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Rein SM, Lampe FC, Ingle SM, Sterne JAC, Trickey A, Gill MJ, Papastamopoulos V, Wittkop L, van der Valk M, Kitchen M, Guest JL, Satre DD, Wandeler G, Galindo P, Castilho J, Crane HM, Smith CJ. All-cause hospitalisation among people living with HIV according to gender, mode of HIV acquisition, ethnicity, and geographical origin in Europe and North America: findings from the ART-CC cohort collaboration. Lancet Public Health 2023; 8:e776-e787. [PMID: 37777287 PMCID: PMC10851157 DOI: 10.1016/s2468-2667(23)00178-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Understanding demographic disparities in hospitalisation is crucial for the identification of vulnerable populations, interventions, and resource planning. METHODS Data were from the Antiretroviral Therapy Cohort Collaboration (ART-CC) on people living with HIV in Europe and North America, followed up between January, 2007 and December, 2020. We investigated differences in all-cause hospitalisation according to gender and mode of HIV acquisition, ethnicity, and combined geographical origin and ethnicity, in people living with HIV on modern combination antiretroviral therapy (cART). Analyses were performed separately for European and North American cohorts. Hospitalisation rates were assessed using negative binomial multilevel regression, adjusted for age, time since cART intitiaion, and calendar year. FINDINGS Among 23 594 people living with HIV in Europe and 9612 in North America, hospitalisation rates per 100 person-years were 16·2 (95% CI 16·0-16·4) and 13·1 (12·8-13·5). Compared with gay, bisexual, and other men who have sex with men, rates were higher for heterosexual men and women, and much higher for men and women who acquired HIV through injection drug use (adjusted incidence rate ratios ranged from 1·2 to 2·5 in Europe and from 1·2 to 3·3 in North America). In both regions, individuals with geographical origin other than the region of study generally had lower hospitalisation rates compared with those with geographical origin of the study country. In North America, Indigenous people and Black or African American individuals had higher rates than White individuals (adjusted incidence rate ratios 1·9 and 1·2), whereas Asian and Hispanic people living with HIV had somewhat lower rates. In Europe there was a lower rate in Asian individuals compared with White individuals. INTERPRETATION Substantial disparities exist in all-cause hospitalisation between demographic groups of people living with HIV in the current cART era in high-income settings, highlighting the need for targeted support. FUNDING Royal Free Charity and the National Institute on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- Sophia M Rein
- CAUSALab and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Institute for Global Health, UCL, London, UK.
| | | | - Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; Health Data Research UK South-West, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Vasileios Papastamopoulos
- Department of Internal Medicine and Infectious Diseases, Evaggelismos General Hospital, Athens, Greece
| | - Linda Wittkop
- University of Bordeaux, INSERM, Bordeaux Population Health-U1219, CIC1401-EC, Bordeaux, France; CHU de Bordeaux-Bordeaux University Hospital, Service d'information médicale, INSERM, CIC-EC 1401, Bordeaux, Franc; SISTM, INRIA, University of Bordeaux, Talence, France
| | - Marc van der Valk
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Stichting HIV Monitoring, Amsterdam, Netherlands
| | - Maria Kitchen
- Department of Dermatology, Venereology, and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jodie L Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Pepa Galindo
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Jessica Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heidi M Crane
- Department of Medicine and Department of Health Services, University of Washington, Seattle, WA, USA
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Husbands W, Etowa J, Oakes W, Omorodion F, Luginaah I, Etowa E, Ghose B, Wong JPH. Advancing research for HIV prevention among African, Caribbean and Black men: Protocol for a multisite cross-sectional study in Ontario (weSpeak study). Medicine (Baltimore) 2021; 100:e25662. [PMID: 33950944 PMCID: PMC8104263 DOI: 10.1097/md.0000000000025662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 04/05/2021] [Indexed: 01/04/2023] Open
Abstract
In Ontario, African, Caribbean, and Black (ACB) men account for almost 60% of the estimated number of HIV-positive people (through heterosexual contact), although they constitute less than 5% of the province's population. However, current HIV research, programming and policy in Ontario are not aligned with heterosexual ACB men's healthcare needs and interests, and fail to engage them in community responses to HIV. weSpeak is a multisite (Ottawa, Toronto, London, and Windsor) project that is aims to: 1. assess the sociocultural and socio-political conditions that contribute to HIV related health disparities among ACB men, 2. examine social and behavioral vulnerabilities to HIV among ACB men, including their social identities related to race, class, gender and sexualities, 3. community engagement and mobilization part of the project, and 4. generate, appraise and share new knowledge, and support its translation into intervention and practice. This will be a mixed method study comprising focus groups, in-depth interviews, and a survey to meet the data objectives. All data collection activities will take place at the same time in 4 cities in 3 sequential phases: 1. focus groups, 2. in-depth interviews, and 3. a questionnaire survey. Service providers will participate in the concept mapping exercise to review the research findings and develop program, policy, and community-based initiatives to promote resilience and meaningfully engage heterosexual ACB men in community responses to HIV survey. This study will provide evidence on: 1. heterosexual ACB men's experience of structural disadvantage and psychological factors is associated with HIV vulnerability. 2. heterosexual ACB men with greater internal resilience and social resources show greater risky behaviors, and 3. a conceptual Model of HIV vulnerability linking the potential internal and external factors that interact to influence HIV vulnerability. This study will lead to better understanding of the structural determinants and the psychosocial risk factors of HIV transmission among ACB men in Ontario which will aid in designing evidence-based intervention programs, and thereby reduce their higher vulnerability to HIV and its associated consequences.
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Affiliation(s)
| | - Josephine Etowa
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa
| | | | - Francisca Omorodion
- Department of Sociology, Anthropology & Criminology, University of Windsor, Windsor
| | - Isaac Luginaah
- Department of Geography and Environment, Western University, London
| | - Egbe Etowa
- Department of Sociology, Anthropology & Criminology, University of Windsor, Windsor
| | - Bishwajit Ghose
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa
| | - Josephine Pui-Hing Wong
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada
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Francisco MTR, Fonte VRFD, Spindola T, Pinheiro CDP, Costa CMA, Rocha FCSD. Testagem para o HIV e profilaxia pós-exposição entre homens que fazem/ não fazem sexo com homens. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivos identificar a realização da testagem para o HIV e o conhecimento sobre profilaxia pós-exposição (PEP) entre homens; e comparar os dados entre homens que fazem (ou não) sexo com homens. Método estudo transversal realizado com 271 homens participantes do carnaval no Rio de Janeiro, selecionados através da amostragem por conveniência. Os dados foram coletados no sambódromo, com auxílio de um questionário em fevereiro de 2017. A análise foi realizada por meio do software SPSS. Resultados houve disparidades na realização de testagem para o HIV e conhecimentos sobre PEP entre homens que fazem (ou não) sexo com homens. Homens que fazem sexo com homens possuem comportamentos e conhecimento melhores de enfrentamento ao HIV. Conclusão e implicações para a prática as políticas de enfrentamento ao HIV têm conseguido alcançar uma das populações-chave da epidemia, os homens que fazem sexo com homens, contudo homens que não fazem sexo com homens continuam vulneráveis.
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Jin F, Dore GJ, Matthews G, Luhmann N, Macdonald V, Bajis S, Baggaley R, Mathers B, Verster A, Grulich AE. Prevalence and incidence of hepatitis C virus infection in men who have sex with men: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 6:39-56. [PMID: 33217341 DOI: 10.1016/s2468-1253(20)30303-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND WHO has set targets for hepatitis C virus (HCV) elimination by 2030. We did a global systematic review of HCV prevalence and incidence in men who have sex with men (MSM) to provide updated estimates that can guide community education and public health policy. METHODS We did a systematic review and meta-analysis of studies published and listed on MEDLINE or Embase between Jan 1, 2000, and Oct 31, 2019, including conference proceedings. Studies were eligible if they reported measures of HCV prevalence or HCV incidence (or both) among MSM. Studies that relied on participants' self-reported HCV status with no laboratory confirmation were excluded. Pooled HCV estimates in MSM were stratified by HIV status and by injecting drug use, then by WHO region and by income level. Random-effects meta-analysis was done to account for between-study heterogeneity and examined using the I2 statistic. Pooled HCV prevalence was also compared with HCV estimates in the general population and presented as prevalence ratios (PRs). In HIV-negative MSM, incidence estimates were stratified by use of HIV pre-exposure prophylaxis (PrEP). The systematic review was registered with PROSPERO, number CRD42020156262. FINDINGS Of 1221 publications identified, 194 were deemed to be eligible and included in the systematic review and meta-analysis. Overall, the pooled HCV prevalence in MSM was 3·4% (95% CI 2·8-4·0; I2=98·0%) and was highest in Africa (5·8%, 2·5-10·4) and South-East Asia (5·0%, 0·0-16·6). Globally, HCV prevalence was 1·5% (1·0-2·1) in HIV-negative MSM and 6·3% (5·3-7·5) in HIV-positive MSM. Compared with the general population, HCV prevalence was slightly higher in HIV-negative MSM (PR 1·58, 95% CI 1·14-2·01) and markedly higher (6·22, 5·14-7·29) in HIV-positive MSM. Pooled HCV prevalence was substantially higher in MSM who had ever injected drugs (30·2%, 22·0-39·0) or currently injected drugs (45·6%, 21·6-70·7) than in those who never injected drugs (2·7%, 2·0-3·6). In HIV-negative MSM, the pooled HCV incidence was 0·12 per 1000 person-years (95% CI 0·00-0·72) in individuals not on PrEP and 14·80 per 1000 person-years (9·65-20·95) in individuals on PrEP. HCV incidence in HIV-positive MSM was 8·46 per 1000 person-years (6·78-10·32). INTERPRETATION HIV-positive MSM are at substantially increased risk of HCV. Overall, HIV-negative MSM had a slightly higher prevalence of HCV than the general population but had a lower prevalence than HIV-positive MSM. High HCV incidence in more recent PrEP studies suggests that as PrEP use increases, greater HCV transmission might occur. HCV burden in MSM varies considerably by region, which is likely to be associated with variation in the prevalence of injecting drug use and HIV. FUNDING World Health Organization.
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Affiliation(s)
- Fengyi Jin
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Gail Matthews
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Virginia Macdonald
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Sahar Bajis
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Rachel Baggaley
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Bradley Mathers
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Annette Verster
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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