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Bonadonna LV, Guerrero E, McClendon T, Union S, Kabbani D, Wittmann D, Cohn J, Veltman J. Evaluation of an HIV homecare program for lost-to-follow-up populations: a mixed methods study in Detroit, Michigan. AIDS Res Ther 2024; 21:21. [PMID: 38609992 PMCID: PMC11015688 DOI: 10.1186/s12981-024-00608-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Maintaining people living with HIV (PLWHIV) in clinical care is a global priority. In the Metro Detroit area of Michigan, approximately 30% of PLWHIV are out of care. To re-engage lost-to-follow-up patients, Wayne Health Infectious Disease clinic launched an innovative Homecare program in 2017. In addition to home healthcare delivery, the program included links to community resources and quarterly community meetings. We aimed to evaluate Homecare's impact on participants' ability to stay engaged in HIV care and reach viral suppression. We included data from PLWHIV and their healthcare workers. METHODS We used a convergent mixed-methods design, including first year program record review, semi-structured interviews, and a validated Likert scale questionnaire rating illness perception before and after Homecare. Interview data were collected from 15 PLWHIV in Metro Detroit and two healthcare workers responsible for program delivery. Semi-structured interviews focused on obstacles to clinic-based care, support networks, and illness perceptions. Interview data were transcribed and analyzed using a thematic approach. A fully coded analysis was used to create a conceptual framework of factors contributing to Homecare's success. Means in eight categories of the Brief Illness Perception (IPQ) were compared using paired T-tests. RESULTS In the first year of Homecare, 28 of 34 participants (82%) became virally suppressed at least once. The program offered (1) social support and stigma reduction through strong relationships with healthcare workers, (2) removal of physical and resource barriers such as transportation, and (3) positive changes in illness perceptions. PLWHIV worked towards functional coping strategies, including improvements in emotional regulation, acceptance of their diagnosis, and more positive perspectives of control. Brief-IPQ showed significant changes in six domains before and after Homecare. CONCLUSION Homecare offers an innovative system for successfully re-engaging and maintaining lost-to-follow-up PLWHIV in care. These findings have implications for HIV control efforts and could inform the development of future programs for difficult to reach populations.
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Affiliation(s)
- L V Bonadonna
- Emory University School of Medicine, Atlanta, GA, USA.
- Wayne State University School of Medicine, Detroit, MI, USA.
| | - E Guerrero
- Wayne State University, Detroit, MI, USA
| | | | - S Union
- Wayne Health, Detroit, MI, USA
| | - D Kabbani
- Wayne State University School of Medicine, Detroit, MI, USA
| | | | - J Cohn
- Wayne State University School of Medicine, Detroit, MI, USA
| | - J Veltman
- Loma Linda University School of Medicine, Loma Linda, CA, USA
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Fonner V, Agostini T, Desai R, Hartzell P, Martin L, Meissner EG. Implementation of free-draft text messaging to enhance care retention and satisfaction for persons living with HIV infection. AIDS Care 2024; 36:452-462. [PMID: 37139535 PMCID: PMC10622326 DOI: 10.1080/09540121.2023.2208320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Abstract
Eligible persons with HIV infection can receive client-centered case management to coordinate medical and social services. Novel mobile health interventions could improve effective case management and retention in care, an important goal to help end the HIV epidemic. Using a hybrid type I effectiveness-implementation design, we assessed whether access to bidirectional, free-draft secure text messaging with a case manager and clinic pharmacist could improve client satisfaction and care retention in a Southern academic HIV clinic. Sixty-four clients enrolled between November 2019 and March 2020, had a median age of 39 years, and were mostly male, single, and African-American. Heavy app users texted over 100 times (n = 6) over the course of the 12-month intervention while others never texted (n = 12). App usage peaked during months of clinic closure due to COVID-19. Most participants reported high satisfaction with the app and planned continued usage after study completion. Changes in clinic retention and virologic suppression rates were not observed, a result confounded by practice changes due to COVID-19. High usage and satisfaction of free-draft text messaging in case-managed HIV clients supports inclusion of this communication option in routine HIV clinical care.
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Affiliation(s)
- Virginia Fonner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Thomas Agostini
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC
| | - Rohan Desai
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC
| | - Peyton Hartzell
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC
| | - Lisa Martin
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC
| | - Eric G. Meissner
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
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Oliveira VHF, Webel AR, Borsari AL, Cárdenas JDG, Deminice R. Health and sociodemographic factors associated with low muscle strength, muscle mass, and physical performance among people living with HIV. AIDS Care 2023; 35:1863-1873. [PMID: 36404290 DOI: 10.1080/09540121.2022.2147482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022]
Abstract
ABSTRACTThis study examined the factors associated with low muscle strength, muscle mass, and physical performance in 331 people living with HIV. Participants completed handgrip as a strength measure, appendicular skeletal muscle mass using bioimpedance analysis, and chair rise was a physical performance measure. Multivariate logistic regression was used to analyze the association between low values on these measures with sociodemographic, HIV-related factors, and comorbidities. Higher body mass index (BMI) (OR = 0.91; CI = 0.86-0.97) and higher CD4/CD8 ratio (OR = 0.38; 95% CI = 0.18-0.82) were associated with decreased likelihood of low handgrip strength. Being non-employed (OR = 2.08; 95% CI = 1.07-4.06), having hypertension (OR = 2.27; 95% CI = 1.13-4.54) and rheumatism (OR = 5.46; 95% CI = 1.68-17.74) increased the chance of low handgrip strength. Higher BMI (OR = 0.43; 95% CI = 0.34-0.56), CD4/CD8 ratio (OR = 0.29; 95% CI = 0.09-0.93), and bioimpedance phase angle (OR = 0.22; 95% CI = 0.12-0.40) were associated with decreased likelihood of low muscle mass. Lastly, having less than eight years of education (OR = 1.87; 95% CI = 1.02-3.41) and being non-employed (OR = 8.18; 95% CI = 3.09-21.61) increased the chance of low chair stand performance. In addition, higher CD4 + lymphocytes count (OR = 0.99; 95% CI = 0.99-0.99) was associated with a decreased likelihood of low chair stand performance. In conclusion, specific and non-specific HIV-related factors are associated with low handgrip strength, low muscle mass, and/or low chair stand performance.
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Affiliation(s)
- Vitor H F Oliveira
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Allison R Webel
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Ana Lucia Borsari
- Department of Physical Education, Londrina State University, Londrina, Brazil
| | | | - Rafael Deminice
- Department of Physical Education, Londrina State University, Londrina, Brazil
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Esber AL, Dear NF, King D, Francisco LV, Sing'oei V, Owuoth J, Maswai J, Iroezindu M, Bahemana E, Kibuuka H, Shah N, Polyak CS, Ake JA, Crowell TA. Achieving the third 95 in sub-Saharan Africa: application of machine learning approaches to predict viral failure. AIDS 2023; 37:1861-1870. [PMID: 37418549 DOI: 10.1097/qad.0000000000003646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
OBJECTIVE Viral failure in people with HIV (PWH) may be influenced by multiple sociobehavioral, clinical, and context-specific factors, and supervised learning approaches may identify novel predictors. We compared the performance of two supervised learning algorithms to predict viral failure in four African countries. DESIGN Cohort study. METHODS The African Cohort Study is an ongoing, longitudinal cohort enrolling PWH at 12 sites in Uganda, Kenya, Tanzania, and Nigeria. Participants underwent physical examination, medical history-taking, medical record extraction, sociobehavioral interviews, and laboratory testing. In cross-sectional analyses of enrollment data, viral failure was defined as a viral load at least 1000 copies/ml among participants on antiretroviral therapy (ART) for at least 6 months. We compared the performance of lasso-type regularized regression and random forests by calculating area under the curve (AUC) and used each to identify factors associated with viral failure; 94 explanatory variables were considered. RESULTS Between January 2013 and December 2020, 2941 PWH were enrolled, 1602 had been on antiretroviral therapy (ART) for at least 6 months, and 1571 participants with complete case data were included. At enrollment, 190 (12.0%) had viral failure. The lasso regression model was slightly superior to the random forest in its ability to identify PWH with viral failure (AUC: 0.82 vs. 0.75). Both models identified CD4 + count, ART regimen, age, self-reported ART adherence and duration on ART as important factors associated with viral failure. CONCLUSION These findings corroborate existing literature primarily based on hypothesis-testing statistical approaches and help to generate questions for future investigations that may impact viral failure.
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Affiliation(s)
- Allahna L Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Nicole F Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - David King
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Leilani V Francisco
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Valentine Sing'oei
- U.S. Army Medical Research Directorate - Africa
- HJF Medical Research International, Kisumu
| | - John Owuoth
- U.S. Army Medical Research Directorate - Africa
- HJF Medical Research International, Kisumu
| | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- U.S. Army Medical Research Directorate - Africa, Kericho, Kenya
| | - Michael Iroezindu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- HJF Medical Research International, Abuja, Nigeria
| | - Emmanuel Bahemana
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- HJF Medical Research International, Mbeya, Tanzania
| | - Hannah Kibuuka
- Makerere University-Walter Reed Project, Kampala, Uganda
| | - Neha Shah
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
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Borchmann O, Weis N, Hansen ABE, Storgaard M, Fetters MD, Chandanabhumma PP, Moseholm E. Patient-reported outcomes in clinical HIV care: protocol for a single-centre, multistage, mixed-methods study in Denmark. BMJ Open 2023; 13:e077303. [PMID: 37709310 PMCID: PMC10503392 DOI: 10.1136/bmjopen-2023-077303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION People with HIV-1 (PWH) have worse health-related quality of life (HRQoL) compared with the general population. Using patient-reported outcomes (PROs) may help reorient the focus of HIV care towards improving HRQoL. This study aims to develop, implement and evaluate the use of PROs in HIV care. METHODS AND ANALYSIS This is a Danish single-centre, multistage mixed-methods study consisting of four substudies (studies I-IV). Study I is a qualitative focus group interview study aiming to identify relevant PRO domains, and barriers and benefits to PRO use. Participants are 5-10 PWH and 5-10 HIV healthcare providers (HCPs). Data are thematically analysed. Results will guide the design of a PRO measure (PROM). Study II is a quantitative study aiming to assess PWH's willingness and ability to engage with PRO. All PWH are consecutively invited to complete the PROMs before their next consultations. Demographic data are collected at enrolment. Differences between PWH who do/do not complete the PROMs are assessed. Study III is a quantitative before-and-after study aiming to assess the impact of PRO use on HCP awareness. Participants are all who complete the PROMs in Study II. In contrast to study II, HCPs are notified of the PROM results. The number of problems documented by the HCP in patients' medical records during studies II and III are compared using χ2 tests. Multiple regression models are used to identify factors associated with HCP awareness. Study IV is a qualitative study aiming to explore PWH and HCP experiences of using PROs. Participants are 15-20 PWH and 10-15 HCP. Data are collected from participant observation of PRO consultations and individual interviews. Data are analysed thematically. ETHICS AND DISSEMINATION This study is approved by the Danish Data Protection Agency. Participants will provide written consent prior to participation. Results will be published in peer-reviewed journals.
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Affiliation(s)
- Olivia Borchmann
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Ann-Brit Eg Hansen
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus Universitetshospital, Aarhus, Denmark
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Mixed Methods Program, University of Michigan, Ann Arbor, Michigan, USA
| | - P Paul Chandanabhumma
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Mixed Methods Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Ellen Moseholm
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
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Kim SJ, Ahn A, Hu E, Peterson CE. Qualitative Analysis of Multiple Sources and Dimensions of Stigma Among Older Adults Living With HIV Infection Released From Corrections. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:126-140. [PMID: 37129593 DOI: 10.1521/aeap.2023.35.2.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
While sources of stigma associated with HIV, incarceration, and aging have been explored separately, the concurrent effects of these multiple sources have been understudied. We conducted in-depth interviews with 48 older adults over 50 years of age with HIV infection who were returning from correctional settings concerning their experiences of stigma. Participants described HIV-related stigma substantially more often than incarceration-related stigma and a greater number of stigma experiences as time passed from release. Anticipated stigma experiences were frequently associated with HIV. Enacted stigma was often related to incarceration. Internalized stigma was associated with both HIV and incarceration. However, participants often described aging as a positive experience of gaining wisdom and control over their life. The findings indicated that multiple sources of stigma affect different dimensions of stigma. Postrelease interventions may benefit from addressing increasing experiences of stigma in the rapidly growing population of older adults living with HIV with a history of incarceration.
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Affiliation(s)
- Sage J Kim
- Division of Health Policy & Administration, School of Public Health, University of Illinois at Chicago
| | - Anna Ahn
- Division of Health Policy & Administration, School of Public Health, University of Illinois at Chicago
| | - Elise Hu
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois at Chicago
| | - Caryn E Peterson
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois at Chicago
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7
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Petroll AE, Quinn KG, John SA, Nigogosyan Z, Walsh JL. Factors associated with lack of care engagement among older, rural-dwelling adults living with HIV in the United States. J Rural Health 2023; 39:477-487. [PMID: 36482508 PMCID: PMC10038837 DOI: 10.1111/jrh.12732] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Most people living with HIV (PLH) in the United States are over age 50 and this sector of PLH continues to grow. Aging with HIV can be challenging due to comorbid medical conditions, mental health disorders, substance use, and lack of social and practical support. Additional challenges are faced by older PLH living in the rural United States, such as longer distances to health care, concerns over privacy and stigma, and social isolation. PLH in rural areas have higher mortality rates than urban PLH. We aimed to understand factors associated with HIV care engagement and quality of life in rural US adults over age 50. METHODS We conducted a cross-sectional study to evaluate the association between patient-level factors and a combined outcome variable encompassing multiple aspects of care engagement. FINDINGS Either online or on paper, 446 participants completed our survey. One-third of the participants (33%) were from the southern United States; one-third were women; one-third were non-White; and 24% completed the survey on paper. In multiple regression analysis, lower income, residing in the southern United States, lacking internet access at home, not having an HIV specialist provider, higher levels of stress, living alone, and longer distance to an HIV provider were all associated with lower engagement in HIV care. CONCLUSIONS Our findings demonstrated multiple potential options for interventions that could improve care engagement, such as providing and enhancing access to technology for health care engagement and remotely delivering social support and mental health services. Research on such potential interventions is needed for older, rural PLH.
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Affiliation(s)
- Andrew E. Petroll
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine G. Quinn
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven A. John
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Zack Nigogosyan
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer L. Walsh
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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A Census Tract-Level Examination of HIV Care Outcomes and Social Vulnerability Among Black/African American, Hispanic/Latino, and White Adults in the Southern United States, 2018. J Community Health 2023:10.1007/s10900-023-01191-y. [PMID: 36823280 PMCID: PMC9950007 DOI: 10.1007/s10900-023-01191-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/25/2023]
Abstract
We examined the association between social vulnerability and HIV diagnoses, linkage to HIV medical care, and viral suppression among adults in the Southern U.S. Data from CDC's National HIV Surveillance System (NHSS) were used to determine census tract-level HIV diagnosis rates and percentages of persons linked to care within one month and with viral suppression within six months of diagnosis among Black/African American, Hispanic/Latino, and White adults aged ≥ 18 years residing in the Southern U.S. in 2018. Census tract-level social vulnerability data were obtained from the 2018 CDC Social Vulnerability Index (SVI). Rate and proportion ratios were used to determine the difference between the lowest quartile of SVI scores (Q1) and the highest quartile (Q4) by age group, transmission category, and region of residence and stratified by sex assigned at birth. Areas with the highest social vulnerability (Q4) had the highest rates of HIV diagnoses (Black: 56.5, Hispanic/Latino: 27.2, and White: 10.3). Those in Q4 also had the lowest percentages of adults linked to care (Black: 76.1%, Hispanic/Latino: 81.2%, and White: 77.8%), and the lowest percentages of adults with viral suppression (Black: 59.8%, Hispanic/Latino: 68.4%, and White: 65.7%). This ecological study found an association between social vulnerability, HIV diagnoses, and poorer care outcomes among Black/African American, Hispanic/Latino, and White adults. Tailoring interventions and improving access for persons residing in areas with the highest social vulnerability is necessary to reduce HIV transmission and improve health outcomes in the Southern U.S.
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Salvi S, Raichur P, Kadam D, Sangle S, Gupte N, Nevrekar N, Patil S, Chavan A, Nimkar S, Marbaniang I, Mave V. Virological failure among people living with HIV receiving second-line antiretroviral therapy in Pune, India. BMC Infect Dis 2022; 22:951. [PMID: 36528762 PMCID: PMC9758821 DOI: 10.1186/s12879-022-07894-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The number of people receiving second-line antiretroviral therapy (ART) has increased as global access to ART has expanded. Data on the burden and factors associated with second-line ART virologic failure (VF) from India remain limited. METHODS We conducted cross-sectional viral load (VL) testing among adults (≥ 18 years) who were registered at a publicly funded ART center in western India between 2014 and 2015 and had received second-line ART for at least 6 months. Sociodemographic and clinical characteristics were abstracted from routinely collected programmatic data. Logistic regression evaluated factors associated with VF (defined as VL > 1000 copies/mL). RESULTS Among 400 participants, median age was 40 years (IQR 34-44), 71% (285/400) were male, and 15% (59/400) had VF. Relative to participants without VF, those with VF had lower median CD4 counts (230 vs 406 cells/mm3, p < 0.0001), lower weight at first-line failure (49 vs 52 kg, p = 0.003), were more likely to have an opportunistic infection (17% vs 3%, p < 0.0001) and less likely to have optimal ART adherence (71% vs 87%, p = 0.005). In multivariable analysis, VF was associated with opportunistic infection (aOR, 4.84; 95% CI, 1.77-13.24), lower CD4 count (aOR 4.15; 95% CI, 1.98-8.71) and lower weight at first-line failure (aOR, 2.67; 95% CI, 1.33-5.34). CONCLUSIONS We found second-line VF in about a sixth of participants in our setting, which was associated with nearly fivefold increased odds in the context of opportunistic infection. Weight could be a useful clinical indicator for second-line VF.
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Affiliation(s)
- Sonali Salvi
- grid.452248.d0000 0004 1766 9915Department of Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Jai Prakash Narayan Road, Pune, India
| | - Priyanka Raichur
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Dileep Kadam
- grid.452248.d0000 0004 1766 9915Department of Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Jai Prakash Narayan Road, Pune, India
| | - Shashikala Sangle
- grid.452248.d0000 0004 1766 9915Department of Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Jai Prakash Narayan Road, Pune, India
| | - Nikhil Gupte
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India ,grid.21107.350000 0001 2171 9311Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Neetal Nevrekar
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Sandesh Patil
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Amol Chavan
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Smita Nimkar
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Ivan Marbaniang
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India ,grid.14709.3b0000 0004 1936 8649Department of Epidemiology, McGill University, Montreal, QC Canada
| | - Vidya Mave
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India ,grid.21107.350000 0001 2171 9311Johns Hopkins University School of Medicine, Baltimore, MD USA
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Logie CH, Sokolovic N, Kazemi M, Islam S, Frank P, Gormley R, Kaida A, de Pokomandy A, Loutfy M. Does resource insecurity drive HIV-related stigma? Associations between food and housing insecurity with HIV-related stigma in cohort of women living with HIV in Canada. J Int AIDS Soc 2022; 25 Suppl 1:e25913. [PMID: 35818863 PMCID: PMC9274209 DOI: 10.1002/jia2.25913] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/28/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Women living with HIV across global contexts are disproportionately impacted by food insecurity and housing insecurity. Food and housing insecurity are resource insecurities associated with poorer health outcomes among people living with HIV. Poverty, a deeply stigmatized phenomenon, is a contributing factor towards food and housing insecurity. HIV-related stigma-the devaluation, mistreatment and constrained access to power and opportunities experienced by people living with HIV-intersects with structural inequities. Few studies, however, have examined food and housing insecurity as drivers of HIV-related stigma. This study aimed to estimate the associations between food and housing insecurity with HIV-related stigma among women living with HIV in Canada. METHODS This prospective cohort study of women living with HIV (≥16 years old) in three provinces in Canada involved three waves of surveys collected at 18-month intervals between 2013 and 2018. To understand associations between food and housing security and HIV-related stigma, we conducted linear mixed effects regression models. We adjusted for socio-demographic characteristics associated with HIV-related stigma. RESULTS AND DISCUSSION Among participants (n = 1422), more than one-third (n = 509; 36%) reported baseline food insecurity and approximately one-tenth (n = 152, 11%) housing insecurity. Mean HIV-related stigma scores were consistent across waves 1 (mean [M] = 57.2, standard deviation [SD] = 20.0, N = 1401) and 2 (M = 57.4, SD = 19.0, N = 1227) but lower at wave 3 (M = 52.8, SD = 18.7, N = 918). On average, across time, food insecure participants reported HIV-related stigma scores that were 8.6 points higher (95% confidence interval [CI]: 6.4, 10.8) compared with food secure individuals. Similarly, participants reporting insecure housing at wave 1 tended to experience greater HIV-related stigma (6.2 points, 95% CI: 2.7, 9.6) over time compared to stably housed participants. There was an interaction between time and housing insecurity, whereby baseline housing insecurity was no longer associated with higher HIV-related stigma at the third wave. CONCLUSIONS Among women living with HIV in Canada, experiencing food and housing insecurity was associated with consistently higher levels of HIV-related stigma. In addition to the urgent need to tackle food and housing insecurity among people living with HIV to optimize wellbeing, getting to the heart of HIV-related stigma requires identifying and dismantling resource insecurity-related stigma drivers.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Nina Sokolovic
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Mina Kazemi
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Shaz Islam
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Alliance for South Asian AIDS Prevention, Toronto, Ontario, Canada
| | - Peggy Frank
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mona Loutfy
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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11
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Lee CY, Lin YP, Tu HP, Wang SF, Lu PL. Sex stratification of the trends and risk of mortality among individuals living with HIV under different transmission categories. Sci Rep 2022; 12:9266. [PMID: 35661129 PMCID: PMC9166722 DOI: 10.1038/s41598-022-13294-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/23/2022] [Indexed: 11/09/2022] Open
Abstract
We retrospectively examined 33,142 persons living with HIV (PLWH) in Taiwan from a nationwide database to assess sex-stratified trends and risk of all-cause mortality under different transmission categories from 1984 to 2016. Overall, 61.25% were men who have sex with men (MSM), 14.37% were men who have sex with women (MSW), 18.32% were male persons who inject drugs (M-PWID), 3.30% were women who have sex with men (WSM), and 2.74% were female PWID (F-PWID). All-cause mortality (per 100 person-years) among heterosexual people and PWID was higher in men (4.04 and 3.39, respectively) than in women (2.93 and 2.18, respectively). In each sex-stratified transmission category, the all-cause mortality reduced substantially from 1984–1996 to 2012–2016, but evolved distinctly from 2007–2011 to 2012–2016. Since 2007–2011, the decline in all-cause mortality has slowed notably in the groups with sexually transmitted HIV, but has increased in PWID, surpassing even that among groups with sexually transmitted HIV in 2012–2016. PLWH with sexually transmitted HIV had lower risks of all-cause mortality than PWID, regardless of sex. Sex and transmission category did not interact significantly on all-cause mortality. Understanding the reasons for the distinct evolving trends of all-cause mortality in each transmission category serves as a reference for developing strategies to reduce mortality in PLWH in Taiwan further.
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Affiliation(s)
- Chun-Yuan Lee
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).,Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan (R.O.C.).,M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
| | - Yi-Pei Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan (R.O.C.)
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
| | - Sheng-Fan Wang
- Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).,Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
| | - Po-Liang Lu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan (R.O.C.). .,School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.). .,Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).
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12
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Papageorgiou V, Davies B, Cooper E, Singer A, Ward H. Influence of Material Deprivation on Clinical Outcomes Among People Living with HIV in High-Income Countries: A Systematic Review and Meta-analysis. AIDS Behav 2022; 26:2026-2054. [PMID: 34894331 PMCID: PMC9046343 DOI: 10.1007/s10461-021-03551-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2021] [Indexed: 11/06/2022]
Abstract
Despite developments in HIV treatment and care, disparities persist with some not fully benefiting from improvements in the HIV care continuum. We conducted a systematic review to explore associations between social determinants and HIV treatment outcomes (viral suppression and treatment adherence) in high-income countries. A random effects meta-analysis was performed where there were consistent measurements of exposures. We identified 83 observational studies eligible for inclusion. Social determinants linked to material deprivation were identified as education, employment, food security, housing, income, poverty/deprivation, socioeconomic status/position, and social class; however, their measurement and definition varied across studies. Our review suggests a social gradient of health persists in the HIV care continuum; people living with HIV who reported material deprivation were less likely to be virologically suppressed or adherent to antiretrovirals. Future research should use an ecosocial approach to explore these interactions across the lifecourse to help propose a causal pathway.
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Affiliation(s)
- Vasiliki Papageorgiou
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK.
| | - Bethan Davies
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Emily Cooper
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Ariana Singer
- School of Public Health, Imperial College London, London, UK
| | - Helen Ward
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
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13
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Bailey DE, Caiola C, Adimora AA, Ramirez C, Holt L, Johnson R, Koch A, McGee K, McMillian-Bohler JM, Randolph SD, Ritchwood TD, Relf MV. Adaptive Challenges, Adaptive Work, and Adaptive Leadership Among Women Living With HIV in the Southern United States: Findings From a Qualitative Study. J Assoc Nurses AIDS Care 2022; 33:259-269. [PMID: 35500057 PMCID: PMC9244859 DOI: 10.1097/jnc.0000000000000288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Women living with HIV have a higher burden of non-AIDS comorbidities and prevalence of chronic conditions. The Adaptive Leadership Framework for Chronic Illness clarifies living with complex health challenges by delineating the technical work of health care providers as well as the adaptive work and leadership behaviors of patients and their providers. We conducted a descriptive, qualitative study of women residing in the Southern United States who were participating in the Women's Interagency HIV Study in North Carolina. Twenty-two participants (mean age = 52.2 years; 90.9% self-identifying as Black or African American) completed semi-structured qualitative interviews. We identified adaptive challenges (e.g., affective and disclosure challenges) and adaptive work and leadership behaviors. Women learned skills to care for their health and support their families and to work with their providers to manage their care. Findings support the importance of identifying leadership behaviors for the purpose of developing person-centered interventions.
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Affiliation(s)
- Donald E. Bailey
- Duke University School of Nursing, Durham, North Carolina, USA. Courtney Caiola
| | - Courtney Caiola
- East Carolina University, School of Nursing, Greenville, North Carolina, USA
| | - Adaora A. Adimora
- Sarah Graham Kenan Distinguished Professor of Medicine, School of Medicine, and Professor of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catalina Ramirez
- School of Medicine, and Project Director, Women’s Interagency HIV Study, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lauren Holt
- Duke University School of Nursing, Durham, NorthCarolina, USA
| | - Ragan Johnson
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Amie Koch
- Duke University School of Nursing, and Palliative Care and Hospice Family Nurse Practitioner, Transitions LifeCare, and a COVID Nurse Practitioner, Lincoln Community Health Clinic, Durham, North Carolina, USA
| | - Kara McGee
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | | | - Tiarney D. Ritchwood
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham,NorthCarolina,USA
| | - Michael V. Relf
- Associate Dean for Global and Community Health Affairs, Duke University School of Nursing, and an Associate Professor, Duke Global Health Institute, Durham, North Carolina, USA
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14
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McClean AR, Trigg J, Ye M, McLinden T, Kooij KW, Bacani N, Hui C, Sereda P, Burchell AN, Walmsley SL, Kelly D, Machouf N, Montaner JSG, Loutfy M, Hogg RS. Neighbourhood-level material deprivation and response to combination antiretroviral therapy in the Canadian Observational Cohort (CANOC): a longitudinal cohort study. CMAJ Open 2022; 10:E183-E189. [PMID: 35292476 PMCID: PMC8929426 DOI: 10.9778/cmajo.20200249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Socioeconomic status has been associated with higher viral loads and lower CD4 cell counts among people living with HIV. The objective of this study was to evaluate the relation between neighbourhood-level material deprivation and immunologic and virologic response to combination antiretroviral therapy (ART) among people living with HIV in Canada. METHODS The Canadian Observational Cohort (CANOC) is a longitudinal cohort of people living with HIV, containing data from 2000-2016 from 5 Canadian provinces. We defined response to combination ART as positive if the CD4 cell count increased by 50 cells/mm3 (0.05 cells × 109/L) or more (CD4+) and viral load decreased to 50 copies/mL or less (VL+) within 6 months of treatment initiation. We further categorized response to therapy as concordant positive (CD4+/VL+), concordant negative (CD4-/VL-) or discordant (CD4+/VL- or CD4-/VL+). We used adjusted multinomial logistic regression to quantify the relation between neighbourhood-level material deprivation and immunologic and virologic response. RESULTS This study included 8274 people living with HIV, of which 1754 (21.2%) lived in the most materially deprived neighbourhoods. Most individuals (62.2%) showed a concordant positive response to combination ART. After adjustment, living in the most materially deprived neighbourhoods was associated with a CD4-/VL+ discordant response (adjusted odds ratio [OR] 1.31, 95% confidence interval [CI] 1.06-1.62) and a concordant negative response (adjusted OR 1.45, 95% CI 1.13-1.86), using a concordant positive response as the reference. No other deprivation quartile was independently associated with a particular response. INTERPRETATION People living with HIV from the most materially deprived neighbourhoods had increased odds of poor immunologic or virologic response to combination ART. These results motivate further study of the specific socioeconomic factors that potentially affect response to combination ART among people living with HIV in Canada.
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Affiliation(s)
- Alison R McClean
- British Columbia Centre for Excellence in HIV/AIDS (McClean, Trigg, Ye, McLinden, Kooij, Bacani, Sereda, Montaner, Hogg); Faculty of Medicine (McClean, Montaner), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Kooij, Hogg), Simon Fraser University, Burnaby, BC; Faculty of Arts (Hui), Ryerson University, Toronto Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Hui, Walmsley), Vancouver, BC; Department of Family and Community Medicine (Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Burchell), Faculty of Health Sciences, University of Toronto; University Health Network (Walmsley), Toronto, Ont.; Faculty of Medicine and School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Clinique de Médecine Urbaine du Quartier Latin (Machouf), Montréal, Que.; Division of Infectious Disease (Loutfy), Department of Medicine, University of Toronto; Women's College Hospital (Loutfy), Toronto, Ont.
| | - Jason Trigg
- British Columbia Centre for Excellence in HIV/AIDS (McClean, Trigg, Ye, McLinden, Kooij, Bacani, Sereda, Montaner, Hogg); Faculty of Medicine (McClean, Montaner), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Kooij, Hogg), Simon Fraser University, Burnaby, BC; Faculty of Arts (Hui), Ryerson University, Toronto Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Hui, Walmsley), Vancouver, BC; Department of Family and Community Medicine (Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Burchell), Faculty of Health Sciences, University of Toronto; University Health Network (Walmsley), Toronto, Ont.; Faculty of Medicine and School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Clinique de Médecine Urbaine du Quartier Latin (Machouf), Montréal, Que.; Division of Infectious Disease (Loutfy), Department of Medicine, University of Toronto; Women's College Hospital (Loutfy), Toronto, Ont
| | - Monica Ye
- British Columbia Centre for Excellence in HIV/AIDS (McClean, Trigg, Ye, McLinden, Kooij, Bacani, Sereda, Montaner, Hogg); Faculty of Medicine (McClean, Montaner), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Kooij, Hogg), Simon Fraser University, Burnaby, BC; Faculty of Arts (Hui), Ryerson University, Toronto Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Hui, Walmsley), Vancouver, BC; Department of Family and Community Medicine (Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Burchell), Faculty of Health Sciences, University of Toronto; University Health Network (Walmsley), Toronto, Ont.; Faculty of Medicine and School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Clinique de Médecine Urbaine du Quartier Latin (Machouf), Montréal, Que.; Division of Infectious Disease (Loutfy), Department of Medicine, University of Toronto; Women's College Hospital (Loutfy), Toronto, Ont
| | - Taylor McLinden
- British Columbia Centre for Excellence in HIV/AIDS (McClean, Trigg, Ye, McLinden, Kooij, Bacani, Sereda, Montaner, Hogg); Faculty of Medicine (McClean, Montaner), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Kooij, Hogg), Simon Fraser University, Burnaby, BC; Faculty of Arts (Hui), Ryerson University, Toronto Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Hui, Walmsley), Vancouver, BC; Department of Family and Community Medicine (Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Burchell), Faculty of Health Sciences, University of Toronto; University Health Network (Walmsley), Toronto, Ont.; Faculty of Medicine and School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Clinique de Médecine Urbaine du Quartier Latin (Machouf), Montréal, Que.; Division of Infectious Disease (Loutfy), Department of Medicine, University of Toronto; Women's College Hospital (Loutfy), Toronto, Ont
| | - Katherine W Kooij
- British Columbia Centre for Excellence in HIV/AIDS (McClean, Trigg, Ye, McLinden, Kooij, Bacani, Sereda, Montaner, Hogg); Faculty of Medicine (McClean, Montaner), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Kooij, Hogg), Simon Fraser University, Burnaby, BC; Faculty of Arts (Hui), Ryerson University, Toronto Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Hui, Walmsley), Vancouver, BC; Department of Family and Community Medicine (Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Burchell), Faculty of Health Sciences, University of Toronto; University Health Network (Walmsley), Toronto, Ont.; Faculty of Medicine and School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Clinique de Médecine Urbaine du Quartier Latin (Machouf), Montréal, Que.; Division of Infectious Disease (Loutfy), Department of Medicine, University of Toronto; Women's College Hospital (Loutfy), Toronto, Ont
| | - Nicanor Bacani
- British Columbia Centre for Excellence in HIV/AIDS (McClean, Trigg, Ye, McLinden, Kooij, Bacani, Sereda, Montaner, Hogg); Faculty of Medicine (McClean, Montaner), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Kooij, Hogg), Simon Fraser University, Burnaby, BC; Faculty of Arts (Hui), Ryerson University, Toronto Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Hui, Walmsley), Vancouver, BC; Department of Family and Community Medicine (Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Burchell), Faculty of Health Sciences, University of Toronto; University Health Network (Walmsley), Toronto, Ont.; Faculty of Medicine and School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Clinique de Médecine Urbaine du Quartier Latin (Machouf), Montréal, Que.; Division of Infectious Disease (Loutfy), Department of Medicine, University of Toronto; Women's College Hospital (Loutfy), Toronto, Ont
| | - Christian Hui
- British Columbia Centre for Excellence in HIV/AIDS (McClean, Trigg, Ye, McLinden, Kooij, Bacani, Sereda, Montaner, Hogg); Faculty of Medicine (McClean, Montaner), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Kooij, Hogg), Simon Fraser University, Burnaby, BC; Faculty of Arts (Hui), Ryerson University, Toronto Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Hui, Walmsley), Vancouver, BC; Department of Family and Community Medicine (Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Burchell), Faculty of Health Sciences, University of Toronto; University Health Network (Walmsley), Toronto, Ont.; Faculty of Medicine and School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Clinique de Médecine Urbaine du Quartier Latin (Machouf), Montréal, Que.; Division of Infectious Disease (Loutfy), Department of Medicine, University of Toronto; Women's College Hospital (Loutfy), Toronto, Ont
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS (McClean, Trigg, Ye, McLinden, Kooij, Bacani, Sereda, Montaner, Hogg); Faculty of Medicine (McClean, Montaner), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Kooij, Hogg), Simon Fraser University, Burnaby, BC; Faculty of Arts (Hui), Ryerson University, Toronto Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Hui, Walmsley), Vancouver, BC; Department of Family and Community Medicine (Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Burchell), Faculty of Health Sciences, University of Toronto; University Health Network (Walmsley), Toronto, Ont.; Faculty of Medicine and School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Clinique de Médecine Urbaine du Quartier Latin (Machouf), Montréal, Que.; Division of Infectious Disease (Loutfy), Department of Medicine, University of Toronto; Women's College Hospital (Loutfy), Toronto, Ont
| | - Ann N Burchell
- British Columbia Centre for Excellence in HIV/AIDS (McClean, Trigg, Ye, McLinden, Kooij, Bacani, Sereda, Montaner, Hogg); Faculty of Medicine (McClean, Montaner), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Kooij, Hogg), Simon Fraser University, Burnaby, BC; Faculty of Arts (Hui), Ryerson University, Toronto Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Hui, Walmsley), Vancouver, BC; Department of Family and Community Medicine (Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Burchell), Faculty of Health Sciences, University of Toronto; University Health Network (Walmsley), Toronto, Ont.; Faculty of Medicine and School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Clinique de Médecine Urbaine du Quartier Latin (Machouf), Montréal, Que.; Division of Infectious Disease (Loutfy), Department of Medicine, University of Toronto; Women's College Hospital (Loutfy), Toronto, Ont
| | - Sharon L Walmsley
- British Columbia Centre for Excellence in HIV/AIDS (McClean, Trigg, Ye, McLinden, Kooij, Bacani, Sereda, Montaner, Hogg); Faculty of Medicine (McClean, Montaner), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Kooij, Hogg), Simon Fraser University, Burnaby, BC; Faculty of Arts (Hui), Ryerson University, Toronto Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Hui, Walmsley), Vancouver, BC; Department of Family and Community Medicine (Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Burchell), Faculty of Health Sciences, University of Toronto; University Health Network (Walmsley), Toronto, Ont.; Faculty of Medicine and School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Clinique de Médecine Urbaine du Quartier Latin (Machouf), Montréal, Que.; Division of Infectious Disease (Loutfy), Department of Medicine, University of Toronto; Women's College Hospital (Loutfy), Toronto, Ont
| | - Deborah Kelly
- British Columbia Centre for Excellence in HIV/AIDS (McClean, Trigg, Ye, McLinden, Kooij, Bacani, Sereda, Montaner, Hogg); Faculty of Medicine (McClean, Montaner), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Kooij, Hogg), Simon Fraser University, Burnaby, BC; Faculty of Arts (Hui), Ryerson University, Toronto Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Hui, Walmsley), Vancouver, BC; Department of Family and Community Medicine (Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Burchell), Faculty of Health Sciences, University of Toronto; University Health Network (Walmsley), Toronto, Ont.; Faculty of Medicine and School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Clinique de Médecine Urbaine du Quartier Latin (Machouf), Montréal, Que.; Division of Infectious Disease (Loutfy), Department of Medicine, University of Toronto; Women's College Hospital (Loutfy), Toronto, Ont
| | - Nimâ Machouf
- British Columbia Centre for Excellence in HIV/AIDS (McClean, Trigg, Ye, McLinden, Kooij, Bacani, Sereda, Montaner, Hogg); Faculty of Medicine (McClean, Montaner), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Kooij, Hogg), Simon Fraser University, Burnaby, BC; Faculty of Arts (Hui), Ryerson University, Toronto Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Hui, Walmsley), Vancouver, BC; Department of Family and Community Medicine (Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Burchell), Faculty of Health Sciences, University of Toronto; University Health Network (Walmsley), Toronto, Ont.; Faculty of Medicine and School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Clinique de Médecine Urbaine du Quartier Latin (Machouf), Montréal, Que.; Division of Infectious Disease (Loutfy), Department of Medicine, University of Toronto; Women's College Hospital (Loutfy), Toronto, Ont
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS (McClean, Trigg, Ye, McLinden, Kooij, Bacani, Sereda, Montaner, Hogg); Faculty of Medicine (McClean, Montaner), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Kooij, Hogg), Simon Fraser University, Burnaby, BC; Faculty of Arts (Hui), Ryerson University, Toronto Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Hui, Walmsley), Vancouver, BC; Department of Family and Community Medicine (Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Burchell), Faculty of Health Sciences, University of Toronto; University Health Network (Walmsley), Toronto, Ont.; Faculty of Medicine and School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Clinique de Médecine Urbaine du Quartier Latin (Machouf), Montréal, Que.; Division of Infectious Disease (Loutfy), Department of Medicine, University of Toronto; Women's College Hospital (Loutfy), Toronto, Ont
| | - Mona Loutfy
- British Columbia Centre for Excellence in HIV/AIDS (McClean, Trigg, Ye, McLinden, Kooij, Bacani, Sereda, Montaner, Hogg); Faculty of Medicine (McClean, Montaner), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Kooij, Hogg), Simon Fraser University, Burnaby, BC; Faculty of Arts (Hui), Ryerson University, Toronto Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Hui, Walmsley), Vancouver, BC; Department of Family and Community Medicine (Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Burchell), Faculty of Health Sciences, University of Toronto; University Health Network (Walmsley), Toronto, Ont.; Faculty of Medicine and School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Clinique de Médecine Urbaine du Quartier Latin (Machouf), Montréal, Que.; Division of Infectious Disease (Loutfy), Department of Medicine, University of Toronto; Women's College Hospital (Loutfy), Toronto, Ont
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS (McClean, Trigg, Ye, McLinden, Kooij, Bacani, Sereda, Montaner, Hogg); Faculty of Medicine (McClean, Montaner), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Kooij, Hogg), Simon Fraser University, Burnaby, BC; Faculty of Arts (Hui), Ryerson University, Toronto Ont.; Canadian Institutes of Health Research Canadian HIV Trials Network (Hui, Walmsley), Vancouver, BC; Department of Family and Community Medicine (Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Burchell), Faculty of Health Sciences, University of Toronto; University Health Network (Walmsley), Toronto, Ont.; Faculty of Medicine and School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Clinique de Médecine Urbaine du Quartier Latin (Machouf), Montréal, Que.; Division of Infectious Disease (Loutfy), Department of Medicine, University of Toronto; Women's College Hospital (Loutfy), Toronto, Ont
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Giacomelli A, Bonazzetti C, Conti F, Pezzati L, Oreni L, Micheli V, Mancon A, Vimercati S, Albrecht M, Passerini M, Cossu MV, Capetti AF, Meraviglia P, Antinori S, Rizzardini G, Galli M, Ridolfo AL. Brief Report: Impact of the COVID-19 Pandemic on Virological Suppression in People Living With HIV Attending a Large Italian HIV Clinic. J Acquir Immune Defic Syndr 2021; 88:299-304. [PMID: 34651605 PMCID: PMC8518206 DOI: 10.1097/qai.0000000000002754] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/15/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND We assessed the impact of the coronavirus disease 2019 (COVID-19) pandemic on HIV suppression rates in people living with HIV (PLWH) attending a large Italian HIV clinic. SETTING The HIV outpatient clinic of the Infectious Diseases Department of Luigi Sacco Hospital, Milan, Italy, which serves more than 5000 PLWH per year. METHODS A before and after quasi-experimental study design was used to make a retrospective assessment of the monthly trend of HIV-RNA determinations of ≥50 among the PLWH attending our clinic, with "before" being the period from January 1, 2016 to February 20, 2020, and "after" being the period from February 21, 2020 to December 31, 2020 (the COVID-19 period). Interrupted time series analysis was used to evaluate any changes in the trend. RESULTS During the study period, 70,349 HIV-RNA viral load determinations were made, and the percentage of HIV-RNA viral load determinations of <50 copies/mL increased from 88.4% in 2016 to 93.2% in 2020 (P < 0.0001). There was a significant monthly trend toward a decrease in the number of HIV-RNA determinations of ≥50 copies/mL before the pandemic (β -0.084; standard error 0.015; P < 0.001), and this did not significantly change after it started (β -0.039, standard error 0.161; P = 0.811). CONCLUSIONS A high prevalence of viral suppression was maintained among the PLWH referring to our clinic, despite the structural barriers raised by the COVID-19 pandemic. The use of simplified methods of delivering care (such as teleconsultations and multiple antiretroviral treatment prescriptions) may have contributed to preserving this continuum.
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Affiliation(s)
- Andrea Giacomelli
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Cecilia Bonazzetti
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Milan, Italy
| | - Federico Conti
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Milan, Italy
| | - Laura Pezzati
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Milan, Italy
| | - Letizia Oreni
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Valeria Micheli
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli- Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Alessandro Mancon
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli- Sacco, Luigi Sacco University Hospital, Milan, Italy
| | | | - Maria Albrecht
- Pharmaceutical Department, ASST Fatebenefratelli-Sacco, Milan, Italy;
| | - Matteo Passerini
- I Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy;
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Milan, Italy
| | - Maria Vittoria Cossu
- I Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy;
| | - Amedeo Ferdinando Capetti
- I Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy;
| | - Paola Meraviglia
- I Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy;
| | - Spinello Antinori
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Milan, Italy
| | - Giuliano Rizzardini
- I Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy;
- School of Medicine, University of the Witwatersrand, Johannesburg, South Africa; and
| | - Massimo Galli
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, Milan, Italy
| | - Anna Lisa Ridolfo
- III Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
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Ronit A, Omland LH, Kronborg G, Pedersen G, Nielsen L, Mohey R, Wiese L, Obel N, Ahlström MG. Incidence of chronic obstructive pulmonary disease in people with HIV, their parents and siblings in Denmark. J Infect Dis 2021; 225:492-501. [PMID: 34260725 DOI: 10.1093/infdis/jiab369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People with HIV (PWH) may be at increased risk of several respiratory syndromes including chronic obstructive pulmonary disease (COPD). In matched cohort studies, we examined risk factors for COPD in PWH, their parents and siblings compared with population controls. METHODS Using data from national registries, competing risk regression models were constructed and used to calculate adjusted hazard ratios (aHR) for COPD. We evaluated the effect of HIV characteristics, smoking and educational attainment on COPD incidence in PWH. RESULTS A total of 226 PWH and 1029 population controls were diagnosed with COPD during 63,661 and 562,171 person years of follow up. PWH had increased risk of being diagnosed with COPD compared to controls (aHR 2.02 [95%CI: 1.75-2.33]). Parents and siblings of PWH were also more likely to be diagnosed with COPD compared to controls. CD4+ T-cell counts were not associated with COPD, but both unsuppressed viral replication, smoking status and educational attainment were associated with COPD in PWH. No COPD diagnoses were registered in PWH with high educational attainment and absence of smoking. CONCLUSIONS PWH have an increased risk of being diagnosed with COPD, as have their parents and siblings. This seems to be driven primarily by smoking and low socioeconomic status.
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Affiliation(s)
- Andreas Ronit
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre,Denmark
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigsh ospitalet,Denmark
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre,Denmark
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg,Denmark
| | - Lars Nielsen
- Department of Infectious Diseases, Hillerød University Hospital, Hillerød,Denmark
| | - Rajesh Mohey
- Department of Infectious Diseases, Herning University Hospital, Herning,Denmark
| | - Lothar Wiese
- Department of Internal Medicine, Division of Infectious Diseases, Zealand University Hospital, Roskilde,Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigsh ospitalet,Denmark
| | - Magnus G Ahlström
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Denmark
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17
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Economic Burden Among Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV or Living Without HIV in the Multicenter AIDS Cohort Study. J Acquir Immune Defic Syndr 2021; 85:436-443. [PMID: 33136741 PMCID: PMC7592888 DOI: 10.1097/qai.0000000000002478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
With HIV now considered a chronic disease, economic burden for people living with HIV (LWH) may threaten long-term disease outcomes. We studied associations between economic burden (employment, income, insurance, and financial difficulty) and HIV status for gay, bisexual, and other men who have sex with men (GBMSM) and how economic burden relates to disease progression.
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18
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Abbott MM, McBain R, Wagner L, Liu HH. Cost evaluation of integrating local HIV and housing data to facilitate service coordination in four demonstration sites. AIDS Care 2021; 34:746-752. [PMID: 33657927 DOI: 10.1080/09540121.2021.1894317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
As part of the evaluation of a federal initiative to integrate HIV medical and housing data at four local jurisdictions in the U.S., we estimated the financial costs of implementing data integration occurring from June 2016 to August 2018. We collected data on labor, non-labor, and overhead expenses based on invoices and surveys of staff time, staff compensation, and non-labor expenses. Non-labor expenses were directly charged or allocated to the project using the number of full-time equivalents as the allocation basis. Reported indirect cost rates were used to estimate overhead expenses. Demonstration sites spent an average of $273,656 over the full 27-month period, with an average monthly spending of $10,010 in 2018 U.S. dollars. There was sizable variation in the data integration costs across sites, implementation phases, and data integration models. Findings may help policymakers and potential adopters of similar data integration efforts customize parameters for local conditions and estimate resources required.
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Affiliation(s)
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- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Washington, DC, USA
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Abela IA, Scherrer AU, Böni J, Yerly S, Klimkait T, Perreau M, Hirsch HH, Furrer H, Calmy A, Schmid P, Cavassini M, Bernasconi E, Günthard HF. Emergence of Drug Resistance in the Swiss HIV Cohort Study Under Potent Antiretroviral Therapy Is Observed in Socially Disadvantaged Patients. Clin Infect Dis 2021; 70:297-303. [PMID: 30843028 DOI: 10.1093/cid/ciz178] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/28/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The rate of acquired human immunodeficiency virus type 1 (HIV-1) drug resistance (ADR) has fallen dramatically since introduction of combined antiretroviral therapy (cART) in Switzerland. However, clinical experience indicates that there are still patients at risk of newly acquiring drug resistance despite having access to cART. Here, we characterized risk factors for ADR, to improve patient care and prevent emergence of drug resistance and treatment failure. METHODS We performed a case-control study to identify risk factors for ADR in all patients starting their first cART in the Swiss HIV Cohort Study (SHCS) since 1996. The SHCS is highly representative and includes >75% of patients receiving ART in Switzerland. To this end, we implemented a systematic medical chart review to obtain more detailed information on additional parameters, which are not routinely collected in the SHCS. The collected data were analyzed using univariable and multivariable conditional logistic regression. RESULTS We included in our study 115 cases and 115 matched controls. Unemployment (multivariable odds ratio [mOR], 2.9 [95% confidence interval {CI}, 1.3-6.4]; P = .008), African origin (mOR, 3.0 [95% CI, 1.0-9.2]; P = .047), comedication with anti-infectives (mOR, 3.7 [95% CI, 1.0-12.6]; P = .045), and symptoms of mental illness (mOR, 2.6 [95% CI, 1.2-5.5]; P = .012) were associated with ADR in the multivariable model. CONCLUSIONS Although ADR has become very rare with cART due to new potent therapies, patients in socially challenging life situations or presenting with mental health issues are at higher risk for drug resistance. Prompt identification and adequate support of these patients before ADR will prevent treatment failure and HIV-1 transmission.
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Affiliation(s)
- Irene A Abela
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich.,Institute of Medical Virology, University of Zurich
| | - Alexandra U Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich.,Institute of Medical Virology, University of Zurich
| | - Jürg Böni
- Institute of Medical Virology, University of Zurich
| | - Sabine Yerly
- Laboratory of Virology, Division of Infectious Diseases, Geneva University Hospitals
| | | | - Matthieu Perreau
- Division of Immunology and Allergy, University Hospital Lausanne
| | - Hans H Hirsch
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern
| | - Alexandra Calmy
- HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospitals
| | - Patrick Schmid
- Division of Infectious Diseases, Cantonal Hospital St Gallen
| | | | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich.,Institute of Medical Virology, University of Zurich
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Gordon K, Hoffman RM, Azhar G, Ramirez D, Schneider S, Wagner GJ. Examining Correlates of Pre-ART and Early ART Adherence to Identify Key Factors Influencing Adherence Readiness. AIDS Behav 2021; 25:113-123. [PMID: 32572711 DOI: 10.1007/s10461-020-02947-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although current standard of care for HIV typically involves immediate initiation of antiretroviral therapy (ART), most patients can benefit from first assessing adherence readiness and addressing any barriers to optimal adherence. A sample of 176 HIV patients planning to start ART enrolled in a controlled trial of an adherence intervention that was based on the Information Motivation and Behavioral skills (IMB) model of health behavior. We examined correlates of multiple adherence readiness measures, as well as electronically measured early ART adherence, to identify variables most important for readiness to adhere well at the start of treatment. Education level, recency of HIV diagnosis and knowledge and commitment to adherence were found to be associated with both ART readiness and early ART adherence. These findings suggest that resources to support adherence readiness should target more experienced HIV patients, and strive to bolster knowledge and attitudes that reinforce commitment to adherence.
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Affiliation(s)
- Kyle Gordon
- Department of Medicine, UCLA, Los Angeles, CA, USA
| | | | - Gulrez Azhar
- Long Beach Education and Research Consultants, Long Beach, CA, USA
| | - Daniel Ramirez
- Social and Economic Wellbeing Division, RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
| | - Stefan Schneider
- Social and Economic Wellbeing Division, RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
| | - Glenn J Wagner
- Long Beach Education and Research Consultants, Long Beach, CA, USA.
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Plymoth M, Sanders EJ, Van Der Elst EM, Medstrand P, Tesfaye F, Winqvist N, Balcha T, Björkman P. Socio-economic condition and lack of virological suppression among adults and adolescents receiving antiretroviral therapy in Ethiopia. PLoS One 2020; 15:e0244066. [PMID: 33320900 PMCID: PMC7737988 DOI: 10.1371/journal.pone.0244066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/02/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction The potential impact of socio-economic condition on virological suppression during antiretroviral treatment (ART) in sub-Saharan Africa is largely unknown. In this case-control study, we compared socio-economic factors among Ethiopian ART recipients with lack of virological suppression to those with undetectable viral load (VL). Methods Cases (VL>1000 copies/ml) and controls (VL<150 copies/ml) aged ≥15years, with ART for >6 months and with available VL results within the last 3 months, were identified from registries at public ART clinics in Central Ethiopia. Questionnaire-based interviews on socio-economic characteristics, health condition and transmission risk behavior were conducted. Univariate variables associated with VL>1000 copies/ml (p<0.25) were added to a multivariable logistic regression model. Results Among 307 participants (155 cases, 152 controls), 61.2% were female, and the median age was 38 years (IQR 32–46). Median HIV-RNA load among cases was 6,904 copies/ml (IQR 2,843–26,789). Compared to controls, cases were younger (median 36 vs. 39 years; p = 0.004), more likely to be male (46.5% vs. 30.9%; p = 0.005) and had lower pre-ART CD4 cell counts (170 vs. 220 cells/μl; p = 0.009). In multivariable analysis of urban residents (94.8%), VL>1000 copies/ml was associated with lower relative wealth (adjusted odds ratio [aOR] 2.98; 95% CI 1.49–5.94; p = 0.016), geographic work mobility (aOR 6.27, 95% CI 1.82–21.6; p = 0.016), younger age (aOR 0.94 [year], 95% CI 0.91–0.98; p = 0.011), longer duration of ART (aOR 1.19 [year], 95% CI 1.07–1.33; p = 0.020), and suboptimal (aOR 3.83, 95% CI 1.33–10.2; p = 0.048) or poor self-perceived wellbeing (aOR 9.75, 95% CI 2.85–33.4; p = 0.012), after correction for multiple comparisons. High-risk sexual behavior and substance use was not associated with lack of virological suppression. Conclusion Geographic work mobility and lower relative wealth were associated with lack of virological suppression among Ethiopian ART recipients in this predominantly urban population. These characteristics indicate increased risk of treatment failure and the need for targeted interventions for persons with these risk factors.
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Affiliation(s)
- Martin Plymoth
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- * E-mail: ,
| | - Eduard J. Sanders
- Centre for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Nuffield Department of Clinical Medicine, University of Oxford, Headington, United Kingdom
| | - Elise M. Van Der Elst
- Centre for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Patrik Medstrand
- Clinical Virology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Fregenet Tesfaye
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Niclas Winqvist
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Taye Balcha
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Per Björkman
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
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22
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Performance of a short, self-report adherence scale in a probability sample of persons using HIV antiretroviral therapy in the United States. AIDS 2020; 34:2239-2247. [PMID: 32932340 DOI: 10.1097/qad.0000000000002689] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Excellent adherence to HIV antiretroviral therapy (ART) remains a cornerstone of HIV care. A three-item adherence self-report scale was recently developed and validated, but the scale has not been previously tested in a nationally representative sample. DESIGN We administered the adherence scale to participants in the Centers for Disease Control and Prevention's Medical Monitoring Project, which is a probability sample of US adults with diagnosed HIV. METHODS We combined sociodemographic and clinical participant data from three consecutive cycles of the Medical Monitoring Project (6/2015-5/2018). We used medical record reviews to determine most recent viral load, and whether viral loads were suppressed at all measurement points in the past 12 months. We describe the relationship between adherence scale score and two measures of viral load suppression (most recent and sustained), and estimate linear regression models using sampling weights to determine independent predictors of ART adherence scores. RESULTS Of those using ART, the median adherence score was 93 (100 = perfect adherence), and the standardized Cronbach's alpha was 0.83. For both measures of viral load suppression, the relationship with the adherence score was generally linear; there was no 'cutoff' point indicating good vs. poor adherence. In the multivariable model, younger age, nonwhite race, poverty, homelessness, depression, binge-drinking, and both non-IDU and IDU were independently associated with lower adherence. CONCLUSION The adherence measure had good psychometric qualities and a linear relationship with viral load, supporting its use in both clinical care and research. Adherence interventions should focus on persons with the highest risk of poor adherence.
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Siefried KJ, Kerr S, Richardson R, Mao L, Rule J, McAllister J, de Wit J, Carr A. Socioeconomic and psychosocial factors are associated with poor treatment outcomes in Australian adults living with HIV: a case-control study. Sex Health 2020; 16:548-553. [PMID: 31514798 DOI: 10.1071/sh18138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 04/16/2019] [Indexed: 11/23/2022]
Abstract
Background A substantial minority of patients living with HIV refuse or cease antiretroviral therapy (ART), have virological failure (VF) or develop an AIDS-defining condition (ADC) or serious non-AIDS event (SNAE). It is not understood which socioeconomic and psychosocial factors may be associated with these poor outcomes. METHODS Thirty-nine patients with poor HIV treatment outcomes, defined as those who refused or ceased ART, had VF or were hospitalised with an ADC or SNAE (cases), were compared with 120 controls on suppressive ART. A self-report survey recorded demographics, physical health, life stressors, social supports, HIV disclosure, stigma or discrimination, health care access, treatment adherence, side effects, health and treatment perceptions and financial and employment status. Socioeconomic and psychosocial covariates significant in bivariate analyses were assessed with conditional multivariable logistic regression, adjusted for year of HIV diagnosis. RESULTS Cases and controls did not differ significantly with regard to sex (96.2% (n = 153) male) or age (mean (± s.d.) 51 ± 11 years). Twenty cases (51%) had refused or ceased ART, 35 (90%) had an HIV viral load >50 copies mL-1, 12 (31%) were hospitalised with an ADC and five (13%) were hospitalised with a new SNAE. Three covariates were independently associated with poor outcomes: foregoing necessities for financial reasons (adjusted odds ratio (aOR) 3.1, 95% confidence interval (95% CI) 1.3-7.6, P = 0.014), cost barriers to accessing HIV care (aOR 3.1, 95% CI 1.0-9.6, P = 0.049) and lower quality of life (aOR 3.8, 95% CI 1.5-9.7, P = 0.004). CONCLUSIONS Despite universal health care, socioeconomic and psychosocial factors are associated with poor HIV outcomes in adults in Australia. These factors should be addressed through targeted interventions to improve long-term successful treatment.
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Affiliation(s)
- Krista J Siefried
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia; and National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Sydney, NSW 2052, Australia; and Corresponding author.
| | - Stephen Kerr
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia
| | - Robyn Richardson
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - John Rule
- National Association of People with HIV Australia, 1 Erskineville Road, Newtown, NSW 2042, Australia; and School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - John McAllister
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia
| | - John de Wit
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia; and Department of Interdisciplinary Social Science, Utrecht University, PO Box 80125, 3508 TC Utrecht, The Netherlands
| | - Andrew Carr
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia
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Brizzi MB, Burgos RM, Chiampas TD, Michienzi SM, Smith R, Yanful PK, Badowski ME. Impact of Pharmacist-Driven Antiretroviral Stewardship and Transitions of Care Interventions on Persons With Human Immunodeficiency Virus. Open Forum Infect Dis 2020; 7:ofaa073. [PMID: 32855982 PMCID: PMC7444735 DOI: 10.1093/ofid/ofaa073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 08/20/2020] [Indexed: 02/06/2023] Open
Abstract
Background Persons with human immunodeficiency virus (HIV) experience high rates of medication-related errors when admitted to the inpatient setting. Data are lacking on the impact of a combined antiretroviral (ARV) stewardship and transitions of care (TOC) program. We investigated the impact of a pharmacist-driven ARV stewardship and TOC program in persons with HIV. Methods This was a retrospective, quasi-experimental analysis evaluating the impact of an HIV-trained clinical pharmacist on hospitalized persons with HIV. Patients included in the study were adults following up, or planning to follow up, at the University of Illinois (UI) outpatient clinics for HIV care and admitted to the University of Illinois Hospital. Data were collected between July 1, 2017 and December 31, 2017 for the preimplementation phase and between July 1, 2018 and December 31, 2018 for the postimplementation phase. Primary and secondary endpoints included medication error rates related to antiretroviral therapy (ART) and opportunistic infection (OI) medications, all-cause readmission rates, medication access at time of hospital discharge, and linkage to care rates. Results A total of 128 patients were included in the study: 60 in the preimplementation phase and 68 in the postimplementation phase. After the implementation of this program, medication error rates associated with ART and OI medications decreased from 17% (10 of 60) to 6% (4 of 68) (P = .051), 30-day all-cause readmission rates decreased significantly from 27% (16 of 60) to 12% (8 of 68) (P = .03), and linkage to care rates increased significantly from 78% (46 of 59) to 92% (61 of 66) (P = .02). Conclusions A pharmacist-led ARV stewardship and TOC program improved overall care of persons with HIV through reduction in medication error rates, all-cause readmission rates, and an improvement in linkage to care rates.
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Affiliation(s)
- Marisa B Brizzi
- Department of Pharmacy, University of Cincinnati Health, Cincinnati, Ohio, USA
| | - Rodrigo M Burgos
- Department of Pharmacy Practice, Section of Infectious Diseases Pharmacotherapy, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, USA
| | - Thomas D Chiampas
- Department of Pharmacy Practice, Section of Infectious Diseases Pharmacotherapy, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, USA
| | - Sarah M Michienzi
- Department of Pharmacy Practice, Section of Infectious Diseases Pharmacotherapy, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, USA
| | - Renata Smith
- Department of Pharmacy Practice, Section of Infectious Diseases Pharmacotherapy, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois, USA
| | - Paa Kwesi Yanful
- Department of Pharmacy, Methodist Health System, Dallas, Texas, USA
| | - Melissa E Badowski
- Department of Pharmacy, University of Cincinnati Health, Cincinnati, Ohio, USA
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Sullivan MC, Eaton LA. Intersecting Barriers to PrEP Awareness and Uptake in Black Men Who Have Sex with Men in Atlanta, GA: a Syndemic Perspective. Int J Behav Med 2020; 28:349-359. [DOI: 10.1007/s12529-020-09925-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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26
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Analysis of Heterogeneity in Survival Benefit of Immunotherapy in Oncology According to Patient Demographics and Performance Status: A Systematic Review and Meta-Analysis of Overall Survival Data. Am J Clin Oncol 2020; 43:193-202. [PMID: 31809328 DOI: 10.1097/coc.0000000000000650] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Immunotherapy (IO) has become standard of care (SOC) for many advanced malignancies, although identifying patients likely to benefit remains difficult. We sought to assess whether demographic factors are associated with response to IO, compared with SOC systemic therapy, using stratified meta-analysis. METHODS A systematic review of MEDLINE, PubMed, Embase, and Scopus from inception to October 2, 2018. Randomized controlled trials comparing IO to SOC in patients with advanced solid organ malignancies were included if results were stratified by age, performance status (PS), or race, assessing overall survival (OS). Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for each group using random-effects models independently. RESULTS We identified 21 eligible randomized controlled trials, including 20 stratified by age, 17 by PS, and 4 by race. Patients with PS 0 (HR, 0.74; 95% CI, 0.63-0.86) and PS≥1 (HR, 0.75; 95% CI, 0.68-0.83) had similar OS benefits from IO compared with SOC (P=0.80). There was no difference on the basis of patient race (white vs. nonwhite) (P=0.46). IO demonstrated an OS benefit for younger (below 65 y: HR, 0.73; 95% CI, 0.65-0.82) and older (65 y and above: HR, 0.79; 95% CI, 0.71-0.88) patients with no difference between age groups (P=0.27). Among prespecified subgroup analyses, there was significant effect modification in 2 subgroups: younger patients in the first-line setting (P=0.03) and those receiving anti-CTLA-4 drugs (P=0.05). CONCLUSIONS When examining OS using stratified meta-analysis, we did not demonstrate significant differences in IO efficacy according to patient age, PS or race, though data on race were sparse.
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Dessie ZG, Zewotir T, Mwambi H, North D. Modeling Viral Suppression, Viral Rebound and State-Specific Duration of HIV Patients with CD4 Count Adjustment: Parametric Multistate Frailty Model Approach. Infect Dis Ther 2020; 9:367-388. [PMID: 32318999 PMCID: PMC7237593 DOI: 10.1007/s40121-020-00296-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Combination antiretroviral therapy has become the standard care of human immunodeficiency virus (HIV)-infected patients and has further led to a dramatically decreased progression probability to acquired immune deficiency syndrome (AIDS) for patients under such a therapy. However, responses of the patients to this therapy have recorded heterogeneous complexity and high dynamism. In this paper, we simultaneously model long-term viral suppression, viral rebound, and state-specific duration of HIV-infected patients. METHODS Full-parametric and semi-parametric Markov multistate models were applied to assess the effects of covariates namely TB co-infection, educational status, marital status, age, quality of life (QoL) scores, white and red blood cell parameters, and liver enzyme abnormality on long-term viral suppression, viral rebound and state-specific duration for HIV-infected individuals before and after treatment. Furthermore, two models, one including and another excluding the effect of the frailty, were presented and compared in this study. RESULTS Results from the diagnostic plots, Akaike information criterion (AIC) and likelihood ratio test showed that the Weibull multistate frailty model fitted significantly better than the exponential and semi-parametric multistate models. Viral rebound was found to be significantly associated with many sex partners, higher eosinophils count, younger age, lower educational level, higher monocyte counts, having abnormal neutrophils count, and higher liver enzyme abnormality. Furthermore, viral suppression was also found to be significantly associated with higher QoL scores, and having a stable sex partner. The analysis result also showed that patients with a stable sex partner, higher educational levels, higher QoL scores, lower eosinophils count, lower monocyte counts, and higher RBC indices were more likely to spend more time in undetectable viral load state. CONCLUSIONS To achieve and maintain the UNAIDS 90% suppression targets, additional interventions are required to optimize antiretroviral therapy outcomes, specifically targeting those with poor clinical characteristics, lower education, younger age, and those with many sex partners. From a methodological perspective, the parametric multistate approach with frailty is a flexible approach for modeling time-varying variables, allowing for dealing with heterogeneity between the sequence of transitions, as well as allowing for a reasonable degree of flexibility with a few additional parameters, which then aids in gaining a better insight into how factors change over time.
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Affiliation(s)
- Zelalem G Dessie
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa.
- College of Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Henry Mwambi
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Delia North
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
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Fleischer L, Avery A. Adhering to antiretroviral therapy: A qualitative analysis of motivations for and obstacles to consistent use of antiretroviral therapy in people living with HIV. SAGE Open Med 2020; 8:2050312120915405. [PMID: 32435479 PMCID: PMC7222653 DOI: 10.1177/2050312120915405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 02/13/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives: Based on the 2015 U.S. Centers for Disease Control and Prevention data, 40% of people living with HIV in the United States with an HIV diagnosis and 18.5% of people living with HIV in HIV care in the United States are not virally suppressed. Many HIV care clinics have implemented recommendations to improve the percentage of people living with HIV on antiretroviral therapy. To understand what more could be done, we examine patients’ motivations and obstacles to maintaining adherence to antiretroviral therapy. Methods: We conducted qualitative analysis using a qualitative description framework of in-depth interviews with people living with HIV receiving care at an urban HIV care clinic in the midwestern United States. Results: We found that while many traditional barriers to care have been addressed by existing programs, there are key differences between those consistent with antiretroviral therapy and those inconsistent with antiretroviral therapy. In particular, self-motivation, diagnosis acceptance, treatment for depression, spiritual beliefs, perceived value of the HIV care team, and prior experience with health care distinguish these two groups. Most significantly, we found that people living with HIV consistent with antiretroviral therapy describe their main motivation as coming from themselves, whereas people living with HIV inconsistent with antiretroviral therapy more often describe their main motivation as coming from the HIV care team. Conclusion: Our results highlight the importance of the HIV care team’s encouragement of maintaining antiretroviral adherence, as well as encouraging treatment for depression.
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Affiliation(s)
- Lisa Fleischer
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Ann Avery
- Division of Infectious Disease, MetroHealth Medical Center, Cleveland, OH, USA
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Davis W, Mantsios A, Karver T, Murray M, Punekar Y, Ward D, Bredeek UF, Moreno S, Merino D, Knobel H, Campis A, Kerrigan D. "It made me more confident that I have it under control": Patient and provider perspectives on moving to a two-drug ART regimen in the United States and Spain. PLoS One 2020; 15:e0232473. [PMID: 32357195 PMCID: PMC7194407 DOI: 10.1371/journal.pone.0232473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/15/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Two-drug regimens (2DR) to treat HIV infection have the potential to reduce long-term toxicity and increase therapeutic options for people living with HIV (PLHIV). Prior phase III trials, SWORD-1 and SWORD-2, as well as GEMINI-1 and GEMINI-2, have demonstrated that a dolutegravir-based 2DR is as effective as three- or four-drug regimens among virologically suppressed patients. Limited information exists, however, on patient and provider experiences with 2DR to inform roll-out and integration into routine clinical care. METHODS We conducted 39 in-depth interviews with PLHIV currently on 2DR in the context of routine care and 8 of their clinical care providers in the United States (U.S.) and Spain. Participants included 33 male and 6 female PLHIV and 8 providers. Interview topics explored perceptions of and experiences with 2DR compared to prior anti-retroviral regimens (ARVs), side effects, patient satisfaction, and clinical performance. Interviews were audio-recorded, transcribed and analyzed using thematic content analysis. RESULTS Participants viewed 2DR as a significant and positive advance, in terms of its ability to effectively treat HIV with reduced toxicity and essentially no reported side effects. Patients noted the central role providers played in the decision to switch to a 2DR regimen and, among U.S. participants, the importance of insurance coverage making this preferred option feasible. Patients and providers agreed that a 2DR regimen would be appropriate for any PLHIV regardless of whether they were treatment naïve or had significant experience with ARVs. CONCLUSIONS Participants' experiences with a 2DR regimen were positive with no participants, reporting side effects and all reporting continued viral suppression. Providers valued the reduced toxicity offered by 2DR and served as the primary gateway to a transition to 2DR for patients in both settings. This study provides a foundation for further research on the transition to 2DR regimens in other populations and contexts including low- and middle-income settings.
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Affiliation(s)
- Wendy Davis
- Center on Health, Risk and Society, American University, Washington, D.C., United States of America
- * E-mail:
| | - Andrea Mantsios
- Center on Health, Risk and Society, American University, Washington, D.C., United States of America
| | - Tahilin Karver
- Center on Health, Risk and Society, American University, Washington, D.C., United States of America
| | - Miranda Murray
- Center on Health, Risk and Society, American University, Washington, D.C., United States of America
| | - Yogesh Punekar
- ViiV Healthcare, Raleigh, North Carolina, United States of America
| | - Douglas Ward
- Dupont Circle Physicians Group, Washington, D.C., United States of America
| | - U. Fritz Bredeek
- Metropolis Medical Group, San Francisco, California, United States of America
| | | | | | | | | | - Deanna Kerrigan
- Center on Health, Risk and Society, American University, Washington, D.C., United States of America
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Goldstein D, Hardy WD, Monroe A, Hou Q, Hart R, Terzian A. Despite early Medicaid expansion, decreased durable virologic suppression among publicly insured people with HIV in Washington, DC: a retrospective analysis. BMC Public Health 2020; 20:509. [PMID: 32299421 PMCID: PMC7164348 DOI: 10.1186/s12889-020-08631-7] [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: 06/10/2019] [Accepted: 04/01/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite widely available access to HIV care in Washington, DC, inequities in HIV outcomes persist. We hypothesized that laboratory monitoring and virologic outcomes would not differ significantly based on insurance type. METHODS We compared HIV monitoring with outcomes among people with HIV (PWH) with private (commercial payer) versus public (Medicare, Medicaid) insurance receiving care at community and hospital clinics. The DC Cohort follows over 8000 PWH from 14 clinics. We included those ≥18 years old enrolled between 2011 and 2015 with stable insurance. Outcomes included frequency of CD4 count and HIV RNA monitoring (> 2 lab measures/year, > 30 days apart) and durable viral suppression (VS; HIV RNA < 50 copies/mL at last visit and receiving antiretroviral therapy (ART) for ≥12 months). Multivariable logistic regression models examined impact of demographic and clinical factors. RESULTS Among 3908 PWH, 67.9% were publicly-insured and 58.9% attended community clinics. Compared with privately insured participants, a higher proportion of publicly insured participants had the following characteristics: female sex, Black race, heterosexual, unemployed, and attending community clinics. Despite less lab monitoring, privately-insured PWH had greater durable VS than publicly-insured PWH (ART-naïve: private 70.0% vs public 53.1%, p = 0.03; ART-experienced: private 80.2% vs public 69.4%, p < 0.0001). Privately-insured PWH had greater durable VS than publicly-insured PWH at hospital clinics (AOR = 1.59, 95% CI: 1.20, 2.12; p = 0.001). CONCLUSIONS Paradoxical differences between HIV monitoring and durable VS exist among publicly and privately-insured PWH in Washington, DC. Programs serving PWH must improve efforts to address barriers creating inequity in HIV outcomes.
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Affiliation(s)
- Deborah Goldstein
- Whitman-Walker Institute, 1525 14th Street, NW, Washington, DC, 20005, USA.
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA.
| | - W David Hardy
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anne Monroe
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | | | - Arpi Terzian
- Patient-centered Outcomes Research Institute, Washington, DC, USA
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Yang X, Li X, Qiao S, Shen Z, Zhou Y. Socioeconomic disparity of immunologic outcome among people living with HIV in Guangxi, China. AIDS Care 2020; 33:347-351. [PMID: 32148069 DOI: 10.1080/09540121.2020.1738004] [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] [Indexed: 10/24/2022]
Abstract
The socioeconomic disadvantage may adversely affect HIV treatment outcomes, particularly in resource-limited settings. Data from people living with HIV (PLWH) who were receiving antiretroviral therapy (ART) in Guangxi, China were analyzed to investigate the impact of socioeconomic status (SES) on the immunologic outcome (i.e., CD4 counts). Among 1198 participants, 55.0% were having CD4 counts ≤500 cells/mm3 and over two-third (68.5%) were considered to have a low level of SES. PLWH with high SES were more likely to have higher CD4 counts (adjusted Odds Ratio [aOR]: 1.44, 95%CI: 1.08-1.91) than PLWH with low SES, after adjusting for potential confounders. CD4 counts were also significantly associated with certain socio-demographic characteristics such as age, gender, and sexual orientation. In order to reduce SES-related disparity, a holistic approach may be needed to address the barriers to successful HIV treatment and care among PLWH with low SES. Poverty reduction and other structural interventions in addressing the socioeconomic disadvantages among PLWH should be key components of the national response to improving HIV treatment outcomes and ending the HIV epidemic in China and other low- and middle-income countries.
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Affiliation(s)
- Xueying Yang
- Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, People's Republic of China
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, People's Republic of China
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Solomon H, Linton SL, Del Rio C, Hussen SA. Housing Instability, Depression, and HIV Viral Load Among Young Black Gay, Bisexual, and Other Men Who Have Sex With Men in Atlanta, Georgia. J Assoc Nurses AIDS Care 2020; 31:219-227. [PMID: 31369417 DOI: 10.1097/jnc.0000000000000114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Housing instability is common among sexual minority youth. Research suggests that psychological distress, such as depression, may mediate the association between housing instability and poor HIV-related outcomes, but this hypothesis remains underexplored. Housing instability was assessed using two variables (residential moves in 6 months, and self-reported homelessness at any time since age 15 years). We examined cross-sectional relationships between the housing instability variables and detectable HIV-1 viral load (VL) in a sample of young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) living with HIV (N = 81) in Atlanta, GA, in 2015-2016. Additionally, we explored whether depressive symptoms mediated this relationship. Our exploratory study suggests that psychological distress may partially mediate the association between housing instability and detectable VL. In addition to structural interventions that ensure housing stability, increasing use of mental health services by unstably housed YB-GBMSM may improve VL suppression in this high-risk population.
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Wang Z, Zhu Y, Cui L, Qu B. Electronic Health Interventions to Improve Adherence to Antiretroviral Therapy in People Living With HIV: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2019; 7:e14404. [PMID: 31621641 PMCID: PMC6913542 DOI: 10.2196/14404] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/25/2019] [Accepted: 08/18/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Electronic health (eHealth) is increasingly used for self-management and service delivery of HIV-related diseases. With the publication of studies increasingly focusing on antiretroviral therapy (ART) adherence, this makes it possible to quantitatively and systematically assess the effectiveness and feasibility of eHealth interventions. OBJECTIVE The purpose of this review was to explore the effectiveness of eHealth interventions on improving ART adherence in people living with HIV. The effects of different intervention characteristics, participant characteristics, and study characteristics were also assessed. METHODS We systematically searched MEDLINE (via PubMed), EMBASE, the Cochrane Central Register of Controlled Trials, and 3 conference abstract databases using search terms related to HIV, ART, adherence, and eHealth interventions. We independently screened the studies, extracted the data, and assessed the study quality and then compared the information in pairs. Articles published in English that used randomized controlled trials to assess eHealth interventions to improve ART adherence of people living with HIV were identified. We extracted the data including study characteristics, participant characteristics, intervention characteristics, and outcome measures. The Cochrane risk-of-bias tool was used to assess the risk of bias and study overall quality. Odds ratios, Cohen d, and their 95% CIs were estimated using random-effects models. We also performed multiple subgroup analyses and sensitivity analyses to define any sources of heterogeneity. RESULTS Among 3941 articles identified, a total of 19 studies (including 21 trials) met the inclusion criteria. We found 8 trials from high-income countries and 13 trials from low- and middle-income countries. Furthermore, at baseline, the health status of participants in 14 trials was healthy. Of the trials included, 7 of 21 used personality content, 12 of 21 used a 2-way communication strategy, and 7 of 21 used medical content. In the pooled analysis of 3937 participants (mean age: 35 years; 47.16%, 1857/3937 females), eHealth interventions significantly improved the ART adherence of people living with HIV (pooled Cohen d=0.25; 95% CI 0.05 to 0.46; P=.01). The interventions were also correlated with improved biochemical outcomes reported by 11 trials (pooled Cohen d=0.25; 95% CI 0.11 to 0.38; P<.001). The effect was sensitive to sample size (Q=5.56; P=.02) and study duration (Q=8.89; P=.003), but it could not be explained by other moderators. The primary meta-analysis result was stable in the 3 sensitivity analyses. CONCLUSIONS Some of the eHealth interventions may be used as an effective method to increase the ART adherence of people living with HIV. Considering that most of the trials included a small sample size and were conducted for a short duration, these results should be interpreted with caution. Future studies need to determine the features of eHealth interventions to better improve ART adherence along with long-term effectiveness of interventions, effectiveness of real-time adherence monitoring, enhancement of study design, and influences on biochemical outcomes.
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Affiliation(s)
- Ziqi Wang
- School of Public Health, China Medical University, Shenyang, China
| | - Yaxin Zhu
- School of Public Health, China Medical University, Shenyang, China
| | - Liyuan Cui
- School of Medical Informatics, China Medical University, Shenyang, China
| | - Bo Qu
- School of Public Health, China Medical University, Shenyang, China
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Fiorentino M, Suzan-Monti M, Vilotitch A, Sagaon-Teyssier L, Dray-Spira R, Lert F, Spire B. Renunciation of health care by people living with HIV in France is still associated with discrimination in health-care services and social insecurity - results from the ANRS-VESPA2 survey. Antivir Ther 2019; 23:443-450. [PMID: 29360097 DOI: 10.3851/imp3220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study aimed to estimate the frequency of renunciation of health care among people living with HIV (PLHIV) in France, including health care unrelated to HIV, and to characterize associated socioeconomic and psychosocial risk factors. METHODS The cross-sectional ANRS-VESPA2 survey was conducted on adult PLHIV attending French hospitals in 2011. Correlates of health-care renunciation in the 12 months before the survey were assessed through logistic modelling. RESULTS Among the 3,020 PLHIV included in the sample, 17% declared health-care renunciation during the preceding year and 42% had a high level of social insecurity. During the previous 2 years, 8% and 11%, respectively, were discriminated against by medical staff and family. In multivariate analysis, positive associations were found between health-care renunciation and a high level of social insecurity (adjusted odds ratio [95% CI] 3.44 [2.54, 4.65]; P<0.001), having children (1.52 [1.10, 2.10]; P=0.01), smoking tobacco (1.50 [1.13, 1.98]; P=0.01), discrimination by medical staff (1.53 [1.22, 2.29]; P=0.04) or family (2.48 [1.75, 3.52]; P<0.001), major depressive episodes (1.46 [1.02, 2.09]; P=0.04), past or current drug injection (1.54 [1.03, 2.30]; P=0.04), and younger age (0.98 [0.97, 1.00]; P=0.03). Health-care renunciation was also negatively associated with HIV diagnosis after 1996 (1996-2002: 0.64 [0.46, 0.90]; P=0.01; ≥2003: 0.56 [0.40, 0.77]; P=0.001). CONCLUSIONS In spite of universal health insurance in France, barrier- and refusal-renunciation of health care by PLHIV remain frequent. Poor psychosocial outcomes and discrimination by families and health-care providers compound the negative effect of social insecurity on health-care seeking in this population. To ensure optimal medical care, strategies are needed to prevent discrimination against PLHIV in health-care services. Special attention must be provided to patients experiencing social insecurity.
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Affiliation(s)
- Marion Fiorentino
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Marie Suzan-Monti
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Antoine Vilotitch
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Rosemary Dray-Spira
- INSERM, UMR S1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in Social Epidemiology, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in Social Epidemiology, Paris, France
| | - France Lert
- Centre de recherche en épidémiologie et santé des populations, Inserm U1018, Villejuif, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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Jiang Y, Li X, Cho H, Brown MJ, Qiao S, Haider MR. Effects of individual and neighborhood socioeconomic status on antiretroviral therapy adherence: The role of adherence self-efficacy. J Health Psychol 2019; 26:1143-1153. [PMID: 31419916 DOI: 10.1177/1359105319869809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to examine the potential mediation effect of adherence self-efficacy on the associations between individual and neighborhood socioeconomic status and antiretroviral therapy adherence in a sample of 337 people living with HIV in South Carolina, United States. Results showed that there were no direct effects of individual or neighborhood socioeconomic status on antiretroviral therapy adherence, whereas both individual socioeconomic status and neighborhood socioeconomic status were associated with adherence self-efficacy, which in turn were related to antiretroviral therapy adherence. These findings suggest that interventions targeting adherence self-efficacy may improve antiretroviral therapy adherence among people living with HIV with low socioeconomic status or those living in socioeconomically disadvantaged neighborhoods.
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Poverty stigma is associated with suboptimal HIV care and treatment outcomes among women living with HIV in the United States. AIDS 2019; 33:1379-1384. [PMID: 30870197 DOI: 10.1097/qad.0000000000002189] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To examine whether experienced poverty stigma is associated with worse HIV care and treatment outcomes. DESIGN We analyzed cross-sectional data from 433 women living with HIV enrolled in the Women's Adherence and Visit Engagement substudy of the Women's Interagency HIV Study. METHODS Exposure was experienced poverty stigma, measured using the Perceived Stigma of Poverty Scale. Outcomes were viral suppression, CD4 cell count at least 350 cells/μl, and attending all HIV care visits in the past 6 months. Multivariable logistic regression models adjusted for income, age, race/ethnicity, education, substance use, months taking antiretroviral therapy (ART), number of antiretroviral pills in ART regimen, unstable housing, relationship status, and exchanging sex for money, drugs, or shelter. We also explored whether self-reported at least 95% ART adherence mediated the relationship between poverty stigma and viral suppression and CD4 cell count at least 350 cells/μl. RESULTS Experienced poverty stigma was associated with lower adjusted odds of viral suppression [adjusted odds ratio (aOR) 0.76; 95% confidence interval (CI) 0.61-0.96], CD4 cell count at least 350 cells/μl (aOR 0.69; 95% CI 0.52-0.91), and attending all HIV care visits (aOR 0.73; 95% CI: 0.54-0.98). Exploratory mediation analysis suggests that at least 95% ART adherence significantly mediates the relationship between experienced poverty stigma and viral suppression and CD4 cell count at least 350 cells/μl. CONCLUSION Longitudinal research should assess these relationships over time. Findings support interventions and policies that seek to reduce poverty stigma among people living with HIV.
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Glynn TR, Llabre MM, Lee JS, Bedoya CA, Pinkston MM, O'Cleirigh C, Safren SA. Pathways to Health: an Examination of HIV-Related Stigma, Life Stressors, Depression, and Substance Use. Int J Behav Med 2019; 26:286-296. [PMID: 31065930 PMCID: PMC6563607 DOI: 10.1007/s12529-019-09786-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite antiretroviral treatment (ART) being an efficacious treatment for HIV, essentially making it a chronic non-terminal illness, two related and frequent concerns for many people living with HIV/AIDS (PLWHA) continue to be HIV-related stigma and life stress. These two variables are frequently associated with depression, substance use, and poorer functional health. Studies to date have not fully examined the degree to which these constructs may be associated within one model, which could reveal a more nuanced understanding of how HIV-related stigma and life stress affect functional health in PLWHA. METHODS The current study employed hybrid structural equation modeling to examine the interconnectedness and potential indirect relationships of HIV-related stigma and life stress to worse health through substance use and depression, controlling for ART adherence and age. Participants were 240 HIV-infected individuals who completed a biopsychosocial assessment battery upon screening for an RCT on treating depression in those infected with HIV. RESULTS Both HIV-related stigma and stressful life events were directly related to depression, and depression was directly related to health. There were significant indirect effects from stigma and stress to health via depression. There were no significant effects involving substance use. CONCLUSION It is important to continue to develop ways to address stigma, stressful life events, and their effects on distress in those living with HIV. Expanding our knowledge of disease progression risk factors beyond ART adherence is important to be able to design adjuvant interventions, particularly because treatment means that people living with HIV have markedly improved life expectancy and that successful treatment means that HIV is not transmittable to others.
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Affiliation(s)
- Tiffany R Glynn
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Maria M Llabre
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Jasper S Lee
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - C Andres Bedoya
- Department of Psychiatry, The Fenway Institute, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Megan M Pinkston
- Department of Psychiatry and Human Behavior, The Miriam Hospital, Clinical Behavioral Medicine Service of the Immunology Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Conall O'Cleirigh
- Department of Psychiatry, The Fenway Institute, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
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Respective roles of migration and social deprivation for virological non-suppression in HIV-infected adults on antiretroviral therapy in France. PLoS One 2019; 14:e0213019. [PMID: 30845270 PMCID: PMC6405133 DOI: 10.1371/journal.pone.0213019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 02/13/2019] [Indexed: 01/07/2023] Open
Abstract
Barriers to achieve sustained HIV virological suppression on antiretroviral therapy (ART) jeopardize the success of the 90:90:90 UNAIDS initiative which aims to end the HIV/AIDS epidemic. In France, where access to ART is free and universally available, we analyze the way in which social determinants of health (i.e. cultural, environmental) and economic factors might influence virological outcomes. A cross-sectional study was performed in two hospitals located in Paris area. All consecutive people living with HIV (PLHIV) on ART for at least 6 months attending the outpatient clinics between 01/05/2013 and 31/10/2014 answered an individual score of deprivation, EPICES, retrieving information on health insurance status, economic status, family support and leisure activity. This score varies from 0 to 100 with deprivation state defined above 30.17. Factors associated with HIV viral load >50 copies/ml were assessed by logistic regression modeling with a backward stepwise selection to select the final multivariable model. Sensitivity analyses were performed using two other thresholds for virological non-suppression (100 or 200 copies/ml). Overall, 475 PLHIV were included (53% male, median age 47 years, 66% not born in France mainly in a sub-Saharan African country). Half of French natives and 85% of migrants were classified as deprived. Median duration on ART was 9.7 years with virological suppression in 95.2% of non-deprived participants and in 83.5% of deprived ones (p = 0.001). The final multivariable model retained ART tiredness, younger age, a previous AIDS event and social deprivation (adjusted Odds Ratio, 2.9; 95%CI, 1.2–7.0) as determinants of virological non-suppression but not migration in itself. When using separate components of EPICES score, reporting economic difficulties and non-homeownership were associated with virological non-suppression. In addition to interventions focusing on cultural aspects of migration, social interventions are needed to help people with social vulnerability to obtain sustained responses on ART.
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Longitudinal association between internalized HIV stigma and antiretroviral therapy adherence for women living with HIV: the mediating role of depression. AIDS 2019; 33:571-576. [PMID: 30702521 DOI: 10.1097/qad.0000000000002071] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We investigated whether internalized HIV-related stigma predicts adherence to antiretroviral therapy (ART) longitudinally in women living with HIV in the United States, and whether depression symptoms mediate the relationship between internalized stigma and suboptimal ART adherence. DESIGN Observational longitudinal study utilizing data from the Women's Interagency HIV Study cohort. METHODS A measure of internalized HIV-related stigma was added to the battery of Women's Interagency HIV Study measures in 2013. For current analyses, participants' first assessment of internalized HIV-related stigma and assessments of other variables at that time were used as baseline measures (Time one or T1, visit occurring in 2013/14), with outcomes measured approximately 2 years later (T3, 2015/16; n = 914). A measure of depression symptoms, assessed approximately 18 months after the baseline (T2, 2014/15), was used in mediation analyses (n = 862). RESULTS Higher internalized HIV-related stigma at T1 predicted lower odds of optimal ART adherence at T3 (adjusted odds ratio = 0.61, P = 0.001, 95% confidence interval [0.45, 0.82]). Results were similar when ART adherence at T1 was added as a control variable. Mediation analysis revealed a significant indirect effect of internalized HIV stigma at T1 on ART adherence at T3 through depression symptoms at T2 (while controlling for depression symptoms and ART adherence at T1; B = -0.05, SE = 0.03, 95% confidence interval [-0.11, -0.006]). CONCLUSION These results provide strong longitudinal support for the hypothesis that internalized HIV-related stigma results in suboptimal ART adherence in a large sample of women living with HIV in the United States, working through the pathway of increased depression symptoms.
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Gatey C, Brun A, Hamet G, Diamantis S, Sellier P, Bouchaud O, Garrait V, Rozenbaum W, Molina JM, Abgrall S. Does region of origin influence the timing and outcome of first-line antiretroviral therapy in France? HIV Med 2018; 20:175-181. [PMID: 30506853 DOI: 10.1111/hiv.12697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of the study was to assess whether the timing of combination antiretroviral therapy (cART) initiation, the choice of cART and virological response differ in migrants versus European natives in the north and east of Paris area, after dissemination of French recommendations for universal treatment. METHODS Antiretroviral therapy-naïve HIV-1-infected adults with at least two follow-up visits at one of 15 participating centres between 1 January 2014 and 31 March 2015 were included in the study. Factors associated with cART initiation before 31 March 2015, with protease inhibitor (PI)-containing cART among individuals initiating cART, and with 1-year virological success after cART initiation were assessed using multivariable logistic regression models. Sex, age, region of origin [Western Europe, sub-Saharan Africa (SSA) or other], HIV transmission group, baseline AIDS status, CD4 cell count and plasma viral load (VL), and hepatitis B and/or C virus infection were considered in the analyses. RESULTS Among 912 individuals, only 584 (64%) started cART during the study period. After adjustment, migrants from SSA were half as likely to initiate cART and to have a subsequent virological response compared with individuals from Western Europe [adjusted odds ratio (aOR) 0.54; 95% confidence interval (CI) 0.36-0.82; and aOR 0.52; 95% CI 0.28-0.98, respectively]. PI-containing cART was more frequently prescribed in migrants from SSA, in people with lower CD4 cell counts and in people with higher VL. CONCLUSIONS Even in the context of universal cART recommendations and of free access to care, migrants from SSA still have delayed access to cART and a lower virological response. Efforts are still necessary to provide immediate cART to all people living with HIV.
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Affiliation(s)
- C Gatey
- Department of Infectious Diseases, Saint-Louis Hospital, AP-HP, Paris, France
| | - A Brun
- Est Paris Area COREVIH (Regional Coordination of the fight against HIV infection), Saint Louis Hospital, Paris, France
| | - G Hamet
- Est Paris Area COREVIH (Regional Coordination of the fight against HIV infection), Saint Louis Hospital, Paris, France
| | - S Diamantis
- Department of Infectious Diseases, Marc Jacquet Hospital, Melun, France
| | - P Sellier
- Department of Internal Medicine, Saint Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | - O Bouchaud
- Department of Infectious Diseases, Avicenne Hospital, AP-HP, Bobigny, France.,Laboratory Health Education and Practice (LEPS EA 3412), Paris 13 University, Bobigny, France
| | - V Garrait
- Department of Internal Medicine, Intercommunal Hospital Centre, Créteil, France
| | - W Rozenbaum
- Department of Infectious Diseases, Saint-Louis Hospital, AP-HP, Paris, France.,Est Paris Area COREVIH (Regional Coordination of the fight against HIV infection), Saint Louis Hospital, Paris, France
| | - J M Molina
- Department of Infectious Diseases, Saint-Louis Hospital, AP-HP, Paris, France.,University of Paris Diderot, Sorbonne Paris University, Paris, France
| | - S Abgrall
- Department of Internal Medicine, Antoine Béclère Hospital, Clamart, France.,University of Paris Saclay, Paris-Sud University, UVSQ, Le Kremlin-Bicêtre, France.,CESP INSERM U1018, Le Kremlin-Bicêtre, France
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Mota TS, Donalisio MR, Silveira LVDA. Spatial risk of death in patients with AIDS in Campinas, São Paulo, Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 21:e180017. [PMID: 30234884 DOI: 10.1590/1980-549720180017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 08/10/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the spatial risk of AIDS mortality in census tracts in a large Brazilian city. METHOD We studied three retrospective cohorts of individuals with AIDS, who were residents in the city of Campinas, in the State of São Paulo, Brazil. The occurrence of death was analyzed from 1980 to 1990 (cohort 1), 1996 to 2000 (cohort 2), and from 2001 to 2005 (cohort 3). We adjusted a Bayesian semi-parametric model, using the Integrated Nested Laplace Approximation (INLA) method, which allowed for the mapping of mortality risk for the three cohorts. RESULTS The incidence of death in cohorts 1, 2 and 3 were, respectively, 72.73, 32.21 and 13.11%. The death risk maps showed a tendency of mortality decrease, and presented the sectors with the highest and lowest risk for each period. The model showed that, in the three cohorts, factors associated with the highest risk of death were: being male, and having an age at diagnosis greater than 49 years old. The homosexual/bisexual orientation was associated with lower risk of dying. CONCLUSIONS Even considering the reduction in the risk of death from AIDS in recent years, after access to highly active antiretroviral therapy, the highest incidence was found among the poorest individuals in the three studied cohorts. The maps and risk factors obtained suggest possible actions for monitoring the disease in the city.
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Affiliation(s)
- Thiago Santos Mota
- Departamento de Bioestatística, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil
| | - Maria Rita Donalisio
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Amram O, Shoveller J, Hogg R, Wang L, Sereda P, Barrios R, Montaner J, Lima V. Distance to HIV care and treatment adherence: Adjusting for socio-demographic and geographical heterogeneity. Spat Spatiotemporal Epidemiol 2018; 27:29-35. [PMID: 30409374 DOI: 10.1016/j.sste.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 07/06/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
Distance to health services plays an important role in determining access to care and an individual's health. This study aims to examine the relationship between distance to antiretroviral therapy (ART) prescribing physician and adherence to HIV treatment in British Columbia, Canada. Only participants who provided highly accurate locational data for both place of residence and their physician were used in the analysis. Using logistic regression, a multivariable confounder model was created to assess the association between distance and adherence. A geographically weighted logistic regression was also performed to adjust for spatial dependency. There were 1528 participants in the analysis, for a median distance of 17.85km. The final model showed further away from ART prescribing physician had a higher chance of incomplete adherence to ART (adjusted odds ratio 1.31; 95% Confidence Interval 1.04-1.65). Mobile services could potentially increase adherence rates for population residing further away from their ART prescribing physician.
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Affiliation(s)
- O Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, 412 E Spokane Falls Blvd, Spokane, WA 99202, USA.
| | - J Shoveller
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - R Hogg
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - L Wang
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - P Sereda
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - R Barrios
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - J Montaner
- British Columbia centre for excellence in HIV/AIDS, University of British Columbia, 613 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - V Lima
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
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Brown MJ, Serovich JM, Laschober TC, Kimberly JA. Age and racial disparities in substance use and self-reported viral suppression among men who have sex with men with HIV. Int J STD AIDS 2018; 29:1174-1182. [PMID: 29945540 DOI: 10.1177/0956462418779663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
HIV disproportionately affects men who have sex with men (MSM). Substance use is common among people living with HIV and may affect antiretroviral therapy adherence. Nevertheless, research examining the association between substance use and viral suppression is lacking. The aims of this study were to determine the association between substance use and self-reported viral suppression, and by age and race among MSM living with HIV. Data were obtained from 309 HIV-positive MSM. Logistic regression was used to determine the association between substance use and self-reported viral suppression at baseline, and by age and race. Approximately 67% of participants reported they were virally suppressed. After adjusting for sociodemographics, every increase in substance use score was associated with a 7% decrease in the odds of reporting viral suppression (odds ratio [OR]: 0.93; 95% confidence interval [CI]: 0.89-0.98; p = 0.003). The negative association between substance use and self-reported viral suppression remained statistically significant among MSM aged 25-34 years (OR = 0.89; 95% CI: 0.79-1.00; p = 0.041) and statistically significant for Black MSM (OR = 0.92; 95% CI: 0.86-0.98; p = 0.009). Intervention programs for MSM living with HIV aimed at improving viral suppression should address substance use and consider the differences by age and race.
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Affiliation(s)
- Monique J Brown
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Julianne M Serovich
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Tanja C Laschober
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Judy A Kimberly
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
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Medication nonadherence, multitablet regimens, and food insecurity are key experiences in the pathway to incomplete HIV suppression. AIDS 2018; 32:1323-1332. [PMID: 29683846 DOI: 10.1097/qad.0000000000001822] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify potential pathways by which a variety of factors act to lead to unsuppressed viral load. DESIGN A prospective cohort of HIV-HCV co-infected adults receiving care from 18 HIV clinics across Canada was followed every 6 months between November 2012 and October 2015. Participants with at least two visits while receiving combined antiretroviral treatment (cART) were included. METHODS A path analysis was conducted on the basis of ordered sequences of multivariate logistic regressions using generalized estimating equations. The first regression model used incomplete viral suppression (viral load >50 copies/ml) as the outcome of interest and all other variables (i.e. nonadherence, food insecurity, treatment attributes, and other sociodemographic, behavioural, and clinical factors) as potential predictors. Any variable determined to be a statistically significant predictor of incomplete viral suppression was then used as the next outcome of interest in the subsequent regression, until all predictors of each selected outcome were purely explanatory variables. RESULTS A total of 566 participants had at least two visits. Drivers of incomplete viral suppression included injection drug use, age 45 years or less, living alone, poor health status, longer duration of HIV infection and baseline CD4 cell count less than 200 cells/μl. Nonadherence, food insecurity, and the use of multitablet regimens mediated the effects of these factors on incomplete viral suppression. CONCLUSION Our results suggest that nonadherence, multitablet regimens, and food insecurity are key points in the pathway to incomplete HIV suppression. These are potentially amenable intervention targets that would not be revealed using traditional regression analyses.
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Johnson LF, May MT, Dorrington RE, Cornell M, Boulle A, Egger M, Davies MA. Estimating the impact of antiretroviral treatment on adult mortality trends in South Africa: A mathematical modelling study. PLoS Med 2017; 14:e1002468. [PMID: 29232366 PMCID: PMC5726614 DOI: 10.1371/journal.pmed.1002468] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 11/07/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Substantial reductions in adult mortality have been observed in South Africa since the mid-2000s, but there has been no formal evaluation of how much of this decline is attributable to the scale-up of antiretroviral treatment (ART), as previous models have not been calibrated to vital registration data. We developed a deterministic mathematical model to simulate the mortality trends that would have been expected in the absence of ART, and with earlier introduction of ART. METHODS AND FINDINGS Model estimates of mortality rates in ART patients were obtained from the International Epidemiology Databases to Evaluate AIDS-Southern Africa (IeDEA-SA) collaboration. The model was calibrated to HIV prevalence data (1997-2013) and mortality data from the South African vital registration system (1997-2014), using a Bayesian approach. In the 1985-2014 period, 2.70 million adult HIV-related deaths occurred in South Africa. Adult HIV deaths peaked at 231,000 per annum in 2006 and declined to 95,000 in 2014, a reduction of 74.7% (95% CI: 73.3%-76.1%) compared to the scenario without ART. However, HIV mortality in 2014 was estimated to be 69% (95% CI: 46%-97%) higher in 2014 (161,000) if the model was calibrated only to HIV prevalence data. In the 2000-2014 period, the South African ART programme is estimated to have reduced the cumulative number of HIV deaths in adults by 1.72 million (95% CI: 1.58 million-1.84 million) and to have saved 6.15 million life years in adults (95% CI: 5.52 million-6.69 million). This compares with a potential saving of 8.80 million (95% CI: 7.90 million-9.59 million) life years that might have been achieved if South Africa had moved swiftly to implement WHO guidelines (2004-2013) and had achieved high levels of ART uptake in HIV-diagnosed individuals from 2004 onwards. The model is limited by its reliance on all-cause mortality data, given the lack of reliable cause-of-death reporting, and also does not allow for changes over time in tuberculosis control programmes and ART effectiveness. CONCLUSIONS ART has had a dramatic impact on adult mortality in South Africa, but delays in the rollout of ART, especially in the early stages of the ART programme, have contributed to substantial loss of life. This is the first study to our knowledge to calibrate a model of ART impact to population-level recorded death data in Africa; models that are not calibrated to population-level death data may overestimate HIV-related mortality.
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Affiliation(s)
- Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Margaret T. May
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Rob E. Dorrington
- Centre for Actuarial Research, University of Cape Town, Cape Town, South Africa
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Matthias Egger
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
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Effect of Legal Status on the Early Treatment Outcomes of Migrants Beginning Combined Antiretroviral Therapy at an Outpatient Clinic in Milan, Italy. J Acquir Immune Defic Syndr 2017; 75:315-321. [PMID: 28418991 DOI: 10.1097/qai.0000000000001388] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In a setting of free access to HIV care, we compared the early treatment outcomes of HIV-infected undocumented migrants (UMs), documented migrants (DMs), and Italian subjects. METHODS The clinical data of 640 Italians and 245 migrants who started combined antiretroviral therapy (cART) at an HIV clinic in Milan, Italy, were reviewed. The migrants were mainly Latin Americans (83 DMs and 56 UMs) or sub-Saharan Africans (52 DMs and 11 UMs), but a minority were of other origin (33 DMs and 10 UMs). Retention in follow-up and HIV suppression were compared between UMs, DMs, and natives 12 months ± 90 days after start of cART. RESULTS There were no significant between-group differences in the stage of HIV infection at the start of cART or the type of regimen received. The Latin American DMs and UMs included a higher proportion of transgender women than the other ethnic groups (P < 0.001). The UMs were less frequently followed up after 12 months than the DMs and natives (P = 0.004) and were more frequently permanently lost to follow-up (P < 0.001). UM status was an independent predictor of lost to follow-up (adjusted odds ratio 8.05, P < 0.001). The DMs and UMs were less frequently HIV suppressed after 12 months than the natives (78% and 80.7% vs 90.5%, P = 0.001), and Latin American migrants were significantly less likely to be virologically suppressed than the natives (adjusted odds ratio 0.30, P = 0.001). CONCLUSIONS Despite their free access to cART, subgroups of migrants facing multiple levels of vulnerability still have difficulties in gaining optimal HIV care.
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Sub-Saharan African migrants have slower initial CD4+ cell recovery after combined antiretroviral treatment initiation than French natives. AIDS 2017; 31:1323-1332. [PMID: 28492394 DOI: 10.1097/qad.0000000000001482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Poorer immunologic responses to combined antiretroviral treatment (cART) have been reported among sub-Saharan African (SSA) migrants than among native Europeans. We studied whether differences in CD4 cell recovery between French natives and SSA migrants starting first-line cART could be explained by differences in socioeconomic conditions, inflammatory marker levels, and other established determinants. METHODS We compared 319 French natives and 175 SSA migrants (ANRS-COPANA cohort). Clinical, biological, and socioeconomic data (education, employment, income, and cohabiting partnership) were recorded at regular visits. A piecewise linear mixed-effects model was used to analyze CD4 cell count kinetics on cART. RESULTS Compared with French natives, SSA migrants were more frequently women, younger, less educated, living in more adverse conditions, and had more frequent symptoms of depression. The rate of CD4 cell recovery during the first 4 months on cART was significantly slower in SSA migrants, despite a similar virologic response, but did not differ significantly thereafter. The mean CD4 cell count rose from 251 cells/μl at baseline to 508 cells/μl at 36 months in migrants, and from 308 to 623 cells/μl in natives (additional mean gain of 58 cells/μl in natives). The difference persisted after adjustment for clinical, updated socioeconomic, and living conditions (-0.40√CD4 cells/month, P = 0.04); 25-hydroxyvitamin D, monocyte chemoattractant protein-1 and soluble tumor necrosis factor receptor 1 (sTNFR1) levels were lower in SSA migrants, but only sTNFR1 contributed to the difference in CD4 slope. CONCLUSION Initial CD4 cell recovery on cART was slower among SSA migrants than among French natives. This difference was not explained by established clinical and biological determinants or by socioeconomic status.
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Socioeconomic factors explain suboptimal adherence to antiretroviral therapy among HIV-infected Australian adults with viral suppression. PLoS One 2017; 12:e0174613. [PMID: 28369066 PMCID: PMC5378347 DOI: 10.1371/journal.pone.0174613] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/13/2017] [Indexed: 12/23/2022] Open
Abstract
Background Missing more than one tablet of contemporary antiretroviral therapy (ART) per month increases the risk of virological failure. Recent studies evaluating a comprehensive range of potential risk factors for suboptimal adherence are not available for high-income settings. Methods Adults on ART with undetectable viral load (UDVL) were recruited into a national, multi-centre cohort, completing a comprehensive survey assessing demographics, socio-economic indicators, physical health, well-being, life stressors, social supports, HIV disclosure, HIV-related stigma and discrimination, healthcare access, ART regimen, adherence, side effects, costs and treatment beliefs. Baseline data were assessed, and suboptimal adherence was defined as self-reported missing ≥1 ART dose/month over the previous 3-months; associated factors were identified using bivariate and multivariate binary logistic regression. Results We assessed 522 participants (494 [94.5%] men, mean age = 50.8 years, median duration UDVL = 3.3 years [IQR = 1.2–6.8]) at 17 sexual health, hospital, and general practice clinics across Australia. Seventy-eight participants (14.9%) reported missing ≥1 dose/month over the previous three months, which was independently associated with: being Australian-born (AOR [adjusted odds ratio] = 2.4 [95%CI = 1.2–4.9], p = 0.014), not being in a relationship (AOR = 3.3 [95%CI = 1.5–7.3], p = 0.004), reaching the “Medicare safety net” (capping annual medical/pharmaceutical costs) (AOR = 2.2 [95%CI = 1.1–4.5], p = 0.024), living in subsidised housing (AOR = 2.5 [95%CI = 1.0–6.2], p = 0.045), receiving home-care services (AOR = 4.4 [95%CI = 1.0–18.8], p = 0.046), HIV community/outreach services linkage (AOR = 2.4 [95%CI = 1.1–5.4], p = 0.033), and starting ART following self-request (AOR = 3.0 [95%CI = 1.3–7.0], p = 0.012). Conclusions In this population, 15% reported recent suboptimal ART adherence at levels associated in prospective studies with subsequent virological failure, despite all having an undetectable viral load. Associations were with social/economic/cultural/patient engagement factors, but not ART regimen/clinical factors. These associations may help identify those at higher risk of future virological failure and guide patient education and support.
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Yang HJ, Bang JH. Factors associated with medication adherence in patients with human immunodeficiency virus in South Korea. AIDS Care 2017; 29:1315-1319. [PMID: 28127987 DOI: 10.1080/09540121.2017.1282104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aimed to identify the factors associated with medication adherence in human immunodeficiency virus (HIV) patients in South Korea. A cross-sectional study was conducted from six hospitals participating in the Nationwide Specialized Counseling Program for HIV infected patients from 22 February to 10 May 2010. A total of 300 HIV patients have completed a self-administered questionnaire. Among 300 patients, 230 patients had above 95% medication adherence. Binary logistic regression analysis revealed that having medical insurance (p = .003) and a good relationship with the medical team (p = .046) were the main factors affecting medication adherence in HIV patients. In conclusion, medical insurance through the National Health Insurance Service and a good relationship between HIV infected patients and physicians are the main influencing factors that impact medication adherence in countries with low economic barriers to treatment.
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Affiliation(s)
- Hye Jin Yang
- a Seoul center for Infectious Disease Control , Korea University , Seoul , Korea
| | - Ji Hwan Bang
- b Division of Infectious Diseases , Seoul Metropolitan Government-Seoul National University Borame Medical Center , Seoul , South Korea
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Burch LS, Smith CJ, Anderson J, Sherr L, Rodger AJ, O'Connell R, Geretti AM, Gilson R, Fisher M, Elford J, Jones M, Collins S, Azad Y, Phillips AN, Speakman A, Johnson MA, Lampe FC. Socioeconomic status and treatment outcomes for individuals with HIV on antiretroviral treatment in the UK: cross-sectional and longitudinal analyses. LANCET PUBLIC HEALTH 2016; 1:e26-e36. [PMID: 28299369 PMCID: PMC5341147 DOI: 10.1016/s2468-2667(16)30002-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Few studies have assessed the effect of socioeconomic status on HIV treatment outcomes in settings with universal access to health care. Here we aimed to investigate the association of socioeconomic factors with antiretroviral therapy (ART) non-adherence, virological non-suppression, and virological rebound, in HIV-positive people on ART in the UK. Methods We used data from the Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) questionnaire study, which recruited participants aged 18 years or older with HIV from eight HIV outpatient clinics in the UK between Feb 1, 2011, and Dec 31, 2012. Participants self-completed a confidential questionnaire on sociodemographic, health, and lifestyle issues. In participants on ART, we assessed associations of financial hardship, employment, housing, and education with: self-reported ART non-adherence at the time of the questionnaire; virological non-suppression (viral load >50 copies per mL) at the time of questionnaire in those who started ART at least 6 months ago (cross-sectional analysis); and subsequent virological rebound (viral load >200 copies per mL) in those with initial viral load of 50 copies per mL or lower (longitudinal analysis). Findings Of the 3258 people who completed the questionnaire, 2771 (85%) reported being on ART at the time of the questionnaire, and 2704 with complete data were included. 873 (32%) of 2704 participants reported non-adherence to ART and 219 (9%) of 2405 had virological non-suppression in cross-sectional analysis. Each of the four measures of lower socioeconomic status was strongly associated with non-adherence to ART, and with virological non-suppression (prevalence ratios [PR] adjusted for gender/sexual orientation, age, and ethnic origin: greatest financial hardship vs none 2·4, 95% CI 1·6–3·4; non-employment 2·0, 1·5–2·6; unstable housing vs homeowner 3·0, 1·9–4·6; non-university education 1·6, 1·2–2·2). 139 (8%) of 1740 individuals had subsequent virological rebound (rate=3·6/100 person-years). Low socioeconomic status was predictive of longitudinal rebound risk (adjusted hazard ratio [HR] for greatest financial hardship vs none 2·3, 95% CI 1·4–3·9; non-employment 3·0, 2·1–4·2; unstable housing vs homeowner 3·3, 1·8–6·1; non-university education 1·6, 1·1–2·3). Interpretation Socioeconomic disadvantage was strongly associated with poorer HIV treatment outcomes in this setting with universal health care. Adherence interventions and increased social support for those most at risk should be considered. Funding National Institute for Health Research.
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Affiliation(s)
- Lisa S Burch
- Research Department of Infection and Population Health, University College London, London, UK
| | - Colette J Smith
- Research Department of Infection and Population Health, University College London, London, UK
| | - Jane Anderson
- Centre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Lorraine Sherr
- Research Department of Infection and Population Health, University College London, London, UK
| | - Alison J Rodger
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Anna-Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Richard Gilson
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Jonathan Elford
- School of Health Sciences, City, University of London, London, UK
| | - Martin Jones
- East Sussex Healthcare NHS Trust, Eastbourne, UK
| | | | | | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew Speakman
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Fiona C Lampe
- Research Department of Infection and Population Health, University College London, London, UK
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