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Shi F, Zhang J, Chen S, Yang X, Li Z, Weissman S, Olatosi B, Li X. Multi-level Factors Associated with HIV Late Presentation with Advanced Disease and Delay Time of Diagnosis in South Carolina, 2005-2019. AIDS Behav 2024:10.1007/s10461-024-04414-y. [PMID: 38896338 DOI: 10.1007/s10461-024-04414-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
This study explored individual- and county-level risk factors of late presentation with advanced disease (LPAD) among people with HIV (PWH) and their longer delay time from infection to diagnosis in South Carolina (SC), using SC statewide Enhanced HIV/AIDS Reporting System (eHARS). LPAD was defined as having an AIDS diagnosis within three months of initial HIV diagnosis, and delay time from HIV infection to diagnosis was estimated using CD4 depletion model. 3,733 (41.88%) out of 8,913 adult PWH diagnosed from 2005 to 2019 in SC were LPAD, and the median delay time was 13.04 years. Based on the generalized estimating equations models, PWH who were male (adjusted prevalence ratio [aPR]: 1.22, 95% CI: 1.12 ∼ 1.33), aged 55+ (aPR: 1.76, 95% CI: 1.62 ∼ 1.92), were Black (aPR: 1.09, 95% CI: 1.03 ∼ 1.15) or Hispanic (aPR: 1.42, 95% CI: 1.26 ∼ 1.61), and living in counties with a larger proportion of unemployment individuals (aPR: 1.02, 95% CI: 1.01 ∼ 1.03) were more likely to be LPAD. Among PWH who were LPAD, Hispanic (adjusted beta: 1.17, 95% CI: 0.49 ∼ 1.85) instead of Black (adjusted beta: 0.11, 95% CI: -0.30 ∼ 0.52) individuals had significant longer delay time compared to White individuals. Targeted and sustained interventions are needed for older, male, Hispanic or Black individuals and those living in counties with a higher percentage of unemployment because of their higher risk of LPAD. Additionally, specific attention should be paid to Hispanic individuals due to their longer delay time to diagnosis.
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Affiliation(s)
- Fanghui Shi
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA.
- SC SmartState Center for Healthcare Quality (CHQ), Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
| | - Jiajia Zhang
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Shujie Chen
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Xueying Yang
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA
- SC SmartState Center for Healthcare Quality (CHQ), Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Zhenlong Li
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA
- Department of Geography, College of Earth and Mineral Sciences, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Sharon Weissman
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, 29208, USA
| | - Bankole Olatosi
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Xiaoming Li
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA
- SC SmartState Center for Healthcare Quality (CHQ), Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
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Lee JJ, Wang L, Vo K, Gonzalez C, Orellana ER, Kerani RP, Katz DA, Sanchez TH, Graham SM. Characterizing the Communication Networks of Spanish- and English-Speaking Latinx Sexual Minority Men and Their Roles in Pre-Exposure Prophylaxis Uptake. JOURNAL OF HEALTH COMMUNICATION 2024:1-14. [PMID: 38872332 DOI: 10.1080/10810730.2024.2366498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
While pre-exposure prophylaxis (PrEP) has demonstrated efficacy in preventing HIV transmission, disparities in access persist in the United States, especially among Hispanic/Latinx sexual minority men (SMM). Language barriers and differences in how Latinx SMM obtain information may impact access to PrEP and HIV prevention. This study used data from the 2021 American Men's Internet Survey (AMIS) to examine differences in communication networks and PrEP use among Latinx SMM by primary language (Spanish vs. English). We examined the associations between Latinx SMM's individual- and meso-level communication networks and PrEP-related outcomes using modified Poisson regression with robust variances. Spanish-speaking Latinx SMM in the study were less likely to test for HIV, be aware of PrEP, and use daily PrEP, compared to English-speaking participants. Sexuality disclosure to a healthcare provider was positively associated with PrEP uptake among all participants and predicted STI testing over the past 12 months among English-speaking Latinx SMM. Findings highlight disparities in PrEP awareness and uptake among Latinx SMM, especially among those whose primary language is Spanish. Addressing these disparities through targeted interventions, including improved communication with healthcare providers, may help facilitate PrEP access and use in this population.
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Affiliation(s)
- Jane J Lee
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Liying Wang
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Katie Vo
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Carmen Gonzalez
- Department of Communication, University of Washington, Seattle, Washington, USA
| | - E Roberto Orellana
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Roxanne P Kerani
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - David A Katz
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Travis H Sanchez
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Susan M Graham
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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Mouinga-Ondeme A, Longo-Pendy NM, Moussadji Kinga IC, Ngoubangoye B, Moussavou-Boundzanga P, Boundenga L, Diane A, Sica J, Mfouo-Tynga IS, Ngoungou EB. Risk Factors Associated with Opportunistic Infections among People Living with HIV/AIDS and Receiving an Antiretroviral Therapy in Gabon, Central Africa. Viruses 2024; 16:85. [PMID: 38257785 PMCID: PMC10819398 DOI: 10.3390/v16010085] [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: 10/19/2023] [Revised: 11/11/2023] [Accepted: 11/11/2023] [Indexed: 01/24/2024] Open
Abstract
The Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is still one of the main causes of death in sub-Saharan Africa. Antiretroviral therapies (ARTs) have significantly improved the health conditions of people living with HIV/AIDS (PLWHA). Consequently, a significant drop in morbidity and mortality, along with a reduced incidence of opportunistic infections (OIs), has been observed. However, certain atypical and biological profiles emerge in ART patients post-examination. The objective of this study was to identify the risk factors that contributed to the onset of OIs in HIV patients undergoing ART in Gabon. Epidemiological and biological data were obtained from medical records (2017 to 2019) found at the outpatient treatment centre (CTA) of Franceville in Gabon. Samples for blood count, CD4, and viral load analysis at CIRMF were collected from PLWHA suffering from other pathogen-induced conditions. A survey was carried out and data were analysed using Rstudio 4.0.2 and Excel 2007 software. Biological and socio-demographic characteristics were examined concerning OIs through both a univariate analysis via Fisher's exact tests or chi2 (χ2), and a multivariate analysis via logistic regression. Out of the 300 participants initially selected, 223 were included in the study, including 154 (69.05%) women and 69 (30.95%) men. The mean age was 40 (38.6; 41.85), with individuals ranging from 2 to 77 years old. The study cohort was classified into five age groups (2 to 12, 20 to 29, 30 to 39, 40 to 49, and 50 to 77 years old), among which the groups aged 30 to 39 and 40 to 49 emerged as the largest, comprising 68 (30.5%) and 75 (33.6%) participants, respectively. It was noted that 57.9% of PLWHA had developed OIs and three subgroups were distinguished, with parasitic, viral, and bacterial infections present in 18%, 39.7%, and 55.4% of cases, respectively. There was a correlation between being male and having a low CD4 T-cell count and the onset of OIs. The study revealed a high overall prevalence of OIs, and extending the study to other regions of Gabon would yield a better understanding of the risk factors associated with the onset of these infections.
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Affiliation(s)
- Augustin Mouinga-Ondeme
- Unité des Infections Rétrovirales et Pathologies Associées, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (P.M.-B.); (A.D.); (I.S.M.-T.)
| | - Neil Michel Longo-Pendy
- Unité de Recherches en Ecologie de la Santé, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (N.M.L.-P.); (L.B.)
| | - Ivan Cyr Moussadji Kinga
- Centre de Primatologie, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (I.C.M.K.); (B.N.)
| | - Barthélémy Ngoubangoye
- Centre de Primatologie, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (I.C.M.K.); (B.N.)
| | - Pamela Moussavou-Boundzanga
- Unité des Infections Rétrovirales et Pathologies Associées, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (P.M.-B.); (A.D.); (I.S.M.-T.)
| | - Larson Boundenga
- Unité de Recherches en Ecologie de la Santé, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (N.M.L.-P.); (L.B.)
- Département d’Anthropologie, Université de Durham, South Road, Durham DH1 3LE, UK
| | - Abdoulaye Diane
- Unité des Infections Rétrovirales et Pathologies Associées, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (P.M.-B.); (A.D.); (I.S.M.-T.)
| | - Jeanne Sica
- Centre de Traitement Ambulatoire, Franceville BP 277, Gabon;
| | - Ivan Sosthene Mfouo-Tynga
- Unité des Infections Rétrovirales et Pathologies Associées, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (P.M.-B.); (A.D.); (I.S.M.-T.)
| | - Edgard Brice Ngoungou
- Département d’Epidémiologie, Biostatistiques et Informatique Médicale (DEBIM)/Unité de Recherche en Epidémiologie des Maladies Chroniques et Santé Environnement (UREMCSE), Faculté de Médecine, Université des Sciences de la Santé, Libreville-Owendo BP 18231, Gabon;
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Ainembabazi B, Katana E, Bongomin F, Wanduru P, Mayega RW, Mukose AD. Prevalence of advanced HIV disease and associated factors among antiretroviral therapy naïve adults enrolling in care at public health facilities in Kampala, Uganda. Ther Adv Infect Dis 2024; 11:20499361241251936. [PMID: 38770168 PMCID: PMC11103927 DOI: 10.1177/20499361241251936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/15/2024] [Indexed: 05/22/2024] Open
Abstract
Background Despite adoption of the 'test-and-treat' strategy, a high proportion of antiretroviral therapy (ART) naïve people living with HIV (PLHIV) enrol in care with, and die of advanced HIV disease (AHD) in Uganda. In this study, we aimed to determine the prevalence of AHD among ART naïve adults enrolling in care and associated factors at selected public health facilities in Kampala, Uganda. Methods From April to July 2022, we conducted a mixed-methods study at Kiswa Health Centre III, Kitebi Health Centre III, and Kawaala Health Centre IV. The study involved cross-sectional enrolment and evaluation of 581 participants, utilizing an interviewer-administered questionnaire and chart reviews. Modified Poisson regression was employed to identify factors associated with AHD, complemented by a qualitative component comprising fifteen in-depth interviews, with data analysed through thematic analysis. Results Overall, 35.1% (204/581) of the study participants had AHD. Being male [adjusted prevalence ratio (aPR): 1.4, 95% CI: 1.04-1.88] and aged 35-50 years (aPR: 1.81, 95% CI: 1.14-2.88) were associated with AHD. Participants with no personal health perception barriers had 37% lower odds of presenting to care with AHD (aPR: 0.63, 95% CI: 0.46-0.85). Qualitative findings indicated that individual factors, such as waiting until physical health deteriorated and initially opting for alternative therapies, took precedence in contributing to enrolment in care with AHD. Conclusion Over one in every three ART naïve adults presents to public health facilities in Uganda with AHD. Male gender, age 35-50 years, and personal health perception barriers emerged as significant factors associated with AHD; emphasizing the need for targeted interventions to address these disparities and enhance early detection and engagement in care. Routine HIV testing should be emphasized and incentivized especially for men and persons aged 35-50 years.
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Affiliation(s)
- Bridget Ainembabazi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elizabeth Katana
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Phillip Wanduru
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Roy William Mayega
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Aggrey David Mukose
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Jamal A, Srinivasan M, Kim G, Nevins AB, Vohra S. Factors associated with HIV Testing within the National Health Interview Survey (2006-2018). J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01728-w. [PMID: 37526879 DOI: 10.1007/s40615-023-01728-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/15/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
The Centers for Disease Control and Prevention recommends that individuals aged 13-64 test for HIV at least once during their lifetime. However, screening has been disproportionate among racial/ethnic populations. Using the National Health Interview Survey data (2006-2018), we examined HIV screening prevalence within racial/ethnic groups in the United States (US), and factors associated with testing among 301,191 individuals. This consisted of 195,696 White, 42,409 Black, 47,705 Hispanic and 15,381 Asian individuals. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) to estimate the association between ever testing for HIV and demographic, socioeconomic and health-related factors. Approximately 36% of White, 61% of Black, 47% of Hispanic and 36% of Asian individuals reported ever testing for HIV. Hispanic (OR = 1.28, 95% CI [1.25-1.32]) and Black individuals (OR = 2.44, 95% CI [2.38-2.50]) had higher odds of HIV testing, whereas Asian individuals (OR = 0.74, 95% CI [0.71-0.77]) had lower odds of HIV testing compared to White individuals. Individuals who identified as males, married, between the ages of 18-26 years or greater than or equal to 50 years were less likely to ever test for HIV compared to their counterparts. Similarly, those with lower education, lower income, better self-reported health, no health professional visits or living in the midwestern US were less likely to ever test for HIV compared to their counterparts (OR range: 0.14-0.92). Understanding the factors associated with HIV testing opens opportunities to increase testing rates for all and reduce health disparities in HIV detection.
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Affiliation(s)
- Armaan Jamal
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building Room 1064, Baltimore, MD, 21205, USA.
| | - Malathi Srinivasan
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Gloria Kim
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrew B Nevins
- Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA, USA
| | - Sanah Vohra
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Weinstein ER, Jimenez DE. Prioritizing recruitment: the benefits to using a disease registry to recruit older adults with HIV and intersecting identities. AIDS Care 2023; 35:624-628. [PMID: 35676752 PMCID: PMC9729382 DOI: 10.1080/09540121.2022.2085867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
The success of a study hinges on its recruitment procedures, however there is a paucity of papers focused on innovative recruitment strategies, especially as it relates to the recruitment and retention of marginalized populations. This paper aims to outline how consent-to-contact databases can be used as an effective tool for recruitment. First, we begin by describing the consent-to-contact databases we used. Then, we offer insight into how a consent-to-contact database was utilized to recruit Latino older adults with HIV participants for an interdisciplinary behavioral and physical health promotion intervention. We outline barriers and challenges to recruitment and research participation with a specific emphasis on the unique hurdles associated with recruiting and retaining racial/ethnic minority older adults with HIV in behavioral health studies. Finally, we provide final recommendations for future researchers interested in how to best employ this type of recruitment tool in their own research.
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Affiliation(s)
| | - Daniel E. Jimenez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine
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Zhao B, Song W, Kang M, Dong X, Li X, Wang L, Liu J, Tian W, Ding H, Chu Z, Wang L, Qiu Y, Han X, Shang H. Molecular Network Analysis Discloses the Limited Contribution to HIV Transmission for Patients with Late HIV Diagnosis in Northeast China. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:679-687. [PMID: 36539633 PMCID: PMC9886604 DOI: 10.1007/s10508-022-02492-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
In the "treat all" era, the high rate of late HIV diagnosis (LHD) worldwide remains an impediment to ending the HIV epidemic. In this study, we analyzed LHD in newly diagnosed people living with HIV (PLWH) and its impact on HIV transmission in Northeast China. Sociodemographic information, baseline clinical data, and plasma samples obtained from all newly diagnosed PLWH in Shenyang, the largest city in Northeast China, between 2016 and 2019 were evaluated. Multivariate logistic regression analysis was performed to identify risk factors associated with LHD. A molecular network based on the HIV pol gene was constructed to assess the risk of HIV transmission with LHD. A total of 2882 PLWH, including 882 (30.6%) patients with LHD and 1390 (48.2%) patients with non-LHD, were enrolled. The risk factors for LHD were older age (≥ 30 years: p < .01) and diagnosis in the general population through physical examination (p < .0001). Moreover, the molecular network analysis revealed that the clustering rate (p < .0001), the fraction of individuals with ≥ 4 links (p = .0847), and the fraction of individuals linked to recent HIV infection (p < .0001) for LHD were significantly or marginally significantly lower than those recorded for non-LHD. Our study indicates the major risk factors associated with LHD in Shenyang and their limited contribution to HIV transmission, revealing that the peak of HIV transmission of LHD at diagnosis may have been missed. Early detection, diagnosis, and timely intervention for LHD may prevent HIV transmission.
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Affiliation(s)
- Bin Zhao
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wei Song
- Department of Food Safety and Nutrition, Shenyang Center for Health Service and Administrative Law Enforcement (Shenyang Center for Disease Control and Prevention), Shenyang, China
| | - Mingming Kang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xue Dong
- Department of Food Safety and Nutrition, Shenyang Center for Health Service and Administrative Law Enforcement (Shenyang Center for Disease Control and Prevention), Shenyang, China
| | - Xin Li
- Department of Food Safety and Nutrition, Shenyang Center for Health Service and Administrative Law Enforcement (Shenyang Center for Disease Control and Prevention), Shenyang, China
| | - Lu Wang
- Department of Food Safety and Nutrition, Shenyang Center for Health Service and Administrative Law Enforcement (Shenyang Center for Disease Control and Prevention), Shenyang, China
| | - Jianmin Liu
- Department of Food Safety and Nutrition, Shenyang Center for Health Service and Administrative Law Enforcement (Shenyang Center for Disease Control and Prevention), Shenyang, China
| | - Wen Tian
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Haibo Ding
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhenxing Chu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Lin Wang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yu Qiu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xiaoxu Han
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China.
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, China.
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
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Men's Endorsement of Intimate Partner Violence and HIV Testing Behavior Across Sub-Saharan Africa. AIDS Behav 2023; 27:454-461. [PMID: 36048291 DOI: 10.1007/s10461-022-03780-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/01/2022]
Abstract
Despite an upward trend in HIV testing across sub-Saharan Africa, men continue to lag women in the use of HIV testing services. Inequitable gender attitudes held by some men may be implicated in their suboptimal HIV testing behaviors. We sought to ascertain the relationship between men?s endorsement of intimate partner violence (IPV), which is one manifestation of inequitable gender attitudes, and their lifetime and recent HIV testing, using nationally representative Demographic and Health Survey data from 23 sub-Saharan African countries. In a pooled analysis, we found that a unit increase in the IPV index scale is associated with 8% lower odds of lifetime HIV testing, and 6% lower odds of recent HIV testing. The strength of this relationship, however, varied across countries and regions. Our findings suggest that efforts to increase men?s HIV testing in the region should address the inequitable gender attitudes underpinning men?s endorsement of IPV, but that it is important to consider contextual variation.
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Trepka MJ, Dawit R, Fernandez SB, Sheehan DM, Degarege A, PhD TL, Maddox LM, Spencer EC. Social disorganization and new HIV diagnoses, 2013-2017, Florida: Rural-urban differences. J Rural Health 2022; 38:960-969. [PMID: 34861068 PMCID: PMC9163207 DOI: 10.1111/jrh.12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the role of neighborhood social disorganization factors on human immunodeficiency virus (HIV) diagnosis rates in urban and rural areas in Florida, we conducted an ecologic study of HIV diagnosis rates during 2013-2017 and social disorganization components, including concentrated disadvantage, ethnic heterogeneity, and residential instability. METHODS Indices of social disorganization components were obtained from principal component analyses of American Community Survey variables for 910 postal codes. Rural/urban classification was based on the United States Department of Agriculture Rural Urban Commuting Area codes. Using multivariable linear regression, the relationship between social disorganization indices and HIV diagnosis rates was assessed. FINDINGS The only social disorganization index that was significantly higher in rural than urban areas was concentrated disadvantage. In rural areas, the concentrated disadvantage index was significantly associated with HIV diagnosis rates (P = .007) when controlling for the other social disorganization factors but was no longer significant after additionally controlling for prevalence of people with an HIV diagnosis who were not virally suppressed. In urban areas, even after controlling for prevalence of people with HIV who were not virally suppressed, lower male-to-female population ratios and higher scores of residential instability, concentrated disadvantage, and LatinX/immigrant density indices were associated with higher HIV diagnosis rates (all P < .01). CONCLUSIONS In addition to improving community levels of viral suppression, the community contextual environment, including the rurality of the environment, needs to be considered in strategies to end the HIV epidemic in the United States.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Sofia B. Fernandez
- Research Center in Minority Institutions, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, 11200 SW 8th St, AHC 5, Miami, Florida, USA
| | - Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tan Li PhD
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Lorene M. Maddox
- HIV/AIDS Section, Bureau of Communicable Diseases, Florida Department of Health, 4025 Esplande Blvd, Tallahassee, Florida, USA
| | - Emma C. Spencer
- HIV/AIDS Section, Bureau of Communicable Diseases, Florida Department of Health, 4025 Esplande Blvd, Tallahassee, Florida, USA
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10
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Factors Associated with HIV Testing among Reproductive Women Aged 15-49 Years in the Gambia: Analysis of the 2019-2020 Gambian Demographic and Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084860. [PMID: 35457730 PMCID: PMC9031325 DOI: 10.3390/ijerph19084860] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/30/2022] [Accepted: 04/14/2022] [Indexed: 11/17/2022]
Abstract
Voluntary counselling and testing for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has always been one of the key policy interventions in the management and control of HIV/AIDS transmission. However, the prevalence of HIV testing among reproductive women in the Gambia remains low despite near universal information about HIV and Sexually Transmitted Infections (STIs) in the Gambia. Understanding factors influencing HIV testing uptake provides empirical data for the development of targeted evidenced-based strategies aimed at enhancing HIV testing uptake. Therefore, this study examined the factors associated with HIV testing among reproductive women aged 15−49 years in the Gambia. Data on weighted sample of 11,865 women from the 2019−2020 Gambia Demographic and Health Survey were analyzed in this study. Chi square, bivariate and multivariate logistic regression models were fitted and analysis conducted through Complex Samples Analysis in Statistical Package for Social Sciences (SPSS). Level of significance was set at p < 0.05 and 95% CI. Further analysis was conducted to determine the variability in HIV testing among women stratified by rural and urban centers. Prevalence of HIV testing among reproductive women was 42.1% (95% CI = 40.1−44.2%) in the Gambia. Women aged 20−24 years and 25−29 years (aOR = 3.10, 95% CI = 2.51−3.83) and (aOR = 4.52, 95% CI = 3.61−5.54) were more likely to test for HIV than those aged 15−19 years, respectively. Married women (aOR = 5.90, 95% CI = 4.84−7.02) were more likely to test for HIV compared to those who were not in any union. Respondents with higher education in urban centers (aOR = 2.65, 95% CI = 2.08−3.86) were likely to test for HIV compared to those in rural areas. HIV testing in the Gambia among reproductive women is low. Age, marital status, wealth index, place of residence, educational level, recent sexual activity, previous history of risky sexual behaviors, and history of an STI were associated with HIV testing. Health interventions targeted at increasing HIV testing uptake should factor in these.
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11
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Walters SM, Frank D, Van Ham B, Jaiswal J, Muncan B, Earnshaw V, Schneider J, Friedman SR, Ompad DC. PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure. AIDS Behav 2022; 26:1308-1320. [PMID: 34626265 PMCID: PMC8501360 DOI: 10.1007/s10461-021-03488-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/04/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a medication that prevents HIV acquisition, yet PrEP uptake has been low among people who inject drugs. Stigma has been identified as a fundamental driver of population health and may be a significant barrier to PrEP care engagement among PWID. However, there has been limited research on how stigma operates in rural and urban settings in relation to PrEP. Using in-depth semi-structured qualitative interviews (n = 57) we explore PrEP continuum engagement among people actively injecting drugs in rural and urban settings. Urban participants had more awareness and knowledge. Willingness to use PrEP was similar in both settings. However, no participant was currently using PrEP. Stigmas against drug use, HIV, and sexualities were identified as barriers to PrEP uptake, particularly in the rural setting. Syringe service programs in the urban setting were highlighted as a welcoming space where PWID could socialize and therefore mitigate stigma and foster information sharing.
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12
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Lawal FJ, Omotayo MO, Lee TJ, Srinivasa Rao ASR, Vazquez JA. HIV Treatment Outcomes in Rural Georgia Using Telemedicine. Open Forum Infect Dis 2021; 8:ofab234. [PMID: 34104669 PMCID: PMC8180244 DOI: 10.1093/ofid/ofab234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/04/2021] [Indexed: 11/29/2022] Open
Abstract
Background The increasing shortage of specialized health care services contributes to the ongoing HIV epidemic. Telemedicine (TM) is a potential tool to improve HIV care, but little is known about its effectiveness when compared with traditional (face-to-face [F2F]) care in rural populations. The objective of this study was to compare the effectiveness of HIV care delivered through TM with the F2F model. Methods We conducted a retrospective chart review of a subset of patients with HIV who attended a TM clinic in Dublin, Georgia, and an F2F clinic in Augusta, Georgia, between May 2017 and April 2018. All TM patients were matched to F2F patients based on gender, age, and race. HIV viral load (VL) and CD4 count gain were compared using t test and Mann-Whitney U statistics. Results Three hundred eighty-five patients were included in the analyses (F2F = 200; TM = 185). The mean CD4 in the TM group was higher (643.9 cells/mm3) than that of the F2F group (596.3 cells/mm3; P < .001). There was no statistically significant difference in VL reduction, control, or mean VL (F2F = 416.8 cp/mL; TM = 713.4 cp/mL; P = .30). Thirty-eight of eighty-five patients with detectable VL achieved viral suppression during the study period (F2F = 24/54; TM = 14/31), with a mean change of 3.34 × 104 and –1 to 0.24 × 104, respectively (P = 1.00). Conclusions TM was associated with outcome measures comparable to F2F. Increased access to specialty HIV care through TM can facilitate HIV control in communities with limited health care access in the rural United States. Rigorous prospective evaluation of TM for HIV care effectiveness is warranted.
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Affiliation(s)
- Folake J Lawal
- Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Moshood O Omotayo
- Centre for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Tae Jin Lee
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Arni S R Srinivasa Rao
- Laboratory for Theory and Mathematical Modeling, Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Jose A Vazquez
- Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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13
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Abstract
Biometric registration may improve services associated with HIV research. A cross-sectional, observational survey was used to evaluate biometric fingerprint scanning for identification (ID) verification in the setting of an HIV prevention study. Survey outcomes were dichotomized (discouraged or not discouraged) by biometric scanning and statistical analyses were used to determine if participation decreased by greater than 10% overall and after stratifying by demographic variables and risk behaviors. 206 participants were recruited from a community-based HIV and sexual health research screening program. Participants completed a quantitative survey to assess their perceptions of biometric scanning for ID verification. The majority of participants (n = 160; 77.7%) indicated no deterrence from testing due to biometric scanning, yet a significant number (n = 45; 23.3%, P < .001) reported at least partial deterrence. Research using biometric scanning for ID verification may significantly limit access to HIV prevention services and may risk reducing meaningful participation among marginalized populations.
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Affiliation(s)
- Matthew P Abrams
- College of Medicine, University of Central Florida, Orlando, FL, USA.
| | | | - Susan J Little
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA.
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14
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Weissman S, Yang X, Zhang J, Chen S, Olatosi B, Li X. Using a machine learning approach to explore predictors of healthcare visits as missed opportunities for HIV diagnosis. AIDS 2021; 35:S7-S18. [PMID: 33867485 PMCID: PMC8172090 DOI: 10.1097/qad.0000000000002735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES A significant number of individuals with a new HIV diagnosis are still late presenters despite numerous healthcare encounters prior to HIV diagnosis. We employed a machine learning approach to identify the predictors for the missed opportunities for earlier HIV diagnosis. METHODS The cohort comprised of individuals who were diagnosed with HIV in South Carolina from January 2008 to December 2016. Late presenters (LPs) (initial CD4 ≤200 cells/mm3 within one month of HIV diagnosis) with any healthcare visit during three years prior to HIV diagnosis were defined as patients with a missed opportunity. Using least absolute shrinkage and selection operator (LASSO) regression, two prediction models were developed to capture the impact of facility type (model 1) and physician specialty (model 2) of healthcare visits on missed opportunities. RESULTS Among 4,725 eligible participants, 72.2% had at least one healthcare visit prior to their HIV diagnosis, with most of the healthcare visits (78.5%) happening in the emergency departments (ED). A total of 1,148 individuals were LPs, resulting in an overall prevalence of 24.3% for the missed opportunities for earlier HIV diagnosis. Common predictors in both models included ED visit, older age, male gender, and alcohol use. CONCLUSIONS The findings underscored the need to reinforce the universal HIV testing strategy ED remains an important venue for HIV screening, especially for medically underserved or elder population. An improved and timely HIV screening strategy in clinical settings can be a key for early HIV diagnosis and play an increasingly important role in ending HIV epidemic.
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Affiliation(s)
- Sharon Weissman
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA, 29208
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Jiajia Zhang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Shujie Chen
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
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15
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Loutfy M, Tharao W, Kazemi M, Logie CH, Underhill A, O’Brien N, Pick N, Kestler M, H.Yudin M, Rana J, MacGillivray J, Kennedy VL, Jaworsky D, Carvalhal A, Conway T, Webster K, Lee M, Islam S, Nicholson V, Ndung’u M, Proulx-Boucher K, Carter A, Gormley R, Narasimhan M, Welbourn A, de Pokomandy A, Kaida A. Development of the Canadian Women-Centred HIV Care Model Using the Knowledge-to-Action Framework. J Int Assoc Provid AIDS Care 2021; 20:2325958221995612. [PMID: 33845677 PMCID: PMC8047935 DOI: 10.1177/2325958221995612] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 01/16/2023] Open
Abstract
In Canada, women make up 25% of the prevalent HIV cases and represent an important population of those living with HIV, as a high proportion are racialized and systemically marginalized; furthermore, many have unmet healthcare needs. Using the knowledge-to-action framework as an implementation science methodology, we developed the "Women-Centred HIV Care" (WCHC) Model to address the needs of women living with HIV. The WCHC Model is depicted in the shape of a house with trauma- and violence-aware care as the "foundation". Person-centred care with attention with attention to social determinants of health and family make up the "first" floor. Women's health (including sexual and reproductive health and rights) and mental and addiction health care are integrated with HIV care, forming the "second" floor. Peer support, leadership, and capacity building make up the "roof". To address the priorities of women living with HIV in all their diversity and across their life course, the WCHC Model should be flexible in its delivery (e.g., single provider, interdisciplinary clinic or multiple providers) and implementation settings (e.g., urban, rural).
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Affiliation(s)
- Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Canada
| | - Mina Kazemi
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Carmen H. Logie
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Angela Underhill
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Nadia O’Brien
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Neora Pick
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, Canada
| | - Mary Kestler
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, Canada
| | - Mark H.Yudin
- Department of Obstetrics and Gynecology, St. Michael’s Hospital, Toronto, Canada
| | - Jesleen Rana
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Canada
| | - Jay MacGillivray
- Department of Obstetrics and Gynecology, St. Michael’s Hospital, Toronto, Canada
| | - V. Logan Kennedy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Denise Jaworsky
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Northern Medical Program, University of Northern British Columbia, Prince George, Canada
| | | | - Tracey Conway
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Shaz Islam
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Alliance for South Asian AIDS Prevention, Toronto, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Mary Ndung’u
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | | | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Kirby Institute, UNSW Sydney, Australia
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health Research, World Health Organization, Geneva, Switzerland
| | - Alice Welbourn
- Salamander Trust, United Kingdom lead coordinator of the Global Values and Preferences Survey
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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16
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Coelho EDAC, Paiva MS, Porcino C, Cabral LDS, Marques SC. Women of different generations living with HIV: social representations about sexuality. Rev Esc Enferm USP 2020; 54:e03658. [PMID: 33295531 DOI: 10.1590/s1980-220x2019018303658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 04/23/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the social representations of women diagnosed with HIV about their sexuality considering generational characteristics. METHOD Qualitative study, carried out with women who participated through interviews. The constituted corpus was processed by the Iramuteq software. The analysis was based on the Theory of Social Representations. RESULTS A total of 39 women participated in the study, aged between 18-76 years old and most of them had high school education, evoked the terms 'people' (301), 'partner' (277), 'children' (249), 'virus' (275) and 'want' (216). The younger ones accept to reveal and/or 'tell' about their condition to their partner(s) and family members, an aspect that is not revealed in the statements of women of other ages. For women aged 45 and over, children occupy a prominent place and for the older adults, the centrality of representation referred to self-censorship and maintaining the victim/guilty game. CONCLUSION This study made it possible to identify processes of anchoring sexualities in terms of what 'cannot be revealed' beyond the family context. It should be noted that the elements 'sex', intercourse' conceived by common sense as a synonym for sexuality, regardless of generation, had low frequency.
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Affiliation(s)
| | - Mirian Santos Paiva
- Universidade Federal da Bahia, Programa de Pós-Graduação em Enfermagem e Saúde, Salvador, BA, Brazil
| | - Carle Porcino
- Universidade Federal da Bahia, Programa de Pós-Graduação em Enfermagem e Saúde, Salvador, BA, Brazil
| | - Letícia da Silva Cabral
- Universidade Federal da Bahia, Programa de Pós-Graduação em Enfermagem e Saúde, Salvador, BA, Brazil
| | - Sérgio Corrêa Marques
- Universidade do Estado do Rio de Janeiro, Programa de Pós-Graduação em Enfermagem, Rio de Janeiro, RJ, Brazil
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17
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Sherbuk JE, Petros de Guex K, Anazco Villarreal D, Knight S, McManus KA, Flickinger T, Dillingham R. Beyond Interpretation: The Unmet Need for Linguistically and Culturally Competent Care for Latinx People Living with HIV in a Southern Region with a Low Density of Spanish Speakers. AIDS Res Hum Retroviruses 2020; 36:933-941. [PMID: 32772713 DOI: 10.1089/aid.2020.0088] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Latinx people living with HIV (PLWH) experience disparities in health outcomes and face unique barriers to care related to language, intersectional stigma, and immigration status. We aimed to explore the lived experience of Spanish-speaking Latinx PLWH in the nonurban South to better understand how to improve care for this minority language population. We conducted semistructured interviews with 22 participants (10 men, 10 women, 2 transgender women) who were recruited from a Ryan White HIV/AIDS program (RWHAP) and a community-based organization. Almost all participants were foreign born. Emerging themes included language barriers, cultural differences, inadequate interpreter services, HIV-related and intersectional stigma, isolation, and relationships as a source of support. These barriers may contribute to disparities in outcomes for Latinx PLWH. New interventions are needed to overcome barriers, foster community, and ensure culturally tailored models of care. Potential clinic-level interventions include the development of specialized training for RWHAP interpreters and inclusion of interpreters in care teams.
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Affiliation(s)
- Jacqueline E. Sherbuk
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Kristen Petros de Guex
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Diego Anazco Villarreal
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
| | - Sarah Knight
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Kathleen A. McManus
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Tabor Flickinger
- Division of General, Geriatric, Palliative, and Hospital Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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18
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Agustí C, Font-Casaseca N, Belvis F, Julià M, Vives N, Montoliu A, Pericàs JM, Casabona J, Benach J. The role of socio-demographic determinants in the geo-spatial distribution of newly diagnosed HIV infections in small areas of Catalonia (Spain). BMC Public Health 2020; 20:1533. [PMID: 33036599 PMCID: PMC7547437 DOI: 10.1186/s12889-020-09603-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spatial visualization of HIV surveillance data could improve the planning of programs to address the HIV epidemic. The objectives of the study were to describe the characteristics and the spatial distribution of newly diagnosed HIV infection in Catalonia and to identify factors associated with HIV infection rates. METHODS Surveillance data from the national registry were presented in the form of descriptive and ring maps and used to study the spatial distribution of new HIV diagnoses in Catalonia (2012-2016) and associated risk factors at the small area level (ABS, acronym for "basic health area" in Catalan). Incident cases were modeled using the following as predictors: type of municipality, prevalence of young men and migrant groups, GBMSM activity indicators, and other variables at the aggregated level. RESULTS New HIV diagnoses are heterogeneously distributed across Catalonia. The predictors that proved to be significantly associated with a higher rate of new HIV diagnoses were ABS located in the city of Barcelona (IRR, 2.520; P < 0.001), a higher proportion of men aged 15-44 years (IRR, 1.193; P = 0.003), a higher proportion of GBMSM (IRR, 1.230; P = 0.030), a higher proportion of men from Western Europe (IRR, 1.281; P = 0.003), a higher proportion of men from Latin America (IRR, 1.260; P = 0.003), and a higher number of gay locations (IRR, 2.665; P < 0.001). No association was observed between the HIV diagnosis rate and economic deprivation. CONCLUSIONS Ring maps revealed substantial spatial associations for the rate of new HIV diagnoses. New HIV diagnoses are concentrated in ABS located in urban areas. Our results show that, in the case of HIV infection, the socioeconomic deprivation index on which the Catalan government bases its budget allocation policies among the ABS should not be the only criterion used.
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Affiliation(s)
- Cristina Agustí
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Edifici Muntanya, Ctra Can Ruti, Cami de les Escoles s/n, 08916 Badalona, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain. .,Fundació Institut d'Investigació Germans Trias i Pujol IGTP, Badalona, Barcelona, Spain.
| | | | - Francesc Belvis
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,Unit of Infections and Cancer - Information and Interventions (UNIC - I&I), Cancer Epidemiology Research Program (CERP), Hospitalet de Llobregat, Barcelona, Spain
| | - Mireia Julià
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Cancer Screening Unit, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Vives
- Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain.,Cancer Screening Unit, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Alexandra Montoliu
- Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain.,Unit of Infections and Cancer - Information and Interventions (UNIC - I&I), Cancer Epidemiology Research Program (CERP), Hospitalet de Llobregat, Barcelona, Spain
| | - Juan M Pericàs
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,Vall d'Hebron Institute for Research (VHIR), Barcelona, Spain.,Infectious Disease Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Casabona
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Edifici Muntanya, Ctra Can Ruti, Cami de les Escoles s/n, 08916 Badalona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain.,Fundació Institut d'Investigació Germans Trias i Pujol IGTP, Badalona, Barcelona, Spain.,Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Universidad Autónoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Joan Benach
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,Grupo de Investigación Transdisciplinar sobre Transiciones Socioecológicas (GinTRANS2), Universidad Autónoma de Madrid, Madrid, Spain
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Ribeiro LCS, Freitas MIDF, Tupinambás U, Lana FCF. Late diagnosis of Human Immunodeficiency Virus infection and associated factors. Rev Lat Am Enfermagem 2020; 28:e3342. [PMID: 32876290 PMCID: PMC7458569 DOI: 10.1590/1518-8345.4072.3342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/26/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE to analyze the occurrence of late diagnosis of infection by the Human Immunodeficiency Virus and its associated factors. METHOD this is an epidemiological, cross-sectional and analytical study, carried out with 369 people followed-up by Specialized Assistance Services, undergoing anti-retroviral treatment, and interviewed by means of a questionnaire. Univariate analysis was performed using Pearson's chi-square test or Fisher's exact test and Kruskall-Wallis test, and multivariate analysis using the ordinal logistic regression model of proportional odds. RESULTS the occurrence of 59.1% for late diagnosis of the infection was observed; the probability of later diagnosis is greater among people who have a steady partnership, when compared to those who do not; with increasing age, particularly above 35 years old; among those with lower schooling; for those who seek the health services to have an HIV test when they feel sick; and for those who test HIV less often or never do it after sex without a condom with a steady partner. CONCLUSION the knowledge on the high proportion of late diagnosis and its associated factors verified in this study make the planning and implementation of new policies and strategies aimed at the timely diagnosis of the infection imperative.
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Affiliation(s)
| | | | - Unaí Tupinambás
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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20
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Abstract
INTRODUCTION Despite statewide progress and continuous HIV prevention efforts in Texas, HIV diagnosis at a late stage of infection persists. Diagnosis delay differs in magnitude and spatial distribution. We examined the local spatial relationships of late HIV diagnosis with a selection of variables in an area of Texas that includes large metropolises and high HIV morbidity. METHODS We compared regression modeling approaches to study the associations between the regional percentage of late HIV diagnosis from 2011 through 2015, regional measures of poverty, lack of health insurance (uninsurance), educational attainment, unemployment, and the average regional distance from residence to an HIV testing site: global ordinary least squares linear regression, spatial error model, geographically weighted regression, and multiscale geographically weighted regression (MGWR). Cartographic representation of the local R2, coefficient estimates, and their t values assisted in the interpretation of results. RESULTS The MGWR model resulted in a better fit and identified education and uninsurance as globally fixed predictors, whereas the relationships between late HIV diagnosis and poverty, unemployment, and distance varied spatially. The model performed better in rural areas and in suburban areas of the largest cities than in urban areas. CONCLUSION The MGWR results provided local estimates of associations. The results highlight the importance of focusing on a local context. Modeling at the local scale is particularly useful for characterizing relationships between explanatory and dependent variables when the relationships vary spatially. In the context of HIV prevention, relationships that are of local relevance can inform local policy and complement routine screening in clinical settings.
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Affiliation(s)
- Sonia I Arbona
- Texas Department of State Health Services, PO Box 149347, MC 1873, Austin, TX 78714-9347.
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21
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Mathews A, Farley S, Conserve DF, Knight K, Le'Marus A, Blumberg M, Rennie S, Tucker J. "Meet people where they are": a qualitative study of community barriers and facilitators to HIV testing and HIV self-testing among African Americans in urban and rural areas in North Carolina. BMC Public Health 2020; 20:494. [PMID: 32295568 PMCID: PMC7161271 DOI: 10.1186/s12889-020-08582-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 03/25/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND HIV testing programs in the United States aim to reach ethnic minority populations who experience high incidence of HIV, yet 40% of African Americans have never been tested for HIV. The objective of this study is to identify community-based strategies to increase testing among African Americans in both urban and rural areas. METHODS This study conducted focus group discussions (FGDs) informed by community-based participatory research principles to examine African American's concerns and ideas around HIV testing and HIV self-testing. Participants included highly affected (i.e., PLWH, MSM, PWID, low-income, teens and young adults) populations from African American communities in North Carolina, aged 15 years and older. We digitally transcribed and analyzed qualitative data using MAXQDA and axial coding to identify emergent themes. RESULTS Fifty-two men and women between 15 to 60 years old living in urban (n=41) and rural (n=11) areas of North Carolina participated in focus group discussions. HIV testing barriers differed by HIV testing setting: facility-based, community-based, and HIV self-testing. In community-based settings, barriers included confidentiality concerns. In facility-based settings (e.g., clinics), barriers included negative treatment by healthcare workers. With HIV self-testing, barriers included improper use of self-testing kits and lack of post-test support. HIV testing facilitators included partnering with community leaders, decentralizing testing beyond facility-based sites, and protecting confidentiality. CONCLUSIONS Findings suggest that HIV testing concerns among African Americans vary by HIV testing setting. African Americans may be willing to test for HIV at community events in public locations if client confidentiality is preserved and use HIV self-testing kits in private if post-test social support and services are provided. These community-identified facilitators may improve African American testing rates and uptake of HIV self-testing kits.
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Affiliation(s)
- Allison Mathews
- Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, 333 South Columbia Street, MacNider Hall, Room #348 / CB #7240, Chapel Hill, NC, 27599-7240, USA.
- Institute for Global Health and Infectious Disease, School of Medicine, The University of North Carolina at Chapel Hill, 333 South Columbia Street, MacNider Hall, Room #348 / CB #7240, Chapel Hill, NC, 27599-7240, USA.
| | - Samantha Farley
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donaldson F Conserve
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, The University of South Carolina, Columbia, SC, USA
| | - Kimberly Knight
- Institute for Global Health and Infectious Disease, School of Medicine, The University of North Carolina at Chapel Hill, 333 South Columbia Street, MacNider Hall, Room #348 / CB #7240, Chapel Hill, NC, 27599-7240, USA
| | - Alston Le'Marus
- Department of Clinical Psychology, Fielding Graduate University, Santa Barbara, CA, USA
| | - Meredith Blumberg
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stuart Rennie
- Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, 333 South Columbia Street, MacNider Hall, Room #348 / CB #7240, Chapel Hill, NC, 27599-7240, USA
| | - Joseph Tucker
- Institute for Global Health and Infectious Disease, School of Medicine, The University of North Carolina at Chapel Hill, 333 South Columbia Street, MacNider Hall, Room #348 / CB #7240, Chapel Hill, NC, 27599-7240, USA
- London School of Hygiene & Tropical Medicine, London, UK
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22
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Patel D, Taylor-Aidoo N, Marandet A, Heitgerd J, Maciak B. Assessing Differences in CDC-Funded HIV Testing by Urbanicity, United States, 2016. J Community Health 2020; 44:95-102. [PMID: 30069826 DOI: 10.1007/s10900-018-0558-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
HIV prevention efforts have contributed to a decline in annual HIV infections in the United States. However, progress has been uneven and certain groups and geographic areas continue to be disproportionately affected. Subsequent to implementation of CDC's high-impact HIV prevention approach to reducing new infections, we analyzed national-level CDC-funded HIV test data from 2016 to describe the population being reached in three urbanicity settings (metropolitan: ≥ 1,000,000 population; urban: 50,000-999,999; rural: < 50,000). Over 70% of CDC-funded HIV tests and almost 80% of persons newly diagnosed with HIV as a result of CDC-funded testing occurred in metropolitan areas. Nonetheless, CDC-funded testing efforts are reaching urban and rural areas, especially in the South, providing opportunities to identify persons unaware of their HIV status and link those with newly diagnosed HIV to medical care and prevention services. While CDC-funded testing efforts have continued to focus on population subgroups and geographic areas at greatest risk, efforts should also continue in rural areas and among groups in need with a low national burden.
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Affiliation(s)
- Deesha Patel
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E59, Atlanta, GA, 30333, USA.
| | - Nicole Taylor-Aidoo
- Keymind, A Division of Axiom Resource Management, Inc., 2941 Fairview Park Drive, Suite 900, Falls Church, VA, 22042, USA
| | - Angèle Marandet
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E59, Atlanta, GA, 30333, USA
| | - Janet Heitgerd
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E59, Atlanta, GA, 30333, USA
| | - Barbara Maciak
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E59, Atlanta, GA, 30333, USA
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23
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Krueger A, Van Handel M, Dietz PM, Williams WO, Patel D, Johnson AS. HIV Testing, Access to HIV-Related Services, and Late-Stage HIV Diagnoses Across US States, 2013-2016. Am J Public Health 2019; 109:1589-1595. [PMID: 31536400 DOI: 10.2105/ajph.2019.305273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine state-level factors associated with late-stage HIV diagnoses in the United States.Methods. We examined state-level factors associated with late-stage diagnoses by estimating negative binomial regression models. We used 2013 to 2016 data from the National HIV Surveillance System (late-stage diagnoses), the Behavioral Risk Factor Surveillance System (HIV testing), and the American Community Survey (sociodemographics).Results. Among individuals 25 to 44 years old, a 5% increase in the percentage of the state population tested for HIV in the preceding 12 months was associated with a 3% decrease in late-stage diagnoses. Among both individuals 25 to 44 years of age and those aged 45 years and older, a 5% increase in the percentage of the population living in a rural area was associated with a 2% to 3% increase in late-stage diagnoses.Conclusions. Increasing HIV testing may lower late-stage HIV diagnoses among younger individuals. Increasing HIV-related services may benefit both younger and older people in rural areas.
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Affiliation(s)
- Amy Krueger
- Amy Krueger, Deesha Patel, and Anna Satcher Johnson are with the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Amy Krueger is also with the School of Health Sciences, University of Tampere, Tampere, Finland. Michelle Van Handel and Patricia M. Dietz are with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. Weston O. Williams is with Public Health Analytic Consulting Services Inc, Hillsborough, NC
| | - Michelle Van Handel
- Amy Krueger, Deesha Patel, and Anna Satcher Johnson are with the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Amy Krueger is also with the School of Health Sciences, University of Tampere, Tampere, Finland. Michelle Van Handel and Patricia M. Dietz are with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. Weston O. Williams is with Public Health Analytic Consulting Services Inc, Hillsborough, NC
| | - Patricia M Dietz
- Amy Krueger, Deesha Patel, and Anna Satcher Johnson are with the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Amy Krueger is also with the School of Health Sciences, University of Tampere, Tampere, Finland. Michelle Van Handel and Patricia M. Dietz are with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. Weston O. Williams is with Public Health Analytic Consulting Services Inc, Hillsborough, NC
| | - Weston O Williams
- Amy Krueger, Deesha Patel, and Anna Satcher Johnson are with the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Amy Krueger is also with the School of Health Sciences, University of Tampere, Tampere, Finland. Michelle Van Handel and Patricia M. Dietz are with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. Weston O. Williams is with Public Health Analytic Consulting Services Inc, Hillsborough, NC
| | - Deesha Patel
- Amy Krueger, Deesha Patel, and Anna Satcher Johnson are with the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Amy Krueger is also with the School of Health Sciences, University of Tampere, Tampere, Finland. Michelle Van Handel and Patricia M. Dietz are with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. Weston O. Williams is with Public Health Analytic Consulting Services Inc, Hillsborough, NC
| | - Anna Satcher Johnson
- Amy Krueger, Deesha Patel, and Anna Satcher Johnson are with the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Amy Krueger is also with the School of Health Sciences, University of Tampere, Tampere, Finland. Michelle Van Handel and Patricia M. Dietz are with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. Weston O. Williams is with Public Health Analytic Consulting Services Inc, Hillsborough, NC
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24
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Li F, Juan BK, Wozniak M, Watson SK, Katz AR, Whiticar PM, McCormick T, Qiu YS, Wasserman GM. Trends and Racial Disparities of Late-Stage HIV Diagnosis: Hawaii, 2010-2016. Am J Public Health 2019; 108:S292-S298. [PMID: 30383422 DOI: 10.2105/ajph.2018.304506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine racial/ethnic disparities in Hawaii in stage 3 classification at HIV diagnosis and trends in such disparities from 2010 through 2016. METHODS We analyzed data including patients' demographic information, behavioral risk factors, residential county at HIV diagnosis, and type of facility where HIV was diagnosed. Multivariable logistic regression modeling was used to examine racial/ethnic disparities in late-stage diagnoses after adjustment for known or possible confounders. RESULTS About 30% of HIV diagnoses were classified as late-stage (stage 3) diagnoses, and there were significant racial/ethnic disparities in stage 3 classification at diagnosis. Relative to Whites, the odds of being diagnosed at stage 3 were 3.7 times higher among Native Hawaiians and other Pacific Islanders (NHPIs; odds ratio [OR] = 3.69; 95% confidence interval [CI] = 1.89, 7.22) and more than twice as high among Asians (OR = 2.46; 95% CI = 1.16, 5.20). Older age and being diagnosed in an inpatient setting were associated with stage 3 classification. CONCLUSIONS Targeted preventive services need to be strengthened for Asians and NHPIs in Hawaii.
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Affiliation(s)
- Fenfang Li
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Brandi K Juan
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Michelle Wozniak
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Stuart K Watson
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Alan R Katz
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Peter M Whiticar
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Timothy McCormick
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Yuanshan Sandy Qiu
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
| | - Glenn M Wasserman
- Fenfang Li and Glenn M. Wasserman are with the Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health, Honolulu. Brandi K. Juan, Michelle Wozniak, Stuart K. Watson, Peter M. Whiticar, Timothy McCormick, and Yuanshan "Sandy" Qiu are with the Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawaii State Department of Health. Alan R. Katz is with the Office of Public Health Studies, University of Hawaii, Honolulu
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Secular trends in HIV/AIDS mortality in China from 1990 to 2016: Gender disparities. PLoS One 2019; 14:e0219689. [PMID: 31318900 PMCID: PMC6638923 DOI: 10.1371/journal.pone.0219689] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 06/29/2019] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES HIV/AIDS has become the leading cause of death by infectious disease in China since 2009. However, the trend of gender disparities in HIV/AIDS has not been reported in China since 1990. Our study aimed to explore the secular trend of HIV/AIDS mortality in China from 1990 to 2016 and to identify its gender disparities over the past 27 years. METHOD The mortality data of HIV/AIDS were obtained from the Global Burden of Disease Study 2016 (GBD 2016). Logistic regression was used to estimate the prevalence odds ratio (POR) of gender for HIV/AIDS mortality in different surveys. RESULTS The standardized mortality of HIV/AIDS in China rose dramatically from 0.33 per 100,000 people in 1990 to 2.50 per 100,000 people in 2016. The rate of HIV/AIDS mortality increased more quickly in men than in women, and the sex gap of mortality of HIV/AIDS widened. By 2016, the HIV/AIDS mortality in men was 3 times that in women and was 5.74 times that in women within the 75- to 79-year-old age group. CONCLUSIONS The mortality of HIV/AIDS in China is increasing, with a widening gender disparity. It is critical for policymakers to develop policies to eliminate these disparities and to ensure that everyone can live a long life in full health.
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26
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Chukwusa E, Verne J, Polato G, Taylor R, J Higginson I, Gao W. Urban and rural differences in geographical accessibility to inpatient palliative and end-of-life (PEoLC) facilities and place of death: a national population-based study in England, UK. Int J Health Geogr 2019; 18:8. [PMID: 31060555 PMCID: PMC6503436 DOI: 10.1186/s12942-019-0172-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Little is known about the role of geographic access to inpatient palliative and end of life care (PEoLC) facilities in place of death and how geographic access varies by settlement (urban and rural). This study aims to fill this evidence gap. METHODS Individual-level death data in 2014 (N = 430,467, aged 25 +) were extracted from the Office for National Statistics (ONS) death registry and linked to the ONS postcode directory file to derive settlement of the deceased. Drive times from patients' place of residence to nearest inpatient PEoLC facilities were used as a proxy estimate of geographic access. A modified Poisson regression was used to examine the association between geographic access to PEoLC facilities and place of death, adjusting for patients' socio-demographic and clinical characteristics. Two models were developed to evaluate the association between geographic access to inpatient PEoLC facilities and place of death. Model 1 compared access to hospice, for hospice deaths versus home deaths, and Model 2 compared access to hospitals, for hospital deaths versus home deaths. The magnitude of association was measured using adjusted prevalence ratios (APRs). RESULTS We found an inverse association between drive time to hospice and hospice deaths (Model 1), with a dose-response relationship. Patients who lived more than 10 min away from inpatient PEoLC facilities in rural areas (Model 1: APR range 0.49-0.80; Model 2: APR range 0.79-0.98) and urban areas (Model 1: APR range 0.50-0.83; Model 2: APR range 0.98-0.99) were less likely to die there, compared to those who lived closer (i.e. ≤ 10 min drive time). The effects were larger in rural areas compared to urban areas. CONCLUSION Geographic access to inpatient PEoLC facilities is associated with where people die, with a stronger association seen for patients who lived in rural areas. The findings highlight the need for the formulation of end of life care policies/strategies that consider differences in settlements types. Findings should feed into local end of life policies and strategies of both developed and developing countries to improve equity in health care delivery for those approaching the end of life.
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Affiliation(s)
- Emeka Chukwusa
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK.
| | - Julia Verne
- Knowledge and Intelligence (South West), National End of Life Care Intelligence Network, Public Health England, Grosvenor House, 2 Rivergate, Temple Quay, Bristol, BS1 6EH, UK
| | - Giovanna Polato
- Monitoring Analytics (Mental Health, Learning Disability and Substance Misuse), Care Quality Commission (CQC), 151 Buckingham Palace Road, London, SWIW 9SZ, UK
| | - Ros Taylor
- Royal Marsden NHS Hospital Trust, London, SW3 6JJ, UK
- Hospice UK, 34-44 Britannia Street, London, WC1X 9JG, UK
| | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
| | - Wei Gao
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
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High HIV/STI Test Acceptance Through a Behavioral Health Encounter in Latino Immigrants with Substance Use and Mental Health Problems. AIDS Behav 2019; 23:835-846. [PMID: 30737609 DOI: 10.1007/s10461-019-02413-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Latino immigrants with substance use and mental health problems are at risk for undiagnosed HIV and sexually transmitted infections (STIs). Participants in a randomized control trial were recruited in Boston, USA and Madrid and Barcelona, Spain. Eligibility criteria were Latino self-identification, age 18-70, elevated substance use and mental health symptoms, and not currently in substance or mental health care. A multinomial logistic regression examined predictors of HIV/STI testing decline and lost to follow-up (LTFU) prior to testing compared with acceptance. Of 341 participants, 74% accepted testing, 4% declined, and 22% were LTFU. The odds of LTFU were higher in those with high concern for HIV and those whose main partner had done HIV testing. Age ≥ 35 years, females, higher education, and higher report of discrimination lowered the odds of LTFU. Delivery of HIV/STI testing through community agencies and outreach could overcome barriers to HIV/STI diagnosis in this population of Latinos.Clinical Trial Number: NCT02038855.
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Salad AM, Mohamed A, Da'ar OB, Abdikarim A, Kour P, Shrestha M, Gele AA. Sick and solo: a qualitative study on the life experiences of people living with HIV in Somalia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2019; 11:45-53. [PMID: 30936752 PMCID: PMC6421892 DOI: 10.2147/hiv.s185040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background HIV stigma and the resultant fear of being identified as HIV-positive can compromise the effectiveness of HIV programs by undermining early diagnosis and antiretroviral treatment initiation and adherence of people living with HIV (PLHIV). In the wake of the longstanding conflict in the country, little is known about the life experiences of PLHIV in Somalia. Methods A qualitative study using unstructured interviews was conducted in Somalia from September to December 2017. A convenience sampling approach was used to recruit 13 participants, including 10 persons who live with HIV and three senior officials who work for the HIV program at the Ministry of Health. Data were analyzed using a thematic analysis. Results Our findings show that PLHIV are alienated and prefer to isolate themselves due to widespread stigma subjected to them by their family members, society, employers, and health providers, which continue to undermine the scale-up of testing and treatment of PLHIV in Somalia. Consequently, they are reluctant to seek voluntary diagnosis and treatment of HIV. They often come to know about their status when their partners are found HIV positive, they are tested for other clinical purposes, or when an individual’s health deteriorates, and all other means fail to work in improving his/her situation. The study also pointed out a shortage of facilities that provide HIV diagnosis, counseling and treatment in Somalia. Conclusion Addressing stigma and discrimination subjected to PLHIV are critical to a successful HIV response in Somalia. To successfully address stigma, HIV programs need evidence on effective interventions at individual, community, and societal levels in order to strategically incorporate stigma and discrimination reduction into national HIV programs.
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Affiliation(s)
- Abdulwahab M Salad
- School of Public Health and Research, Somali National University, Mogadishu, Somalia
| | - Abdinasir Mohamed
- The Department of Public Health, Ministry of Health, Puntland State, Somalia
| | - Omar B Da'ar
- St. Mary's University of Minnesota, Winona, MN, USA
| | | | - Prabhjot Kour
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Ottestad, Norway
| | - Mary Shrestha
- Migrants Health Unit, Norwegian Institute of Public Health, Oslo, Norway,
| | - Abdi A Gele
- Migrants Health Unit, Norwegian Institute of Public Health, Oslo, Norway,
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Ribeiro LCS, Giami A, Freitas MIDF. Representations of people living with HIV: influences on the late diagnosis of infection. Rev Esc Enferm USP 2019; 53:e03439. [PMID: 30864619 DOI: 10.1590/s1980-220x2018009703439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/17/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the representations constructed by people living with HIV on the infection and their influence on the late search for diagnosis. METHOD A qualitative study, conducted through an open interview with people who had a late diagnosis of HIV infection. The theoretical framework adopted was the Theory of Social Representations based on a critical approach. For data analysis, was used the Structural Analysis of Narration method and the MAXQDA 12® software. RESULTS Eighteen people participated in the study. The following original representations were unveiled: AIDS as a transmissible and dangerous disease; disease of the other; severe, incurable and deadly disease; and denial of risk due to trust in a steady partner. These representations contributed to the late search for diagnosis, either because of the attitude of distance from susceptible people, or because they did not perceive or deny the risks to which they were exposed in their life trajectories. CONCLUSION Understanding the reasons that lead people to a late diagnosis of HIV is imperative in the current epidemic scenario for the planning and implementation of new strategies and policies for the timely diagnosis of the infection.
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Zheng Z, Lin J, Lu Z, Su J, Li J, Tan G, Zhou C, Geng W. Mortality risk in the population of HIV-positive individuals in Southern China: A cohort study. PLoS One 2019; 14:e0210856. [PMID: 30742626 PMCID: PMC6370196 DOI: 10.1371/journal.pone.0210856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/03/2019] [Indexed: 12/22/2022] Open
Abstract
To evaluate the mortality risk in the HIV-positive population, we conducted an observational cohort study involving routine data collection of HIV-positive patients who presented at HIV clinics and multiple treatment centers throughout Guangxi province, Southern China in 2011. The patients were screened for tuberculosis (TB) and tested for hepatitis B (HBV) and C (HCV) virus infections yearly. Following the registration, the cohort was followed up for a 60-month period till the end-point (December 31, 2015). Univariable and multivariable Cox proportional hazards regression models were used to analyze the hazard ratio (HR) and 95% confidence interval (95% CI) for mortality after adjusting for confounding factors stratified by patients’ sociodemographic and behavioral characteristics. HRs were compared within risk-factor levels. With the median follow-up of 3.7-person years for each individual, 5,398 (37.8%) (of 14,293 patients with HIV/AIDS) died; among whom, 78.4% were antiretroviral therapy (ART)-naïve; 43.6% presented late; and 12.2% and 3.3% of patients had Mycobacterium tuberculosis (MTB) and HBV and HCV co-infection, respectively. Of individuals with CD4 counts, those with CD4 count >350 cells/μL formed 14.0% of those who died. Furthermore, gender [multivariable HR (95% CI):1.94 (1.68–2.25)], Han ethnicity [2.15 (1.07–4.32)], illiteracy [3.28 (1.96–5.5)], elementary education [2.91 (1.8–4.72)], late presentation [2.89 (2.46–3.39)], and MTB co-infection [1.28 (1.10–1.49)] strongly increased the all-cause mortality risk of HIV-positive individuals. The HR for ART-based stratification was 0.08 (0.07–0.09); and for HBV and HCV co-infection, HR was 1.02 (0.86–1.21). The findings emphasized that accessibility to HIV testing among high-risk populations and screening for viral hepatitis and TB co-infection are important for the survival of HIV-positive individuals. Initiating early ART, even for individuals with higher CD4 counts, is advisable to help increase the prolongation of lives within the community.
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Affiliation(s)
- Zhigang Zheng
- HIV/AIDS Program, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
- Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
- * E-mail:
| | | | - ZhenZhen Lu
- HIV/AIDS Program, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Jinming Su
- HIV/AIDS Program, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Jianjun Li
- HIV/AIDS Program, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Guangjie Tan
- HIV/AIDS Program, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Chongxing Zhou
- HIV/AIDS Program, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Wenkui Geng
- Guangxi Health and Family Planning Committee, Nanning, China
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Levison JH, Levinson JK, Alegría M. A Critical Review and Commentary on the Challenges in Engaging HIV-Infected Latinos in the Continuum of HIV Care. AIDS Behav 2018; 22:2500-2512. [PMID: 29948334 DOI: 10.1007/s10461-018-2187-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Antiretroviral therapy for treatment of HIV infection has become increasingly effective. Persistent poor HIV outcomes in racial and ethnic minority populations in the US call for a closer examination into why Latinos are at significant risk for acquiring and dying from HIV. To improve clinical outcomes and achieve an AIDS-free generation, HIV research must address disparities in HIV outcomes in Latinos, the largest ethnic/racial minority population in the US. Immigrant status as well as cultural factors influence HIV care utilization and are essential to highlight for effective intervention development in Latinos. A better understanding of these individual and contextual factors is critical to developing tailored approaches to engaging Latinos in HIV care. Based on a comprehensive literature review, we offer a framework for understanding what is needed from clinical practice and research to improve engagement in HIV care for US-based Latinos. These findings may have implications for other minority populations.
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Lo CC, Runnels RC, Cheng TC. Racial/ethnic differences in HIV testing: An application of the health services utilization model. SAGE Open Med 2018; 6:2050312118783414. [PMID: 29977553 PMCID: PMC6024279 DOI: 10.1177/2050312118783414] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/21/2018] [Indexed: 11/25/2022] Open
Abstract
This study applying the health services utilization model examined the importance of predisposing, enabling, and need variables to the social mechanisms explaining lifetime HIV testing across racial/ethnic groups. Data for the study were derived from the National Health Interview Survey (collected 2013–2014), our final sample numbering 18,574 adults. Four subsamples reflected race/ethnicity: 13,347 Whites, 2267 Blacks, 2074 Hispanics, and 886 Asians. Logistic regression established respondent odds of ever having received HIV testing. Further statistical testing evaluated race/ethnicity’s potential moderating role in HIV testing. The findings generally support a role for Aday’s predisposing, enabling, and need factors in explaining HIV testing. Across the four subsamples, female gender, older age, and sexual minority status consistently increased lifetime HIV testing. However, we found racial/ethnic differences in HIV testing’s associations with these factors and others. Our study made a beginning in the effort to specify mechanisms leading to HIV testing—and reliable diagnosis—among four racial/ethnic groups. Understanding these mechanisms might multiply opportunities to raise testing rates for all, in turn reducing racial/ethnic disparities in HIV treatment.
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Affiliation(s)
- Celia C Lo
- Department of Sociology and Social Work, Texas Woman's University, Denton, TX, USA
| | - Ratonia C Runnels
- Department of Sociology and Social Work, Texas Woman's University, Denton, TX, USA
| | - Tyrone C Cheng
- Department of Social Work and Child Advocacy, Montclair State University, NJ, USA
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Wójcik-Cichy K, Jabłonowska O, Piekarska A, Jabłonowska E. The high incidence of late presenters for HIV/AIDS infection in the Lodz province, Poland in the years 2009-2016: we are still far from the UNAIDS 90% target. AIDS Care 2018; 30:1538-1541. [PMID: 29781305 DOI: 10.1080/09540121.2018.1470306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The present study retrospectively analyses the prevalence of late diagnosis in patients with newly-diagnosed HIV infection in Lodz, Poland from January 2009 to December 2016, and assesses the predictive factors associated with late presenters. Late presentation is defined as a diagnosis of HIV with a CD4 count<350 cells/μL, or the occurrence of an AIDS- defining event, regardless of the CD4 cell count. Two hundred and fifty-nine (62.86%) patients were late presenters, 178 of whom (68.72%) were advanced late presenters (CD4 cell count below 200 cells/μL). Multivariate factors associated with late HIV presentation included referral from physician for HIV testing (OR: 3.95, 95% CI 2.42-6.46), older age (OR: 1.81, 95% CI: 1.38-2.38) and route of HIV transmission. Heterosexual patients (OR 1.98, 95% CI: 1.01-3.90), active drug users (OR: 3.49, 95% CI: 1.63-7.48) and patients who did not report the route of transmission (OR: 4.29, 95%: CI 1.45-12.62) were more likely to present late than MSM subjects. In conclusion, the majority of HIV-infected patients are still diagnosed late. There is a need for expanded testing not only in MSM group, in which HIV prevalence is the highest, but also in intravenous drug users, or among subjects who are heterosexual or from a higher age group.
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Affiliation(s)
- Kamila Wójcik-Cichy
- a Department of Infectious Diseases and Hepatology , Medical University of Lodz , Łódź , Poland
| | - Olga Jabłonowska
- a Department of Infectious Diseases and Hepatology , Medical University of Lodz , Łódź , Poland
| | - Anna Piekarska
- a Department of Infectious Diseases and Hepatology , Medical University of Lodz , Łódź , Poland
| | - Elżbieta Jabłonowska
- a Department of Infectious Diseases and Hepatology , Medical University of Lodz , Łódź , Poland
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Sheehan DM, Trepka MJ, Fennie KP, Prado G, Madhivanan P, Dillon FR, Maddox LM. Individual and Neighborhood Determinants of Late HIV Diagnosis Among Latinos, Florida, 2007-2011. J Immigr Minor Health 2018; 19:825-834. [PMID: 27119364 DOI: 10.1007/s10903-016-0422-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The objective of this study was to examine individual and neighborhood determinants of late HIV diagnosis by gender and birthplace among Latinos. Florida HIV surveillance data for 2007-2011 were merged with American Community Survey data to estimate the odds of late HIV diagnosis (AIDS within 3 months of HIV diagnosis). Of 5522 HIV-positive Latinos, 26.5 % were diagnosed late. The odds ratio (OR) for late diagnosis was 1.39 times higher for males than females [95 % confidence interval (CI) 1.14-1.69]. Neighborhood-level factors associated with late diagnosis included residing in the 3 highest quartiles of neighborhood unemployment for males. The OR was 1.22 times higher for foreign- than US-born Latinos (95 % CI 1.07-1.40). Among foreign-born, residing in areas in the 2nd and 3rd quartiles of unemployment, in rural areas, and areas with <25 % Hispanic/Latino population were associated with late diagnosis. Population-based HIV testing campaigns may require tailoring to ensure that they effectively reach male Latinos in areas with high unemployment and foreign-born Latinos in rural and predominantly non-Latino areas.
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Affiliation(s)
- Diana M Sheehan
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.,Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 478, Miami, FL, 33199, USA
| | - Mary Jo Trepka
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA. .,Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 478, Miami, FL, 33199, USA.
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 478, Miami, FL, 33199, USA
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Purnima Madhivanan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 478, Miami, FL, 33199, USA
| | - Frank R Dillon
- Department of Educational and Counseling Psychology, School of Education, University at Albany - State University of New York, 1400 Washington Ave, Albany, NY, 12222, USA
| | - Lorene M Maddox
- HIV/AIDS Section, Florida Department of Health, 4052 Bald Cypress Way, Tallahassee, FL, 32399, USA
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Sheehan DM, Cosner C, Fennie KP, Gebrezgi MT, Cyrus E, Maddox LM, Levison JH, Spencer EC, Niyonsenga T, Trepka MJ. Role of Country of Birth, Testing Site, and Neighborhood Characteristics on Nonlinkage to HIV Care Among Latinos. AIDS Patient Care STDS 2018; 32:165-173. [PMID: 29630853 DOI: 10.1089/apc.2018.0021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The objective of this study was to estimate disparities in linkage to human immunodeficiency virus (HIV) care among Latinos by country/region of birth, HIV testing site, and neighborhood characteristics. A retrospective study was conducted using Florida HIV surveillance records of Latinos/Hispanics aged ≥13 diagnosed during 2014-2015. Linkage to HIV care was defined as a laboratory test (HIV viral load or CD4) within 3 months of HIV diagnosis. Multi-level Poisson regression models were used to estimate adjusted prevalence ratios (aPR) for nonlinkage to care. Of 2659 Latinos, 18.8% were not linked to care within 3 months. Compared with Latinos born in mainland United States, those born in Cuba [aPR 0.60, 95% confidence interval (CI) 0.47-0.76] and Puerto Rico (aPR 0.61, 95% CI 0.41-0.90) had a decreased prevalence of nonlinkage. Latinos diagnosed at blood banks (aPR 2.34, 95% CI 1.75-3.12), HIV case management and screening facilities (aPR 1.76, 95% CI 1.46-2.14), and hospitals (aPR 1.42, 95% CI 1.03-1.96) had an increased prevalence of nonlinkage compared with outpatient general, infectious disease, and tuberculosis/sexually transmitted diseases/family planning clinics. Latinos who resided in the lowest (aPR 1.57, 95% CI 1.19-2.07) and third lowest (aPR 1.33, 95% CI 1.01-1.76) quartiles of neighborhood socioeconomic status compared with the highest quartile were at increased prevalence. Latinos who resided in neighborhoods with <25% Latinos also had increased prevalence of nonlinkage (aPR 1.23, 95% CI 1.01-1.51). Testing site at diagnosis may be an important determinant of HIV care linkage among Latinos due to neighborhood or individual-level resources that determine location of HIV testing.
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Affiliation(s)
- Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, Florida
| | - Chelsea Cosner
- Herbert Wertheim College of Medicine, Florida International University, Miami Florida
| | - Kristopher P. Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Merhawi T. Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Elena Cyrus
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, Florida
| | - Lorene M. Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, Florida
| | - Julie H. Levison
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emma C. Spencer
- HIV/AIDS Section, Florida Department of Health, Tallahassee, Florida
| | | | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
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Kalichman S, Katner H, Banas E, Kalichman M. Population Density and AIDS-Related Stigma in Large-Urban, Small-Urban, and Rural Communities of the Southeastern USA. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 18:517-525. [PMID: 28190136 DOI: 10.1007/s11121-017-0761-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIDS stigmas delay HIV diagnosis, interfere with health care, and contribute to mental health problems among people living with HIV. While there are few studies of the geographical distribution of AIDS stigma, research suggests that AIDS stigmas are differentially experienced in rural and urban areas. We conducted computerized interviews with 696 men and women living with HIV in 113 different zip code areas that were classified as large-urban, small-urban, and rural areas in a southeast US state with high-HIV prevalence. Analyses conducted at the individual level (N = 696) accounting for clustering at the zip code level showed that internalized AIDS-related stigma (e.g., the sense of being inferior to others because of HIV) was experienced with greater magnitude in less densely populated communities. Multilevel models indicated that after adjusting for potential confounding factors, rural communities reported greater internalized AIDS-related stigma compared to large-urban areas and that small-urban areas indicated greater experiences of enacted stigma (e.g., discrimination) than large-urban areas. The associations between anticipated AIDS-related stigma (e.g., expecting discrimination) and population density at the community-level were not significant. Results suggest that people living in rural and small-urban settings experience greater AIDS-related internalized and enacted stigma than their counterparts living in large-urban centers. Research is needed to determine whether low-density population areas contribute to or are sought out by people who experienced greater AIDS-related stigma. Regardless of causal directions, interventions are needed to address AIDS-related stigma, especially among people in sparsely populated areas with limited resources.
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Affiliation(s)
- Seth Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
| | | | - Ellen Banas
- Mercer University Medical School, Macon, GA, USA
| | - Moira Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
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Taveras J, Trepka MJ, Madhivanan P, Gollub EL, Devieux J, Ibrahimou B. HIV Testing Behaviors Among Latina Women Tested for HIV in Florida, 2012. HISPANIC HEALTH CARE INTERNATIONAL 2018; 15:27-34. [PMID: 28558511 DOI: 10.1177/1540415317696196] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Latina women in the United States (US) are not only disproportionately affected by human immunodeficiency virus (HIV) infection but also underuse HIV prevention services, such as HIV testing. METHOD HIV testing events were examined to describe the HIV testing behaviors and test results among Latinas tested in 2012 at publicly funded sites in Florida, United States. Multivariable logistic regression was used to assess the demographic characteristics associated with reports of previous testing and positive HIV test results. RESULTS Of the 184,037 testing events, 87,569 (45.6%) were among non-Hispanic Blacks (NHBs), 47,926 (26.0%) non-Hispanic Whites (NHWs), 41,117 (22.3%) Latinas, 5,672 (3.1%) those with unknown race/ethnicity, and 1,753 (1.0%) other racial/ethnic groups. Compared to NHW and NHB women, Latinas testing for HIV were older (mean age = 32.1, NHW = mean age 30.3, NHB = mean age 30.0; p < .0001). Results indicated that women who reported previous HIV testing had decreased odds of being Latina (adjusted odds ratio = 0.90; 95% confidence interval [0.87, 0.94]). CONCLUSION These findings indicate that Latinas are underusing HIV testing, and efforts are needed to increase the proportion of Latinas, especially younger Latinas, tested for HIV in Florida.
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Fan H, Fife KH, Cox D, Cox AD, Zimet GD. Behavior and health beliefs as predictors of HIV testing among women: a prospective study of observed HIV testing. AIDS Care 2018; 30:1062-1069. [PMID: 29466877 DOI: 10.1080/09540121.2018.1442555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Much of the research examining predictors of HIV testing has used retrospective self-report to assess HIV testing. FINDINGS therefore, may be subject to recall bias and to difficulties determining the direction of associations. In this prospective study, we administered surveys to women in community clinics to identify predictors of subsequent observed HIV testing, overcoming these limitations. Eighty-three percent were tested. In the adjusted multivariable model, being born in the U.S., perceived benefits of testing, worries about being infected with HIV, having had more than 15 lifetime sexual partners, and having had one or more casual sexual partners in the previous three months predicted acceptance of testing. Perceived obstacles to testing predicted non-acceptance. Those who had never been tested for HIV and those tested two to five years previously had greater odds of test acceptance than those who had been tested within the last year. The findings from this study with observed testing as the outcome, confirm some of the results from retrospective, self-report studies. Participants made largely rational decisions about testing, reflecting assessments of their risk and their history of HIV testing. Health beliefs are potentially modifiable through behavioral intervention, and such interventions might result in greater acceptance of testing. ABBREVIATIONS HIV: human immunodeficiency virus; AIDS: acquired immune deficiency syndrome; CDC: Centers for Disease Control and Prevention; ACASI: audio computer-assisted self-interview; TRA: theory of reasoned action; HBM: Health Belief Model; STI: sexually transmitted infection; STD: Sexually Transmitted Disease; AOR: adjusted odds ratio; CI: confidence interval.
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Affiliation(s)
- Hao Fan
- a Department of Epidemiology , Richard M. Fairbanks School of Public Health, Indiana University , Indianapolis , IN , USA
| | - Kenneth H Fife
- b Department of Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Dena Cox
- c Department of Marketing , Kelley School of Business, Indiana University , Indianapolis , USA
| | - Anthony D Cox
- c Department of Marketing , Kelley School of Business, Indiana University , Indianapolis , USA
| | - Gregory D Zimet
- d Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
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Cyrus E, Sheehan DM, Fennie K, Sanchez M, Dawson CT, Cameron M, Maddox L, Trepka MJ. Delayed Diagnosis of HIV among Non-Latino Black Caribbean Immigrants in Florida 2000-2014. J Health Care Poor Underserved 2018; 29:266-283. [PMID: 29503300 PMCID: PMC6446079 DOI: 10.1353/hpu.2018.0019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Prompt HIV diagnosis decreases the risk of HIV transmission and improves health outcomes. The study objective was to examine rates of delayed HIV diagnosis among non-Latino Black Caribbean immigrants in Florida. The sample included 39,008 Black HIV-positive individuals, aged 13 or older from the Caribbean and the mainland U.S. Delayed HIV diagnosis was defined as AIDS diagnosis within three months of HIV diagnosis. After adjusting for demographic factors, year of HIV diagnosis, transmission mode, neighborhood level socioeconomic status, and rural-urban residence, a disparity persisted for Caribbean-born Blacks in the Bahamas and Haiti compared with U.S.-born Blacks. Male Jamaican-Bahamian-Haitian-born Blacks were more likely to have delayed diagnosis (aOR 2.17, 95% confidence interval [CI] 1.53-3.03; aOR 1.88, 95% CI 1.01-3.44; aOR 1.58, 95%CI 1.58). Findings suggest the need for targeted, culturally relevant interventions to reduce delayed diagnosis incidence among specific Caribbean-born Blacks.
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Affiliation(s)
- Elena Cyrus
- The Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University (FIU), Miami, FL
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, FIU, Miami, FL
| | - Kristopher Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, FIU, Miami, FL
| | - Mariana Sanchez
- The Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University (FIU), Miami, FL
| | - Christyl T. Dawson
- The Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University (FIU), Miami, FL
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, FIU, Miami, FL
| | - Marsha Cameron
- George Washington Milken Institute School of Public Health, Washington, DC
| | - Lorene Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, FIU, Miami, FL
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Pourmarzi D, Khoramirad A, Gaeeni M. Perceived Stigma in People Living With HIV in Qom. J Family Reprod Health 2017; 11:202-210. [PMID: 30288167 PMCID: PMC6168756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: This study aimed to report on perceived stigma by PLWH and factors that affect it. Materials and methods: A cross-sectional study was carried out on 120 PLWH in Qom, Iran from November 2015 to April 2016. Persian version of Fife and Wright's scale was used to measure perceived stigma. Results: The mean score of stigma was 73.19 ± 12.23 (range: 48-97). The means of external stigma and internal stigma were 43.70 ± 8.61 (range: 19-60), and 29.49 ± 5.32 (range: 17-40), respectively. Living in a rural areas (β = 10.341, p = 0.006), unemployment status (β = 6.910, p = 0.006), and poor support from family members (β = 4.772, p = 0.028) significantly increased the level of perceived stigma. PLWH experience a considerable level of stigma in their daily life. Mass media involvement to increase public awareness and reduce HIV related stigma need be more highlighted. Conclusion: Working with the patients' families, interventions in the rural areas and workplaces, and providing social supports is necessary to minimize the HIV related stigma.
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Affiliation(s)
- Davoud Pourmarzi
- Reproductive Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ashraf Khoramirad
- Faculty of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Mina Gaeeni
- Faculty of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
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Schafer KR, Albrecht H, Dillingham R, Hogg RS, Jaworsky D, Kasper K, Loutfy M, MacKenzie LJ, McManus KA, Oursler KAK, Rhodes SD, Samji H, Skinner S, Sun CJ, Weissman S, Ohl ME. The Continuum of HIV Care in Rural Communities in the United States and Canada: What Is Known and Future Research Directions. J Acquir Immune Defic Syndr 2017; 75:35-44. [PMID: 28225437 PMCID: PMC6169533 DOI: 10.1097/qai.0000000000001329] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The nature of the HIV epidemic in the United States and Canada has changed with a shift toward rural areas. Socioeconomic factors, geography, cultural context, and evolving epidemics of injection drug use are coalescing to move the epidemic into locations where populations are dispersed and health care resources are limited. Rural-urban differences along the care continuum demonstrate the implications of this sociogeographic shift. Greater attention is needed to build a more comprehensive understanding of the rural HIV epidemic in the United States and Canada, including research efforts, innovative approaches to care delivery, and greater community engagement in prevention and care.
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Affiliation(s)
- Katherine R Schafer
- *Section on Infectious Diseases, Wake Forest University Health Sciences, Winston-Salem, NC; †Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine; ‡Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA; §Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; ‖BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; ¶Clinician Investigator Program, University of British Columbia, Vancouver, BC, Canada; #Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada; **Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada; ††CIHR Canadian HIV Trials Network, Vancouver, BC, Canada; ‡‡Clinician Investigator Program, University of Manitoba, Winnipeg, MB, Canada; §§Carver College of Medicine, University of Iowa, Iowa City, IA; ‖‖Salem Veterans Affairs Medical Center, Virginia Tech Carilion School of Medicine, Salem, VA; ¶¶Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC; ##British Columbia Centre for Disease Control, Vancouver, BC, Canada; ***University of Saskatchewan, Saskatoon, SK, Canada; and †††Oregon Health & Science University-Portland State University School of Public Health, Portland, OR
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Sun J, Liu L, Shen J, Chen P, Lu H. Trends in baseline CD4 cell counts and risk factors for late antiretroviral therapy initiation among HIV-positive patients in Shanghai, a retrospective cross-sectional study. BMC Infect Dis 2017; 17:285. [PMID: 28420350 PMCID: PMC5395868 DOI: 10.1186/s12879-017-2398-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/11/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUNDS There are few studies focus on the factors underlying the late initiation of ART in China. We analyzed the trends in the median CD4 cell counts among different patient groups over time and the risk factors for the late initiation of ART in Shanghai, China. METHODS A retrospective cross-sectional survey was made in the Department of Infectious Disease of Shanghai Public Health Clinical Center which is a designated diagnosis and treatment center for HIV-positive patients in Shanghai during the period of January 1st, 2008--June 30th, 2014. Late ART initiation was defined as a CD4 cell count <200 cells/mm3 or having a clinical AIDS diagnosis prior to ART initiation. Trends in the median CD4 cell count at ART initiation and the proportion of late ART initiation by year were evaluated using Spearman's correlations and Chi-squared methods, respectively. We used a logistic regression model to analyze the risk factors for late ART initiation. The related factors collected in the multivariate model were the patient's age, gender, infection routes and marital status. RESULTS A total of 3796 patients were analyzed in this study, with a median baseline CD4 cell count of 205 cells/mm3 [interquartile range: 75-287]. The median CD4 cell counts of patients initiating ART late increased from 76 cells/mm3 in 2008 to 103 cells/mm3 in 2014 (p < 0.001), and the proportion of late ART initiation decreased from 80% to 45% (p < 0.001). The risk factors for late ART initiation were male gender, heterosexual transmission and older age (>30 years) (p < 0.001). CONCLUSIONS Notable improvements were made in the median CD4 cell count at ART initiation and the proportion of late ART initiation from 2008 to 2014. However, persons with high risk of HIV exposure who are male, older even heterosexual orientation should be given more opportunities to receive frequently screening, earlier diagnoses and timely treatment.
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Affiliation(s)
- Jianjun Sun
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Li Liu
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Jiayin Shen
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China
| | - Panpan Chen
- Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China
| | - Hongzhou Lu
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China. .,Department of Infectious Diseases, Huashan Hospital Affiliated to Fudan University, Shanghai, 200040, China. .,Department of Internal Medicine, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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43
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Ransome Y, Kawachi I, Dean LT. Neighborhood Social Capital in Relation to Late HIV Diagnosis, Linkage to HIV Care, and HIV Care Engagement. AIDS Behav 2017; 21:891-904. [PMID: 27752875 PMCID: PMC5306234 DOI: 10.1007/s10461-016-1581-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
High neighborhood social capital could facilitate earlier diagnosis of HIV and higher rates of linkage and HIV care engagement. Multivariate analysis was used to examine whether social capital (social cohesion, social participation, and collective engagement) in 2004/2006 was associated with lower 5-year average (2007-2011) prevalence of (a) late HIV diagnosis, (b) linked to HIV care, and (c) engaged in HIV care within Philadelphia, PA, United States. Census tracts (N = 332). Higher average neighborhood social participation was associated with higher prevalence of late HIV diagnosis (b = 1.37, se = 0.32, p < 0.001), linked to HIV care (b = 1.13, se = 0.20, p < 0.001) and lower prevalence of engaged in HIV care (b = -1.16, se = 0.30, p < 0.001). Higher collective engagement was associated with lower prevalence of linked to HIV care (b = -0.62, se = 0.32, p < 0.05).The findings of different directions of associations among social capital indicators and HIV-related outcomes underscore the need for more nuanced research on the topic that include longitudinal assessment across key populations.
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Affiliation(s)
- Yusuf Ransome
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA, 02115, USA.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA, 02115, USA
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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44
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Golden MR, Hughes JP, Dombrowski JC. Optimizing the Timing of HIV Screening as Part of Routine Medical Care. AIDS Patient Care STDS 2017; 31:27-32. [PMID: 28051896 DOI: 10.1089/apc.2016.0185] [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] [Indexed: 11/12/2022] Open
Abstract
US federal guidelines recommend that medical providers test all adolescents and adults for HIV infection at least once before the age of 64. The wide age range included in these guidelines may limit their utility and impact. We created an arithmetic model to estimate how HIV screening at different ages would impact the total number of years of undiagnosed HIV infection in the population and the number of persons developing clinical manifestations of HIV/AIDS. Our base case model assumed that age of infection in the screened population was the same as the estimated age of infection among all persons diagnosed with HIV in the United States in 2010. We parameterized a second model assuming age of infection was similar to the younger age distribution observed in African Americans. In the base case model, the number of years of undiagnosed HIV infection and number of persons with clinical manifestations of HIV/AIDS were both minimized by screening at age 34. If age of infection was similar to that estimated to occur among African Americans, testing at age 24 and 27 would minimize the number of years of undiagnosed infection and clinical cases, respectively. For both parameterization scenarios, testing between the ages of 21 and 38 resulted in outcomes within 10% of the model's estimated optimal age for screening. Focusing HIV screening on a narrower age range than is currently recommended may improve the impact of routine HIV screening efforts.
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Affiliation(s)
- Matthew R. Golden
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
- Public Health—Seattle & King County, HIV/STD Program, Seattle, Washington
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Julia C. Dombrowski
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
- Public Health—Seattle & King County, HIV/STD Program, Seattle, Washington
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45
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Late Presentation of HIV Infection: Prevalence, Trends, and the Role of HIV Testing Strategies in Guangzhou, China, 2008-2013. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1631878. [PMID: 27761466 PMCID: PMC5059519 DOI: 10.1155/2016/1631878] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/10/2016] [Accepted: 09/06/2016] [Indexed: 12/13/2022]
Abstract
Background. The prevalence, trends, and the role of different HIV testing strategies in late presentation of HIV infection in China were unknown. Methods. Data of newly reported HIV cases in Guangzhou between 2008 and 2013 was analyzed to examine the prevalence, trends, and characteristics of late presentation of HIV infection by three types of HIV testing strategies. Results. Overall, 53.2% (1412/2653) and 27.3% (724/2653) met the criteria of late presentation and presentation with advanced HIV disease. The overall trend of late presentation of HIV infection within the study period was declining. Late presentation was 62.9% in 2008 and dropped to 43.3% in 2013 (P < 0.001); presentation with advanced HIV disease was 40.3% in 2008 and dropped to 15.2% in 2013 (P < 0.001). Of the three testing strategies, PITC presented higher odds of both late presentation [AOR (95% CI): PITC versus VCT: 1.37 (1.09, 1.73); PITC versus MHT: 3.09 (2.16, 4.42)] and presentation with advanced HIV disease [AOR (95% CI): PITC versus VCT: 1.65 (1.29, 2.11); PITC versus MHT: 13.14 (8.47, 20.39)]. Conclusions. Although the late presentation of HIV infection was declining, it was still high in Guangzhou. The worse situation among PITC cases urges the policy adjustment in medical settings to increase early HIV diagnosis.
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46
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Nelson JA, Kinder A, Johnson AS, Hall HI, Hu X, Sweet D, Guido A, Katner H, Janelle J, Gonzalez M, Paz NM, Ledonne C, Henry J, Bramel T, Harris J. Differences in Selected HIV Care Continuum Outcomes Among People Residing in Rural, Urban, and Metropolitan Areas-28 US Jurisdictions. J Rural Health 2016; 34:63-70. [PMID: 27620836 DOI: 10.1111/jrh.12208] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 06/24/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The HIV care continuum is used to monitor success in HIV diagnosis and treatment among persons living with HIV in the United States. Significant differences exist along the HIV care continuum between subpopulations of people living with HIV; however, differences that may exist between residents of rural and nonrural areas have not been reported. METHODS We analyzed the Centers for Disease Control and Prevention's National HIV Surveillance System data on adults and adolescents (≥13 years) with HIV diagnosed in 28 jurisdictions with complete reporting of HIV-related lab results. Lab data were used to assess linkage to care (≥1 CD4 or viral load test ≤3 months of diagnosis), retention in care (≥2 CD4 and/or viral load tests ≥3 months apart), and viral suppression (viral load <200 copies/mL) among persons living with HIV. Residence at diagnosis was grouped into rural (<50,000 population), urban (50,000-499,999 population), and metropolitan (≥500,000 population) categories for statistical comparison. Prevalence ratios and 95% CI were calculated to assess significant differences in linkage, retention, and viral suppression. FINDINGS Although greater linkage to care was found for rural residents (84.3%) compared to urban residents (83.3%) and metropolitan residents (81.9%), significantly lower levels of retention in care and viral suppression were found for residents of rural (46.2% and 50.0%, respectively) and urban (50.2% and 47.2%) areas compared to residents of metropolitan areas (54.5% and 50.8%). CONCLUSIONS Interventions are needed to increase retention in care and viral suppression among people with HIV in nonmetropolitan areas of the United States.
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Affiliation(s)
- John A Nelson
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Anna Kinder
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,Casper Natrona County Health Department, Casper, Wyoming
| | - Anna Satcher Johnson
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Prevention; Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - H Irene Hall
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Prevention; Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Xiaohong Hu
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Prevention; Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Donna Sweet
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,School of Medicine, University of Kansas, Wichita, Kansas
| | - Alyssa Guido
- College of Medicine, University of Arizona, Tucson, Arizona
| | - Harold Katner
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,School of Medicine, Mercer University, Macon, Georgia
| | - Jennifer Janelle
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,Department of Medicine, University of Florida, Gainesville, Florida
| | - Maribel Gonzalez
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,Florida Department of Health, LaBelle, Florida
| | - Natalia Martínez Paz
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,School of Medicine, University of Washington, Seattle, Washington
| | - Charlotte Ledonne
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,San Luis Valley Area Health Education Center, Alamosa, Colorado
| | - Jason Henry
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,Northeast/Caribbean AIDS Education and Training Center, St. Croix, US Virgin Islands
| | - Theresa Bramel
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,Alaska Native Tribal Health Consortium, Anchorage, Alaska
| | - Jeanne Harris
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,College of Medicine, University of Kentucky, Lexington, Kentucky
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47
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Sheehan DM, Trepka MJ, Fennie KP, Prado G, Ibanez G, Maddox LM. Racial/ethnic disparities in delayed HIV diagnosis among men who have sex with men, Florida, 2000-2014. AIDS Care 2016; 29:311-318. [PMID: 27455856 DOI: 10.1080/09540121.2016.1211609] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Only about 85% of men who have sex with men (MSM) with human immunodeficiency virus (HIV) have been tested for and diagnosed with HIV. Racial/ethnic disparities in HIV risk and HIV care outcomes exist within MSM. We examined racial/ethnic disparities in delayed HIV diagnosis among MSM. Males aged ≥13 reported to the Florida Enhanced HIV/AIDS Reporting System 2000-2014 with a reported HIV transmission mode of MSM were analyzed. We defined delayed HIV diagnosis as an AIDS diagnosis within three months of the HIV diagnosis. Multilevel logistic regressions were used to estimate adjusted odds ratios (aOR). Of 39,301 MSM, 27% were diagnosed late. After controlling for individual factors, neighborhood socioeconomic status, and rural-urban residence, non-Latino Black MSM had higher odds of delayed diagnosis compared with non-Latino White MSM (aOR 1.15, 95% confidence interval [CI] 1.08-1.23). Foreign birth compared with US birth was a risk factor for Black MSM (aOR 1.27, 95% CI 1.12-1.44), but a protective factor for White MSM (aOR 0.77, 95% CI 0.68-0.87). Rural residence was a risk for Black MSM (aOR 1.79, 95% CI 1.36-2.35) and Latino MSM (aOR 1.87, 95% CI 1.24-2.84), but not for White MSM (aOR 1.26, 95% CI 0.99-1.60). HIV testing barriers particularly affect non-Latino Black MSM. Social and/or structural barriers to testing in rural communities may be significantly contributing to delayed HIV diagnosis among minority MSM.
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Affiliation(s)
- Diana M Sheehan
- a Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University , Miami , FL , USA.,b Department of Epidemiology, Robert Stempel College of Public Health and Social Work , Florida International University , Miami , FL , USA
| | - Mary Jo Trepka
- a Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University , Miami , FL , USA.,b Department of Epidemiology, Robert Stempel College of Public Health and Social Work , Florida International University , Miami , FL , USA
| | - Kristopher P Fennie
- b Department of Epidemiology, Robert Stempel College of Public Health and Social Work , Florida International University , Miami , FL , USA
| | - Guillermo Prado
- c Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Gladys Ibanez
- b Department of Epidemiology, Robert Stempel College of Public Health and Social Work , Florida International University , Miami , FL , USA
| | - Lorene M Maddox
- d Florida Department of Health , HIV/AIDS Section , Tallahassee , FL , USA
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48
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Kwan CK, Rose CE, Brooks JT, Marks G, Sionean C. HIV Testing Among Men at Risk for Acquiring HIV Infection Before and After the 2006 CDC Recommendations. Public Health Rep 2016; 131:311-9. [PMID: 26957666 DOI: 10.1177/003335491613100215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Testing for human immunodeficiency virus (HIV) is the key first step in HIV treatment and prevention. In 2006, the Centers for Disease Control and Prevention (CDC) recommended annual HIV testing for people at high risk for HIV infection. We evaluated HIV testing among men with high-risk heterosexual (HRH) contact and sexually active men who have sex with men (MSM) before and after the CDC recommendations. METHODS We used data from the National Survey of Family Growth, 2002 and 2006-2010, to assess proportions of HRH respondents and MSM reporting HIV testing in the prior 12 months, compare rates of testing before and after release of the 2006 CDC HIV testing guidelines, and examine demographic variables and receipt of health-care services as correlates of HIV testing. RESULTS Among MSM, the proportion tested was 37.2% (95% confidence interval [CI] 28.2, 47.2) in 2002, 38.2% (95% CI 25.9, 52.2) in 2006-2008, and 41.7% (95% CI 29.2, 55.3) in 2008-2010; among HRH respondents, the proportion was 23.7% (95% CI 20.5, 27.3) in 2002, 24.5% (95% CI 20.9, 28.7) in 2006-2008, and 23.9% (95% CI 20.2, 28.1) in 2008-2010. HIV testing was more likely among MSM and HRH respondents who received testing or treatment for sexually transmitted disease in the prior 12 months, received a physical examination in the prior 12 months (MSM only), or were incarcerated in the prior 12 months. CONCLUSIONS The rate of annual HIV testing was low for men with sexual risk for HIV infection, and little improvement took place from 2002 to 2006-2010. Interventions aimed at men at risk, especially MSM, in both nonmedical and health-care settings, likely could increase HIV testing.
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Affiliation(s)
- Candice K Kwan
- Epidemic Intelligence Service, Atlanta, GA; Current affiliation: New York University School of Medicine, New York, NY
| | - Charles E Rose
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - John T Brooks
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Gary Marks
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Catlainn Sionean
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
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49
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Assen A, Molla F, Wondimu A, Abrha S, Melkam W, Tadesse E, Yilma Z, Eticha T, Abrha H, Workneh BD. Late presentation for diagnosis of HIV infection among HIV positive patients in South Tigray Zone, Ethiopia. BMC Public Health 2016; 16:558. [PMID: 27405542 PMCID: PMC4942918 DOI: 10.1186/s12889-016-3263-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 07/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In spite of the availability and accessibility of HIV testing opportunities and efforts, people are being late to test in the course of HIV infection. Late diagnosis leads to late anti-retroviral therapy initiation which in turn results in poor treatment outcome and prognosis of the disease. The aim of this study was to determine the prevalence and predictors of late HIV diagnosis among HIV-infected patients in South Tigray Zone, Ethiopia. METHODS A facility based cross sectional study was conducted among HIV positive patients from February 1-30, 2014 in Southern Tigray, Ethiopia. Multistage sampling technique was employed to select the study participants. Data were collected by reviewing patient medical card and interviewing using structured questionnaire. Data were entered using Epi-Data version 3.1 and analyzed using SPSS version 20.0. Both bivariate and multivariate logistic regressions were modeled to evaluate the association of predictors with late diagnosis of HIV infection. RESULTS Out of 789 study participants, 68.8 % of them were late for HIV diagnosis. Feeling healthy (65.7 %), fear of stigma and discrimination (32.4 %) and using traditional treatment (1.5 %) were reported as the main reasons for late HIV diagnosis. Use of Khat [AOR = 3.27, 95 % CI (1.75, 6.13)], bed ridden functional status [AOR = 2.66, 95 % CI (1.60, 4.42)], ambulatory functional status [AOR = 1.56, 95 % CI (1.03, 2.35)] and Muslim religion [AOR = 2.26, 95 % CI (1.13, 4.49)] were significantly associated with late presentation for HIV diagnosis. CONCLUSIONS High prevalence of late HIV diagnosis was recorded in Southern Tigray Zone, Ethiopia. Public health educations and campaigns targeted at improving early diagnosis and prognosis of people living with HIV/AIDS in Southern Tigray, Northern Ethiopia should be underway.
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Affiliation(s)
- Admassu Assen
- Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Fantahun Molla
- Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Abrham Wondimu
- Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Solomon Abrha
- Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Wondim Melkam
- Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Ebisa Tadesse
- Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Zewdu Yilma
- Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Tadele Eticha
- Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Hagos Abrha
- Department of Internal Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Birhanu Demeke Workneh
- Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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50
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Bruneau L, Billaud E, Raffi F, Hanf M. Factors associated with the level of CD4 cell counts at HIV diagnosis in a French cohort: a quantile regression approach. Int J STD AIDS 2016; 28:397-403. [PMID: 27178069 DOI: 10.1177/0956462416650980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The consensus definition of late presentation for human immunodeficiency virus patient based on a CD4 threshold of 350 cells/mm3 has limitations concerning risk factors identification since there is growing biomedical justification for earlier initiation of treatment. The objective was to overcome this problem by simultaneously determining factors associated with different levels of CD4 counts at the time of diagnosis. Between January 2000 and July 2014, 1179 patients with a first human immunodeficiency virus diagnosis and entering care in a French human immunodeficiency virus reference center were enrolled. Factors associated with each 5 percentile from 5th to 95th quantile of CD4 counts at diagnosis were simultaneously studied in a multivariable quantile regression model. At each of the quantiles, the factors identified as negatively associated with CD4 count at diagnosis were older age, male sex , foreign patients, hepatitis B virus or hepatitis C virus co-infection, employment status, non-MSM transmission, heterosexual transmission, suburban and rural's place of residence and earlier period of diagnosis. Association with CD4 count was not uniformly significant, most factors being significant for some quantiles. The only significant determinant for all quantiles was being born in a foreign country. These results are particularly helpful in the context of human immunodeficiency virus clinical care, management and prevention.
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Affiliation(s)
- Léa Bruneau
- 1 Regional Coordination Center for the Fight against HIV (COREVIH) of Pays de la Loire, Nantes, France.,2 Methodological Support and Biostatistics Unit, Saint Denis University Hospital, Saint Denis, Reunion Island, France
| | - Eric Billaud
- 1 Regional Coordination Center for the Fight against HIV (COREVIH) of Pays de la Loire, Nantes, France.,3 Infectious and Tropical Diseases Department, Nantes University Hospital, Nantes, France
| | - François Raffi
- 3 Infectious and Tropical Diseases Department, Nantes University Hospital, Nantes, France
| | - Matthieu Hanf
- 4 National Institute of Health and Medical Research (INSERM) CIC 1413, Nantes University Hospital, Nantes, France
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