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Jhuti D, Zakaryan G, El-Kechen H, Rehman N, Youssef M, Garcia C, Arora V, Zani B, Leenus A, Wu M, Makanjuola O, Mbuagbaw L. Describing Engagement in the HIV Care Cascade: A Methodological Study. HIV AIDS (Auckl) 2023; 15:257-265. [PMID: 37255532 PMCID: PMC10226482 DOI: 10.2147/hiv.s406524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/24/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Engagement in the HIV care cascade is required for people living with HIV (PLWH) to achieve an undetectable viral load. However, varying definitions of engagement exist, contributing to heterogeneity in research regarding how many individuals are actively participating and benefitting from care. A standardized definition is needed to enhance comparability and pooling of data from engagement studies. Objectives The objective of this paper was to describe the various definitions for engagement used in HIV clinical trials. Methods Articles were retrieved from CASCADE, a database of 298 clinical trials conducted to improve the HIV care cascade (https://hivcarecascade.com/), curated by income level, vulnerable population, who delivered the intervention, the setting in which it was delivered, the intervention type, and the level of pragmatism of the intervention. Studies with engagement listed as an outcome were selected from this database. Results 13 studies were eligible, of which five did not provide an explicit definition for engagement. The remaining studies used one or more of the following: appointment adherence (n=6), laboratory testing (n=2), adherence to antiretroviral therapy (n=2), time specification (n=5), intervention adherence (n=5), and quality of interaction (n=1). Conclusion This paper highlights the existing diversity in definitions for engagement in the HIV care cascade and categorize these definitions into appointment adherence, laboratory testing, adherence to antiretroviral therapy, time specification, intervention adherence, and quality of interaction. We recommend consensus on how to describe and measure engagement.
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Affiliation(s)
- Diya Jhuti
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gohar Zakaryan
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Hussein El-Kechen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Nadia Rehman
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Mark Youssef
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cristian Garcia
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vaibhav Arora
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Babalwa Zani
- Public Health Research Unit, AB Consulting, Cape Town, South Africa
| | - Alvin Leenus
- Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Michael Wu
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Rehman N, Wu M, Garcia C, Leenus A, El-Kechen H, Bhandari M, Zakaryan G, Zani B, Hajizadeh A, Wang A, Morassut RE, Bartoszko JJ, Makanjuola O, Jhuti D, Arora V, Kapoor A, Jones A, Djiadeu P, Mbuagbaw L. Measures of Retention in HIV Care: A Study Within a Review. AIDS Patient Care STDS 2023; 37:192-198. [PMID: 36951646 DOI: 10.1089/apc.2022.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
People living with HIV (PLHIV) need lifelong medical care. However, retention in HIV care is not measured uniformly, making it challenging to compare or pool data. The objective of this study within a review (SWAR) is to describe the assortment of definitions used for retention in HIV care in randomized controlled trials (RCTs). We conducted a SWAR, drawing data from an overview of systematic reviews on interventions to improve the HIV care cascade. Ethics review was not required for this analysis of secondary data. We identified RCTs of interventions used to improve retention in care for PLHIV, including all age groups and extracted the definitions used and their characteristics. We identified 50 trials that measured retention published between 2007 and 2021 and provided 59 definitions for retention in care. The definitions consisted of nine different characteristics with follow-up time (n = 47), and clinical visits (n = 36) most used. The definitions of retention in HIV care are highly heterogeneous. In this study, we present the pros and cons of characteristics used to measure retention in HIV care.
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Affiliation(s)
- Nadia Rehman
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Michael Wu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Cristian Garcia
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Alvin Leenus
- Faculty of Law, University of Ottawa, Ottawa, Canada
| | - Hussein El-Kechen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Manika Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Gohar Zakaryan
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Babalwa Zani
- Public Health Research Unit, AB Consulting, Cape Town, South Africa
| | - Anisa Hajizadeh
- Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Annie Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Rita E Morassut
- Department of Obstetrics and Gynaecology Western University, London, Canada
| | - Jessica J Bartoszko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Oluwatoni Makanjuola
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Diya Jhuti
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Vaibhav Arora
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Andrew Kapoor
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Aaron Jones
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Pascal Djiadeu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Canada
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Mbuagbaw L, Ongolo-Zogo C, Mendoza OC, Zani B, Morfaw F, Nyambi A, Wang A, Kiflen M, El-Kechen H, Leenus A, Youssef M, Rehman N, Hermans L, MacDonald V, Bertagnolio S. Guidelines are needed for studies of pre-treatment HIV drug resistance: a methodological study. BMC Med Res Methodol 2021; 21:76. [PMID: 33874897 PMCID: PMC8056637 DOI: 10.1186/s12874-021-01258-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/25/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The expansion of access to antiretroviral therapy (ART) has been accompanied by an increase in pre-treatment drug resistance (PDR). While it is critical to monitor the increasing prevalence of PDR across countries and populations to inform optimal regimen selection, the completeness of reporting is often suboptimal, limiting the interpretation and generalizability of the results. Indeed, there is no formal guidance on how studies investigating the prevalence of drug resistance should be reported. Thus, we sought to determine the completeness of reporting in studies of PDR and the factors associated with sub-optimal reporting to ascertain the need for guidelines. METHODS As part of a systematic review on the global prevalence of PDR in key populations (men who have sex with men, sex workers, transgender people, people who inject drugs and people in prisons), we searched 10 electronic databases until January 2019. We extracted information on selected study characteristics useful for interpreting prevalence data. Data were extracted in duplicate. Analyses of variance and correlation were used to explore factors that may explain the number of items reported. RESULTS We found 650 studies of which 387 were screened as full text and 234 were deemed eligible. The included studies were published between 1997 and 2019 and included a median of 239 (quartile 1 = 101; quartile 3 = 778) participants. Most studies originated from high-income countries (125/234; 53.0%). Of 23 relevant data items, including study design, setting, participant sociodemographic characteristics, HIV risk factors, type of resistance test conducted, definition of resistance, the mean (standard deviation) number of items reported was 13 (2.2). We found that more items were reported in studies published more recently (r = 0.20; p < 0.002) and in studies at low risk of bias (F [2231] = 8.142; p < 0.001). CONCLUSIONS Incomplete reporting in studies on PDR makes characterising levels of PDR in subpopulations across countries challenging. Hence, guidelines are needed to define a minimum set of variables to be included in such studies.
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Affiliation(s)
- Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada.
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon.
| | - Clémence Ongolo-Zogo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- McMaster Health Forum, Hamilton, ON, Canada
| | - Olivia C Mendoza
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Babalwa Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Frederick Morfaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada
| | | | - Annie Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Michel Kiflen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Hussein El-Kechen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Alvin Leenus
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Mark Youssef
- School of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nadia Rehman
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Lucas Hermans
- Virology, Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Virginia MacDonald
- Department of HIV, Hepatitis, and Sexually Transmitted Diseases, World Health Organization, Geneva, Switzerland
| | - Silvia Bertagnolio
- Department of HIV, Hepatitis, and Sexually Transmitted Diseases, World Health Organization, Geneva, Switzerland
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