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Ikhile O, Shah GH, Smallwood S, Waterfield KC, Nazaruk D. Demographic and Clinical Characteristics Predicting Missed Clinic Visits among Patients Living with HIV on Antiretroviral Treatment in Kinshasa and Haut-Katanga Provinces of the Democratic Republic of Congo. Healthcare (Basel) 2024; 12:1327. [PMID: 38998862 PMCID: PMC11241828 DOI: 10.3390/healthcare12131327] [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: 05/21/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Patients living with HIV (PLHIV) often face challenges that contribute to missed clinical care which can impact their health outcomes. METHODS This retrospective quantitative study comprised 5338 adults living with HIV who received antiretroviral treatment (ART) for 12 months, from July 2018 to June 2019 in Kinshasa and Haut-Katanga provinces of the Democratic Republic of Congo. Descriptive statistics were computed to show the level of missed appointments for ART. Multivariable associations of clinical and sociodemographic factors with a tendency to miss scheduled visits after adjusting for the covariates were examined using multivariable logistic regression analysis. RESULTS Six percent of PLHIV experienced at least one missed visit while 94% did not miss any visits. A small proportion (20%) of PLHIV had a viral load ≥1000 copies/mL. PLHIV receiving ART from urban clinics showed significantly higher odds of missed visits compared to those from rural areas (AOR = 4.18, 95% CI [1.84-9.511]; p < 0.0001). Similarly, patients from semi-rural/semi-urban clinics showed significantly higher odds of missed visits compared to those from rural areas. (AOR = 2.57, 95% CI [1.08-6.141]; p = 0.03). Additionally, older PLHIV (18-34 years old) demonstrated increased odds of missed visits (AOR= 1.71, 95% CI [1.0078-2.697]; p = 0.02) compared to those under 18 years old. CONCLUSIONS The findings from this study strongly suggest that there is a significant association between certain demographic factors, such as age and rurality-urbanicity, and missed visits. The study findings have implications for policy and interventions targeting PLHIV at higher risk of missed visits.
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Affiliation(s)
| | | | | | - Kristie C. Waterfield
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA; (O.I.); (G.H.S.); (S.S.); (D.N.)
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Schmitt J, Devlin SA, Mason JA, Lauritsen J, Tabidze I, Friedman EE, Massey RA, Winkler N, Ridgway JP. Data to Care Pilot Program in Chicago: Experience, Outcomes, and Direction for the Future. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024:00124784-990000000-00292. [PMID: 38950425 DOI: 10.1097/phh.0000000000001918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
CONTEXT Data to Care (D2C) involves sharing HIV surveillance data between health care facilities and health departments to improve continuity of care for people living with HIV (PLWH). The Chicago Department of Public Health (CDPH) initiated a D2C pilot program at the University of Chicago Medicine (UCM) from June 2016 to September 2019. OBJECTIVES To describe the proportion of patients reported by UCM as not in care who were able to be matched to CDPH enhanced HIV/AIDS Reporting System (eHARS) and to report the individual-level factors associated with matching and viral suppression. DESIGN Retrospective program evaluation. SETTING UCM, an academic health care center that provides HIV care to adults via a Ryan White clinic on the south side of Chicago. PARTICIPANTS Adult PLWH who had received care at UCM but did not have current documented HIV care visit(s). MAIN OUTCOME MEASURE Proportion of matched patients; factors associated with matching and viral suppression. RESULTS Overall, 72.4% (n = 813/1123) of patients reported by UCM were matched by CDPH to eHARS. Individuals aged 40 to 49 years (odds ratio [OR] = 1.99; 95% confidence interval [CI], 1.10-3.62), 50 to 59 years (OR = 2.47; 95% CI, 1.37-4.47), and 60 years or older (OR = 6.18; 95% CI, 3.18-12.32) were more likely to match in eHARS. People who lived outside of Chicago (OR = 0.09; 95% CI, 0.05-0.15) or with unknown zip codes (OR = 0.08; 95% CI, 0.05-0.12) were less likely to match. Men who have sex with men and persons older than 50 years were more likely to be virally suppressed. CONCLUSIONS D2C is an evidence-based strategy for reengagement of PLWH; however, program implementation relies on successful data matching. We found that a large proportion of patients from UCM were not matched, particularly those who were younger or lived outside of Chicago. Additional research is needed to understand ways to improve data matching to facilitate reengagement in HIV care.
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Affiliation(s)
- Jessica Schmitt
- Author Affiliations: Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, Illinois(Mss Schmitt, Devlin, and Massey, Messrs Mason and Winkler, and Drs Friedman and Ridgway); and Chicago Department of Public Health, Chicago, Illinois (Mr Lauritsen and Dr Tabidze)
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3
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Sohail M, Cleveland JD, McCollum CG, Burgan KW, Hearld LR, Carodine A, Johnson K, Fort M, Thompson J, Mugavero MJ. Assessing the Impact of Social Determinants of Health on HIV Care Engagement in the Southern United States: A Cross-Sectional Study. J Int Assoc Provid AIDS Care 2024; 23:23259582241251728. [PMID: 38816001 DOI: 10.1177/23259582241251728] [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] [Indexed: 06/01/2024] Open
Abstract
Recent studies have shown social determinants of health (SDOH) to impact HIV care engagement. This cross-sectional study (Oct 20-Apr 21) assessed the impact of a range of SDOH on HIV care engagement using data from HIV Care Connect, a consortium of three HIV care facility-led programs (Alabama, Florida, Mississippi). The exposures were captured using the PRAPARE (Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences) scale. The outcome was captured using the Index of Engagement in HIV Care scale. Participants (n = 132) were predominantly non-White (87%) and male (52%) with a median age of 41 years. Multivariable logistic regression adjusted for various sociodemographics showed lower HIV care engagement to be associated with being uninsured/publicly insured, having 1-3 unmet needs, socially integrating ≤five times/week, and having stable housing. Factors such as unmet needs, un-/underinsurance, and social integration may be addressed by healthcare and community organizations.
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Affiliation(s)
- Maira Sohail
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John D Cleveland
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C Greer McCollum
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kaylee W Burgan
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Larry R Hearld
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alyssa Carodine
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kendra Johnson
- University of Mississippi Medical Center, Adult Special Care Clinic, Jackson, MS, USA
| | - Melvin Fort
- Care Resource, Linkage Department, Miami, FL, USA
| | - Jennifer Thompson
- Five Horizons Health Services, Department of Social Services, Montgomery, AL, USA
| | - Michael J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
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Ingram MV, Amodei N, Perez VV, German V. Factors predicting 12-month retention in care for minority women living with HIV. Ther Adv Infect Dis 2022; 9:20499361221089815. [PMID: 35450384 PMCID: PMC9016542 DOI: 10.1177/20499361221089815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Retention in HIV medical care is associated with improved clinical outcomes
and reduced mortality. The present study was conducted to identify
significant predictors of 1-year retention in care for a sample of minority
women whose engagement in HIV care at baseline varied along the care
continuum from newly diagnosed to lost-to-care. Methods: One hundred sixty-five cisgender and transgender women living with HIV in a
southern US state were offered a multicomponent retention intervention that
included outreach, medical case management (MCM), patient navigation
services (PN), and a group intervention for stigma. Multilevel logistic
regression analysis was performed to identify baseline and intervention
predictors of retention in care at 12 months following enrollment. Results: Multilevel logistic regression analysis revealed that baseline
characteristics such as working significantly reduced the odds of being
retained as did increasing CD4 counts. However, greater amounts of patient
navigation and medical case management services received increased the odds
of being retained. Conclusion: MCM services designed to accelerate coordination and linkage or re-linkage to
primary care and PN services to help navigate the complex system of HIV
offered in the present study are particularly effective for minority women
who lack health insurance, have low CD4 counts, and are unemployed.
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Affiliation(s)
- Mercedes V. Ingram
- Community Initiatives and Population Health, University Health System, 4502 Medical Dr., MS 82-2, San Antonio, TX 78229, USA
| | - Nancy Amodei
- Community Initiatives and Population Health, University Health System, San Antonio, TX, USA
| | - Veronica Villela Perez
- Community Initiatives and Population Health, University Health System, San Antonio, TX, USA
| | - Victor German
- Community Initiatives and Population Health, University Health System, San Antonio, TX, USA
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Understanding the HIV Epidemic Among MSM in Baltimore: A Modeling Study Estimating the Impact of Past HIV Interventions and Who Acquired and Contributed to Infections. J Acquir Immune Defic Syndr 2021; 84:253-262. [PMID: 32141958 PMCID: PMC8432604 DOI: 10.1097/qai.0000000000002340] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Supplemental Digital Content is Available in the Text. Men who have sex with men (MSM) in the United States are disproportionately affected by HIV. We estimated the impact of past interventions and contribution of different population groups to incident MSM HIV infections.
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Buchacz K, Armon C, Palella FJ, Novak RM, Fuhrer J, Tedaldi E, Ward D, Mayer C, Battalora L, Carlson K, Purinton S, Durham M, Li J. The HIV Outpatient Study-25 Years of HIV Patient Care and Epidemiologic Research. Open Forum Infect Dis 2020; 7:ofaa123. [PMID: 32455145 PMCID: PMC7235508 DOI: 10.1093/ofid/ofaa123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background The clinical epidemiology of treated HIV infection in the United States has dramatically changed in the past 25 years. Few sources of longitudinal data exist for people with HIV (PWH) spanning that period. Cohort data enable investigating new exposure and disease associations and monitoring progress along the HIV care continuum. Methods We synthesized key published findings and conducted primary data analyses in the HIV Outpatient Study (HOPS), an open cohort of PWH seen at public and private HIV clinics since 1993. We assessed temporal trends in health outcomes (1993-2017) and mortality (1994-2017) for 10 566 HOPS participants. Results The HOPS contributed to characterizing new conditions (eg, lipodystrophy), demonstrated reduced mortality with earlier HIV treatment, uncovered associations between select antiretroviral agents and cardiovascular disease, and documented remarkable shifts in morbidity from AIDS opportunistic infections to chronic noncommunicable diseases. The median CD4 cell count of participants increased from 244 cells/mm3 to 640 cells/mm3 from 1993 to 2017. Mortality fell from 121 to 16 per 1000 person-years from 1994 to 2017 (P < .001). In 2010, 83.7% of HOPS participants had a most recent HIV viral load <200 copies/mL, compared with 92.2% in 2017. Conclusions Since 1993, the HOPS has been detecting emerging issues and challenges in HIV disease management. HOPS data can also be used for monitoring trends in infectious and chronic diseases, immunologic and viral suppression status, retention in care, and survival, thereby informing progress toward the Ending the HIV Epidemic initiative.
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Affiliation(s)
- Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carl Armon
- Cerner Corporation, Kansas City, Missouri, USA
| | - Frank J Palella
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Richard M Novak
- University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Jack Fuhrer
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Ellen Tedaldi
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Douglas Ward
- Dupont Circle Physicians Group, Washington, DC, USA
| | - Cynthia Mayer
- St. Joseph’s Hospital Comprehensive Research Institute, Tampa Florida, USA
| | - Linda Battalora
- Cerner Corporation, Kansas City, Missouri, USA
- Colorado School of Mines, Golden, Colorado, USA
| | | | | | - Marcus Durham
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jun Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Gebrezgi MT, Fennie KP, Sheehan DM, Ibrahimou B, Jones SG, Brock P, Ladner RA, Trepka MJ. Developing a triage tool for use in identifying people living with HIV who are at risk for non-retention in HIV care. Int J STD AIDS 2020; 31:244-253. [PMID: 32036751 PMCID: PMC7044017 DOI: 10.1177/0956462419893538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Identifying PLHIV in HIV care who are at particular risk of non-retention in care is an important element in improving their HIV care outcomes. The purpose of this study was to develop a risk prediction tool to identify PLHIV at risk of non-retention in care over the course of the next year. Method: We used stepwise logistic regression to assess sociodemographic, clinical and behavioral predictors of non-retention in HIV care. Retention in care was defined as having evidence of at least two encounters with an HIV care provider (or CD4 or viral load lab tests as a proxy measure for the encounter), at least 3 months apart within a year. We validated the risk prediction tool internally using the bootstrap method. Results: The risk prediction tool included a total of six factors: age group, race, poverty level, homelessness, problematic alcohol/drug use and viral suppression status. The total risk score ranged from 0 to 17. Compared to those in the lowest quartile (0 risk score), those who were in the middle two quartiles (score 1–4) and those in the upper quartile (>4 risk score) were more likely not to be retained in care (odds ratio [OR] 1.63 [CI; 1.39–1.92] and OR 4.82 [CI; 4.04–5.78] respectively). The discrimination ability for the prediction model was 0.651. Conclusion: We found that increased risk for non-retention in care can be predicted with routinely available variables. Since the discrimination of the tool was low, future studies may need to include more prognostic factors in the risk prediction tool.
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Affiliation(s)
- Merhawi T. Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Kristopher P. Fennie
- Division of Natural Sciences, New College of Florida, 5800 Bay Shore Road, Sarasota, FL 34243, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Boubakari Ibrahimou
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Sandra G. Jones
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
| | - Petra Brock
- Behavioral Science Research Corporation, Miami, Florida
| | | | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, Miami, FL 33199, USA
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Rodriguez AE, Wawrzyniak AJ, Tookes HE, Vidal MG, Soni M, Nwanyanwu R, Goldberg D, Freeman R, Villamizar K, Alcaide ML, Kolber MA. Implementation of an Immediate HIV Treatment Initiation Program in a Public/Academic Medical Center in the U.S. South: The Miami Test and Treat Rapid Response Program. AIDS Behav 2019; 23:287-295. [PMID: 31520241 DOI: 10.1007/s10461-019-02655-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Test and Rapid Response Treatment (TRRT) linkage programs have demonstrated improved HIV suppression rates. This paper describes the design and implementation of the Miami TRRT initiative and its clinical impact. Assisted by a dedicated care navigator, patients receiving a reactive HIV rapid test at the Florida Department of Health STD Clinic were offered same-day HIV care at the University of Miami/Jackson Memorial Medical Center Adult HIV Outpatient Clinic. Patient retention and labs were tracked for 12 months. Of the 2337 individuals tested, 46 had a reactive HIV test; 41 (89%) consented to participate. For the 36 patients in continued care for a year, 33 (91.7%) achieved virological suppression (< 200 copies/mL) within 70 days of their reactive HIV rapid test; at 12 months, 35 (97.2%) remained suppressed, and mean CD4 T cell counts increased from 452 ± 266 to 597 ± 322 cells/mm3. The Miami TRRT initiative demonstrated that immediate linkage to care is feasible and improves retention and suppression in a public/academic medical center in the U.S. South.
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Affiliation(s)
- Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 856, Miami, FL, 33136, USA.
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 856, Miami, FL, 33136, USA
| | - Marcia G Vidal
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 856, Miami, FL, 33136, USA
| | - Manasi Soni
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 856, Miami, FL, 33136, USA
| | | | - David Goldberg
- Florida Department of Health in Miami-Dade County, Miami, FL, USA
| | | | - Kira Villamizar
- Florida Department of Health in Miami-Dade County, Miami, FL, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 856, Miami, FL, 33136, USA
| | - Michael A Kolber
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 856, Miami, FL, 33136, USA
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Jose S, Delpech V, Howarth A, Burns F, Hill T, Porter K, Sabin CA. A continuum of HIV care describing mortality and loss to follow-up: a longitudinal cohort study. Lancet HIV 2019; 5:e301-e308. [PMID: 29893243 PMCID: PMC5990495 DOI: 10.1016/s2352-3018(18)30048-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/02/2018] [Accepted: 03/20/2018] [Indexed: 12/11/2022]
Abstract
Background The cross-sectional HIV care continuum is widely used to assess the success of HIV care programmes among populations of people with HIV and the potential for ongoing transmission. We aimed to investigate whether a longitudinal continuum, which incorporates loss to follow-up and mortality, might provide further insights about the performance of care programmes. Methods In this longitudinal cohort study, we included individuals who entered the UK Collaborative HIV Cohort (CHIC) study between Jan 1, 2000, and Dec 31, 2004, and were linked to the national HIV cohort database (HIV and AIDS Reporting System). For each month during a 10 year follow up period, we classified individuals into one of ten distinct categories according to engagement in care, antiretroviral therapy (ART) use, viral suppression, loss to cohort follow-up and loss to care, and mortality, and assessed the proportion of person-months of follow-up spent in each stage of the continuum. 5 year longitudinal continuums were also constructed for three separate cohorts (baseline years of entry 2000–03, 2004–07, and 2008–09) to compare changes over time. Findings We included 12 811 people contributing 1 537 320 person-months in our analysis. During 10 years of follow-up, individuals spent 811 057 (52·8%) of 1 537 320 person-months on ART. Of the 811 057 person-months spent on ART, individuals had a viral load of 200 copies per mL or less for 607 185 (74·9%) person-months. 10 years after cohort entry, 3612 (28·1%) of 12 811 individuals were lost to follow-up, 954 (26·4%) of whom had transferred to a non-CHIC UK clinic for care. By 10 years, 759 (5·9%) of 12 811 participants who entered the cohort had died. Loss to follow-up decreased and the proportion of person-months that individuals spent virally suppressed increased over calendar time. Interpretation Loss to follow-up in HIV care programmes was high and rates of viral suppression were lower than previously reported. Complementary information provided by a longitudinal continuum might highlight areas for intervention along the HIV care pathway, however, transfers outside the cohort must be accounted for. Funding Medical Research Council, UK.
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Affiliation(s)
- Sophie Jose
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
| | - Valerie Delpech
- Public Health England, London, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
| | - Alison Howarth
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
| | - Fiona Burns
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK
| | - Teresa Hill
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Kholoud Porter
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
| | - Caroline A Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK.
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Mitchell KM, Hoots B, Dimitrov D, German D, Flynn C, Farley JE, Gelman M, Hughes JP, Donnell D, Adeyeye A, Remien RH, Beyrer C, Paz‐Bailey G, Boily M. Improvements in the HIV care continuum needed to meaningfully reduce HIV incidence among men who have sex with men in Baltimore, US: a modelling study for HPTN 078. J Int AIDS Soc 2019; 22:e25246. [PMID: 30868739 PMCID: PMC6416473 DOI: 10.1002/jia2.25246] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/18/2019] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION HIV prevalence is high among men who have sex with men (MSM) in Baltimore, Maryland, United States, and the levels of viral suppression among HIV-positive MSM are relatively low. The HIV Prevention Trials Network 078 trial seeks to increase the levels of viral suppression among US MSM by increasing the rates of diagnosis and linkage to care and treatment. We estimated the increases in viral suppression needed to reach different HIV incidence reduction targets, and the impact of meeting diagnosis and treatment targets. METHODS We used a mathematical model of HIV transmission among MSM from Baltimore, US, parameterised with behavioural data and fitted to HIV prevalence and care continuum data for Baltimore wherever possible, to project increases in viral suppression needed to reduce the HIV incidence rate among Baltimore MSM by 10, 20, 30 or 50% after 2, 5 and 10 years. We also projected HIV incidence reductions achieved if US national targets - 90% of people living with HIV (PLHIV) know their HIV serostatus, 90% of those diagnosed are retained in HIV medical care and 80% of those diagnosed are virally suppressed - or UNAIDS 90-90-90 targets (90% of PLHIV know their status, 90% of those diagnosed receive antiretroviral therapy (ART), 90% of those receiving ART are virally suppressed) are each met by 2020. RESULTS To reduce the HIV incidence rate by 20% and 50% after five years (compared with the base-case at the same time point), the proportion of all HIV-positive MSM who are virally suppressed must increase above 2015 levels by a median 13 percentage points (95% uncertainty interval 9 to 16 percentage points) from median 49% to 60%, and 27 percentage points (22 to 35) from 49% to 75% respectively. Meeting all three US or 90-90-90 UNAIDS targets results in a 48% (31% to 63%) and 51% (38% to 65%) HIV incidence rate reduction in 2020 respectively. CONCLUSIONS Substantial improvements in levels of viral suppression will be needed to achieve significant incidence reductions among MSM in Baltimore, and to meet 2020 US and UNAIDS targets. Future modelling studies should additionally consider the impact of pre-exposure prophylaxis for MSM.
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Affiliation(s)
- Kate M Mitchell
- Department of Infectious Disease EpidemiologyImperial College LondonHPTN Modelling CentreLondonUK
| | - Brooke Hoots
- Division of STD PreventionCenters for Disease Control and PreventionAtlantaGAUSA
| | - Dobromir Dimitrov
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Danielle German
- Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Colin Flynn
- Center for HIV Surveillance, Epidemiology and EvaluationMaryland Department of HealthBaltimoreMDUSA
| | - Jason E Farley
- Department of Community‐Public HealthJohns Hopkins University School of NursingBaltimoreMDUSA
| | | | - James P Hughes
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
- Department of BiostatisticsUniversity of WashingtonSeattleWAUSA
| | - Deborah Donnell
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Adeola Adeyeye
- Division of AIDS, NIAIDNational Institutes of HealthWashingtonDCUSA
| | - Robert H Remien
- HIV Center for Clinical and Behavioral StudiesNY State Psychiatric InstituteNew YorkNYUSA
- Department of PsychiatryColumbia UniversityNew YorkNYUSA
| | - Chris Beyrer
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Gabriela Paz‐Bailey
- Division of HIV/AIDS PreventionCenters for Disease Control and PreventionAtlantaGAUSA
| | - Marie‐Claude Boily
- Department of Infectious Disease EpidemiologyImperial College LondonHPTN Modelling CentreLondonUK
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Kinoshita M, Oka S. Migrant patients living with HIV/AIDS in Japan: Review of factors associated with high dropout rate in a leading medical institution in Japan. PLoS One 2018; 13:e0205184. [PMID: 30339665 PMCID: PMC6195273 DOI: 10.1371/journal.pone.0205184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/28/2018] [Indexed: 12/27/2022] Open
Abstract
The present study aimed to identify factors associated with retention in HIV/AIDS care among migrant patients who visited the outpatient clinic of the AIDS Clinical Center, National Center for Global Health and Medicine in Tokyo, Japan. We reviewed the records of 551 selected (78 non-Japanese and 473 Japanese) patients who started visiting our clinic between 2011 and 2014. A total of 390 patients (70.8%: 38 non-Japanese and 352 Japanese) continued their visits during the study: from the date of their first visit to the end of 2015. The difference in retention rate was not significant (Incidence Rate Ratio (IRR) = 0.89, p = 0.27), but the loss-to-follow-up cases were considerably high among non-Japanese patients (n = 13, Incidence rate (IR) = 24.6 per 100,000 person-days, IRR = 3.65, p<0.01 after adjusting for time since diagnosis). The results showed, nevertheless, that there was no apparent association between retention and factors peculiar to non-Japanese. Twelve out of thirteen lost-to-follow-up non-Japanese patients held legal status to reside in Japan and were eligible for public health services. Nine had limited fluency in Japanese language, and six used alternative verbal communication. Further studies are needed to identify the factors responsible for the high dropout rate and to improve the care of migrant patients living with HIV/AIDS.
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Affiliation(s)
- Mari Kinoshita
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
- * E-mail:
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
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Beyond binary retention in HIV care: predictors of the dynamic processes of patient engagement, disengagement, and re-entry into care in a US clinical cohort. AIDS 2018; 32:2217-2225. [PMID: 30005018 DOI: 10.1097/qad.0000000000001936] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Studies examining engagement in HIV care often capture cross-sectional patient status to estimate retention and identify predictors of attrition, which ignore longitudinal patient care-seeking behaviors. We describe the cyclical nature of (dis)engagement and re-entry into HIV care using the state transition framework. DESIGN We represent the dynamic patterns of patient care-retention using five states: engaged in care, missed one, two, three, or more expected visits, and deceased. Then we describe various care-seeking behaviors in terms of transitioning from one state to another (e.g. from disengaged to engaged). This analysis includes 31 009 patients enrolled in the Center for AIDS Research Network of Integrated Systems (CNICS) in the United States from 1996 to 2014. METHOD Multistate models for longitudinal data were used to identify barriers to retention and subgroups at higher risk of falling out of care. RESULTS The initial 2 years following primary engagement in care were a crucial time for improving retention. Patients who had not initiated antiretroviral therapy, with lower CD4 cell counts, higher viral load, or not having an AIDS-defining illness were less likely to be retained in care. CONCLUSION Beyond the individual patient characteristics typically used to characterize retention in HIV care, we identified specific periods of time and points in the care continuum associated with elevated risk of transitioning out of care. Our findings can contribute to evidence-based recommendations to enhance long-term retention in CNICS. This approach can also be applied to other cohort data to identify retention strategies tailored to each population.
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Improving Retention in HIV Care Through New York's Expanded Partner Services Data-to-Care Pilot. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:255-263. [PMID: 27902561 PMCID: PMC5381495 DOI: 10.1097/phh.0000000000000483] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Supplemental Digital Content is Available in the Text. Context: Data to Care (DTC) represents a public health strategy using HIV surveillance data to link persons living with diagnosed HIV infection (PLWDHI) to HIV-related medical care. Objective: To investigate the feasibility of the DTC approach applied to a Partner Services program serving a geographically diffuse area of New York State. Design: Disease intervention specialists received training to function as Expanded Partner Services (ExPS) advocates. HIV surveillance data identified PLWDHI presumed to be out of care (OOC). ExPS advocates attempted to locate and reengage OOC individuals in HIV-related care. The pilot ran from September 1, 2013, to August 31, 2014. Setting: Four upstate New York counties, home to one-third of all PLWDHI in upstate New York. Participants: A total of 1155 PLWDHI presumed to be OOC. Main Outcome Measures: Linked to HIV medical care—cases verified as attending 1 or more HIV medical appointments subsequent to case assignment; reengaging in HIV care—any HIV laboratory test in the 6 months following case closure; and retention in HIV care—2 or more HIV laboratory tests in the 6 months following case closure. Results: The majority of assigned cases (85.3%) were located; 23.7% (n = 233) of located cases confirmed as OOC; and 71.2% of OOC cases (n = 166) were successfully relinked into care. Relinkage success did not differ by gender, transmission risk, or major race/ethnicity categories; however, there was a direct relationship between age and successful relinkage (P < .001). Ninety-five percent of relinked cases reengaged in medical care, and 63.3% were retained in care. Individuals relinked by ExPS advocates were more likely to reengage in care (95%) than individuals interviewed but not relinked to care by advocates (53.7%) and individuals ineligible for the ExPS intervention (34.2%). Conclusion: DTC can be effective when conducted outside large metropolitan areas and/or closed health care systems. It can also be effectively incorporated into existing Partner Services programs; however, the relative priority of DTC work must be established in this context.
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Buchacz K, Armon C, Tedaldi E, Palella FJ, Novak RM, Ward D, Hart R, Durham MD, Brooks JT, Hays H, Subramanian T, Purinton S, Franklin D, Akridge C, Rayeed N, Jahangir S, Flaherty CD, Bustamante P, Hammer J, Greenberg KS, Widick B, Franklin R, Yangco BG, Chagaris K, Thomas T, Stewart C, Fuhrer J, Ording-Bauer L, Kelly R, Esteves J, Christian RA, Ruley F, Beadle D, Davenport P, Wendrow A, Young B, Scott M, Thomas B. Disparities in HIV Viral Load Suppression by Race/Ethnicity Among Men Who Have Sex with Men in the HIV Outpatient Study. AIDS Res Hum Retroviruses 2018; 34:357-364. [PMID: 29316797 DOI: 10.1089/aid.2017.0162] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Maximizing the rates of virologic suppression (VS) among gay, bisexual, and other men who have sex with men (MSM) is essential to limiting HIV morbidity and sexual transmission of HIV in the United States. We analyzed data for MSM of non-Hispanic white (white), non-Hispanic black (black), or Hispanic/Latino race/ethnicity in the HIV Outpatient Study (HOPS) at nine U.S. HIV clinics. VS (HIV RNA <50 copies/ml) was measured closest to January 1, 2015. We modeled factors associated with VS among persons prescribed antiretroviral therapy (ART) for ≥6 months and assessed VS for a subset of participants with behavioral interview data. Among 1,303 MSM studied, 24% were black and 11% were Hispanic/Latino. Fewer black than white or Hispanic/Latino MSM had any documented ART use history (92% vs. 99% and 94%, respectively), and fewer had VS (72% vs. 91% and 81%), p < .001. In analyses of MSM prescribed ART, which adjusted for insurance type, duration of ART use, and CD4+ cell count, blacks had lower prevalence of VS than whites [adjusted prevalence ratio (PR) 0.87, confidence interval (95% CI) 0.81-0.93] and Hispanics/Latinos did not (PR 0.95, 95% CI 0.88-1.02). Among 331 MSM with interview data, 6% had no VS, but reported anal sex without a condom with an HIV-uninfected or unknown HIV serostatus male partner in the past 6 months. In this study of HIV-infected MSM, blacks had a significantly lower prevalence of VS than white men. Optimizing HIV care and prevention among all MSM will require addressing underlying risk factors and social determinants of health that contribute to racial/ethnic disparities in HIV outcomes.
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Affiliation(s)
- Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carl Armon
- Cerner Corporation, Kansas City, Missouri
| | - Ellen Tedaldi
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Frank J. Palella
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Richard M. Novak
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Douglas Ward
- Dupont Circle Physicians Group, Washington, District of Columbia
| | | | - Marcus D. Durham
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John T. Brooks
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Sucharitakul K, Boily MC, Dimitrov D, Mitchell KM. Influence of model assumptions about HIV disease progression after initiating or stopping treatment on estimates of infections and deaths averted by scaling up antiretroviral therapy. PLoS One 2018; 13:e0194220. [PMID: 29554136 PMCID: PMC5858778 DOI: 10.1371/journal.pone.0194220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/27/2018] [Indexed: 01/17/2023] Open
Abstract
Background Many mathematical models have investigated the population-level impact of expanding antiretroviral therapy (ART), using different assumptions about HIV disease progression on ART and among ART dropouts. We evaluated the influence of these assumptions on model projections of the number of infections and deaths prevented by expanded ART. Methods A new dynamic model of HIV transmission among men who have sex with men (MSM) was developed, which incorporated each of four alternative assumptions about disease progression used in previous models: (A) ART slows disease progression; (B) ART halts disease progression; (C) ART reverses disease progression by increasing CD4 count; (D) ART reverses disease progression, but disease progresses rapidly once treatment is stopped. The model was independently calibrated to HIV prevalence and ART coverage data from the United States under each progression assumption in turn. New HIV infections and HIV-related deaths averted over 10 years were compared for fixed ART coverage increases. Results Little absolute difference (<7 percentage points (pp)) in HIV infections averted over 10 years was seen between progression assumptions for the same increases in ART coverage (varied between 33% and 90%) if ART dropouts reinitiated ART at the same rate as ART-naïve MSM. Larger differences in the predicted fraction of HIV-related deaths averted were observed (up to 15pp). However, if ART dropouts could only reinitiate ART at CD4<200 cells/μl, assumption C predicted substantially larger fractions of HIV infections and deaths averted than other assumptions (up to 20pp and 37pp larger, respectively). Conclusion Different disease progression assumptions on and post-ART interruption did not affect the fraction of HIV infections averted with expanded ART, unless ART dropouts only re-initiated ART at low CD4 counts. Different disease progression assumptions had a larger influence on the fraction of HIV-related deaths averted with expanded ART.
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Affiliation(s)
- Kanes Sucharitakul
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Dobromir Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, United States of America
| | - Kate M. Mitchell
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- * E-mail:
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Amirkhanian YA, Kelly JA, DiFranceisco WJ, Kuznetsova AV, Tarima SS, Yakovlev AA, Musatov VB. Predictors of HIV Care Engagement, Antiretroviral Medication Adherence, and Viral Suppression Among People Living with HIV Infection in St. Petersburg, Russia. AIDS Behav 2018; 22:791-799. [PMID: 27990579 DOI: 10.1007/s10461-016-1638-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Over 1 million HIV infections have been diagnosed in Russia, and HIV care uptake and viral suppression are very low. 241 HIV-positive individuals in St. Petersburg were enrolled through social networks, provided blood for viral load testing, and completed measures of medication-taking adherence, readiness, and self-efficacy; psychosocial well-being; and substance use. Outcomes included attending an HIV care appointment in the past 6 months, >90% ART adherence, and undetectable viral load. 26% of participants had no recent care appointment, 18% had suboptimal adherence, and 56% had detectable viral load. Alcohol use consistently predicted all adverse health outcomes. Having no recent care visit was additionally associated with being single and greater past-month drug injection frequency. Poor adherence was additionally predicted by lower medication-taking self-efficacy and lower anxiety. Detectable viral load was additionally related to younger age. Comprehensive interventions to improve HIV care in Russia must address substance abuse, anxiety, and medication-taking self-efficacy.
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Affiliation(s)
- Yuri A Amirkhanian
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Center for AIDS Intervention Research (CAIR), 2071 North Summit Avenue, Milwaukee, WI, 53202, USA.
- Botkin Hospital for Infectious Diseases, Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia.
| | - Jeffrey A Kelly
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Center for AIDS Intervention Research (CAIR), 2071 North Summit Avenue, Milwaukee, WI, 53202, USA
| | - Wayne J DiFranceisco
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Center for AIDS Intervention Research (CAIR), 2071 North Summit Avenue, Milwaukee, WI, 53202, USA
| | - Anna V Kuznetsova
- Botkin Hospital for Infectious Diseases, Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia
| | - Sergey S Tarima
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Center for AIDS Intervention Research (CAIR), 2071 North Summit Avenue, Milwaukee, WI, 53202, USA
| | - Alexey A Yakovlev
- Botkin Hospital for Infectious Diseases, Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia
| | - Vladimir B Musatov
- Botkin Hospital for Infectious Diseases, Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia
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Abstract
A systematic literature review was conducted to identify predictors of poor adult retention in HIV medical care in developed and developing countries. An electronic search was conducted with MEDLINE (OVID), PubMED, EBSCO, SCOPUS, and Cochrane databases, as well as manual searches. Original, quantitative, adult studies in English, published between 1995 and 2015 were included. Only those with a focus on predictors of retention in care were reported on. Of the 345 articles identified, thirty were included following an independent assessment by two raters. In developed countries, the most frequently cited predictors of poor retention were active substance use and demographic factors. In developing countries, physical health factors were most frequently associated with poor retention in care. The results from this review suggests primary concerns for poor retention include substance use and physical health factors. Other psychosocial factors, such as psychiatric illness and social/welfare factors, were also found to be relevant.
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Safo SA, Blank AE, Cunningham CO, Quinlivan EB, Lincoln T, Blackstock OJ. Pain is Associated with Missed Clinic Visits Among HIV-Positive Women. AIDS Behav 2017; 21:1782-1790. [PMID: 27388160 DOI: 10.1007/s10461-016-1475-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pain is highly prevalent among HIV-positive individuals, with women representing a large subset of those with pain. However, little is known about the relationship between pain and retention in HIV medical care. Among a cohort of HIV-positive women of color, we evaluated the association between pain and retention in care, as measured by missed clinic visits. The Health Resources and Services Administration's Women of Color Initiative was a multi-site observational cohort study evaluating demonstration projects to engage HIV-positive women in medical care. From November 2010 to July 2013, 921 women were enrolled in the study across nine U.S. sites; baseline interviews collected data on socio-demographic, clinical, and risk behavior characteristics. Pain was assessed at baseline based on number of days in pain over the last 30 days and was categorized as no pain (0 days), infrequent pain (1-13 days), and frequent pain (14-30 days), with 14 days being the median. Missed visits over the one-year follow-up period, evaluated by chart abstraction, were dichotomized as ≤1 missed visit versus >1 missed visit. We conducted multivariate logistic regression to assess the association between pain at baseline and missed visits, adjusting for pertinent covariates. Among our sample (N = 862), 52.2 % of women reported no pain, 23.7 % reported infrequent pain and 24.1 % reported frequent pain. Forty-five percent had >1 missed visit during the one-year follow-up period. Overall, we did not find a significant association between pain and missed visits (aOR 2.30; 95 % CI 1.00-5.25). However, in planned stratified analyses, among women reporting current substance use at baseline, reporting frequent pain was associated with a higher odds of missed visits as compared with reporting no pain (aOR 15.14; 95 % CI 1.78-128.88). In our overall sample, pain was not significantly associated with missed visits. However, frequent pain was associated with missed visits among HIV-positive women of color who reported substance use at baseline. A better understanding of the relationship between pain and missed visits could guide efforts to improve retention in care in this population.
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Affiliation(s)
| | | | - Chinazo O Cunningham
- Montefiore Medical Center, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - E Byrd Quinlivan
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
- Center for AIDS Research, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas Lincoln
- Baystate Medical Center & Tufts University School of Medicine, Springfield, MA, USA
| | - Oni J Blackstock
- Montefiore Medical Center, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
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Morales-Alemán MM, Opoku J, Murray A, Lanier Y, Kharfen M, Sutton MY. Disparities in Retention in HIV Care Among HIV-Infected Young Men Who Have Sex with Men in the District of Columbia, 2013. LGBT Health 2017; 4:34-41. [PMID: 28045573 DOI: 10.1089/lgbt.2016.0126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Among young men who have sex with men (YMSM), aged 13-24 years, Blacks/African Americans and Hispanics/Latinos are disproportionately affected by HIV, accounting for 58% and 21%, respectively, of diagnoses of HIV infection in the United States. In the District of Columbia (DC), YMSM of color are also disproportionately affected by HIV. National goals are that 80% of HIV-infected persons be retained in HIV care. We analyzed DC surveillance data to examine retention among YMSM living with HIV infection in DC. METHODS We characterized correlates of retention in HIV care (≥2 clinical visits, ≥3 months apart, within 12 months of diagnosis) among YMSM in DC to inform and strengthen local HIV care efforts. We analyzed data from DC HIV surveillance system for YMSM aged 13-29 years diagnosed between 2005 and 2012 and alive in 2013. We also combined demographic and clinical variables with sociodemographic data from the U.S. American Community Survey (ACS) by census tracts. RESULTS From 2005 to 2012, 1034 YMSM were diagnosed and living with HIV infection in DC; 83% were Black or Latino. Of the 1034 YMSM, 910 (88%) had census tract data available and were included in analyses (72% Black, 10% Latino, and 17% White); among the 854 (94%) linked to care, 376 (44%) were retained in care. In multivariate analyses, retention in care was less likely among 19-24 year YMSM compared with 13-18-year-old YMSM (adjusted prevalence ratios [aPR] = 0.89, 95% confidence intervals [CI] 0.80-0.99). CONCLUSION Retention in HIV care was suboptimal for YMSM. Increased retention efforts are warranted to improve outcomes and reduce age and racial/ethnic disparities.
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Affiliation(s)
- Mercedes M Morales-Alemán
- 1 Department of Community and Rural Medicine, Institute for Rural Health Research, College of Community Health Sciences, The University of Alabama , Tuscaloosa, Alabama.,2 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Jenevieve Opoku
- 3 HIV/AIDS, Hepatitis, STD and TB Administration, District of Columbia Department of Health, Washington, DC
| | - Ashley Murray
- 2 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Yzette Lanier
- 4 College of Nursing, New York University , New York, New York
| | - Michael Kharfen
- 3 HIV/AIDS, Hepatitis, STD and TB Administration, District of Columbia Department of Health, Washington, DC
| | - Madeline Y Sutton
- 2 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
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Kuznetsova AV, Meylakhs AY, Amirkhanian YA, Kelly JA, Yakovlev AA, Musatov VB, Amirkhanian AG. Barriers and Facilitators of HIV Care Engagement: Results of a Qualitative Study in St. Petersburg, Russia. AIDS Behav 2016; 20:2433-2443. [PMID: 26767534 DOI: 10.1007/s10461-015-1282-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Russia has a large HIV epidemic, but medical care engagement is low. Eighty HIV-positive persons in St. Petersburg completed in-depth interviews to identify barriers and facilitators of medical HIV care engagement. The most commonly-reported barriers involved difficulties accessing care providers, dissatisfaction with the quality of services, and negative attitudes of provider staff. Other barriers included not having illness symptoms, life stresses, low value placed on health, internalized stigma and wanting to hide one's HIV status, fears of learning about one's true health status, and substance abuse. Care facilitators were feeling responsible for one's health and one's family, care-related support from other HIV-positive persons, and the onset of health decline and fear of death. Substance use remission facilitated care engagement, as did good communication from providers and trust in one's doctor. Interventions are needed in Russia to address HIV care infrastructural barriers and integrate HIV, substance abuse, care, and psychosocial services.
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Increased antiretroviral therapy prescription and HIV viral suppression among persons receiving clinical care for HIV infection. AIDS 2016; 30:2117-24. [PMID: 27465279 DOI: 10.1097/qad.0000000000001164] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess trends during 2009-2013 in antiretroviral therapy (ART) prescription and viral suppression among adults receiving HIV clinical care in the United States. DESIGN We used data from the Medical Monitoring Project, a surveillance system producing national estimates of characteristics of HIV-infected adults receiving clinical care in the United States. METHODS We estimated weighted proportions of persons receiving HIV medical care who were prescribed ART and achieved HIV viral suppression (<200 copies/ml) at both last test and at all tests in the previous 12 months during 2009-2013. We assessed trends overall and by gender, age, race/ethnicity, and sexual behavior/orientation. RESULTS ART prescription and viral suppression increased significantly during 2009-2013, overall and in subgroups. ART prescription increased from 89 to 94% (P for trend <0.01). Viral suppression at last measurement increased from 72 to 80% (P for trend <0.01). The largest increases were among 18-29 year olds (56-68%), 30-39 year olds (62-75%), and non-Hispanic blacks (64-76%). Sustained viral suppression increased from 58 to 68% (P for trend <0.01). The largest increases were among 18-29 year olds (32-51%), 30-39 year olds (47-63%), and non-Hispanic blacks (49-61%). CONCLUSION Adults receiving HIV medical care are increasingly likely to be prescribed ART and achieve viral suppression. Recent efforts to promote early antiretroviral therapy use may have contributed to these increases, bringing us closer to realizing key goals of the National HIV/AIDS Strategy.
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Adams JW, Brady KA, Michael YL, Yehia BR, Momplaisir FM. Postpartum Engagement in HIV Care: An Important Predictor of Long-term Retention in Care and Viral Suppression. Clin Infect Dis 2015; 61:1880-7. [DOI: 10.1093/cid/civ678] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 07/28/2015] [Indexed: 01/21/2023] Open
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