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Medeiros P, Warren L, Kazemi M, Massaquoi N, Smith S, Tharao W, Serghides L, Logie CH, Kroch A, Burchell AN, de Pokomandy A, Kaida A, Loutfy M. HIV care cascade for women living with HIV in the Greater Toronto Area versus the rest of Ontario and Canada. Int J STD AIDS 2023; 34:4-17. [PMID: 36411243 PMCID: PMC9806481 DOI: 10.1177/09564624221108034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Greater Toronto Area (GTA) is home to 39% of Canada's population living with HIV. To identify gaps in access and engagement in care and treatment, we assessed the care cascade of women living with HIV (WLWH) in the GTA versus the rest of Ontario and Canada (in this case: Quebec and British Columbia). METHODS We analyzed 2013-2015 self-reported baseline data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study for six care cascade stages: linked to care, retained in care, initiated antiretroviral therapy (ART), currently on ART, ART adherence (≥90%), and undetectable (<50 copies/mL). Multivariable logistic regression was used to reveal associations with being undetectable. RESULTS Comparing the GTA to the rest of Ontario and Canada, respectively: 96%, 98%, 100% were linked to care; 92%, 94%, 98% retained in care; 72%, 89%, 96% initiated ART; 67%, 81%, 90% were currently using ART; 53%, 66%, 77% were adherent; 59%, 69%, 81% were undetectable. Factors associated with viral suppression in the multivariable model included: living outside of the GTA (Ontario: aOR = 1.72, 95% CI: 1.09-2.72; Canada: aOR = 2.42, 95% CI: 1.62-3.62), non-Canadian citizenship (landed immigrant/permanent resident: aOR = 3.23, 95% CI: 1.66-6.26; refugee/protected person/other status: aOR = 4.77, 95% CI: 1.96-11.64), completed high school (aOR = 1.77, 95% CI: 1.15-2.73), stable housing (aOR = 2.13, 95% CI: 1.33-3.39), income of ≥$20,000 (aOR = 1.52, 95% CI: 1.00-2.31), HIV diagnosis <6 years (6-14 years: aOR = 1.75, 95% CI: 1.16-2.63; >14 years: aOR = 1.87, 95% CI: 1.19-2.96), and higher resilience (aOR = 1.02, 95% CI: 1.00-1.04). CONCLUSION WLWH living in the GTA had lower rates of viral suppression compared to the rest of Ontario and Canada even after adjustment of age, ethnicity, and HIV diagnosis duration. High-impact programming for WLWH in the GTA to improve HIV outcomes are greatly needed.
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Affiliation(s)
- Priscilla Medeiros
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Priscilla Medeiros, PhD, Women’s College
Research Institute, Women’s College Hospital, 76 Grenville Street, Room 6415,
Toronto, ON M5G 1N8, Canada. E-mail:
| | - Laura Warren
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mina Kazemi
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada
| | | | - Stephanie Smith
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands
Community Health, Toronto, ON, Canada
| | - Lena Serghides
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Toronto General Hospital Research
Institute, University Health
Network, Toronto, ON, Canada,Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Carmen H Logie
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | - Ann N Burchell
- Department of Family and Community
Medicine, St. Michael’s Hospital, Toronto, ON, Canada,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health
Centre, Montreal, QC, Canada,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Maritim C, McClarty L, Leung S, Bruce S, Restall G, Migliardi P, Becker M. HIV treatment outcomes among newcomers living with HIV in Manitoba, Canada. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:119-128. [PMID: 36341034 PMCID: PMC9608691 DOI: 10.3138/jammi-2020-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/04/2020] [Indexed: 06/16/2023]
Abstract
BACKGROUND Despite the overrepresentation of immigrants and refugees (newcomers) in the HIV epidemic in Canada, research on their HIV treatment outcomes is limited. This study addressed this knowledge gap by describing treatment outcomes of newcomers in comparison with Canadian-born persons living with HIV in Manitoba. METHODS Clinical data from 1986 to 2017 were obtained from a cohort of people living with HIV and receiving care from the Manitoba HIV Program. Retrospective cohort analysis of secondary data was completed using univariate and multivariate statistics to compare differences in socio-demographic and clinical characteristics and treatment outcomes among newcomers, Canadian-born Indigenous persons, and Canadian-born non-Indigenous persons on entry into HIV care. RESULTS By end of 2017, 86 newcomers, 259 Canadian-born Indigenous persons, and 356 Canadian-born non-Indigenous persons were enrolled in the cohort. Newcomers were more likely than Canadian-born Indigenous and non- Indigenous cohort participants to be younger and female and have self-reported HIV risk exposure as heterosexual contact. Average CD4 counts at entry into care did not differ significantly between groups. A higher proportion of newcomers was also diagnosed with tuberculosis within 6 months of entry into care (21%), compared with 6% and 0.6% of Canadian-born Indigenous non-Indigenous persons, respectively. Newcomers and Canadian-born non-Indigenous persons had achieved viral load suppression (< 200 copies/mL) at a similar proportion (93%), compared with 82% of Canadian-born Indigenous participants (p < 0.05). CONCLUSIONS The distinct demographic and clinical characteristics of newcomers living with HIV requires a focused approach to facilitate earlier diagnosis, engagement, and support in care.
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Affiliation(s)
- Charity Maritim
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leigh McClarty
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stella Leung
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sharon Bruce
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gayle Restall
- Department of Occupational Therapy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paula Migliardi
- Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Marissa Becker
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba HIV Program, Winnipeg, Manitoba, Canada
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3
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Gebreegziabher EA, McCoy SI, Ycasas JC, Murgai N. The Role of Neighborhood Poverty in the Association between Foreign-Born status and HIV Care Continuum Outcomes in Alameda County, California. J Immigr Minor Health 2020; 22:1023-1030. [PMID: 32270326 DOI: 10.1007/s10903-020-01002-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Foreign-born persons living in the US have an increased risk of exposure to HIV and higher rates of HIV diagnosis (Patel-Larson et al. in Poster presented at the 2007 National HIV Prevention Conference, pp 2-5, 2007; Prosser et al. in JAMA 308:601-607, 2012). Foreign-born persons also tend to live in areas with high concentration of immigrants and more often neighborhoods of high poverty, for at least some time (Jargowsky in J Ethn Migr Stud 35:1129-1151, 2009). Using HIV surveillance data in Alameda County, California, we examined whether the association between immigrant status and the four outcomes on the HIV care cascade (late diagnosis, linkage to care within 30 days of diagnosis, retention in HIV care, and viral load status a year after diagnosis) differed by census tract poverty level. We used generalized estimating equations (GEE) adjusted for sex at birth, age, race, and transmission mode. Of 1235 individuals with HIV diagnosis reported between 2011 and 2016, 29% were foreign-born. Foreign-born status was significantly associated with late HIV diagnosis but not with linkage, retention in care, and achievement of undetectable viral load a year after diagnosis. Neighborhood poverty modified the association between immigrant status and retention in care, but not late diagnosis, linkage or viral load status. Our findings suggest that neighborhood resources may buffer against disparities in retention. Thus, immigrants in poorer neighborhoods may require more support to stay in care.
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Affiliation(s)
- Elisabeth A Gebreegziabher
- HIV Epidemiology and Surveillance Unit, Alameda County Public Health Department, 1000 Broadway Suite 310, Oakland, CA, 94607, USA.
| | - Sandra I McCoy
- School of Public Health, University of California, 5414 Berkeley Way West, Berkeley, CA, 94704, USA
| | - Joyce C Ycasas
- HIV Epidemiology and Surveillance Unit, Alameda County Public Health Department, 1000 Broadway Suite 310, Oakland, CA, 94607, USA
| | - Neena Murgai
- HIV Epidemiology and Surveillance Unit, Alameda County Public Health Department, 1000 Broadway Suite 310, Oakland, CA, 94607, USA
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Masindi KI, Jembere N, Kendall CE, Burchell AN, Bayoumi AM, Loutfy M, Raboud J, Rourke SB, Luyombya H, Antoniou T. Co-morbid Non-communicable Diseases and Associated Health Service Use in African and Caribbean Immigrants with HIV. J Immigr Minor Health 2019; 20:536-545. [PMID: 29209931 DOI: 10.1007/s10903-017-0681-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We sought to characterize non-communicable disease (NCD)-related and overall health service use among African and Caribbean immigrants living with HIV between April 1, 2010 and March 31, 2013. We conducted two population-based analyses using Ontario's linked administrative health databases. We studied 1525 persons with HIV originally from Africa and the Caribbean. Compared with non-immigrants with HIV (n = 11,931), African and Caribbean immigrants had lower rates of hospital admissions, emergency department visits and non-HIV specific ambulatory care visits, and higher rates of health service use for hypertension and diabetes. Compared with HIV-negative individuals from these regions (n = 228,925), African and Caribbean immigrants with HIV had higher rates of health service use for chronic obstructive pulmonary disease [rate ratio (RR) 1.78; 95% confidence interval (CI) 1.36-2.34] and malignancy (RR 1.20; 95% CI 1.19-1.43), and greater frequency of hospitalizations for mental health illness (RR 3.33; 95% CI 2.44-4.56), diabetes (RR 1.37; 95% CI 1.09-1.71) and hypertension (RR 1.85; 95% CI 1.46-2.34). African and Caribbean immigrants with HIV have higher rates of health service use for certain NCDs than non-immigrants with HIV. The evaluation of health services for African and Caribbean immigrants with HIV should include indicators of NCD care that disproportionately affect this population.
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Affiliation(s)
- Khatundi-Irene Masindi
- Department of Family and Community Medicine, St. Michael's Hospital, 410 Sherbourne Street, Toronto, ON, M4X 1K2, Canada
| | | | - Claire E Kendall
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,CT Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine, St. Michael's Hospital, 410 Sherbourne Street, Toronto, ON, M4X 1K2, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Ahmed M Bayoumi
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mona Loutfy
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Janet Raboud
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Sean B Rourke
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.,Ontario HIV Treatment Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Tony Antoniou
- Department of Family and Community Medicine, St. Michael's Hospital, 410 Sherbourne Street, Toronto, ON, M4X 1K2, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
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Assessing Timely Presentation to Care Among People Diagnosed with HIV During Hospital Admission: A Population-Based Study in Ontario, Canada. AIDS Behav 2018. [PMID: 29536283 DOI: 10.1007/s10461-018-2063-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Timely presentation to care for people newly diagnosed with HIV is critical to optimize health outcomes and reduce onward HIV transmission. Studies describing presentation to care following diagnosis during a hospital admission are lacking. We sought to assess the timeliness of presentation to care and to identify factors associated with delayed presentation. We conducted a population-level study using health administrative databases. Participants were all individuals older than 16 and newly diagnosed with HIV during hospital admission in Ontario, Canada, between April 1, 2007 and March 31, 2015. We used modified Poisson regression models to derive relative risk ratios for the association between sociodemographic and clinical variables and the presentation to out-patient HIV care by 90 days following hospital discharge. Among 372 patients who received a primary HIV diagnosis in hospital, 83.6% presented to care by 90 days. Following multivariable analysis, we did not find associations between patient sociodemographic or clinical characteristics and presentation to care by 90 days. In a secondary analysis of 483 patients diagnosed during hospitalization but for whom HIV was not recorded as the principal reason for admission, 73.1% presented to care by 90 days. Following multivariable adjustment, we found immigrants from countries with generalized HIV epidemics (RR 1.265, 95% CI 1.133-1.413) were more likely to present to care, whereas timely presentation was less likely for people with a mental health diagnosis (RR 0.817, 95% CI 0.742-0.898) and women (RR 0.748, 95% CI 0.559-1.001). Future work should evaluate mechanisms to facilitate presentation to care among these populations.
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Rachlis B, Burchell AN, Gardner S, Light L, Raboud J, Antoniou T, Bacon J, Benoit A, Cooper C, Kendall C, Loutfy M, Wobeser W, McGee F, Rachlis A, Rourke SB. Social determinants of health and retention in HIV care in a clinical cohort in Ontario, Canada. AIDS Care 2016; 29:828-837. [PMID: 28027668 DOI: 10.1080/09540121.2016.1271389] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Continuous HIV care supports antiretroviral therapy initiation and adherence, and prolongs survival. We investigated the association of social determinants of health (SDH) and subsequent retention in HIV care in a clinical cohort in Ontario, Canada. The Ontario HIV Treatment Network Cohort Study is a multi-site cohort of patients at 10 HIV clinics. Data were collected from medical charts, interviews, and via record linkage with the provincial public health laboratory for viral load tests. For participants interviewed in 2009, we used three-category multinomial logistic regression to identify predictors of retention in 2010-2012, defined as (1) continuous care (≥2 viral loads ≥90 days in all years; reference category); (2) discontinuous care (only 1 viral load/year in ≥1 year); and (3) a gap in care (≥1 year in 2010-2012 with no viral load). In total, 1838 participants were included. In 2010-2012, 71.7% had continuous care, 20.9% had discontinuous care, and 7.5% had a gap in care. Discontinuous care in 2009 was predictive (p < .0001) of future retention. SDH associated with discontinuous care were Indigenous ethnicity, being born in Canada, being employed, reporting hazardous drinking, and non-injection drug use. Being a heterosexual male was associated with having a gap in care, and being single and younger were associated with discontinuous care and a gap in care. Various SDH were associated with retention. Care discontinuity was highly predictive of future gaps. Targeted strategic interventions that better engage those at risk of suboptimal retention merit exploration. ABBREVIATIONS AOR: adjusted odds ratio; ART: antiretroviral therapy; AUDIT: Alcohol Use Disorders Identification Test; CES-D: Center for Epidemiologic Studies Depression Scale; CIs: confidence intervals; HIV: human immunodeficiency virus; IQR: interquartile range; MSM: men who have sex with men; NA-ACCORD: North American AIDS Cohort Collaboration on Research and Design; OCS: Ontario HIV Treatment Network Cohort Study; OHTN: Ontario HIV Treatment Network; OR: odds ratio; PHOL: Public Health Ontario Laboratories; REB: Research Ethics Board; SDH: social determinants of health; US: United States.
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Affiliation(s)
- Beth Rachlis
- a Ontario HIV Treatment Network , Toronto , Canada.,b Division of Clinical Public Health, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
| | - Ann N Burchell
- c Division of Epidemiology , Dalla Lana School of Public Health, University of Toronto , Toronto , Canada.,d Department of Family and Community Medicine , St. Michael's Hospital, Toronto , Canada.,e Department of Family and Community Medicine , University of Toronto , Toronto , Canada.,f Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada
| | - Sandra Gardner
- g Division of Biostatistics, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.,h Rotman Research Institute , Baycrest, Toronto , Canada
| | - Lucia Light
- a Ontario HIV Treatment Network , Toronto , Canada
| | - Janet Raboud
- g Division of Biostatistics, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.,i Toronto General Research Institute, University Health Network , Toronto , Canada
| | - Tony Antoniou
- d Department of Family and Community Medicine , St. Michael's Hospital, Toronto , Canada.,e Department of Family and Community Medicine , University of Toronto , Toronto , Canada.,f Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada
| | - Jean Bacon
- a Ontario HIV Treatment Network , Toronto , Canada
| | - Anita Benoit
- j Women's College Research Institute, Women's College Hospital , Toronto , Canada
| | - Curtis Cooper
- k Ottawa Hospital Research Institute , Ottawa , Canada
| | - Claire Kendall
- l Bruyère Research Institute , Ottawa , Canada.,m Department of Family Medicine , University of Ottawa , Ottawa , Canada
| | - Mona Loutfy
- n Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health , Toronto , Canada.,o Department of Medicine , Women's College Research Institute, Women's College Hospital , Toronto , Canada.,p Department of Medicine , University of Toronto , Toronto , Canada
| | - Wendy Wobeser
- q Department of Medicine , Queen's University , Kingston , Canada.,r Hotel Dieu Hospital , Kingston , Canada
| | - Frank McGee
- s AIDS Bureau, Ontario Ministry of Health and Long Term Care , Toronto , Canada
| | - Anita Rachlis
- p Department of Medicine , University of Toronto , Toronto , Canada.,t Sunnybrook Health Science Centre , Toronto , Canada
| | - Sean B Rourke
- a Ontario HIV Treatment Network , Toronto , Canada.,f Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada.,u Department of Psychiatry , University of Toronto , Toronto , Canada
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- a Ontario HIV Treatment Network , Toronto , Canada
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Ivanova E, Coroiu A, Ahluwalia A, Alexandrov E, Lafreniere KD. Preliminary Findings on the Association Between Symptoms of Depression and Adherence to Antiretroviral Therapy in Individuals Born Inside Versus Outside of Canada. J Assoc Nurses AIDS Care 2016; 27:512-23. [PMID: 26987784 DOI: 10.1016/j.jana.2016.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 02/07/2016] [Indexed: 11/29/2022]
Abstract
For optimal health, people living with HIV (PLWH) need to adhere to antiretroviral therapy (ART). We explored the relationship between symptoms of depression and ART adherence for PLWH born inside versus outside of Canada. PLWH taking ART (N = 57) completed self-assessments of depression and adherence to ART. Adherence rates did not differ significantly for PLWH who were born outside (66.7% were ≥95% adherent) versus inside Canada (51.6% were ≥95% adherent), but the relationship between symptoms of depression and ART adherence depended on the country of birth: for individuals born in Canada, depression was associated with lower ART adherence (β = -.21, p = .005, 95% confidence interval -.35 to -.07); for PLWH born outside of Canada there was no association between symptoms of depression and ART adherence. Symptoms of depression may not universally affect ART adherence; country of birth may be one critical variable impacting this relationship.
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Tseng A, Szadkowski L, Walmsley S, Salit I, Raboud J. Association of Age With Polypharmacy and Risk of Drug Interactions With Antiretroviral Medications in HIV-Positive Patients. Ann Pharmacother 2013; 47:1429-39. [DOI: 10.1177/1060028013504075] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Alice Tseng
- Toronto General Hospital, University Health Network, ON, Canada
- University of Toronto, ON, Canada
| | - Leah Szadkowski
- Toronto General Research Institute, University Health Network, ON, Canada
| | - Sharon Walmsley
- Toronto General Hospital, University Health Network, ON, Canada
- Toronto General Research Institute, University Health Network, ON, Canada
- University of Toronto, ON, Canada
| | - Irving Salit
- Toronto General Hospital, University Health Network, ON, Canada
- University of Toronto, ON, Canada
| | - Janet Raboud
- Toronto General Research Institute, University Health Network, ON, Canada
- University of Toronto, ON, Canada
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Caring for women living with HIV: gaps in the evidence. J Int AIDS Soc 2013; 16:18509. [PMID: 24088395 PMCID: PMC3789211 DOI: 10.7448/ias.16.1.18509] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 08/12/2013] [Accepted: 08/15/2013] [Indexed: 02/07/2023] Open
Abstract
Introduction In the management of HIV, women and men generally undergo the same treatment pathway, with gender differences being given limited consideration. This is in spite of accumulating evidence that there are a number of potential differences between women and men which may affect response to treatment, pharmacokinetics, toxicities and coping. There are also notable psychological, behavioural, social and structural factors that may have a unique impact on women living with HIV (WLWH). Despite our increasing knowledge of HIV and advances in treatment, there are significant gaps in the data relating specifically to women. One of the factors contributing to this situation is the under-representation of women in all aspects of HIV clinical research. Furthermore, there are clinical issues unique to women, including gynaecologic and breast diseases, menopause-related factors, contraception and other topics related to women's and sexual health. Methods Using scoping review methodology, articles from the literature from 1980 to 2012 were identified using appropriate MeSH headings reflecting the clinical status of WLWH, particularly in the areas of clinical management, sexual health, emotional wellbeing and treatment access. Titles and abstracts were scanned to determine whether they were relevant to non-reproductive health in WLWH, and papers meeting inclusion criteria were reviewed. Results This review summarizes our current knowledge of the clinical status of WLWH, particularly in the areas of clinical management, sexual health, emotional wellbeing and treatment access. It suggests that there are a number of gender differences in disease and treatment outcomes, and distinct women-specific issues, such as menopause and co-morbidities, that pose significant challenges to the care of WLWH. Conclusions Based on a review of this evidence, outstanding questions and areas where further studies are required to determine gender differences in the efficacy and safety of treatment and other clinical and psychological issues specifically affecting WLWH have been identified. Well-controlled and adequately powered clinical studies are essential to help provide answers to these questions and to contribute to activities aimed at improving the health and wellbeing of WLWH.
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Tan DHS, Raboud JM, Kaul R, Brunetta J, Kaushic C, Kovacs C, Lee E, Luetkehoelter J, Rachlis A, Smaill F, Smieja M, Walmsley SL. Herpes Simplex Virus Type 2 Coinfection Does Not Accelerate CD4 Count Decline in Untreated HIV Infection. Clin Infect Dis 2013; 57:448-57. [DOI: 10.1093/cid/cit208] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Antoniou T, Zagorski B, Loutfy MR, Strike C, Glazier RH. Socio-economic- and sex-related disparities in rates of hospital admission among patients with HIV infection in Ontario: a population-based study. OPEN MEDICINE : A PEER-REVIEWED, INDEPENDENT, OPEN-ACCESS JOURNAL 2012; 6:e146-54. [PMID: 23687530 PMCID: PMC3654511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/09/2012] [Accepted: 08/27/2012] [Indexed: 12/03/2022]
Abstract
BACKGROUND Among people living with HIV infection in the era of combination antiretroviral therapy (cART), admission to hospital may indicate inadequate community-based care. As such, population-based assessments of the utilization of inpatient services represent a necessary component of evaluating the quality of HIV-related care. METHODS We used a validated algorithm to search Ontario's administrative health care databases for all persons living with HIV infection aged 18 years or older between 1992/93 and 2008/09. We then conducted a population-based study using time-series and longitudinal analyses to first quantify the immediate effect of cART on hospital admission rates and then analyze recent trends (for 2002/03 to 2008/09) in rates of total and HIV-related admissions. RESULTS The introduction of cART in 1996/97 was associated with more pronounced reductions in the rate of hospital admissions among men than among women (for total admissions, -89.9 v. -60.5 per 1000 persons living with HIV infection, p = 0.003; for HIV-related admissions, -56.9 v. -36.3 per 1000 persons living with HIV infection, p < 0.001). Between 2002/03 and 2008/09, higher rates of total hospital admissions were associated with female sex (adjusted relative rate [RR] 1.15, 95% confidence interval [CI] 1.05-1.27) and low socio-economic status (adjusted RR 1.21, 95% CI 1.14-1.29). Higher rates of HIV-related hospital admission were associated with low socio-economic status (adjusted RR 1.30, 95% CI 1.17-1.45). Recent immigrants had lower rates of both total admissions (adjusted RR 0.70, 95% CI 0.61-0.80) and HIV-related admissions (adjusted RR 0.77, 95% CI 0.61-0.96). INTERPRETATION We observed important socio-economic- and sex-related disparities in rates of hospital admission among people with HIV living in Ontario, Canada.
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