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Nyman F, Jellesma FC. Prevention of HIV in the MSM Population: A Cultural-Historical Comparison of Sweden and the Netherlands. JOURNAL OF HOMOSEXUALITY 2024; 71:28-55. [PMID: 35895000 DOI: 10.1080/00918369.2022.2103870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of this article is to compare the cultural-historical events and decisions regarding how to deal with the higher risks of HIV in MSM, and more specifically, gay populations in Sweden and the Netherlands. A narrative literature was used, based on 46 scientific articles and 20 additional semi-scientific resources. The themes of the arrival of HIV and AIDS, blood donations, offender/victim, the balance of risks with respect to the statistical probabilities and the human factor, and finally, prevention were discussed. It is concluded that certain context-specific historical events (the Dutch Bloody Sunday and the Swedish gay sauna ban) and culturally determined processes (trust in others in the Netherlands, and disapproval of casual sex in Sweden) have led to some important differences in how HIV and AIDS and the higher risks for gay men and MSM have been dealt with. In the Netherlands, there is a stronger protective attitude when it comes to the freedom and autonomy of MSM both when it comes to decisions about sexual behavior and to sharing any positive HIV status. In Sweden, on the other hand, there is a stronger tendency to enforce informing others of their HIV status. In both countries, despite efforts to prevent this, HIV has increased stigma for gay men and other MSM.
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Affiliation(s)
- Fredrik Nyman
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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2
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Bedert M, Davidovich U, de Bree G, van Bilsen W, van Sighem A, Zuilhof W, Brinkman K, van der Valk M, de Wit J. Understanding Reasons for HIV Late Diagnosis: A Qualitative Study Among HIV-Positive Individuals in Amsterdam, The Netherlands. AIDS Behav 2021; 25:2898-2906. [PMID: 33788120 PMCID: PMC8373722 DOI: 10.1007/s10461-021-03239-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 12/18/2022]
Abstract
Since the introduction of effective anti-retroviral therapy, early diagnosis and treatment of HIV have become increasingly important from individual and public health perspectives. People who are diagnosed with a CD4 count below 350 cells/µL blood are today considered to be “late” diagnoses. In an effort to understand the reasons for late diagnosis, we conducted in-depth interviews (n = 14) in Amsterdam, the Netherlands. Two main factors were identified: psychosocial factors and health-system factors. Psychosocial factors relate to people’s personal relationship with health professionals, low risk perception, fear related to the outcome of testing, and trauma from observed past experiences of living with HIV. Health-system factors relate to institutional barriers and missed opportunities during client-provider interactions. We conclude that in order to mitigate late diagnosis, the social and institutional context within which HIV testing is conducted should be addressed.
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Affiliation(s)
- Maarten Bedert
- Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Wim Zuilhof
- SOA AIDS Nederland, Amsterdam, The Netherlands
| | - Kees Brinkman
- Onze Lieve Vrouwenziekenhuis, Amsterdam, The Netherlands
| | - Marc van der Valk
- Amsterdam UMC, Location AMC & DC Klinieken Valeriusplein, Amsterdam, The Netherlands
| | - John de Wit
- Utrecht University, Utrecht, The Netherlands
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3
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Bil JP, Schrooders PA, Prins M, Kouw PM, Klomp JH, Scholing M, Huijbregts LP, Sonder GJ, Waegemaekers TC, de Vries HJ, Meijer W, Zuure FR, Tostmann A. Integrating hepatitis B, hepatitis C and HIV screening into tuberculosis entry screening for migrants in the Netherlands, 2013 to 2015. ACTA ACUST UNITED AC 2019; 23. [PMID: 29560855 PMCID: PMC5861593 DOI: 10.2807/1560-7917.es.2018.23.11.17-00491] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We evaluated uptake and diagnostic outcomes of voluntary hepatitis B (HBV) and C virus (HCV) screening offered during routine tuberculosis entry screening to migrants in Gelderland and Amsterdam, the Netherlands, between 2013 and 2015. In Amsterdam, HIV screening was also offered. Overall, 54% (461/859) accepted screening. Prevalence of chronic HBV infection (HBsAg-positive) and HCV exposure (anti-HCV-positive) in Gelderland was 4.48% (9/201; 95% confidence interval (CI): 2.37–8.29) and 0.99% (2/203; 95% CI: 0.27–3.52), respectively, all infections were newly diagnosed. Prevalence of chronic HBV infection, HCV exposure and chronic HCV infection (HCV RNA-positive) in Amsterdam was 0.39% (1/256; 95% CI: 0.07–2.18), 1.17% (3/256; 95% CI: 0.40–3.39) and 0.39% (1/256; 95% CI: 0.07–2.18), respectively, with all chronic HBV/HCV infections previously diagnosed. No HIV infections were found. In univariate analyses, newly diagnosed chronic HBV infection was more likely in participants migrating for reasons other than work or study (4.35% vs 0.83%; odds ratio (OR) = 5.45; 95% CI: 1.12–26.60) and was less likely in participants in Amsterdam than Gelderland (0.00% vs 4.48%; OR = 0.04; 95% CI: 0.00–0.69). Regional differences in HBV prevalence might be explained by differences in the populations entering compulsory tuberculosis screening. Prescreening selection of migrants based on risk factors merits further exploration.
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Affiliation(s)
- Janneke P Bil
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Peter Ag Schrooders
- Department of Infectious Diseases, Public Health Service of Noord- en Oost-Gelderland, Warnsveld, the Netherlands
| | - Maria Prins
- Department of Internal Medicine, Amsterdam Infection and Immunity Institute (AI&II), Academic Medical Center (University of Amsterdam), Amsterdam, The Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Peter M Kouw
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Judith He Klomp
- Department of Infectious Diseases, Public Health Service of Gelderland Zuid, Nijmegen, the Netherlands
| | - Maarten Scholing
- Department of Medical Microbiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Lutje Phm Huijbregts
- Department of Infectious Diseases, Public Health Service of Noord- en Oost-Gelderland, Warnsveld, the Netherlands
| | - Gerard Jb Sonder
- Department of Internal Medicine, Amsterdam Infection and Immunity Institute (AI&II), Academic Medical Center (University of Amsterdam), Amsterdam, The Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Toos Chfm Waegemaekers
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Henry Jc de Vries
- Department of Internal Medicine, Amsterdam Infection and Immunity Institute (AI&II), Academic Medical Center (University of Amsterdam), Amsterdam, The Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Wieneke Meijer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Freke R Zuure
- These authors share joint last authorship.,Department of Internal Medicine, Amsterdam Infection and Immunity Institute (AI&II), Academic Medical Center (University of Amsterdam), Amsterdam, The Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Alma Tostmann
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.,These authors share joint last authorship
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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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Kayabu DE, Ngocho JS, Mmbaga BT. Effective linkage from point of HIV testing to care and treatment in Tanga region, Tanzania. PLoS One 2018; 13:e0201644. [PMID: 30114244 PMCID: PMC6095519 DOI: 10.1371/journal.pone.0201644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 07/19/2018] [Indexed: 12/03/2022] Open
Abstract
Background Linkage to care and treatment is an important part of efforts to accelerate HIV prevention, treatment, care, and support. It offers an opportunity for PLHIV to receive information and services in a timely manner. Clients who present late for HIV care and treatment may miss out on timely initiation of prophylaxis and ART, which may accelerate disease progression and lead to an increased rate of HIV transmission within the community. The objective of this study was to determine the factors influencing effective linkages of newly diagnosed PLHIV from the point of testing to entry in care and treatment centres (CTCs) in Tanga Region, Tanzania. Methods This cross-sectional study examined five clinics with a high volume of clients in each of the three districts in Tanga Region. All adults ages 18 years and above at the time of CTC enrolment, between 2010 and 2014, were eligible to participate in the study. The study engaged both secondary and primary data. To complement the secondary data, mixed methods were applied in primary data collection. Using a structured questionnaire, interviews with the sampled CTC clients while focus group discussions with healthcare providers and in-depth interviews with CTC clients. The qualitative data were analysed using a thematic analysis framework. The outcome of interest was whether a client enrolled in a CTC within three months of his or her first positive HIV test. A logistic regression model was used to determine factors associated with effective linkage of newly diagnosed HIV clients to CTC. Results A total of 16,041 adults from the three study districts were enrolled at a CTC from 2010 to 2014. A total of 1,096 clients from the sampled CTCs were recruited into the study for interview. The characteristics of these clients were representative of the larger group (16,041). The majority (72.4%) were female. More than half (52.1%) were married, and almost a quarter (21.2%) were single. The majority (59.6%) of participants completed primary education and almost half (45.1%) were subsistence farmers. The median CD4 count at enrolment was 218 (87–397) cells/mL with more than half (56.3%) having CD4 counts of less than 350 cells per millilitre (mL). Nearly all (91%) of the clients presented at a CTC within three months of receiving a positive HIV test. In a multivariate analysis, factors that remained significantly associated with early entry in CTC were level of education, CD4 count, and point of diagnosis. Participants’ responses were consistent with many of the factors explained by participants to be barriers to effective linkages and referrals repeated in the FGDs and IDIs across the study sites. For instance, FGD respondent expressed that clients were worried about stigma from their relatives, which creates a delay in seeking treatment. Conclusion Although the rate of early entry in care and treatment services is high, surprisingly was a marked increase in those who waited more than three months to seek treatment. To meet the target, issues such as disclosure and stigma need to be addressed.
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Affiliation(s)
| | - James Samwel Ngocho
- Kilimanjaro Christian Medical Centre Duke University Collaboration, Moshi, Tanzania
- * E-mail:
| | - Blandina Theophil Mmbaga
- Kilimanjaro Christian Medical Centre Duke University Collaboration, Moshi, Tanzania
- Kilimanjaro Christian Clinical Research Institute, Moshi, Tanzania
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Li MJ, Huang JH. Healthcare Seeking Intention if Diagnosed with HIV Among Young MSM in Taiwan: A Theory-Based Comparison by Voluntary Counseling and Testing Experience. AIDS Behav 2018; 22:2480-2490. [PMID: 29808258 DOI: 10.1007/s10461-018-2169-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The number of HIV cases in Taiwan exceeded 30,000 in 2016. Per the UNAIDS 90-90-90 target, 81% of people living with HIV should receive medication. However, numerous previous studies focused on adherence rather than the initial healthcare seeking intention if diagnosed with HIV (HIV HSI). Based on the Theory of Planned Behavior (TPB), anonymous online survey data were collected from December 2016 through February 2017 from 2709 young MSM (YMSM) ages 15-39. Multivariate logistic regression found the significant factors and strengths of associations with HIV HSI varied by their HIV voluntary counseling and testing (VCT) experience. YMSM without VCT experience perceiving high support from salient others (AOR = 1.28) and high control under facilitating conditions (AOR = 2.73) had higher HIV HSI. YMSM with VCT experience perceiving high control under facilitating (AOR = 1.79) and constraining (AOR = 1.54) conditions had higher HIV HSI. Regardless of VCT experience, YMSM with positive attitudes toward positive healthcare seeking outcomes (AOR = 3.72-3.95) had highest HIV HSI, highlighting the importance of increasing positive outcome expectations in YMSM.
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Croxford S, Yin Z, Burns F, Copas A, Town K, Desai S, Skingsley A, Delpech V. Linkage to HIV care following diagnosis in the WHO European Region: A systematic review and meta-analysis, 2006-2017. PLoS One 2018; 13:e0192403. [PMID: 29451875 PMCID: PMC5815583 DOI: 10.1371/journal.pone.0192403] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/22/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Timely linkage to care after HIV diagnosis is crucial as delayed access can result in poor patient outcomes. The aim of this systematic review was to synthesise the evidence to achieve a better understanding of what proportion of patients are linked to care and what factors impact linkage. METHODS Systematic searches were run in six databases up to the end of February 2017. The grey literature was also reviewed. Inclusion criteria were: sample size ≥50 people (aged ≥15), from the WHO European Region, published 2006-2017 and in English. Linkage to care was defined as a patient seen for HIV care after diagnosis. Study selection, data extraction and quality assurance were performed by two independent reviewers. Random-effects meta-analysis was carried out to summarise linkage to care within three months of diagnosis. RESULTS Twenty-four studies were included; 22 presented linkage to care data and seven examined factors for linkage. Linkage among 89,006 people in 19 countries was captured. Meta-analysis, restricted to 12 studies and measuring prompt linkage within three months, gave a pooled estimate of 85% (95% CI: 75%-93%). Prompt linkage was higher in studies including only people in care (94%; 95% CI: 91%-97%) than in those of all new diagnoses (71%; 95% CI: 50%-87%). Heterogeneity was high across and within strata (>99%). Factors associated with delaying or not linking to care included: acquiring HIV through heterosexual contact/injecting drug use, younger age at diagnosis, lower levels of education, feeling well at diagnosis and diagnosis outside an STI clinic. CONCLUSION Overall, linkage to care was high, though estimates were lower in studies with a high proportion of people who inject drugs. The high heterogeneity between studies made it challenging to synthesise findings. Studies should adopt a standardised definition with a three month cut-off to measure prompt linkage to care to ensure comparability.
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Affiliation(s)
- Sara Croxford
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- Centre for Population Research in Sexual Health and HIV, Institute of Global Health, University College London, London, United Kingdom
| | - Zheng Yin
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
| | - Fiona Burns
- Centre for Population Research in Sexual Health and HIV, Institute of Global Health, University College London, London, United Kingdom
- Royal Free London NHS Foundation Trust, London United Kingdom
| | - Andrew Copas
- Centre for Population Research in Sexual Health and HIV, Institute of Global Health, University College London, London, United Kingdom
| | - Katy Town
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- Centre for Population Research in Sexual Health and HIV, Institute of Global Health, University College London, London, United Kingdom
| | - Sarika Desai
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
| | - Andrew Skingsley
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
| | - Valerie Delpech
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
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Raimondo M, Camoni L, Suligoi B, Pezzotti P, CARPHA Study Group. HIV-Positive Individuals on Antiretroviral Therapy and with Viral Load Suppressed in 12 Infectious Diseases Clinics in Italy: Successes and Disparities in the HIV Continuum of Care. AIDS Res Hum Retroviruses 2017; 33:575-582. [PMID: 28135809 DOI: 10.1089/aid.2016.0256] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The HIV care continuum is a tool that describes the quality of HIV care for people living with HIV and assesses the extent to which the goal of viral suppression has been achieved. In 2014, we conducted a retrospective cross-sectional study to assess the characteristics associated with three steps of the HIV continuum of care in Italy [i.e., most recent diagnoses, people diagnosed and in care who are on therapy, and people with viral load (VL) suppressed among those on therapy]. Among the 10,262 individuals diagnosed and linked to care, 9,810 (95.6%) were on therapy and among these 8,383 (85.7%) had VL suppressed. The comparison between people diagnosed in 2013 to those diagnosed before 2013 shows that they were more likely to be male [adjusted odds ratios (AOR) = 1.46; 95% confidence interval (95% CI): 1.18-1.79], <25 years of age (AOR = 7.59; 95% CI: 4.17-13.79), and born in Italy (AOR = 1.33; 95% CI: 1.09-1.62). Factors significantly associated with not being in therapy were as follows: age <35 years (AOR = 4.03; 95% CI: 2.50-6.51), age 35-55 years (AOR = 1.85; 95% CI: 1.19-2.87), being migrants (AOR = 1.25; 95% CI: 1.13-1.39), being men who have sex with men (MSM) (AOR = 1.54; 95% CI: 1.22-1.95), have been diagnosed in 2010-2012 (AOR = 4.51; 95% CI: 3.03-6.73), or before 2010 (AOR = 3.18; 95% CI: 2.41-4.21), and not had previous clinical AIDS (AOR = 8.24; 95% CI: 3.33-20.23), whereas factors significantly associated with not having VL suppressed were as follows: age <35 years (AOR = 1.56; 95% CI: 1.13-2.13) and age 35-55 years (AOR = 1.23; 95% CI: 1.10-1.38), being migrants (AOR = 1.38; 95% CI: 1.11-1.70), have been diagnosed in 2010-2012 (AOR = 1.34; 95% CI: 1.14-1.57), in 2013 (AOR = 4.35; 95% CI: 2.47-7.68), and not having had previous clinical AIDS (AOR = 0.74; 95% CI: 0.63-0.86). Despite this we observed significant disparities for young people, MSM, and migrants, overall in Italy the vast majority of people diagnosed with HIV and in care in 2013 received therapy and the percentage of people who are VL suppressed is near the Joint United Nations Programme on HIV/AIDS goal.
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Affiliation(s)
- Mariangela Raimondo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Laura Camoni
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Barbara Suligoi
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - CARPHA Study Group
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
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Heijman T, Zuure F, Stolte I, Davidovich U. Motives and barriers to safer sex and regular STI testing among MSM soon after HIV diagnosis. BMC Infect Dis 2017; 17:194. [PMID: 28264658 PMCID: PMC5339973 DOI: 10.1186/s12879-017-2277-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 02/21/2017] [Indexed: 02/07/2023] Open
Abstract
Background Understanding why some recently with HIV diagnosed men who have sex with men (MSM) choose for safer sex and regular STI testing, whereas others do not, is important for the development of interventions that aim to improve the sexual health of those newly infected. Methods To gain insight into motives and barriers to condom use and regular STI testing among MSM soon after HIV diagnosis, 30 HIV-positive MSM participated in semi-structured qualitative interviews on sexual health behaviours in the first year after HIV diagnosis. Results Typical barriers to condom use soon after diagnosis were emotions such as anger, relief, and feelings of vulnerability. Additional barriers were related to pre-diagnosis patterns of sexual-social behaviour that were difficult to change, communication difficulties, and substance use. Barriers to STI testing revolved around perceptions of low STI risk, faulty beliefs, and burdensome testing procedures. Conclusions The great diversity of motives and barriers to condom use and STI testing creates a challenge to accommodate newly infected men with information, motivation, and communication skills to match their personal needs. An adaptive, tailored intervention can be a promising tool of support.
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Affiliation(s)
- Titia Heijman
- STI outpatient Clinic, Amsterdam Public Health Service, Amsterdam, The Netherlands.
| | - Freke Zuure
- Department Infectious Diseases, Research and Prevention, Amsterdam Public Health Service, Amsterdam, The Netherlands.,Centre for Infection and Immunology Amsterdam (CINIMA), Academic Medical Centre (University of Amsterdam), Amsterdam, The Netherlands
| | - Ineke Stolte
- University of applied sciences InHolland, Haarlem, The Netherlands
| | - Udi Davidovich
- Department Infectious Diseases, Research and Prevention, Amsterdam Public Health Service, Amsterdam, The Netherlands.,Centre for Infection and Immunology Amsterdam (CINIMA), Academic Medical Centre (University of Amsterdam), Amsterdam, The Netherlands
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Op de Coul ELM, van Sighem A, Brinkman K, van Benthem BH, van der Ende ME, Geerlings S, Reiss P. Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996-2014: results from a national observational cohort. BMJ Open 2016; 6:e009688. [PMID: 26729389 PMCID: PMC4716151 DOI: 10.1136/bmjopen-2015-009688] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Early testing for HIV and entry into care are crucial to optimise treatment outcomes of HIV-infected patients and to prevent spread of HIV. We examined risk factors for presentation with late or advanced disease in HIV-infected patients in the Netherlands. METHODS HIV-infected patients registered in care between January 1996 and June 2014 were selected from the ATHENA national observational HIV cohort. Risk factors for late presentation and advanced disease were analysed by multivariable logistic regression. Furthermore, geographical differences and time trends were examined. RESULTS Of 20,965 patients, 53% presented with late-stage HIV infection, and 35% had advanced disease. Late presentation decreased from 62% (1996) to 42% (2013), while advanced disease decreased from 46% to 26%. Late presentation only declined significantly among men having sex with men (MSM; p <0.001), but not among heterosexual males (p=0.08) and females (p=0.73). Factors associated with late presentation were: heterosexual male (adjusted OR (aOR), 1.59; 95% CI 1.44 to 1.75 vs MSM), injecting drug use (2.00; CI 1.69 to 2.38), age ≥ 50 years (1.46; CI 1.33 to 1.60 vs 30-49 years), region of origin (South-East Asia 2.14; 1.80 to 2.54, sub-Saharan Africa 2.11; 1.88 to 2.36, Surinam 1.59; 1.37 to 1.84, Caribbean 1.31; 1.13 to 1.53, Latin America 1.23; 1.04 to 1.46 vs the Netherlands), and location of HIV diagnosis (hospital 3.27; 2.94 to 3.63, general practitioner 1.66; 1.50 to 1.83, antenatal screening 1.76; 1.38 to 2.34 vs sexually transmitted infection clinic). No association was found for socioeconomic status or level of urbanisation. Compared with Amsterdam, 2 regions had higher adjusted odds and 2 regions had lower odds of late presentation. Results were highly similar for advanced disease. CONCLUSIONS Although the overall rate of late presentation is declining in the Netherlands, targeted programmes to reduce late HIV diagnoses remain needed for all risk groups, but should be prioritised for heterosexual males, migrant populations, people aged ≥ 50 years and certain regions in the Netherlands.
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Affiliation(s)
- Eline L M Op de Coul
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Ard van Sighem
- Stichting HIV Monitoring, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
| | - Birgit H van Benthem
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - Suzanne Geerlings
- Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Peter Reiss
- Stichting HIV Monitoring, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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12
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Chemtob D, Op de Coul E, van Sighem A, Mor Z, Cazein F, Semaille C. Impact of Male Circumcision among heterosexual HIV cases: comparisons between three low HIV prevalence countries. Isr J Health Policy Res 2015; 4:36. [PMID: 26244087 PMCID: PMC4524174 DOI: 10.1186/s13584-015-0033-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/11/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Studies performed in high-HIV prevalence countries showed a strong epidemiological association between male circumcision (MC) and the prevention of HIV transmission. We estimated the potential impact of MC on the general heterosexual population in low-HIV prevalence countries. METHODS Cross-national comparisons, including data on newly diagnosed HIV cases among heterosexuals living in Israel (where almost all males undergo MC), to similar data from the Netherlands and France (where <10 % of males are circumcised) were performed. National data from HIV registers and Bureaus of Statistics for the period of 2004-2010, global rates, rates by sex, age, and year of HIV-diagnosis were compared. MC and potential biases were examined. RESULTS Annual rates of new HIV diagnoses per 100,000 were significantly lower in Israel compared to the Netherlands and France (for men: 0.26-0.70, 1.91-2.28, and 2.69-3.47, respectively; for women: 0.10-0.34, 1.10-2.10 and 2.41-3.08, respectively). Similarly, HIV-rates were much lower in Israel when comparing by age groups. Although Gross National Income per capita in 2010 was lower in Israel compared to the Netherlands and France, access to HIV testing and treatment were not different between countries. Also, the number of sexual-partners and condom-use in the general population showed a high similarity between the countries. CONCLUSIONS The lower rate of HIV among heterosexuals in Israel compared to the Netherlands and France might be explained by MC routinely practiced in Israel, since other parameters of influence on HIV transmission were rather similar between the countries. However, recommendation for systematic MC in low HIV prevalence countries requires further investigations.
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Affiliation(s)
- Daniel Chemtob
- />Department of Tuberculosis and AIDS, Ministry of Health, P.O.B. 1176, Jerusalem, 944727 Israel
| | - Eline Op de Coul
- />Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - Zohar Mor
- />Department of Tuberculosis and AIDS, Ministry of Health, P.O.B. 1176, Jerusalem, 944727 Israel
| | - Françoise Cazein
- />HIV/AIDS-STI-Hepatitis B and C Unit, Department of Infectious Diseases, Institut de Veille Sanitaire, Saint Maurice, France
| | - Caroline Semaille
- />HIV/AIDS-STI-Hepatitis B and C Unit, Department of Infectious Diseases, Institut de Veille Sanitaire, Saint Maurice, France
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