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Ortega-Gonzalez E, Martínez-Roma M, Dolores Ocete M, Jimeno C, Fornos A, Esteban A, Martinez M, Valero C, Gómez-Muñoz N, Carrodeguas A, Medina D, Garcia-Deltoro M. HIV screening and linkage to care in a health department in Valencia, Spain: Lessons learned from a healthcare quality improvement project. Medicine (Baltimore) 2022; 101:e30400. [PMID: 36254051 PMCID: PMC9575804 DOI: 10.1097/md.0000000000030400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Spain's rate of new human immunodeficiency virus (HIV) diagnoses exceeds that of the European Economic Area average (8.6 vs 5.6:100,000 in 2018). The country has failed to meet the first of United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets for HIV control by 2020, with 87.0% of people living with HIV knowing their status, and late presentation rates of 47.6% and 51.5% country-wide and in the Valencian autonomous community, respectively. Advancing screening and linkage to care (SLTC) practices is necessary to effectively control the epidemic. The Valencia Viral Screening (CRIVALVIR) project adopted the TEST model for opportunistic and systematic HIV SLTC in individuals aged 18 to 80 who required blood work for any purpose, as of February 2019. SLTC was integrated into routine clinical workflow across primary care centers serving a population of 360,000 people in Valencia, Spain. Our project successfully upscaled total HIV testing by 194% to over 32,000 patients tested in 14 months. We found an overall prevalence of 0.13% (0.08-0.21) among those screened per protocol (n = 13,061), with foreign-born citizens presenting a 12.5 times significantly higher likelihood of acquiring HIV (95% confidence interval 4.63-33.96, P < .0001). We improved late presentation by 18.2 percentage points and prevented an estimated 58 to 70 new secondary infections. HIV screening of the general population in primary care is an effective strategy for achieving timely diagnosis and preventing new infections. Opportunistic, systematic, opt-out approaches are essential to control the HIV epidemic.
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Affiliation(s)
- Enrique Ortega-Gonzalez
- Fundació Investigació Hospital General Universitari Valencia, Valencia, Spain
- * Correspondence: Enrique Ortega-Gonzalez, Fundació Investigació Hospital General Universitari València, Spain. Av. Tres Cruces, 2, 46014, Valencia, Spain (e-mail: )
| | - María Martínez-Roma
- Fundació Investigació Hospital General Universitari Valencia, Valencia, Spain
| | | | | | | | | | | | - Carmen Valero
- Departament Hospital General València, Valencia, Spain
| | - Neus Gómez-Muñoz
- Fundació Investigació Hospital General Universitari Valencia, Valencia, Spain
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Rava M, Domínguez-Domínguez L, Bisbal O, López-Cortés LF, Busca C, Antela A, González-Ruano P, Hernández C, Iribarren JA, Rubio R, Moreno S, Jarrín I. Late presentation for HIV remains a major health issue in Spain: Results from a multicenter cohort study, 2004-2018. PLoS One 2021; 16:e0249864. [PMID: 33882093 PMCID: PMC8059864 DOI: 10.1371/journal.pone.0249864] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/26/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES With the purpose of reducing the well-known negative impact of late presentation (LP) on people living with HIV (PLWH), guidelines on early HIV diagnosis were published in 2014 in Spain, but since then no data on LP prevalence have been published. To estimate prevalence and risk factors of LP and to evaluate their impact on the development of clinical outcomes in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) during 2004-2018. METHODS CoRIS is an open prospective multicenter cohort of PLWH, adults, naive to ART at entry. LP was defined as HIV diagnosis with CD4 count ≤350 cells/μL or an AIDS defining event (ADE). Multivariable Poisson regression models were used to estimate both prevalence ratios (PR) for the association of potential risk factors with LP and Incidence rate ratios (IRRs) for its impact on the development of the composite endpoint (first ADE, first serious non-AIDS event [SNAE] or overall mortality). RESULTS 14,876 individuals were included. Overall, LP prevalence in 2004-2018 was 44.6%. Risk factors for LP included older age, having been infected through injection drug use or heterosexual intercourse, low educational level and originating from non-European countries. LP was associated with an increased risk of the composite endpoint (IRR: 1.34; 95%CI 1.20, 1.50), ADE (1.39; 1.18, 1.64), SNAE (1.22; 1.01, 1.47) and mortality (1.71; 1.41, 2.08). CONCLUSIONS LP remains a health problem in Spain, mainly among certain populations, and is associated with greater morbidity and mortality. Public policies should be implemented to expand screening and early diagnosis of HIV infection, for a focus on those at greatest risk of LP.
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Affiliation(s)
- Marta Rava
- Unit AIDS Research Network Cohort (CoRIS), National Center of Epidemiology (CNE), Health Institute Carlos III (ISCIII), Madrid, Spain
| | | | | | | | | | - Antonio Antela
- University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Cristina Hernández
- Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
| | - Josè-Antonio Iribarren
- Department of Infectious Diseases, University Hospital, IIS Biodonostia, San Sebastián, Spain
| | - Rafael Rubio
- 12 de Octubre University Hospital, Madrid, Spain
| | | | - Inmaculada Jarrín
- Unit AIDS Research Network Cohort (CoRIS), National Center of Epidemiology (CNE), Health Institute Carlos III (ISCIII), Madrid, Spain
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3
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Xu J, Sönnerborg A, Gao L, Wang P, Bouey JZ, Cheng F. Delayed Treatment for People Living With HIV in China, 2004-2016: An Analysis of An Observational Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051809. [PMID: 32164380 PMCID: PMC7084641 DOI: 10.3390/ijerph17051809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/04/2020] [Accepted: 03/07/2020] [Indexed: 12/12/2022]
Abstract
Early universal access to antiretroviral treatment (ART) is critical in the control of the HIV epidemic. However, prompt initiation of ART remains problematic in China. This study analyzed the late testing and lag time between HIV diagnosis and initiation of ART from 2004 to 2016 and identified the risk factors for delayed initiation of ART. Data from 16,957 people living with HIV were abstracted from a hospital electronic health record database and a case report database for AIDS prevention and control in Yunnan province. Reasons for delayed initiation of ART were categorized into late testing, defined as CD4 count of < 350 cells/μL at baseline HIV diagnosis, and delayed access, defined as a lag time of > 1 month between the diagnosis and initiation of ART. Binary logistic regression models were used to identify risk factors for late testing and delayed access. The CD4 counts at diagnosis increased from 201 ± 147 cells/μL (mean ± SD) in 2004 to 324 ± 238 cells/μL in 2016 (p = 0.024). The CD4 count was higher for persons < 45 years, unmarried, and men who have sex with men (MSM) (356, 357, and 409 cells/μL, respectively) compared to their peers in 2016 (p < 0.05). The lag time from diagnosis to initiation of ART was significantly reduced from 59.2 months in 2004 to 0.9 months in 2016 (p < 0.05). The shorter lag time over the years was consistent when analysis was stratified by sex, age, marital status, and transmission routes, even though the lag time for people using drugs was longest in 2016 (> 2 months versus 0.82 and 0.72 month of heterosexuals and MSM, respectively). Compared to their peers, married persons (AOR = 0.63, 95%CI: 0.57, 0.69) were less likely to have delayed access to ART, and drugs-using patients (AOR = 3.58, 95%CI: 2.95,4.33) were more likely to have delayed access to ART. Late testing rather than delayed access to ART after a diagnosis remains problematic in China, although improvements have been seen for both parameters from 2004 to 2016. Our data highlight the importance of continued efforts to promote early diagnosis of HIV to prevent transmission, morbidity, and early mortality in HIV infection.
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Affiliation(s)
- Junfang Xu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China;
| | - Anders Sönnerborg
- Divisions of Infectious Diseases and Clinical Microbiology, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Liangmin Gao
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing 100084, China; (L.G.); (P.W.)
- Institute for International and Area Studies, Tsinghua University, Beijing 100084, China
| | - Peicheng Wang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing 100084, China; (L.G.); (P.W.)
| | - Jennifer Z.H. Bouey
- Department of International Health, School of Nursing & Health Studies, Georgetown University, Washington, DC 20037, USA;
| | - Feng Cheng
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing 100084, China; (L.G.); (P.W.)
- Correspondence:
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Kesselring S, Osborne C, Bever A, Salters K, Cui Z, Chia J, Moore DM, Parashar S, Kaida A, Samji H, Duddy J, Gabler K, Howard T, Nash D, McCandless LC, Patterson TL, Corneil T, Montaner JSG, Hogg RS. Factors associated with delayed and late ART initiation among people living with HIV in BC: results from the engage study. AIDS Care 2018; 31:885-892. [PMID: 30466303 DOI: 10.1080/09540121.2018.1549722] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We examined correlates of late and delayed initiation of antiretroviral therapy (ART) in British Columbia, Canada. From December 2013 to December 2015 we recruited treatment-naïve people living with HIV who initiated ART within the previous year. 'Late initiation' was defined as CD4 cell count ≤500 cells/µL at ART initiation and 'delayed initiation' as ≥1 year between HIV diagnosis and initiation. Multivariable logistic regression assessed independent correlates of late and delayed initiation. Of 87 participants, 44 (51%) initiated late and 22 (26%) delayed initiation. Delayed initiation was positively associated with older age (adjusted odds ratio [AOR]: 1.06 per year, 95% confidence interval [95% CI]: 1.01-1.12) and inversely associated with wanting to start ART at diagnosis (AOR: 0.06, 95% CI: 0.02-0.21). Variables associated with late initiation were older age (AOR: 1.09 per year, 95% CI: 1.03-1.15) and medical reason(s) for initiation (AOR: 5.00, 95% CI: 1.41-17.86). Late initiation was less likely among those with greater perceived ART efficacy (AOR 0.94, 95% CI: 0.90-0.98) and history of incarceration (AOR: 0.12, 95% CI: 0.03-0.56). Disparities in timing of initiation were observed for age, perceived ART efficacy, and history of incarceration. Enhanced health services that address these factors may facilitate earlier treatment initiation.
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Affiliation(s)
- Sarah Kesselring
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Charles Osborne
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Andrea Bever
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Kate Salters
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Zishan Cui
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Jason Chia
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - David M Moore
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada.,b University of British Columbia , Vancouver , British Columbia , Canada
| | - Surita Parashar
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada.,c Simon Fraser University , Burnaby , British Columbia , Canada
| | - Angela Kaida
- c Simon Fraser University , Burnaby , British Columbia , Canada
| | - Hasina Samji
- c Simon Fraser University , Burnaby , British Columbia , Canada.,d British Columbia Centre for Disease Control , Vancouver , British Columbia , Canada
| | - Janice Duddy
- e Pacific AIDS Network , Vancouver , British Columbia , Canada
| | - Karyn Gabler
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Terry Howard
- f Engage Study Knowledge User , Vancouver , British Columbia , Canada
| | - Denis Nash
- g City University of New York School of Public Health , New York , NY , USA.,h City University of New York Institute for Implementation Science in Population Health , New York , NY , USA
| | | | | | - Trevor Corneil
- j Interior Health Authority , Kelowna , British Columbia , Canada
| | - Julio S G Montaner
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada.,b University of British Columbia , Vancouver , British Columbia , Canada
| | - Robert S Hogg
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada.,c Simon Fraser University , Burnaby , British Columbia , Canada
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5
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Wilton J, Light L, Gardner S, Rachlis B, Conway T, Cooper C, Cupido P, Kendall CE, Loutfy M, McGee F, Murray J, Lush J, Rachlis A, Wobeser W, Bacon J, Kroch AE, Gilbert M, Rourke SB, Burchell AN. Late diagnosis, delayed presentation and late presentation among persons enrolled in a clinical HIV cohort in Ontario, Canada (1999-2013). HIV Med 2018; 20:110-120. [PMID: 30430742 DOI: 10.1111/hiv.12686] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Timely HIV diagnosis and presentation to medical care are important for treatment and prevention. Our objective was to measure late diagnosis, delayed presentation and late presentation among individuals in the Ontario HIV Treatment Network Cohort Study (OCS) who were newly diagnosed in Ontario. METHODS The OCS is a multi-site clinical cohort study of people living with HIV in Ontario, Canada. We measured prevalence of late diagnosis [CD4 count < 350 cells/μL or an AIDS-defining condition (ADC) within 3 months of HIV diagnosis], delayed presentation (≥ 3 months from HIV diagnosis to presentation to care), and late presentation (CD4 count < 350 cells/μL or ADC within 3 months of presentation). We identified characteristics associated with these outcomes and explored their overlap. RESULTS A total of 1819 OCS participants were newly diagnosed in Ontario from 1999 to 2013. Late diagnosis (53.0%) and presentation (54.0%) were common, and a quarter (23.1%) of participants were delayed presenters. In multivariable models, the participants of delayed presentation decreased over calendar time, but that of late diagnosis/presentation did not. Late diagnosis contributed to the majority (> 87%) of late presentation, and the prevalence of delayed presentation was similar among those diagnosed late versus early (13.4 versus 13.4%, respectively; P = 0.99). Characteristics associated with higher odds of late diagnosis/presentation in multivariable analyses included older age at diagnosis/presentation; African, Caribbean and Black race/ethnicity; Indigenous race/ethnicity; female sex; and being a male who did not report sex with men. There were lower odds of late diagnosis/presentation among participants who had ever injected drugs. In contrast, delayed presentation risk factors included younger age at diagnosis and having ever injected drugs. CONCLUSIONS Late presentation is common in Ontario, as it is in other high-income countries. Our findings suggest that efforts to reduce late presentation should focus on facilitating earlier diagnosis for the populations identified in this analysis.
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Affiliation(s)
- J Wilton
- Ontario HIV Treatment Network, Toronto, Canada
| | - L Light
- Ontario HIV Treatment Network, Toronto, Canada
| | - S Gardner
- Baycrest Health Sciences, Toronto, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - B Rachlis
- Ontario HIV Treatment Network, Toronto, Canada.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - T Conway
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Canadian Positive People Network, Ottawa, Canada
| | - C Cooper
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - P Cupido
- Ontario HIV Treatment Network, Toronto, Canada
| | - C E Kendall
- Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - M Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - F McGee
- AIDS Bureau, Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - J Murray
- AIDS Bureau, Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - J Lush
- AIDS Bureau, Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - A Rachlis
- Department of Medicine, University of Toronto, Toronto, Canada.,Sunnybrook Health Science Centre, Toronto, Canada
| | - W Wobeser
- Department of Molecular and Biomedical Sciences, Queen's University, Kingston, Canada.,Department of Public Health, Queen's University, Kingston, Canada
| | - J Bacon
- Ontario HIV Treatment Network, Toronto, Canada
| | - A E Kroch
- Ontario HIV Treatment Network, Toronto, Canada.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - M Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - S B Rourke
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - A N Burchell
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, St Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Hahn A, Hinz R, Meyer T, Loderstädt U, Herchenröder O, Meyer CG, Schwarz NG, Frickmann H. HIV prevention strategies and risk of infection: a model-based analysis. Epidemiol Infect 2018; 146:1015-1025. [PMID: 29655384 PMCID: PMC9184949 DOI: 10.1017/s0950268818000845] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 12/24/2022] Open
Abstract
Risk populations for HIV infections tend to neglect condom use, making alternative preventive approaches necessary. Accordingly, we modelled the risk of sexual HIV transmission for condom use vs. use of rapid diagnostic test (RDT) systems with subsequent exclusion of potential sexual partners with a correctly or falsely positive test from unprotected sex with and without the use of HIV pre-exposure prophylaxis (PrEP) in a bio-statistical approach. We combined a previously described model of transmission risk for HIV-exposed individuals with a newly suggested model of risk of HIV exposure for sexually active HIV-negative individuals. The model was adapted for several stages of infection and different strategies of HIV infection prevention.HIV prevention with RDTs can reduce the transmission risk by up to 97% compared with having sex without any prevention and up to 80% compared with condom use. Nevertheless, RDT-based prevention strategies demonstrate a lack of protection in several stages of infection; in particular, RNA-based RDT systems may fail under treatment. RDT-based pre-screening of potential sex partners prior to unprotected sexual contacts substantially reduces HIV transmission risk. Combination of different prevention strategies is advisable for high-risk groups.
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Affiliation(s)
- A. Hahn
- Institute for Microbiology, Charité – University Medicine Berlin, Berlin, Germany
| | - R. Hinz
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - T. Meyer
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - U. Loderstädt
- Institute for Hygiene and Environment, City of Hamburg, Hamburg, Germany
| | - O. Herchenröder
- Institute for Experimental Gene Therapy and Cancer Research, University Medicine Rostock, Rostock, Germany
| | - C. G. Meyer
- Duy Tan University, Đà Nẵng, Vietnam
- Institute for Tropical Medicine, Eberhard Karls University, Tübingen, Germany
| | - N. G. Schwarz
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - H. Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
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Abstract
Background Many people living with HIV in South Africa (SA) are not aware of their seropositive status and are diagnosed late during the course of HIV infection. These individuals do not obtain the full benefit from available HIV care and treatment services. Objectives To describe the prevalence of late presentation for HIV care among newly diagnosed HIV-positive individuals and evaluate sociodemographic variables associated with late presentation for HIV care in three high-burden districts of SA. Methods We used data abstracted from records of 8 138 newly diagnosed HIV-positive individuals in 35 clinics between 1 June 2014 and 31 March 2015 to determine the prevalence of late presentation among newly diagnosed HIV-positive individuals in selected high-prevalence health districts. Individuals were categorised as ‘moderately late’, ‘very late’ or ‘extremely late’ presenters based on specified criteria. Descriptive analysis was performed to measure the prevalence of late presentation, and multivariate regression analysis was conducted to identify variables independently associated with extremely late presentation. Results Overall, 79% of the newly diagnosed cases presented for HIV care late in the course of HIV infection (CD4+ count ≤500 cells/ μL and/or AIDS-defining illness in World Health Organization (WHO) stage III/IV), 19% presented moderately late (CD4+ count 351 – 500 cells/μL and WHO clinical stage I or II), 27% presented very late (CD4+ count 201 – 350 cells/μL or WHO clinical stage III), and 33% presented extremely late (CD4+ count ≤200 cells/μL and/or WHO clinical stage IV) for HIV care. Multivariate regression analysis indicated that males, non-pregnant women, individuals aged >30 years, and those accessing care in facilities located in townships and inner cities were more likely to present late for HIV care. Conclusions The majority of newly diagnosed HIV-positive individuals in the three high-burden districts (Gert Sibande, uThukela and City of Johannesburg) presented for HIV care late in the course of HIV infection. Interventions that encourage early presentation for HIV care should be prioritised in SA and should target males, non-pregnant women, individuals aged >30 years and those accessing care in facilities located in inner cities and urban townships.
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8
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Kelly H, Weiss HA, Benavente Y, de Sanjose S, Mayaud P. Association of antiretroviral therapy with high-risk human papillomavirus, cervical intraepithelial neoplasia, and invasive cervical cancer in women living with HIV: a systematic review and meta-analysis. Lancet HIV 2017; 5:e45-e58. [PMID: 29107561 PMCID: PMC5757426 DOI: 10.1016/s2352-3018(17)30149-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 07/15/2017] [Accepted: 08/02/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The interactions between antiretroviral therapy (ART) and high-risk human papillomavirus (HPV) and cervical lesions in women living with HIV are poorly understood. We reviewed the association of ART with these outcomes. METHODS We did a systematic review and meta-analysis by searching MEDLINE and Embase databases for cross-sectional or cohort studies published in English between Jan 1, 1996, and May 6, 2017, which reported the association of ART with prevalence of high-risk HPV or prevalence, incidence, progression, or regression of histological or cytological cervical abnormalities, or incidence of invasive cervcal cancer. Studies were eligible if they reported the association of combination ART or highly active ART use with the following outcomes: high-risk HPV prevalence; squamous intraepithelial lesion (SIL) or cervical intraepithelial neoplasia (CIN) prevalence, incidence, progression, or regression; and invasive cervical cancer incidence among women living with HIV. We did random-effects meta-analyses to estimate summary statistics. We examined heterogeneity with the I2 statistic. This review is registered on the PROSPERO database at the Centre of Reviews and Dissemination, University of York, York, UK (registration number CRD42016039546). FINDINGS We identified 31 studies of the association of ART with prevalence of high-risk HPV (6537 women living with HIV) and high grade cervical lesions (HSIL-CIN2+; 9288 women living with HIV). Women living with HIV on ART had lower prevalence of high-risk HPV than did those not on ART (adjusted odds ratio [aOR] 0·83, 95% CI 0·70-0·99; I2=51%, adjusted for CD4 cell count and ART duration), and there was some evidence of association with HSIL-CIN2+ (0·65, 0·40-1·06; I2=30%). 17 studies reported the association of ART with longitudinal cervical lesion outcomes. ART was associated with a decreased risk of HSIL-CIN2+ incidence among 1830 women living with HIV (0·59, 0·40-0·87; I2=0%), SIL progression among 6212 women living with HIV (adjusted hazard ratio [aHR] 0·64, 95% CI 0·54-0·75; I2=18%), and increased likelihood of SIL or CIN regression among 5261 women living with HIV (1·54, 1·30-1·82; I2=0%). In three studies among 15 846 women living with HIV, ART was associated with a reduction in invasive cervical cancer incidence (crude HR 0·40, 95% CI 0·18-0·87, I2=33%). INTERPRETATION Early ART initiation and sustained adherence is likely to reduce incidence and progression of SIL and CIN and ultimately incidence of invasive cervical cancer. Future cohort studies should aim to confirm this possible effect. FUNDING UK Medical Research Council.
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Affiliation(s)
- Helen Kelly
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK,Correspondence to: Dr Helen Kelly, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UKCorrespondence to: Dr Helen Kelly, Department of Clinical ResearchFaculty of Infectious and Tropical DiseasesLondon School of Hygiene & Tropical MedicineLondonUK
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Yolanda Benavente
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Philippe Mayaud
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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9
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Ruadze E, Chkhartishvili N, Chokoshvili O, Tsertsvadze T. Cascade of care among HIV patients diagnosed in 2013 in Georgia: Risk factors for late diagnosis and attrition from HIV care. SAGE Open Med 2017; 5:2050312117731977. [PMID: 28975029 PMCID: PMC5613841 DOI: 10.1177/2050312117731977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 08/24/2017] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The major challenge in the HIV epidemic in Georgia is a high proportion of undiagnosed people living with HIV (estimated 48%) as well as a very high proportion of late presentations for care, with 66% presenting for HIV care with CD4 count <350 and 40% with <200 cells/mm3, in 2013. The objectives of this study was to evaluate patient engagement in the continuum of HIV care for HIV patients diagnosed in 2013 and, within this cohort, to evaluate factors associated with late diagnosis and attrition from care. METHODS Factors associated with late diagnosis were analyzed through binary logistic regression. Exposure variables were the mode of HIV transmission (injecting drug use, male-to-male contact, and heterosexual contact), gender (male vs female), and age (categorized by median value ≤36 vs >36). In addition, CD4 count at diagnosis (cells/mm3) (≤350 or >350) together with all above factors were tested for the association with attrition through Poisson regression. RESULTS Overall, 317 patients retained in care, representing 65% of those diagnosed (n = 488). Out of eligible 295 patients, 89.5% were on treatment and 84% of those viral load count was measured after 6 months of antiretroviral treatment initiation had HIV-1 viral load <1000 copies/mL. Patients reporting injecting drug use as a route-of HIV transmission had two times the odds (95% confidence interval = 1.34-3.49) to be diagnosed late and patients reporting male-to-male contact as a way of HIV transmission had half the odds (odds ratio = 0.46 (95% confidence interval = 0.26-0.81)) of late diagnosis compared to patients acquiring HIV through heterosexual contact. Patients older than 36 years were more likely to being diagnosed late. CONCLUSION More attention should be given to injecting drug users as they represent the most at-risk population for late diagnosis together with older age and attrition.
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Affiliation(s)
- Ekaterine Ruadze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Otar Chokoshvili
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
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Loos J, Nöstlinger C, Vuylsteke B, Deblonde J, Ndungu M, Kint I, Manirankunda L, Reyniers T, Adobea D, Laga M, Colebunders R. First HIV prevalence estimates of a representative sample of adult sub-Saharan African migrants in a European city. Results of a community-based, cross-sectional study in Antwerp, Belgium. PLoS One 2017; 12:e0174677. [PMID: 28380051 PMCID: PMC5381894 DOI: 10.1371/journal.pone.0174677] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 03/12/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction While sub-Saharan African migrants are the second largest group affected by HIV in Europe, sound HIV prevalence estimates based on representative samples of these heterogeneous communities are lacking. Such data are needed to inform prevention and public health policy. Methods This community-based, cross-sectional study combined oral fluid HIV testing with an electronic behavioral survey. Adopting a two-stage time location sampling HIV prevalence estimates for a representative sample of adult sub-Saharan African migrants in Antwerp, Belgium were obtained. Sample proportions and estimated adjusted population proportions were calculated for all variables. Univariable and multivariable logistic regression analysis explored factors independently associated with HIV infection. Results Between December 2013 and October 2014, 744 sub-Saharan African migrants were included (37% women). A substantial proportion was socially, legally and economically vulnerable: 21% were probably of undocumented status, 63% had financial problems in the last year and 9% lacked stable housing. Sexual networks were mostly African and crossed national borders, i.e. sexual encounters during travels within Europa and Africa. Concurrency is common, 34% of those in a stable relationship had a partner on the side in the last year. HIV prevalence was 5.9%(95%CI:3.4%-10.1%) among women and 4.2% (95%CI:1.6%-10.6%) among men. Although high lifetime HIV testing was reported at community level (73%), 65.2% (CI95%:32.4%-88.0%) of sub-Saharan African migrants were possibly undiagnosed. Being 45 years or older, unprotected sex when travelling within Europe in the last year, high intentions to use condoms, being unaware of their last sexual partners’ HIV status, recent HIV testing and not having encountered partner violence in the last year were independently associated with HIV infection in multivariable logical regression. In univariable analysis, HIV infection was additionally associated to unemployment. Conclusions This is the first HIV prevalence study among adult sub-Saharan African migrants resettling in a European city based on a representative sample. HIV prevalence was high and could potentially increase further due to the high number of people with an undiagnosed HIV infection, social vulnerability, high levels of concurrency and mainly African sexual networks. Given this population’s mobility, an aligned European combination prevention approach addressing these determinants is urgently needed.
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Affiliation(s)
- Jasna Loos
- HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | - Christiana Nöstlinger
- HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bea Vuylsteke
- HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jessika Deblonde
- Epidemiology of Infectious Diseases Unit, Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| | - Morgan Ndungu
- Community researcher of the TOGETHER Project, HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ilse Kint
- AIDS Reference Center, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lazare Manirankunda
- HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thijs Reyniers
- HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dorothy Adobea
- Community researcher of the TOGETHER Project, HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marie Laga
- HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Robert Colebunders
- AIDS Reference Center, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Epidemiology for Global Health Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
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MacCarthy S, Hoffmann M, Nunn A, da Silva LAV, Dourado I. Barriers to HIV testing, linkage to care, and treatment adherence: a cross-sectional study from a large urban center of Brazil. Rev Panam Salud Publica 2016; 40:418-426. [PMID: 28718490 PMCID: PMC9897025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/29/2016] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Early, continued engagement with the HIV treatment continuum can help achieve viral suppression, though few studies have explored how risk factors for delays differ across the continuum. The objective of this study was to identify predictors of delayed diagnosis, delayed linkage to care, and nonadherence to treatment in the city of Salvador, Bahia, Brazil. METHODS Data were collected during 2010 in a cross-sectional study with a sample (n = 1 970) of HIV-infected individuals enrolled in care. Multiple logistic regression analyses identified sociodemographic variables, behaviors, and measures of health service quality that were associated with delayed diagnosis, delayed linkage to care, and treatment nonadherence. RESULTS For delayed diagnosis, male gender (adjusted odds ratio (AOR), 3.02; 95% confidence interval (CI), 2.0-4.6); age 45 years and older (AOR, 1.67; 95% CI, 1.1-2.5); and provider-initiated testing (AOR, 3.00; 95% CI, 2.1-4.4) increased odds, while drug use (AOR, 0.29; 95% CI, 0.2-0.5) and receiving results in a private space (AOR, 0.37; 95% CI, 0.2-0.8) decreased odds. For delayed linkage to care, unemployment (AOR, 1.42; 95% CI, 1.07-1.9) and difficulty understanding or speaking with a health care worker (AOR, 1.61; 95% CI, 1.2-2.1) increased odds, while posttest counseling (AOR, 0.49; 95% CI, 0.3-0.7) decreased odds. For nonadherence, experiencing verbal or physical discrimination related to HIV (AOR, 1.94; 95% CI, 1.3-3.0) and feeling mistreated or not properly attended to at HIV care (AOR, 1.60; 95% CI, 1.0-2.5) increased odds, while posttest counseling (AOR, 0.34; 95% CI, 0.2-0.6) decreased odds. CONCLUSIONS More attention is needed on how policies, programs, and research can provide tailored support across the treatment continuum.
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Affiliation(s)
- Sarah MacCarthy
- RAND Corporation, Santa Monica, California, United States of America
| | - Michael Hoffmann
- Brown University, Providence, Rhode Island, United States of America
| | - Amy Nunn
- Brown University, Providence, Rhode Island, United States of America
| | | | - Ines Dourado
- Instituto de Saúde Coletiva/Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Aniley AB, Ayele TA, Zeleke EG, Kassa AA. Factors associated with late Human Immunodeficiency Virus (HIV) diagnosis among peoples living with it, Northwest Ethiopia: hospital based unmatched case-control study. BMC Public Health 2016; 16:1076. [PMID: 27733197 PMCID: PMC5062890 DOI: 10.1186/s12889-016-3727-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 07/21/2016] [Indexed: 11/17/2022] Open
Abstract
Background Early HIV diagnosis and access to treatment is one of the most effective ways to prevent its further spread and to protect the health of those living with the virus. However, delay in diagnosis is the major risk factor for uptake of and response to antiretroviral therapy. Methods Institution-based unmatched case-control study design was used in the study. The study was conducted in Debre-Markos and Finote-Selam Hospitals, Northwest Ethiopia. Cases were people living with HIV who had CD4 count <350cells/mm3 or WHO clinical stage III and IV regardless of the CD4 count at first presentation and controls were those who had CD4 count ≥350cells/mm3 or WHO clinical stage I and II. If both criteria were available, the CD4 count was used in the study as World Health Organization recommended. A total of 392 respondents (196 cases and 196 controls) were recruited and selected systematically. The data were collected by trained nurses using chart review and interviewer administered structured questionnaire. Binary Logistic Regression Model was used to identify the factors associated with late HIV diagnosis. Results About 95.9 % of study participants provided complete response. Having no understanding, compared to having understanding, about HIV/AIDS (AOR = 1.7, 95 %CI = 1.08–2.79) and ART (AOR = 2.1, 95 %CI: 1.25–3.72), being tested as a result of symptoms/ illness, compared to being tested for risk exposure (inverted AOR =2.5, 95 %CI: 1.64–4.76), and acquiring HIV through sexual contact, compared to acquiring it through other modes (AOR = 2.5, 95 %CI = 1.52–4.76) were positively and independently associated with late HIV diagnosis. Conclusions Unlike perceived HIV stigma, having no understanding about HIV and ART, being tested for presence of symptoms/illness, and acquiring HIV through sexual contact were independent and significant factors for late HIV diagnosis.
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Affiliation(s)
- Abebayehu Bitew Aniley
- Department of Public Health, College of Medicine and Health Sciences, Wollo University, P.O. Box: 1145, Dessiee, Ethiopia.
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box:196, Gondar, Ethiopia
| | - Ejigu Gebeye Zeleke
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box:196, Gondar, Ethiopia
| | - Assefa Andargie Kassa
- Department of Public Health, College of Medicine and Health Sciences, Wollo University, P.O. Box: 1145, Dessiee, Ethiopia
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Symptomatic Patients without Epidemiological Indicators of HIV Have a High Risk of Missed Diagnosis: A Multi-Centre Cross Sectional Study. PLoS One 2016; 11:e0162503. [PMID: 27603207 PMCID: PMC5014346 DOI: 10.1371/journal.pone.0162503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/23/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives One quarter of HIV-1 positive individuals in Sweden present for care with HIV or AIDS associated conditions without an HIV test (missed presentations) and 16% report neglect of such symptoms. The objective of this study was to identify risk factors for these missed opportunities of HIV-1 diagnosis. Methods A national study, recruiting 409 newly diagnosed HIV-1 infected adults over a 2.5-year period, was performed. Logistic regression models tested the relationship between missed presentation and patient’s neglect versus socio-demographic and behavioural risk factors. Additionally the initiator of the HIV test was assessed. Results The odds for a missed presentation was lower for migrants (from East Europe, Asia, and Pacific (East): OR 0.4 (0.2–0.8); Sub-Saharan Africa (SSA): 0.3 (0.2–0.6); other: 0.5 (0.2–1.0)), compared to patients born in Sweden, just as symptoms neglected by the patient (East (0.3 (0.1–1.0); SSA (0.4 (0.2–0.8)). The latter was also lower for men who have sex with men (0.5 (0.2–1.0)), compared to patients infected heterosexually. Patients infected in the East, with present/previous substance use or a previous negative HIV test were more likely to take the initiative to test on their own, whereas those >50 years and with a previously missed presentation had significantly reduced odds, p<0.05. Conclusions Individuals without epidemiological indicators of HIV are more likely to have a history of missed presentations, to neglect symptoms and are less prone to take an initiative to test for HIV themselves. It is important to further implement testing to include all patients with symptoms and conditions indicative of HIV.
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Raffetti E, Postorino MC, Castelli F, Casari S, Castelnuovo F, Maggiolo F, Di Filippo E, D'Avino A, Gori A, Ladisa N, Di Pietro M, Sighinolfi L, Zacchi F, Torti C. The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: results from the Italian MASTER Cohort. BMC Public Health 2016; 16:878. [PMID: 27557878 PMCID: PMC4997689 DOI: 10.1186/s12889-016-3477-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 08/10/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We aimed at evaluating frequency and factors associated with late presentation and advanced HIV disease and excess risk of death due to these conditions from 1985 to 2013 among naïve HIV infected patients enrolled in the Italian MASTER Cohort. METHODS All antiretroviral naive adults with available CD4+ T cell count after diagnosis of HIV infection were included. Multivariable logistic regression analysis investigated factors associated either with late presentation or advanced HIV disease. Probabilities of survival were estimated both at year-1 and at year-5 according to the Kaplan-Meier method. Flexible parametric models were used to evaluate changes in risk of death overtime according to late presentation and advanced HIV disease. The analyses were stratified for calendar periods. RESULTS 19,391 patients were included (54 % were late presenters and 37.6 % were advanced presenters). At multivariable analysis, the following factors were positively associated with late presentation: male gender (OR = 1.29), older age (≥55 years vs. <25 years; OR = 7.45), migration (OR = 1.54), and heterosexual risk factor for HIV acquisition (OR = 1.52) or IDU (OR = 1.27) compared to homosexual risk. Survival rates at year-5 increased steadily and reached 92.1 % for late presenters vs. 97.4 % for non-late presenters enrolled in the period 2004-2009. Using flexible parametric models we found a sustained reduction of hazard ratios over time for any cause deaths between late and non-late presenters over time. Similar results were found for advanced HIV disease. CONCLUSION Screening polices need to be urgently implemented, particularly in most-at-risk categories for late presentation, such as migrants, older patients and those with heterosexual intercourse or IDU as risk factors for HIV acquisition. Although in recent years the impact of late presentation on survival decreased, about 10 % of patients diagnosed in more recent years remains at increased risk of death over a long-term follow-up.
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Affiliation(s)
- Elena Raffetti
- Institute of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | - Maria Concetta Postorino
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, University "Magna Graecia", Catanzaro, Italy
| | - Francesco Castelli
- Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Salvatore Casari
- Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | | | - Franco Maggiolo
- Clinic of Infectious Diseases, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Elisa Di Filippo
- Clinic of Infectious Diseases, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Alessandro D'Avino
- Institute of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Andrea Gori
- Clinic of Infectious Diseases, Ospedale "S. Gerardo", Monza, Italy
| | - Nicoletta Ladisa
- Institute of Infectious Diseases, University of Bari, Bari, Italy
| | - Massimo Di Pietro
- Clinic of Infectious Diseases, "S. M. Annunziata" Hospital, Florence, Italy
| | - Laura Sighinolfi
- Clinic of Infectious Diseases, "S. Anna" Hospital, Ferrara, Italy
| | - Fabio Zacchi
- Clinic of Infectious Diseases, Istituti Ospitalieri Cremona, Cremona, Italy
| | - Carlo Torti
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, University "Magna Graecia", Catanzaro, Italy.
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Loos J, Manirankunda L, Platteau T, Albers L, Fransen K, Vermoesen T, Namanya F, Nöstlinger C. Acceptability of a Community-Based Outreach HIV-Testing Intervention Using Oral Fluid Collection Devices and Web-Based HIV Test Result Collection Among Sub-Saharan African Migrants: A Mixed-Method Study. JMIR Public Health Surveill 2016; 2:e33. [PMID: 27493067 PMCID: PMC4990717 DOI: 10.2196/publichealth.5519] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/11/2016] [Accepted: 06/17/2016] [Indexed: 12/03/2022] Open
Abstract
Background Late human immunodeficiency virus (HIV) diagnosis is common among sub-Saharan African migrants. To address their barriers to HIV testing uptake and improve timely HIV diagnoses and linkage to care, the outreach HIV testing intervention, “swab2know,” was developed. It combined a community-based approach with innovative testing methods: oral fluid self-sampling and the choice between Web-based HIV test result collections using a secured website or post-test counseling at a sexual health clinic. The sessions included an informational speech delivered by a physician of sub-Saharan African origin and testimonies by community members living with HIV. Objectives The objectives of this study were to evaluate the intervention’s acceptability among sub-Saharan African migrants and its potential to reach subgroups at higher risk for HIV infection and to identify facilitators and barriers for HIV testing uptake. Methods This mixed-method study combined qualitative (participant observations and informal interviews with testers and nontesters) and quantitative data (paper–pencil survey, laboratory data, and result collection files). Data were analyzed using a content analytical approach for qualitative and univariate analysis for quantitative data. Results A total of 10 testing sessions were organized in sub-Saharan African migrant community venues in the city of Antwerp, Belgium, between December 2012 and June 2013. Overall, 18.2% of all people present (N=780) underwent HIV testing; 29.8% of them tested for HIV for the first time, 22.3% did not have a general practitioner, and 21.5% reported 2 or more sexual partners (last 3 months). Overall, 56.3% of participants chose to collect their HIV test results via the protected website. In total, 78.9% collected their results. The qualitative analysis of 137 participant observation field notes showed that personal needs and Internet literacy determined the choice of result collection method. Generally, the oral fluid collection devices were well accepted mainly because sub-Saharan African migrants dislike blood taking. For some participants, the method raised concerns about HIV transmission via saliva. The combination of information sessions, testimonies, and oral fluid collection devices was perceived as effectively reducing thresholds to participation. Acceptability of the intervention differed between individual participants and settings. Acceptance was higher among women, in churches and settings where community leaders were engaged in HIV awareness raising. Higher preventive outcomes were observed in settings with lower acceptance. The presence of the intervention team visualized the magnitude of the HIV epidemic to the public and promoted HIV testing uptake at large, for example, those who declined indicated they would take up testing later. Conclusions When accompanied by tailored provision of information, outreach HIV testing interventions adopting a community-based approach and innovative methods such as Web-based result collection and oral fluid collection devices are acceptable and reduce thresholds for HIV testing uptake. The swab2know intervention was able to reach sub-Saharan African migrants at risk of HIV infection, and with limited access to regular HIV testing. Among nontesters, the intervention contributed to awareness raising and therefore has a place in a multipronged HIV test promotion strategy.
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Affiliation(s)
- Jasna Loos
- HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
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Noble G, Okpo E, Tonna I, Fielding S. Factors associated with late HIV diagnosis in North-East Scotland: a six-year retrospective study. Public Health 2016; 139:36-43. [PMID: 27393624 DOI: 10.1016/j.puhe.2016.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/24/2016] [Accepted: 06/08/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Late HIV diagnosis is associated with increased morbidity and mortality, increased risk of transmission, impaired response to antiretroviral therapy and increased health care costs. The aim of this study was to determine the factors associated with late HIV diagnosis in Grampian, North-East Scotland. STUDY DESIGN A population based retrospective database analysis. METHODS All newly diagnosed HIV positive individuals in Grampian, North-East Scotland between 2009 and 2014 were included in the study. Participants were classified as having a late diagnosis if the CD4 cell count at presentation was less than 350 cells/mm3. Socio-economic and demographic factors were investigated in relation to outcome (late diagnosis) using Chi-squared and Mann-Whitney tests. RESULTS CD4 cell count results were available for 111 (89.5%) of the 124 newly diagnosed individuals during the study period. The prevalence of late diagnosis was 53.2% (n = 59). Those infected via heterosexual mode of transmission had a 2.83 times higher odds of late diagnosis (OR 2.83 [95% CI: 1.10-7.32]) than men who have sex with men (MSM) and those with no previous HIV testing had a 5.46 increased odds of late diagnosis (OR 5.46 [95% CI: 1.89-15.81]) compared to those who had previously been tested. Missed opportunities for HIV diagnosis were identified in 16.3% (n = 15) of participants. CONCLUSION Heterosexual individuals and those with no previous HIV testing were more likely to be diagnosed late. Targeted initiatives to increase perception of HIV risk and uptake of testing in these risk groups are recommended.
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Affiliation(s)
- G Noble
- Institute of Applied Health Sciences, Postgraduate Education Department, University of Aberdeen, Aberdeen, Scotland, UK
| | - E Okpo
- Institute of Applied Health Sciences, Postgraduate Education Department, University of Aberdeen, Aberdeen, Scotland, UK; Public Health Department, NHS Grampian, Summerfield House, 2 Eday Road, Aberdeen, AB15 6RE, UK.
| | - I Tonna
- Aberdeen Royal Infirmary, Infectious Diseases Department, Emergency Care Centre, Aberdeen, UK
| | - S Fielding
- Institute of Applied Health Sciences, Medical Statistics Department, University of Aberdeen, Aberdeen, Scotland, UK
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Loos J, Vuylsteke B, Manirankunda L, Deblonde J, Kint I, Namanya F, Fransen K, Colebunders R, Laga M, Adobea D, Nöstlinger C. TOGETHER Project to Increase Understanding of the HIV Epidemic Among Sub-Saharan African Migrants: Protocol of Community-Based Participatory Mixed-Method Studies. JMIR Res Protoc 2016; 5:e48. [PMID: 26988266 PMCID: PMC4816927 DOI: 10.2196/resprot.5162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/18/2015] [Accepted: 11/29/2015] [Indexed: 11/20/2022] Open
Abstract
Background Sub-Saharan African Migrants (SAM) are the second largest group affected by HIV/AIDS in Belgium and the rest of Western Europe. Increasing evidence shows that, more than previously thought, SAM are acquiring HIV in their host countries. This calls for a renewed focus on primary prevention. Yet, knowledge on the magnitude of the HIV epidemic among SAM (HIV prevalence estimates and proportions of undiagnosed HIV infections) and underlying drivers are scarce and limit the development of such interventions. Objective By applying a community-based participatory and mixed-methods approach, the TOGETHER project aims to deepen our understanding of HIV transmission dynamics, as well as inform future primary prevention interventions for this target group. Methods The TOGETHER project consists of a cross-sectional study to assess HIV prevalence and risk factors among SAM visiting community settings in Antwerp city, Belgium, and links an anonymous electronic self-reported questionnaire to oral fluid samples. Three formative studies informed this method: (1) a social mapping of community settings using an adaptation of the PLACE method; (2) a multiple case study aiming to identify factors that increase risk and vulnerability for HIV infection by triangulating data from life history interviews, lifelines, and patient files; and (3) an acceptability and feasibility study of oral fluid sampling in community settings using participant observations. Results Results have been obtained from 4 interlinked studies and will be described in future research. Conclusions Combining empirically tested and innovative epidemiological and social science methods, this project provides the first HIV prevalence estimates for a representative sample of SAM residing in a West European city. By triangulating qualitative and quantitative insights, the project will generate an in-depth understanding of the factors that increase risk and vulnerability for HIV infection among SAM. Based on this knowledge, the project will identify priority subgroups within SAM communities and places for HIV prevention. Adopting a community-based participatory approach throughout the full research process should increase community ownership, investment, and mobilization for HIV prevention.
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Affiliation(s)
- Jasna Loos
- HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium.
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Gelaw YA, Senbete GH, Adane AA, Alene KA. Determinants of late presentation to HIV/AIDS care in Southern Tigray Zone, Northern Ethiopia: an institution based case-control study. AIDS Res Ther 2015; 12:40. [PMID: 26633988 PMCID: PMC4667535 DOI: 10.1186/s12981-015-0079-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late diagnosis and presentation to human immune deficiency virus (HIV)/acquired immune deficiency syndrome care reduce the benefits of antiretroviral therapy and increase the risk of HIV transmission. OBJECTIVES This study was conducted to identify determinants of late presentation to HIV care among people living with HIV in Southern Tigray, Northern Ethiopia. METHODS An institution based un-matched case-control (1:2 ratios) supported with qualitative data was conducted in Southern Tigray Zone from March 1 to April 30, 2014. Individuals with HIV enrolled from six randomly selected health facilities were included in the study. Cases were people living with HIV who had cluster of differentiation four count <350 cells/μl or World Health Organization stages 3 or 4. A total of 442 study participants were included by systematic sampling techniques. Bivariable and multivariable binary logistic regression model was used to identify associated factors. Odds ratio with 95 % CI was computed to assess the strength of the associations. RESULT Age categories, 25-29 years [AOR 3, 95 % CI (1.2-8.1)] and 35-39 years [AOR 4.1, 95 % CI (1.4-12.5)], having two [AOR 6, 95 % CI (1.3-28)] and more [AOR 5.2, 95 % CI (1.1-24.8)] lifetime sexual partners, poor social support [AOR 2.3, 95 % CI (1.26-4.30)], second (next to lowest) wealth quintile [AOR 3.3, 95 % CI 91.3-8.5)], fear of stigma [AOR 4.4, 95 % CI (2.2-8.3)], fear of losing job [AOR 6.8, 95 % CI (1.8-24.5)], and reported severe illness [AOR 4.3, 95 % CI (2.26-8)] were identified to be the risk factors for late presentation. CONCLUSION Low socio-economic status and social support, fear of stigma were potential risk factors for late presentation. Efforts towards promoting early care seeking should target on these factors in the study area and other similar settings.
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Affiliation(s)
- Yalemzewod Assefa Gelaw
- />Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Akelew Awoke Adane
- />Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kefyalew Addis Alene
- />Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Brännström J, Svedhem Johansson V, Marrone G, Wendahl S, Yilmaz A, Blaxhult A, Sönnerborg A. Deficiencies in the health care system contribute to a high rate of late HIV diagnosis in Sweden. HIV Med 2015; 17:425-35. [PMID: 26559921 DOI: 10.1111/hiv.12321] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the study was to identify factors in HIV-infected patients and the health care system which contribute to late diagnosis. METHODS All patients who were newly diagnosed with HIV infection at 12 clinics in Sweden over a period of 2.5 years (n = 575) were included in the study, corresponding to three-quarters of newly diagnosed HIV infections in the country. The patients were classified as non-late presenters or late presenters (LPs), defined as those with a CD4 count < 350 cells/μL or AIDS. LPs were subdivided into those without and those with advanced HIV disease, which was defined as a CD4 count < 200 cells/μL or AIDS. Demographics, missed AIDS and HIV-associated symptoms in the preceding 3 years, immigration date, and health examination at immigration were recorded. RESULTS Fifty-eight per cent of the patients were LPs, of whom 66% had advanced disease. Age > 30 years, origin in sub-Saharan Africa or Eastern Europe/Asia/the Pacific region, and country of transmission being in sub-Saharan Africa or unknown were associated with late presentation. Half of the patients of non-Swedish origin had lived for more than 1 year in Sweden at diagnosis and 66% had a missed HIV testing opportunity at immigration. Twenty-seven per cent of all patients had presented for health care with AIDS- and/or HIV-associated conditions without having an HIV test. Sixteen per cent had a history of symptoms without seeking care. CONCLUSIONS Deficiencies in the health care system with missed HIV testing opportunities contribute to the high proportion of late presenters in Sweden, especially among migrants. With increased testing at immigration and further incorporation of "indicator-guided" testing in general practice, most patients could be diagnosed earlier.
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Affiliation(s)
- J Brännström
- Unit of Infectious Diseases, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - V Svedhem Johansson
- Unit of Infectious Diseases, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - G Marrone
- Unit of Infectious Diseases, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - S Wendahl
- Department of Infectious Diseases, Sunderbyn Hospital, Luleå, Sweden
| | - A Yilmaz
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - A Blaxhult
- Department of Clinical Science and Education, Venhälsan, South General Hospital, Stockholm, Sweden
| | - A Sönnerborg
- Unit of Infectious Diseases, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
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20
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Tossas-Milligan KY, Hunter-Mellado RF, Mayor AM, Fernández-Santos DM, Dworkin MS. Late HIV Testing in a Cohort of HIV-Infected Patients in Puerto Rico. PUERTO RICO HEALTH SCIENCES JOURNAL 2015; 34:148-54. [PMID: 26356739 PMCID: PMC4776320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Late HIV testing (LT), defined as receiving an AIDS diagnosis within a year of one's first positive HIV test, is associated with higher HIV transmission, lower HAART effectiveness, and worse outcomes. Latinos represent 36% of LT in the US, yet research concerning LT among HIV cases in Puerto Rico is scarce. METHODS Multivariable logistic regression analysis was used to identify factors associated with LT, and a Cochran‒Armitage test was used to determine LT trends in an HIV-infected cohort followed at a clinic in Puerto Rico specialized in the management and treatment of HIV. RESULTS From 2000 to 2011, 47% of eligible patients were late testers, with lower median CD4 counts (54 vs. 420 cells/mm3) and higher median HIV viral load counts (253,680 vs. 23,700 copies/mL) than non-LT patients. LT prevalence decreased significantly, from 47% in 2000 to 37% in 2011. In a mutually adjusted logistic regression model, males, older age at enrollment and past history of IDU significantly increased LT odds, whereas having a history of amphetamine use decreased LT odds. When the data were stratified by mode of transmission, it became apparent that only the category men who have sex with men (MSM) saw a significant reduction in the proportion of LT, falling from 67% in 2000 to 33% in 2011. CONCLUSION These results suggest a gap in early HIV detection in Puerto Rico, a gap that decreased only among MSM. An evaluation of the manner in which current HIV-testing guidelines are implemented on the island is needed.
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Affiliation(s)
- Katherine Y Tossas-Milligan
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, M/C 923, Chicago, IL
| | - Robert F Hunter-Mellado
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Bayamón, PR
| | - Angel M Mayor
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Bayamón, PR
| | - Diana M Fernández-Santos
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Bayamón, PR
| | - Mark S Dworkin
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, M/C 923, Chicago, IL
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21
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Essomba NE, Mbatchou Ngahane BH, Nida M, Temfack E, Mapoure Njankouo Y, Abeng RL, Fokalbo ZK, Achu Joko H, Mbenoun M, Meledie AP, Halle MP, Malongue A, Tchente C, Nana Njamen T, Halle Ekane G, Ngwane S, Barla E, Abena P, Ndobo P, Moungo Kuidjeu C, Adiogo D, Mouelle Sone A, Luma Namme H, Coppieters Y. [Clinical and immunological profile of HIV-infected patients at the initiation of antiretroviral therapy in Douala]. ACTA ACUST UNITED AC 2015; 108:255-61. [PMID: 26296430 DOI: 10.1007/s13149-015-0444-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 07/07/2015] [Indexed: 01/06/2023]
Abstract
The aim of this study was to describe the clinical and immunological profile of patients infected with HIV after initiation of antiretroviral therapy. Sociodemographic characteristics, clinical and immunological patients were recorded. Chi square test and Mann-Whitney were used to compare variables. The multivariate regression model identified risk factors. So that, 936 (56.2%) patients were in stages III and IV of the WHO and 65.2% at an advanced stage of the disease. Factors associated with initiation at an advanced stage, were male sex (p = 0.007) and time to diagnosis (p = 0.005). In 2/3 cases, treatment is started at an advanced stage of disease. It is therefore important to intensify awareness campaigns for early detection and encourage patients to ensure regular medical follow-up screening.
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Affiliation(s)
- N E Essomba
- Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun. .,Comité national de lutte contre le sida du Cameroun, Douala, Cameroun.
| | - B H Mbatchou Ngahane
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun.,Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - M Nida
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun.,Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - E Temfack
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - Y Mapoure Njankouo
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun.,Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - R L Abeng
- Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - Z Kobe Fokalbo
- Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - H Achu Joko
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - M Mbenoun
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun.,Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - A P Meledie
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun.,Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - M P Halle
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun.,Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - A Malongue
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - C Tchente
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - T Nana Njamen
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - G Halle Ekane
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - S Ngwane
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - E Barla
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - P Abena
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - P Ndobo
- Hôpital de District de Bonassama, Douala, Cameroun
| | | | - D Adiogo
- Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - A Mouelle Sone
- Faculté de médecine et des sciences pharmaceutiques, BP 15253, Douala, Cameroun
| | - H Luma Namme
- Centre de traitement agréé de l'Hôpital général de Douala, Douala, Cameroun
| | - Y Coppieters
- École de santé publique, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgique
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22
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Lapadula G, Chatenoud L, Gori A, Castelli F, Di Giambenedetto S, Fabbiani M, Maggiolo F, Focà E, Ladisa N, Sighinolfi L, Di Pietro M, Pan A, Torti C. Risk of Severe Non AIDS Events Is Increased among Patients Unable to Increase their CD4+ T-Cell Counts >200+/μl Despite Effective HAART. PLoS One 2015; 10:e0124741. [PMID: 26020949 PMCID: PMC4447446 DOI: 10.1371/journal.pone.0124741] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/05/2015] [Indexed: 01/26/2023] Open
Abstract
Background Immunological non-response (INR) despite virological suppression is associated with AIDS-defining events/death (ADE). Little is known about its association with serious non-AIDS-defining events (nADE). Methods Patients highly-active antiretroviral therapy (HAART) with <200 CD4+/μl and achieving HIV-RNA <50 copies/ml within 12 (±3) months were categorized as INR if CD4+ T-cell count at year 1 was <200/μl. Predictors of nADE (malignancies, severe infections, renal failure—ie, estimated glomerular filtration rate <30 ml/min, cardiovascular events and liver decompensation) were assessed using multivariable Cox models. Follow-up was right-censored in case of HAART discontinuation or confirmed HIV-RNA>50. Results 1221 patients were observed for a median of 3 (IQR: 1.3-6.1) years. Pre-HAART CD4+ were 77/μl (IQR: 28-142) and 56% of patients had experienced an ADE. After 1 year, CD4+ increased to 286 (IQR: 197-387), but 26.1% of patients were INR. Thereafter, 86 nADE (30.2% malignancies, 27.9% infectious, 17.4% renal, 17.4% cardiovascular, 7% hepatic) were observed, accounting for an incidence of 1.83 events (95%CI: 1.73-2.61) per 100 PYFU. After adjusting for measurable confounders, INR had a significantly greater risk of nADE (HR 1.65; 95%CI: 1.06-2.56). Older age (per year, HR 1.03; 95%CI: 1.01-1.05), hepatitis C co-infection (HR 2.09; 95%CI: 1.19-3.7), a history of previous nADE (HR 2.16; 95%CI: 1.06-4.4) and the occurrence of ADE during the follow-up (HR 2.2; 95%CI: 1.15-4.21) were other independent predictors of newly diagnosed nADE. Conclusions Patients failing to restore CD4+ to >200 cells/μl run a greater risk of serious nADE, which is intertwined or predicted by AIDS progression. Improved management of this fragile population and innovative therapy able to induce immune-reconstitution are urgently needed. Also, our results strengthen the importance of earlier diagnosis and HAART introduction.
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Affiliation(s)
- Giuseppe Lapadula
- Clinic of Infectious Diseases, “San Gerardo de’ Tintori” Hospital, Monza, Italy
- * E-mail:
| | - Liliane Chatenoud
- IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy
| | - Andrea Gori
- Clinic of Infectious Diseases, “San Gerardo de’ Tintori” Hospital, Monza, Italy
| | - Francesco Castelli
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | | | - Massimiliano Fabbiani
- Clinic of Infectious Diseases, “Sacro Cuore” Catholic University of Rome, Rome, Italy
| | - Franco Maggiolo
- Clinic of Infectious Diseases, Ospedali Riuniti, Bergamo, Italy
| | - Emanuele Focà
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Nicoletta Ladisa
- Clinic of Infectious Diseases, Ospedale Policlinico, Bari, Italy
| | - Laura Sighinolfi
- Clinic of Infectious Diseases, Ospedale Sant’Anna, Ferrara, Italy
| | - Massimo Di Pietro
- Clinic of Infectious Diseases, Ospedale S.M. Annunziata, Florence, Italy
| | - Angelo Pan
- Clinic of Infectious Diseases, Istituti Ospitalieri, Cremona, Italy
| | - Carlo Torti
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, University “Magna Graecia”, Catanzaro, Italy
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23
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Khoury Z, Silva RS, Villela W. Factors associated with a delay in seeking HIV/AIDS treatment in São Paulo, Brazil. AIDS Behav 2015; 19:679-83. [PMID: 25210003 DOI: 10.1007/s10461-014-0885-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This quantitative cross-sectional study of HIV/AIDS patients (N = 1,520) in São Paulo evaluated factors associated with a delay in seeking care. Analysis included Chi square tests and multiple logistic regression. Care was sought at the AIDS stage in 56.7 % (861) of patients, and 48.2 % (732) had a CD4 count ≤350 cells/mm(3); 9 % (136) delayed seeking care for 6 months or more after a positive HIV test. Women sought medical care earlier after testing (odds ratio (OR) = 1.79; P = 0.0227), but were already symptomatic (OR = 1.90; P = 0.0004). Partners of seropositive patients (OR = 3.92; P = 0.0000) also sought care symptomatic. Reasons for late presentation for care were non-acceptance of HIV diagnosis (OR = 24.56; P = 0.0000), treatment refusal (OR = 55.34; P = 0.0000), and physical disability (OR = 1.90; P = 0.0414). Necessary strategies for HIV treatment and prevention include improved education and access to services.
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Affiliation(s)
- Zarifa Khoury
- Universidade Federal de São Paulo, Bloc A1. 2nd Floor, Room 211, Av. Albert Einstein 627 Morumbi, São Paulo, SP, 05651-901, Brazil,
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24
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Kwobah CM, Braitstein P, Koech JK, Simiyu G, Mwangi AW, Wools-Kaloustian K, Siika AM. Factors Associated with Late Engagement to HIV Care in Western Kenya: A Cross-Sectional Study. J Int Assoc Provid AIDS Care 2015; 15:505-511. [PMID: 25589304 DOI: 10.1177/2325957414567682] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Late presentation of patients contributes significantly to the high mortality reported in HIV -care and treatment programs in sub-Saharan Africa. METHODS A cross-sectional study was conducted to assess factors associated with late engagement to HIV care at the Academic Model Providing Access to Healthcare in western Kenya. Late engagement was defined as baseline CD4 ≤100 cells/mm3. RESULTS Of the 10 533 participants included in the analysis, 67% were female and mean age was 36.7 years. Overall, 23% of the participants presented late. Factors associated with late engagement included male gender (adjusted odds ratio [AOR]: 1.54, 95% confidence interval [CI]: 1.35-1.75), older age (AOR: 1.62, 95% CI: 1.02-2.56), and longer travel time to clinic (AOR: 1.18, 95% CI: 1.04-1.34). CONCLUSION Nearly one-quarter of HIV-infected patients in our setting present with advanced immune suppression at initial encounter. Being male, older age, and living further away from clinic are associated with late engagement to care.
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Affiliation(s)
- Charles Meja Kwobah
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya .,Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,University of Toronto, Dalla Lana School of Public Health, Toronto, Canada
| | - Julius K Koech
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Gilbert Simiyu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ann W Mwangi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Abraham M Siika
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
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25
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Trends in HIV diagnoses, HIV care, and uptake of antiretroviral therapy among heterosexual adults in England, Wales, and Northern Ireland. Sex Transm Dis 2014; 41:257-65. [PMID: 24622638 DOI: 10.1097/olq.0000000000000111] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM To examine epidemiological trends among heterosexual adults (≥15 years) in England, Wales, and Northern Ireland (E,W&NI) newly diagnosed as having HIV between 1992 and 2011, or seen for HIV care in 2011. METHODS Trend analyses of heterosexual adults newly diagnosed as having HIV in E,W&NI in 1992 to 2011 was performed, as well as univariate and multivariate analyses examining the late diagnosis of HIV, integration into care, AIDS, uptake of antiretroviral therapy, and mortality in 2002 to 2011. Data are as reported to the national HIV and AIDS Reporting System. RESULTS The number of heterosexual adults newly diagnosed as having HIV in E,W&NI increased steadily between 1992 (731) and 2004 (4676), before declining (2631 in 2011). Nonetheless, in 2011, heterosexuals accounted for 49% (2631/5423) of all newly diagnosed adults in E,W&NI. Of 38,228 heterosexual adults as having HIV between 2002 and 2011, 72% were black African, of whom 99% were born abroad. Over the decade, there was an increase in the percentage of HIV diagnosed heterosexuals integrated into care within 28 days of diagnosis (61%-78%) and in receipt of antiretroviral therapy within 1 year of diagnosis (45%-52%) and a decline in the percentage with AIDS (16%-7%; all, P < 0.01). Late HIV diagnoses (CD4 <350 mm) among heterosexuals exceeded 60% in all years. CONCLUSIONS Our analyses highlight the impact of migration on the epidemiology of heterosexually acquired HIV in E,W&NI. Although there was evidence of an improvement in clinical care over time, continued high rates of late diagnosis suggest that current testing policies are failing among heterosexuals.
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26
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Advanced disease at enrollment in HIV care in four sub-Saharan African countries: change from 2006 to 2011 and multilevel predictors in 2011. AIDS 2014; 28:2429-38. [PMID: 25136842 DOI: 10.1097/qad.0000000000000427] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine changes between 2006 and 2011 in the proportion of HIV-positive patients newly enrolled in HIV care with advanced disease and the median CD4 cell count at enrollment; and identify patient, facility, and contextual-level factors associated with late enrollment in care in 2011. DESIGN Cross-sectional over time. METHODS For time-trends analyses, routinely collected patient-level data (307 110 adults newly enrolled in 138 HIV clinical care facilities) in Kenya, Mozambique, Rwanda and Tanzania; and for analyses of correlates, patient-level data (46 201 in 195 facilities), and facility and population-level survey data were used. Late enrollment was defined as CD4 cell count 350 cells/μl or less and/or WHO clinical stage 3/4. RESULTS Late enrollment declined from 69.9 to 57.2% (P < 0.0001); median CD4 cell count increased from 242 to 292 cells/μl (Ptrend < 0.0001). In 2011, risk of late enrollment was significantly higher for men and nonpregnant women vs. pregnant women; patients aged above 25 vs. 15-25 years; nonmarried vs. married; and those entering from sites other than prevention of mother-to-child transmission. More extensive HIV testing coverage in the region of a facility was significantly associated with lower risk of late enrollment. CONCLUSIONS Despite improvement, in 2011, 57% of patients entered HIV care who were already antiretroviral therapy-eligible. The lower risk of late enrollment among those referred from prevention of mother-to-child transmission and in regions where HIV testing coverage was higher suggests that innovative approaches to rapidly increase testing uptake among people living with HIV prior to the development of symptoms have the potential to reduce late enrollment in care.
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Wilson KD, Dray-Spira R, Aubrière C, Hamelin C, Spire B, Lert F. Frequency and correlates of late presentation for HIV infection in France: older adults are a risk group - results from the ANRS-VESPA2 Study, France. AIDS Care 2014; 26 Suppl 1:S83-93. [PMID: 24731147 DOI: 10.1080/09540121.2014.906554] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Correlates of late presentation (LP) for HIV infection in Metropolitan France and French overseas departments (FODs) were assessed among HIV-infected patients recently diagnosed, using data from a large cross-sectional survey, representative of the French HIV-infected population, conducted in 2011. LP was defined as presentation with either clinical AIDS events within the calendar year of diagnosis or CD4 < 350/mm(3) and presentation with advanced disease (PAD) was defined as presentation with either clinical AIDS events or CD4 < 200/mm(3). Correlates of LP/PAD were assessed through logistic modelling, separately in Metropolitan France and FODs. In Metropolitan France, 47.7% of participants were late presenters and 29.3% presented with advanced disease. LP was more frequent among male and female migrants from sub-Saharan Africa (SSA; 58.5% and 56.4%) and non-African heterosexual males (61.8%) than among men who have sex with men (34.8%). In FODs, 53.2% of participants were late presenters and 36.8% presented with an advanced disease. LP was more frequent among men than women (60.6% vs. 45.3%) and among those with a lower level of education (56.6% vs. 47.5%). A consistent positive association was found in adjusted analyses between LP/PAD and increasing age at diagnosis among all subpopulations, in both settings. In Metropolitan France, among men who have sex with men, those self-declaring as bisexual were at higher risk of LP/PAD; among non-African heterosexual males and females, religiosity was associated with increased risk of LP/PAD; and among SSA migrants, those diagnosed within the year following their arrival in France were at higher risk of LP/PAD. Older age at diagnosis is a major risk factor for LP/PAD independently of any other socio-demographic characteristics. Promotion of HIV testing should be renewed to target each subgroup at risk while paying a particular attention to middle-aged or older adults whose attitudes and beliefs towards HIV/AIDS might prevent them from seeking testing.
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Affiliation(s)
- Kayigan d'Almeida Wilson
- a Department of Social Epidemiology, INSERM, UMR_S 1136 , Pierre Louis Institute of Epidemiology and Public Health , Paris , France
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28
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Agaba PA, Meloni ST, Sule HM, Agbaji OO, Ekeh PN, Job GC, Nyango N, Ugoagwu PO, Imade GE, Idoko JA, Kanki PJ. Patients who present late to HIV care and associated risk factors in Nigeria. HIV Med 2014; 15:396-405. [PMID: 24580742 DOI: 10.1111/hiv.12125] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Our objectives were to assess trends in late presentation and advanced HIV disease (AHD) and determine associated risk factors. METHODS We conducted a retrospective cohort analysis of patients who had received care and treatment at the AIDS Prevention Initiative Nigeria Plus (APIN)/Harvard School of Public Health-President's Emergency Plan for AIDS Relief (PEPFAR) programme at the Jos University Teaching Hospital, Jos, Nigeria from 2005 to 2010. We used the European Consensus Definition to assess trends in late presentation (CD4 count < 350 cells/μL or AIDS-defining illness) and AHD (CD4 count < 200 cells/μL or AIDS-defining illness) and evaluated associated risk factors using logistic regression methods. RESULTS Among 14,487 eligible patients, 12,401 (85.6%) were late presenters and 9127 (63.0%) presented with AHD. Late presentation decreased from 88.9% in 2005 to 80.1% in 2010 (P < 0.001). Similarly, AHD decreased from 67.8% in 2005 to 53.6% in 2010 (P < 0.001). In logistic regression models adjusting for sociodemographic and biological variables, male sex [adjusted odds ratio (aOR) = 1.80; 95% confidence interval (CI) 1.60-2.04], older age (aOR = 1.37; 95% CI 1.22-1.54), civil service employment (aOR = 1.48; 95% CI 1.00-2.21), referral from out-patient (aOR = 2.18; 95% CI 1.53-3.08) and in-patient (aOR = 1.55; 95% CI 1.11-2.17) services, and hepatitis B virus (aOR = 1.43; 95% CI 1.26-1.63) and hepatitis C virus (aOR = 1.18; 95% CI 1.02-1.37) coinfections were associated with late presentation. Predictors of AHD were male sex (aOR = 1.67; 95% CI 1.54-1.82), older age (aOR = 1.26; 95% CI 1.16-1.36), unemployment (aOR = 1.34; 95% CI 1.00-1.79), referral from out-patient (aOR = 2.40; 95% CI 1.84-3.14) and in-patient (aOR = 1.97; 95% CI 1.51-2.57) services and hepatitis B virus coinfection (aOR = 1.30; 95% CI 1.19-1.42). CONCLUSIONS Efforts to reduce the proportion of patients who first seek care at late stages of disease are needed. The identified risk factors should be utilized in formulating targeted public health interventions to improve early diagnosis and presentation for HIV care.
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Affiliation(s)
- P A Agaba
- Department of Family Medicine, University of Jos, Jos, Nigeria; AIDS Prevention Initiative Nigeria Plus, Jos University Teaching Hospital, Jos, Nigeria
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Yombi JC, Jonckheere S, Vincent A, Wilmes D, Vandercam B, Belkhir L. Late presentation for human immunodeficiency virus HIV diagnosis results of a Belgian single centre. Acta Clin Belg 2014; 69:33-9. [PMID: 24635397 DOI: 10.1179/0001551213z.00000000014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Antiretroviral therapy reduces mortality and morbidity in HIVinfected individuals, most markedly when initiated early, before advanced immunodeficiency has developed. Although the international guidelines recommend starting antiretroviral therapy ART with a high CD4 cell count level, in the practice, this is particularly challenging to achieve, especially in late presentation of HIV diagnosis. The aim of this study was to determine the frequency and the demographic features associated with late presentation for HIV diagnosis in our Centre. METHODS All newly diagnosed patients with HIV between January 2007 and December 2011 in our AIDS Reference Centre, were included. Late presenter patient was defined as patient with CD4 count 350/mm(3) at the time of diagnosis. Demographic age, sex, ethnicity, migration and clinical characteristics transmission mode, CD4 cell count, viral load were collected. We also collected data on outcome median day of hospitalization, mortality, virological response to ART and lost to followup LTFU. LTFU was defined as patient without any medical contact and viral load measurements during two consecutive years in our centre. RESULTS From 2007 to 2011, 154 429 out of 359 patients newly diagnosed with HIV were late presenters. According to univariate analysis, age 50, female gender, migrant from subSaharan Africa and heterosexual contact were associated with late presentation for HIV diagnosis. In the multivariate analysis, age 50, heterosexual contact and migrant status particularly women were the only independent risk factors for late presentation. Late presenters tend to have a worse outcome than nonlate presenters. CONCLUSION A considerable proportion of patients continue to be diagnosed with advanced HIV disease, despite the fact that risk factors for late presentation have been clearly identified. Despite high testing rate for HIV in Belgium, highrisk population like migrant, heterosexual contact, remain under tested. In order to be able to detect and treat all patients with high CD4 cell count as recommended by all international guidelines, we recommend developing testing policies specifically focused on these categories at high risk for late presentation.
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Grabmeier-Pfistershammer K, Rieger A, Schröck T, Schlag M. Economic burden of late presentation in HIV disease in Austria: a comparison of the initial costs imposed by advanced HIV disease vs. non-late presentation. Wien Klin Wochenschr 2013; 125:402-7. [DOI: 10.1007/s00508-013-0392-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
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Kozak M, Zinski A, Leeper C, Willig JH, Mugavero MJ. Late diagnosis, delayed presentation and late presentation in HIV: proposed definitions, methodological considerations and health implications. Antivir Ther 2013; 18:17-23. [PMID: 23341432 DOI: 10.3851/imp2534] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
Abstract
Contemporary literature emphasizes HIV treatment across multiple stages of the care continuum, beginning with HIV testing, followed by linkage and retention in medical care. As a sizeable global population remains undiagnosed or not engaged in medical care, researchers must evaluate the earliest phases of the HIV treatment cascade in order to optimize individual health outcomes and treatment-as-prevention initiatives. Because ambiguity persists for classification of these early stages of HIV care, the aim of this review is to propose a congruous approach to defining the constructs of late diagnosis, delayed presentation and late presentation for HIV medical care, as well as focus attention on methodological considerations and associated clinical and public health implications for these entities.
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Affiliation(s)
- Michael Kozak
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Late presentation of HIV despite earlier opportunities for detection, experience from an Irish tertiary referral institution. Ir J Med Sci 2013; 182:389-94. [PMID: 23322091 DOI: 10.1007/s11845-012-0898-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 12/31/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Late presentation of HIV continues to undermine advances in the management of HIV. Opportunities to detect HIV at an earlier stage are often missed. Current estimates suggest that undiagnosed individuals comprise approximately one quarter of all people in the western world living with HIV. 'Testing-and-treating' this group has been proposed as a means to curb the HIV epidemic. In this study we assessed the characteristics of individuals newly diagnosed with HIV, and their utilisation of healthcare services in Ireland prior to their diagnosis. METHODS A retrospective review was undertaken of all patients newly diagnosed with HIV over a 27-month period. Patient demographics were recorded, as were details of healthcare contacts in the year preceding diagnosis. Individuals detected via screening of recent immigrants/asylum seekers were excluded. RESULTS In the period studied 114 patients received a new diagnosis of HIV, 59 met inclusion criteria. The majority (54%) fulfilled the European consensus definition for late presenters (CD4<350 cells/µl). 'Late presenters' were significantly more likely to be symptomatic at diagnosis (OR=4.62; 95% CI 1.45-14.67; p=0.015), diagnosed by acute tertiary hospital services (p=0.015), and 56% reported heterosexual mode of acquisition (OR=2.12; 95% CI 0.73-6.16; p=0.19). Patients detected via screening had significantly higher CD4 counts at diagnosis compared with those diagnosed due to symptoms (Median CD4 422 cells/µl; IQR 285-594 vs. 142 cells/µl; IQR 62-333; p=0.0007). 'Symptomatic' patients were significantly more likely to report prior healthcare contacts (OR 4.71; 95 % CI 1.32-16.79; p=0.013). CONCLUSION Current screening activities are inadequate. Unfortunately newly diagnosed HIV patients continue to be symptomatic, at advanced stages of disease, to acute hospital services. Heterosexual groups in particular are at risk for late detection.
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Johnson M, Afonina L, Haanyama O. The challenges of testing for HIV in women: experience from the UK and other European countries. Antivir Ther 2013; 18 Suppl 2:19-25. [DOI: 10.3851/imp2637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 10/26/2022]
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Mocroft A, Lundgren JD, Sabin ML, Monforte AD, Brockmeyer N, Casabona J, Castagna A, Costagliola D, Dabis F, De Wit S, Fätkenheuer G, Furrer H, Johnson AM, Lazanas MK, Leport C, Moreno S, Obel N, Post FA, Reekie J, Reiss P, Sabin C, Skaletz-Rorowski A, Suarez-Lozano I, Torti C, Warszawski J, Zangerle R, Fabre-Colin C, Kjaer J, Chene G, Grarup J, Kirk O. Risk factors and outcomes for late presentation for HIV-positive persons in Europe: results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE). PLoS Med 2013; 10:e1001510. [PMID: 24137103 PMCID: PMC3796947 DOI: 10.1371/journal.pmed.1001510] [Citation(s) in RCA: 241] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 07/29/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Few studies have monitored late presentation (LP) of HIV infection over the European continent, including Eastern Europe. Study objectives were to explore the impact of LP on AIDS and mortality. METHODS AND FINDINGS LP was defined in Collaboration of Observational HIV Epidemiological Research Europe (COHERE) as HIV diagnosis with a CD4 count <350/mm(3) or an AIDS diagnosis within 6 months of HIV diagnosis among persons presenting for care between 1 January 2000 and 30 June 2011. Logistic regression was used to identify factors associated with LP and Poisson regression to explore the impact on AIDS/death. 84,524 individuals from 23 cohorts in 35 countries contributed data; 45,488 were LP (53.8%). LP was highest in heterosexual males (66.1%), Southern European countries (57.0%), and persons originating from Africa (65.1%). LP decreased from 57.3% in 2000 to 51.7% in 2010/2011 (adjusted odds ratio [aOR] 0.96; 95% CI 0.95-0.97). LP decreased over time in both Central and Northern Europe among homosexual men, and male and female heterosexuals, but increased over time for female heterosexuals and male intravenous drug users (IDUs) from Southern Europe and in male and female IDUs from Eastern Europe. 8,187 AIDS/deaths occurred during 327,003 person-years of follow-up. In the first year after HIV diagnosis, LP was associated with over a 13-fold increased incidence of AIDS/death in Southern Europe (adjusted incidence rate ratio [aIRR] 13.02; 95% CI 8.19-20.70) and over a 6-fold increased rate in Eastern Europe (aIRR 6.64; 95% CI 3.55-12.43). CONCLUSIONS LP has decreased over time across Europe, but remains a significant issue in the region in all HIV exposure groups. LP increased in male IDUs and female heterosexuals from Southern Europe and IDUs in Eastern Europe. LP was associated with an increased rate of AIDS/deaths, particularly in the first year after HIV diagnosis, with significant variation across Europe. Earlier and more widespread testing, timely referrals after testing positive, and improved retention in care strategies are required to further reduce the incidence of LP.
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Affiliation(s)
- Amanda Mocroft
- Department of Infection and Population Health, University College London, London, United Kingdom
- * E-mail:
| | - Jens D. Lundgren
- Copenhagen HIV programme, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | | | | | - Norbert Brockmeyer
- Department of Dermatology, Venerology, and Allergology, St. Josef Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Jordi Casabona
- CEEISCAT (Agència de Salut Pública de Catalunya) and CIBERESP, Badalona, Catalonia, Spain
| | | | | | - Francois Dabis
- Université of Bordeaux, ISPED, Centre Inserm, U897–Epidémiologie–Biostatistiques, Bordeaux, France
- Inserm U897–Epidémiologie–Biostatistiques, Bordeaux, France
| | | | | | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Anne M. Johnson
- Department of Infection and Population Health, University College London, London, United Kingdom
| | - Marios K. Lazanas
- 3rd Internal Medicine Department and Infectious Disease Unit, Red Cross General Hospital of Athens, Greece
| | - Catherine Leport
- Université Paris Diderot, Sorbonne Paris Cité, UMR 738, Paris, France
- INSERM, UMR 738, Paris, France
| | - Santiago Moreno
- Department of Infectious Diseases. University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Frank A. Post
- Kings College London School of Medicine, London, United Kingdom
| | - Joanne Reekie
- Department of Infection and Population Health, University College London, London, United Kingdom
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Peter Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Caroline Sabin
- Department of Infection and Population Health, University College London, London, United Kingdom
| | - Adriane Skaletz-Rorowski
- German Competence Network for HIV/AIDS, St. Josef Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Ignacio Suarez-Lozano
- Infectious Diseases Unit, Complejo Hospitalario de Huelva, Spanish VACH Cohort, Spain
| | - Carlo Torti
- University Division of Infectious and Tropical Diseases, University and Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Sciences, Unit of Infectious Diseases, University “Magna Graecia,” Catanzaro, Italy
| | - Josiane Warszawski
- INSERM CESP U1018, Université Paris-Sud, AP-HP Public Health Department, Le Kremlin-Bicêtre, France
| | | | - Céline Fabre-Colin
- Université de Bordeaux, ISPED, Centre INSERM U897-Epidémiologie Statistique, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897-Epidémiologie Statistique, Bordeaux, France
| | - Jesper Kjaer
- Copenhagen HIV programme, University of Copenhagen, Copenhagen, Denmark
| | - Genevieve Chene
- Université de Bordeaux, ISPED, Centre INSERM U897-Epidémiologie Statistique, Bordeaux, France
- INSERM, ISPED, Centre INSERM U897-Epidémiologie Statistique, Bordeaux, France
| | - Jesper Grarup
- Copenhagen HIV programme, University of Copenhagen, Copenhagen, Denmark
| | - Ole Kirk
- Copenhagen HIV programme, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
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Eleventh International Congress on Drug Therapy in HIV Infection. J Int AIDS Soc 2012. [DOI: 10.7448/ias.15.6.18447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Time trends and correlates of late presentation for HIV care in Northern Greece during the decade 2000 to 2010. J Int AIDS Soc 2012; 15:17395. [PMID: 23305650 PMCID: PMC3494173 DOI: 10.7448/ias.15.2.17395] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 07/02/2012] [Accepted: 08/21/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The aim of our study was to assess the extent of late presentation for HIV care in Northern Greece during the period 2000 to 2010 and to explore correlations aiming to provide guidance for future interventions. METHODS HIV-positive patients with no prior history of HIV care at presentation and with a CD4 T cell count within three months from the first confirmatory Western blot result were eligible for this study. Late presentation and advanced HIV disease were defined in concordance with the recommendations of the European Late Presenter Consensus working group. Time trends in presentation status and risk factors linked to late presentation and advanced HIV disease were identified in multivariable logistic regression models. Additional analyses after multiple imputation of missing values were performed to assess the robustness of our findings. RESULTS The status at presentation was evaluated for 631 eligible HIV-positive individuals. Overall, 52.5% (95% CI: 48.6% to 56.4%) of patients presented late for HIV care and 31.2% (95% CI: 27.6% to 34.8%) presented with advanced HIV disease. Time trends were consistent with an improvement in the presentation status of our study population (p<0.001). Risk factors associated with late presentation in multivariable logistic regression were intravenous drug use, heterosexual HIV transmission, immigrant status and age at diagnosis. CONCLUSIONS Despite the trend for improvement, a significant proportion of newly diagnosed HIV-positive patients present late for care. Targeted interventions with focus on social groups such as the elderly, persons who inject drugs, immigrants and individuals at risk for heterosexual HIV transmission are mandated.
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Manirankunda L, Loos J, Debackaere P, Nöstlinger C. "It is not easy": challenges for provider-initiated HIV testing and counseling in Flanders, Belgium. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2012; 24:456-468. [PMID: 23016506 DOI: 10.1521/aeap.2012.24.5.456] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study identified physicians' HIV testing practices and their barriers toward implementing provider-initiated HIV testing and counseling (PITC) for Sub-Saharan African migrants (SAM) in Flanders, Belgium. In-depth interviews were conducted on a purposive sample of 20 physicians (ten GPs and ten internists). GPs performed mainly patient-initiated tests, while internists carried out tests based on disease indicators and risk behavior. For the most part, World Health Organization (WHO) guidelines were not followed. Study participants were not in favor of implementing PITC. Reasons included lack of information on the HIV epidemic among SAM, fear of stigmatizing patients, perceiving testing as unethical for undocumented patients, questionable relevance of pre-test counseling, lack of expertise in discussing sexuality, language barriers, lack of time, and the absence of a national or regional HIV testing policy. Implementing PITC will require appropriate training of service providers. Also, supporting policies should be developed with the participation of stakeholders encouraging "normalization" of HIV testing.
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Thorsteinsson K, Ladelund S, Jensen-Fangel S, Larsen MV, Johansen IS, Katzenstein TL, Pedersen G, Storgaard M, Obel N, Lebech AM. Impact of gender on the risk of AIDS-defining illnesses and mortality in Danish HIV-1-infected patients: a nationwide cohort study. ACTA ACUST UNITED AC 2012; 44:766-75. [PMID: 22803607 DOI: 10.3109/00365548.2012.684220] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Gender differences in the risk of AIDS-defining illness (ADI) and mortality have been reported in the HIV-1-infected (HIV-positive) population, with conflicting findings. We aimed to assess the impact of gender on the risk of ADI and death in HIV-positive patients infected sexually. METHODS This was a population-based, nationwide cohort study of incident Danish HIV-positive individuals infected by sexual contact. Outcomes were progression to AIDS and death. We used Cox proportional hazards models and Poisson regression analyses to calculate the risk of progression to AIDS and mortality rate ratios (MRR) between risk groups and compared these with the general Danish population. RESULTS We identified 587 heterosexually infected women, 583 men who have sex with women (MSW), and 1089 men who have sex with men (MSM). The total follow-up time was 13,708 person-y. At the time of HIV diagnosis MSM had a lower prevalence of AIDS compared to MSW. Women and MSW presented more often with tuberculosis and less often with AIDS-defining cancers compared to MSM. In the adjusted analyses we observed no differences in progression to AIDS. In the adjusted analyses of risk of death, there were no differences between the 3 risk groups, although we saw a trend towards a higher risk of death in older MSW. MSM had a lower risk of death compared to the background population than women and MSW. CONCLUSIONS In the Danish HIV population, gender has no major impact on progression to AIDS or mortality. Differences in these factors between women, MSW, and MSM are mainly due to confounding from race and CD4 + cell count at diagnosis.
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Kall MM, Smith RD, Delpech VC. Late HIV diagnosis in Europe: A call for increased testing and awareness among general practitioners. Eur J Gen Pract 2012; 18:181-6. [DOI: 10.3109/13814788.2012.685069] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Grangeiro A, Escuder MML, Pereira JCR. Late entry into HIV care: lessons from Brazil, 2003 to 2006. BMC Infect Dis 2012; 12:99. [PMID: 22530925 PMCID: PMC3464677 DOI: 10.1186/1471-2334-12-99] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 04/24/2012] [Indexed: 11/10/2022] Open
Abstract
Background To ascertain the population rates and proportion of late entry into HIV care, as well as to determine whether such late entry correlates with individual and contextual factors. Methods Data for the 2003–2006 period in Brazil were obtained from public health records. A case of late entry into HIV care was defined as one in which HIV infection was diagnosed at death, one in which HIV infection was diagnosed after the condition of the patient had already been aggravated by AIDS-related diseases, or one in which the CD4+ T-cell count was ≤ 200 cells/mm3 at the time of diagnosis. We also considered extended and stricter sets of criteria (in which the final criterion was ≤ 350 cells/mm3 and ≤ 100 cells/mm3, respectively). The estimated risk ratio was used in assessing the effects of correlates, and the population rates (per 100,000 population) were calculated on an annual basis. Results Records of 115,369 HIV-infected adults were retrieved, and 43.6% (50,358) met the standard criteria for late entry into care. Diagnosis at death accounted for 29% (14,457) of these cases. Late entry into HIV care (standard criterion) was associated with certain individual factors (sex, age, and transmission category) and contextual factors (region with less economic development/increasing incidence of AIDS, lower local HIV testing rate, and smaller municipal population). Use of the extended criteria increased the proportion of late entry by 34% but did not substantially alter the correlations analyzed. The overall population rate of late entry was 9.9/100,000 population, specific rates being highest for individuals in the 30–59 year age bracket, for men, and for individuals living in regions with greater economic development/higher HIV testing rates, collectively accounting for more than half of the cases observed. Conclusions Although the high proportion of late entry might contribute to spreading the AIDS epidemic in less developed regions, most cases occurred in large cities, with broader availability of HIV testing, and in economically developed regions.
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Affiliation(s)
- Alexandre Grangeiro
- Departamento de Medicina Preventiva da Faculdade de Medicina da Universidade de São Paulo, Brazil.
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Touré A, Khanafer N, Baratin D, Bailly F, Livrozet JM, Trepo C, Peyramond D, Touraine JL, Vanhems P. First presentation for care of HIV-infected patients with low CD4 cell count in Lyon, France: risk factors and consequences for survival. AIDS Care 2012; 24:1272-6. [PMID: 22416893 DOI: 10.1080/09540121.2012.656574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To identify the risk factors associated with presentation for care with CD4 cell count ≤ 200 cells/mm(3) and death in HIV-infected patients in Lyon, France. Data were analyzed on participants from mid-1992 to December 2006 in the Lyon section of the French Hospital Database on HIV Infection. Patients were stratified into two categories according to CD4 cell count at first presentation for care in University of Lyon hospitals: Group 1 (Gr1) patients with CD4 ≤ 200 cells/mm(3) and Group 2 (Gr2) patients with CD4 >200 cells/mm(3). Multivariate logistic regression assessed the risk factors associated with first presentation for care with CD4 ≤ 200 cells/mm(3). Survival was analyzed according to the Cox regression model. Among 3569 eligible patients (838 females and 2731 males, mean age: 36.3 ± 10.3 years), 1139 (31.9%) were categorized as Gr1. The factors associated with first presentation for care with CD4 ≤ 200 cells/mm(3) were: older age, male gender, route of HIV transmission, migrant populations, geographical areas other than Rhône-Alpes, and access to care in 1992-1997. Overall mortality was higher in Gr1 than in Gr2 (24.4% [278/1139] vs. 4.1% [101/2430]; p<0.001). The risk of death was 5.81 [4.61-7.32] in Gr1 compared to Gr2. In addition to CD4 cell count, age and enrollment periods for care were factors independently related to death. Despite public health efforts in Lyon, one-third of HIV-infected patients reach the health care system with CD4 cell count ≤ 200 cells/mm(3), which was linked with higher mortality.
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Affiliation(s)
- Abdoulaye Touré
- Laboratory of Epidemiology and Public Health Unit, Lyon, France.
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Waters L, Sabin CA. Late HIV presentation: epidemiology, clinical implications and management. Expert Rev Anti Infect Ther 2012; 9:877-89. [PMID: 21973300 DOI: 10.1586/eri.11.106] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Late presentation of HIV is common and is associated with several adverse outcomes including an increased risk of clinical progression, blunted immune recovery on highly active antiretroviral therapy and a greater risk of drug toxicity. Late presenters may have higher rates of poor adherence, exacerbated by the same factors that contribute to their late diagnosis, such as lack of knowledge about HIV and the benefits of highly active antiretroviral therapy. We review the definitions of, risk factors for and subsequent impact of late presentation. Evidence regarding how and when to start antiretroviral therapy, and with which agents, will be discussed, as well as issues surrounding vaccination and opportunistic infection prophylaxis for individuals with a low CD4 count. Finally, strategies to increase HIV testing uptake to reduce late presentation will be summarized.
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Affiliation(s)
- Laura Waters
- St Stephens Research, St Stephens Centre, Chelsea & Westminster Hospital, 369 Fulham Road, London, UK
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Champenois K, Le Gall JM, Jacquemin C, Jean S, Martin C, Rios L, Benoit O, Vermoesen S, Lert F, Spire B, Yazdanpanah Y. ANRS-COM'TEST: description of a community-based HIV testing intervention in non-medical settings for men who have sex with men. BMJ Open 2012; 2:e000693. [PMID: 22466158 PMCID: PMC3323802 DOI: 10.1136/bmjopen-2011-000693] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe a community-based HIV testing programme. DESIGN AND SETTING An intervention of HIV voluntary testing conducted in non-medical settings in four French cities. PARTICIPANTS Men who have sex with men (MSM). INTERVENTION Counselling and rapid HIV testing staffed by trained personnel from an HIV/AIDS community-based organisation. PRIMARY AND SECONDARY OUTCOME MEASURES The population that has taken hold of the intervention and the satisfaction of participants. Data were collected on demographics, HIV testing history, sexual practices and satisfaction with the testing programme. RESULTS 532 MSM were tested between February 2009 and June 2010, of whom 49 (9%) were tested two or more times. 468 MSM (88%) had casual male partners in the previous 6 months, and 152 (35%) reported having unprotected anal intercourse with risky casual partners (HIV infected or HIV serostatus unknown). 159 men (30%) had not been tested in the previous 2 years, and 50 (31%) of whom had unprotected anal intercourse with risky casual partners. Among the 15 patients who tested positive (2.8%), 12 (80%) received confirmation and were linked to care (median CD4 cell count =550/mm(3)). Satisfaction was high: 92% reported being 'very satisfied' with their experience. Steps of counselling and testing procedure were respected by testers and difficulties in handling tests were rare. CONCLUSIONS This community-based HIV testing programme reached high-risk MSM, of whom a substantial proportion had not been tested lately. This novel service supplements pre-existing HIV testing services and increases access to HIV testing in high-risk groups.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bruno Spire
- AIDES, Pantin, France
- Inserm U912 (SE4S), Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
| | - Yazdan Yazdanpanah
- ATIP-Avenir, Inserm U995, Lille, France
- CH de Tourcoing, Tourcoing, France
- Université Lille—Nord de France, Lille, France
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de Olalla P, Mazardo C, Sambeat MA, Ocaña I, Knobel H, Humet V, Domingo P, Ribera E, Guelar A, Marco A, Belza MJ, Miró JM, Caylà JA. Epidemiological characteristics and predictors of late presentation of HIV infection in Barcelona (Spain) during the period 2001-2009. AIDS Res Ther 2011; 8:22. [PMID: 21729332 PMCID: PMC3143919 DOI: 10.1186/1742-6405-8-22] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 07/06/2011] [Indexed: 11/10/2022] Open
Abstract
Background Early diagnosis of HIV infection can prevent morbidity and mortality as well as reduce HIV transmission. The aim of the present study was to assess prevalence, describe trends and identify factors associated with late presentation of HIV infection in Barcelona (Spain) during the period 2001-09. Methods Demographic and epidemiological characteristics of cases reported to the Barcelona HIV surveillance system were analysed. Late presentation was defined for individuals with a CD4 count below 350 cells/ml upon HIV diagnosis or diagnosis of AIDS within 3 months of HIV diagnosis. Multivariate logistic regression were used to identify predictors of late presentation. Results Of the 2,938 newly diagnosed HIV-infected individuals, 2,507 (85,3%) had either a CD4 cell count or an AIDS diagnosis available. A total of 1,139 (55.6%) of the 2,507 studied cases over these nine years were late presenters varying from 48% among men who have sex with men to 70% among heterosexual men. The proportion of late presentation was 62.7% in 2001-2003, 51.9% in 2004-2005, 52.6% in 2006-2007 and 52.1% in 2008-2009. A decrease over time only was observed between 2001-2003 and 2004-2005 (p = 0.001) but remained constant thereafter (p = 0.9). Independent risk factors for late presentation were older age at diagnosis (p < 0.0001), use of injected drugs by men (p < 0.0001), being a heterosexual men (p < 0.0001), and being born in South America (p < 0.0001) or sub-Saharan Africa (p = 0.002). Conclusion Late presentation of HIV is still too frequent in all transmission groups in spite of a strong commitment with HIV prevention in our city. It is necessary to develop interventions that increase HIV testing and facilitate earlier entry into HIV care.
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