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Vaucher MB, Fisch P, Kliemann DA. Human immunodeficiency virus cascade-continuum of care stages and outcomes in a hospital in southern Brazil. World J Virol 2024; 13:96416. [PMID: 39323453 PMCID: PMC11401005 DOI: 10.5501/wjv.v13.i3.96416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/06/2024] [Accepted: 07/18/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND The human immunodeficiency virus (HIV) continuum of care cascade illustrates the 90-90-90 goals defined by the Joint United Nations Program on HIV/acquired immunodeficiency syndrome (UNAIDS). The care cascade includes the following five steps: Diagnosis, linkage to care, retention in care, adherence to antiretroviral therapy (ART), and viral suppression. AIM To elaborate the HIV cascade of patients diagnosed with HIV at the Nossa Senhora da Conceição Hospital (HNSC) and to determine possible local causes for the loss of patients between each step of the cascade. METHODS This retrospective cohort study included patients diagnosed with HIV infection from January 1, 2015 to December 31, 2016 and followed up until July 31, 2019. The data were analyzed by IBM SPSS software version 25, and Poisson regression with simple robust variance was used to analyze variables in relation to each step of the cascade. Variables with P < 0.20 were included in multivariable analysis, and P < 0.05 was considered significant. Pearson's χ 2 test was used to compare the groups of patients followed up at the HNSC and those followed up at other sites. RESULTS The results were lower than those expected by the UNAIDS, with 94% of patients linked, 91% retained, 81% adhering to ART, and 84% in viral suppression. Age and site of follow-up were the variables with the highest statistical significance. A comparison showed that the cascade of patients from the HNSC had superior results than outpatients, with a significant difference in the last step of the cascade. CONCLUSION The specialized and continued care provided at the HNSC was associated with better results and was closer to the goals set by the UNAIDS. The development of the HIV cascade using local data allowed for the stratification and evaluation of risk factors associated with the losses occurring between each step of the cascade.
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Affiliation(s)
- Manoela Badinelli Vaucher
- Department of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
- Department of Medicine, Universidade do Vale do Taquari (UNIVATES), Lajeado 95914-014, Rio Grande do Sul, Brazil
- Department of Life Sciences, Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul 96815-900, Rio Grande do Sul, Brazil
| | - Patrícia Fisch
- Department of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre 90619-900, Rio Grande do Sul, Brazil
- Department of Epidemiology, Hospital Nossa Senhora da Conceição, Porto Alegre 91350-250, Rio Grande do Sul, Brazil
| | - Dimas Alexandre Kliemann
- Department of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
- Department of Infectious Disease, Hospital Nossa Senhora da Conceição, Porto Alegre 91350-250, Rio Grande do Sul, Brazil
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Bin Ahmad MZ, Md. Yasin M, Mat Nasir N, Mohamad M. The association between HIV-related stigma, HIV knowledge and HIV late presenters among people living with HIV (PLHIV) attending public primary care clinic settings in Selangor. PLoS One 2024; 19:e0306904. [PMID: 39037975 PMCID: PMC11262653 DOI: 10.1371/journal.pone.0306904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 06/25/2024] [Indexed: 07/24/2024] Open
Abstract
INTRODUCTION HIV late presenters were defined as individuals presenting with a CD4 count below 350 cells/μL or with an AIDS-defining event, according to the European Late Presenter Consensus working group. Early diagnosis and treatment of HIV have proven beneficial for people living with HIV (PLHIV), reducing the burden on healthcare systems, and contributing to ending the HIV/AIDS epidemic. However, in Malaysia, over 50% of newly diagnosed HIV patients present late, leading to increased morbidity and premature mortality. This study aims to determine the prevalence of late HIV presenters and its association with HIV-related stigma and HIV knowledge among PLHIV attending public primary care clinics in Selangor. METHODS A cross-sectional study was conducted at selected public health clinics in Selangor, involving PLHIV aged 18 years and older, who were diagnosed since 2019. HIV-related stigma was measured using the Malay version of Berger's HIV Stigma Scale, and HIV knowledge was assessed using the Malay version of Brief HIV-KQ-18. Univariate and multivariate logistic regression analyses were performed to identify factors associated with late HIV presentation. RESULTS A total of 400 participants were included in the study, with 60.0% (n = 240, 95% CI: 55.0-65.0) classified as late presenters. The participants had a mean age of 30.29 (±7.77) years. The risk factors for late presenters were high levels of HIV-related stigma (aOR = 1.049, 95% CI: 1.034-1.063, p-value <0.001), low levels of HIV knowledge (aOR = 0.709, 95% CI: 0.646-0.778, p-value <0.001), tertiary education background (aOR = 15.962, 95% CI: 1.898-134.235, p-value = 0.011), and being single (aOR = 3.582, 95% CI: 1.393-9.208, p-value = 0.008). CONCLUSION This study highlights the association between high levels of HIV-related stigma, low levels of HIV knowledge, and late HIV presentation. Interventions targeting stigma reduction and HIV education can promote early testing and prompt access to care, improving health outcomes for PLHIV.
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Affiliation(s)
- Mohd Zulfikry Bin Ahmad
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Mazapuspavina Md. Yasin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Nafiza Mat Nasir
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Mariam Mohamad
- Department of Population Health and Preventive Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
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McClarty LM, Green K, Leung S, Ejeckam C, Adesina A, Shaw SY, Neufeld B, Isac S, Emmanuel F, Blanchard JF, Aliyu G. Advancing Programme Science approaches to understand gaps in HIV prevention programme coverage for key populations in 12 Nigerian states: findings from the 2020 Integrated Biological and Behavioural Surveillance Survey. J Int AIDS Soc 2024; 27 Suppl 2:e26269. [PMID: 38988042 PMCID: PMC11236907 DOI: 10.1002/jia2.26269] [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: 11/24/2023] [Accepted: 04/29/2024] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION Effective HIV prevention programme coverage is necessary to achieve Nigeria's goal of ending the epidemic by 2030. Recent evidence highlights gaps in service coverage and utilization across the country. The Effective Programme Coverage framework is a Programme Science tool to optimize a programme's population-level impact by examining gaps in programme coverage using data generated through programme-embedded research and learning. We apply the framework using Integrated Biological and Behavioural Surveillance Survey (IBBSS) data from Nigeria to examine coverage of four prevention interventions-condoms, HIV testing, and needle and syringe programmes (NSP)-among four key population groups-female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID) and transgender people. METHODS Data from Nigeria's 2020 IBBSS, implemented in 12 states, were analysed to examine HIV prevention programme coverage among key populations. For each key population group and prevention intervention of interest, weighted IBBSS data were used to retrospectively generate coverage cascades that identify and quantify coverage gaps. Required coverage targets were informed by targets articulated in Nigeria's National HIV/AIDS Strategic Framework or, in their absence, by guidelines from policy normative bodies. Availability-, outreach- and utilization coverage proxy indicators were defined using variables from IBBSS data collection tools. Sankey diagrams are presented to visualize pathways followed by participants between coverage cascade steps. RESULTS Required coverage targets were missed for HIV testing and NSP among all key population groups. Condom availability coverage surpassed required coverage targets among FSW and MSM, while utilization coverage only among FSW exceeded the 90% required coverage target. Outreach coverage was low for all key population groups, falling below all required coverage targets. CONCLUSIONS Our findings identify critical gaps in HIV prevention programme coverage for key populations in Nigeria and demonstrate non-linear movement across coverage cascades, signalling the need for innovative solutions to optimize coverage of prevention services. Programme-embedded research is required to better understand how key population groups in Nigeria access and use different HIV prevention services so that programmes, policies and resource allocation decisions can be optimized to achieve effective programme coverage and population-level impact.
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Affiliation(s)
- Leigh M. McClarty
- Institute for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
| | - Kalada Green
- Institute for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
- West African Centre for Public Health and DevelopmentAbujaNigeria
| | - Stella Leung
- Institute for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
| | | | - Adediran Adesina
- West African Centre for Public Health and DevelopmentAbujaNigeria
| | - Souradet Y. Shaw
- Institute for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
| | - Bronwyn Neufeld
- Institute for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
- National Sexually Transmitted and Blood Borne Infection LaboratoryPublic Health Agency of CanadaWinnipegManitobaCanada
| | - Shajy Isac
- Institute for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
- India Health Action TrustDelhiIndia
| | - Faran Emmanuel
- Institute for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
| | - James F. Blanchard
- Institute for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
| | - Gambo Aliyu
- National Agency for the Control of AIDSAbujaNigeria
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Al-Mughales J. Immuno-Diagnostic Interest in Monitoring CD16+CD56+ (Natural Killer) Cells and CD19+CD45+ (B Lymphocytes) in Individuals Newly Diagnosed with HIV in a Tertiary Care Center. J Clin Med 2024; 13:1154. [PMID: 38398466 PMCID: PMC10889093 DOI: 10.3390/jcm13041154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND/OBJECTIVE Monitoring multiple cellular markers of immune cells may provide a more accurate evaluation of the immune status of people living with human immunodeficiency virus (PLHIV). This study assessed the value of CD16+CD56+ cells (NK cells) and CD19+ lymphocytes (B cells) phenotyping in indicating viral load, AIDS status, and treatment efficacy. METHOD A retrospective, laboratory-based study was conducted at the Diagnostic immunology division of a referral tertiary hospital. It involved 82 newly diagnosed HIV patients treated between 2009-2016. We explored three objectives: (1) the paired change in CD16+CD56+ and CD19+CD45+ cells counts and percentages from baseline to 2-to-6 months after treatment; (2) the association of these phenotypes with 5 gradual categories of viral load; and (3) the accuracy of CD16+CD56+ and CD19+CD45+ cells counts in indicating AIDS stage defined as CD4+ < 200 cells/mm3. The second and third objectives were tested using a pooled analysis (N = 300-373). RESULT The median CD19+CD45+ and CD16+CD56+ counts increased by 1.9-fold and 1.3-fold after treatment respectively (p < 0.001). A negative correlation of viral load with both CD16+CD56+ (ρ = -0.29, p < 0.001) and CD19+CD45+ (ρ = -0.34, p < 0.001) counts was observed. CD16+CD56+ count < 73 cells/mm3 and CD19+CD45+ count < 166.5 were indicative for AIDS with 95.5% and 63.6% sensitivity respectively. CONCLUSIONS Findings advocate for the usefulness of CD16+CD56+ and CD19+CD45+ phenotyping in characterizing the severity of HIV infection and its impact on both the humoral and cellular immunity, as well as monitoring the effectiveness of treatment.
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Affiliation(s)
- Jamil Al-Mughales
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Clinical Laboratories, Diagnostic Immunology Division, King Abdulaziz University Hospital, Jeddah 23623, Saudi Arabia
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McClarty LM, Becker ML, García PJ, Garnett GP, Dallabetta GA, Ward H, Aral SO, Blanchard JF. Programme science: a route to effective coverage and population-level impact for HIV and sexually transmitted infection prevention. Lancet HIV 2023; 10:e825-e834. [PMID: 37944547 DOI: 10.1016/s2352-3018(23)00224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 11/12/2023]
Abstract
Improvements in context-specific programming are essential to address HIV and other sexually transmitted and blood-borne infection epidemics globally. A programme science approach emphasises the need for context-specific evidence and knowledge, generated on an ongoing basis, to inform timely and appropriate programmatic decisions. We aim to accelerate and improve the use of embedded research, inquiry, and learning to optimise population-level impact of public health programmes and to introduce an effective programme coverage framework as one tool to facilitate this goal. The framework was developed in partnership with public health experts in HIV and sexually transmitted and blood-borne infections through several workshops and meetings. The framework is a practice-based tool that centres on the use of data from iterative cycles of programme-embedded research and learning, as well as routine programme monitoring, to refine the strategy and implementation of a programme. This programme science approach aims to reduce programme coverage gaps, to optimise impact at the population level, and to achieve effective coverage. This framework should facilitate the generation of programme-embedded research and learning agendas to inform resource allocation, optimise population-level impact, and achieve equitable and effective programme coverage.
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Affiliation(s)
- Leigh M McClarty
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Marissa L Becker
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Patricia J García
- School of Public Health, Universidad Peruana Cayetano Heredia, San Martin de Porres, Lima, Peru
| | | | | | - Helen Ward
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Sevgi O Aral
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James F Blanchard
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Mathai R, Hinestrosa F, DeJesus E, Rolle CP. Racial/ethnic disparities in HIV care outcomes among insured patients at a large urban sexual health clinic. J Investig Med 2023; 71:946-952. [PMID: 37365802 DOI: 10.1177/10815589231182313] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Prior studies demonstrate that non-White patients are less likely to achieve human immunodeficiency virus (HIV) suppression compared to White patients due to lack of health insurance. This study aims to determine whether racial disparities in the HIV care cascade persist among a cohort of privately and publicly insured patients. This retrospective analysis evaluated HIV care outcomes during the first year of care. Eligible patients were aged 18-65 years, treatment-naïve, and seen between 2016 and 2019. Demographic and clinical variables were extracted from the medical record. Differences in the proportion of patients achieving each HIV care cascade stage by race were evaluated using unadjusted chi-square testing. Risk factors for viral non-suppression at 52 weeks were analyzed using multivariate logistic regression. We included 285 patients; ninety-nine were White, 101 were Black, and 85 identified as Hispanic/LatinX ethnicity. Significant differences in retention in care for Hispanic/LatinX patients (odds ratio (OR): 0.214, 95% confidence interval (CI): 0.067-0.676) and viral suppression for both Black (OR: 0.348, 95% CI: 0.178, 0.682) and Hispanic/LatinX patients (OR: 0.392, 95% CI: 0.195, 0.791) compared to White patients were observed. In multivariate analyses, Black patients were less likely to achieve viral suppression compared to White patients (OR: 0.464, 95% CI: 0.236, 0.902). This study showed that non-White patients were less likely to achieve viral suppression after 1 year despite insurance and suggests that other unmeasured factors may disproportionately affect viral suppression in these patients. Interventions to identify and address these factors are needed to improve HIV care outcomes for non-White populations.
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Affiliation(s)
- Reanne Mathai
- University of Central Florida, College of Medicine, Orlando, USA
| | | | - Edwin DeJesus
- University of Central Florida, College of Medicine, Orlando, USA
- Orlando Immunology Center, Orlando, FL, USA
| | - Charlotte-Paige Rolle
- Orlando Immunology Center, Orlando, FL, USA
- Emory University Rollins School of Public Health, Atlanta, GA, USA
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Benade M, Mchiza Z, Raquib RV, Prasad SK, Yan LD, Brennan AT, Davies J, Sudharsanan N, Manne-Goehler J, Fox MP, Bor J, Rosen SB, Stokes AC. Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011-2017. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002055. [PMID: 37676845 PMCID: PMC10484448 DOI: 10.1371/journal.pgph.0002055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/06/2023] [Indexed: 09/09/2023]
Abstract
Hypertension is a major contributor to global morbidity and mortality. In South Africa, the government has employed a whole systems approach to address the growing burden of non-communicable diseases. We used a novel incident care cascade approach to measure changes in the South African health system's ability to manage hypertension between 2011 and 2017. We used data from Waves 1-5 of the National Income Dynamics Study (NIDS) to estimate trends in the hypertension care cascade and unmet treatment need across four successive cohorts with incident hypertension. We used a negative binomial regression to identify factors that may predict higher rates of hypertension control, controlling for socio-demographic and healthcare factors. In 2011, 19.6% (95%CI 14.2, 26.2) of individuals with incident hypertension were diagnosed, 15.4% (95%CI 10.8, 21.4) were on treatment and 7.1% had controlled blood pressure. By 2017, the proportion of individuals with diagnosed incident hypertension had increased to 24.4% (95%CI 15.9, 35.4). Increases in treatment (23.3%, 95%CI 15.0, 34.3) and control (22.1%, 95%CI 14.1, 33.0) were also observed, translating to a decrease in unmet need for hypertension care from 92.9% in 2011 to 77.9% in 2017. Multivariable regression showed that participants with incident hypertension in 2017 were 3.01 (95%CI 1.77, 5.13) times more likely to have a controlled blood pressure compared to those in 2011. Our data show that while substantial improvements in the hypertension care cascade occurred between 2011 and 2017, a large burden of unmet need remains. The greatest losses in the incident hypertension care cascades came before diagnosis. Nevertheless, whole system programming will be needed to sufficiently address significant morbidity and mortality related to having an elevated blood pressure.
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Affiliation(s)
- Mariet Benade
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - Zandile Mchiza
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Rafeya V. Raquib
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Sridevi K. Prasad
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Lily D. Yan
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Alana T. Brennan
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Justine Davies
- Department of Global Health, University of Birmingham, Birmingham, United Kingdom
| | - Nikkil Sudharsanan
- Heidelberg Institute for Global Health, Heidelberg University, Heidelberg, Germany
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Matthew P. Fox
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Sydney B. Rosen
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
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Ransome Y, Hayashi K, Gamble-George JC, Dean LT, Villalonga-Olives E. Racial and ethnic differences in the association of social cohesion and social capital with HIV testing. SSM Popul Health 2023; 21:101327. [PMID: 36618543 PMCID: PMC9811247 DOI: 10.1016/j.ssmph.2022.101327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/24/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
HIV testing rates vary by race and ethnicity. Whether social capital indicators are related to HIV testing and whether these associations differ by race or ethnicity is unknown. Multivariable analysis was used to examine whether social capital (collective engagement and civic and social participation), including social cohesion (trust in neighbors, neighbors willing to help, feelings of belongingness) were associated with testing for HIV in the past 12 months. Participants were white, Black or African American, and Hispanic/Latino adults ages 18 to 44 (N = 2823) from the general population, in Philadelphia, PA who participated in the Southeastern Pennsylvania Household Health Surveys 2010 and 2012. Overall HIV testing in this sample was 42%, and was higher among women, and Black compared to white people. Mean social capital scores were significantly highest among whites. Greater trust in neighbors was associated with lower odds of testing for HIV (adjusted Odds Ratio[aOR]:0.61, 95% CI = 0.49-0.74), and this relationship varied by race/ethnicity, with stronger inverse associations among Hispanic/Latino (aOR = 0.43, p < 0.001) and white adults (aOR = 0.50, p < -0.001) than among Black adults (aOR = 0.75, p < 0.05). Greater neighborhood belongingness (aOR = 1.31, 95% CI = 1.11-1.54) and working together to improve the neighborhood (aOR = 1.33, 95%CI = 1.03-1.73) were associated with higher odds of testing for HIV. Different indicators of social capital were associated with higher as well as lower odds of testing for HIV. These patterns did not vary statistically by race or ethnicity. HIV testing prevention interventions will need to address social capital in design and implementation strategies.
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Affiliation(s)
- Yusuf Ransome
- Social and Behavioral Sciences, Yale University, School of Public Health, 60 College Street, LEPH 4th Floor, New Haven, CT, 06520, USA
| | - Kamden Hayashi
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Joyonna C. Gamble-George
- Behavioral Science Training in Drug Abuse Research, New York University Rory Meyers College of Nursing, 380 2nd Avenue, Suite 306, NY, 10010, USA
- Center for Interdisciplinary Research on AIDS, Yale University, School of Public Health, 135 College Street, Suite 200, New Haven, CT, 06510, USA
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6650, Baltimore, MD, 21205, USA
| | - Ester Villalonga-Olives
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA
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Nepomuceno M, Abad CL, Salvaña EM. A descriptive retrospective study on HIV care cascade in a tertiary hospital in the Philippines. PLoS One 2023; 18:e0281104. [PMID: 36719909 PMCID: PMC9888700 DOI: 10.1371/journal.pone.0281104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 01/16/2023] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The HIV care cascade is a model used to examine the engagement of people living with HIV (PLHIV) in medical care from the time of diagnosis to sustained viral suppression. This study describes the stages of the cascade from linkage to care, antiretroviral therapy (ART) initiation, retention in care, and virologic suppression- at the University of the Philippines-Philippine General Hospital (UP-PGH) STD/AIDS Guidance and Intervention Prevention (SAGIP) treatment hub in the context of existing cascades with similar demographics. METHODS We retrospectively reviewed the medical records of patients enrolled at the UP-PGH SAGIP treatment hub from June 2015 to December 2017. Baseline demographic and clinical data were collected, relevant to each stage of the cascade. Descriptive statistics using Microsoft Excel version 16.0 was used to characterize data and cumulative and conditional proportions were reported. RESULTS Of the 584 patients included in the cohort, majority were male (91.1%), with a median age of 29 years (range, 0.17 to 68 years). Male-to-male sex was the most common mode of transmission (325/584, 55.6%). Among all patients enrolled at the UP PGH SAGIP treatment hub, 99.5% were linked to care, 95.0% initiated ART, 78.8% were retained in care and maintained on ART, 47.9% were tested for HIV viral load, and 45.5% achieved viral suppression. CONCLUSION A high proportion of patients enrolled at the UP-PGH SAGIP treatment hub are linked to care and initiate ART, exceeding the set goal of 90%, which is higher than reported nationwide. However, there is a substantial decrease in the number of patients who are subsequently retained in care, tested for HIV viral load, and achieve viral suppression. Gaps in the cascade related to healthcare delivery need to be investigated further and addressed by future studies. We recommend implementation of a community-based, patient-centered approach in order to reach the goals of the HIV cascade, with particular focus on young, MSM-PLHIV.
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Affiliation(s)
- Marisse Nepomuceno
- Division of Infectious Diseases, Department of Medicine, University of the Philippines–Philippine General Hospital, Manila, Philippines
| | - Cybele Lara Abad
- Division of Infectious Diseases, Department of Medicine, University of the Philippines–Philippine General Hospital, Manila, Philippines
| | - Edsel Maurice Salvaña
- Division of Infectious Diseases, Department of Medicine, University of the Philippines–Philippine General Hospital, Manila, Philippines
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Reyes N, Benites C, García-Fernández L, Calderon M, Fiestas F, Vasquez-Becerra R, Aranda E, Yabar CA, García A, Ramal C, Gutiérrez EL. HIV treatment cascade in regions of Peru with the highest HIV prevalence. HIV Med 2022; 24:620-627. [PMID: 36574977 DOI: 10.1111/hiv.13452] [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: 04/25/2022] [Accepted: 11/22/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To describe the HIV treatment cascade and care continuum in regions of highest HIV prevalence in Peru. METHODS An observational longitudinal study was carried out in 14 tertiary hospitals in Peru. These are the main hospitals that administer antiretroviral treatment (ART) in the regions that represent approximately 95% of reports of HIV/AIDS cases in Peru in 2013. We included individuals older than 18 years newly diagnosed with HIV from 1 January 2011 to 31 December 2012. Medical records were reviewed until 2015. RESULTS A total of 2119 people living with HIV (PLHIV) were identified in the selected health facilities (mean age = 35.26 years, 78% male). 97.25% [1845/1897; 95% confidence interval (CI): 96.4-97.9%] of the patients attended the consultation at least once during the follow-up, but only 64.84% (885/1365; 95% CI: 62.2-67.4%) attended within a month after the diagnosis. After starting ART, 74.63% (95% CI: 71.9-77.2%) of PLHIV remained in healthcare. Regardless of the time after diagnosis, 88.40% (1837/2078; 95% CI: 86.9-89.7%) of PLHIV started ART during the observation time. However, 78.68% (95% CI: 76.8-80.4%) did so during the first post-treatment year and only 28.88% (95% CI: 27.9-31.9%) after 1 month. After starting treatment, it was observed that 51.60% (95% CI: 49.2-54%) of PLHIV reached viral suppression during the follow-up period. CONCLUSIONS Further analysis and improvements in the definition of indicators are required to achieve conclusive results; however, these data will give us a general understanding of the progress of Peruvian health policies in achieving the goal established by the WHO.
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Affiliation(s)
- Nora Reyes
- Instituto Nacional de Salud, Lima, Peru.,Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | | | | | | | | | | | - Carlos A Yabar
- Instituto Nacional de Salud, Lima, Peru.,Universidad de San Martín de Porres, Facultad de Medicina, Lima, Peru
| | | | | | - Ericson L Gutiérrez
- Instituto Nacional de Salud, Lima, Peru.,Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
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11
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Wirtz AL, Logie CH, Mbuagbaw L. Addressing Health Inequities in Digital Clinical Trials: A Review of Challenges and Solutions From the Field of HIV Research. Epidemiol Rev 2022; 44:87-109. [PMID: 36124659 PMCID: PMC10362940 DOI: 10.1093/epirev/mxac008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/10/2022] [Accepted: 09/12/2022] [Indexed: 12/29/2022] Open
Abstract
Clinical trials are considered the gold standard for establishing efficacy of health interventions, thus determining which interventions are brought to scale in health care and public health programs. Digital clinical trials, broadly defined as trials that have partial to full integration of technology across implementation, interventions, and/or data collection, are valued for increased efficiencies as well as testing of digitally delivered interventions. Although recent reviews have described the advantages and disadvantages of and provided recommendations for improving scientific rigor in the conduct of digital clinical trials, few to none have investigated how digital clinical trials address the digital divide, whether they are equitably accessible, and if trial outcomes are potentially beneficial only to those with optimal and consistent access to technology. Human immunodeficiency virus (HIV), among other health conditions, disproportionately affects socially and economically marginalized populations, raising questions of whether interventions found to be efficacious in digital clinical trials and subsequently brought to scale will sufficiently and consistently reach and provide benefit to these populations. We reviewed examples from HIV research from across geographic settings to describe how digital clinical trials can either reproduce or mitigate health inequities via the design and implementation of the digital clinical trials and, ultimately, the programs that result. We discuss how digital clinical trials can be intentionally designed to prevent inequities, monitor ongoing access and utilization, and assess for differential impacts among subgroups with diverse technology access and use. These findings can be generalized to many other health fields and are practical considerations for donors, investigators, reviewers, and ethics committees engaged in digital clinical trials.
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Affiliation(s)
- Andrea L Wirtz
- Correspondence to Dr. Andrea L. Wirtz, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 (e-mail: )
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12
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Knight DK, Belenko S, Dennis ML, Wasserman GA, Joe GW, Aarons GA, Bartkowski JP, Becan JE, Elkington KS, Hogue A, McReynolds LS, Robertson AA, Yang Y, Wiley TRA. The comparative effectiveness of Core versus Core+Enhanced implementation strategies in a randomized controlled trial to improve substance use treatment receipt among justice-involved youth. BMC Health Serv Res 2022; 22:1535. [PMID: 36527067 PMCID: PMC9758864 DOI: 10.1186/s12913-022-08902-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Most justice-involved youth are supervised in community settings, where assessment and linkage to substance use (SU) treatment services are inconsistent and fragmented. Only 1/3 of youth with an identified SU need receive a treatment referral and even fewer initiate services. Thus, improving identification and linkage to treatment requires coordination across juvenile justice (JJ) and behavioral health (BH) agencies. The current study examines the comparative effectiveness of two bundled implementation intervention strategies for improving SU treatment initiation, engagement, and continuing care among justice-involved youth supervised in community settings. Exploration, Preparation, Implementation, Sustainment (EPIS) served as the conceptual framework for study design and selection/timing of implementation intervention components, and the BH Services Cascade served as the conceptual and measurement framework for identifying and addressing gaps in service receipt. METHODS Part of a larger Juvenile-Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) Cooperative, this study involved a multisite, cluster-randomized control trial where sites were paired then randomly assigned to receive Core (training teams on the BH Services Cascade and data-driven decision making; supporting goal selection) or Core+Enhanced (external facilitation of implementation teams) intervention components. Youth service records were collected from 20 JJ community supervision agencies (in five states) across five study phases (baseline, pre-randomization, early experiment, late experiment, maintenance). Implementation teams comprised of JJ and BH staff collaboratively identified goals along the BH Cascade and used data-driven decision-making to implement change. RESULTS Results suggest that Core intervention components were effective at increasing service receipt over time relative to baseline, but differences between Core and Core+Enhanced conditions were non-significant. Time to service initiation was shorter among Core+Enhanced sites, and deeper Cascade penetration occurred when external facilitation (of implementation teams) was provided. Wide variation existed in the degree and nature of change across service systems. CONCLUSIONS Findings demonstrate the criticality of early EPIS phases, demonstrating that strategies provided during the formative exploration and preparation phases produced some improvement in service receipt, whereas implementation-focused activities produced incremental improvement in moving youth farther along the Cascade.
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Affiliation(s)
- Danica K. Knight
- grid.264766.70000 0001 2289 1930Karyn Purvis Institute of Child Development, Texas Christian University, Fort Worth, USA
| | - Steven Belenko
- grid.264727.20000 0001 2248 3398Department of Criminal Justice, Temple University, Philadelphia, USA
| | | | - Gail A. Wasserman
- grid.21729.3f0000000419368729Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA
| | - George W. Joe
- grid.264766.70000 0001 2289 1930Institute of Behavioral Research, Texas Christian University, Fort Worth, USA
| | - Gregory A. Aarons
- grid.266100.30000 0001 2107 4242Child and Adolescent Services Research Center, University of California, San Diego, USA
| | - John P. Bartkowski
- grid.215352.20000000121845633Department of Sociology, University of Texas at San Antonio, San Antonio, USA
| | - Jennifer E. Becan
- grid.264766.70000 0001 2289 1930Institute of Behavioral Research, Texas Christian University, Fort Worth, USA
| | - Katherine S. Elkington
- grid.21729.3f0000000419368729Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA
| | - Aaron Hogue
- grid.475801.fPartnership to End Addiction, New York, USA
| | - Larkin S. McReynolds
- grid.239585.00000 0001 2285 2675Mailman School of Public Health, Columbia University, NYS Psychiatric Institute, New York, USA
| | - Angela A. Robertson
- grid.260120.70000 0001 0816 8287Social Science Research Center, Mississippi State University, Starkville, USA
| | - Yang Yang
- grid.264766.70000 0001 2289 1930Institute of Behavioral Research, Texas Christian University, Fort Worth, USA
| | - Tisha R. A. Wiley
- grid.420090.f0000 0004 0533 7147Service Research Branch, National Institute on Drug Abuse, Bethesda, USA
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Jere J, Nyondo-Mipando AL. Exploring preferences of market traders of the type and delivery methods of HIV services in Lilongwe, Malawi. AFRICAN JOURNAL OF AIDS RESEARCH 2022; 21:373-384. [DOI: 10.2989/16085906.2022.2145490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- James Jere
- Epidemiology and Surveillance Division, Public Health Institute of Malawi, Ministry of Health and Population, Lilongwe, Malawi
| | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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Reaching the 90–90–90 UNAIDS treatment target for people who inject drugs receiving integrated clinical care at a drug-use outpatient treatment facility. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01298-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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15
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Developing a cascade of care for opioid use disorder among individuals in jail. J Subst Abuse Treat 2022; 138:108751. [DOI: 10.1016/j.jsat.2022.108751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/25/2022] [Accepted: 02/14/2022] [Indexed: 12/30/2022]
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Understanding the Reasons for Deferring ART Among Patients Diagnosed Under the Same-Day-ART Policy in Johannesburg, South Africa. AIDS Behav 2021; 25:2779-2792. [PMID: 33534055 PMCID: PMC8373761 DOI: 10.1007/s10461-021-03171-6] [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] [Accepted: 01/16/2021] [Indexed: 12/20/2022]
Abstract
We aimed to examine the correlates of antiretroviral therapy (ART) deferral to inform ART demand creation and retention interventions for patients diagnosed with HIV during the Universal Test and Treat (UTT) policy in South Africa. We conducted a cohort study enrolling newly diagnosed HIV-positive adults (≥ 18 years), at four primary healthcare clinics in Johannesburg between October 2017 and August 2018. Patients were interviewed immediately after HIV diagnosis, and ART initiation was determined through medical record review up to six-months post-test. ART deferral was defined as not starting ART six months after HIV diagnosis. Participants who were not on ART six-months post-test were traced and interviewed telephonically to determine reasons for ART deferral. Modified Poisson regression was used to evaluate correlates of six-months ART deferral. We adjusted for baseline demographic and clinical factors. We present crude and adjusted risk ratios (aRR) associated with ART deferral. Overall, 99/652 (15.2%) had deferred ART by six months, 20.5% men and 12.2% women. Baseline predictors of ART deferral were older age at diagnosis (adjusted risk ratio (aRR) 1.5 for 30-39.9 vs 18-29.9 years, 95% confidence intervals (CI): 1.0-2.2), disclosure of intentions to test for HIV (aRR 2.2 non-disclosure vs disclosure to a partner/spouse, 95% CI: 1.4-3.6) and HIV testing history (aRR 1.7 for > 12 months vs < 12 months/no prior test, 95% CI: 1.0-2.8). Additionally, having a primary house in another country (aRR 2.1 vs current house, 95% CI: 1.4-3.1) and testing alone (RR 4.6 vs partner/spouse support, 95% CI: 1.2-18.3) predicted ART deferral among men. Among the 43/99 six-months interviews, women (71.4%) were more likely to self-report ART initiation than men (RR 0.4, 95% CI: 0.2-0.8) and participants who relocated within SA (RR 2.1 vs not relocated, 95% CI: 1.2-3.5) were more likely to still not be on ART. Under the treat-all ART policy, nearly 15.2% of study participants deferred ART initiation up to six months after the HIV diagnosis. Our analysis highlighted the need to pay particular attention to patients who show little social preparation for HIV testing and mobile populations.
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17
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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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18
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Davoglio RS, Gandin H, Mocellin LP. HIV/AIDS epidemic in a western border municipality of Rio Grande do Sul, Brazil: evolution, HIV cascade of care and lethality. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210018. [PMID: 33886891 DOI: 10.1590/1980-549720210018.supl.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the characteristics and trends of HIV/AIDS epidemic in Uruguaiana, Rio Grande do Sul, between 2005 and 2015 through indicators related to infection and the cascade of care of people living with HIV/AIDS (PLWHA). METHODS Descriptive study performed with data from the Health Information Systems of the Ministry of Health. Historical sets of indicators related to detection of HIV/AIDS cases and deaths were developed, comparing with national and state data from 2005 to 2015. Also, the cascades of care for PLWHA were elaborated for the municipality between 2013 and 2015. RESULTS AIDS detection rates of Uruguaiana were higher in comparison to the country and state, the same happened with the mortality and lethality indicators, which varied between 35.1 and 17.7 deaths/100,000 inhabitants and 6.5 and 2.7 deaths/100 inhabitants, respectively. The cascades of care for PLWHA showed an increase in individuals diagnosed with HIV in the period (from 1,125 to 1,527). The main gap occurred between the "diagnosed" and "connected" categories, expanding over time (78, 48 and 43.4%, respectively). There was a low proportion of individuals in the "undetectable viral load" category in the three years, ranging from 32 to 22.9%. CONCLUSION Indicators of detection, mortality, and lethality due to HIV/AIDS are high in Uruguaiana, with an increase in the number of people diagnosed with HIV and decrease in their link with health services, suggesting the need for advances in strategies to attract and link PLWHA to the health care network.
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Affiliation(s)
- Rosane Silvia Davoglio
- Centro de Ciências, Tecnologias e Saúde, Universidade Federal de Santa Catarina - Araranguá (SC), Brazil
| | - Henrique Gandin
- Centro de Ciências, Tecnologias e Saúde, Universidade Federal de Santa Catarina - Araranguá (SC), Brazil
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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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Boothe MAS, Sathane I, Baltazar CS, Chicuecue N, Horth R, Fazito E, Raymond HF. Low engagement in HIV services and progress through the treatment cascade among key populations living with HIV in Mozambique: alarming gaps in knowledge of status. BMC Public Health 2021; 21:146. [PMID: 33451344 PMCID: PMC7811257 DOI: 10.1186/s12889-020-10039-2] [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: 05/09/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Mozambique has a generalized HIV epidemic of 13.5% among the general population. Early modeling exercises in Mozambique estimate that key populations (KP), defined as men who have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID), along with their partners account for about one third of all new infections. There is limited data describing the engagement of KP living with HIV in testing, care and treatment services. Methods We conducted a secondary data analysis of HIV-positive participants in the first Bio-behavioral Surveillance (BBS) surveys in Mozambique conducted 2011–2014 in order to assess service uptake and progress though the HIV treatment cascade among MSM, FSW, and PWID. Unweighted pooled estimates were calculated for each key population group. Results Among HIV-positive MSM, 63.2% of participants had ever received an HIV test, 8.8% were aware of their status, 6.1% reported having been linked to care, while 3.5% initiated ART and were currently on treatment. Of the HIV-infected FSW participants, 76.5% reported a previous HIV test and 22.4% were previously aware of their status. Linkage to care was reported by 20.1%, while 12.7% reported having initiated ART and 11.8% reported being on treatment at the time of the survey. Among HIV-infected PWID participants, 79.9% had previously received an HIV test, 63.2% were aware of their HIV status, and 49.0% reported being linked to care for their HIV infection. ART initiation was reported by 42.7% of participants, while 29.4% were on ART at the time of the survey. Conclusion Among the three high risk populations in Mozambique, losses occurred throughout critical areas of service uptake with the most alarming breakpoint occurring at knowledge of HIV status. Special attention should be given to increasing HIV testing and linkage to ART treatment. Future surveys will provide the opportunity to monitor improvements across the cascade in line with global targets and should include viral load testing to guarantee a more complete picture of the treatment cascade.
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Affiliation(s)
- Makini A S Boothe
- Institute for Global Health Sciences, University of California (UCSF), San Francisco, USA. .,Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium.
| | - Isabel Sathane
- The National Program of the Control of STIs and HIV/AIDS, Ministry of Health, Maputo, Mozambique
| | - Cynthia Semá Baltazar
- Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium.,National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Noela Chicuecue
- Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Roberta Horth
- Institute for Global Health Sciences, University of California (UCSF), San Francisco, USA
| | - Erika Fazito
- ICAP, Columbia University, Pretoria, South Africa
| | - Henry F Raymond
- Institute for Global Health Sciences, University of California (UCSF), San Francisco, USA.,School of Public Health, Rutgers University, New Brunswick, USA
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21
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Haghighat R, Toska E, Bungane N, Cluver L. The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study. BMC Infect Dis 2021; 21:60. [PMID: 33435861 PMCID: PMC7805141 DOI: 10.1186/s12879-020-05742-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 12/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. METHODS All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014-2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. RESULTS Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14-5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06-1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29-4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04-11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06-1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12-2.58], p=0.013) were more likely to be fully viral suppressed. CONCLUSIONS Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring.
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Affiliation(s)
- Roxanna Haghighat
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, Oxford, OX1 3DW, UK.
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.,Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Nontuthuzelo Bungane
- Department of Nursing Science, Faculty of Health Sciences, University of Fort Hare, Alice, South Africa
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, Oxford, OX1 3DW, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Gu LY, Zhang N, Mayer KH, McMahon JM, Nam S, Conserve DF, Moskow M, Brasch J, Adu-Sarkodie Y, Agyarko-Poku T, Boakye F, Nelson LE. Autonomy-Supportive Healthcare Climate and HIV-Related Stigma Predict Linkage to HIV Care in Men Who Have Sex With Men in Ghana, West Africa. J Int Assoc Provid AIDS Care 2021; 20:2325958220978113. [PMID: 33733909 PMCID: PMC7983411 DOI: 10.1177/2325958220978113] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
In Ghana, the HIV prevalence among MSM is more than 10 times greater than the general population of adults, and rates of engagement in HIV medical care are low among MSM diagnosed with HIV. Using structured surveys, we investigated the impact of HIV-related stigma, same-sex behavior stigma, and gender nonconformity stigma on linkage to HIV care (LTC) in MSM (N = 225) living with HIV in Ghana. Autonomy-supportive healthcare climate (OR = 1.63, p < .01), vicarious HIV stigma (OR = 2.73, p < .01), and age (OR = 1.06, p < .004) predicted LTC. Conversely, felt normative HIV stigma negatively predicted LTC (OR = 0.65, p < .05). Finally, we identified regional disparities, with MSM from Takoradi being 4 times and 5 times more likely to be LTC compared to Kumasi and Accra, respectively. Our findings highlight the nuanced roles of stigmas in shaping the HIV care continuum among MSM living with HIV, while revealing potential gaps in current measures of HIV-related stigma.
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Affiliation(s)
- Lily Y. Gu
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Nanhua Zhang
- Division of Biostatistics and Bioinformatics, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Soohyun Nam
- School of Nursing, Yale University, New Haven, CT, USA
| | - Donaldson F. Conserve
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Marian Moskow
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Judith Brasch
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Yaw Adu-Sarkodie
- School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Thomas Agyarko-Poku
- School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - LaRon E. Nelson
- School of Nursing, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Yale Institute of Global Health, Yale University, New Haven, CT, USA
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
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23
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McClarty LM, Kasper K, Ireland L, Loeppky C, Blanchard JF, Becker ML. The HIV care cascade in Manitoba, Canada: Methods, measures, and estimates to meet local needs. J Clin Epidemiol 2020; 132:26-33. [PMID: 33301907 DOI: 10.1016/j.jclinepi.2020.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 11/02/2020] [Accepted: 11/29/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE We describe the development of the first HIV care cascade for Manitoba, Canada, detailing steps taken to establish indicator definitions for each cascade step, and derive a full complement of local estimates. METHODS Manitoba is a Canadian Prairie Province with disproportionately high annual HIV incidence. In 2013, a clinical cohort of people living with HIV was established within the primary HIV care program in Manitoba. Using cohort data from 2017, we describe the creation of a set of indicator definitions and calculate estimates for each cascade step to create the first Manitoban cascade model. RESULTS Of the 703 cohort participants categorized as alive and diagnosed, 638 (90.8%) were in care, 606 (86.2%) retained in care, 573 (81.5%) on treatment, and 523 (74.4%) virologically suppressed. The greatest point of leakage occurred between the first and second steps; 9.3% of those alive and diagnosed in 2017 were not in care in the same calendar year. CONCLUSION This is the first comprehensive examination of HIV clinical epidemiology in Manitoba using a cascade framework, with the potential inform programming to improve service coverage within Manitoba and significantly contribute to evidence informing provincial policies to support these efforts.
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Affiliation(s)
- Leigh M McClarty
- Institute for Global Public Health, Rady Faculty of Health Science, University of Manitoba, R065 Medical Rehabilitation Building - 771 McDermot Ave. Winnipeg, Manitoba R3E 0T6 Canada.
| | - Ken Kasper
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences University of Manitoba Health Sciences Centre - 820 Sherbrook St. Winnipeg, Manitoba R3A 1R9 Canada
| | - Laurie Ireland
- Nine Circles Community Health Centre, 705 Broadway Ave. Winnipeg, Manitoba, R3G 0X2 Canada
| | - Carla Loeppky
- Information Management & Analytics, Manitoba Health, Seniors and Active Living 4 th Floor, 300 Carlton St.Winnipeg, MB. R3B 3M9 Canada
| | - James F Blanchard
- Institute for Global Public Health, Rady Faculty of Health Science, University of Manitoba, R065 Medical Rehabilitation Building - 771 McDermot Ave. Winnipeg, Manitoba R3E 0T6 Canada
| | - Marissa L Becker
- Institute for Global Public Health, Rady Faculty of Health Science, University of Manitoba, R065 Medical Rehabilitation Building - 771 McDermot Ave. Winnipeg, Manitoba R3E 0T6 Canada
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24
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Abstract
The benefits of “early” antiretroviral therapy (ART; ie, initiation when CD4 ≥500 cells/mm3) are now well accepted as reflected in the removal of the CD4-based eligibility from new ART guidelines by the World Health Organization (WHO). However, neither the “treat-all” strategy recommendations presented in the guidelines nor the HIV care cascade goals in the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets adequately address the issue of ART timing. Our recent study on “immediate” ART (ie, ≤30 days after HIV diagnosis) adds important evidence demonstrating the real and meaningful benefits of rapid ART initiation even among those who have CD4 ≥500 cells/mm3. We call on WHO and UNAIDS to consider this research and encourage a shift from the treat-all strategy to an “immediately-treat-all” strategy, and from a slow, fragmented, complicated, multistep HIV care cascade to a fast, easy, and simple cascade with effectiveness measures that incorporate the important aspect of time.
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Affiliation(s)
- Yan Zhao
- 1 National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jennifer M McGoogan
- 1 National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zunyou Wu
- 1 National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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25
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Limitations of the UNAIDS 90-90-90 metrics: a simulation-based comparison of cross-sectional and longitudinal metrics for the HIV care continuum. AIDS 2020; 34:1047-1055. [PMID: 32044844 PMCID: PMC7253182 DOI: 10.1097/qad.0000000000002502] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The Joint United Nations Programme on HIV/AIDS (UNAIDS) 90–90–90 and other cross-sectional metrics can lead to potentially counterintuitive conclusions when used to evaluate health systems’ performance. This study demonstrates how time and population dynamics impact UNAIDS 90–90–90 metrics in comparison with a longitudinal analogue.
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26
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Blanco C, Wiley TRA, Lloyd JJ, Lopez MF, Volkow ND. America's opioid crisis: the need for an integrated public health approach. Transl Psychiatry 2020; 10:167. [PMID: 32522999 PMCID: PMC7286889 DOI: 10.1038/s41398-020-0847-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 02/28/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
Continued increases in overdose deaths and recent declines in life expectancy call for need to adopt comprehensive public health approaches to the United States opioid crisis and to establish an infrastructure to avert future crises. Successfully addressing the challenges posed by the crisis requires a translational, integrated approach that combines the contribution of neuroscience, pharmacology, epidemiology, treatment services and prevention. It also is critical to integrate interventions across settings, including healthcare, justice, education and social service systems. This review highlights four interconnected themes: (1) social determinants of health and disease; (2) person-centered approaches for prevention and treatment; (3) bridging the gap between implementation science and practice; and (4) using data to build learning systems of care, relevant to public health approaches to address the opioid crisis. We discuss how across these four themes taking into account the influence of developmental factors on brain function and sensitivity to environmental stimuli including drugs, addressing the complex interactions between biological and social factors, and promoting an ongoing dialogue across disciplines and settings will help accelerate public health advances that are evidenced based and sustainable to address the current opioid crisis and avert future ones.
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Affiliation(s)
- Carlos Blanco
- National Institute on Drug Abuse, Bethesda, MD, 20892, USA.
| | | | | | - Marsha F Lopez
- National Institute on Drug Abuse, Bethesda, MD, 20892, USA
| | - Nora D Volkow
- National Institute on Drug Abuse, Bethesda, MD, 20892, USA
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27
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Girum T, Yasin F, Wasie A, Shumbej T, Bekele F, Zeleke B. The effect of "universal test and treat" program on HIV treatment outcomes and patient survival among a cohort of adults taking antiretroviral treatment (ART) in low income settings of Gurage zone, South Ethiopia. AIDS Res Ther 2020; 17:19. [PMID: 32423457 PMCID: PMC7236275 DOI: 10.1186/s12981-020-00274-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/04/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Through universal "test and treat approach" (UTT) it is believed that HIV new infection and AIDS related death will be reduced at community level and through time HIV can be eliminated. With this assumption the UTT program was implemented since 2016. However, the effect of this program in terms of individual patient survival and treatment outcome was not assessed in relation to the pre-existing defer treatment approach. OBJECTIVE To assess the effects of UTT program on HIV treatment outcomes and patient survival among a cohort of adult HIV infected patients taking antiretroviral treatment in Gurage zone health facilities. METHODS Institution based retrospective cohort study was conducted in facilities providing HIV care and treatment. Eight years (2012-2019) HIV/AIDS treatment records were included in the study. Five hundred HIV/AIDS treatment records were randomly selected and reviewed. Data were abstracted using standardized checklist by trained health professionals; then it was cleaned, edited and entered by Epi info version 7 and analyzed by STATA. Cox model was built to estimate survival differences across different study variables. RESULTS A total of 500 patients were followed for 1632.6 person-year (PY) of observation. The overall incidence density rate (IDR) of death in the cohort was 3 per-100-PY. It was significantly higher for differed treatment program, which is 3.8 per-100-PY compared to 2.4 per-100-PY in UTT program with a p value of 0.001. The relative risk of death among differed cases was 1.58 times higher than the UTT cases. The cumulative probability of survival at the end of 1st, 2nd, 3rd, and 4th years was 98%, 90.2%, 89.2% and 88% respectively with difference between groups. The log rank test and Kaplan-Meier survival curve indicated patients enrolled in the UTT program survived longer than patients enrolled in the differed treatment program (log rank X2 test = 4.1, p value = 0.04). Age, residence, base line CD4 count, program of enrolment, development of new OIS and treatment failure were predicted mortality from HIV infection. CONCLUSION Mortality was significantly reduced after UTT. Therefore, intervention to further reduce deaths has to focus on early initiation of treatment and strengthening UTT programs.
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Affiliation(s)
- Tadele Girum
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Fedila Yasin
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Abebaw Wasie
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Teha Shumbej
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Fitsum Bekele
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Bereket Zeleke
- Department of Pharmacy, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
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28
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Bulstra CA, Hontelez JA, Ogbuoji O, Bärnighausen T. Which delivery model innovations can support sustainable HIV treatment? AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 18:315-323. [PMID: 31779572 DOI: 10.2989/16085906.2019.1686033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The rapid scale-up of antiretroviral treatment (ART) for HIV since the mid-2000s, mostly through disease-specific or "vertical" programmes, has been a highly successful undertaking, which averted millions of deaths and prevented many new infections. However, the dynamics of the HIV epidemic and changing political and financial commitment to fight the disease will likely require new models for the delivery of ART over the coming decades if the promises of universal treatment are to be met. Delivery model innovations for ART are intended to improve both the effectiveness and efficiency of the HIV treatment cascade, reaching new people who require ART and providing ART to more people without an increase in resources. We describe twelve models for ART delivery, which could be achieved through five categories of delivery innovations: integrating ART ("vertical ART plus", "partially-integrated ART" and "fully-integrated ART"); modifying steps in the ART value chain ("professional task-shifted ART", "people task-shifted ART" and "technology-supported ART"); eliminating steps in the ART value chain ("immediate ART" and "less frequent ART pick-up"); changing ART locations ("private-sector ART", "traditional-sector ART" and "ART outside the health sector"); and keeping the status quo ("vertical ART"). The different delivery model innovations are not mutually exclusive and several could be combined, such as "vertical ART plus" with "task-shifted ART". Suitability of the models will highly depend on local and national contexts, including existing health systems resources, available funding, and type of HIV epidemic. Future implementation research needs to identify which models are the best fit for different contexts.
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Affiliation(s)
- Caroline A Bulstra
- Erasmus Medical Centre, Department of Public Health, Rotterdam, The Netherlands.,Institute of Global Health, University of Heidelberg, Germany
| | - Jan Ac Hontelez
- Erasmus Medical Centre, Department of Public Health, Rotterdam, The Netherlands.,Institute of Global Health, University of Heidelberg, Germany
| | - Osondu Ogbuoji
- Center for Policy Impact in Global Health, Duke University, Durham, USA
| | - Till Bärnighausen
- Institute of Global Health, University of Heidelberg, Germany.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, USA.,Africa Health Research Institute, Durban, South Africa
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29
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Matsuoka S, Nagashima M, Sadamasu K, Mori H, Kawahata T, Zaitsu S, Nakamura A, de Souza MS, Matano T. Estimating HIV-1 incidence in Japan from the proportion of recent infections. Prev Med Rep 2019; 16:100994. [PMID: 31720200 PMCID: PMC6838929 DOI: 10.1016/j.pmedr.2019.100994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/07/2019] [Accepted: 09/17/2019] [Indexed: 11/25/2022] Open
Abstract
The first step of the UNAIDS/WHO 90-90-90 targets to encourage early diagnosis with treatment for the control of HIV-1 epidemic is to achieve 90% HIV-1 diagnosis in infected individuals. In Japan, approximately 30% of newly reported cases have been annually identified by AIDS onset, implying that substantial numbers of HIV-1-infected individuals remain undiagnosed. However, the proportion of undiagnosed cases has not yet been determined. In the present study, the proportion of recent HIV-1 infections to newly-diagnosed cases was determined from 2006 to 2015 using a recent infection assay for three metropolitan areas in Japan: Tokyo, Osaka, and Fukuoka. Estimated median periods between infection and diagnosis were 1.0, 1.8, and 2.9 years for Tokyo, Osaka, and Fukuoka, respectively. Estimation of annual HIV-1 incidence by a back-calculation method using these data as well as HIV/AIDS national surveillance data indicated proportions of undiagnosed to new HIV-1 infections from 2006 to 2015 to be 18% in Tokyo, 22% in Osaka, 38% in Fukuoka, and 28% in Japan. This is the first report estimating HIV-1 incidence in Japan using a serological biomarker in combination with national HIV/AIDS surveillance data.
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Affiliation(s)
- Saori Matsuoka
- AIDS Research Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Mami Nagashima
- Division of Microbiology, Tokyo Metropolitan Institute of Public Health, 3-24-1 Hyakunincho, Shinjuku-ku, Tokyo 169-0073, Japan
| | - Kenji Sadamasu
- Division of Microbiology, Tokyo Metropolitan Institute of Public Health, 3-24-1 Hyakunincho, Shinjuku-ku, Tokyo 169-0073, Japan
| | - Haruyo Mori
- Division of Microbiology, Osaka Institute of Public Health, 1-3-69 Nakamichi, Higashinari-ku, Osaka 537-0025, Japan
| | - Takuya Kawahata
- Division of Microbiology, Osaka Institute of Public Health, 1-3-69 Nakamichi, Higashinari-ku, Osaka 537-0025, Japan
| | - Shuichi Zaitsu
- Health Science Section, Fukuoka City Institute of Health and Environment, 2-1-34 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
| | - Asako Nakamura
- Division of Virology, Fukuoka Institute of Health and Environmental Sciences, 39 Mukaisano, Dazaihu-shi, Fukuoka 818-0135, Japan
| | - Mark S. de Souza
- AIDS Research Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
- SEARCH, Thai Red Cross AIDS Research Centre, 104 Rajdumri Road, Pathumwan, Bangkok 10330, Thailand
| | - Tetsuro Matano
- AIDS Research Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
- Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
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30
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Ma Y, Dou Z, Guo W, Mao Y, Zhang F, McGoogan JM, Zhao Y, Zhao D, Wu Y, Liu Z, Wu Z. The Human Immunodeficiency Virus Care Continuum in China: 1985-2015. Clin Infect Dis 2019; 66:833-839. [PMID: 29216405 DOI: 10.1093/cid/cix911] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/05/2017] [Indexed: 11/13/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) care continuum attrition is a major global public health challenge. Few studies have examined this problem in resource-limited settings. We aimed to assess cumulative, current, and historical achievement along China's HIV continuum of care. Methods A nationwide, serial cross-sectional study of all individuals with HIV infection diagnosed in China between 1 January 1985 and 31 December 2015 was conducted using data from China's HIV/AIDS information systems. Biennial estimates of the number of persons living with HIV were also used. We defined 7 steps in HIV care continuum as infected (estimated), diagnosed, linked, retained, enrolled, receiving antiretroviral therapy (ART), and virally suppressed. Cumulative, 30-year performance, and biennial performance during the most recent 10 years were examined. Results A total of 573529 persons diagnosed with HIV infection were included. Cumulatively, 94% were linked, 88% were retained, 73% were enrolled, 67% were receiving ART, and 44% were suppressed. Greatest attrition was observed for adolescents, minorities, and those who reported injecting drug use as their route of infection. Improvement was observed from 2005 to 2015. As of the end of 2015, 68% among those infected were diagnosed, 67% among diagnosed were receiving ART, and 65% among those receiving ART were virally suppressed. After adjusting for those without viral load testing, the proportion suppressed increased to 89%. Conclusions Despite dramatic improvements, China faces serious challenges in achieving the Joint United Nations Programme on HIV/AIDS 90-90-90 targets, because of substantial attrition along its continuum of HIV care.
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Affiliation(s)
- Ye Ma
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Zhihui Dou
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Wei Guo
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Yurong Mao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Fujie Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China.,Beijing Ditan Hospital, Capital Medical University, China
| | - Jennifer M McGoogan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Yan Zhao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Decai Zhao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Yasong Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Zhongfu Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California
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31
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Gardner SK, Elkington KS, Knight DK, Huang S, DiClemente RJ, Spaulding AC, Oser CB, Robertson AA, Baird-Thomas C. Juvenile justice staff endorsement of HIV/STI prevention, testing, and treatment linkage. HEALTH & JUSTICE 2019; 7:15. [PMID: 31485779 PMCID: PMC6724232 DOI: 10.1186/s40352-019-0096-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/22/2019] [Indexed: 05/11/2023]
Abstract
BACKGROUND While involvement in the legal system offers an opportunity to educate, screen, and treat high-risk youth, research shows that staff attitudes toward these practices can serve as barriers to implementation. The current study investigates the degree to which JJ staff endorse HIV prevention, testing, and treatment linkage practices with youth under community supervision and examines differences between individuals who supervise youth (e.g., juvenile probation officer) and those working in non-supervisory roles (e.g., case manager, assessment specialist). METHODS Juvenile justice staff consenting to participation in JJ-TRIALS completed an initial staff survey (N = 501). Survey items measured perceived importance of HIV/STI prevention (4 items); perceived importance of HIV/STI testing (7 items); and perceived importance of HIV/STI treatment linkage (8 items). RESULTS Confirmatory Factor Analysis (CFA) was computed (SAS CALIS procedure) for each of the three domains. Findings suggest that while staff recognize that youth are at risk for HIV/STIs and require provision of HIV/STI prevention and treatment linkage, attitudes concerning the importance of procuring or providing testing services for youth is substantially lower. Furthermore, analytic models comparing staff with and without supervision responsibilities (computed using SAS PROC MIXED) indicated that attitudes differed by site and staff responsible for supervision rated HIV treatment linkage practices as less important compared to non-supervising staff. CONCLUSIONS Establishing partnerships with health agencies equipped with resources and skillsets to provide HIV/STI testing and related services may be an effective model to promote greater awareness and use of best practices among JJ staff and more effectively address the unmet needs of this high-risk population of youth.
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Affiliation(s)
- Sheena K. Gardner
- Social Science Research Center, Mississippi State University, 1 Research Blvd., Suite 103, Starkville, MS 39759 USA
| | - Katherine S. Elkington
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University, 1051 Riverside Drive, #15, New York, NY 10032 USA
| | - Danica K. Knight
- Institute of Behavioral Research, Texas Christian University, 3034 Sandage Avenue, Fort Worth, TX 76109 USA
| | - Sofia Huang
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University, 1051 Riverside Drive, #15, New York, NY 10032 USA
| | - Ralph J. DiClemente
- College of Global Public Health, New York University, 715 #719, Broadway, New York, NY 10003 USA
| | - Anne C. Spaulding
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
| | - Carrie B. Oser
- Department of Sociology, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY 40506 USA
| | - Angela A. Robertson
- Social Science Research Center, Mississippi State University, 1 Research Blvd., Suite 103, Starkville, MS 39759 USA
| | - Connie Baird-Thomas
- Social Science Research Center, Mississippi State University, 153 Mississippi Parkway, Canton, MS 39046 USA
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32
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Re-thinking Linkage to Care in the Era of Universal Test and Treat: Insights from Implementation and Behavioral Science for Achieving the Second 90. AIDS Behav 2019; 23:120-128. [PMID: 31161462 PMCID: PMC6773672 DOI: 10.1007/s10461-019-02541-5] [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] [Indexed: 01/14/2023]
Abstract
To successfully link to care, persons living with HIV must negotiate a complex series of processes from HIV diagnosis through initial engagement with HIV care systems and providers. Despite the complexity involved, linkage to care is often oversimplified and portrayed as a single referral step. In this article, we offer a new conceptual framework for linkage to care, tailored to the current universal test and treat era that presents linkage to care as its own nuanced pathway within the larger HIV care cascade. Conceptualizing linkage to care in this way may help better identify and specify processes posing a barrier to linkage, and allow for the development of targeted implementation and behavioral science-based approaches to address them. Such approaches are likely to be most relevant to programmatic and clinical settings with limited resources and high HIV burden.
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33
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Priest JL, Irwin DE, Evans KA, Oglesby AK, Brady BL. Benchmarking HIV Quality Measures Across US Payer Types. Popul Health Manag 2019; 23:146-156. [PMID: 31305206 PMCID: PMC7074887 DOI: 10.1089/pop.2019.0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite advances in antiretroviral therapy (ART), human immunodeficiency virus (HIV) remains a significant issue in the United States. Early diagnosis, continuous treatment access/adherence, and long-term care engagement help patients benefit fully from ART; however, a shortfall in care engagement remains, potentially leading to poorer health outcomes. This analysis benchmarks rates of health care quality and process measures to identify areas for improvement. This retrospective, claims-based, real-world cohort study assessed the percentage of prevalent (existing) and incident (newly diagnosed) patients with HIV with commercial or public health insurance meeting 4 National Quality Forum (NQF)-endorsed, 1 Pharmacy Quality Alliance (PQA), and 3 Centers for Disease Control and Prevention (CDC) measures over a 4-year period. Most prevalent patients consistently met the NQF-endorsed prescribed ART and gaps in visits measures. Longer-term visit frequency measure rates were well below the 90% Joint United Nations Programme on HIV/AIDS target. Proportion of prevalent patients meeting each NQF-endorsed measure was maintained/increased with increasing age in 2015–2016. Substantially fewer incident patients than prevalent patients met NQF-endorsed measures across all measurement periods, particularly for visit frequency (32%–51%). PQA ART adherence was low (36%–73%). CDC receipt of care rates were high (83%–92%), whereas retention in care rates were low (67%–72%) among prevalent patients. For incident patients, linkage to care rates were consistently low (21%–44%). This study benchmarks current US HIV care engagement and highlights the need for improvement in early care engagement, ART adherence and long-term retention of care among patients with HIV.
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34
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Mateo-Urdiales A, Johnson S, Smith R, Nachega JB, Eshun-Wilson I. Rapid initiation of antiretroviral therapy for people living with HIV. Cochrane Database Syst Rev 2019; 6:CD012962. [PMID: 31206168 PMCID: PMC6575156 DOI: 10.1002/14651858.cd012962.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite antiretroviral therapy (ART) being widely available, HIV continues to cause substantial illness and premature death in low-and-middle-income countries. High rates of loss to follow-up after HIV diagnosis can delay people starting ART. Starting ART within seven days of HIV diagnosis (rapid ART initiation) could reduce loss to follow-up, improve virological suppression rates, and reduce mortality. OBJECTIVES To assess the effects of interventions for rapid initiation of ART (defined as offering ART within seven days of HIV diagnosis) on treatment outcomes and mortality in people living with HIV. We also aimed to describe the characteristics of rapid ART interventions used in the included studies. SEARCH METHODS We searched CENTRAL, the Cochrane Database of Systematic Reviews, MEDLINE, Embase, and four other databases up to 14 August 2018. There was no restriction on date, language, or publication status. We also searched ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform, and websites for unpublished literature, including conference abstracts. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared rapid ART versus standard care in people living with HIV. Children, adults, and adolescents from any setting were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of the studies identified in the search, assessed the risk of bias and extracted data. The primary outcomes were mortality and virological suppression at 12 months. We have presented all outcomes using risk ratios (RR), with 95% confidence intervals (CIs). Where appropriate, we pooled the results in meta-analysis. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included seven studies with 18,011 participants in the review. All studies were carried out in low- and middle-income countries in adults aged 18 years old or older. Only one study included pregnant women.In all the studies, the rapid ART intervention was offered as part of a package that included several cointerventions targeting individuals, health workers and health system processes delivered alongside rapid ART that aimed to facilitate uptake and adherence to ART.Comparing rapid ART with standard initiation probably results in greater viral suppression at 12 months (RR 1.18, 95% CI 1.10 to 1.27; 2719 participants, 4 studies; moderate-certainty evidence) and better ART uptake at 12 months (RR 1.09, 95% CI 1.06 to 1.12; 3713 participants, 4 studies; moderate-certainty evidence), and may improve retention in care at 12 months (RR 1.22, 95% CI 1.11 to 1.35; 5001 participants, 6 studies; low-certainty evidence). Rapid ART initiation was associated with a lower mortality estimate, however the CIs included no effect when compared to standard of care (RR 0.72, 95% CI 0.51 to 1.01; 5451 participants, 7 studies; very low-certainty evidence). It is uncertain whether rapid ART has an effect on modification of ART treatment regimens as data are lacking (RR 7.89, 95% CI 0.76 to 81.74; 977 participants, 2 studies; very low-certainty evidence). There was insufficient evidence to draw conclusions on the occurrence of adverse events. AUTHORS' CONCLUSIONS RCTs that include initiation of ART within one week of diagnosis appear to improve outcomes across the HIV treatment cascade in low- and middle-income settings. The studies demonstrating these effects delivered rapid ART combined with several setting-specific cointerventions. This highlights the need for pragmatic research to identify feasible packages that assure the effects seen in the trials when delivered through complex health systems.
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Affiliation(s)
- Alberto Mateo-Urdiales
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, L3 5QA
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Snedecor SJ, Radford M, Kratochvil D, Grove R, Punekar YS. Comparative efficacy and safety of dolutegravir relative to common core agents in treatment-naïve patients infected with HIV-1: a systematic review and network meta-analysis. BMC Infect Dis 2019; 19:484. [PMID: 31146698 PMCID: PMC6543679 DOI: 10.1186/s12879-019-3975-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/11/2019] [Indexed: 01/30/2023] Open
Abstract
Background Network meta-analyses (NMAs) provide comparative treatment effects estimates in the absence of head-to-head randomized controlled trials (RCTs). This NMA compared the efficacy and safety of dolutegravir (DTG) with other recommended or commonly used core antiretroviral agents. Methods A systematic review identified phase 3/4 RCTs in treatment-naïve patients with HIV-1 receiving core agents: ritonavir-boosted protease inhibitors (PIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), or integrase strand inhibitors (INSTIs). Efficacy (virologic suppression [VS], CD4+ cell count change from baseline) and safety (adverse events [AEs], discontinuations, discontinuation due to AEs, lipid changes) were analyzed at Week 48 using Bayesian NMA methodology, which allowed calculation of probabilistic results. Subgroup analyses were conducted for VS (baseline viral load [VL] ≤/> 100,000copies/mL, ≤/> 500,000copies/mL; baseline CD4+ ≤/>200cells/μL). Results were adjusted for the nucleoside/nucleotide reverse transcriptase inhibitors (NRTI) combined with the core agent (except subgroup analyses). Results The NMA included 36 studies; 2 additional studies were included in subgroup analyses only. Odds of achieving VS with DTG were statistically superior to PIs (odds ratios [ORs] 1.78–2.59) and NNRTIs (ORs 1.51–1.86), and similar but numerically higher than other INSTIs. CD4+ count increase was significantly greater with DTG than PIs (difference: 23.63–31.47 cells/μL) and efavirenz (difference: 34.54 cells/μL), and similar to other core agents. INSTIs were more likely to result in patients achieving VS versus PIs (probability: 76–100%) and NNRTIs (probability: 50–100%), and a greater CD4+ count increase versus PIs (probability: 72–100%) and NNRTIs (probability: 60–100%). DTG was more likely to result in patients achieving VS (probability: 94–100%), and a greater CD4+ count increase (probability: 53–100%) versus other core agents, including INSTIs (probability: 94–97% and 53–93%, respectively). Safety outcomes with DTG were generally similar to other core agents. In patients with baseline VL > 100,000copies/mL or ≤ 200 CD4+cells/μL (18 studies), odds of achieving VS with DTG were superior or similar to other core agents. Conclusion INSTI core agents had superior efficacy and similar safety to PIs and NNRTIs at Week 48 in treatment-naïve patients with HIV-1, with DTG being among the most efficacious, including in patients with baseline VL > 100,000copies/mL or ≤ 200 CD4+cells/μL, who can be difficult to treat. Electronic supplementary material The online version of this article (10.1186/s12879-019-3975-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Matthew Radford
- ViiV Healthcare, GSK House, 980 Great West Rd, Brentford, Middlesex, TW8 9GS, UK
| | | | | | - Yogesh S Punekar
- ViiV Healthcare, GSK House, 980 Great West Rd, Brentford, Middlesex, TW8 9GS, UK.
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Liu J, Wilton J, Sullivan A, Marchand-Austin A, Rachlis B, Giles M, Light L, Sider D, Kroch AE, Gilbert M. Cohort profile: Development and profile of a population-based, retrospective cohort of diagnosed people living with HIV in Ontario, Canada (Ontario HIV Laboratory Cohort). BMJ Open 2019; 9:e027325. [PMID: 31133591 PMCID: PMC6537973 DOI: 10.1136/bmjopen-2018-027325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Population-based cohorts of diagnosed people living with HIV (PLWH) are limited worldwide. In Ontario, linked HIV diagnostic and viral load (VL) test databases are centralised and contain laboratory data commonly used to measure engagement in HIV care. We used these linked databases to create a population-based, retrospective cohort of diagnosed PLWH in Ontario, Canada. PARTICIPANTS A datamart was created by integrating diagnostic and VL databases and linking records at the individual level. These databases contain information on laboratory test results and sociodemographic/clinical information collected on requisition/surveillance forms. Datamart individuals enter our cohort with the first record of a nominal HIV-positive diagnostic test (1985-2015) or VL test (1996-2015), and remain unless administratively lost to follow-up (LTFU; no VL test for >2 years and no VL test in later years). Non-nominal diagnostic tests are excluded as they lack identifying information to permit linkage to other tests. However, individuals diagnosed non-nominally are included in the cohort with record of a VL test. The LTFU rule is applied to indirectly censor for death/out-migration. FINDINGS TO DATE As of the end of 2015, the datamart contained 40 372 HIV-positive diagnostic tests and 23 851 individuals with ≥1 VL test. Almost half (46.3%) of the diagnostic tests were non-nominal and excluded, although this was lower (~15%) in recent years. Overall, 29 587 individuals have entered the cohort-contributing 229 302 person-years of follow-up since 1996. Between 2000 and 2015, the number of diagnosed PLWH (cohort individuals not LTFU) increased from 8859 to 16 110, and the percent who were aged ≥45 years increased from 29.1% to 62.6%. The percent of diagnosed PLWH who were virally suppressed (<200 copies/mL) increased from 40.7% in 2000 to 79.5% in 2015. FUTURE PLANS We plan to conduct further analyses of HIV care engagement and link to administrative databases with information on death, migration, physician billing claims and prescriptions. Linkage to other data sources will address cohort limitations and expand research opportunities.
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Affiliation(s)
- Juan Liu
- Public Health Ontario, Toronto, Ontario, Canada
| | - James Wilton
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | | | | | - Beth Rachlis
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Madison Giles
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lucia Light
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Doug Sider
- Public Health Ontario, Toronto, Ontario, Canada
| | - Abigail E Kroch
- Public Health Ontario, Toronto, Ontario, Canada
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Schatz E, Houle B, Mojola SA, Angotti N, Williams J. How to "Live a Good Life": Aging and HIV Testing in Rural South Africa. J Aging Health 2019; 31:709-732. [PMID: 29318924 PMCID: PMC6027599 DOI: 10.1177/0898264317751945] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The African HIV epidemic is aging, yet HIV testing behavior studies either exclude older persons or include too few to say much about age differences. METHOD Strategically combining focus group interviews (participants in 40s/50s/60s-plus age groups) and survey data from rural South Africa (where HIV prevalence peaks in the late 30s, but continues to be over 10% into the late 60s), we examine gender and life course variation, motivations, and barriers in HIV testing. RESULTS We find significant gender differences-Women test at higher rates at younger ages, men at older ages. Our qualitative data not only highlight recognition of testing importance but also suggest gendered motivations and perceptions of testing. Men and women report similar barriers, however, including fear of finding out their (positive) HIV status, limited confidentiality, and partner nondisclosure. DISCUSSION We conclude with recommendations to increase HIV testing uptake among older adults including home testing, couples testing, and HIV testing concurrently with noncommunicable diseases.
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Affiliation(s)
- Enid Schatz
- Department of Health Sciences, University of Missouri
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
- Institute of Behavioral Science, University of Colorado, Boulder, Boulder, CO, USA
| | - Brian Houle
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
- Institute of Behavioral Science, University of Colorado, Boulder, Boulder, CO, USA
- School of Demography, The Australian National University, Australia
| | - Sanyu A. Mojola
- Institute of Behavioral Science, University of Colorado, Boulder, Boulder, CO, USA
- Department of Sociology, University of Colorado, Boulder, Boulder, CO, USA
- Department of Sociology, University of Michigan, Ann Arbor, MI, USA
| | - Nicole Angotti
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
- Institute of Behavioral Science, University of Colorado, Boulder, Boulder, CO, USA
- Department of Sociology, American University, Washington, D.C., USA
| | - Jill Williams
- Institute of Behavioral Science, University of Colorado, Boulder, Boulder, CO, USA
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Seeley J, Bond V, Yang B, Floyd S, MacLeod D, Viljoen L, Phiri M, Simuyaba M, Hoddinott G, Shanaube K, Bwalya C, de Villiers L, Jennings K, Mwanza M, Schaap A, Dunbar R, Sabapathy K, Ayles H, Bock P, Hayes R, Fidler S. Understanding the Time Needed to Link to Care and Start ART in Seven HPTN 071 (PopART) Study Communities in Zambia and South Africa. AIDS Behav 2019; 23:929-946. [PMID: 30415432 PMCID: PMC6458981 DOI: 10.1007/s10461-018-2335-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To achieve UNAIDS 90:90:90 targets at population-level, knowledge of HIV status must be followed by timely linkage to care, initiation and maintenance of antiretroviral therapy (ART) for all people living with HIV (PLHIV). Interpreting quantitative patterns using qualitative data, we investigate time taken to link to care and initiate ART amongst individuals aware of their HIV-status in high HIV-prevalence urban communities in the HPTN 071 (PopART) study, a community-randomised trial of a combination HIV prevention package, including universal testing and treatment, in 21 communities in Zambia and South Africa. Data are drawn from the seven intervention communities where immediate ART irrespective if CD4 count was offered from the trial-start in 2014. Median time from HIV-diagnosis to ART initiation reduced after 2 years of delivering the intervention from 10 to 6 months in both countries but varied by gender and community of residence. Social and health system realities impact decisions made by PLHIV about ART initiation.
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Affiliation(s)
- Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Virginia Bond
- London School of Hygiene and Tropical Medicine, London, UK
- Zambart, School of Medicine, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Blia Yang
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, K-Floor, Clinical Building, Tygerberg Medical Campus, Francie van Zyl Drive, Tygerberg, 7505, South Africa
| | - Sian Floyd
- London School of Hygiene and Tropical Medicine, London, UK
| | - David MacLeod
- London School of Hygiene and Tropical Medicine, London, UK
| | - Lario Viljoen
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, K-Floor, Clinical Building, Tygerberg Medical Campus, Francie van Zyl Drive, Tygerberg, 7505, South Africa
| | - Mwelwa Phiri
- Zambart, School of Medicine, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Melvin Simuyaba
- Zambart, School of Medicine, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Graeme Hoddinott
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, K-Floor, Clinical Building, Tygerberg Medical Campus, Francie van Zyl Drive, Tygerberg, 7505, South Africa
| | - Kwame Shanaube
- Zambart, School of Medicine, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Chiti Bwalya
- Zambart, School of Medicine, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Laing de Villiers
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, K-Floor, Clinical Building, Tygerberg Medical Campus, Francie van Zyl Drive, Tygerberg, 7505, South Africa
| | - Karen Jennings
- City of Cape Town Health Directorate, Cape Town, South Africa
| | - Margaret Mwanza
- Zambia Prevention Care and Treatment partnership (ZPCT), Lusaka, Zambia
| | - Ab Schaap
- Zambart, School of Medicine, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Rory Dunbar
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, K-Floor, Clinical Building, Tygerberg Medical Campus, Francie van Zyl Drive, Tygerberg, 7505, South Africa
| | | | - Helen Ayles
- London School of Hygiene and Tropical Medicine, London, UK
- Zambart, School of Medicine, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Peter Bock
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, K-Floor, Clinical Building, Tygerberg Medical Campus, Francie van Zyl Drive, Tygerberg, 7505, South Africa
| | - Richard Hayes
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Fidler
- Department of Medicine, Imperial College, London, UK
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Okoboi S, Twimukye A, Lazarus O, Castelnuovo B, Agaba C, Immaculate M, Nanfuka M, Kambugu A, King R. Acceptability, perceived reliability and challenges associated with distributing HIV self-test kits to young MSM in Uganda: a qualitative study. J Int AIDS Soc 2019; 22:e25269. [PMID: 30932364 PMCID: PMC6441924 DOI: 10.1002/jia2.25269] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/07/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION HIV self-testing is a flexible, accessible and acceptable emerging technology with a particular potential to identify people living with HIV who are reluctant to interact with conventional HIV testing approaches. We assessed the acceptability, perceived reliability and challenges associated with distributing HIV self-test (HIVST) to young men who have sex with men (MSM) in Uganda. METHODS Between February and May, 2018, we enrolled 74 MSM aged ≥18 years purposively sampled and verbally consented to participate in six focus group discussions (FGDs) in The AIDS Support Organization (TASO Masaka and Entebbe). We also conducted two FGDs of 18 health workers. MSM FGD groups included individuals who had; (1) tested greater than one year previously; (2) tested between six months and one year previously; (3) tested three to six months previously; (4) never tested. FGDs examined: (i) the acceptability of HIVST distribution; (iii) preferences for various HIVST distribution channels; (iv) perceptions about the accuracy of HIVST; (v) challenges associated with HIVST distribution. We identified major themes, developed and refined a codebook. We used Nvivo version 11 for data management. RESULTS MSM participants age ranged between 19 and 30 years. Participants described HIVST as a mechanism that would facilitate HIV testing uptake in a rapid, efficient, confidential, non-painful; and non-stigmatizing manner. Overall, MSM preferred HIVST to the conventional HIV testing approaches. Health workers were in support of distributing HIVST kits through MSM peers. MSM participants were willing to distribute the kits and recommended HIVST to their peers and sexual partners. They suggested HIVST kit distribution model work similarly to the current condom and lubricant peer model being implemented by TASO. Preferred channels were peers, hot spots, drop-in centres, private pharmacies and MSM friendly health facilities. Key concerns regarding use of HIVST were; unreliable HIVST results, social harm due to a positive result, need for a confirmatory test and linking both HIV positive and negative participants for additional HIV services. CONCLUSIONS Distribution of HIVST kits by MSM peers is an acceptable strategy that can promote access to testing. HIVST was perceived by participants as beneficial because it would address many barriers that affect their acceptance of testing. However, a combined approach that includes follow-up, linkage to HIV care and prevention services are needed for effective results.
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Affiliation(s)
- Stephen Okoboi
- Infectious Diseases instituteCollege of Health SciencesSchool of MedicineMakerere UniversityKampalaUganda
- Clarke International UniversityKampalaUganda
| | - Adelline Twimukye
- Infectious Diseases instituteCollege of Health SciencesSchool of MedicineMakerere UniversityKampalaUganda
| | | | - Barbara Castelnuovo
- Infectious Diseases instituteCollege of Health SciencesSchool of MedicineMakerere UniversityKampalaUganda
| | | | | | | | - Andrew Kambugu
- Infectious Diseases instituteCollege of Health SciencesSchool of MedicineMakerere UniversityKampalaUganda
| | - Rachel King
- University of California, Global Health SciencesSan FranciscoCA
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Wilton J, Liu J, Sullivan A, Rachlis B, Marchand-Austin A, Giles M, Light L, Rank C, Burchell AN, Gardner S, Sider D, Gilbert M, Kroch AE. Trends in HIV care cascade engagement among diagnosed people living with HIV in Ontario, Canada: A retrospective, population-based cohort study. PLoS One 2019; 14:e0210096. [PMID: 30608962 PMCID: PMC6319701 DOI: 10.1371/journal.pone.0210096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/16/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The HIV cascade is an important framework for assessing systems of care, but population-based assessment is lacking for most jurisdictions worldwide. We measured cascade indicators over time in a population-based cohort of diagnosed people living with HIV (PLWH) in Ontario, Canada. METHODS We created a retrospective cohort of diagnosed PLWH using a centralized laboratory database with HIV diagnostic and viral load (VL) test records linked at the individual-level. Individuals enter the cohort with record of a nominal HIV-positive diagnostic test or VL test, and remain unless administratively lost to follow-up (LTFU, >2 consecutive years with no VL test and no VL test in later years). We calculated the annual percent of diagnosed PLWH (cohort individuals not LTFU) between 2000 and 2015 who were in care (≥1 VL test), on ART (as documented on VL test requisition) or virally suppressed (<200 copies/ml). We also calculated time from diagnosis to linkage to care and viral suppression among individuals newly diagnosed with HIV. Analyses were stratified by sex and age. Upper/lower bounds were calculated using alternative indicator definitions. RESULTS The number of diagnosed PLWH increased from 8,859 (8,859-11,389) in 2000 to 16,110 (16,110-17,423) in 2015. Over this 16-year period, the percent of diagnosed PLWH who were: in care increased from 81% (63-81%) to 87% (81-87%), on ART increased from 55% (34-60%) to 81% (70-82%) and virally suppressed increased from 41% (23-46%) to 80% (67-81%). Between 2000 and 2014, the percent of newly diagnosed individuals who linked to care within three months of diagnosis or achieved viral suppression within six months of diagnosis increased from 67% to 82% and from 22% to 42%, respectively. Estimates were generally lower for females and younger individuals. DISCUSSION HIV cascade indicators among diagnosed PLWH in Ontario improved between 2000 and 2015, but gaps still remain-particularly for younger individuals.
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Affiliation(s)
- James Wilton
- Data and Applied Science Impact, Ontario HIV Treatment Network, Toronto, Canada
| | - Juan Liu
- Public Health Ontario, Toronto, Canada
| | | | - Beth Rachlis
- Data and Applied Science Impact, Ontario HIV Treatment Network, Toronto, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Dignitas International, Toronto, Ontario, Canada
| | | | - Madison Giles
- Data and Applied Science Impact, Ontario HIV Treatment Network, Toronto, Canada
| | - Lucia Light
- Data and Applied Science Impact, Ontario HIV Treatment Network, Toronto, Canada
| | | | - Ann N. Burchell
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sandra Gardner
- Baycrest Health Sciences, Toronto, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Mark Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Abigail E. Kroch
- Data and Applied Science Impact, Ontario HIV Treatment Network, Toronto, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Milburn NG, Hamilton AB, Lopez S, Wyatt GE. Mentoring the next generation of behavioral health scientists to promote health equity. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2019; 89:369-377. [PMID: 31070422 PMCID: PMC7577403 DOI: 10.1037/ort0000415] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Health inequities and disparities among various racial/ethnic minority, sexual minority, and rural populations are the focus of increasing national efforts. Three health problems disproportionately affecting these populations-HIV/AIDS, substance abuse, and trauma-deserve particular attention because of their harmful effects on health across the life span. To address these problems, our training program, the UCLA HIV/AIDS, Substance Abuse, and Trauma Training Program (HA-STTP), mentors and trains early career behavioral health scientists to conduct research using scientifically sound, culturally collaborative, and population-centered approaches. HA-STTP has been highly successful in training a diverse, productive, nationwide group of scholars. The program provides 2 years of training and mentorship to 20 (5 per year over 4 years) scholars. It is unique in its attention to traumatic stress as a form of dysregulation, particularly as experienced by underserved populations. Furthermore, our training program embraces a uniquely comprehensive, culturally grounded understanding of traumatic stress and its implications for substance abuse and HIV. HA-STTP advances scholars' knowledge of the interconnections among substance abuse, HIV/AIDS, traumatic stress, and health disparities, particularly in underrepresented populations; provides intensive mentorship to support scholars' research interests and career trajectories; capitalizes on a multidisciplinary, multiracial/ethnic network of expert faculty; and evaluates the program's impact on scholars' knowledge and productivity. By fostering the growth of scholars committed to conducting research with underrepresented populations that are disproportionately affected by HIV/AIDS, substance abuse, and traumatic stress, this program enhances nationwide efforts to diminish the prevalence of these problems and improve health and quality of life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Norweeta G Milburn
- Department of Psychiatry and Biobehavioral Sciences, Division of Population Behavioral Health, Semel Institute for Neuroscience & Human Behavior, University of California
| | - Alison B Hamilton
- Department of Psychiatry and Biobhavioral Sciences, University of California, Los Angeles
| | - Susana Lopez
- Department of Psychiatry and Biobehavioral Sciences, Division of Population Behavioral Health, University of California
| | - Gail E Wyatt
- Department of Psychiatry and Biobhavioral Sciences, University of California, Los Angeles
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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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Price JT, Chi BH, Phiri WM, Ayles H, Chintu N, Chilengi R, Stringer JSA, Mutale W. Associations between health systems capacity and mother-to-child HIV prevention program outcomes in Zambia. PLoS One 2018; 13:e0202889. [PMID: 30192777 PMCID: PMC6128540 DOI: 10.1371/journal.pone.0202889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/12/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Zambia has made substantial investments in health systems capacity, yet it remains unclear whether improved service quality improves outcomes. We investigated the association between health system capacity and use of prevention of mother-to-child HIV transmission (PMTCT) services in Zambia. Materials and methods We analyzed data from two studies conducted in rural and semi-urban Lusaka Province in 2014–2015. Health system capacity, our primary exposure, was measured with a validated balanced scorecard approach. Based on WHO building blocks for health systems strengthening, we derived overall and domain-specific facility scores (range: 0–100), with higher scores indicating greater capacity. Our outcome, community-level maternal antiretroviral drug use at 12 months postpartum, was measured via self-report in a large cohort study evaluating PMTCT program impact. Associations between health systems capacity and our outcome were analyzed via linear regression. Results Among 29 facilities, median overall facility score was 72 (IQR:67–74). Median domain scores were: patient satisfaction 75 (IQR 71–78); human resources 85 (IQR:63–87); finance 50 (IQR:50–67); governance 82 (IQR:74–91); service capacity 77 (IQR:68–79); service provision 60 (IQR:52–76). Our programmatic outcome was measured from 804 HIV-infected mothers. Median community-level antiretroviral use at 12 months was 81% (IQR:69–89%). Patient satisfaction was the only domain score significantly associated with 12-month maternal antiretroviral use (β:0.22; p = 0.02). When we excluded the human resources and finance domains, we found a positive association between composite 4-domain facility score and 12-month maternal antiretroviral use in peri-urban but not rural facilities. Conclusions In these Zambian health facilities, patient satisfaction was positively associated with maternal antiretroviral 12 months postpartum. The association between overall health system capacity and maternal antiretroviral drug use was stronger in peri-urban versus rural facilities. Additional work is needed to guide strategic investments for improved outcomes in HIV and broader maternal-child health region-wide.
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Affiliation(s)
- Joan T. Price
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Benjamin H. Chi
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | | | | | - Roma Chilengi
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Jeffrey S. A. Stringer
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Wilbroad Mutale
- University of Zambia School of Public Health, Lusaka, Zambia
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Januraga PP, Reekie J, Mulyani T, Lestari BW, Iskandar S, Wisaksana R, Kusmayanti NA, Subronto YW, Widyanthini DN, Wirawan DN, Wongso LV, Sudewo AG, Sukmaningrum E, Nisa T, Prabowo BR, Law M, Cooper DA, Kaldor JM. The cascade of HIV care among key populations in Indonesia: a prospective cohort study. Lancet HIV 2018; 5:e560-e568. [PMID: 30143455 DOI: 10.1016/s2352-3018(18)30148-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/05/2018] [Accepted: 06/19/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Indonesia has had low uptake of HIV testing and treatment. We did a study to estimate the cascade of HIV care in key populations and identify predictors of outcomes at key cascade steps. METHODS We used an observational cohort study design to recruit and follow up men who have sex with men (MSM), female sex workers, transgender women (known as waria in Indonesia), and people who inject drugs (PWID) diagnosed with HIV in four locations in Indonesia: Bali, Bandung, Jakarta, and Yogyakarta. Recruitment, baseline, and follow-up visits were done at collaborating clinical services, including both primary care sites and hospitals. Inclusion criteria for participants included identifying as a member of a key population, age 16 years or older, not previously tested positive for HIV, and HIV positivity at baseline. All participants were offered treatment as per national guidelines, with the addition of viral load testing and completion of study-specific forms. Estimates were calculated of proportions of participants linked to care, commencing treatment, adherent to treatment, and who achieved virological suppression. We used logistic regression to investigate characteristics associated with antiretroviral therapy (ART) initiation and viral suppression and Cox regression to identify factors associated with loss to follow-up. This study is registered with ClinicalTrials.gov, NCT03429842. FINDINGS Between Sept 15, 2015, and Sept 30, 2016, 831 individuals were enrolled in the study, comprising 637 (77%) MSM, 116 (14%) female sex workers, 27 (3%) waria, and 51 (6%) PWID. Of those enrolled, 703 (84·6%, 95% CI 82·1-87·1) were linked to HIV care and 606 (86·2%, 83·7-88·8) who were linked with care started ART. Among participants who started treatment, 457 (75·4%, 71·8-78·9) were retained in care, of whom 325 (71·1%, 66·7-75·2) had a viral load test about 6 months after enrolment, with 294 (90·5%, 86·7-93·4) of those tested (294 [35%, 32·1-38·7] of the original cohort) virally suppressed. 146 (24%) of 606 who started treatment were lost to follow-up. People who enrolled at sites that offered both testing and treatment had a higher likelihood of treatment initiation than those who enrolled at sites offering testing only (p<0·0001 by multivariate analysis), and participants who had been linked to care and had a high school or university education were significantly more likely to achieve viral suppression than those with a primary school or lower level of education (p≤0·029 by mulivariate analysis). INTERPRETATION HIV cascade data among key populations in Indonesia show very poor rates of retention in treatment and viral suppression. Site and individual characteristics associated with initiating and continuing treatment suggest an urgent need to develop and implement effective interventions to support patients in achieving viral suppression among all people with HIV. FUNDING Australian Government Department of Foreign Affairs and Trade, WHO, and Indonesian Government.
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Affiliation(s)
- Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Indonesia.
| | | | - Tri Mulyani
- Faculty of Medicine, Padjajaran University, West Java, Indonesia
| | | | - Shelly Iskandar
- Faculty of Medicine, Padjajaran University, West Java, Indonesia
| | - Rudi Wisaksana
- Faculty of Medicine, Padjajaran University, West Java, Indonesia
| | - Nur Aini Kusmayanti
- Center for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yanri Wijayanti Subronto
- Center for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | | | - Lydia Verina Wongso
- AIDS Research Center, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | | | - Evi Sukmaningrum
- AIDS Research Center, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Tiara Nisa
- WHO Country Office of Indonesia, Jakarta, Indonesia
| | | | - Matthew Law
- Kirby Institute, UNSW, Sydney, NSW, Australia
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Daniels AK, Van Niekerk RL. The impact of a therapeutic exercise intervention on depression and body self-image in HIV-positive women in sub-Saharan Africa. HIV AIDS (Auckl) 2018; 10:133-144. [PMID: 30038525 PMCID: PMC6053174 DOI: 10.2147/hiv.s167005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Attitudes, responses, and reactions of HIV-positive women in three sub-Saharan African regions toward a therapeutic exercise intervention, aimed to determine the presence of depression and low body self-image, were captured. This provided insight into body satisfaction and desire to exercise (Stage 1, n=60), body self-image and depression (Stage 2, n=60), and overall concerns around the often adverse side effects of antiretroviral treatment (ART). A program of therapeutic (specialty) exercise was developed for the experimental design (Stage 2), to quantify the psychological side effects of these variables. METHODOLOGY Stage 1 constituted a qualitative exploration into attitudes and perceptions around ART, toxicity, health concerns, metabolic irregularities (lipodystrophy), body shape and size dissatisfaction, and cultural attitudes toward exercise. This stage deployed brief informal face-to-face interviews, based on the World Health Organization (WHO)/United Nations Fund for Population Activities (UNFPA) AIDS Inventory, in three sub-Saharan African regions (including provincial and district hospitals, nongovernmental organizations, voluntary counseling and testing/HIV and testing centers, and primary care outpatient clinics). Stage 2 of the study comprised a quantitative experimental design, conducted on a sample of HIV-positive women (mean age=39.0 years; mean years on ART=5.5; 86% black) in three selected HIV outpatient clinics in Johannesburg, South Africa. DATA ANALYSIS The collated data sets from both stages of the research were presented, analyzed, and interpreted (thematic analyses [Stage 1] and statistical analyses [Stage 2]) using the body self-image questionnaire and Beck's depression inventory. RESULTS Stage 1 outlined participants' concerns and reports around 1) body shape and size, including long-term effects of ART and 2) attitudes toward exercise, as a function of HIV status. Stage 2 represented pre- and posttest statistics, showing low statistical means for both the experiment and the control groups, with statistical significance for four out of nine items of subscales of body self-image questionnaire.
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Affiliation(s)
- Andrea K Daniels
- School of Community Psychosocial Research (COMPRES), Faculty of Health Sciences, North West University, Potchefstroom, South Africa,
| | - Rudolph L Van Niekerk
- Department of Human Movement Science, Faculty of Health Sciences, University of Fort Hare, Alice, South Africa
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Towards 90-90-90 Target: Factors Influencing Availability, Access, and Utilization of HIV Services-A Qualitative Study in 19 Ugandan Districts. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9619684. [PMID: 29750175 PMCID: PMC5884295 DOI: 10.1155/2018/9619684] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 02/13/2018] [Indexed: 12/15/2022]
Abstract
Background UNAIDS has set a new target 90-90-90 by 2020. To achieve this target, current programs need to address challenges that limit access, availability, and utilization of HIV testing and treatment services. Therefore, the aim of this study was to identify the barriers that influence access, availability, and utilization of HIV services in rural Uganda within the setting of a large donor funded program. Methods We conducted key informant interviews with stakeholders at the district level, staff of existing HIV/AIDS projects, and health facilities in 19 districts. Data were also collected from focus group discussions comprised of clients presenting for HIV care and treatment. Data were transcribed and analyzed using content analysis. Results. Barriers identified were as follows: (1) drug shortages including antiretroviral drugs at health facilities. Some patients were afraid to start ART because of worrying about shortages; (2) distance and (3) staffing shortages; (4) stigma persistence; (5) lack of social and economic support initiatives that enhance retention in treatment. Conclusions In conclusion, our study has identified several factors that influence access, availability, and utilization of HIV services. Programs need to address drug and staff shortages, HIV stigma, and long distances to health facilities to broaden access and utilization in order to realize the UNAIDS target.
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Ogunbajo A, Kershaw T, Kushwaha S, Boakye F, Wallace-Atiapah ND, Nelson LE. Barriers, Motivators, and Facilitators to Engagement in HIV Care Among HIV-Infected Ghanaian Men Who have Sex with Men (MSM). AIDS Behav 2018; 22:829-839. [PMID: 28550380 DOI: 10.1007/s10461-017-1806-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In Ghana, men who have sex with men (MSM) bear a high burden of HIV. Identifying factors that influence engagement in HIV care among HIV-infected Ghanaian MSM is critical to devising novel interventions and strengthening existing programs aimed at improving outcomes across the HIV care continuum. Consequently, we conducted an exploratory qualitative research study with 30 HIV-infected Ghanaian MSM between May 2015 and July 2015. Common barriers were fear of being seen in HIV-related health facility, financial difficulties, and health system challenges. Major motivators for engagement in care included social support, fear of mortality from HIV, and knowledge of effectiveness of HIV treatment. Key facilitators were enrollment in health insurance, prior relationship and familiarity with hospital personnel, and positive experience in healthcare setting. Our findings highlight the need for new and innovative care delivery mediums, affirming and competent healthcare providers, and increased access to health insurance.
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Affiliation(s)
- Adedotun Ogunbajo
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
- Brown School of Public Health, 120 South Main St., Box G-S121-3, Providence, RI, 02912, USA.
| | - Trace Kershaw
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | | | | | | | - LaRon E Nelson
- University of Toronto, Toronto, ON, Canada
- School of Nursing, University of Rochester, Rochester, NY, USA
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Mateo-Urdiales A, Johnson S, Nachega JB, Eshun-Wilson I. Rapid initiation of antiretroviral therapy for people living with HIV. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2018. [DOI: 10.1002/14651858.cd012962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Alberto Mateo-Urdiales
- Liverpool School of Tropical Medicine; Department of Clinical Sciences; Liverpool UK L3 5QA
| | - Samuel Johnson
- Liverpool School of Tropical Medicine; Department of Clinical Sciences; Liverpool UK L3 5QA
| | - Jean B Nachega
- University of Pittsburgh; Department of Epidemiology, Infectious Diseases and Microbiology; Pittsburgh Pennsylvania USA
- Johns Hopkins Bloomberg School of Public Health; Department of Epidemiology and International Health; Baltimore Maryland USA
- Stellenbosch University; Centre for Infectious Diseases; Cape Town South Africa
| | - Ingrid Eshun-Wilson
- Stellenbosch University; Centre for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences; Francie van Zyl Drive, Tygerberg, 7505, Parow Cape Town Western Cape South Africa 7505
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Stuart RM, Fraser‐Hurt N, Kerr CC, Mabusela E, Madi V, Mkhwanazi F, Pillay Y, Barron P, Muzah B, Matsebula T, Gorgens M, Wilson DP. The City of Johannesburg can end AIDS by 2030: modelling the impact of achieving the Fast-Track targets and what it will take to get there. J Int AIDS Soc 2018; 21:e25068. [PMID: 29359533 PMCID: PMC5810342 DOI: 10.1002/jia2.25068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION In 2014, city leaders from around the world endorsed the Paris Declaration on Fast-Track Cities, pledging to achieve the 2020 and 2030 HIV targets championed by UNAIDS. The City of Johannesburg - one of South Africa's metropolitan municipalities and also a health district - has over 600,000 people living with HIV (PLHIV), more than any other city worldwide. We estimate what it would take in terms of programmatic targets and costs for the City of Johannesburg to meet the Fast-Track targets, and demonstrate the impact that this would have. METHODS We applied the Optima HIV epidemic and resource allocation model to demographic, epidemiological and behavioural data on 26 sub-populations in Johannesburg. We used data on programme costs and coverage to produce baseline projections. We calculated how many people must be diagnosed, put onto treatment and maintained with viral suppression to achieve the 2020 and 2030 targets. We also estimated how treatment needs - and therefore fiscal commitments - could be reduced if the treatment targets are combined with primary HIV prevention interventions (voluntary medical male circumcision (VMMC), an expanded condom programme, and comprehensive packages for female sex workers (FSW) and young females). RESULTS If current programmatic coverage were maintained, Johannesburg could expect 303,000 new infections and 96,000 AIDS-related deaths between 2017 and 2030 and 769,000 PLHIV by 2030. Achieving the Fast-Track targets would require an additional 135,000 diagnoses and 232,000 people on treatment by 2020 (an increase in around 80% over 2016 treatment numbers), but would avert 176,000 infections and 56,500 deaths by 2030. Assuming stable ART unit costs, this would require ZAR 29 billion (USD 2.15 billion) in cumulative treatment investments over the 14 years to 2030. Plausible scale-ups of other proven interventions (VMMC, condom distribution and FSW strategies) could yield additional reductions in new infections (between 4 and 15%), and in overall treatment investment needs. Scaling up VMMC in line with national targets is found to be cost-effective in the medium term. CONCLUSIONS The scale-up in testing and treatment programmes over this decade has been rapid, but these efforts must be doubled to reach 2020 targets. Strategic investments in proven interventions will help Johannesburg achieve the treatment targets and be on track to end AIDS by 2030.
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Affiliation(s)
- Robyn M Stuart
- Department of Mathematical SciencesUniversity of CopenhagenCopenhagenDenmark
- Burnet InstituteMelbourneAustralia
| | | | - Cliff C Kerr
- Burnet InstituteMelbourneAustralia
- School of PhysicsUniversity of SydneySydneyAustralia
| | - Emily Mabusela
- Department of HealthGauteng ProvinceJohannesburgSouth Africa
| | - Vusi Madi
- Department of HealthGauteng ProvinceJohannesburgSouth Africa
| | - Fredrika Mkhwanazi
- Department of HealthJohannesburg Health DistrictJohannesburgSouth Africa
| | - Yogan Pillay
- National Department of HealthPretoriaSouth Africa
| | - Peter Barron
- School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | | | | | - David P Wilson
- Burnet InstituteMelbourneAustralia
- Monash UniversityMelbourneAustralia
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