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Pichlinski EM, Saysana KH, Moscowitz AE, Maxwell DN, Leveno MJ, King HL, Nijhawan AE. Ongoing crisis across the HIV care continuum: high mortality among PWH admitted to the ICU in an urban safety-net hospital in the South. AIDS Care 2025:1-10. [PMID: 39908411 DOI: 10.1080/09540121.2025.2459878] [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: 01/20/2024] [Accepted: 01/21/2025] [Indexed: 02/07/2025]
Abstract
We present a retrospective study of people with HIV (PWH) admitted to the medical intensive care unit (MICU) of an 862-bed academic, safety-net hospital. We aimed to determine the characteristics of ICU admissions among PWH, measure the mortality in this population and identify predictors of mortality. All patients ≥ 18 years old with a diagnosis of HIV infection admitted to the MICU between January 1, 2017 and December 31, 2019 were included. A total of 195 ICU admissions occurred during the study period. The mean age was 46.2 years, 77.4% were male and the majority were people of color. Overall, 125 (64.8%) patients had CD4<200 cells/mL and 12 (6.7%) were newly diagnosed with HIV. ICU mortality was 21.5% and hospital mortality was 24.6%. High APACHE score and CD4<200 were independent predictors of ICU mortality. Our three-year retrospective analysis of PWH admitted to the ICU in a large urban safety-net hospital in the US South during the recent modern ART era identified high ICU- and hospital mortality. We also identified a higher mortality risk at each step of the HIV care cascade, reinforcing the importance of proactive interventions including expanded HIV testing and implementation of strategies which improve engagement in care, ART adherence and virologic suppression.
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Affiliation(s)
- Elisa M Pichlinski
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Parkland Health and Hospital System, Dallas, TX, USA
| | - Kyle H Saysana
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anna E Moscowitz
- Parkland Health and Hospital System, Dallas, TX, USA
- Department of Internal Medicine, Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel N Maxwell
- Department of Internal Medicine, Division of Infectious Diseases, Veterans Affairs, Dallas, TX, USA
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Veterans Affairs, Dallas, TX, USA
| | - Matthew J Leveno
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Helen L King
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ank E Nijhawan
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Ochonye B, Sanni OF, Emmanuel G, Umoh P, Kalaiwo A, Abang R, Amechi P, Ahkigbe M, Akinpelumi S, Motilewa O. A retrospective study of tuberculosis prevalence and associated factors among HIV-positive key populations in Nigeria. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003461. [PMID: 38995935 PMCID: PMC11244832 DOI: 10.1371/journal.pgph.0003461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024]
Abstract
HIV is a major risk factor for active Tuberculosis (TB.) This raises patients' risk of original infection, reinfection, and TB reactivation. Providing healthcare to KPLHIV in developing countries requires TB prevalence research. This study aims to determine the prevalence of TB and HIV co-infection and associated factors among KPLHIV. This is a retrospective cross-sectional study among KP's living with HIV enrolled on care in One Stop Shop (OSS) of Heartland Alliance Ltd/GTE across six states in Nigeria. Data were analysed using IBM SPSS version 25.0. Secondary data analysis of client's records from the RADET files of the KPCARE 1 project from 6 states was conducted. Means with standard deviations were computed for continuous variables like age, and frequency tables were generated for categorical variables. Chi-square tests and t-tests were used for the bivariate analysis of variables. All tests were done at a 5% level of statistical significance (p = 0.05).TB prevalence was 19.1% among KP's living with HIV, with variations observed in age groups, geographic locations, target populations, marital status, educational backgrounds, clinical characteristics, and antiretroviral therapy (ART) history. KPs aged 51 and above exhibited the highest TB prevalence (21.0%), while those aged below 20 years had the lowest (18.2%). Jigawa KPs recorded the highest TB prevalence (38.4%), and Niger had the least (13.3%). TB was more prevalent among People who inject drugs (20.3%), divorced (32.3%), and those who attained Qur'anic education (29.7%). KPs who had to restart ART exhibited the highest TB prevalence (22.0%), whereas those who experienced Interruption in treatment (IIT) reported the lowest at 10.0%. Immune-suppressed KPs (CD4 counts < 200 cells/m3) had a higher TB prevalence of 26.6%. TB prevalence among KPs living with HIV varies greatly, underlining the need for targeted treatments, especially for high-risk categories, to improve HIV treatment outcomes and reduce TB prevalence.
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Affiliation(s)
| | | | - Godwin Emmanuel
- Research and Development Department, Heartland Alliance, Abuja, Nigeria
| | - Paul Umoh
- Research and Development Department, Heartland Alliance, Abuja, Nigeria
| | | | - Roger Abang
- Research and Development Department, Heartland Alliance, Abuja, Nigeria
| | - Paul Amechi
- Research and Development Department, Heartland Alliance, Abuja, Nigeria
| | - Mark Ahkigbe
- Research and Development Department, Heartland Alliance, Abuja, Nigeria
| | | | - Olugbemi Motilewa
- Department of Community Medicine, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
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Hajarizadeh B, Kairouz A, Ottaviano S, Ireland J, Willing A, Cunningham E, Webb P, Colledge-Frisby S, Wheeler A, Leung J, Tran LT, Price O, Vickerman P, Farrell M, Hickman M, Dore GJ, Bergenström A, Degenhardt L, Grebely J. Global, regional, and country-level coverage of testing and treatment for HIV and hepatitis C infection among people who inject drugs: a systematic review. Lancet Glob Health 2023; 11:e1885-e1898. [PMID: 37973339 DOI: 10.1016/s2214-109x(23)00461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND People who inject drugs are disproportionately affected by HIV and hepatitis C virus (HCV) infections, while there is little global data on HIV and HCV testing and treatment coverage of this population. We conducted a systematic review to evaluate country-level, regional, and global coverage of HIV and HCV testing and treatment among people who inject drugs. METHODS We did a systematic review, and searched bibliographic databases (MEDLINE, Embase, and PsycINFO) and grey literature for studies published between Jan 1, 2017, and April 30, 2022, that evaluated the proportion of people who inject drugs who received testing or treatment for HIV or HCV. For each country, we estimated the proportion of people who inject drugs tested for HIV antibodies in the past 12 months (recent), people who inject drugs ever tested for HCV antibodies and HCV RNA, people who inject drugs with HIV currently receiving antiretroviral therapy, and people who inject drugs with HCV ever receiving HCV antiviral treatment. Regional and global estimates, weighted by the population size of people who inject drugs, were generated where sufficient data were available. This study is registered with PROSPERO (CRD42020173974). FINDINGS 512 documents reported data eligible for analyses, including 337 peer-reviewed articles, 27 conference abstracts or presentations, and 148 documents from grey literature or supplementary searches. Data of recent HIV antibody testing were available for 67 countries and ever having had HCV antibody testing were available for 49 countries. Globally, an estimated 48·8% of people who inject drugs were recently tested for HIV antibodies (95% uncertainty interval [UI] 43·3-54·2%; range 0·9-86·0%), and 47·1% had ever been tested for HCV antibodies (95% UI 43·4-51·0%; range 0·0-93·3%). HCV RNA testing data were available from three countries. Coverage of HIV antibody testing was high (>75%) in four countries and for HCV antibody testing in 15 countries. The estimated uptake of current HIV treatment (18 countries) ranged from 2·6% to 81·9%, and the estimated uptake of ever having HCV treatment (23 countries) ranged from 1·8% to 88·6% across countries. Uptake of HIV treatment was high in two countries, and of HCV treatment in one country. INTERPRETATION HIV and HCV testing and treatment uptake among people who inject drugs was highly variable, and suboptimal in most countries. Strategies to improve access to HIV and HCV care among people who inject drugs and the availability of public health surveillance are urgently required. FUNDING Australian National Health and Medical Research Council and UK National Institute for Health and Care Research Health Protection Research Unit in Behavioural Science and Evaluation.
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Affiliation(s)
- Behzad Hajarizadeh
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Abe Kairouz
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Sophie Ottaviano
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Jeremy Ireland
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Alex Willing
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Evan Cunningham
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Paige Webb
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Samantha Colledge-Frisby
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Alice Wheeler
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Janni Leung
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia; National Centre For Youth Substance Use Research, The University of Queensland, QLD, Australia
| | - Lucy T Tran
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Olivia Price
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Peter Vickerman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, England
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, England
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Anne Bergenström
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Collins AB, Macon EC, Langdon K, Joseph R, Thomas A, Dogon C, Beckwith CG. Perceptions of Long-Acting Injectable Antiretroviral Therapy Among People Living with HIV Who Use Drugs and Service Providers: a Qualitative Analysis in Rhode Island. J Urban Health 2023; 100:1062-1073. [PMID: 37563518 PMCID: PMC10618145 DOI: 10.1007/s11524-023-00755-6] [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] [Accepted: 06/12/2023] [Indexed: 08/12/2023]
Abstract
Long-acting injectable antiretroviral therapy (LAI-ART) is a novel method to deliver HIV treatment, and the first regimen was approved in the USA in 2021. LAI-ART may mitigate barriers to oral treatment adherence, but little is known about LAI-ART perceptions among people living with HIV (PLWH) who use drugs, despite these populations facing greater barriers to treatment retention and ART adherence. We assessed LAI-ART perceptions and implementation considerations among PLWH who use drugs and health and ancillary service providers in Rhode Island. Data was collected from November 2021 to September 2022, and include in-depth interviews with 15 PLWH who use drugs and two focus groups with HIV clinical providers (n = 8) and ancillary service providers (n = 5) working with PLWH who use drugs. Data were analyzed thematically, with attention paid to how levels of structural vulnerability and social-structural environments shaped participants' LAI-ART perceptions and the HIV care continuum. Willingness to consider LAI-ART was impacted by HIV outcomes (e.g., viral suppression) and previous experiences with oral regimens, with those on stable regimens reluctant to consider alternative therapies. However, LAI-ART was seen as potentially improving HIV outcomes for PLWH who use drugs and enhancing people's quality of life by reducing stress related to daily pill-taking. Recommendations for optimal implementation of LAI-ART varied across participants and included decentralized approaches to delivery. HIV care delivery must consider the needs of PLWH who use drugs. Developing patient-centered and community-based delivery approaches to LAI-ART may address adherence challenges specific to PLWH who use drugs.
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Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, 121 S Main Street, Providence, RI, USA.
| | - E Claire Macon
- Department of Epidemiology, Brown University School of Public Health, 121 S Main Street, Providence, RI, USA
| | - Kirsten Langdon
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Aurielle Thomas
- Division of Infectious Diseases, Warren Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Calli Dogon
- Division of Infectious Diseases, Warren Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Curt G Beckwith
- Division of Infectious Diseases, Warren Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
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Aung HL, Alagaratnam J, Chan P, Chow FC, Joska J, Falutz J, Letendre SL, Lin W, Muñoz-Moreno JA, Cinque P, Taylor J, Brew B, Winston A. Cognitive Health in Persons With Human Immunodeficiency Virus: The Impact of Early Treatment, Comorbidities, and Aging. J Infect Dis 2023; 227:S38-S47. [PMID: 36930639 PMCID: PMC10022711 DOI: 10.1093/infdis/jiac388] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/15/2022] [Indexed: 03/18/2023] Open
Affiliation(s)
| | | | - Phillip Chan
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | | | | | | | | | - Woody Lin
- National Institute on Drug Abuse, Rockville, Maryland, USA
| | | | - Paola Cinque
- Unit of Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy
| | - Jeff Taylor
- HIV and Aging Research Project, Palm Springs, California, USA
| | - Bruce Brew
- Correspondence: Bruce Brew, MD, PhD, Department of Neurology, Level 4 Xavier Bldg, St Vincent’s Hospital Sydney, 390 Victoria St, Darlinghurst NSW 2010, Australia ()
| | - Alan Winston
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
- Genitourinary Medicine and HIV Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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How food support improves mental health among people living with HIV: A qualitative study. PLoS One 2023; 18:e0282857. [PMID: 36917580 PMCID: PMC10013904 DOI: 10.1371/journal.pone.0282857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/10/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Food insecurity is associated with poor mental health among people living with HIV (PLHIV). This qualitative study explored the mental health experiences of PLHIV participating in a medically appropriate food support program. METHODS Semi-structured interviews were conducted post-intervention (n = 34). Interview topics included changes, or lack thereof, in mental health and reasons for changes. Interviews were audio-recorded, transcribed, and double-coded. Salient themes were identified using an inductive-deductive method. RESULTS Positive changes in mental health self-reported by PLHIV included improved mood and reduced stress, worry, and anxiety. Participants attributed these changes to: 1) increased access to sufficient and nutritious foods, 2) increased social support, 3) reduced financial hardship, 4) increased sense of control and self-esteem, and 5) reduced functional barriers to eating. CONCLUSIONS Medically appropriate food support may improve mental health for some PLHIV. Further work is needed to understand and prevent possible adverse consequences on mental health after programs end.
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Shah GH, Etheredge GD, Smallwood SW, Maluantesa L, Waterfield KC, Ikhile O, Ditekemena J, Engetele E, Ayangunna E, Mulenga A, Bossiky B. HIV viral load suppression before and after COVID-19 in Kinshasa and Haut Katanga, Democratic Republic of the Congo. South Afr J HIV Med 2022; 23:1421. [PMCID: PMC9634654 DOI: 10.4102/sajhivmed.v23i1.1421] [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: 06/28/2022] [Accepted: 08/23/2022] [Indexed: 11/07/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic resulted in unique programmatic opportunities to test hypotheses related to the initiation of antiretroviral treatment (ART) and viral load (VL) suppression during a global health crisis, which would not otherwise have been possible. Objectives To generate practice-relevant evidence on the impact of initiating ART pre-COVID-19 versus during the COVID-19 pandemic on HIV VL. Method Logistic regression was performed on data covering 6596 persons with HIV whose VL data were available, out of 36 585 persons who were initiated on ART between 01 April 2019 and 30 March 2021. Results After controlling for covariates such as age, gender, duration on ART, tuberculosis status at the time of the last visit, and rural vs urban status, the odds of having a VL < 1000 copies/mL were significantly higher for clients who started ART during the COVID-19 pandemic than the year before COVID-19 (adjusted odds ratio [AOR]: 2.50; confidence interval [CI]: 1.55–4.01; P < 0.001). Odds of having a VL < 1000 copies/mL were also significantly higher among female participants than male (AOR: 1.23; CI: 1.02–1.48), among patients attending rural clinics compared to those attending urban clinics (AOR: 1.83; CI: 1.47–2.28), and in clients who were 15 years or older at the time of their last visit (AOR: 1.50; CI: 1.07–2.11). Conclusion Viral loads did not deteriorate despite pandemic-induced changes in HIV services such as the expansion of multi-month dispensing (MMD), which may have played a protective role regardless of the general negative impacts of response to the COVID-19 crises on communities and individuals. What this study adds This research capitalises on the natural experiment of COVID-19-related changes in HIV services and provides new practice-relevant research evidence.
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Affiliation(s)
- Gulzar H. Shah
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, United States of America
| | | | - Stacy W. Smallwood
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, United States of America
| | | | - Kristie C. Waterfield
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, United States of America
| | - Osaremhen Ikhile
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, United States of America
| | | | | | - Elizabeth Ayangunna
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, United States of America
| | | | - Bernard Bossiky
- National Multisectoral HIV/AIDS program (PNMLS), HIV Program, Presidency of DRC, Democratic Republic of the Congo
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Mitchell M, Hansen E, Tseng TY, Shen M, Catanzarite Z, Cruz-Oliver D, Parker L, Knowlton A. Caregiver role strain in caring for vulnerable persons living with HIV: correlates of caregiver and care recipient reports. AIDS Care 2022; 34:1314-1320. [PMID: 34445898 PMCID: PMC8881545 DOI: 10.1080/09540121.2021.1968997] [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: 10/09/2020] [Accepted: 08/09/2021] [Indexed: 01/26/2023]
Abstract
Informal care of family and friends is important for the health and well-being of disadvantaged persons living with HIV (PLWH). Caregiver role strain may threaten the function and continuity of their main relationships and their health impacts. Data were from a disadvantaged, primarily African American, sample of PLWH care recipients. Caregiver role strain was operationalized as a latent factor measured by variables including PLWH's perceptions of their caregiver not wanting or complaining about helping them or wanting a break. We found that greater caregiver role strain was associated with higher levels of HIV-related stigma and depressive symptoms. Lower role strain was associated with more collaborative problem solving and shared medical treatment decision-making. Caregiver role strain was linked to disadvantaged PLWHs' worse stigma and mental health; collaborative engagement in care and coping assistance were protective of role strain. Caregiving relationship-focused research and interventions are needed for resourcing and sustaining disadvantaged African American communities' caregiving and health.
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Affiliation(s)
| | - Eric Hansen
- Department of Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Tuo-Yen Tseng
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | - Mary Shen
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | - Zachary Catanzarite
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | | | - Lauren Parker
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | - Amy Knowlton
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
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Mohd Salleh NA, Ahmad A, Vicknasingam B, Kamarulzaman A, Yahya 'A. Material Security Scale as a Measurement of Poverty among Key Populations At-Risk for HIV/AIDS in Malaysia: An Implication for People who Use Drugs and Transgender People during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158997. [PMID: 35897368 PMCID: PMC9331958 DOI: 10.3390/ijerph19158997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/10/2022]
Abstract
The HIV epidemic is fueled by poverty; yet, methods to measure poverty remain scarce among populations at risk for HIV infection and disease progression to AIDS in Malaysia. Between August and November 2020, using data from a cross-sectional study of people who use drugs, (PWUD), transgender people, sex workers and men who have sex with men, this study examined the reliability and validity of a material security scale as a measurement of poverty. Additionally, we assessed factors associated with material security scores. We performed confirmatory factor analysis (CFA) for 268 study participants included in the analysis. A revised nine-item three-factor structure of the material security scale demonstrated an excellent fit in CFA. The revised material security score displayed good reliability, with Cronbach’s alpha of 0.843, 0.826 and 0.818 for housing, economic resources and basic needs factors, respectively. In a subsequent analysis, PWUD and transgender people were less likely to present good material security scores during the pandemic, compared to their counterparts. The revised nine-item scale is a useful tool to assess poverty among key populations at-risk for HIV/AIDS with the potential to be extrapolated in similar income settings.
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Affiliation(s)
- Nur Afiqah Mohd Salleh
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
- Centre of Excellence of Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (A.A.); (A.K.)
| | - Ahsan Ahmad
- Centre of Excellence of Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (A.A.); (A.K.)
- Yale School of Medicine, Yale University, New Heven, CT 06510, USA
| | | | - Adeeba Kamarulzaman
- Centre of Excellence of Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (A.A.); (A.K.)
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - 'Abqariyah Yahya
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
- Correspondence: ; Tel.: +603-7967-4756
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Brothers TD, Lewer D, Bonn M, Webster D, Harris M. Social and structural determinants of injecting-related bacterial and fungal infections among people who inject drugs: protocol for a mixed studies systematic review. BMJ Open 2021; 11:e049924. [PMID: 34373309 PMCID: PMC8354281 DOI: 10.1136/bmjopen-2021-049924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/26/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Injecting-related bacterial and fungal infections are a common complication among people who inject drugs (PWID), associated with significant morbidity and mortality. Invasive infections, including infective endocarditis, appear to be increasing in incidence. To date, preventive efforts have focused on modifying individual-level risk behaviours (eg, hand-washing and skin-cleaning) without much success in reducing the population-level impact of these infections. Learning from successes in HIV prevention, there may be great value in looking beyond individual-level risk behaviours to the social determinants of health. Specifically, the risk environment conceptual framework identifies how social, physical, economic and political environmental factors facilitate and constrain individual behaviour, and therefore influence health outcomes. Understanding the social and structural determinants of injecting-related bacterial and fungal infections could help to identify new targets for prevention efforts in the face of increasing incidence of severe disease. METHODS AND ANALYSIS This is a protocol for a systematic review. We will review studies of PWID and investigate associations between risk factors (both individual-level and social/structural-level) and the incidence of hospitalisation or death due to injecting-related bacterial infections (skin and soft-tissue infections, bacteraemia, infective endocarditis, osteomyelitis, septic arthritis, epidural abscess and others). We will include quantitative, qualitative and mixed methods studies. Using directed content analysis, we will code risk factors for these infection-related outcomes according to their contributions to the risk environment in type (social, physical, economic or political) and level (microenvironmental or macroenvironmental). We will also code and present risk factors at each stage in the process of drug acquisition, preparation, injection, superficial infection care, severe infection care or hospitalisation, and outcomes after infection or hospital discharge. ETHICS AND DISSEMINATION As an analysis of the published literature, no ethics approval is required. The findings will inform a research agenda to develop and implement social/structural interventions aimed at reducing the burden of disease. PROSPERO REGISTRATION NUMBER CRD42021231411.
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Affiliation(s)
- Thomas D Brothers
- UCL Collaborative Centre for Inclusion Health, Institue of Epidemiology and Health Care, University College London, London, UK
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Dan Lewer
- UCL Collaborative Centre for Inclusion Health, Institue of Epidemiology and Health Care, University College London, London, UK
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, Nova Scotia, Canada
| | - Duncan Webster
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Infectious Diseases, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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11
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Suri S, Yoong D, Short D, Tan DH, Naccarato M, Crane HM, Musten A, Fredericksen RJ, Lober WB, Gough K. Feasibility of implementing a same-day electronic screening tool for clinical assessment to measure patient-reported outcomes for eliciting actionable information on adherence to HIV medication and related factors in a busy Canadian urban HIV clinic. Int J STD AIDS 2021; 33:247-256. [PMID: 34293990 DOI: 10.1177/09564624211032796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND An optimal adherence to antiretroviral therapy (ART) is fundamental for suppression of HIV viral load and favourable treatment outcomes. Patient-reported outcomes (PROs) are effective tools for improving patient-provider communication and focusing providers' awareness on current health problems. The objectives of this analysis were (1) to determine the feasibility of implementing an electronic screening tool to measure PROs in a Canadian HIV clinic to obtain information on ART adherence and related factors and (2) to determine the factors related to sub-optimal adherence. METHODS This implementation research with a convenience sample of 600 people living with HIV (PLWH) was conducted in a busy, academic, urban HIV clinic in Toronto, Canada. PLWH were approached to participate in PRO assessments just prior to their in-clinic appointments, including health-related domains such as mental health, housing, nutrition, financial stress and medication adherence, and responses were summarized on a single sheet available for providers to review. Feasibility of implementing PROs was assessed by quantifying response rate, completion rate, time taken and participation rate. Medication adherence was elicited by self-report of the percentage of prescribed HIV medications taken in the last month. Unadjusted and adjusted odds ratios were estimated from logistic regression models to identify factors associated with adherence of <95%. RESULTS Of the 748 PLWH invited to participate, 692 (participation rate: 92.5%) completed the PRO assessments as standard of care in clinic. Of these, 600 consented to the use of their PRO results for research and were included in this analysis. The average response rate to the ART-related questions was 96.8% and mean completion rate was 95.5%. The median time taken to complete the assessment was 12.0 (IQR = 8.4-17.3) min, adjusted 8.7 (IQR = 7.2-10.8) min. 445 (74.9%) of participants were male, and 153 (26.2%) reported dissatisfaction with ART. 105 (19.7%) of the PLWH reported ART adherence of <95%. Multivariable logistic regression identified the following risk factors for sub-optimal adherence: dissatisfaction with ART (OR = 2.30, 95% CI 1.38-3.83), not having a family doctor or not visiting a family doctor in last year (OR = 1.69, 95% CI 1.02-2.79). CONCLUSION Collecting self-reported health information from PLWH through PROs in a busy urban clinic was feasible and can provide relevant information to healthcare providers on issues related to adherence. This has a potential to help in individualizing ambulatory care.
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Affiliation(s)
- Shivali Suri
- Division of Infectious Diseases, 10071St. Michael's Hospital, Toronto, ON, Canada
| | - Deborah Yoong
- Division of Infectious Diseases, 10071St. Michael's Hospital, Toronto, ON, Canada
| | | | - Darrell Hs Tan
- Division of Infectious Diseases, 10071St. Michael's Hospital, Toronto, ON, Canada.,MAP Centre for Urban Health Solutions, 10071St. Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto
| | - Mark Naccarato
- Division of Infectious Diseases, 10071St. Michael's Hospital, Toronto, ON, Canada
| | | | | | | | | | - Kevin Gough
- Division of Infectious Diseases, 10071St. Michael's Hospital, Toronto, ON, Canada
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12
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Han WM, Jiamsakul A, Salleh NAM, Choi JY, Huy BV, Yunihastuti E, Do CD, Merati TP, Gani YM, Kiertiburanakul S, Zhang F, Chan YJ, Lee MP, Chaiwarith R, Ng OT, Khusuwan S, Ditangco R, Kumarasamy N, Sangle S, Ross J, Avihingsanon A. HIV treatment outcomes among people who acquired HIV via injecting drug use in the Asia-Pacific region: a longitudinal cohort study. J Int AIDS Soc 2021; 24:e25736. [PMID: 34021711 PMCID: PMC8140190 DOI: 10.1002/jia2.25736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Data on HIV treatment outcomes in people who inject drugs (PWID) in the Asia‐Pacific are sparse despite the high burden of drug use. We assessed immunological and virological responses, AIDS‐defining events and mortality among PWID receiving antiretroviral therapy (ART). METHODS We investigated HIV treatment outcomes among people who acquired HIV via injecting drug use in the TREAT Asia HIV Observational Database (TAHOD) between January 2003 and March 2019. Trends in CD4 count and viral suppression (VS, HIV viral load <1000 copies/mL) were assessed. Factors associated with mean CD4 changes were analysed using repeated measures linear regression, and combined AIDS event and mortality were analysed using survival analysis. RESULTS Of 622 PWID from 12 countries in the Asia‐Pacific, 93% were male and the median age at ART initiation was 31 years (IQR, 28 to 34). The median pre‐ART CD4 count was 71 cells/µL. CD4 counts increased over time, with a mean difference of 401 (95% CI, 372 to 457) cells/µL at year‐10 (n = 78). Higher follow‐up HIV viral load and pre‐ART CD4 counts were associated with smaller increases in CD4 counts. Among 361 PWID with ≥1 viral load after six months on ART, proportions with VS were 82%, 88% and 93% at 2‐, 5‐ and 10‐years following ART initiation. There were 52 new AIDS‐defining events and 50 deaths during 3347 person‐years of follow‐up (PYS) (incidence 3.05/100 PYS, 95% CI, 2.51 to 3.70). Previous AIDS or TB diagnosis, lower current CD4 count and adherence <95% were associated with combined new AIDS‐defining event and death. CONCLUSIONS Despite improved outcomes over time, our findings highlight the need for rapid ART initiation and adherence support among PWID within Asian settings.
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Affiliation(s)
- Win Min Han
- Kirby Institute, UNSW, Sydney, Australia.,HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | - Nur Afiqah Mohd Salleh
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Bui Vu Huy
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Evy Yunihastuti
- Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | - Tuti P Merati
- Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia
| | | | | | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yu-Jiun Chan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Man-Po Lee
- Queen Elizabeth Hospital, Hong Kong, China
| | | | - Oon Tek Ng
- Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | | | - Rossana Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
| | - Shashikala Sangle
- BJ Government Medical College and Sassoon General Hospital, Pune, India
| | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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13
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Fleming T, Collins AB, Bardwell G, Fowler A, Boyd J, Milloy MJ, Small W, McNeil R. A qualitative investigation of HIV treatment dispensing models and impacts on adherence among people living with HIV who use drugs. PLoS One 2021; 16:e0246999. [PMID: 33635886 PMCID: PMC7909635 DOI: 10.1371/journal.pone.0246999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 01/29/2021] [Indexed: 12/03/2022] Open
Abstract
Antiretroviral therapy (ART) dispensing is strongly associated with treatment adherence. Among illicit drug-using populations, whom experience greater structural barriers to adherence, directly administered antiretroviral therapy (DAAT) is often regarded as a stronger predictor of optimal adherence over self-administered medications. In Vancouver, Canada, people living with HIV (PLHIV) who use drugs and live in low-income housing are a critical population for treatment support. This group is typically able to access two key DAAT models, daily delivery and daily pickup, in addition to ART self-administration. This ethno-epidemiological qualitative study explores how key dispensing models impact ART adherence among PLHIV who use drugs living in low-income housing, and how this is framed by structural vulnerability. Semi-structured interviews lasting 30-45 minutes were conducted between February and May 2018 with 31 PLHIV who use drugs recruited from an ongoing prospective cohort of PLHIV who use drugs. Interviews were audio-recorded, transcribed verbatim, and analyzed using QSR International's NVivo 12 software. Interviews focused on housing, drug use, and HIV management. Models that constrained agency were found to have negative impacts on adherence and quality of life. Treatment interruptions were framed by structural vulnerabilities (e.g., housing vulnerability) that impacted ability to maintain adherence under certain dispensing models, and led participants to consider other models. Participants using DAAT models which accounted for their structural vulnerabilities (e.g., mobility issues, housing instability), credited these models for their treatment adherence, but also acknowledged factors that constrained agency, and the negative impacts this could have on both adherence, and quality of life. Being able to integrate ART into an established routine is key to supporting ART adherence. ART models that account for the structural vulnerability of PLHIV who use drugs and live in low-income housing are necessary and housing-based supports could be critical, but the impacts of such models on agency must be considered to ensure optimal adherence.
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Affiliation(s)
- Taylor Fleming
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Alexandra B. Collins
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Al Fowler
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
| | - M. J. Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Will Small
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Ryan McNeil
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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14
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Impact of Advanced HIV Disease on Quality of Life and Mortality in the Era of Combined Antiretroviral Treatment. J Clin Med 2021; 10:jcm10040716. [PMID: 33670229 PMCID: PMC7916912 DOI: 10.3390/jcm10040716] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/13/2022] Open
Abstract
Currently, AIDS or severe immunodeficiency remains as a challenge for people with HIV (PWHIV) and healthcare providers. Our purpose was to analyze the impact of advanced HIV disease (AHD) on mortality, life expectancy and health-related quality of life (HRQoL). We reviewed cohort studies and meta-analyses conducted in middle- and high-income countries. To analyze HRQoL, we selected studies that reported overall health and/or physical/mental health scores on a validated HRQoL instrument. AIDS diagnosis supposes a higher risk of mortality during the first six months, remaining higher for 48 months. It has been reported that cancer and cardiovascular disease persist as frequent causes of mortality in PWHIV, especially those with previous or current AHD. PWHIV who initiate combination antiretroviral therapy (cART) with CD4 < 200 cells/µL have significantly lower estimated life expectancy than those with higher counts. AHD is associated with lower HRQoL, and a worse physical health or mental health status. AIDS and non-AIDS defining events are significant predictors of a lower HRQoL, especially physical health status. AHD survivors are in risk of mortality and serious comorbidities, needing special clinical attention and preventive programs for associated comorbidities. Their specific needs should be reflected in HIV guidelines.
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15
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Longitudinal patterns of illicit drug use, antiretroviral therapy exposure and plasma HIV-1 RNA viral load among HIV-positive people who use illicit drugs. AIDS 2020; 34:1389-1396. [PMID: 32590435 DOI: 10.1097/qad.0000000000002551] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES HIV-positive people who use illicit drugs (PWUD) experience elevated rates of HIV-associated morbidity and mortality compared with members of other key affected populations. Although suboptimal levels of access and adherence to antiretroviral therapy (ART) are common among HIV-positive PWUD, there is a need for studies investigating the possible biological impacts of noninjection illicit drug use among people living with HIV in real-world settings. METHODS We accessed data from the ACCESS study, an ongoing prospective cohort of illicit drug users with systematic HIV viral load monitoring in a setting with universal care and ART dispensation records. We used multivariable generalized linear mixed models to estimate the longitudinal associations between noninjection use of crack cocaine, powder cocaine, opioids, methamphetamine, cannabis and alcohol on plasma HIV-1 RNA viral load, adjusted for ART exposure and relevant confounders. RESULTS Between 2005 and 2018, 843 individuals from the ACCESS cohort were included and contributed to 8698 interviews. At baseline, the mean age was 43 years, 566 (67%) reported male sex and 659 (78%) used crack cocaine in the previous 6 months. In multivariable models adjusted for ART exposure, only crack cocaine use in the last 6 months was found to be significantly associated with higher HIV viral load. CONCLUSION We observed significantly higher HIV viral load during periods of crack cocaine use independent of ART exposure. Our findings support further research to investigate the possible biological mechanisms of this effect.
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16
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Fleming T, Valleriani J, Ng C, Maher L, Small W, McNeil R. Acceptability of a hypothetical preventative HIV vaccine among people who use drugs in Vancouver, Canada. BMC Public Health 2020; 20:1081. [PMID: 32646390 PMCID: PMC7350753 DOI: 10.1186/s12889-020-09202-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 07/02/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND As research on HIV vaccines continues to advance, studies exploring the feasibility of this intervention are necessary to inform uptake and dissemination strategies with key populations, including people who use drugs (PWUD). METHODS We conducted 25 in-depth qualitative interviews examining HIV vaccine acceptability among PWUD in Vancouver, Canada. Participants were recruited from an ongoing prospective cohort of HIV-negative PWUD. Data were coded using NVivo, and analyzed thematically. RESULTS Acceptability was framed by practical considerations such as cost and side effects, and was influenced by broader trust of government bodies and health care professionals. While an HIV vaccine was perceived as an important prevention tool, willingness to be vaccinated was low. Results suggest that future vaccine implementation must consider how to minimize the burden an HIV vaccine may place on PWUD. Centering the role of health care providers in information dissemination and delivery may assist with uptake. CONCLUSIONS Our findings suggest improvements in care and improved patient-provider relationships would increase the acceptability of a potential HIV vaccine among this population.
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Affiliation(s)
- Taylor Fleming
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Interdisciplinary Graduate Studies Program, University of British Columbia, Vancouver, BC, Canada
| | - Jenna Valleriani
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- National Institute for Cannabis Health and Education, Toronto, ON, Canada
| | - Cara Ng
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Lisa Maher
- The Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- The Burnet Institute, Melbourne, VIC, Australia
| | - Will Small
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
- Program in Addiction Medicine, Yale School of Medicine, Yale University, 367 Cedar Street, New Haven, CT, USA.
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17
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Glick JL, Lim S, Beckham SW, Tomko C, Park JN, Sherman SG. Structural vulnerabilities and HIV risk among sexual minority female sex workers (SM-FSW) by identity and behavior in Baltimore, MD. Harm Reduct J 2020; 17:43. [PMID: 32539784 PMCID: PMC7296724 DOI: 10.1186/s12954-020-00383-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/26/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Research suggests sexual minority female sex workers (SM-FSW) face elevated structural vulnerability and HIV risk compared to their heterosexual counterparts. Structural vulnerabilities reflect societal level factors (e.g., sexism, homophobia, racism) that constrain an individual's agency, particularly related to health outcomes. This study examines the association between SM status by identity and behavior, structural vulnerability, and HIV risk among a sample of street-based FSW. METHODS The current study utilizes baseline data from the SAPPHIRE study, a prospective cohort of cis gender and transgender FSW in Baltimore, MD, recruited through targeted time-location sampling from April 2016 to January 2017. The current analysis focuses on cisgender women. The baseline survey ascertained demographics, substance use, intimate partner violence (IPV), and sex work characteristics. Multivariable models were constructed using self-identity and behaviorally defined SM status as independent variables with vulnerability outcomes (e.g., injection drug use, injection speedball, binge drinking, homelessness, physical IPV, ever had a pimp, and being a minor at sex work entry (age < 18)) as dependent variables. RESULTS Of the participants (n = 247), 25.5% (n = 63) self-identified as a SM by identity (e.g., gay or bisexual), and 8.5% (n = 21) reported SM behavior (e.g., same-gender sexual behavior) in the past 3 months. In multivariable logistic regression models, SM status by identity was associated with increased odds of injection drug use, binge drinking, homelessness, physical IPV, and being a minor at sex work entry. SM status by behavior was associated with increased odds of binge drinking, homelessness, ever having a pimp, and being a minor at sex work entry. CONCLUSION The study indicates disproportionate structural vulnerability and heightened HIV risk among SM-FSW, as compared to their heterosexual counterparts, with differences in their profile by sexual identity and behavior. Findings suggest a need for nuanced interventions tailored to these populations.
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Affiliation(s)
- Jennifer L Glick
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Sahnah Lim
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - S Wilson Beckham
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Catherine Tomko
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Ju Nyeong Park
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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18
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McManus KA, Ferey J, Farrell E, Dillingham R. National Survey of US HIV Clinicians: Knowledge and Attitudes About the Affordable Care Act and Opinions of its Impact on Quality of Care and Barriers to Care. Open Forum Infect Dis 2020; 7:ofaa225. [PMID: 32665960 PMCID: PMC7336569 DOI: 10.1093/ofid/ofaa225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background The Affordable Care Act’s (ACA’s) major reforms started in 2014. In addition to assessing HIV clinicians’ ACA knowledge and attitudes, this study aims to evaluate HIV clinicians’ perspectives on whether the ACA has impacted the quality of HIV care and whether it addresses the main barriers to HIV care. Methods HIV clinicians were emailed a survey weblink in 2018. Descriptive statistics, Mann-Whitney U tests, and binary logistic regression were performed. Results Of the 211 survey participants, the majority (70%) answered all 4 knowledge questions correctly. About 80% knew correctly whether their state had expanded Medicaid. Participants from Medicaid expansion states were more likely to report an improved ability to provide high-quality care compared with participants from Medicaid nonexpansion states (50% vs 34%; P = .01). The average response to whether the ACA addresses the main barriers to HIV care was neutral and did not differ based on Medicaid status. The top 3 main barriers to HIV care cited were mental health, substance use, and transportation. Conclusions HIV clinicians in Medicaid expansion states were more likely to report an improved ability to provide high-quality care since ACA implementation compared with those in Medicaid nonexpansion states. However, HIV clinicians across the United States are concerned that the ACA does not address the main barriers to HIV care. To be successful, the “Ending the HIV Epidemic” initiative should address these identified barriers.
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Affiliation(s)
- Kathleen A McManus
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.,Center for Health Policy, University of Virginia, Charlottesville, Virginia, USA
| | - Joshua Ferey
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Elizabeth Farrell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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19
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Philbin MM, Feaster DJ, Gooden L, Duan R, Das M, Jacobs P, Lucas GM, Batey DS, Nijhawan A, Jacobson JM, Mandler R, Daar E, McMahon DK, Armstrong WS, Del Rio C, Metsch LR. The North-South Divide: Substance Use Risk, Care Engagement, and Viral Suppression Among Hospitalized Human Immunodeficiency Virus-Infected Patients in 11 US Cities. Clin Infect Dis 2020; 68:146-149. [PMID: 29920584 DOI: 10.1093/cid/ciy506] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/15/2018] [Indexed: 12/26/2022] Open
Abstract
Regional variability in human immunodeficiency virus (HIV) care engagement remains underexplored. Multiple logistic models compared HIV outcomes for participants from 5 Southern (n = 557) and 6 non-Southern (n = 670) sites. Southern participants were less likely to experience viral suppression (adjusted odds ratio [aOR], 0.52; 95% confidence interval [CI], .37-.72) and had a higher likelihood of a CD4+ count <200 cells/µL (aOR, 1.53; 95% CI, 1.17-2.00). HIV intervention and social safety net programs should be expanded. Clinical Trials Registration NCT01612169.
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Affiliation(s)
- Morgan M Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida
| | - Lauren Gooden
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida
| | - Rui Duan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida
| | | | | | - Gregory M Lucas
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - D Scott Batey
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham
| | - Ank Nijhawan
- Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas
| | - Jeffrey M Jacobson
- Departments of Medicine and Neuroscience, Center for Translational AIDS Research, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | - Eric Daar
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | | | | | - Carlos Del Rio
- Department of Medicine, Emory University School of Medicine.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
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20
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Mumtaz GR, Hilmi N, Majed EZ, Abu-Raddad LJ. Characterising HIV/AIDS knowledge and attitudes in the Middle East and North Africa: Systematic review and data synthesis. Glob Public Health 2019; 15:275-298. [PMID: 31558094 DOI: 10.1080/17441692.2019.1668452] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This article reviews HIV/AIDS knowledge and attitudes in various population groups in the Middle East and North Africa (MENA), and highlights their relevance to HIV epidemiology and the design and implementation of preventions and treatment efforts. PubMed and the MENA HIV/AIDS Epidemiology Synthesis Project database of grey/unpublished literature were searched. Levels of knowledge were categorised based on presence of basic knowledge, comprehensive knowledge, and misconceptions and misinformation. Attitudes towards people living with HIV/AIDS (PLHIV) were classified into positive or negative. Basic knowledge was overall high among key populations at higher risk of infection (KPAR), and bridging and general population groups, but still a few population pockets had low basic knowledge. Level of comprehensive knowledge was overall low, and misinformation and misconceptions were prevalent. Some KPAR, including people who inject drugs, men who have sex with men, and female sex workers, were unaware of some modes of HIV transmission. Perception of risk of infection was low even among KPAR. We found differentials in knowledge putting women, rural populations, refugees, and other marginalised minorities at a disadvantage. Attitudes towards PLHIV tended to be negative. These findings are of concern, particularly for KPAR currently experiencing emerging HIV epidemics.
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Affiliation(s)
- Ghina R Mumtaz
- Department of Epidemiology and population Health, American University of Beirut, Beirut, Lebanon.,Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Nahla Hilmi
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - El Zahraa Majed
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, USA.,College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
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21
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Aggarwal R, Pham M, Dillingham R, McManus KA. Expanded HIV Clinic-Based Mental Health Care Services: Association With Viral Suppression. Open Forum Infect Dis 2019; 6:ofz146. [PMID: 31041347 PMCID: PMC6483129 DOI: 10.1093/ofid/ofz146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/15/2019] [Indexed: 11/13/2022] Open
Abstract
Background An academic Ryan White HIV/AIDS Program clinic increased co-located mental health care (MH) services in 2013. The study objectives were to characterize the changing demographics of the people living with HIV (PLWH) who initiated MH and to determine MH initiation's association with HIV outcomes. Methods The cohort included PLWH who received clinic-based MH services from 2012 to 2014. Cohorts A and B initiated MH before or during 2012 and during 2013-2014, respectively. Demographics were compared for the 2 cohorts, and for Cohort B, pre/post-MH initiation clinical outcomes were compared. Results Compared with Cohort A (n = 130), Cohort B (n = 181) had 3 times the participants with CD4 counts <200 (P = .02). One-third of Cohort B had detectable viral loads compared with <20% of Cohort A (P = .01). Cohort B received more substance use diagnoses (P = .005). Pre/post-MH initiation, engagement in care did not change. For Cohort B, MH initiation was associated with increased rates of viral suppression. For those who were prescribed antiretroviral therapy more than 1 year before MH initiation, participants who were older and nonblack were more likely to achieve viral suppression. Conclusions PLWH who gained access to MH in 2013-2014 were more likely to have lower CD4 counts and detectable viral loads. Engagement in care did not increase with initiation of MH, but initiation of MH was associated with higher rates of viral suppression. Younger and minority patients may not have benefited as much from increased access to co-located MH and substance use services.
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Affiliation(s)
- Raina Aggarwal
- School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Michael Pham
- School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Kathleen A McManus
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia.,Center for Health Policy, University of Virginia, Charlottesville, Virginia
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Cepeda JA, Astemborski J, Kirk GD, Celentano DD, Thomas DL, Mehta SH. Rising role of prescription drugs as a portal to injection drug use and associated mortality in Baltimore, Maryland. PLoS One 2019; 14:e0213357. [PMID: 30830944 PMCID: PMC6398863 DOI: 10.1371/journal.pone.0213357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/20/2019] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Prescription drug abuse is a major public health problem in rural and suburban areas of the United States, however its emergence in large urban settings with endemic injection drug use remains understudied. We examined temporal trends in injection drug use initiation and mortality among people who inject drugs (PWID) in Baltimore, Maryland. METHODS Data were derived from the baseline assessment of PWID enrolled in a community-based cohort study with longitudinal follow-up for mortality assessment. PWID were recruited from 2005-2008 (N = 1,008) and 2015-2018 (N = 737). We compared characteristics by birth cohort (before/after 1980) and type of drug initiated (prescription opioids, prescription non-opioids, non-injection illicit drugs, or injection drugs). We calculated standardized mortality ratios (SMR) using the US general population as the reference. RESULTS PWID born after 1980 were more likely to initiate drug use with prescription opioids and non-opioids and had higher levels of polysubstance prior to injection initiation, compared to individuals born before 1980. Overall mortality was high: 2.59 per 100 person-years (95% CI: 2.27-2.95 per 100 person-years). Compared to the US population, the highest SMRs were observed among participants between 40-44 years of age, with especially high mortality among women in this age group (SMR:29.89, 95% CI: 15.24-44.54). CONCLUSIONS Mirroring national trends, the profile of PWID in Baltimore has changed with increased prescription drug abuse and high levels of polysubstance use among younger PWID. Interventions need to reach those using prescription drugs early after initiation of use in order to reduce transition to injecting. Urgent attention is warranted to address premature mortality, particularly among middle-aged and female PWID.
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Affiliation(s)
- Javier A. Cepeda
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - David D. Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - David L. Thomas
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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23
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Social and structural factors associated with greater time with a plasma HIV-1 RNA viral load above log10(1500) copies/ml among illicit drug users. AIDS 2018; 32:1059-1067. [PMID: 29424782 DOI: 10.1097/qad.0000000000001777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Although previous cross-sectional studies have identified correlates of detectable plasma HIV-1 RNA viral load (VL) among HIV-positive people who use drugs (PWUD), longitudinal factors associated with heightened HIV transmission potential have not been well described. Therefore, we longitudinally examined factors associated with amount of person-time spent above log10(1500) copies/ml plasma among HIV-positive PWUD in Vancouver, Canada. DESIGN Data were derived from a long-running prospective cohort of HIV-positive PWUD linked to comprehensive clinical records including systematic VL monitoring. METHODS We used generalized estimating equations modeling to longitudinally examine factors associated with person-time (in days) with a VL more than log10(1500) copies/ml plasma in the previous 180 days. RESULTS Between December 2005 and May 2014, 845 PWUD were eligible and included in the study. Participants spent an average of 26.8% of observation time with a VL more than log10(1500) copies/ml. In multivariable analyses, homelessness (Adjusted Rate Ratio [ARR] = 1.45) and lack of social support (ARR = 1.27) were positively associated with person-time with a VL more than log10(1500) copies/ml. Older age (ARR = 0.97) and enrolment in addiction treatment (ARR = 0.75) were negatively associated with the outcome in multivariable analyses (all P < 0.05). CONCLUSION Social and structural factors, including periods of homelessness or lacking in social support, were independently associated with greater amount of time with heightened HIV transmission potential. These findings suggest the need for targeted efforts to address modifiable contextual factors that contribute to increased risk of onward HIV transmission among PWUD.
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24
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De Boni RB, Peratikos MB, Shepherd BE, Grinsztejn B, Cortés C, Padgett D, Gotuzzo E, Belaunzarán-Zamudio PF, Rebeiro PF, Duda SN, McGowan CC. Is substance use associated with HIV cascade outcomes in Latin America? PLoS One 2018; 13:e0194228. [PMID: 29543857 PMCID: PMC5854364 DOI: 10.1371/journal.pone.0194228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/09/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The HIV care cascade has improved in Latin America over the last decade. However, the influence of alcohol and noninjected drug use (NIDU) on cascade outcomes is mostly unknown. This study estimated the association of alcohol and NIDU with retention in care, loss to follow up (LTFU), and virologic failure (VF). METHODS Individuals ≥18 years attending routine HIV clinic visits and completing the Rapid Screening Tool (RST; evaluating NIDU and ART adherence in 7-day recall period) during 2012-13 were followed up to 2015 in the Caribbean, Central and South America network for HIV epidemiology. Adjusted odds ratios (aOR) were calculated for the association of alcohol consumption and NIDU with retention in care by logistic regression; adjusted hazard ratios (aHR) were estimated for the associations with LTFU and VF by Cox regression. RESULTS Among 3604 individuals, the proportions retained in care for one year were 84%, 79%, 72%, and 69% for patients reporting non-use, alcohol use, NIDU, and both alcohol and NIDU, respectively. For the same patient groups, the proportions LTFU over 18 months were 6%, 8%, 12%, and 13%, respectively. There were 1901 patients (53%) with HIV RNA results; VF proportions were similar between users and nonusers (ranging from 14-16%). After controlling for age, sex, study site, HIV transmission mode, time on ART, AIDS status, and CD4 count, neither alcohol use (aOR = 1.1, CI = 0.9-1.4; aHR = 1.0, CI = 0.8-1.3) nor NIDU (aOR = 1.3, CI = 0.9-1.8; aHR = 1.4, CI = 0.9-2.1) were significantly associated with retention or VF, respectively. However, both alcohol use (aHR = 1.2, CI = 1.02-1.4) and NIDU (aHR = 1.3, CI = 1.00-1.8) were associated with increased LTFU. CONCLUSION Alcohol use and NIDU in a 7-day recall period increased the risk of being LTFU during the next 18 months, highlighting the need for routine screening and targeted interventions to keep these individuals in care and on ART.
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Affiliation(s)
- Raquel B. De Boni
- Instituto Nacional de Infectologia Evandro Chagas- FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Bryan E. Shepherd
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas- FIOCRUZ, Rio de Janeiro, Brazil
| | - Claudia Cortés
- Fundación Arriaran–Facultad de Medicina Universidad de Chile, Santiago, Chile
| | - Denis Padgett
- Instituto Hondureno de Seguridad Social and Hospital Escuela, Tegucigalpa, Honduras
| | | | - Pablo F. Belaunzarán-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Peter F. Rebeiro
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Stephany N. Duda
- Vanderbilt University Medical Center, Nashville, TN, United States of America
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25
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Campbell ANC, Wolff M, Weaver L, Jarlais DD, Tross S. "It's Never Just About the HIV:" HIV Primary Care Providers' Perception of Substance Use in the Era of "Universal" Antiretroviral Medication Treatment. AIDS Behav 2018; 22:1006-1017. [PMID: 29264736 DOI: 10.1007/s10461-017-2007-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Antiretroviral therapy (ART) is recommended for all people living with HIV (PLWH), regardless of disease status. Substance use disorders (SUD) are common barriers to successful HIV treatment; however, few studies have comprehensively explored how HIV primary care providers take SUDs into account in the context of universal ART implementation. This study uses thematic analysis of qualitative interviews to explore providers' (N = 25) substance use assessment and factors associated with ART initiation. 64% of providers had 15 or more years of HIV treatment experience. Almost all providers agreed with the guidelines for universal ART initiation despite the presence of SUD. Still, identification and management of SUD is challenged by inconsistent assessment, providers' misperceptions about SUD and patients' willingness to discuss it, and lack of accessible treatment resources when SUD is identified. Greater guidance in systematic SUD assessment and management, combined with integrated addiction services, could enhance universal ART implementation among PLWH/SUD.
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Affiliation(s)
- Aimee N C Campbell
- Division on Substance Use Disorders and New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, 1051 Riverside, Drive Box 120, New York, NY, 10032, USA.
| | - Margaret Wolff
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Laurel Weaver
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Don Des Jarlais
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susan Tross
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, USA
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26
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Armenta RF, Collins KM, Strathdee SA, Bulterys MA, Munoz F, Cuevas-Mota J, Chiles P, Garfein RS. Mycobacterium tuberculosis infection among persons who inject drugs in San Diego, California. Int J Tuberc Lung Dis 2018; 21:425-431. [PMID: 28284258 DOI: 10.5588/ijtld.16.0434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persons who inject drugs (PWID) might be at increased risk for Mycobacterium tuberculosis infection and reactivation of latent tuberculous infection (LTBI) due to their injection drug use. OBJECTIVES To determine prevalence and correlates of M. tuberculosis infection among PWID in San Diego, California, USA. METHODS PWID aged 18 years underwent standardized interviews and serologic testing using an interferon-gamma release assay (IGRA) for LTBI and rapid point-of-care assays for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections. Independent correlates of M. tuberculosis infection were identified using multivariable log-binomial regression. RESULTS A total of 500 participants met the eligibility criteria. The mean age was 43.2 years (standard deviation 11.6); most subjects were White (52%) or Hispanic (30.8%), and male (75%). Overall, 86.7% reported having ever traveled to Mexico. Prevalence of M. tuberculosis infection was 23.6%; 0.8% were co-infected with HIV and 81.7% were co-infected with HCV. Almost all participants (95%) had been previously tested for M. tuberculosis; 7.6% had been previously told they were infected. M. tuberculosis infection was independently associated with being Hispanic, having longer injection histories, testing HCV-positive, and correctly reporting that people with 'sleeping' TB cannot infect others. CONCLUSIONS Strategies are needed to increase awareness about and treatment for M. tuberculosis infection among PWID in the US/Mexico border region.
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Affiliation(s)
- R F Armenta
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, San Diego
| | - K M Collins
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego
| | - S A Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego
| | - M A Bulterys
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego
| | - F Munoz
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego
| | - J Cuevas-Mota
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego
| | - P Chiles
- Division of Pulmonology, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - R S Garfein
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego
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27
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Levintow SN, Pence BW, Ha TV, Minh NL, Sripaipan T, Latkin CA, Vu PT, Quan VM, Frangakis C, Go VF. Prevalence and predictors of depressive symptoms among HIV-positive men who inject drugs in Vietnam. PLoS One 2018; 13:e0191548. [PMID: 29364928 PMCID: PMC5783407 DOI: 10.1371/journal.pone.0191548] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 01/05/2018] [Indexed: 02/05/2023] Open
Abstract
Background HIV infection is common among people who inject drugs (PWID), and HIV-positive PWID may be particularly vulnerable to depression. This study measured the prevalence of depressive symptoms and the factors associated with severe symptoms among 455 HIV-positive PWID in Thai Nguyen, Vietnam. Methods We used cross-sectional data from PWID in a randomized controlled trial of an intervention to reduce high-risk injecting and sexual behaviors in Thai Nguyen from 2009–2013. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). We used logistic regression to assess demographic, clinical, and psychosocial predictors of severe depressive symptoms (CES-D≥23) with prevalence odds ratios (POR) and 95% confidence intervals (CI). Results The prevalence of severe depressive symptoms (CES-D≥23) was 44%. 25% of participants had mild to moderate depressive symptoms (16≤CES-D<23), and 31% experienced no depressive symptoms (CES-D<16). Not being married, self-rated poor health, greater frequency of injection drug use, history of overdose, no alcohol use, and daily cigarette smoking were positively associated with severe depressive symptoms in unadjusted models and remained predictive in a multivariable model. The strongest predictors of depressive symptoms were self-reported poor health (POR = 2.94, 95% CI: 1.82, 4.76), no current alcohol use (POR = 2.35, 95% CI: 1.47, 3.77), and not currently married or cohabitating (POR = 2.21, 95% CI = 1.40, 3.47). Conclusion Severe depressive symptoms were common among HIV-positive PWID in Thai Nguyen and were strongly associated with demographic, clinical, and psychosocial factors. Interventions that promote social support from family and reduce drug dependence may particularly benefit PWID experiencing severe depressive symptoms. Greater recognition and treatment of depressive symptoms has the potential to enhance quality of life and improve HIV clinical outcomes for PWID.
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Affiliation(s)
- Sara N. Levintow
- University of North Carolina, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, United States of America
- * E-mail:
| | - Brian W. Pence
- University of North Carolina, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, United States of America
| | - Tran Viet Ha
- University of North Carolina, Gillings School of Global Public Health, Department of Health Behavior, Chapel Hill, NC, United States of America
| | - Nguyen Le Minh
- Thai Nguyen Center for Preventive Medicine, Thai Nguyen, Vietnam
| | - Teerada Sripaipan
- University of North Carolina, Gillings School of Global Public Health, Department of Health Behavior, Chapel Hill, NC, United States of America
| | - Carl A. Latkin
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, United States of America
| | - Pham The Vu
- Thai Nguyen Center for Preventive Medicine, Thai Nguyen, Vietnam
| | - Vu Minh Quan
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States of America
| | - Constantine Frangakis
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD, United States of America
| | - Vivian F. Go
- University of North Carolina, Gillings School of Global Public Health, Department of Health Behavior, Chapel Hill, NC, United States of America
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Tran BX, Nguyen LH, Tran TT, Latkin CA. Social and structural barriers for adherence to methadone maintenance treatment among Vietnamese opioid dependence patients. PLoS One 2018; 13:e0190941. [PMID: 29346444 PMCID: PMC5773191 DOI: 10.1371/journal.pone.0190941] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 12/22/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Methadone maintenance treatment (MMT) services may reduce the risk of HIV transmission if patients completely adhere to the treatment. Identifying adherence patterns and potential related factors is vital for the sustainability of MMT program in Vietnam. This study examined social and structural factors associated with adherence to MMT among patients in different service delivery models. Materials and methods A total of 510 patients at three MMT clinics in Hanoi were interviewed. Measures of self-reported adherence included the number of missed doses in the past 7 days and the level of adherence in the past 30 days using a visual analog scale (VAS) scoring from 0 (non-adherence) to 100 (perfect adherence). Multivariate regressions were employed to identify factors associated with non-adherence to MMT. Results A total of 17.7% of participants reported incomplete MMT adherence in the last 30 days and 8.3% reported missing a dose in the last seven days, respectively. Living with HIV/AIDS, poor self-care and usual activities, and disclosure of health issues to spouses or intimate partners were associated with non-adherence. Those patients with pain or depression were more likely to report better adherence. Disclosing health status to spouse/partner increased the risk of incomplete adherence, while disclosing to friends reduced the number of missed dose in the last seven days. Patients attending clinics with comprehensive services had a lower VAS score of adherence compared to those enrolling in clinics with only MMT and general health care. Conclusions Sustaining the compliance of patients to MMT is principal in the rapid expansion of this service in Vietnam. It is necessary to address the complexity of health care demands of drug users, their difficulties to be rehabilitated into workforce and society, and the stigmatization to maximize the outcomes of MMT program.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail: ,
| | - Long Hoang Nguyen
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Tung Thanh Tran
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Carl A. Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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29
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Green JL, Bucher Bartelson B, Le Lait MC, Roland CL, Masters ET, Mardekian J, Bailey JE, Dart RC. Medical outcomes associated with prescription opioid abuse via oral and non-oral routes of administration. Drug Alcohol Depend 2017; 175:140-145. [PMID: 28414990 DOI: 10.1016/j.drugalcdep.2017.01.039] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 01/13/2017] [Accepted: 01/14/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prescription opioid abuse and misuse is a serious and growing public health issue. While the most common form of abuse is swallowing intact tablets/capsules, some abusers manipulate, or tamper with, these medications by altering the dosage form to allow for non-oral routes of administration (e.g., injection, inhalation) in order to achieve more rapid or enhanced psychoactive effects. Because administration of opioids via non-oral routes results in greater systemic availability and more rapid central nervous system penetration, we hypothesized that death and major medical outcomes occur more frequently with non-oral routes compared to oral route alone. METHODS This retrospective cohort study analyzed data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Poison Center Program to investigate relative risk of prescription opioid abuse via oral and non-oral routes. RESULTS While the oral route was the most commonly reported route of abuse (64.0%), non-oral routes were reported in 14.6% exposures and unknown routes in 21.4% exposures. The relative risk of an exposure resulting in death or major effect was 2.43 (95% CI 1.97, 2.99) if non-oral routes were reported compared to exposures involving oral route only. CONCLUSION Analysis of acute health events recorded by poison centers indicates that death or major effects are twice as likely to occur with intentional abuse of prescription opioids via non-oral routes of administration than ingestion alone. Effective interventions to prevent abuse via non-oral routes of solid dosage forms of prescription opioids, such as abuse-deterrent formulations could have a significant public health impact.
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Affiliation(s)
- Jody L Green
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA.
| | - Becki Bucher Bartelson
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA.
| | - M Claire Le Lait
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA.
| | - Carl L Roland
- Pfizer Inc, 4222 Emperor Blvd., Suite 335, Durham, NC 27703 USA.
| | | | | | - J Elise Bailey
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA.
| | - Richard C Dart
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, 660 Bannock Street, MC 0180, Denver, CO 80204 USA.
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30
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Residential Eviction and Risk of Detectable Plasma HIV-1 RNA Viral Load Among HIV-Positive People Who Use Drugs. AIDS Behav 2017; 21:678-687. [PMID: 26906022 DOI: 10.1007/s10461-016-1315-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We examined the relationship between residential eviction and exhibiting detectable plasma HIV-1 RNA viral load (VL) among a prospective cohort of antiretroviral therapy (ART)-exposed HIV-seropositive people who use illicit drugs (PWUD) in Vancouver, Canada. We used multivariable generalized estimating equations to estimate the effect of residential eviction on detectable VL and examine ART adherence as a mediating variable. Between June 2007 and May 2014, 705 ART-exposed participants were included in the study, among whom 500 (70.9 %) experienced at least one period of detectable VL. In a time-updated multivariable model, eviction independently increased the odds of detectable VL among those who were homeless [adjusted odds ratio (AOR) = 2.25; 95 % confidence interval (CI) 1.18-4.29] as well as not homeless (AOR = 1.76; 95 % CI 1.17-2.63) post eviction. The results of mediation analyses suggest that this association was mediated by incomplete ART adherence. These findings suggest the need for further development and evaluation of interventions to prevent evictions and promote ART adherence among PWUD facing eviction.
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31
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Stitzer M, Calsyn D, Matheson T, Sorensen J, Gooden L, Metsch L. Development of a Multi-Target Contingency Management Intervention for HIV Positive Substance Users. J Subst Abuse Treat 2017; 72:66-71. [PMID: 27624618 PMCID: PMC5154853 DOI: 10.1016/j.jsat.2016.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/24/2016] [Indexed: 12/23/2022]
Abstract
Contingency management (CM) interventions generally target a single behavior such as attendance or drug use. However, disease outcomes are mediated by complex chains of both healthy and interfering behaviors enacted over extended periods of time. This paper describes a novel multi-target contingency management (CM) program developed for use with HIV positive substance users enrolled in a CTN multi-site study (0049 Project HOPE). Participants were randomly assigned to usual care (referral to health care and SUD treatment) or 6-months strength-based patient navigation interventions with (PN+CM) or without (PN only) the CM program. Primary outcome of the trial was viral load suppression at 12-months post-randomization. Up to $1160 could be earned over 6 months under escalating schedules of reinforcement. Earnings were divided among eight CM targets; two PN-related (PN visits; paperwork completion; 26% of possible earnings), four health-related (HIV care visits, lab blood draw visits, medication check, viral load suppression; 47% of possible earnings) and two drug-use abatement (treatment entry; submission of drug negative UAs; 27% of earnings). The paper describes rationale for selection of targets, pay amounts and pay schedules. The CM program was compatible with and fully integrated into the PN intervention. The study design will allow comparison of behavioral and health outcomes for participants receiving PN with and without CM; results will inform future multi-target CM development.
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Affiliation(s)
- Maxine Stitzer
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Baltimore, MD, 21224.
| | - Donald Calsyn
- Department of Psychiatry and Behavioral Science, University of Washington
| | - Timothy Matheson
- San Francisco Department of Public Health, 25 Van Ness Avenue Suite 500, San Francisco, CA, 94102.
| | - James Sorensen
- UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue SFGH Building 20, Rm. 2117, San Francisco, CA, 94110.
| | - Lauren Gooden
- Department of Sociomedical Sciences Mailman School of Public Health, Columbia University Columbia University, 722 West 168th Street, Room 918, New York, NY, 10032.
| | - Lisa Metsch
- Department of Sociomedical Sciences Mailman School of Public Health, Columbia University Columbia University, 722 West 168th Street, Room 918, New York, NY, 10032.
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32
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Gardner LI, Marks G, Strathdee SA, Loughlin AM, Del Rio C, Kerndt P, Mahoney P, Pitasi MA, Metsch LR. Faster entry into HIV care among HIV-infected drug users who had been in drug-use treatment programs. Drug Alcohol Depend 2016; 165:15-21. [PMID: 27296978 DOI: 10.1016/j.drugalcdep.2016.05.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/19/2016] [Accepted: 05/07/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We evaluated whether being in drug use treatment improves linkage to HIV medical care for HIV-infected drug users. We assessed whether an evidence-based intervention for linkage to care ['ARTAS'] works better for HIV-infected drug users who had been in drug use treatment than those who had not. DESIGN Randomized trial. METHODS 295 Participants in the Antiretroviral Treatment Access Study ['ARTAS'] trial were followed for time to first HIV medical care. Drug use (injected and non-injected drugs) in the last 30days and being in drug treatment in the last 12 months were assessed by audio-CASI. We used a proportional hazards model of time to care in drug users with and without drug treatment, adjusting for barriers to care, AIDS symptoms, and demographic factors. We tested whether drug treatment modified the intervention effect by using a drug use/drug treatment*intervention interaction term. RESULTS Ninety-nine participants (30%) reported drug use in the 30days before enrollment. Fifty-three (18%) reported being in a drug treatment program in the last 12 months. Drug users reporting methadone maintenance became engaged in care in less than half the time of drug users without a treatment history [HR 2.97 (1.20, 6.21)]. The ARTAS intervention effect was significantly larger for drug users with a treatment history compared to drug users without a treatment history (AHR 5.40, [95% CI, 2.03-14.38]). CONCLUSIONS Having been in drug treatment programs facilitated earlier entry into care among drug users diagnosed with HIV infection, and improved their response to the ARTAS linkage intervention.
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Affiliation(s)
- Lytt I Gardner
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA.
| | - Gary Marks
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA.
| | | | - Anita M Loughlin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Carlos Del Rio
- Department of Global Health, Rollins School of Public Health, and Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
| | - Peter Kerndt
- Department of Internal Medicine, Division of Infectious Disease, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA.
| | | | - Marc A Pitasi
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA.
| | - Lisa R Metsch
- University of Miami School of Medicine, Miami, FL, USA.
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Small W, Milloy MJ, McNeil R, Maher L, Kerr T. Plasma HIV-1 RNA viral load rebound among people who inject drugs receiving antiretroviral therapy (ART) in a Canadian setting: an ethno-epidemiological study. AIDS Res Ther 2016; 13:26. [PMID: 27462360 PMCID: PMC4960678 DOI: 10.1186/s12981-016-0108-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/10/2016] [Indexed: 12/26/2022] Open
Abstract
Background People who inject drugs (PWID) living with HIV often experience sub-optimal antiretroviral therapy (ART) treatment outcomes, including HIV plasma viral load (PVL) rebound. While previous studies have identified risk factors for PVL rebound among PWID, no study has examined the perspectives of PWID who have experienced PVL rebound episodes. We conducted an ethno-epidemiological study to investigate the circumstances surrounding the emergence of rebound episodes among PWID in Vancouver, BC, Canada. Methods Comprehensive clinical records linked to a community-based prospective observational cohort of HIV-positive drug users were used to identify PWID who had recently experienced viral rebound. In-depth qualitative interviews with 16 male and 11 female participants explored participant perspectives regarding the emergence of viral rebound. A timeline depicting each participant’s HIV viral load and adherence to ART was used to elicit discussion of circumstances surrounding viral rebound. Findings Viral rebound episodes were shaped by interplay between various individual, social, and environmental factors that disrupted routines facilitating adherence. Structural-environmental influences resulting in non-adherence included housing transitions, changes in drug use patterns and intense drug scene involvement, and inadequate care for co-morbid health conditions. Social-environmental influences on ART adherence included poor interactions between care providers and patients producing non-adherence, and understandings of HIV treatment that fostered intentional treatment discontinuation. Conclusions This study describes key pathways which led to rebound episodes among PWID receiving ART and illustrates how environmental forces may increase vulnerability for non-adherence leading to treatment failure. Our findings have potential to help inform interventions and supports that address social-structural forces that foster non-adherence among PWID.
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Metsch LR, Feaster DJ, Gooden L, Matheson T, Stitzer M, Das M, Jain MK, Rodriguez AE, Armstrong WS, Lucas GM, Nijhawan AE, Drainoni ML, Herrera P, Vergara-Rodriguez P, Jacobson JM, Mugavero MJ, Sullivan M, Daar ES, McMahon DK, Ferris DC, Lindblad R, VanVeldhuisen P, Oden N, Castellón PC, Tross S, Haynes LF, Douaihy A, Sorensen JL, Metzger DS, Mandler RN, Colfax GN, del Rio C. Effect of Patient Navigation With or Without Financial Incentives on Viral Suppression Among Hospitalized Patients With HIV Infection and Substance Use: A Randomized Clinical Trial. JAMA 2016; 316:156-70. [PMID: 27404184 PMCID: PMC5339876 DOI: 10.1001/jama.2016.8914] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Substance use is a major driver of the HIV epidemic and is associated with poor HIV care outcomes. Patient navigation (care coordination with case management) and the use of financial incentives for achieving predetermined outcomes are interventions increasingly promoted to engage patients in substance use disorders treatment and HIV care, but there is little evidence for their efficacy in improving HIV-1 viral suppression rates. OBJECTIVE To assess the effect of a structured patient navigation intervention with or without financial incentives to improve HIV-1 viral suppression rates among patients with elevated HIV-1 viral loads and substance use recruited as hospital inpatients. DESIGN, SETTING, AND PARTICIPANTS From July 2012 through January 2014, 801 patients with HIV infection and substance use from 11 hospitals across the United States were randomly assigned to receive patient navigation alone (n = 266), patient navigation plus financial incentives (n = 271), or treatment as usual (n = 264). HIV-1 plasma viral load was measured at baseline and at 6 and 12 months. INTERVENTIONS Patient navigation included up to 11 sessions of care coordination with case management and motivational interviewing techniques over 6 months. Financial incentives (up to $1160) were provided for achieving targeted behaviors aimed at reducing substance use, increasing engagement in HIV care, and improving HIV outcomes. Treatment as usual was the standard practice at each hospital for linking hospitalized patients to outpatient HIV care and substance use disorders treatment. MAIN OUTCOMES AND MEASURES The primary outcome was HIV viral suppression (≤200 copies/mL) relative to viral nonsuppression or death at the 12-month follow-up. RESULTS Of 801 patients randomized, 261 (32.6%) were women (mean [SD] age, 44.6 years [10.0 years]). There were no differences in rates of HIV viral suppression versus nonsuppression or death among the 3 groups at 12 months. Eighty-five of 249 patients (34.1%) in the usual-treatment group experienced treatment success compared with 89 of 249 patients (35.7%) in the navigation-only group for a treatment difference of 1.6% (95% CI, -6.8% to 10.0%; P = .80) and compared with 98 of 254 patients (38.6%) in the navigation-plus-incentives group for a treatment difference of 4.5% (95% CI -4.0% to 12.8%; P = .68). The treatment difference between the navigation-only and the navigation-plus-incentives group was -2.8% (95% CI, -11.3% to 5.6%; P = .68). CONCLUSIONS AND RELEVANCE Among hospitalized patients with HIV infection and substance use, patient navigation with or without financial incentives did not have a beneficial effect on HIV viral suppression relative to nonsuppression or death at 12 months vs treatment as usual. These findings do not support these interventions in this setting. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01612169.
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Affiliation(s)
- Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Lauren Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Tim Matheson
- San Francisco Department of Public Health, San Francisco, California
| | - Maxine Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Moupali Das
- San Francisco Department of Public Health, San Francisco, California5San Francisco General Hospital, San Francisco, California6University of California, San Francisco
| | - Mamta K Jain
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas8Parkland Health and Hospital System, Dallas, Texas
| | - Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | - Wendy S Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Gregory M Lucas
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ank E Nijhawan
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts13Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Patricia Herrera
- Ruth M. Rothstein CORE Center, John H. Stroger, Jr, Hospital of Cook County, Chicago, Illinois
| | | | - Jeffrey M Jacobson
- Division of Infectious Diseases, Drexel University College of Medicine, Philadelphia, Pennsylvania16Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania17Department of Neuroscience, Lewis Katz School of Medi
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham
| | - Meg Sullivan
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Eric S Daar
- Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance
| | | | - David C Ferris
- Mount Sinai St Luke's and Mount Sinai West Hospitals, New York, New York23Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Neal Oden
- The Emmes Corporation, Rockville, Maryland
| | - Pedro C Castellón
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Susan Tross
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, Department of Psychiatry, Columbia University Medical Center, New York, New York26Greater New York Node, National Drug Abuse Treatment Clinical Trials Network, Subst
| | - Louise F Haynes
- Division of Addiction Sciences, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Antoine Douaihy
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - James L Sorensen
- Western States Node, National Drug Abuse Treatment Clinical Trials Network, Department of Psychiatry, University of California, San Francisco
| | - David S Metzger
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia31Treatment Research Institute, Philadelphia, Pennsylvania
| | - Raul N Mandler
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Grant N Colfax
- San Francisco Department of Public Health, San Francisco, California
| | - Carlos del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia33Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Shaw SY, Nowicki DL, Schillberg E, Green CG, Ross CP, Reimer J, Plourde PJ, Elliott LJ. Epidemiology of incident chlamydia and gonorrhoea infections and population attributable fractions associated with living in the inner-core of Winnipeg, Canada. Int J STD AIDS 2016; 28:550-557. [PMID: 26503554 DOI: 10.1177/0956462415614168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Population attributable fractions help to convey public health significance of differential disease risk for chlamydia and gonorrhoea. Geographical residence serves as a useful proxy for complex processes creating ill health. Using population-based data, Poisson regression models were used to examine factors associated with chlamydia and gonorrhoea incidence. Population attributable fractions due to residency in the Winnipeg Health Region's inner-core were determined for chlamydia/gonorrhoea infections among 15-59-year olds (2005-2013), stratified by age group. For both chlamydia and gonorrhoea, it was found that the 15-24-year old age group had the highest incidence rates. There was also a stronger association between residency in the inner-core and incidence for gonorrhoea, compared to chlamydia. Overall, 24% (95% CI: 12-34%) of chlamydia infections were attributable to residency in the inner-core, compared to 46% (95% CI: 35-54%) for gonorrhoea ( p < .05). Within chlamydia/gonorrhoea, no statistically significant differences in population attributable fraction were observed by age group. The conclusion was that a concentration of efforts towards inner-core residents with gonorrhoea infections may result in a relatively larger decrease in incidence.
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Affiliation(s)
- Souradet Y Shaw
- 1 Population Health Surveillance, Population and Public Health Program, Winnipeg Regional Health Authority, Canada.,2 Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Canada
| | - Deborah L Nowicki
- 1 Population Health Surveillance, Population and Public Health Program, Winnipeg Regional Health Authority, Canada.,3 Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Canada
| | - Erin Schillberg
- 1 Population Health Surveillance, Population and Public Health Program, Winnipeg Regional Health Authority, Canada
| | - Christopher G Green
- 1 Population Health Surveillance, Population and Public Health Program, Winnipeg Regional Health Authority, Canada.,2 Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Canada
| | - Craig P Ross
- 1 Population Health Surveillance, Population and Public Health Program, Winnipeg Regional Health Authority, Canada
| | - Joss Reimer
- 1 Population Health Surveillance, Population and Public Health Program, Winnipeg Regional Health Authority, Canada.,2 Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Canada.,4 Department of Family Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Canada
| | - Pierre J Plourde
- 1 Population Health Surveillance, Population and Public Health Program, Winnipeg Regional Health Authority, Canada.,2 Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Canada
| | - Lawrence J Elliott
- 1 Population Health Surveillance, Population and Public Health Program, Winnipeg Regional Health Authority, Canada.,2 Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Canada.,4 Department of Family Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Canada
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36
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Surratt HL, O'Grady CL, Kurtz SP, Buttram ME, Levi-Minzi MA. HIV testing and engagement in care among highly vulnerable female sex workers: implications for treatment as prevention models. J Health Care Poor Underserved 2016; 25:1360-78. [PMID: 25130245 DOI: 10.1353/hpu.2014.0113] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although emerging Treatment as Prevention models can be effective in reducing HIV incidence among high-risk populations, many HIV infected individuals remain undiagnosed or fail to engage in HIV care. METHODS This study examined the factors associated with HIV testing and care among a population of substance using female sex workers. RESULTS Recent HIV testing was associated with higher education level, having a regular health care provider or clinic, recent crack use, and higher sexual risk behaviors; HIV treatment utilization was associated with higher levels of social support, having a regular health care provider or clinic, housing stability and insurance coverage. Qualitative data revealed HIV-related stigma, denial, social isolation, and substance use as barriers to HIV testing and treatment; social support and accessibility of services were key enablers. CONCLUSIONS Improving HIV testing and linkage to treatment among female sex workers will require structural initiatives to reduce stigma and increase service seeking support.
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Kesselring S, Cescon A, Colley G, Osborne C, Zhang W, Raboud JM, Hosein SR, Burchell AN, Cooper C, Klein MB, Loutfy M, Machouf N, Montaner J, Rachlis A, Tsoukas C, Hogg RS, Lima VD. Quality of initial HIV care in Canada: extension of a composite programmatic assessment tool for HIV therapy. HIV Med 2016; 18:151-160. [PMID: 27385643 DOI: 10.1111/hiv.12409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To document the quality of initial HIV care in Canada using the Programmatic Compliance Score (PCS), to explore the association of the PCS with mortality, and to identify factors associated with higher quality of care. METHODS We analysed data from the Canadian Observational Cohort Collaboration (CANOC), a multisite Canadian cohort of HIV-positive adults initiating combination antiretroviral therapy (ART) from 2000 to 2011. PCS indicators of noncompliance with HIV treatment guidelines include: fewer than three CD4 count tests in the first year of ART; fewer than three viral load tests in the first year of ART; no drug resistance testing before initiation; baseline CD4 count < 200 cells/mm3 ; starting a nonrecommended ART regimen; and not achieving viral suppression within 6 months of initiation. Indicators are summed for a score from 0 to 6; higher scores indicate poorer care. Cox regression was used to assess the association between PCS and mortality and ordinal logistic regression was used to explore factors associated with higher quality of care. RESULTS Of the 7460 participants (18% female), the median score was 1.0 (Q1-Q3 1.0-2.0); 21% scored 0 and 8% scored ≥ 4. In multivariable analysis, compared with a score of 0, poorer PCS was associated with mortality for scores > 1 [score = 2: adjusted hazard ratio (AHR) 1.64; 95% confidence interval (CI) 1.13-2.36; score = 3: AHR 2.02; 95% CI 1.38-2.97; score ≥ 4: AHR 2.14; 95% CI 1.43-3.21], after adjustments for age, sex, province, ART start year, hepatitis C virus (HCV) coinfection, and baseline viral load. Women, individuals with HCV coinfection, younger people, and individuals starting ART earlier (2000-2003) had poorer scores. CONCLUSIONS Our findings further validate the PCS as a predictor of all-cause mortality. Disparities identified suggest that further efforts are needed to ensure that care is equitably accessible.
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Affiliation(s)
- S Kesselring
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - A Cescon
- Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - G Colley
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - C Osborne
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - W Zhang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - J M Raboud
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | | | - A N Burchell
- University of Toronto, Toronto, ON, Canada.,Ontario HIV Treatment Network, Toronto, ON, Canada
| | - C Cooper
- University of Ottawa, Ottawa, ON, Canada
| | - M B Klein
- McGill University, Montreal, QC, Canada
| | - M Loutfy
- University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada.,Maple Leaf Medical Clinic, Toronto, ON, Canada
| | - N Machouf
- Clinique médicale l'Actuel, Montreal, QC, Canada
| | - Jsg Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - A Rachlis
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C Tsoukas
- McGill University, Montreal, QC, Canada
| | - R S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Simon Fraser University, Burnaby, BC, Canada
| | - V D Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
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Loh J, Kennedy MC, Wood E, Kerr T, Marshall B, Parashar S, Montaner J, Milloy MJ. Longer duration of homelessness is associated with a lower likelihood of non-detectable plasma HIV-1 RNA viral load among people who use illicit drugs in a Canadian setting. AIDS Care 2016; 28:1448-54. [PMID: 27248328 DOI: 10.1080/09540121.2016.1189498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Homelessness is common among people who use drugs (PWUD) and, for those living with HIV/AIDS, an important contributor to sub-optimal HIV treatment outcomes. This study aims to investigate the relationship between the duration of homelessness and the likelihood of plasma HIV-1 RNA viral load (VL) non-detectability among a cohort of HIV-positive PWUD. We used data from the ACCESS study, a long-running prospective cohort study of HIV-positive PWUD linked to comprehensive HIV clinical records including systematic plasma HIV-1 RNA VL monitoring. We estimated the longitudinal relationship between the duration of homelessness and the likelihood of exhibiting a non-detectable VL (i.e., <500 copies/mL plasma) using generalized linear mixed-effects modelling. Between May 1996 and June 2014, 922 highly active antiretroviral therapy-exposed participants were recruited and contributed 8188 observations. Of these, 4800 (59%) were characterized by non-detectable VL. Participants reported they were homeless in 910 (11%) interviews (median: six months, interquartile range: 6-12 months). A longer duration of homelessness was associated with lower odds of VL non-detectability (adjusted odds ratio = 0.71 per six-month period of homelessness, 95% confidence interval: 0.60-0.83) after adjustment for age, ancestry, drug use patterns, engagement in addiction treatment, and other potential confounders. Longer durations of episodes of homelessness in this cohort of HIV-positive illicit drug users were associated with a lower likelihood of plasma VL non-detectability. Our findings suggest that interventions that seek to promptly house homeless individuals, such as Housing First approaches, might assist in maximizing the clinical and public health benefits of antiretroviral therapy among people living with HIV/AIDS.
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Affiliation(s)
- Jane Loh
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | - Mary Clare Kennedy
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | - Evan Wood
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Thomas Kerr
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Brandon Marshall
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | - Surita Parashar
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | - Julio Montaner
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - M-J Milloy
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
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Cooper HLF, Linton S, Kelley ME, Ross Z, Wolfe ME, Chen YT, Zlotorzynska M, Hunter-Jones J, Friedman SR, Des Jarlais D, Semaan S, Tempalski B, DiNenno E, Broz D, Wejnert C, Paz-Bailey G. Racialized risk environments in a large sample of people who inject drugs in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 27:43-55. [PMID: 26342272 PMCID: PMC4715941 DOI: 10.1016/j.drugpo.2015.07.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 06/27/2015] [Accepted: 07/31/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Substantial racial/ethnic disparities exist in HIV infection among people who inject drugs (PWID) in many countries. To strengthen efforts to understand the causes of disparities in HIV-related outcomes and eliminate them, we expand the "Risk Environment Model" to encompass the construct "racialized risk environments," and investigate whether PWID risk environments in the United States are racialized. Specifically, we investigate whether black and Latino PWID are more likely than white PWID to live in places that create vulnerability to adverse HIV-related outcomes. METHODS As part of the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance, 9170 PWID were sampled from 19 metropolitan statistical areas (MSAs) in 2009. Self-reported data were used to ascertain PWID race/ethnicity. Using Census data and other administrative sources, we characterized features of PWID risk environments at four geographic scales (i.e., ZIP codes, counties, MSAs, and states). Means for each feature of the risk environment were computed for each racial/ethnic group of PWID, and were compared across racial/ethnic groups. RESULTS Almost universally across measures, black PWID were more likely than white PWID to live in environments associated with vulnerability to adverse HIV-related outcomes. Compared to white PWID, black PWID lived in ZIP codes with higher poverty rates and worse spatial access to substance abuse treatment and in counties with higher violent crime rates. Black PWID were less likely to live in states with laws facilitating sterile syringe access (e.g., laws permitting over-the-counter syringe sales). Latino/white differences in risk environments emerged at the MSA level (e.g., Latino PWID lived in MSAs with higher drug-related arrest rates). CONCLUSION PWID risk environments in the US are racialized. Future research should explore the implications of this racialization for racial/ethnic disparities in HIV-related outcomes, using appropriate methods.
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Affiliation(s)
- Hannah L F Cooper
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Sabriya Linton
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Mary E Kelley
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Zev Ross
- ZevRoss SpatialAnalysis, 120 N Aurora St, Suite 3A, Ithaca, NY 14850, USA
| | - Mary E Wolfe
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Yen-Tyng Chen
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Maria Zlotorzynska
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Josalin Hunter-Jones
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Fl, New York, NY 10010, USA
| | - Don Des Jarlais
- The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, 160 Water Street, 24th floor, New York, NY 10038, USA
| | - Salaam Semaan
- Centers for Disease Control and Prevention, Corporate Square Building 8, Atlanta, GA 30333, USA
| | - Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Fl, New York, NY 10010, USA
| | - Elizabeth DiNenno
- Centers for Disease Control and Prevention, Corporate Square Building 8, Atlanta, GA 30333, USA
| | - Dita Broz
- Centers for Disease Control and Prevention, Corporate Square Building 8, Atlanta, GA 30333, USA
| | - Cyprian Wejnert
- Centers for Disease Control and Prevention, Corporate Square Building 8, Atlanta, GA 30333, USA
| | - Gabriela Paz-Bailey
- Centers for Disease Control and Prevention, Corporate Square Building 8, Atlanta, GA 30333, USA
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Di Carlo P, Guadagnino G, Immordino P, Mazzola G, Colletti P, Alongi I, Adamoli L, Vitale F, Casuccio A. Behavioral and clinical characteristics of people receiving medical care for HIV infection in an outpatient facility in Sicily, Italy. Patient Prefer Adherence 2016; 10:919-27. [PMID: 27307712 PMCID: PMC4889094 DOI: 10.2147/ppa.s90456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM The authors examined a cohort of HIV-positive outpatients at the AIDS Center of Palermo University in Italy in order to identify factors related to the frequency of their visits to the outpatient facility for health care services. METHODS Two hundred and twenty-four HIV-infected subjects were enrolled in the study. Demographic and HIV disease characteristics were recorded and assessed with the number of days accessed to our outpatients unit in univariate and multivariate analyses. The potential relationship with immunological status was also analyzed stratifying the patients into groups according to their CD4(+) T-cell counts (≥500 vs <500/mm(3), and ≥200 vs <200/mm(3)). RESULTS Both univariate and multivariate analyses showed that duration of antiretroviral therapy <5 years and hypertension were significantly associated with a CD4(+) T-cell count of <500/mm(3), whereas geographic origin (Africa) was associated with a CD4(+) T-cell count of <200/mm(3). Mean number of days the patients sought access to day-care services for laboratory tests was negatively associated with CD4(+) T-cell count. CONCLUSION Patients with low CD4(+) T-cell counts showed higher use of health care services, demonstrating how early HIV diagnosis can help to reduce health care costs. The CD4(+) T-cell cut-off of 200 cells emphasizes the importance of identifying and managing HIV infection among hard-to-reach groups like vulnerable migrants. In our sample, the illegal status of immigrants does not influence the management of their HIV/AIDS condition, but the lack of European health card that documents the current antiretroviral status, could interfere with the efforts to eradicate AIDS. A better understanding of the major determinants of HIV treatment costs has led to appropriate large-scale actions, which in turn has increased resources and expanded intervention programs. Further guidance should be offered to hard-to-reach groups in order to improve early AIDS diagnosis, and procedures for identifying and managing these vulnerable subjects should be made available to care commissioners and service providers.
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Affiliation(s)
- Paola Di Carlo
- Department of Sciences for Health Promotion and Mother-Child Care “G D’Alessandro”, University of Palermo, Palermo, Italy
| | - Giuliana Guadagnino
- Department of Sciences for Health Promotion and Mother-Child Care “G D’Alessandro”, University of Palermo, Palermo, Italy
| | - Palmira Immordino
- Department of Sciences for Health Promotion and Mother-Child Care “G D’Alessandro”, University of Palermo, Palermo, Italy
| | - Giovanni Mazzola
- Department of Medicinal Clinics and Emerging Diseases, “Paolo Giaccone” Polyclinic University Hospital, Palermo, Italy
| | - Pietro Colletti
- Department of Medicinal Clinics and Emerging Diseases, “Paolo Giaccone” Polyclinic University Hospital, Palermo, Italy
| | - Ilenia Alongi
- Department of Sciences for Health Promotion and Mother-Child Care “G D’Alessandro”, University of Palermo, Palermo, Italy
| | - Lucia Adamoli
- Department of Sciences for Health Promotion and Mother-Child Care “G D’Alessandro”, University of Palermo, Palermo, Italy
| | - Francesco Vitale
- Department of Sciences for Health Promotion and Mother-Child Care “G D’Alessandro”, University of Palermo, Palermo, Italy
| | - Alessandra Casuccio
- Department of Sciences for Health Promotion and Mother-Child Care “G D’Alessandro”, University of Palermo, Palermo, Italy
- Correspondence: Alessandra Casuccio, Department of Sciences for Health Promotion and Mother-Child Care “G D’Alessandro”, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy, Tel +39 91 655 3929, Fax +39 91 655 3905, Email
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Luchenski S, Ti L, Hayashi K, Dong H, Wood E, Kerr T. Protective factors associated with short-term cessation of injection drug use among a Canadian cohort of people who inject drugs. Drug Alcohol Rev 2015; 35:620-7. [PMID: 26661408 DOI: 10.1111/dar.12364] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/16/2015] [Accepted: 10/25/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Strategies are needed to transition persons who inject drugs out of injecting. We undertook this study to identify protective factors associated with cessation of injection drug use. DESIGN AND METHODS Data were derived from three prospective cohorts of people who use illicit drugs in Vancouver, Canada, between September 2005 and November 2011. Generalised estimating equations were used to examine protective factors and 6-month cessation of injection drug use. RESULTS Our sample of 1663 people who inject drugs included 563 (33.9%) women, and median age was 40 years. Overall, 904 (54.4%) individuals had at least one 6-month injection cessation event. In multivariable analysis, protective factors associated with cessation of injection drug use included the following: having a regular place to stay [adjusted odds ratio (AOR) = 1.30; 95% confidence interval (CI) 1.13-1.48]; formal employment (AOR = 1.12; 95% CI 1.01-1.23); social support from personal contacts (AOR = 1.22; 95% CI 1.10-1.35); social support from professionals (AOR = 1.26; 95% CI 1.14-1.39); ability to access health and social services (AOR = 1.21; 95% CI 1.09-1.34); and positive self-rated health (AOR = 1.21, 95% CI 1.11-1.32). DISCUSSION AND CONCLUSIONS Over half of people who inject drugs in this study reported achieving 6-month cessation of injection drug use, with cessation being associated with a range of modifiable protective factors. Policy makers and practitioners should promote increased access to stable housing, employment, social support and other services to promote cessation of injection drug use. [Luchenski S, Ti L, Hayashi K, Dong H, Wood E, Kerr T. Protective factors associated with short-term cessation of injection drug use among a Canadian cohort of people who inject drugs Drug Alcohol Rev 2016;35:620-627].
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Affiliation(s)
- Serena Luchenski
- The Farr Institute of Health Informatics Research, University College London, London, UK.,Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Lianping Ti
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Kanna Hayashi
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Huiru Dong
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Evan Wood
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Thomas Kerr
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.
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Dickson-Gomez J, Bodnar G, Petroll A, Johnson K, Glasman L. HIV Treatment for Alcohol and Non-Injection Drug Users in El Salvador. QUALITATIVE HEALTH RESEARCH 2015; 25:1719-1732. [PMID: 25595149 PMCID: PMC5027900 DOI: 10.1177/1049732314568322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Since the mid-1990 s, many developing countries have introduced and expanded the availability of combination antiretroviral therapy (cART) to persons living with HIV (PLH). However, AIDS-related mortality continues to be high particularly among drug users. In this article, we present results from in-depth interviews with 13 HIV medical providers and 29 crack cocaine and alcohol using PLH in El Salvador. Providers endorsed negative attitudes toward substance using PLH and warned PLH that combining cART with drugs and alcohol would damage their livers and kidneys resulting in death. Upon diagnosis, PLH received little information about HIV treatment and many suffered depression and escalated their drug use. PLH reported suspending cART when they drank or used drugs because of providers' warnings. Substance using PLH were given few strategies and resources to quit using drugs. Messages from medical providers discourage drug users from initiating or adhering to antiretroviral therapy (ART) and may contribute to treatment abandonment.
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Affiliation(s)
| | - Gloria Bodnar
- Fundación Antidrogas de El Salvador, Santa Tecla, El Salvador
| | - Andy Petroll
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kali Johnson
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Laura Glasman
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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43
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Castro JL, Ravasi G. Insights into HIV treatment in Latin America and the Caribbean. Lancet HIV 2015; 2:e458-9. [PMID: 26520923 DOI: 10.1016/s2352-3018(15)00205-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Affiliation(s)
- José Luis Castro
- Pan American Health Organization/World Health Organization, Washington, DC, USA.
| | - Giovanni Ravasi
- Pan American Health Organization/World Health Organization, Washington, DC, USA
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Matsumoto S, Tanuma J, Mizushima D, Nguyen NCT, Pham TTT, Do CD, Nguyen TQ, Nguyen DT, Nguyen HDT, Nguyen LT, Nguyen KV, Oka S. High Treatment Retention Rate in HIV-Infected Patients Receiving Antiretroviral Therapy at Two Large HIV Clinics in Hanoi, Vietnam. PLoS One 2015; 10:e0139594. [PMID: 26422474 PMCID: PMC4589350 DOI: 10.1371/journal.pone.0139594] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/14/2015] [Indexed: 11/29/2022] Open
Abstract
Background Loss to follow-up (LTFU) is viewed as a major challenge in improving retention in HIV treatment. In Vietnam, the reasons for disengagement from clinics and the effect of injection drug use (IDU) on LTFU with unknown outcome (true LTFU) are not well known. Methods Patients receiving antiretroviral therapy (ART) from two HIV clinics in Hanoi were included in this observational study between 2007 and 2012, and followed up every 6 months until the end of 2013. The reasons for disengagement from the clinic, and ART status during imprisonment were investigated in patients with a history of IDU to identify true LTFU. The retention rate at 6–54 months and true LTFU rate were calculated. Cox proportional hazards regression models were performed to identify factors associated with true LTFU. Results There were 1,431 patients, with a follow-up time of 4,371 person-years (median 2.49 years). At the end of the follow-up period, 71 (5.0%) patients died, 79 (5.5%) transferred to other clinics, 16 (1.1%) disengaged from the clinics, and the calculated true LTFU was 45 (3.1%), with 12-month ART retention rate of 95.3% for the entire study population. Imprisonment was the most frequent reason for disengagement from the clinics. True LTFU correlated significantly with low CD4 count and high plasma viral load, but not history of IDU. Conclusion Imprisonment is a major cause of disengagement from HIV care among patients with a history of IDU.
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Affiliation(s)
- Shoko Matsumoto
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
- Graduate School of Public Health, Teikyo University, Tokyo, Japan
- * E-mail:
| | - Junko Tanuma
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Daisuke Mizushima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
- Center for AIDS Research, Kumamoto University, Kumamoto, Japan
| | | | | | - Cuong Duy Do
- Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | - Tuan Quang Nguyen
- Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | | | | | | | | | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
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Abstract
PURPOSE OF REVIEW HIV management in people who use drugs (PWUD) is typically complex and challenging due to the presence of multiple medical and psychiatric comorbidities as well as social, physical, economic and legal factors that often disrupt the HIV continuum of care. In this review, we describe the individual, health systems and societal barriers to HIV treatment access and care retention for PWUD. In addition, the clinical management of HIV-infected PWUD is often complicated by the presence of multiple infectious and noninfectious comorbidities. RECENT FINDINGS Improved HIV treatment outcomes can be enhanced through improved testing and linkage strategies along with better treatment retention and antiretroviral (ART) adherence. Improved ART adherence can be achieved through the provision of opioid substitution therapy (OST), directly administered ART (DAART) and integration of ART with OST services. Recent advances with direct-acting antivirals (DAAs) for hepatitis C virus (HCV) have shown superior outcomes than interferon-based regimes in HIV-HCV coinfected patients. Newer diagnostic technologies for tuberculosis (TB) hold promise for earlier diagnosis for PWUD coinfected with TB, and TB treatment outcomes are improved through combination with OST. SUMMARY HIV-infected PWUDs are a key population who frequently experience suboptimal outcomes along the HIV continuum of care. A comprehensive strategy that encompasses evidence-based prevention and treatment interventions that target the individual, family, healthcare system, legal and societal structure is required to ensure greater participation and success in HIV treatment and care.
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Affiliation(s)
- Adeeba Kamarulzaman
- aCentre of Excellence for Research in AIDS (CERiA), University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia bYale University, School of Medicine, Section of Infectious Diseases cYale University, School of Public Health, Section of Epidemiology of Microbial Diseases, New Haven, Connecticut, USA
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Surratt HL, Kurtz SP, Levi-Minzi MA, Chen M. Environmental Influences on HIV Medication Adherence: The Role of Neighborhood Disorder. Am J Public Health 2015; 105:1660-6. [PMID: 26066966 DOI: 10.2105/ajph.2015.302612] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES We hypothesized that highly disordered neighborhoods would expose residents to environmental pressures, leading to reduced antiretroviral (ARV) medication adherence. METHODS Using targeted sampling, we enrolled 503 socioeconomically disadvantaged HIV-positive substance users in urban South Florida between 2010 and 2012. Participants completed a 1-time standardized interview that took approximately 1 hour. We tested a multiple mediation model to examine the direct and indirect effects of neighborhood disorder on diversion-related nonadherence to ARVs; risky social networks and housing instability were examined as mediators of the disordered neighborhood environment. RESULTS The total indirect effect in the model was statistically significant (P = .001), and the proportion of the total effect mediated was 53%. The model indicated substantial influence of neighborhood disorder on nonadherence to ARVs, operating through recent homelessness and diverter network size. CONCLUSIONS Long-term improvements in diversion-related ARV adherence will require initiatives to reduce demand for illicit ARV medications, as well as measures to reduce patient vulnerability to diversion, including increased resources for accessible housing, intensive treatment, and support services.
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Affiliation(s)
- Hilary L Surratt
- Hilary L. Surratt, Steven P. Kurtz, and Maria A. Levi-Minzi are with the Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, FL. Minxing Chen is with the Department of Biostatistics, MD Anderson Cancer Center, University of Texas, Houston
| | - Steven P Kurtz
- Hilary L. Surratt, Steven P. Kurtz, and Maria A. Levi-Minzi are with the Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, FL. Minxing Chen is with the Department of Biostatistics, MD Anderson Cancer Center, University of Texas, Houston
| | - Maria A Levi-Minzi
- Hilary L. Surratt, Steven P. Kurtz, and Maria A. Levi-Minzi are with the Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, FL. Minxing Chen is with the Department of Biostatistics, MD Anderson Cancer Center, University of Texas, Houston
| | - Minxing Chen
- Hilary L. Surratt, Steven P. Kurtz, and Maria A. Levi-Minzi are with the Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, FL. Minxing Chen is with the Department of Biostatistics, MD Anderson Cancer Center, University of Texas, Houston
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Joseph B, Kerr T, Puskas CM, Montaner J, Wood E, Milloy MJ. Factors linked to transitions in adherence to antiretroviral therapy among HIV-infected illicit drug users in a Canadian setting. AIDS Care 2015; 27:1128-36. [PMID: 25915438 DOI: 10.1080/09540121.2015.1032205] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
HIV-positive people who use illicit drugs typically achieve lower levels of adherence to antiretroviral therapy and experience higher rates of sub-optimal HIV/AIDS treatment outcomes. Given the dearth of longitudinal research into ART adherence dynamics, we sought to identify factors associated with transitioning into and out of optimal adherence to ART in a longitudinal study of HIV-infected people who use illicit drugs (PWUD) in a setting of universal no-cost HIV/AIDS treatment. Using data from a prospective cohort of community-recruited HIV-positive illicit drug users confidentially linked to comprehensive HIV/AIDS treatment records, we estimated longitudinal factors associated with losing or gaining ≥95% adherence in the previous six months using two generalized linear mixed-effects models. Among 703 HIV-infected ART-exposed PWUD, becoming non-adherent was associated with periods of homelessness (adjusted odds ratio [AOR] = 2.52, 95% confidence interval [95% CI]: 1.56-4.07), active injection drug use (AOR = 1.25, 95% CI: 1.01-1.56) and incarceration (AOR = 1.54, 95% CI: 1.10-2.17). Periods of sex work (AOR = 0.51, 95% CI: 0.34-0.75) and injection drug use (AOR = 0.62, 95% CI: 0.50-0.77) were barriers to becoming optimally adherent. Methadone maintenance therapy was associated with becoming optimally adherent (AOR = 1.87, 95% CI: 1.50-2.33) and was protective against becoming non-adherent (AOR = 0.52, 95% CI: 0.41-0.65). In conclusion, we identified several behavioural, social and structural factors that shape adherence patterns among PWUD. Our findings highlight the need to consider these contextual factors in interventions that support the effective delivery of ART to this population.
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Affiliation(s)
- Brenden Joseph
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , BC , Canada
| | - Thomas Kerr
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , BC , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , BC , Canada
| | - Cathy M Puskas
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , BC , Canada.,c Faculty of Health Sciences , Simon Fraser University , Burnaby , Canada
| | - Julio Montaner
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , BC , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , BC , Canada
| | - Evan Wood
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , BC , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , BC , Canada
| | - M-J Milloy
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , BC , Canada.,b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , BC , Canada
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Protopopescu C, Raffi F, Spire B, Hardel L, Michelet C, Cheneau C, Le Moing V, Leport C, Carrieri MP. Twelve-year mortality in HIV-infected patients receiving antiretroviral therapy: the role of social vulnerability. The ANRS CO8 APROCO-COPILOTE cohort. Antivir Ther 2015; 20:763-72. [PMID: 25859625 DOI: 10.3851/imp2960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although the role of clinical/biological factors associated with mortality has already been explored in HIV-infected patients on antiretroviral therapy (ART), to date little attention has been given to the potential role of social vulnerability. This study aimed to construct an appropriate measure of social vulnerability and to evaluate whether this measure is predictive of increased mortality risk in ART-treated patients followed up in the ANRS CO8 APROCO-COPILOTE cohort. METHODS The cohort enrolled 1,281 patients initiating a protease inhibitor-based regimen in 1997-1999. Clinical/laboratory data were collected every 4 months. Self-administered questionnaires collected psycho-social/behavioural characteristics at enrolment (month [M] 0), M4 and every 8-12 months thereafter. A multiple correspondence analysis using education, employment and housing indicators helped construct a composite indicator measuring social vulnerability. The outcome studied was all-cause deaths occurring after M4. The relationship between social vulnerability and mortality, after adjustment for other predictors, was studied using a shared-frailty Cox model, taking into account informative study dropout. RESULTS Over a median (IQR) follow-up of 7.9 (3.0-11.2) years, 121 deaths occurred among 1,057 eligible patients, corresponding to a mortality rate (95% CI) of 1.64 (1.37, 1.96)/100 person-years. Leading causes of death were non-AIDS defining cancers (n=26), AIDS (n=23) and cardiovascular diseases (n=12). Social vulnerability (HR [95% CI] =1.2 [1.0, 1.5]) was associated with increased mortality risk, after adjustment for other known behavioural and bio-medical predictors. CONCLUSIONS Social vulnerability remains a major mortality predictor in ART-treated patients. A real need exists for innovative interventions targeting individuals cumulating several sources of social vulnerability, to ensure that social inequalities do not continue to lead to higher mortality.
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Chu CE, Wu F, He X, Ma Q, Cheng Y, Cai W, Volberding P, Tucker JD. Exploring the social meaning of curing HIV: a qualitative study of people who inject drugs in Guangzhou, China. AIDS Res Hum Retroviruses 2015; 31:78-84. [PMID: 25427547 DOI: 10.1089/aid.2014.0200] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Our objective was to explore the social meaning of HIV and perceptions of an HIV cure among people who inject drugs (PWID) in Guangzhou, China, which speaks to ethical and resource challenges to development in this field. We conducted a qualitative research study using in-depth interviews. We analyzed interview transcripts from 29 PWID, eight physicians, and three social workers from an outpatient HIV clinic and two methadone maintenance treatment centers. The social meaning of HIV infection and perceptions of an HIV cure reflected patients' relationships with society, health systems, and physicians. First, HIV infection decreased perceived social worth and disrupted peer relationships. The possibility of being cured renewed patient hope for regaining physical well-being and achieving social mobility. However, the existence of a cure may not alter the HIV-related stigma due to its association with stigmatized behaviors and marginalized groups. Second, although stigma was a significant barrier to engagement in health care, hope for a cure may outweigh fears of stigma and enhance linkage to HIV testing and treatment as well as methadone services. A cure may exacerbate perceived health disparities if inaccessible to key affected populations such as PWID. The social implications of an HIV cure among this key affected population may inform the design and implementation of cure clinical trials. Careful management of patient expectations, focusing research on key affected populations, expanding HIV testing and treatment systems, improving access to harm reduction programs, and ensuring post-trial access are important considerations for HIV cure research.
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Affiliation(s)
- Carissa E Chu
- 1 Department of Medicine, School of Medicine, University of California San Francisco , San Francisco, California
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Staton-Tindall M, Webster JM, Oser CB, Havens JR, Leukefeld CG. Drug use, hepatitis C, and service availability: perspectives of incarcerated rural women. SOCIAL WORK IN PUBLIC HEALTH 2015; 30:385-96. [PMID: 25950907 PMCID: PMC4425245 DOI: 10.1080/19371918.2015.1021024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This study examined drug use, hepatitis C, and service availability and use among a high-risk sample of rural women serving time in jails. Data was collected from female offenders (N = 22) who participated in four focus groups in three rural jail facilities located in Appalachia. Findings indicated that drug misuse is prevalent in this impoverished area of the country, and that the primary route of administration of drug use is injection. Findings also indicate that injection drug use is also commonly associated with contracting hepatitis C (HCV), which is also perceived to be prevalent in the area. Despite knowledge associated with HCV risks, women in this sample were seemingly apathetic about the increasing spread of HCV in the area and unconcerned about the long-term consequences of the course of the infection. Implications for future research and practice are discussed.
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Affiliation(s)
| | - J. Matthew Webster
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Carrie B. Oser
- Department of Sociology, University of Kentucky, Lexington, KY, USA
| | - Jennifer R. Havens
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Carl G. Leukefeld
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
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