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Nuwagaba-Biribonwoha H, Wu Y, Gachuhi AB, McNairy ML, Madau V, Lamb M, Mazibuko S, Mnisi Z, Burke S, Philip N, Sahabo R, El Sadr WM. Low rates of prior HIV testing among HIV-positive adults accessing outpatient services in Eswatini. AIDS Res Ther 2019; 16:38. [PMID: 31806036 PMCID: PMC6896727 DOI: 10.1186/s12981-019-0254-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/20/2019] [Indexed: 11/24/2022] Open
Abstract
Prior HIV testing and awareness of HIV-positive status were assessed among HIV-positive adults at 20 clinics in Eswatini. Of 2196 HIV-positive adults, 1183 (53.8%) reported no prior HIV testing, and 1948 (88.7%) were unaware of their HIV-positive status. Males [adjusted odds ratio, AOR, (95% confidence interval): 0.7 (0.5–0.9)], youth 18–25 years [AOR 0.6 (0.4–0.95)], adults ≥ 50 years [AOR 0.5 (0.3–0.9)], those needing family support [AOR 0.6 (0.5–0.8)], and those living ≥ 45 min from clinic [AOR 0.5 (0.4–0.8)] were less likely to know their HIV-positive status. More HIV testing is needed to achieve 95-95-95 targets, with targeted strategies for those less likely to test for HIV.
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Rodriguez AE, Wawrzyniak AJ, Tookes HE, Vidal MG, Soni M, Nwanyanwu R, Goldberg D, Freeman R, Villamizar K, Alcaide ML, Kolber MA. Implementation of an Immediate HIV Treatment Initiation Program in a Public/Academic Medical Center in the U.S. South: The Miami Test and Treat Rapid Response Program. AIDS Behav 2019; 23:287-295. [PMID: 31520241 DOI: 10.1007/s10461-019-02655-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Test and Rapid Response Treatment (TRRT) linkage programs have demonstrated improved HIV suppression rates. This paper describes the design and implementation of the Miami TRRT initiative and its clinical impact. Assisted by a dedicated care navigator, patients receiving a reactive HIV rapid test at the Florida Department of Health STD Clinic were offered same-day HIV care at the University of Miami/Jackson Memorial Medical Center Adult HIV Outpatient Clinic. Patient retention and labs were tracked for 12 months. Of the 2337 individuals tested, 46 had a reactive HIV test; 41 (89%) consented to participate. For the 36 patients in continued care for a year, 33 (91.7%) achieved virological suppression (< 200 copies/mL) within 70 days of their reactive HIV rapid test; at 12 months, 35 (97.2%) remained suppressed, and mean CD4 T cell counts increased from 452 ± 266 to 597 ± 322 cells/mm3. The Miami TRRT initiative demonstrated that immediate linkage to care is feasible and improves retention and suppression in a public/academic medical center in the U.S. South.
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Affiliation(s)
- Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 856, Miami, FL, 33136, USA.
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 856, Miami, FL, 33136, USA
| | - Marcia G Vidal
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 856, Miami, FL, 33136, USA
| | - Manasi Soni
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 856, Miami, FL, 33136, USA
| | | | - David Goldberg
- Florida Department of Health in Miami-Dade County, Miami, FL, USA
| | | | - Kira Villamizar
- Florida Department of Health in Miami-Dade County, Miami, FL, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 856, Miami, FL, 33136, USA
| | - Michael A Kolber
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 856, Miami, FL, 33136, USA
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Khawcharoenporn T, Mongkolkaewsub S, Naijitra C, Khonphiern W, Apisarnthanarak A, Phanuphak N. HIV risk, risk perception and uptake of HIV testing and counseling among youth men who have sex with men attending a gay sauna. AIDS Res Ther 2019; 16:13. [PMID: 31189481 PMCID: PMC6560849 DOI: 10.1186/s12981-019-0229-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are amongst populations at-risk for HIV acquisition in Thailand. In youth MSM (aged 15-24 years), the incidence of HIV infection has substantially increased. However, data on HIV risk, risk perception and HIV testing and counseling (HTC) uptake among youth MSM in hotspots are limited. METHODS A subanalysis of a prospective study among Thai MSM attending a gay sauna was conducted. HIV risk and risk perception were assessed by an anonymous survey. The MSM were categorized as having actual "low-risk", "moderate-risk" and "high-risk" for HIV acquisition based on the validated study risk categorization tool. HTC was provided on-site with result notification within 1 h. HIV care establishment appointment was arranged by the counselors for HIV-infected participants. Care engagement within 1 year of diagnosis was subsequently assessed. RESULTS There were 358 MSM participants; 87 (24%) were youth MSM. Comparing to other MSM, youth MSM had significantly higher median number of lifetime sexual partners [2 (IQR 1-9) vs. 1 (IQR 0-1); P < 0.001), were more-likely to ever exchange sex for money (44% vs. 9%; P < 0.001) and have sexual partner who exchanged sex for money (8% vs. 1%; P < 0.001). Rates of consistent condom use in the past 3 months for anal, oral and vaginal sexes were low and not significantly different between youth and other MSM (51% vs. 61%, 26% vs. 35% and 72% vs. 61%, respectively). By using the study risk categorization tool, there were 68 youth MSM with moderate or high-risk for HIV acquisition, of which 43 (63%) had false perception of low HIV risk. Youth MSM were more likely than other MSM to accept HTC [68% vs. 33%, P < 0.001)] and to be first-time testers (42% vs. 28%, P = 0.07). By HTC, the rates of HIV infection tended to be higher among youth MSM comparing to other MSM [14/59 (24%) vs. 11/89 (12%); P = 0.07]. Among the 14 youth MSM newly-diagnosed with HIV infection, only 6 (43%) showed-up for continuity care after 1-year follow-up. CONCLUSIONS Youth MSM had substantial high HIV risk, false perception of low HIV risk and low rate of care engagement but demonstrated considerable rate of HTC uptake. Strategies to improve access to HTC, risk perception and linkage to care are needed for HIV prevention and management among the youth MSM.
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Affiliation(s)
- Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Thammasat University Hospital, Pathumthani, Thailand
| | | | | | | | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Thammasat University Hospital, Pathumthani, Thailand
| | - Nittaya Phanuphak
- PREVENTION, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
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Choko AT, Candfield S, Maheswaran H, Lepine A, Corbett EL, Fielding K. The effect of demand-side financial incentives for increasing linkage into HIV treatment and voluntary medical male circumcision: A systematic review and meta-analysis of randomised controlled trials in low- and middle-income countries. PLoS One 2018; 13:e0207263. [PMID: 30427889 PMCID: PMC6235355 DOI: 10.1371/journal.pone.0207263] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 10/29/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Linkage to HIV treatment is a vital step in the cascade of HIV services and is critical to slowing down HIV transmission in countries with high HIV prevalence. Equally, linkage to voluntary medical male circumcision (VMMC) has been shown to decrease HIV transmission by 60% and increasing numbers of men receiving VMMC has a substantial impact on HIV incidence. However, only 48% of newly diagnosed HIV positive people link to HIV treatment let alone access HIV prevention methods such as VMMC globally. METHODS A systematic review investigating the effect of demand-side financial incentives (DSFIs) on linkage into HIV treatment or VMMC for studies conducted in low- and middle-income countries. We searched the title, abstract and keywords in eight bibliographic databases: MEDLINE, EMBASE, Web of Science, Econlit, Cochrane, SCOPUS, IAS Conference database of abstracts, and CROI Conference database of abstracts. Searches were done in December 2016 with no time restriction. We fitted random effects (RE) models and used forest plots to display risk ratios (RR) and 95% CIs separately for the linkage to VMMC outcome. The RE model was also used to assess heterogeneity for the linkage to HIV treatment outcome. RESULTS Of the 1205 citations identified from searches, 48 full text articles were reviewed culminating in nine articles in the final analysis. Five trials investigated the effect of DSFIs on linkage to HIV treatment while four trials investigated linkage to VMMC. Financial incentives improved linkage to HIV treatment in three of the five trials that investigated this outcome. Significant improvements were observed among postpartum women RR 1.26 (95% CI: 1.08; 1.48), among people who inject drugs RR 1.42 (95% CI: 1.09; 1.96), and among people testing at the clinic RR 1.10 (95% CI: 1.07; 1.14). One of the two trials that did not find significant improvement in linkage to ART was among people testing HIV positive in clinics RR 0.96 (95% CI: 0.81; 1.16) while the other was among new HIV positive individuals identified through a community testing study RR 0.82 (95% CI: 0.56; 1.22). We estimate an average 4-fold increase in the uptake of circumcision among HIV negative uncircumcised men from our fitted RE model with overall RR 4.00 (95% CI: 2.17; 7.37). There was negligible heterogeneity in the estimates from the different studies with I-squared = 0.0%; p = 0.923. CONCLUSIONS Overall, DSFIs appeared to improve linkage for both HIV treatment and VMMC with greater effect for VMMC. Demand-side financial incentives could improve linkage to HIV treatment or VMMC in low- and middle-income countries although uptake by policy makers remains a challenge.
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Affiliation(s)
- Augustine T. Choko
- TB/HIV Theme, Malawi-Liverpool-Wellcome Clinical Research Programme (MLW), Blantyre, Malawi
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Sophie Candfield
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | | | - Aurelia Lepine
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Elizabeth Lucy Corbett
- TB/HIV Theme, Malawi-Liverpool-Wellcome Clinical Research Programme (MLW), Blantyre, Malawi
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Katherine Fielding
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
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Stevens ER, Li L, Nucifora KA, Zhou Q, McNairy ML, Gachuhi A, Lamb MR, Nuwagaba-Biribonwoha H, Sahabo R, Okello V, El-Sadr WM, Braithwaite RS. Cost-effectiveness of a combination strategy to enhance the HIV care continuum in Swaziland: Link4Health. PLoS One 2018; 13:e0204245. [PMID: 30222768 PMCID: PMC6141095 DOI: 10.1371/journal.pone.0204245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/04/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Link4Health, a cluster-RCT, demonstrated the effectiveness of a combination strategy targeting barriers at various HIV continuum steps on linkage to and retention in care; showing effectiveness in achieving linkage to HIV care within 1 month plus retention in care at 12 months after HIV testing for people living with HIV (RR 1.48, 95% CI 1.19-1.96, p = 0.002). In addition to standard of care, Link4Health included: 1) Point-of-care CD4+ count testing; 2) Accelerated ART initiation; 3) Mobile phone appointment reminders; 4) Care and prevention package including commodities and informational materials; and 5) Non-cash financial incentive. Our objective was to evaluate the cost-effectiveness of a scale-up of the Link4Health strategy in Swaziland. METHODS AND FINDINGS We incorporated the effects and costs of the Link4Health strategy into a computer simulation of the HIV epidemic in Swaziland, comparing a scenario where the strategy was scaled up to a scenario with no implementation. The simulation combined a deterministic compartmental model of HIV transmission with a stochastic microsimulation of HIV progression calibrated to Swaziland epidemiological data. It incorporated downstream health costs potentially saved and infections potentially prevented by improved linkage and treatment adherence. We assessed the incremental cost-effectiveness ratio of Link4Health compared to standard care from a health sector perspective reported in US$2015, a time horizon of 20 years, and a discount rate of 3% in accordance with WHO guidelines.[1] Our results suggest that scale-up of the Link4Health strategy would reduce new HIV infections over 20 years by 11,059 infections, a 7% reduction from the projected 169,019 cases and prevent 5,313 deaths, an 11% reduction from the projected 49,582 deaths. Link4Health resulted in an incremental cost per infection prevented of $13,310 and an incremental cost per QALY gained of $3,560/QALY from the health sector perspective. CONCLUSIONS Using a threshold of <3 x per capita GDP, the Link4Health strategy is likely to be a cost-effective strategy for responding to the HIV epidemic in Swaziland.
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Affiliation(s)
- Elizabeth R. Stevens
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
| | - Lingfeng Li
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
| | - Kimberly A. Nucifora
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
| | - Qinlian Zhou
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
| | | | - Averie Gachuhi
- ICAP at Columbia University, New York, NY, United States of America
| | - Matthew R. Lamb
- ICAP at Columbia University, New York, NY, United States of America
| | - Harriet Nuwagaba-Biribonwoha
- ICAP at Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | | | | | - Wafaa M. El-Sadr
- ICAP at Columbia University, New York, NY, United States of America
| | - R. Scott Braithwaite
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
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McNairy ML, Lamb MR, Gachuhi AB, Nuwagaba-Biribonwoha H, Burke S, Mazibuko S, Okello V, Ehrenkranz P, Sahabo R, El-Sadr WM. Effectiveness of a combination strategy for linkage and retention in adult HIV care in Swaziland: The Link4Health cluster randomized trial. PLoS Med 2017; 14:e1002420. [PMID: 29112963 PMCID: PMC5675376 DOI: 10.1371/journal.pmed.1002420] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/29/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gaps in the HIV care continuum contribute to poor health outcomes and increase HIV transmission. A combination of interventions targeting multiple steps in the continuum is needed to achieve the full beneficial impact of HIV treatment. METHODS AND FINDINGS Link4Health, a cluster-randomized controlled trial, evaluated the effectiveness of a combination intervention strategy (CIS) versus the standard of care (SOC) on the primary outcome of linkage to care within 1 month plus retention in care at 12 months after HIV-positive testing. Ten clusters of HIV clinics in Swaziland were randomized 1:1 to CIS versus SOC. The CIS included point-of-care CD4+ testing at the time of an HIV-positive test, accelerated antiretroviral therapy (ART) initiation for treatment-eligible participants, mobile phone appointment reminders, health educational packages, and noncash financial incentives. Secondary outcomes included each component of the primary outcome, mean time to linkage, assessment for ART eligibility, ART initiation and time to ART initiation, viral suppression defined as HIV-1 RNA < 1,000 copies/mL at 12 months after HIV testing among patients on ART ≥6 months, and loss to follow-up and death at 12 months after HIV testing. A total of 2,197 adults aged ≥18 years, newly tested HIV positive, were enrolled from 19 August 2013 to 21 November 2014 (1,096 CIS arm; 1,101 SOC arm) and followed for 12 months. The median participant age was 31 years (IQR 26-39), and 59% were women. In an intention-to-treat analysis, 64% (705/1,096) of participants at the CIS sites achieved the primary outcome versus 43% (477/1,101) at the SOC sites (adjusted relative risk [RR] 1.52, 95% CI 1.19-1.96, p = 0.002). Participants in the CIS arm versus the SOC arm had the following secondary outcomes: linkage to care regardless of retention at 12 months (RR 1.08, 95% CI 0.97-1.21, p = 0.13), mean time to linkage (2.5 days versus 7.5 days, p = 0.189), retention in care at 12 months regardless of time to linkage (RR 1.48, 95% CI 1.18-1.86, p = 0.002), assessment for ART eligibility (RR 1.20, 95% CI 1.07-1.34, p = 0.004), ART initiation (RR 1.16, 95% CI 0.96-1.40, p = 0.12), mean time to ART initiation from time of HIV testing (7 days versus 14 days, p < 0.001), viral suppression among those on ART for ≥6 months (RR 0.97, 95% CI 0.88-1.07, p = 0.55), loss to follow-up at 12 months after HIV testing (RR 0.56, 95% CI 0.40-0.79, p = 0.002), and death (N = 78) within 12 months of HIV testing (RR 0.80, 95% CI 0.46-1.35, p = 0.41). Limitations of this study include a small number of clusters and the inability to evaluate the incremental effectiveness of individual components of the combination strategy. CONCLUSIONS A combination strategy inclusive of 5 evidence-based interventions aimed at multiple steps in the HIV care continuum was associated with significant increase in linkage to care plus 12-month retention. This strategy offers promise of enhanced outcomes for HIV-positive patients. TRIAL REGISTRATION ClinicalTrials.gov NCT01904994.
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Affiliation(s)
- Margaret L. McNairy
- ICAP at Columbia University, New York, New York, United States of America
- Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
- * E-mail:
| | - Matthew R. Lamb
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Averie B. Gachuhi
- ICAP at Columbia University, New York, New York, United States of America
| | - Harriet Nuwagaba-Biribonwoha
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Sean Burke
- ICAP at Columbia University, New York, New York, United States of America
| | | | - Velephi Okello
- Ministry of Health, Kingdom of Swaziland, Mbabane, Swaziland
| | - Peter Ehrenkranz
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Ruben Sahabo
- ICAP at Columbia University, New York, New York, United States of America
| | - Wafaa M. El-Sadr
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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Choko AT, Fielding K, Stallard N, Maheswaran H, Lepine A, Desmond N, Kumwenda MK, Corbett EL. Investigating interventions to increase uptake of HIV testing and linkage into care or prevention for male partners of pregnant women in antenatal clinics in Blantyre, Malawi: study protocol for a cluster randomised trial. Trials 2017; 18:349. [PMID: 28738857 PMCID: PMC5525336 DOI: 10.1186/s13063-017-2093-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 07/02/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Despite large-scale efforts to diagnose people living with HIV, 54% remain undiagnosed in sub-Saharan Africa. The gap in knowledge of HIV status and uptake of follow-on services remains wide with much lower rates of HIV testing among men compared to women. Here, we design a study to investigate the effect on uptake of HIV testing and linkage into care or prevention of partner-delivered HIV self-testing alone or with an additional intervention among male partners of pregnant women. METHODS A phase II, adaptive, multi-arm, multi-stage cluster randomised trial, randomising antenatal clinic (ANC) days to six different trial arms. Pregnant women accessing ANC in urban Malawi for the first time will be recruited into either the standard of care (SOC) arm (invitation letter to the male partner offering HIV testing) or one of five intervention arms offering oral HIV self-test kits. Three of the five intervention arms will additionally offer the male partner a financial incentive (fixed or lottery amount) conditional on linkage after self-testing with one arm testing phone call reminders. Assuming that 25% of male partners link to care or prevention in the SOC arm, six clinic days, with a harmonic mean of 21 eligible participants, per arm will provide 80% power to detect a 0.15 absolute difference in the primary outcome. Cluster proportions will be analysed by a cluster summaries approach with adjustment for clustering and multiplicity. DISCUSSION This trial applies adaptive methods which are novel and efficient designs. The methodology and lessons learned here will be important as proof of concept of how to design and conduct similar studies in the future. Although small, this trial will potentially present good evidence on the type of effective interventions for improving linkage into ART or prevention. The trial results will also have important policy implications on how to implement HIVST targeting male partners of pregnant women who are accessing ANC for the first time while paying particular attention to safety concerns. Contamination may occur if women in the intervention arms share their self-test kits with women in the SOC arm. TRIAL REGISTRATION ISRCTN, ID: 18421340 . Registered on 31 March 2016.
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Affiliation(s)
- Augustine T. Choko
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, PO Box 30096, Chichiri, Blantyre 3, Malawi
- London School of Hygiene and Tropical Medicine, London, UK
- Warwick Medical School, Coventry, UK
| | | | | | | | - Aurelia Lepine
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nicola Desmond
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, PO Box 30096, Chichiri, Blantyre 3, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Moses K. Kumwenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, PO Box 30096, Chichiri, Blantyre 3, Malawi
- College of Medicine, Blantyre, Malawi
| | - Elizabeth L. Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, PO Box 30096, Chichiri, Blantyre 3, Malawi
- College of Medicine, Blantyre, Malawi
- London School of Hygiene and Tropical Medicine, London, UK
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Kujawski SA, Lamb MR, Lahuerta M, McNairy ML, Ahoua L, Abacassamo F, Nuwagaba-Biribonwoha H, Gachuhi A, El-Sadr WM, Elul B. Advanced Human Immunodeficiency Virus Disease at Diagnosis in Mozambique and Swaziland. Open Forum Infect Dis 2017; 4:ofx156. [PMID: 28959700 PMCID: PMC5610724 DOI: 10.1093/ofid/ofx156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/17/2017] [Indexed: 11/14/2022] Open
Abstract
Background Early diagnosis of human immunodeficiency virus (HIV) is a prerequisite to maximizing individual and societal benefits of antiretroviral therapy. Methods Adults ≥18 years of age testing HIV positive at 10 health facilities in Mozambique and Swaziland received point-of-care CD4+ cell count testing immediately after diagnosis. We examined median CD4+ cell count at diagnosis, the proportion diagnosed with advanced HIV disease (CD4+ cell count ≤350 cells/μL) and severe immunosuppression (CD4+ cell count ≤100 cells/μL), and determinants of the latter 2 measures. Results Among 2333 participants, the median CD4+ cell count at diagnosis was 313 cells/μL (interquartile range, 164–484), more than half (56.5%) had CD4+ ≤350 cells/μL, and 13.9% had CD4+ ≤100 cells/μL. The adjusted relative risk (aRR) of both advanced HIV disease and severe immunosuppression at diagnosis was higher in men versus women (advanced disease aRR = 1.31; 95% confidence interval [CI] = 1.16–1.48; severe immunosuppression aRR = 1.54, 95% CI = 1.17–2.02) and among those who sought HIV testing because they felt ill (advanced disease aRR = 1.30, 95% CI = 1.08–1.55; severe immunosuppression aRR = 2.10, 95% CI = 1.35–2.26). Age 18–24 versus 25–39 was associated with a lower risk of both outcomes (advanced disease aRR = 0.70, 95% CI = 0.59–0.84; severe immunosuppression aRR = 0.62, 95% CI = 0.41–0.95). Conclusions More than 10 years into the global scale up of comprehensive HIV services, the majority of adults diagnosed with HIV at health facilities in 2 high-prevalence countries presented with advanced disease and 1 in 7 had severe immunosuppression. Innovative strategies for early identification of HIV-positive individuals are urgently needed.
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Affiliation(s)
- Stephanie A Kujawski
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Matthew R Lamb
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.,ICAP at Columbia University Mailman School of Public Health, New York, New York
| | - Maria Lahuerta
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.,ICAP at Columbia University Mailman School of Public Health, New York, New York
| | | | - Laurence Ahoua
- ICAP at Columbia University Mailman School of Public Health, New York, New York
| | | | - Harriet Nuwagaba-Biribonwoha
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.,ICAP at Columbia University Mailman School of Public Health, New York, New York
| | - Averie Gachuhi
- ICAP at Columbia University Mailman School of Public Health, New York, New York
| | - Wafaa M El-Sadr
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.,ICAP at Columbia University Mailman School of Public Health, New York, New York
| | - Batya Elul
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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9
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Mejia CM, Acland D, Buzdugan R, Grimball R, Natoli L, McGrath MR, Klausner JD, McCoy SI. An Intervention Using Gamification to Increase Human Immunodeficiency Virus and Sexually Transmitted Infection Screening Among Young Men Who Have Sex With Men in California: Rationale and Design of Stick To It. JMIR Res Protoc 2017; 6:e140. [PMID: 28716771 PMCID: PMC5537559 DOI: 10.2196/resprot.8064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In the United States, young men who have sex with men (YMSM) remain disproportionately affected by human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). Although routine HIV/STI screening is pivotal to the timely diagnosis of HIV and STIs, initiation of appropriate treatment, and reduced onward disease transmission, repeat screening is underused. Novel interventions that incorporate elements of games, an approach known as gamification, have the potential to increase routinization of HIV/STI screening among YMSM. OBJECTIVE The study aims to test the hypothesis that an incentive-based intervention that incorporates elements of gamification can increase routine HIV/STI screening among YMSM in California. METHODS The study consists of a formative research phase to develop the intervention and an implementation phase where the intervention is piloted in a controlled research setting. In the formative research phase, we use an iterative development process to design the intervention, including gathering information about the feasibility, acceptability, and expected effectiveness of potential game elements (eg, points, leaderboards, rewards). These activities include staff interviews, focus group discussions with members of the target population, and team meetings to strategize and develop the intervention. The final intervention is called Stick To It and consists of 3 components: (1) online enrollment, (2) Web-based activities consisting primarily of quizzes and a countdown "timer" to facilitate screening reminders, and (3) in-person activities that occur at 2 sexual health clinics. Participants earn points through the Web-based activities that are then redeemed for chances to win various prizes during clinic visits. The pilot study is a quasi-experimental study with a minimum of 60 intervention group participants recruited at the clinics, at community-based events, and online. We will compare outcomes in the intervention group with a historical control group consisting of individuals meeting the inclusion criteria who attended study clinics in the 12 months prior to intervention implementation. Eligible participants in the pilot study (1) are 18 to 26 years old, (2) were born or identify as male, 3) report male sexual partners, and 4) have a zip code of residence within defined areas in the vicinity of 1 of the 2 implementation sites. The primary outcome is repeat HIV/STI screening within 6 months. RESULTS This is an ongoing research study with initial results expected in the fourth quarter of 2017. CONCLUSIONS We will develop and pilot test a gamification intervention to encourage YMSM to be regularly screened for HIV/STIs. The results from this research will provide preliminary evidence about the potential effectiveness of using gamification to amplify health-related behavioral change interventions. Further, the research aims to determine the processes that are essential to developing and implementing future health-related gamification interventions. TRIAL REGISTRATION Clinicaltrials.gov NCT02946164; https://clinicaltrials.gov/ct2/show/NCT02946164 (Archived by WebCite at http://www.webcitation.org/6ri3G4HwD).
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Affiliation(s)
- Christopher M Mejia
- Public Health Division, AIDS Healthcare Foundation, Los Angeles, CA, United States
| | - Daniel Acland
- Goldman School of Public Policy, University of California, Berkeley, CA, United States
| | - Raluca Buzdugan
- School of Public Health, University of California, Berkeley, CA, United States
| | - Reva Grimball
- School of Public Health, University of California, Berkeley, CA, United States
| | - Lauren Natoli
- Public Health Division, AIDS Healthcare Foundation, Los Angeles, CA, United States
| | - Mark R McGrath
- Public Health Division, AIDS Healthcare Foundation, Los Angeles, CA, United States
| | - Jeffrey D Klausner
- David Geffen School of Medicine, University of California, Los Angeles, CA, United States
- Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Sandra I McCoy
- School of Public Health, University of California, Berkeley, CA, United States
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Beyrer C, Shisana O, Baral SD, Milsana K, Mayer KH, Pozniak A, Walker BD, Mboup S, Sohn AH, Serwadda D, Rees H, Dvoriak S, Warren M, Thiam S, El-Sadr WM, Hospital X, Ryan O, Thomson N, Bekker LG. The science of Durban, AIDS 2016. J Int AIDS Soc 2017; 20:21781. [PMID: 28692209 PMCID: PMC5515038 DOI: 10.7448/ias.20.1.21781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/25/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The science presented at the 21st International AIDS Conference in Durban, South Africa, in July 2016, addressed the state of the field across basic, clinical, prevention, law and policy and implementation science. METHODS AND RESULTS The AIDS response has seen remarkable achievements in scientific advances, in translation of those advances into prevention, treatment and care for affected individuals and communities, and in large scale implementation - reaching 18 million people with antiviral therapy by mid-year 2016. Yet incident HIV infections in adults remain stubbornly stable and are increasing in some regions and among adolescents and adults in some key populations, challenging current science, policy and programming. There have been important advances in both preventive vaccines and in cure research, but both areas require ongoing investment and innovation. Clinical research has flourished with new agents, regimens, delivery modes and diagnostics but has been challenged by aging and increasingly complex patient populations, long-term adherence challenges, co-infections and co-morbidities, and unresolved issues in TB management and epidemic control. It is an extraordinary period of innovation in prevention, yet the promise of new tools and combination approaches have yet to deliver epidemic HIV control. CONCLUSIONS Proven interventions, most notably pre-exposure prophylaxis, PrEP, have been limited in rollout and impact. Treatment as prevention has the promise to improve clinical outcomes but remains uncertain as a prevention tool to reduce population-level HIV incidence. The improvement of legal, policy and human rights environments for those most at risk for HIV acquisition and most at risk for lack of access to essential services; sexual and gender minorities, sex workers of all genders, people who inject drugs, and prisoners and detainees remain among the greatest unmet needs in HIV/AIDS. Failure to do better for these individuals and communities could undermine the HIV response.
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Affiliation(s)
- Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- International AIDS Society, Geneva, Switzerland
| | | | - Stefan D. Baral
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Koleka Milsana
- Department of Medicine, University of KwaZulua Natal, Durban, South Africa
| | - Kenneth H. Mayer
- Department of Medicine, Harvard Medical School, Fenway Community Health Center, Boston, USA
| | - Anton Pozniak
- Department of Medicine, Chelsea and Westminster Hospital, London, UK
| | - Bruce D. Walker
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Souleman Mboup
- Institut de Recherche en Santé, de Surveillance Epidemiologique et de Formations, Dakar, Senegal
| | - Annette H. Sohn
- TREAT Asia, amfAR – The Foundation for AIDS Research, Bangkok, Thailand
| | - David Serwadda
- Department of Epidemiology, Makerere University School of Public Health Kampala, Uganda
| | - Helen Rees
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kiev, Ukraine
| | | | - Safiatou Thiam
- Department of Health, National AIDS Council of Senegal, Dakar
| | - Wafaa M. El-Sadr
- Mailman School of Public Health, ICAP at Columbia University, New York, NY, USA
| | - Xavier Hospital
- Department of Health, UNESCO Regional Office in Dakar, Dakar, Senegal
| | - Owen Ryan
- International AIDS Society, Geneva, Switzerland
| | - Nicolas Thomson
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Linda-Gail Bekker
- International AIDS Society, Geneva, Switzerland
- Desmond Tutu HIV Research Foundation, University of Cape Town, Cape Town, South Africa
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11
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McNairy ML, Abrams EJ, Rabkin M, El-Sadr WM. Clinical decision tools are needed to identify HIV-positive patients at high risk for poor outcomes after initiation of antiretroviral therapy. PLoS Med 2017; 14:e1002278. [PMID: 28419097 PMCID: PMC5395167 DOI: 10.1371/journal.pmed.1002278] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Margaret McNairy and colleagues highlight the need for clinical decision tools to help identify HIV patients who would benefit from tailored services to avoid poor outcomes such as death and loss to follow-up.
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Affiliation(s)
- Margaret L. McNairy
- ICAP, Columbia University, New York, New York, United States of America
- Department of Medicine, Cornell Medical College, New York, New York, United States of America
| | - Elaine J. Abrams
- ICAP, Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Miriam Rabkin
- ICAP, Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Wafaa M. El-Sadr
- ICAP, Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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12
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Haberer JE, Sabin L, Amico KR, Orrell C, Galárraga O, Tsai AC, Vreeman RC, Wilson I, Sam‐Agudu NA, Blaschke TF, Vrijens B, Mellins CA, Remien RH, Weiser SD, Lowenthal E, Stirratt MJ, Sow PS, Thomas B, Ford N, Mills E, Lester R, Nachega JB, Bwana BM, Ssewamala F, Mbuagbaw L, Munderi P, Geng E, Bangsberg DR. Improving antiretroviral therapy adherence in resource-limited settings at scale: a discussion of interventions and recommendations. J Int AIDS Soc 2017; 20:21371. [PMID: 28630651 PMCID: PMC5467606 DOI: 10.7448/ias.20.1.21371] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 02/24/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction: Successful population-level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale-up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource-limited settings. Methods: In July 2015, the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in resource-limited settings. This article summarizes that discussion with recent updates. It is not a systematic review, but rather provides practical considerations for programme implementation based on evidence from individual studies, systematic reviews, meta-analyses, and the World Health Organization Consolidated Guidelines for HIV, which include evidence from randomized controlled trials in low- and middle-income countries. Interventions are categorized broadly as education and counselling; information and communication technology-enhanced solutions; healthcare delivery restructuring; and economic incentives and social protection interventions. Each category is discussed, including descriptions of interventions, current evidence for effectiveness, and what appears promising for the near future. Approaches to intervention implementation and impact assessment are then described. Results and discussion: The evidence base is promising for currently available, effective, and scalable ART adherence interventions for resource-limited settings. Numerous interventions build on existing health care infrastructure and leverage available resources. Those most widely studied and implemented to date involve peer counselling, adherence clubs, and short message service (SMS). Many additional interventions could have an important impact on ART adherence with further development, including standardized counselling through multi-media technology, electronic dose monitoring, decentralized and differentiated models of care, and livelihood interventions. Optimal targeting and tailoring of interventions will require improved adherence measurement. Conclusions: The opportunity exists today to address and resolve many of the challenges to effective ART adherence, so that they do not limit the potential of ART to help bring about the end of AIDS.
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Affiliation(s)
- Jessica E. Haberer
- Massachusetts General Hospital Global Health, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lora Sabin
- Department of Global Health, Center for Global Health and Department, Boston University School of Public Health, Boston, MA, USA
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Alexander C. Tsai
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel C. Vreeman
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ira Wilson
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Nadia A. Sam‐Agudu
- Clinical Department, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Terrence F. Blaschke
- Department of Medicine and Clinical Pharmacology, Stanford University School of Medicine, Stanford, CA, USA
| | - Bernard Vrijens
- Department of Biostatistics, University of Liège, Liège, Wallonia, Belgium
- WestRock Healthcare, Sion, Switzerland
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, NYSPI and Department of Psychiatry, Columbia; University, New York, NY, USA
| | - Robert H. Remien
- HIV Center for Clinical and Behavioral Studies, NYSPI and Department of Psychiatry, Columbia; University, New York, NY, USA
| | - Sheri D. Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Elizabeth Lowenthal
- Departments of Pediatrics and Epidemiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Michael J. Stirratt
- Division of AIDS Research, National Institute of Mental Health, Bethesda, MD, USA
| | - Papa Salif Sow
- Bill and Melinda Gates Foundation, Seattle, WA, USA
- Department of Infectious diseases, University of Dakar, Dakar, Sénégal
| | | | - Nathan Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Edward Mills
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard Lester
- Division of Infectious Diseases, Department of Medicine, University of British Columbia
| | - Jean B. Nachega
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Bosco Mwebesa Bwana
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Fred Ssewamala
- Columbia University School of Social Work & School of International and Public Affairs, New York, NY, USA
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Paula Munderi
- HIV Care Research Program, Medical Research Council, Uganda Virus Research Institute, Entebbe, Uganda
| | - Elvin Geng
- Division of HIV, Infectious Disease and Global Medicine, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA
| | - David R. Bangsberg
- Oregon Health & Sciences University‐Portland State University School of Public Health, Portland, OR, USA
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Jong S, Cuca Y, Thompson LM. Meta-analysis of Mobile Phone Reminders on HIV Patients' Retention to Care. JOURNAL OF MOBILE TECHNOLOGY IN MEDICINE 2017; 6:5-18. [PMID: 30197685 PMCID: PMC6124685 DOI: 10.7309/jmtm.6.1.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS This research aims to systematically review the current clinical evidence of the efficacy of mobile phone reminders on retention to care among HIV patients. This study also seeks to determine an effect size of the intervention and presents implications for future studies. BACKGROUND Use of mobile technologies is an innovative and affordable approach to HIV prevention and care, particularly in resource limited settings. Approximately two-thirds of people who are initially diagnosed with HIV are lost to follow-up before starting HIV treatment in low and middle-income countries, posing serious global health concerns. While mobile text message reminders for HIV medication adherence have shown positive health outcomes, it is not well understood whether the reminders can also improve patients' retention to care. METHODS The authors conducted a meta-analysis of literature in the following databases: PubMed, CINAHL, ProQuest, and Web of Science. Of the 667 peer-reviewed research articles reviewed, nine studies were included in the final analysis. Stata version 13 was used for the analysis. RESULTS Nine studies (5 randomized controlled and 4 before and after studies) from 7 countries included 3,004 HIV patients. Random-effect meta-analysis (I-squared = 94.1%) found that HIV patients who received mobile phone reminders for their follow-up appointments were two times more likely to return to care than those who didn't receive reminders (pooled odd ratio (OR)=2.04, 95% CI: 0.97-4.27). Our sub-group analysis of 5 randomized controlled studies showed a significant effect of mobile phone reminders (OR=2.04, 95% CI: 1.11-3.74). Six studies in Africa showed that HIV patients (mostly women) receiving mobile phone reminders were three times more likely to return to care than those who received no reminders (OR=2.92, 95% CI: 1.13-7.53). CONCLUSION Mobile phone reminders are an effective intervention to improve retention to HIV care. Women with HIV living in resource limited settings benefit significantly from the intervention. Also, mobile phone reminders using text messages are as effective as phone calls to improve retention to HIV care.
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Affiliation(s)
- SoSon Jong
- School of Nursing, University of California, San Francisco
| | - Yvette Cuca
- School of Nursing, University of California, San Francisco
| | - Lisa M Thompson
- School of Nursing, Global Health Sciences, University of California, San Francisco
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Katz IT, Bangsberg DR. Cascade of Refusal-What Does It Mean for the Future of Treatment as Prevention in Sub-Saharan Africa? Curr HIV/AIDS Rep 2016; 13:125-30. [PMID: 26894487 DOI: 10.1007/s11904-016-0309-9] [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] [Indexed: 01/14/2023]
Abstract
Recent recommendations by the World Health Organization support treatment for all people living with HIV (PLWH) globally to be initiated at the point of testing. While there has been marked success in efforts to identify and expand treatment for PLWH throughout sub-Saharan Africa, the goal of universal treatment may prove challenging to achieve. The pre-ART phase of the care cascade from HIV testing to HIV treatment initiation includes several social and structural barriers. One such barrier is antiretroviral therapy (ART) treatment refusal, a phenomenon in which HIV-infected individuals choose not to start treatment upon learning their ART eligibility. Our goal is to provide further understanding of why treatment-eligible adults may choose to present for HIV testing but not initiate ART when indicated. In this article, we will discuss factors driving pre-ART loss and present a framework for understanding the impact of decision-making on early losses in the care cascade, with a focus on ART refusal.
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Affiliation(s)
- Ingrid T Katz
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, 1620 Tremont St, Boston, MA, 02120, USA. .,Harvard Medical School, Boston, MA, USA. .,Massachusetts General Hospital Center for Global Health, Boston, MA, USA.
| | - David R Bangsberg
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital Center for Global Health, Boston, MA, USA
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15
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Khawcharoenporn T, Apisarnthanarak A, Phanuphak N. Active targeted HIV testing and linkage to care among men who have sex with men attending a gay sauna in Thailand. AIDS Care 2016; 29:355-364. [PMID: 27855485 DOI: 10.1080/09540121.2016.1259450] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Existing data on the feasibility of human immunodeficiency virus (HIV) testing and counseling (HTC) and linkage to care among men who have sex with men (MSM) in hotspots are currently limited. A prospective study on active targeted HTC and linkage to care among MSM (≥18 years old) was conducted at a gay sauna in Thailand from November 2013 to October 2015. HIV risks and risk perception were evaluated through an anonymous survey. HIV testing with result notification and care appointment arrangement were provided on-site. Of the 358 participants; median age was 30 years; 206/358(58%) were at high risk for HIV acquisition; 148/358(41%) accepted HTC, all of whom either had prior negative HIV tests [98/148 (66%)] or had not known their HIV status [50/148 (34%)]. The three most common reasons for declining HTC were prior HIV testing within 6 months (48%), not ready (19%) and perceiving self as no risk (11%). Of the 262 moderate- and high-risk participants, 172 (66%) had false perception of low HIV risk which was significantly associated with declining HTC. Among the 148 participants undergoing HTC, 25 (17%) were HIV-infected. Having false perception of low risk (P = 0.004) and age <30 years (P = 0.02) were independently associated with HIV positivity. Only 14 of the 25 HIV-infected participants (56%) could be contacted after the result notification, of whom 12 (86%) had established HIV care and received immediate antiretroviral therapy. The active targeted HTC and facilitating care establishment was feasible among MSM attending the gay sauna but required strategies to improve accuracy of HIV-risk perception and linkage to care.
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Affiliation(s)
- Thana Khawcharoenporn
- a Division of Infectious Diseases, Faculty of Medicine , Thammasat University , Pathumthani , Thailand.,b HIV/AIDS Care Unit of Thammasat University Hospital , Pathumthani , Thailand
| | - Anucha Apisarnthanarak
- a Division of Infectious Diseases, Faculty of Medicine , Thammasat University , Pathumthani , Thailand.,b HIV/AIDS Care Unit of Thammasat University Hospital , Pathumthani , Thailand
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Khawcharoenporn T, Chunloy K, Apisarnthanarak A. Uptake of HIV testing and counseling, risk perception and linkage to HIV care among Thai university students. BMC Public Health 2016; 16:556. [PMID: 27405648 PMCID: PMC4942919 DOI: 10.1186/s12889-016-3274-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/05/2016] [Indexed: 11/24/2022] Open
Abstract
Background HIV testing and counseling (HTC) with linkage to care after known infection are key components for HIV transmission prevention. This study was conducted to assess HTC uptake, HIV risk perception and linkage to care among Thai university students. Methods An outreach HTC program was conducted in a large public university in Thailand from January 2013 to December 2014. The program consisted of brief HIV knowledge assessment, free HTC, HIV risk assessment and education provided by the healthcare personnel. Students were categorized into low, moderate and high-risk groups according to the pre-defined HIV risk characteristics. Results One-thousand-eight-hundred-one students participated in the program, 494 (27 %) underwent HTC. Independent characteristics associated with no HTC uptake included female sex (P < 0.001), lower HIV knowledge score (P < 0.001), younger age (P < 0.001) and students from non-health science faculties (P = 0.02). Among the 494 students undergoing HTC, 141 (29 %) were categorized into moderate or high-risk group, of whom 45/141 (32 %) had false perception of low HIV risk. Being heterosexual was independently associated with false perception of low HIV risk (P = 0.04). The rate of new HIV infection diagnosis was 4/494 (0.8 %). Of these 4 HIV-infected students, 3 (75 %) were men who have sex with men and only 2 of the 4 students (50 %) showed up for HIV continuity care. Conclusions An outreach HIV prevention program with HTC was feasible and beneficial in detecting HIV risk and infection among the university students. However, interventions to improve HTC uptake, HIV risk perception and linkage to care are needed.
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Affiliation(s)
- Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand. .,HIV/AIDS Care Unit of Thammasat Univesity Hospital, Pathumthani, Thailand.
| | - Krongtip Chunloy
- HIV/AIDS Care Unit of Thammasat Univesity Hospital, Pathumthani, Thailand
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.,HIV/AIDS Care Unit of Thammasat Univesity Hospital, Pathumthani, Thailand
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Enrollment in HIV Care Two Years after HIV Diagnosis in the Kingdom of Swaziland: An Evaluation of a National Program of New Linkage Procedures. PLoS One 2016; 11:e0150086. [PMID: 26910847 PMCID: PMC4766101 DOI: 10.1371/journal.pone.0150086] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/09/2016] [Indexed: 01/31/2023] Open
Abstract
To improve early enrollment in HIV care, the Swaziland Ministry of Health implemented new linkage procedures for persons HIV diagnosed during the Soka Uncobe male circumcision campaign (SOKA, 2011–2012) and the Swaziland HIV Incidence Measurement Survey (SHIMS, 2011). Abstraction of clinical records and telephone interviews of a retrospective cohort of HIV-diagnosed SOKA and SHIMS clients were conducted in 2013–2014 to evaluate compliance with new linkage procedures and enrollment in HIV care at 92 facilities throughout Swaziland. Of 1,105 clients evaluated, within 3, 12, and 24 months of diagnosis, an estimated 14.0%, 24.3%, and 37.0% enrolled in HIV care, respectively, after adjusting for lost to follow-up and non-response. Kaplan-Meier functions indicated lower enrollment probability among clients 14–24 (P = 0.0001) and 25–29 (P = 0.001) years of age compared with clients >35 years of age. At 69 facilities to which clients were referred for HIV care, compliance with new linkage procedures was low: referral forms were located for less than half (46.8%) of the clients, and few (9.6%) were recorded in the appointment register or called either before (0.3%) or after (4.9%) their appointment. Of over one thousand clients newly HIV diagnosed in Swaziland in 2011 and 2012, few received linkage services in accordance with national procedures and most had not enrolled in HIV care two years after their diagnosis. Our findings are a call to action to improve linkage services and early enrollment in HIV care in Swaziland.
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Lack of awareness of treatment failure among HIV-1-infected patients in Guinea-Bissau - a retrospective cohort study. J Int AIDS Soc 2015; 18:20243. [PMID: 26426197 PMCID: PMC4590343 DOI: 10.7448/ias.18.1.20243] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 08/14/2015] [Accepted: 08/25/2015] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION With more people receiving antiretroviral treatment (ART), the need to detect treatment failure and switch to second-line ART has also increased. We assessed CD4 cell counts (as a marker of treatment failure), determined the rate of switching to second-line treatment and evaluated mortality related to treatment failure among HIV-infected patients in Guinea-Bissau. METHODS In this retrospective cohort study, adult patients infected with HIV-1 receiving ≥6 months of ART at an HIV clinic in Bissau were included from June 2005 to July 2014 and followed until January 2015. Treatment failure was defined as 1) a fall in CD4 count to baseline (or below) or 2) CD4 levels persistently below 100 cells/µL after ≥6 months of ART. Cox hazard models, with time since six months of ART as the time-varying coefficient, were used to estimate the hazard ratio for death and loss to follow-up. RESULTS We assessed 1,591 HIV-1-infected patients for immunological treatment failure. Treatment failure could not be determined in 594 patients (37.3%) because of missing CD4 cell counts. Among the remaining 997 patients, 393 (39.4%) experienced failure. Only 39 patients (9.9%) with failure were switched from first- to second-line ART. The overall switching rate was 3.1 per 100 person-years. Mortality rate was higher in patients with than without treatment failure, with adjusted hazard rate ratios (HRRs) 10.0 (95% CI: 0.9-107.8), 7.6 (95% CI: 1.6-35.5) and 3.1 (95% CI: 1.5-6.3) in the first, second and following years, respectively. During the first year of follow-up, patients experiencing treatment failure had a higher risk of being lost to follow-up than patients not experiencing treatment failure (adjusted HRR 4.4; 95% CI: 1.7-11.8). CONCLUSIONS We found a high rate of treatment failure, an alarmingly high number of patients for whom treatment failure could not be assessed, and a low rate of switching to a second-line therapy. These factors could lead to an increased risk of resistance development and excess mortality.
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