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Nanyeenya N, Kiwanuka N, Nakanjako D, Nakigozi G, Kibira SP, Nabadda S, Kiyaga C, Sewanyana I, Nasuuna E, Makumbi F. Low-level viraemia: An emerging concern among people living with HIV in Uganda and across sub-Saharan Africa. Afr J Lab Med 2022; 11:1899. [PMID: 36353193 PMCID: PMC9639359 DOI: 10.4102/ajlm.v11i1.1899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/29/2022] [Indexed: 11/04/2023] Open
Abstract
Attaining viral load (VL) suppression for over 95% of the people living with HIV on antiretroviral therapy is a fundamental step in enabling Uganda and other sub-Saharan African countries to achieve global Sustainable Development Goal targets to end the HIV/AIDS epidemic by 2030. In line with the 2013 World Health Organization recommendations, several sub-Saharan African countries, including Uganda, use a threshold of 1000 HIV viral RNA copies/mL to determine HIV viral non-suppression. The United States Centers for Disease Control and Prevention and the International Association of Providers of AIDS Care deem this threshold very high, and hence recommend using 200 copies/mL to determine viral non-suppression. Using 1000 copies/mL as a threshold ignores people living with HIV who have low-level viraemia (LLV; HIV VL of at least 50 copies/mL but less than 1000 copies/mL). Despite the 2021 World Health Organization recommendations of using intensive adherence counselling for people living with HIV with LLV, several sub-Saharan African countries have no interventions to address LLV. However, recent studies have associated LLV with increased risks of HIV drug resistance, virologic failure and transmission. The purpose of this narrative review is to provide insights on the emerging concern of LLV among people living with HIV receiving antiretroviral therapy in sub-Saharan Africa. The review also provides guidance for Uganda and other sub-Saharan African countries to implement immediate appropriate interventions like intensive adherence counselling, reducing VL thresholds for non-suppression and conducting more research to manage LLV which threatens progress towards ending HIV by 2030.
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Affiliation(s)
- Nicholus Nanyeenya
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Simon P.S. Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Susan Nabadda
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Charles Kiyaga
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Isaac Sewanyana
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Esther Nasuuna
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Haider MR, Brown MJ, Harrison S, Yang X, Ingram L, Bhochhibhoya A, Hamilton A, Olatosi B, Li X. Sociodemographic factors affecting viral load suppression among people living with HIV in South Carolina. AIDS Care 2021; 33:290-298. [PMID: 31856584 PMCID: PMC7302958 DOI: 10.1080/09540121.2019.1703892] [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] [Received: 06/10/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
Adherence to antiretroviral therapy (ART) enables people living with HIV (PLWH) to reach and maintain viral suppression. As viral suppression significantly reduces risk for secondary transmission, this study aimed to examine sociodemographic factors associated with viral suppression among PLWH in South Carolina (SC). We analyzed cross-sectional data collected from 342 PLWH receiving HIV care from a large clinic in SC and provided complete information on most recent viral load, ART adherence, and sociodemographic factors. Bivariate analysis examined associations between key variables, and logistic regression was used to calculate the odds of viral suppression among select sociodemographic groups and adherence levels. Results indicated that approximately 82% of participants reported achieving viral suppression. PLWH who were older, male, and employed full-time had higher odds of being virally suppressed compared to those who were younger, female, and unemployed. PLWH with medium (adjusted Odds Ratio [aOR]: 3.79; 95% CI: 1.15-12.48) and high (aOR: 3.51; 95% CI: 1.21-10.24) levels of adherence were more likely to report viral suppression than those with low adherence. Targeted interventions are warranted for groups at-risk of low ART adherence, and healthcare providers should also be aware of contextual factors that serve as barriers to adherence for PLWH.
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Affiliation(s)
- Mohammad Rifat Haider
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Monique J. Brown
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sayward Harrison
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | | | - Amir Bhochhibhoya
- William Preston Turner School of Nursing, Lander University, Greenwood, SC, USA
| | - Akeen Hamilton
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Muttai H, Guyah B, Musingila P, Achia T, Miruka F, Wanjohi S, Dande C, Musee P, Lugalia F, Onyango D, Kinywa E, Okomo G, Moth I, Omondi S, Ayieko C, Nganga L, Joseph RH, Zielinski-Gutierrez E. Development and Validation of a Sociodemographic and Behavioral Characteristics-Based Risk-Score Algorithm for Targeting HIV Testing Among Adults in Kenya. AIDS Behav 2021; 25:297-310. [PMID: 32651762 PMCID: PMC7846530 DOI: 10.1007/s10461-020-02962-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
To inform targeted HIV testing, we developed and externally validated a risk-score algorithm that incorporated behavioral characteristics. Outpatient data from five health facilities in western Kenya, comprising 19,458 adults ≥ 15 years tested for HIV from September 2017 to May 2018, were included in univariable and multivariable analyses used for algorithm development. Data for 11,330 adults attending one high-volume facility were used for validation. Using the final algorithm, patients were grouped into four risk-score categories: ≤ 9, 10-15, 16-29 and ≥ 30, with increasing HIV prevalence of 0.6% [95% confidence interval (CI) 0.46-0.75], 1.35% (95% CI 0.85-1.84), 2.65% (95% CI 1.8-3.51), and 15.15% (95% CI 9.03-21.27), respectively. The algorithm's discrimination performance was modest, with an area under the receiver-operating-curve of 0.69 (95% CI 0.53-0.84). In settings where universal testing is not feasible, a risk-score algorithm can identify sub-populations with higher HIV-risk to be prioritized for HIV testing.
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Affiliation(s)
- Hellen Muttai
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya.
| | - Bernard Guyah
- School of Public Health, Maseno University, Kisumu, Kenya
| | - Paul Musingila
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
| | - Thomas Achia
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
| | - Fredrick Miruka
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
| | | | - Caroline Dande
- University of California at San Francisco, Kisumu, Kenya
| | - Polycarp Musee
- Elizabeth Glaser Pediatric AIDS Foundation, Homa Bay, Kenya
| | | | | | | | - Gordon Okomo
- Homa Bay County Department of Health, Homa Bay, Kenya
| | - Iscah Moth
- Homa Bay County Department of Health, Homa Bay, Kenya
| | | | | | - Lucy Nganga
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
| | - Rachael H Joseph
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
| | - Emily Zielinski-Gutierrez
- Division of Global HIV & TB (DGHT), United States Centers for Disease Control and Prevention (CDC), Kenya, KEMRI Campus, P.O. Box 606, Nairobi, 00621, Kenya
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Mwangwa F, Getahun M, Itiakorit H, Jain V, Ayieko J, Owino L, Akatukwasa C, Maeri I, Koss CA, Chamie G, Clark TD, Kabami J, Atukunda M, Kwarisiima D, Sang N, Bukusi EA, Kamya MR, Petersen ML, Cohen CR, Charlebois ED, Havlir DV, Camlin CS. Provider and Patient Perspectives of Rapid ART Initiation and Streamlined HIV Care: Qualitative Insights From Eastern African Communities. J Int Assoc Provid AIDS Care 2021; 20:23259582211053518. [PMID: 34841945 PMCID: PMC8641109 DOI: 10.1177/23259582211053518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022] Open
Abstract
The Sustainable East Africa Research in Community Health (SEARCH), a universal test and treat (UTT) trial, implemented 'Streamlined Care'-a multicomponent strategy including rapid linkage to care and antiretroviral therapy (ART) start, 3-monthly refills, viral load counseling, and accessible, patient-centered care provision. To understand patient and provider experiences of Streamlined Care to inform future care innovations, we conducted in-depth interviews with patients (n = 18) and providers (n = 28) at baseline (2014) and follow-up (2015) (n = 17 patients; n = 21 providers). Audio recordings were transcribed, translated, and deductively and inductively coded. Streamlined Care helped to decongest clinic spaces and de-stigmatize human immunodeficiency virus (HIV) care. Patients credited the individualized counselling, provider-assisted HIV status disclosure, and providers' knowledge of patient's drug schedules, availability, and phone call reminders for their care engagement. However, for some, denial (repeated testing to disprove HIV+ results), feeling healthy, limited understanding of the benefits of early ART, and anticipated side-effects, and mistrust of researchers hindered rapid ART initiation. Patients' short and long-term mobility proved challenging for both patients and providers. Providers viewed viral load counselling as a powerful tool to convince otherwise healthy and high-CD4 patients to initiate ART. Patient-centered HIV care models should build on the successes of Streamlined Care, while addressing persistent barriers.#NCT01864683-https://clinicaltrials.gov/ct2/show/NCT01864603.
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Affiliation(s)
| | | | | | - Vivek Jain
- University of California San Francisco, San Francisco, USA
| | - James Ayieko
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Irene Maeri
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Gabriel Chamie
- University of California San Francisco, San Francisco, USA
| | | | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | - Norton Sang
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | | | | | - Carol S. Camlin
- University of California San Francisco, San Francisco, USA
- University of California, San Francisco, San Francisco, CA, USA
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Tun W, Go V, Yansaneh A. Implementation Science: Helping to Accelerate Progress Toward Achieving the 90-90-90 Goal. AIDS Behav 2019; 23:115-119. [PMID: 31512068 PMCID: PMC6773667 DOI: 10.1007/s10461-019-02649-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Waimar Tun
- HIV and AIDS Program, Population Council, 4301 Connecticut Avenue, NW, Suite 280, Washington, DC, 20008, USA.
| | - Vivian Go
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Aisha Yansaneh
- United States Agency for International Development (USAID), Washington, DC, USA
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Care continuum entry interventions: seek and test strategies to engage persons most impacted by HIV within the United States. AIDS 2018; 32:407-417. [PMID: 29381558 DOI: 10.1097/qad.0000000000001733] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
: The current review re-conceptualizes seek and test strategies, particularly given the changing importance of HIV testing as care continuum entry for persons irrespective of their HIV status. Care continuum entry advances previous seek and test strategies for client engagement with two next-generation functions: use of testing to engage (or re-engage) HIV negative clients in preexposure prophylaxis (PrEP) care; and testing individuals who may already be known positives for care continuum re-entry. We review existing seek and test strategies for most impacted community members with a goal of optimizing care continuum entry as we move towards HIV transmission elimination. These strategies are context, sub-group, community and epidemic-specific. This review is timely, given the initiation of routine PrEP care, which shifts and broadens our conceptualization of care continuum entry triggered by the HIV testing event. In addition, as the epidemic becomes more concentrated, focusing on re-engagement of HIV-infected persons becomes increasingly important given that transmission events involve both those acutely and newly infected as well as the large numbers who may not be virally suppressed. We start with examination of routine testing in healthcare settings, emphasizing its potential role in re-engagement for persons out of care. Subsequently, we describe risk-based testing to identify key populations. We then review network-based approaches and their impact on the epidemic. We close with future directions for individual and combination care continuum entry strategies most relevant to elimination of HIV transmission in the United States.
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Sousa AIAD, Pinto VL. Community viral load of HIV in Brazil, 2007 - 2011: potential impact of highly active antiretroviral therapy (HAART) in reducing new infections. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 19:582-593. [PMID: 27849272 DOI: 10.1590/1980-5497201600030009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 02/03/2016] [Indexed: 11/21/2022] Open
Abstract
Objectives: To estimate the human immunodeficiency virus (HIV) viral load in the Brazilian population and to assess the potential impact of highly active antiretroviral therapy (HAART) in reducing new infections to build evidences and to gather information to support health policies. Methods: Spatial analysis and modeling tools were used to describe the existing patterns of the viral load density, using the Kernel method. Data on viral load and treatment were retrieved from the databases Laboratory Tests Control System (SISCEL), which contains information on the individual's history of viral load, and Medication Logistics Control System (SICLOM), which controls the dispensing of drugs used for antiretroviral therapy. Results: It was observed that the community viral load (CVL) decreased progressively from 2007 to 2011, accompanied by a decrease of more than 32% in the mean CVL (CVLM) - 22,900 copies/mL in 2007 versus 15,418 copies/mL in 2011. During this period, there was a reduction of CVLM in all regions of Brazil, although North and Northeast showed, respectively, CVLM 1.7 and 1.5 times higher than that in the Southeast region. A comparison between the individuals who underwent and who did not undergo HAART showed an increase of up to 3.9 times in 2011 in the viral load among those who did not undergo the therapy. Conclusion: The approach presented in this study indicates the existence of clusters with high concentrations. The use of Kernel in the identification of clusters proved to be a good tool for exploratory analysis, enabling the risk identification in certain geographic areas without the usual political and administrative divisions.
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Affiliation(s)
- Artur Iuri Alves de Sousa
- Universidade de Brasília, Faculdade de Medicina, Núcleo de Medicina Tropical - Brasília (DF), Brasil
| | - Vitor Laerte Pinto
- Fundação Oswaldo Cruz, Diretoria Regional de Brasília - Brasília (DF), Brasil
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van Griensven F, Guadamuz TE, de Lind van Wijngaarden JW, Phanuphak N, Solomon SS, Lo YR. Challenges and emerging opportunities for the HIV prevention, treatment and care cascade in men who have sex with men in Asia Pacific. Sex Transm Infect 2017; 93:356-362. [PMID: 28729520 DOI: 10.1136/sextrans-2016-052669] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/19/2017] [Accepted: 06/03/2017] [Indexed: 01/23/2023] Open
Abstract
In Asia Pacific, most countries have expanded HIV treatment guidelines to include all those with HIV infection and adopted antiretroviral treatment for prevention (TFP) as a blanket strategy for HIV control. Although the overall epidemic development associated with this focus is positive, the HIV epidemic in men who have sex with men (MSM) is continuing unperturbed without any signs of decline or reversal. This raises doubt about whether TFP as a blanket HIV prevention policy is the right approach. This paper reviews currently available biomedical HIV prevention strategies, national HIV prevention policies and guidelines from selected countries and published data on the HIV cascade in MSM. No evidence for efficacy of TFP in protecting MSM from HIV infection was found. The rationale for this approach is based on assumptions about biological plausibility and external validity of latency-based efficacy found in heterosexual couples. This is different from the route and timing of HIV transmission in MSM. New HIV infections in MSM principally occur in chains of acutely HIV-infected highly sexually active young men, in whom acquisition and transmission are correlated in space and time. By the time TFP renders its effects, most new HIV infections in MSM will have already occurred. On a global level, less than 6% of all reports regarding the HIV care cascade from 1990 to 2016 included MSM, and only 2.3% concerned MSM in low/middle-income countries. Only one report originated from Asia Pacific. Generally, HIV cascade data in MSM show a sobering picture of TFP in engaging and retaining MSM along the continuum. Widening the cascade with a preventive extension, including pre-exposure prophylaxis, the first proven efficacious and only biomedical HIV prevention strategy in MSM, will be instrumental in achieving HIV epidemic control in this group.
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Affiliation(s)
- Frits van Griensven
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Thomas E Guadamuz
- Department of Society and Health, Mahidol University, Nakorn Pathom, Thailand
| | | | - Nittaya Phanuphak
- Prevention Department, Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | - Sunil Suhas Solomon
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ying-Ru Lo
- HIV, Hepatitis and STI Unit, Regional Office for the Western Pacific, World Health Organization, Manila, Philippines
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Robbins GK, Cohn SE, Harrison LJ, Smeaton L, Moran L, Rusin D, Dehlinger M, Flynn T, Lammert S, Wu AW, Safren SA, Reynolds NR. Characteristics associated with virologic failure in high-risk HIV-positive participants with prior failure: a post hoc analysis of ACTG 5251. HIV CLINICAL TRIALS 2017; 17:165-72. [PMID: 27347650 DOI: 10.1080/15284336.2016.1189754] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
UNLABELLED Patients with prior virologic failure (VF) are at an increased risk of subsequent failure, emergence of resistance, and death. This analysis identifies outcomes and correlates of VF in a high-risk population. METHODS A5251 was designed to evaluate an enhanced adherence counseling intervention delivered by nurses from a central call site on virologic suppression. Due to slow enrollment, the study was closed prematurely and revised study endpoints were evaluated (week 24 VF (HIV-1 RNA ≥200 copies/ml) and non-perfect adherence (<100% self-reported using both the ACTG adherence questionnaire and visual analog scale (VAS)). RESULTS Fifty-nine participants were enrolled, 43 (73%) black non-Hispanic and 23 (39%) women. Median prior antiretroviral regimen changes were three and the co-morbidity in this population was higher than typical for HIV clinical trials. At week 24 (n = 41), 24 (59%) failed to reach virologic suppression (HIV-1 RNA <200 copies/ml) and 25 (63%) reported non-perfect adherence. Higher depression (CES-D10) and adverse illness perceptions (IPQ-B) were associated with week 24 non-adherence. Early clinical assessments (week 12 HIV-RNA ≥200 copies/mL and non-perfect adherence) as well as higher depression and adverse illness perceptions were associated with week 24 VF. DISCUSSION In this high-risk population, the proportion of participants with suboptimal adherence and VF was unacceptably high. Interventions to address this treatment gap are clearly needed. Depression and a higher illness perception score, failure to achieve virologic suppression by week 12, and less than perfect adherence could be used to target individuals for early interventions in treatment-experienced, high-risk individuals at high risk for VF.
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Affiliation(s)
- Gregory K Robbins
- a Massachusetts General Hospital/Harvard Medical School , Boston, MA , USA
| | - Susan E Cohn
- b Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago, IL , USA
| | - Linda J Harrison
- c Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health , Boston, MA , USA
| | - Laura Smeaton
- c Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health , Boston, MA , USA
| | - Laura Moran
- d Social and Scientific Systems, Inc , Silver Spring, MD , USA
| | - David Rusin
- e Frontier Science & Technology Research Foundation , Amherst, NY , USA
| | - Marjorie Dehlinger
- f National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, MD , USA
| | - Theresa Flynn
- a Massachusetts General Hospital/Harvard Medical School , Boston, MA , USA
| | - Sara Lammert
- a Massachusetts General Hospital/Harvard Medical School , Boston, MA , USA
| | - Albert W Wu
- g Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA
| | - Steven A Safren
- h Department of Psychology , University of Miami , Coral Gables, FL , USA
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Reynolds NR, Satyanarayana V, Duggal M, Varghese M, Liberti L, Singh P, Ranganathan M, Jeon S, Chandra PS. MAHILA: a protocol for evaluating a nurse-delivered mHealth intervention for women with HIV and psychosocial risk factors in India. BMC Health Serv Res 2016; 16:352. [PMID: 27491288 PMCID: PMC4973541 DOI: 10.1186/s12913-016-1605-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 07/29/2016] [Indexed: 01/12/2023] Open
Abstract
Background Women living with HIV are vulnerable to a variety of psychosocial barriers that limit access and adherence to treatment. There is little evidence supporting interventions for improving access and treatment adherence among vulnerable groups of women in low- and middle-income countries. The Mobile Phone-BasedApproach forHealthImprovement,Literacy andAdherence (MAHILA) trial is assessing the feasibility, acceptability and preliminary efficacy of a novel, theory-guided mobile health intervention delivered by nurses for enhancing self-care and treatment adherence among HIV-infected women in India. Methods/Design Women (n = 120) with HIV infection who screen positive for depressive symptoms and/or other psychosocial vulnerabilities are randomly assigned in equal numbers to one of two treatment arms: treatment as usual plus the mobile phone intervention (experimental group) or treatment as usual (control group). In addition to treatment as usual, the experimental group receives nurse-delivered self-care counselling via mobile phone at fixed intervals over 16 weeks. Outcome measures are collected at baseline and at 4, 12, 24 and 36 weeks post-baseline. Outcomes include antiretroviral treatment adherence, HIV-1 RNA, depressive symptoms, illness perceptions, internalized stigma and quality of life. Discussion The MAHILA trial will provide information about how a mobile health counselling intervention delivered by non specialist nurses may improve access to care and support the adherence and clinical outcomes of women with HIV infection living in low- and middle-income countries such as India. Trial registration NCT02319330 (First received: July 30, 2014; Last verified: January 2016)
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Affiliation(s)
- Nancy R Reynolds
- Division of Acute Care/Health Systems, School of Nursing, Yale University, 400 West Campus Drive, West Haven, CT, 06516, USA.
| | - Veena Satyanarayana
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, 560029, India
| | - Mona Duggal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Meiya Varghese
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560029, India
| | - Lauren Liberti
- Division of Acute Care/Health Systems, School of Nursing, Yale University, 400 West Campus Drive, West Haven, CT, 06516, USA
| | - Pushpendra Singh
- Indraprastha Institute of Information Technology (IIIT-D), B-304, Academic Block, Okhla Phase III, New Delhi, 110020, India
| | - Mohini Ranganathan
- Department of Psychiatry, Yale University, School of Medicine, 300 George Street, New Haven, CT, 06511, USA
| | - Sangchoon Jeon
- Division of Acute Care/Health Systems, School of Nursing, Yale University, 400 West Campus Drive, West Haven, CT, 06516, USA
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560029, India.
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Rutenberg N, Tun W, Borse NN. Lessons learned and study results from HIVCore: an HIV implementation science initiative. J Int AIDS Soc 2016; 19:21194. [PMID: 27443275 PMCID: PMC4956738 DOI: 10.7448/ias.19.5.21194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/13/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Naomi Rutenberg
- HIV and AIDS Program, Population Council, Washington, DC, USA
| | - Waimar Tun
- HIV and AIDS Program, Population Council, Washington, DC, USA;
| | - Nagesh N Borse
- Research Division, Office of HIV and AIDS, US Agency for International Development (USAID), Washington, DC, USA
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12
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Lessons learned and study results from HIVCore, an HIV implementation science initiative. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.5.21261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Milloy MJ, Wood E, Kerr T, Hogg B, Guillemi S, Harrigan PR, Montaner J. Increased Prevalence of Controlled Viremia and Decreased Rates of HIV Drug Resistance Among HIV-Positive People Who Use Illicit Drugs During a Community-wide Treatment-as-Prevention Initiative. Clin Infect Dis 2015; 62:640-7. [PMID: 26553011 DOI: 10.1093/cid/civ929] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 10/24/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although treatment-as prevention (TasP) is a new cornerstone of global human immunodeficiency virus (HIV)-AIDS strategies, its effect among HIV-positive people who use illicit drugs (PWUD) has yet to be evaluated. We sought to describe longitudinal trends in exposure to antiretroviral therapy (ART), plasma HIV-1 RNA viral load (VL) and HIV drug resistance during a community-wide TasP intervention. METHODS We used data from the AIDS Care Cohort to Evaluate Exposure to Survival Services study, a prospective cohort of HIV-positive PWUD linked to HIV clinical monitoring records. We estimated longitudinal changes in the proportion of individuals with VL <50 copies/mL and rates of HIV drug resistance using generalized estimating equations (GEE) and extended Cox models. RESULTS Between 1 January 2006 and 30 June 2014, 819 individuals were recruited and contributed 1 or more VL observation. During that time, the proportion of individuals with nondetectable VL increased from 28% to 63% (P < .001). In a multivariable GEE model, later year of observation was independently and positively associated with greater likelihood of nondetectable VL (adjusted odds ratio = 1.20 per year; P < .001). Although the proportion of individuals on ART increased, the incidence of HIV drug resistance declined (adjusted hazard ratio = 0.78 per year; P = .011). CONCLUSIONS We observed significant improvements in several measures of exposure to ART and virologic status, including declines in HIV drug resistance, in this large long-running community-recruited cohort of HIV-seropositive illicit drug users during a community-wide ART expansion intervention. Our findings support continued efforts to scale up ART coverage among HIV-positive PWUD.
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Affiliation(s)
- M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver
| | - Bob Hogg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Silvia Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital
| | - P Richard Harrigan
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver
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Engstrom-Melnyk J, Rodriguez PL, Peraud O, Hein RC. Clinical Applications of Quantitative Real-Time PCR in Virology. METHODS IN MICROBIOLOGY 2015; 42:161-197. [PMID: 38620180 PMCID: PMC7148891 DOI: 10.1016/bs.mim.2015.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Since the invention of the polymerase chain reaction (PCR) and discovery of Taq polymerase, PCR has become a staple in both research and clinical molecular laboratories. As clinical and diagnostic needs have evolved over the last few decades, demanding greater levels of sensitivity and accuracy, so too has PCR performance. Through optimisation, the present-day uses of real-time PCR and quantitative real-time PCR are enumerable. The technique, combined with adoption of automated processes and reduced sample volume requirements, makes it an ideal method in a broad range of clinical applications, especially in virology. Complementing serologic testing by detecting infections within the pre-seroconversion window period and infections with immunovariant viruses, real-time PCR provides a highly valuable tool for screening, diagnosing, or monitoring diseases, as well as evaluating medical and therapeutic decision points that allows for more timely predictions of therapeutic failures than traditional methods and, lastly, assessing cure rates following targeted therapies. All of these serve vital roles in the continuum of care to enhance patient management. Beyond this, quantitative real-time PCR facilitates advancements in the quality of diagnostics by driving consensus management guidelines following standardisation to improve patient outcomes, pushing for disease eradication with assays offering progressively lower limits of detection, and rapidly meeting medical needs in cases of emerging epidemic crises involving new pathogens that may result in significant health threats.
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Affiliation(s)
- Julia Engstrom-Melnyk
- Medical and Scientific Affairs, Roche Diagnostic Corporation, Indianapolis, Indiana, USA
| | - Pedro L Rodriguez
- Medical and Scientific Affairs, Roche Diagnostic Corporation, Indianapolis, Indiana, USA
| | - Olivier Peraud
- Medical and Scientific Affairs, Roche Diagnostic Corporation, Indianapolis, Indiana, USA
| | - Raymond C Hein
- Medical and Scientific Affairs, Roche Diagnostic Corporation, Indianapolis, Indiana, USA
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15
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Chakraborty H, Iyer M, Duffus WA, Samantapudi AV, Albrecht H, Weissman S. Disparities in viral load and CD4 count trends among HIV-infected adults in South Carolina. AIDS Patient Care STDS 2015; 29:26-32. [PMID: 25458918 DOI: 10.1089/apc.2014.0158] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
On a population level, trends in viral load (VL) and CD4 cell counts can provide a marker of infectivity and an indirect measure of retention in care. Thus, observing the trend of CD4/VL over time can provide useful information on disparities in populations across the HIV care continuum when stratified by demography. South Carolina (SC) maintains electronic records of all CD4 cell counts and HIV VL measurements reported to the state health department. We examined temporal trends in individual HIV VLs reported in SC between January 1, 2005 and December 31, 2012 by using mixed effects models adjusting for gender, race/ethnicity, age, baseline CD4 count, HIV risk category, and residence. Overall VL levels gradually decreased over the observation period. There were significant differences in the VL decline by gender, age groups, rural/urban residence, and HIV risk exposure group. There were significant differences in CD4 increases by race/ethnicity, age groups, and HIV risk exposure group. However, the population VL declines were slower among individuals aged 13-19 years compared to older age groups (p<0.0001), among men compared to women (p=0.002), and among people living with HIV/AIDS (PLWHA) with CD4 count ≤200 cell/mm(3) compared to those with higher CD4 counts (p<0.0001). Significant disparities were observed in VL decline by gender, age, and CD4 counts among PLWHA in SC. Population based data such as these can help streamline and better target local resources to facilitate retention in care and adherence to medications among PLWHA.
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Affiliation(s)
- Hrishikesh Chakraborty
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Medha Iyer
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Wayne A. Duffus
- Division of Infectious Disease, Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Ashok Varma Samantapudi
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Helmut Albrecht
- Division of Infectious Disease, Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Sharon Weissman
- Division of Infectious Disease, Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina
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16
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Charest H, Doualla-Bell F, Cantin R, Murphy DG, Lemieux L, Brenner B, Hardy I, Moisi D, Lo E, Baril JG, Wainberg MA, Roger M, Tremblay C. A significant reduction in the frequency of HIV-1 drug resistance in Québec from 2001 to 2011 is associated with a decrease in the monitored viral load. PLoS One 2014; 9:e109420. [PMID: 25295725 PMCID: PMC4190276 DOI: 10.1371/journal.pone.0109420] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/25/2014] [Indexed: 11/18/2022] Open
Abstract
Background HIV drug resistance represents a major threat for effective treatment. We assessed the trends in the frequency of drug resistance mutations and the monitored viral load (VL) in treatment-naïve (TN) and treatment-experienced (TE) individuals infected with HIV-1 in Québec, Canada, between 2001 and 2011. Methods and Findings Resistance data were obtained from 4,105 and 5,086 genotypic tests performed on TN and TE patients, respectively. Concomitantly, 274,161 VL tests were carried out in the Province. Changes over time in drug resistance frequency and in different categories of VL were assessed using univariate logistic regression. Multiple logistic regression was used to evaluate associations between the rates of certain mutations and antiretroviral prescriptions. From 2001 to 2011, the proportion of undetectable VL test results continually increased, from 42.1% to 75.9%, while a significant decrease in the frequency of resistance mutations associated with protease inhibitors [PI (from 54% to 16%)], nucleoside [NRTI (from 78% to 37%) and non-nucleoside reverse transcriptase inhibitors [NNRTI (from 44% to 31%)] was observed in TE patients. In TN individuals, the overall frequency of transmitted drug resistance was 13.1%. A multiple logistic regression analysis indicated that the introduction of co-formulated emtricitabine/tenofovir or emtricitabine/tenofovir/efavirenz was positively associated with the decrease of the frequency of the M184I/V mutations observed overtime (p = 0.0004). Conclusions We observed a significant decrease in the frequency of drug resistance mutations in TE patients, concomitant with a decrease in the proportion of patients with detectable viremia. These findings may be related to both the increased potencies and adherence to therapy associated with newer antiretroviral regimens. Nevertheless, our data demonstrate that broad use of antiretrovirals does not increase the level of circulating drug resistant variants.
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Affiliation(s)
- Hugues Charest
- Laboratoire de santé publique du Québec/Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
- Département de microbiologie, infectiologie et immunologie, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
- * E-mail:
| | - Florence Doualla-Bell
- Laboratoire de santé publique du Québec/Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montréal, Québec, Canada
| | - Régis Cantin
- Laboratoire de santé publique du Québec/Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
| | - Donald G. Murphy
- Laboratoire de santé publique du Québec/Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
| | - Linda Lemieux
- Laboratoire de santé publique du Québec/Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
| | - Bluma Brenner
- McGill AIDS Center, Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Isabelle Hardy
- Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Daniela Moisi
- McGill AIDS Center, Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Ernest Lo
- Laboratoire de santé publique du Québec/Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | | | - Mark A. Wainberg
- McGill AIDS Center, Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Michel Roger
- Département de microbiologie, infectiologie et immunologie, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
- Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Cécile Tremblay
- Laboratoire de santé publique du Québec/Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
- Département de microbiologie, infectiologie et immunologie, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
- Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
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Mountain E, Pickles M, Mishra S, Vickerman P, Alary M, Boily MC. The HIV care cascade and antiretroviral therapy in female sex workers: implications for HIV prevention. Expert Rev Anti Infect Ther 2014; 12:1203-19. [PMID: 25174997 DOI: 10.1586/14787210.2014.948422] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
To achieve viral suppression and fully benefit from antiretroviral therapy (ART), it is important that individuals with HIV know that they are HIV infected, link to and remain in HIV care, start and remain on ART and adhere to treatment. In HIV epidemics where female sex workers (FSWs) are key drivers of HIV transmission, the extent to which FSWs use ART and engage in the HIV care cascade could have a considerable impact on HIV transmission from FSWs to the wider population. In this article we review the spectrum of FSW engagement in the HIV care cascade, look at the impact of the HIV care cascade and ART use among FSWs on population-level HIV transmission and discuss HIV prevention for FSWs in the context of ART and the HIV care cascade.
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Affiliation(s)
- Elisa Mountain
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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18
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Kulkarni SP, Shah KR, Sarma KV, Mahajan AP. Clinical uncertainties, health service challenges, and ethical complexities of HIV "test-and-treat": a systematic review. Am J Public Health 2013; 103:e14-23. [PMID: 23597344 PMCID: PMC3670656 DOI: 10.2105/ajph.2013.301273] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2013] [Indexed: 12/13/2022]
Abstract
Despite the HIV "test-and-treat" strategy's promise, questions about its clinical rationale, operational feasibility, and ethical appropriateness have led to vigorous debate in the global HIV community. We performed a systematic review of the literature published between January 2009 and May 2012 using PubMed, SCOPUS, Global Health, Web of Science, BIOSIS, Cochrane CENTRAL, EBSCO Africa-Wide Information, and EBSCO CINAHL Plus databases to summarize clinical uncertainties, health service challenges, and ethical complexities that may affect the test-and-treat strategy's success. A thoughtful approach to research and implementation to address clinical and health service questions and meaningful community engagement regarding ethical complexities may bring us closer to safe, feasible, and effective test-and-treat implementation.
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Affiliation(s)
- Sonali P Kulkarni
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA 90005, USA.
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Loutfy MR, Wu W, Letchumanan M, Bondy L, Antoniou T, Margolese S, Zhang Y, Rueda S, McGee F, Peck R, Binder L, Allard P, Rourke SB, Rochon PA. Systematic review of HIV transmission between heterosexual serodiscordant couples where the HIV-positive partner is fully suppressed on antiretroviral therapy. PLoS One 2013; 8:e55747. [PMID: 23418455 PMCID: PMC3572113 DOI: 10.1371/journal.pone.0055747] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 12/31/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The risk of sexual HIV transmission in serodiscordant couples when the HIV-positive partner has full virologic suppression on combination antiretroviral therapy (cART) is debated. This study aims to systematically review observational studies and randomized controlled trials (RCTs), evaluating rates of sexual HIV transmission between heterosexual serodiscordant couples when the HIV-positive partner has full suppression on cART. METHODS AND FINDINGS We searched major bibliographic databases to November 2012 for relevant observational studies and RCTs without language restrictions. Conference proceedings, key journals and bibliographies were also searched. Studies reporting HIV transmission rates, cART histories and viral loads of the HIV-positive partners were included. Two reviewers extracted methodologic characteristics and outcomes. Of 20,252 citations, 3 studies met all eligibility criteria with confirmed full virologic suppression in the HIV-positive partner. We included 3 additional studies (2 cohort studies, 1 RCT) that did not confirm viral suppression in the HIV-positive partner at transmission in a secondary meta-analysis. Methodologic quality was reasonable. The rate of transmission in the 3 studies confirming virologic suppression was 0 per 100 person-years (95% CI = 0-0.05), with low heterogeneity (I(2) = 0%). When we included the 3 studies that did not confirm virologic suppression, the rate of transmission was 0.14 per 100 person-years (95%CI = 0.04-0.31) (I(2) = 0%). In a sensitivity analysis including all 6 studies, the rate of transmission was 0 per 100 person-years (95%CI = 0-0.01) after omitting all transmissions with known detectable or unconfirmed viral loads, as full suppression in these cases was unlikely. Limitations included lack of data on same-sex couples, type of sexual intercourse (vaginal vs. anal), direction of HIV transmission, exact viral load at the time of transmission, sexually transmitted infections (STI) rates, and extent of condom use. CONCLUSIONS Our findings suggest minimal risk of sexual HIV transmission for heterosexual serodiscordant couples when the HIV-positive partner has full viral suppression on cART with caveats regarding information on sexual intercourse type, STIs, and condom use. These findings have implications when counseling heterosexual serodiscordant couples on sexual and reproductive health. More research is needed to explore HIV transmission risk between same-sex couples.
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Affiliation(s)
- Mona R Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada.
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20
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Abstract
Cash payments to improve health outcomes have been used for many years; however, their use for HIV prevention is new and the impact not yet well understood. We provide a brief background on the rationale behind using cash to improve health outcomes, review current studies completed or underway using cash for prevention of sexual transmission of HIV, and outline some key considerations on the use of cash payments to prevent HIV infections. We searched the literature for studies that implemented cash transfer programs and measured HIV or HIV-related outcomes. We identified 16 studies meeting our criteria; 10 are completed. The majority of studies have been conducted with adolescents in developing countries and payments are focused on addressing structural risk factors such as poverty. Most have seen reductions in sexual behavior and one large trial has documented a difference in HIV prevalence between young women getting cash transfers and those not. Cash transfer programs focused on changing risky sexual behaviors to reduce HIV risk suggest promise. The context in which programs are situated, the purpose of the cash transfer, and the population will all affect the impact of such programs; ongoing RCTs with HIV incidence endpoints will shed more light on the efficacy of cash payments as strategy for HIV prevention.
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Perception of vulnerability to HIV infection among older people in Nairobi, Kenya: a need for intervention. J Biosoc Sci 2012; 45:249-66. [PMID: 22795035 DOI: 10.1017/s0021932012000417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
It is evident that sexual activity tends to decrease with age. Nonetheless, it is still prevalent enough to be considered a risk factor for the spread of HIV among older people. This paper uses quantitative data for 2053 individuals to examine HIV risk perception and correlates of perceived risk among older people aged 50 years and older living in Nairobi slums. It emerged that a majority of older people did not consider themselves at risk of infection. Of those who felt at risk, a greater proportion sensed only a small chance of contracting HIV. Women cited 'no sexual activity' while men mentioned 'having only one and/or a faithful sexual partner' as the primary reasons for perceiving minimal risk of HIV infection. There were no differences by sex in the basis for perceiving moderate-to-great risk of infection. Religion is a key factor in risk perception with Muslims perceiving higher levels of risk and, conversely, devotees irrespective of faith perceiving lower levels of risk. Older people willing to be tested for HIV had a decreased likelihood of perceived risk compared with those unwilling to be tested. This paper recommends evaluation of older people's perception of risk in order to better inform interventions aimed at minimizing their vulnerability to HIV infection.
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