1
|
Cabrera-Rodríguez R, Pérez-Yanes S, Estévez-Herrera J, Márquez-Arce D, Cabrera C, Espert L, Blanco J, Valenzuela-Fernández A. The Interplay of HIV and Autophagy in Early Infection. Front Microbiol 2021; 12:661446. [PMID: 33995324 PMCID: PMC8113651 DOI: 10.3389/fmicb.2021.661446] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022] Open
Abstract
HIV/AIDS is still a global threat despite the notable efforts made by the scientific and health communities to understand viral infection, to design new drugs or to improve existing ones, as well as to develop advanced therapies and vaccine designs for functional cure and viral eradication. The identification and analysis of HIV-1 positive individuals that naturally control viral replication in the absence of antiretroviral treatment has provided clues about cellular processes that could interact with viral proteins and RNA and define subsequent viral replication and clinical progression. This is the case of autophagy, a degradative process that not only maintains cell homeostasis by recycling misfolded/old cellular elements to obtain nutrients, but is also relevant in the innate and adaptive immunity against viruses, such as HIV-1. Several studies suggest that early steps of HIV-1 infection, such as virus binding to CD4 or membrane fusion, allow the virus to modulate autophagy pathways preparing cells to be permissive for viral infection. Confirming this interplay, strategies based on autophagy modulation are able to inhibit early steps of HIV-1 infection. Moreover, autophagy dysregulation in late steps of the HIV-1 replication cycle may promote autophagic cell-death of CD4+ T cells or control of HIV-1 latency, likely contributing to disease progression and HIV persistence in infected individuals. In this scenario, understanding the molecular mechanisms underlying HIV/autophagy interplay may contribute to the development of new strategies to control HIV-1 replication. Therefore, the aim of this review is to summarize the knowledge of the interplay between autophagy and the early events of HIV-1 infection, and how autophagy modulation could impair or benefit HIV-1 infection and persistence, impacting viral pathogenesis, immune control of viral replication, and clinical progression of HIV-1 infected patients.
Collapse
Affiliation(s)
- Romina Cabrera-Rodríguez
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, e IUETSPC de la Universidad de La Laguna, Campus de Ofra s/n, Tenerife, Spain
| | - Silvia Pérez-Yanes
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, e IUETSPC de la Universidad de La Laguna, Campus de Ofra s/n, Tenerife, Spain
| | - Judith Estévez-Herrera
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, e IUETSPC de la Universidad de La Laguna, Campus de Ofra s/n, Tenerife, Spain
| | - Daniel Márquez-Arce
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, e IUETSPC de la Universidad de La Laguna, Campus de Ofra s/n, Tenerife, Spain
| | - Cecilia Cabrera
- AIDS Research Institute IrsiCaixa, Institut de Recerca en Ciències de la Salut Germans Trias i Pujol (IGTP), Barcelona, Spain
| | - Lucile Espert
- Institut de Recherche en Infectiologie de Montpellier, Université de Montpellier, CNRS, Montpellier, France
| | - Julià Blanco
- AIDS Research Institute IrsiCaixa, Institut de Recerca en Ciències de la Salut Germans Trias i Pujol (IGTP), Barcelona, Spain.,Universitat de Vic-Central de Catalunya (UVIC-UCC), Catalonia, Spain
| | - Agustín Valenzuela-Fernández
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, e IUETSPC de la Universidad de La Laguna, Campus de Ofra s/n, Tenerife, Spain
| |
Collapse
|
2
|
Iliyasu Z, Galadanci HS, Muhammad B, Yadudu FZ, Kwaku AA, Salihu HM, Aliyu MH. Correlates of HIV-Positive Fathers' Involvement in Prevention of Mother-to-child Transmission Programs in Northern Nigeria. Curr HIV Res 2020; 18:443-457. [PMID: 32778029 DOI: 10.2174/1570162x18666200810133347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/08/2020] [Accepted: 07/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The involvement of men in prevention of mother-to-child HIV transmission (PMTCT) programs could accelerate the elimination of vertical transmission. Yet, little research has focused on HIV-positive male partners. This study determined the predictors of male partners' PMTCT knowledge and involvement in a tertiary hospital in northern Nigeria. METHODS A clinic-based sample of 401 HIV-positive male partners of women who delivered within 12 months prior were interviewed using structured questionnaires. PMTCT knowledge and involvement scores were computed. Adjusted odd ratios (AOR) for predictors were derived from multivariate logistic regression models. RESULTS The proportion of respondents with adequate PMTCT knowledge was 40.9%. Less than half (43.6%) of the respondents participated in PMTCT, with median involvement score of 2.00 (interquartile range, IQR = 0, 5.0). One quarter of respondents (25.7%, n =103) reported >1 sex partners, 10.5% consistently used condoms, and 20.7% had disclosed to all partners. Fathers' involvement in PMTCT was predicted by paternal education (AOR = 0.30; 95% Confidence Interval (CI): 0.12-0.77, no formal vs. post-secondary), HIV-positive child (AOR = 3.85; 95%CI: 1.41-10.54, yes vs. no), treatment duration (AOR = 4.17; 95%CI: 1.67-10.41, ≤1 vs. ≥10 years), disclosure to partner(s) (AOR = 1.21; 95%CI: 1.15-3.52, 'disclosed to all' vs. 'not disclosed'), condom use (AOR = 5.81; 95%CI: 3.07-11.0, always vs. never), and PMTCT knowledge (AOR = 0.62; 95%CI: 0.31-0.92, inadequate versus adequate). CONCLUSION The involvement of fathers in HIV PMTCT programs was low and predicted by paternal education, HIV-positive child, duration of antiretroviral treatment, disclosure to partner, consistent condom use, and level of PMTCT knowledge. Our findings will inform the development of policies to increase male partner involvement in PMTCT in Nigeria.
Collapse
Affiliation(s)
- Zubairu Iliyasu
- Epidemiology & Biostatistics Division, Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | | | - Bashir Muhammad
- Epidemiology & Biostatistics Division, Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Fatima Z Yadudu
- School of Medicine, University of Kentucky, Lexington, KY, United States
| | - Aminatu A Kwaku
- Epidemiology & Biostatistics Division, Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Hamisu M Salihu
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Muktar H Aliyu
- Department of Health Policy and Vanderbilt Institute for Global Health,Vanderbilt University Medical Center, Tennessee, United States
| |
Collapse
|
3
|
Iliyasu Z, Owen J, Aliyu MH, Simkhada P. "I prefer not to have a child than have a HIV-positive child": a Mixed Methods Study of Fertility Behaviour of Men Living with HIV in Northern Nigeria. Int J Behav Med 2020; 27:87-99. [PMID: 31836947 DOI: 10.1007/s12529-019-09837-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND In the era of HIV treatment as prevention, little research has focused on the fertility behaviour of men living with HIV. This study examines the predictors and motivators of fertility among men living with HIV and on antiretroviral treatment in Kano, Nigeria. METHOD Using mixed methods, structured questionnaires were administered to a clinic-based sample of men living with HIV (n = 270) and HIV-negative/untested controls (n = 270), followed by in-depth interviews with a sub-group of 22 HIV-positive participants. Logistic regression and the framework approach were used to analyse the data. RESULTS Compared to HIV-negative/untested controls, lower proportions of men living with HIV desired more children (79.3%, n = 214 vs. 91.1%, n = 246, p < 0.05) and intended to bear children within 3 years (57.0%, n = 154 vs. 67.0%, n = 181) (p < 0.05). Marital status (ever married vs. single) predicted fertility intention among men living with HIV (adjusted odds ratio, AOR = 4.70, 95% confidence interval CI, 1.75-13.64) and HIV-negative/untested controls (AOR = 4.23, 95% CI, 1.37-16.45). Men considered self and partner health status, HIV transmission risks, poverty, the effectiveness of interventions, child survival and religion when making fertility decisions. CONCLUSION Fertility desires remain high post-HIV diagnosis. HIV services should include integrated reproductive health programs that address the fertility desires of clients and include considerations for fertility services.
Collapse
Affiliation(s)
- Zubairu Iliyasu
- Section of Public Health, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK.
- Department of Community Medicine, Bayero University Kano, Kano, Nigeria.
| | - Jenny Owen
- Section of Public Health, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Muktar H Aliyu
- Department of Health Policy & Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Padam Simkhada
- Section of Public Health, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| |
Collapse
|
4
|
Hassan S, Cooke A, Saleem H, Mushi D, Mbwambo J, Lambdin BH. Evaluating the Integrated Methadone and Anti-Retroviral Therapy Strategy in Tanzania Using the RE-AIM Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050728. [PMID: 30823440 PMCID: PMC6427450 DOI: 10.3390/ijerph16050728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/14/2019] [Accepted: 02/22/2019] [Indexed: 01/03/2023]
Abstract
There are an estimated 50,000 people who inject drugs in Tanzania, with an HIV prevalence in this population of 42%. The Integrated Methadone and Anti-Retroviral Therapy (IMAT) strategy was developed to integrate HIV services into an opioid treatment program (OTP) in sub-Saharan Africa and increase anti-retroviral therapy (ART) initiation rates. In this paper, we evaluate the IMAT strategy using an implementation science framework to inform future care integration efforts in the region. IMAT centralized HIV services into an OTP clinic in Dar Es Salaam, Tanzania: HIV diagnosis, ART initiation, monitoring and follow up. A mixed-methods, concurrent design, was used for evaluation: quantitative programmatic data and semi-structured interviews with providers and clients addressed 4 out of 5 components of the RE-AIM framework: reach, effectiveness, adoption, implementation. Results showed high reach: 98% of HIV-positive clients received HIV services; effectiveness: 90-day ART initiation rate doubled, from 41% pre-IMAT to 87% post-IMAT (p < 0.001); proportion of HIV-positive eligible clients on ART increased from 71% pre-IMAT to 98% post-IMAT (p < 0.001). There was high adoption and implementation protocol fidelity. Qualitative results informed barriers and facilitators of RE-AIM components. In conclusion, we successfully integrated HIV care into an OTP clinic in sub-Saharan Africa with increased rates of ART initiation. The IMAT strategy represents an effective care integration model to improve HIV care delivery for OTP clients.
Collapse
Affiliation(s)
- Saria Hassan
- Yale School of Medicine, Yale University, New Haven, CT 06511, USA.
| | - Alexis Cooke
- San Francisco Department of Psychiatry, University of California, San Francisco, CA 94118, USA.
| | - Haneefa Saleem
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Dorothy Mushi
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar-Es-Salaam 11000, Tanzania.
| | - Jessie Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar-Es-Salaam 11000, Tanzania.
| | | |
Collapse
|
5
|
CD4/CD8 Ratio as a Predictor for the Occurrence of Metabolic Syndrome in HIV / AIDS Patients During 6 Months of cART Therapy. J Med Biochem 2019; 38:489-495. [PMID: 31496914 PMCID: PMC6708296 DOI: 10.2478/jomb-2018-0049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/17/2018] [Indexed: 12/18/2022] Open
Abstract
Background HIV infection is characterized by progressive depletion of CD4+ T cells due to their reduced synthesis and increased destruction followed by marked activation and expansion of CD8+ T lymphocytes. CD4/CD8 ratio was traditionally described as a marker of immune system ageing in the general population, but it increasingly appears as a marker of different outcomes in the HIV-infected population. The main objective of this study is to examine the power of CD4/CD8 ratio in predicting the occurrence of metabolic syndrome (MetS) in HIV-positive patients receiving cART therapy. Methods 80 HIV/AIDS subjects were included in a retrospective case-control study. Flow cytometry was used to determine the percentage of CD4+ and CD8+ cells in peripheral blood of these patients. The values of biochemical parameters (triglycerides, HDL, blood sugar, blood counts), immunological parameters (CD4/CD8, PCR), anthropometric measurements and type of cART therapy were evaluated in this study. Results After six months of cART therapy 19 (23.8%) subjects had all the elements necessary for making the diagnosis of MetS. Using multivariate analysis CD4/CD8 ratio was statistically significant (p < 0.05) and had the largest effect on development of MetS (Wald = 9.01; OR = 0.45), followed by cART (Wald = 7.87; OR = 0.10) and triglycerides (Wald = 5.27; OR = 1.7). On the other hand, body weight and waist circumference showed no statistically significant effect on the development of MetS after six months of cART, p > 0.05. Conclusions CD4/CD8 ratio proved to be a significant marker for prediction of metabolic syndrome in HIV/AIDS patients.
Collapse
|
6
|
Ho LPP, Goh ECL. Using Identity Theory to Examine the Function of Normative Identities in Living with HIV. HEALTH & SOCIAL WORK 2018; 43:274-277. [PMID: 30215714 DOI: 10.1093/hsw/hly023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 04/17/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Lai Peng Priscilla Ho
- Lai Peng Priscilla Ho, MSW, is principal medical social worker, Tan Tock Seng Hospital, National Centre for Infectious Diseases, Singapore. Esther C. L. Goh, PhD, is associate professor, National University of Singapore, 3 Arts Link, AS3 Level 4, Singapore, 117570; e-mail:
| | - Esther C L Goh
- Lai Peng Priscilla Ho, MSW, is principal medical social worker, Tan Tock Seng Hospital, National Centre for Infectious Diseases, Singapore. Esther C. L. Goh, PhD, is associate professor, National University of Singapore, 3 Arts Link, AS3 Level 4, Singapore, 117570; e-mail:
| |
Collapse
|
7
|
Reyes-Urueña J, Campbell C, Diez E, Ortún V, Casabona J. Can we afford to offer pre-exposure prophylaxis to MSM in Catalonia? Cost-effectiveness analysis and budget impact assessment. AIDS Care 2017; 30:784-792. [PMID: 29262694 DOI: 10.1080/09540121.2017.1417528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pre-exposure prophylaxis (PrEP) effectiveness has been well established. This study aims to assess the cost-effectiveness of providing PrEP, estimate the number of eligible MSM, and its budget impact in Catalonia. Cost-effectiveness analysis compared costs of on daily basis and "on demand" PrEP to prevent one infection with lifetime costs of one HIV infection. We estimated the total cost of providing PrEP by estimating number of eligible MSM, and included in the budget impact assessment antiretroviral and laboratory costs. Costs were lower for the on-demand PrEP group by €64015.1 and the incremental benefit was nearly 15 life-years and 17 quality-adjusted life-years gained. The incremental cost-effectiveness ratio (ICER) was cost-effective at €6281.62 when undiscounted PrEP was given daily. On-demand PrEP can be considered cost-saving in 20 years if the price is reduced by 90%. The number of eligible MSM in Catalonia ranges from 5,989 to 10,972. At current antiretroviral costs, the annual cost would range between €25.3-46.7 million/year (on demand PrEP), and €42.9-78.7 million/year (daily basis PrEP). PrEP is most cost-effective if targeted towards groups with high incidence rates of over 3%/year. Beneficial ICER depends on reducing the current price of Truvada® and ensuring that effectiveness is maintained at high levels.
Collapse
Affiliation(s)
- J Reyes-Urueña
- a Centre for Epidemiological Studies on HIV/STI of Catalonia (CEEISCAT) , Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya , Badalona , Spain.,b The Institute for Health Science Research Germans Trias i Pujol (IGTP) , Badalona , Spain.,c Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine , Univ Autonoma Barcelona , Bellaterra , Spain.,d CIBER Epidemiologia y Salud Pública (CIBERESP) , Spain
| | - C Campbell
- e Tuberculosis Section, Centre for Infectious Disease Surveillance and Control, National Infection Service , Public Health England , London , England
| | - E Diez
- f Agència de Salut Pública de Barcelona (ASPB) , Barcelona , Spain
| | - V Ortún
- g Faculty of Economic and Business Sciences , Universitat Pompeu Fabra , Barcelona , Spain
| | - J Casabona
- a Centre for Epidemiological Studies on HIV/STI of Catalonia (CEEISCAT) , Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya , Badalona , Spain.,b The Institute for Health Science Research Germans Trias i Pujol (IGTP) , Badalona , Spain.,c Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine , Univ Autonoma Barcelona , Bellaterra , Spain.,d CIBER Epidemiologia y Salud Pública (CIBERESP) , Spain
| |
Collapse
|
8
|
Frequent HIV Testing: Impact on HIV Risk Among Chinese Men Who Have Sex with Men. J Acquir Immune Defic Syndr 2017; 72:452-61. [PMID: 27003496 DOI: 10.1097/qai.0000000000001001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The HIV epidemic continues to expand among men who have sex with men (MSM) in China. The NIMH Project Accept/HPTN 043 trial suggested a borderline significant trend toward HIV incidence reduction among persons with higher testing rates. METHODS We assessed HIV testing histories and infection status among a community-based Beijing MSM. HIV serostatus was lab confirmed. We ascertained demographic/behavioral factors through questionnaire-based interviews. Associations of previous HIV testing with odds of current HIV infection were assessed, seeking improved like-with-like risk comparisons through multivariable logistic regression analysis with propensity score adjustment and restricted cubic spline modeling. RESULTS Among 3588 participants, 12.7% were HIV infected; 70.8% reported having ever tested for HIV. Compared with MSM who never tested, those ever testing had a 41% reduction in the odds of being HIV positive [adjusted odds ratio (aOR): 0.59; 95% confidence interval (CI): 0.48 to 0.74. Higher HIV testing frequencies were associated with a decreasing trend in the odds of being infected with HIV vs. a referent group with no previous testing [>6 tests (aOR: 0.27; 95% CI: 0.18 to 0.41); 4-6 (aOR: 0.55; 95% CI: 0.39 to 0.78); 2-3 (aOR: 0.61; 95% CI: 0.45 to 0.82); P for trend <0.001]. The multivariable-adjusted model with restricted cubic spline of HIV testing frequency showed a higher frequency of previous HIV testing associated with lower odds of HIV infection, particularly among men with ≥10 lifetime male sexual partners. CONCLUSIONS Using risk probability adjustments to enable less biased comparisons, frequent HIV testing was associated with a lower HIV odds among Chinese MSM.
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Kalichman SC, Price D, Eaton LA, Burnham K, Sullivan M, Finneran S, Cornelius T, Allen A. Diminishing Perceived Threat of AIDS and Increasing Sexual Risks of HIV Among Men Who Have Sex with Men, 1997-2015. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:895-902. [PMID: 28168543 PMCID: PMC5967889 DOI: 10.1007/s10508-016-0934-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/13/2016] [Accepted: 12/28/2016] [Indexed: 05/15/2023]
Abstract
Community-wide awareness that antiretroviral therapies (ART) provides protection against HIV has the potential to increase perceived safety and thereby increase condomless anal sex among men who have sex with men (MSM). Furthermore, reductions in condom use can increase exposure to sexually transmitted infections, which in turn can reduce the protective effects of ART on HIV transmission. The current study extends previous community-based behavioral surveillance research on beliefs regarding use of ART for HIV prevention and sexual practices among MSM. Anonymous cross-sectional community surveys were collected from 1831 men at the same gay pride event in Atlanta, GA four times over nearly two decades; 1997, 2005-2006 (the 2006 survey over-sampled African-Americans to diversify the study), and 2015. Results indicate clear and consistent trends of increasing beliefs that HIV treatments reduce HIV transmission risks, reflecting the dissemination of HIV prevention research findings. Changes in treatment beliefs coincide with increased rates of condomless anal intercourse. Increased beliefs that treatments prevent HIV and increased condomless anal sex were observed for both HIV positive men and men who had not tested HIV positive. Results illustrate the emergence of an era where ART is the focus of HIV prevention and community-held beliefs and behaviors regarding definitions of risk create a new and potentially problematic environment for HIV transmission.
Collapse
Affiliation(s)
- Seth C Kalichman
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA.
| | - Devon Price
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Lisa A Eaton
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Kaylee Burnham
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Matthew Sullivan
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Stephanie Finneran
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Talea Cornelius
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| | - Aerielle Allen
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 06269, USA
| |
Collapse
|
11
|
Gowda C, Coppock D, Brickman C, Shaw PA, Gross R. Determinants of HIV Transmission Risk Among HIV-Infected Persons Engaged in Care. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:440-452. [PMID: 27710086 DOI: 10.1521/aeap.2016.28.5.440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
People living with HIV (PLWH) engaged in medical care represent an accessible group to focus HIV prevention efforts. In an analysis of 1,883 PLWH from 2007 and 2015, we determined the proportion at risk of HIV transmission and identified factors associated with HIV transmission risk using multivariable mixed effects logistic regression models with random intercepts. HIV transmission risk was defined by an HIV viral load > 1,500 copies/mL and self-reported unprotected sex. We found that 174 (9.2%) individuals were at risk for HIV transmission at least once. Factors associated with HIV transmission risk included younger age (adjusted OR [95% CI] per decade decrease = 2.30 [1.84, 2.89]), illicit drug use (adjusted OR = 5.36 [3.02, 9.56]), depression (adjusted OR = 1.88 [1.10, 3.21]), and education <12th grade (adjusted OR = 2.05 [1.15, 3.67]). Thus, nearly 1 in 10 HIV-infected individuals engaged in care between 2007 and 2015 were potentially at risk of transmitting HIV. Behavioral interventions to decrease HIV transmission should focus on younger, less educated patients who are depressed and actively using illicit drugs.
Collapse
Affiliation(s)
- Charitha Gowda
- Division of Infectious Diseases, Nationwide Children's Hospital and the Department of Pediatrics, the Ohio State University College of Medicine, Columbus, Ohio
| | - Dagan Coppock
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Cristina Brickman
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco School of Medicine, San Francisco
| | - Pamela A Shaw
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Robert Gross
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
12
|
Young SD, Cumberland WG, Nianogo R, Menacho LA, Galea JT, Coates T. The HOPE social media intervention for global HIV prevention in Peru: a cluster randomised controlled trial. Lancet HIV 2016; 2:e27-32. [PMID: 26236767 DOI: 10.1016/s2352-3018(14)00006-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Social media technologies offer new approaches to HIV prevention and promotion of testing. We examined the efficacy of the Harnessing Online Peer Education (HOPE) social media intervention to increase HIV testing among men who have sex with men (MSM) in Peru. METHODS In this cluster randomised controlled trial, Peruvian MSM from Greater Lima (including Callao) who had sex with a man in the past 12 months, were 18 years of age or older, were HIV negative or serostatus unknown, and had a Facebook account or were willing to create one (N=556) were randomly assigned (1:1) by concealed allocation to join intervention or control groups on Facebook for 12 weeks. For the intervention, Peruvian MSM were trained and assigned to be HIV prevention mentors (peer-leaders) to participants in Facebook groups. The interventions period lasted 12 weeks. Participants in control groups received an enhanced standard of care, including standard offline HIV prevention available in Peru and participation in Facebook groups (without peer leaders) that provided study updates and HIV testing information. After accepting a request to join the groups, continued participation was voluntary. Participants also completed questionnaires on HIV risk behaviours and social media use at baseline and 12 week follow-up. The primary outcome was the number of participants who received a free HIV test at a local community clinic. The facebook groups were analysed as clusters to account for intracluster correlations. This trial is registered with ClinicalTrials.gov, number NCT01701206. FINDINGS Of 49 peer-leaders recruited, 34 completed training and were assigned at random to the intervention Facebook groups. Between March 19, 2012, and June 11, 2012, and Sept 26, 2012, and Dec 19, 2012, 556 participants were randomly assigned to intervention groups (N=278) or control groups (N=278); we analyse data for 252 and 246. 43 participants (17%) in the intervention group and 16 (7%) in the control groups got tested for HIV (adjusted odds ratio 2·61, 95% CI 1·55–4·38). No adverse events were reported. INTERPRETATION Development of peer-mentored social media communities seemed to be an efficacious method to increase HIV testing among high-risk populations in Peru. Results suggest that the HOPE social media intervention could improve HIV testing rates among MSM in Peru. FUNDING National Institute of Mental Health.
Collapse
|
13
|
High Drop-off Along the HIV Care Continuum and ART Interruption Among Female Sex Workers in the Dominican Republic. J Acquir Immune Defic Syndr 2015; 69:216-22. [PMID: 25714246 DOI: 10.1097/qai.0000000000000590] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Engagement in HIV care offers clear individual and societal benefits, but little evidence exists on the care experiences of key populations. METHODS A cross-sectional survey was conducted with 268 female sex workers (FSWs) living with HIV in Santo Domingo, Dominican Republic, to describe the HIV care continuum and to determine factors associated with antiretroviral therapy (ART) interruption. RESULTS FSWs disengaged throughout the care continuum with the highest drop-off after ART initiation. Most participants were linked to care (92%), retained in care (85%), and initiated onto ART (78%), but ART discontinuation and irregular adherence were frequent. Only 48% of participants had an undetectable HIV viral load. Overall, 36% of participants ever initiated onto ART reported lifetime experience with ART interruption. The odds of ART interruption were 3.24 times higher among women who experienced FSW-related discrimination [95% confidence interval (CI): 1.28 to 8.20], 2.41 times higher among women who used any drug (95% CI: 1.09 to 5.34), and 2.35 times higher among women who worked in an FSW establishment (95% CI: 1.20 to 4.60). Internalized stigma related to FSW was associated with higher odds of interruption (adjusted odds ratio: 1.09; 95% CI: 1.02 to 1.16), and positive perceptions of HIV providers were protective (adjusted odds ratio: 0.91; 95% CI: 0.85 to 0.98). CONCLUSIONS FSWs living with HIV confront multiple barriers throughout the HIV care continuum, many of which are related to the social context and stigmatization of sex work. Given the clear importance of maximizing the potential benefits of engagement in HIV care, there is an urgent need for interventions to support FSWs throughout the HIV care continuum.
Collapse
|
14
|
Abstract
Advances in treatment are contributing to substantial increases in life expectancy for individuals living with HIV, prompting a need to develop care models for the effective management of HIV as a chronic illness. With many individuals continuing to experience symptoms and complications that add to the disease burden across the spectrum of HIV disease, the discussion herein explores the complementary role that early palliative care can play in HIV primary care as a strategy for enhancing long-term quality of life. After first defining the concept of early palliative care, its scope in the context of current clinical realities in HIV treatment and implications for HIV care models is described. After reviewing the emerging extant research literature on HIV palliative care outcomes, a program description is offered as an illustration of how palliative care integration with HIV primary care can be achieved.
Collapse
|
15
|
Zulliger R, Maulsby C, Barrington C, Holtgrave D, Donastorg Y, Perez M, Kerrigan D. Retention in HIV care among female sex workers in the Dominican Republic: implications for research, policy and programming. AIDS Behav 2015; 19:715-22. [PMID: 25566761 DOI: 10.1007/s10461-014-0979-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There are clear benefits of retention in HIV care, yet millions of people living with HIV are sub-optimally retained. This study described factors from Andersen's behavioral model that were associated with retention in HIV care among 268 female sex workers (FSWs) living with HIV in the Dominican Republic using two measures of retention: a 6-month measure of HIV clinic attendance and a measure that combined clinic attendance and missed visits. FSWs who ever attended HIV care reported high rates (92 %) of 6-month attendance, but 37 % reported missed visits. Using the combined retention measure, the odds of being retained in HIV care were higher among FSWs with more positive perceptions of HIV service providers [adjusted odds ratio (AOR) 1.17; 95 % confidence interval (CI) 01.09, 1.25] and lower among women who reported recent alcohol consumption (AOR 0.50; 95 % CI 0.28, 0.92) and self-stigmatizing beliefs related to sex work (AOR 0.93; 95 % CI 0.88, 0.98). These findings support the hypothesis that retention in HIV care may be best determined through a combined measure as missed visits are an important mechanism to identify in-care patients who require additional support.
Collapse
Affiliation(s)
- Rose Zulliger
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 904, Baltimore, MD, 21205, USA,
| | | | | | | | | | | | | |
Collapse
|
16
|
Winchester MS. Synergistic vulnerabilities: antiretroviral treatment among women in Uganda. Glob Public Health 2015; 10:881-94. [PMID: 25647145 DOI: 10.1080/17441692.2015.1007468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite being an early success story in the reduction of HIV infection rates, Uganda faces myriad challenges in the recent era of accelerated antiretroviral treatment (ARV) scale-up. For those able to access treatment, ongoing vulnerabilities of poverty and violence compound treatment-related costs and concerns. This paper explores experiences of one particularly vulnerable population - women on ARVs who have also experienced intimate partner violence (IPV). Data were collected over 12 months in Uganda. They include ethnographic interviews (n = 40) drawn from a larger sample of women on ARV and semi-structured interviews with policy-makers and service providers (n = 42), examining the intersection of experiences and responses to treatment from multiple perspectives. Women's narratives show that due to treatment, immediate health concerns take on secondary importance, while other forms of vulnerability, including IPV and poverty, can continue to shape treatment experiences and the decision to stay in violent relationships. Providers likewise face difficulties in overburdened clinics, though they recognise women's concerns and the importance of considering other forms of vulnerability in treatment. This analysis makes the case for integrating treatment with other types of social services and demonstrates the importance of understanding the ways in which synergistic and compounding vulnerabilities confound treatment scale-up efforts.
Collapse
Affiliation(s)
- Margaret S Winchester
- a Department of Geography , The Pennsylvania State University , University Park , PA , USA
| |
Collapse
|
17
|
Okome-Nkoumou M, Guiyedi V, Dzeing-Ella A, Komba-Boussaga Y, Efire-Emagha N, Menguet-Abessolo MP, Ongali B, Akoume MY, Bissagnene E. Socio-Demographic and Behavioral Factors Associated with the Desire to Procreate Among Patients Living with HIV in Gabon. Open AIDS J 2015; 9:1-8. [PMID: 25646139 PMCID: PMC4311383 DOI: 10.2174/1874613601509010001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/17/2014] [Accepted: 12/22/2014] [Indexed: 11/22/2022] Open
Abstract
The desire to procreate in patients living with HIV (PLHIV) has been seldom investigated in Africa, particularly in Gabon. The aim of this transversal and descriptive study was to analyze the socio-demographic and behavioral factors associated with a desire to have children in a cohort of PLHIV. The study included 442 patients, predominantly females [79.9% (337/422)], and those with a secondary school education [64.2% 271/422)]. The highest prevalence of HIV was found in patients aged 30-39 years old (44.3%), of which 59% (249/422) were unemployed. The desire to have children was noted in 78% (329/422) of patients, of which 82.4% (271/329) were treated with antiretroviral drugs; this was significantly higher in subjects under 40 years versus those over 40 years old [81% (268/329) versus 19% (61/329), p<0.001]. Sero-discordant couples represented 33.4% (110/329) of patients. The frequency of patients with the desire to have a child was significantly higher when patients wanted to hold the status of parent of a child [77% (255/329) versus 23% (74/329), p<0.001]; this was influenced by the partner's desire [60% 197/329 versus 40% (132/329), p< 0.001], as well as by the absence of weight loss [56% (185/329) versus 44% (144/329), p<0.001]. The average number of children was significantly lower in patients with the desire to procreate compared to those with no desire to have children [1.7 versus 3.2, p<0.001]. These first observations in Gabon highlight the importance of the desire to have children in PLHIV and sero-discordant couples, and they show the level of interest in developing assistance methods for procreation and family planning programs to help this population, as well as to reduce the risk of mother-to-child HIV transmission.
Collapse
Affiliation(s)
- Madeleine Okome-Nkoumou
- Department of Infectious and Tropical Diseases, Libreville Faculty of Medicine, Health Sciences University, Libreville, Gabon
| | - Vincent Guiyedi
- Department of Infectious and Tropical Diseases, Libreville Faculty of Medicine, Health Sciences University, Libreville, Gabon ; Service of Internal Medicine-Infectious and Tropical Diseases, Albert Schweitzer University Hospital Center of Lambaréné, Gabon
| | - Arnaud Dzeing-Ella
- Department of Infectious and Tropical Diseases, Libreville Faculty of Medicine, Health Sciences University, Libreville, Gabon ; Service of Internal Medicine-Infectious and Tropical Diseases, Albert Schweitzer University Hospital Center of Lambaréné, Gabon ; Service of Internal Medicine-Infectious and Tropical Diseases, Valenciennes Hospital Center, France
| | - Yvonne Komba-Boussaga
- Department of Infectious and Tropical Diseases, Libreville Faculty of Medicine, Health Sciences University, Libreville, Gabon
| | - Nora Efire-Emagha
- Department of Infectious and Tropical Diseases, Libreville Faculty of Medicine, Health Sciences University, Libreville, Gabon
| | | | - Brice Ongali
- Service of Internal Medicine-Infectious and Tropical Diseases, Albert Schweitzer University Hospital Center of Lambaréné, Gabon
| | - Marie-Yvonne Akoume
- Service of Internal Medicine-Infectious and Tropical Diseases, Albert Schweitzer University Hospital Center of Lambaréné, Gabon
| | - Emmanuel Bissagnene
- Department of Infectious and Tropical Diseases, University Hospital of Treichville, Côte d'Ivoire
| |
Collapse
|
18
|
Lebouché B, Engler K, Lévy JJ, Gilmore N, Spire B, Rozenbaum W, Lacene T, Routy JP. French HIV experts on early antiretroviral treatment for prevention: uncertainty and heterogeneity. J Int Assoc Provid AIDS Care 2014; 13:160-9. [PMID: 23761218 DOI: 10.1177/2325957413488196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Early use of highly active antiretroviral treatment (ART) in people living with HIV for HIV prevention has gained legitimacy but remains controversial. Nineteen French HIV experts with diverse specializations (over half of whom were clinicians) were qualitatively interviewed on their views about ART irrespective of CD4 count of more than 500 cells/mm3 for purposes of HIV prevention, which is not systematically recommended in France. Content analysis identified 2 broad categories: individual considerations (subcategories: patient health and well-being; patient preparedness and choice) and collective considerations (subcategories:HIV transmission risk; impact on the epidemic; cost). Uncertainty surrounded many experts' considerations, and unity was lacking on key issues (eg, candidacy for early preventive treatment, expected clinical- and population-level effects). An umbrella theme labeled "Weighing the merits of early ART in the face of uncertainties was identified. Our analyses raise doubts about the current acceptability of widespread implementation of early ART for HIV prevention in France.
Collapse
|
19
|
Knight R, Small W, Pakula B, Thomson K, Shoveller J. A scoping study to identify opportunities to advance the ethical implementation and scale-up of HIV treatment as prevention: priorities for empirical research. BMC Med Ethics 2014; 15:54. [PMID: 24994501 PMCID: PMC4086269 DOI: 10.1186/1472-6939-15-54] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 06/13/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite the evidence showing the promise of HIV treatment as prevention (TasP) in reducing HIV incidence, a variety of ethical questions surrounding the implementation and "scaling up" of TasP have been articulated by a variety of stakeholders including scientists, community activists and government officials. Given the high profile and potential promise of TasP in combatting the global HIV epidemic, an explicit and transparent research priority-setting process is critical to inform ongoing ethical discussions pertaining to TasP. METHODS We drew on the Arksey and O'Malley framework for conducting scoping review studies as well as systematic approaches to identifying empirical and theoretical gaps within ethical discussions pertaining to population-level intervention implementation and scale up. We searched the health science database PubMed to identify relevant peer-reviewed articles on ethical and implementation issues pertaining to TasP. We included English language articles that were published after 2009 (i.e., after the emergence of causal evidence within this field) by using search terms related to TasP. Given the tendency for much of the criticism and support of TasP to occur outside the peer-reviewed literature, we also included grey literature in order to provide a more exhaustive representation of how the ethical discussions pertaining to TasP have and are currently taking place. To identify the grey literature, we systematically searched a set of search engines, databases, and related webpages for keywords pertaining to TasP. RESULTS Three dominant themes emerged in our analysis with respect to the ethical questions pertaining to TasP implementation and scale-up: (a) balancing individual- and population-level interests; (b) power relations within clinical practice and competing resource demands within health care systems; (c) effectiveness considerations and socio-structural contexts of HIV treatment experiences within broader implementation contexts. CONCLUSION Ongoing research and normative deliberation is required in order to successfully and ethically scale-up TasP within the continuum of HIV care models. Based on the results of this scoping review, we identify several ethical and implementation dimensions that hold promise for informing the process of scaling up TasP and that could benefit from new research.
Collapse
Affiliation(s)
- Rod Knight
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, Canada.
| | | | | | | | | |
Collapse
|
20
|
Sexual risk behaviour and viral suppression among HIV-infected adults receiving medical care in the United States. AIDS 2014; 28:1203-11. [PMID: 25000558 PMCID: PMC4004641 DOI: 10.1097/qad.0000000000000273] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the prevalence and association of sexual risk behaviours and viral suppression among HIV-infected adults in the United States. DESIGN Cross-sectional analysis of weighted data from a probability sample of HIV-infected adults receiving outpatient medical care. The facility and patient response rates were 76 and 51%, respectively. METHODS We analysed 2009 interview and medical record data. Sexual behaviours were self-reported in the past 12 months. Viral suppression was defined as all viral load measurements in the medical record during the past 12 months less than 200 copies/ml. RESULTS An estimated 98 022 (24%) HIV-infected adults engaged in unprotected vaginal or anal sex; 50 953 (12%) engaged in unprotected vaginal or anal sex with at least one partner of negative or unknown HIV status; 23 933 (6%) did so while not virally suppressed. Persons who were virally suppressed were less likely than persons who were not suppressed to engage in vaginal or anal sex [prevalence ratio, 0.88; 95% confidence interval (CI), 0.82-0.93]; unprotected vaginal or anal sex (prevalence ratio, 0.85; 95% CI, 0.73-0.98); and unprotected vaginal or anal sex with a partner of negative or unknown HIV status (prevalence ratio, 0.79; 95% CI, 0.64-0.99). CONCLUSION The majority of HIV-infected adults receiving medical care in the U.S. did not engage in sexual risk behaviours that have the potential to transmit HIV, and of the 12% who did, approximately half were not virally suppressed. Persons who were virally suppressed were less likely than persons who were not suppressed to engage in sexual risk behaviours.
Collapse
|
21
|
Maughan-Brown B, Nyblade L. Different dimensions of HIV-related stigma may have opposite effects on hiv testing: evidence among young men and women in South Africa. AIDS Behav 2014; 18:958-65. [PMID: 24101100 DOI: 10.1007/s10461-013-0636-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although HIV-related stigma in general is known to deter HIV-testing, the extent to which different dimensions of stigma independently influence testing behaviour is poorly understood. We used data on young black men (n = 553) and women (n = 674) from the 2009 Cape Area Panel Study to examine the independent effects of stigmatising attitudes, perceived stigma and observed enacted stigma on HIV-testing. Multivariate logistic regression models showed that stigma had a strong relationship with HIV-testing among women, but not men. Women who held stigmatising attitudes were more likely to have been tested (OR 3, p < 0.01), while perceived stigma (OR 0.61, p < 0.1) and observed enacted stigma (OR 0.42, p < 0.01) reduced the odds significantly of women having had an HIV test. Our findings highlight that different dimensions of stigma may have opposite effects on HIV testing, and point towards the need for interventions that limit the impact of enacted and perceived stigma on HIV-testing among women.
Collapse
Affiliation(s)
- Brendan Maughan-Brown
- Southern Africa Labour and Development Research Unit (SALDRU), University of Cape Town, Private Bag, Rondebosch, Cape Town, 7701, South Africa,
| | | |
Collapse
|
22
|
Donastorg Y, Barrington C, Perez M, Kerrigan D. Abriendo Puertas: baseline findings from an integrated intervention to promote prevention, treatment and care among FSW living with HIV in the Dominican Republic. PLoS One 2014; 9:e88157. [PMID: 24551079 PMCID: PMC3925113 DOI: 10.1371/journal.pone.0088157] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022] Open
Abstract
Female sex workers (FSW) are often the focus of primary HIV prevention efforts. However, little attention has been paid to the prevention, treatment, and care needs of FSW living with HIV. Based on formative research, we developed an integrated model to promote prevention and care for FSW living with HIV in Santo Domingo, Dominican Republic, including (1) individual counseling and education; (2) peer navigation; (3) clinical provider training; and (4) community mobilization. We enrolled 268 FSW living with HIV into the intervention and conducted socio-behavioral surveys, sexually transmitted infection (STI) testing, and viral load (VL) assessments. We used multivariate logistic regression to identify behavioral and socio-demographic factors associated with detectable VL (>50 copies/mL) and STI prevalence. Over half of all participants (51.9%) had a detectable VL, even though most received HIV-related care in the last 6 months (85.1%) and were currently on anti-retroviral treatment (ART) (72.4%). Factors positively associated with a detectable VL included being 18-35 years of age (Adjusted Odds Ratio [AOR] 2.46, 95% CI 1.31-4.60), having ever used drugs (AOR 2.34, 95% CI 1.14-4.79), and having ever interrupted ART (AOR 3.09, 95% CI 1.44-6.59). Factors protective against having a detectable VL included being single (AOR 0.45, 95% 0.20-0.98) and being currently on ART (AOR 0.17, 95% CI 0.07-0.41). Nearly one-quarter (23.1%) had an STI, which was associated with being single (AOR 3.21, 95% CI 1.27-8.11) and using drugs in the last 6 months (AOR 3.54, 95% CI 1.32-9.45). Being on ART was protective against STI (AOR 0.51, 95% CI 0.26-1.00). Baseline findings indicate significant barriers to VL suppression and STI prevention among FSW living with HIV and highlight gaps in the continuum of HIV care and treatment. These findings have important implications for both the individual health of FSW and population-level HIV transmission dynamics.
Collapse
Affiliation(s)
- Yeycy Donastorg
- HIV Vaccine Research Unit, Instituto Dermatalógico y Cirugia de Piel Dr. Humberto Bogart Diaz, Santo Domingo, Rep. Dom
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Martha Perez
- HIV Vaccine Research Unit, Instituto Dermatalógico y Cirugia de Piel Dr. Humberto Bogart Diaz, Santo Domingo, Rep. Dom
| | - Deanna Kerrigan
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| |
Collapse
|
23
|
McGrath JW, Winchester MS, Kaawa-Mafigiri D, Walakira E, Namutiibwa F, Birungi J, Ssendegye G, Nalwoga A, Kyarikunda E, Kisakye S, Ayebazibwe N, Rwabukwali CB. Challenging the paradigm: anthropological perspectives on HIV as a chronic disease. Med Anthropol 2014; 33:303-17. [PMID: 24661100 PMCID: PMC4390365 DOI: 10.1080/01459740.2014.892483] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recently HIV has been framed as a 'manageable' chronic disease in contexts in which access to effective care is reliable. The chronic disease paradigm emphasizes self-care, biomedical disease management, social normalization, and uncertainty. Data from a longitudinal study of patients (N = 949) in HIV care at two sites in Uganda, collected through semistructured interviews and ethnographic data, permit examination of the salience of this model in a high burden, low resource context struggling to achieve the promise of a manageable HIV epidemic. Our data highlight the complexity of the emerging social reality of long-term survival with HIV. Participants struggle to manage stigma as well as to meet the costs involved in care seeking. In these settings, economic vulnerability leads to daily struggles for food and basic services. Reconceptualizing the chronic disease model to accommodate a 'social space,' recognizing this new social reality will better capture the experience of long-term survival with HIV.
Collapse
Affiliation(s)
- Janet W McGrath
- a Department of Anthropology , Case Western Reserve University , Cleveland , Ohio , USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Chung J, DiGiusto DL, Rossi JJ. Combinatorial RNA-based gene therapy for the treatment of HIV/AIDS. Expert Opin Biol Ther 2013; 13:437-45. [PMID: 23394377 DOI: 10.1517/14712598.2013.761968] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION HIV/AIDS continues to be a worldwide health problem and viral eradication has been an elusive goal. HIV+ patients are currently treated with combination antiretroviral therapy (cART) which is not curative. For many patients, cART is inaccessible, intolerable or unaffordable. Therefore, a new class of therapeutics for HIV is required to overcome these limitations. Cell and gene therapy for HIV has been proposed as a way to provide a functional cure for HIV in the form of a virus/infection resistant immune system. AREAS COVERED In this review, the authors describe the standard therapy for HIV/AIDS, its limitations, current areas of investigation and the potential of hematopoietic stem cells modified with anti-HIV RNAs as a means to affect a functional cure for HIV. EXPERT OPINION Cell and gene therapy for HIV/AIDS is a promising alternative to antiviral drug therapy and may provide a functional cure. In order to show clinical benefit, multiple mechanisms of inhibition of HIV entry and lifecycle are likely to be required. Among the most promising antiviral strategies is the use of transgenic RNA molecules that provide protection from HIV infection. When these molecules are delivered as gene-modified hematopoietic stem and progenitor cells, long-term repopulation of the patient's immune system with gene-modified progeny has been observed.
Collapse
Affiliation(s)
- Janet Chung
- Beckman Research Institute of City of Hope, Department of Molecular and Cell Biology, 1500 East Duarte Road, CA 91010, USA
| | | | | |
Collapse
|
25
|
Chen Y. Treatment-related optimistic beliefs and risk of HIV transmission: a review of recent findings (2009-2012) in an era of treatment as prevention. Curr HIV/AIDS Rep 2013; 10:79-88. [PMID: 23239272 DOI: 10.1007/s11904-012-0144-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The promising outlook for HIV treatment as prevention (TasP) offered by the recent success in clinical trials has highlighted the need for effort against over-optimism toward anti-retroviral therapy (ART). It has been of a central concern that such optimistic beliefs may fuel an increase in risk behaviors to counter the protective effect of ART on reducing overall transmissibility of HIV. The current review was conducted to provide an updated look at the potential impact of treatment-related optimistic beliefs on the risk of HIV transmission. The review yielded a total of 14 studies published during the past 4 years that have examined the role of treatment-related optimistic beliefs in changing people's adoption of sexual risk behaviors. Findings from quantitative studies were largely in support of an association between optimistic beliefs and risk of HIV transmission. Results from qualitative studies discovered additional information concealed under the numerical associations, and pointed to the need of more rigorous and comprehensive examination of the relationship between optimistic beliefs and HIV transmission risk. Gaps in the current literature were identified and suggestions for future research were provided.
Collapse
Affiliation(s)
- Yiyun Chen
- Department of Psychology, University of Connecticut, 206 Babbige Road, Unit 1020, Storrs, CT 06269, USA.
| |
Collapse
|
26
|
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.
Collapse
Affiliation(s)
- Sonali P Kulkarni
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA 90005, USA.
| | | | | | | |
Collapse
|
27
|
Malow R, Dévieux JG, Stein JA, Rosenberg R, Jean-Gilles M, Attonito J, Koenig SP, Raviola G, Sévère P, Pape JW. Depression, substance abuse and other contextual predictors of adherence to antiretroviral therapy (ART) among Haitians. AIDS Behav 2013; 17:1221-30. [PMID: 23338563 DOI: 10.1007/s10461-012-0400-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Haiti has the highest number of individuals living with HIV in the Caribbean. Due to Haiti's resource-poor environment and inadequate mental health and substance abuse services, adherence to antiretroviral therapy (ART) may be especially difficult. This study examined associations among demographics, maladaptive coping, partner conflict, alcohol problems, depression, and negative attitudes about medications and their impact on adherence among 194 HIV-positive Haitians. In a mediated directional structural equation model, depression and negative attitudes about ART directly predicted poorer adherence. Greater partner conflict, maladaptive coping and alcohol problems predicted more depression. Maladaptive coping predicted a negative attitude about ART. Alcohol problems predicted partner conflict and maladaptive coping. Significant indirect effects on adherence mediated through both depression and negative attitudes about ART include negative effects of female gender, alcohol problems and maladaptive coping. Results highlight the importance of integrated care for depression, alcohol use and other psychosocial problems to increase ART adherence.
Collapse
Affiliation(s)
- Robert Malow
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, 3000 N.E. 151 Street - ACI #260, Miami, FL 33181, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
OBJECTIVE The current Centers of Disease Control and Prevention (CDC) guidelines from 2006 recommend a one-time test for low-risk individuals and annual testing for those at high risk. These guidelines may not be aggressive enough, even for those at low risk of infection, due to the earlier initiation of HAART and a movement towards a test-and-treat environment. We evaluated the optimal testing frequencies for various risk groups in comparison to the CDC recommendations. METHODS We build a deterministic mathematical model optimizing the tradeoff between the societal cost of testing and the benefits over a patient's lifetime of earlier diagnosis. RESULTS Under a test-and-treat scenario with immediate initiation of HAART, the optimal testing frequency is every 2.4 years for low-risk (0.01% annual incidence) individuals; every 9 months for moderate risk (0.1% incidence) individuals; and every 3 months for high-risk (1.0% incidence) individuals. The incremental cost-effectiveness of the optimal policy is $ 36 ,342/quality-adjusted life-years (QALY) for low-risk individuals and $ 45 ,074/QALY for high-risk individuals compared with 20-year and annual testing, respectively. CONCLUSION The current CDC guidelines for HIV testing are too conservative, and more frequent testing is cost-effective for all risk groups.
Collapse
|
29
|
Arnold EA, Hazelton P, Lane T, Christopoulos KA, Galindo GR, Steward WT, Morin SF. A qualitative study of provider thoughts on implementing pre-exposure prophylaxis (PrEP) in clinical settings to prevent HIV infection. PLoS One 2012; 7:e40603. [PMID: 22792384 PMCID: PMC3394704 DOI: 10.1371/journal.pone.0040603] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 06/11/2012] [Indexed: 11/18/2022] Open
Abstract
Background A recent clinical trial demonstrated that a daily dose tenofovir disoproxil fumarate and emtricitabrine (TDF-FTC) can reduce HIV acquisition among men who have sex with men (MSM) and transgender (TG) women by 44%, and up to 90% if taken daily. We explored how medical and service providers understand research results and plan to develop clinical protocols to prescribe, support and monitor adherence for patients on PrEP in the United States. Methods Using referrals from our community collaborators and snowball sampling, we recruited 22 healthcare providers in San Francisco, Oakland, and Los Angeles for in-depth interviews from May-December 2011. The providers included primary care physicians seeing high numbers of MSM and TG women, HIV specialists, community health clinic providers, and public health officials. We analyzed interviews thematically to produce recommendations for setting policy around implementing PrEP. Interview topics included: assessing clinician impressions of PrEP and CDC guidance, considerations of cost, office capacity, dosing schedules, and following patients over time. Results Little or no demand for PrEP from patients was reported at the time of the interviews. Providers did not agree on the most appropriate patients for PrEP and believed that current models of care, which do not involve routine frequent office visits, were not well suited for prescribing PrEP. Providers detailed the need to build capacity and were concerned about monitoring side effects and adherence. PrEP was seen as potentially having impact on the epidemic but providers also noted that community education campaigns needed to be tailored to effectively reach specific vulnerable populations. Conclusions While PrEP may be a novel and clinically compelling prevention intervention for MSM and TG women, it raises a number of important implementation challenges that would need to be addressed. Nonetheless, most providers expressed optimism that they eventually could prescribe and monitor PrEP in their practice.
Collapse
Affiliation(s)
- Emily A Arnold
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America.
| | | | | | | | | | | | | |
Collapse
|
30
|
Holtgrave DR, Maulsby C, Wehrmeyer L, Hall HI. Behavioral factors in assessing impact of HIV treatment as prevention. AIDS Behav 2012; 16:1085-91. [PMID: 22491813 DOI: 10.1007/s10461-012-0186-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The recent NIH HPTN 052 study of using HIV treatment to prevent HIV transmission in serostatus discordant heterosexual partnerships has garnered much attention. In subsequent discussions, however, the topic of HIV-related risk behavior has been nearly absent. Here, we identify the critical roles that HIV-related risk behavior plays in determining the unmet needs, optimal targeting, and ultimate impact of treatment as prevention. We describe the size of the population at risk of HIV and three subgroups of persons living with HIV (PLWH) based on awareness of serostatus and risk behavior, and the corresponding HIV transmission rates to seronegative partners. For each of the subgroups of PLWH, we identify which approach is most relevant ("testing and linkage to care," "treatment as prevention," and/or "treatment as clinical care"). We observe that the impact of "treatment as prevention" on HIV incidence will depend heavily on which subgroup of PLWH is targeted for services.
Collapse
Affiliation(s)
- David R Holtgrave
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA.
| | | | | | | |
Collapse
|