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Kraef C, Singh S, Fursa O, Abutidze A, Rukhadze N, Mulabdic V, Yancheva N, Mehmeti M, Balayan T, Harxhi A, Trajanovska J, Mackintosh C, Duvivier C, Beniowski M, Jilich D, Reikvam DH, Tau L, Podlekareva D, Ryom L, Peters L, Kowalska J, Kirk O. Differences in integrated assessment and management of non-communicable diseases (NCDs) for people with HIV across the WHO European region. HIV Med 2024; 25:700-710. [PMID: 38361216 DOI: 10.1111/hiv.13619] [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: 10/11/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVES We aimed to assess the extent of integration of non-communicable disease (NCD) assessment and management in HIV clinics across Europe. METHODS A structured electronic questionnaire with 41 multiple-choice and rating-scale questions assessing NCD assessment and management was sent to 88 HIV clinics across the WHO European Region during March-May 2023. One response per clinic was collected. RESULTS In all, 51 clinics from 34 countries with >100 000 people with HIV under regular follow-up responded. Thirty-seven clinics (72.6%) reported shared NCD care responsibility with the general practitioner. Systematic assessment for NCDs and integration of NCD management were common overall [median agreement 80%, interquartile range (IQR): 55-95%; and 70%, IQR: 50-88%, respectively] but were lowest in central eastern and eastern Europe. Chronic kidney disease (median agreement 96%, IQR: 85-100%) and metabolic disorders (90%, IQR: 75-100%) were regularly assessed, while mental health (72%, IQR: 63-85%) and pulmonary diseases (52%, IQR: 40-75%) were less systematically assessed. Some essential diagnostic tests such as glycated haemoglobin (HbA1c) for diabetes (n = 38/51, 74.5%), proteinuria for kidney disease (n = 30/51, 58.8%) and spirometry for lung disease (n = 11/51, 21.6%) were only employed by a proportion of clinics. The most frequent barriers for integrating NCD care were the lack of healthcare workers (n = 17/51, 33.3%) and lack of time during outpatient visits (n = 12/51, 23.5%). CONCLUSION Most HIV clinics in Europe systematically assess and manage NCDs. People with HIV appear to be screened more frequently than the general population at the same age. There are, however, larger gaps among eastern European clinics in general and for clinics in all regions related to mental health, pulmonary diseases and the employment of some essential diagnostic tests.
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Affiliation(s)
- Christian Kraef
- CHIP, RIgshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sabine Singh
- CHIP, RIgshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Olga Fursa
- CHIP, RIgshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Akaki Abutidze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Nino Rukhadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Velida Mulabdic
- Clinic for Infectious Diseases, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nina Yancheva
- Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases & Department for Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Murat Mehmeti
- Department of Infectious Diseases, University Clinical Centre, Pristina, Kosovo
| | - Tatevik Balayan
- National Center for Disease Control and Prevention, Yerevan, Armenia
| | - Arjan Harxhi
- Infectious Disease Service, HIV Ambulatory Clinic, Tirana, Albania
| | - Jasmina Trajanovska
- University Clinic for Infectious Diseases & Febrile Conditions, Skopje, North Macedonia
| | | | - Claudine Duvivier
- AP-HP-Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Center, IHU Imagine, Université de Paris, NSERM, U1016, Institut Cochin, CNRS, UMR8104, Paris, France
- Institut Pasteur, Medical Center of Institut Pasteur, Necker-Pasteur Infectiology Center, Paris, France
| | - Marek Beniowski
- Diagnostics and Therapy for AIDS, Specialistic Hospital, Chorzów, Poland
| | - David Jilich
- Charles University in Prague and Na Bulovce Hospital, Prague, Czech Republic
| | - Dag Henrik Reikvam
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Luba Tau
- Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Daria Podlekareva
- CHIP, RIgshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
| | - Lene Ryom
- CHIP, RIgshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark
| | - Lars Peters
- CHIP, RIgshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Justyna Kowalska
- Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Ole Kirk
- CHIP, RIgshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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McGettigan P, Morales DR, Moreno-Martos D, Matin N. Changing co-morbidity and increasing deprivation among people living with HIV: UK population-based cross-sectional study. HIV Med 2023; 24:311-324. [PMID: 36123816 DOI: 10.1111/hiv.13389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/08/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The great success of HIV treatments means that, increasingly, people living with HIV (PLHIV) are growing old enough to develop age-associated comorbid conditions. We investigated the evolution of comorbid conditions and demographics among PLHIV in England. METHODS In a cross-sectional study linking Clinical Practice Research Datalink (CPRD) primary care, hospitalization, death registry and Index of Multiple Deprivation data, we measured the prevalence of 304 individual health conditions, categorized into 47 condition groups (36 non-communicable, 11 communicable). Using logistic regression, we calculated odds ratios (ORs) for the likelihood of each condition and condition group in 2015 versus 2008, adjusting for age, sex and deprivation. RESULTS In 2015, there were 964 CPRD-registered PLHIV compared with 1987 in 2008; 62% were male and 38% female in both cohorts. The 2015 cohort was older, with 51.1% aged 45-64 years and 7.2% aged 65-84 years compared with 31.8% and 3.2%, respectively, in 2008. Deprivation was higher in 2015, at 23.9% (quintile 4) and 28.7% (quintile 5) compared with 5.8% and 6.6%, respectively, in 2008. Of 36 non-communicable condition groups, 14 (39%) occurred in ≥ 10% of PLHIV in 2015, of which seven were more likely in 2015 than in 2008: renal-chronic-kidney-disease [odds ratio (OR) = 1.96 (95% CI: 1.33-2.90); endocrine-obesity [OR = 1.76 (1.12-2.77)]; rheumatology [OR = 1.64 (1.30-2.07)]; dermatology [OR = 1.55(1.29-1.85)]; genito-urinary-gynaecological [OR = 1.44(1.18-1.76)]; eyes-ears/nose/throat [OR = 1.31(1.08-1.59)]; and gastro-intestinal conditions [OR = 1.28 (1.04-1.58)]. Two condition groups, respiratory-chronic-obstructive-pulmonary-disease [OR = 0.36 (0.19-0.69)] and endocrine-diabetes [OR = 0.49 (0.34-0.70)], were less likely in 2015. Ten out of 11 communicable infectious condition groups were less likely in 2015. CONCLUSIONS Although infections in PLHIV have fallen, chronic non-communicable comorbidity is increasingly prevalent. Alongside the marked increases in deprivation and ageing, this study suggests that socio-economic measures in addition to healthcare provision are needed to achieve holistic health for PLHIV.
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Affiliation(s)
- Patricia McGettigan
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Daniel R Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, UK.,Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - David Moreno-Martos
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Nashaba Matin
- Barts Health NHS Trust, Grahame Hayton Unit, Royal London Hospital, London, UK
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Abstract
PURPOSE OF REVIEW The management of people with HIV has shifted focus from acute AIDS-defining illness towards improving detection of chronic disease and reducing impact of multimorbidity. In this review, we explore this shifting paradigm of HIV care and the evidence for alternative models proposed to provide integrated holistic services for people with HIV (PWH) with multimorbidity. RECENT FINDINGS Despite 25 years of the antiretroviral treatment (ART) era an increased incidence of noncommunicable disease (NCD) and multimorbidity in PWH persists. As the world moves closer to universal ART coverage this phenomenon is now reported in low- and middle-income settings. Multimorbidity affects PWH disproportionately compared to the general population and results in reduced health related quality of life (HRQoL), greater hospitalization and higher mortality. There is evidence that NCD care provision and outcomes may be inferior for PWH than their HIV negative counterparts. Various models of integrated multimorbidity care have developed and are grouped into four categories; HIV specialist clinics incorporating NCD care, primary care services incorporating HIV care, community NCD clinics offering integrated HIV care, and multidisciplinary care integrated with HIV in secondary care. Evidence is limited as to the best way to provide multimorbidity care for PWH. SUMMARY A new era of HIV care for an ageing population with multimorbidity brings challenges for health providers who need to develop holistic patient focused services which span a range of coexisting conditions.
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Affiliation(s)
- Paul Collini
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield
| | - Rebecca L Mawson
- Academic Unit of Primary Medical Care, The University of Sheffield, Samuel Fox House, Sheffield, UK
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Demir E, Adeyemi S, Kengne AP, Kayode GA, Adeoti A. HIV-MSS: A user-friendly management support system for better planning of HIV care services. Int J Health Plann Manage 2021; 36:1847-1860. [PMID: 34180550 DOI: 10.1002/hpm.3268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/13/2021] [Accepted: 06/17/2021] [Indexed: 11/06/2022] Open
Abstract
The advent of antiretroviral therapy (ART) has transformed HIV infection from a deadly disease to a manageable chronic condition. The life expectancy of people living with HIV has been prolonged dramatically. Therefore, health systems are now confronted with new challenges, with ever-increasing number of newly diagnosed cases, fuelling the pool of existing patients, with many comorbidities and requiring hospital admissions. Are health systems prepared to handle large and increasing numbers of people with HIV? We developed a HIV-Management Support System (MSS) to support service evaluation and management using simulation by capturing individual patient's pathways within HIV services in the United Kingdom. Two scenarios were tested: (1) the impact of increasing the number of diagnosed cases in steps of 5% on human resources and (2) the impact of treating all patients with ART on hospital admissions. A 5% increase in newly diagnosed HIV cases increases human resource requirements between 4% and 8%, whereas the impact of treating all HIV patients with ART on hospital admissions is far greater. HIV services are under intense pressure and managing patient and service needs are far more important than ever, hence the development of our HIV MSS is timely, to support better planning of services. Note that the HIV simulation model presented in this study is the first of its kind.
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Affiliation(s)
- Eren Demir
- Hertfordshire Business School, University of Hertfordshire, Hatfield, UK
| | | | - Andre Pascal Kengne
- South African Medical Research Council, Cape Town, Western Cape, South Africa
| | | | - Adekunle Adeoti
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
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Hedge B, Devan K, Catalan J, Cheshire A, Ridge D. HIV-related stigma in the UK then and now: to what extent are we on track to eliminate stigma? A qualitative investigation. BMC Public Health 2021; 21:1022. [PMID: 34053441 PMCID: PMC8166014 DOI: 10.1186/s12889-021-11000-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
Background The introduction of effective antiretroviral treatment in the late 1990s led to the perception that HIV was a chronic but manageable condition. Nevertheless, stigma remains one of the major hurdles for people living with HIV (PLWH) to accessing healthcare and biomedical preventions. Thus, Fast Track Cities has set a target of zero HIV discrimination by 2030 as part of its strategy to end HIV transmission. Methods Fifty-three participants from the United Kingdom, including PLWH (n = 21, 40%), health and social care workers (n = 24, 45%), and charity workers and activists (n = 13, 25%), were recruited. Semi-structured interviews investigated stigma and discrimination, focusing on both before and after the widespread use of effective antiretroviral treatment in the late 1990s. Data were analysed using a thematic approach. Results Before effective antiretroviral treatment narratives were shaped by two main themes: 1) the media’s role in influencing public opinion and contributing to misunderstandings of HIV transmission; and 2) personal experiences of HIV-related stigma, which for PLWH included incidents of physical violence and aggression, as well as fears of their HIV status being publicised. Contemporary narratives on stigma experiences were organised around four themes: 1) discrimination in healthcare settings; 2) stigma amongst men who have sex with men (MSM); 3) stigma towards African and Afro-Caribbean PLWH; and 4) the limits of change in public HIV-related knowledge and attitudes. Contemporary narratives indicated a reduction in enacted stigma, but continued anticipation of discrimination and self-reported shame, particularly in MSM and African and Afro-Caribbean PLWH. Conclusion The nature of stigma against those with HIV has evolved. The intersection of PLWH and minority groups (e.g. MSM and African and Afro-Caribbean persons) may enhance anticipatory and internalised stigma, with some suggestion that this may contribute to reduced engagement in HIV care and prevention services. Our findings indicate the need for further research in this area, as well as proactive interventions with community groups to enhance knowledge of HIV. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11000-7.
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Affiliation(s)
| | | | - Jose Catalan
- South Kensington and Chelsea Mental Health Centre, CNWL NHS Trust, London, UK
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