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Yang X, Wang Z, Wang X, Ma T, Xue H, He Y, Lau JTF. Behavioral Intention to Initiate Antiretroviral Therapy (ART) Among Chinese HIV-Infected Men Who Have Sex With Men Having High CD4 Count in the Era of "Treatment for All". Am J Mens Health 2020; 13:1557988319828615. [PMID: 30819066 PMCID: PMC6775561 DOI: 10.1177/1557988319828615] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
China has updated its national guideline recommending antiretroviral therapy (ART) to all people living with HIV (PLWH) since 2016. This study was to investigate the prevalence of behavioral intention to initiate ART among HIV-infected men who have sex with men (MSM) with CD4 levels >350 cells/mm3, who had just become eligible to receive free ART in China. A cross-sectional survey was conducted among 262 eligible HIV-infected MSM who had never received ART. The theory of planned behavior (TPB) was used to guide the variable selection. The prevalence of behavioral intention to initiate ART was 69.9%. After adjusting for significant background variables, all five constructs of TPB were significantly associated with behavioral intention to initiate ART. These significant constructs were: positive attitudes (adjusted odds ratios, AOR: 1.14; 95% CI [1.06, 1.24]) and negative attitudes (AOR: 0.89; 95% CI [0.82, 0.97]) toward immediate ART initiation; perceived their significant others would support them to initiate ART immediately (perceived subjective norm; AOR: 1.14; 95% CI [1.03, 1.25]); perceived high proportion of PLWH having similar CD4 cell levels were on ART (perceived descriptive norm; AOR: 2.22, 95% CI [1.16, 4.24]); and being confident in initiating ART immediately (perceived behavioral control; AOR: 1.21; 95% CI [1.04, 1.39]). Prevalence of behavioral intention to initiate ART was high among this group of MSM. Effective health promotion is needed to translate behavioral intention into related action. TPB may be a useful framework for developing future health promotion increasing ART coverage in this group.
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Affiliation(s)
- Xueying Yang
- 1 Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,2 Beijing Chaoyang Centre for Disease Control and Prevention, China
| | - Zixin Wang
- 1 Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,3 Shenzhen Research Institute, The Chinese University of Hong Kong, China
| | - Xiaodong Wang
- 4 Chengdu Tongle Health Counselling Service Centre, China
| | - Tiecheng Ma
- 5 Consultation Center of AIDS Aid and Health Service, Shenyang, China
| | - Honghong Xue
- 6 Fujian Volunteers Association of STD&AIDS Prevention and Control, Fuzhou, China
| | | | - Joseph Tak Fai Lau
- 1 Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.,3 Shenzhen Research Institute, The Chinese University of Hong Kong, China
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Esber AL, Coakley P, Ake JA, Bahemana E, Adamu Y, Kiweewa F, Maswai J, Owuoth J, Robb ML, Polyak CS, Crowell TA. Decreasing time to antiretroviral therapy initiation after HIV diagnosis in a clinic-based observational cohort study in four African countries. J Int AIDS Soc 2020; 23:e25446. [PMID: 32064776 PMCID: PMC7025087 DOI: 10.1002/jia2.25446] [Citation(s) in RCA: 8] [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: 08/28/2019] [Revised: 12/06/2019] [Accepted: 12/16/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION World Health Organization (WHO) guidelines have shifted over time to recommend earlier initiation of antiretroviral therapy (ART) and now encourage ART initiation on the day of HIV diagnosis, if possible. However, barriers to ART access may delay initiation in resource-limited settings. We characterized temporal trends and other factors influencing the interval between HIV diagnosis and ART initiation among participants enrolled in a clinic-based cohort across four African countries. METHODS The African Cohort Study enrols adults engaged in care at 12 sites in Uganda, Kenya, Tanzania and Nigeria. Participants provide a medical history, complete a physical examination and undergo laboratory assessments every six months. Participants with recorded dates of HIV diagnosis were categorized by WHO guideline era (<2006, 2006 to 2009, 2010 to 2012, 2013 to 2015, ≥2016) at the time of diagnosis. Cox proportional hazard modelling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) for time to ART initiation. RESULTS AND DISCUSSION From January 2013 to September 2019, a total of 2888 adults living with HIV enrolled with known diagnosis dates. Median time to ART initiation decreased from 22.0 months (interquartile range (IQR) 4.0 to 77.3) among participants diagnosed prior to 2006 to 0.5 months (IQR 0.2 to 1.8) among those diagnosed in 2016 and later. Comparing those same periods, CD4 nadir increased from a median of 166 cells/mm3 (IQR: 81 to 286) to 298 cells/mm3 (IQR: 151 to 501). In the final adjusted model, participants diagnosed in each subsequent WHO guideline era had increased rates of ART initiation compared to those diagnosed before 2006. CD4 nadir ≥500 cells/mm3 was independently associated with a lower rate of ART initiation as compared to CD4 nadir <200 cells/mm3 (HR: 0.32; 95% CI: 0.28 to 0.37). Age >50 years at diagnosis was independently associated with shorter time to ART initiation as compared to 18 to 29 years (HR: 1.38; 95% CI: 1.19 to 1.61). CONCLUSIONS Consistent with changing guidelines, the interval between diagnosis and ART initiation has decreased over time. Still, many adults living with HIV initiated treatment with low CD4, highlighting the need to diagnose HIV earlier while improving access to immediate ART after diagnosis.
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Affiliation(s)
- Allahna L Esber
- U.S. Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
- Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMDUSA
| | - Peter Coakley
- U.S. Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
- Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMDUSA
| | - Julie A Ake
- U.S. Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
| | - Emmanuel Bahemana
- U.S. Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
- Henry Jackson Foundation MRIMbeyaTanzania
| | - Yakubu Adamu
- U.S. Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
- U.S. Army Medical Research Directorate – AfricaNairobiKenya
- Henry Jackson Foundation MRIAbujaNigeria
| | | | - Jonah Maswai
- U.S. Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
- Kenya Medical Research Institute/U.S. Army Medical Research DirectorateNairobiKenya
- Henry Jackson Foundation MRIKerichoKenya
| | - John Owuoth
- U.S. Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
- Kenya Medical Research Institute/U.S. Army Medical Research DirectorateNairobiKenya
- Henry Jackson Foundation MRIKisumuKenya
| | - Merlin L Robb
- U.S. Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
- Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMDUSA
| | - Christina S Polyak
- U.S. Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
- Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMDUSA
| | - Trevor A Crowell
- U.S. Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
- Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMDUSA
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Yang X, Wang Z, Harrison S, Lau JTF. Coverage and adherence of antiretroviral therapy among Chinese HIV-positive men who have sex with men with high CD4 counts in the era of 'Treat all'. Trop Med Int Health 2019; 25:308-318. [PMID: 31758830 DOI: 10.1111/tmi.13353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES HIV-positive men who have sex with men (MSM) with CD4 cell counts> 350 cells/mm3 in China recently became eligible for free antiretroviral therapy (ART) due to updated national guidelines. This study aimed to investigate ART coverage and adherence among a large sample of HIV-positive MSM in China. METHODS A cross-sectional survey was conducted in Chengdu and Hangzhou, China, from February to November 2016. Participants were 277 MSM who had received a confirmatory HIV diagnosis and had CD4 levels of> 350 cells/mm3 . Trained staff of collaborating non-governmental organizations contacted all HIV-positive MSM listed in their service records and invited them to join the study. The ART initiation, ART adherence and interactions between healthcare professionals and the patients were assessed. RESULTS ART coverage was 60.3%. Among those who were on ART (n = 167), no participants reported missing any doses in the last four days, but 25.7% reported non-compliance to either ART dosing schedule or dosage instructions. After adjusting for background variables and perceived eligibility for ART, two variables were significant factors of higher ART coverage: (i) receiving a recommendation from healthcare professionals for immediate ART initiation and (ii) perceiving having received an adequate explanation of potential harms of ART. Being prescribed> 3 pills per dose and not having a temporary resident permit were associated with non-compliance. CONCLUSIONS Significant efforts are needed to increase ART coverage among HIV-positive MSM with high CD4 counts in China. Although prevalence of missing doses was low, non-compliance to dosing schedule/instructions should not be neglected. Interactions between healthcare professionals and MSMs play an important role in facilitating ART initiation.
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Affiliation(s)
- Xueying Yang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Sayward Harrison
- Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Joseph T F Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
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Better Outcomes Among HIV-Infected Rwandan Children 18-60 Months of Age After the Implementation of "Treat All". J Acquir Immune Defic Syndr 2019; 80:e74-e83. [PMID: 30422899 PMCID: PMC6392203 DOI: 10.1097/qai.0000000000001907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: In 2012, Rwanda introduced a Treat All approach for HIV-infected children younger than 5 years. We compared antiretroviral therapy (ART) initiation, outcomes, and retention, before and after this change. Methods: We conducted a retrospective study of children enrolled into care between June 2009 and December 2011 [Before Treat All (BTA) cohort] and between July 2012 and April 2015 [Treat All (TA) cohort]. Setting: Medical records of a nationally representative sample were abstracted for all eligible aged 18–60 months from 100 Rwandan public health facilities. Results: We abstracted 374 medical records: 227 in the BTA and 147 in the TA cohorts. Mean (SD) age at enrollment was [3 years (1.1)]. Among BTA, 59% initiated ART within 1 year, vs. 89% in the TA cohort. Median time to ART initiation was 68 days (interquartile range 14–494) for BTA and 9 days (interquartile range 0–28) for TA (P < 0.0001), with 9 (5%) undergoing same-day initiation in BTA compared with 50 (37%) in TA (P < 0.0001). Before ART initiation, 59% in the BTA reported at least one health condition compared with 35% in the TA cohort (P < 0.0001). Although overall loss to follow-up was similar between cohorts (BTA: 13%, TA: 8%, P = 0.18), loss to follow-up before ART was significantly higher in the BTA (8%) compared with the TA cohort (2%) (P = 0.02). Conclusions: Nearly 90% of Rwandan children started on ART within 1 year of enrollment, most within 1 month, with greater than 90% retention after implementation of TA. TA was also associated with fewer morbidities.
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Guiteau Moise C, Rivera VR, Hennessey KA, Bellot C, Nicholas C, Fang AP, Verdier RI, Severe P, Sainvil A, Charles B, Dorval D, St Amour J, Pape JW, Koenig SP. A Successful Model of Expedited Antiretroviral Therapy for Clinically Stable Patients Living With HIV in Haiti. J Acquir Immune Defic Syndr 2018; 79:70-76. [PMID: 29771791 PMCID: PMC6092230 DOI: 10.1097/qai.0000000000001725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recommendations for universal antiretroviral therapy have greatly increased the number of HIV-infected patients who qualify for treatment, particularly with early clinical disease. Less intensive models of care are needed for clinically stable patients. SETTING A rapid pathway (RP) model of expedited outpatient care for clinically stable patients was implemented at the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) Center, Port-au-Prince, Haiti. Expedited visits included nurse-led assessments and point-of-service antiretroviral therapy dispensing. METHODS We conducted a retrospective analysis including patients who initiated RP care between June 1, 2014, and September 30, 2015, comparing outcomes of patients with timely visit attendance (never >3 days late) with patients with ≥1 nontimely visit within 6 months before RP enrollment. We calculated retention in care and adherence at 12 months, and assessed predictors of both outcomes. RESULTS Of the 2361 patients who initiated RP care during the study period, 1429 (61%) had timely visit attendance and 932 (39%) had ≥1 nontimely visit before RP enrollment. Among RP-enrolled patients, 94% were retained at 12 months and 75% had ≥90% adherence, with higher proportions in those with timely pre-RP visits (95% vs. 92%; 87% vs. 55%). In multivariable analysis, pre-RP visit timeliness was associated with both retention (adjusted odds ratio: 1.67; 95% confidence interval: 1.08 to 2.59) and adherence (adjusted odds ratio: 4.53; 95% confidence interval: 3.58 to 5.72). CONCLUSIONS RP care was associated with high levels of retention and adherence for clinically stable patients. Timeliness of pre-RP visits was predictive of outcomes after RP initiation.
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Affiliation(s)
- Colette Guiteau Moise
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa R Rivera
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Division of Global Health, Weill Cornell Medical College, New York, NY
| | - Kelly A Hennessey
- Analysis Group, Boston, MA
- University of Washington School of Medicine, Seattle, WA
| | - Clovy Bellot
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Chris Nicholas
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Anna P Fang
- Analysis Group, Boston, MA
- Harvard Medical School, Boston, MA
| | - Rose Irène Verdier
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Patrice Severe
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Alix Sainvil
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Benedict Charles
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Derothy Dorval
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Juseline St Amour
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jean W Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Division of Global Health, Weill Cornell Medical College, New York, NY
| | - Serena P Koenig
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA
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McNairy ML, Jannat-Khah D, Pape JW, Marcelin A, Joseph P, Mathon JE, Koenig S, Wells M, Fitzgerald DW, Evans A. Predicting death and lost to follow-up among adults initiating antiretroviral therapy in resource-limited settings: Derivation and external validation of a risk score in Haiti. PLoS One 2018; 13:e0201945. [PMID: 30157197 PMCID: PMC6114504 DOI: 10.1371/journal.pone.0201945] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 06/19/2018] [Indexed: 12/23/2022] Open
Abstract
Background Over 18 million adults have initiated life-saving antiretroviral therapy (ART) in resource-poor settings; however, mortality and lost-to-follow-up rates continue to be high among patients in their first year after treatment start. Clinical decision tools are needed to identify patients at high risk for poor outcomes in order to provide individualized risk assessment and intervention. This study aimed to develop and externally validate risk prediction tools that estimate the probability of dying or of being lost to follow-up (LTF) during the year after starting ART. Methods We used a derivation cohort of 7,031 adults age 15–70 years initiating ART from 2007 to 2013 at 6 clinics in Haiti; 242 (3.5%) had documented death and 1,521 (21.6%) were LTF at 1 year after starting ART. The following routinely collected data were used as predictors in two logistic regression models (one to predict death and another to predict LTF): age, gender, weight, CD4 count, WHO Stage, and diagnosis of tuberculosis (TB). The validation cohort consisted of 1,835 adults initiating ART at a different HIV clinic in Haiti during 2012. We assessed model discrimination by measuring the C-statistic, and measured model calibration by how closely the predicted probabilities approximated actual probabilities of the two outcomes. We derived a nomogram and a point-based risk score from the predictive models. Findings The model predicting death within the year after starting ART had a C-statistic of 0.75 (95% CI 0.74 to 0.81). There was no evidence for significant overfitting and the predictions were well calibrated. The strongest predictors of 1-year mortality were male gender, low weight, low CD4 count, advanced WHO stage, and the absence of TB. In the validation cohort, the C-statistic was 0.69 (95% CI 0.59 to 0.77). A point-based risk score for death had a C-statistic 0.73 (95% CI 0.69 to 0.76) and categorizes patients as low risk (<2% risk of death), average risk (3–4%), and high-risk (8–10%) and very high-risk (14–19%) with likelihood ratios to be used in settings where the baseline risk is different from our study population. The model predicting LTF did not discriminate well (C-statistic 0.59). Conclusions A simple risk-score using routinely collected data can predict 1-year mortality after ART initiation for HIV-positive adults in Haiti. However, predicting lost to follow-up using routinely collected data was not as successful. The next step is to assess whether use of this risk score can identify patients who need tailored services to reduce mortality in resource-poor settings such as Haiti.
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Affiliation(s)
- Margaret L. McNairy
- Division of General Internal Medicine, Weill Cornell Medicine, New York, United States of America
- Center for Global Health, Weill Cornell Medicine, New York, United States of America
- * E-mail:
| | - Deanna Jannat-Khah
- Division of General Internal Medicine, Weill Cornell Medicine, New York, United States of America
| | - Jean W. Pape
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port au Prince Haiti
| | - Adias Marcelin
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port au Prince Haiti
| | - Patrice Joseph
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port au Prince Haiti
| | - Jean Edward Mathon
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port au Prince Haiti
| | - Serena Koenig
- Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston MA, United States of America
| | - Martin Wells
- Department of Statistical Science, Cornell University, Ithaca, United States of America
| | - Daniel W. Fitzgerald
- Center for Global Health, Weill Cornell Medicine, New York, United States of America
| | - Arthur Evans
- Division of General Internal Medicine, Weill Cornell Medicine, New York, United States of America
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Wong NS, Mao J, Cheng W, Tang W, Cohen MS, Tucker JD, Xu H. HIV Linkage to Care and Retention in Care Rate Among MSM in Guangzhou, China. AIDS Behav 2018; 22:701-710. [PMID: 28849284 DOI: 10.1007/s10461-017-1893-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Quantifying HIV service provision along the HIV care continuum is increasingly important for monitoring and evaluating HIV interventions. We examined factors associated with linkage and retention in care longitudinally among MSM (n = 1974, 4933 person-years) diagnosed and living in Guangzhou, China, in 2008-2014. We measured longitudinal change of retention in care (≥2 CD4 tests per year) from linkage and antiretroviral therapy initiation (ART). We examined factors associated with linkage using logistic regression and with retention using generalized estimating equations. The rate of linkage to care was 89% in 2014. ART retention rate dropped from 71% (year 1) to 46% (year 2), suggesting that first-year retention measures likely overestimate retention over longer periods. Lower CD4 levels and older age predicted retention in ART care. These data can inform interventions to improve retention about some subgroups.
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Affiliation(s)
- Ngai Sze Wong
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina Project-China, Guangzhou, Guangdong, China
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Jessica Mao
- David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Weibin Cheng
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1 Qide Road, Jiahe Street, Baiyun District, Guangzhou, 510440, Guangdong, China
| | - Weiming Tang
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina Project-China, Guangzhou, Guangdong, China
| | - Myron S Cohen
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph D Tucker
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina Project-China, Guangzhou, Guangdong, China
| | - Huifang Xu
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1 Qide Road, Jiahe Street, Baiyun District, Guangzhou, 510440, Guangdong, China.
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Auld AF, Valerie Pelletier, Robin EG, Shiraishi RW, Dee J, Antoine M, Desir Y, Desforges G, Delcher C, Duval N, Joseph N, Francois K, Griswold M, Domercant JW, Patrice Joseph YA, Van Onacker JD, Deyde V, Lowrance DW, And The Groupe d'Analyses Salvh. Retention Throughout the HIV Care and Treatment Cascade: From Diagnosis to Antiretroviral Treatment of Adults and Children Living with HIV-Haiti, 1985-2015. Am J Trop Med Hyg 2017; 97:57-70. [PMID: 29064357 PMCID: PMC5676635 DOI: 10.4269/ajtmh.17-0116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Monitoring retention of people living with HIV (PLHIV) in the HIV care and treatment cascade is essential to guide program strategy and evaluate progress toward globally-endorsed 90–90–90 targets (i.e., 90% of PLHIV diagnosed, 81% on sustained antiretroviral therapy (ART), and 73% virally suppressed). We describe national retention from diagnosis throughout the cascade for patients receiving HIV services in Haiti during 1985–2015, with a focus on those receiving HIV services during 2008–2015. Among the 266,256 newly diagnosed PLHIV during 1985–2015, 49% were linked-to-care, 30% started ART, and 18% were retained on ART by the time of database closure. Similarly, among the 192,187 newly diagnosed HIV-positive patients during 2008–2015, 50% were linked to care, 31% started ART, and 19% were retained on ART by the time of database closure. Most patients (90–92%) at all cascade steps were adults (≥ 15 years old), among whom the majority (60–61%) were female. During 2008–2015, outcomes varied significantly across 42 administrative districts (arrondissements) of residence; cumulative linkage-to-care ranged from 23% to 69%, cumulative ART initiation among care enrollees ranged from 2% to 80%, and cumulative ART retention among ART enrollees ranged from 30% to 88%. Compared with adults, children had lower cumulative incidence of ART initiation among care enrollees (64% versus 47%) and lower cumulative retention among ART enrollees (64% versus 50%). Cumulative linkage-to-care was low and should be prioritized for improvement. Variations in outcomes by arrondissement and between adults and children require further investigation and programmatic response.
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Affiliation(s)
- Andrew F Auld
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Valerie Pelletier
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - Ermane G Robin
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
| | - Ray W Shiraishi
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacob Dee
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mayer Antoine
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - Yrvel Desir
- National Alliance of State and Territorial AIDS Directors (NASTAD), Port-au-Prince, Haiti
| | - Gracia Desforges
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
| | - Chris Delcher
- Department of Health Outcomes and Policy, University of Florida, Gainesville, Florida.,National Alliance of State and Territorial AIDS Directors (NASTAD), Port-au-Prince, Haiti
| | - Nirva Duval
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
| | - Nadjy Joseph
- National Alliance of State and Territorial AIDS Directors (NASTAD), Port-au-Prince, Haiti
| | - Kesner Francois
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
| | - Mark Griswold
- National Alliance of State and Territorial AIDS Directors (NASTAD), Washington, District of Columbia
| | - Jean Wysler Domercant
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - Yves Anthony Patrice Joseph
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - Joelle Deas Van Onacker
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
| | - Varough Deyde
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - David W Lowrance
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - And The Groupe d'Analyses Salvh
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
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Koenig SP, Dorvil N, Dévieux JG, Hedt-Gauthier BL, Riviere C, Faustin M, Lavoile K, Perodin C, Apollon A, Duverger L, McNairy ML, Hennessey KA, Souroutzidis A, Cremieux PY, Severe P, Pape JW. Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV: A randomized unblinded trial. PLoS Med 2017; 14:e1002357. [PMID: 28742880 PMCID: PMC5526526 DOI: 10.1371/journal.pmed.1002357] [Citation(s) in RCA: 177] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/16/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Attrition during the period from HIV testing to antiretroviral therapy (ART) initiation is high worldwide. We assessed whether same-day HIV testing and ART initiation improves retention and virologic suppression. METHODS AND FINDINGS We conducted an unblinded, randomized trial of standard ART initiation versus same-day HIV testing and ART initiation among eligible adults ≥18 years old with World Health Organization Stage 1 or 2 disease and CD4 count ≤500 cells/mm3. The study was conducted among outpatients at the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic infections (GHESKIO) Clinic in Port-au-Prince, Haiti. Participants were randomly assigned (1:1) to standard ART initiation or same-day HIV testing and ART initiation. The standard group initiated ART 3 weeks after HIV testing, and the same-day group initiated ART on the day of testing. The primary study endpoint was retention in care 12 months after HIV testing with HIV-1 RNA <50 copies/ml. We assessed the impact of treatment arm with a modified intention-to-treat analysis, using multivariable logistic regression controlling for potential confounders. Between August 2013 and October 2015, 762 participants were enrolled; 59 participants transferred to other clinics during the study period, and were excluded as per protocol, leaving 356 in the standard and 347 in the same-day ART groups. In the standard ART group, 156 (44%) participants were retained in care with 12-month HIV-1 RNA <50 copies, and 184 (52%) had <1,000 copies/ml; 20 participants (6%) died. In the same-day ART group, 184 (53%) participants were retained with HIV-1 RNA <50 copies/ml, and 212 (61%) had <1,000 copies/ml; 10 (3%) participants died. The unadjusted risk ratio (RR) of being retained at 12 months with HIV-1 RNA <50 copies/ml was 1.21 (95% CI: 1.04, 1.38; p = 0.015) for the same-day ART group compared to the standard ART group, and the unadjusted RR for being retained with HIV-1 RNA <1,000 copies was 1.18 (95% CI: 1.04, 1.31; p = 0.012). The main limitation of this study is that it was conducted at a single urban clinic, and the generalizability to other settings is uncertain. CONCLUSIONS Same-day HIV testing and ART initiation is feasible and beneficial in this setting, as it improves retention in care with virologic suppression among patients with early clinical HIV disease. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov number NCT01900080.
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Affiliation(s)
- Serena P. Koenig
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Nancy Dorvil
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jessy G. Dévieux
- AIDS Prevention Program, Florida International University, Miami, Florida, United States of America
| | - Bethany L. Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
| | - Cynthia Riviere
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Mikerlyne Faustin
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Kerlyne Lavoile
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Christian Perodin
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Alexandra Apollon
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Limathe Duverger
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Margaret L. McNairy
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
| | - Kelly A. Hennessey
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | | | - Patrice Severe
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jean W. Pape
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
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Auld AF, Shiraishi RW, Oboho I, Ross C, Bateganya M, Pelletier V, Dee J, Francois K, Duval N, Antoine M, Delcher C, Desforges G, Griswold M, Domercant JW, Joseph N, Deyde V, Desir Y, Van Onacker JD, Robin E, Chun H, Zulu I, Pathmanathan I, Dokubo EK, Lloyd S, Pati R, Kaplan J, Raizes E, Spira T, Mitruka K, Couto A, Gudo ES, Mbofana F, Briggs M, Alfredo C, Xavier C, Vergara A, Hamunime N, Agolory S, Mutandi G, Shoopala NN, Sawadogo S, Baughman AL, Bashorun A, Dalhatu I, Swaminathan M, Onotu D, Odafe S, Abiri OO, Debem HH, Tomlinson H, Okello V, Preko P, Ao T, Ryan C, Bicego G, Ehrenkranz P, Kamiru H, Nuwagaba-Biribonwoha H, Kwesigabo G, Ramadhani AA, Ng'wangu K, Swai P, Mfaume M, Gongo R, Carpenter D, Mastro TD, Hamilton C, Denison J, Wabwire-Mangen F, Koole O, Torpey K, Williams SG, Colebunders R, Kalamya JN, Namale A, Adler MR, Mugisa B, Gupta S, Tsui S, van Praag E, Nguyen DB, Lyss S, Le Y, Abdul-Quader AS, Do NT, Mulenga M, Hachizovu S, Mugurungi O, Barr BAT, Gonese E, Mutasa-Apollo T, Balachandra S, Behel S, Bingham T, Mackellar D, Lowrance D, Ellerbrock TV. Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment - 10 Countries, 2004-2015. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 66:558-563. [PMID: 28570507 PMCID: PMC5657820 DOI: 10.15585/mmwr.mm6621a3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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McNairy ML, Joseph P, Unterbrink M, Galbaud S, Mathon JE, Rivera V, Jannat-Khah D, Reif L, Koenig SP, Domercant JW, Johnson W, Fitzgerald DW, Pape JW. Outcomes after antiretroviral therapy during the expansion of HIV services in Haiti. PLoS One 2017; 12:e0175521. [PMID: 28437477 PMCID: PMC5402937 DOI: 10.1371/journal.pone.0175521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/27/2017] [Indexed: 11/18/2022] Open
Abstract
Background We report patient outcomes after antiretroviral therapy (ART) initiation in a network of HIV facilities in Haiti, including temporal trends and differences across clinics, during the expansion of HIV services in the country. Methods We assessed outcomes at 12 months after ART initiation (baseline) using routinely collected data on adults (≥15 years) in 11 HIV facilities from July 2007-December 2013. Outcomes include death (ascertained from medical records), lost to follow-up (LTF) defined as no visit > 365 days from ART initiation, and retention defined as being alive and attending care ≥ 365 days from ART initiation. Outcomes were compared across calendar year of ART initiation and across facilities. Risk factors for death and LTF were assessed using Cox proportional hazards and competing risk regression models. Results Cumulatively, 9,718 adults initiated ART with median age 37 years (IQR 30–46). Median CD4 count was 254 cells/uL (IQR 139–350). Twelve months after ART initiation, 4.4% (95% CI 4.0–4.8) of patients died, 21.7% (95% CI 20.9–22.6) were LTF, and 73.9% (95% CI 73.0–74.8) were retained in care. Twelve-month mortality decreased from 13.8% among adults who started ART in 2007 to 4.4% in 2013 (p<0.001). Twelve-month LTF after ART start was 29.2% in 2007, 18.7% in 2008, and increased to 30.1% in 2013 (p<0.001). Overall, twelve-month retention after ART start did not change over time but varied widely across facilities from 61.1% to 86.5%. Conclusion Expansion of HIV services across Haiti has been successful with increasing numbers of patients initiating ART and decreasing twelve-month mortality rates. However, overall retention has not improved, despite differences across facilities, suggesting additional strategies to improve engagement in care are needed.
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Affiliation(s)
- Margaret L. McNairy
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
- Division of General Medicine, Weill Cornell Medical College, New York, New York, United States of America
- * E-mail:
| | - Patrice Joseph
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Michelle Unterbrink
- Division of General Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Stanislas Galbaud
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jean-Edouard Mathon
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa Rivera
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Deanna Jannat-Khah
- Division of General Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Lindsey Reif
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
| | - Serena P. Koenig
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Warren Johnson
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
| | - Daniel W. Fitzgerald
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
| | - Jean W. Pape
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
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12
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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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Reniers G, Blom S, Calvert C, Martin-Onraet A, Herbst AJ, Eaton JW, Bor J, Slaymaker E, Li ZR, Clark SJ, Bärnighausen T, Zaba B, Hosegood V. Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: an observational community cohort study. Lancet HIV 2017; 4:e113-e121. [PMID: 27956187 PMCID: PMC5405557 DOI: 10.1016/s2352-3018(16)30225-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/13/2016] [Accepted: 10/24/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Antiretroviral therapy (ART) substantially decreases morbidity and mortality in people living with HIV. In this study, we describe population-level trends in the adult life expectancy and trends in the residual burden of HIV mortality after the roll-out of a public sector ART programme in KwaZulu-Natal, South Africa, one of the populations with the most severe HIV epidemics in the world. METHODS Data come from the Africa Centre Demographic Information System (ACDIS), an observational community cohort study in the uMkhanyakude district in northern KwaZulu-Natal, South Africa. We used non-parametric survival analysis methods to estimate gains in the population-wide life expectancy at age 15 years since the introduction of ART, and the shortfall of the population-wide adult life expectancy compared with that of the HIV-negative population (ie, the life expectancy deficit). Life expectancy gains and deficits were further disaggregated by age and cause of death with demographic decomposition methods. FINDINGS Covering the calendar years 2001 through to 2014, we obtained information on 93 903 adults who jointly contribute 535 42 8 person-years of observation to the analyses and 9992 deaths. Since the roll-out of ART in 2004, adult life expectancy increased by 15·2 years for men (95% CI 12·4-17·8) and 17·2 years for women (14·5-20·2). Reductions in pulmonary tuberculosis and HIV-related mortality account for 79·7% of the total life expectancy gains in men (8·4 adult life-years), and 90·7% in women (12·8 adult life-years). For men, 9·5% is the result of a decline in external injuries. By 2014, the life expectancy deficit had decreased to 1·2 years for men (-2·9 to 5·8) and to 5·3 years for women (2·6-7·8). In 2011-14, pulmonary tuberculosis and HIV were responsible for 84·9% of the life expectancy deficit in men and 80·8% in women. INTERPRETATION The burden of HIV on adult mortality in this population is rapidly shrinking, but remains large for women, despite their better engagement with HIV-care services. Gains in adult life-years lived as well as the present life expectancy deficit are almost exclusively due to differences in mortality attributed to HIV and pulmonary tuberculosis. FUNDING Wellcome Trust, the Bill & Melinda Gates Foundation, and the National Institutes of Health.
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Affiliation(s)
- Georges Reniers
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Sylvia Blom
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Clara Calvert
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Jeffrey W Eaton
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Jacob Bor
- Department of Global Health, Boston University, Boston, MA, USA
| | - Emma Slaymaker
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Zehang R Li
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Samuel J Clark
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Till Bärnighausen
- Africa Health Research Institute, Durban, South Africa; Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Basia Zaba
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Victoria Hosegood
- Africa Health Research Institute, Durban, South Africa; Social Statistics and Demography, University of Southampton, Southampton, UK
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Abstract
Un tratamiento médico eficaz con un compromiso ininterrumpido en el cuidado es crítico para mejorar la supervivencia y la calidad de vida de los pacientes infectados con el virus de la inmunodeficiencia humana (VIH). Objetivos: se han llevado a cabo múltiples intervenciones conductuales para promover comportamientos de adherencia. Sin embargo, la adhesión a los medicamentos contra el VIH y las citas médicas siguen siendo un tema de preocupación mundial. Método: el modelo de promoción de la salud (HPM) es una adaptación de enfermería del modelo de creencias de salud. El HPM se centra en características y experiencias individuales, así como cogniciones y resultados específicos del comportamiento. La integración del HPM en el abordaje de los comportamientos de adherencia podría ser uno de los pilares del éxito en el cambio del comportamiento de la salud. Resultados: una búsqueda en la literatura no mostró ningún estudio que aplicó el HPM en los estudios de comportamiento de adherencia realizados entre las poblaciones infectadas por el VIH. Conclusión: este artículo presenta al lector la disponibilidad de las actuales intervenciones de adherencia-comportamiento y estrategias que se alinean con los componentes del modelo HPM. Además, propone la necesidad de que los miembros del equipo de tratamiento médico adopten el HPM en la práctica clínica actual con el fin de abordar eficazmente los problemas de comportamiento de adherencia.
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Mecha JO, Kubo EN, Nganga LW, Muiruri PN, Njagi LN, Mutisya IN, Odionyi JJ, Ilovi SC, Wambui M, Githu C, Ngethe R, Obimbo EM, Ngumi ZW. Trends in clinical characteristics and outcomes of Pre-ART care at a large HIV clinic in Nairobi, Kenya: a retrospective cohort study. AIDS Res Ther 2016; 13:38. [PMID: 27895697 PMCID: PMC5109784 DOI: 10.1186/s12981-016-0122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/01/2016] [Indexed: 11/11/2022] Open
Abstract
Background The success of antiretroviral therapy in resource-scarce settings is an illustration that complex healthcare interventions can be successfully delivered even in fragile health systems. Documenting the success factors in the scale-up of HIV care and treatment in resource constrained settings will enable health systems to prepare for changing population health needs. This study describes changing demographic and clinical characteristics of adult pre-ART cohorts, and identifies predictors of pre-ART attrition at a large urban HIV clinic in Nairobi, Kenya. Methods We conducted a retrospective cohort analysis of data on HIV infected adults (≥15 years) enrolling in pre-ART care between January 2004 and September 2015. Attrition (loss to program) was defined as those who died or were lost to follow-up (having no contact with the facility for at least 6 months). We used Kaplan-Meier survival analysis to determine time to event for the different modes of transition, and Cox proportional hazards models to determine predictors of pre-ART attrition. Results Over the 12 years of observation, there were increases in the proportions of young people (age 15 to 24 years); and patients presenting with early disease (by WHO clinical stage and higher median CD4 cell counts), p = 0.0001 for trend. Independent predictors of attrition included: aHR (95% CI): male gender 1.98 (1.69–2.33), p = 0.0001; age 20–24 years 1.80 (1.37–2.37), p = 0.0001), or 25–34 years 1.22 (1.01–1.47), p = 0.0364; marital status single 1.55 (1.29–1.86), p = 0.0001) or divorced 1.41(1.02–1.95), p = 0.0370; urban residency 1.83 (1.40–2.38), p = 0.0001; CD4 count of 0–100 cells/µl 1.63 (1.003–2.658), p = 0.0486 or CD4 count >500 cells/µl 2.14(1.46–3.14), p = 0.0001. Conclusions In order to optimize the impact of HIV prevention, care and treatment in resource scarce settings, there is an urgent need to implement prevention and treatment interventions targeting young people and patients entering care with severe immunosuppression (CD4 cell counts <100 cells/µl). Additionally, care and treatment programmes should strengthen inter-facility referrals and linkages to improve care coordination and prevent leakages in the HIV care continuum.
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