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Paer J, Ratcliffe J, Chang M, Carnevale C, Quigee D, Gordon P, Olender S, Sobieszczyk ME, Zucker J. Predictors of missed HIV screening opportunities among newly diagnosed individuals at an urban medical center in New York City, 2018-2022. PLoS One 2023; 18:e0290414. [PMID: 37676864 PMCID: PMC10484428 DOI: 10.1371/journal.pone.0290414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To identify demographic and clinical factors predictive of having a missed opportunity (MO) for HIV screening. DESIGN Retrospective cohort study. METHODS Electronic medical records were queried for individuals newly diagnosed with HIV in different sites within a large urban academic medical center in New York City between 2018 and 2022. The primary outcome was having one or more MO for HIV screening within the institution, defined as any encounter at which screening was not performed in the 365 days preceding the HIV diagnosis. RESULTS Over one third of new diagnoses had at least one MO in the preceding year. Older individuals, cisgender women and those assigned female sex at birth, and heterosexual individuals were more likely to have at least one MO. An initial CD4 < 200 cells/ul was more likely among men who have sex with women specifically. Most MOs occurred in the emergency department and outpatient settings, with minimal HIV prevention discussions documented during each MO. CONCLUSIONS These findings suggest that populations perceived to be at lower risk for HIV are more likely to have MOs and possibly late diagnoses, and that universal HIV screening must be implemented into the workflows of emergency department and outpatient settings to facilitate early diagnosis and reduce the incidence of HIV.
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Affiliation(s)
- Jeffrey Paer
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Judy Ratcliffe
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Michelle Chang
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Caroline Carnevale
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Daniela Quigee
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Peter Gordon
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Susan Olender
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Magdalena E. Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Jason Zucker
- Division of Infectious Diseases, Department of Medicine and Pediatrics, Columbia University Medical Center, New York, New York, United States of America
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Adamson T, Hanley M, Baral S, Beyrer C, Wallach S, Howell S. Rapid, application-based survey to characterise the impacts of COVID-19 on LGBTQ+ communities around the world: an observational study. BMJ Open 2022; 12:e041896. [PMID: 35414537 PMCID: PMC9006192 DOI: 10.1136/bmjopen-2020-041896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Emerging evidence indicates that the COVID-19 pandemic, and the responses it has generated, have had disproportionate impacts on lesbian, gay, bisexual, transgender and queer (LGBTQ+) communities. This study seeks to build on existing information and provide regional insight. METHODS In response, a cross-sectional survey was administered to a global sample of LGBTQ+ individuals (n=13 358) between 16 April and 20 May 2020 via the social networking application Hornet. The survey contained questions that characterise the impact of COVID-19 and associated mitigation strategies on economics, employment, mental health and access to healthcare. RESULTS 5191 (43.9%) individuals indicated they were somewhat, slightly or unable to meet basic needs with their current income, while 2827 (24.1%) and 4710 (40.1%) felt physically or emotionally unsafe in their living environment, respectively. 2202 individuals (24.7%) stated they are at risk for losing health insurance coverage. 2685 (22.7%) persons reported having skipped or cut meals as there was not enough money. CONCLUSION Many LGBTQ+persons who responded reported adverse consequences to mental health, economics, interruptions to care and lack of support from their government. This data is part of ongoing analyses but accentuates the unique needs of LGBTQ+ communities that will require targeted, ameliorative approaches.
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Affiliation(s)
- Tyler Adamson
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
| | | | - Stefan Baral
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
| | - Chris Beyrer
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
| | - Sara Wallach
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
| | - Sean Howell
- LGBT Foundation, San Francisco, California, USA
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Zucker J, Purpura L, Sani F, Huang S, Schluger A, Ruperto K, Slowkowski J, Olender S, Scherer M, Castor D, Gordon P. Individualized Provider Feedback Increased HIV and HCV Screening and Identification in a New York City Emergency Department. AIDS Patient Care STDS 2022; 36:106-114. [PMID: 35289689 PMCID: PMC8971984 DOI: 10.1089/apc.2021.0225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Efforts to end the HIV and hepatitis C virus (HCV) epidemics begin with ascertainment of a person's infection status through screening. Despite its importance as a site of testing, missed opportunities for screening in the Emergency Department (ED) are common. We describe the impact of implementing an individualized provider feedback intervention on HIV and HCV testing in a quaternary ED. We conducted an interrupted time series analysis to evaluate the impact of the intervention on weekly HIV and HCV screening in an observational cohort of patients seeking care in the ED. The intervention included a physician champion individualized feedback with peer comparisons to all providers in the ED and an existing HIV/HCV testing and response team. Data were abstracted from the electronic medical record (EMR) for 30 weeks before, during, and after implementing the intervention. We used Poisson regression analysis to estimate changes in the weekly counts and rates of HIV and HCV testing. The incidence rate ratios (IRRs) of HIV testing were 1.94 [95% confidence interval (CI) 1.85-2.04] and 1.38 (95% CI 1.31-1.45) times higher for the intervention and post-intervention period compared with the pre-intervention period. The IRRs of HCV testing was 6.96 (95% CI 6.40-7.58) and 4.70 (95% CI 4.31-5.13) for the intervention and post-intervention periods. There were no meaningful differences in demographic characteristics during the observation period. The intervention meaningfully increased HIV and HCV testing volume and positive case detection, including testing in high-risk groups like young adults and individuals without prior testing. Although diminished, the intervention effect sustained in the 30-week period following implementation.
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Affiliation(s)
- Jason Zucker
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.,Address correspondence to: Jason Zucker, MD, Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, 622 West 168th Street 8th Floor, New York, NY 10032, USA
| | - Lawrence Purpura
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.,ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Fereshteh Sani
- Acute Care Services, Attending Physician, Emergency Medicine, Permanente Medicine, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Simian Huang
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Aaron Schluger
- Department of Medicine, Westchester Medical Center, Valhalla, New York, USA
| | - Kenneth Ruperto
- New York Presbyterian Hospital, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jacek Slowkowski
- New York Presbyterian Hospital, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Susan Olender
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Matt Scherer
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Delivette Castor
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Peter Gordon
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
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Dhairyawan R, Okhai H, Hill T, Sabin CA. Differences in HIV clinical outcomes amongst heterosexuals in the United Kingdom by ethnicity. AIDS 2021; 35:1813-1821. [PMID: 33973878 PMCID: PMC7611528 DOI: 10.1097/qad.0000000000002942] [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: 12/29/2022]
Abstract
OBJECTIVE We investigated differences in clinical outcomes in heterosexual participants, by ethnicity in the UK Collaborative HIV Cohort Study from 2000 to 2017. DESIGN Cohort analysis. METHODS Logistic/proportional hazard regression assessed ethnic group differences in CD4+ cell count at presentation, engagement-in-care, combination antiretroviral therapy (cART) initiation, viral suppression and rebound. RESULTS Of 12 302 participants [median age: 37 (interquartile range: 31-44) years, 52.5% women, total follow-up: 85 846 person-years], 64.4% were black African, 19.1% white, 6.3% black Caribbean, 3.6% black other, 3.3% South Asian/other Asian and 3.4% other/mixed. CD4+ cell count at presentation amongst participants from non-white groups were lower than the white group. Participants were engaged-in-care for 79.6% of follow-up time; however, black and other/mixed groups were less likely to be engaged-in-care than the white group (adjusted odds ratios vs. white: black African: 0.70 (95% confidence interval (CI) 0.63-0.79], black Caribbean: 0.74 (0.63-0.88), other/mixed: 0.78 (0.62-0.98), black other: 0.81 (0.64-1.02)). Of 8867 who started cART, 79.1% achieved viral suppression, with no differences by ethnicity in cART initiation or viral suppression. Viral rebound (22.2%) was more common in the black other [1.95 (1.37-2.77)], black African [1.85 (1.52-2.24)], black Caribbean [1.73 (1.28-2.33)], South Asian/other Asian [1.35 (0.90-2.03)] and other/mixed [1.09 (0.69-1.71)] groups than in white participants. CONCLUSION Heterosexual people from black, Asian and minority ethnic (BAME) groups presented with lower CD4+ cell counts, spent less time engaged-in-care and were more likely to experience viral rebound than white people. Work to understand and address these differences is needed.
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Affiliation(s)
| | - Hajra Okhai
- Institute for Global Health, University College London, UK
| | - Teresa Hill
- Institute for Global Health, University College London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London, UK
- National Institute for Health Research Health Protection Research Unit in Blood-Borne and Sexually Transmitted Infections, University College London, London, UK
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Zucker J, Carnevale C, Theodore D, Castor D, Meyers K, Gold J, Winetsky D, Scherer M, Cohall A, Gordon P, Sobieszczyk M, Olender S. Attitudes and Perceived Barriers to Routine HIV Screening and Provision and Linkage of Postexposure Prophylaxis and Pre-Exposure Prophylaxis Among Graduate Medical Trainees. AIDS Patient Care STDS 2021; 35:180-187. [PMID: 33901410 PMCID: PMC8106251 DOI: 10.1089/apc.2021.0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
New York City is the metropolitan area in the United States with the highest number of new HIV diagnoses nationwide. The End-The-Epidemic (EtE) initiative calls for identifying persons with HIV who remain undiagnosed, linking and retaining persons living with HIV to maximize viral suppression, and facilitate access to pre-exposure prophylaxis (PrEP) for patients at increased risk of HIV. HIV screening represents the first step to both the primary and secondary HIV prevention cascades. We conducted an online, anonymous, cross-sectional survey of residents at all stages of training within four residency programs at one institution in Northern Manhattan between August 2017 and August 2018. All internal medicine, emergency medicine, obstetrics and gynecology trainees, and pediatrics were invited to complete the survey via email. Of 298 eligible trainees, 142 (48%) completed the survey. Most trainees were aware of the HIV testing law and agreed that HIV testing was their responsibility, but few successfully screened most of their patients. Most trainees were not knowledgeable about non-occupational post-exposure prophylaxis (nPEP) or PrEP, but felt that it was important to provide these services across settings. Barriers to HIV, nPEP, and PrEP varied across specialties. Ending the HIV epidemic will require efforts across clinical specialties. In this survey from an EtE jurisdiction, most trainees felt that it is important to provide HIV prevention services in most settings; however, their knowledge and comfort with HIV prevention services other than testing were low. Barriers varied across specialties, and developing specialty-specific materials for trainees may be beneficial.
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Affiliation(s)
- Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Caroline Carnevale
- New York-Presbyterian Hospital HIV Prevention Program, New York, New York, USA
| | - Deborah Theodore
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Delivette Castor
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Kathrine Meyers
- Aaron Diamond AIDS Research Center at Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Jeremy Gold
- Department of Internal Medicine and Columbia University Irving Medical Center, New York, USA
| | - Daniel Winetsky
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Matthew Scherer
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Alwyn Cohall
- Department of Pediatrics, Columbia University Irving Medical Center, New York, USA
| | - Peter Gordon
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Magdalena Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Susan Olender
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Smith DK, Chang MH, Duffus WA, Okoye S, Weissman S. Missed Opportunities to Prescribe Preexposure Prophylaxis in South Carolina, 2013-2016. Clin Infect Dis 2020; 68:37-42. [PMID: 29790923 DOI: 10.1093/cid/ciy441] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/19/2018] [Indexed: 12/17/2022] Open
Abstract
Background Expanding use of preexposure prophylaxis (PrEP) in ways that address current racial/ethnic disparities is an important human immunodeficiency virus (HIV) prevention goal. We investigated missed opportunities to provide PrEP during healthcare visits that occur prior to HIV infection. Methods This retrospective cohort study linked South Carolina HIV case surveillance data to 3 statewide healthcare databases. Characteristics of patients, healthcare visits and providers, sexually transmitted diseases (STDs), and other diagnoses were assessed for medical encounters occurring before an initial HIV diagnosis. Adjusted odds ratios were used to identify correlates of missed opportunities for PrEP provision. Results Of 885 persons newly diagnosed during the study period, 586 (66%) had 4029 visits to a healthcare facility prior to their HIV diagnosis (mean of 6.9 visits) with missed opportunities for provision of PrEP. Emergency medicine-trained clinicians conducted (61%) and primary care clinicians (family practice or internal medicine) conducted 10% of visits. Also, 42% of visits were by persons who were uninsured or self-paid, 36% had public insurance, and 18% had commercial insurance. In multivariable analyses, being female, black, or aged <30 years were statistically significant predictors of having prior healthcare visits. Among persons with at least 1 healthcare visit prior to their HIV diagnosis, 28.5% had a diagnosis of gonorrhea, syphilis, or chlamydia at any visit. Conclusions Healthcare visits occurring among persons who would benefit from provision of PrEP, especially persons with diagnosed STDs, should be leveraged to increase use of PrEP and reduce the risk of HIV acquisition.
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Affiliation(s)
- Dawn K Smith
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Man-Huei Chang
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wayne A Duffus
- Office of Health Equity, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stella Okoye
- University of South Carolina School of Medicine, Columbia
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Zucker J, Patterson B, Ellman T, Slowikowski J, Olender S, Gordon P, Morrison EA, Sobieszczyk ME. Missed Opportunities for Engagement in the Prevention Continuum in a Predominantly Black and Latino Community in New York City. AIDS Patient Care STDS 2018; 32:432-437. [PMID: 30398951 DOI: 10.1089/apc.2018.0127] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Even though over the last 25 years, the Centers for Disease Control and Prevention recommendations for HIV screening have expanded to encompass population-wide screening in all healthcare settings, and despite the availability of pre-exposure prophylaxis (PrEP), a large proportion of individuals at risk of infection are not linked to prevention care. We evaluated missed opportunities for HIV screening and linkage to PrEP from 2006 through 2017 at an urban academic medical center serving a predominantly minority community. A missed opportunity for HIV screening was a provider visit that did not include HIV testing and occurred within the 12 months before the first positive HIV test. A missed opportunity for prevention was a visit after 2012 that included a negative HIV test, no evaluation for PrEP, and was followed by a positive HIV test. Univariate analysis was performed to assess characteristics of individuals with missed opportunities for screening and prevention services. Between 2006 and 2017, 721 patients were newly diagnosed with HIV. Two hundred forty-seven diagnoses were made in the early period (2006-2010), 236 in the middle period (2010-2013), and 238 in the late period (2014-2017). Overall 60% of patients had at least one missed opportunity, 36% for HIV screening, and 42% for PrEP. There was no improvement in the rates of individuals with a missed opportunity for HIV screening over time. Ending the HIV epidemic will require concerted efforts to bolster access to testing and ensure that all individuals are offered screening, counseling, and linkage to prevention and care services.
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Affiliation(s)
- Jason Zucker
- Division of Infectious Diseases, Department of Internal Medicine and Pediatrics, Columbia University Medical Center, New York, New York
| | - Benjamin Patterson
- Division of Infectious Diseases, Department of Internal Medicine and Pediatrics, Columbia University Medical Center, New York, New York
| | - Tanya Ellman
- Division of Infectious Diseases, Department of Internal Medicine and Pediatrics, Columbia University Medical Center, New York, New York
| | - Jacek Slowikowski
- Division of Infectious Diseases, Department of Internal Medicine and Pediatrics, Columbia University Medical Center, New York, New York
| | - Susan Olender
- Division of Infectious Diseases, Department of Internal Medicine and Pediatrics, Columbia University Medical Center, New York, New York
| | - Peter Gordon
- Division of Infectious Diseases, Department of Internal Medicine and Pediatrics, Columbia University Medical Center, New York, New York
| | - Ellen A.B. Morrison
- Division of Infectious Diseases, Department of Internal Medicine and Pediatrics, Columbia University Medical Center, New York, New York
| | - Magdalena E. Sobieszczyk
- Division of Infectious Diseases, Department of Internal Medicine and Pediatrics, Columbia University Medical Center, New York, New York
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Alexandra MO, Carolina PJ, Andrea GR, Patricia VF. Impact and barriers of an HIV rapid test program implementation at an oncological referral center in Mexico. Int J STD AIDS 2018; 29:884-889. [PMID: 29629655 DOI: 10.1177/0956462418762235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of this study was to evaluate the implementation of human immunodeficiency virus (HIV) screening with rapid tests in an oncologic center in Mexico City, report the HIV prevalence, and describe contacts screening and linkage to HIV care while identifying barriers to the performance of the program. In 2014, an HIV rapid test program was implemented in four departments of the hospital "Instituto Nacional de Cancerología". From 2014 to 2016, 3032 HIV rapid tests were performed in the hospital. The overall HIV prevalence was 0.8%, with the highest prevalence in the Hematology Department (2.4%). In the Gynecology Department, prevalence was 0.05%. Only 25 and 22 tests were performed in the lung cancer and germ cell tumor clinic, respectively, with one positive test. The health staff not offering the test was the main limitation to the full implementation of the program in those departments. The contacts screening led to three positive cases. The acceptance of the test was 99%. Patients who tested positive were seen by an infectious diseases physician on the same day the test was performed. Rapid HIV tests are a useful tool to expand HIV diagnosis in patients with cancer and to establish a rapid linkage to HIV care. Staff education needs to be improved to raise awareness of the health staff for a successful scale up of the program.
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Affiliation(s)
| | - Perez-Jimenez Carolina
- 1 Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City, Mexico
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9
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Inghels M, Niangoran S, Minga A, Yoboue JM, Dohoun L, Yao A, Eholié S, Anglaret X, Danel C. Missed opportunities for HIV testing among newly diagnosed HIV-infected adults in Abidjan, Côte d'Ivoire. PLoS One 2017; 12:e0185117. [PMID: 28977006 PMCID: PMC5627899 DOI: 10.1371/journal.pone.0185117] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/05/2017] [Indexed: 12/16/2022] Open
Abstract
Background HIV testing is crucial for starting ART earlier in HIV-infected people. We describe Missed Opportunities (MO) for HIV testing among adults newly diagnosed with HIV in Abidjan, Côte d’Ivoire. Methods Between april,2nd 2013 and april 1st 2014, a cross-sectional study was conducted among all adults newly diagnosed (< 1year) for HIV at the Blood Donors Medical Center of Abidjan with face to face questionnaire. An MO for HIV testing was defined as a medical consultation for a clinical indicator (e.g. symptoms, hospitalization, and pregnancy) or a non-clinical indicator (e.g. high-risk sexual behavior, HIV-infected partner) potentially related to an HIV infection but did not lead to HIV test proposal by a health care professional. Results Of the 341 patients who attended the center suring this period, 273 (157 women and 116 men) were included in this analysis. 130 (47.6%) reported at least one medical consultation for an indicator relevant for a test proposal between 1 month and five years prior to their diagnosis. Among them, 92 (77.3%) experienced at least one MO for testing. The 273 included patients reported a total of 216 indicators; 146 (67.6%) were reported without test proposal and thus were MO. Hospitalization, extreme lose of weight, chronic or repeat fever and herpes zoster were the indicators with the largest number of MO. While 66 (24.2%) patients experienced non-clinical indicators relevant to risk of HIV infection, only 11 (4.0%) mentioned it to a health professional. Conclusion MO for HIV testing are frequent, even in situations for which testing is clearly recommended. Better train healthcare professionals and creating new opportunities of testing inside and, outside of medical settings are crucial to improve HIV control.
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Affiliation(s)
- Maxime Inghels
- Centre Population et Développement (CEPED), UMR 196 Paris Descartes–Institut de Recherche et Développement (IRD), France
- * E-mail:
| | - Serge Niangoran
- Programme PAC-CI/ANRS Research Site, CHU de Treichville, Abidjan, Côte d’Ivoire
| | - Albert Minga
- Programme PAC-CI/ANRS Research Site, CHU de Treichville, Abidjan, Côte d’Ivoire
- CMSDS, Centre Médical de Suivi des Donneurs de Sang, CNTS, Abidjan, Côte d’Ivoire
| | - Jean Michel Yoboue
- Programme PAC-CI/ANRS Research Site, CHU de Treichville, Abidjan, Côte d’Ivoire
- CMSDS, Centre Médical de Suivi des Donneurs de Sang, CNTS, Abidjan, Côte d’Ivoire
| | - Lambert Dohoun
- Programme PAC-CI/ANRS Research Site, CHU de Treichville, Abidjan, Côte d’Ivoire
- CMSDS, Centre Médical de Suivi des Donneurs de Sang, CNTS, Abidjan, Côte d’Ivoire
| | - Abo Yao
- Programme PAC-CI/ANRS Research Site, CHU de Treichville, Abidjan, Côte d’Ivoire
- CMSDS, Centre Médical de Suivi des Donneurs de Sang, CNTS, Abidjan, Côte d’Ivoire
| | - Serge Eholié
- Programme PAC-CI/ANRS Research Site, CHU de Treichville, Abidjan, Côte d’Ivoire
- Department of Infectious Diseases, Treichville Hospital, Abidjan, Côte d’Ivoire
| | - Xavier Anglaret
- Programme PAC-CI/ANRS Research Site, CHU de Treichville, Abidjan, Côte d’Ivoire
- Centre Inserm 1219, Bordeaux University, Bordeaux, France
| | - Christine Danel
- Programme PAC-CI/ANRS Research Site, CHU de Treichville, Abidjan, Côte d’Ivoire
- Centre Inserm 1219, Bordeaux University, Bordeaux, France
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Aguilar-Zapata D, Piñeirúa-Menéndez A, Volkow-Fernández P, Rodríguez-Zulueta P, Ramos-Alamillo U, Cabrera-López T, Martin-Onraet A. Sociodemographic differences among HIV-positive and HIV-negative recently pregnant women in Mexico City: A case-control study. Medicine (Baltimore) 2017; 96:e7305. [PMID: 28682879 PMCID: PMC5502152 DOI: 10.1097/md.0000000000007305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
National HIV preventive programs in Mexico focus on high-risk groups that do not consider women, apart from prenatal screening. Nonetheless, the epidemic in women is growing, and there is a need to better understand sociodemographic factors in women living with HIV (WLH). We performed a case-control study in Mexico City, including HIV+ and HIV- women with a recent pregnancy to compare their sociodemographic characteristics and describe the circumstances of diagnosis in HIV+ women, as well as prenatal screening frequency in both groups. Fifty cases and 102 controls were interviewed. HIV+ women were more frequently the only economic support of the family (20% vs 0%, P < .0001). Thirty-eight percent of cases had their first pregnancy at ≤18 years, versus 16% of controls (odds ratio 2.47, 95% confidence interval 1.07-5.72, P = .03); 16% of cases had lived in the street; 6% reported transactional sex, versus none of the controls (P < .0001). In the multivariate analysis, there was strong evidence of an association between HIV infection and age at the time of the interview, history of sexually transmitted diseases, substance abuse, history of violence, and civil status. Only 6% of controls were tested for HIV during prenatal follow-up. WLH in this study faced important social vulnerability. Targeting women living in these social contexts might increase early diagnosis and could tailor HIV prevention strategies. Prenatal coverage needs to be improved and should represent a national priority.
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Affiliation(s)
- Daniel Aguilar-Zapata
- Departamento de Enfermedades Infecciosas, Instituto Nacional de Cancerología (INCan), Secretaría de Salud (SSA)
| | | | - Patricia Volkow-Fernández
- Departamento de Enfermedades Infecciosas, Instituto Nacional de Cancerología (INCan), Secretaría de Salud (SSA)
| | - Patricia Rodríguez-Zulueta
- Departamento de Enfermedades Infecciosas, Hospital General Manuel Gea Gonzalez, Secretaría de Salud (SSA), Mexico City, Mexico
| | - Ubaldo Ramos-Alamillo
- Medical Director at the Clinica Especializada Condesa and Teresita Cabrera, Gynecology Service
| | - Teresita Cabrera-López
- Medical Director at the Clinica Especializada Condesa and Teresita Cabrera, Gynecology Service
| | - Alexandra Martin-Onraet
- Departamento de Enfermedades Infecciosas, Instituto Nacional de Cancerología (INCan), Secretaría de Salud (SSA)
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Martin-Onraët A, Volkow-Fernández P, Alvarez-Wyssmann V, González-Rodríguez A, Casillas-Rodríguez J, Rivera-Abarca L, Torres-Escobar I, Sierra-Madero J. Late Diagnosis Due to Missed Opportunities and Inadequate Screening Strategies in HIV Infected Mexican Women. AIDS Behav 2017; 21:505-514. [PMID: 27651138 DOI: 10.1007/s10461-016-1560-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Late diagnosis of HIV remains a public health issue in Mexico. Most national programs target high-risk groups, not including women. More data on factors associated with late diagnosis and access to care in women are needed. In 2012-2013, Mexican women recently diagnosed with HIV were interviewed. Socio-cultural background, household-dynamics and clinical data were collected. Of 301 women, 49 % had <200 CD4 cells/mm3, 8 % were illiterate, 31 % had only primary school. Physical/sexual violence was reported by 47/30 %; 75 % acquired HIV from their stable partners. Prenatal HIV screening was not offered in 61 %; 40 % attended consultation for HIV-related symptoms without being tested for HIV. Seeking medical care ≥3 times before diagnosis was associated with baseline CD4 <200 cells/mm3 (adjusted OR 3.74, 95 % CI 1.88-7.45, p < 0.001). There were missed opportunities during prenatal screening and when symptomatic women seeked medical care. Primary care needs to be improved and new strategies implemented for early diagnosis in women.
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Affiliation(s)
| | | | - Victoria Alvarez-Wyssmann
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Delegación Tlalpan, 14000, Mexico City, DF, Mexico
| | | | | | | | - Indiana Torres-Escobar
- Facultad de Medicina de la Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
- CAPASITS, Puebla, Mexico
| | - Juan Sierra-Madero
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Delegación Tlalpan, 14000, Mexico City, DF, Mexico.
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12
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Abstract
It has been previously shown that patients may present for multiple health issues in the years preceding their initial HIV diagnosis. This retrospective cohort study analyzed the data of patients with a new HIV diagnosis, at Ochsner Health System between January 1, 2011, and December 31, 2012. The primary end point was missed opportunities, the number of healthcare visits these patients made in the 2 years prior to being diagnosed with HIV. The 125 patients in the study cohort had 649 healthcare visits during which an HIV test was not performed. These missed opportunities are the key to capturing the undiagnosed and unaware HIV-positive individual. Primary care is an ideal setting to conduct HIV testing for those who have access to regular health care. However, nontraditional providers should also be encouraged to conduct HIV testing regardless of their ability to provide treatment because evidence shows that knowledge of the diagnosis may change behavior.
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Affiliation(s)
- Asia Downing
- 1 Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Julia B Garcia-Diaz
- 2 Department of Infectious Diseases, Ochsner Clinic Foundation, New Orleans, LA, USA.,3 Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
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13
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Wigfall LT, Bynum SA, Friedman DB, Brandt HM, Richter DL, Glover SH, Hébert JR. Patient-provider communication with HIV-positive women about abnormal Pap test results. Women Health 2016; 57:19-39. [PMID: 26886433 DOI: 10.1080/03630242.2016.1150386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In this article, the authors examine communication between women living with human immunodeficiency virus (WLH) and health care providers (HCPs) regarding abnormal Pap tests. During the period of March 2011 through April 2012, 145 WLH were recruited from Ryan White funded clinics and community-based AIDS service organizations located in the southeastern United States. WLH who had an abnormal Pap test (69%, n = 100/145) were asked if their HCP shared and explained information about abnormal Pap tests. The authors performed chi-square tests and multivariable logistic regression analyses using Stata I/C 13. HCPs shared information about abnormal Pap tests with 60% of participants, and explained the information they shared to 78% of those. Health literate participants were more than three times as likely to have read the information received about abnormal Pap tests (adjusted odds ratio [aOR] = 3.49, 95% confidence interval [CI] 1.19-10.23), and almost five times as likely to have understood the cancer information they read (aOR = 4.70, 95% CI 1.55-14.24). Knowing other women who had had an abnormal Pap test was not significantly associated with cancer information seeking or processing after controlling for confounding factors. The present findings underscore the need to increase WLH's health literacy as an intermediate step to improving patient-provider communication among WLH. Lay sources of cancer information for WLH warrant further study.
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Affiliation(s)
- Lisa T Wigfall
- a Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA.,b Department of Health Services Policy and Management, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
| | - Shalanda A Bynum
- c Department of Preventive Medicine and Biometrics, F. Edward Hébert School of Medicine , Uniformed Services University of the Health Sciences , Bethesda , Maryland , USA
| | - Daniela B Friedman
- d South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA.,e Department of Health Promotion, Education, and Behavior, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
| | - Heather M Brandt
- d South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA.,e Department of Health Promotion, Education, and Behavior, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
| | - Donna L Richter
- d South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
| | - Saundra H Glover
- a Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA.,b Department of Health Services Policy and Management, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
| | - James R Hébert
- d South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA.,f Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA
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14
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IAPAC Guidelines for Optimizing the HIV Care Continuum for Adults and Adolescents. J Int Assoc Provid AIDS Care 2015; 14 Suppl 1:S3-S34. [PMID: 26527218 DOI: 10.1177/2325957415613442] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND An estimated 50% of people living with HIV (PLHIV) globally are unaware of their status. Among those who know their HIV status, many do not receive antiretroviral therapy (ART) in a timely manner, fail to remain engaged in care, or do not achieve sustained viral suppression. Barriers across the HIV care continuum prevent PLHIV from achieving the therapeutic and preventive effects of ART. METHODS A systematic literature search was conducted, and 6132 articles, including randomized controlled trials, observational studies with or without comparators, cross-sectional studies, and descriptive documents, met the inclusion criteria. Of these, 1047 articles were used to generate 36 recommendations to optimize the HIV care continuum for adults and adolescents. RECOMMENDATIONS Recommendations are provided for interventions to optimize the HIV care environment; increase HIV testing and linkage to care, treatment coverage, retention in care, and viral suppression; and monitor the HIV care continuum.
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15
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Wigfall LT, Brandt HM, Kirby H, Iyer M, Levkoff SE, Glover SH. HIV Testing Among Financially Disadvantaged Women Diagnosed with Cervical Cancer. J Womens Health (Larchmt) 2014; 23:714. [DOI: 10.1089/jwh.2014.4895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lisa T. Wigfall
- Institute for Partnerships to Eliminate Health Disparities, University of South Carolina, Columbia, South Carolina
| | - Heather M. Brandt
- Department of Health Promotion, Education, and Behavior Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina
| | - Heather Kirby
- Health and Demographics Section, Office of Research and Statistics, South Carolina Budget and Control Board, Columbia, South Carolina
| | - Medha Iyer
- South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Sue E. Levkoff
- College of Social Work, University of South Carolina, Columbia, South Carolina
| | - Saundra H. Glover
- Institute for Partnerships to Eliminate Health Disparities, University of South Carolina, Columbia, South Carolina
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16
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Yombi JC, Jonckheere S, Vincent A, Wilmes D, Vandercam B, Belkhir L. Late presentation for human immunodeficiency virus HIV diagnosis results of a Belgian single centre. Acta Clin Belg 2014; 69:33-9. [PMID: 24635397 DOI: 10.1179/0001551213z.00000000014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Antiretroviral therapy reduces mortality and morbidity in HIVinfected individuals, most markedly when initiated early, before advanced immunodeficiency has developed. Although the international guidelines recommend starting antiretroviral therapy ART with a high CD4 cell count level, in the practice, this is particularly challenging to achieve, especially in late presentation of HIV diagnosis. The aim of this study was to determine the frequency and the demographic features associated with late presentation for HIV diagnosis in our Centre. METHODS All newly diagnosed patients with HIV between January 2007 and December 2011 in our AIDS Reference Centre, were included. Late presenter patient was defined as patient with CD4 count 350/mm(3) at the time of diagnosis. Demographic age, sex, ethnicity, migration and clinical characteristics transmission mode, CD4 cell count, viral load were collected. We also collected data on outcome median day of hospitalization, mortality, virological response to ART and lost to followup LTFU. LTFU was defined as patient without any medical contact and viral load measurements during two consecutive years in our centre. RESULTS From 2007 to 2011, 154 429 out of 359 patients newly diagnosed with HIV were late presenters. According to univariate analysis, age 50, female gender, migrant from subSaharan Africa and heterosexual contact were associated with late presentation for HIV diagnosis. In the multivariate analysis, age 50, heterosexual contact and migrant status particularly women were the only independent risk factors for late presentation. Late presenters tend to have a worse outcome than nonlate presenters. CONCLUSION A considerable proportion of patients continue to be diagnosed with advanced HIV disease, despite the fact that risk factors for late presentation have been clearly identified. Despite high testing rate for HIV in Belgium, highrisk population like migrant, heterosexual contact, remain under tested. In order to be able to detect and treat all patients with high CD4 cell count as recommended by all international guidelines, we recommend developing testing policies specifically focused on these categories at high risk for late presentation.
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Reilly KH, Neaigus A, Jenness SM, Hagan H, Wendel T, Gelpí-Acosta C. High HIV prevalence among low-income, Black women in New York City with self-reported HIV negative and unknown status. J Womens Health (Larchmt) 2013; 22:745-54. [PMID: 23931126 DOI: 10.1089/jwh.2013.4341] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Black women are disproportionally affected by human immunodeficiency virus (HIV). This study investigates factors associated with newly identified HIV infection among previously self-reported HIV negative or unknown status black women living in high risk areas (HRAs) of New York City (NYC). METHODS Heterosexuals residing in or socially connected to NYC HRAs were recruited using respondent driven sampling for participation in the United States Centers for Disease Control-sponsored National HIV Behavioral Surveillance System in 2010. Eligible individuals were interviewed and offered an HIV test. The analysis reported here focused on black women with valid HIV results who did not report being HIV positive, and examined factors related to HIV infection in this group. RESULTS Of 153 black women who did not report being HIV positive at enrollment, 15 (9.8%) tested HIV positive. Age ≥40 years, ever injected drugs, and in the last 12 months had unprotected vaginal sex, exchange sex, last sex partner used crack, non-injection crack use, and non-injection heroin use were significantly associated with HIV infection (p<0.05). Only ever injected drugs (prevalence ratio: 5.1; 95% confidence interval: 2.0, 12.9) was retained in the final model. CONCLUSIONS Black women who had reported being either HIV negative or unaware of their serostatus had high HIV prevalence. Efforts to identify and treat HIV positive black women in HRAs should target those with a history of injection drug use. Frequent testing for HIV should be promoted in HRAs.
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Affiliation(s)
- Kathleen H Reilly
- HIV Epidemiology Program, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA.
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Haberl A, Johnson M, Dominguez S, Miralles C, d’Arminio Monforte A, Anderson J. The need for data on women living with HIV in Europe. Antivir Ther 2013; 18 Suppl 2:1-10. [DOI: 10.3851/imp2640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2013] [Indexed: 10/26/2022]
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Affiliation(s)
- S Duncan
- Specialty Registrar Genitourinary Medicine, The Garden Clinic, Upton Hospital, Slough, UK.
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