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Silberzan L, Bajos N, Kelly‐Irving M. Unveiling the gaps: Hypertension control beyond the cascade of care framework. J Clin Hypertens (Greenwich) 2024; 26:861-866. [PMID: 38852065 PMCID: PMC11232448 DOI: 10.1111/jch.14849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 06/10/2024]
Abstract
This study examines hypertension control beyond the cascade of care framework, which assesses awareness, treatment, and control sequentially. The analysis included 52 434 hypertensive adults (blood pressure (BP) ≥140/90 mm Hg and/or treatment in the past 6 months), aged 25-69, from the French population-based CONSTANCES cohort from 2012 to 2021. The authors assessed the typical "awareness, treatment, and control" scenario and characterized other possible control patterns. The authors found that 13% achieved control. This percentage rose to 19% when considering individuals who were not aware but treated and controlled. This alternative control scenario was associated with female sex, younger age, higher education, Northern-African origin, and reporting prior cardiovascular diseases (CVD). Sub-Saharan African origin, diabetes and overweight/obesity were associated with the typical control scenario. This study highlights that applying a typical sequential cascade of care approach may lead to the exclusion of some specific groups of participants who do not fit into the defined categories.
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Affiliation(s)
- Léna Silberzan
- INSERM, IRIS (UMR8156‐U997)AubervilliersFrance
- UMR1295, Equity research teamToulouse III University‐Paul SabatierToulouseFrance
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Wegener M, Brooks R, Speers S, Nichols L, Villanueva M. Implementing a Surveillance-Based Approach to Create a Statewide Viral Clearance Cascade for Hepatitis C Among People With HIV and HCV Coinfection in Connecticut. Public Health Rep 2024; 139:208-217. [PMID: 37232422 PMCID: PMC10851907 DOI: 10.1177/00333549231172173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES Highly effective direct-acting antiviral medications have made it feasible to achieve elimination of hepatis C virus (HCV), including for people with HIV and HCV coinfection. The Centers for Disease Control and Prevention offers guidance for a laboratory surveillance-based HCV viral clearance cascade, which allows public health departments to track the outcomes of people with HCV based on the following steps: ever infected, virally tested, initial infection, and cured or cleared. We examined the feasibility of this approach among people with HIV and HCV coinfection in Connecticut. METHODS We matched an HIV surveillance database, which included cases from the enhanced HIV/AIDS Reporting System as of December 31, 2019, and the HCV surveillance database, the Connecticut Electronic Disease Surveillance System, to define a cohort of coinfected people. We used HCV laboratory results obtained from January 1, 2016, through August 3, 2020, to determine HCV status. RESULTS Of 1361 people who were ever infected with HCV as of December 31, 2019, 1256 (92.3%) received HCV viral testing, 865 of 1256 people tested (68.9%) were HCV infected, and 336 of 865 infected people (38.8%) were cleared or cured. People who had undetectable HIV viral loads at most recent HIV test (<200 copies/mL) were more likely than those with detectable HIV viral loads to achieve HCV cure (P = .02). CONCLUSIONS A surveillance-based approach that includes data based on the Centers for Disease Control and Prevention HCV viral clearance cascade is feasible to implement, can help track population-level outcomes longitudinally, and can help identify gaps to inform HCV elimination strategies.
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Affiliation(s)
| | - Ralph Brooks
- School of Medicine, Yale University, New Haven, CT, USA
| | - Suzanne Speers
- Connecticut Department of Public Health, Hartford, CT, USA
| | - Lisa Nichols
- School of Medicine, Yale University, New Haven, CT, USA
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Brennan AT, Lauren E, Bor J, George JA, Chetty K, Mlisana K, Dai A, Khoza S, Rosen S, Stokes AC, Raal F, Hibberd P, Alexanian SM, Fox MP, Crowther NJ. Gaps in the type 2 diabetes care cascade: a national perspective using South Africa's National Health Laboratory Service (NHLS) database. BMC Health Serv Res 2023; 23:1452. [PMID: 38129852 PMCID: PMC10740239 DOI: 10.1186/s12913-023-10318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Research out of South Africa estimates the total unmet need for care for those with type 2 diabetes mellitus (diabetes) at 80%. We evaluated the care cascade using South Africa's National Health Laboratory Service (NHLS) database and assessed if HIV infection impacts progression through its stages. METHODS The cohort includes patients from government facilities with their first glycated hemoglobin A1c (HbA1c) or plasma glucose (fasting (FPG); random (RPG)) measured between January 2012 to March 2015 in the NHLS. Lab-diagnosed diabetes was defined as HbA1c ≥ 6.5%, FPG ≥ 7.0mmol/l, or RPG ≥ 11.1mmol/l. Cascade stages post diagnosis were retention-in-care and glycaemic control (defined as an HbA1c < 7.0% or FPG < 8.0mmol/l or RPG < 10.0mmol/l) over 24-months. We estimated gaps at each stage nationally and by people living with HIV (PLWH) and without (PLWOH). RESULTS Of the 373,889 patients tested for diabetes, 43.2% had an HbA1c or blood glucose measure indicating a diabetes diagnosis. Amongst those with lab-diagnosed diabetes, 30.9% were retained-in-care (based on diabetes labs) and 8.7% reached glycaemic control by 24-months. Prevalence of lab-diagnosed diabetes in PLWH was 28.6% versus 47.3% in PLWOH. Among those with lab-diagnosed diabetes, 34.3% of PLWH were retained-in-care versus 30.3% PLWOH. Among people retained-in-care, 33.8% of PLWH reached glycaemic control over 24-months versus 28.6% of PLWOH. CONCLUSIONS In our analysis of South Africa's NHLS database, we observed that 70% of patients diagnosed with diabetes did not maintain in consistent diabetes care, with fewer than 10% reaching glycemic control within 24 months. We noted a disparity in diabetes prevalence between PLWH and PLWOH, potentially linked to different screening methods. These differences underscore the intricacies in care but also emphasize how HIV care practices could guide better management of chronic diseases like diabetes. Our results underscore the imperative for specialized strategies to bolster diabetes care in South Africa.
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Affiliation(s)
- Alana T Brennan
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Evelyn Lauren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jaya A George
- Wits Diagnostic Innovation Hub, University of the Witwatersrand, Johannesburg, South Africa
| | - Kamy Chetty
- National Health Laboratory Service, Johannesburg, South Africa
| | - Koleka Mlisana
- Academic Affairs, Research & Quality Assurance, National Health Laboratory Service, Johannesburg, South Africa
| | - Andrew Dai
- Department of Mathematics and Statistics, Boston University, Boston, USA
| | - Siyabonga Khoza
- National Health Laboratory Service, Johannesburg, South Africa
- Department of Chemical Pathology, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew C Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Frederick Raal
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patricia Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Matthew P Fox
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Nigel J Crowther
- National Health Laboratory Service, Johannesburg, South Africa
- Department of Chemical Pathology, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
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Silberzan L, Kelly-Irving M, Bajos N. [Analysing hypertension in France : A call for an intersectional approach of the cascade of care]. Rev Epidemiol Sante Publique 2023; 71:102159. [PMID: 37729691 DOI: 10.1016/j.respe.2023.102159] [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] [Received: 02/17/2023] [Revised: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Abstract
In metropolitan France, estimates suggest that more than one in three adults has hypertension. Low-cost treatments are available, yet fewer than one in four hypertensive adults has a controlled level of hypertension below 140/90 mmHg. This rate is higher in other high-income countries such as Canada (65%) or Germany (52%). Using a 'cascade of care' model, that decomposes the hypertension care continuum in awareness, treatment, and control, provides a better understanding of the origins of poor control. Furthermore, the theoretical framework of intersectionality, which simultaneously considers social positions of gender, class, and ethno-racial origin, could be used to understand the complexity of the social inequalities observed in hypertension-related outcomes. In this article we conducted a critical review of the international literature to identify new lines of analyses that could be applied to examine complex inequalities in France.
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Affiliation(s)
- L Silberzan
- Inserm-IRIS (UMR8156 - U997), Inserm, Aubervilliers, France; UMR1295, Toulouse III Université, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France.
| | - M Kelly-Irving
- UMR1295, Toulouse III Université, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France
| | - N Bajos
- Inserm-IRIS (UMR8156 - U997), Inserm, Aubervilliers, France
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Azadnajafabad S, Ahmadi N, Rezaei N, Rashidi MM, Saeedi Moghaddam S, Mohammadi E, Abbasi-Kangevari M, Naderian M, Ghasemi E, Farzi Y, Kazemi A, Dilmaghani-Marand A, Yoosefi M, Rezaei S, Nasserinejad M, Fattahi N, Rezaei N, Haghshenas R, Foroutan Mehr E, Koolaji S, Razi F, Djalalinia S, Larijani B, Farzadfar F. Evaluation of the diabetes care cascade and compliance with WHO global coverage targets in Iran based on STEPS survey 2021. Sci Rep 2023; 13:13528. [PMID: 37598214 PMCID: PMC10439917 DOI: 10.1038/s41598-023-39433-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/25/2023] [Indexed: 08/21/2023] Open
Abstract
This study aimed to investigate the diabetes mellitus (DM) and prediabetes epidemiology, care cascade, and compliance with global coverage targets. We recruited the results of the nationally representative Iran STEPS Survey 2021. Diabetes and prediabetes were two main outcomes. Diabetes awareness, treatment coverage, and glycemic control were calculated for all population with diabetes to investigate the care cascade. Four global coverage targets for diabetes developed by the World Health Organization were adopted to assess the DM diagnosis and control status. Among 18,119 participants, the national prevalence of DM and prediabetes were 14.2% (95% confidence interval 13.4-14.9) and 24.8% (23.9-25.7), respectively. The prevalence of DM treatment coverage was 65.0% (62.4-67.7), while the prevalence of good (HbA1C < 7%) glycemic control was 28.0% (25.0-31.0) among all individuals with diabetes. DM diagnosis and statin use statics were close to global targets (73.3% vs 80%, and 50.1% vs 60%); however, good glycemic control and strict blood pressure control statistics, were much way behind the goals (36.7% vs 80%, and 28.5% vs 80%). A major proportion of the Iranian population are affected by DM and prediabetes, and glycemic control is poorly achieved, indicating a sub-optimal care for diabetes and comorbidities like hypertension.
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Affiliation(s)
- Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Naderian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yosef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Kazemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Dilmaghani-Marand
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Mathematics and Statistics, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Shahabeddin Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Human Nutrition Program, Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Maryam Nasserinejad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Nima Fattahi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Foroutan Mehr
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sogol Koolaji
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Razi
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-E-Ahmad Highway, Tehran, 1411713137, Iran.
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Islam MT, Bruce M, Alam K. Cascade of diabetes care in Bangladesh, Bhutan and Nepal: identifying gaps in the screening, diagnosis, treatment and control continuum. Sci Rep 2023; 13:10285. [PMID: 37355725 PMCID: PMC10290703 DOI: 10.1038/s41598-023-37519-w] [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] [Received: 03/31/2023] [Accepted: 06/22/2023] [Indexed: 06/26/2023] Open
Abstract
Diabetes has become a major cause of morbidity and mortality in South Asia. Using the data from the three STEPwise approach to Surveillance (STEPS) surveys conducted in Bangladesh, Bhutan, and Nepal during 2018-2019, this study tried to quantify the gaps in diabetes screening, awareness, treatment, and control in these three South Asian countries. Diabetes care cascade was constructed by decomposing the population with diabetes (diabetes prevalence) in each country into five mutually exclusive and exhaustive categories: (1) unscreened and undiagnosed, (2) screened but undiagnosed, (3) diagnosed but untreated, (4) treated but uncontrolled, (5) treated and controlled. In Bangladesh, Bhutan, and Nepal, among the participants with diabetes, 14.7%, 35.7%, and 4.9% of the participants were treated and controlled, suggesting that 85.3%, 64.3%, and 95.1% of the diabetic population had unmet need for care, respectively. Multivariable logistic regression models were used to explore factors associated with awareness of the diabetes diagnosis. Common influencing factors for awareness of the diabetes diagnosis for Bangladesh and Nepal were living in urban areas [Bangladesh-adjusted odd ratio (AOR):2.1; confidence interval (CI):1.2, 3.6, Nepal-AOR:6.2; CI:1.9, 19.9].
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Affiliation(s)
- Md Tauhidul Islam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia.
| | - Mieghan Bruce
- School of Veterinary Medicine and Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, Perth, WA, 6150, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
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Walters SM, Frank D, Van Ham B, Jaiswal J, Muncan B, Earnshaw V, Schneider J, Friedman SR, Ompad DC. PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure. AIDS Behav 2022; 26:1308-1320. [PMID: 34626265 PMCID: PMC8501360 DOI: 10.1007/s10461-021-03488-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/04/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a medication that prevents HIV acquisition, yet PrEP uptake has been low among people who inject drugs. Stigma has been identified as a fundamental driver of population health and may be a significant barrier to PrEP care engagement among PWID. However, there has been limited research on how stigma operates in rural and urban settings in relation to PrEP. Using in-depth semi-structured qualitative interviews (n = 57) we explore PrEP continuum engagement among people actively injecting drugs in rural and urban settings. Urban participants had more awareness and knowledge. Willingness to use PrEP was similar in both settings. However, no participant was currently using PrEP. Stigmas against drug use, HIV, and sexualities were identified as barriers to PrEP uptake, particularly in the rural setting. Syringe service programs in the urban setting were highlighted as a welcoming space where PWID could socialize and therefore mitigate stigma and foster information sharing.
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Chikafu H, Chimbari M. Hypertension care cascade in the Ingwavuma rural community, uMkhanyakude District, KwaZulu-Natal province of South Africa. PeerJ 2021; 9:e12372. [PMID: 34824908 PMCID: PMC8590801 DOI: 10.7717/peerj.12372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/01/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Treatment and control of hypertension are associated with a substantial reduction in adverse cardiovascular disease outcomes. Although South Africa aims to reduce the burden of cardiovascular diseases, there is limited evidence on the hypertension care cascade (HCC) performance in rural areas where stroke and hypertension are high. This study estimated HCC performance and identified predictors of hypertension screening among adults in the Ingwavuma community of KwaZulu-Natal, South Africa. METHODS This was a cross-sectional study. Data were collected using the WHO STEPwise approach to surveillance (STEPS) questionnaire from 400 adult participants, excluding pregnant women and those with physical or cognitive impairments. Three hundred and ninety-three participants had complete data, and 131 had high blood pressure. We calculated progression rates for screening, diagnosis, treatment and control of hypertension from the sub-sample of participants with high blood pressure and assessed the bivariate association between HCC stages and participant characteristics and their effect sizes. We used binary and multivariable logistic regression to identify predictors of hypertension screening. RESULTS Eighty-eight per cent of participants reported prior screening for hypertension. However, only 53.5% of patients under pharmacological treatment for hypertension had controlled blood pressure. In bivariate regression, employed participants were 80.3% (COR = 0.197, 95% CI [0.042-0.921]) more likely to be screened. In multivariable regression, the likelihood of hypertension screening was 82.4% (AOR = 0.176, 95% CI [0.047-0.655]) lower among participants in a cohabiting union than single participants. Similarly, employed participants were 87.4% (AOR = 0.129, 95% CI [0.017-0.952]) less likely to be screened than their unemployed counterparts. CONCLUSIONS The considerable attrition from the HCC across socio-demographic categories indicates a need for community-wide interventions. Empowering health care workers for community-based health promotion and hypertension management through point-of-care diagnostic tools could improve HCC performance. Efforts to improve the HCC should also focus on social determinants of health, notably gender and formal educational attainment.
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Affiliation(s)
- Herbert Chikafu
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Moses Chimbari
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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Mugglin C, Kläger D, Gueler A, Vanobberghen F, Rice B, Egger M. The HIV care cascade in sub-Saharan Africa: systematic review of published criteria and definitions. J Int AIDS Soc 2021; 24:e25761. [PMID: 34292649 PMCID: PMC8297382 DOI: 10.1002/jia2.25761] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The HIV care cascade examines the attrition of people living with HIV from diagnosis to the use of antiretroviral therapy (ART) and suppression of viral replication. We reviewed the literature from sub-Saharan Africa to assess the definitions used for the different steps in the HIV care cascade. METHODS We searched PubMed, Embase and CINAHL for articles published from January 2004 to December 2020. Longitudinal and cross-sectional studies were included if they reported on at least one step of the UNAIDS 90-90-90 cascade or two steps of an extended 7-step cascade. A step was clearly defined if authors reported definitions for numerator and denominator, including the description of the eligible population and methods of assessment or measurement. The review protocol has been published and registered in Prospero. RESULTS AND DISCUSSION Overall, 3364 articles were screened, and 82 studies from 19 countries met the inclusion criteria. Most studies were from Southern (38 studies, 34 from South Africa) and East Africa (29 studies). Fifty-eight studies (71.6%) were longitudinal, with a median follow-up of three years. The medium number of steps covered out of 7 steps was 3 (interquartile range [IQR] 2 to 4); the median year of publication was 2015 (IQR 2013 to 2019). The number of different definitions for the numerators ranged from four definitions (for step "People living with HIV") to 21 (step "Viral suppression"). For the denominators, it ranged from three definitions ("Diagnosed and aware of HIV status") to 14 ("Viral suppression"). Only 12 studies assessed all three of the 90-90-90 steps. Most studies used longitudinal data, but denominator-denominator or denominator-numerator linkages over several steps were rare. Also, cascade data are lacking for many countries. Our review covers the academic literature but did not consider other data, such as government reports on the HIV care cascade. Also, it did not examine disengagement and reengagement in care. CONCLUSIONS The proportions of patients retained at each step of the HIV care cascade cannot be compared between studies, countries and time periods, nor meta-analysed, due to the many different definitions used for numerators and denominators. There is a need for standardization of methods and definitions.
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Affiliation(s)
- Catrina Mugglin
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Delia Kläger
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Aysel Gueler
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Fiona Vanobberghen
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
- Swiss Tropical and Public Health InstituteBaselSwitzerland
- University of BaselBaselSwitzerland
| | - Brian Rice
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
- Centre for Infectious Disease Epidemiology and Research (CIDER)University of Cape TownCape TownSouth Africa
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
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Metsch LR, Feaster DJ, Gooden LK, Masson C, Perlman DC, Jain MK, Matheson T, Nelson CM, Jacobs P, Tross S, Haynes L, Lucas GM, Colasanti JA, Rodriguez A, Drainoni ML, Osorio G, Nijhawan AE, Jacobson JM, Sullivan M, Metzger D, Vergara-Rodriguez P, Lubelchek R, Duan R, Batycki JN, Matthews AG, Munoz F, Jelstrom E, Mandler R, Del Rio C. Care Facilitation Advances Movement Along the Hepatitis C Care Continuum for Persons With Human Immunodeficiency Virus, Hepatitis C, and Substance Use: A Randomized Clinical Trial (CTN-0064). Open Forum Infect Dis 2021; 8:ofab334. [PMID: 34377726 PMCID: PMC8339611 DOI: 10.1093/ofid/ofab334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022] Open
Abstract
Background Direct-acting antivirals can cure hepatitis C virus (HCV). Persons with HCV/HIV and living with substance use are disadvantaged in benefiting from advances in HCV treatment. Methods In this randomized controlled trial, participants with HCV/HIV were randomized between February 2016 and January 2017 to either care facilitation or control. Twelve-month follow-up assessments were completed in January 2018. Care facilitation group participants received motivation and strengths-based case management addressing retrieval of HCV viral load results, engagement in HCV/HIV care, and medication adherence. Control group participants received referral to HCV evaluation and an offer of assistance in making care appointments. Primary outcome was number of steps achieved along a series of 8 clinical steps (eg, receiving HCV results, initiating treatment, sustained virologic response [SVR]) of the HCV/HIV care continuum over 12 months postrandomization. Results Three hundred eighty-one individuals were screened and 113 randomized. Median age was 51 years; 58.4% of participants were male and 72.6% were Black/African American. Median HIV-1 viral load was 27 209 copies/mL, with 69% having a detectable viral load. Mean number of steps completed was statistically significantly higher in the intervention group vs controls (2.44 vs 1.68 steps; χ 2 [1] = 7.36, P = .0067). Men in the intervention group completed a statistically significantly higher number of steps than controls. Eleven participants achieved SVR with no difference by treatment group. Conclusions The care facilitation intervention increased progress along the HCV/HIV care continuum, as observed for men and not women. Study findings also highlight continued challenges to achieve individual-patient SVR and population-level HCV elimination. Clinical Trials Registration NCT02641158.
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Affiliation(s)
- Lisa R Metsch
- Department of Sociomedical Sciences, Columbia University, New York, New York, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Columbia University, New York, New York, USA
| | - Carmen Masson
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - David C Perlman
- Division of Infectious Diseases, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mamta K Jain
- Division of Infectious Diseases, University of Texas Southwestern Medical Center and Parkland Health & Hospital System, Dallas, Texas, USA
| | - Tim Matheson
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, California, USA
| | - C Mindy Nelson
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Petra Jacobs
- Center for Clinical Trials Network, National Institute on Drug Abuse, Rockville, Maryland, USA
| | - Susan Tross
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Louise Haynes
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gregory M Lucas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Allan Rodriguez
- Infectious Disease, University of Miami, Miami, Florida, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Georgina Osorio
- Division of Infectious Diseases, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ank E Nijhawan
- Division of Infectious Diseases, University of Texas Southwestern Medical Center and Parkland Health & Hospital System, Dallas, Texas, USA
| | - Jeffrey M Jacobson
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Meg Sullivan
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David Metzger
- HIV/AIDS Prevention Research Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pamela Vergara-Rodriguez
- Mental Health and Substance Abuse Division, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA
| | - Ronald Lubelchek
- Infectious Diseases, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA
| | - Rui Duan
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Jacob N Batycki
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Abigail G Matthews
- Data Statistical Center, The Emmes Company, LLC, Rockville, Maryland, USA
| | - Felipe Munoz
- Data Statistical Center, The Emmes Company, LLC, Rockville, Maryland, USA
| | - Eve Jelstrom
- Clinical Coordinating Center, The Emmes Company, LLC, Rockville, Maryland, USA
| | - Raul Mandler
- Clinical/Medical Branch, National Institute on Drug Abuse, Rockville, Maryland, USA
| | - Carlos Del Rio
- Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
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11
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Huang SH, Lee CY, Tsai CS, Tsai MS, Liu CE, Hsu WT, Chen HA, Liu WD, Yang CJ, Sun HY, Ko WC, Lu PL, Lee YT, Hung CC. Screening for Cryptococcal Antigenemia and Burden of Cryptococcosis at the Time of HIV Diagnosis: A Retrospective Multicenter Study. Infect Dis Ther 2021; 10:1363-1377. [PMID: 34057690 PMCID: PMC8322196 DOI: 10.1007/s40121-021-00451-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/22/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction Screening for cryptococcal antigen (CrAg) is recommended for people living with HIV (PLWH) who present with low CD4 lymphocyte counts. Real-world experience is important to identify gaps between the guidelines and clinical practice. We investigated the trends of CrAg testing and prevalence of cryptococcal antigenemia among PLWH at the time of HIV diagnosis and the related mortality in Taiwan from 2009 to 2018. Methods Medical records of newly diagnosed PLWH seeking care at six medical centers around Taiwan between 2009 and 2018 were reviewed. The annual trends of PLWH who had CrAg testing and cryptococcal antigenemia were examined by Cochran-Armitage test. Among PLWH with CD4 < 200 cells/µl, timing of CrAg testing was analyzed for association with 12-month all-cause mortality in Kaplan-Meier plots and in a Cox proportional hazards model after adjustments. Results Among 5372 included PLWH, 1150 (21.4%) presented with baseline CD4 < 100 cells/µl, and this proportion had decreased during the study period [from 108 (29.3%) in 2009 to 93 (22.3%) in 2018 (P = 0.039)]. The overall prevalence of cryptococcal antigenemia was 7.8% among PLWH with CD4 < 100 cells/µl, which remained stable during the 10-year study period (P = 0.356) and was 2.6% among PLWH with CD4 100–199 cells/µl. The uptake of CrAg testing had increased from 65.7% in 2009 to 78.0% in 2018 (P = 0.002) among PLWH with CD4 < 100 cells/µl. Late CrAg testing, defined by 14 days or later after HIV diagnosis, was associated with increased risk of 12-month mortality compared to early CrAg testing (adjusted hazard ratio 2.028, 95% CI 1.109–3.708). Conclusions Burden of cryptococcosis remained high among PLWH with low CD4 lymphocyte counts in Taiwan. Uptake of CrAg screening among late HIV presenters was still suboptimal and delayed. Late CrAg testing was associated with a higher mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00451-5.
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Affiliation(s)
- Sung-Hsi Huang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.,Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Yuan Lee
- Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chin-Shiang Tsai
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Mao-Song Tsai
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Eng Liu
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Wei-Ting Hsu
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu, Yun-Lin County, Taiwan
| | - Hong-An Chen
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wang-Da Liu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, Taiwan.,Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Chia-Jui Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Ti Lee
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chien-Ching Hung
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan. .,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, Taiwan. .,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. .,China Medical University, Taichung, Taiwan.
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12
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Carvour ML, Chiu A, Page K. Visualizing complex healthcare disparities: proof of concept for representing a cyclical continuum of care model for a retrospective cohort of patients with musculoskeletal infections. BMC Musculoskelet Disord 2021; 22:465. [PMID: 34020634 PMCID: PMC8140443 DOI: 10.1186/s12891-021-04358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/12/2021] [Indexed: 11/19/2022] Open
Abstract
Background Care continuum models (also known as care cascade models) are used by researchers and health system planners to identify potential gaps or disparities in healthcare, but these models have limited applications to complex or chronic clinical conditions. Cyclical continuum models that integrate more complex clinical information and that are displayed using circular data visualization tools may help to overcome these limitations. We performed proof-of-concept cyclical continuum modeling for one such group of conditions—musculoskeletal infections—and assessed for racial and ethnic disparities across the complex care process related to these infections. Methods Cyclical continuum modeling was performed in a diverse, retrospective cohort of 1648 patients with musculoskeletal infections, including osteomyelitis, septic arthritis, and/or infectious myositis, in the University of New Mexico Health System. Logistic regression was used to estimate the relative odds of each element or outcome of care in the continuum. Results were visualized using circularized, map-like images depicting the continuum of care. Results Racial and ethnic disparities differed at various phases in the care process. Hispanic/Latinx patients had evidence of healthcare disparities across the continuum, including diabetes mellitus [odds ratio (OR) 2.04, 95% confidence interval (CI): 1.61, 2.60 compared to a white non-Hispanic reference category]; osteomyelitis (OR 1.28, 95% CI: 1.01, 1.63); and amputation (OR 1.48; 95% CI: 1.10, 2.00). Native American patients had evidence of disparities early in the continuum (diabetes mellitus OR 3.59, 95% CI: 2.63, 4.89; peripheral vascular disease OR 2.50; 95% CI: 1.45, 4.30; osteomyelitis OR 1.43; 95% CI: 1.05, 1.95) yet lower odds of later-stage complications (amputation OR 1.02; 95% CI: 0.69, 1.52). African American/Black non-Hispanic patients had higher odds of primary risk factors (diabetes mellitus OR 2.70; 95% CI: 1.41, 5.19; peripheral vascular disease OR 4.96; 95% CI: 2.06, 11.94) and later-stage outcomes (amputation OR 2.74; 95% CI: 1.38, 5.45) but not intervening, secondary risk factors (osteomyelitis OR 0.79; 95% CI: 0.42, 1.48). Conclusions By identifying different structural and clinical barriers to care that may be experienced by groups of patients interacting with the healthcare system, cyclical continuum modeling may be useful for the study of healthcare disparities.
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Affiliation(s)
- Martha L Carvour
- Division of Epidemiology, Biostatistics, and Preventive Medicine; Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico; MSC 10-5550, Albuquerque, NM, 87131, USA. .,Division of Infectious Diseases; Department of Internal Medicine, University of New Mexico, 1 University of New Mexico; MSC 10-5550, Albuquerque, NM, 87131, USA. .,Division of Infectious Diseases; Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Allyssa Chiu
- Division of Epidemiology, Biostatistics, and Preventive Medicine; Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico; MSC 10-5550, Albuquerque, NM, 87131, USA
| | - Kimberly Page
- Division of Epidemiology, Biostatistics, and Preventive Medicine; Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico; MSC 10-5550, Albuquerque, NM, 87131, USA
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13
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Jordan AE, Cleland CM, Schackman BR, Wyka K, Perlman DC, Nash D. Hepatitis C Virus (HCV) Care Continuum Outcomes and HCV Community Viral Loads Among Patients in an Opioid Treatment Program. J Infect Dis 2021; 222:S335-S345. [PMID: 32877560 DOI: 10.1093/infdis/jiz686] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) remains endemic among people who use drugs (PWUD). Measures of HCV community viral load (CVL) and HCV care continuum outcomes may be valuable for ascertaining unmet treatment need and for HCV surveillance and control. METHODS Data from patients in an opioid treatment program during 2013-2016 were used to (1) identify proportions of antibody and viral load (VL) tested, linked-to-care, and treated, in 2013-2014 and 2015-2016, and pre- and postimplementation of qualitative reflex VL testing; (2) calculate engaged-in-care HCV CVL and "documented" and "estimated" unmet treatment need; and (3) examine factors associated with linkage-to-HCV-care. RESULTS Among 11 267 patients, proportions of HCV antibody tested (52.5% in 2013-2014 vs 73.3% in 2015-2016), linked-to-HCV-care (15.7% vs 51.8%), and treated (12.0% vs 44.7%) all increased significantly. Hispanic ethnicity was associated with less linkage-to-care, and Manhattan residence was associated with improved linkage-to-care. The overall engaged-in-care HCV CVL was 4 351 079 copies/mL (standard deviation = 7 149 888); local HCV CVLs varied by subgroup and geography. Documented and estimated unmet treatment need decreased but remained high. CONCLUSIONS After qualitative reflex VL testing was implemented, care continuum outcomes improved, but gaps remained. High rates of unmet treatment need suggest that control of the HCV epidemic among PWUD will require expansion of HCV treatment coverage.
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Affiliation(s)
- Ashly E Jordan
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA.,Center for Drug Use and HIV Research (multi-institutional), New York, New York, USA.,Behavioral Science Training Program in Drug Abuse Research, New York University, New York, New York, USA
| | - Charles M Cleland
- Center for Drug Use and HIV Research (multi-institutional), New York, New York, USA.,Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Bruce R Schackman
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - David C Perlman
- Center for Drug Use and HIV Research (multi-institutional), New York, New York, USA.,Division of Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Denis Nash
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
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Polanco-Pasaje JE, Rodríguez-Márquez I, Tello-Hoyos KY, Torres-Pereda P, Guzmán-Salazar BL, Pérez F. Tuberculosis care cascade for the indigenous population in Colombia: an operational research study. Rev Panam Salud Publica 2021; 45:e20. [PMID: 33643402 PMCID: PMC7901045 DOI: 10.26633/rpsp.2021.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/15/2020] [Indexed: 12/23/2022] Open
Abstract
Objective. Construct and evaluate the care cascade for pulmonary tuberculosis in the indigenous population of the department of Cauca (Colombia) and identify existing gaps. Methods. Mixed-methods sequential explanatory design. In the first phase, the pulmonary tuberculosis care cascade for the indigenous population of Cauca was evaluated. Data were obtained from secondary sources and all cases diagnosed from 1 January 2016 to 31 December 2017 were included. In the second phase, semi-structured interviews were done with nine program coordinators and 11 nursing auxiliaries to explain identified gaps. Absolute and percentage values were estimated for each of the steps and gaps in the care cascade. Quantitative and qualitative results were triangulated. Results. In 2016 and 2017, an estimated 202 patients with respiratory symptoms were expected to be positive and 106 cases of pulmonary tuberculosis were reported among the indigenous population of the department of Cauca. A gap of 47.5% was found for diagnosis, since only 52.5% of subjects were diagnosed in health services. This gap was explained by poor quality of samples and flawed smear techniques; flaws in correct identification of patients with respiratory symptoms; limited access to diagnostic methods, such as culture and molecular tests; and limited training and high turnover of personnel in health service provider institutions. Conclusions. The tuberculosis control program should focus actions on bridging the gap in case detection in the indigenous population.
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Affiliation(s)
- Jhon Edwin Polanco-Pasaje
- Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia Medellín Colombia Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Iader Rodríguez-Márquez
- Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia Medellín Colombia Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Kelly Yoana Tello-Hoyos
- Secretaría de Salud Departamental, Gobernación del Cauca Colombia Secretaría de Salud Departamental, Gobernación del Cauca, Colombia
| | - Pilar Torres-Pereda
- Instituto Nacional de Salud Pública Cuernavaca Mexico Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Bertha Leonor Guzmán-Salazar
- Secretaría de Salud Departamental, Gobernación del Cauca Colombia Secretaría de Salud Departamental, Gobernación del Cauca, Colombia
| | - Freddy Pérez
- Department of Communicable Diseases and Environmental Determinants of Health Pan American Health Organization Washington D.C. United States of America Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington D.C., United States of America
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Polanco-Pasaje JE, Rodríguez-Márquez I, Tello-Hoyos KY, Torres-Pereda P, Guzmán-Salazar BL, Pérez F. [Tuberculosis care cascade for the indigenous population in Colombia: an operational research studyCascata de atenção da tuberculose para os povos indígenas na Colômbia: pesquisa operacional]. Rev Panam Salud Publica 2020; 44:e150. [PMID: 33346246 PMCID: PMC7746001 DOI: 10.26633/rpsp.2020.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
Objetivo Construir y evaluar la cascada de atención de la tuberculosis pulmonar en la población indígena del departamento del Cauca (Colombia) e identificar las brechas existentes. Métodos Metodología mixta con diseño secuencial explicativo. En la primera fase se evaluó la cascada de atención de la tuberculosis pulmonar para la población indígena del Cauca. Se obtuvieron datos de fuentes secundarias y se incluyeron todos los casos diagnosticados entre el 1 de enero del 2016 y el 31 de diciembre de 2017. En la segunda fase, se aplicaron entrevistas semiestructuradas a nueve coordinadores de programa y 11 auxiliares de enfermería para explicar las brechas identificadas. Se estimaron los valores absolutos y porcentuales en cada uno de los pasos y las brechas de la cascada de atención. Se triangularon los resultados cuantitativos y cualitativos. Resultados Durante 2016 y 2017 se estimaron 202 sintomáticos respiratorios esperados positivos y se notificaron 106 casos de tuberculosis pulmonar en la población indígena del departamento del Cauca. Se encontró una brecha de 47,5% para el diagnóstico, ya que solo 52,5% de los sujetos recibieron el diagnóstico en los servicios de salud. Las explicaciones a esta brecha fueron la mala calidad de muestras y fallas en la técnica del extendido, fallas en la correcta identificación del sintomático respiratorio, acceso limitado a métodos diagnósticos como cultivo y pruebas moleculares, así como capacitación escasa y rotación alta de personal al interior de las instituciones prestadoras de servicios de salud. Conclusiones Las acciones del programa de control de tuberculosis deben enfocarse en reducir la brecha de detección de casos en la población indígena.
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Affiliation(s)
- Jhon Edwin Polanco-Pasaje
- Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia Medellín Colombia Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Iader Rodríguez-Márquez
- Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia Medellín Colombia Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Kelly Yoana Tello-Hoyos
- Secretaría de Salud Departamental Gobernación del Cauca Colombia Secretaría de Salud Departamental, Gobernación del Cauca, Colombia
| | - Pilar Torres-Pereda
- Instituto Nacional de Salud Pública Cuernavaca México Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Bertha Leonor Guzmán-Salazar
- Secretaría de Salud Departamental Gobernación del Cauca Colombia Secretaría de Salud Departamental, Gobernación del Cauca, Colombia
| | - Freddy Pérez
- Departamento de Enfermedades Transmisibles y Determinantes Ambientales de la Salud, Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Departamento de Enfermedades Transmisibles y Determinantes Ambientales de la Salud, Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América
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Akl C, Akik C, Ghattas H, Obermeyer CM. The cascade of care in managing hypertension in the Arab world: a systematic assessment of the evidence on awareness, treatment and control. BMC Public Health 2020; 20:835. [PMID: 32493255 PMCID: PMC7268748 DOI: 10.1186/s12889-020-08678-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 04/08/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Hypertension is a leading risk factor for mortality and morbidity globally and in the Arab world. We summarize the evidence on awareness, treatment, and control of hypertension, to assess the extent of gaps in the hypertension continuum of care. We also assess the influence of gender and other social determinants at each level of the cascade of care. METHODS We searched MEDLINE and SSCI databases for studies published between 2000 and 2017, reporting the rates of awareness, treatment or control of hypertension and/or their determinants in the Arab region. We included sources on both general populations and on clinical populations. The review process was based on the PRISMA guidelines. We present rates on the three stages of the care cascade corresponding to (1) awareness (2) treatment and (3) control of blood pressure, and estimated the losses that occur when moving from one stage to another. We also take stock of the evidence on social determinants and assess the statistical significance of gender differences in awareness, treatment and control. RESULTS Data from 73 articles were included. Substantial proportions of hypertensives were lost at each step of the hypertension care continuum, with more missed opportunities for care resulting from lack of awareness of hypertension and from uncontrolled blood pressure. More than 40% and 19% of all hypertensive individuals were found to be unaware and to have uncontrolled blood pressure, respectively, but among individuals diagnosed with hypertension, less than 21% were untreated. Awareness rates were higher among women than men but this advantage was not consistently translated into better blood pressure control rates among women. CONCLUSIONS This analysis of the cascade of care indicates that barriers to proper diagnosis and adequate control are greater than barriers to delivery of treatment, and discusses potential factors that may contribute to the gaps in delivery.
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Affiliation(s)
- Christelle Akl
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut, 1107-2020 Lebanon
| | - Chaza Akik
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut, 1107-2020 Lebanon
| | - Hala Ghattas
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut, 1107-2020 Lebanon
| | - Carla Makhlouf Obermeyer
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut, 1107-2020 Lebanon
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Nash D. Designing and Disseminating Metrics to Support Jurisdictional Efforts to End the Public Health Threat Posed by HIV Epidemics. Am J Public Health 2020; 110:53-57. [PMID: 31800278 DOI: 10.2105/ajph.2019.305398] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The US Department of Health and Human Services has launched a large-scale plan that aims to "End the HIV Epidemic" (EtHE) in America, including ambitious goals and targets over the next 5 to 10 years.To be successful, the EtHE Plan will require timely dissemination of relevant metrics to inform the broad array of stakeholders who are in a position to act in support of the plan's goals. Metrics should include both population health outcome metrics and implementation metrics that track the deployment and uptake of specific intervention delivery strategies. In addition to the usual HIV care continuum metrics that include all people living with HIV in the denominator, metrics dedicated to those not yet reached (i.e., as the denominator) are essential to help target EtHE implementation efforts. Special attention is required around metrics and targets that inform and drive action on HIV-related health disparities.Well-chosen metrics and a well-designed dissemination system can serve as important tools to assess the progress of the EtHE Plan, and to identify and disseminate lessons learned quickly within and across jurisdictions aiming to end HIV as a local public health threat.
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Affiliation(s)
- Denis Nash
- Denis Nash is with the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY, and is executive director of the CUNY Institute for Implementation Science in Population Health. He has served as a member of two governor's task forces in New York, including the Ending the HIV Epidemic Task Force and the Hepatitis C Elimination Task Force
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Kedziora DJ, Abeysuriya R, Kerr CC, Chadderdon GL, Harbuz VȘ, Metzger S, Wilson DP, Stuart RM. The Cascade Analysis Tool: software to analyze and optimize care cascades. Gates Open Res 2020; 3:1488. [PMID: 31942536 PMCID: PMC6944813 DOI: 10.12688/gatesopenres.13031.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction: Cascades, which track the progressive stages of engagement on the path towards a successful outcome, are increasingly being employed to quantitatively assess progress towards targets associated with health and development responses. Maximizing the proportion of people with successful outcomes within a budget-constrained context requires identifying and implementing interventions that are not only effective, but also cost-effective. Methods: We developed a software application called the Cascade Analysis Tool that implements advanced analysis and optimization methods for understanding cascades, combined with the flexibility to enable application across a wide range of areas in health and development. The tool allows users to design the cascade, collate and enter data, and then use the built-in analysis methods in order to answer key policy questions, such as: understanding where the biggest drop-offs along the cascade are; visualizing how the cascade varies by population; investigating the impact of introducing a new intervention or scaling up/down existing interventions; and estimating how available funding should be optimally allocated among available interventions in order to achieve a variety of different objectives selectable by the user (such as optimizing cascade outcomes in target years). The Cascade Analysis Tool is available via a user-friendly web-based application, and comes with a user guide, a library of pre-made examples, and training materials. Discussion: Whilst the Cascade Analysis Tool is still in the early stages of existence, it has already shown promise in preliminary applications, and we believe there is potential for it to help make sense of the increasing quantities of data on cascades.
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Affiliation(s)
- David J Kedziora
- School of Physics, University of Sydney, Physics Rd, Camperdown, Sydney, NSW 2006, Australia.,Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Romesh Abeysuriya
- Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Cliff C Kerr
- School of Physics, University of Sydney, Physics Rd, Camperdown, Sydney, NSW 2006, Australia
| | | | | | - Sarah Metzger
- Bill and Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA, 98109, USA
| | - David P Wilson
- Bill and Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA, 98109, USA
| | - Robyn M Stuart
- Department of Mathematical Sciences, University of Copenhagen, Universitetsparken 5, Copenhagen, 2100, Denmark
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Yan LD, Hanvoravongchai P, Aekplakorn W, Chariyalertsak S, Kessomboon P, Assanangkornchai S, Taneepanichskul S, Neelapaichit N, Stokes AC. Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand. PLoS One 2020; 15:e0226286. [PMID: 31940366 PMCID: PMC6961827 DOI: 10.1371/journal.pone.0226286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/22/2019] [Indexed: 12/31/2022] Open
Abstract
Background Diabetes is a growing challenge in Thailand. Data to assess health system response to diabetes is scarce. We assessed what factors influence diabetes care cascade retention, under universal health coverage. Methods We conducted a cross-sectional analysis of the 2014 Thai National Health Examination Survey. Diabetes was defined as fasting plasma glucose ≥126mg/dL or on treatment. National and regional care cascades were constructed across screening, diagnosis, treatment, and control. Unmet need was defined as the total loss across cascade levels. Logistic regression was used to examine the demographic and healthcare factors associated with cascade attrition. Findings We included 15,663 individuals. Among Thai adults aged 20+ with diabetes, 67.0% (95% CI 60.9% to 73.1%) were screened, 34.0% (95% CI 30.6% to 37.2%) were diagnosed, 33.3% (95% CI 29.9% to 36.7%) were treated, and 26.0% (95% CI 22.9% to 29.1%) were controlled. Total unmet need was 74.0% (95% CI 70.9% to 77.1%), with regional variation ranging from 58.4% (95% CI 45.0% to 71.8%) in South to 78.0% (95% CI 73.0% to 83.0%) in Northeast. Multivariable models indicated older age (OR 1.76), males (OR 0.65), and a higher density of medical staff (OR 2.40) and health centers (OR 1.58) were significantly associated with being diagnosed among people with diabetes. Older age (OR 1.80) and higher geographical density of medical staff (OR 1.82) and health centers (OR 1.56) were significantly associated with being controlled. Conclusions Substantial attrition in the diabetes care continuum was observed at diabetes screening and diagnosis, related to both individual and health system factors. Even with universal health insurance, Thailand still needs effective behavioral and structural interventions, especially in primary health care settings, to address unmet need in diabetes care for its population.
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Affiliation(s)
- Lily D. Yan
- Internal Medicine, Boston Medical Center, Boston, MA, United States of America
| | | | - Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suwat Chariyalertsak
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | - Nareemarn Neelapaichit
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Thailand Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Andrew C. Stokes
- Global Health, Boston University School of Public Health, Boston, MA, United States of America
- * E-mail:
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Sherbuk JE, McManus KA, Kemp Knick T, Canan CE, Flickinger T, Dillingham R. Disparities in Hepatitis C Linkage to Care in the Direct Acting Antiviral Era: Findings From a Referral Clinic With an Embedded Nurse Navigator Model. Front Public Health 2019; 7:362. [PMID: 31828056 PMCID: PMC6890553 DOI: 10.3389/fpubh.2019.00362] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Direct acting antivirals (DAAs) have simplified and expanded access to Hepatitis C virus (HCV) treatment. Only 17% of the 2.4 million Americans with HCV have linked to HCV care. We aimed to evaluate linkage to care (LTC) in a non-urban HCV referral clinic with a nurse navigator model and identify disparities in LTC. Methods: A single-center retrospective cohort analysis was performed among all patients referred to an infectious diseases HCV clinic between 2014 and 2018. The primary outcome was LTC, defined as attendance at a clinic appointment. A multivariable Poisson regression model estimated the association of variables with LTC. Results: Among 824 referred patients, 624 (76%) successfully linked to care and 369 (45%) successfully achieved sustained virologic response. Forty-six percent of those referred were uninsured. On multivariable analysis, LTC rates were higher among women (Incidence Rate Ratio [IRR] 1.11, 95% CI 1.03-1.20, p-value = 0.01) and people with cirrhosis (IRR 1.20, 95% CI 1.11-1.30, p-value < 0.001). Lower LTC rates were found for young people (<40 years; IRR 0.88, 95% CI 0.79-0.98, p-value = 0.02) and uninsured people (IRR 0.85, 95% CI 0.77-0.94, p-value = 0.002). Among those without LTC, 10% were incarcerated. Race, proximity to care, substance use, and HIV status were not associated with LTC. Conclusions: Using an embedded nurse navigator model, high LTC rates were achieved despite the prevalence of barriers, including a high uninsured rate. Disparities in LTC based on age, sex, and insurance status are present. Substance use was not associated with LTC. Future interventions to improve care should include expanded access to insurance and programs bridging care for incarcerated populations.
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Affiliation(s)
- Jacqueline E Sherbuk
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United States
| | - Kathleen A McManus
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United States
| | - Terry Kemp Knick
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United States
| | - Chelsea E Canan
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United States
| | - Tabor Flickinger
- Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United States
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Nemes MIB, Castanheira ERL, Alves AM, Adania CSS, Loch AP, Monroe AA, Souza RA, Gianna MC, Caminada S, Farias NSDO, Sousa PDOE, Domingues CSB, Silva MHD, Cervantes V, Yamashiro J, Caraciolo JMDM, Silva FLD, Nemes Filho A, Jesus GLD, Helena ETDS, Albiero JFG, Lima MSS, Bellenzani R, Kehrig RT, Vale FCD, Nunes LO, Mendonça CS, Zarili TFT, Vilela MC, Dantas JCDO, Paula ID, Tayra Â, Coelho DM, Santos GPD, Quevedo DC, Silva MAD, Silva IBD, Nasser MA, Andrade MC, Santos MA, Mercuri J, Trindade KV, Neves MATD, Toledo RVAD, Almeida MCRD, Lima IN. The QualiRede intervention: improving the performance of care continuum in HIV, congenital syphilis, and hepatitis C in health regions. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22Suppl 1:e190010. [PMID: 31576986 DOI: 10.1590/1980-549720190010.supl.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/24/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). METHODS HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility's process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. RESULTS The indicators are available at www.qualirede.org. The workshops took place in the regions of Alto Tietê, Baixada Santista, Grande ABC, and Registro (São Paulo) and of Foz do Rio Itajaí (Santa Catarina), which resulted in regional action plans in São Paulo, but not in Santa Catarina. A lack of awareness was observed regarding the new HIV and HCV protocols, as well as an incipient use of indicators in routine practices. CONCLUSION Improving the performance of the care continuum requires appropriation of performance indicators and coordination of care flows at local, regional, and state levels of management.
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Affiliation(s)
| | | | - Ana Maroso Alves
- School of Medicine, University of São Paulo - São Paulo (SP), Brazil
| | | | - Ana Paula Loch
- School of Medicine, University of São Paulo - São Paulo (SP), Brazil
| | - Aline Aparecida Monroe
- School of Nursing of Ribeirão Preto, University of São Paulo - Ribeirão Preto (SP), Brazil
| | - Rosa Alencar Souza
- State Program of STD/AIDS, Center for Referral and Training in STD/AIDS, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
| | - Maria Clara Gianna
- State Program of STD/AIDS, Center for Referral and Training in STD/AIDS, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
| | - Sirlene Caminada
- State Program of Viral Hepatitis, Epidemiological Surveillance Center, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
| | - Norma Suely de Oliveira Farias
- State Program of Viral Hepatitis, Epidemiological Surveillance Center, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
| | - Paula de Oliveira E Sousa
- State Program of STD/AIDS, Center for Referral and Training in STD/AIDS, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
| | - Carmen Silva Bruniera Domingues
- State Program of STD/AIDS, Center for Referral and Training in STD/AIDS, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
| | - Mariliza Henrique da Silva
- State Program of STD/AIDS, Center for Referral and Training in STD/AIDS, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
| | - Vilma Cervantes
- State Program of STD/AIDS, Center for Referral and Training in STD/AIDS, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
| | - Juliana Yamashiro
- State Program of Viral Hepatitis, Epidemiological Surveillance Center, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
| | | | | | | | | | | | | | | | | | | | | | - Luceime Olivia Nunes
- School of Medicine of Botucatu, São Paulo State University - Botucatu (SP), Brazil
| | | | | | - Mara Cristina Vilela
- State Program of STD/AIDS, Center for Referral and Training in STD/AIDS, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
| | - Jean Carlos de Oliveira Dantas
- State Program of STD/AIDS, Center for Referral and Training in STD/AIDS, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
| | - Ivone de Paula
- State Program of STD/AIDS, Center for Referral and Training in STD/AIDS, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
| | - Ângela Tayra
- State Program of STD/AIDS, Center for Referral and Training in STD/AIDS, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
| | - Débora Moraes Coelho
- State Program of Viral Hepatitis, Epidemiological Surveillance Center, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
| | | | - Dulce Castro Quevedo
- Epidemiological Surveillance Board, State Secretariat of Health of Santa Catarina - Florianópolis (SC), Brazil
| | - Marcia Aparecida da Silva
- Epidemiological Surveillance Board, State Secretariat of Health of Santa Catarina - Florianópolis (SC), Brazil
| | - Iraci Batista da Silva
- Coordination of Primary Health Care, State Secretariat of Health of Santa Catarina - Florianópolis (SC), Brazil
| | - Mariana Arantes Nasser
- Department of Preventive Medicine, São Paulo School of Medicine, Federal University of São Paulo - São Paulo (SP), Brazil
| | | | | | - Juliana Mercuri
- School of Medicine, University of São Paulo - São Paulo (SP), Brazil
| | - Katia Valeska Trindade
- State Program of STD/AIDS, Center for Referral and Training in STD/AIDS, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
| | | | | | | | - Iraty Nunes Lima
- Epidemiological Surveillance Center, State Secretariat of Health of São Paulo - São Paulo (SP), Brazil
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Nash D, Robertson M. How to Evolve the Response to the Global HIV Epidemic With New Metrics and Targets Based on Pre-Treatment CD4 Counts. Curr HIV/AIDS Rep 2019; 16:304-313. [PMID: 31278620 PMCID: PMC10938289 DOI: 10.1007/s11904-019-00452-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF THE REVIEW Early diagnosis and treatment of HIV following seroconversion improves individual and population health. Using published data on pre-treatment CD4 cell counts, we benchmarked the level of immunodeficiency at HIV diagnosis and ART initiation in the "real world" against those of the treatment and control arms of landmark controlled trials that successfully reduced HIV-related deaths (INSIGHT/START) and onward HIV transmission (HPTN 052). RECENT FINDINGS The median CD4 count in the treatment vs. control arms of the INSIGHT/START trial and HPTN 052 were 650 vs. 408 cells/μL and 442 vs. 221 cells/μL, respectively. In the real world, recent global estimates of the median CD4 count at start of ART range from 234 to 350 cells/μL, and only 25% of those initiating ART do so early (i.e., with CD4 > 500 cells/μL). Recent global data on trends in the median CD4 count at diagnosis and ART initiation are not encouraging. We identify a critical need for new targets and metrics for persons newly diagnosed with HIV, newly enrolling in HIV care, and newly initiating ART, based on pre-treatment CD4 counts, to help increase the focus of implementation efforts on achieving earlier diagnosis, linkage to care, and ART initiation.
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Affiliation(s)
- Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA.
- Department of Epidemiology and Biostatistics, CUNY School of Public Health, New York, NY, USA.
- CUNY Institute for Implementation Science in Population Health, 55 W. 125th St., 6th Floor, New York, NY, USA.
| | - McKaylee Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, NY, USA
- Department of Epidemiology and Biostatistics, CUNY School of Public Health, New York, NY, USA
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Kedziora DJ, Abeysuriya R, Kerr CC, Chadderdon GL, Harbuz VȘ, Metzger S, Wilson DP, Stuart RM. The Cascade Analysis Tool: software to analyze and optimize care cascades. Gates Open Res 2019; 3:1488. [PMID: 31942536 PMCID: PMC6944813 DOI: 10.12688/gatesopenres.13031.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 08/01/2023] Open
Abstract
Introduction: Cascades, which track the progressive stages of engagement on the path towards a successful outcome, are increasingly being employed to quantitatively assess progress towards targets associated with health and development responses. Maximizing the proportion of people with successful outcomes within a budget-constrained context requires identifying and implementing interventions that are not only effective, but also cost-effective. Methods: We developed a software application called the Cascade Analysis Tool that implements advanced analysis and optimization methods for understanding cascades, combined with the flexibility to enable application across a wide range of areas in health and development. The tool allows users to design the cascade, collate and enter data, and then use the built-in analysis methods in order to answer key policy questions, such as: understanding where the biggest drop-offs along the cascade are; visualizing how the cascade varies by population; investigating the impact of introducing a new intervention or scaling up/down existing interventions; and estimating how available funding should be optimally allocated among available interventions in order to achieve a variety of different objectives selectable by the user (such as optimizing cascade outcomes in target years). The Cascade Analysis Tool is available via a user-friendly web-based application, and comes with a user guide, a library of pre-made examples, and training materials. Discussion: Whilst the Cascade Analysis Tool is still in the early stages of existence, it has already shown promise in preliminary applications, and we believe there is potential for it to help make sense of the increasing quantities of data on cascades.
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Affiliation(s)
- David J Kedziora
- School of Physics, University of Sydney, Physics Rd, Camperdown, Sydney, NSW 2006, Australia
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Romesh Abeysuriya
- Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Cliff C Kerr
- School of Physics, University of Sydney, Physics Rd, Camperdown, Sydney, NSW 2006, Australia
| | | | | | - Sarah Metzger
- Bill and Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA, 98109, USA
| | - David P Wilson
- Bill and Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA, 98109, USA
| | - Robyn M Stuart
- Department of Mathematical Sciences, University of Copenhagen, Universitetsparken 5, Copenhagen, 2100, Denmark
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Høj SB, Jacka B, Minoyan N, Artenie AA, Bruneau J. Conceptualising access in the direct-acting antiviral era: An integrated framework to inform research and practice in HCV care for people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:11-23. [PMID: 31003825 DOI: 10.1016/j.drugpo.2019.04.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/22/2019] [Accepted: 04/01/2019] [Indexed: 12/17/2022]
Abstract
As direct-acting antiviral (DAA) therapy costs fall and eligibility criteria are relaxed, people who inject drugs (PWID) will increasingly become eligible for HCV treatment. Yet eligibility does not necessarily equate to access. Amidst efforts to expand treatment uptake in this population, we seek to synthesise and clarify the conceptual underpinnings of access to health care for PWID, with a view to informing research and practice. Integrating dominant frameworks of health service utilisation, care seeking processes, and ecological perspectives on health promotion, we present a comprehensive theoretical framework to understand, investigate and intervene upon barriers and facilitators to HCV care for PWID. Built upon the concept of Candidacy, the framework describes access to care as a continually negotiated product of the alignment between individuals, health professionals, and health systems. Individuals must identify themselves as candidates for services and then work to stake this claim; health professionals serve as gatekeepers, adjudicating asserted candidacies within the context of localised operating conditions; and repeated interactions build experiential knowledge and patient-practitioner relationships, influencing identification and assertion of candidacy over time. These processes occur within a complex social ecology of interdependent individual, service, system, and policy factors, on which other established theories provide guidance. There is a pressing need for a deliberate and nuanced theory of health care access to complement efforts to document the HCV 'cascade of care' among PWID. We offer this framework as an organising device for observational research, intervention, and implementation science to expand access to HCV care in this vulnerable population. Using practical examples from the HCV literature, we demonstrate its utility for specifying research questions and intervention targets across multiple levels of influence; describing and testing plausible effect mechanisms; and identifying potential threats to validity or barriers to research translation.
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Affiliation(s)
- Stine Bordier Høj
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada.
| | - Brendan Jacka
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Nanor Minoyan
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada; École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, H3N 1X9, Canada
| | - Andreea Adelina Artenie
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada; École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, H3N 1X9, Canada
| | - Julie Bruneau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada; Département de Médicine Familiale et Médecine d'Urgence, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada.
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Amele S, Peters L, Sluzhynska M, Yakovlev A, Scherrer A, Domingo P, Gerstoft J, Viard JP, Gisinger M, Flisiak R, Bhaghani S, Ristola M, Leen C, Jablonowska E, Wandeler G, Stellbrink H, Falconer K, D'Arminio Monforte A, Horban A, Rockstroh JK, Lundgren JD, Mocroft A. Establishing a hepatitis C continuum of care among HIV/hepatitis C virus-coinfected individuals in EuroSIDA. HIV Med 2019; 20:264-273. [PMID: 30734998 DOI: 10.1111/hiv.12711] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of the study was to establish a methodology for evaluating the hepatitis C continuum of care in HIV/hepatitis C virus (HCV)-coinfected individuals and to characterize the continuum in Europe on 1 January 2015, prior to widespread access to direct-acting antiviral (DAA) therapy. METHODS Stages included in the continuum were as follows: anti-HCV antibody positive, HCV RNA tested, currently HCV RNA positive, ever HCV RNA positive, ever received HCV treatment, completed HCV treatment, follow-up HCV RNA test, and cure. Sustained virological response (SVR) could only be assessed for those with a follow-up HCV RNA test and was defined as a negative HCV RNA result measured > 12 or 24 weeks after stopping treatment. RESULTS Numbers and percentages for the stages of the HCV continuum of care were as follows: anti-HCV positive (n = 5173), HCV RNA tested (4207 of 5173; 81.3%), currently HCV RNA positive (3179 of 5173; 61.5%), ever HCV RNA positive (n = 3876), initiated HCV treatment (1693 of 3876; 43.7%), completed HCV treatment (1598 of 3876; 41.2%), follow-up HCV RNA test to allow SVR assessment (1195 of 3876; 30.8%), and cure (629 of 3876; 16.2%). The proportion that achieved SVR was 52.6% (629 of 1195). There were significant differences between regions at each stage of the continuum (P < 0.0001). CONCLUSIONS In the proposed HCV continuum of care for HIV/HCV-coinfected individuals, we found major gaps at all stages, with almost 20% of anti-HCV-positive individuals having no documented HCV RNA test and a low proportion achieving SVR, in the pre-DAA era.
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Affiliation(s)
- S Amele
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - L Peters
- CHIP, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - M Sluzhynska
- Lviv Regional HIV/AIDS Prevention and Control CTR, Lviv, Ukraine
| | - A Yakovlev
- Medical Academy Botkin Hospital, St Petersburg, Russia
| | - A Scherrer
- University Hospital Zurich, Zurich, Switzerland
| | | | - J Gerstoft
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - J P Viard
- Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu Hospital and Paris Descartes University, Paris, France
| | - M Gisinger
- Medical University Innsbruck, Innsbruck, Austria
| | - R Flisiak
- Department of Infectious Diseases and Hepatology, Medical University, Bialystok, Poland
| | - S Bhaghani
- Department of Infectious Diseases/HIV Medicine, Royal Free London Foundation Trust, London, UK
| | - M Ristola
- Helsinki University Hospital, Helsinki, Finland
| | - C Leen
- Western General Hospital, Edinburgh, UK
| | - E Jablonowska
- Department of Infectious Diseases and Hepatology, Medical University, Lodz, Poland
| | - G Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - K Falconer
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - A Horban
- Warsaw Medical University & Hospital of Infectious Diseases, Warsaw, Poland
| | | | - J D Lundgren
- CHIP, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - A Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
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Yotebieng M, Brazier E, Addison D, Kimmel AD, Cornell M, Keiser O, Parcesepe AM, Onovo A, Lancaster KE, Castelnuovo B, Murnane PM, Cohen CR, Vreeman RC, Davies M, Duda SN, Yiannoutsos CT, Bono RS, Agler R, Bernard C, Syvertsen JL, Sinayobye JD, Wikramanayake R, Sohn AH, von Groote PM, Wandeler G, Leroy V, Williams CF, Wools‐Kaloustian K, Nash D. Research priorities to inform "Treat All" policy implementation for people living with HIV in sub-Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA). J Int AIDS Soc 2019; 22:e25218. [PMID: 30657644 PMCID: PMC6338103 DOI: 10.1002/jia2.25218] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/07/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION "Treat All" - the treatment of all people with HIV, irrespective of disease stage or CD4 cell count - represents a paradigm shift in HIV care that has the potential to end AIDS as a public health threat. With accelerating implementation of Treat All in sub-Saharan Africa (SSA), there is a need for a focused agenda and research to identify and inform strategies for promoting timely uptake of HIV treatment, retention in care, and sustained viral suppression and addressing bottlenecks impeding implementation. METHODS The Delphi approach was used to develop consensus around research priorities for Treat All implementation in SSA. Through an iterative process (June 2017 to March 2018), a set of research priorities was collectively formulated and refined by a technical working group and shared for review, deliberation and prioritization by more than 200 researchers, implementation experts, policy/decision-makers, and HIV community representatives in East, Central, Southern and West Africa. RESULTS AND DISCUSSION The process resulted in a list of nine research priorities for generating evidence to guide Treat All policies, implementation strategies and monitoring efforts. These priorities highlight the need for increased focus on adolescents, men, and those with mental health and substance use disorders - groups that remain underserved in SSA and for whom more effective testing, linkage and care strategies need to be identified. The priorities also reflect consensus on the need to: (1) generate accurate national and sub-national estimates of the size of key populations and describe those who remain underserved along the HIV-care continuum; (2) characterize the timeliness of HIV care and short- and long-term HIV care continuum outcomes, as well as factors influencing timely achievement of these outcomes; (3) estimate the incidence and prevalence of HIV-drug resistance and regimen switching; and (4) identify cost-effective and affordable service delivery models and strategies to optimize uptake and minimize gaps, disparities, and losses along the HIV-care continuum, particularly among underserved populations. CONCLUSIONS Reflecting consensus among a broad group of experts, researchers, policy- and decision-makers, PLWH, and other stakeholders, the resulting research priorities highlight important evidence gaps that are relevant for ministries of health, funders, normative bodies and research networks.
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Affiliation(s)
| | - Ellen Brazier
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
- Department of Epidemiology and BiostatisticsGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNYUSA
| | - Diane Addison
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
- Department of Epidemiology and BiostatisticsGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNYUSA
| | - April D Kimmel
- Department of Health Behavior and PolicyVirginia Commonwealth University School of MedicineRichmondVAUSA
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology& ResearchSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Olivia Keiser
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
| | | | - Amobi Onovo
- University of North Carolina at Chapel HillChapel HillNCUSA
| | | | | | - Pamela M Murnane
- Center for AIDS Prevention StudiesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive SciencesBixby Center for Global Reproductive HealthUniversity of California San FranciscoSan FranciscoCAUSA
| | - Rachel C Vreeman
- Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Mary‐Ann Davies
- School of Public Health and Family MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | | | | | - Rose S Bono
- Department of Health Behavior and PolicyVirginia Commonwealth University School of MedicineRichmondVAUSA
| | | | - Charlotte Bernard
- InsermCentre INSERM U1219‐Epidémiologie‐BiostatistiqueSchool of Public Health (ISPED)University of BordeauxBordeauxFrance
| | | | | | - Radhika Wikramanayake
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
- Department of Epidemiology and BiostatisticsGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNYUSA
| | - Annette H Sohn
- TREAT AsiaamfAR – The Foundation for AIDS ResearchBangkokThailand
| | - Per M von Groote
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Gilles Wandeler
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Valeriane Leroy
- Inserm (French Institute of Health and Medical Research)UMR 1027 Université Toulouse 3ToulouseFrance
| | - Carolyn F Williams
- Epidemiology BranchDivision of AIDS at National Institute of Allergy and Infectious Diseases (NIAID)National Institute of Health (NIH)RockvilleMDUSA
| | | | - Denis Nash
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNYUSA
- Department of Epidemiology and BiostatisticsGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNYUSA
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Vogler IH, Alfieri DF, Gianjacomo HDB, Almeida ERDD, Reiche EMV. Cascade of care for people living with HIV infection in Southern Brazil: results from a public health network. CAD SAUDE PUBLICA 2018; 34:e00009718. [PMID: 30517309 DOI: 10.1590/0102-311x00009718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/05/2018] [Indexed: 11/22/2022] Open
Abstract
The cascade of care for people living with HIV infection (PLHIV) describes steps in diagnosis, linkage and retention in care, as well as the provision and success of combination antiretroviral therapy (cART). The aim of this study was to evaluate the rates regarding the retention in care, on cART, and suppressed viral load for PLHIV attended at a Brazilian public health network. Data on PLHIV from 116 cities of Paraná, Southern Brazil, attended from 2012 to 2015, were retrospectively collected through the Laboratory Tests Control System (SISCEL). The number of PLHIV related to care increased about 22.5% from 2012 to 2015 (4,106 to 5,030 individuals). The proportion of PLHIV retained in care showed a trend toward stabilization around 81.7-86.9%. Every year, the use of cART increased up to 90.3% for PLHIV retained in care. Viral load suppression was achieved by 72.8% of patients on cART and 57.1% by those linked to care. Retention in care and HIV viral suppression were more likely to occur in older PLHIV than younger ones; similarly, patients living in medium-sized cities were more susceptible to these factors than in large- or small-sized cities. In conclusion, the study showed a high level of retention in care and HIV suppression on cART, as well as emphasized that current efforts for treating already-infected PLHIV remain a challenge for our health public institutions and may contribute to highlight steps for improvement of the HIV cascade of care in our population.
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Affiliation(s)
- Ingridt Hildegard Vogler
- Centro de Ciências da Saúde, Universidade Estadual de Londrina, Londrina, Brasil.,Hospital Universitário, Universidade Estadual de Londrina, Londrina, Brasil
| | | | | | - Elaine Regina Delicato de Almeida
- Centro de Ciências da Saúde, Universidade Estadual de Londrina, Londrina, Brasil.,Hospital Universitário, Universidade Estadual de Londrina, Londrina, Brasil
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Nash D, Robertson MM, Penrose K, Chamberlin S, Robbins RS, Braunstein SL, Myers JE, Abraham B, Kulkarni S, Waldron L, Levin B, Irvine MK. Short-term effectiveness of HIV care coordination among persons with recent HIV diagnosis or history of poor HIV outcomes. PLoS One 2018; 13:e0204017. [PMID: 30248136 PMCID: PMC6152971 DOI: 10.1371/journal.pone.0204017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 08/31/2018] [Indexed: 11/25/2022] Open
Abstract
The New York City HIV Care Coordination Program (CCP) combines multiple evidence-based strategies to support persons living with HIV (PLWH) at risk for, or with a recent history of, poor HIV outcomes. We assessed the comparative effectiveness of the CCP by merging programmatic data on CCP clients with population-based surveillance data on all New York City PLWH. A non-CCP comparison group of similar PLWH who met CCP eligibility criteria was identified using surveillance data. The CCP and non-CCP groups were matched on propensity for CCP enrollment within four baseline treatment status groups (newly diagnosed or previously diagnosed and either consistently unsuppressed, inconsistently suppressed or consistently suppressed). We compared CCP to non-CCP proportions with viral load suppression at 12-month follow-up. Among the 13,624 persons included, 15∙3% were newly diagnosed; among the 84∙7% previously diagnosed, 14∙2% were consistently suppressed, 28∙9% were inconsistently suppressed, and 41∙6% were consistently unsuppressed in the year prior to baseline. At 12-month follow-up, 59∙9% of CCP and 53∙9% of non-CCP participants had viral load suppression (Relative Risk = 1.11, 95%CI:1.08–1.14). Among those newly diagnosed and those consistently unsuppressed at baseline, the relative risk of viral load suppression in the CCP versus non-CCP participants was 1.15 (95%CI:1.09–1.23) and 1.32 (95%CI:1.23–1.42), respectively. CCP exposure shows benefits over no CCP exposure for persons newly diagnosed or consistently unsuppressed, but not for persons suppressed in the year prior to baseline. We recommend more targeted case finding for CCP enrollment and increased attention to viral load suppression maintenance.
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Affiliation(s)
- Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY United States of America
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY United States of America
- * E-mail:
| | - McKaylee M. Robertson
- Institute for Implementation Science in Population Health, City University of New York, New York, NY United States of America
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY United States of America
| | - Kate Penrose
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
| | - Stephanie Chamberlin
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
| | - Rebekkah S. Robbins
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
| | - Sarah L. Braunstein
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
| | - Julie E. Myers
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
- Division of Infectious Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY United States of America
| | - Bisrat Abraham
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
| | - Sarah Kulkarni
- Institute for Implementation Science in Population Health, City University of New York, New York, NY United States of America
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY United States of America
| | - Levi Waldron
- Institute for Implementation Science in Population Health, City University of New York, New York, NY United States of America
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY United States of America
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY United States of America
| | - Mary K. Irvine
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
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Austad K, Chary A, Xocop SM, Messmer S, King N, Carlson L, Rohloff P. Barriers to Cervical Cancer Screening and the Cervical Cancer Care Continuum in Rural Guatemala: A Mixed-Method Analysis. J Glob Oncol 2018; 4:1-10. [PMID: 30084698 PMCID: PMC6223515 DOI: 10.1200/jgo.17.00228] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose Cervical cancer is an important cause of mortality in low- and middle-income countries. Although screening technologies continue to improve, systems of care remain fragmented. It is important to better understand factors that affect use of screening services and loss to follow-up along the care continuum. Methods We conducted a mixed-methods study of a cytology-based screening program in rural Guatemala. A retrospective electronic chart review was performed on data from all patients from 2013 to 2014. We analyzed progression through care and calculated loss-to-follow-up rates. We also analyzed the prior experiences of patients with cervical cancer screening on the basis of self-reported historical data available in the chart review. Structured interviews with a subset of individuals to explore social supports and barriers to screening and engagement in care were conducted at the time of screening. Results The analysis included 515 women (median age, 36 years). Cytologic screening showed concern for neoplastic changes in 0.83%; half resulted in biopsy-proven cervical intraepithelial neoplasia. An additional 9.9% showed severe inflammation. The rate of loss to follow-up was 11.3%. All losses to follow-up occurred for severe inflammation, not for cervical intraepithelial neoplasia. Historical data showed that 73% of the cohort had previously been screened and had high levels of loss to follow-up (57.4%). Qualitative interviews revealed factors that promoted loss to follow-up; these included cost, lack of social supports, transportation, distrust in public facilities, long turn-around times, and failure to return test results or offer follow-up treatments. Conclusions Taken together, these quantitative and qualitative results highlight the need for cervical cancer screening programs in Guatemala to improve uptake of screening services by eligible women and to improve follow-up after a first abnormal screen.
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Affiliation(s)
- Kirsten Austad
- Kirsten Austad, Anita Chary, Sandy Mux Xocop, Sarah Messmer, Nora King, and Peter Rohloff, Wuqu’ Kawoq, Maya Health Alliance, Santiago Sacatepéquez, Guatemala; Kirsten Austad, Brigham and Women’s Hospital, Boston, MA; and Lauren Carlson, Mayo Medical School, Minnesota Campus, Rochester, MN
| | - Anita Chary
- Kirsten Austad, Anita Chary, Sandy Mux Xocop, Sarah Messmer, Nora King, and Peter Rohloff, Wuqu’ Kawoq, Maya Health Alliance, Santiago Sacatepéquez, Guatemala; Kirsten Austad, Brigham and Women’s Hospital, Boston, MA; and Lauren Carlson, Mayo Medical School, Minnesota Campus, Rochester, MN
| | - Sandy Mux Xocop
- Kirsten Austad, Anita Chary, Sandy Mux Xocop, Sarah Messmer, Nora King, and Peter Rohloff, Wuqu’ Kawoq, Maya Health Alliance, Santiago Sacatepéquez, Guatemala; Kirsten Austad, Brigham and Women’s Hospital, Boston, MA; and Lauren Carlson, Mayo Medical School, Minnesota Campus, Rochester, MN
| | - Sarah Messmer
- Kirsten Austad, Anita Chary, Sandy Mux Xocop, Sarah Messmer, Nora King, and Peter Rohloff, Wuqu’ Kawoq, Maya Health Alliance, Santiago Sacatepéquez, Guatemala; Kirsten Austad, Brigham and Women’s Hospital, Boston, MA; and Lauren Carlson, Mayo Medical School, Minnesota Campus, Rochester, MN
| | - Nora King
- Kirsten Austad, Anita Chary, Sandy Mux Xocop, Sarah Messmer, Nora King, and Peter Rohloff, Wuqu’ Kawoq, Maya Health Alliance, Santiago Sacatepéquez, Guatemala; Kirsten Austad, Brigham and Women’s Hospital, Boston, MA; and Lauren Carlson, Mayo Medical School, Minnesota Campus, Rochester, MN
| | - Lauren Carlson
- Kirsten Austad, Anita Chary, Sandy Mux Xocop, Sarah Messmer, Nora King, and Peter Rohloff, Wuqu’ Kawoq, Maya Health Alliance, Santiago Sacatepéquez, Guatemala; Kirsten Austad, Brigham and Women’s Hospital, Boston, MA; and Lauren Carlson, Mayo Medical School, Minnesota Campus, Rochester, MN
| | - Peter Rohloff
- Kirsten Austad, Anita Chary, Sandy Mux Xocop, Sarah Messmer, Nora King, and Peter Rohloff, Wuqu’ Kawoq, Maya Health Alliance, Santiago Sacatepéquez, Guatemala; Kirsten Austad, Brigham and Women’s Hospital, Boston, MA; and Lauren Carlson, Mayo Medical School, Minnesota Campus, Rochester, MN
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Moore MS, Bocour A, Laraque F, Winters A. A Surveillance-Based Hepatitis C Care Cascade, New York City, 2017. Public Health Rep 2018; 133:497-501. [PMID: 29902392 DOI: 10.1177/0033354918776641] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The care cascade, a method for tracking population-level progression from diagnosis to cure, is an important tool in addressing and monitoring the hepatitis C virus (HCV) epidemic. However, little agreement exists on appropriate care cascade steps or how best to measure them. The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) sought to construct a care cascade by using laboratory surveillance data with clinically relevant categories that can be readily updated over time. METHODS We identified all NYC residents ever reported to the DOHMH surveillance registry with HCV through June 30, 2017 (n = 175 896). To account for outmigration, death, or treatment before negative RNA results became reportable to the health department, we limited the population to people with any test reported since July 1, 2014. Of these residents, we identified the proportion with a reported positive RNA test and estimated the proportion treated and cured since July 2014 by using DOHMH-developed surveillance-based algorithms. RESULTS Of 78 886 NYC residents ever receiving a diagnosis of HCV and tested since July 1, 2014, a total of 70 397 (89.2%) had ever been reported as RNA positive through June 30, 2017; 36 875 (46.7%) had initiated treatment since July 1, 2014, and 23 766 (30.1%) appeared cured during the same period. CONCLUSION A substantial gap exists between confirming HCV infection and initiating treatment, even in the era of direct-acting antivirals. Using this cascade, we will monitor progress in improved treatment and cure of HCV in NYC.
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Affiliation(s)
- Miranda S Moore
- 1 Viral Hepatitis Program Surveillance Unit, Bureau of Communicable Diseases, Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Angelica Bocour
- 1 Viral Hepatitis Program Surveillance Unit, Bureau of Communicable Diseases, Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Fabienne Laraque
- 1 Viral Hepatitis Program Surveillance Unit, Bureau of Communicable Diseases, Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Ann Winters
- 1 Viral Hepatitis Program Surveillance Unit, Bureau of Communicable Diseases, Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
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Perlman DC, Jordan AE. The Syndemic of Opioid Misuse, Overdose, HCV, and HIV: Structural-Level Causes and Interventions. Curr HIV/AIDS Rep 2018; 15:96-112. [PMID: 29460225 PMCID: PMC5884743 DOI: 10.1007/s11904-018-0390-3] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW This article reviews the case for recognizing (1) the epidemics of opioid misuse, overdose, hepatitis C virus, and HIV as a syndemic and (2) the importance of examining and addressing structural factors in responses to this syndemic. We focus on the current syndemic in the US, but also consider data from other locations to highlight the issues existing and arising in various contexts. RECENT FINDINGS Advances in multi-level theory and statistical methods allow sound ecologic and multi-level analyses of the impact of structural factors on the syndemic. Studies of opioid misuse, overdoses, hepatitis C virus, and HIV demonstrate that area-level access to healthcare, medication-assisted treatment of opioid use disorders, sterile injection equipment, and overdose prevention with naloxone, as well as factors such as opioid marketing, income inequality, intensity of policing activities, and health care policies, are related to the prevalence of substance misuse, overdoses, infection risk, and morbidity. Structural variables can predict area-level vulnerability to the syndemic. The implementation of combined prevention and treatment interventions can control and reverse components of the syndemic. Recognizing and monitoring potent structural factors can facilitate the identification of areas at risk of vulnerability to the syndemic. Further, many structural factors are modifiable through intervention and policy to reduce structural vulnerability and create health-enabling environments. Evidence supports the immediate implementation of broader HCV and HIV testing and substance use screening, medication-assisted treatment, needle/syringe exchange programs, naloxone programs, increased population-level implementation of HCV treatment, and further attention to structural-level factors predicting, and contributing to, area-level vulnerability, such as degrees of opioid marketing, distribution, and prescribing.
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Affiliation(s)
- David C Perlman
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, 350 East 17th St, 19th Floor, New York, NY, 10003, USA.
- Center for Drug Use and HIV Research, New York, NY, 10003, USA.
| | - Ashly E Jordan
- Center for Drug Use and HIV Research, New York, NY, 10003, USA
- City University New York, Graduate School of Public Health and Health Policy, New York, NY, 10016, USA
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Jordan AE, Perlman DC, Smith DJ, Reed JR, Hagan H. Use of the PRECIS-II instrument to categorize reports along the efficacy-effectiveness spectrum in an hepatitis C virus care continuum systematic review and meta-analysis. J Clin Epidemiol 2018; 93:66-75. [PMID: 29102682 PMCID: PMC5767157 DOI: 10.1016/j.jclinepi.2017.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 10/08/2017] [Accepted: 10/11/2017] [Indexed: 01/11/2023]
Abstract
There is increasing recognition of the importance of the distinction between efficacy and effectiveness research in the design, conduct, and evaluation of interventions and program outcomes. There is a concurrent increase in the application of systematic reviews and meta-analyses. These two lines of inquiry are only beginning to meet. There is an emerging need for systematic reviews and meta-analyses to account for differences in degrees to which included studies reflect either efficacy or effectiveness design. Based on ongoing work on a formal systematic review of the hepatitis C virus care continuum, this paper describes and discusses the rationale for, and how the PRECIS-II instrument can be used on, and modestly adapted to, studies included in the systematic review examining the extent to which studies include elements of efficacy or effectiveness or a combination of the two. We also highlight that use of such an instrument may have general applicability to and value in the conduct of systematic reviews and meta-analysis.
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Affiliation(s)
- Ashly E Jordan
- Rory Myers College of Nursing, New York University, 433 First Avenue 7th Floor, New York, NY 10010, USA; Center for Drug Use and HIV Research, New York, NY 10003, USA.
| | - David C Perlman
- Center for Drug Use and HIV Research, New York, NY 10003, USA; Icahn School of Medicine at Mount Sinai Beth Israel, Department of Infectious Disease, Baird Hall, 350 East 17th St 19th Floor, New York, NY 10003, USA
| | - Daniel J Smith
- Rory Myers College of Nursing, New York University, 433 First Avenue 7th Floor, New York, NY 10010, USA
| | - Jennifer R Reed
- Rory Myers College of Nursing, New York University, 433 First Avenue 7th Floor, New York, NY 10010, USA
| | - Holly Hagan
- Rory Myers College of Nursing, New York University, 433 First Avenue 7th Floor, New York, NY 10010, USA; Center for Drug Use and HIV Research, New York, NY 10003, USA
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Jordan AE, Perlman DC, Reed J, Smith DJ, Hagan H. Patterns and Gaps Identified in a Systematic Review of the Hepatitis C Virus Care Continuum in Studies among People Who Use Drugs. Front Public Health 2017; 5:348. [PMID: 29326922 PMCID: PMC5741609 DOI: 10.3389/fpubh.2017.00348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/05/2017] [Indexed: 12/23/2022] Open
Abstract
Introduction Systematic reviews are useful for synthesizing data on various health conditions and for identifying gaps in available data. In the US, the main risk group for hepatitis C virus (HCV) infection is people who use drugs (PWUD); as a group, PWUD have the highest prevalence of chronic HCV. While the care continuum construct has been increasingly applied to studies of HCV care among PWUD, what constitutes the steps in an HCV care continuum is not standardized. We sought to examine the range of HCV care continuum outcomes that studies reported on, to identify gaps in the literature, and to develop strategies that allowed for valuable syntheses of care continuum data. Methods We conducted searches of electronic databases for published literature. Reports were eligible if they provided original data from 1990 to 2016 from the US, presented data on one or more HCV care continuum outcomes, and provided outcome data on PWUD as a distinct group. Results A total of 313 full-text reports were assessed for eligibility. Of 212 potentially eligible reports, 32 (15.1%) did not present outcomes for PWUD separately from those who were non-PWUD. Among 101 eligible reports, a total of 166 care continuum outcomes were extracted; outcomes could be grouped into three categories that represent the HCV care continuum: testing (39.8%, n = 66/166); linkage to care (16.9%, n = 28/166); and treatment (43.4%, n = 72/166). Seventy-four reports (73.3%, n = 74/101) presented data on only one step. Linkage to care occurred variably after only antibody, or after antibody and viral load (VL) testing. Six (5.9%, n = 6/101) reports presented data on all three steps. Conclusion Reports examined a variety of HCV care continuum outcomes that could be grouped into the three steps of testing, linkage to care, and treatment. The application of this care continuum model would facilitate subsequent data synthesis for program comparison and public health evaluation. Given the two-step nature of HCV testing, analyses also need to account for variation in whether linkage to care occurred after antibody testing or after sequential antibody and VL testing. Additional data are needed on the progression of PWUD through the entire care continuum.
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Affiliation(s)
- Ashly E Jordan
- Rory Meyers College of Nursing, New York University, New York, NY, United States.,Center for Drug Use and HIV Research New York, New York, NY, United States
| | - David C Perlman
- Center for Drug Use and HIV Research New York, New York, NY, United States.,Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY, United States
| | - Jennifer Reed
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Daniel J Smith
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Holly Hagan
- Rory Meyers College of Nursing, New York University, New York, NY, United States.,Center for Drug Use and HIV Research New York, New York, NY, United States
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Carvour ML, Chiu A. A Cyclical Approach to Continuum Modeling: A Conceptual Model of Diabetic Foot Care. Front Public Health 2017; 5:337. [PMID: 29276706 PMCID: PMC5727019 DOI: 10.3389/fpubh.2017.00337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/27/2017] [Indexed: 01/25/2023] Open
Abstract
“Cascade” or “continuum” models have been developed for a number of diseases and conditions. These models define the desired, successive steps in care for that disease or condition and depict the proportion of the population that has completed each step. These models may be used to compare care across subgroups or populations and to identify and evaluate interventions intended to improve outcomes on the population level. Previous cascade or continuum models have been limited by several factors. These models are best suited to processes with stepwise outcomes—such as screening, diagnosis, and treatment—with a single defined outcome (e.g., treatment or cure) for each member of the population. However, continuum modeling is not well developed for complex processes with non-sequential or recurring steps or those without singular outcomes. As shown here using the example of diabetic foot care, the concept of continuum modeling may be re-envisioned with a cyclical approach. Cyclical continuum modeling may permit incorporation of non-sequential and recurring steps into a single continuum, while recognizing the presence of multiple desirable outcomes within the population. Cyclical models may simultaneously represent the distribution of clinical severity and clinical resource use across a population, thereby extending the benefits of traditional continuum models to complex processes for which population-based monitoring is desired. The models may also support communication with other stakeholders in the process of care, including health care providers and patients.
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Affiliation(s)
- Martha L Carvour
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Allyssa Chiu
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
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Stokes A, Berry KM, Mchiza Z, Parker WA, Labadarios D, Chola L, Hongoro C, Zuma K, Brennan AT, Rockers PC, Rosen S. Prevalence and unmet need for diabetes care across the care continuum in a national sample of South African adults: Evidence from the SANHANES-1, 2011-2012. PLoS One 2017; 12:e0184264. [PMID: 28968435 PMCID: PMC5624573 DOI: 10.1371/journal.pone.0184264] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 08/21/2017] [Indexed: 12/30/2022] Open
Abstract
South Africa faces an epidemic of chronic non-communicable diseases (NCDs), yet national surveillance is limited due to the lack of recent data. We used data from the first comprehensive national survey on NCDs—the South African National Health and Nutrition Examination Survey (SANHANES-1 (2011–2012))—to evaluate the prevalence of and health system response to diabetes through a diabetes care cascade. We defined diabetes as a Hemoglobin A1c equal to or above 6.5% or currently on treatment for diabetes. We constructed a diabetes care cascade by categorizing the population with diabetes into those who were unscreened, screened but undiagnosed, diagnosed but untreated, treated but uncontrolled, and treated and controlled. We then used multivariable logistic regression models to explore factors associated with diagnosed and undiagnosed diabetes. The age-standardized prevalence of diabetes in South Africans aged 15+ was 10.1%. Prevalence rates were higher among the non-white population and among women. Among individuals with diabetes, a total of 45.4% were unscreened, 14.7% were screened but undiagnosed, 2.3% were diagnosed but untreated, 18.1% were treated but uncontrolled, and 19.4% were treated and controlled, suggesting that 80.6% of the diabetic population had unmet need for care. The diabetes care cascade revealed significant losses from lack of screening, between screening and diagnosis, and between treatment and control. These results point to significant unmet need for diabetes care in South Africa. Additionally, this analysis provides a benchmark for evaluating efforts to manage the rising burden of diabetes in South Africa.
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Affiliation(s)
- Andrew Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United Stated of America
- * E-mail:
| | - Kaitlyn M. Berry
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United Stated of America
| | - Zandile Mchiza
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Whadi-ah Parker
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Demetre Labadarios
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Lumbwe Chola
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Charles Hongoro
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Khangelani Zuma
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Alana T. Brennan
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United Stated of America
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Peter C. Rockers
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United Stated of America
| | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United Stated of America
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Berry KM, Parker WA, Mchiza ZJ, Sewpaul R, Labadarios D, Rosen S, Stokes A. Quantifying unmet need for hypertension care in South Africa through a care cascade: evidence from the SANHANES, 2011-2012. BMJ Glob Health 2017; 2:e000348. [PMID: 29082013 PMCID: PMC5656122 DOI: 10.1136/bmjgh-2017-000348] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction Hypertension has become a major cause of morbidity and premature mortality in South Africa, but population-wide estimates of prevalence and access to care are scarce. Using data from the South African National Health and Nutrition Examination Survey (2011–2012), this analysis evaluates the national prevalence of hypertension and uses a care cascade to examine unmet need for care. Methods Hypertension was defined as blood pressure over 140/90 mm Hg or use of antihypertensive medication. We constructed a hypertension care cascade by decomposing the population with hypertension into five mutually exclusive and exhaustive subcategories: (1) unscreened and undiagnosed, (2) screened but undiagnosed, (3) diagnosed but untreated, (4) treated but uncontrolled and (5) treated and controlled. Multivariable logistic regression models were used to explore factors associated with hypertension prevalence and diagnosis. Results In South Africans aged 15 and above, the age standardised prevalence of hypertension was 35.1%. Among those with hypertension, 48.7% were unscreened and undiagnosed, 23.1% were screened but undiagnosed, 5.8% were diagnosed but untreated, 13.5% were treated but uncontrolled and 8.9% were controlled. The hypertension care cascade demonstrates that 49% of those with hypertension were lost at the screening stage, 50% of those who were screened never received a diagnosis, 23% of those who were diagnosed did not receive treatment and 48% of those who were treated did not reach the threshold for control. Men and older individuals had increased risks of being undiagnosed after controlling for other factors. Conclusions There is significant unmet need for hypertension care in South Africa; 91.1% of the hypertensive population was unscreened, undiagnosed, untreated or uncontrolled. Data from this study provide insight into where patients are lost in the hypertension care continuum and serve as a benchmark for evaluating efforts to manage the rising burden of hypertension in South Africa.
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Affiliation(s)
- Kaitlyn M Berry
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Whadi-Ah Parker
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Zandile J Mchiza
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Ronel Sewpaul
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Demetre Labadarios
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
| | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.,Department of Internal Medicine, Health Economics and Epidemiology Research Office, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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Perlman DC, Jordan AE. Considerations for the Development of a Substance-Related Care and Prevention Continuum Model. Front Public Health 2017; 5:180. [PMID: 28770195 PMCID: PMC5513894 DOI: 10.3389/fpubh.2017.00180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/04/2017] [Indexed: 12/19/2022] Open
Abstract
There are significant gaps in the identification and engagement in care and prevention services of people who use illicit substances. Care continuum models have proven to be useful tools in the evaluation of care for HIV and other conditions; numerous issues in substance-related care and prevention resemble those identified in other continua models. Systems of care for substance misuse and substance use disorders (SUDs) can be viewed as consisting of a prevention and care continuum, reflecting incidence and prevalence of substance misuse and SUDs, screening and identification, medical and psychosocial evaluation for treatment, engagement in evidence-based treatment, treatment retention, relapse prevention, timeliness of step completion, and measures of overall and substance use-related specific morbidity and mortality. Care and prevention continuum models could potentially be applied at program, local, regional, state, and national levels. We discuss important lessons that can be drawn from applications of continuum models in other fields. The development and use of a substance-related care and prevention continuum may yield significant patient care, program evaluation and improvement, and population-level benefits.
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Affiliation(s)
- David C. Perlman
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, United States
- Center for Drug Use and HIV Research, New York, NY, United States
| | - Ashly E. Jordan
- Center for Drug Use and HIV Research, New York, NY, United States
- Department of Epidemiology, School of Public Health, City University of New York, New York, NY, United States
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Ransome Y, Batson A, Galea S, Kawachi I, Nash D, Mayer KH. The relationship between higher social trust and lower late HIV diagnosis and mortality differs by race/ethnicity: results from a state-level analysis. J Int AIDS Soc 2017; 20:21442. [PMID: 28406271 PMCID: PMC5515017 DOI: 10.7448/ias.20.01/21442] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 03/19/2017] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Black men who have sex with men (MSM) continue to suffer a disproportionate burden of new HIV diagnoses and mortality. To better understand some of the reasons for these profound disparities, we examined whether the association between social trust and late HIV diagnosis and mortality differed by race/ethnicity, and investigated potential indirect effects of any observed differences. METHODS We performed generalized structural equation modelling to assess main and interaction associations between trust among one's neighbours in 2009 (i.e. social trust) and race/ethnicity (Black, White, and Hispanic) predicting late HIV diagnosis (a CD4 count ≤200 cell/µL within three months of a new HIV diagnosis) rates and all-cause mortality rates of persons ever diagnosed late with HIV, across 47 American states for the years 2009-2013. We examined potential indirect effects of state-level HIV testing between social trust and late HIV diagnosis. Social trust data were from the Gallup Healthways Survey, HIV data from the Centers for Disease Control and Prevention, and HIV testing from the Behavioral Risk Factor Surveillance System. Covariates included state-level structural, healthcare, and socio-demographic factors including income inequality, healthcare access, and population density. We stratified analysis by transmission group (male-to-male, heterosexual, and injection drug use (IDU)). RESULTS States with higher levels of social trust had lower late HIV diagnosis rates: Adjusted Rate Ratio [aRR] were consistent across risk groups (0.57; 95%CI 0.53-0.62, male-to-male), (aRR 0.58; 95%CI 0.54-0.62, heterosexual) and (aRR 0.64; 95%CI 0.60-0.69, IDU). Those associations differed by race/ethnicity (all p < 0.001). The associations were most protective for Blacks followed by Hispanics, and least protective for Whites. HIV testing mediated between 18 and 32% of the association between social trust and late HIV diagnosis across transmission group but for Blacks relative to Whites only. Social trust was associated with lower all-cause mortality rates and that association varied by race/ethnicity within the male-to-male and IDU transmission groups only. CONCLUSION Social trust may promote timely HIV testing, which can facilitate earlier HIV diagnosis, thus it can be a useful determinant to monitor the relationship with HIV care continuum outcomes especially for racial/ethnic minority groups disproportionately infected by HIV.
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Affiliation(s)
- Yusuf Ransome
- Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ashley Batson
- Department Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | - Ichiro Kawachi
- Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
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