institute, New York, New York.,HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California.,Institute for Implementation Science in Population Health, New York.,Graduate School of Public Health and Health Policy, City University of New York, New York
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28
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Cumulative plasma HIV burden disparities among adults in HIV care: implications for HIV transmission in the era of treatment as prevention. AIDS 2018; 32:1881-1889. [PMID: 29894384 DOI: 10.1097/qad.0000000000001914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To characterize disparities in cumulative plasma HIV burden in a sample of adults accessing HIV care in San Francisco, California. DESIGN Observational cohort and supplemental HIV surveillance data. METHODS Data from the San Francisco Medical Monitoring Project 2012-2014 cycles and HIV surveillance data were used to create an analytic cohort followed for 2 years. Matched HIV viral load test results from HIV surveillance were used to create five viral outcome measures: any unsuppressed viral load (>200 copies/ml), any transmittable viral load (>1500 copies/ml), person-time spent unsuppressed, person-time spent transmittable, and 2-year viremia copy-years, a measure of cumulative plasma HIV burden. Rao-Scott chi-squares and analysis of variance examined differences in durable suppression and mean percentage time spent unsuppressed and transmittable. Weighted linear regression was used to describe differences in cumulative HIV burden. RESULTS Adults receiving HIV care spent approximately 12% of the 2-year time period with an unsuppressed viral load and approximately 7% of the time at a transmittable viral level. Factors independently associated with higher cumulative HIV viremia in an adjusted model included trans women identity, younger age, lower CD4 cell count, and a history of homelessness, incarceration, not taking ART, and nonadherence to ART. CONCLUSION Although 95% of the cohort of adults in HIV care in San Francisco self-reported ART use during MMP interview, they spent on average almost 1 month per year at a transmittable viral level. We identified characteristics of those who were more likely to have higher viral burden, highlighting priorities for resource allocation to reduce onward HIV transmission.
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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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