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Ryan P, Manzano S, Deihim-Rahampour N, Cuevas G, Martin-Gonzalez L, Gonzalez-Baeza A, Torres P, Lazarus JV, Torres-Macho J, Valencia J, Sanchez-Conde M. HIV-infected Latin American asylum seekers in Madrid, Spain, 2022: A prospective cohort study from a major gateway in Europe. Euro Surveill 2024; 29:2300692. [PMID: 39027943 PMCID: PMC11258946 DOI: 10.2807/1560-7917.es.2024.29.29.2300692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/28/2024] [Indexed: 07/20/2024] Open
Abstract
BackgroundRecent migration trends have shown a notable entry of Latin American asylum seekers to Madrid, Spain.AimTo characterise the profile of asylum-seeking Latin American migrants who are living with HIV in Spain and to outline the barriers they face in accessing HIV treatment.MethodsA prospective cohort study was conducted between 2022 and 2023 with a 6-month follow-up period. Latin American asylum seekers living with HIV were recruited mainly from non-governmental organisations and received care at an HIV clinic in a public hospital in Madrid.ResultsWe included 631 asylum seekers. The primary countries of origin were Colombia (30%), Venezuela (30%) and Peru (18%). The median age was 32 years (interquartile range (IQR): 28-37), and 553 (88%) were cis men of which 94% were men who have sex with men. Upon their arrival, 49% (n = 309) lacked social support, and 74% (n = 464) faced barriers when attempting to access the healthcare system. Upon entry in Europe, 500 (77%) participants were taking antiretroviral therapy (ART). At their first evaluation at the HIV clinic, only 386 (61%) had continued taking ART and 33% (n = 209) had detectable plasma HIV-1 RNA levels. Six months later, 99% took ART and 98% had achieved an undetectable viral load.ConclusionsLatin American asylum seekers living with HIV in Madrid, Spain encountered barriers to healthcare and to ART. One-third of these individuals presented detectable HIV viral load when assessed in the HIV clinic, highlighting this as an important public health issue.
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Affiliation(s)
- Pablo Ryan
- Universidad Complutense de Madrid (UCM), Madrid, Spain
- Hospital Universitario Infanta Leonor, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- These authors contributed equally to this work and share first authorship
| | - Samuel Manzano
- These authors contributed equally to this work and share first authorship
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Neda Deihim-Rahampour
- Fundación Estatal, Salud, Infancia y Bienestar Social, F.S.P. (FSCAI), Madrid, Spain
| | | | | | | | - Pedro Torres
- Fundación para la Investigación e Innovación Biomédica H.U. Infanta Leonor y H.U. Sureste, Madrid, Spain
| | - Jeffrey V Lazarus
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, United States
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Juan Torres-Macho
- Universidad Complutense de Madrid (UCM), Madrid, Spain
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Jorge Valencia
- These authors contributed equally to this work and share last authorship
- Fundación para la Investigación e Innovación Biomédica H.U. Infanta Leonor y H.U. Sureste, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Matilde Sanchez-Conde
- These authors contributed equally to this work and share last authorship
- Hospital Universitario Ramon y Cajal, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Ham L, Montoya JL, Serrano V, Yeager S, Paltin D, Pasipanodya EC, Marquine MJ, Hoenigl M, Ramers CB, Kua J, Moore DJ. High Psychosocial Burden Relates to Poorer Antiretroviral Treatment Adherence Among Black/African American People with HIV. AIDS Patient Care STDS 2023; 37:103-113. [PMID: 36689195 PMCID: PMC9963477 DOI: 10.1089/apc.2022.0180] [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] [Indexed: 01/24/2023] Open
Abstract
Black/African American communities continue to be disproportionately impacted by HIV with Black people with HIV (PWH) exhibiting poorer outcomes along the HIV treatment cascade. Psychosocial burden may, in part, explain these health disparities among PWH. We implemented a culturally adapted intervention [individualized Texting for Adherence Building (iTAB)] to improve ART adherence among 89 Black PWH in San Diego, CA. We aimed to (1) characterize psychosocial risk factors (depression, negative life events, discrimination, medical mistrust) hypothesized to be barriers to HIV outcomes among Black PWH and (2) determine if these factors influence intervention engagement, HIV outcomes, and self-reported physical and mental health. We identified three levels of psychosocial burden (low, moderate, high) through hierarchical cluster analysis. Participants in the high burden cluster (n = 25) experienced the highest levels of depression, negative life events, and discrimination, in addition to the poorest intervention outcomes, HIV outcomes, and physical and mental health compared to low and moderate burden clusters. Participants in the low (n = 29) burden cluster had less medical mistrust than the moderate (n = 34) and high burden clusters, but low and moderate clusters did not differ on any outcomes. Overall, self-reported ART adherence was 83%, which is above estimates of ART adherence in the Western region of the United States. The iTAB intervention shows promise in improving HIV-related outcomes among Black PWH with low to moderate psychosocial burden; however, additional supports may need to be identified for those with high psychosocial burden.
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Affiliation(s)
- Lillian Ham
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Jessica L. Montoya
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- Department of Psychiatry and University of California San Diego, La Jolla, California, USA
| | - Vanessa Serrano
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Samantha Yeager
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Dafna Paltin
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | | | - Maria J. Marquine
- Geriatrics Division, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Martin Hoenigl
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Medical University of Graz, Graz, Austria
| | - Christian B. Ramers
- Laura Rodriguez Research Institute, Family Health Centers, San Diego, California, USA
| | - John Kua
- Laura Rodriguez Research Institute, Family Health Centers, San Diego, California, USA
| | - David J. Moore
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- Department of Psychiatry and University of California San Diego, La Jolla, California, USA
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3
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Gelhorn H, Garris C, Arthurs E, Spinelli F, Cutts K, Chua GN, Collacott H, Lebouché B, Lowman E, Rice H, Heidenreich S. Patient and Physician Preferences for Regimen Attributes for the Treatment of HIV in the United States and Canada. J Pers Med 2022; 12:jpm12030334. [PMID: 35330334 PMCID: PMC8948790 DOI: 10.3390/jpm12030334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 02/18/2022] [Indexed: 11/24/2022] Open
Abstract
A long-acting injectable (LAI) antiretroviral therapy (ART) regimen is now available as a treatment option for virologically suppressed adults with HIV-1. This study assessed preference for a LAI regimen using an online survey of virally suppressed people living with HIV (PLWH) and physicians treating HIV in the US and Canada. Preference was elicited in a discrete choice experiment (DCE) with three choice options (switch to a LAI regimen, switch to another daily oral ART regimen, or stay on their current daily oral ART regimen) and four treatment attributes. A total of 553 PLWH and 450 physicians completed the survey. From the DCE results, 59% of PLWH were predicted to prefer a LAI over an alternative oral ART or staying on their current oral treatment, and 55–66% of physicians were predicted to recommend LAI for PLWH, depending on the treatment challenge scenario presented. PLWH indicated LAI would remove daily reminders of HIV (75%) and reduce feelings of being stigmatized (68%). A majority of PLWH and physicians preferred a LAI over oral ART to overcome treatment challenges such as daily pill burden and adherence. These benefits of LAI ART along with preferences of PLWH and physicians can help to inform ART choice.
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Affiliation(s)
| | - Cindy Garris
- US Health Outcomes, ViiV Healthcare, Research Triangle Park, NC 27709, USA
- Correspondence:
| | - Erin Arthurs
- GlaxoSmithKline, Mississauga, ON L5N 6L4, Canada;
| | - Frank Spinelli
- North American Medical Affairs, ViiV Healthcare, Research Triangle Park, NC 27709, USA;
| | | | - Gin Nie Chua
- Evidera, London W6 8BJ, UK; (G.N.C.); (H.C.); (S.H.)
| | | | - Bertrand Lebouché
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H3H 2R9, Canada;
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC H3S 1Z1, Canada
| | - Erik Lowman
- Midland Medical Center, Oakland Park, FL 33334, USA;
| | - Howard Rice
- Rice Medical Group, Mountain View, CA 94040, USA;
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4
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Edwards RJ, Lyons N, Samaroo-Francis W, Lavia LO, John I, Todd S, Edwards J, Boyce G. The expansion of a patient tracer programme to identify and return patients loss to follow up at a large HIV clinic in Trinidad. AIDS Res Ther 2021; 18:20. [PMID: 33892747 PMCID: PMC8063284 DOI: 10.1186/s12981-021-00341-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients who default from HIV care are usually poorly adherent to antiretroviral treatment which results in suboptimal viral suppression. The study assessed the outcomes of retention in care and viral suppression by expansion of an intervention using two patient tracers to track patients lost to follow up at a large HIV clinic in Trinidad. METHODS Two Social Workers were trained as patient tracers and hired for 15 months (April 2017-June 2018) to call patients who were lost to follow up for 30 days or more during the period July 2016-May 2018 at the HIV clinic Medical Research Foundation of Trinidad and Tobago. RESULTS Over the 15-month period, of the of 2473 patients who missed their scheduled visits for 1 month or more, 261 (10.6%) patients were no longer in active care-89 patients dead, 65 migrated, 55 hospitalized, 33 transferred to another treatment clinic and 19 incarcerated. Of the remaining 2212 patients eligible for tracing, 1869 (84.5%) patients were returned to care, 1278 (68.6%) were virally unsuppressed (viral load > 200 copies/ml) and 1727 (92.4%) were re-initiated on ART. Twelve months after their return, 1341 (71.7%) of 1869 patients were retained in care and 1154 (86.1%) of these were virally suppressed. Multivariate analysis using logistic regression showed that persons were more likely to be virally suppressed if they were employed (OR, 1.39; 95% CI 1.07-1.80), if they had baseline CD4 counts < 200 cells/mm3 (OR, 1.71; 95% CI 1.26-2.32) and if they were retained in care at 12 months (OR, 2.48; 95% CI 1.90-3.24). Persons initiated on ART for 4-6 years (OR, 3.09; 95% CI 1.13-8.48,), 7-9 years (OR, 3.97; 95% CI 1.39-11.31), > 10 years (OR, 5.99; 95% CI 1.74-20.64 were more likely to be retained in care. CONCLUSIONS Patient Tracing is a feasible intervention to identify and resolve the status of patients who are loss to follow up and targeted interventions such as differentiated care models may be important to improve retention in care.
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5
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Stecher C, Linnemayr S. Promoting antiretroviral therapy adherence habits: a synthesis of economic and psychological theories of habit formation. AIDS 2021; 35:711-716. [PMID: 33306553 PMCID: PMC9207816 DOI: 10.1097/qad.0000000000002792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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6
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Sutton SS, Magagnoli J, H Cummings T, Hardin JW. Adherence after treatment switch from a multiple tablet antiretroviral regimen to a single tablet antiretroviral regimen. Therapie 2021; 76:567-576. [PMID: 33589316 DOI: 10.1016/j.therap.2020.12.017] [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: 06/21/2019] [Revised: 09/01/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate adherence after treatment switch from a multiple-tablet regimen (MTR) to a single-tablet regimen (STR) in a national cohort of human immunodeficiency virus (HIV) patients. METHODS This retrospective observational cohort, with data spanning January 1, 2000 to March 1, 2019, consisted of HIV infected patients receiving treatment from the Veterans Affairs (VA) health system. Patients were required to have a complete MTR regimen after January 1, 2006 and before December 31, 2018 with at least 60 days of treatment. Medical and pharmacy data were analyzed from the Veterans Affairs Informatics and Computing Infrastructure (VINCI) database. Statistical analyses examined differences in adherence when patients switched to a STR. Patients who switched to a STR were propensity score matched to those who never switched. Descriptive statistics and multivariable linear mixed effects models were utilized to evaluate differences in adherence between MTR and STR treatment in both the matched and unmatched samples. RESULTS A total of 5021 patients met the study criteria, 3906 patients in the MTR only cohort and 1115 patients in the switch to STR cohort. The unmatched cohorts were similar in terms of sex, index year, drug/alcohol abuse, and viral load but differed in terms of race, Charlson comorbidity and mental health conditions. The one to one propensity score matched cohort included 2230 patients, 1115 patients in each cohort. Among patients that switched from a MTR to STR, adherence increased on average from 65.9% to 78.12%. We find overall adherence is higher with STRs than with MTR HIV regimens in both the matched and unmatched sample and adherence declines with time for both STR and MTR regimens. CONCLUSIONS Switching to a STR is associated with higher adherence compared to MTR among patients with HIV treated with antiretrovirals. However, adherence declines over time with both STR and MTR regimens.
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Affiliation(s)
- Scott S Sutton
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, College of Pharmacy, 715 Sumter Street, Columbia, SC 29208, USA
| | - Joseph Magagnoli
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, College of Pharmacy, 715 Sumter Street, Columbia, SC 29208, USA.
| | - Tammy H Cummings
- Dorn Research Institute, Columbia VA Health Care System , 29209, Columbia, SC, USA
| | - James W Hardin
- Department of Epidemiology & Biostatistics, University of South Carolina, 29208, Columbia, SC, USA
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7
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Furtado Dos Santos S, Almeida-Brasil CC, Costa JDO, Reis EA, Afonso Cruz M, Silveira MR, Ceccato MDGB. Does switching from multiple to single-tablet regimen containing the same antiretroviral drugs improve adherence? A group-based trajectory modeling analysis. AIDS Care 2020; 32:1268-1276. [PMID: 32148071 DOI: 10.1080/09540121.2020.1736258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Combination Antiretroviral Therapy (cART) in single-tablet regimens (STR) is a simplification strategy that can potentially improve medication adherence and clinical outcomes. We conducted a retrospective cohort study of 1206 patients using efavirenz, tenofovir and lamivudine in multiple-tablet regimen who switched to the STR containing the same active ingredients in a southeast metropolis in Brazil. We measured adherence using the proportion of days covered (PDC≥95%) and evaluated this outcome before and after the switch using paired non-parametric statistics. Additionally, we used group-based trajectory modeling to identify adherence patterns to cART for each period and evaluate the migration behavior of patients between the trajectory groups. We observed a 14% increase in the proportion of adherent patients after switching to STR and a 6.2% increase in the proportion of patients with CD4 count>500 cells/μl (p < 0.001), without changes in viral load outcomes. We identified four adherence trajectories in each period. Most patients (60%, n = 722) migrated towards a group with better adherence trajectory or remained in the trajectory group with the highest probability of adherence after the switch. Our findings suggest that the implementation of the STR had a positive impact on adherence and CD4 count. This may potentially improve virologic outcomes later on treatment.
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Affiliation(s)
- Simone Furtado Dos Santos
- Department of Social Pharmacy, School of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Celline Cardoso Almeida-Brasil
- Department of Social Pharmacy, School of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Juliana de Oliveira Costa
- Department of Social and Preventive Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Edna Afonso Reis
- Department of Statistics, Institute of Exact Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Márcio Afonso Cruz
- Graduation in Information Systems and Knowledge Management, Fundação Mineira de Educação e Cultura, Brazil
| | - Micheline Rosa Silveira
- Departamento de Farmácia Social - Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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8
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Grant C, Bergin C, O’Connell S, Cotter J, Ní Cheallaigh C. High-Cost, High-Need Users of Acute Unscheduled HIV Care: A Cross-Sectional Study. Open Forum Infect Dis 2020; 7:ofaa037. [PMID: 32110681 PMCID: PMC7041127 DOI: 10.1093/ofid/ofaa037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/30/2020] [Indexed: 11/22/2022] Open
Abstract
Background High-cost, high-need users are defined as patients who accumulate large numbers of emergency department visits and hospital admissions that might have been prevented by relatively inexpensive early interventions and primary care. This phenomenon has not been previously described in HIV-infected individuals. Methods We analyzed the health records of HIV-infected individuals using scheduled or unscheduled inpatient or outpatient health care in St James’s Hospital, Dublin, Ireland, from October 2014 to October 2015. Results Twenty-two of 2063 HIV-infected individuals had a cumulative length of stay >30 days in the study period. These individuals accrued 99 emergency department attendances and 1581 inpatient bed days, with a direct cost to the hospital of >€1 million during the study period. Eighteen of 22 had potentially preventable requirements for unscheduled care. Two of 18 had a late diagnosis of HIV. Sixteen of 18 had not been successfully engaged in outpatient HIV care and presented with consequences of advanced HIV. Fourteen of 16 of those who were not successfully engaged in care had ≥1 barrier to care (addiction, psychiatric disease, and/or homelessness). Conclusions A small number of HIV-infected individuals account for a high volume of acute unscheduled care. Intensive engagement in outpatient care may prevent some of this usage and ensuing costs.
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Affiliation(s)
| | - Colm Bergin
- St James’s Hospital, Dublin, Ireland
- Trinity College, Dublin, Ireland
| | | | | | - Clíona Ní Cheallaigh
- St James’s Hospital, Dublin, Ireland
- Trinity College, Dublin, Ireland
- Correspondence: Clíona Ní Cheallaigh, MB, MRCP, PhD, Department of Clinical Medicine, Trinity Centre for Health Sciences, St James’s Hospital, Dublin 8, Ireland ()
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9
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Steinbrink J, Imlay H, Rao K, Riddell J. Identifying causes of persistent HIV viremia in adult patients at an academic medical center. SAGE Open Med 2019; 7:2050312119851006. [PMID: 31205698 PMCID: PMC6537052 DOI: 10.1177/2050312119851006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/24/2019] [Indexed: 12/05/2022] Open
Abstract
Objectives: Despite many advances in medicine, not all individuals with HIV are able to achieve complete virologic suppression. This retrospective study identifies variables associated with persistent HIV viremia in an academic clinic. Methods: We studied 66 HIV-infected patients with a viral load of >200 copies/mL over 1 year, with controls matched 1:1 via a propensity score utilizing age at diagnosis, era of diagnosis, gender, and initial CD4 count. We collected data on multiple variables including medications, adherence, comorbidities, hospitalizations, and insurance status. Conditional logistic regression was used for unadjusted and adjusted analyses. Results: A total of 66 viremic cases/matched controls were included. Fewer viremic patients were on antiretroviral therapy for all 12 months (45% vs 77%; odds ratio: 0.33, p = .018) and fewer were of white race (52% vs 70%; odds ratio: 0.49, p = .053). Hospitalization (11% vs 3%; odds ratio: 10, p = .028), underinsurance (20% vs 1%; odds ratio: 5.87, p = .022), and conflicting personal beliefs about their disease (17% vs 3%; odds ratio: 5.5, p = .027) were more common in viremic patients. Psychiatric illness increased the odds of viremia in patients who had four or more visits (odds ratio: 1.63/6.64 with four/five clinic visits, respectively). Conclusion: Psychiatric illness is an important contributor to the presence of persistent viremia in HIV-infected patients and deserves further study.
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Affiliation(s)
- Julie Steinbrink
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Division of Infectious Diseases, Duke University Hospital, Durham, NC, USA
| | - Hannah Imlay
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Krishna Rao
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
| | - James Riddell
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
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Belenky N, Pence BW, Cole SR, Dusetzina SB, Edmonds A, Oberlander J, Plankey M, Adedimeji A, Wilson TE, Cohen J, Cohen MH, Milam JE, Adimora AA. Impact of Medicare Part D on mental health treatment and outcomes for dual eligible beneficiaries with HIV. AIDS Care 2019; 31:505-512. [PMID: 30189747 PMCID: PMC6342646 DOI: 10.1080/09540121.2018.1516283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Abstract
Depression is common among women with HIV and untreated depression can result in poor quality of life and worsen HIV outcomes. Women with HIV who are dually enrolled in Medicaid and Medicare faced a potential disruption in medication access when Medicare Part D was implemented in 2006. The goal of this study was to estimate the effects of Medicare Part D implementation on antidepressant use, depressive symptoms, and hospitalization in Medicaid-Medicare dual eligible women with HIV. This study used 2003-2008 data from the Women's Interagency HIV Study. The effects of Medicare Part D were estimated using a difference-in-differences approach, adjusting for temporal trends using a matched control group of Medicaid-only enrollees. Before Medicare Part D implementation, dual eligibles differed from Medicaid-only enrollees in antidepressant use and hospitalization, despite having identical prescription drug coverage through Medicaid. For dual enrollees, the transition to Medicare Part D was not associated with changes in antidepressant use, depressive symptoms, or hospitalization. We did not find disruptive effects on antidepressant use and related outcomes among dual eligibles in this study. Stable antidepressant use may be due to better access to medical care for dual eligibles through Medicare both before and after Medicare Part D implementation, which may have eclipsed any effects of the transition. It may also signal that classification of antidepressants as a protected drug class under Medicare Part D was effective in preventing psychiatric medication disruption.
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Affiliation(s)
- Nadya Belenky
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephen R. Cole
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stacie B. Dusetzina
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jonathan Oberlander
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Social Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael Plankey
- Division of Infectious Diseases and Travel Medicine, Department of Medicine, Georgetown University, Washington, DC
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Tracey E. Wilson
- Department of Community Health Sciences School of Public Health, State University of New York, Downstate Medical Center, Brooklyn, New York
| | - Jennifer Cohen
- Department of Clinical Pharmacy, University of California, San Francisco, California
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital and Rush University, Chicago, Illinois
| | - Joel E. Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Adaora A. Adimora
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, NC
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11
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Hines DM, Ding Y, Wade RL, Beaubrun A, Cohen JP. Treatment Adherence And Persistence Among HIV-1 Patients Newly Starting Treatment. Patient Prefer Adherence 2019; 13:1927-1939. [PMID: 31806941 PMCID: PMC6844203 DOI: 10.2147/ppa.s207908] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 08/01/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To assess adherence and persistence with first-line single-tablet regimen (STR) and multi-tablet regimen (MTR) antiretroviral therapy (ART) in newly treated HIV-1 patients. METHODS Retrospective analysis of longitudinal pharmacy claims among US patients initiating ART between 1/1/2016 and 5/31/2016 (index date was defined by first ART claim for STRs, and fill date for the last therapy in the regimen for MTRs). Adherence was assessed over a 12-month period and reported as the proportion of adherent or non-adherent (defined as ≤5-day and > a 5-day gap between successive fills, respectively) patients. Sensitivity analysis using ≤7-day and ≤14-day gap thresholds to define adherence was performed. Persistence was assessed as the number of days on therapy from index until treatment discontinuation (>90 day gap in therapy). Kaplan-Meier curves and Cox Proportional Hazard models were generated to evaluate discontinuation rates. Assessments were performed on STRs vs MTRs overall and by regimen. RESULTS Patients initiating ART (STR: n=10,623; MTR: n=2504) had a mean age of 42.8 years; 76.0% were male. STR patients were >2 times more likely to be adherent over 12 months than MTR patients (24.9% vs 11.7%, respectively). Patients using EVG/COBI/FTC/TAF had greater adherence than those using other STRs. Among MTRs, patients were more adherent with FTC/TDF+DTG (15.1%) than other MTRs. Persistence was also greater with STRs, with MTR patients being 61% more likely to discontinue therapy. Persistence was best for FTC/TAF-based regimens. Predictors of treatment discontinuation included younger age, female gender, and Medicare or Medicaid insurance type. CONCLUSION Patients receiving STRs were significantly less likely to discontinue therapy and were more adherent with their regimens, providing further evidence of greater adherence and persistence with STRs versus MTRs. However, there was a large proportion of patients who interrupted or discontinued treatment. Further research examining treatment patterns beyond first line is warranted.
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Affiliation(s)
- Dionne M Hines
- Health Economics and Outcomes Research, IQVIA Inc, Plymouth Meeting, PA, USA
| | - Yao Ding
- Health Economics and Outcomes Research, IQVIA Inc, Plymouth Meeting, PA, USA
| | - Rolin L Wade
- Health Economics and Outcomes Research, IQVIA Inc, Plymouth Meeting, PA, USA
- Correspondence: Rolin L Wade IQVIA Inc., One IMS Drive, Plymouth Meeting, PA19462, USATel +1 215 434 812 2958 Email
| | - Anne Beaubrun
- Health Economics and Outcomes Research, Gilead Sciences Inc, Foster City, CA, USA
| | - Joshua P Cohen
- Institute for Clinical Research and Health Policy Studies, Tufts University, Boston, MA, USA
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12
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Kapadia SN, Grant RR, German SB, Singh B, Davidow AL, Swaminathan S, Hodder S. HIV virologic response better with single-tablet once daily regimens compared to multiple-tablet daily regimens. SAGE Open Med 2018; 6:2050312118816919. [PMID: 30574301 PMCID: PMC6295695 DOI: 10.1177/2050312118816919] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/12/2018] [Indexed: 11/16/2022] Open
Abstract
Background Single-tablet regimens are preferred prescription choices for HIV treatment, but there are limited outcomes data comparing single-tablet regimens to multiple-tablet regimens. Methods We retrospectively assessed treatment-naïve patients at a single urban HIV clinic in the United States for viral load suppression at 6 and 12 months after initiating either single-tablet or multiple-tablet regimens. Multivariate regression was performed to obtain relative risks and adjust for potential confounders. Results Of 218 patients, 47% were on single-tablet regimens and 53% on multiple-tablet regimens; 77% of single-tablet regimen patients had undetectable viral load at 6 months compared to 61% of multiple-tablet regimen patients (p = 0.012). At 12 months, 82% on single-tablet regimens and 66% on multiple-tablet regimens (p = 0.019) had undetectable viral load. Relative risk of any detectable viral load was 1.6 (95% confidence interval: 1.1-2.5) for patients on multiple-tablet regimens compared to single-tablet regimens at 6 months, and 2.2 (95% confidence interval: 1.2-4.0) at 12 months. Conclusion Single-tablet regimens may provide better virologic control than multiple-tablet regimens in urban HIV-infected persons.
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Affiliation(s)
- Shashi N Kapadia
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | | | - Susan B German
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Amy L Davidow
- Department of Biostatistics, Rutgers School of Public Health, Newark, NJ, USA
| | - Shobha Swaminathan
- Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Sally Hodder
- West Virginia Clinical and Translational Science Institute, West Virginia University, Morgantown, WV, USA
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13
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Abstract
Antiretroviral therapy (ART) is a combination treatment involving three or more antiretroviral agents for patients with HIV. ART has reduced HIV-related morbidity and mortality via single-tablet or multiple-tablet regimens. Single-tablet regimens, with their lower pill burdens, have demonstrated higher adherence rates, improved viral suppression, and reduced resource use compared with multiple-tablet regimens. In addition, select newer ARTs do not require the high levels of adherence for viral load suppression required by older ART formulations.
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14
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Jaworsky D, Phillips P, Cui Z, Chau W, Colley G, Dutta R, Yip B, Kremer H, Eyawo O, Montaner JS, Hull MW. Trends in discharges from the HIV/AIDS ward at a tertiary Canadian Hospital from 2005 to 2014. AIDS Care 2018; 30:1099-1106. [PMID: 29397766 DOI: 10.1080/09540121.2018.1434121] [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: 10/18/2022]
Abstract
Advances in HIV therapies have transformed HIV infection into a manageable chronic disease. Accordingly, hospital admission trends among people living with HIV may have evolved over time. This study describes discharge diagnoses from the dedicated HIV/AIDS ward at St. Paul's Hospital in Vancouver, Canada. A retrospective database review of admissions to the HIV/AIDS ward between 1 July 2005 and 30 June 2014 was conducted. Primary discharge diagnoses were manually categorized by condition and reviewed by two physicians. Data were analysed in 12-month intervals. Trends were fitted using generalized estimating equations. A total of 1595 individuals with 3919 admissions were included. The median age was 46 years, 77.1% identified as male, 63.6% had a history of injection drug use (IDU) and 61.8% had a history of hepatitis C virus exposure. The most common reasons for admission included non-opportunistic respiratory tract infections (18.2%), cellulitis (7.3%), gastroenteritis (6.0%), endocarditis/bacteremia (4.9%) and bone/joint infections (3.5%). The proportion of admissions attributable to opportunistic infections declined from 16.2% in 2005 to 5.5% in 2014. Over this period, the proportion of individuals on antiretroviral therapy and with virologic suppression increased (odds ratio 1.19 [95% confidence interval 1.16, 1.23] and 1.22 [95% confidence interval 1.17, 1.26], respectively). These results demonstrate a decline in admissions related to opportunistic infections but increased admissions due to other infections among people living with HIV. Preventive and outpatient care for respiratory infections and complications of IDU may further improve health care outcomes and decrease hospital admissions in this setting.
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Affiliation(s)
- Denise Jaworsky
- a Department of Medicine , University of British Columbia , Vancouver , BC , Canada
| | - Peter Phillips
- a Department of Medicine , University of British Columbia , Vancouver , BC , Canada.,b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada.,c Division of Infectious Diseases , St. Paul's Hospital , Vancouver , BC , Canada
| | - Zishan Cui
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
| | - William Chau
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
| | - Guillaume Colley
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
| | - Raja Dutta
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
| | - Benita Yip
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
| | - Hayden Kremer
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
| | - Oghenowede Eyawo
- b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada.,d Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
| | - Julio Sg Montaner
- a Department of Medicine , University of British Columbia , Vancouver , BC , Canada.,b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
| | - Mark W Hull
- a Department of Medicine , University of British Columbia , Vancouver , BC , Canada.,b British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
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15
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Rowell-Cunsolo TL, Liu J, Shen Y, Britton A, Larson E. The impact of HIV diagnosis on length of hospital stay in New York City, NY, USA. AIDS Care 2018; 30:591-595. [PMID: 29338331 DOI: 10.1080/09540121.2018.1425362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
While hospitalizations among people living with human immunodeficiency virus (PLWH) have been elevated in the past compared to their uninfected counterparts, the introduction of antiretroviral therapy (ART) has resulted in great strides in controlling symptomatic infection. However, research largely overlooks important differences among HIV-infected individuals, primarily PLWH who are symptomatic versus those who are asymptomatic. We conducted a retrospective study assessing the length of hospital stay among 717,237 admissions from three hospitals in the New York City area. Using zero-truncated negative binomial regression we documented trends in length of hospital stay among individuals who are HIV positive (with symptoms versus those without symptoms) compared to HIV-negative patients over nine consecutive years, from 2006 to 2014. Approximately 0.85% of the admissions were infected with asymptomatic HIV (n = 6,131), while 1.43% of admissions were infected with symptomatic HIV (n = 10,271). The length of stay (LOS) among symptomatic HIV-infected admissions was 32.0% (95% CI: 29.7%-34.2%) longer than LOS in the general admissions. The mean LOS dropped about 1.5% (95% CI: 1.5%-1.6%) per year in the study sample. The LOS in inpatients with asymptomatic HIV had the same LOS as the general inpatient population. Our findings highlight the need for comprehensive strategies to reduce length of hospitalization among HIV-infected individuals.
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Affiliation(s)
| | - Jianfang Liu
- a Columbia University School of Nursing , New York , NY , USA
| | - Yanhan Shen
- b Columbia University Mailman School of Public Health , New York , NY , USA
| | - Amber Britton
- b Columbia University Mailman School of Public Health , New York , NY , USA
| | - Elaine Larson
- a Columbia University School of Nursing , New York , NY , USA
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16
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Hirasen K, Evans D, Maskew M, Sanne IM, Shearer K, Govathson C, Malete G, Kluberg SA, Fox MP. The right combination - treatment outcomes among HIV-positive patients initiating first-line fixed-dose antiretroviral therapy in a public sector HIV clinic in Johannesburg, South Africa. Clin Epidemiol 2017; 10:17-29. [PMID: 29296098 PMCID: PMC5739109 DOI: 10.2147/clep.s145983] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Long-term antiretroviral therapy (ART) adherence is critical for achieving optimal HIV treatment outcomes. Fixed-dose combination (FDC) single-pill regimens, introduced in South Africa in April 2013, has simplified pill taking. We evaluated treatment outcomes among patients initiated on a FDC compared to a similar multi-pill ART regimen in Johannesburg, South Africa. Methods We conducted a retrospective cohort study of ART-naïve HIV-positive non-pregnant adult (≥18 years) patients without tuberculosis who initiated first-line ART on tenofovir and emtricitabine or lamivudine with efavirenz at Themba Lethu Clinic in Johannesburg, South Africa. We compared those initiated on a multi-pill ART regimen (3–5 pills/day; September 1, 2011–August 31, 2012) to those initiated on a FDC ART regimen (one pill/day; September 1, 2013–August 31, 2014). Treatment outcomes included attrition (combination of lost to follow-up and mortality), missed medical visits, and virologic suppression (viral load <400 copies/mL) by 12 months post-ART initiation. Cox proportional hazards models and Poisson regression were used to estimate the association between FDCs vs multiple pills and treatment outcomes. Results We included 3151 patients in our analysis; 2230 (70.8%) patients initiated multi-pill ART and 921 (29.2%) patients initiated on a FDC. By 12 months post-initiation, attrition (adjusted hazard ratio: 0.98; 95% CI: 0.77–1.24) was similar across regimen types (FDC vs multi-pill). Although not significant, patients on a FDC were marginally more likely to achieve viral suppression by 6 (adjusted relative rate [aRR]: 1.10; 95% CI: 0.99–1.23) and 12 months (aRR: 1.12; 95% CI: 0.92–1.36) on ART. Patients initiated on a FDC were significantly less likely to miss medical visits during the first 12 months of treatment (aRR: 0.66; 95% CI: 0.52–0.83). Conclusion Our results suggest FDCs may have a role to play in supporting patient adherence and medical monitoring through improved medical visit attendance. This may potentially improve treatment outcomes later on in treatment.
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Affiliation(s)
- Kamban Hirasen
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Denise Evans
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mhairi Maskew
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ian M Sanne
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Right to Care, Johannesburg, South Africa.,Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kate Shearer
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline Govathson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Given Malete
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheryl A Kluberg
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Matthew P Fox
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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17
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Byrd KK, Bush T, Gardner LI. Do Persons Living with HIV Continue to Fill Prescriptions for Antiretroviral Drugs during a Gap in Care? Analysis of a Large Commercial Claims Database. J Int Assoc Provid AIDS Care 2017; 16:632-638. [PMID: 28899258 DOI: 10.1177/2325957417729750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The significance of a gap in HIV care depends, at least partially, on whether patients continue to fill prescriptions for antiretroviral (ARV) drugs during the gap in care. We used a billing claims database to determine the proportion of persons who filled ≥1 prescription for ARV drugs during a gap in care (no clinic visit in >6 months). Persons were stratified into 3 groups: "never" (prescriptions never filled), "sometimes" (prescriptions filled >0%-<100% of months), and "always" (prescriptions filled monthly). Logistic regression analyses were conducted to determine factors associated with "never" filling ARV drugs. Of 14 308 persons, 69% (n = 9817), 13% (n = 1928), and 18% (n = 2563) "never," "sometimes," and "always" filled ARV drugs during the gap in care. Persons aged 18 to 29 years (odds ratio [OR] = 1.56, 95% confidence interval [CI] 1.39-1.74), women (OR = 1.67, CI 1.52-1.83), and persons from the Northeast region of the United States (OR = 1.86, CI 1.69-2.03) were more likely to never fill ARV drugs than persons aged ≥30 years, men, and persons outside the Northeast, respectively. Efforts should be made to minimize gaps in care, emphasize importance of therapy, and provide adherence support.
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Affiliation(s)
- Kathy K Byrd
- 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tim Bush
- 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lytt I Gardner
- 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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18
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Sutton SS, Magagnoli J, Hardin JW. Odds of Viral Suppression by Single-Tablet Regimens, Multiple-Tablet Regimens, and Adherence Level in HIV/AIDS Patients Receiving Antiretroviral Therapy. Pharmacotherapy 2017; 37:204-213. [PMID: 28028855 DOI: 10.1002/phar.1889] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
STUDY OBJECTIVE To evaluate the odds of achieving viral suppression in human immunodeficiency virus (HIV) patients using antiretroviral therapy as a single-tablet regimen (STR) or multiple-tablet regimen (MTR). DESIGN Retrospective cohort study. DATA SOURCES South Carolina Medicaid medical and pharmacy paid claims data were obtained from the South Carolina Revenue and Fiscal Affairs Office; laboratory data were obtained from the South Carolina Department of Health and Environmental Control. PATIENTS A total of 1536 patients who were dispensed a complete STR (477 patients) or MTR (1059 patients) regimen lasting at least 60 days between January 1, 2006, and December 31, 2013. MEASUREMENTS AND MAIN RESULTS The analysis examined adherence levels and regimen type on odds of viral load suppression. Regimen adherence levels (90-94%, 85-89%, 80-84%, and less than 80%) were compared with the gold standard adherence for HIV of 95% or greater. Patients were followed from index date until the earliest date of regimen discontinuation, treatment switch, end of study period, last date of eligibility, or death. Differences in outcomes were evaluated by χ2 , Wilcoxon rank sum statistical tests, and multivariate regression models controlling for covariates. For STR regimens we find that, when compared with 95% or greater adherence, there is no statistical difference in the odds of viral suppression with adherence levels greater than or equal to 80%. However, adherence levels greater than or equal to 95% were associated with a greater odds of viral suppression when compared with less than 80% STR adherence (odds ratio [OR] 2.57, Dunnett 95% confidence interval [CI] 1.04-6.32). For MTR regimens, there was no statistical difference in the odds of viral suppression for the adherence level 90-94% compared with the 95% or greater adherence (OR 3.59, Dunnett 95% CI 0.805-16.043). However, the 95% or greater adherence has greater odds of viral suppression compared with all other MTR adherence levels. In addition, no difference was found in the odds of viral suppression between STR and MTR for all adherence levels. CONCLUSIONS Compared with 95% or greater adherence, STR regimens achieve viral suppression with adherence levels of 80% or greater, whereas MTR regimens require adherence levels of 90% or greater to achieve viral suppression in South Carolina Medicaid patients with HIV/AIDS.
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Affiliation(s)
- S Scott Sutton
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Joseph Magagnoli
- Health and Demographics, South Carolina Revenue and Fiscal Affairs Office, Columbia, South Carolina
| | - James W Hardin
- Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, South Carolina
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19
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Velvanathan T, Islahudin F, Sim BL, Taha NA. Simplification of HAART therapy on ambulatory HIV patients in Malaysia:a randomized controlled trial. Pharm Pract (Granada) 2016; 14:830. [PMID: 28042354 PMCID: PMC5184376 DOI: 10.18549/pharmpract.2016.04.830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/22/2016] [Indexed: 11/14/2022] Open
Abstract
Objective: Evaluate the impact of fixed-dose combination (FDC) containing emtricitabine (FTC), tenofovir (TDF), and efavirenz (EFV) versus a free-dose combination (FRC) of the same three drugs on clinical outcomes, adherence and quality of life in Malaysian outpatients with HIV. Methods: HIV patients (n=120) on highly active antiretroviral therapy (HAART) in the infectious disease clinic of Hospital Sungai Buloh were randomized to either FDC (n=60) or FRC (n=60). Morisky scores, health-related quality of life scores and clinical outcomes such as CD4 count and viral load were assessed in both groups at baseline and six months. Result: Patients on FDC (108 SD=1.1) had a significantly higher CD4 count increase compared to the FRC group (746.1 SD=36.3 vs 799.8 SD=33.8) (p <0.001). The viral load profile was unchanged and remained undetectable in both groups. The quality of life EQ-5D scores showed a positive correlation with CD4 counts in the FDC group (ρ=0.301, p=0.019) at six months. On the other hand, quality of life EQ-VAS scores was significantly associated with medication adherence in the FDC group at six months (ρ=0.749, p=0.05). However, no significant changes or associations were observed in the FRC group. Conclusion: Management of HAART using an FDC demonstrated a positive clinical outcome, adherence and quality of life within six months in local HIV patients.
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Affiliation(s)
| | - Farida Islahudin
- Faculty of Pharmacy, National University of Malaysia . Kuala Lumpur ( Malaysia ).
| | | | - Nur A Taha
- Faculty of Pharmacy, National University of Malaysia . Kuala Lumpur ( Malaysia ).
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20
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Abara WE, Adekeye OA, Xu J, Rust G. Adherence to combination antiretroviral treatment and clinical outcomes in a Medicaid sample of older HIV-infected adults. AIDS Care 2016; 29:441-448. [PMID: 27894190 DOI: 10.1080/09540121.2016.1257774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The adherence threshold for combination antiretroviral therapy (cART) has historically been set at 95% or greater. We examined whether different levels of cART adherence (≥95% [optimal adherence], 90-94%, 80-89%, and <80%) were associated with different clinical outcomes (emergency department visits [ED visits] and duration of hospital admission) in a sample of older (50-64 years) persons living with HIV (PLWH). Medicaid data from 29 US states (n = 5177) were used for this study. cART adherence was measured and data regarding relevant covariates, such as race, sex, age, urbanicity, and comorbidity were obtained. Descriptive statistics were conducted to characterize study participants. We conducted univariate and multivariable regression analyses to evaluate the association between cART adherence and ED visits and duration of hospital admission while adjusting for covariates (race, sex, age, urbanicity, and comorbidity). Approximately 32% of all participants (n = 5177) reported optimal cART adherence (≥95%). After adjusting for covariates, only participants who reported <80% adherence were more likely to have an ED visit (adjusted odds ratio = 1.34, 95% CI = 1.08-1.48, p < .0001) and a longer duration of hospital admission (regression coefficient = 1.24, 95% CI = 0.53-1.96, p = .0007) when compared to participants who reported ≥95% adherence. There were no significant differences in likelihood of having an ED visit and longer duration of hospital admission between participants who reported ≥95% adherence and participants who reported 90-94% adherence and 80-89% adherence. Significant differences by covariates were observed. Adverse clinical outcomes were associated with low cART adherence (<80%) among older PLWH, though they did not differ between optimal and moderate cART adherence (90-94% and 80-89%). Although optimal cART adherence is an important goal, clinical outcomes in older PLWH may not differ between moderate and optimal cART adherence.
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Affiliation(s)
- Winston E Abara
- a Department of Community Health and Preventive Medicine , Satcher Health Leadership Institute, Morehouse School of Medicine , Atlanta , GA , USA
| | - Oluwatoyosi A Adekeye
- a Department of Community Health and Preventive Medicine , Satcher Health Leadership Institute, Morehouse School of Medicine , Atlanta , GA , USA
| | - Junjun Xu
- b National Center for Primary Care, Morehouse School of Medicine , Atlanta , GA , USA
| | - George Rust
- b National Center for Primary Care, Morehouse School of Medicine , Atlanta , GA , USA
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Montes-Escalante I, Monje-Agudo P, Calvo-Cidoncha E, Almeida-González CV, Morillo-Verdugo R. Design and validation of a predictive model for 1-year hospital admission in HIV patients on antiretroviral treatment. Eur J Hosp Pharm 2016; 23:224-227. [PMID: 31156853 DOI: 10.1136/ejhpharm-2015-000788] [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] [Received: 09/09/2015] [Revised: 11/20/2015] [Accepted: 11/30/2015] [Indexed: 11/03/2022] Open
Abstract
Objectives To develop and validate a model for predicting the risk of hospital admission within 1 year in the HIV population under antiretroviral treatment. Methods We conducted a retrospective observational study. Patients receiving antiretroviral treatment for at least 1 year who were followed by the pharmacy service in a Spanish-speaking hospital between January 2008 and December 2012 were included. Demographics, and clinical and pharmacotherapy variables, were included in the model design. To find prognostic factors for hospital admission a multivariate logistic regression model was created after performing a univariate analysis. Model validity was determined by the shrinkage method and the model discrimination by Harrell's C-index. Results 442 patients were included in the study. The variables 'CD4 count <200 (cells/µL)', 'drug/alcohol use', 'detectable viral load (>50 copies/mL)', 'number of previous admissions', and 'number of drugs different from antiretroviral treatment' were the independent predictors of risk of hospital admission. Probabilities predicted by the model showed an R2=0.98 for the development sample and an R2=0.86 for the validation sample. The Harrell's C index for the development and validation data were 0.82 (95% CI 0.77 to 0.87) and 0.80 (95% CI 0.73 to 0.88), respectively. Conclusions The model developed in this study may be useful in daily practice for identifying HIV patients at high risk of 1-year hospital admission.
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Scott Sutton S, Magagnoli J, Hardin JW. Impact of Pill Burden on Adherence, Risk of Hospitalization, and Viral Suppression in Patients with HIV Infection and AIDS Receiving Antiretroviral Therapy. Pharmacotherapy 2016; 36:385-401. [PMID: 26923931 DOI: 10.1002/phar.1728] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
STUDY OBJECTIVE To evaluate the impact of pill burden on outcomes in patients with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) receiving antiretroviral therapy (ART) as a single-tablet regimen (STR) or multiple-tablet regimen (MTR). DESIGN Retrospective cohort study. DATA SOURCES South Carolina Medicaid medical and pharmacy paid claims data were obtained from the South Carolina Revenue and Fiscal Affairs Office; laboratory data were obtained from the South Carolina Department of Health and Environmental Control. PATIENTS A total of 2174 patients covered by South Carolina Medicaid who were dispensed a complete ART STR (580 patients) or MTR (1594 patients) lasting at least 60 days between January 1, 2006, and December 31, 2013. MEASUREMENTS AND MAIN RESULTS Outcomes were ART adherence; risk of, time to, and total number of hospitalizations; and viral load suppression. Patients were followed from the index date (start date of their complete ART regimen) until the earliest date of one of the following: treatment discontinuation; treatment switch from MTR to STR, or vice versa; end of study period; last date of Medicaid eligibility; or death. Differences in outcomes were evaluated by using bivariate χ(2) and Wilcoxon rank sum tests, as well as multivariate regression models controlling for covariates measured during a 6-month baseline period. The STR and MTR cohorts were, on average, similar in terms of age at index date, Charlson Comorbidity Index score, sex, drug abuse, and mental health diagnoses, but they differed significantly in racial composition, index year of regimen, previous treatment, baseline viral load, and CD4 measures. The bivariate analysis revealed that the STR cohort was more adherent (p<0.0001), had a lower risk of hospitalization (p=0.0076), and had a higher proportion of patients with viral suppression (64.5% vs 49.5%, p<0.0001). In addition, multivariate regression models revealed that the STR cohort was more adherent and was associated with a lower risk of hospitalization (hazard ratio 0.71, 95% confidence interval 0.59-0.86), but no significant difference in viral load suppression was noted between the STR and MTR cohorts. CONCLUSION The STR was associated with higher adherence rates and a lower risk of hospitalization (both in the adjusted and unadjusted analyses) in South Carolina Medicaid patients with HIV infection and AIDS. A higher proportion of patients in the STR cohort had viral suppression during the follow-up period in the unadjusted analysis compared with the MTR cohort; however, no significant difference in viral suppression was observed when controlling for adherence.
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Affiliation(s)
- S Scott Sutton
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, South Carolina College of Pharmacy, Columbia, South Carolina
| | - Joseph Magagnoli
- Health and Demographics, South Carolina Revenue and Fiscal Affairs Office, Columbia, South Carolina
| | - James W Hardin
- Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, South Carolina
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Abara WE, Xu J, Adekeye OA, Rust G. The association between combination antiretroviral adherence and AIDS-defining conditions at HIV diagnosis. AIDS Care 2016; 28:1013-7. [PMID: 26886075 DOI: 10.1080/09540121.2016.1139044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Combination antiretroviral therapy (cART) has changed the clinical course of HIV. AIDS-defining conditions (ADC) are suggestive of severe or advanced disease and are a leading cause of HIV-related hospitalizations and death among people living with HIV/AIDS (PLWHA) in the USA. Optimal adherence to cART can mitigate the impact of ADC and disease severity on the health and survivability of PLWHA. The objective of this study was to evaluate the association between ADC at HIV diagnosis and optimal adherence among PLWHA. Using data from the 2008 and 2009 Medicaid data from 29 states, we identified individuals, between 18 and 49 years, recently infected with HIV and with a cART prescription. Frequencies and descriptive statistics were conducted to characterize sample. Univariate and multivariable Poisson regression analyses were employed to evaluate the association optimal cART adherence (defined as ≥ 95% study days covered by cART) and ADC at HIV diagnosis (≥1 ADC) were assessed. Approximately 17% of respondents with ADC at HIV diagnosis reported optimal cART adherence. After adjusting for covariates, respondents with an ADC at HIV diagnosis were less likely to report optimal cART adherence (adjusted prevalence ratio (APR) = 0.64, 95% confidence intervals (CI), 0.54-0.75). Among the covariates, males (APR=1.10, 95% CI, 1.02-1.19) compared to females were significantly more likely to report optimal adherence while younger respondents, 18-29 years (APR=0.67, 95% CI, 0.57-0.77), 30-39 years (APR=0.86, 95% CI, 0.79-0.95) compared to older respondents were significantly less likely to report optimal adherence. PLWHA with ADC at HIV diagnosis are at risk of suboptimal cART adherence. Multiple adherence strategies that include healthcare providers, case managers, and peer navigators should be utilized to improve cART adherence and optimize health outcomes among PLWHA with ADC at HIV diagnosis. Targeted adherence programs and services are required to address suboptimal adherence in this population.
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Affiliation(s)
- Winston E Abara
- a Morehouse School of Medicine, Department of Community Health and Preventive Medicine , Satcher Health Leadership Institute , Atlanta , GA , USA
| | - Junjun Xu
- b Morehouse School of Medicine, National Center for Primary Care , Atlanta , GA , USA
| | - Oluwatoyosi A Adekeye
- a Morehouse School of Medicine, Department of Community Health and Preventive Medicine , Satcher Health Leadership Institute , Atlanta , GA , USA
| | - George Rust
- b Morehouse School of Medicine, National Center for Primary Care , Atlanta , GA , USA
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Calvo-Cidoncha E, González-Bueno J, Almeida-González CV, Morillo-Verdugo R. Influence of treatment complexity on adherence and incidence of blips in HIV/HCV coinfected patients. J Manag Care Spec Pharm 2015; 21:153-7. [PMID: 25615004 PMCID: PMC10397842 DOI: 10.18553/jmcp.2015.21.2.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The addition of antihepatitis C therapy to highly active antiretroviral treatment (HAART) in human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfected patients leads to an increase in the treatment complexity that may result in decreased adherence. Blips, defined as intermittent episodes of detectable low-level HIV viremia, may be an indication of poor adherence to HAART. OBJECTIVES To (a) determine the influence of adding anti-HCV therapy to HAART on complexity index, adherence, and incidence of blips and (b) determine complexity index and adherence in patient subgroups based on anti-HCV therapy. METHODS We conducted a prospective 2-center observational study. HIV/HCV coinfected patients under antiretroviral treatment who started anti-HCV bi-therapy or triple therapy between January 2011 and December 2013 were included. Patients were excluded if they were virologically uncontrolled (HIV viral load greater than 50 copies RNA/mL) or if they had changed antiretroviral treatment in the 6 months prior to the introduction of anti-HCV therapy. Data were collected before and after the addition of anti-HCV therapy to HAART. The main variables were complexity index, incidence of blips, and adherence. The complexity index was based on a score that utilized the number of pills per day, dosing schedule, dosage form, and any specific instructions linked to use of the drug. Blips were defined as a detectable HIV-RNA level ( greater than 50 copies/mL but no more than 1,000 copies/mL) occurring between 2 negative assays. Medication adherence was assessed using electronic pharmacy refill records. The threshold for optimal adherence was defined at 95% and above. Differences in the variables collected were assessed before and after the addition of anti-HCV therapy to HAART.R ESULTS: A total of 66 patients were included in the study. Based on the complexity index, the median value before and after the addition of anti-HCV therapy to HAART was 4.2 (interquartile range [IQR] = 3.5-5.5) and 11.5 (IQR = 10.4-13.4), respectively. The median difference between both complexity indices was 6.9 (95% CI = 6.9-7, P less than 0.001). After introducing the anti-HCV therapy into HAART, the number of adherent patients decreased from 50 (75.8%) to 45 (68.2%, P greater than 0.05), and 12 (18.2%) patients presented blips (P less than 0.001). Subgroup analysis based on anti-HCV therapy showed that patients on boceprevir or telaprevir therapy had a higher complexity index, 16.8 (IQR = 6.0-18.4), compared with patients on bi-therapy anti-HCV, 11.3 (IQR = 10.3-12). The median difference was 6.0 (95% CI = 5.0-7.2, P less than 0.001). The number of adherent patients decreased only in patients on bi-therapy from 42 (79.2%) to 37 (69.8%, P greater than 0.05). CONCLUSIONS Adding anti-HCV therapy to antiretroviral treatment significantly increases treatment complexity and the incidence of blips. The introduction of anti-HCV therapy is also associated with a decrease in the number of adherent patients. The regimen complexity calculation may be useful for identifying patients who need more care from health care professionals or are at risk for failure to comply with treatment regimens.
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Skwara P, Bociąga-Jasik M, Kalinowska-Nowak A, Sobczyk-Krupiarz I, Garlicki A. Adherence to single-tablet versus multiple-tablet regimens in the treatment of HIV infection—A questionnaire-based survey on patients satisfaction. HIV & AIDS REVIEW 2014. [DOI: 10.1016/j.hivar.2014.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Calvo-Cidoncha E, González-Bueno J, Almeida-González CV, Morillo-Verdugo R. Influence of adding etravirine on complexity index and patients' perceived complexity. J Clin Pharm Ther 2013; 39:154-7. [PMID: 24372048 DOI: 10.1111/jcpt.12120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 11/20/2013] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Adherence to highly active antiretroviral treatment (HAART) is an important predictive factor of treatment outcome. Medication regimen complexity can be one of the main causes of non-adherence. Thus, treatment simplification is a key strategy in the development of antiretroviral therapy. The aim of this study was to determine the influence of adding etravirine on complexity index and patients' perceived complexity of their treatment regimen. METHODS We conducted a prospective two-centre observational study. Patients on etravirine-based therapy, for at least 6 months, who came personally to pharmacy departments for a drug refill from February to July 2012 were included. Data were collected for the current etravirine-based HAART and for the previous HAART without etravirine. The main variables were complexity index and patients' perceived complexity. We also evaluated the adherence during the 6 months before and after the introduction of etravirine into HAART. The complexity index was based on a score which takes into account the number of pills per day, the dosing schedule, the dosage form and any specific instructions linked to use of the drug. To evaluate the patients' perceived complexity of their current and previous HAART, patients were asked to assign a mark on a visual analogue scale ranging from 0 (minimum) to 10 (maximum). We assessed the differences in the variables collected between the current and previous antiretroviral therapy. Finally, we carried out a correlation analysis between the complexity index and the patients' perceived complexity. RESULTS AND DISCUSSION Eighty patients were included. The complexity index was significantly reduced after the addition of etravirine to HAART (P = 0·035). Perceived complexity was also reduced (P = 0·015). After the introduction of the drug, the proportion of adherent patients increased from 65% to 81·3% (P = 0·002). The correlation between the complexity index and the patients' perceived complexity was positive (r = 0·594). The correlation increased (r = 0·696) when the difference between the complexity index before and after the introduction of etravirine in HAART grew. WHAT IS NEW AND CONCLUSION The addition of etravirine to HAART results in a significant reduction in complexity index and patients' perceived complexity of their therapy. These changes were associated with better adherence to treatment.
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Finigan J, Naylor K, Paggiosi MA, Peel NF, Eastell R. Adherence to raloxifene therapy: assessment methods and relationship with efficacy. Osteoporos Int 2013; 24:2879-86. [PMID: 23695420 DOI: 10.1007/s00198-013-2386-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED Response to therapy depends on patient compliance but accurate assessment is difficult and adequate levels of adherence are uncertain. Adherence to raloxifene treatment may be assessed more accurately by electronic monitoring than by counting returned tablets. The level of adherence is positively associated with the degree of bone response. INTRODUCTION Adherence to study medication is usually estimated by counting returned tablets. This method relies on subjects' honesty and may be inaccurate. We aimed to assess adherence more accurately, and examine its effect on measures of bone response, by using electronic monitoring. METHODS Osteopenic women, ages 50 to 80, were prescribed daily raloxifene for 2 years. Electronic bottle caps (Medication Event Monitoring System (MEMS), Aardex) recorded the date and time on opening. Returned tablets were also counted. We measured bone mineral density (BMD) in duplicate at the spine and hip at baseline and 2 years. We also measured urinary N-terminal cross-linked telopeptide of type I collagen (NTX) at baseline, 1 and 2 years. We calculated the percentage changes in BMD and NTX from mean baseline to mean follow up measurements. Percentage adherence was assessed by both methods for 71 subjects that completed the study. RESULTS The two methods correlated significantly (p <0.001, Spearman's rho = 0.73) but the tablet count showed a higher median adherence than the MEMS caps (95.7 vs. 85.0%, p <0.001), with greater divergence at lower adherence levels. MEMS adherence in 65 subjects with complete data correlated with NTX response (p <0.01, rho = -0.33) but with BMD response only at the femoral neck. However, adherence in the lowest quartile was associated with poorer BMD response at all sites (p <0.05). CONCLUSION Tablet counts may give similar results overall but conceal substantial individual non-adherence. Monitoring caps may assess adherence more accurately than tablet counts and would be the preferred method in clinical trials. The degree of adherence is associated with both bone turnover and BMD responses to anti-resorptive therapy.
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Affiliation(s)
- J Finigan
- Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK,
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Cohen CJ, Meyers JL, Davis KL. Association between daily antiretroviral pill burden and treatment adherence, hospitalisation risk, and other healthcare utilisation and costs in a US medicaid population with HIV. BMJ Open 2013; 3:bmjopen-2013-003028. [PMID: 23906955 PMCID: PMC3733306 DOI: 10.1136/bmjopen-2013-003028] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Lower pill burden leads to improved antiretroviral therapy (ART) adherence among HIV patients. Simpler dosing regimens have not been widely explored in real-world populations. We retrospectively assessed ART adherence, all-cause hospitalisation risk and costs, and other healthcare utilisation and costs in Medicaid enrollees with HIV treated with ART as a once-daily single-tablet regimen (STR) or two or more pills per day (2+PPD). DESIGN Patients with an HIV diagnosis from 2005 to 2009 receiving complete ART (ie, two nucleoside/nucleotide reverse transcriptase inhibitors plus a third agent) for ≥60 days as STR or 2+PPD were selected and followed until the first of (1) discontinuation of the complete ART, (2) loss of enrolment or (3) end of database. Adherence was measured using the medication possession ratio. Monthly all-cause healthcare utilisation and costs were observed from regimen initiation until follow-up end. RESULTS Of the 7381 patients who met inclusion criteria, 1797 were treated with STR and 5584 with 2+PPD. STR patients were significantly more likely to reach 95% adherence and had fewer hospitalisations than 2+PPD patients (both p<0.01). STR patients had mean (SD) total monthly costs of $2959 ($4962); 2+PPD patients had $3544 ($5811; p<0.001). Hospital costs accounted for 53.8% and pharmacy costs accounted for 32.5% of this difference. Multivariate analyses found that STR led to a 23% reduction in hospitalisations and a 17% reduction in overall healthcare costs. ART adherence appears to be a key mechanism mediating hospitalisation risk, as patients with ≥95% adherence (regardless of regimen type) had a lower hospitalisation rate compared with <95% adherence. CONCLUSIONS While it was expected that STR patients would have lower pharmacy costs, we also found that STR patients had fewer hospitalisations and lower hospital costs than 2+PPD patients, resulting in significantly lower total healthcare costs for STR patients.
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Affiliation(s)
- Calvin J Cohen
- CRI New England, Harvard Medical School, Boston, Massachusetts, USA
| | - Juliana L Meyers
- Department of Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Keith L Davis
- Department of Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina, USA
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de Fatima Bonolo P, Ceccato MDGB, Rocha GM, de Assis Acúrcio F, Campos LN, Guimarães MDC. Gender differences in non-adherence among Brazilian patients initiating antiretroviral therapy. Clinics (Sao Paulo) 2013; 68:612-20. [PMID: 23778401 PMCID: PMC3654293 DOI: 10.6061/clinics/2013(05)06] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 01/03/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We conducted a study to identify gender differences in factors associated with the first episode of non-adherence in the 12 months following the first antiretroviral prescription. METHODS A concurrent prospective study of patients initiating antiretroviral therapy in Brazil was conducted from 2001-2002. The self-reported measurement of adherence was defined as an intake of less than 95% of the prescribed number of doses. Only the first occurrence of non-adherence was considered in this analysis. All analyses were stratified by gender. A Cox proportional hazard model was used to estimate the risk of non-adherence, and the time to non-adherence was estimated using the Kaplan-Meier method. RESULTS The cumulative incidence of non-adherence was 34.6% (29.7% and 43.9% among men and women, respectively; p=0.010). Marital status (being married or in stable union; p=0.022), alcohol use in the month prior to the baseline interview (p=0.046), and current tobacco use (p=0.005) increased the risk of non-adherence among female participants only, whereas a self-reported difficulty with the antiretroviral treatment was associated with non-adherence in men only. For both men and women, we found that a longer time between the HIV test and first antiretroviral therapy prescription (p=0.028) also presented an increased risk of non-adherence. CONCLUSIONS In this cohort study, the incidence of non-adherence was 1.5 times greater among women compared to men. Our results reinforce the need to develop interventions that account for gender differences in public referral centers. Additionally, we emphasize that, to achieve and maintain appropriate adherence levels, it is important to understand the barriers to seeking and utilizing health care services.
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Uglietti A, Zanaboni D, Gnarini M, Maserati R. Emtricitabine/tenofovir in the treatment of HIV infection: current PK/PD evaluation. Expert Opin Drug Metab Toxicol 2012; 8:1305-14. [PMID: 22943210 DOI: 10.1517/17425255.2012.714367] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Emtricitabine/tenofovir disoproxil fumarate fixed-dose combination (FTC/TDF FDC) is the co-formulation of a nucleoside and a nucleotide, respectively. After oral administration, both drugs exhibit plasma and intracellular half-lives suitable for once-daily dosing. Within the host cells, active metabolites FTC-TP and TFV-DP act as chain terminators to the newly synthesized proviral DNA, showing synergy at enzymatic level (viral reverse transcriptase). When given in HAART combinations, FTC/TDF FDC has a remarkable effectiveness in controlling HIV replication and securing a significant CD4(+) cell recovery. If patients treated with FTC/TDF FDC fail, a lower incidence of TDF-associated K65R resistance mutation seems to develop. Furthermore, cytidine analog-associated M184V is less likely to appear with FTC than with lamivudine when both are given with TDF. FTC and TFV are not metabolized by CYP450 enzymes and are eliminated by the renal route. TFV may accumulate in tubular cells and cause a decrease in GFR and a loss of phosphates. As a onsequence, patients treated with FTC/TDF FCD may experience varied degrees of renal impairment and osteopenia/osteoporosis. AREAS COVERED This paper has focused on the PK/PD features of FTC and TDF, when given as single agent or when administered as FDC. The interpretation of efficacy/toxicity was guided by PK/PD features. The review of the available literature included also conference presentations and recent guidelines (as of May 2012). EXPERT OPINION FTC/TDF FDC is a potent and reliable component of most HAART combinations due to its maintained activity across time, as demonstrated in many trials and studies. Toxicity issues (kidney, bone) are still to be entirely elucidated and the drug-induced component well separated from patient- and HIV-related ones. However, the clinical gain associated with the use of FTC/TDF FDC is fully acknowledged by its leading position in most current treatment guidelines.
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Affiliation(s)
- Alessia Uglietti
- Infectious Disease Department, Foundation IRCCS Policlinico San Matteo, Piazzale Golgi, 19, 27100 Pavia, Italy
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Sabbatani S, Manfredi R, Fulgaro C. Long-term stabilized immunological-virological parameters of HIV infection in an AIDS presenter followed for 20 years, with irregular or no antiretroviral therapy. Int J STD AIDS 2012; 23:e46-7. [PMID: 22581897 DOI: 10.1258/ijsa.2009.009215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report the case of an HIV-infected patient who has been followed for 20 years, and despite presenting with AIDS (due to three episodes of cryptococcosis plus one of Pneumocystis jirovecii pneumonia) who during subsequent years missed, refused or took with limited compliance all recommended medications, including combination antiretroviral therapy, and primary and secondary antimicrobial chemoprophylaxis against opportunistic infections. The unexpected clinical and laboratory stabilization of our patient paralleled a progressive increase in his peripheral CD4+ T-lymphocyte count (range 410-825 cells/mL) and a relatively controlled HIV viraemia (5970-44,000 HIV-RNA copies/mL). Such a recovery of sufficient immune competency after experiencing four episodes of severe AIDS-associated opportunistic infections, without reliable antiretroviral and antimicrobial support raises several questions.
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Affiliation(s)
- S Sabbatani
- Division of Infectious Diseases, Department of Internal Medicine, Aging, and Nephrologic Diseases, University of Bologna Alma Mater Studiorum, S Orsola-Malipighi Hospital, Via Massarenti 11, Bologna I-40138, Italy
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Sax PE, Meyers JL, Mugavero M, Davis KL. Adherence to antiretroviral treatment and correlation with risk of hospitalization among commercially insured HIV patients in the United States. PLoS One 2012; 7:e31591. [PMID: 22384040 PMCID: PMC3286454 DOI: 10.1371/journal.pone.0031591] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 01/16/2012] [Indexed: 11/19/2022] Open
Abstract
Purpose A lower daily pill burden may improve adherence to antiretroviral treatment (ART) and clinical outcomes in patients with human immunodeficiency virus (HIV). This study assessed differences in adherence using the number of pills taken per day, and evaluated how adherence correlated with hospitalization. Methodology Commercially insured patients in the LifeLink database with an HIV diagnosis (International Classification of Diseases, 9th Revision, Clinical Modification code 042.xx) between 6/1/2006 and 12/31/2008 and receipt of a complete ART regimen were selected for inclusion. Patients were grouped according to their daily pill count and remained on ART for at least 60 days. Outcomes included adherence and rates of hospitalization. Adherence was measured as the proportion of days between the start and end of the regimen in which the patient maintained supply of all initiated ART components. Logistic regressions assessed the relationship between pills per day, adherence, and hospitalization, controlling for demographics, comorbidities, and ART-naïve (vs. experienced) status. Results 7,073 patients met the study inclusion criteria, and 33.4%, 5.8%, and 60.8% received an ART regimen comprising one, two, or three or more pills per day, respectively. Regression analysis showed patients receiving a single pill per day were significantly more likely to reach a 95% adherence threshold versus patients receiving three or more pills per day (odds ratio [OR] = 1.59; P<0.001). Regardless of the number of pills received per day, patients were over 40% less likely to have a hospitalization if they were adherent to therapy (OR = 0.57; P<0.001). Patients receiving a single pill per day were 24% less likely to have a hospitalization versus patients receiving three or more pills per day (OR = 0.76; P = 0.003). Conclusions ART consisting of a single pill per day was associated with significantly better adherence and lower risk of hospitalization in patients with HIV compared to patients receiving three or more pills per day.
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Affiliation(s)
- Paul E. Sax
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Juliana L. Meyers
- RTI Health Solutions, Research Triangle Park, North Carolina, United States of America
- * E-mail:
| | - Michael Mugavero
- University of Alabama, Birmingham, Alabama, United States of America
| | - Keith L. Davis
- RTI Health Solutions, Research Triangle Park, North Carolina, United States of America
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Women and vulnerability to HAART non-adherence: a literature review of treatment adherence by gender from 2000 to 2011. Curr HIV/AIDS Rep 2012; 8:277-87. [PMID: 21989672 DOI: 10.1007/s11904-011-0098-0] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A literature review of original research articles on adherence to antiretroviral therapy (ART) in developed countries, covering January 2000 to June 2011, was conducted to determine if gender differences exist in the prevalence of nonadherence to ART. Of the 1,255 articles reviewed, only 189 included data on the proportion of the study population that was adherent and only 57 (30.2%) of these reported proportional adherence values by gender. While comparing articles was challenging because of varied reporting strategies, women generally exhibit poorer adherence than men. Thirty of the 44 articles (68.2%) that reported comparative data on adherence by gender found women to be less adherent than men. Ten articles (17.5%) reported significant differences in proportional adherence by gender, nine of which showed women to be less adherent than men. These findings suggest that in multiple studies from developed countries, female gender often predicts lower adherence. The unique circumstances of HIV-positive women require specialized care to increase adherence to ART.
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Gmel G, Shield KD, Rehm J. Developing a method to derive alcohol-attributable fractions for HIV/AIDS mortality based on alcohol's impact on adherence to antiretroviral medication. Popul Health Metr 2011; 9:5. [PMID: 21320310 PMCID: PMC3048542 DOI: 10.1186/1478-7954-9-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 02/14/2011] [Indexed: 12/11/2022] Open
Abstract
Background Alcohol consumption is causally linked to nonadherence to antiretroviral treatment that in turn causes an increase in HIV/AIDS mortality. This article presents a method to calculate the percentage of HIV/AIDS deaths attributable to alcohol consumption and the associated uncertainty. Methods By combining information on risk relations from a number of published sources, we estimated alcohol-attributable fractions (AAFs) of HIV/AIDS in a stepwise procedure. First, we estimated the effect of alcohol consumption on adherence to antiretroviral treatment, and then we combined this estimate with the impact of nonadherence on death. The 95% uncertainty intervals were computed by estimating the variance of the AAFs using Taylor series expansions of one and multiple variables. AAFs were determined for each of the five Global Burden of Disease regions of Africa, based on country-specific treatment and alcohol consumption data from 2005. Results The effects of alcohol on HIV/AIDS in the African Global Burden of Disease regions range from 0.03% to 0.34% for men and from 0% to 0.17% for women, depending on region and age category. The detrimental effect of alcohol consumption was statistically significant in every region and age category except for the North Africa/Middle East region. Conclusions Although the method has its limitations, it was shown to be feasible and provided estimates of the impact of alcohol use on the mortality outcome of HIV/AIDS.
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Affiliation(s)
- Gerrit Gmel
- Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada.
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Rocha GM, Machado CJ, Acurcio FDA, Guimarães MDC. Monitoring adherence to antiretroviral treatment in Brazil: an urgent challenge. CAD SAUDE PUBLICA 2011; 27 Suppl 1:S67-78. [DOI: 10.1590/s0102-311x2011001300008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 04/05/2010] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to describe the effect of non-adherence on the main laboratory outcomes, TCD4+ lymphocyte count and viral load, routinely used to monitor patients initiating treatment according to three different approaches to measure adherence to antiretroviral therapy. Among 288 participants, 22.9%, 31.9% and 74.3% were considered non-adherent, according to medical charts, self-report and pharmacy records, respectively. Depending on the adherence measures used, the average gain in TCD4+ lymphocyte count ranged from 142.4 to 195.4 cells/mm3 among adherent patients, and from 58.5 to 99.8 lymphocytes TCD4+/mm3 among those non-adherent. The average reduction on viral load ranged from 4.25 to 4.62 log copies/mL among the adherent patients, and from 1.99 to 4.07 log among those non-adherent. Monitoring antiretroviral adherence should be considered a priority in these public AIDS referral centers in order to identify patients at high risk of developing virologic failure. Early interventions are necessary in order to maintain the initial therapeutic regimens for longer periods.
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Deribew A, Abebe G, Apers L, Jira C, Tesfaye M, Shifa J, Abdisa A, Woldemichael K, Deribie F, Bezabih M, Aseffa A, Colebunders R. Prejudice and misconceptions about tuberculosis and HIV in rural and urban communities in Ethiopia: a challenge for the TB/HIV control program. BMC Public Health 2010; 10:400. [PMID: 20604951 PMCID: PMC2909168 DOI: 10.1186/1471-2458-10-400] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 07/06/2010] [Indexed: 12/02/2022] Open
Abstract
Background In Ethiopia, where HIV and tuberculosis (TB) are very common, little is known about the prejudice and misconceptions of rural communities towards People living with HIV/AIDS (PLHA) and TB. Methods We conducted a cross sectional study in Gilgel Gibe Field Research area (GGFRA) in southwest Ethiopia to assess the prejudice and misconceptions of rural and urban communities towards PLHA and TB. The study population consisted of 862 randomly selected adults in GGFRA. Data were collected by trained personnel using a pretested structured questionnaire. To triangulate the findings, 8 focus group discussions among women and men were done. Results Of the 862 selected study participants, 750(87%) accepted to be interviewed. The mean age of the respondents was 31.2 (SD ± 11.0). Of the total interviewed individuals, 58% of them were females. More than half of the respondents did not know the possibility of transmission of HIV from a mother to a child or by breast feeding. For fear of contagion of HIV, most people do not want to eat, drink, and share utensils or clothes with a person living with HIV/AIDS. A higher proportion of females [OR = 1.5, (95% CI: 1.0, 2.2)], non-literate individuals [OR = 2.3, (95%CI: 1.4, 3.6)], rural residents [OR = 3.8, (95%CI: 2.2, 6.6)], and individuals who had poor knowledge of HIV/AIDS [OR = 2.8, (95%CI: 1.8, 2.2)] were more likely to have high prejudice towards PLHA than respectively males, literates, urban residents and individuals with good knowledge. Exposure to cold air was implicated as a major cause of TB. Literates had a much better knowledge about the cause and methods of transmission and prevention of TB than non-literates. More than half of the individuals (56%) had high prejudice towards a patient with TB. A larger proportion of females [OR = 1.3, (95% CI: 1.0, 1.9)] and non-literate individuals [OR = 1.4, (95% CI: 1.1, 2.0)] had high prejudice towards patients with TB than males and literate individuals. Conclusion TB/HIV control programs in collaboration with other partners should invest more in social mobilization and education of the communities to rectify the widespread prejudice and misconceptions.
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Affiliation(s)
- Amare Deribew
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium.
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Berry SA, Manabe YC, Moore RD, Gebo KA. Hospitalization risk following initiation of highly active antiretroviral therapy. HIV Med 2009; 11:289-98. [PMID: 20002778 DOI: 10.1111/j.1468-1293.2009.00776.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES While highly active antiretroviral therapy (HAART) decreases long-term morbidity and mortality, its short-term effect on hospitalization rates is unknown. The primary objective of this study was to determine hospitalization rates over time in the year after HAART initiation for virological responders and nonresponders. METHODS Hospitalizations among 1327 HAART-naïve subjects in an urban HIV clinic in 1997-2007 were examined before and after HAART initiation. Hospitalization rates were stratified by virological responders (> or =1 log(10) decrease in HIV-1 RNA within 6 months after HAART initiation) and nonresponders. Causes were determined through International Classification of Diseases, 9th Revision (ICD-9) codes and chart review. Multivariate negative binomial regression was used to assess factors associated with hospitalization. RESULTS During the first 45 days after HAART initiation, the hospitalization rate of responders was similar to their pre-HAART baseline rate [75.1 vs. 78.8/100 person-years (PY)] and to the hospitalization rate of nonresponders during the first 45 days (79.4/100 PY). The hospitalization rate of responders fell significantly between 45 and 90 days after HAART initiation and reached a plateau at approximately 45/100 PY from 91 to 365 days after HAART initiation. Significant decreases were seen in hospitalizations for opportunistic and nonopportunistic infections. CONCLUSIONS The first substantial clinical benefit from HAART may be realized by 90 days after HAART initiation; providers should keep close vigilance at least until this time.
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Affiliation(s)
- S A Berry
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287-2100, USA.
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