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Zuniga JM, Prachniak C, Policek N, Magula N, Gandhi A, Anderson J, Diallo DD, Lima VD, Ravishankar S, Acharya S, Achrekar A, Adeleke M, Aïna É, Baptiste S, Barrow G, Begovac J, Bukusi E, Castel A, Castellanos E, Cestou J, Chirambo G, Crowley J, Dedes N, Ditiu L, Doherty M, Duncombe C, Durán A, Futterman D, Hader S, Kounkeu C, Lawless F, Lazarus JV, Lex S, Lobos C, Mayer K, Mejia M, Moheno HR, d'Arminio Monforte A, Morán-Arribas M, Nagel D, Ndugwa R, Ngunu C, Poonkasetwattana M, Prins M, Quesada A, Rudnieva O, Ruth S, Saavedra J, Toma L, Wanjiku Njenga L, Williams B. IAPAC-Lancet HIV Commission on the future of urban HIV responses. Lancet HIV 2024:S2352-3018(24)00124-3. [PMID: 39043198 DOI: 10.1016/s2352-3018(24)00124-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 07/25/2024]
Affiliation(s)
- José M Zuniga
- International Association of Providers of AIDS Care, Washington, DC, USA; Fast-Track Cities Institute, Washington, DC, USA.
| | | | | | | | - Anisha Gandhi
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | | | | | | | | | | | | | | | | | - Solange Baptiste
- International Treatment Preparedness Coalition, Johannesburg, South Africa
| | | | | | - Elizabeth Bukusi
- Kenya Medical Research Institute, Nairobi, Kenya; University of Nairobi, Nairobi, Kenya
| | | | | | - Jorge Cestou
- Chicago Department of Public Health, Chicago, IL, USA
| | | | | | | | | | - Meg Doherty
- World Health Organization, Geneva, Switzerland
| | - Chris Duncombe
- International Association of Providers of AIDS Care, Washington, DC, USA
| | - Adriana Durán
- Ministry of Health, City of Buenos Aires, Buenos Aires, Argentina
| | | | | | - Chyrol Kounkeu
- Cameroonian Association for the Development and Empowerment of Vulnerable People, Yaoundé, Cameroon
| | - Fran Lawless
- Mayor's Office of Health Policy, New Orleans, LA, USA
| | - Jeffrey V Lazarus
- University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Policy, New York, NY, USA
| | | | | | - Kenneth Mayer
- Fenway Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | - Carol Ngunu
- Nairobi City County Department of Health, Nairobi, Kenya
| | | | - Maria Prins
- Academic Medical Center, Amsterdam, Netherlands
| | - Amara Quesada
- Action for Health Initiatives, Quezon City, Philippines
| | | | - Simon Ruth
- Thorne Harbour Health, Melbourne, VIC, Australia
| | | | - Lance Toma
- San Francisco Community Health Center, San Francisco, CA, USA
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Hovhannisyan L, Coelho LE, Velasque L, De Boni RB, Clark J, Cardoso SW, Lake J, Veloso VG, Grinsztejn B, Luz PM. Multilevel Analysis of Individual and Neighborhood Characteristics Associated with Viral Suppression Among Adults with HIV in Rio de Janeiro, Brazil. AIDS Behav 2022; 26:947-962. [PMID: 34564777 PMCID: PMC8898026 DOI: 10.1007/s10461-021-03450-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
Understanding the impact of neighborhood context on viral suppression outcomes may help explain health disparities and identify future interventions. We assessed the relationship between individual characteristics, neighborhood socioeconomic context, and viral suppression using multilevel logistic regression models. Adults with HIV initiating antiretroviral therapy (ART) between 2000 and 2017, who resided in Rio de Janeiro and had an HIV-1 RNA level (viral load) measured 90-270 days after ART initiation were included. Overall, 83.9% achieved viral suppression. Participants who were older, had a higher level of education, and identified as heterosexual cisgender men and cisgender men-who-have-sex-with-men had increased odds of viral suppression. Later calendar year of ART initiation carried the strongest association with viral suppression, reflecting the increased effectiveness and tolerability of ART over time. Neighborhood socioeconomic indicators did not predict viral suppression in unadjusted or adjusted analyses, which may result from the integrated care provided in our health care facility together with Brazil's universal treatment.
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Affiliation(s)
- Lyolya Hovhannisyan
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA.
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, USA.
| | - Lara E Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luciane Velasque
- Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Raquel B De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jesse Clark
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jordan Lake
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA
- Department of Medicine, Division of Infectious Diseases, McGovern Medical School at University of Texas Health Science Center at Houston (UTHealth) , Houston, USA
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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3
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Park SE, Pinto RM. Factors that Influence Co-production among Student Interns, Consumers, and Providers of Social and Public Health Services: Implications for Interprofessional Collaboration and Training. SOCIAL WORK IN PUBLIC HEALTH 2022; 37:71-83. [PMID: 34488568 PMCID: PMC8665028 DOI: 10.1080/19371918.2021.1974638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Providers of public health and social services ("providers") develop and deliver services by engaging in interprofessional collaboration (IPC), from seeking external advice to making referrals and linkages to various social and public health services. Providers collaborate with consumers of social and public health services ("consumers") and student interns (e.g., social work, public health) to explore, determine, and deliver relevant services through a process referred to as co-production. Both IPC and co-production are widespread strategies with the potential to improve service accessibility and quality. However, the intersection of co-production and IPC remains understudied. This study examines factors that influence co-production in IPC among service providers, consumers, and student interns. We used cross-sectional survey data from an NIMH-funded study, including 379 providers in 36 HIV-service organizations in New York City. We examined the relationships between providers' perspectives on co-production in IPC and multiple provider- and organization-level variables using random-effects logistic regression. Most respondents said that consumers and students in their agency participate in IPC on the issues that concern them. Providers who perceive greater flexibility in the IPC process were more likely to agree that their organizations' providers co-produced IPC. Organizational service offerings (i.e., multilingual services, a comprehensive range of services), job positions, and full-time employment status were strong predictors of co-production. Our findings indicate that intentional and inclusive models of flexible IPC are needed. Fostering co-production in the HIV service field requires more institutional support and incentives for organizations, providers, and student interns. Implications for research and practice are discussed.
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Gregg E, Linn C, Nace E, Gelberg L, Cowan B, Fulcher JA. Implementation of HIV Preexposure Prophylaxis in a Homeless Primary Care Setting at the Veterans Affairs. J Prim Care Community Health 2021; 11:2150132720908370. [PMID: 32100617 PMCID: PMC7045292 DOI: 10.1177/2150132720908370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective: Oral preexposure prophylaxis (PrEP) is highly effective in preventing HIV-1 acquisition, yet it is underutilized among at-risk populations. In this pilot quality improvement (QI) initiative, we sought to identify barriers to PrEP implementation and create interventions to improve access to PrEP in a primary care clinic for homeless veterans. Methods: The setting was a large homeless primary care clinic at the Veterans Affairs in an urban area with high HIV prevalence. A root cause analysis was performed to identify barriers to PrEP expansion in the primary care clinic. Targeted interventions to improve provider knowledge and patient access to PrEP were implemented by the QI team. Results: Root cause analysis revealed 3 primary barriers to PrEP expansion in the primary care clinic: institutional limitations for prescribing PrEP, inconsistent screening and recognition of eligible patients by clinic staff, and lack of clinic workflow processes to support PrEP prescription. A multidisciplinary focus group found low levels of PrEP awareness and knowledge, with only 22% of providers reporting comfort discussing PrEP with patients. This improved to 40% of providers following targeted clinic educational interventions. The QI team also developed a pathway for primary care providers to obtain institutional PrEP prescribing privileges and used work groups to develop clinic workflows and protocols for PrEP. At the end of the intervention, at least 50% of primary care providers in the clinic had initiated PrEP in a new patient. Conclusions: We describe a multidisciplinary QI model to implement PrEP within a primary care setting serving Veterans and persons experiencing homelessness. Our program successfully addressed provider knowledge deficits and improved primary care capacity to prescribe PrEP. The primary care clinic can be a viable and important clinical setting to improve access to PrEP for HIV prevention, especially for vulnerable populations.
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Affiliation(s)
- Elizabeth Gregg
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Carrie Linn
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Emma Nace
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Lillian Gelberg
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Brianna Cowan
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jennifer A Fulcher
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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5
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Heglar R, Mood R, Priest JL, Schulman KL, Fusco GP. Benchmarking HIV Quality Measures in the US OPERA HIV Cohort. Open Forum Infect Dis 2019; 6:ofz418. [PMID: 31660374 PMCID: PMC6800831 DOI: 10.1093/ofid/ofz418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Quality measures are effective tools to improve patient outreach, retention in care, adherence, and outcomes. This study benchmarks National Quality Forum-endorsed HIV quality measures in a US clinical cohort. Methods This observational study utilized prospectively captured data from the Observational Pharmaco-Epidemiology Research and Analysis (OPERA) database over 2014-2016 to assess quality measure achievement among patients with HIV in terms of medical visit frequency (#2079), medical visit gaps (#2080), viral suppression (#2082), and antiretroviral therapy (ART) prescriptions (#2083). The proportion of patients meeting each measure was calculated. Generalized estimating equations assessed trends in measure achievement. Results The OPERA sample included 23 059-42 285 patients with similar demographics and characteristics across measurement periods. Overall, 62%-66% of patients met the visit frequency measure (#2079), 81%-85% had no gaps between visits (#2080), 71%-73% achieved viral suppression (#2082), and 92%-94% were prescribed ART (#2083). The adjusted odds of achieving viral suppression and being prescribed ART increased over time by 3% and 19%, respectively, despite a significant decline in patient engagement (16% for #2079, 25% for #2080). Patients <30 years of age were significantly less likely to meet all measures than older patients (P < .0001), with particularly low levels of engagement. Measure achievement also varied by gender, ethnicity, region, and select clinical characteristics. Conclusions Despite gains in the rate of ART prescription and viral suppression, there remains room for improvement in the care of patients with HIV. Strategies for quality improvement may be more effective if tailored by age group.
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Affiliation(s)
- Robert Heglar
- Familiy Medicine, AIDS Healthcare Foundation, Fort Lauderdale, Florida, USA
| | - Rodney Mood
- Health Economics and Outcomes Research, Epividian Inc., Durham, North Carolina, USA
| | - Julie L Priest
- US Health Outcomes, ViiV Healthcare, Durham, North Carolina, USA
| | - Kathy L Schulman
- Health Economics and Outcomes Research, Epividian Inc., Durham, North Carolina, USA
| | - Gregory P Fusco
- Health Economics and Outcomes Research, Epividian Inc., Durham, North Carolina, USA
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Wyse J, Robbins JL, McGinnis KA, Edelman EJ, Gordon AJ, Manhapra A, Fiellin DA, Moore BA, Korthuis PT, Gaither JR, Gordon K, Skanderson M, Barry DT, Crystal S, Justice A, Kraemer KL. Predictors of timely opioid agonist treatment initiation among veterans with and without HIV. Drug Alcohol Depend 2019; 198:70-75. [PMID: 30878769 PMCID: PMC6836871 DOI: 10.1016/j.drugalcdep.2019.01.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 01/02/2019] [Accepted: 01/18/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Opioid use disorder (OUD) is prevalent among people with HIV (PWH). Opioid agonist therapy (OAT) is the most effective treatment for OUD and is associated with improved health outcomes, but is often not initiated. To inform clinical practice, we identified factors predictive of OAT initiation among patients with and without HIV. METHODS We identified 19,698 new clinical encounters of OUD between 2000 and 2012 in the Veterans Aging Cohort Study (VACS), a national observational cohort of PWH and matched uninfected controls. Mixed effects models examined factors predictive of OAT initiation within 30-days of a new OUD clinical encounter. RESULTS 4.9% of both PWH and uninfected patients initiated OAT within 30 days of a new OUD clinical encounter. In adjusted models, participants with a psychiatric diagnosis (aOR = 0.54, 95% CI 0.47 - 0.62), PWH (aOR = 0.79, 95% CI 0.68-0.92), and rural residence (aOR = 0.56, 95% CI 0.39-0.78) had a lower likelihood of any OAT initiation, while African-American patients (aOR = 1.60, 95% CI 1.34-1.92), those with an alcohol related diagnosis (aOR = 1.76, 95% CI 1.48-2.08), diagnosis year 2005-2008 relative to 2000-2004 (aOR = 1.24, 95% CI 1.05-1.45), and patients with HCV (aOR = 1.50, 95% CI 1.27-1.77) had a greater likelihood of initiating any OAT within 30 days. Predictive factors were similar in the total sample and PWH only models. CONCLUSIONS PWH were less likely to receive timely OAT initiation than demographically similar uninfected patients. Given the health benefits of such treatment, the low rate of OAT initiation warrants focused efforts in both PWH and uninfected populations.
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Affiliation(s)
- Jessica Wyse
- VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA,School of Public Health, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Jonathan L. Robbins
- Division of General Internal Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | | | - E. Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, New Haven, CT 06520, USA,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
| | - Adam J. Gordon
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, USA,VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148, USA
| | - Ajay Manhapra
- Advanced PACT Pain Clinic, Hampton VA Medical Center, 100 Emancipation Dr, Hampton, VA 23667, USA,Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA
| | - David A. Fiellin
- Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, New Haven, CT 06520, USA,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
| | - Brent A. Moore
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA,Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA
| | - P. Todd Korthuis
- Section of Addiction Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Julie R. Gaither
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA,Department of Pediatrics, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Kirsha Gordon
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA,Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, New Haven, CT 06520, USA
| | - Melissa Skanderson
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA
| | - Declan T. Barry
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA,APT Foundation, Pain Treatment Services, 1 Long Wharf Dr, New Haven, CT 06511, USA
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, 112 Paterson St, New Brunswick, NJ 08901, USA
| | - Amy Justice
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA,Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, New Haven, CT 06520, USA,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
| | - Kevin L. Kraemer
- Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Suite 933W, Pittsburgh, PA 15213, USA,VA Pittsburgh Healthcare System, 4100 Allequippa St, Pittsburgh, PA 15213, USA
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7
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Ulloa AC, Puskas C, Yip B, Zhang W, Stanley C, Stone S, Pedromingo M, Lima VD, Montaner JSG, Guillemi S, Barrios R. Retention in care and mortality trends among patients receiving comprehensive care for HIV infection: a retrospective cohort study. CMAJ Open 2019; 7:E236-E245. [PMID: 30979728 PMCID: PMC6461542 DOI: 10.9778/cmajo.20180136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Studies examining the relation between comprehensive care and health outcomes associated with comorbidities unrelated to HIV infection have focused mainly on the health outcomes of HIV-infected people and comorbid substance use disorders. We aimed to assess the impact of retention in comprehensive HIV infection care on overall, AIDS-related and non-AIDS-related mortality. METHODS Using a retrospective cohort design, we collected data for HIV-infected patients aged 19 years or more who first visited a comprehensive HIV infection clinic in Vancouver between Jan. 1, 2004, and Dec. 31, 2014. We defined retention in care as visit constancy (whether the patient attended the clinic at least once per given period) of 75% or greater. We used Poisson regression modelling to examine mortality trends. We performed Cox proportional hazards modelling to assess survival by retention during the first year of follow-up and identify factors associated with death. RESULTS A total of 2101 patients were included in the study. Of the 2101, 1340 (63.8%) were retained in the first year of care, and 271 (12.9%) died during the study period. Among the 264 cases in which the cause of death was known, although the primary underlying cause of death (74 [28.0%]) was AIDS-related, half of all AIDS-related deaths (37/74 [50%]) occurred early in the study (2004-2007). In later years, most deaths (147/184 [79.9%]) were non-AIDS-related. Overall mortality was significantly reduced among patients with higher retention in care during the first year of follow-up (per 20% increase in visit constancy; adjusted hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.79-0.96). Higher retention was also associated with reduced risk of AIDS-related death (adjusted HR 0.79, 95% CI 0.64-0.97). INTERPRETATION Although there was an overall trend toward decreased AIDS-related mortality over time, retention in care markedly decreased the likelihood of death. Maintaining patient engagement in comprehensive ancillary care is a patient-centred way of decreasing mortality rates among HIV-infected people.
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Affiliation(s)
- Ana C Ulloa
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Cathy Puskas
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Benita Yip
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Wendy Zhang
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Cole Stanley
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Sarah Stone
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Miguel Pedromingo
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Viviane Dias Lima
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Julio S G Montaner
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Silvia Guillemi
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
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Wilton J, Liu J, Sullivan A, Rachlis B, Marchand-Austin A, Giles M, Light L, Rank C, Burchell AN, Gardner S, Sider D, Gilbert M, Kroch AE. Trends in HIV care cascade engagement among diagnosed people living with HIV in Ontario, Canada: A retrospective, population-based cohort study. PLoS One 2019; 14:e0210096. [PMID: 30608962 PMCID: PMC6319701 DOI: 10.1371/journal.pone.0210096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/16/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The HIV cascade is an important framework for assessing systems of care, but population-based assessment is lacking for most jurisdictions worldwide. We measured cascade indicators over time in a population-based cohort of diagnosed people living with HIV (PLWH) in Ontario, Canada. METHODS We created a retrospective cohort of diagnosed PLWH using a centralized laboratory database with HIV diagnostic and viral load (VL) test records linked at the individual-level. Individuals enter the cohort with record of a nominal HIV-positive diagnostic test or VL test, and remain unless administratively lost to follow-up (LTFU, >2 consecutive years with no VL test and no VL test in later years). We calculated the annual percent of diagnosed PLWH (cohort individuals not LTFU) between 2000 and 2015 who were in care (≥1 VL test), on ART (as documented on VL test requisition) or virally suppressed (<200 copies/ml). We also calculated time from diagnosis to linkage to care and viral suppression among individuals newly diagnosed with HIV. Analyses were stratified by sex and age. Upper/lower bounds were calculated using alternative indicator definitions. RESULTS The number of diagnosed PLWH increased from 8,859 (8,859-11,389) in 2000 to 16,110 (16,110-17,423) in 2015. Over this 16-year period, the percent of diagnosed PLWH who were: in care increased from 81% (63-81%) to 87% (81-87%), on ART increased from 55% (34-60%) to 81% (70-82%) and virally suppressed increased from 41% (23-46%) to 80% (67-81%). Between 2000 and 2014, the percent of newly diagnosed individuals who linked to care within three months of diagnosis or achieved viral suppression within six months of diagnosis increased from 67% to 82% and from 22% to 42%, respectively. Estimates were generally lower for females and younger individuals. DISCUSSION HIV cascade indicators among diagnosed PLWH in Ontario improved between 2000 and 2015, but gaps still remain-particularly for younger individuals.
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Affiliation(s)
- James Wilton
- Data and Applied Science Impact, Ontario HIV Treatment Network, Toronto, Canada
| | - Juan Liu
- Public Health Ontario, Toronto, Canada
| | | | - Beth Rachlis
- Data and Applied Science Impact, Ontario HIV Treatment Network, Toronto, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Dignitas International, Toronto, Ontario, Canada
| | | | - Madison Giles
- Data and Applied Science Impact, Ontario HIV Treatment Network, Toronto, Canada
| | - Lucia Light
- Data and Applied Science Impact, Ontario HIV Treatment Network, Toronto, Canada
| | | | - Ann N. Burchell
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sandra Gardner
- Baycrest Health Sciences, Toronto, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Mark Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Abigail E. Kroch
- Data and Applied Science Impact, Ontario HIV Treatment Network, Toronto, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Frost MC, Matson TE, Tsui JI, Williams EC. Influence of comorbid drug use disorder on receipt of evidence-based treatment for alcohol use disorder among VA patients with alcohol use disorder and Hepatitis C and/or HIV. Drug Alcohol Depend 2019; 194:288-295. [PMID: 30469100 PMCID: PMC6312483 DOI: 10.1016/j.drugalcdep.2018.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/08/2018] [Accepted: 10/16/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Alcohol use is risky for patients with hepatitis C virus (HCV) and/or human immunodeficiency virus (HIV) infection, but alcohol use disorder (AUD) treatment is underutilized in these populations. Comorbid drug use disorders (DUD) are common, but their influence on AUD treatment receipt is understudied. We evaluated the association between DUD and AUD treatment receipt in two national samples of patients with AUD, those with HIV and those with HCV, in the U.S. Veterans Health Administration. METHODS Samples included patients with AUD and HCV and/or HIV among positive alcohol screens (AUDIT-C≥5) documented 10/01/09-5/30/13 in the national electronic health record. Poisson regression models estimated incidence rate ratios for receiving specialty treatment (stop codes) and pharmacotherapy (filled prescription for naltrexone, disulfiram, acamprosate, or topiramate) within 365 days of positive alcohol screening for patients with DUD versus those without. Models were clustered on patient and adjusted for potential confounders. RESULTS Among 22,039 patients with HCV/AUD, 45.2% (N = 9,964) had DUD, which was associated with receiving specialty treatment [adjusted incidence rate ratio: 1.89 (95% confidence interval 1.82-1.96)] and pharmacotherapy [aIRR: 1.50 (1.37-1.65)]. Among 1,834 patients with HIV/AUD, 56.9% (N = 1,043) had DUD, which was associated with receiving specialty treatment [aIRR: 1.94 (1.68-2.24)], but not pharmacotherapy. CONCLUSIONS Rates of AUD treatment receipt among patients with AUD and HCV and/or HIV were low overall, but likelihood of treatment receipt was generally higher among those with comorbid DUD. Future research should investigate mechanisms underlying these associations, such as enhanced readiness for treatment or differential provider prescribing or referral practices.
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Affiliation(s)
- Madeline C Frost
- Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, United States.
| | - Theresa E Matson
- Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, United States; Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, United States.
| | - Judith I Tsui
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, United States.
| | - Emily C Williams
- Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, United States; Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA, 98195, United States.
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10
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Dux MC, Lee-Wilk T. Integration of Neuropsychological Services in a VA HIV Primary Care Clinic. Arch Clin Neuropsychol 2018; 33:290-300. [PMID: 29718082 DOI: 10.1093/arclin/acx133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/04/2017] [Indexed: 11/15/2022] Open
Abstract
The Department of Veteran Affairs (VA) is the largest health care provider for individuals with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), with >28,000 Veterans with HIV/AIDS enrolled in care. Advances in medical treatment have improved the life-limiting effects of the disease, though many chronic symptoms persist. Comprehensive care is critical to manage the diverse constellation of symptoms. However, many patients face challenges to receiving optimal care due to limited resources, mistrust of health care providers, and/or co-occurring medical, psychiatric, and substance use disorders. The VA is a leader in developing integrated models of care to address these barriers. The inclusion of subspecialty mental health and substance abuse treatment in HIV care has been implemented across many VAs, with evidence of improved patient outcomes. However, neuropsychology has not traditionally been included, despite the fact that cognitive dysfunction represents one of the most ubiquitous complications of HIV/AIDS. Cognitive impairment is associated with myriad negative outcomes including medication non-adherence, reduced quality of life, and increased mortality. We contend that neuropsychologists are uniquely equipped to contribute to the comprehensive care of patients with HIV/AIDS. Neuropsychologists understand the range of factors that can impact cognition and have the requisite knowledge and skills to assess and treat cognitive dysfunction. Although we focus on HIV/AIDS, neuropsychologists often play critical roles in the provision of care for other infectious diseases (e.g., hepatitis C).
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Affiliation(s)
- Moira C Dux
- VA Maryland Health Care System (VAMHCS), Mental Health, Neuropsychology Section, Baltimore, MD, USA
| | - Terry Lee-Wilk
- VA Maryland Health Care System (VAMHCS), Mental Health, Neuropsychology Section, Baltimore, MD, USA
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11
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Gender and alcohol use: influences on HIV care continuum in a national cohort of patients with HIV. AIDS 2018; 32:2247-2253. [PMID: 30005010 DOI: 10.1097/qad.0000000000001946] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To investigate whether gender is associated with three recommended stages of the HIV care continuum and whether gender modifies known associations between level of alcohol use and HIV care among US veterans. DESIGN Retrospective cohort. METHODS Veterans Aging Cohort Study data were used to identify Veterans Health Administration (VA) patients with HIV and AUDIT-C alcohol screening from 1 February 2008 to 30 September 2014. Modified Poisson regression models estimated the relative risk and predicted prevalences of engagement in HIV care (documented CD4 cells/μl or viral load copies/ml lab values), ART treatment (at least one prescription), and viral suppression (HIV RNA <500 copies/ml) in the year following AUDIT-C (1) for women compared to men, and (2) for each level of alcohol use compared to nondrinking among women and among men. A multiplicative interaction between gender and alcohol use was tested. RESULTS Among 33 224 patients, women (n = 971) were less likely than men (n = 32 253) to receive HIV care (P values <0.001). Respective predicted prevalences for women and men were 71.9% (95% CI 69.1-74.7%) and 77.9% (77.5-78.4%) for engagement, 60.0% (57.0-73.14%) and 73.8% (73.4-74.3%) for ART treatment, and 46.4% (43.3-49.6%) and 55.8% (55.3-56.3%) for viral suppression. Although the interaction between gender and alcohol use was not statistically significant, stratified analyses suggested worse outcomes for women than men at higher levels of alcohol use. CONCLUSION In this large national cohort, women were less likely than men to be engaged in HIV medical care, prescribed ART, and virally suppressed. Interventions to improve HIV care for women are needed at all levels of alcohol use.
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Noska AJ, Belperio PS, Loomis TP, O'Toole TP, Backus LI. Prevalence of Human Immunodeficiency Virus, Hepatitis C Virus, and Hepatitis B Virus Among Homeless and Nonhomeless United States Veterans. Clin Infect Dis 2018; 65:252-258. [PMID: 28379316 DOI: 10.1093/cid/cix295] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/27/2017] [Indexed: 12/11/2022] Open
Abstract
Background Veterans are disproportionately affected by human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Homeless veterans are at particularly high risk for HIV, HCV, and HBV due to a variety of overlapping risk factors, including high rates of mental health disorders and substance use disorders. The prevalence of HIV, HCV, and HBV among homeless veterans nationally is currently unknown. This study describes national testing rates and prevalence of HIV, HCV, and HBV among homeless veterans. Methods Using data from the Department of Veterans Affairs (VA) Corporate Warehouse Data from 2015, we evaluated HIV, HCV, and HBV laboratory testing and infection confirmation rates and diagnoses on the Problem List for nonhomeless veterans and for veterans utilizing homeless services in 2015. Results Among 242740 homeless veterans in VA care in 2015, HIV, HCV, and HBV testing occurred in 63.8% (n = 154812), 78.1% (n = 189508), and 52.8% (n = 128262), respectively. The HIV population prevalence was 1.52% (3684/242740) among homeless veterans, compared with 0.44% (23797/5424685) among nonhomeless veterans. The HCV population prevalence among homeless veterans was 12.1% (29311/242740), compared with 2.7% (148079/5424685) among nonhomeless veterans, while the HBV population prevalence was 0.99% (2395/242740) for homeless veterans and 0.40% (21611/5424685) among nonhomeless veterans. Conclusions To our knowledge this work represents the most comprehensive tested prevalence and population prevalence estimates of HIV, HCV, and HBV among homeless veterans nationally. The data demonstrate high prevalence of HIV, HCV, and HBV among homeless veterans, and reinforce the need for integrated healthcare services along with homeless programming.
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Affiliation(s)
- Amanda J Noska
- Providence VA Medical Center, Division of Infectious Diseases, Providence, Rhode Island
| | - Pamela S Belperio
- Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, California
| | - Timothy P Loomis
- Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, California
| | - Thomas P O'Toole
- National Center on Homelessness Among Veterans, Homeless PACT Program, Veterans Health Administration Homeless Program Office, Providence, Rhode Island
| | - Lisa I Backus
- Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, California
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Abstract
The two largest providers of HIV care in the US are the Veterans Administration and Kaiser Permanente. Both organizations are significantly outperforming the general population in implementing the HIV Care Continuum, which involves 1) testing and diagnosis, 2) linkage to care, 3) retention in care, 4) initiation and continuation of antiretroviral therapy, and 5) achievement of viral suppression. Adherence to the care continuum allows people living with HIV to achieve viral suppression to levels where the virus is undetectable. Such individuals are less likely to transmit the virus than are other infected individuals not receiving medical care. In this interview article, leaders from the two comprehensive integrated health care systems share insight about how their organizations achieve top-quality HIV care outcomes, as well as their ongoing efforts to identify and close gaps in care.
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Affiliation(s)
- Brian Raymond
- Senior Policy Consultant for the Kaiser Permanente Institute for Health Policy in Oakland, CA.
| | - Benjamin Wheatley
- Senior Health Policy Consultant for the Kaiser Permanente Institute for Health Policy in Oakland, CA.
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Danan ER, Krebs EE, Ensrud K, Koeller E, MacDonald R, Velasquez T, Greer N, Wilt TJ. An Evidence Map of the Women Veterans' Health Research Literature (2008-2015). J Gen Intern Med 2017; 32:1359-1376. [PMID: 28913683 PMCID: PMC5698220 DOI: 10.1007/s11606-017-4152-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/08/2017] [Accepted: 07/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Women comprise a growing proportion of Veterans seeking care at Veterans Affairs (VA) healthcare facilities. VA initiatives have accelerated changes in services for female Veterans, yet the corresponding literature has not been systematically reviewed since 2008. In 2015, VA Women's Health Services and the VA Women's Health Research Network requested an updated literature review to facilitate policy and research planning. METHODS The Minneapolis VA Evidence-based Synthesis Program performed a systematic search of research related to female Veterans' health published from 2008 through 2015. We extracted study characteristics including healthcare topic, design, sample size and proportion female, research setting, and funding source. We created an evidence map by organizing and presenting results within and across healthcare topics, and describing patterns, strengths, and gaps. RESULTS We identified 2276 abstracts and assessed each for relevance. We excluded 1092 abstracts and reviewed 1184 full-text articles; 750 were excluded. Of 440 included articles, 208 (47%) were related to mental health, particularly post-traumatic stress disorder (71 articles), military sexual trauma (37 articles), and substance abuse (20 articles). The number of articles addressing VA priority topic areas increased over time, including reproductive health, healthcare organization and delivery, access and utilization, and post-deployment health. Three or fewer articles addressed each of the common chronic diseases: diabetes, hypertension, depression, or anxiety. Nearly 400 articles (90%) used an observational design. Eight articles (2%) described randomized trials. CONCLUSIONS Our evidence map summarizes patterns, progress, and growth in the female Veterans' health and healthcare literature. Observational studies in mental health make up the majority of research. A focus on primary care delivery over clinical topics in primary care and a lack of sex-specific results for studies that include men and women have contributed to research gaps in addressing common chronic diseases. Interventional research using randomized trials is needed.
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Affiliation(s)
- Elisheva R Danan
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA. .,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Erin E Krebs
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kristine Ensrud
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eva Koeller
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Roderick MacDonald
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Tina Velasquez
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Nancy Greer
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Timothy J Wilt
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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15
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Wessinger MH, Hennink MM, Kaiser BN, Mangal JP, Gokhale RH, Ruchin L, Moanna A, Rimland D, Farber EW, Marconi VC. Retention in HIV care depends on patients' perceptions of the clinic experience. AIDS Care 2017; 29:1212-1217. [PMID: 28366008 PMCID: PMC7375480 DOI: 10.1080/09540121.2017.1308465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Institutional barriers in HIV primary care settings can contribute substantially to disparities in retention in HIV treatment and HIV-related outcomes. This qualitative study compared the perceptions of clinic experiences of persons living with HIV (PLWH) in a Veterans Affairs HIV primary care clinic setting who were retained in care with the experiences of those who were not retained in care. Qualitative data from 25 in-depth interviews were analyzed to identify facilitators and barriers to retention in HIV care. Results showed that participants not retained in care experienced barriers to retention involving dissatisfaction with clinic wait times, low confidence in clinicians, and customer service concerns. For participants retained in care, patience with procedural issues, confidence in clinicians, and interpersonal connections were factors that enhanced retention despite the fact that these participants recognized the same barriers as those who were not retained in care. These findings can inform interventions aimed at improving retention in HIV care.
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Affiliation(s)
- Matthew H. Wessinger
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA
| | - Monique M. Hennink
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA
| | | | - Jed P. Mangal
- Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD
- Department of Psychiatry, Walter Reed National Military Medical Center, Bethesda, MD
| | - Runa H. Gokhale
- Hospital Medicine Section, Atlanta VA Medical Center, Atlanta, GA
| | - Lauren Ruchin
- Infectious Disease Clinic, Atlanta VA Medical Center, Atlanta, GA
| | - Abeer Moanna
- Department of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
- Infectious Disease Clinic, Atlanta VA Medical Center, Atlanta, GA
| | - David Rimland
- Department of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
- Infectious Disease Clinic, Atlanta VA Medical Center, Atlanta, GA
| | - Eugene W. Farber
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA
| | - Vincent C. Marconi
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA
- Department of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
- Infectious Disease Clinic, Atlanta VA Medical Center, Atlanta, GA
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Xia Q, Shah D, Gill B, Torian LV, Braunstein SL. Continuum of Care Among People Living with Perinatally Acquired HIV Infection in New York City, 2014. Public Health Rep 2017; 131:566-73. [PMID: 27453601 DOI: 10.1177/0033354916662215] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The HIV care continuum outlines the steps from HIV infection to diagnosis, linkage to care, and viral suppression among people living with HIV. We examined data for steps along the HIV care continuum among people living with perinatally acquired infection in New York City using surveillance data. METHODS This study included data for people who acquired HIV infection perinatally and lived in New York City as of December 31, 2014. We defined "in care" as having ≥1 CD4 or viral load test in 2014, "in continuous care" as having ≥2 CD4 or viral load tests ≥3 months apart in 2014, and "virally suppressed" as having a viral load of #200 copies per milliliter in the most recent test in 2014. We estimated factors associated with viral suppression from a weighted log-binomial regression model that included sex, race/ethnicity, age, and country of birth as independent variables. RESULTS As of December 31, 2014, an estimated 1,596 people were living with perinatally acquired HIV infection in New York City. All were diagnosed, 96% were in care, 80% were in continuous care, and 61% were virally suppressed. The multivariable analysis showed significant differences in viral suppression by race/ethnicity and age. Black patients (59%, 534/907) were the least likely of all racial/ethnic groups examined to have a suppressed viral load. By age, compared with 73% (80/109) of children aged 0-12 years who were virally suppressed, 58% (568/987) of adults aged 20-29 years and 56% (54/96) of adults aged 30-39 years were virally suppressed; the adjusted prevalence ratio was 0.80 (95% confidence interval [CI] 0.69, 0.92) for those aged 20-29 years and 0.79 (95% CI 0.63, 0.99) for those aged 30-39 years. CONCLUSION The low level of viral suppression among people living with perinatally acquired infection found in this study warrants further exploration to identify the best management strategies to improve viral suppression in this population, especially those transitioning from pediatric to adult health care.
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Affiliation(s)
- Qiang Xia
- New York City Department of Health and Mental Hygiene, Bureau of HIV Prevention and Control, HIV Epidemiology and Field Services Program, Queens, NY
| | - Dipal Shah
- New York City Department of Health and Mental Hygiene, Bureau of HIV Prevention and Control, HIV Epidemiology and Field Services Program, Queens, NY
| | - Balwant Gill
- New York City Department of Health and Mental Hygiene, Bureau of HIV Prevention and Control, HIV Epidemiology and Field Services Program, Queens, NY
| | - Lucia V Torian
- New York City Department of Health and Mental Hygiene, Bureau of HIV Prevention and Control, HIV Epidemiology and Field Services Program, Queens, NY
| | - Sarah L Braunstein
- New York City Department of Health and Mental Hygiene, Bureau of HIV Prevention and Control, HIV Epidemiology and Field Services Program, Queens, NY
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Bagwell A, McFarland MS, Hulgan T. An Innovative Approach to Addressing the HIV Care Continuum: Implementation of a Clinical Pharmacy Resident in a Veterans Affairs HIV Specialty Clinic. J Pharm Pract 2017. [PMID: 28639465 DOI: 10.1177/0897190017715580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Engagement of patients in the HIV care continuum and adherence to antiretroviral therapy (ART) continue to limit successful viral suppression. Innovative practices to improve this continuum and ameliorate potential physician shortages are needed. The objective of this evaluation was to determine the clinical benefits of incorporating pharmacy resident involvement on a multidisciplinary team in caring for patients with HIV. METHODS A single-center pre-post cohort pilot evaluation was conducted at the Tennessee Valley Healthcare Systems VA Medical Center. Patients were enrolled in an HIV pharmacotherapy clinic implemented by an ambulatory care pharmacy resident. The primary end point of the evaluation was the percentage of patients achieving an undetectable plasma HIV viral load after enrollment. Secondary end points included change from baseline in CD4 T-cell count and self-reported adherence. RESULTS A total of 55 patients were seen in the HIV pharmacotherapy clinic over a 28-week evaluation period. Of those patients with detectable viral load at enrollment, 70% reached viral suppression during follow-up, with a significant 0.75 log10 decrease in the median viral load ( P < .0001 for both). The median CD4 T-cell count increased from 464 to 525 cells/mm3 ( P = .01). Reported adherence, assessed using the Visual Analogue adherence Scale (VAS) increased significantly ( P = .0001). CONCLUSION After enrollment in an HIV pharmacotherapy clinic, a significant decrease in viral load was seen, as were improvements in secondary end points of CD4 T cells and adherence. These data demonstrate the clinical benefits of pharmacy resident involvement on a multidisciplinary team in caring for patients with HIV.
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Affiliation(s)
- Autumn Bagwell
- 1 Vanderbilt University Medical Center-Nashville, Nashville, TN, USA
| | | | - Todd Hulgan
- 1 Vanderbilt University Medical Center-Nashville, Nashville, TN, USA.,3 Tennessee Valley Healthcare System, Nashville, TN, USA
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Beer L, Bradley H, Mattson CL, Johnson CH, Hoots B, Shouse RL. Trends in Racial and Ethnic Disparities in Antiretroviral Therapy Prescription and Viral Suppression in the United States, 2009-2013. J Acquir Immune Defic Syndr 2016; 73:446-453. [PMID: 27391389 PMCID: PMC5085853 DOI: 10.1097/qai.0000000000001125] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To examine trends in racial/ethnic disparities in antiretroviral therapy (ART) prescription and viral suppression among HIV-infected persons in care, overall and among men who have sex with men (MSM), from 2009 to 2013. DESIGN The Medical Monitoring Project (MMP) is a complex sample survey of HIV-infected adults receiving medical care in the United States. METHODS We used weighted interview and medical record data collected June 2009-May 2014 to estimate the prevalence of ART prescription and viral suppression among racial/ethnic groups overall and among MSM. RESULTS We found significant increases in ART prescription and viral suppression among all racial/ethnic groups from 2009 to 2013, both overall and among MSM. By 2013, overall and among MSM, the Hispanic-white disparity in ART prescription was nonexistent, and the black-white disparity was not significant after accounting for differences between blacks and whites in age and length of HIV diagnosis. Despite reductions in racial/ethnic disparities in viral suppression over the time period, significant disparities remained among the total population, even after adjusting for differences in racial/ethnic group characteristics. Encouragingly, however, there was no significant Hispanic-white disparity in viral suppression among MSM by 2013. CONCLUSIONS Despite significant improvements in ART prescription and viral suppression in recent years, racial and ethnic disparities persist, particularly for black persons. If the United States is to achieve the National HIV/AIDS Strategy goal of reducing HIV-related health disparities, continued efforts to accelerate the rate of improvement in ART prescription and viral suppression among Hispanic and black persons may need to be prioritized.
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Affiliation(s)
- Linda Beer
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heather Bradley
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine L. Mattson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christopher H. Johnson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brooke Hoots
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - R. Luke Shouse
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Veteran's Administration Care Continuum Uses the Wrong Denominator. J Acquir Immune Defic Syndr 2016; 71:e84. [PMID: 26536322 PMCID: PMC4770373 DOI: 10.1097/qai.0000000000000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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