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Tam C, Wang L, Salters K, Moore D, Wesseling T, Grieve S, Parry R, Barath J, Hogg R, Barrios R. Evaluating experiences of HIV-related stigma among people living with HIV diagnosed in different treatment eras in British Columbia, Canada. AIDS Care 2024; 36:238-247. [PMID: 37963415 DOI: 10.1080/09540121.2023.2277150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
There is mixed evidence on whether experiences of HIV-related stigma are mitigated with lived experience. We sought to examine whether people living with HIV (PLWH) with longer living experience reported varying levels of HIV-related stigma. Between January 2016-September 2018, we used purposive sampling to enrol PLWH aged ≥19 across British Columbia, Canada, where participants completed the 10-item Berger HIV Stigma Scale. We conducted bivariate analyzes examining key sociodemographic characteristics and HIV-related stigma scores. Multivariable linear regression modelled the association between year of HIV diagnosis by treatment era and HIV-related stigma scores. We enrolled 644 participants; median age at enrolment was 50 years (Q1-Q3: 42-56), with 37.4% (n = 241) diagnosed before the year 2000. The median HIV-stigma scores of all participants (19.0, Q1-Q3: 13-25, range 0-40) stratified by treatment era were: 17.0 (pre-1996), 20.0 (1996-1999), 20.0 (2000-2009), 19.0 (2010-2018) (p = 0.03). While there was a significant association at the univariate level, year of HIV diagnosis by treatment era was not associated with stigma scores after controlling for age, gender, HIV key populations, ethnicity, relationship status, social support, and ever having a mental health disorder diagnosis. This suggests that PLWH still experience HIV-related stigma today, compared to those diagnosed in earlier time periods.
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Affiliation(s)
- Clara Tam
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Lu Wang
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kate Salters
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - David Moore
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Tim Wesseling
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Sean Grieve
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Rebeccah Parry
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Justin Barath
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Robert Hogg
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Rolando Barrios
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Zhao Y, Shannon K, Buxton JA, Ti L, Genovy TA, Braschel M, Pick N, Kestler M, Deering K. Precarious Housing Associated with Unsuppressed Viral load, sub-optimal Access to HIV Treatment and Unmet Health care Needs, Among Women Living with HIV in Metro Vancouver, Canada. AIDS Behav 2023; 27:2271-2284. [PMID: 36729293 PMCID: PMC10564463 DOI: 10.1007/s10461-022-03957-2] [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] [Accepted: 12/12/2022] [Indexed: 02/03/2023]
Abstract
We investigated associations between (1) housing status (four categories measuring housing stability) and outcomes along the HIV care continuum (not currently on antiretroviral therapy [ART]; sub-optimal ART adherence [< 95% in the last 3-4 weeks]; unsuppressed viral load [> 200 copies/ml], median CD4 < 200 in the last six months), and (2) housing status and unmet primary, dental and mental health care needs in the last six months among WLWH. Housing status was defined according to the Canadian Definition of Homelessness and had four categories: unsheltered (i.e., living in ≥ 1 unsheltered location [e.g., street, abandoned buildings]), unstable (i.e., living in ≥ 1 unstable location [e.g., shelter, couch surfing]), supportive housing (i.e., only living in supportive housing), and stable housing (i.e., only living in one's own housing; reference). At baseline, in the last six months, 47.3% of participants reported unstable housing, followed by 24.4% unsheltered housing, 16.4% stable housing, and 11.9% supportive housing. Overall, 19.1% of the full sample (N = 336, 2010-2019) reported not currently on ART; among participants on ART, 28.0% reported sub-optimal ART adherence. Overall, 32.1% had recent unsuppressed viral load. Among a subsample (n = 318, 2014-2019), 15.7% reported unmet primary care needs, 26.1% unmet dental care needs, and 16.4% unmet mental health care needs. In adjusted models, being unsheltered (vs. stable housing) was associated with not currently on ART, unsuppressed viral load, and unmet primary and dental care needs. Housing and health services need to be developed with and for WLWH to address structural inequities and fulfill basic rights to housing and health.
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Affiliation(s)
- Yinong Zhao
- Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jane A Buxton
- Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Lianping Ti
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Theresa Anne Genovy
- Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, Canada
| | - Neora Pick
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, Canada
| | - Mary Kestler
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, Canada
| | - Kathleen Deering
- Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, Canada.
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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van Santen DK, Lodi S, Dietze P, van den Boom W, Hayashi K, Dong H, Cui Z, Maher L, Hickman M, Boyd A, Prins M. Comprehensive needle and syringe program and opioid agonist therapy reduce HIV and hepatitis c virus acquisition among people who inject drugs in different settings: A pooled analysis of emulated trials. Addiction 2023; 118:1116-1126. [PMID: 36710474 PMCID: PMC10175130 DOI: 10.1111/add.16147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS Although the Netherlands, Canada and Australia were early adopters of harm reduction for people who inject drugs (PWID), their respective HIV and hepatitis C (HCV) epidemics differ. We measured the pooled effect of needle and syringe program (NSP) and opioid agonist therapy (OAT) participation on HIV and HCV incidence in these settings. DESIGN For each cohort, we emulated the design and statistical analysis of a target trial using observational data. SETTING AND PARTICIPANTS We included PWID at risk of HIV or HCV infection from the Amsterdam Cohort Studies (1985-2013), Vancouver Injection Drug Users Study (1997-2009) and Melbourne Injecting Drug User Cohort Study (SuperMIX) (2010-2021). MEASUREMENTS Separately for each infection and cohort (only HCV in SuperMIX), marginal structural models were used to compare the effect of comprehensive (on OAT and 100% NSP coverage or on OAT only if no recent injection drug use) versus no/partial NSP/OAT (no OAT and/or <100% NSP coverage) participation. Pooled hazard ratios (HR) and 95% CI were calculated using random-effects meta-analysis. FINDINGS We observed 94 HIV seroconversions and 81 HCV seroconversions among 2023 and 430 participants, respectively. Comprehensive NSP/OAT led to a 41% lower risk of HIV acquisition (pooled HR = 0.59, 95% CI = 0.36-0.96) and a 76% lower risk of HCV acquisition (pooled HR = 0.24, 95% CI = 0.11-0.51), compared with no/partial NSP/OAT, with little heterogeneity between studies for both infections (I2 = 0%). CONCLUSIONS In the Netherlands, Canada and Australia, comprehensive needle and syringe program and opioid agonist therapy participation appears to substantially reduce HIV and hepatitis C acquisition compared with no or partial needle and syringe program/opioid agonist therapy participation. These findings from an emulated trial design reinforce the critical role of comprehensive access to harm reduction in optimizing infection prevention for people who inject drugs.
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Affiliation(s)
- Daniela K. van Santen
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Disease Elimination, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Paul Dietze
- Department of Disease Elimination, Burnet Institute, Melbourne, Australia
| | | | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Zishan Cui
- British Columbia Centre on Substance Use, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Lisa Maher
- The Kirby Institute for Infection and Immunity, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anders Boyd
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam, The Netherlands
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Jaibat L, Cui Z, Mitra S, Loh J, Reddon H, Fairbairn N, Milloy MJ. Perceived Mistreatment in Health Care Settings and its Relationship with HIV Clinical Outcomes in HIV-positive People who Use Drugs in Vancouver, Canada. AIDS Behav 2023; 27:1636-1646. [PMID: 36318426 PMCID: PMC10149567 DOI: 10.1007/s10461-022-03895-z] [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] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
People living with HIV (PLWH) often experience stigma and discrimination by health care professionals. We investigated the prevalence of perceived mistreatment in health care settings and its associations with HIV clinical outcomes and health care-seeking behaviour using data from a long-running prospective cohort of PLWH who use drugs. Of the 857 participants included, 19% reported at least one instance of perceived mistreatment during the study period. In adjusted longitudinal analyses, perceived mistreatment was positively associated with not being on ART in the same follow-up period, and participants who reported perceived mistreatment were less likely to report seeing a physician in the subsequent follow-up period. Daily use of injection drugs was positively associated with reporting perceived mistreatment. These findings demonstrate the implications of negative health care interactions in a population that must consistently engage with the health care system, and the need for stigma-reducing educational interventions for health care professionals.
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Affiliation(s)
- Laura Jaibat
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zishan Cui
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400-1045 Howe St, V6Z2A9, Vancouver, BC, Canada
| | - Sanjana Mitra
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400-1045 Howe St, V6Z2A9, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jane Loh
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400-1045 Howe St, V6Z2A9, Vancouver, BC, Canada
| | - Hudson Reddon
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400-1045 Howe St, V6Z2A9, Vancouver, BC, Canada
- Division of social medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400-1045 Howe St, V6Z2A9, Vancouver, BC, Canada.
- Division of social medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Silva JKBD, Santos JMD, Moreira WC, Romero ROG, Leadebal ODCP, Nogueira JDA. Modelo multinível na identificação de fatores de risco comportamentais e estruturais ao HIV: revisão integrativa. Rev Bras Enferm 2023. [DOI: 10.1590/0034-7167-2021-0853pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivos: investigar estudos que adotaram o modelo de análise multinível na identificação de fatores de risco comportamentais e estruturais, que estão associados a infecção pelo HIV. Métodos: revisão integrativa da literatura com estudos disponíveis na íntegra, obtidos nas bases EMBASE, CINAHL, Pubmed e Scopus, cujos descritores selecionados foram os termos constantes: “HIV”, “multilevel analysis”, “behavior”. Resultados: a pesquisa resultou em 236 artigos. Destes, dez artigos compuseram a amostra. Desvantagem econômica, características de vizinhança, instabilidade habitacional, encarceramento, sexo transacional, múltiplos parceiros, abuso de substâncias e idade da primeira relação sexual foram classificados como fatores de risco estruturais e comportamentais ao HIV. Redução da desvantagem socioeconômica, fornecimento de estabilidade habitacional e uso de preservativos foram associados a fatores de proteção à exposição ao HIV. Conclusões: com a aplicabilidade do modelo multinível nos estudos de investigação de fatores de risco, foi possível identificar os elementos estruturais e comportamentais de risco ao HIV.
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Process description of developing HIV prevention monitoring indicators for a province-wide pre-exposure prophylaxis (PrEP) program in British Columbia, Canada. PLoS One 2023; 18:e0283025. [PMID: 36920956 PMCID: PMC10016663 DOI: 10.1371/journal.pone.0283025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
In 2018, the pre-exposure prophylaxis (PrEP) program was initiated in British Columbia (BC), Canada, providing PrEP at no cost to qualifying residents. This observational study discussed the steps to develop key evidence-based monitoring indicators and their calculation using real-time data. The indicators were conceptualized, developed, assessed and approved by the Technical Monitoring Committee of representatives from five health authority regions in BC, the BC Ministry of Health, the BC Centre for Disease Control, and the BC Centre for Excellence in HIV/AIDS. Indicator development followed the steps adopted from the United States Centers for Disease Control and Prevention framework for program evaluation in public health. The assessment involved eight selection criteria: data quality, indicator validity, existing scientific evidence, indicator informativeness, indicator computing feasibility, clients' confidentiality maintenance capacity, indicator accuracy, and administrative considerations. Clients' data from the provincial-wide PrEP program (January 2018-December 2020) shows the indicators' calculation. The finalized 14 indicators included gender, age, health authority, new clients enrolled by provider type and by the health authority, new clients dispensed PrEP, clients per provider, key qualifying HIV risk factor(s), client status, PrEP usage type, PrEP quantity dispensed, syphilis and HIV testing and incident cases, and adverse drug reaction events. Cumulative clients' data (n = 6966; 99% cis-gender males) identified an increased new client enrollment and an unexpected drop during the COVID-19 pandemic. About 80% dispensed PrEP from the Vancouver Coastal health authority. The HIV incidence risk index for men who have sex with men score ≥10 was the most common qualifying risk factor. The framework we developed integrating indicators was applied to monitor our PrEP program, which could help reduce the public health impact of HIV.
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da Silva JKB, dos Santos JM, Moreira WC, Romero ROG, Leadebal ODCP, Nogueira JDA. Multilevel model in the identification of behavioral and structural risk factors for HIV: integrative review. Rev Bras Enferm 2022; 76:e20210853. [PMID: 36542051 PMCID: PMC9749773 DOI: 10.1590/0034-7167-2021-0853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 08/21/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES to investigate studies that adopted the multilevel analysis model to identify behavioral and structural risk factors associated with HIV infection. METHODS an integrative review of the literature with studies available in full, obtained from EMBASE, CINAHL, Pubmed, and Scopus, whose selected descriptors were the indexed terms: "HIV", "multilevel analysis" and "behavior". RESULTS the search resulted in 236 studies. Out of these, ten studies comprised the sample. Economic disadvantage, neighborhood characteristics, housing instability, incarceration, transactional sex, multiple partners, substance abuse, and age at first intercourse were classified as structural and behavioral risk factors for HIV. Reduced socioeconomic disadvantage, provision of housing stability, and condom use were associated with protective factors for HIV exposure. CONCLUSIONS by applying the multilevel model in risk factor research studies, it was possible to identify the structural and behavioral elements of HIV risk.
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McClean AR. Trends in Use of Combination Antiretroviral Therapy and Treatment Response from 2000 to 2016 in the Canadian Observational Cohort (CANOC): A Longitudinal Cohort Study. Can J Hosp Pharm 2022; 75:309-316. [PMID: 36246433 PMCID: PMC9524546 DOI: 10.4212/cjhp.3234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Advances in treatment have turned HIV from a terminal illness to a more manageable condition. Over the past 20 years, there have been considerable changes to HIV treatment guidelines, including changes in preferred antiretrovirals and timing of initiation of combination antiretroviral therapy (cART). Objective To examine real-world trends in cART utilization, viral control, and immune reconstitution among people living with HIV in Canada. Methods Data were obtained from the Canadian Observational Cohort (CANOC). CANOC participants were eligible if they were antiretroviral therapy-naive at entry and initiated 3 or more antiretrovirals on or after January 1, 2000; if they were at least 18 years of age at treatment initiation; if they were residing in Canada; and if they had at least 1 viral load determination and CD4 count within 1 year of CANOC entry. Baseline and annual mean CD4 counts were categorized as less than 200, 200-350, 351-500, and more than 500 cells/mm3. Annual mean viral loads were reported as suppressed (< 50 copies/mL), low (50-199 copies/mL), or high detectable (≥ 200 copies/mL). The cART regimens were reported yearly. Results All CANOC participants were included (n = 13 040). Over the study period, the proportion of individuals with an annual mean CD4 count above 500 cells/mm3 increased from 16.3% to 65.8%, while the proportion of individuals with an undetectable mean viral load increased from 10.6% to 83.2%. As of 2007, the most commonly prescribed 2-agent nucleoside reverse transcriptase inhibitor backbone was tenofovir disoproxil fumarate and emtricitabine. In terms of third agents, non-nucleoside reverse transcriptase inhibitors were the most common class in the periods 2000-2003 and 2014-2015, protease inhibitors were most common in the period 2004-2013, and integrase inhibitors were most common in 2016. Conclusions Concordance with treatment guidelines was demonstrated over time with respect to cART prescribing and immunologic and virologic response.
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Fonseca-Cuevas A, Nanditha NGA, Shen T, Moore DM, Lachowsky NJ, Card KG, Sang JM, Wang L, Chia J, Duailibe F, Hogg RS, Lima VD. Use of Gay Chatlines and Online Dating Platforms as Potential Mediators or Moderators in the Relationship Between Loneliness, Self-Rated Attractiveness and Human Immunodeficiency Virus Acquisition Risk Among Gay, Bisexual, and Other Men Who Have Sex With Men in Vancouver, Canada. Sex Transm Dis 2022; 49:706-712. [PMID: 35794818 PMCID: PMC9481688 DOI: 10.1097/olq.0000000000001672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/22/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (gbMSM) remain disproportionately affected by human immunodeficiency virus (HIV). Interaction between psychosocial factors likely plays a role in HIV acquisition risk. We aimed to analyze the association of loneliness and self-rated attractiveness with HIV acquisition risk, and determine whether these associations were mediated by gay telephone chatlines or online dating platforms. METHODS This cross-sectional study included HIV-negative gbMSM 16 years or older enrolled into the Momentum Health Study from February 2012 to February 2015. Loneliness, self-rated attractiveness (exposures) and use of gay chatlines or online dating platforms (mediators) were assessed through self-interviews. Human immunodeficiency virus acquisition risk (outcome) was assessed by the HIV Incidence Risk Index. Weighted logistic regression modeled the association and moderation effect between exposures and outcome. Mediation models estimated 3-way direct effect among exposures, mediators, and outcome. RESULTS Of 542 gbMSM, those who were lonely (adjusted odds ratio [aOR], 1.54; 95% confidence intervals [CI], 1.04-2.28) and attractive (aOR, 1.69; 95% CI, 1.04-2.76) had increased odds for HIV acquisition risk. Our moderation analysis demonstrated a heightened joint effect among lonely and attractive participants (aOR, 1.70; 95% CI, 1.08-2.65). Use of gay telephone chatlines or online dating platforms mediated 30.5% of the association between loneliness and HIV acquisition risk, but did not mediate attractiveness and HIV acquisition risk. CONCLUSIONS Our findings suggest that the provision of interventions focusing on mental health support and safer sex practices through gay telephone chatlines or online dating platforms is promising to help alleviate the HIV burden among gbMSM.
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Affiliation(s)
| | - Ni Gusti Ayu Nanditha
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
- Department of Medicine
| | - Tian Shen
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
| | - David M. Moore
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver
| | - Nathan J. Lachowsky
- Canadian Institute for Substance Use Research
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria
| | - Kiffer G. Card
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Jordan M. Sang
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
| | - Lu Wang
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
| | - Jason Chia
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
| | - Felipe Duailibe
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
- Department of Medicine
| | - Robert S. Hogg
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Viviane D. Lima
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
- Department of Medicine
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10
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Juwono S, Milloy MJ, Choi J, Fairbairn N, Nolan S, Socías ME. Opioid agonist treatment improves progression through the HIV cascade of care among people living with HIV who use unregulated opioids. AIDS 2022; 36:1429-1436. [PMID: 35608126 PMCID: PMC9329231 DOI: 10.1097/qad.0000000000003247] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Opioid agonist treatment (OAT) has been shown to improve certain HIV-related treatment measures among people with HIV (PHIV) with opioid use disorder (OUD). However, there is limited data on the impacts of OAT along the whole HIV cascade of care. DESIGN AND METHODS Using data from an ongoing cohort of PHIV who use drugs in Vancouver, Canada, we used cumulative link mixed-effects models to estimate the independent effect of OAT on achieving progressive steps in the HIV cascade among participants using unregulated opioids daily, after adjusting for confounders. RESULTS Between 2005 and 2017, we recruited 639 PHIV regularly using opioids (median age 42 years, 59% male, 56% White), of whom 70% were on OAT at their baseline visit. Engagement in OAT showed a nonsignificant trend with higher linkage to HIV care (adjusted partial proportional odds ratio [APPO] = 1.75, 95% confidence interval [CI]: 0.83-3.69), and significantly higher cumulative odds of successfully achieving subsequent HIV cascade steps: on ART (APPO = 3.85, 95% CI: 2.33-6.37); adherent to ART (APPO = 3.15, 95% CI: 2.15-4.62); and HIV viral suppression (APPO = 2.18, 95% CI: 1.51-3.14). CONCLUSIONS This study found a high level of OAT engagement among PHIV using unregulated opioids and that OAT engagement resulted in significantly increased progression through some of the higher steps of the HIV cascade. While these findings are encouraging, they highlight the need to reach populations off OAT to maximize the clinical and community-level benefits of ART.
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Affiliation(s)
| | - M-J Milloy
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Nadia Fairbairn
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Seonaid Nolan
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M Eugenia Socías
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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11
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Tattersall T, Tam C, Moore D, Wesseling T, Grieve S, Wang L, Bacani N, Montaner JSG, Hogg RS, Barrios R, Salters K. Healthcare and treatment experiences among people diagnosed with HIV before and after a province-wide treatment as prevention initiative in British Columbia, Canada. BMC Public Health 2022; 22:1022. [PMID: 35597938 PMCID: PMC9123764 DOI: 10.1186/s12889-022-13415-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/10/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction In 2010, the Canadian province of British Columbia (BC) initiated the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) program to improve HIV testing, linkage to care, and treatment uptake, thereby operationalizing the HIV Treatment as Prevention (TasP) framework at the population-level. In this analysis, we evaluated self-reported HIV care experiences and therapeutic outcomes among people diagnosed with HIV prior to and after implementation of this provincial program. Methods A cross-sectional analysis was performed on the baseline data of a cohort of people living with HIV (PLWH) (19 years and older) in the province of BC sampled from July 2016 to September 2018. All participants consented to linking their survey data to the provincial HIV treatment registry. Individuals diagnosed with HIV from January 1 2000—December 31 2009 were classified as pre-intervention and those diagnosed January 1 2010—December 31 2018 as post-intervention cohorts. Bivariate analyses were run using Chi-square and Wilcoxon Rank Sum tests. Cox proportional hazards regression model demonstrates time to antiretroviral therapy (ART) initiation (from HIV baseline) and virological suppression (2 consecutive plasma viral load measurements < 200 copies/ml). Results Of the 325 participants included in this analysis, 198 (61%) were diagnosed with HIV in the pre-intervention era and 127 (39%) in the post-intervention era. A higher proportion of participants in post-intervention era were diagnosed at walk-in clinics (45% vs. 39%) and hospitals (21% vs. 11%) (vs pre-intervention) (p = 0.042). Post-intervention participants had initiated ART with less advanced HIV disease (CD4 count 410 vs. 270 cells/ul; p = 0.001) and were less likely to experience treatment interruptions at any point in the 5 years after HIV diagnosis (17% vs. 48%; p < 0.001). The post-intervention cohort had significantly more timely ART initiation (aHR: 5.97, 95%CI 4.47, 7.97) and virologic suppression (aHR: 2.03, 95%CI 1.58, 2.60) following diagnosis, after controlling for confounders. Conclusions We found favourable treatment experiences and more timely ART initiation and virologic suppression after a targeted TasP provincial program. Our results illustrate the importance of accessible low-barrier HIV testing and treatment in tackling the HIV epidemic.
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Affiliation(s)
- Tessa Tattersall
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada
| | - Clara Tam
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada
| | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tim Wesseling
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada
| | - Sean Grieve
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada
| | - Nic Bacani
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada. .,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
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Improving Post-Release Care Engagement for People Living with HIV Involved in the Criminal Justice System: A Systematic Review. AIDS Behav 2022; 26:1607-1617. [PMID: 34705154 DOI: 10.1007/s10461-021-03513-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2021] [Indexed: 10/20/2022]
Abstract
Given sub-optimal HIV care outcomes for people living with HIV (PLWH) post-release from incarceration, we systematically searched peer-reviewed literature (2010-2021) describing controlled trial interventions aimed at improving Antiretroviral Therapy (ART) adherence and care linkage following release from correctional facilities for PLWH. Of 392 studies, 16 (4%) met the inclusion criteria. All studies were conducted in the United States and involved some form of intensive case management. Trials that scored highest in terms of study quality provided cell phones for engagement, reported sustained viral load suppression as a measurable outcome to infer ART adherence, and measured longitudinal data collected for at least 3-to-6 months following release. The two trials that demonstrated improved HIV viral load suppression involved Peer Navigators, and incentivized undetectable viral load, respectively. Facilitating support for addictions and addressing other social and structural barriers to achieving optimal health is also of vital importance in bridging care gaps for PLWH.
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13
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Caught between HIV exceptionalism and health service integration: Making visible the role of public health policy in the scale-up of novel sexual health services. Health Place 2021; 72:102696. [PMID: 34736155 DOI: 10.1016/j.healthplace.2021.102696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/13/2021] [Accepted: 10/07/2021] [Indexed: 11/21/2022]
Abstract
The role of contextual factors for program implementation is well-documented; however, their changing function throughout implementation phases is less established. We conducted an institutional ethnography to understand how structural conditions for scaling up initiatives are shaped by public health policy. We conducted 25 interviews with implementers of a comprehensive sexual health testing service in Canada, 21 meeting observations, and textual analyses of key policies and reports. Our analysis revealed a disjuncture between implementers' task of scaling up programming and the actualities of working within the discursive and material confines of policies premised on HIV exceptionalism and underfunded integrated health services.
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14
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St-Jean M, Dong X, Tafessu H, Moore D, Honer WG, Vila-Rodriguez F, Sereda P, Hogg RS, Patterson TL, Salters K, Barrios R, Montaner JSG, Lima VD. Overdose mortality is reducing the gains in life expectancy of antiretroviral-treated people living with HIV in British Columbia, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103195. [PMID: 33773878 DOI: 10.1016/j.drugpo.2021.103195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND A remarkable reduction in AIDS-related mortality has been achieved through the widespread use of triple combination antiretroviral therapy, considerably increasing the life expectancy of people living with HIV (PLWH). However, these survival gains are now at risk in North America due to an unprecedented public health emergency: the deadly drug overdose epidemic. Drug overdoses are now the leading cause of unintentional death in British Columbia (BC), Canada and the United States due to synthetic opioids (e.g., fentanyl) in illegal markets. This manuscript aimed to estimate the effect of overdose mortality on life expectancy and identify covariates associated with the hazard for overdose mortality in the presence of competing risk among PLWH in BC. METHODS Those eligible were aged ≥20 years, initiated antiretroviral therapy from 1-Apr-1996 to 30-Dec-2017, and were followed until 31-Dec-2017, last contact or death date. We estimated the potential gains in life expectancy from abridged life tables. We modelled the association between covariates and the cause-specific hazard for overdose mortality, accounting for mortality of other causes as a competing risk. RESULTS Among the 10,362 PLWH, 3% experienced overdose mortality. The life expectancy at age 20 increased by 8.7 years from 2002-2007 to 2008-2013 compared to only 3.0 years from 2008-2013 to 2014-2017. The potential gain in life expectancy was 3.3 years at age 20 during the ongoing overdose epidemic (2014-2017). There were gender differences in life expectancies throughout the study period. People who have ever injected drugs, women and viral load monitoring non-compliance were key covariates associated with an increased hazard of overdose mortality. CONCLUSION Survival gains among PLWH have been considerably reduced due to the ongoing overdose epidemic.
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Affiliation(s)
- Martin St-Jean
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Xinzhe Dong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Hiwot Tafessu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, Canada
| | | | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; Vancouver Coastal Health, Vancouver, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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15
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Fleming T, Collins AB, Bardwell G, Fowler A, Boyd J, Milloy MJ, Small W, McNeil R. A qualitative investigation of HIV treatment dispensing models and impacts on adherence among people living with HIV who use drugs. PLoS One 2021; 16:e0246999. [PMID: 33635886 PMCID: PMC7909635 DOI: 10.1371/journal.pone.0246999] [Citation(s) in RCA: 1] [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: 05/28/2019] [Accepted: 01/29/2021] [Indexed: 12/03/2022] Open
Abstract
Antiretroviral therapy (ART) dispensing is strongly associated with treatment adherence. Among illicit drug-using populations, whom experience greater structural barriers to adherence, directly administered antiretroviral therapy (DAAT) is often regarded as a stronger predictor of optimal adherence over self-administered medications. In Vancouver, Canada, people living with HIV (PLHIV) who use drugs and live in low-income housing are a critical population for treatment support. This group is typically able to access two key DAAT models, daily delivery and daily pickup, in addition to ART self-administration. This ethno-epidemiological qualitative study explores how key dispensing models impact ART adherence among PLHIV who use drugs living in low-income housing, and how this is framed by structural vulnerability. Semi-structured interviews lasting 30-45 minutes were conducted between February and May 2018 with 31 PLHIV who use drugs recruited from an ongoing prospective cohort of PLHIV who use drugs. Interviews were audio-recorded, transcribed verbatim, and analyzed using QSR International's NVivo 12 software. Interviews focused on housing, drug use, and HIV management. Models that constrained agency were found to have negative impacts on adherence and quality of life. Treatment interruptions were framed by structural vulnerabilities (e.g., housing vulnerability) that impacted ability to maintain adherence under certain dispensing models, and led participants to consider other models. Participants using DAAT models which accounted for their structural vulnerabilities (e.g., mobility issues, housing instability), credited these models for their treatment adherence, but also acknowledged factors that constrained agency, and the negative impacts this could have on both adherence, and quality of life. Being able to integrate ART into an established routine is key to supporting ART adherence. ART models that account for the structural vulnerability of PLHIV who use drugs and live in low-income housing are necessary and housing-based supports could be critical, but the impacts of such models on agency must be considered to ensure optimal adherence.
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Affiliation(s)
- Taylor Fleming
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Alexandra B. Collins
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Al Fowler
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
| | - M. J. Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Will Small
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Ryan McNeil
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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16
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Ng C, Chayama KL, Krüsi A, Small W, Knight R. Perspectives of HIV-positive and -negative people who use drugs regarding the criminalization of HIV non-disclosure in Canada: a qualitative study. BMC Public Health 2020; 20:1220. [PMID: 32778084 PMCID: PMC7418386 DOI: 10.1186/s12889-020-09291-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 07/23/2020] [Indexed: 11/19/2022] Open
Abstract
Background While previous research has identified how criminalization of HIV non-disclosure can have deleterious effects on those living with HIV, the perspectives of people who use drugs – a population disproportionately affected by HIV– should be more meaningfully considered in these discussions. Methods Using constant comparative techniques, data from 60 interviews with men and women living with and without HIV and who use drugs in Vancouver were analyzed to explore their perceptions about Canada’s HIV non-disclosure legal framework. Results Participants’ perspectives on the framework involved three themes: understandings of HIV risk; HIV-related stigma; and their own experiences with HIV. While several participants favored the punitive character of the legal framework, these arguments were premised on misinformed and stigmatized assumptions regarding HIV. Conclusions The paper concludes by discussing the challenges and opportunities for resisting HIV stigma and misconceptions about HIV within the context of personal accounts that, at times, support criminalization of non-disclosure.
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Affiliation(s)
- Cara Ng
- British Columbia Centre on Substance Use, 4th Floor, 1045 Howe Street, Vancouver, B.C, V6Z 2A9, Canada
| | - Koharu Loulou Chayama
- British Columbia Centre on Substance Use, 4th Floor, 1045 Howe Street, Vancouver, B.C, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Andrea Krüsi
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Will Small
- British Columbia Centre on Substance Use, 4th Floor, 1045 Howe Street, Vancouver, B.C, V6Z 2A9, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, 4th Floor, 1045 Howe Street, Vancouver, B.C, V6Z 2A9, Canada. .,Department of Medicine, University of British Columbia, Vancouver, Canada.
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Chayama KL, McNeil R, Shoveller J, Small W, Knight R. Implementation opportunities and challenges identified by key stakeholders in scaling up HIV Treatment as Prevention in British Columbia, Canada: a qualitative study. Implement Sci Commun 2020; 1:54. [PMID: 32885210 PMCID: PMC7427937 DOI: 10.1186/s43058-020-00044-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 06/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background The province of British Columbia (BC), Canada, was among the first jurisdictions to scale up HIV Treatment as Prevention (TasP) to the population level, including funding and policy commitments that enhanced HIV testing efforts (e.g., expansion of routine, opt-out testing), while also making antiretroviral therapy universally available to all people living with HIV. As such, BC represents a critical context within which to identify factors that influenced the scalability of TasP (e.g., acceptability, adoption, fidelity, equitable reach, sustainability), including key opportunities and challenges. Methods We draw on in-depth, semi-structured interviews with 10 key stakeholders, comprised policymakers at the local and provincial levels and representatives from community-based organizations. Using the Consolidated Framework for Implementation Research (CFIR) to guide data collection, coding, and analysis, we identified key factors that influenced practice transformation and scale up. Results Key factors that contributed to the successful scale up of TasP included: (i) opportunities that enhanced stakeholder buy-in based on features of the intervention characteristics, including with regard to assessments about the quality and strength of evidence supporting TasP; (ii) an inner setting implementation climate that was, in part, shaped by the large and highly symbolic government investments into TasP; (iii) features of the outer setting such as external policies (e.g., harm reduction) that cultivated opportunities to implement new "systems-level" approaches to HIV intervention; (iv) the personal attributes of some "middle-level" influencers, including a team that was comprised of some highly motivated and social justice-oriented individuals (e.g., folks who were deeply committed to serving marginalized populations); and (v) the capacity to develop various implementation processes that could maintain "nimble and evidence-informed" adaptations across a highly decentralized service delivery system, while also creating opportunities to adapt features of TasP programming based on "real time" program data. Conclusion Constructs across all five domains of CFIR (intervention characteristics, outer setting, inner setting, characteristics of individuals, and process) were identified to influence the success of TasP in BC. Our findings provide important insights into how BC can successfully implement and scale up other systems-level interventions that have demonstrated efficacy, while also offering insights for other jurisdictions that are currently or planning to scale up TasP.
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Affiliation(s)
- Koharu Loulou Chayama
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada.,Department of Experimental Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1 M9 Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada.,General Internal Medicine, School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06520 USA.,Yale Program in Addiction Medicine, School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06520 USA
| | - Jean Shoveller
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 1459 Oxford Street, Halifax, NS B3H 4R2 Canada.,Izaak Walton Killam Health Centre, 5850/5980 University Avenue, Halifax, NS B3K 6R8 Canada
| | - Will Small
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada.,Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada.,Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 W. Hastings Street, Vancouver, BC V6B 5 K3 Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
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18
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Material security and adherence to antiretroviral therapy among HIV-positive people who use illicit drugs. AIDS 2020; 34:1037-1045. [PMID: 32073444 DOI: 10.1097/qad.0000000000002501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the relationship between poverty, operationalized using a novel material security measure, and adherence to antiretroviral therapy (ART) among people who use illicit drugs (PWUD) in a context of universal access to HIV care. DESIGN We analyzed data from a community-recruited prospective cohort in Vancouver, Canada (n = 623), from 2014 to 2017. METHODS We used multivariable generalized mixed-effects analyses to estimate longitudinal factors associated with mean material security score. We then estimated the association between achieving at least 95% adherence to ART and overall mean material score, as well as mean score for three factors derived from a factor analysis. The three-factor structure, employed in the current analyses, were factor 1 (basic needs); factor 2 (housing-related variables) and factor 3 (economic resources). RESULTS Recent incarceration [β-coefficient (β) = -0.176, 95% confidence interval (95% CI): -0.288 to -0.063], unmet health needs [β = -0.110, 95% CI: -0.178 to -0.042), unmet social service needs (β = -0.264, 95% CI: -0.336 to -0.193) and having access to social services (β= -0.102, 95% CI: -0.1586 to -0.0465) were among the factors associated with lower material security scores. Contrary to expectations that low levels of material security in this population would lead to poor ART adherence, we did not observe a significant relationship between adherence and overall material security score, or for each factor individually. CONCLUSION Our findings highlight the potentially important role of no-cost, universal access to HIV prevention and treatment, in mitigating the impact of socioeconomic disadvantage on ART adherence.
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19
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Employment Cessation, Long Term Labour Market Engagement and HIV Infection Risk Among People Who Inject Drugs in an Urban Canadian Setting. AIDS Behav 2019; 23:3267-3276. [PMID: 30924066 DOI: 10.1007/s10461-019-02472-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The potential for changes in socio-economic status, such as employment exits, to increase HIV infection risk are not well examined among people who inject illicit drugs (PWID). We used longstanding cohort data from Vancouver, Canada, to longitudinally assess associations between employment cessation and outcomes with documented linkages to HIV infection risk among PWID. From 2005 to 2015, 1222 participants reported 1154 employment exits. Employment exits were significantly associated with transitions into unstable housing; moving to the inner-city; initiating informal, prohibited or illegal income generation; high risk drug use practices; and exiting methadone maintenance therapy. HIV infection rates were higher among participants with lower long-term labour market engagement. These findings suggest that employment cessation coincides with initiating exposure to aspects of socioeconomic marginalization and drug use associated with HIV infection risk. Support for employment retention that prevents poverty entrenchment and harmful drug use could contribute to HIV prevention measures for PWID.
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20
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Enns B, Min JE, Panagiotoglou D, Montaner JSG, Nosyk B. Geographic variation in the costs of medical care for people living with HIV in British Columbia, Canada. BMC Health Serv Res 2019; 19:626. [PMID: 31481056 PMCID: PMC6724338 DOI: 10.1186/s12913-019-4391-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/01/2019] [Indexed: 12/04/2022] Open
Abstract
Background Regional variation in medical care costs can indicate heterogeneity in clinical practice, inequities in access, or inefficiencies in service delivery. We aimed to estimate regional variation in medical costs for people living with HIV (PLHIV), adjusting for demographics and case-mix. Methods We conducted a retrospective cohort study using linked health administrative databases of PLHIV, from 2010 to 2014, in British Columbia (BC), Canada. Quarterly health care costs (2018 CAD) were derived from inpatient, outpatient, prescription drugs, antiretroviral therapy (ART), and HIV diagnostics. We used a two-part model with a logit link for the probability of incurring costs, and a log link and gamma distribution for observations with positive costs. We also estimated quarterly utilization rates for hospitalization-, physician billing- and prescription drug-days. Primary variables were indicators of individuals’ Health Service Delivery Area (HSDA). We adjusted cost and utilization estimates for demographic characteristics, HIV-disease progression, and comorbidities. Results Our cohort included 9577 PLHIV (median age 45.5 years, 80% male). Adjusted total quarterly costs for all 16 HSDAs were within 20% of the provincial mean, 8/16 for hospitalization costs, 16/16 for physician billing costs and 10/16 for prescription drug costs. Northern Interior and Northeast HSDAs had 38 and 44% lower quarterly non-ART prescription drug costs, and 2 and 5% higher quarterly inpatient costs, respectively. Conclusions We observed limited variation in medical care costs and utilization among PLHIV in BC. However, lower levels of outpatient care and higher levels of inpatient care indicate possible barriers to accessing care among PLHIV in the most rural regions of the province. Electronic supplementary material The online version of this article (10.1186/s12913-019-4391-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Enns
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Jeong Eun Min
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Dimitra Panagiotoglou
- Faculty of Medicine, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada
| | - Julio S G Montaner
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada. .,Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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21
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Beaulieu T, Krishnamoorthy A, Lima V, Li T, Wu A, Montaner J, Barrios R, Ti L. Impact of personality disorders on leaving hospital against medical advice among people living with HIV in British Columbia, Canada. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1153-1159. [PMID: 30903233 DOI: 10.1007/s00127-019-01693-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/09/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Leaving hospital against medical advice (AMA) is a significant source of morbidity, mortality, and a major burden to the healthcare system. Studies have indicated that marginalized populations, including people living with HIV (PLHIV) and those living with a personality disorder (PD), experience high hospitalization rates. We sought to identify whether being diagnosed with a PD was associated with leaving hospital AMA among PLHIV in British Columbia (BC), Canada. METHODS Data were derived from the STOP HIV/AIDS in BC cohort, a provincial-level linkage of a series of surveillance, laboratory, and health administrative databases of all identified PLHIV in BC. Using multivariable generalized estimating equations (GEE), we examined the relationship between diagnoses of PD and premature hospital discharge among PLHIV. RESULTS Among 8763 PLHIV included in the study sample, 1321 (15%) were diagnosed with a PD. The prevalence of leaving hospital AMA at least once during the study period was 9%. In multivariable GEE analyses, after adjusting for a range of demographic and clinical confounders, there remained a positive association between being diagnosed with a PD and leaving hospital prematurely. Results showed a significant and independent association between a PD diagnosis and leaving AMA among PLHIV. CONCLUSIONS These findings underscore the importance of identifying and addressing specific PD-related behaviour which negatively impact inpatient treatment completion among this subpopulation of PLHIV. Furthermore, these findings suggest a need to develop novel health system interventions to minimize AMA discharge among this population.
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Affiliation(s)
- Tara Beaulieu
- Faculty of Medicine, Graduate Programs in Rehabilitation Sciences, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, Canada.,British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | | | - Viviane Lima
- Faculty of Medicine, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada.,British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada
| | - Tian Li
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada.,Department of Statistics & Actuarial Science, Faculty of Science, Simon Fraser University, Room SC K10545 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Anthony Wu
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada.,Assessment and Grants Division, Assessment Services Branch, Government of Alberta Municipal Affairs, 15th Floor, Commerce Place 10155 - 102 Street, Edmonton, AB, T5J 4L4, Canada
| | - Julio Montaner
- Faculty of Medicine, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada.,British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada
| | - Rolando Barrios
- Vancouver Coastal Health, 520 West 6th Ave, Vancouver, BC, V5Z 4H5, Canada.,British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. .,Faculty of Medicine, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada.
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22
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St-Jean M, Tafessu H, Closson K, Patterson TL, Lavergne MR, Elefante J, Ti L, Hull MW, Hogg RS, Barrios R, Shoveller JA, Montaner JSG, Lima VD. The syndemic effect of HIV/HCV co-infection and mental health disorders on acute care hospitalization rate among people living with HIV/AIDS: a population-based retrospective cohort study. Canadian Journal of Public Health 2019; 110:779-791. [PMID: 31441005 DOI: 10.17269/s41997-019-00253-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 07/25/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Our primary objective was to examine the syndemic effect of HIV/HCV co-infection and mental health disorders (MHD) on the acute care hospitalization rate among people living with HIV (PLW-HIV) in British Columbia, Canada. Secondarily, we aimed to characterize the longitudinal trends in the aforementioned rate, while controlling for the effect of several factors. METHODS In this retrospective cohort study, individuals were antiretroviral therapy-naïve, ≥ 18 years old, initiated treatment between 1 January 2000 and 31 December 2014, and were followed for at least 6 months until 31 December 2015 or last contact. The outcome was acute care hospitalization rate (every 6-month interval) per individual. The exposure was the interaction between HIV/HCV co-infection and MHD. Generalized non-linear mixed-effects models were built. RESULTS Of the 4046 individuals in the final analytical sample, 1597 (39%) were PLW-HIV without MHD, 606 (15%) were people living with HIV and HCV (PLW-HIV/HCV) without MHD, 988 (24%) were PLW-HIV with MHD, and 855 (21%) were PLW-HIV/HCV with MHD. The adjusted rate ratios for acute care hospitalizations were 1.31 (95% [confidence interval] 1.13-1.52), 2.01 (95% CI 1.71-2.36), and 2.53 (95% CI 2.20-2.92) for PLW-HIV with MHD, PLW-HIV/HCV without MHD, and PLW-HIV/HCV with MHD, respectively, relative to PLW-HIV without MHD. CONCLUSION The HIV/HCV co-infection and MHD interaction demonstrated a significant effect on the rate of acute care hospitalization, particularly for PLW-HIV/HCV with MHD. Implementing widely accessible integrative care model best practices may address this public health challenge.
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Affiliation(s)
- Martin St-Jean
- British Columbia Centre for Excellence in HIV/AIDS, Room 608, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Hiwot Tafessu
- British Columbia Centre for Excellence in HIV/AIDS, Room 608, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kalysha Closson
- British Columbia Centre for Excellence in HIV/AIDS, Room 608, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Thomas L Patterson
- Department of Psychiatry, University of California at San Diego, San Diego, CA, USA
| | - M Ruth Lavergne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Julius Elefante
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Lianping Ti
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Mark W Hull
- British Columbia Centre for Excellence in HIV/AIDS, Room 608, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Room 608, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Room 608, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jean A Shoveller
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Room 608, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, Room 608, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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23
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Ulloa AC, Puskas C, Yip B, Zhang W, Stanley C, Stone S, Pedromingo M, Lima VD, Montaner JSG, Guillemi S, Barrios R. Retention in care and mortality trends among patients receiving comprehensive care for HIV infection: a retrospective cohort study. CMAJ Open 2019; 7:E236-E245. [PMID: 30979728 PMCID: PMC6461542 DOI: 10.9778/cmajo.20180136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Studies examining the relation between comprehensive care and health outcomes associated with comorbidities unrelated to HIV infection have focused mainly on the health outcomes of HIV-infected people and comorbid substance use disorders. We aimed to assess the impact of retention in comprehensive HIV infection care on overall, AIDS-related and non-AIDS-related mortality. METHODS Using a retrospective cohort design, we collected data for HIV-infected patients aged 19 years or more who first visited a comprehensive HIV infection clinic in Vancouver between Jan. 1, 2004, and Dec. 31, 2014. We defined retention in care as visit constancy (whether the patient attended the clinic at least once per given period) of 75% or greater. We used Poisson regression modelling to examine mortality trends. We performed Cox proportional hazards modelling to assess survival by retention during the first year of follow-up and identify factors associated with death. RESULTS A total of 2101 patients were included in the study. Of the 2101, 1340 (63.8%) were retained in the first year of care, and 271 (12.9%) died during the study period. Among the 264 cases in which the cause of death was known, although the primary underlying cause of death (74 [28.0%]) was AIDS-related, half of all AIDS-related deaths (37/74 [50%]) occurred early in the study (2004-2007). In later years, most deaths (147/184 [79.9%]) were non-AIDS-related. Overall mortality was significantly reduced among patients with higher retention in care during the first year of follow-up (per 20% increase in visit constancy; adjusted hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.79-0.96). Higher retention was also associated with reduced risk of AIDS-related death (adjusted HR 0.79, 95% CI 0.64-0.97). INTERPRETATION Although there was an overall trend toward decreased AIDS-related mortality over time, retention in care markedly decreased the likelihood of death. Maintaining patient engagement in comprehensive ancillary care is a patient-centred way of decreasing mortality rates among HIV-infected people.
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Affiliation(s)
- Ana C Ulloa
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Cathy Puskas
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Benita Yip
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Wendy Zhang
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Cole Stanley
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Sarah Stone
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Miguel Pedromingo
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Viviane Dias Lima
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Julio S G Montaner
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Silvia Guillemi
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS (Ulloa, Puskas, Yip, Zhang, Lima, Montaner, Guillemi, Barrios); John Ruedy Immunodeficiency Clinic (Stanley, Stone, Pedromingo), St. Paul's Hospital; Division of AIDS (Lima, Montaner), Department of Family Practice (Guillemi) and School of Population and Public Health (Barrios), University of British Columbia, Vancouver, BC
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Nanditha NGA, St-Jean M, Tafessu H, Guillemi SA, Hull MW, Lu M, Henry B, Barrios R, Montaner JSG, Lima VD. Missed opportunities for earlier diagnosis of HIV in British Columbia, Canada: A retrospective cohort study. PLoS One 2019; 14:e0214012. [PMID: 30897143 PMCID: PMC6428302 DOI: 10.1371/journal.pone.0214012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 03/05/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Late HIV diagnosis is associated with increased AIDS-related morbidity and mortality as well as an increased risk of HIV transmission. In this study, we quantified and characterized missed opportunities for earlier HIV diagnosis in British Columbia (BC), Canada. DESIGN Retrospective cohort. METHODS A missed opportunity was defined as a healthcare encounter due to a clinical manifestation which may be caused by HIV infection, or is frequently present among those with HIV infection, but no HIV diagnosis followed within 30 days. We developed an algorithm to identify missed opportunities within one, three, and five years prior to diagnosis. The algorithm was applied to the BC STOP HIV/AIDS population-based cohort. Eligible individuals were ≥18 years old, and diagnosed from 2001-2014. Multivariable logistic regression identified factors associated with missed opportunities. RESULTS Of 2119 individuals, 7%, 12% and 14% had ≥1 missed opportunity during one, three and five years prior to HIV diagnosis, respectively. In all analyses, individuals aged ≥40 years, heterosexuals or people who ever injected drugs, and those residing in Northern health authority had increased odds of experiencing ≥1 missed opportunity. In the three and five-year analysis, individuals with a CD4 count <350 cells/mm3 were at higher odds of experiencing ≥1 missed opportunity. Prominent missed opportunities were related to recurrent pneumonia, herpes zoster/shingles among younger individuals, and anemia related to nutritional deficiencies or unspecified cause. CONCLUSIONS Based on our newly-developed algorithm, this study demonstrated that HIV-diagnosed individuals in BC have experienced several missed opportunities for earlier diagnosis. Specific clinical indicator conditions and population sub-groups at increased risk of experiencing these missed opportunities were identified. Further work is required in order to validate the utility of this proposed algorithm by establishing the sensitivity, specificity, positive and negative predictive values corresponding to the incidence of the clinical indicator conditions among both HIV-diagnosed and HIV-negative populations.
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Affiliation(s)
- Ni Gusti Ayu Nanditha
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Martin St-Jean
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Hiwot Tafessu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Silvia A. Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mark W. Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Michelle Lu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Bonnie Henry
- British Columbia Ministry of Health, Victoria, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Viviane D. Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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25
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Jenkins RA. Getting to Zero: We Can't Do It Without Addressing Substance Use. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:225-231. [PMID: 29969312 DOI: 10.1521/aeap.2018.30.3.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
HIV elimination by 2030 cannot occur without attention to substance use. It cuts across risk groups and affects sexual risk behavior, treatment adherence, and systemic processes such as immunity and inflammation. There continues to be often limited attention to non-injection drug use and the syndemic character of HIV and substance use. There is a need for a more comprehensive approach that addresses the multiple influences of substance use on HIV prevention and care, integrating this into evidence-based services and building on the successes of comprehensive Seek, Test, Treat, and Retain approaches to substantially reducing new HIV cases among drug users.
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Ma H, Villalobos CF, St-Jean M, Eyawo O, Lavergne MR, Ti L, Hull MW, Yip B, Wu L, Hogg RS, Barrios R, Shoveller JA, Montaner JSG, Lima VD. The impact of HCV co-infection status on healthcare-related utilization among people living with HIV in British Columbia, Canada: a retrospective cohort study. BMC Health Serv Res 2018; 18:319. [PMID: 29720155 PMCID: PMC5932856 DOI: 10.1186/s12913-018-3119-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 04/15/2018] [Indexed: 12/11/2022] Open
Abstract
Background The burden of HCV among those living with HIV remains a major public health challenge. We aimed to characterize trends in healthcare-related visits (HRV) of people living with HIV (PLW-HIV) and those living with HIV and HCV (PLW-HIV/HCV), in British Columbia (BC), and to identify risk factors associated with the highest HRV rates over time. Methods Eligible individuals, recruited from the BC Seek and Treat for Optimal Prevention of HIV/AIDS population-based retrospective cohort (N = 3955), were ≥ 18 years old, first started combination antiretroviral therapy (ART) between 01/01/2000–31/12/2013, and were followed for ≥6 months until 31/12/2014. The main outcome was HRV rate. The main exposure was HIV/HCV co-infection status. We built a confounder non-linear mixed effects model, adjusting for several demographic and time-dependent factors. Results HRV rates have decreased since 2000 in both groups. The overall age-sex standardized HRV rate (per person-year) among PLW-HIV and PLW-HIV/HCV was 21.11 (95% CI 20.96–21.25) and 41.69 (95% CI 41.51–41.88), respectively. The excess in HRV in the co-infected group was associated with late presentation for ART, history of injection drug use, sub-optimal ART adherence and a higher number of comorbidities. The adjusted HRV rate ratio for PLW-HIV/HCV in comparison to PLW-HIV was 1.18 (95% CI 1.13–1.24). Conclusions Although HRV rates have decreased over time in both groups, PLW-HIV/HCV had 18% higher HRV than those only living with HIV. Our results highlight several modifiable risk factors that could be targeted as potential means to minimize the disease burden of this population and of the healthcare system. Electronic supplementary material The online version of this article (10.1186/s12913-018-3119-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Huiting Ma
- Department of Statistics, University of British Columbia, 3182 Earth Sciences Building, 2207 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Conrado Franco Villalobos
- British Columbia Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Martin St-Jean
- British Columbia Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Oghenowede Eyawo
- British Columbia Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Miriam Ruth Lavergne
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 10502, Burnaby, BC, V5A 1S6, Canada
| | - Lianping Ti
- British Columbia Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Mark W Hull
- British Columbia Centre for Excellence in HIV/AIDS, 667 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Benita Yip
- British Columbia Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Lang Wu
- Department of Statistics, University of British Columbia, 3182 Earth Sciences Building room ESB 3126, 2207 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jean A Shoveller
- School of Population & Public Health, University of British Columbia, 2206 East Mall, Rm 414, Vancouver, BC, V6T 1Z3, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, 667 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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