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Lefrancois LH, Nguyen BT, Pham TTP, Le NTH, Dao HTT, Tran TH, Ngo KP, Tong HT, Phan HTT, Ait-Ahmed M, Pham TH, Nguyen TA, Taieb F, Madec Y. Assessment of HIV viral load monitoring in remote settings in Vietnam - comparing people who inject drugs to the other patients. PLoS One 2023; 18:e0281857. [PMID: 36802388 PMCID: PMC9942987 DOI: 10.1371/journal.pone.0281857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Increasing access to viral load (VL) monitoring is essential to fight HIV epidemics. In remote settings in Vietnam, using dried blood spot (DBS) sampling for specimen collection could improve the situation. Here, people who inject drugs (PWID) represent many newly antiretroviral therapy (ART)-initiated patients. The goals of this evaluation were to evaluate if access to VL monitoring and the rate of virological failure differed between PWID and non-PWID. METHODS Prospective cohort study of patients newly initiated on ART in remote settings in Vietnam. DBS coverage at 6, 12 and 24 months of ART was investigated. Factors associated with DBS coverage were identified through logistic regression, as were factors associated with virological failure (VL ≥1,000 copies/mL) at 6, 12 and 24 months of ART. RESULTS Overall 578 patients were enrolled in the cohort, of whom 261 (45%) were PWID. DBS coverage improved from 74.7% to 82.9% between 6 and 24 months of ART (p = 0.001). PWID status was not associated with DBS coverage (p = 0.74), but DBS coverage was lower in patients who were late to clinical visits and in those in WHO stage 4 (p = 0.023 and p = 0.001, respectively). The virological failure rate decreased from 15.8% to 6.6% between 6 and 24 months of ART (p<0.001). In multivariate analysis, PWID were more at risk of failure (p = 0.001), as were patients who were late to clinical visits (p<0.001) and not fully adherent (p<0.001). CONCLUSIONS Despite training and simple procedures, DBS coverage was not perfect. DBS coverage was not associated with PWID status. Close management is required for effective routine HIV VL monitoring. PWID were more at risk of failure, as were patients who were not fully adherent and patients who were late to clinical visits. Specific interventions targeting these patients are needed to improve their outcomes. Overall, efforts in coordination and communication are essential to improve global HIV care. TRIAL REGISTRATION Clinical Trial Number: NCT03249493.
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Affiliation(s)
- Louise H. Lefrancois
- Epidemiology of Emerging Diseases, Institut Pasteur, Université de Paris, Paris, France
| | - Binh Thanh Nguyen
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tram Thi Phuong Pham
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Nhung Thi Hong Le
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Huyen Thi Thanh Dao
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tram Hong Tran
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Khanh Phuong Ngo
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Ha Thi Tong
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Huong Thi Thu Phan
- Vietnam Administration of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Mohand Ait-Ahmed
- Center for Translational Research, Institut Pasteur, Université de Paris, Paris, France
| | - Thang Hong Pham
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
- HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Fabien Taieb
- Center for Translational Research, Institut Pasteur, Université de Paris, Paris, France
- Department of International Affairs, Institut Pasteur, Université de Paris, Paris, France
| | - Yoann Madec
- Epidemiology of Emerging Diseases, Institut Pasteur, Université de Paris, Paris, France
- * E-mail:
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Brown PCM, Thuy DTT, Edsall A, Hang NT, Mai PP, Hoffman K, Bart G, Korthuis PT, Giang LM. Familial support in integrated treatment with antiretroviral therapy and medications for opioid use disorder in Vietnam: A qualitative study. Subst Abus 2022; 43:1004-1010. [PMID: 35435799 PMCID: PMC9678077 DOI: 10.1080/08897077.2022.2060435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Patients report that familial support can facilitate initiation and maintenance of antiretroviral therapy (ART) and medications for opioid use disorder (MOUD). However, providing such support can create pressure and additional burdens for families of people with opioid use disorder (OUD) and HIV. We examined perspectives of people with HIV receiving treatment for OUD in Vietnam and their family members. Methods: Between 2015 and 2018, we conducted face-to-face qualitative interviews with 44 patients and 30 of their family members in Hanoi, Vietnam. Participants were people living with HIV and OUD enrolled in the BRAVO study comparing HIV clinic-based buprenorphine with referral to methadone treatment at 4 HIV clinics and their immediate family members (spouses or parents). Interviews were professionally transcribed, coded in Vietnamese, and analyzed using a semantic, inductive approach to qualitative thematic analysis. Results: Family members of people with OUD and HIV in Vietnam reported financially and emotionally supporting MOUD initiation and maintenance as well as actively participating in treatment. Family members described the burdens of supporting patients during opioid use, including financial costs and secondary stigma. Conclusions: Describing the role of family support in the lives of people living with OUD and HIV in the context of Vietnam enriches our understanding of their experiences and will support future treatment efforts targeting the family unit.
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Affiliation(s)
| | | | - Andrew Edsall
- Oregon Health & Science University School of Medicine
| | | | | | - Kim Hoffman
- Portland State University-Oregon Health & Science University School of Public Health, Portland, OR
| | - Gavin Bart
- University of Minnesota Medical School and Hennepin Healthcare
| | - P. Todd Korthuis
- Oregon Health & Science University School of Medicine,Portland State University-Oregon Health & Science University School of Public Health, Portland, OR
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Nguyen TT, Luong AN, Dao TDT, Nagot N, Laureillard D, Visier L, Le MG. What Shapes Late HIV Diagnosis in Vietnam? A Qualitative Investigation of Multilevel Factors. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:450-463. [PMID: 34596428 DOI: 10.1521/aeap.2021.33.5.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Late HIV treatment remains a global public health issue despite significant efforts. To better understand what shapes this issue, we interviewed 36 Vietnamese ART-naive patients who came to HIV treatment in 2017. Half of them had intake CD4 counts fewer than 100 cells/mm3, the others had intake CD4 counts of 350 cells/mm3 and above. Late diagnosis was the reason of late treatment in our sample. Most late presenters were not members of the key populations at increased risk of HIV (e.g., people who inject drugs, commercial sex workers, and men who have sex with men). Individual-level factors included low risk appraisal, habit of self-medication, and fear of stigma. Network and structural-level factors included challenges to access quality health care, normalization of HIV testing in key populations and inconsistent provider-initiated HIV testing practices. Structural interventions coupled with existing key population-targeted strategies would improve the issue of late HIV diagnosis.
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Affiliation(s)
- Thu Trang Nguyen
- Centre for Research and Training on Substance Abuse-HIV, Hanoi Medical University, Vietnam
| | - Anh Ngoc Luong
- Centre for Research and Training on Substance Abuse-HIV, Hanoi Medical University, Vietnam
| | - Thi Dieu Thuy Dao
- Centre for Research and Training on Substance Abuse-HIV, Hanoi Medical University, Vietnam
| | | | - Didier Laureillard
- Infectious Disease and Tropical Disease Department, University Hospital, Nîmes, France
| | | | - Minh Giang Le
- Centre for Research and Training on Substance Abuse-HIV, Hanoi Medical University, Vietnam
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Frequency and reasons for delayed treatment initiation after HIV diagnosis: cross-sectional study in Lahore, Pakistan. BMC Public Health 2021; 21:1000. [PMID: 34044793 PMCID: PMC8161554 DOI: 10.1186/s12889-021-11031-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/10/2021] [Indexed: 11/22/2022] Open
Abstract
Background Well-timed initiation of HIV therapy enhances life expectancy, decreases mortality and morbidity, and inhibits the transmission of HIV and complications related to it. The purpose of the present survey is to investigate the frequency and reasons for delayed initiation of anti-retroviral therapy (ART) and to determine its relationship with various socio-demographic variables and HIV-related characteristics. Methods The analysis is based on a cross-sectional study involving 355 people living with HIV (diagnosed by PCR) who were more than 18 years of age and not receiving HIV therapy before enrolment at the HIV clinics of two selected tertiary-care teaching hospitals in Lahore, Pakistan. In this study, delayed initiation of ART was defined as not attending the HIV management centre or a clinic for ART within 3 months of a confirmed diagnosis. The participants were selected using a systematic probability sampling technique. Bivariate logistic regression was performed using a backward stepwise technique to establish the variables related to delayed onset of HIV therapy. Factors significant at p ≤ 0.20 were considered for multivariate analysis, which was used to describe the association between independent factors and delayed initiation of treatment. Results Delayed onset of ART was observed in 28.5% of individuals. Factors such as no schooling (AOR = 5.92; 95% CI: 1.38–25.41; p = 0.017) and occasional household income (AOR = 3.88; 95% CI: 1.01–14.89; p = 0.048) were significantly associated with late onset of ART. Our research findings also indicated that the main reasons for late beginning of HIV therapy were: feeling healthy (45.5%), did not have time to go to the HIV treatment centre (42.6%), did not want to discuss HIV test result (37.6%), and fear of stigma and discrimination within their community (35.6%). Conclusions Late commencement of HIV therapy in Pakistan is common, and an improved connection is needed between identification of HIV and beginning of therapy. HIV management centres should counsel and monitor patients from the time of a positive HIV test result until they initiate therapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11031-0.
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Hoang NT, Nguyen NTT, Nguyen QN, Bollinger JW, Tran BX, Do NT, Nguyen THT, Nguyen HLT, Nguyen TH, Latkin CA, Ho CSH, Ho RCM. Survival Outcomes of Vietnamese People with HIV after Initiating Antiretroviral Treatment: Role of Clinic-Related Factors. AIDS Behav 2021; 25:1626-1635. [PMID: 33244641 DOI: 10.1007/s10461-020-03079-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 01/04/2023]
Abstract
Given the rapid development of HIV clinics in Vietnam, this study evaluates the infrastructure surrounding this expansion, identifying clinic-related factors that impact survival outcomes. A retrospective longitudinal study was conducted among people living with HIV (PLWH) who initiated antiretroviral therapy (ART) between 2011 and 2015 among 62 ART clinics in 15 provinces. The mortality rate during the 717674.1 person-years of observation (PYO) was 0.29/100 PYO. Location in rural areas (versus urban) and in Central Vietnam (versus Northern Vietnam) were associated with higher risk of mortality. The risk was lower among clinics that had peer-educators. As Vietnam's HIV/AIDS program continues to expand, this data supports increasing resource allocation for rural clinics, incorporation of ART with the community's existing healthcare infrastructure in its efforts to decentralize, and integration of services to reflect patients' anticipated needs.
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Affiliation(s)
| | | | - Quang Nhat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Université, Claude Bernard Lyon 1, Villeurbanne, France
| | | | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nhan Thi Do
- Vietnam Authority of HIV/AIDS Control, Hanoi, Vietnam
| | - Trang Huyen Thi Nguyen
- Center of Excellence in Pharmacoeconomics and Management, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Huong Lan Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
- Faculty of Nursing, Duy Tan University, Da Nang, Vietnam.
| | - Trang Ha Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Faculty of Nursing, Duy Tan University, Da Nang, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
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Chau LB, Hoa DM. Newly diagnosed HIV individuals: Barriers to timely entrance into care after adopting treat all policy. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1836724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Le Bao Chau
- Health Management Training Institute, Hanoi University of Public Health (HUPH), Hanoi, Vietnam
| | - Do Mai Hoa
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
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Fuspita Y, Yona S, Waluyo A. HIV testing of housewives with HIV in Lampung, Indonesia: A qualitative study. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Than PQT, Tran BX, Nguyen CT, Truong NT, Thai TPT, Latkin CA, Ho CSH, Ho RCM. Stigma against patients with HIV/AIDS in the rapid expansion of antiretroviral treatment in large drug injection-driven HIV epidemics of Vietnam. Harm Reduct J 2019; 16:6. [PMID: 30654814 PMCID: PMC6337792 DOI: 10.1186/s12954-019-0277-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 01/04/2019] [Indexed: 02/01/2023] Open
Abstract
Background Despite existing efforts to provide antiretroviral treatment (ART) for all HIV-diagnosed people, stigma deprives them of the highest attainable health status and challenges the effectiveness of ART program in Vietnam. This study aimed to assess five dimensions of HIV-related stigma and explore its associated factors among ART patients in a multisite survey. Implications of this study support the development of HIV policies to improve patients’ access, utilization, and outcomes of ART program toward the 90-90-90 goal in Vietnam. Methods A total of 1133 ART patients who were recruited by convenience sampling method from 8 ART clinics in Hanoi and Nam Dinh in a cross-sectional study from January to August 2013. Multivariate logistic regression was employed to identify factors associated with stigmatization. Results The majority of participants reported experiencing stigmatization due to shame (36.9%), blame/judge (21.6%), and discrimination (23.4%). Further, 91.5% of participants disclosed their HIV status with others. The likelihood of experiencing stigmatization did not only associate with the patients’ socioeconomic status (e.g., age, occupation, education) and HIV status disclosure, but also their health problems. Those with anxiety or depression and perceived lower quality of life were more likely to experience stigma. Conclusions To maximize the efficiency of the ART program, it is essential to develop interventions that reduce stigma involving individuals, families, and communities, and recognize and address complex health problems especially those patients showing depressive symptoms. Increasing quality of life of HIV-positive patients by providing vocational training, financial, family, and peer support will reduce the likelihood of experiencing stigma.
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Affiliation(s)
- Phung Quoc Tat Than
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam.
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam
| | - Nu Thi Truong
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Thao Phuong Thi Thai
- Department of General Planning and Department of Cardiology, Friendship Hospital, Hanoi, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Lancaster KE, Hoffman IF, Hanscom B, Ha TV, Dumchev K, Susami H, Rose S, Go VF, Reifeis SA, Mollan KR, Hudgens MG, Piwowar‐Manning EM, Richardson P, Dvoriak S, Djoerban Z, Kiriazova T, Zeziulin O, Djauzi S, Ahn CV, Latkin C, Metzger D, Burns DN, Sugarman J, Strathdee SA, Eshleman SH, Clarke W, Donnell D, Emel L, Sunner LE, McKinstry L, Sista N, Hamilton EL, Lucas JP, Duong BD, Van Vuong N, Sarasvita R, Miller WC. Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis. J Int AIDS Soc 2018; 21:e25195. [PMID: 30350406 PMCID: PMC6198168 DOI: 10.1002/jia2.25195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/26/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION People who inject drugs (PWID) experience high HIV incidence and face significant barriers to engagement in HIV care and substance use treatment. Strategies for HIV treatment as prevention and substance use treatment present unique challenges in PWID that may vary regionally. Understanding differences in the risk structure for HIV transmission and disease progression among PWID is essential in developing and effectively targeting intervention strategies of HIV treatment as prevention. METHODS We present a baseline analysis of HIV Prevention Trials Network (HPTN) 074, a two-arm, randomized controlled trial among PWID in Indonesia (n = 258), Ukraine (n = 457) and Vietnam (n = 439). HPTN 074 was designed to determine the feasibility, barriers and uptake of an integrated intervention combining health systems navigation and psychosocial counselling for the early engagement of antiretroviral therapy (ART) and substance use treatment for PWID living with HIV. Discordant PWID networks were enrolled, consisting of an HIV-positive index and their HIV-negative network injection partner(s). Among the enrolled cohort of 1154 participants (502 index participants and 652 network partners), we examine regional differences in the baseline risk structure, including sociodemographics, HIV and substance use treatment history, and injection and sexual risk behaviours. RESULTS The majority of participants were male (87%), with 82% of the enrolled females coming from Ukraine. The overall mean age was 34 (IQR: 30, 38). Most commonly injected substances included illegally manufactured methadone in Ukraine (84.2%), and heroin in Indonesia (81.8%) and Vietnam (99.5%). Injection network sizes varied by region: median number of people with whom participants self-reported injecting drugs was 3 (IQR: 2, 5) in Indonesia, 5 (IQR: 3, 10) in Ukraine and 3 (IQR: 2, 4) in Vietnam. Hazardous alcohol use, assessed using the Alcohol Use Disorders Identification Test - Alcohol Consumption Questions (AUDIT-C), was prominent in Ukraine (54.7%) and Vietnam (26.4%). Reported sexual risk behaviours in the past month, including having two or more sex partners and giving/receiving money or drugs in exchange for sex, were uncommon among all participants and regions. CONCLUSIONS While regional differences in risk structure exist, PWID particularly in Ukraine need immediate attention for risk reduction strategies. Substantial regional differences in risk structure will require flexible, tailored treatment as prevention interventions for distinct PWID populations.
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Affiliation(s)
- Kathryn E Lancaster
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
| | - Irving F Hoffman
- Division of Infectious DiseasesSchool of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Tran Viet Ha
- Department of Health BehaviorGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Hepa Susami
- University of Indonesia/Cipto Mangunkusumo HospitalJakartaIndonesia
| | | | - Vivian F Go
- Department of Health BehaviorGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Sarah A Reifeis
- Department of BiostatisticsGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
- Center for AIDS Research (CFAR)School of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Katie R Mollan
- Center for AIDS Research (CFAR)School of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Michael G Hudgens
- Department of BiostatisticsGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
- Center for AIDS Research (CFAR)School of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | | | | | - Sergii Dvoriak
- Ukrainian Institute on Public Health PolicyKyivUkraine
- Academy of Labor, Social Relations and TourismKyivUkraine
| | - Zubairi Djoerban
- University of Indonesia/Cipto Mangunkusumo HospitalJakartaIndonesia
| | | | | | | | | | - Carl Latkin
- Department of Health, Behavior, and SocietyJohns Hopkins UniversityBaltimoreMDUSA
| | - David Metzger
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - David N Burns
- Division of AIDSNational Institute of Allergy and Infectious DiseasesU.S. National Institutes of HealthBethesdaMDUSA
| | - Jeremy Sugarman
- Department of MedicineBerman Institute of BioethicsJohns Hopkins UniversityBaltimoreMDUSA
| | - Steffanie A Strathdee
- Department of MedicineSchool of MedicineUniversity of California San DiegoSan DiegoCAUSA
| | | | - William Clarke
- School of MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | | | | | | | | | | | | | | | - Bui D Duong
- Vietnam Authority of HIV/AIDS Control ‐ Ministry of HealthHanoiVietnam
| | | | | | - William C Miller
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
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Kawuma R, Seeley J, Mupambireyi Z, Cowan F, Bernays S. "Treatment is not yet necessary": delays in seeking access to HIV treatment in Uganda and Zimbabwe. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 17:217-225. [PMID: 30132397 DOI: 10.2989/16085906.2018.1490785] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We examined the logic that individuals use to account for delaying HIV testing and/or initiating HIV treatment. Our qualitative study, situated within the REALITY trial (Reduction of EArly mortaLITY in HIV infected adults and children starting antiretroviral therapy), was conducted in Uganda and Zimbabwe in 2015. Forty-eight participants (different age groups, sex and viral load/WHO disease stage) were included. Each participant had 2 interviews (1 after 4 weeks of participation in the trial the other after 12 weeks). If a person could manage presenting symptoms, they felt they had "more time" before starting antiretroviral therapy (ART). Their reluctance to have an HIV test (despite deteriorating health) arose from a belief that they were not "sick", that treatment was "not yet necessary". People in our study did not consider themselves as presenting "late", and treatment was not considered urgent as long as they considered their health to be "good enough".
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Affiliation(s)
- Rachel Kawuma
- a Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI and LSHTM) , Uganda Research Unit , Entebbe , Uganda
| | - Janet Seeley
- a Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI and LSHTM) , Uganda Research Unit , Entebbe , Uganda.,b Global Health and Development Department , London School of Hygiene and Tropical Medicine , London , UK
| | - Zivai Mupambireyi
- c Centre for Sexual Health and HIV/AIDS Research , Harare , Zimbabwe
| | - Frances Cowan
- d International Public Health Department , Liverpool School of Tropical Medicine , Liverpool , UK.,e Centre for Sexual Health and HIV/AIDS Research , Harare , Zimbabwe
| | - Sarah Bernays
- f School of Public Health , University of Sydney , Sydney , Australia
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- a Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI and LSHTM) , Uganda Research Unit , Entebbe , Uganda
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Assessing Timely Presentation to Care Among People Diagnosed with HIV During Hospital Admission: A Population-Based Study in Ontario, Canada. AIDS Behav 2018. [PMID: 29536283 DOI: 10.1007/s10461-018-2063-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Timely presentation to care for people newly diagnosed with HIV is critical to optimize health outcomes and reduce onward HIV transmission. Studies describing presentation to care following diagnosis during a hospital admission are lacking. We sought to assess the timeliness of presentation to care and to identify factors associated with delayed presentation. We conducted a population-level study using health administrative databases. Participants were all individuals older than 16 and newly diagnosed with HIV during hospital admission in Ontario, Canada, between April 1, 2007 and March 31, 2015. We used modified Poisson regression models to derive relative risk ratios for the association between sociodemographic and clinical variables and the presentation to out-patient HIV care by 90 days following hospital discharge. Among 372 patients who received a primary HIV diagnosis in hospital, 83.6% presented to care by 90 days. Following multivariable analysis, we did not find associations between patient sociodemographic or clinical characteristics and presentation to care by 90 days. In a secondary analysis of 483 patients diagnosed during hospitalization but for whom HIV was not recorded as the principal reason for admission, 73.1% presented to care by 90 days. Following multivariable adjustment, we found immigrants from countries with generalized HIV epidemics (RR 1.265, 95% CI 1.133-1.413) were more likely to present to care, whereas timely presentation was less likely for people with a mental health diagnosis (RR 0.817, 95% CI 0.742-0.898) and women (RR 0.748, 95% CI 0.559-1.001). Future work should evaluate mechanisms to facilitate presentation to care among these populations.
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Symptoms of Depression in People Living with HIV in Ho Chi Minh City, Vietnam: Prevalence and Associated Factors. AIDS Behav 2018; 22:76-84. [PMID: 29079945 DOI: 10.1007/s10461-017-1946-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This cross-sectional study investigated the prevalence and correlates of symptoms of depression among 400 people living with HIV/AIDS (PLHIV) from two HIV clinics in Ho Chi Minh City, Vietnam. Based on the Center for Epidemiologic Studies-Depression scale, 36.5% of participants were classified as likely to be clinically depressed. Factors independently associated with symptoms of depression included self-report of poor or fair health (aOR 2.16, 95% CI 1.33-3.51), having a low body mass index (aOR 1.85, 95% CI 1.13-3.04), reporting recent problems with family (aOR 1.97, 95% CI 1.21-3.19), feeling shame about being HIV-infected (aOR 1.90, 95% CI 1.20-3.00), and reporting conflict with a partner (aOR 2.21, 95% CI 1.14-4.26). Participants who lived with family (aOR 0.48, 95% CI 0.25-0.90) or who received emotional support from their families or supportive HIV networks (aOR 0.45, 95% CI 0.25-0.80) were less likely to experience symptoms of depression. Screening for and treatment of depression among Vietnamese PLHIV are needed.
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Gesesew HA, Ward P, Woldemichael K, Mwanri L. Late presentation for HIV care in Southwest Ethiopia in 2003-2015: prevalence, trend, outcomes and risk factors. BMC Infect Dis 2018; 18:59. [PMID: 29378523 PMCID: PMC5789710 DOI: 10.1186/s12879-018-2971-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 01/19/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Early presentation for HIV care is vital as an initial tread in the UNAIDS 90-90-90 targets. However, late presentation for HIV care (LP) challenges achieving the targets. This study assessed the prevalence, trends, outcomes and risk factorsfor LP. METHODS A 12 year retrospective cohort study was conducted using electronic medical records extracted from an antiretroviral therapy (ART) clinic at Jimma University Teaching Hospital. LP for children refers to moderate or severe immune-suppression, or WHO clinical stage 3 or 4 at the time of first presentation to the ART clinics. LP for adults refers to CD4 lymphocyte count of < 200 cells/ μl and < 350 cells/μl irrespective of clinical staging, or WHO clinical stage 3 or 4 irrespective of CD4 count at the time of first presentation to the ART clinics. Binary logistic regression was used to identify factors that were associated with LP, and missing data were handled using multiple imputations. RESULTS Three hundred ninety-nine children and 4900 adults were enrolled in ART care between 2003 and 15. The prevalence of LP was 57% in children and 66.7% in adults with an overall prevalence of 65.5%, and the 10-year analysis of LP showed upward trends. 57% of dead children, 32% of discontinued children, and 97% of children with immunological failure were late presenters for HIV care. Similarly, 65% of dead adults, 65% of discontinued adults, and 79% of adults with immunological failure presented late for the care. Age between 25- < 50 years (AOR = 0.4,95% CI:0.3-0.6) and 50+ years (AOR = 0.4,95% CI:0.2-0.6), being female (AOR = 1.2, 95% CI: 1.03-1.5), having Tb/HIV co-infection (AOR = 1.6, 95% CI: 1.09-2.1), having no previous history of HIV testing (AOR = 1.2, 95% CI: 1.1-1.4), and HIV care enrollment period in 2012 and after (AOR = 0.8, 95% CI: 0.7-0.9) were the factors associated with LP for Adults. For children, none of the factors were associated with LP. CONCLUSIONS The prevalence of LP was high in both adults and children. The majority of both children and adults who presented late for HIV care had died and developed immunological failure. Effective programs should be designed and implemented to tackle the gap in timely HIV care engagement.
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Affiliation(s)
- Hailay Abrha Gesesew
- Public Health, Flinders University, Adelaide, Australia. .,Epidemiology, Jimma University, Jimma, Ethiopia.
| | - Paul Ward
- Public Health, Flinders University, Adelaide, Australia
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Chau LB, Hoa DM, Hoang NM, Anh ND, Nuong NT. Linkage between HIV diagnosis and care: Understanding the role of gender in a Northern Province in Vietnam. Health Care Women Int 2017; 39:429-441. [PMID: 29068776 DOI: 10.1080/07399332.2017.1390752] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Early linkage to HIV care is associated significantly with improved patient outcomes and reduced the risk of HIV transmission. However, delays between HIV diagnosis and registering for care have prevailed in Vietnam. The aim of researchers in this study is to examine linkages to care for individuals newly diagnosed with HIV in 2014, especially to highlight the impact of gender upon these linkages in a Northern Province of Ninh Binh. We collected secondary data of all 125 eligible HIV positive people diagnosed in 2014 and conducted a gender-based descriptive analysis of their registration to care within 6 months. Nineteen in-depth interviews and two focus group discussions were completed. We found that women accounted for one-third of newly diagnosed cases (42/125), but initiated HIV treatment at an earlier stage of HIV disease than men (65% women at stage 1, 2 versus 31% in men). Stigma and discrimination was greater among women while inadequate awareness of treatment was greater for men. Dissatisfaction with HIV testing and counseling and no or passive referral to treatment were other barriers for both the genders for enrolling in care services after diagnosis.
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Affiliation(s)
- Le Bao Chau
- a Health Management Training Institute, Hanoi University of Public Health , Hanoi , Vietnam
| | - Do Mai Hoa
- a Health Management Training Institute, Hanoi University of Public Health , Hanoi , Vietnam
| | - Nguyen Minh Hoang
- a Health Management Training Institute, Hanoi University of Public Health , Hanoi , Vietnam
| | - Nguyen Duy Anh
- b Hanoi Obstetric and Gynecology Hospital , Hanoi , Vietnam
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15
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Kulkarni S, Tymejczyk O, Gadisa T, Lahuerta M, Remien RH, Melaku Z, El-Sadr W, Elul B, Nash D, Hoffman S. "Testing, Testing": Multiple HIV-Positive Tests among Patients Initiating Antiretroviral Therapy in Ethiopia. J Int Assoc Provid AIDS Care 2017; 16:546-554. [PMID: 29117777 DOI: 10.1177/2325957417737840] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Repeat HIV testing after receiving a positive result has never been studied systematically and may give insight into reasons for delayed linkage to care. Among 831 adults in 6 secondary facilities in Oromia, Ethiopia, who completed an interviewer-administered structured questionnaire within 2 weeks of initiating antiretroviral therapy in 2012 to 2013, 110 (13.2%) reported having retested after an HIV-positive result. The odds of repeat (versus single) HIV-positive testing were higher among those who had doubted their HIV status (adjusted odds ratio [AOR]ref=nodoubt = 6.5; 95% confidence interval [CI]: 3.7-11.4) and those who initially tested at another facility, whether another secondary facility (AOR ref=studyfacility = 22.7; 95% CI: 11.0-46.9) or a lower-level facility (AORref=studyfacility = 19.1; 95% CI: 10.5-34.5). The odds of repeat (versus single) HIV-positive testing were lower among those who initially tested because of symptoms (AORref=not a reason = 0.40; 95% CI: 0.24-0.66). Median time between initial diagnosis and enrollment in care was 12.3 versus 1.0 month for repeat and single HIV-positive testers, respectively ( P < .001). Repeat HIV-positive testing-not a rare occurrence-appears to stem from doubt, seeking care at a facility other than where diagnosed, and testing for a reason other than having symptoms. Because repeat HIV-positive testing is associated with delay in linkage to care, providers should be aware of this potential when counseling those who test HIV positive.
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Affiliation(s)
- Sarah Kulkarni
- 1 CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.,2 CUNY Institute of Implementation Science in Population Health, New York, NY, USA
| | - Olga Tymejczyk
- 1 CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.,2 CUNY Institute of Implementation Science in Population Health, New York, NY, USA
| | - Tsigereda Gadisa
- 3 ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Maria Lahuerta
- 3 ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Robert H Remien
- 4 HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Zenebe Melaku
- 3 ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Wafaa El-Sadr
- 3 ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA.,5 Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Batya Elul
- 3 ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA.,5 Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Denis Nash
- 1 CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.,2 CUNY Institute of Implementation Science in Population Health, New York, NY, USA.,4 HIV Center for Clinical and Behavioral Studies, New York, NY, USA.,5 Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Susie Hoffman
- 4 HIV Center for Clinical and Behavioral Studies, New York, NY, USA.,5 Mailman School of Public Health, Columbia University, New York, NY, USA
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The impact of HCV therapy in a high HIV-HCV prevalence population: A modeling study on people who inject drugs in Ho Chi Minh City, Vietnam. PLoS One 2017; 12:e0177195. [PMID: 28493917 PMCID: PMC5426709 DOI: 10.1371/journal.pone.0177195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/23/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) coinfection is a major global health problem especially among people who inject drugs (PWID), with significant clinical implications. Mathematical models have been used to great effect to shape HIV care, but few have been proposed for HIV/HCV. METHODS We constructed a deterministic compartmental ODE model that incorporated layers for HIV disease progression, HCV disease progression and PWID demography. Antiretroviral therapy (ART) and Methadone Maintenance Therapy (MMT) scale-ups were modeled as from 2016 and projected forward 10 years. HCV treatment roll-out was modeled beginning in 2026, after a variety of MMT scale-up scenarios, and projected forward 10 years. RESULTS Our results indicate that scale-up of ART has a major impact on HIV though not on HCV burden. MMT scale-up has an impact on incidence of both infections. HCV treatment roll-out has a measurable impact on reductions of deaths, increasing multifold the mortality reductions afforded by just ART/MMT scale-ups. CONCLUSION HCV treatment roll-out can have major and long-lasting effects on averting PWID deaths on top of those averted by ART/MMT scale-up. Efficient intervention scale-up of HCV alongside HIV interventions is critical in Vietnam.
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Pollack TM, Duong HT, Pham TT, Do CD, Colby D. Cigarette smoking is associated with high HIV viral load among adults presenting for antiretroviral therapy in Vietnam. PLoS One 2017; 12:e0173534. [PMID: 28267790 PMCID: PMC5340371 DOI: 10.1371/journal.pone.0173534] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/21/2017] [Indexed: 11/18/2022] Open
Abstract
High HIV viral load (VL >100,000 cp/ml) is associated with increased HIV transmission risk, faster progression to AIDS, and reduced response to some antiretroviral regimens. To better understand factors associated with high VL, we examined characteristics of patients presenting for treatment in Hanoi, Vietnam. We examined baseline data from the Viral Load Monitoring in Vietnam Study, a randomized controlled trial of routine VL monitoring in a population starting antiretroviral therapy (ART) at a clinic in Hanoi. Patients with prior treatment failure or ART resistance were excluded. Characteristics examined included demographics, clinical and laboratory data, and substance use. Logistic regression was used to calculate crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Out of 636 patients, 62.7% were male, 72.9% were ≥30 years old, and 28.3% had a history of drug injection. Median CD4 was 132 cells/mm3, and 34.9% were clinical stage IV. Active cigarette smoking was reported by 36.3% with 14.0% smoking >10 cigarettes per day. Alcohol consumption was reported by 20.1% with 6.1% having ≥5 drinks per event. Overall 53.0% had a VL >100,000 cp/ml. Male gender, low body weight, low CD4 count, prior TB, and cigarette smoking were associated with high VL. Those who smoked 1–10 cigarettes per day were more likely to have high VL (aOR = 1.99, 95% CI = 1.15–3.45), while the smaller number of patients who smoked >10 cigarettes per day had a non-significant trend toward higher VL (aOR = 1.41, 95% CI = 0.75–2.66). Alcohol consumption was not significantly associated with high VL. Tobacco use is increasingly recognized as a contributor to premature morbidity and mortality among HIV-infected patients. In our study, cigarette smoking in the last 30 days was associated with a 1.5 to 2-fold higher odds of having an HIV VL >100,000 cp/ml among patients presenting for ART. These findings provide further evidence of the negative effects of tobacco use among HIV-infected patients.
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Affiliation(s)
- Todd M. Pollack
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
- Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Hao T. Duong
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
| | - Thuy T. Pham
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
- Department of Infectious Diseases, Bach Mai hospital (BMH), Hanoi, Vietnam
| | - Cuong D. Do
- Department of Infectious Diseases, Bach Mai hospital (BMH), Hanoi, Vietnam
| | - Donn Colby
- Center for Applied Research on Men and Community Health (CARMAH), HCMC, Vietnam
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
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Utami S, Sawitri AAS, Wulandari LPL, Artawan Eka Putra IWG, Astuti PAS, Wirawan DN, Causer L, Mathers B. Mortality among people living with HIV on antiretroviral treatment in Bali, Indonesia: incidence and predictors. Int J STD AIDS 2017; 28:1199-1207. [PMID: 28201952 DOI: 10.1177/0956462417692942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Indonesia has the third highest number of people living with HIV/AIDS (PLWH) and the greatest increase in proportion of AIDS-related mortality in the Asia Pacific region between 2005 and 2013. Longitudinal mortality data among PLWH in Indonesia are limited. We conducted a retrospective cohort study from medical records of antiretroviral treatment (ART) recipients attending Badung General Hospital (BGH) and Bali Medica Clinic (BMC) between 2006 and 2014. We explored incidence of mortality by Kaplan-Meier analysis and identified predictors using a Cox proportional hazard model. In total, 575 patients were included in the analysis; the majority were male. The overall mortality rate was 10% per year. Multivariate analysis suggested that being male (adjusted hazard ratio [aHR]: 2.74; 95% confidence interval [CI]: 1.34-5.59), having a lower education (aHR: 2.17; 95%CI: 1.31-3.61), having heterosexual (aHR: 7.40; 95% CI: 2.61-21.00) or injecting drug use (aHR: 13.20; 95% CI: 3.17-55.00) as the likely transmission risk category, starting treatment with low CD4 cell counts (aHR: 3.18; 95% CI: 1.16-8.69), and not having a treatment supervisor (aHR: 4.02; 95% CI: 2.44-6.65) were independent predictors of mortality. The mortality was high, particularly in the first three months after initiating ART. These findings highlight the need to encourage HIV testing and early diagnosis and prompt treatment. Applying aspects of BMCs targeted HIV services model in more generalised services such as BGH may be beneficial. Providing adherence support as part of ART services is key to promoting adherence to ART.
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Affiliation(s)
- Sri Utami
- 1 Post Graduate Program in Public Health, Faculty of Medicine, Udayana University, Bali, Indonesia
| | | | | | | | | | - Dewa Nyoman Wirawan
- 2 Community and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Louise Causer
- 4 Faculty of Medicine, Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Bradley Mathers
- 4 Faculty of Medicine, Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
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Zelaya CE, Le Minh N, Lau B, Latkin CA, Viet Ha T, Minh Quan V, Mo TT, Sripaipan T, Davis WW, Celentano DD, Frangakis C, Go VF. The Effect of a Multi-Level Intervention on the Initiation of Antiretroviral Therapy (ART) among HIV-Infected Men Who Inject Drugs and Were Diagnosed Late in Thai Nguyen, Vietnam. PLoS One 2016; 11:e0161718. [PMID: 27579772 PMCID: PMC5007027 DOI: 10.1371/journal.pone.0161718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/09/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Vietnam, an estimated 256,000 people are living with HIV, and 58% of HIV-infections reported are among people who inject drugs (PWID). While antiretroviral therapy (ART) is widely available in Vietnam, marginalized hard-to-reach male PWID, demonstrate significantly reduced and delayed access to ART. METHODS We investigated the effect of a randomized four-arm multi-level intervention trial on ART initiation among male PWID. Our analysis was conducted among a subset of trial participants (n = 136), who were newly diagnosed as HIV-infected, treatment naïve, and eligible for ART (baseline late diagnosis). The trial arms included: 1, standard of care (HIV testing and counseling); 2, structural-level intervention (door-to-door communications and community video screenings); 3, individual-level intervention (counseling plus group support); and 4, individual-level plus structural-level intervention. In a time-to-event analysis, we used a non-parametric approach for competing risks to estimate cumulative incidence function (CIF) for ART initiation (event of interest) by arm and the difference in CIF for each trial arm as compared to Arm 1. Follow-up was conducted at 6, 12, 18 and 24 months. Data collection occurred from 2009 to 2013. FINDINGS By 24-months, 61.0% initiated ART, and 30.9% had died prior to ART initiation. In the first 6 months, participants in arm 4 (individual plus community intervention) had a 28% (95% confidence interval (CI): 6-50%) increased probability of initiating ART. Despite increasing coverage of ART in all arms throughout follow-up, participants in arm 4 retained a 31% (95% CI: 5-56%) increased probability of initiating ART. The individual and community components of the intervention were only effective when delivered together. CONCLUSIONS Marginalized, hard-to-reach men, who do not routinely engage in HIV services, and therefore come into care late, may benefit significantly from both individual counseling and group support, in combination with community-focused stigma reduction, when being referred and attempting to initiate urgently needed ART.
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Affiliation(s)
- Carla E. Zelaya
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, Maryland 21205, United States of America
- * E-mail:
| | - Nguyen Le Minh
- Centre for Preventive Medicine of Thai Nguyen, 971 Duong Tu Minh Road, Thai Nguyen City, Vietnam
| | - Bryan Lau
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, Maryland 21205, United States of America
| | - Carl A. Latkin
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, 624 N. Broadway, Hampton House 737, Baltimore, Maryland 21205, United States of America
| | - Tran Viet Ha
- University of North Carolina, No 6, Lane 76, Linh Lang Street, Hanoi, Vietnam
| | - Vu Minh Quan
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, Maryland 21205, United States of America
| | - Thi Tran Mo
- University of North Carolina, No 6, Lane 76, Linh Lang Street, Hanoi, Vietnam
| | - Teerada Sripaipan
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 361 Rosenau Hall, Campus Box 7440, Chapel Hill, NC 27599, United States of America
| | - Wendy W. Davis
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, Maryland 21205, United States of America
| | - David D. Celentano
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, Maryland 21205, United States of America
| | - Constantine Frangakis
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, 615 N. Wolfe Street, Room E3642, Baltimore, Maryland 21205, United States of America
| | - Vivian F. Go
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 361 Rosenau Hall, Campus Box 7440, Chapel Hill, NC 27599, United States of America
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Colasanti J, Goswami ND, Khoubian JJ, Pennisi E, Root C, Ziemer D, Armstrong WS, del Rio C. The Perilous Road from HIV Diagnosis in the Hospital to Viral Suppression in the Outpatient Clinic. AIDS Res Hum Retroviruses 2016; 32:729-36. [PMID: 27005488 DOI: 10.1089/aid.2015.0346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The HIV care continuum has received considerable attention in recent years, however, few care continua focus on the population of patients who are diagnosed during an inpatient hospital admission. We aimed to describe the HIV care continuum for patients newly diagnosed during hospitalization through 24-month follow-up. A retrospective chart review of HIV patients diagnosed at Grady Memorial Hospital from 2011 to 2012 was performed and records were matched to Georgia Department of Public Health HIV/AIDS surveillance data. Descriptive statistics and statistical tests of independence were utilized. Ninety-four new diagnoses were confirmed during the 2-year study period. Median age was 43 years (interquartile range [IQR] 30-51), 77% were male, 72% were non-Hispanic Black, 31% were men who have sex with men (MSM), and 77% were uninsured. Median CD4 count at diagnosis was 134 cells/μL (IQR 30-307). Eighty-four percent received their diagnosis before hospital discharge, 68% linked to care by 90 days, 73% were retained for 12 months, 48% were virologically suppressed by 12 months, 58% were retained for 24 continuous months, and 38% achieved continuous viral suppression (VS) during the initial 24 months after diagnosis. Late diagnosis is a persistent problem in hospitalized patients. Despite relative success with linkage to care and 12-month retention in care, a minority of patients maintained retention and VS for 24 continuous months.
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Affiliation(s)
- Jonathan Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia
| | - Neela D. Goswami
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Eugene Pennisi
- HIV/AIDS Epidemiology Section, Georgia Department of Public Health, Atlanta, Georgia
| | - Christin Root
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dorothy Ziemer
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia
- Department of Social Work, Grady Health System, Atlanta, Georgia
| | - Wendy S. Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia
- Center for AIDS Research, Emory University, Atlanta, Georgia
| | - Carlos del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Center for AIDS Research, Emory University, Atlanta, Georgia
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Rangarajan S, Colby DJ, Giang LT, Bui DD, Hung Nguyen H, Tou PB, Danh TT, Tran NBC, Nguyen DA, Hoang Nguyen BT, Doan VTN, Nguyen NQ, Pham VP, Dao DG, Chen M, Zeng Y, Van Tieu TT, Tran MH, Le TH, Hoang XC, West G. Factors associated with HIV viral load suppression on antiretroviral therapy in Vietnam. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)30466-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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22
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Rangarajan S, Colby DJ, Giang LT, Bui DD, Hung Nguyen H, Tou PB, Danh TT, Tran NBC, Nguyen DA, Hoang Nguyen BT, Doan VTN, Nguyen NQ, Pham VP, Dao DG, Chen M, Zeng Y, Tieu TTV, Tran MH, Le TH, Hoang XC, West G. Factors associated with HIV viral load suppression on antiretroviral therapy in Vietnam. J Virus Erad 2016; 2:94-101. [PMID: 27482442 PMCID: PMC4965252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Limited data are available on HIV viral suppression rates among men and women on antiretroviral therapy (ART) and factors associated with HIV RNA viral load (VL) suppression in Vietnam. METHODS We conducted a cross-sectional survey of 1255 adult patients on ART for at least 1 year across four provinces in Vietnam. Data collection included a standardised questionnaire, routine laboratory testing, and an HIV VL assay. Bivariate and logistic multivariate analyses were conducted to assess viral suppression rates and factors associated with unsuppressed HIV VL. RESULTS The median age was 34.5 years and the median time on ART was 46 months. Gender was 66% male (n=828) and 34% female (n=427). HIV viral suppression below 1000 copies/mL was 93%. Viral suppression among woman was not significantly different than among men (93.7% vs 92.9%; P=0.59). On multivariate analysis, unsuppressed HIV VL was independently associated with lower CD4 cell count, social isolation, high stigma, not receiving a single-tablet daily regimen, multiple late appointments in past year, and immunological failure. CONCLUSION On-treatment viral load suppression rates in Vietnam are high and already exceed the UNAIDS 90% target for viral suppression on ART. Gender does not impact viral suppression rates of patients on ART in Vietnam. Access to routine viral load testing should be improved, adherence monitoring and counselling streamlined, and ART regimens simplified to maintain viral suppression rates, as more people start ART. Psychological and social factors are also associated with unsuppressed HIV VL, necessitating treatment support interventions to address social isolation and stigma among people living with HIV in Vietnam.
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Affiliation(s)
| | - Donn J Colby
- SEARCH, Thai Red Cross AIDS Research Center,
Bangkok,
Thailand
- Center for Applied Research on Men and Health,
Ho Chi Minh City,
Vietnam
| | - Le Truong Giang
- Ho Chi Minh City Provincial AIDS Committee,
Ho Chi Minh City,
Vietnam
| | - Duc Duong Bui
- Vietnam Administration for AIDS Control,
Hanoi,
Vietnam
| | - Huu Hung Nguyen
- Ho Chi Minh City Provincial AIDS Committee,
Ho Chi Minh City,
Vietnam
| | | | | | | | | | | | | | | | | | | | | | | | - Thi Thu Van Tieu
- Ho Chi Minh City Provincial AIDS Committee,
Ho Chi Minh City,
Vietnam
| | - My Hanh Tran
- An Giang Provincial AIDS Center,
Long Xuyen,
An Giang,
Vietnam
| | - Thi Hoa Le
- Quang Ninh Provincial AIDS Center,
Ha Long,
Vietnam
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23
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Factors associated with HIV RNA viral loads in ART-naïve patients: implications for treatment as prevention in concentrated epidemics. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)30689-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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24
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Factors associated with HIV RNA viral loads in ART-naïve patients: implications for treatment as prevention in concentrated epidemics. J Virus Erad 2016; 2:36-42. [PMID: 27482434 PMCID: PMC4946694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Limited data are available on factors associated with HIV-RNA viral load (VL) among antiretroviral treatment (ART)-naïve key populations in concentrated epidemics. METHODS We conducted a cross-sectional survey of 1211 adult ART-naïve patients at 19 HIV clinics in Ho Chi Minh City (HCMC), Vietnam. Data collection included a standardised questionnaire, routine laboratory testing, hepatitis serology and HIV VL. Correlation between CD4 cell count and VL was assessed across all participants. In 904 participants not meeting Vietnam criteria for ART (CD4 cell count >350 cells/mm(3), WHO clinical stage 1 or 2 and not pregnant), multivariate analyses were conducted to assess factors associated with HIV VL. RESULTS Pre-ART patients had a median age of 31 years and 54% were male. Median CD4 cell count was 533 cells/mm(3). Median HIV VL was 17,378 copies/mL; 60% had VL greater than 10,000 copies/mL and 16% had VL above 100,000 copies/mL. Although declining CD4 cell count was correlated with rising VL across all CD4 cell counts, correlation of VL with CD4 cell counts between 351 and 500 cell/mm(3) was not significant. On multivariate linear regression, higher HIV VL was independently associated with male sex, men who have sex with men (MSM), CD4 cell count 351-500, HIV diagnosis within the previous 6 months, and hepatitis B (HBV). Lower HIV VL was independently associated with hepatitis C (HCV). CONCLUSIONS The majority of HIV patients who were not eligible for ART in HCMC in 2014 had HIV VL greater than 10,000 copies/mL. These data support expanded eligibility of ART to all HIV patients with the goal of treatment as prevention. This study is also among the first to demonstrate that MSM had a higher VL than women and heterosexual men and highlights the need for improved outreach and linkages to HIV care for this high-risk group.
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Compulsory drug detention centers in East and Southeast Asia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26 Suppl 1:S33-7. [PMID: 25727259 DOI: 10.1016/j.drugpo.2014.11.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/15/2014] [Accepted: 11/17/2014] [Indexed: 11/20/2022]
Abstract
Over the last three decades in response to a rise in substance use in the region, many countries in East and Southeast Asia responded by establishing laws and policies that allowed for compulsory detention in the name of treatment for people who use drugs. These centers have recently come under international scrutiny with a call for their closure in a Joint Statement from United Nations entities in March 2012. The UN's response was a result of concern for human rights violations, including the lack of consent for treatment and due process protections for compulsory detention, the lack of general healthcare and evidence based drug dependency treatment and in some centers, of forced labor and physical and sexual abuse (United Nations, 2012). A few countries have responded to this call with evidence of an evolving response for community-based voluntary treatment; however progress is likely going to be hampered by existing laws and policies, the lack of skilled human resource and infrastructure to rapidly establish evidence based community treatment centers in place of these detention centers, pervasive stigmatization of people who use drugs and the ongoing tensions between the abstinence-based model of treatment as compared to harm reduction approaches in many of these affected countries.
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Yang Y, Wojnar D, Lewis FM. Becoming a person with HIV: experiences of Cambodian women infected by their spouses. CULTURE, HEALTH & SEXUALITY 2015; 18:200-211. [PMID: 26281855 DOI: 10.1080/13691058.2015.1064164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We conducted an interpretive phenomenological investigation in order to understand, within a Cambodian sociocultural context, the lived experiences of women infected with HIV by their husbands as they navigated the tasks of discovering, disclosing and dealing with the diagnosis. Using an open-ended interview protocol and an interpretive phenomenological approach, data were analysed from 15 women (aged 28-42 years) who self-identified the HIV transmission as coming from their spouses. Using qualitative inductive analysis, we were able to identify three main themes: (1) finding oneself to be HIV-positive, (2) encountering HIV--accepting an unwelcomed guest and (3) going public--dealing with the fear of discrimination. Participants consistently delayed testing for HIV and, after receiving an HIV-positive diagnosis, had to deal with painful emotions and discrimination within their social network. The complexity of gender roles and the sociocultural status of the women acted as behavioural determinants of their responses to HIV transmission from their spouses.
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Affiliation(s)
- Youngran Yang
- a School of Nursing , Research Institute of Nursing Science, Chonbuk National University , Jeonju , Republic of Korea
| | - Danuta Wojnar
- b College of Nursing , Seattle University , Seattle , USA
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