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Collins LF, Sheth AN, Tisdale T, Mehta CC, Daniel G, Westreich D, Kassaye S, Topper EF, Konkle-Parker D, Rana A, Alcaide ML, Philbin MM. Interest in and Preference for Long-acting Injectable Antiretroviral Therapy in the Era of Approved Cabotegravir/Rilpivirine among Reproductive-aged Women in the U.S. South. Clin Infect Dis 2024:ciae331. [PMID: 38943370 DOI: 10.1093/cid/ciae331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/26/2024] [Accepted: 06/14/2024] [Indexed: 07/01/2024] Open
Abstract
Among 103 reproductive-aged women with HIV in the U.S. South surveyed post-approval of long-acting injectable (LAI) cabotegravir/rilpivirine, nearly two-thirds reported willingness to try LAI antiretroviral therapy (ART). Most expressed preference for LAI over daily oral ART and had minimal concerns over potential LAI-ART use impacting reproductive health.
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Affiliation(s)
- Lauren F Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Ponce de Leon Center, Grady Health System, Atlanta, GA, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Ponce de Leon Center, Grady Health System, Atlanta, GA, USA
| | - Tina Tisdale
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Ponce de Leon Center, Grady Health System, Atlanta, GA, USA
| | - C Christina Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Gaea Daniel
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Daniel Westreich
- Department of Epidemiology, University of North Carolina-Chapel Hill, NC, USA
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, D.C., USA
| | - Elizabeth F Topper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Aadia Rana
- Division of Infectious Diseases, Department of Medicine, University of Alabama-Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Morgan M Philbin
- Division of Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Lindh M, Brännström J, Reepalu A, Svedhem V, Mellgren Å. Factors associated with sex differences in viral non-suppression in the Swedish InfCareHIV cohort: An observational real-world study. HIV Med 2024; 25:540-553. [PMID: 38196293 DOI: 10.1111/hiv.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/16/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Women living with HIV are underrepresented in clinical trials assessing outcomes of antiretroviral treatment (ART), justifying the need for observational studies. We investigated differences in viral non-suppression between women and men in the Swedish InfCareHIV cohort and analysed results in relation to biological and socio-demographic variables and patient-reported outcome measures (PROMs). METHODS The study included people living with HIV (PLWH) aged ≥18 years, who initiated ART at least 6 months prior to inclusion. Data from the InfCareHIV registry 2011-2018 were collected. Associations between variables and HIV RNA ≥50 copies/mL were investigated in uni- and multivariable analyses using generalized estimating equations, providing relative risks (RRs) as effect size. RESULTS The study included 38% (n = 2981) women. Women were more likely to have HIV RNA ≥50 copies/mL than were men [RR = 1.20, 95% confidence interval (CI): 1.10-1.31]. After adjusting for origin and route of transmission, sex at birth was no longer associated with viral non-suppression. PROMs were available in 52.4% of PLWH, and items associated with viral non-suppression were impaired adherence in women (RR = 2.38, 95% CI: 1.79-3.17) and men (RR 1.84, 95% CI: 1.40-2.42), and experience of side effects in women (RR = 1.49, 95% CI: 1.10-2.02). CONCLUSIONS This observational study found a 20% higher relative risk of viral non-suppression in women than in men and the difference was associated with socio-demographic factors. The associations between PROMs and viral non-suppression varied between women and men. PROMs are important health outcomes that may identify PLWH in need of support to achieve viral non-suppression.
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Affiliation(s)
- Maria Lindh
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Södra Älvsborg Hospital, Department of Research, Education and Innovation, Borås, Sweden
- Department of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden
| | - Johanna Brännström
- Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Department of Infectious Diseases/Venhälsan, South Hospital, Stockholm, Sweden
| | - Anton Reepalu
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
| | - Veronica Svedhem
- Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
| | - Åsa Mellgren
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Ojukwu EN, Cianelli R, Rodriguez NV, Gattamorta K, De Oliveira G, Duthely L. Predictors and social determinants of HIV treatment engagement among post-partum Black women living with HIV in southeastern United States. J Adv Nurs 2023; 79:4365-4380. [PMID: 37243385 DOI: 10.1111/jan.15712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 03/27/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
AIM Guided by Mcleroy's socio-ecological model, this study explored the predictors and social determinants of HIV treatment engagement among Black post-partum women living with HIV. METHOD Quantitative, research methodology. DESIGN We conducted a retrospective, secondary data analysis of 143 Black post-partum women living with HIV who received peripartum care in South-Florida, United States, from 2009 to 2017. We examined odds of immediate post-partum engagement at 3 months post-partum, and ongoing primary care engagement at 12 months post-partum. RESULTS The independent group analyses showed low levels of immediate post-partum (32.9%) and ongoing primary care engagement (24.5%). At the intrapersonal level, maternal prenatal health significantly affected both immediate post-partum and ongoing primary care engagement; and at the interpersonal level, HIV disclosure and intimate partner violence/abuse significantly affected immediate post-partum engagement. Also, immediate post-partum disengagement was a significant predictor for ongoing primary care disengagement. CONCLUSION This study provides timely and critical information to address recent calls for awareness and interventions to address issues on health disparities and inequities among racialized communities. IMPACT The study provides significant evidence on the effects of social determinants of health on health outcomes for Black women living with HIV. Critical understanding and assessment of these factors, together with proper, proactive interventions may help to gauge such negative effects. Healthcare providers taking care of Black women living with HIV ought to be cognizant of these factors, assess at-risk women and intervene accordingly to ensure that their care is not marginalized. PATIENT/PUBLIC CONTRIBUTION This study includes direct patient data from Black post-partum women living with HIV who were seen at prenatal and post-partum clinics wherein data for this study were obtained. The study results were presented locally, nationally and internationally to communities, organizations of healthcare providers, stakeholders and service-users, who further corroborated our findings, and provided insights and future recommendations.
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Affiliation(s)
- Emmanuela N Ojukwu
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rosina Cianelli
- School of Nursing and Health Studies, University of Miami, Miami, Florida, USA
| | | | - Karina Gattamorta
- School of Nursing and Health Studies, University of Miami, Miami, Florida, USA
| | | | - Lunthita Duthely
- Miller School of Medicine, University of Miami, Miami, Florida, USA
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Paioni P, Aebi-Popp K, Martinez de Tejada B, Rudin C, Bernasconi E, Braun DL, Kouyos R, Wagner N, Crisinel PA, Güsewell S, Darling KE, Duppenthaler A, Baumann M, Polli C, Fischer T, Kahlert CR. Viral suppression and retention in HIV care during the postpartum period among women living with HIV: a longitudinal multicenter cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 31:100656. [PMID: 37303945 PMCID: PMC10250913 DOI: 10.1016/j.lanepe.2023.100656] [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] [Received: 01/12/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 06/13/2023]
Abstract
Background Low rates of postnatal retention in HIV care and viral suppression have been reported in women living with HIV (WLWH) despite viral suppression at delivery. At the same time, postpartum follow-up is of crucial importance in light of the increasing support offered in many resource-rich countries including Switzerland to WLWH choosing to breastfeed their infant, if optimal scenario criteria are met. Methods We longitudinally investigated retention in HIV care, viral suppression, and infant follow-up in a prospective multicentre HIV cohort study of WLWH in the optimal scenario who had a live birth between January 2000 and December 2018. Risk factors for adverse outcomes in the first year postpartum were assessed using logistic and proportional hazard models. Findings Overall, WLWH were retained in HIV care for at least six months after 94.2% of the deliveries (694/737). Late start of combination antiretroviral therapy (cART) during the third trimester was found to be the main risk factor for failure of retention in HIV care (crude odds ratio [OR] 3.91; 95% confidence interval [CI], 1.50-10.22; p = 0.005). Among mothers on cART until at least one year after delivery, 4.4% (26/591) experienced viral failure, with illicit drugs use being the most important risk factor (hazard ratio [HR], 13.2; 95% CI, 2.35-73.6; p = 0.003). The main risk factors for not following the recommendations regarding infant follow-up was maternal depression (OR, 3.52; 95% CI, 1.18-10.52; p = 0.024). Interpretation Although the results are reassuring, several modifiable risk factors for adverse postpartum outcome, such as late treatment initiation and depression, were identified. These factors should be addressed in HIV care of all WLWH, especially those opting to breastfeed in resource-rich countries. Funding This study has been financed within the framework of the Swiss HIV Cohort Study, supported by the Swiss National Science Foundation (grant #201369), by SHCS project 850 and by the SHCS research foundation.
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Affiliation(s)
- Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
- Department of Obstetrics and Gynecology, Lindenhofspital Bern, Switzerland
| | - Begoña Martinez de Tejada
- Department of Obstetrics and Gynecology, University Hospital Geneva, University of Geneva, Switzerland
| | | | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale, University of Geneva and University of Southern Switzerland, Lugano, Switzerland
| | - Dominique L. Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Roger Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Noémie Wagner
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals Geneva, Switzerland
| | - Pierre Alex Crisinel
- Unit of Pediatric Infectious Diseases and Vaccinology, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sabine Güsewell
- Cantonal Hospital St. Gallen, Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Katharine E.A. Darling
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andrea Duppenthaler
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marc Baumann
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Polli
- Department of Obstetrics and Gynecology, Regional Hospital, Lugano, Switzerland
| | - Tina Fischer
- Department of Obstetrics, Community Hospital St. Gallen, St. Gallen, Switzerland
| | - Christian R. Kahlert
- Cantonal Hospital St. Gallen, Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
- Children's Hospital of Eastern Switzerland, Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
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Attanasio LB, Ranchoff BL, Cooper MI, Geissler KH. Postpartum Visit Attendance in the United States: A Systematic Review. Womens Health Issues 2022; 32:369-375. [PMID: 35304034 DOI: 10.1016/j.whi.2022.02.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Adequate postpartum care, including the comprehensive postpartum visit, is critical for long-term maternal health and the reduction of maternal mortality, particularly for people who may lose insurance coverage postpartum. However, variation in previous estimates of postpartum visit attendance in the United States makes it difficult to assess rates of attendance and associated characteristics. METHODS We conducted a systematic review of estimates of postpartum visit attendance. We searched PubMed, CINAHL, PsycInfo, and Web of Science for articles published in English from 1995 to 2020 using search terms to capture postpartum visit attendance and use in the United States. RESULTS Eighty-eight studies were included in this analysis. Postpartum visit attendance rates varied substantially, from 24.9% to 96.5%, with a mean of 72.1%. Postpartum visit attendance rates were higher in studies using patient self-report than those using administrative data. The number of articles including an estimate of postpartum visit attendance increased considerably over the study period; the majority were published in 2015 or later. CONCLUSIONS Our findings suggest that increased systematic data collection efforts aligned with postpartum care guidelines and attention to postpartum visit attendance rates may help to target policies to improve maternal wellbeing. Most estimates indicate that a substantial proportion of women do not attend at least one postpartum visit, potentially contributing to maternal morbidity as well as preventing a smooth transition to future well-woman care. Estimates of current postpartum visit attendance are important for informing efforts that seek to increase postpartum visit attendance rates and to improve the quality of care.
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Affiliation(s)
- Laura B Attanasio
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts.
| | - Brittany L Ranchoff
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts
| | - Michael I Cooper
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts
| | - Kimberley H Geissler
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts
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Okhai H, Tariq S, Burns F, Gilleece Y, Dhairyawan R, Hill T, Peters H, Thorne C, Sabin CA. Association of pregnancy with engagement in HIV care among women with HIV in the UK: a cohort study. Lancet HIV 2021; 8:e747-e754. [PMID: 34762836 DOI: 10.1016/s2352-3018(21)00194-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Women with HIV face challenges in engaging in HIV care post partum. We aimed to examine changes in engagement in HIV care through clinic attendance before, during, and after pregnancy, compared with matched women with HIV who had never had a recorded pregnancy. METHODS In this cohort study, we describe changes in engagement in HIV care before, during, and after pregnancy among women with HIV from the UK Collaborative HIV Cohort (CHIC) study from 25 HIV clinics in the UK with a livebirth reported to the National Surveillance of HIV in Pregnancy and Childhood between Jan 1, 2000, and Dec 31, 2017. To investigate whether changes were specific to HIV, we compared these changes to those over equivalent periods among non-pregnant women with HIV in the UK CHIC study matched for ethnicity, year of conception, age, CD4 cell count, viral suppression, and antiretroviral therapy use. Analyses were via logistic regression using generalised estimated equations with an interaction between case-control status (pregnant women vs non-pregnant women) and pregnancy or pseudo pregnancy (for non-pregnant women) stage. FINDINGS 1116 matched pairs of pregnant and non-pregnant women were included (median age 34 years [IQR 30-38], 80·1% Black African, 12·5% white). 69 330 person-months of follow-up were recorded, 25 412 in the before stage, 18 897 during, and 25 021 after pregnancy or pseudo pregnancy stages. Among pregnant women, the proportion of time engaged in care increased during pregnancy (8477 [90·5%] of 9371 person-months) and after pregnancy (10 501 [84·6%] of 12 407), compared with before pregnancy (9979 [78·5%] of 12 707). Among non-pregnant women in the control group, engagement in HIV care remained stable across the three equivalent stages (9688 [76·3%] of 12 705 person-months before pseudo pregnancy; 7463 [78·3%] of 9526 during pseudo pregnancy; and 9892 [78·4%] of 12 614 after pseudo pregnancy). The association of engagement in HIV care with pregnancy or pseudo pregnancy stage differed significantly by case-control status (pinteraction<0·0001); the odds of engagement in HIV care were higher during pregnancy (odds ratio [OR] 3·32, 95% CI 2·68-4·12) and after pregnancy (OR 1·49, 1·24-1·79) only among pregnant women, and not among non-pregnant women, when compared with the before pseudo pregnancy stage. INTERPRETATION Women with HIV and a pregnancy resulting in a livebirth were more likely to engage in HIV care post partum when compared with before pregnancy. A detailed understanding of the reason for this finding could support interventions to maximise engagement in HIV care for all women with HIV. FUNDING Medical Research Council and National Institute for Health Research.
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Affiliation(s)
- Hajra Okhai
- Institute for Global Health, University College London, London, UK; National Institute for Health Research Health Protection Research Unit in Blood-borne and Sexually Transmitted Infections, University College London, London, UK.
| | - Shema Tariq
- Institute for Global Health, University College London, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
| | - Yvonne Gilleece
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK; Brighton and Sussex Medical School, Brighton, UK
| | | | - Teresa Hill
- Institute for Global Health, University College London, London, UK
| | - Helen Peters
- Institute for Global Health, University College London, London, UK; Integrated Screening Outcomes Surveillance Service, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Claire Thorne
- Institute for Global Health, University College London, London, UK; Integrated Screening Outcomes Surveillance Service, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK; National Institute for Health Research Health Protection Research Unit in Blood-borne and Sexually Transmitted Infections, University College London, London, UK
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Shoemaker ES, Saiyin T, Smith S, Loutfy M, Darling L, Walker M, Hawken S, Begum J, Bibeau C, Bertozzi B, Fraleigh A, Kwaramba G, Johnson K, Cousineau A, Kendall CE. Patterns of cesarean birth among women living with HIV in Ontario: A cross-sectional, population-level study. Birth 2021; 48:357-365. [PMID: 33733473 DOI: 10.1111/birt.12545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/10/2020] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Canada, as is found globally, women of reproductive age are a growing demographic of persons living with HIV. Combination antiretroviral therapy (cART) treatment enables women living with HIV (WLWH) to become pregnant without perinatal transmission, and they are increasingly planning to become pregnant. Since 2014, Canadian guidelines no longer recommend routine elective cesarean birth (CB) for women who are virally suppressed and receiving cART. It is unknown whether their obstetric care has changed since this update. Our objective was to describe trends in cesarean births among WLWH in Ontario, Canada, over a 12-year period. METHODS Our research is co-led and codesigned with WLWH. We conducted a retrospective population-level cohort study using linked health administrative databases at ICES (formally, the Institute for Clinical and Evaluative Sciences). Participants were all women who gave birth in Ontario, between 2006/07 and 2017/18. We assessed their intrapartum characteristics and used multivariable regression to determine an association between HIV status and CB, controlling for sociodemographic and clinical variables. RESULTS Since 2014, the overall proportion of CB among WLWH remained stable and was higher than among women without HIV (39.9% vs 29.0%, P < 0.001). In addition, the proportion of primary CB decreased between 2006 and 2010 and between 2014 and 2018 (28.5%-19.3%), whereas the proportion of repeat CB increased (13.1%-20.5%, P = 0.013). CONCLUSIONS Because of decreasing HIV-related indications for CB, more practitioners may be following the guidelines for first-time mothers. Currently, no guidelines exist for care of WLWH with a previous CB, and opportunities for vaginal birth may be missed in this population.
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Affiliation(s)
- Esther S Shoemaker
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
| | - Tana Saiyin
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Stephanie Smith
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Mona Loutfy
- ICES, Ottawa, ON, Canada.,Infectious Disease Clinician Scientist, Departments of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Liz Darling
- ICES, Ottawa, ON, Canada.,Department of Midwifery, McMaster University, Hamilton, ON, Canada
| | - Mark Walker
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
| | - Steven Hawken
- ICES, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Christine Bibeau
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Breklyn Bertozzi
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Annette Fraleigh
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Gladys Kwaramba
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Kerrigan Johnson
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Ashlee Cousineau
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Claire E Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
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Oliwa T, Furner B, Schmitt J, Schneider J, Ridgway JP. Development of a predictive model for retention in HIV care using natural language processing of clinical notes. J Am Med Inform Assoc 2021; 28:104-112. [PMID: 33150369 DOI: 10.1093/jamia/ocaa220] [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: 05/15/2020] [Revised: 07/10/2020] [Accepted: 08/24/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Adherence to a treatment plan from HIV-positive patients is necessary to decrease their mortality and improve their quality of life, however some patients display poor appointment adherence and become lost to follow-up (LTFU). We applied natural language processing (NLP) to analyze indications towards or against LTFU in HIV-positive patients' notes. MATERIALS AND METHODS Unstructured lemmatized notes were labeled with an LTFU or Retained status using a 183-day threshold. An NLP and supervised machine learning system with a linear model and elastic net regularization was trained to predict this status. Prevalence of characteristics domains in the learned model weights were evaluated. RESULTS We analyzed 838 LTFU vs 2964 Retained notes and obtained a weighted F1 mean of 0.912 via nested cross-validation; another experiment with notes from the same patients in both classes showed substantially lower metrics. "Comorbidities" were associated with LTFU through, for instance, "HCV" (hepatitis C virus) and likewise "Good adherence" with Retained, represented with "Well on ART" (antiretroviral therapy). DISCUSSION Mentions of mental health disorders and substance use were associated with disparate retention outcomes, however history vs active use was not investigated. There remains further need to model transitions between LTFU and being retained in care over time. CONCLUSION We provided an important step for the future development of a model that could eventually help to identify patients who are at risk for falling out of care and to analyze which characteristics could be factors for this. Further research is needed to enhance this method with structured electronic medical record fields.
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Affiliation(s)
- Tomasz Oliwa
- Center for Research Informatics, University of Chicago, Chicago, Illinois, USA
| | - Brian Furner
- Center for Research Informatics, University of Chicago, Chicago, Illinois, USA
| | - Jessica Schmitt
- Department of Medicine, University of Chicago, Chicago, Illinois, USA.,Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - John Schneider
- Department of Medicine, University of Chicago, Chicago, Illinois, USA.,Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Jessica P Ridgway
- Department of Medicine, University of Chicago, Chicago, Illinois, USA.,Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
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Ravikumar S, D'Aquila E, Daud M, Skinner C, Hayes C, Seabrook T, Crittendon E, Daskalakis D, Lim S, Abraham B. Association between HIV clinic caseloads and viral load suppression in New York City. AIDS Care 2021; 34:647-654. [PMID: 33729059 DOI: 10.1080/09540121.2021.1896662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The relationship between HIV patient caseload and a clinic's ability to achieve viral load suppression (VLS) in their HIV patient population is not understood. The New York City Department of Health and Mental Hygiene (NYCDOHMH) administered a survey to clinics providing HIV care to people living with HIV (PLWH) in NYC in 2016. Clinics were stratified by quartiles of HIV patient caseload and dichotomized by whether ≥85% (n = 36) or <85% (n = 74) of their patients achieved VLS. Multivariable logistic regression adjusted for confounders of age, sex, ethnicity, and race. Provider to patient ratios (PPR) were calculated for each clinic as staffing full time equivalents per 100 HIV patients.
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Affiliation(s)
- Saiganesh Ravikumar
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA.,University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Erica D'Aquila
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Muhammad Daud
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Carly Skinner
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Craig Hayes
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Tyeirra Seabrook
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Erica Crittendon
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Demetre Daskalakis
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Sungwoo Lim
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Bisrat Abraham
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
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McKinney J, Jackson J, Sangi-Haghpeykar H, Hickerson L, Hawkins J, Peters Y, Levison J. HIV-Adapted Group Prenatal Care: Assessing Viral Suppression and Postpartum Retention in Care. AIDS Patient Care STDS 2021; 35:39-46. [PMID: 33571047 DOI: 10.1089/apc.2020.0249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Viral suppression and postpartum retention in care have far-reaching health implications for pregnant women living with HIV and their children, yet remain public health challenges. Prenatal care presents a unique opportunity to engage pregnant women in care. The purpose of this study is to evaluate whether group prenatal care is effective in impacting these outcomes for pregnant women living with HIV. A retrospective cohort study was performed of all women living with HIV who obtained prenatal care from a community-based health center between 2013 and 2019. Women who spoke English or Spanish, remained within the system, and had not participated in group prenatal care previously were included. Women self-selected a prenatal care model: 85 selected group care and 109 elected individual care. Group prenatal care followed a standard Centering Pregnancy® curriculum with the addition of HIV-related topics. The primary outcomes of the study were viral suppression (viral load <20 copies/mL) and postpartum retention in care (attending at least one or two visits with HIV primary care within 12 months postpartum). After adjusting for potential confounding factors, women who participated in group prenatal care were significantly more likely to have at least one HIV primary care visit postpartum {adjusted odds ratio (aOR) = 2.71 [95% confidence interval (CI 1.14-6.46)]; p = 0.024}, and had a trend for achieving viral suppression by the time of delivery [aOR = 2.29 (95% CI 0.94-5.55); p = 0.068]. We have demonstrated that group prenatal care for pregnant women living with HIV is feasible and effective, with positive impacts on retention in care and viral suppression, factors that affect long-term outcomes from patients living with HIV.
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Affiliation(s)
- Jennifer McKinney
- Department of Maternal Fetal Medicine and Baylor College of Medicine, Houston, Texas, USA
| | - Josef Jackson
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Haleh Sangi-Haghpeykar
- Department of Maternal Fetal Medicine and Baylor College of Medicine, Houston, Texas, USA
| | - Latia Hickerson
- Department of Obstetrics and Gynecology, Harris Health System, Houston, Texas, USA
| | - Joanna Hawkins
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Yvette Peters
- Department of Obstetrics and Gynecology, Harris Health System, Houston, Texas, USA
| | - Judy Levison
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
- Department of Obstetrics and Gynecology, Harris Health System, Houston, Texas, USA
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Momplaisir FM, Fortune K, Nkwihoreze H, Groves AK, Aaron E, Jemmott JB. Outcome expectancies toward adherence to antiretroviral therapy for pregnant and postpartum women with HIV. WOMEN'S HEALTH 2021; 17:17455065211061094. [PMID: 34812095 PMCID: PMC8640315 DOI: 10.1177/17455065211061094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives: Adherence to antiretroviral therapy and retention in care significantly drop for women with HIV during the postpartum period. We have a limited understanding of how outcome expectancies influence maternal adherence and retention in care. Methods: Women with HIV from an urban academic clinic completed in-depth interviews in the third trimester and at 3 to 9 months postpartum to evaluate outcome expectancies, facilitators, and barriers to antiretroviral therapy adherence and retention in care. Interviews were audio-recorded and analyzed for content. A codebook was created using deductive (based on the theory of reasoned action approach) and inductive (based on emergent themes) codes. Results: We conducted 21 interviews with 12 women during pregnancy and 9 women during postpartum period. Participants had a mean age of 31 (standard deviation = 5.7) and most were African American (75%). Outcome expectancies centered mostly around pediatric health to prevent perinatal transmission of HIV and to be healthy to raise their children. Other outcome expectancies included preventing transmission of HIV to their partners. Social support from partners served as a strong facilitator as they helped routinize pill-taking behaviors, provided reminders, and decreased social isolation. Barriers to antiretroviral therapy adherence included depression, the disruption of scheduling routines, and the physical demands associated with the postpartum period. These barriers were accentuated for women with multiple children. Conclusion: Women’s commitment to pediatric health was the primary motive for antiretroviral therapy adherence. Partners also served an important role. These findings suggest that interventions linking pediatric and maternal health, and partner support can improve maternal HIV treatment in the postpartum period.
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Affiliation(s)
- Florence M Momplaisir
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Hervette Nkwihoreze
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Allison K Groves
- Department of Community and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Erika Aaron
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - John B Jemmott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
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12
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Contraception methods used among women with HIV starting antiretroviral therapy in a large United States clinical trial, 2009-2011. Contraception 2020; 103:225-231. [PMID: 33189709 DOI: 10.1016/j.contraception.2020.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE(S) We describe contraception and dual method use among women with HIV initiating antiretroviral therapy (ART) in a U.S. clinical trial and examine associated factors. STUDY DESIGN We analyzed data from ART-naïve women aged 45 years and under initiating one of 3 regimens as part of A5257 (May 2009-June 2011) which required that women at risk for pregnancy use contraception. We classified self-reported methods as more effective (Tier 1 [intrauterine device, hysterectomy, permanent contraception] and Tier 2 [hormonal rings, patches, injections, pills]) versus less effective (Tier 3 [condoms alone] and Tier 4 [withdrawal, none]). We used logistic regression models to assess associations with use of (a) more effective, and (b) dual methods (condoms with a more effective method). RESULTS Of 285 women, majority were Black (59%), had annual income <$20,000 (54%), and had government insurance (68%). The most common contraceptive methods reported at baseline were permanent contraception (37%), male condoms alone (31%), and injectable progestin (8%); 41% and 16% reported Tier 1 and 2 use, respectively; 36% reported dual method use. Use of more effective and dual methods did not change 48 and 96 weeks after ART initiation (p > 0.05). In multivariable analyses, baseline use of more effective and dual methods was associated with age at least 40 years versus 18 to 29 years (odds ratio [OR] 4.46, 95% confidence interval [CI] 2.12, 9.35) and having at least one child (OR 2.31, 95%CI 1.27, 4.20). CONCLUSIONS In women initiating modern ART in a clinical trial, permanent contraception was common, while use of other more effective contraceptive methods was low and did not change after ART initiation. Efforts are needed to improve integration of family planning services for women within the context of HIV clinical trials. IMPLICATIONS The findings highlight the importance of improving integration of HIV and family planning services, including in the context of clinical trials.
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Cruz Zonenschein AC, João Filho EC, Cruz MLS, Gouvea MI, Teixeira MDLB, Fuller T, Dias MAB. Treatment dropout after pregnancy: a study of women living with HIV in Rio de Janeiro. AIDS Care 2020; 32:1283-1289. [PMID: 32338056 DOI: 10.1080/09540121.2020.1755011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite the investment in prevention of mother-to-child transmission of HIV, there is still little data about the proportion of women that are retained in treatment after pregnancy in Brazil. Research worldwide shows that a significant proportion of women drop out of treatment after pregnancy. The aim of this study was to identify factors associated with treatment dropout of women that received prenatal care at a federal hospital in Rio de Janeiro between 2016 and 2017 and abandoned treatment after pregnancy. This was a retrospective cohort study using data on prescription refills and hospital medical records. Cross-sectional analysis of data from 454 women showed that 18% were not on cART after pregnancy. Illicit drug use during pregnancy, being less than 35 years old, and being aware of HIV diagnosis before conceiving but not taking cART were factors associated with treatment interruption postpartum. The high prevalence of interruption of HIV treatment after pregnancy suggests that there is a need for better post-natal care to increase adherence in this population.
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Affiliation(s)
- Ana Clara Cruz Zonenschein
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.,Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Esaú Custódio João Filho
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | | | - Maria Isabel Gouvea
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.,Instituto Nacional de Infectologia, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Maria de Lourdes Benamor Teixeira
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.,Instituto Nacional de Infectologia, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Trevon Fuller
- Institute of the Environment and Sustainability, University of California, Los Angeles, CA, USA
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