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Hepatitis B, C and human immunodeficiency virus knowledge among the general greek population: results from the Hprolipsis nationwide survey. BMC Public Health 2022; 22:2026. [PMCID: PMC9637311 DOI: 10.1186/s12889-022-14353-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 09/09/2022] [Indexed: 11/08/2022] Open
Abstract
Abstract
Background
Although several studies on hepatitis B (HBV), C (HCV) and human immunodeficiency virus (HIV) infection have been conducted in Greece, little is known on the knowledge level of the Greek population towards these three infections. Our aim was to assess the knowledge level of the adult Greek general population about the HBV, HCV and HIV.
Methods
Data were derived from the first general population health survey, Hprolipsis. The sample was selected by multistage stratified random sampling. A standardized questionnaire was administered by trained interviewers during home visits. A knowledge score was constructed based on responses to 17 per infection selected items and categorized in three levels; high (12–17 correct replies) medium (6–11) and low (0–5). Among 8,341 eligible individuals, 6,006 were recruited (response rate: 72%) and 5,878 adults (≥ 18 years) were included in the analysis. The statistical analysis accounted for the study design.
Results
Only 30.4%, 21.6%, and 29.6% of the participants had a high overall knowledge level of HBV, HCV and HIV, respectively. These low percentages were mainly attributed to the high levels of misconception about transmission modes (65.9%, 67.2%, and 67.9%, respectively). Results showed that increasing age and living out of the big metropolitan cities were associated with decreased odds of having higher knowledge. Female gender, higher education level, higher monthly family income, higher medical risk score, history of testing and being born in Greece or Cyprus, were associated with increased odds of having higher knowledge.
Conclusions
There are significant knowledge gaps in the Greek general population regarding modes of transmission, preventive measures and treatment availability for HBV, HCV and HIV. There is an urgent need for large scale but also localized awareness activities targeted to less privileged populations, to fill the gaps in knowledge and increase population engagement in preventive measures.
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KORUNMASIZ CİNSEL İLİŞKİ SONUCU ÜRETRİT TANISI ALAN SÜNNETLİ HASTALARDA ASEMPTOMATİK HIV, HEPATİT B, HEPATİT C VE SİFİLİZ GÖRÜLME SIKLIĞI. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1030661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aim: In this study, it was aimed to determine the frequency of asymptomatic Human Immunodeficiency Virus (HIV), Hepatitis B, Hepatitis C, and syphilis in circumcised patients diagnosed with urethritis transmitted by sexual intercourse because of unprotected sexual contact.
Material and Methods: We retrospectively investigated the serological results of HIV, Hepatitis B, Hepatitis C, and Syphilis diseases in 364 male patients diagnosed with urethritis, all of them were circumcised during childhood. The study included patients who applied to the urology outpatient clinic of secondary state hospital between January 2017 and December 2019 with symptoms or signs of urethritis. In the examination, only urethral discharge could be seen without symptoms. After the patients were examined, first void urine samples were taken. Also at the first examination, peripheral blood samples were tested for HIV, Hepatitis B, Hepatitis C, and syphilis antibodies.
Results: As a result of retrospective screening of the serological results of 364 male patients diagnosed with urethritis, Hepatitis B positivity was 1.09% with 4 cases, Hepatitis C positivity was found as 0.27% in 1 case and the Syphilis positivity rate was 1.92% with 7 cases in 364 patients. None of the patients had HIV positivity.
Conclusions: The fact that there was not any encounter of HIV-positive patients in patients diagnosed with urethritis because of unprotected sexual contact led to the thought that circumcision had a protective contribution in these patients with urethritis, who were all circumcised. Also, screening tests, especially syphilis, should be performed on all patients diagnosed with STI infection.
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Touloumi G, Thomadakis C, Pantazis N, Papastamopoulos V, Paparizos V, Metallidis S, Adamis G, Chini M, Psichogiou M, Chrysos G, Sambatakou H, Barbunakis E, Vourli G, Antoniadou A. HIV continuum of care: bridging cross-sectional and longitudinal analyses. AIDS 2022; 36:583-591. [PMID: 34772850 DOI: 10.1097/qad.0000000000003131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to propose a unified continuum-of-care (CoC) analysis combining cross-sectional and longitudinal elements, incorporating time spent between stages. DESIGN The established 90-90-90 target follows a cross-sectional four-stage CoC analysis, lacking information on timing of diagnosis, antiretroviral therapy (ART) initiation, and viral suppression durability. METHODS Data were derived from the Athens Multicenter AIDS Cohort Study (AMACS). In the cross-sectional CoC, we added stratification of diagnosed people with HIV (PWH) by estimated time from infection to diagnosis; of those who ever initiated ART or achieved viral suppression by corresponding current status (in 2018); and cumulative incidence function (CIF) of ART initiation and viral suppression, treating loss-to-follow-up (LTFU) as competing event. Viral suppression was defined as viral load less than 500 copies/ml. Viral suppression durability was assessed by the CIF of viral load rebound. FINDINGS About 89.1% of PWH in 2018 were diagnosed (range of diagnoses: 1980-2018). Median time to diagnosis was 3.5 years (IQR: 1.1-7.0). Among diagnosed, 89.1% were ever treated, of whom 86.7% remained on ART. CIF of ART initiation and LTFU before ART initiation were 80.9 and 6.0% at 5 years since diagnosis, respectively. Among treated, 89.4% achieved viral suppression, of whom 87.4% were currently virally suppressed. The CIF of viral load rebound was 24.2% at 5 years since first viral suppression but substantially reduced in more recent years. INTERPRETATION The proposed analysis highlights time gaps in CoC not evident by the standard cross-sectional approach. Our analysis highlights the need for early diagnosis and identifies late presenters as a key population for interventions that could decrease gaps in the CoC.
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Affiliation(s)
- Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Christos Thomadakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Vasileios Papastamopoulos
- 5th Department of Internal Medicine - Division of Infectious Diseases, Evangelismos General Hospital of Athens
| | - Vasilios Paparizos
- AIDS Unit, Clinic of Venereologic & Dermatologic Diseases, Medical School, National and Kapodistrian University of Athens, Syngros Hospital, Athens
| | - Simeon Metallidis
- 1 Internal Medicine Department, Infectious Diseases Unit, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki
| | - Georgios Adamis
- 1st Department of Internal Medicine and Infectious Diseases Unit, General Hospital of Athens G. Gennimatas
| | - Maria Chini
- 3rd Department of Internal Medicine - Infectious Diseases Unit, Red Cross General Hospital
| | - Mina Psichogiou
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens
| | | | - Helen Sambatakou
- HIV Unit, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Hippokration University General Hospital, Athens
| | - Emmanouil Barbunakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete
| | - Georgia Vourli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
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Stengaard AR, Combs L, Supervie V, Croxford S, Desai S, Sullivan AK, Jakobsen SF, Santos Q, Simões D, Casabona J, Lazarus JV, de Wit JBF, Amort FM, Pharris A, Nerlander L, Raben D. HIV seroprevalence in five key populations in Europe: a systematic literature review, 2009 to 2019. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2021; 26. [PMID: 34823636 PMCID: PMC8619876 DOI: 10.2807/1560-7917.es.2021.26.47.2100044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background In Europe, HIV disproportionately affects men who have sex with men (MSM), people who inject drugs (PWID), prisoners, sex workers, and transgender people. Epidemiological data are primarily available from national HIV case surveillance systems that rarely capture information on sex work, gender identity or imprisonment. Surveillance of HIV prevalence in key populations often occurs as independent studies with no established mechanism for collating such information at the European level. Aim We assessed HIV prevalence in MSM, PWID, prisoners, sex workers, and transgender people in the 30 European Union/European Economic Area countries and the United Kingdom. Methods We conducted a systematic literature review of peer-reviewed studies published during 2009–19, by searching PubMed, Embase and the Cochrane Library. Data are presented in forest plots by country, as simple prevalence or pooled across multiple studies. Results Eighty-seven country- and population-specific studies were identified from 23 countries. The highest number of studies, and the largest variation in HIV prevalence, were identified for MSM, ranging from 2.4–29.0% (19 countries) and PWID, from 0.0–59.5% (13 countries). Prevalence ranged from 0.0–15.6% in prisoners (nine countries), 1.1–8.5% in sex workers (five countries) and was 10.9% in transgender people (one country). Individuals belonging to several key population groups had higher prevalence. Conclusion This review demonstrates that HIV prevalence is highly diverse across population groups and countries. People belonging to multiple key population groups are particularly vulnerable; however, more studies are needed, particularly for sex workers, transgender people and people with multiple risks.
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Affiliation(s)
- Annemarie Rinder Stengaard
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lauren Combs
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Virginie Supervie
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | | | | | - Ann K Sullivan
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Stine Finne Jakobsen
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Quenia Santos
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Simões
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, Porto, Portugal.,Grupo de Ativistas em Tratamentos (GAT), Lisboa, Portugal
| | - Jordi Casabona
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - John B F de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | - Frank M Amort
- FH JOANNEUM, University of Applied Sciences, Bad Gleichenberg, Austria
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Lina Nerlander
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Dorthe Raben
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Perez-Molina JA, Crespillo-Andújar C, Moreno S, Serrano-Villar S, López-Vélez R. Travelling with HIV in the XXI century: Case report and narrative review. Travel Med Infect Dis 2020; 38:101921. [PMID: 33220457 DOI: 10.1016/j.tmaid.2020.101921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/26/2022]
Abstract
The number of migrants and travellers has grown in recent decades. This phenomenon is also true of people living with HIV, given their much-improved life expectancy and quality of life. A significant number of travellers with HIV are migrants returning to their home countries to visit friends and relatives (VFRs). This population constitutes a high-risk group because they travel for longer and often to rural and remote areas and have closer contact with the local population. In this review we discuss the sociodemographic characteristics of travellers with HIV, the differences between conventional travellers and VFRs, and the risks of HIV acquisition and transmission during travel. We also present the most relevant travel-associated illnesses and highlight the particularities of pre-travel advice given to this population, including immunosuppression, responses to vaccines, high incidence of comorbidities, drug interactions, legal and language barriers. The need to integrate these factors based on far less evidence than that available for the general population makes pre-travel advice for travellers with HIV genuinely challenging.
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Affiliation(s)
- Jose A Perez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar, Km 9.1, 28034, Madrid, Spain.
| | - Clara Crespillo-Andújar
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar, Km 9.1, 28034, Madrid, Spain
| | - Santiago Moreno
- HIV Unit, Infectious Diseases Department, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar, Km 9.1, 28034, Madrid, Spain
| | - Sergio Serrano-Villar
- HIV Unit, Infectious Diseases Department, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar, Km 9.1, 28034, Madrid, Spain
| | - Rogelio López-Vélez
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar, Km 9.1, 28034, Madrid, Spain
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Giardina F, Romero-Severson EO, Axelsson M, Svedhem V, Leitner T, Britton T, Albert J. Getting more from heterogeneous HIV-1 surveillance data in a high immigration country: estimation of incidence and undiagnosed population size using multiple biomarkers. Int J Epidemiol 2020; 48:1795-1803. [PMID: 31074780 PMCID: PMC6929534 DOI: 10.1093/ije/dyz100] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2019] [Indexed: 01/08/2023] Open
Abstract
Background Most HIV infections originate from individuals who are undiagnosed and unaware of their infection. Estimation of this quantity from surveillance data is hard because there is incomplete knowledge about (i) the time between infection and diagnosis (TI) for the general population, and (ii) the time between immigration and diagnosis for foreign-born persons. Methods We developed a new statistical method for estimating the incidence of HIV-1 and the number of undiagnosed people living with HIV (PLHIV), based on dynamic modelling of heterogeneous HIV-1 surveillance data. The methods consist of a Bayesian non-linear mixed effects model using multiple biomarkers to estimate TI of HIV-1-positive individuals, and a novel incidence estimator which distinguishes between endogenous and exogenous infections by modelling explicitly the probability that a foreign-born person was infected either before or after immigration. The incidence estimator allows for direct calculation of the number of undiagnosed persons. The new methodology is illustrated combining heterogeneous surveillance data from Sweden between 2003 and 2015. Results A leave-one-out cross-validation study showed that the multiple-biomarker model was more accurate than single biomarkers (mean absolute error 1.01 vs ≥1.95). We estimate that 816 [95% credible interval (CI) 775-865] PLHIV were undiagnosed in 2015, representing a proportion of 10.8% (95% CI 10.3-11.4%) of all PLHIV. Conclusions The proposed methodology will enhance the utility of standard surveillance data streams and will be useful to monitor progress towards and compliance with the 90–90-90 UNAIDS target.
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Affiliation(s)
- Federica Giardina
- Department of Mathematics, Stockholm University, Stockholm, Sweden.,Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ethan O Romero-Severson
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Maria Axelsson
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
| | - Veronica Svedhem
- Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Leitner
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Tom Britton
- Department of Mathematics, Stockholm University, Stockholm, Sweden
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
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Whittaker R, Case KK, Nilsen Ø, Blystad H, Cowan S, Kløvstad H, van Sighem A. Monitoring progress towards the first UNAIDS 90-90-90 target in key populations living with HIV in Norway. BMC Infect Dis 2020; 20:451. [PMID: 32590964 PMCID: PMC7318482 DOI: 10.1186/s12879-020-05178-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/18/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In line with the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, Norway aims for at least 90% of people living with HIV (PLHIV) to know their HIV-status. We produced current estimates of the number of PLHIV and undiagnosed population in Norway, overall and for six key subpopulations: Norwegian-born men who have sex with men (MSM), migrant MSM, Norwegian-born heterosexuals, migrant Sub-Saharan Africa (SSA)-born heterosexuals, migrant non-SSA-born heterosexuals and people who inject drugs. METHODS We used the European Centre for Disease Prevention and Control (ECDC) HIV Modelling Tool on Norwegian HIV surveillance data through 2018 to estimate incidence, time from infection to diagnosis, PLHIV, and the number and proportion undiagnosed. As surveillance data on CD4 count at diagnosis were not collected in Norway, we ran two models; using default model CD4 assumptions, or a proxy for CD4 distribution based on Danish national surveillance data. We also generated alternative overall PLHIV estimates using the Spectrum AIDS Impact Model, to compare with those obtained from the ECDC tool. RESULTS Estimates of the overall number of PLHIV in 2018 using different modelling approaches aligned at approximately 5000. In both ECDC models, the overall number undiagnosed decreased continuously from 2008. The proportion undiagnosed in 2018 was lower using default model CD4 assumptions (7.1% [95%CI: 5.3-8.9%]), than the Danish CD4 proxy (10.2% [8.3-12.1%]). This difference was driven by results for heterosexual migrants. Estimates for Norwegian-born MSM, migrant MSM and Norwegian-born heterosexuals were similar in both models. In these three subpopulations, incidence in 2018 was < 30 new infections, and the number undiagnosed had decreased in recent years. Norwegian-born MSM had the lowest estimated number of undiagnosed infections (45 [30-75], using default CD4 assumptions) and undiagnosed fraction (3.6% [2.4-5.7%], using default CD4 assumptions) in 2018. CONCLUSIONS Results allow cautious confidence in concluding that Norway has achieved the first UNAIDS 90-90-90 target, and clearly highlight the success of prevention strategies among MSM. Estimates for subpopulations strongly influenced by migration remain less clear, and future modelling should appropriately account for all-cause mortality and out-migration, and adjust for time of in-migration.
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Affiliation(s)
- Robert Whittaker
- Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway
- European Program for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Kelsey K. Case
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Øivind Nilsen
- Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway
| | - Hans Blystad
- Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway
| | | | - Hilde Kløvstad
- Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway
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Rüütel K, Lemsalu L, Lätt S, Epštein J, On Behalf Of OptTEST By HiE. Missed opportunities for HIV testing in people diagnosed with HIV, Estonia, 2014 to 2015. ACTA ACUST UNITED AC 2020; 24. [PMID: 30994106 PMCID: PMC6470370 DOI: 10.2807/1560-7917.es.2019.24.15.1800382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Studies of missed opportunities for earlier diagnosis of HIV have shown that patients with undiagnosed HIV often present to healthcare settings numerous times before eventually receiving their diagnosis. Aim The aim of the study was to assess missed opportunities for HIV testing among people newly diagnosed with HIV. Methods In this observational retrospective study, we collected data from the Estonian Health Board on new HIV cases in people aged 16–49 years diagnosed in 2014–15 and from the Estonian Health Insurance Fund database for treatment invoices on their contacts with healthcare services in the 2 years preceding diagnosis. Diagnoses on treatment invoices were categorised as HIV indicator conditions using ICD-10 codes. Results Of 538 newly diagnosed HIV cases (62.5%; 336 men), 82% had visited healthcare services at least once during the 2 years before HIV diagnosis; the mean number of visits was 9.1. Of these, 16% had been tested for HIV and 31% had at least one ICD-10 code for an HIV indicator condition on at least one of their treatment invoices. In 390 cases of HIV indicator conditions, only 5% were tested for HIV. Of all new HIV cases aged 20–49 years from high-incidence regions (defined as priority groups in national testing guidance), 18% had been tested. Conclusions The HIV testing rate in the 2 years before an HIV diagnosis was very low, even in the presence of an HIV indicator condition. This emphasises the importance of implementing the Estonian HIV testing guidelines.
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Affiliation(s)
- Kristi Rüütel
- National Institute for Health Development, Tallinn, Estonia
| | - Liis Lemsalu
- National Institute for Health Development, Tallinn, Estonia
| | - Sirly Lätt
- Estonian Health Insurance Fund, Tallinn, Estonia
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van den Bogaart L, Ranzani A, Oreni L, Giacomelli A, Corbellino M, Rusconi S, Galli M, Antinori S, Ridolfo AL. Overlooked cases of HIV infection: An Italian tale of missed diagnostic opportunities. Eur J Intern Med 2020; 73:30-35. [PMID: 31635999 DOI: 10.1016/j.ejim.2019.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/06/2019] [Accepted: 09/12/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Late diagnoses are still a cause of increased HIV-related morbidity and mortality despite the availability of highly effective treatments. The aim of this study was to identify indicator conditions (ICs) in late presenters with HIV infection (LPs) that may represent missed opportunities of undertaking earlier HIV testing. METHODS The medical records of LPs referred to a specialist clinic in Milan, Italy, between 2011 and 2017 were reviewed to assess the frequency of ICs during the five years preceding diagnosis. Logistic regression analysis was used to investigate the factors associated with missed opportunities of making an earlier diagnosis. RESULTS The analysis considered 203 LPs (60.6% of the patients newly diagnosed as having HIV infection during the study period). Most had had ≥1 medical encounter in the five years before diagnosis, and 54 (26.6%) had been diagnosed as having ≥1 IC without undergoing HIV testing. The most frequent ICs were herpes zoster (19.8%), constitutional symptoms (17.4%) and lympho/thrombocytopenia (12.8%), and the missed opportunities for testing occurred in the settings of primary care (44.9%), specialist medical (38.2%) or surgical services (11.3%), and emergency departments (5.6%). Twenty-five (53.2%) of the 47 subjects with a non AIDS-defining IC had AIDS at the time of the diagnosis of HIV infection. Subjects aged >60 years were at increased risk of missed diagnostic opportunities (aOR 4.80, p = 0.008). CONCLUSION Implementing IC-guided HIV testing in non-specialist settings is an essential means of reducing late diagnoses of HIV infection even in the case of older subjects.
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Affiliation(s)
- Lorena van den Bogaart
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy.
| | - Alice Ranzani
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Letizia Oreni
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Andrea Giacomelli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Stefano Rusconi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
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10
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Touloumi G, Karakosta A, Sypsa V, Petraki I, Anagnostou O, Terzidis A, Voudouri NM, Gavana M, Vantarakis A, Rachiotis G, Kantzanou M, Rosenberg T, Papatheodoridis G, Hatzakis A. Design and Development of a Viral Hepatitis and HIV Infection Screening Program (Hprolipsis) for the General, Greek Roma, and Migrant Populations of Greece: Protocol for Three Cross-Sectional Health Examination Surveys. JMIR Res Protoc 2020; 9:e13578. [PMID: 32004142 PMCID: PMC7055811 DOI: 10.2196/13578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/25/2019] [Accepted: 07/19/2019] [Indexed: 01/17/2023] Open
Abstract
Background Although infectious diseases are globally on the decline, they remain a major global public health problem. Among them, the hepatitis B virus (HBV) or hepatitis C virus (HCV) and HIV infection are of primary interest. Valid prevalence data on these infections are sparse in Greece, especially for vulnerable populations. Objective This study aimed to present the design and methods of Hprolipsis, an integrated viral hepatitis and HIV screening program administered to adults (≥18 years) from the general, Greek Roma, and migrant populations. Its aims were to estimate the prevalence of HBV, HCV, and HIV; assess infectious disease knowledge level; design, implement, and assess population-specific awareness actions; and offer individual counseling and referral when indicated and HBV vaccination to susceptible Roma and migrants. Methods Multistage, stratified, random sampling based on the 2011 Census was applied to select the general population sample, and nonprobability multistage quota sampling was used for Roma and migrant sample selection. Trained personnel made home (general population) or community (Roma and migrants) visits. Collected blood samples were tested for Hepatitis B surface Antigen, Hepatitis B core Antibody, Hepatitis B surface Antibody, Hepatitis C Antibody, and HIV 1,2 Antibody. The surveys were conducted during May 2013 and June 2016. To estimate an HCV prevalence of 1.5% with 0.3 precision, the required general population sample size was estimated to be 6000. As migrants constitute 10% of the whole Greek population, the migrant sample size was set to 600. A feasible sample size of 500 Greek Roma was set. Results In total, 6006 individuals from the general population (response rate 72%), 534 Greek Roma, and 612 migrants were recruited. Blood test results are available for 4245 individuals from the general population, 523 Roma, and 537 migrants. Conclusions Hprolipsis is the first nationwide survey on HBV, HCV, and HIV. Its results will enhance our understanding of the health needs and disease burden of these diseases in the 3 studied populations. Its implementation provided useful recommendations for future studies, particularly in vulnerable populations. International Registered Report Identifier (IRRID) DERR1-10.2196/13578
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Affiliation(s)
- Giota Touloumi
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Argiro Karakosta
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Petraki
- International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Olga Anagnostou
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Agis Terzidis
- International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Niki Maria Voudouri
- Programs of Development, Social Support, and Medical Cooperation (PRAKSIS), Athens, Greece
| | | | - Magda Gavana
- Department of Primary Health Care, General Practice, and Health Services Research, Medical School of Aristotle University, Thessaloniki, Greece
| | - Apostolos Vantarakis
- Environmental Microbiology Unit of Public Health, Medical School, University of Patras, Patra, Greece
| | - George Rachiotis
- Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Larisa, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theofilos Rosenberg
- International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Papatheodoridis
- Department of Gastroenterology, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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11
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Abstract
BACKGROUND Global targets call for a 75% reduction in new HIV infections and AIDS deaths between 2010 and 2020. UNAIDS supports countries to measure progress towards these targets. In 2019, this effort resulted in revised national, regional and global estimates reflecting the best available data. METHODS Spectrum software was used to develop estimates for 170 countries. Country teams from 151 countries developed HIV estimates directly and estimates for an additional 19 country were developed by UNAIDS based on available evidence. 107 countries employed models using HIV prevalence data from sentinel surveillance, routinely collected HIV testing and household surveys while the remaining 63 countries applied models using HIV case surveillance and/or reported AIDS deaths. Model parameters were informed by the UNAIDS Reference Group on Estimates, Modeling and Projections. RESULTS HIV estimates were available for 170 countries representing 99% of the global population. An estimated 37.9 million (uncertainty bounds 32.7-44.0 million) people were living with HIV in 2018. There were 1.7 million (1.4-2.3 million) new infections and 770 000 (570 000-1.1 million) AIDS-related deaths. New HIV infections declined in five of eight regions and AIDS deaths were declining in six of eight regions between 2010 and 2018. CONCLUSION The estimates demonstrate progress towards ending the AIDS epidemic by 2030, however, through 2018 declines in new HIV infections and AIDS-related deaths were not sufficient to meet global interim targets. The UNAIDS estimates have made important contributions to guide decisions about the HIV response at global, regional and country level.
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12
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Matsuoka S, Nagashima M, Sadamasu K, Mori H, Kawahata T, Zaitsu S, Nakamura A, de Souza MS, Matano T. Estimating HIV-1 incidence in Japan from the proportion of recent infections. Prev Med Rep 2019; 16:100994. [PMID: 31720200 PMCID: PMC6838929 DOI: 10.1016/j.pmedr.2019.100994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/07/2019] [Accepted: 09/17/2019] [Indexed: 11/25/2022] Open
Abstract
The first step of the UNAIDS/WHO 90-90-90 targets to encourage early diagnosis with treatment for the control of HIV-1 epidemic is to achieve 90% HIV-1 diagnosis in infected individuals. In Japan, approximately 30% of newly reported cases have been annually identified by AIDS onset, implying that substantial numbers of HIV-1-infected individuals remain undiagnosed. However, the proportion of undiagnosed cases has not yet been determined. In the present study, the proportion of recent HIV-1 infections to newly-diagnosed cases was determined from 2006 to 2015 using a recent infection assay for three metropolitan areas in Japan: Tokyo, Osaka, and Fukuoka. Estimated median periods between infection and diagnosis were 1.0, 1.8, and 2.9 years for Tokyo, Osaka, and Fukuoka, respectively. Estimation of annual HIV-1 incidence by a back-calculation method using these data as well as HIV/AIDS national surveillance data indicated proportions of undiagnosed to new HIV-1 infections from 2006 to 2015 to be 18% in Tokyo, 22% in Osaka, 38% in Fukuoka, and 28% in Japan. This is the first report estimating HIV-1 incidence in Japan using a serological biomarker in combination with national HIV/AIDS surveillance data.
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Affiliation(s)
- Saori Matsuoka
- AIDS Research Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Mami Nagashima
- Division of Microbiology, Tokyo Metropolitan Institute of Public Health, 3-24-1 Hyakunincho, Shinjuku-ku, Tokyo 169-0073, Japan
| | - Kenji Sadamasu
- Division of Microbiology, Tokyo Metropolitan Institute of Public Health, 3-24-1 Hyakunincho, Shinjuku-ku, Tokyo 169-0073, Japan
| | - Haruyo Mori
- Division of Microbiology, Osaka Institute of Public Health, 1-3-69 Nakamichi, Higashinari-ku, Osaka 537-0025, Japan
| | - Takuya Kawahata
- Division of Microbiology, Osaka Institute of Public Health, 1-3-69 Nakamichi, Higashinari-ku, Osaka 537-0025, Japan
| | - Shuichi Zaitsu
- Health Science Section, Fukuoka City Institute of Health and Environment, 2-1-34 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
| | - Asako Nakamura
- Division of Virology, Fukuoka Institute of Health and Environmental Sciences, 39 Mukaisano, Dazaihu-shi, Fukuoka 818-0135, Japan
| | - Mark S de Souza
- AIDS Research Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.,SEARCH, Thai Red Cross AIDS Research Centre, 104 Rajdumri Road, Pathumwan, Bangkok 10330, Thailand
| | - Tetsuro Matano
- AIDS Research Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.,Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
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13
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Regine V, Dorrucci M, Pezzotti P, Mammone A, Quinten C, Pharris A, Suligoi B, The Regional Representatives Of The National Hiv Surveillance System. People living with undiagnosed HIV infection and a low CD4 count: estimates from surveillance data, Italy, 2012 to 2014. ACTA ACUST UNITED AC 2019; 23. [PMID: 29667577 PMCID: PMC6836199 DOI: 10.2807/1560-7917.es.2018.23.15.17-00240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background and aims Late HIV diagnosis is associated with onward HIV transmission, higher morbidity, mortality and healthcare costs. In Italy, more than half of people living with HIV were diagnosed late during the last decade, with a CD4 count < 350 cells/mm3 at diagnosis. We aimed to determine the number and characteristics of people living with undiagnosed HIV infection and low CD4 counts in Italy. Methods Data on newly reported HIV diagnoses from 2012 –2014 were obtained from the national HIV surveillance system. We used the European Centre for Disease Prevention and Control HIV modelling tool to calculate the undiagnosed prevalence and yearly diagnosed fraction (YDF) in people with low CD4 count. Results The estimated annual number undiagnosed HIV infections with low CD4 count was on average 6,028 (95% confidence interval (CI): 4,954–8,043) from 2012–2014. In 2014, most of the undiagnosed people with low CD4 count were men (82.8%), a third acquired HIV through sex between men (MSM) (35.0%), and heterosexual transmission (33.4%), respectively. The prevalence of undiagnosed HIV infection was 11.3 (95% CI: 9.3–14.9) per 100,000 residents ranging from 0.7 to 20.8 between Italian regions. Nationally the prevalence rate was 280.4 (95% CI: 173.3–450.2) per 100,000 MSM, 8.3 (95% CI: 4.9–13.6) per 100,000 heterosexual men, and 3.0 (95% CI: 1.4–5.6) per 100,000 women. The YDF was highest among heterosexual women (27.1%; 95% CI: 16.9–45.2%). Conclusions These findings highlight the importance of improving efforts to identify undiagnosed HIV infections primarily among men, both MSM and heterosexual men.
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Affiliation(s)
- Vincenza Regine
- Infectious Diseases Department, Italian National Institute of Health, Rome, Italy
| | - Maria Dorrucci
- Infectious Diseases Department, Italian National Institute of Health, Rome, Italy
| | - Patrizio Pezzotti
- Infectious Diseases Department, Italian National Institute of Health, Rome, Italy
| | - Alessia Mammone
- National Institute for Infectious Diseases 'L. Spallanzani', Rome, Italy
| | - Chantal Quinten
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Barbara Suligoi
- Infectious Diseases Department, Italian National Institute of Health, Rome, Italy
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14
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Fernàndez-López L, Reyes-Urueña J, Agustí C, Kustec T, Serdt M, Klavs I, Casabona J. The COBATEST network: monitoring and evaluation of HIV community-based practices in Europe, 2014-2016. HIV Med 2019; 19 Suppl 1:21-26. [PMID: 29488701 DOI: 10.1111/hiv.12592] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this paper is to describe the data collected by the CBVCT services from the Community-based testing (COBATEST) network, from 2014 to 2016, in order to provide an insight into community-based voluntary counselling and testing (CBVCT) services' testing activity in Europe. METHODS A descriptive analysis of HIV testing activity in CBVCT services that are using the COBATEST tools was performed for the period 2014-2016. RESULTS During the study period, a total of 30 329 HIV tests were performed on 27 934 individuals, of which 1.8% were reactive. Of these reactive tests, 75.8% had a confirmatory test, 92.2% of those were confirmed as positive, and 90.38% of the confirmed positives were linked to care. The total number of tests performed over the study period increased 19.31%. The proportion of confirmatory tests increased from 63.0% to 90.0% and proportion linked to care increased from 84.1% to 93.8%. Most of the tested individuals were men (70.6%), aged between 21 and 35 years (58.5%) and non-foreign born (68.1%). A high proportion of individuals tested were men who have sex with men (MSM; 42.2%). The percentage of reactive screening tests was particularly high among transgender people (8.37%) and among male sex workers (6.38%). Repeat testers had a higher percentage of reactive tests (2.02%) than those tested for first time (1.1%). CONCLUSIONS These results prove the feasibility of collecting standardized data from CBVCT services in different countries across Europe and demonstrate the usefulness of such data.
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Affiliation(s)
- L Fernàndez-López
- Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Badalona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - J Reyes-Urueña
- Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Badalona, Spain
| | - C Agustí
- Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Badalona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - T Kustec
- National Institute of Public Health, Ljubljana, Slovenia
| | - M Serdt
- National Institute of Public Health, Ljubljana, Slovenia
| | - I Klavs
- National Institute of Public Health, Ljubljana, Slovenia
| | - J Casabona
- Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Badalona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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15
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Martin-Iguacel R, Pedersen C, Llibre JM, Søndergaard J, Jensen J, Omland LH, Johansen IS, Obel N, Rasmussen LD. Primary health care: an opportunity for early identification of people living with undiagnosed HIV infection. HIV Med 2019; 20:404-417. [PMID: 31016849 DOI: 10.1111/hiv.12735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES We aimed to determine the fraction of HIV-diagnosed individuals who had primary health care (PHC) contacts 3 years prior to HIV diagnosis and whether the risk of HIV diagnosis and degree of immunodeficiency were associated with the frequency of visits or procedures performed. METHODS We used data from national registries to conduct a population-based nested case-control study. Cases were individuals diagnosed with HIV infection in Denmark from 1998 to 2016. Population controls were extracted from the general population matched 13:1 on gender and age. We used conditional logistic regression. As there was a statistically significant interaction, analyses were further stratified by gender and Danish/non-Danish origin. RESULTS We identified 2784 cases and 36 192 controls. Ninety-three per cent of cases and 88% of controls attended PHC at least once in the 3 years prior to diagnosis, with a higher median number of visits to PHC (NVPC) for cases. We found a statistically significant positive association between NVPC and risk of subsequent HIV diagnosis in men and non-Danish women. A U-shaped association between NVPC and risk of HIV diagnosis among Danish women. No substantial association between NVPC and degree of immunodeficiency was found. Risk of HIV diagnosis and degree of immunodeficiency were weakly associated with type of procedures performed. CONCLUSIONS For most HIV-infected individuals, there seem to be many opportunities for earlier diagnosis in PHC. In men and non-Danish women, the risk of HIV diagnosis but not the degree of immunodeficiency was related to NVPC. The results suggest that the type of medical procedure performed cannot not be used as a guide by the primary physician to indicate which patients to test.
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Affiliation(s)
- R Martin-Iguacel
- Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark
| | - C Pedersen
- Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark
| | - J M Llibre
- Fight AIDS Foundation, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
| | - J Søndergaard
- Department of Public Health, The Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - J Jensen
- Department of Internal Medicine, Kolding Sygehus, Kolding, Denmark
| | - L H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - I S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark
| | - N Obel
- Fight AIDS Foundation, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
| | - L D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark
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16
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Pottie K, Lotfi T, Kilzar L, Howeiss P, Rizk N, Akl EA, Dias S, Biggs BA, Christensen R, Rahman P, Magwood O, Tran A, Rowbotham N, Pharris A, Noori T, Pareek M, Morton R. The Effectiveness and Cost-Effectiveness of Screening for HIV in Migrants in the EU/EEA: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081700. [PMID: 30096905 PMCID: PMC6121945 DOI: 10.3390/ijerph15081700] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/19/2018] [Accepted: 08/01/2018] [Indexed: 01/08/2023]
Abstract
Migrants, defined as individuals who move from their country of origin to another, account for 40% of newly-diagnosed cases of human immunodeficiency virus (HIV) in the European Union/European Economic Area (EU/EEA). Populations at high risk for HIV include migrants, from countries or living in neighbourhoods where HIV is prevalent, and those participating in high risk behaviour. These migrants are at risk of low CD4 counts at diagnosis, increased morbidity, mortality, and onward transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of HIV testing strategies in migrant populations and to estimate their effect on testing uptake, mortality, and resource requirements. Following a systematic overview, we included four systematic reviews on the effectiveness of strategies in non-migrant populations and inferred their effect on migrant populations, as well as eight individual studies on cost-effectiveness/resource requirements. We assessed the certainty of our results using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The systematic reviews reported that HIV tests are highly accurate (rapid test >90% sensitivity, Western blot and ELISA >99% sensitivity). A meta-analysis showed that rapid testing approaches improve the access and uptake of testing (risk ratio = 2.95, 95% CI: 1.69 to 5.16), and were associated with a lower incidence of HIV in the middle-aged women subgroup among marginalised populations at a high risk of HIV exposure and HIV related stigma. Economic evidence on rapid counselling and testing identified strategic advantages with rapid tests. In conclusion, community-based rapid testing programmes may have the potential to improve uptake of HIV testing among migrant populations across a range of EU/EEA settings.
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Affiliation(s)
- Kevin Pottie
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada.
- Departments of Family Medicine & Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Tamara Lotfi
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Lama Kilzar
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Pamela Howeiss
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Nesrine Rizk
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Elie A Akl
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut 1107 2020, Lebanon.
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Sonia Dias
- National School of Public Health, Centro de Investigação em Saúde Pública & GHTM/IHMT, Universidade Nova de Lisboa, 2825-149 Caparica, Portugal.
| | - Beverly-Ann Biggs
- Department of Medicine/RMH at the Doherty Institute, The University of Melbourne Vic Australia, Parkville 3010, Australia.
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark.
- Department of Rheumatology, Odense University Hospital, 5000 Odense, Denmark.
| | - Prinon Rahman
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada.
| | - Olivia Magwood
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada.
| | - Anh Tran
- NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia.
| | - Nick Rowbotham
- NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia.
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control, 16973 Solna, Sweden.
| | - Teymur Noori
- European Centre for Disease Prevention and Control, 16973 Solna, Sweden.
| | - Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 7RH, UK.
| | - Rachael Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia.
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17
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Tavoschi L, Vroling H, Madeddu G, Babudieri S, Monarca R, Vonk Noordegraaf-Schouten M, Beer N, Gomes Dias J, O’Moore É, Hedrich D, Oordt-Speets A. Active Case Finding for Communicable Diseases in Prison Settings: Increasing Testing Coverage and Uptake Among the Prison Population in the European Union/European Economic Area. Epidemiol Rev 2018; 40:105-120. [PMID: 29648594 PMCID: PMC5982719 DOI: 10.1093/epirev/mxy001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 12/15/2017] [Accepted: 12/15/2017] [Indexed: 12/16/2022] Open
Abstract
Prison populations are disproportionally affected by communicable diseases when compared with the general community because of a complex mix of socioeconomic determinants and environmental factors. Tailored and adequate health care provision in prisons has the potential to reach vulnerable and underserved groups and address their complex needs. We investigated the available evidence on modalities and effectiveness of active case-finding interventions in prisons by searching PubMed, Embase, and the Cochrane Library for records on prison and active case finding with no language limit. Conference abstracts and unpublished research reports also were retrieved. We analyzed the findings by testing modality, outcomes, and study quality. The included 90 records-63 peer-reviewed, 26 from gray literature, and 1 systematic review-reported variously on viral hepatitis, human immunodeficiency virus, sexually transmitted infections, and tuberculosis. No records were retrieved for other communicable diseases. Provider-initiated opt-in testing was the most frequently investigated modality. Testing at entry and provider-initiated testing were reported to result in comparatively higher uptake ranges. However, no comparative studies were identified that reported statistically significant differences between testing modalities. Positivity rates among tested inmates ranged broadly but were generally high for all diseases. The evidence on active case finding in correctional facilities is limited, heterogeneous, and of low quality, making it challenging to draw conclusions on the effect of different testing modalities. Scale-up of provider-initiated testing in European correctional facilities could substantially reduce the undiagnosed fraction and, hence, prevent additional disease transmission in both prison settings and the community at large.
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Affiliation(s)
- Lara Tavoschi
- Surveillance and Response Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Hilde Vroling
- Pallas, Health Research and Consultancy B.V., Rotterdam, the Netherlands
| | - Giordano Madeddu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Sergio Babudieri
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Roberto Monarca
- Health Without Barriers – European Federation for Prison Health, Viterbo, Italy
| | | | - Netta Beer
- Surveillance and Response Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Joana Gomes Dias
- Surveillance and Response Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Éamonn O’Moore
- Department of Health & Justice, Public Health England, London, UK
| | - Dagmar Hedrich
- Public Health Unit, European Monitoring Centre on Drugs and Drug Addiction, Lisbon, Portugal
| | - Anouk Oordt-Speets
- Pallas, Health Research and Consultancy B.V., Rotterdam, the Netherlands
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18
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van Sighem A, Pharris A, Quinten C, Noori T, Amato-Gauci AJ. Reduction in undiagnosed HIV infection in the European Union/European Economic Area, 2012 to 2016. ACTA ACUST UNITED AC 2018; 22. [PMID: 29208159 PMCID: PMC5725787 DOI: 10.2807/1560-7917.es.2017.22.48.17-00771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It is well-documented that early HIV diagnosis and linkage to care reduces morbidity and mortality as well as HIV transmission. We estimated the median time from HIV infection to diagnosis in the European Union/European Economic Area (EU/EEA) at 2.9 years in 2016, with regional variation. Despite evidence of a decline in the number of people living with undiagnosed HIV in the EU/EEA, many remain undiagnosed, including 33% with more advanced HIV infection (CD4 < 350 cells/mm3).
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Affiliation(s)
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Chantal Quinten
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Teymur Noori
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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- The members of the networks are listed at the end of the article
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19
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Reyes-Urueña JM, Campbell CNJ, Vives N, Esteve A, Ambrosioni J, Tural C, Ferrer E, Navarro G, Force L, García I, Masabeu À, Vilaró JM, García de Olalla P, Caylà JA, Miró JM, Casabona J. Estimating the HIV undiagnosed population in Catalonia, Spain: descriptive and comparative data analysis to identify differences in MSM stratified by migrant and Spanish-born population. BMJ Open 2018; 8:e018533. [PMID: 29490955 PMCID: PMC5855442 DOI: 10.1136/bmjopen-2017-018533] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Undiagnosed HIV continues to be a hindrance to efforts aimed at reducing incidence of HIV. The objective of this study was to provide an estimate of the HIV undiagnosed population in Catalonia and compare the HIV care cascade with this step included between high-risk populations. METHODS To estimate HIV incidence, time between infection and diagnosis and the undiagnosed population stratified by CD4 count, we used the ECDC HIV Modelling Tool V.1.2.2. This model uses data on new HIV and AIDS diagnoses from the Catalan HIV/AIDS surveillance system from 2001 to 2013. Data used to estimate the proportion of people enrolled, on ART and virally suppressed in the HIV care cascade were derived from the PISCIS cohort. RESULTS The total number of people living with HIV (PLHIV) in Catalonia in 2013 was 34 729 (32 740 to 36 827), with 12.3% (11.8 to 18.1) of whom were undiagnosed. By 2013, there were 8458 (8101 to 9079) Spanish-born men who have sex with men (MSM) and 2538 (2334 to 2918) migrant MSM living with HIV in Catalonia. A greater proportion of migrant MSM than local MSM was undiagnosed (32% vs 22%). In the subsequent steps of the HIV care cascade, migrants MSM experience greater losses than the Spanish-born MSM: in retention in care (74% vs 55%), in the proportion on combination antiretroviral treatment (70% vs 50%) and virally suppressed (65% vs 46%). CONCLUSIONS By the end of 2013, there were an estimated 34 729 PLHIV in Catalonia, of whom 4271 were still undiagnosed. This study shows that the Catalan epidemic of HIV has continued to expand with the key group sustaining HIV transmission being MSM living with undiagnosed HIV.
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Affiliation(s)
- Juliana Maria Reyes-Urueña
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
- Departament de Pediatria, d'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Colin N J Campbell
- Tuberculosis Section, Centre for Infectious Disease Surveillance and Control, National Infection Service, Public Health England, London, UK
| | - Núria Vives
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
- Departament de Pediatria, d'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Anna Esteve
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
- Departament de Pediatria, d'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Juan Ambrosioni
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Cristina Tural
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Elena Ferrer
- Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Gemma Navarro
- Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain
| | | | | | | | | | - Patricia García de Olalla
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Agencia de Salud Pública de Barcelona, Barcelona, Spain
| | - Joan Artur Caylà
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Agencia de Salud Pública de Barcelona, Barcelona, Spain
| | - Josep M Miró
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Jordi Casabona
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
- Departament de Pediatria, d'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
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20
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Ricci A, Allende A, Bolton D, Chemaly M, Davies R, Fernández Escámez PS, Girones R, Herman L, Koutsoumanis K, Nørrung B, Robertson L, Ru G, Sanaa M, Simmons M, Skandamis P, Snary E, Speybroeck N, Ter Kuile B, Threlfall J, Wahlström H, Takkinen J, Wagner M, Arcella D, Da Silva Felicio MT, Georgiadis M, Messens W, Lindqvist R. Listeria monocytogenes contamination of ready-to-eat foods and the risk for human health in the EU. EFSA J 2018; 16:e05134. [PMID: 32760461 PMCID: PMC7391409 DOI: 10.2903/j.efsa.2018.5134] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Food safety criteria for Listeria monocytogenes in ready-to-eat (RTE) foods have been applied from 2006 onwards (Commission Regulation (EC) 2073/2005). Still, human invasive listeriosis was reported to increase over the period 2009-2013 in the European Union and European Economic Area (EU/EEA). Time series analysis for the 2008-2015 period in the EU/EEA indicated an increasing trend of the monthly notified incidence rate of confirmed human invasive listeriosis of the over 75 age groups and female age group between 25 and 44 years old (probably related to pregnancies). A conceptual model was used to identify factors in the food chain as potential drivers for L. monocytogenes contamination of RTE foods and listeriosis. Factors were related to the host (i. population size of the elderly and/or susceptible people; ii. underlying condition rate), the food (iii. L. monocytogenes prevalence in RTE food at retail; iv. L. monocytogenes concentration in RTE food at retail; v. storage conditions after retail; vi. consumption), the national surveillance systems (vii. improved surveillance), and/or the bacterium (viii. virulence). Factors considered likely to be responsible for the increasing trend in cases are the increased population size of the elderly and susceptible population except for the 25-44 female age group. For the increased incidence rates and cases, the likely factor is the increased proportion of susceptible persons in the age groups over 45 years old for both genders. Quantitative modelling suggests that more than 90% of invasive listeriosis is caused by ingestion of RTE food containing > 2,000 colony forming units (CFU)/g, and that one-third of cases are due to growth in the consumer phase. Awareness should be increased among stakeholders, especially in relation to susceptible risk groups. Innovative methodologies including whole genome sequencing (WGS) for strain identification and monitoring of trends are recommended.
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Limousi F, Lert F, Desgrées du Loû A, Dray-Spira R, Lydié N. Dynamic of HIV-testing after arrival in France for migrants from sub-Saharan Africa: The role of both health and social care systems. PLoS One 2017; 12:e0188751. [PMID: 29267347 PMCID: PMC5739385 DOI: 10.1371/journal.pone.0188751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 11/13/2017] [Indexed: 11/24/2022] Open
Abstract
Objective HIV testing is an important tool in the management of the HIV epidemic among key populations. We aimed to explore the dynamic of first-time HIV testing in France for sub-Saharan migrants after their arrival. Methods ANRS-Parcours is a retrospective life-event survey conducted from 2012 to 2013 in healthcare facilities in the Paris region, among 926 sub-Saharan HIV-infected migrants and 763 non-infected migrants. After describing the time to first HIV test in France and associated circumstances, we performed a discrete-time logistic regression to analyze the influence of socioeconomic position, contact with the healthcare system and sexual behaviors, on first-time HIV testing in France in migrants who arrived after 2000. Results Median first-time HIV testing occurred during the second year spent in France for non-infected men and women in both groups, and during the first year for men of the HIV group. The probability of testing increased with hospitalization and pregnancy for women of both groups. For non-infected men unemployment and absence of a residence permit were associated with an increased probability of HIV testing [respectively, OR = 2.2 (1.2–4.1) and OR = 2.0 (1.1–3.5)]. Unemployment was also associated with an increased probability of first-time HIV-testing for women of the HIV group [OR: 1.7 (1.0–2.7)]. Occasional and multiple sexual relationships were associated with an increased probability of first-time testing only for HIV-infected women [OR: 2.2 (1.2–4.0) and OR = 2.4 (1.3–4.6)]. Conclusion Access to first HIV testing in France is promoted by contact with the health care system and is facilitated for unemployed and undocumented migrants after arrival.However, testing should be offered more systematically and repeated in order to reduce time between HIV infection and diagnosis, especially for deprived people which are particularly vulnerable regarding HIV infection.
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Affiliation(s)
| | - France Lert
- Institut National de la Santé et de la Recherche Médicale (INSERM), CESP-U 1018, Villejuif, France
| | - Annabel Desgrées du Loû
- CEPED, UMR Institut de Recherche pour le développement (IRD)-Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Rosemary Dray-Spira
- Sorbonne Universités, UPMC Univ Paris 06, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
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22
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Aïm-Eusébi A, Prothon E, Majerholc C, Barger D, Yazdanpanah Y, Aubert JP. The acceptability and effectiveness of a questionnaire for the identification of risk factors for HIV and hepatitis B and C: An observational study in general practice. Eur J Gen Pract 2017; 24:60-67. [PMID: 29172800 PMCID: PMC5795630 DOI: 10.1080/13814788.2017.1400529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Many people in Europe remain undiagnosed for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV). Objectives: To evaluate acceptability and effectiveness of a questionnaire designed to facilitate identification of risk factors for these viruses. Methods: We performed an observational study, in a prospectively enrolled cohort of patients in Paris (France) seen in 2014. Eighteen GPs administered a questionnaire to the first 50 patients, collecting information about risk factors. GPs were randomized into two groups: A (self-administered questionnaire) and B (GP-administered questionnaire). We used the overall response rate to assess the acceptability of the questionnaire. We used the rate of newly identified risk factors and compared the number of tests performed one year before and immediately after the intervention to assess the effectiveness of the questionnaire. Results: 842 patients were randomized: 349 (41.5%) in group A and 493 (58.5%) in group B. Acceptability was 88.5% (95%CI: 86.3–90.6); 93.1% (95%CI: 90.5–95.8) in-group A and 85.2% (95%CI: 82.1–88.3) in group B (P = 0.0004). Prevalence of risk factors was 51.8% (95%CI: 48.2–54.4) and 58.3% were newly identified (95%CI: 52.9–63.7). The number of HIV tests performed during the four weeks after intervention increased by 27% compared to the same period one year before (P = 0.22). It increased by 113% (P = 0.005) and 135% (P = 0.005) for HBV and HCV, respectively. Conclusion: The questionnaire proved acceptable and effective in identifying risk factors for HIV, HBV and HCV in general practice.
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Affiliation(s)
- Amélie Aïm-Eusébi
- a Département de médecine générale, Sorbonne Paris Cité , Univ. Paris Diderot , Paris , France
| | - Emmanuel Prothon
- b Département de médecine générale , Univ. Bordeaux , Bordeaux , France
| | - Catherine Majerholc
- a Département de médecine générale, Sorbonne Paris Cité , Univ. Paris Diderot , Paris , France
| | - Diana Barger
- c ISPED, Centre INSERM U1219-Bordeaux Population Health , Univ. Bordeaux , Bordeaux , France
| | - Yazdan Yazdanpanah
- d Service de maladies infectieuses et tropicales (SMIT) , AP-HP, Hôpital Bichat , Paris , France
| | - Jean-Pierre Aubert
- a Département de médecine générale, Sorbonne Paris Cité , Univ. Paris Diderot , Paris , France.,e EA Recherche clinique Ville-Hôpital, Méthodologies et Société (REMES) , Paris , France
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Malinverni S, Gennotte AF, Schuster M, De Wit S, Mols P, Libois A. Adherence to HIV post-exposure prophylaxis: A multivariate regression analysis of a 5 years prospective cohort. J Infect 2017; 76:78-85. [PMID: 29074102 DOI: 10.1016/j.jinf.2017.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/26/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Non-occupational post-exposure prophylaxis (nPEP) is a recommended public health intervention after a sexual or percutaneous exposure to human immunodeficiency virus (HIV). METHODS We conducted a prospective observational study recording consultations for nPEP at a reference HIV center in Brussels, Belgium from January 2011 to December 2015. We recorded attendance to follow-up, reported completion of nPEP and pharmacy records to measure adherence. Multivariate logistic regressions were performed to identify independent risk factors for adherence to nPEP and attendance to first follow-up visit at the STI clinic. FINDINGS Among 1881 patients receiving nPEP, 66.4% had a documented completion of a 28-day course of nPEP and 87.3% attended their first follow-up clinic visit. MSM (OR, 1.40; 95%CI, 1.04-1.90), being a native Belgian (OR, 1.50; 95%CI, 1.18-1.90), older age (OR, 1.02; 95%CI, 1.01-1.04), being a sexual assault survivor (OR, 0.59; 95%CI, 0.38-0.91), having had a previous nPEP treatment (OR, 1.44; 95%CI, 1.02-2.02), consultation during daytime (OR, 1.35; 95%CI, 1.07-1.70) and benefitting from a health insurance (OR, 2.11; 95%CI, 1.58-2.89) were significant independent predictors for adherence to nPEP. Patients whose initial treatment was AZT/3TC/IDV/r had similar adherence than patients on d4T/3TC/LPV/r (OR, 0.898; 95%CI, 0.68-1.20). INTERPRETATION Multiple independent risk factors for nPEP retention into care and adherence are present at treatment initiation and might be targeted by tailored interventions. Sexual assault victims are overexposed to deleterious consequences of the lack of health insurance on compliance.
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Affiliation(s)
- Stefano Malinverni
- Emergency Department, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Rue Haute 322, 1000 Brussels, Belgium.
| | - Anne-Françoise Gennotte
- Infectious Diseases Department, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Monica Schuster
- Institute of Development Policy and Management (IOB), University of Antwerp, Antwerp, Belgium
| | - Stéphane De Wit
- Infectious Diseases Department, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Mols
- Department of Emergency Medicine, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Agnès Libois
- Infectious Diseases Department, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
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Sasse A. Letter to the editor: New metrics to monitor progress towards global HIV targets: using the estimated number of undiagnosed HIV-infected individuals as denominator. ACTA ACUST UNITED AC 2017; 21:30424. [PMID: 28006652 PMCID: PMC5291133 DOI: 10.2807/1560-7917.es.2016.21.50.30424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/15/2016] [Indexed: 12/23/2022]
Affiliation(s)
- André Sasse
- Scientific Institute of Public Health, Brussels, Belgium
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25
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O'Donnell K, Igoe D. Letter to the editor: Increasing proportion of new HIV diagnoses in Ireland previously diagnosed elsewhere – potential impact on estimating incidence. Euro Surveill 2017; 22:30472. [PMID: 28277221 PMCID: PMC5356429 DOI: 10.2807/1560-7917.es.2017.22.9.30472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 02/27/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Derval Igoe
- Health Protection Surveillance Centre, Dublin, Ireland
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Pharris A, Quinten C, Noori T, Amato-Gauci AJ, van Sighem A. Authors' reply: New metrics to monitor progress towards global HIV targets: using the estimated number of undiagnosed HIV-infected individuals as denominator. Euro Surveill 2016; 21:30428. [PMID: 28006654 PMCID: PMC5291137 DOI: 10.2807/1560-7917.es.2016.21.50.30428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 12/03/2022] Open
Affiliation(s)
- Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Chantal Quinten
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Teymur Noori
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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