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Cushnie A, Reintjes R, Artama M, Figueroa JP. Reduction in time to viral suppression among persons living with HIV in Jamaica between 2017-2019. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003107. [PMID: 38662640 PMCID: PMC11045129 DOI: 10.1371/journal.pgph.0003107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/21/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION HIV viral suppression is important for effective treatment and for reducing new infections. In 2019, only 66% of persons on antiretroviral treatment (ART) in Jamaica were virally suppressed. We aim to compare time to viral suppression by ART initiation year and type of treatment site to understand the implications for programming. METHODS We assessed time to viral suppression among 4560 persons who received viral load testing either pre or post ART initiation from 2017-2019. We used descriptive statistics and Kaplan-Meier estimates to compare survival curves by ART year (2017, 2018, 2019), sex and type of treatment site (public and non-governmental organizations). Persons were censored if suppression was not achieved. Mixed effects Cox regression was used to determine the effect of covariates on the likelihood of viral suppression. We report hazard ratios and 95% confidence intervals. RESULTS Pre-ART viral load testing decreased from 36% in 2017 to 30% in 2019. For post-ART viral load tests, approximately 78% (n = 1589) of persons achieved suppression, 51% (n = 809) were female and 86% (n = 1341) used a public treatment site. The median time to suppression decreased by 3 months from 2017 to 2019. The likelihood of suppression was almost 2 times greater in 2018 (HR = 1.56, CI = 1.39-1.75) and 3 times greater in 2019 (HR = 3.17, CI = 2.76-3.64) compared to 2017. NGO treatment sites were also significantly associated with the likelihood of viral suppression compared to public sites. CONCLUSION Pre-ART viral load testing and the time to viral suppression decreased over three years. Initiating ART after 2017 and early use of NGO treatment sites were found to significantly increase the likelihood of achieving suppression. This demonstrates improvements in the national HIV response but there is need to increase the number of persons on ART and achieving viral suppression.
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Affiliation(s)
- Anya Cushnie
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Ralf Reintjes
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Department of Health Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Miia Artama
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - J. Peter Figueroa
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Jamaica
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Walcott MM, Tieu HV, Tipre M, Nandi V, Davis A, Wu E, Wheatle M, Frye V, Figueroa JP. Factors associated with discussing HIV pre-exposure prophylaxis (PrEP) among Jamaican medical providers. Int J STD AIDS 2024; 35:188-196. [PMID: 37966358 DOI: 10.1177/09564624231201187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND The Ministry of Health and Wellness of Jamaica has endorsed the use of pre-exposure prophylaxis (PrEP) as an HIV prevention strategy; however, PrEP was not included in the national HIV prevention program in 2021. METHODS A cross-sectional online study involving physicians in Jamaica was conducted in 2021 to describe PrEP awareness, beliefs, attitudes, and practices. The study also assessed individual and social factors associated with discussing PrEP with patients and willingness to prescribe PrEP. FINDINGS The mean age and standard deviation (SD) of the 69 physicians who completed the survey were 45.5 ± 13.6 years. Most of the participants (80%) reported that they were somewhat familiar with PrEP. PrEP attitude and perceived comfort in prescribing PrEP were moderate among participating physicians, with a mean and SD of 3.9 ± 0.8 and 3.6 ± 0.9 respectively. Six percent of physicians reported that they had prescribed PrEP and 17% had discussed PrEP with their patients in the past year. However, most (90%) reported that they were willing to prescribe PrEP after being informed about it. In the unadjusted model, identifying as Christian (compared to non-Christian) and reporting stronger homophobic beliefs were associated with reduced odds of discussing PrEP with patients. In the multivariable model, only homophobia remained statistically significant (OR, 0.24; 95% CI: 0.07-0.63). CONCLUSION The findings suggest that physicians in Jamacia may be willing to prescribe PrEP; however, homophobia is a barrier to discussions, underscoring the need for the Ministry of Health and Wellness to recognize the role that homophobia plays in the national HIV program to further reduce HIV incidence in Jamaica.
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Affiliation(s)
- Melonie M Walcott
- School of Public Health, University at Albany, Rensselaer, New York, USA
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Meghan Tipre
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vijay Nandi
- Laboratory of Data Analytics, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Alissa Davis
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
| | - Elwin Wu
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
| | | | - Victoria Frye
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
- Community Health and Social Medicine (CSOM), City University of New York, New York, NY, USA
| | - J Peter Figueroa
- Department of Columbia, University School of Social Work, New York, NY, USA
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Andrews C, Reuter TK, Londono V, Claye L, Aung M, Jolly P. "It's Not Good to Be Sick and Have the Child": Perspectives on Pregnancy After HIV-Positive Diagnosis Among Women in Western Jamaica. Int J Womens Health 2022; 14:565-573. [PMID: 35479291 PMCID: PMC9037423 DOI: 10.2147/ijwh.s352343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To identify factors associated with reproductive decision-making for women living with HIV in Western Jamaica, to assess their confidence in anti-retroviral therapy to reduce the chances of mother to child transmission of HIV, and to better understand the experience of stigmatization surrounding becoming pregnant after HIV diagnosis. Participants and Methods Two focus groups were conducted among women living with HIV in the four parishes of Western Jamaica in 2011. A trained moderator conducted the focus groups along with two student notetakers. Qualitative coding and content analysis were used to identify common themes and exemplary quotations characterizing those themes. Results Participants agree that adherence to antiretroviral therapy as prescribed by a physician facilitates better health and longevity; however, they were conflicted on the efficacy of the therapy to prevent mother to child transmission of the virus. Participants report that becoming pregnant after HIV diagnosis continues to be highly stigmatized. Among participants, fear of MTCT and concern that their children will be mistreated are the primary drivers of reproductive decision-making. Conclusion Despite advances in HIV treatment and assisted technologies to prevent MTCT, participants show skepticism that ARV medication is effective at preventing MTCT. Stigma and discriminatory behavior by community members and health-care professionals continue to shape reproductive decision-making for the women who participated in this study. More informed counseling that includes education on recent advancements in HIV treatment and its efficacy at preventing MTCT should be more widely available to pregnant women. To reduce stigma and discriminatory behavior, this education should extend to the larger community.
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Affiliation(s)
- Courtney Andrews
- Institute for Human Rights, University of Alabama at Birmingham, Birmingham, Alabama, USA, Birmingham, AL, USA
| | - Tina Kempin Reuter
- Institute for Human Rights, University of Alabama at Birmingham, Birmingham, Alabama, USA, Birmingham, AL, USA
| | - Valeria Londono
- Minority Health Research Training, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lea Claye
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maung Aung
- Epidemiology and Research Unit, Western Regional Health Authority, Ministry of Health, Montego Bay, Jamaica
| | - Pauline Jolly
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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