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Kra AK, Fotso AS, N’guessan KN, Geoffroy O, Younoussa S, Kabemba OK, Gueye PA, Ndeye PD, Rouveau N, Boily MC, Silhol R, d’Elbée M, Maheu-Giroux M, Vautier A, Larmarange J. Can HIV self-testing reach first-time testers? A telephone survey among self-test end users in Côte d'Ivoire, Mali, and Senegal. BMC Infect Dis 2023; 22:972. [PMID: 37749490 PMCID: PMC10518917 DOI: 10.1186/s12879-023-08626-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/18/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Coverage of HIV testing remains sub-optimal in West Africa. Between 2019 and 2022, the ATLAS program distributed ~400 000 oral HIV self-tests (HIVST) in Côte d'Ivoire, Mali, and Senegal, prioritising female sex workers (FSW) and men having sex with men (MSM), and relying on secondary redistribution of HIVST to partners, peers and clients to reach individuals not tested through conventional testing. This study assesses the proportion of first-time testers among HIVST users and the associated factors. METHODS A phone-based survey was implemented among HIVST users recruited using dedicated leaflets inviting them to anonymously call a free phone number. We collected socio-demographics, sexual behaviours, HIV testing history, HIVST use, and satisfaction with HIVST. We reported the proportion of first-time testers and computed associated factors using logistic regression. RESULTS Between March and June 2021, 2 615 participants were recruited for 50 940 distributed HIVST (participation rate: 5.1%). Among participants, 30% received their HIVST kit through secondary distribution (from a friend, sexual partner, family member, or colleague). The proportion who had never tested for HIV before HIVST (first-time testers) was 41%. The main factors associated with being a first-time tester were sex, age group, education level, condom use, and secondary distribution. A higher proportion was observed among those aged 24 years or less (55% vs 32% for 25-34, aOR: 0.37 [95%CI: 0.30-0.44], and 26% for 35 years or more, aOR: 0.28 [0.21-0.37]); those less educated (48% for none/primary education vs 45% for secondary education, aOR: 0.60 [0.47-0.77], and 29% for higher education, aOR: 0.33 [0.25-0.44]). A lower proportion was observed among women (37% vs 43%, aOR: 0.49 [0.40-0.60]); those reporting always using a condom over the last year (36% vs 51% for those reporting never using them, aOR: 2.02 [1.59-2.56]); and those who received their HISVST kit through primary distribution (39% vs 46% for secondary distribution, aOR: 1.32 [1.08-1.60]). CONCLUSION ATLAS HIVST strategy, including secondary distribution, successfully reached a significant proportion of first-time testers. HIVST has the potential to reach underserved populations and contribute to the expansion of HIV testing services in West Africa.
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Affiliation(s)
- Arsène Kouassi Kra
- Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD), Université Paris Cité, Inserm, Paris, France
| | - Arlette Simo Fotso
- Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD), Université Paris Cité, Inserm, Paris, France
- Institut National d’Etudes Démographiques (INED), Aubervilliers, France
| | | | - Olivier Geoffroy
- Solidarité Thérapeutique et Initiatives pour la Santé (Solthis), Abidjan, Côte d’Ivoire
| | - Sidibé Younoussa
- Solidarité Thérapeutique et Initiatives pour la Santé (Solthis), Bamako, Mali
| | - Odé Kanku Kabemba
- Solidarité Thérapeutique et Initiatives pour la Santé (Solthis), Bamako, Mali
| | - Papa Alioune Gueye
- Solidarité Thérapeutique et Initiatives pour la Santé (Solthis), Dakar, Sénégal
| | - Pauline Dama Ndeye
- Solidarité Thérapeutique et Initiatives pour la Santé (Solthis), Dakar, Sénégal
| | - Nicolas Rouveau
- Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD), Université Paris Cité, Inserm, Paris, France
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Romain Silhol
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Marc d’Elbée
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health and Medical Research UMR 1219, Research Institute for Sustainable Development EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC H3A 1A2 Canada
| | - Anthony Vautier
- Solidarité Thérapeutique et Initiatives pour la Santé (Solthis), Dakar, Sénégal
| | - Joseph Larmarange
- Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD), Université Paris Cité, Inserm, Paris, France
| | - on behalf of the ATLAS team
- Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD), Université Paris Cité, Inserm, Paris, France
- Institut National d’Etudes Démographiques (INED), Aubervilliers, France
- Solidarité Thérapeutique et Initiatives pour la Santé (Solthis), Abidjan, Côte d’Ivoire
- Solidarité Thérapeutique et Initiatives pour la Santé (Solthis), Bamako, Mali
- Solidarité Thérapeutique et Initiatives pour la Santé (Solthis), Dakar, Sénégal
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health and Medical Research UMR 1219, Research Institute for Sustainable Development EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC H3A 1A2 Canada
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Maity B, Banerjee S, Senapati A, Chattopadhyay J. Quantifying optimal resource allocation strategies for controlling epidemics. J R Soc Interface 2023; 20:20230036. [PMID: 37194270 PMCID: PMC10189312 DOI: 10.1098/rsif.2023.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/25/2023] [Indexed: 05/18/2023] Open
Abstract
Frequent emergence of communicable diseases is a major concern worldwide. Lack of sufficient resources to mitigate the disease burden makes the situation even more challenging for lower-income countries. Hence, strategy development for disease eradication and optimal management of the social and economic burden has garnered a lot of attention in recent years. In this context, we quantify the optimal fraction of resources that can be allocated to two major intervention measures, namely reduction of disease transmission and improvement of healthcare infrastructure. Our results demonstrate that the effectiveness of each of the interventions has a significant impact on the optimal resource allocation in both long-term disease dynamics and outbreak scenarios. The optimal allocation strategy for long-term dynamics exhibits non-monotonic behaviour with respect to the effectiveness of interventions, which differs from the more intuitive strategy recommended in the case of outbreaks. Further, our results indicate that the relationship between investment in interventions and the corresponding increase in patient recovery rate or decrease in disease transmission rate plays a decisive role in determining optimal strategies. Intervention programmes with decreasing returns promote the necessity for resource sharing. Our study provides fundamental insights into determining the best response strategy when controlling epidemics in resource-constrained situations.
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Affiliation(s)
- Biplab Maity
- Agricultural and Ecological Research Unit, Indian Statistical Institute, 203, B. T. Road, Kolkata 700108, India
| | - Swarnendu Banerjee
- Agricultural and Ecological Research Unit, Indian Statistical Institute, 203, B. T. Road, Kolkata 700108, India
- Copernicus Institute of Sustainable Development, Utrecht University, PO Box 80115, Utrecht 3508 TC, The Netherlands
| | - Abhishek Senapati
- Agricultural and Ecological Research Unit, Indian Statistical Institute, 203, B. T. Road, Kolkata 700108, India
- Center for Advanced Systems Understanding (CASUS), Untermarkt 20, Goerlitz 02826, Germany
| | - Joydev Chattopadhyay
- Agricultural and Ecological Research Unit, Indian Statistical Institute, 203, B. T. Road, Kolkata 700108, India
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Ranjit YS, Krishnan A, Ghosh D, Cravero C, Zhou X, Altice FL. mHealth Intervention to Improve Treatment Outcomes Among People With HIV Who Use Cocaine: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e28332. [PMID: 35254270 PMCID: PMC8938831 DOI: 10.2196/28332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/07/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background Antiretroviral therapy is effective in reducing HIV-related morbidity, mortality, and transmission among people with HIV. However, adherence and persistence to antiretroviral therapy are crucial for successful HIV treatment outcomes. People with HIV who use cocaine have poor access to HIV services and lower retention in care. Objective The primary goal of this paper is to provide a detailed description of a mobile health intervention. This study is designed to improve medication adherence among people with HIV who use cocaine. A secondary goal is to list the important challenges and adaptations incorporated in the study design. Methods This study, titled Project SMART, used a wireless technology–based intervention, including cellular-enabled electronic pillboxes called TowerView Health and smartphones, to provide reminders and feedback on adherence behavior. The intervention design was based on the theoretical frameworks provided by the self-determination theory and the Motivation Technology Model. The 12-week pilot randomized controlled trial with four arms provided three types of feedback: automated feedback, automated+clinician feedback, and automated feedback+social network feedback. Results The study was funded by the National Institute of Drug Abuse (R21DA039842) on August 1, 2016. The institutional review board for the study was approved by Yale University on March 21, 2017. Data collection lasted from June 2017 to January 2020. The final enrollment was 71 participants, of whom 57 (80%) completed the study. The data are currently undergoing analysis, and the manuscript is being developed for publication in early 2022. Conclusions Implementing complex mobile health interventions for high-risk and marginalized populations with multicomponent interventions poses certain challenges, such as finding companies with adequate technology for clients and financial stability and minimizing the research-related burden for the study population. Conducting feasibility studies is important to recognize these challenges and the opportunity to address these challenges with solutions while keeping the design of a randomized controlled trial as true as possible. Trial Registration Clinicaltrials.gov NCT04418076; https://clinicaltrials.gov/ct2/show/NCT04418076 International Registered Report Identifier (IRRID) DERR1-10.2196/28332
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Affiliation(s)
- Yerina S Ranjit
- Department of Communication, University of Missouri, Columbia, MO, United States
| | - Archana Krishnan
- Department of Social Scienes, University at Albany, State University of New York, Albany, NY, United States
| | - Debarchana Ghosh
- Department of Geography, University of Connecticut, Storrs, CT, United States
| | - Claire Cravero
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Xin Zhou
- Department of Internal Medicine, Section of Infectious Diseases, Yale University, New Haven, CT, United States
| | - Frederick L Altice
- Department of Internal Medicine, Section of Infectious Diseases, Yale University, New Haven, CT, United States
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Barry M, Ghonem L, Albeeshi N, Alrabiah M, Alsharidi A, Al-Omar HA. Resource Utilization and Caring Cost of People Living with Human Immunodeficiency Virus (PLHIV) in Saudi Arabia: A Tertiary Care University Hospital Experience. Healthcare (Basel) 2022; 10:118. [PMID: 35052282 PMCID: PMC8776132 DOI: 10.3390/healthcare10010118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 11/24/2022] Open
Abstract
The human immunodeficiency virus (HIV) is associated with a significant burden of disease, including medical and non-medical costs. Therefore, it is considered to be a priority for all health authorities. The aim of this study is to determine healthcare and treatment costs of caring for PLHIV at one of the tertiary care university hospitals in Riyadh, Saudi Arabia. This was a micro-costing, retrospective, observational study from a tertiary care university hospital and included all confirmed HIV-infected patients who visited infectious disease clinics in the period from 1 January 2015 to 31 December 2018. A total of 42 PLHIV were included in this study. The mean age of the study participants was 38.76 ± 11.47 years with a mean disease duration of 5.27 ± 4.81 years. The majority of patients were male (85.7%) and Saudi (88.1%). More than half of included patients (59.5%) had a CD4 count of more than 500. During the study period, 26 patients (61.9%) were initiated on a single-tablet regimen. Overall, the main cost-driver was antiretroviral medications, which cumulatively represented more than 64% of the total cost. Patients who developed opportunistic infections had a statistically significant (p = 0.033) higher financial impact, both as a total and on a patient level, than those presented without opportunistic infections. On a patient level, the mean and median costs were higher and statistically significant for those with co-morbidities than those without co-morbidities (p = 0.002). The majority of the economic burden of PLHIV is attributable to antiretroviral therapy use. The healthcare costs of PLHIV can vary greatly, depending on the presenting illness, clinical stage, developed opportunistic infection, co-morbidity, and pharmacological therapy.
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Affiliation(s)
- Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh 11451, Saudi Arabia; (M.B.); (A.A.)
| | - Leen Ghonem
- Department of Pharmacy, King Saud University Medical City, Riyadh 12372, Saudi Arabia;
| | - Nourah Albeeshi
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia;
| | - Maha Alrabiah
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh 12372, Saudi Arabia;
| | - Aynaa Alsharidi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh 11451, Saudi Arabia; (M.B.); (A.A.)
| | - Hussain Abdulrahman Al-Omar
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
- Health Technology Assessment Unit, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
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Wu C, Zhang B, Dai Z, Zheng Q, Duan Z, He Q, Zhu C. Impact of immediate initiation of antiretroviral therapy among men who have sex with men infected with HIV in Chengdu, southwest China: trends analysis, 2008-2018. BMC Public Health 2021; 21:689. [PMID: 33832451 PMCID: PMC8034144 DOI: 10.1186/s12889-021-10580-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 03/07/2021] [Indexed: 02/01/2023] Open
Abstract
Background Given the rampant HIV epidemic among men who have sex with men (MSM) in Chengdu, southwest China, Treat All policy, defined as immediate antiretroviral therapy (ART) initiation after HIV diagnosis, was implemented since 2014. Real-world research evaluating impacts of immediate ART on HIV epidemics is needed to optimize policy-making as national and international guidelines have been lowering ART eligibility threshold. The purpose of this study is to: assess temporal trends of the HIV epidemic and impacts of Treat All policy among MSM; and lay foundation for HIV-related policy evaluation using longitudinal routine data from health information systems. Methods Data used in this study were HIV sentinel seroprevalence, annual reported HIV cases and ART coverage rate among MSM in Chengdu from 2008 to 2018, derived from national HIV/AIDS information system. Temporal trends of the HIV epidemic were described using Joinpoint Regression Program. Interrupted time-series method was deployed to evaluate Treat All policy. Results HIV sentinel seroprevalence rose from 11.20% in 2008 to 17.67% in 2013 and Annual Percent Change (APC) was 8.25% (95% CI − 2.40%, 20.07%), then decreased to 5.17% in 2018 (APC = − 19.63%, 95% CI − 27.54%, − 10.86%). Newly reported HIV cases increased from 168 cases in 2008 to 1232 cases in 2015 (APC = 26.99%, 95% CI 21.32%, 32.93%), and reduced to 1014 cases in 2018 (APC = − 8.80%, 95% CI − 18.45%, 2.01%). ART coverage rate has been climbing from 11.11% in 2008 to 92.29% in 2018 and Average Annual Percent Change was 16.09% (95% CI 11.76%, 20.59%). Results of interrupted time-series models showed that compared to an annual increase of 0.87% during pre-policy period, there was a decline of 3.08% (95% CI − 0.0366%, − 0.0250%) per year of HIV sentinel seroprevalence since 2014; and compared to an annual increase of 116 cases before 2014, there was an annual drop of 158 newly reported HIV cases (95% CI − 194.87%, − 121.69%) during the post-policy period. Conclusions Immediate ART after HIV diagnosis could potentially curb HIV transmission at population level among MSM, along with other strategies. Future assessment of HIV prevention and control policy can be carried out using routinely collected longitudinal data from health information systems.
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Affiliation(s)
- Chenyao Wu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, 610041 No. 17 Section 3, Renmin South Road, Chengdu, Sichuan, China
| | - Baiyang Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, 610041 No. 17 Section 3, Renmin South Road, Chengdu, Sichuan, China
| | - Zhen Dai
- Department of AIDS&STD Control and Prevention, Chengdu Center for Disease Control and Prevention, 610041 No. 4 Longxiang Road, Sichuan, Chengdu, China
| | - Qianwen Zheng
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, 610041 No. 17 Section 3, Renmin South Road, Chengdu, Sichuan, China
| | - Zhenhua Duan
- Department of AIDS&STD Control and Prevention, Chengdu Center for Disease Control and Prevention, 610041 No. 4 Longxiang Road, Sichuan, Chengdu, China
| | - Qinying He
- Department of AIDS&STD Control and Prevention, Chengdu Center for Disease Control and Prevention, 610041 No. 4 Longxiang Road, Sichuan, Chengdu, China.
| | - Cairong Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, 610041 No. 17 Section 3, Renmin South Road, Chengdu, Sichuan, China.
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Rodrigues A, Struchiner CJ, Coelho LE, Veloso VG, Grinsztejn B, Luz PM. Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment. BMC Public Health 2021; 21:389. [PMID: 33607975 PMCID: PMC7893724 DOI: 10.1186/s12889-021-10421-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 02/10/2021] [Indexed: 12/27/2022] Open
Abstract
Background Late antiretroviral treatment initiation for HIV disease worsens health outcomes and contributes to ongoing transmission. We investigated whether socioeconomic inequalities exist in access to treatment in a setting with universal access to care and treatment. Methods This study investigated the association of educational level, used as a proxy for socioeconomic status, with late treatment initiation and treatment initiation with advanced disease. Study participants included adults (≥25 years) who started treatment from 2005 to 2018 at Instituto Nacional de Infectologia Evandro Chagas of Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil. Educational level was categorized following UNESCO’s International Standard Classification of Education: incomplete basic education, basic education, secondary level, and tertiary level. We defined late treatment initiation as those initiating treatment with a CD4 < 350 cells/mL or an AIDS-defining event, and treatment initiation with advanced disease as those initiating treatment with a CD4 < 200 cells/mL or an AIDS-defining event. A directed acyclic graph (DAG) was constructed to represent the theoretical-operational model and to understand the involvement of covariates. Logistic regression models were used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (95%CI). Multiple imputation using a chained equations approach was used to treat missing values and non-linear terms for continuous variables were tested. Results In total, 3226 individuals composed the study population: 876 (27.4%) had incomplete basic education, 540 (16.9%) basic, 1251 (39.2%) secondary level, and 525 (16.4%) tertiary level. Late treatment initiation was observed for 2076 (64.4%) while treatment initiation with advanced disease was observed for 1423 (44.1%). Compared to tertiary level of education, incomplete basic, basic and secondary level increased the odds of late treatment initiation by 89% (aOR:1.89 95%CI:1.47–2.43), 61% (aOR:1.61 95%CI:1.23–2.10), and 35% (aOR:1.35 95%CI:1.09–1.67). Likewise, the odds of treatment initiation with advanced disease was 2.5-fold (aOR:2.53 95%CI:1.97–3.26), 2-fold (aOR:2.07 95%CI:1.59–2.71), 1.5-fold (aOR:1.51 95%CI:1.21–1.88) higher for those with incomplete basic, basic and secondary level education compared to tertiary level. Conclusion Despite universal access to HIV care and antiretroviral treatment, late treatment initiation and social inequalities persist. Lower educational level significantly increased the odds of both outcomes, reinforcing the existence of barriers to “universal” antiretroviral treatment.
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Affiliation(s)
- Amanda Rodrigues
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Claudio J Struchiner
- Escola de Matemática Aplicada, Fundação Getúlio Vargas, Praia de Botafogo, 190, Rio de Janeiro, Brazil
| | - Lara E Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
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Lima VD, Wang L, Sereda P, McLinden T, Barrios R, Montaner JSG. Estimation of time of HIV seroconversion using a modified CD4 depletion model. PLoS One 2021; 16:e0246135. [PMID: 33577551 PMCID: PMC7880448 DOI: 10.1371/journal.pone.0246135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/13/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Several methods have been proposed to estimate the time of HIV seroconversion, including those based on CD4 cell depletion models. However, previous models have failed to consider the heterogeneity that exists in CD4 trajectories among different sub-populations. Our objective was to estimate the time from HIV seroconversion relative to the HIV diagnosis date in a population-based cohort of people living with HIV (PLWH) in the province of British Columbia, Canada. Methods We used linked administrative and clinical data from the British Columbia Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) cohort, which contains longitudinal individual-level data on all PLWH ever diagnosed in the province. Eligible participants were aged ≥18 years and diagnosed with HIV between 1989 and 2013. The outcome was pre-antiretroviral treatment CD4 cell count measurements assessed every six months. Models were stratified by age and stage of HIV infection at diagnosis. Several explanatory variables were considered including longitudinal viral load measurements. Longitudinal CD4, square root transformed, was modeled via a non-linear mixed effects model; time was modeled using an exponential decay function. We assumed a Gaussian distribution (identity link), an AR(1) correlation structure, and a random intercept and slope for the longitudinal viral load measurements. Due to the population variation in CD4 count among uninfected individuals, we assumed 500 to 1500 cells/mm3 as the normal range when estimating the time of HIV seroconversion. Results Longitudinal data on 1,253 individuals were analysed: 80% male, 33% White, and the median age at diagnosis was 38 years (25th-75th percentile [Q1-Q3], 31 to 45). CD4 decay differed by stage of infection at diagnosis and age, with those ≥50 years in Stages 1 and 2 experiencing a faster decline in CD4 over time. The median duration of infection from seroconversion until HIV diagnosis was 6.9 (Q1-Q3, 3.9 to 10.1) years. Conclusions Considering the heterogeneity that exists in individual CD4 cell trajectories in a population, we presented a methodology that only relies on routinely collected HIV-related data, which can be further extended to estimate other epidemic measures.
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Affiliation(s)
- Viviane D. Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- * E-mail:
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Taylor McLinden
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Alfonso S, Jenner AL, Craig M. Translational approaches to treating dynamical diseases through in silico clinical trials. CHAOS (WOODBURY, N.Y.) 2020; 30:123128. [PMID: 33380031 DOI: 10.1063/5.0019556] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
Abstract
The primary goal of drug developers is to establish efficient and effective therapeutic protocols. Multifactorial pathologies, including dynamical diseases and complex disorders, can be difficult to treat, given the high degree of inter- and intra-patient variability and nonlinear physiological relationships. Quantitative approaches combining mechanistic disease modeling and computational strategies are increasingly leveraged to rationalize pre-clinical and clinical studies and to establish effective treatment strategies. The development of clinical trials has led to new computational methods that allow for large clinical data sets to be combined with pharmacokinetic and pharmacodynamic models of diseases. Here, we discuss recent progress using in silico clinical trials to explore treatments for a variety of complex diseases, ultimately demonstrating the immense utility of quantitative methods in drug development and medicine.
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Affiliation(s)
- Sofia Alfonso
- Department of Physiology, McGill University, Montreal, Quebec H3A 0G4, Canada
| | - Adrianne L Jenner
- Department of Mathematics and Statistics, Université de Montréal, Montreal, Quebec H3C 3J7, Canada
| | - Morgan Craig
- Department of Physiology, McGill University, Montreal, Quebec H3A 0G4, Canada
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Brown SE, Krishnan A, Ranjit YS, Marcus R, Altice FL. Assessing mobile health feasibility and acceptability among HIV-infected cocaine users and their healthcare providers: guidance for implementing an intervention. Mhealth 2020; 6:4. [PMID: 32190615 PMCID: PMC7063267 DOI: 10.21037/mhealth.2019.09.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) can provide innovative, cost-effective strategies to improve medication adherence and optimize HIV treatment outcomes. Very little, however, is known about the acceptability and feasibility of mHealth among people with HIV (PWH) who use drugs. Our study objective was to assess feasibility, acceptability, and barriers and facilitators of implementing an mHealth intervention among PWH who are cocaine users, a group for whom no pharmacological treatment to reduce cocaine use is available. METHODS Five focus groups (FGs) (N=20) were conducted with PWH who self-reported cocaine use in the past 30 days, with 3 groups (N=8) of healthcare providers. Topics included previous experience with smartphones; barriers and facilitators of mobile technology for health purposes; and attitudes toward receiving types of feedback about adherence. RESULTS Patients preferred text reminders over phone calls for reasons of privacy, accessibility and economizing phone minutes. Direct communication via text messages and phone calls was considered more appropriate for social workers and case managers, who have greater frequency of communication and deeper relationships with patients, and less so for doctors, who see patients less regularly than community health workers. Patients seem particular about who has what information, and overall, they seem to prefer that their medical information, especially HIV-related, stay within the confines of patient-provider relationships. CONCLUSIONS HIV still provokes stigma and makes health information particularly sensitive for both providers and patients. The rise of mobile technology and related applications such as mHealth, means that new norms have to be established for its use. Participants' suggestions and feedback informed the design of a subsequent mHealth pilot randomized control trial to improve medication adherence.
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Affiliation(s)
- Shan-Estelle Brown
- Department of Anthropology, Rollins College, Winter Park, FL, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Archana Krishnan
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Communication, University at Albany, State University of New York, Albany, NY, USA
| | - Yerina S. Ranjit
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Communication, University of Missouri, Columbia, MO, USA
| | - Ruthanne Marcus
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Frederick L. Altice
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Division of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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10
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Phanuphak N, Seekaew P, Phanuphak P. Optimising treatment in the test-and-treat strategy: what are we waiting for? Lancet HIV 2019; 6:e715-e722. [PMID: 31515166 DOI: 10.1016/s2352-3018(19)30236-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 06/10/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
To move from science to guidelines, more than a decade was spent debating the clinical benefits, public health benefits, client autonomy, ethical conflicts, and adherence challenges for the HIV test-and-treat strategy. 2 years after WHO recommended antiretroviral therapy (ART) initiation for all, only 66% of countries reported full implementation. Many countries with the highest HIV burden, with increasing new HIV infections and HIV-related deaths, have not yet adopted or fully implemented the strategy. Whether to implement rapid or same-day ART should not follow the same cycle of debate. Now that there is strong evidence and high policy adoption, the test-and-treat strategy must be implemented as efficiently as possible. More research is needed to optimise-not delay-its implementation.
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Affiliation(s)
- Nittaya Phanuphak
- PREVENTION, Thai Red Cross AIDS Research Centre, Pathumwan, Bangkok 10330, Thailand.
| | - Pich Seekaew
- PREVENTION, Thai Red Cross AIDS Research Centre, Pathumwan, Bangkok 10330, Thailand
| | - Praphan Phanuphak
- PREVENTION, Thai Red Cross AIDS Research Centre, Pathumwan, Bangkok 10330, Thailand
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11
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Mendez‐Lopez A, McKee M, Stuckler D, Granich R, Gupta S, Noori T, Semenza JC. Population uptake and effectiveness of test-and-treat antiretroviral therapy guidelines for preventing the global spread of HIV: an ecological cross-national analysis. HIV Med 2019; 20:501-512. [PMID: 31140715 PMCID: PMC6772052 DOI: 10.1111/hiv.12750] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Although the benefits of adopting test-and-treat antiretroviral therapy (ART) guidelines that recommend initiation of ART regardless of CD4 cell counts have been demonstrated at the individual level, there is uncertainty about how this translates to the population level. Here, we explored whether adopting ART guidelines recommending earlier treatment initiation improves population ART access and viral suppression and reduces overall disease transmission. METHODS Data on ART initiation guidelines and treatment coverage, viral suppression, and HIV incidence from 37 European and Central Asian countries were collected from the European Centre for Disease Prevention and Control and the Global HIV Policy Watch and HIV 90-90-90 Watch databases. We used multivariate linear regression models to quantify the association of ART initiation guidelines with population ART access, viral suppression, and HIV incidence, adjusting for potential confounding factors. RESULTS Test-and-treat policies were associated with 15.2 percentage points (pp) [95% confidence interval (CI) 0.8-29.6 pp; P = 0.039] greater treatment coverage (proportion of HIV-positive people on ART) compared with countries with ART initiation at CD4 cell counts ≤ 350 cells/μL. The presence of test-and-treat policies was associated with 15.8 pp (95% CI 2.4-29.1 pp; P = 0.023) higher viral suppression rates (people on ART virally suppressed) compared with countries with treatment initiation at CD4 counts ≤ 350 cells/μL. ART initiation at CD4 counts ≤ 500 cells/μL did not significantly improve ART coverage compared to initiation at CD4 counts ≤ 350 cells/μL but achieved similar degrees of viral suppression as test-and-treat. CONCLUSIONS Test-and-treat was found to be associated with substantial improvements in population-level access to ART and viral suppression, further strengthening evidence that rapid initiation of treatment will help curb the spread of HIV.
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Affiliation(s)
| | - M McKee
- Department of Public Health & PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | - D Stuckler
- Department of Public Health & PolicyLondon School of Hygiene & Tropical MedicineLondonUK
- Dondena Research CentreUniversity of BocconiMilanItaly
| | - R Granich
- Independent Public Health ConsultantSan FranciscoCAUSA
| | - S Gupta
- Independent Public Health ConsultantDelhiIndia
| | - T Noori
- European Centre for Disease Prevention and ControlStockholmSweden
| | - JC Semenza
- European Centre for Disease Prevention and ControlStockholmSweden
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12
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Scaling Up Human Immunodeficiency Virus Screening and Antiretroviral Therapy Among Men Who Have Sex With Men to Achieve the 90-90-90 Targets in China. Sex Transm Dis 2019; 45:343-349. [PMID: 29465693 DOI: 10.1097/olq.0000000000000744] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Joint United Nations Programme on human immunodeficiency virus (HIV)/acquired immune deficiency syndrome has proposed the 90-90-90 targets by 2020. Human immunodeficiency virus epidemic is spreading rapidly among men who have sex with men (MSM) in China. This study investigates how the scale-up of HIV testing and treatment in achieving the targets and its cost-effectiveness. METHODS We constructed a compartmental model to forecast the HIV epidemic in Chinese MSM based on various "test-and-treat" scale-up scenarios. We assessed their cost effectiveness based on the cost for each HIV infection, death, and disability-adjusted life years (DALYs) prevented by the scale-up. RESULTS If the current epidemic continued, HIV prevalence among Chinese MSM would increase from 9.2% in 2016 to 12.6% (9.2-15.6%) in 2020 and 16.2% (11.3-20.0%) in 2025. By 2020, 49.2% of infected MSM would be diagnosed and 40.1% of whom on treatment, falling short of the 90-90-90 targets, so would be even by 2025. To achieve these targets by 2020, additional 850,000 HIV screening tests and 112,500 person-years of antiretroviral treatment (ART) annually are necessary. This spending is US $478 million during 2016 to 2020, which almost tripled the status quo. However, by delaying to 2025, an investment of US $1210 million over 2016 to 2025 corresponding to 52% increase to the status quo, will enable extra 340,000 HIV screening tests and 60,000 person-year on ART annually. In both scenarios, the incremental cost-effectiveness ratio was US $733 to 960 for each DALY prevented, indicating highly cost-effective scenarios. CONCLUSIONS Achieving the 90-90-90 targets by 2020 requires steep increase in investment, but delaying the targets to 2025 is practical and cost-effective.
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Niewiadomska AM, Jayabalasingham B, Seidman JC, Willem L, Grenfell B, Spiro D, Viboud C. Population-level mathematical modeling of antimicrobial resistance: a systematic review. BMC Med 2019; 17:81. [PMID: 31014341 PMCID: PMC6480522 DOI: 10.1186/s12916-019-1314-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/25/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Mathematical transmission models are increasingly used to guide public health interventions for infectious diseases, particularly in the context of emerging pathogens; however, the contribution of modeling to the growing issue of antimicrobial resistance (AMR) remains unclear. Here, we systematically evaluate publications on population-level transmission models of AMR over a recent period (2006-2016) to gauge the state of research and identify gaps warranting further work. METHODS We performed a systematic literature search of relevant databases to identify transmission studies of AMR in viral, bacterial, and parasitic disease systems. We analyzed the temporal, geographic, and subject matter trends, described the predominant medical and behavioral interventions studied, and identified central findings relating to key pathogens. RESULTS We identified 273 modeling studies; the majority of which (> 70%) focused on 5 infectious diseases (human immunodeficiency virus (HIV), influenza virus, Plasmodium falciparum (malaria), Mycobacterium tuberculosis (TB), and methicillin-resistant Staphylococcus aureus (MRSA)). AMR studies of influenza and nosocomial pathogens were mainly set in industrialized nations, while HIV, TB, and malaria studies were heavily skewed towards developing countries. The majority of articles focused on AMR exclusively in humans (89%), either in community (58%) or healthcare (27%) settings. Model systems were largely compartmental (76%) and deterministic (66%). Only 43% of models were calibrated against epidemiological data, and few were validated against out-of-sample datasets (14%). The interventions considered were primarily the impact of different drug regimens, hygiene and infection control measures, screening, and diagnostics, while few studies addressed de novo resistance, vaccination strategies, economic, or behavioral changes to reduce antibiotic use in humans and animals. CONCLUSIONS The AMR modeling literature concentrates on disease systems where resistance has been long-established, while few studies pro-actively address recent rise in resistance in new pathogens or explore upstream strategies to reduce overall antibiotic consumption. Notable gaps include research on emerging resistance in Enterobacteriaceae and Neisseria gonorrhoeae; AMR transmission at the animal-human interface, particularly in agricultural and veterinary settings; transmission between hospitals and the community; the role of environmental factors in AMR transmission; and the potential of vaccines to combat AMR.
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Affiliation(s)
- Anna Maria Niewiadomska
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, USA
| | - Bamini Jayabalasingham
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, USA.,Present Address: Elsevier Inc., 230 Park Ave, Suite B00, New York, NY, 10169, USA
| | - Jessica C Seidman
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, USA
| | | | - Bryan Grenfell
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, USA.,Princeton University, Princeton, NJ, USA
| | - David Spiro
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, USA
| | - Cecile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, USA.
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14
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Wei X, Zhang Y, Santella AJ, Wang L, Zhuang G, Li S, Zhang H. Effect of early highly active antiretroviral therapy on viral suppression among newly diagnosed men who have sex with men living with human immunodeficiency virus in Xi'an, China. J Med Virol 2019; 91:1263-1271. [PMID: 30840771 DOI: 10.1002/jmv.25449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND The number of men who have sex with men (MSM) living with human immunodeficiency virus (HIV) in China has increased rapidly and thus immediate highly active antiretroviral therapy (HAART) after diagnosis was implemented as a strategy to reduce the HIV transmission. METHODS MSM who were diagnosed with HIV and received HAART between 2013 to 2015 in Xi'an were divided into three groups (>350, 200-350, and <200 cell/μL) according to their baseline CD4+ T cell count. The time of follow-up was calculated from the first date of receiving HAART to December 31, 2016. The CD4+ T cell count was detected with 1 week before or after HAART. The plasma viral loads were tested after 1, 2, and 3 years of treatment. RESULTS Of 1442 subjects who received HAART, 690 (47.9%) cases were in >350 cell/μL group, whereas 400 (27.7%) cases and 352 (24.4%) cases were in the 200-350 cell/μL group and <200 cell/μL group, respectively. After 1 year of treatment, the viral suppression rate in the <200 cell/μL group was 91.1%, which was significantly lower than the other two groups. The logistic regression results show that the >350 cell/μL group and 200-350 cell/μL group predicted higher viral suppression rates. CONCLUSIONS Baseline CD4+ T cell count more than 350 cell/μL can improve viral suppression among MSM living with HIV. Furthermore, to reduce the transmission risk, the treatment compliance of people living with HIV with high CD4+ T cell levels should be improved, and their diagnosis to the treatment time should be decreased.
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Affiliation(s)
- Xiaoli Wei
- Department of Sexually Transmitted Diseases Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Yajuan Zhang
- Department of Sexually Transmitted Diseases Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Anthony J Santella
- Department of Health Professions, School of Health Professions and Human Services, Hofstra University, Hempstead, New York
| | - Lirong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Guihua Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Siwen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hailan Zhang
- Department of Sexually Transmitted Diseases Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
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15
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Acceptability of Home-Based Human Immunodeficiency Virus Testing and Counseling in Low- and Middle-Income Countries. POINT OF CARE 2018. [DOI: 10.1097/poc.0000000000000172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Foreman KJ, Marquez N, Dolgert A, Fukutaki K, Fullman N, McGaughey M, Pletcher MA, Smith AE, Tang K, Yuan CW, Brown JC, Friedman J, He J, Heuton KR, Holmberg M, Patel DJ, Reidy P, Carter A, Cercy K, Chapin A, Douwes-Schultz D, Frank T, Goettsch F, Liu PY, Nandakumar V, Reitsma MB, Reuter V, Sadat N, Sorensen RJD, Srinivasan V, Updike RL, York H, Lopez AD, Lozano R, Lim SS, Mokdad AH, Vollset SE, Murray CJL. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet 2018; 392:2052-2090. [PMID: 30340847 PMCID: PMC6227505 DOI: 10.1016/s0140-6736(18)31694-5] [Citation(s) in RCA: 1153] [Impact Index Per Article: 192.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/29/2018] [Accepted: 07/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Understanding potential trajectories in health and drivers of health is crucial to guiding long-term investments and policy implementation. Past work on forecasting has provided an incomplete landscape of future health scenarios, highlighting a need for a more robust modelling platform from which policy options and potential health trajectories can be assessed. This study provides a novel approach to modelling life expectancy, all-cause mortality and cause of death forecasts -and alternative future scenarios-for 250 causes of death from 2016 to 2040 in 195 countries and territories. METHODS We modelled 250 causes and cause groups organised by the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) hierarchical cause structure, using GBD 2016 estimates from 1990-2016, to generate predictions for 2017-40. Our modelling framework used data from the GBD 2016 study to systematically account for the relationships between risk factors and health outcomes for 79 independent drivers of health. We developed a three-component model of cause-specific mortality: a component due to changes in risk factors and select interventions; the underlying mortality rate for each cause that is a function of income per capita, educational attainment, and total fertility rate under 25 years and time; and an autoregressive integrated moving average model for unexplained changes correlated with time. We assessed the performance by fitting models with data from 1990-2006 and using these to forecast for 2007-16. Our final model used for generating forecasts and alternative scenarios was fitted to data from 1990-2016. We used this model for 195 countries and territories to generate a reference scenario or forecast through 2040 for each measure by location. Additionally, we generated better health and worse health scenarios based on the 85th and 15th percentiles, respectively, of annualised rates of change across location-years for all the GBD risk factors, income per person, educational attainment, select intervention coverage, and total fertility rate under 25 years in the past. We used the model to generate all-cause age-sex specific mortality, life expectancy, and years of life lost (YLLs) for 250 causes. Scenarios for fertility were also generated and used in a cohort component model to generate population scenarios. For each reference forecast, better health, and worse health scenarios, we generated estimates of mortality and YLLs attributable to each risk factor in the future. FINDINGS Globally, most independent drivers of health were forecast to improve by 2040, but 36 were forecast to worsen. As shown by the better health scenarios, greater progress might be possible, yet for some drivers such as high body-mass index (BMI), their toll will rise in the absence of intervention. We forecasted global life expectancy to increase by 4·4 years (95% UI 2·2 to 6·4) for men and 4·4 years (2·1 to 6·4) for women by 2040, but based on better and worse health scenarios, trajectories could range from a gain of 7·8 years (5·9 to 9·8) to a non-significant loss of 0·4 years (-2·8 to 2·2) for men, and an increase of 7·2 years (5·3 to 9·1) to essentially no change (0·1 years [-2·7 to 2·5]) for women. In 2040, Japan, Singapore, Spain, and Switzerland had a forecasted life expectancy exceeding 85 years for both sexes, and 59 countries including China were projected to surpass a life expectancy of 80 years by 2040. At the same time, Central African Republic, Lesotho, Somalia, and Zimbabwe had projected life expectancies below 65 years in 2040, indicating global disparities in survival are likely to persist if current trends hold. Forecasted YLLs showed a rising toll from several non-communicable diseases (NCDs), partly driven by population growth and ageing. Differences between the reference forecast and alternative scenarios were most striking for HIV/AIDS, for which a potential increase of 120·2% (95% UI 67·2-190·3) in YLLs (nearly 118 million) was projected globally from 2016-40 under the worse health scenario. Compared with 2016, NCDs were forecast to account for a greater proportion of YLLs in all GBD regions by 2040 (67·3% of YLLs [95% UI 61·9-72·3] globally); nonetheless, in many lower-income countries, communicable, maternal, neonatal, and nutritional (CMNN) diseases still accounted for a large share of YLLs in 2040 (eg, 53·5% of YLLs [95% UI 48·3-58·5] in Sub-Saharan Africa). There were large gaps for many health risks between the reference forecast and better health scenario for attributable YLLs. In most countries, metabolic risks amenable to health care (eg, high blood pressure and high plasma fasting glucose) and risks best targeted by population-level or intersectoral interventions (eg, tobacco, high BMI, and ambient particulate matter pollution) had some of the largest differences between reference and better health scenarios. The main exception was sub-Saharan Africa, where many risks associated with poverty and lower levels of development (eg, unsafe water and sanitation, household air pollution, and child malnutrition) were projected to still account for substantive disparities between reference and better health scenarios in 2040. INTERPRETATION With the present study, we provide a robust, flexible forecasting platform from which reference forecasts and alternative health scenarios can be explored in relation to a wide range of independent drivers of health. Our reference forecast points to overall improvements through 2040 in most countries, yet the range found across better and worse health scenarios renders a precarious vision of the future-a world with accelerating progress from technical innovation but with the potential for worsening health outcomes in the absence of deliberate policy action. For some causes of YLLs, large differences between the reference forecast and alternative scenarios reflect the opportunity to accelerate gains if countries move their trajectories toward better health scenarios-or alarming challenges if countries fall behind their reference forecasts. Generally, decision makers should plan for the likely continued shift toward NCDs and target resources toward the modifiable risks that drive substantial premature mortality. If such modifiable risks are prioritised today, there is opportunity to reduce avoidable mortality in the future. However, CMNN causes and related risks will remain the predominant health priority among lower-income countries. Based on our 2040 worse health scenario, there is a real risk of HIV mortality rebounding if countries lose momentum against the HIV epidemic, jeopardising decades of progress against the disease. Continued technical innovation and increased health spending, including development assistance for health targeted to the world's poorest people, are likely to remain vital components to charting a future where all populations can live full, healthy lives. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Kyle J Foreman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Neal Marquez
- Department of Sociology, University of Washington, Seattle, WA, USA
| | - Andrew Dolgert
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kai Fukutaki
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Madeline McGaughey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Martin A Pletcher
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Amanda E Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kendrick Tang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chun-Wei Yuan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jonathan C Brown
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joseph Friedman
- School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Mollie Holmberg
- Department of Geography, University of British Columbia, Vancouver, BC, Canada
| | - Disha J Patel
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Austin Carter
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kelly Cercy
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Abigail Chapin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Dirk Douwes-Schultz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Tahvi Frank
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Falko Goettsch
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Patrick Y Liu
- School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Vishnu Nandakumar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Marissa B Reitsma
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Vince Reuter
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nafis Sadat
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Reed J D Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Vinay Srinivasan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Rachel L Updike
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Hunter York
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alan D Lopez
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; National Institute of Public Health, Cuernavaca, Mexico
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Stein Emil Vollset
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
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Lou J, Cheng J, Li Y, Zhang C, Xing H, Ruan Y, Shao Y. Comparison of different strategies for controlling HIV/AIDS spreading in MSM. Infect Dis Model 2018; 3:293-300. [PMID: 30839918 PMCID: PMC6326225 DOI: 10.1016/j.idm.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 11/30/2022] Open
Abstract
As proposed in the UNAIDSs 2014 report, to end global AIDS epidemic by 2030, 90% of people living with HIV need to be diagnosed, 90% of the diagnosed need to receive antiretroviral therapy (ART), and 90% of those on treatment need to achieve viral suppression (90-90-90 strategy). The strategies focus on the reservoir. It controls HIV spreading by reducing infectiousness of HIV infected individuals via diagnosis and treatment. In this manuscript, we compared the effects of HIV/AIDS interventions that focus on different individuals in MSM population through a dynamics model. Our results showed that, the success or not of the "90-90-90" strategies depends on a very important factor: the infectious strength among individuals taking ART. Without highly effective HIV treatment, the "90-90-90" strategies are likely to fail. Therefore, we call for the combination of both primary prevention among the susceptible with the 90-90-90 strategy among the infected to curb the HIV epidemic in Chinese MSM.
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Affiliation(s)
- Jie Lou
- Department of Mathematics, Shanghai University, 99 Shangda Road, Shanghai, China
| | - Jinjin Cheng
- Department of Mathematics, Shanghai University, 99 Shangda Road, Shanghai, China
| | - Yan Li
- Henan Cable TV Network Group Co., Ltd, Zhengzhou Branch, Zhengzhou, China
| | - Chen Zhang
- School of Nursing, University of Rochester Medical Center, 255 Crittenden Blvd, Rm 2w218, Rochester, NY, 14642, USA
| | - Hui Xing
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yuhua Ruan
- Guangxi Center for Disease Control and Prevention, Nanning, China.,State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
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Marfatia YS, Shah RJ, Baxi RR, Surani A. Epidemiological, clinical, and immunological profile of cases at the time of HIV testing (a clinic-based observational cross-sectional study). Indian J Sex Transm Dis AIDS 2018; 39:7-12. [PMID: 30187019 PMCID: PMC6111640 DOI: 10.4103/ijstd.ijstd_20_18] [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] [Indexed: 11/04/2022] Open
Abstract
Introduction With the availability of free antiretroviral therapy (ART), HIV/AIDS has become a chronic manageable disease, but its transmission still continues. Early testing, though desirable, is still a far-fetched goal. Materials and Methods Forty-six newly detected HIV cases attending skin and sexually transmitted disease (STD) outpatient department (OPD) were studied. Careful inquiry was made to know the reason for HIV testing, marital status, concordance rate in married couples, and CD4 count at the time of presentation. Results Of the 46 cases, 27 (59%) cases were in the age range of 20-40 years with 41% females and 59% males. Forty-one cases were married and cohabiting, out of which 19 were seroconcordant. Condom was used by 5/19 cases in seroconcordant group and 3/22 cases in serodiscordant group. Fourteen (30.4%) cases were tested for an epidemiologic reason (the most common being spouse positivity and antenatal care testing). Of the remaining 32 cases, the reason for testing was mucocutaneous manifestations in 16 cases, STD in 10 cases, and systemic illnesses (fever of unknown origin and weight loss) in 6 cases. Mean CD4 count was 336/cumm, with 17 cases having CD4 count <250/cumm. Conclusion Except one, all cases were tested either because they were symptomatic or were referred by health-care provider for epidemiologic reasons. The presence of mucocutaneous manifestations including STD and systemic illnesses as the reason for testing as well as low CD4 count at the time of testing suggest less and late testing. Low condom use and high STD rate in married couple imply continued intramarital transmission. Although HIV seropositivity offers an entry point into continuum of comprehensive care package which includes free ART, it appears that HIV testing is still less and late.
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Affiliation(s)
- Yogesh S Marfatia
- Department of Dermatology and Venereology, Medical College, Baroda, Gujarat, India
| | | | - Reema Rajesh Baxi
- Department of Dermatology and Venereology, Medical College, Baroda, Gujarat, India
| | - Ashma Surani
- Department of Dermatology and Venereology, Medical College, Baroda, Gujarat, India
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Palmer A, Gabler K, Rachlis B, Ding E, Chia J, Bacani N, Bayoumi AM, Closson K, Klein M, Cooper C, Burchell A, Walmsley S, Kaida A, Hogg R. Viral suppression and viral rebound among young adults living with HIV in Canada. Medicine (Baltimore) 2018; 97:e10562. [PMID: 29851775 PMCID: PMC6392935 DOI: 10.1097/md.0000000000010562] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Describe the prevalence and covariates of viral suppression and subsequent rebound among younger (≤29 years old) compared with older adults.A retrospective clinical cohort study; eligibility criteria: documented HIV infection; resident of Canada; 18 years and over; first antiretroviral regimen comprised of at least 3 individual agents on or after January 1, 2000.Viral suppression and rebound were defined by at least 2 consecutive viral load measurements <50 or >50 HIV-1 RNA copies/mL, respectively, at least 30 days apart, in a 1-year period. Time to suppression and rebound were measured using the Kaplan-Meier method and Life Table estimates. Accelerated failure time models were used to determine factors independently associated with suppression and rebound.Younger adults experienced lower prevalence of viral suppression and shorter time to viral rebound compared with older adults. For younger adults, viral suppression was associated with being male and later era of combination antiretroviral initiation (cART) initiation. Viral rebound was associated with a history of injection drug use, Indigenous ancestry, baseline CD4 cell count >200, and initiating cART with a protease inhibitor (PI) containing regimen.The influence of age on viral suppression and rebound was modest for this cohort. Our analysis revealed that key covariates of viral suppression and rebound for young adults in Canada are similar to those of known importance to older adults. Women, people who use injection drugs, and people with Indigenous ancestry could be targeted by future health interventions.
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Affiliation(s)
- Alexis Palmer
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Karyn Gabler
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | | | - Erin Ding
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Jason Chia
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Nic Bacani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | | | - Kalysha Closson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Marina Klein
- Department of Medicine, McGill University Health Centre, Montreal, QB
| | - Curtis Cooper
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa
| | - Ann Burchell
- Dalla Lana School of Public Health, University of Toronto
- St. Michael's Hospital, Toronto, ON
| | - Sharon Walmsley
- Toronto General Research Institute, University Health Network, Toronto, ON
| | - Angela Kaida
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Robert Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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20
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Nosyk B, Min JE, Krebs E, Zang X, Compton M, Gustafson R, Barrios R, Montaner JSG. The Cost-Effectiveness of Human Immunodeficiency Virus Testing and Treatment Engagement Initiatives in British Columbia, Canada: 2011-2013. Clin Infect Dis 2018; 66:765-777. [PMID: 29028964 PMCID: PMC5850008 DOI: 10.1093/cid/cix832] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/22/2017] [Indexed: 01/03/2023] Open
Abstract
Background Recognition of the secondary preventive benefits of antiretroviral therapy (ART) has mobilized global efforts to "seek, test, treat, and retain" people living with human immunodeficiency virus [HIV]/AIDS (PLHIV) in HIV care. We aimed to determine the cost-effectiveness of a set of HIV testing and treatment engagement interventions initiated in British Columbia, Canada, in 2011-2013. Methods Using a previously validated dynamic HIV transmission model, linked individual-level health administrative data for PLHIV, and aggregate-level HIV testing data, we estimated the cost-effectiveness of primary care testing (hospital, emergency department [ED], outpatient), ART initiation, and ART retention initiatives vs a counterfactual scenario that approximated the status quo. HIV incidence, mortality, costs (in 2015$CDN), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios were estimated. Analyses were executed over 5- to 25-year time horizons from a government-payer perspective. Results ED testing was the best value at $30216 per QALY gained and had the greatest impact on incidence and mortality among PLHIV, while ART initiation provided the greatest QALY gains. The ART retention initiative was not cost-effective. Delivered in combination at the observed scale and sustained throughout the study period, we estimated a 12.8% reduction in cumulative HIV incidence and a 4.7% reduction in deaths among PLHIV at $55258 per QALY gained. Results were most sensitive to uncertainty in the number of undiagnosed PLHIV. Conclusions HIV testing and ART initiation interventions were cost-effective, while the ART retention intervention was not. Developing strategies to reengage PLHIV lost to care is a priority moving forward.
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Affiliation(s)
- Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, Vancouver
- Faculty of Health Sciences, Simon Fraser University, Burnaby
| | - Jeong E Min
- BC Centre for Excellence in HIV/AIDS, Vancouver
| | | | - Xiao Zang
- BC Centre for Excellence in HIV/AIDS, Vancouver
| | - Miranda Compton
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada
| | - Reka Gustafson
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, Vancouver
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julio S G Montaner
- BC Centre for Excellence in HIV/AIDS, Vancouver
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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21
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Cook CL, Canidate S, Ennis N, Cook RL. Types and delivery of emotional support to promote linkage and engagement in HIV care. Patient Prefer Adherence 2018; 12:45-52. [PMID: 29343948 PMCID: PMC5749556 DOI: 10.2147/ppa.s145698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Despite recommendations for early entry into human immunodeficiency virus (HIV) care, many people diagnosed with HIV delay seeking care. Multiple types of social support (ie, cognitive, emotional, and tangible) are often needed for someone to transition into HIV care, but a lack of emotional support at diagnosis may be the reason why some people fail to stay engaged in care. Thus, the purpose of this study was to identify how people living with HIV conceptualized emotional support needs and delivery at diagnosis. METHOD We conducted a secondary analysis of qualitative data from 27 people living with HIV, many of whom delayed entry into HIV care. RESULTS Participants described their experiences seeking care after an HIV diagnosis and identified components of emotional support that aided entry into care - identification, connection, and navigational presence. Many participants stated that these types of support were ideally delivered by peers with HIV. CONCLUSION In clinical practice, providers often use an HIV diagnosis as an opportunity to educate patients about HIV prevention and access to services. However, this type of social support may not facilitate engagement in care if emotional support needs are not met.
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Affiliation(s)
- Christa L Cook
- Department of Family, Community, and Health System Science, College of Nursing
- Correspondence: Christa L Cook, College of Nursing, University of Florida, PO Box 100197, Gainesville, FL 32610-0197, USA, Tel +1 352 273 6350, Fax +1 352 273 6577, Email
| | - Shantrel Canidate
- Social and Behavioral Science, College of Public Health and Health Profession
| | - Nicole Ennis
- Department of Clinical and Health Psychology, College of Public Health and Health Professions
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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22
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Gutiérrez F. HIV/AIDS infection: The beginning of the end for today's greatest pandemic? Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2017.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Early detection of HIV infection and of asymptomatic sexually transmitted infections among men who have sex with men. Clin Microbiol Infect 2017; 24:540-545. [PMID: 28843621 DOI: 10.1016/j.cmi.2017.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/12/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To provide data on incidence of early diagnosis of HIV infections and define prevalence and incidence of asymptomatic sexually transmitted infections (STI) in men who have sex with men (MSM). METHODS We assessed a prospective cohort study of HIV-uninfected MSM at high risk for HIV infection. Participants were selected through a risk-assessment questionnaire, and they were screened for HIV infection (quarterly) and for other STI (yearly): syphilis, and hepatitis A, B and C (serology); Chlamydia trachomatis and Neisseria gonorrhoeae in penis and rectum; and human papillomavirus in anus and mouth (PCR). RESULTS Between November 2009 and October 2012, a total of 258 HIV-uninfected MSM at high risk for HIV infection were included and followed up for a median of 2 years (interquartile range 1.4, 2.5). Nineteen acute HIV infections were diagnosed (incidence, 3.9 per 100 person-years). Prevalence of STI at baseline was follows: syphilis 8.4% (95% confidence interval (CI) 5.4-12.7); hepatitis C virus (HCV) 2.0% (95% CI 0.7-4.8); C. trachomatis in penis 3.2% (95% CI 1.5-6.5) and in rectum 6.5% (95% CI 3.9-10.5); N. gonorrhoeae in penis 2.0% (95% CI 0.8-5.0) and in rectum 6.1% (95% CI 3.6-10.1); human papillomavirus in anal canal 75.7% (95% CI 68.8-81.5) and in mouth 3.8% (95% CI 1.8-7.7). CONCLUSIONS The implementation of the Check-Ear Project in a MSM community centre allowed for the identification of early HIV infections and asymptomatic STI among MSM. The high incidence of HIV infections and the high prevalence of STI strongly support the recommendation of periodic screenings among sexually active MSM.
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Gamble T, Branson B, Donnell D, Hall HI, King G, Cutler B, Hader S, Burns D, Leider J, Wood AF, G Volpp K, Buchacz K, El-Sadr WM. Design of the HPTN 065 (TLC-Plus) study: A study to evaluate the feasibility of an enhanced test, link-to-care, plus treat approach for HIV prevention in the United States. Clin Trials 2017. [PMID: 28627929 PMCID: PMC5639958 DOI: 10.1177/1740774517711682] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background/Aims HIV continues to be a major public health threat in the United States, and mathematical modeling has demonstrated that the universal effective use of antiretroviral therapy among all HIV-positive individuals (i.e. the “test and treat” approach) has the potential to control HIV. However, to accomplish this, all the steps that define the HIV care continuum must be achieved at high levels, including HIV testing and diagnosis, linkage to and retention in clinical care, antiretroviral medication initiation, and adherence to achieve and maintain viral suppression. The HPTN 065 (Test, Link-to-Care Plus Treat [TLC-Plus]) study was designed to determine the feasibility of the “test and treat” approach in the United States. Methods HPTN 065 was conducted in two intervention communities, Bronx, NY, and Washington, DC, along with four non-intervention communities, Chicago, IL; Houston, TX; Miami, FL; and Philadelphia, PA. The study consisted of five components: (1) exploring the feasibility of expanded HIV testing via social mobilization and the universal offer of testing in hospital settings, (2) evaluating the effectiveness of financial incentives to increase linkage to care, (3) evaluating the effectiveness of financial incentives to increase viral suppression, (4) evaluating the effectiveness of a computer-delivered intervention to decrease risk behavior in HIV-positive patients in healthcare settings, and (5) administering provider and patient surveys to assess knowledge and attitudes regarding the use of antiretroviral therapy for prevention and the use of financial incentives to improve health outcomes. The study used observational cohorts, cluster and individual randomization, and made novel use of the existing national HIV surveillance data infrastructure. All components were developed with input from a community advisory board, and pragmatic methods were used to implement and assess the outcomes for each study component. Results A total of 76 sites in Washington, DC, and the Bronx, NY, participated in the study: 37 HIV test sites, including 16 hospitals, and 39 HIV care sites. Between September 2010 and December 2014, all study components were successfully implemented at these sites and resulted in valid outcomes. Our pragmatic approach to the study design, implementation, and the assessment of study outcomes allowed the study to be conducted within established programmatic structures and processes. In addition, it was successfully layered on the ongoing standard of care and existing data infrastructure without disrupting health services. Conclusion The HPTN 065 study demonstrated the feasibility of implementing and evaluating a multi-component “test and treat” trial that included a large number of community sites and involved pragmatic approaches to study implementation and evaluation.
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Affiliation(s)
- Theresa Gamble
- 1 Science Facilitation Department, HPTN Leadership and Operations Center, FHI 360, Durham, NC, USA
| | | | - Deborah Donnell
- 3 Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - H Irene Hall
- 4 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
| | - Georgette King
- 1 Science Facilitation Department, HPTN Leadership and Operations Center, FHI 360, Durham, NC, USA
| | - Blayne Cutler
- 5 Public Health Foundation Enterprises, La Puente, CA, USA
| | - Shannon Hader
- 6 DC Department of Health, HIV/AIDS, Hepatitis, STD and TB Administration, Washington, DC, USA
| | - David Burns
- 7 Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Jason Leider
- 8 Albert Einstein College of Medicine, New York, NY, USA
| | | | - Kevin G Volpp
- 10 Center for Health Incentives and Behavioral Economics; Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Kate Buchacz
- 4 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
| | - Wafaa M El-Sadr
- 11 ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
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25
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HIV/AIDS infection: The beginning of the end for today's greatest pandemic? Rev Clin Esp 2017; 217:468-472. [PMID: 28579286 DOI: 10.1016/j.rce.2017.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/07/2017] [Accepted: 04/18/2017] [Indexed: 11/23/2022]
Abstract
Recently, there have been significant advances in the fight against human immunodeficiency virus, which have increased the hopes of definitively halting its dissemination and of starting the decline of the epidemic it has caused. Transmission of the infection was drastically reduced when infected patients were given antiretroviral treatments, which boosted the diffusion of treatments to middle- and low-income countries. Global therapy coverage has doubled in recent years; meanwhile the incidence of new infections has decreased. Various curative strategies are also actively being investigated, including those aiming to induce cell resistance to the infection through gene therapy and the elimination of latent virus reservoirs. This article reviews the current situation and future developments in terms of controlling the pandemic and, eventually, curing the infection.
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26
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King E, Kinvig K, Steif J, Qiu AQ, Maan EJ, Albert AY, Pick N, Alimenti A, Kestler MH, Money DM, Lester RT, Murray MCM. Mobile Text Messaging to Improve Medication Adherence and Viral Load in a Vulnerable Canadian Population Living With Human Immunodeficiency Virus: A Repeated Measures Study. J Med Internet Res 2017; 19:e190. [PMID: 28572079 PMCID: PMC5472843 DOI: 10.2196/jmir.6631] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 03/02/2017] [Accepted: 04/11/2017] [Indexed: 02/05/2023] Open
Abstract
Background Combination antiretroviral therapy (cART) as treatment for human immunodeficiency virus (HIV) infection is effective and available, but poor medication adherence limits benefits, particularly in vulnerable populations. In a Kenyan randomized controlled trial, a weekly text-messaging intervention (WelTel) improved cART adherence and HIV viral load (VL). Despite growing evidence for short message service (SMS) text-message interventions in HIV care, there is a paucity of data utilizing these interventions in marginalized or female cohorts. Objective This study was undertaken to assess whether the standardized WelTel SMS text-message intervention applied to a vulnerable, predominantly female, population improved cART adherence and VL. Methods We conducted a repeated measures study of the WelTel intervention in high-risk HIV-positive persons by measuring change in VL, CD4 count, and self-reported adherence 12 months before and 12 months after the WelTel intervention was introduced. Inclusion criteria included VL ≥200 copies/mL, indication for treatment, and meeting vulnerability criteria. Participants were given a mobile phone with unlimited texting (where required), and weekly check-in text messages were sent for one year from the WelTel computer platform. Clinical data were collected for control and intervention years. Participants were followed by a multidisciplinary team in a clinical setting. Outcomes were assessed using Wilcoxon signed ranks tests for change in CD4 and VL from control year to study end and mixed-effects logistic regressions for change in cART adherence and appointment attendance. A secondary analysis was conducted to assess the effect of response rate on the outcome by modeling final log10 VL by number of responses while controlling for mean log10 VL in the control year. Results Eighty-five participants enrolled in the study, but 5 withdrew (final N=80). Participants were predominantly female (90%, 72/80) with a variety of vulnerabilities. Mean VL decreased from 1098 copies/mL in the control year to 439 copies/mL at study end (P=.004). Adherence to cART significantly improved (OR 1.14, IQR 1.10-1.18; P<.001), whereas appointment attendance decreased slightly with the intervention (OR 0.81, IQR 0.67-0.99; P=.03). A response was received for 46.57% (1753/3764) of messages sent and 9.62% (362/3764) of text messages sent were replied to with a problem. An outcome analysis examining relationship between reply rate and VL did not meet statistical significance (P=.07), but may be worthy of investigating further in a larger study. Conclusions WelTel may be an effective tool for improving cART adherence and reducing VLs among high-risk, vulnerable HIV-positive persons. Trial Registration Clinicaltrials.gov NCT02603536; https://clinicaltrials.gov/ct2/show/NCT02603536 (Archived by WebCite at http://www.webcitation.org/6qK57zCwv)
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Affiliation(s)
- Elizabeth King
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karen Kinvig
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Jonathan Steif
- Department of Mathematics, University of British Columbia, Vancouver, BC, Canada
| | - Annie Q Qiu
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Evelyn J Maan
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Arianne Yk Albert
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Neora Pick
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada.,Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ariane Alimenti
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Mary H Kestler
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada.,Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deborah M Money
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada.,Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Richard T Lester
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Melanie Caroline Margaret Murray
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada.,Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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27
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Hayes R, Floyd S, Schaap A, Shanaube K, Bock P, Sabapathy K, Griffith S, Donnell D, Piwowar-Manning E, El-Sadr W, Beyers N, Ayles H, Fidler S. A universal testing and treatment intervention to improve HIV control: One-year results from intervention communities in Zambia in the HPTN 071 (PopART) cluster-randomised trial. PLoS Med 2017; 14:e1002292. [PMID: 28464041 PMCID: PMC5412988 DOI: 10.1371/journal.pmed.1002292] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/27/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets require that, by 2020, 90% of those living with HIV know their status, 90% of known HIV-positive individuals receive sustained antiretroviral therapy (ART), and 90% of individuals on ART have durable viral suppression. The HPTN 071 (PopART) trial is measuring the impact of a universal testing and treatment intervention on population-level HIV incidence in 21 urban communities in Zambia and South Africa. We report observational data from four communities in Zambia to assess progress towards the UNAIDS targets after 1 y of the PopART intervention. METHODS AND FINDINGS The PopART intervention comprises annual rounds of home-based HIV testing delivered by community HIV-care providers (CHiPs) who also support linkage to care, ART retention, and other services. Data from four communities in Zambia receiving the full intervention (including immediate ART for all individuals with HIV) were used to determine proportions of participants who knew their HIV status after the CHiP visit; proportions linking to care and initiating ART following referral; and overall proportions of HIV-infected individuals who knew their status (first 90 target) and the proportion of these on ART (second 90 target), pre- and post-intervention. We are not able to assess progress towards the third 90 target at this stage of the study. Overall, 121,130 adults (59,283 men and 61,847 women) were enumerated in 46,714 households during the first annual round (December 2013 to June 2015). Of the 45,399 (77%) men and 55,703 (90%) women consenting to the intervention, 80% of men and 85% of women knew their HIV status after the CHiP visit. Of 6,197 HIV-positive adults referred by CHiPs, 42% (95% CI: 40%-43%) initiated ART within 6 mo and 53% (95% CI: 52%-55%) within 12 mo. In the entire population, the estimated proportion of HIV-positive adults who knew their status increased from 52% to 78% for men and from 56% to 87% for women. The estimated proportion of known HIV-positive individuals on ART increased overall from 54% after the CHiP visit to 74% by the end of the round for men and from 53% to 73% for women. The estimated overall proportion of HIV-positive adults on ART, irrespective of whether they knew their status, increased from 44% to 61%, compared with the 81% target (the product of the first two 90 targets). Coverage was lower among young men and women than in older age groups. The main limitation of the study was the need for assumptions concerning knowledge of HIV status and ART coverage among adults not consenting to the intervention or HIV testing, although our conclusions were robust in sensitivity analyses. CONCLUSIONS In this analysis, acceptance of HIV testing among those consenting to the intervention was high, although linkage to care and ART initiation took longer than expected. Knowledge of HIV-positive status increased steeply after 1 y, almost attaining the first 90 target in women and approaching it in men. The second 90 target was more challenging, with approximately three-quarters of known HIV-positive individuals on ART by the end of the annual round. Achieving higher test uptake in men and more rapid linkage to care will be key objectives during the second annual round of the intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT01900977.
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Affiliation(s)
- Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ab Schaap
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Zambart, University of Zambia School of Medicine, Lusaka, Zambia
| | - Kwame Shanaube
- Zambart, University of Zambia School of Medicine, Lusaka, Zambia
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, University of Stellenbosch, Stellenbosch, South Africa
| | - Kalpana Sabapathy
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sam Griffith
- FHI 360, HIV Prevention Trials Network, Durham, North Carolina, United States of America
| | - Deborah Donnell
- HIV Prevention Trials Network Statistical and Data Management Center, Statistical Center for HIV/AIDS Research and Prevention, Seattle, Washington, United States of America
| | - Estelle Piwowar-Manning
- HIV Prevention Trials Network Laboratory Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Wafaa El-Sadr
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Nulda Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, University of Stellenbosch, Stellenbosch, South Africa
| | - Helen Ayles
- Zambart, University of Zambia School of Medicine, Lusaka, Zambia.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Fidler
- HIV Clinical Trials Unit, Imperial College London, London, United Kingdom
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28
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Expanded antiretroviral treatment, sexual networks, and condom use: Treatment as prevention unlikely to succeed without partner reduction among men who have sex with men in China. PLoS One 2017; 12:e0171295. [PMID: 28406992 PMCID: PMC5390964 DOI: 10.1371/journal.pone.0171295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 01/19/2017] [Indexed: 12/26/2022] Open
Abstract
Background To project the impact of partner reduction on preventing new HIV infections among men who have sex with men (MSM) under varying conditions of enhanced HIV testing and treatment (T&T) and condom use in Beijing, China. Methods and findings A complex network model was fitted to predict the number of new HIV infections averted from 2014 to 2023 under four scenarios of sexual behavior risk reduction (S)—S1: Male sexual partners decrease (reduced by a random value m from 1–50) while condom use increases (risk constant p is a random value between 0.2 and 1]); S2: Both sexual partners and condom use decrease (m 1, 50; p 1, 1.8); S3: Sexual partners reduce (m 1, 10) while condom use increases or decreases (p 0.2, 1.8); S4: Only MSM with ≥100 male sexual partners reduce their partners (m 1, 50) while condom use increases (p 0.2, 1). HIV prevalence will reach 23.2% by 2023 among Beijing MSM if T&T remains at the 2013 level. The three most influential factors are: T&T coverage; partner reduction (m); and the background risk (p). Under scenarios 1–4 of sexual behavioral changes with enhanced T&T interventions, the cumulative HIV new infections prevented over the 10 years will be 46.8% for S1 (interquartile range [IQR] 32.4%, 60.1%); 29.7% for S2 (IQR 18.0%, 41.4%), 23.2% for S3 (IQR 12.2%, 37.0%) and 11.6% for S4 (IQR 4.0%, 26.6%), respectively. The reproduction number R0 could drop below 1 if there were a substantial reduction of male sexual partners and/or expanded condom use. Conclusion Partner reduction is a vital factor within HIV combination interventions to reduce HIV incidence among Beijing MSM, with substantial additional benefits derived from condom use. T&T without substantial partner reduction and increased condom use is less promising unless its implementation were extremely (and improbably) efficient.
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Tao LL, Liu M, Li SM, Liu J, Jiang SL, Wang LJ, Luo FJ, Wang N. Impact of Antiretroviral Therapy on the Spread of Human Immunodeficiency Virus in Chaoyang District, Beijing, China: Using the Asian Epidemic Model. Chin Med J (Engl) 2017; 130:32-38. [PMID: 28051020 PMCID: PMC5221108 DOI: 10.4103/0366-6999.196571] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Successful antiretroviral therapy (ART) has been demonstrated to be effective in reducing the infectivity of human immunodeficiency virus (HIV). We conducted a study to predict the potential effect of ART on the spread of HIV in Chaoyang District, Beijing, China, using the Asian Epidemic Model (AEM). METHODS The AEM baseline workbook was used to determine the current infection status and to project the future spread of HIV under current conditions. We changed the input on the ART coverage from 2014 to 2025 and also modified the treatment eligibility in the AEM intervention workbook, in order to allow for analysis of the projected downstream impact of ART. RESULTS By gradually increasing the ART coverage rate from 29.7% (rate of 2013) to 40.0%, 50.0%, 60.0%, 70.0%, 80.0%, and 90.0% (at CD4+ ≤350 cells/μl), and by changing the dates of coverage from 2014 to 2020, the number of new infections showed a cumulative decline of 0.60%, 1.59%, 2.94%, 5.33%, 9.32%, and 14.98%, respectively. After 2020, the projected rates of infection rebounded slightly, so with the exception of the years with very high coverage (90.0%), new infections continued to decrease. When we changed the initial threshold of therapy to CD4+ cell counts ≤500 cells/μl, new infections decreased 6.00%, 11.64%, 15.92%, 21.11%, 26.92%, 33.05%, and 38.75%, respectively, under varying ART coverages. CONCLUSION Our study demonstrates that the early initiation of ART for people living with HIV/acquired immune deficiency syndrome (AIDS) has a positive effect in slowing the spread of HIV.
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Affiliation(s)
- Li-Li Tao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Shu-Ming Li
- Department of STD and AIDS Prevention and Control, Beijing Chaoyang District Centre for Disease Control and Prevention, Beijing 100021, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Shu-Lin Jiang
- Department of STD and AIDS Prevention and Control, Beijing Chaoyang District Centre for Disease Control and Prevention, Beijing 100021, China
| | - Li-Juan Wang
- Department of STD and AIDS Prevention and Control, Beijing Chaoyang District Centre for Disease Control and Prevention, Beijing 100021, China
| | - Feng-Ji Luo
- Department of STD and AIDS Prevention and Control, Beijing Chaoyang District Centre for Disease Control and Prevention, Beijing 100021, China
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
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30
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Bärnighausen T, Bloom DE, Humair S. Human Resources for Treating HIV/AIDS: Are the Preventive Effects of Antiretroviral Treatment a Game Changer? PLoS One 2016; 11:e0163960. [PMID: 27716813 PMCID: PMC5055321 DOI: 10.1371/journal.pone.0163960] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/16/2016] [Indexed: 11/19/2022] Open
Abstract
Shortages of human resources for treating HIV/AIDS (HRHA) are a fundamental barrier to reaching universal antiretroviral treatment (ART) coverage in developing countries. Previous studies suggest that recruiting HRHA to attain universal ART coverage poses an insurmountable challenge as ART significantly increases survival among HIV-infected individuals. While new evidence about ART's prevention benefits suggests fewer infections may mitigate the challenge, new policies such as treatment-as-prevention (TasP) will exacerbate it. We develop a mathematical model to analytically study the net effects of these countervailing factors. Using South Africa as a case study, we find that contrary to previous results, universal ART coverage is achievable even with current HRHA numbers. However, larger health gains are possible through a surge-capacity policy that aggressively recruits HRHA to reach universal ART coverage quickly. Without such a policy, TasP roll-out can increase health losses by crowding out sicker patients from treatment, unless a surge capacity exclusively for TasP is also created.
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Affiliation(s)
- Till Bärnighausen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Africa Health Research Institute (AHRI), Mtubatuba, KwaZulu Natal, South Africa
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - David E. Bloom
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Salal Humair
- Amazon.com, Inc., Seattle, Washington, United States of America
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31
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Kesselring S, Cescon A, Colley G, Osborne C, Zhang W, Raboud JM, Hosein SR, Burchell AN, Cooper C, Klein MB, Loutfy M, Machouf N, Montaner J, Rachlis A, Tsoukas C, Hogg RS, Lima VD. Quality of initial HIV care in Canada: extension of a composite programmatic assessment tool for HIV therapy. HIV Med 2016; 18:151-160. [PMID: 27385643 DOI: 10.1111/hiv.12409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To document the quality of initial HIV care in Canada using the Programmatic Compliance Score (PCS), to explore the association of the PCS with mortality, and to identify factors associated with higher quality of care. METHODS We analysed data from the Canadian Observational Cohort Collaboration (CANOC), a multisite Canadian cohort of HIV-positive adults initiating combination antiretroviral therapy (ART) from 2000 to 2011. PCS indicators of noncompliance with HIV treatment guidelines include: fewer than three CD4 count tests in the first year of ART; fewer than three viral load tests in the first year of ART; no drug resistance testing before initiation; baseline CD4 count < 200 cells/mm3 ; starting a nonrecommended ART regimen; and not achieving viral suppression within 6 months of initiation. Indicators are summed for a score from 0 to 6; higher scores indicate poorer care. Cox regression was used to assess the association between PCS and mortality and ordinal logistic regression was used to explore factors associated with higher quality of care. RESULTS Of the 7460 participants (18% female), the median score was 1.0 (Q1-Q3 1.0-2.0); 21% scored 0 and 8% scored ≥ 4. In multivariable analysis, compared with a score of 0, poorer PCS was associated with mortality for scores > 1 [score = 2: adjusted hazard ratio (AHR) 1.64; 95% confidence interval (CI) 1.13-2.36; score = 3: AHR 2.02; 95% CI 1.38-2.97; score ≥ 4: AHR 2.14; 95% CI 1.43-3.21], after adjustments for age, sex, province, ART start year, hepatitis C virus (HCV) coinfection, and baseline viral load. Women, individuals with HCV coinfection, younger people, and individuals starting ART earlier (2000-2003) had poorer scores. CONCLUSIONS Our findings further validate the PCS as a predictor of all-cause mortality. Disparities identified suggest that further efforts are needed to ensure that care is equitably accessible.
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Affiliation(s)
- S Kesselring
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - A Cescon
- Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - G Colley
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - C Osborne
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - W Zhang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - J M Raboud
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | | | - A N Burchell
- University of Toronto, Toronto, ON, Canada.,Ontario HIV Treatment Network, Toronto, ON, Canada
| | - C Cooper
- University of Ottawa, Ottawa, ON, Canada
| | - M B Klein
- McGill University, Montreal, QC, Canada
| | - M Loutfy
- University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada.,Maple Leaf Medical Clinic, Toronto, ON, Canada
| | - N Machouf
- Clinique médicale l'Actuel, Montreal, QC, Canada
| | - Jsg Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - A Rachlis
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C Tsoukas
- McGill University, Montreal, QC, Canada
| | - R S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Simon Fraser University, Burnaby, BC, Canada
| | - V D Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
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32
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Nichols BE, Götz HM, van Gorp ECM, Verbon A, Rokx C, Boucher CAB, van de Vijver DAMC. Partner Notification for Reduction of HIV-1 Transmission and Related Costs among Men Who Have Sex with Men: A Mathematical Modeling Study. PLoS One 2015; 10:e0142576. [PMID: 26554586 PMCID: PMC4640527 DOI: 10.1371/journal.pone.0142576] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/24/2015] [Indexed: 12/14/2022] Open
Abstract
Background Earlier antiretroviral treatment initiation prevents new HIV infections. A key problem in HIV prevention and care is the high number of patients diagnosed late, as these undiagnosed patients can continue forward HIV transmission. We modeled the impact on the Dutch men-who-have-sex-with-men (MSM) HIV epidemic and cost-effectiveness of an existing partner notification process for earlier identification of HIV-infected individuals to reduce HIV transmission. Methods Reduction in new infections and cost-effectiveness ratios were obtained for the use of partner notification to identify 5% of all new diagnoses (Scenario 1) and 20% of all new diagnoses (Scenario 2), versus no partner notification. Costs and quality adjusted life years (QALYs) were assigned to each disease state and calculated over 5 year increments for a 20 year period. Results Partner notification is predicted to avert 18–69 infections (interquartile range [IQR] 13–24; 51–93) over the course of 5 years countrywide to 221–830 (IQR 140–299; 530–1,127) over 20 years for Scenario 1 and 2 respectively. Partner notification was considered cost-effective in the short term, with increasing cost-effectiveness over time: from €41,476 -€41, 736 (IQR €40,529-€42,147; €40,791-€42,397) to €5,773 -€5,887 (€5,134-€7,196; €5,411-€6,552) per QALY gained over a 5 and 20 year period, respectively. The full monetary benefits of partner notification by preventing new HIV infections become more apparent over time. Conclusions Partner notification will not lead to the end of the HIV epidemic, but will prevent new infections and be increasingly cost-effectiveness over time.
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Affiliation(s)
- Brooke E. Nichols
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
- * E-mail:
| | - Hannelore M. Götz
- Department Infectious Disease Control, Public Health Service Rotterdam-Rijnmond, Rotterdam, the Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eric C. M. van Gorp
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine and Infectious Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Annelies Verbon
- Department of Internal Medicine and Infectious Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Casper Rokx
- Department of Internal Medicine and Infectious Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
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Initiation of antiretroviral therapy at high CD4+ cell counts is associated with positive treatment outcomes. AIDS 2015; 29:1871-82. [PMID: 26165354 DOI: 10.1097/qad.0000000000000790] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE There is limited research investigating the possible mechanisms of how starting combination antiretroviral therapy (cART) at a higher CD4 cell count decreases mortality. This study investigated the association between initiating cART with short-term and long-term achievement of viral suppression; emergence of any drug resistance and of an AIDS-defining illness (ADI); long-term treatment adherence; and all-cause mortality. METHODS This retrospective cohort study included 4120 naive patients who initiated cART between 2000 and 2012. Patients were followed until 2013, death or until the last contact date (varied by outcome). The main exposure was the interaction between period of cART initiation (2000-2006 and 2007-2012) and CD4 cell count at cART initiation (<500 versus ≥500 cells/μl). We considered both baseline and longitudinal covariates. We fitted different multivariable models using cross-sectional and longitudinal statistical methods, depending on the outcome. RESULTS Patients who initiated cART with a CD4 cell count at least 500 cells/μl in 2007-2012 had an increased likelihood of achieving viral suppression at 9 months and of maintaining an adherence level of at least 95% over time, and the lowest probability of developing any resistance and an ADI during follow-up. These patients were not the ones with the highest likelihood of maintaining viral suppression over time, most likely due to viral load blips experienced during the follow-up. CONCLUSION The outcomes in this study likely play an important role in explaining the positive impact of early cART initiation on mortality. These results should alleviate some of the concerns clinicians may have when initiating cART in patients with high CD4s as recommended by current treatment guidelines.
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Kok S, Rutherford AR, Gustafson R, Barrios R, Montaner JSG, Vasarhelyi K. Optimizing an HIV testing program using a system dynamics model of the continuum of care. Health Care Manag Sci 2015; 18:334-62. [PMID: 25595433 PMCID: PMC4543429 DOI: 10.1007/s10729-014-9312-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 11/26/2014] [Indexed: 12/01/2022]
Abstract
Realizing the full individual and population-wide benefits of antiretroviral therapy for human immunodeficiency virus (HIV) infection requires an efficient mechanism of HIV-related health service delivery. We developed a system dynamics model of the continuum of HIV care in Vancouver, Canada, which reflects key activities and decisions in the delivery of antiretroviral therapy, including HIV testing, linkage to care, and long-term retention in care and treatment. To measure the influence of operational interventions on population health outcomes, we incorporated an HIV transmission component into the model. We determined optimal resource allocations among targeted and routine testing programs to minimize new HIV infections over five years in Vancouver. Simulation scenarios assumed various constraints informed by the local health policy. The project was conducted in close collaboration with the local health care providers, Vancouver Coastal Health Authority and Providence Health Care.
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Affiliation(s)
- Sarah Kok
- />The IRMACS Centre, Simon Fraser University, Burnaby, British Columbia Canada
| | - Alexander R. Rutherford
- />The IRMACS Centre and Department of Mathematics, Simon Fraser University, Burnaby, British Columbia Canada
| | - Reka Gustafson
- />Vancouver Coastal Health, Vancouver, British Columbia Canada
| | - Rolando Barrios
- />British Columbia Centre for Excellence in HIV/AIDS and Vancouver Coastal Health, Vancouver, British Columbia Canada
| | - Julio S. G. Montaner
- />British Columbia Centre for Excellence in HIV/AIDS and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia Canada
| | - Krisztina Vasarhelyi
- />Faculty of Health Sciences and The IRMACS Centre, Simon Fraser University, Burnaby, British Columbia Canada
| | - on behalf of the Vancouver HIV Testing Program Modelling Group
- />The IRMACS Centre, Simon Fraser University, Burnaby, British Columbia Canada
- />The IRMACS Centre and Department of Mathematics, Simon Fraser University, Burnaby, British Columbia Canada
- />Vancouver Coastal Health, Vancouver, British Columbia Canada
- />British Columbia Centre for Excellence in HIV/AIDS and Vancouver Coastal Health, Vancouver, British Columbia Canada
- />British Columbia Centre for Excellence in HIV/AIDS and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia Canada
- />Faculty of Health Sciences and The IRMACS Centre, Simon Fraser University, Burnaby, British Columbia Canada
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35
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Caro-Vega Y, del Rio C, Dias Lima V, Lopez-Cervantes M, Crabtree-Ramirez B, Bautista-Arredondo S, Colchero MA, Sierra-Madero J. Estimating the Impact of Earlier ART Initiation and Increased Testing Coverage on HIV Transmission among Men Who Have Sex with Men in Mexico using a Mathematical Model. PLoS One 2015; 10:e0136534. [PMID: 26302044 PMCID: PMC4547810 DOI: 10.1371/journal.pone.0136534] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 08/04/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To estimate the impact of late ART initiation on HIV transmission among men who have sex with men (MSM) in Mexico. METHODS An HIV transmission model was built to estimate the number of infections transmitted by HIV-infected men who have sex with men (MSM-HIV+) MSM-HIV+ in the short and long term. Sexual risk behavior data were estimated from a nationwide study of MSM. CD4+ counts at ART initiation from a representative national cohort were used to estimate time since infection. Number of MSM-HIV+ on treatment and suppressed were estimated from surveillance and government reports. Status quo scenario (SQ), and scenarios of early ART initiation and increased HIV testing were modeled. RESULTS We estimated 14239 new HIV infections per year from MSM-HIV+ in Mexico. In SQ, MSM take an average 7.4 years since infection to initiate treatment with a median CD4+ count of 148 cells/mm3(25th-75th percentiles 52-266). In SQ, 68% of MSM-HIV+ are not aware of their HIV status and transmit 78% of new infections. Increasing the CD4+ count at ART initiation to 350 cells/mm3 shortened the time since infection to 2.8 years. Increasing HIV testing to cover 80% of undiagnosed MSM resulted in a reduction of 70% in new infections in 20 years. Initiating ART at 500 cells/mm3 and increasing HIV testing the reduction would be of 75% in 20 years. CONCLUSION A substantial number of new HIV infections in Mexico are transmitted by undiagnosed and untreated MSM-HIV+. An aggressive increase in HIV testing coverage and initiating ART at a CD4 count of 500 cells/mm3 in this population would significantly benefit individuals and decrease the number of new HIV infections in Mexico.
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Affiliation(s)
- Yanink Caro-Vega
- Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Carlos del Rio
- Hubert Department of Global Health, Rollins School of Public Health & Emory Center for AIDS Research, Atlanta, Georgia, United States of America
| | - Viviane Dias Lima
- Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Brenda Crabtree-Ramirez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Sergio Bautista-Arredondo
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - M. Arantxa Colchero
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Juan Sierra-Madero
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
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Abstract
Uptake of antiretroviral regimens with associated durable virologic suppression has been shown to reduce the risk of HIV transmission. Expanding antiretroviral therapy (ART) programs at a population level may serve as a vital strategy in the elimination of the AIDS epidemic. The global expansion of ART programs has greatly improved access to life-saving therapies and is likely to achieve the target of 15 million individuals on therapy set by UNAIDS. In addition to the incontrovertible gains in terms of life expectancy, growing evidence demonstrates that durable virologic suppression is associated with significant reductions in HIV transmission amongst heterosexual couples and men who have sex with men. Expansion of successful ART programs, best monitored by a program-level continuum of care cascade to assess progress in diagnosis, retention in care, and virologic suppression, is associated with reductions in HIV incidence at a population level. Expanding and sustaining successful ART delivery at a global level is a key component in a comprehensive approach to combating the HIV epidemic over the next two decades.
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Affiliation(s)
- Mark Hull
- BC Centre for Excellence in HIV/AIDS, Room 667, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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37
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Ma W, Wu G, Zheng H, Zhang W, Peng Z, Yu R, Wang N. Prevalence and risk factors of HIV and syphilis, and knowledge and risk behaviors related to HIV/AIDS among men who have sex with men in Chongqing, China. J Biomed Res 2015; 30:101-111. [PMID: 28276665 PMCID: PMC4820887 DOI: 10.7555/jbr.30.20150057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/30/2015] [Accepted: 06/07/2015] [Indexed: 11/06/2022] Open
Abstract
High HIV prevalence and incidence burdens have been reported in men who have sex with men (MSM) in Chongqing, China. We aimed to estimate the prevalence of HIV and other sexually transmitted infections (STIs), to appraise the knowledge and risk behaviors related to HIV/AIDS among MSM, and to analyze the possible causes of deviation between behavior and knowledge to make better strategies. We recruited 617 MSM from February to July in 2008 by using a respondent-driven sampling (RDS) method in Chongqing, China. Through the collection of questionnaire-based data and biological testing results from all objects, we launched a cross-sectional survey. STATA/SE was used for data analysis by frequency, ANOVA, rank sum test and logistic regression models. MSM with syphilis (OR=4.16, 95%CI: 2.35-7.33, P<0.0001) were more likely to be HIV infected. Being a company employee (OR=3.64, 95%CI: 1.22-10.08, P<0.0001) and having bought male for sex (OR=3.52, 95%CI: 1.10-11.32, P < 0.034) were associated with a higher probability of syphilis. MSM with younger age, higher education and greater monthly income had a higher mean knowledge score. MSM who had HIV testing had a higher mean knowledge score than those who never had. Students, venues for finding sex partners by Internet and homosexuals in MSM had a higher mean knowledge score compared to other occupations, venues for finding sex partners and sexual orientation. There is an urgent need for delivery of barrier and biomedical interventions with coordinated behavioral and structural strategies to improve the effect of HIV interventions among MSM.
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Affiliation(s)
- Wenzhe Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Gohui Wu
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Hui Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Wenjuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Zhihang Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China;
| | - Rongbin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China;
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Luo S, Han L, Lu H, Dou Z, Tao Q, Khoshnood K, Wu Z, Xu J. Evaluating the Impact of Test-and-Treat on the HIV Epidemic among MSM in China Using a Mathematical Model. PLoS One 2015; 10:e0126893. [PMID: 26039075 PMCID: PMC4454496 DOI: 10.1371/journal.pone.0126893] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/08/2015] [Indexed: 02/07/2023] Open
Abstract
Background Various studies have modeled the impact of test-and-treat policies on the HIV epidemics worldwide. However, few modeling studies have taken into account China’s context. To understand the potential effect of test-and-treat on the HIV epidemic among men who have sex with men (MSM) in China, we developed a mathematical model to evaluate the impact of the strategy. Method Based on the natural history of the CD4 count of people living with HIV and AIDS (PLWHA), we constructed a dynamic compartmental model of HIV transmission among Chinese MSM to project the number of HIV new infections and prevalence over 10 years. We predicted the annual number of HIV new infections and the total number of MSM living with HIV and AIDS (based on Beijing data) between 2010 and 2022 under the following conditions: (1) current practice (testing rate of 50% and ART coverage of 39%); (2) both testing rate and ART coverage increasing to 70% in 2013; (3) both testing rate and ART coverage increasing to 90% in 2013; and (4) both testing rate and ART coverage increasing gradually every year until 90% since 2013. Results Based on our model, if the HIV test-and-treat policy was implemented among Chinese MSM, the total number of HIV new infections over 10 years (2013-2022) would be reduced by 50.6-70.9% compared with the current policy. When ART coverage for PLWHA increased to 58% since 2013, the ‘turning point’ would occur on the curve of HIV new infections by 2015. A 25% reduction in annual number of HIV new infections by 2015 might be achieved if the testing rate increased from 50% to 70% and treatment coverage for PLWHA increased to 55% since 2013. Conclusion Implementation of the test-and-treat strategy may significantly reduce HIV new infections among MSM in China. Great efforts need to be made to scale up HIV testing rate and ART coverage among Chinese MSM.
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Affiliation(s)
- Sitong Luo
- Division of Prevention Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology and Biostatistics, Peking Union Medical College, Beijing, China
| | - Litao Han
- School of Information, Renmin University of China, Beijing, China
- * E-mail: (JX); (LH)
| | - Hongyan Lu
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing, China
| | - Zhi Dou
- Division of Prevention Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qian Tao
- School of Information, Renmin University of China, Beijing, China
| | - Kaveh Khoshnood
- Department of Epidemiology of Microbial Diseases, Yale University, New Haven, Connecticut, United States of America
| | - Zunyou Wu
- Division of Prevention Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Xu
- Division of Prevention Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (JX); (LH)
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van Loggerenberg F, Gray D, Gengiah S, Kunene P, Gengiah TN, Naidoo K, Grant AD. A qualitative study of patient motivation to adhere to combination antiretroviral therapy in South Africa. AIDS Patient Care STDS 2015; 29:299-306. [PMID: 25692575 DOI: 10.1089/apc.2014.0293] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Taken as prescribed, that is, with high adherence, combination antiretroviral therapy (ART) has changed HIV infection and disease from being a sure predictor of death to a manageable chronic illness. Adherence, however, is difficult to achieve and maintain. The CAPRISA 058 study was conducted between 2007 and 2009 to test the efficacy of individualized motivational counselling to enhance ART adherence in South Africa. As part of the overall trial, a qualitative sub-study was conducted, including 30 individual interviews and four focus group discussions with patients in the first 9 months of ART initiation. Data were inductively analyzed, using thematic analysis, to identify themes central to ART adherence in this context. Four themes emerged that characterize the participants' experiences and high motivation to adhere to ART. Participants in this study were highly motivated to adhere, as they acknowledged that ART was 'life-giving', in the face of a large amount of morbidity and mortality. They were further supported by techniques of routine remembering, and highlighted the importance of good social support and access to supportive healthcare workers, to their continued success in negotiating their treatment. Participants in the current study told us that their adherence motivation is enhanced by free accessible care, approachable and supportive healthcare workers, broad social acceptance of ART, and past first-hand experiences with AIDS-related co-morbidity and mortality. Programs that include specific attention to these aspects of care will likely be successful in the long term.
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Affiliation(s)
- Francois van Loggerenberg
- The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- CAPRISA, University of KwaZulu-Natal, Durban, South Africa
| | - Debra Gray
- University of Winchester, Winchester, United Kingdom
| | | | - Pinky Kunene
- CAPRISA, University of KwaZulu-Natal, Durban, South Africa
| | | | | | - Alison D. Grant
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Lima VD, Thirumurthy H, Kahn JG, Saavedra J, Cárceres CF, Whiteside A. Modeling scenarios for the end of AIDS. Clin Infect Dis 2015; 59 Suppl 1:S16-20. [PMID: 24926027 DOI: 10.1093/cid/ciu339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
At the end of 2012, 3 decades after the human immunodeficiency virus (HIV) was first identified, neither a cure nor a fully preventive vaccine was available. Despite multiple efforts, the epidemic remains an exceptional public health challenge. At the end of 2012, it was estimated that, globally, 35 million people were living with HIV, 2.3 million had become newly infected, and 1.6 million had died from AIDS-related causes. Despite substantial prevention efforts and increases in the number of individuals on highly active antiretroviral therapy (HAART), the epidemic burden continues to be high. Here, we provide a brief overview of the epidemiology of HIV transmission, the work that has been done to date regarding HIV modeling in different settings around the world, and how to finance the response to the HIV epidemic. In addition, we suggest discussion topics on how to move forward with the prevention agenda and highlight the role of treatment as prevention (TasP) in curbing the epidemic.
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Affiliation(s)
- Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | | | | | | | - Alan Whiteside
- Centre for International Governance Innovation, Waterloo, ON, Canada
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Sidibé M, Zuniga JM, Montaner J. Leveraging HIV treatment to end AIDS, stop new HIV infections, and avoid the cost of inaction. Clin Infect Dis 2015; 59 Suppl 1:S3-6. [PMID: 24926030 PMCID: PMC4060255 DOI: 10.1093/cid/ciu321] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We have the tools at our disposal to significantly bend AIDS-related morbidity and mortality curves and reduce human immunodeficiency virus (HIV) incidence. It is thus essential to redouble our efforts to reach the goal of placing 15 million people on life-saving and -enhancing antiretroviral therapy (ART) by 2015. In reaching this milestone, we can write a new chapter in the history of global health, demonstrating that a robust, multidimensional response can succeed against a complex pandemic that presents as many social and political challenges as it does medical ones. This milestone is also critical to advance our ultimate goal of ending AIDS by maximizing the therapeutic and preventive effects of ART, which translates into a world in which AIDS-related deaths and new HIV infections are exceedingly rare.
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Affiliation(s)
- Michel Sidibé
- Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - José M Zuniga
- International Association of Providers of AIDS Care, Washington, District of Columbia
| | - Julio Montaner
- British Columbia Centre of Excellence in HIV/AIDS, Vancouver, Canada
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Patterson S, Cescon A, Samji H, Cui Z, Yip B, Lepik KJ, Moore D, Lima VD, Nosyk B, Harrigan PR, Montaner JSG, Shannon K, Wood E, Hogg RS. Cohort Profile: HAART Observational Medical Evaluation and Research (HOMER) cohort. Int J Epidemiol 2015; 44:58-67. [PMID: 24639444 PMCID: PMC4339756 DOI: 10.1093/ije/dyu046] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2014] [Indexed: 11/13/2022] Open
Abstract
Since 1986, antiretroviral therapy (ART) has been available free of charge to individuals living with HIV in British Columbia (BC), Canada, through the BC Centre of Excellence in HIV/AIDS (BC-CfE) Drug Treatment Program (DTP). The Highly Active Antiretroviral Therapy (HAART) Observational Medical Evaluation and Research (HOMER) cohort was established in 1996 to maintain a prospective record of clinical measurements and medication profiles of a subset of DTP participants initiating HAART in BC. This unique cohort provides a comprehensive data source to investigate mortality, prognostic factors and treatment response among people living with HIV in BC from the inception of HAART. Currently over 5000 individuals are enrolled in the HOMER cohort. Data captured include socio-demographic characteristics (e.g. sex, age, ethnicity, health authority), clinical variables (e.g. CD4 cell count, plasma HIV viral load, AIDS-defining illness, hepatitis C co-infection, mortality) and treatment variables (e.g. HAART regimens, date of treatment initiation, treatment interruptions, adherence data, resistance testing). Research findings from the HOMER cohort have featured in numerous high-impact peer-reviewed journals. The HOMER cohort collaborates with other HIV cohorts on both national and international scales to answer complex HIV-specific research questions, and welcomes input from external investigators regarding potential research proposals or future collaborations. For further information please contact the principal investigator, Dr Robert Hogg (robert_hogg@sfu.ca).
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Affiliation(s)
- Sophie Patterson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Angela Cescon
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hasina Samji
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Benita Yip
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Katherine J Lepik
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - P Richard Harrigan
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kate Shannon
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada and Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Melesse DY, Becker M, McClarty LM, Hodge K, Thompson LH, Blanchard JF, Kaufert J. Programmatic and ethical challenges in the implementation of treatment-as-prevention in the context of HIV and drug-resistant tuberculosis co-infection in sub-Saharan Africa. Glob Public Health 2014; 11:336-347. [PMID: 25513964 DOI: 10.1080/17441692.2014.988164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There is limited literature on programmatic challenges in the implementation of a treatment-as-prevention (TasP) strategy among human immunodeficiency virus (HIV) and drug-resistant tuberculosis (DR-TB) co-infected individuals in sub-Saharan Africa (SSA). This paper highlights specific programmatic challenges surrounding the implementation of this strategy among HIV and DR-TB co-infected populations in SSA. In SSA, limitations in administrative, human and financial resources and poor health infrastructure, as well as increased duration and complexity of providing long-term treatment for HIV individuals co-infected with DR-TB, pose substantial challenges to the implementation of a TasP strategy and warrant further investigation. A comprehensive approach must be devised to implement TasP strategy, with special attention paid to the sizable HIV and DR-TB co-infected populations. We suggest that evidence-informed and human rights-based guidelines for participant protection and strategies for programme delivery must be developed and tailored to maximise the benefits to those most at risk of developing HIV and DR-TB co-infection. Assessing regional circumstances is crucial, and TasP programmes in the region should be complemented by combined prevention strategies to achieve the intended goals.
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Affiliation(s)
- Dessalegn Y Melesse
- a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.,b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Marissa Becker
- a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.,b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Leigh M McClarty
- a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.,b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Kellee Hodge
- b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Laura H Thompson
- a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.,b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - James F Blanchard
- a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.,b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Joseph Kaufert
- b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
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HIV treatment as prevention: contradictory perspectives from dynamic mathematical models. ScientificWorldJournal 2014; 2014:760734. [PMID: 25580461 PMCID: PMC4279253 DOI: 10.1155/2014/760734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 11/26/2014] [Indexed: 12/20/2022] Open
Abstract
The preventative effects of antiretroviral therapy for people with HIV have been debated since they were first raised. Models commenced studying the preventive effects of treatment in the 1990s, prior to initial public reports. However, the outcomes of the preventive effects of antiretroviral use were not consistent. Some outcomes of dynamic models were based on unfeasible assumptions, such as no consideration of drug resistance, behavior disinhibition, or economic inputs in poor countries, and unrealistic input variables, for example, overstated initiation time, adherence, coverage, and efficacy of treatment. This paper reviewed dynamic mathematical models to ascertain the complex effects of ART on HIV transmission. This review discusses more conservative inputs and outcomes relative to antiretroviral use in HIV infections in dynamic mathematical models. ART alone cannot eliminate HIV transmission.
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Samji H, Chen Y, Salters K, Montaner JSG, Hogg RS. Correlates of unstructured antiretroviral treatment interruption in a cohort of HIV-positive individuals in British Columbia. AIDS Behav 2014; 18:2240-8. [PMID: 24781638 DOI: 10.1007/s10461-014-0776-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Treatment interruptions (TIs) limit the therapeutic success of combination antiretroviral therapy and are associated with higher morbidity and mortality. HIV-positive individuals dealing with concurrent health issues, access challenges and competing life demands are hypothesized to be more likely to interrupt treatment. Individuals were included if they initiated cART ≥1 year prior to interview date and had a CD4 cell count and initial regimen recorded at initiation. Using pharmacy recording, a TI was defined as a patient-initiated gap in treatment ≥90 consecutive days during the 12 months preceding or following the study interview. 117 (15.2 %) of 768 participants included in this study had a TI during the study window. 76.0 % of participants were male, 27.5 % were of Aboriginal ancestry and the median age was 46 (interquartile range 40-52). In multivariable logistic regression, TIs were significantly associated with current illicit drug use (adjusted odds ratio [aOR] 1.68, 95 % confidence interval [CI] 1.05-2.68); <95 % adherence in the first year of treatment (aOR 2.68, 95 % CI 1.67-4.12); living with at least one person (aOR 1.95; 95 % CI 1.22-3.14) or living on the street (aOR 5.08, 95 % CI 1.72-14.99) compared to living alone; poor perception of overall health (aOR 1.64 95 % CI 1.05-2.55); being unemployed (aOR: 2.22, 95 % CI 1.16-4.23); and younger age at interview (aOR 0.57, 95 % CI 0.44-0.75, per 10 year increase). Addressing socioeconomic barriers to treatment retention is vital for supporting the continuous engagement of patients in care.
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Lange JMA, Ananworanich J. The discovery and development of antiretroviral agents. Antivir Ther 2014; 19 Suppl 3:5-14. [PMID: 25310317 DOI: 10.3851/imp2896] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2014] [Indexed: 10/24/2022]
Abstract
Since the discovery of HIV as the causative agent of AIDS in 1983/1984, remarkable progress has been made in finding antiretroviral drugs (ARVs) that are effective against it. A major breakthrough occurred in 1996 when it was found that triple drug therapy (HAART) could durably suppress viral replication to minimal levels. It was then widely felt, however, that HAART was too expensive and complex for low- and middle-income countries, and so, with the exception of a few of these countries, such as Brazil, a massive scale-up did not begin until the WHO launched its '3 by 5' initiative and sizeable funding mechanisms, such as the Global Fund to Fight AIDS, TB and Malaria and the US President's Emergency Plan for AIDS Relief (PEPFAR), came into existence. A pivotal enabler of the scale-up was a steady lowering of drug prices through entry of generic antiretrovirals, competition between generic manufacturers and the making of volume commitments. The WHO Prequalification of Medicines Programme and the Expedited Review Provision of the US Food and Drug Administration have been important for the assurance of quality standards. Antiretroviral drug development by research-based pharmaceutical companies continues, with several important innovative products, such as long-acting agents, in the pipeline.
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Affiliation(s)
- Joep M A Lange
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
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Antiretroviral treatment associated hyperglycemia and dyslipidemia among HIV infected patients at Burayu Health Center, Addis Ababa, Ethiopia: a cross-sectional comparative study. BMC Res Notes 2014; 7:380. [PMID: 24950924 PMCID: PMC4077831 DOI: 10.1186/1756-0500-7-380] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 06/09/2014] [Indexed: 01/12/2023] Open
Abstract
Background The effects of highly active antiretroviral therapy (HAART) on glucose and lipid metabolism among sub-Saharan Africans, for whom access to antiretroviral therapy is expanding, remain largely unknown. Therefore, the aim of this study was to assess antiretroviral treatment associated hyperglycemia and dyslipidemia among HIV infected patients at Burayu health center, Addis Ababa, Ethiopia. Methods A cross-sectional comparative study was conducted among HIV infected adults at Burayu Health Center, Addis Ababa, Ethiopia from September, 2011 to May, 2012. Equal number of HAART naïve and HAART initiated patients (n = 126 each) were included in the study. Demographic data were collected using a well-structured questionnaire. Total cholesterol (TC), Triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and glucose were determined. The data were analyzed using SPSS version 20 software. Result Of 252 study participants, 72.2% were females; mean age was 35.3 years; mean Body Mass Index (BMI) was 21.4(kg/m2); mean time living with the virus was 20.6 months and 15.5% were TB-HIV co-infected. The prevalence of hyperglycemia, increased LDL-C hypercholesterolemia, hypertriglyceridemia and decreased HDL-C were 7.9%, 23%, 42.1%, 46.8% and 50.8% in HAART and 5.6%, 7.1%, 11.1%, 31% and 73% in non-HAART groups, respectively. First line antiretrovirals were drugs containing 2 nucleoside backbones (from Zidovudine/Stavudine/Lamivudine/Tenofovir) with either Nevirapine or Efavirenz. There was statistically significant increase in serum lipid profile levels among HAART initiated patients than HAART naïve individuals (p =0.01 for TG and <0.001 for others). Conclusion First-line HAART is associated with potentially atherogenic lipid profile levels in patients with HIV infection compared to untreated patients. This indicates glucose and lipid profile levels need to be monitored regularly in HIV infected patients taking antiretroviral treatment.
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Alistar SS, Long EF, Brandeau ML, Beck EJ. HIV epidemic control-a model for optimal allocation of prevention and treatment resources. Health Care Manag Sci 2014; 17:162-81. [PMID: 23793895 PMCID: PMC3839258 DOI: 10.1007/s10729-013-9240-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 04/18/2013] [Indexed: 10/26/2022]
Abstract
With 33 million people living with human immunodeficiency virus (HIV) worldwide and 2.7 million new infections occurring annually, additional HIV prevention and treatment efforts are urgently needed. However, available resources for HIV control are limited and must be used efficiently to minimize the future spread of the epidemic. We develop a model to determine the appropriate resource allocation between expanded HIV prevention and treatment services. We create an epidemic model that incorporates multiple key populations with different transmission modes, as well as production functions that relate investment in prevention and treatment programs to changes in transmission and treatment rates. The goal is to allocate resources to minimize R 0, the reproductive rate of infection. We first develop a single-population model and determine the optimal resource allocation between HIV prevention and treatment. We extend the analysis to multiple independent populations, with resource allocation among interventions and populations. We then include the effects of HIV transmission between key populations. We apply our model to examine HIV epidemic control in two different settings, Uganda and Russia. As part of these applications, we develop a novel approach for estimating empirical HIV program production functions. Our study provides insights into the important question of resource allocation for a country's optimal response to its HIV epidemic and provides a practical approach for decision makers. Better decisions about allocating limited HIV resources can improve response to the epidemic and increase access to HIV prevention and treatment services for millions of people worldwide.
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Affiliation(s)
- Sabina S. Alistar
- Department of Management Science and Engineering, Stanford University, Stanford, California,
| | - Elisa F. Long
- School of Management, Yale University, New Haven, Connecticut,
| | - Margaret L. Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, California,
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HIV prevention services and testing utilization behaviors among men who have sex with men at elevated risk for HIV in Chongqing, China. BIOMED RESEARCH INTERNATIONAL 2014; 2014:174870. [PMID: 24783195 PMCID: PMC3982458 DOI: 10.1155/2014/174870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 12/05/2013] [Accepted: 12/21/2013] [Indexed: 11/24/2022]
Abstract
Objective. To investigate barriers and correlates of the use of HIV prevention services and HIV testing behaviors among men who have sex with men in Chongqing. Methods. Three consecutive cross-sectional surveys provided demographic, sexual behavior, HIV/syphilis infection, HIV prevention service, and testing behavior data. Results. Of 1239 participants, 15.4% were infected with HIV, incidence was 12.3 per 100 persons/year (95% CI: 9.2–15.3), 38% of the participants reported ever having unprotected insertive anal sex, 40% ever received free condom/lubricants in the past year, and 27.7% ever obtained free sexually transmitted infection examination/treatment in the past year. Multivariable logistic regression revealed that lower levels of HIV/AIDS related stigmatizing/discriminatory attitudes, full-time jobs, and sex debut with men at a younger age were independently associated with use of free condom/lubricants. Large social networks, higher incomes, and sexual debut with men at a younger age were associated with use of any HIV prevention and HIV testing services. Lower levels of stigmatizing/discriminatory attitudes were also associated with HIV testing. Fearing needles and being unaware of the venues for testing were top barriers for testing service utilization. Conclusion. It is imperative to address HIV/AIDS related stigmatizing/discriminatory attitudes and other barriers while delivering intervention and testing services.
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50
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Kiselinova M, De Spiegelaere W, Verhofstede C, Callens SFJ, Vandekerckhove L. Antiretrovirals for HIV prevention: when should they be recommended? Expert Rev Anti Infect Ther 2014; 12:431-45. [PMID: 24621251 DOI: 10.1586/14787210.2014.896739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Since the introduction of the first antiretroviral agent for HIV treatment, information on antiretroviral therapy (ART) effectiveness has grown continuously. In recent years, there has also been a growth of interest in use of ART for the prevention of HIV transmission, either by reducing the infectivity of the infected person or by protecting the uninfected individuals from HIV acquisition. The purpose of this review is to summarize the body of evidence available for treatment as prevention and pre-exposure prophylaxis and their effectiveness in prevention of infection. In addition, our aim is to discuss the operational aspects of both prevention strategies and to provide commentary for future HIV prevention programs.
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Affiliation(s)
- Maja Kiselinova
- Department of Internal Medicine, HIV Translational Research Unit (HTRU), Ghent University and Ghent University Hospital, Ghent, Belgium
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