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Glass TR, Günthard HF, Calmy A, Bernasconi E, Scherrer AU, Battegay M, Steffen A, Böni J, Yerly S, Klimkait T, Cavassini M, Furrer H. The Role of Human Immunodeficiency Virus (HIV) Asymptomatic Status When Starting Antiretroviral Therapy on Adherence and Treatment Outcomes and Implications for Test and Treat: The Swiss HIV Cohort Study. Clin Infect Dis 2021; 72:1413-1421. [PMID: 32157270 DOI: 10.1093/cid/ciaa239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since the advent of universal test-and-treat , more people living with human immunodeficiency virus (PLHIV) initiating antiretroviral therapy (ART) are asymptomatic with a preserved immune system. We explored the impact of asymptomatic status on adherence and clinical outcomes. METHODS PLHIV registered in the Swiss HIV Cohort Study (SHCS) between 2003 and 2018 were included. We defined asymptomatic as Centers for Disease Control and Prevention stage A within 30 days of starting ART, non-adherence as any self-reported missed doses and viral failure as two consecutive viral load>50 copies/mL after >24 weeks on ART. Using logistic regression models, we measured variables associated with asymptomatic status and adherence and Cox proportional hazard models to assess association between symptom status and viral failure. RESULTS Of 7131 PLHIV, 76% started ART when asymptomatic and 1478 (22%) experienced viral failure after a median of 1.9 years (interquartile range, 1.1-4.2). In multivariable models, asymptomatic PLHIV were more likely to be younger, men who have sex with men, better educated, have unprotected sex, have a HIV-positive partner, have a lower viral load, and have started ART more recently. Asymptomatic status was not associated with nonadherence (odds ratio, 1.03 [95% confidence interval {CI}, .93-1.15]). Asymptomatic PLHIV were at a decreased risk of viral failure (adjusted hazard ratio, 0.87 [95% CI, .76-1.00]) and less likely to develop resistance (14% vs 27%, P < .001) than symptomatic PLHIV. CONCLUSIONS Despite concerns regarding lack of readiness, our study found no evidence of adherence issues or worse clinical outcomes in asymptomatic PLHIV starting ART.
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Affiliation(s)
- Tracy R Glass
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | | | - Manuel Battegay
- University of Basel, Basel, Switzerland.,Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Ana Steffen
- Division of Infectious Diseases, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Jürg Böni
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Sabine Yerly
- Laboratory of Virology, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Klimkait
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, University Hospital Lausanne, Lausanne, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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2
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Shangase N, Pence B, Lippman SA, Dufour MSK, Kabudula CW, Gómez-Olivé FX, Kahn K, Pettifor A. Built Environment and HIV Linkage to Care in Rural South Africa. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 43:133-141. [PMID: 33818211 PMCID: PMC9684657 DOI: 10.1177/0272684x211006590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background We assessed built environment (residential density, landuse mix and
aesthetics) and HIV linkage to care (LTC) among 1,681 (18–49 years-old)
residents of 15 Mpumalanga villages, South Africa. Methods Multilevel models (linear-binomial) were used for the association between
built environment, measured using NEWS for Africa, and LTC from a clinical
database of 9 facilities (2015–2018). Additionally, we assessed
effect-measure modification by universal test-and-treat policy (UTT). Results We observed, a significant association in the adjusted 3-month probability of
LTC for residential density (risk difference (RD)%: 5.6, 95%CI: 1.2–10.1),
however, no association for land-use mix (RD%: 2.4, 95%CI: −0.4, 5.2) and
aesthetics (RD%: −1.2, 95%CI: −4.5–2.2). Among those diagnosed after UTT,
residents of high land-use villages were more likely to link-to-care than
those of low land-use villages at 12 months (RD%: 4.6, 95%CI: 1.1–8.1,
p < 0.04), however, not at 3 months (RD%: 3.0, 95%CI: −2.1–8.0,
p > 0.10). Conclusion Findings suggest, better built environment conditions (adequate
infrastructure, proximity to services etc.) help facilitate LTC. Moreover,
UTT appears to have a protective effect on LTC.
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Affiliation(s)
- Nosipho Shangase
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Sheri A Lippman
- Department of Medicine, University of California, San Francisco, California, United States.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mi-Suk Kang Dufour
- Department of Medicine, University of California, San Francisco, California, United States
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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3
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Jabłonowska E, Szetela B, Bielecki M, Horban A, Bociąga-Jasik M, Mularska E, Hlebowicz M, Olczak A, Parczewski M, Grzeszczuk A, Bielec D, Cybula A, Kocbach-Przudzik A, Ankiersztejn-Bartczak M, Kowalska JD. Acquired immune deficiency syndrome (AIDS) and late presentation in Poland - data from Test and Keep in Care (TAK) Polska project. HIV Med 2021; 22:387-396. [PMID: 33410278 DOI: 10.1111/hiv.13041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/17/2020] [Accepted: 11/26/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Late presentation (LP) at HIV diagnosis is associated with worse prognosis and an increase in the number of new infections. We analyse the proportion of patients diagnosed late and factors related to LP in Poland in 2016-2017. METHODS Data were obtained from 13 out of 17 HIV centres in Poland from 2016 and 2017, including date of diagnosis, age, sex, transmission route, anti-hepatitis C virus (anti-HCV), Venereal Diseases Research Laboratory (VDRL) antibodies, AIDS diagnosis, baseline HIV viral load and CD4 count. RESULTS Out of 1522 patients, 88.9% were male with median age of 33.6 years. Men who have sex with men (MSM) comprised 69.4% of all new infections, heterosexual route of transmission (HTX) 18.2% and injecting drug use (IDU) 4.7%. Late presenters comprised 44.8% of the study group. Factors associated with LP were female sex [odds ratio (OR) = 1.5, 95% confidence interval (95% CI): 1.09-2.08], older age (OR = 1.59, 95% CI: 1.42-1.79 per decade), route of transmission (HTX: OR = 1.96, 95% CI: 1.50-2.56; IDU: OR = 3.17, 95% CI: 1.92-5.37), positive HCV results (OR = 1.90, 95% CI: 1.23-2.95) and syphilis diagnosis (OR = 2.06, 95% CI: 2.29-3.31). Adjusting for these factors, the only independent factors associated with LP were age (OR = 1.52, 95% CI: 1.35-1.71) and route of transmission (HTX: OR = 1.73, 95% CI: 1.23-2.44; IDU: OR = 2.24, 95% CI: 1.25-4.10). CONCLUSIONS Late presentation in Poland follows European trends. A total of 44.8% of all newly diagnosed patients in Poland continue to present late or at the AIDS stage. Independent factors associated with LP/AIDS were older age, IDU and HTX. Patients from these groups should be targeted to improve early diagnosis and medical care.
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Affiliation(s)
- E Jabłonowska
- Department of Infectious Diseases and Hepatology, Medical University of Lodz, Lodz, Poland
| | - B Szetela
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiencies, Wroclaw Medical University, Wroclaw, Poland
| | - M Bielecki
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warszawa, Poland
| | - A Horban
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - M Bociąga-Jasik
- Department of Infectious Diseases, Jagiellonian University Medical College, Cracow, Poland
| | - E Mularska
- Outpatient Clinic for AIDS Diagnostics and Therapy Specialistic Hospital, Chorzow, Poland
| | - M Hlebowicz
- Department of Infectious Diseases, Gdansk Medical University, Gdansk, Poland
| | - A Olczak
- Faculty of Medicine, Department of Infectious Diseases and Hepatology Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - M Parczewski
- Department of Infectious and Tropical Diseases and Immune Deficiency, Pomeranian Medical University, Szczecin, Poland
| | - A Grzeszczuk
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Bialystok, Poland
| | - D Bielec
- Department of Infectious Diseases, Medical University in Lublin, Lublin, Poland
| | - A Cybula
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
| | - A Kocbach-Przudzik
- Clinical Division of Infectious Diseases, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | | | - J D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
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4
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Neduzhko O, Postnov O, Sereda Y, Kulchynska R, Bingham T, Myers JJ, Flanigan T, Kiriazova T. Modified Antiretroviral Treatment Access Study (MARTAS): A Randomized Controlled Trial of the Efficacy of a Linkage-to-Care Intervention Among HIV-Positive Patients in Ukraine. AIDS Behav 2020; 24:3142-3154. [PMID: 32333208 DOI: 10.1007/s10461-020-02873-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Between October 2015 and March 2018, we conducted the Modified Antiretroviral Treatment Access Study (MARTAS), a nurse-delivered case management intervention to improve linkage-to-care for persons recently tested HIV positive. Adult participants from nine urban clinics in three regions of Ukraine were randomized to either MARTAS or standard of care (SOC) using individual, parallel, two-arm design. The main study outcome was linkage-to-care (defined as registration at an HIV clinic) within a 3-month period from enrollment in the study. Intention-to-treat analysis of MARTAS (n = 135) versus SOC (n = 139) showed intervention efficacy in linkage to HIV care (84.4% vs. 33.8%; adjusted RR 2.45; 95% CI 1.72, 3.47; p < 0.001). MARTAS is recommended for implementation in Ukraine and may be helpful in other countries with similar gaps in linkage-to-care. Clinicaltrials.gov registration number: NCT02338024.
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Affiliation(s)
- Oleksandr Neduzhko
- Ukrainian Institute on Public Health Policy, 5 Mala Zhytomyrska str., Office 61A, Kiev, 01001, Ukraine.
| | - Oleksandr Postnov
- Ukrainian Institute on Public Health Policy, 5 Mala Zhytomyrska str., Office 61A, Kiev, 01001, Ukraine
| | - Yuliia Sereda
- Ukrainian Institute on Public Health Policy, 5 Mala Zhytomyrska str., Office 61A, Kiev, 01001, Ukraine
| | - Roksolana Kulchynska
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kiev, Ukraine
| | - Trista Bingham
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Janet J Myers
- Prevention Research Center, University of California, San Francisco, USA
| | | | - Tetiana Kiriazova
- Ukrainian Institute on Public Health Policy, 5 Mala Zhytomyrska str., Office 61A, Kiev, 01001, Ukraine
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5
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Croxford S, Raben D, Jakobsen SF, Burns F, Copas A, Brown AE, Delpech VC, On Behalf Of OptTEST By Hiv In Europe. Defining linkage to care following human immunodeficiency virus (HIV) diagnosis for public health monitoring in Europe. ACTA ACUST UNITED AC 2019; 23. [PMID: 30514415 PMCID: PMC6280421 DOI: 10.2807/1560-7917.es.2018.23.48.1700858] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Prompt linkage to human immunodeficiency virus (HIV) care after diagnosis is crucial to ensure optimal patient outcomes. However, few countries monitor this important public health marker and different definitions have been applied, making country and study comparisons difficult. This article presents an expert-agreed, standard definition of linkage to care for a pragmatic approach to public health monitoring, appropriate to the European context. Here, linkage to care is defined as patient entry into specialist HIV care after diagnosis, measured as the time between the HIV diagnosis date and one of the following markers: either the first clinic attendance date, first CD4+ cell count or viral load date, or HIV treatment start date, depending on data availability; Linkage is considered prompt if within 3 months of diagnosis. Application of this definition by researchers and public health professionals when reporting surveillance or research data relating to linkage to care after HIV diagnosis will enable reliable comparisons across countries, better assessment of the success of health services programmes aimed at improving peoples access to HIV treatment and care and the identification of barriers limiting access to HIV care across Europe.
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Affiliation(s)
- Sara Croxford
- Institute for Global Health, University College London, Mortimer Market Centre, Capper Street, London, United Kingdom.,National Infection Service, Public Health England, 61 Colindale Avenue, London, United Kingdom
| | - Dorthe Raben
- Center of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark
| | - Stine F Jakobsen
- Center of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark
| | - Fiona Burns
- Royal Free London NHS Foundation Trust, Pond Street, London, United Kingdom.,Institute for Global Health, University College London, Mortimer Market Centre, Capper Street, London, United Kingdom
| | - Andrew Copas
- Institute for Global Health, University College London, Mortimer Market Centre, Capper Street, London, United Kingdom
| | - Alison E Brown
- National Infection Service, Public Health England, 61 Colindale Avenue, London, United Kingdom
| | - Valerie C Delpech
- National Infection Service, Public Health England, 61 Colindale Avenue, London, United Kingdom
| | - On Behalf Of OptTEST By Hiv In Europe
- Royal Free London NHS Foundation Trust, Pond Street, London, United Kingdom.,Center of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark.,Institute for Global Health, University College London, Mortimer Market Centre, Capper Street, London, United Kingdom.,National Infection Service, Public Health England, 61 Colindale Avenue, London, United Kingdom
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6
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Sharp J, Angert CD, Mcconnell T, Wortley P, Pennisi E, Roland L, Mehta CC, Armstrong WS, Shah B, Colasanti JA. Health Information Exchange: A Novel Re-linkage Intervention in an Urban Health System. Open Forum Infect Dis 2019; 6:ofz402. [PMID: 31660364 PMCID: PMC6785665 DOI: 10.1093/ofid/ofz402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/06/2019] [Indexed: 01/17/2023] Open
Abstract
Background Public health information exchanges (HIEs) link real-time surveillance and clinical data and can help to re-engage out-of-care people with HIV (PWH). Methods We conducted a retrospective cohort study of out-of-care PWH who generated an HIE alert in the Grady Health System (GHS) Emergency Department (ED) between January 2017 and February 2018. Alerts were generated for PWH who registered in the GHS ED without Georgia Department of Public Health (GDPH) CD4 or HIV-1 RNA in the prior 14 months. The alert triggered a social work (SW)–led re-linkage effort. Multivariate logistic regression analyses used HIE-informed SW re-linkage efforts as the independent variable, and linkage to care and 3- and 6-month viral suppression (HIV-1 RNA < 200 c/mL) as primary outcomes. Patients admitted to the hospital were excluded from primary analysis. Results One hundred forty-seven out-of-care patients generated an alert. Ninety-eight were included in the primary analysis (mean age [SD], 41 ± 12 years; 70% male; 93% African American), and 20 received the HIE-informed SW intervention. Sixty percent of patients receiving the intervention linked to care in 6 months, compared with 35% who did not. Patients receiving the intervention were more likely to link to care (adjusted risk ratio [aRR], 1.63; 95% confidence interval [CI], 0.99–2.68) and no more likely to achieve viral suppression (aRR, 1.49; 95% CI, 0.50–4.46) than those who did not receive the intervention. Conclusions An HIE-informed, SW-led intervention systematically identified out-of-care PWH and may increase linkage to care for this important population. HIEs create an opportunity to intervene with linkage and retention strategies.
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Affiliation(s)
- Joseph Sharp
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christine D Angert
- Department of Biostatistics and Bioinformatics, Rollins School Public Health, Emory University, Atlanta, Georgia, USA
| | | | | | - Eugene Pennisi
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | | | - C Christina Mehta
- Department of Biostatistics and Bioinformatics, Rollins School Public Health, Emory University, Atlanta, Georgia, USA
| | - Wendy S Armstrong
- Grady Health System, Atlanta, Georgia, USA.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bijal Shah
- Grady Health System, Atlanta, Georgia, USA.,Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan A Colasanti
- Grady Health System, Atlanta, Georgia, USA.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Global Health, Rollins School Public Health, Emory University, Atlanta, Georgia, USA
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7
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Ayieko J, Petersen ML, Charlebois ED, Brown LB, Clark TD, Kwarisiima D, Kamya MR, Cohen CR, Bukusi EA, Havlir DV, Van Rie A. A Patient-Centered Multicomponent Strategy for Accelerated Linkage to Care Following Community-Wide HIV Testing in Rural Uganda and Kenya. J Acquir Immune Defic Syndr 2019; 80:414-422. [PMID: 30807481 PMCID: PMC6410970 DOI: 10.1097/qai.0000000000001939] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/26/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION As countries move toward universal HIV treatment, many individuals fail to link to care after diagnosis of HIV. Efficient and effective linkage strategies are needed. METHODS We implemented a patient-centered, multicomponent linkage strategy in the SEARCH "test-and-treat" trial (NCT 01864603) in Kenya and Uganda. After population-based, community-wide HIV testing, eligible participants were (1) introduced to clinic staff after testing, (2) provided a telephone "hot-line" for enquiries, (3) provided an appointment reminder phone call, (4) given transport reimbursement on linkage, and (5) tracked if linkage appointment was missed. We estimated the proportion linked to care within 1 year and evaluated factors associated with linkage at 7, 30, and 365 days after diagnosis. RESULTS Among 71,308 adults tested, 6811 (9.6%) were HIV-infected; of these, 4760 (69.9%) were already in HIV care, and 30.1% were not. Among 2051 not in care, 58% were female, median age was 32 (interquartile range 26-40) years, and median CD4 count was 493 (interquartile range 331-683) cells/µL. Half (49.7%) linked within 1 week, and 73.4% linked within 1 year. Individuals who were younger [15-34 vs. >35 years, adjusted Risk Ratio (aRR) 0.83, 95% confidence interval (CI): 0.74 to 0.94], tested at home vs. community campaign (aRR = 0.87, 95% CI: 0.81 to 0.94), had a high HIV-risk vs. low-risk occupation (aRR = 0.81, 95% CI: 0.75 to 0.88), and were wealthier (aRR 0.90, 95% CI: 0.83 to 0.97) were less likely to link. Linkage did not differ by marital status, stable residence, level of education, or having a phone contact. CONCLUSIONS Using a multicomponent linkage strategy, high proportions of people living with HIV but not in care linked rapidly after HIV testing.
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Affiliation(s)
- James Ayieko
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Maya L. Petersen
- Department of Biostatistics, School of Public Health, University of California, Berkeley, CA
| | | | | | - Tamara D. Clark
- School of Medicine, University of California, San Francisco, CA
| | - Dalsone Kwarisiima
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Craig R. Cohen
- School of Medicine, University of California, San Francisco, CA
| | - Elizabeth A. Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Diane V. Havlir
- School of Medicine, University of California, San Francisco, CA
| | - Annelies Van Rie
- Faculty of Medicine and Public Health, University of Antwerp, Antwerp, Belgium
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8
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Factors associated with poor linkage to HIV care and related barriers among men who have sex with men. Enferm Infecc Microbiol Clin 2019; 37:521-524. [PMID: 30948138 DOI: 10.1016/j.eimc.2018.12.014] [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: 07/18/2018] [Revised: 12/07/2018] [Accepted: 12/15/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We assessed poor linkage to HIV care in a sample of HIV positive men who have sex with men (MSM) diagnosed in Spain. METHODS From 2012 to 2013 we recruited a sample of MSM mainly through gay-dating websites. Poor linkage to care was defined as receiving the first CD4 count >3 months after HIV diagnosis. We performed a logistic regression analysis to estimate factors associated with poor linkage to care and analyzed the underlying reasons. RESULTS Some 9.4% self-reported poor linkage to care. Those diagnosed in clinical settings other than sexual health clinics or in non-clinical settings presented increased odds of poor linkage to care. The most common reason was being assigned an appointment for first CD4 count >3 months after initial HIV diagnosis. CONCLUSION Poor linkage to care was very low, but for further improvements fast-track referral pathways should be created, especially in contexts outside sexual health clinics.
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