1
|
Takamiya M, Takarinda K, Balachandra S, Musuka G, Radin E, Hakim A, Pearson ML, Choto R, Sandy C, Maphosa T, Rogers JH. Missed opportunities for TB diagnostic testing among people living with HIV in Zimbabwe: Cross-sectional analysis of the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) survey 2015-16. J Clin Tuberc Other Mycobact Dis 2024; 35:100427. [PMID: 38516197 PMCID: PMC10955630 DOI: 10.1016/j.jctube.2024.100427] [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] [Indexed: 03/23/2024] Open
Abstract
Background Using data from the Zimbabwe Population-based HIV Impact Assessment survey 2015-2016, we examined the TB care cascade and factors associated with not receiving TB diagnostic testing among adult PLHIV with TB symptoms. Methods Statistical Analysis was limited to PLHIV aged 15 years and older in HIV care. Weighted logistic regression with not receiving TB testing as outcome was adjusted for covariates with crude odd ratios (ORs) with p < 0.25. All analyses accounted for multistage survey design. Results Among 3507 adult PLHIV in HIV care, 2288 (59.7 %, 95 % CI:58.1-61.3) were female and 2425 (63.6 %, 95 % CI:61.1-66.1) lived in rural areas. 1197(48.7 %, 95 % CI:46.5-51.0) reported being screened for TB symptoms at their last HIV care visit. In the previous 12 months, 639 (26.0 %, 95 % CI:23.9-28.1) reported having symptoms and of those, 239 (37.8 %, 95 % CI:33.3-42.2) received TB testing. Of PLHIV tested for TB, 36 (49.5 %, 95 % CI:35.0-63.1) were diagnosed with TB; 32 (90.3 %, 95 % CI:78.9-100) of those diagnosed with TB received treatment. Never having used IPT was associated with not receiving TB testing. Conclusion The results suggest suboptimal utilization of TB screening and diagnostic testing among PLHIV. New approaches are needed to reach opportunities missed in the HIV/TB integrated services.
Collapse
Affiliation(s)
| | | | | | | | | | - Avi Hakim
- U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Michele L. Pearson
- U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Regis Choto
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Talent Maphosa
- U.S. Centers for Disease Control and Prevention (CDC), Harare, Zimbabwe
| | - John H. Rogers
- U.S. Centers for Disease Control and Prevention (CDC), Harare, Zimbabwe
| |
Collapse
|
2
|
Xiong S, Jiang W, Wang Y, Hu C, Yang J, Bao M, Hou H, Li F, Liu T, Zhang X, Ma Y, Ye P, Wang Q, Chen Z, Mao L, Peiris D, Tian M. Using routinely collected data to determine care cascades of hypertension and type-2 diabetes management in China: a cross-sectional study. Lancet Reg Health West Pac 2024; 45:101019. [PMID: 38371948 PMCID: PMC10869296 DOI: 10.1016/j.lanwpc.2024.101019] [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] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/27/2023] [Accepted: 01/15/2024] [Indexed: 02/20/2024]
Abstract
Background China's National Essential Public Health Service Package (NEPHSP) aims to promote health for all at the primary health care level and includes a focus on hypertension and type-2 diabetes mellitus (T2DM). However, there are limited contemporary data to quantify the care cascades of hypertension and T2DM in primary health care. Methods This cross-sectional study involved individual level linkage of routinely collected data from the NEPHSP, health insurance claims and hospital electronic health records, from four diverse regions in China, including Xiling District (central China), Wenchuan County (western), Acheng District and Jiao District (northern). We first compared numbers of people aged ≥35 with a recorded diagnosis of hypertension and T2DM against expected numbers derived from epidemiological data. We then constructed care cascades to assess the percentages (1) enrolled in the NEPHSP, (2) adherent to the follow-up care of NEPHSP, (3) receiving medication treatment, and (4) having hypertension and/or T2DM controlled. Findings In the four regions, the total numbers of people aged ≥35 diagnosed of hypertension and T2DM from any data source were 149,176 and 50,828, respectively. This was estimated to be 46.0% (95% confidence interval [CI]: 45.8%-46.2%) and 45.6% (95% CI: 45.3%-45.9%) of the expected totals for hypertension and T2DM, respectively. Among those diagnosed, 65.4% (95% CI: 65.1%-65.6%) with hypertension and 66.1% (95% CI: 65.7%-66.5%) with T2DM were enrolled in the NEPHSP, respectively, in which 54.8% (95% CI: 54.5%-55.2%) with hypertension and 64.7% (95% CI: 64.1%-65.2%) with T2DM were adherent to the required services. Among those enrolled, the overall treatment rates were 70.8% (95% CI: 70.6%-71.1%) for hypertension and 82.2% (95% CI: 81.8%-82.6%) for T2DM. Among those treated, a further 80.9% (95% CI: 80.6%-81.2%) with hypertension and 73.9% (95% CI: 73.3%-74.4%) with T2DM achieved control. These results varied considerably across regions, with the northern sites showing relatively higher enrolment rates while the central site had higher control rates. Interpretation Detection and control rates for hypertension and T2DM are suboptimal in these four regions of China. Further strategies are needed to improve people's enrolment in and adherence to the NEPHSP and strengthen care delivery processes. Of note, our estimations of the diagnosis rates for each region are based on national level large epidemiological data. The interpretation of these data needs caution due to potential bias caused by regional variations. Funding This study is funded by National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Diseases funding (APP1169757), and National Natural Science Foundation of China (72074065).
Collapse
Affiliation(s)
- Shangzhi Xiong
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Global Health Research Centre, Duke Kunshan University, Kunshan, China
| | - Wei Jiang
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Yongchen Wang
- Department of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chi Hu
- Yichang City Centre for Disease Control and Prevention, Yichang, China
| | - Jiajuan Yang
- Yichang City Centre for Disease Control and Prevention, Yichang, China
| | - Mingjia Bao
- Jiamusi City Centre for Disease Control and Prevention, Jiamusi, China
| | - Huinan Hou
- Jiamusi City Centre for Disease Control and Prevention, Jiamusi, China
| | - Fan Li
- Health Bureau of Wenjiang District, Chengdu, China
| | - Tingzhuo Liu
- School of Public Health, Harbin Medical University, Harbin, China
| | - Xinyi Zhang
- School of Public Health, Harbin Medical University, Harbin, China
| | - Yanqiuzi Ma
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Pengpeng Ye
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Qiujun Wang
- Department of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhengming Chen
- Nuffield Department of Population Health, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
| | - Limin Mao
- Centre for Social Research in Health, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Maoyi Tian
- Department of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- School of Public Health, Harbin Medical University, Harbin, China
| |
Collapse
|
3
|
Ahmed M, Nijhawan AE, Gao A, Ahn C, Chow JY. Association Between Substance Abuse and Mental Illness Symptoms Screener (SAMISS) Scores and HIV Care Continuum Outcomes in People Newly Diagnosed with HIV in the US South. AIDS Behav 2024:10.1007/s10461-024-04287-1. [PMID: 38361170 DOI: 10.1007/s10461-024-04287-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
Mental illness (MI) and substance use (SU) are highly prevalent among people with HIV (PWH) and impact care outcomes. The Substance Abuse and Mental Illness Symptoms Screener (SAMISS) is a validated screener for MI and SU, but it is unknown how screening results at entry to care correlate with subsequent HIV outcomes. This is a retrospective chart review of individuals newly diagnosed with HIV between 2016 and 2019 in a Southern US, safety-net clinic. Baseline demographics, HIV risk factors, socioeconomic variables, and SAMISS screening scores were collected. Outcomes included retention in care, achieving virologic suppression (VS), and continuous VS. Data analyses included stepwise Cox and logistic multivariate regression modeling. Among the 544 newly diagnosed PWH, mean age was 35, 76% were male, 46% non-Hispanic Black, 40% Hispanic/other. Overall, 35% screened positive for SU and 41% for MI. A positive SU (odds ratio (OR) 0.66, p = 0.04) or MI (OR 0.65, p = 0.03) SAMISS screening was associated with lower retention in care in univariate analysis, but was not statistically significant after adjusting for other variables. Positive SAMISS screening for SU and MI were both associated with reduced continuous VS in univariate and multivariate analyses (SU: adjusted OR (aOR) 0.67, p = 0.05; MI: aOR 0.66, p = 0.03). SAMISS is a useful tool for prospectively identifying individuals at risk for low retention in care and for not achieving sustained VS. Future interventions guided by SAMISS may improve HIV care continuum outcomes.
Collapse
Affiliation(s)
- Manal Ahmed
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Ank E Nijhawan
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ang Gao
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Chul Ahn
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeremy Y Chow
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| |
Collapse
|
4
|
Brennan AT, Lauren E, Bor J, George JA, Chetty K, Mlisana K, Dai A, Khoza S, Rosen S, Stokes AC, Raal F, Hibberd P, Alexanian SM, Fox MP, Crowther NJ. Gaps in the type 2 diabetes care cascade: a national perspective using South Africa's National Health Laboratory Service (NHLS) database. BMC Health Serv Res 2023; 23:1452. [PMID: 38129852 PMCID: PMC10740239 DOI: 10.1186/s12913-023-10318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Research out of South Africa estimates the total unmet need for care for those with type 2 diabetes mellitus (diabetes) at 80%. We evaluated the care cascade using South Africa's National Health Laboratory Service (NHLS) database and assessed if HIV infection impacts progression through its stages. METHODS The cohort includes patients from government facilities with their first glycated hemoglobin A1c (HbA1c) or plasma glucose (fasting (FPG); random (RPG)) measured between January 2012 to March 2015 in the NHLS. Lab-diagnosed diabetes was defined as HbA1c ≥ 6.5%, FPG ≥ 7.0mmol/l, or RPG ≥ 11.1mmol/l. Cascade stages post diagnosis were retention-in-care and glycaemic control (defined as an HbA1c < 7.0% or FPG < 8.0mmol/l or RPG < 10.0mmol/l) over 24-months. We estimated gaps at each stage nationally and by people living with HIV (PLWH) and without (PLWOH). RESULTS Of the 373,889 patients tested for diabetes, 43.2% had an HbA1c or blood glucose measure indicating a diabetes diagnosis. Amongst those with lab-diagnosed diabetes, 30.9% were retained-in-care (based on diabetes labs) and 8.7% reached glycaemic control by 24-months. Prevalence of lab-diagnosed diabetes in PLWH was 28.6% versus 47.3% in PLWOH. Among those with lab-diagnosed diabetes, 34.3% of PLWH were retained-in-care versus 30.3% PLWOH. Among people retained-in-care, 33.8% of PLWH reached glycaemic control over 24-months versus 28.6% of PLWOH. CONCLUSIONS In our analysis of South Africa's NHLS database, we observed that 70% of patients diagnosed with diabetes did not maintain in consistent diabetes care, with fewer than 10% reaching glycemic control within 24 months. We noted a disparity in diabetes prevalence between PLWH and PLWOH, potentially linked to different screening methods. These differences underscore the intricacies in care but also emphasize how HIV care practices could guide better management of chronic diseases like diabetes. Our results underscore the imperative for specialized strategies to bolster diabetes care in South Africa.
Collapse
Affiliation(s)
- Alana T Brennan
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Evelyn Lauren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jaya A George
- Wits Diagnostic Innovation Hub, University of the Witwatersrand, Johannesburg, South Africa
| | - Kamy Chetty
- National Health Laboratory Service, Johannesburg, South Africa
| | - Koleka Mlisana
- Academic Affairs, Research & Quality Assurance, National Health Laboratory Service, Johannesburg, South Africa
| | - Andrew Dai
- Department of Mathematics and Statistics, Boston University, Boston, USA
| | - Siyabonga Khoza
- National Health Laboratory Service, Johannesburg, South Africa
- Department of Chemical Pathology, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew C Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Frederick Raal
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patricia Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Matthew P Fox
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Nigel J Crowther
- National Health Laboratory Service, Johannesburg, South Africa
- Department of Chemical Pathology, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| |
Collapse
|
5
|
Basu S, Maheshwari V, Malik M, Agarwal P. Diabetes care cascade and their predictors in young and middle-aged population in India: evidence from the National Family Health Survey (2019-21). J Diabetes Metab Disord 2023; 22:1405-1415. [PMID: 37975129 PMCID: PMC10638169 DOI: 10.1007/s40200-023-01263-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/04/2023] [Indexed: 11/19/2023]
Abstract
Purpose Weak care cascade of diabetes from the time of screening, diagnosis, treatment initiation and attainment of optimal glycemic control is a public health challenge particularly in resource limited settings. We aimed to assess the diabetes care cascade in India and its determinants in the 15-49 age group. Methods We conducted a secondary data analysis of the National Family Health Survey (NFHS-5, 2019-2021), a nationally representative cross-sectional survey, including a total of 724,115 women and 101,839 men with mean (SD) age 30.6 (9.9) years. Results The prevalence of self-reported Diabetes Mellitus (DM) in the sample was 2.14% (n = 14,116, 95% CI: 2.06, 2.21) of which 55.13% (n = 6990, 95% CI: 53.37, 56.88) were currently undergoing anti-diabetes therapy. The net prevalence of DM including both old and new cases detected on screening was 2.9%. Poor glycemic control was observed in 52.43% (n = 3506, 95% CI: 50.69, 54.16) of patients with DM on anti-diabetes therapy. Patients from the richest wealth quintile (aOR = 5.17, 95% CI: 1.93, 13.84) had significantly higher odds of accessing private health facilities, while female patients with DM were less likely to be on anti-diabetes therapy. Conclusion The prevalence of self-reported DM in India has increased from 1.7% (NFHS-4, 2015-16) to 2.1% (NFHS-5, 2019-21) while more than half of existing patients continue to remain undiagnosed. Consequently, diabetes care cascade have major lacunae at every stage from screening to diagnosis, initiation of effective treatment, and achievement of safe blood glucose levels. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01263-9.
Collapse
Affiliation(s)
- Saurav Basu
- Indian Institute of Public Health – Delhi, Public Health Foundation of India, Plot No 47, Institutional Area, Sector 44, Gurugram, 122002 Haryana India
| | - Vansh Maheshwari
- Indian Institute of Public Health – Delhi, Public Health Foundation of India, Plot No 47, Institutional Area, Sector 44, Gurugram, 122002 Haryana India
| | - Mansi Malik
- Indian Institute of Public Health – Delhi, Public Health Foundation of India, Plot No 47, Institutional Area, Sector 44, Gurugram, 122002 Haryana India
| | - Paras Agarwal
- Max Healthcare, Max Multi Speciality Centre, Panchsheel Park, New Delhi India
| |
Collapse
|
6
|
Singh MM, Basu S, Lalwani H, Rao S, Maheshwari V, Garg S, Sharma N. Hypertension care cascade in an urban resettlement colony and slum in Delhi, India: a cross-sectional survey. BMC Public Health 2023; 23:2116. [PMID: 37891517 PMCID: PMC10612386 DOI: 10.1186/s12889-023-17021-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Hypertension care cascade in resource-limited settings is compromised with a majority of patients with hypertension remaining undiagnosed, untreated, non-adherent, and poorly controlled at every stage. However, there is paucity of information on care and management of hypertensive patients in community-based settings of low-income urban neighbourhoods in India. METHODS This was a community-based cross-sectional study conducted in an urban resettlement colony and slum area in the Northeast District of Delhi. The adult population was screened for hypertension using standardized methods, and adherence to medications was assessed using the Morisky Green Levine scale. Binary logistic regression analysis was conducted to ascertain the sociodemographic predictors of the outcome (presence of hypertension, adherence to antihypertensive medication, blood pressure control). A p-value < 0.05 was considered statistically significant. RESULTS We included 8850 adult participants including 5295 females and 3555 males in this study. Nearly 29% of the participants were hypertensive, of which 61.77% were newly diagnosed cases. Furthermore, nearly 81% of the previously diagnosed cases had been initiated on antihypertensive medication, of which 57.54% were adherent to their medications while 36.12% attained controlled blood pressure levels. The odds of having hypertension were significantly higher among males (AOR = 1.87, 95% CI: 1.63 to 2.15), age ≥ 60 years (AOR = 9.15, 95% CI: 7.82 to 10.70), high waist circumference (AOR = 2.24, 95% CI: 1.86 to 2.70) and Body Mass Index of ≥ 25.00 (AOR = 2.55, 95% CI: 2.00 to 3.26). Furthermore, on adjusted analysis, patients of hypertension having diabetes (DM) comorbidity had significantly higher odds of being adherent to anti-hypertensive medications (AOR = 1.81, 95% CI: 1.31 to 2.51) compared to those without DM comorbidity, while tobacco users had significantly lower odds of being adherent to antihypertensive medication (AOR = 0.50, 95% CI: 0.31 to 0.82). CONCLUSIONS Hypertension care cascade in urban slum-resettlement colony setting revealed a high burden of undiagnosed hypertension, low rates of medication adherence, and poor blood pressure control. Strengthening community screening and primary care continuum of care is necessary to improve the hypertension care cascade from early diagnosis to effective management with optimal health outcomes to reduce patient complications and increase longevity.
Collapse
Affiliation(s)
| | - Saurav Basu
- Indian Institute of Public Health - Delhi, Public Health Foundation of India, New Delhi, India.
| | - Heena Lalwani
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India.
| | - Shivani Rao
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Vansh Maheshwari
- Indian Institute of Public Health - Delhi, Public Health Foundation of India, New Delhi, India
| | - Sandeep Garg
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - Nandini Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
7
|
Lafferty L, Sheehan Y, Cochrane A, Grebely J, Lloyd AR, Treloar C. Reducing barriers to the hepatitis C care cascade in prison via point-of-care RNA testing: a qualitative exploration of men in prison using an integrated framework. Addiction 2023; 118:1153-1160. [PMID: 36683132 PMCID: PMC10952703 DOI: 10.1111/add.16137] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/04/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIMS Hepatitis C virus (HCV) is highly prevalent within the prison setting. Although HCV testing and treatment are available within prisons, system barriers can impede progress along the HCV care cascade for those who are incarcerated. The PIVOT intervention used a 'one-stop-shop' model (i.e. point-of-care HCV RNA testing, Fibroscan-based liver disease assessment and treatment) at a reception prison in New South Wales, Australia. This analysis sought to understand the role of point-of-care HCV RNA testing at intake in reducing barriers to the HCV care cascade within the male prison setting. DESIGN AND SETTING Qualitative analysis using semi-structured interviews in a reception prison in Australia. PARTICIPANTS Twenty-four men enrolled in the PIVOT study; all participants had undergone HCV point-of-care testing in the intervention arm. MEASUREMENTS Høj's Integrated Framework informed this analysis. FINDINGS Participants widely expressed the view that point-of-care HCV RNA testing on entry was beneficial for care engagement. Point-of-care testing was perceived as timely (compared with standard pathology) and reduced opportunities for adjudication by correctional officers due to fewer clinic visits for testing and results. Adoption of routine opt-out testing at prison intake was regarded as an important strategy for normalising HCV testing (and likely to increase pathways to treatment uptake) and fostered patient candidacy (i.e. self-perceived eligibility to access care). CONCLUSION Twenty-four men in prison in New South Wales, Australia, who underwent opt-out point-of-care HCV RNA testing on entry into prison, widely supported the programme as a means of overcoming barriers to HCV testing and treatment in the prison setting, as well as providing public health benefits through early detection of HCV infection among people entering into custody.
Collapse
Affiliation(s)
- Lise Lafferty
- Centre for Social Research in HealthUNSW SydneySydneyNew South WalesAustralia
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - Yumi Sheehan
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - Amanda Cochrane
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
- Justice Health and Forensic Mental Health NetworkNSW HealthMatravilleNew South WalesAustralia
| | - Jason Grebely
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - Andrew R. Lloyd
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - Carla Treloar
- Centre for Social Research in HealthUNSW SydneySydneyNew South WalesAustralia
| |
Collapse
|
8
|
Åhsberg J, Bjerrum S, Ganu VJ, Kwashie A, Commey JO, Adusi-Poku Y, Puplampu P, Andersen ÅB, Kenu E, Lartey M, Johansen IS. The in-hospital tuberculosis diagnostic cascade and early clinical outcomes among people living with HIV before and during the COVID-19 pandemic - a prospective multisite cohort study from Ghana. Int J Infect Dis 2023; 128:290-300. [PMID: 36632893 PMCID: PMC9827749 DOI: 10.1016/j.ijid.2022.12.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/23/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic had a disruptive impact on tuberculosis (TB) and HIV services. We assessed the in-hospital TB diagnostic care among people with HIV (PWH) overall and before and during the pandemic. METHODS In this prospective study, adult PWH admitted at three hospitals in Ghana were recruited if they had a positive World Health Organization four-symptom screen or one or more World Health Organization danger signs or advanced HIV. We collected data on patient characteristics, TB assessment, and clinical outcomes after 8 weeks and used descriptive statistics and survival analysis. RESULTS We enrolled 248 PWH with a median clusters of differentiation 4 count of 80.5 cells/mm3 (interquartile range 24-193). Of those, 246 (99.2%) patients had a positive World Health Organization four-symptom screen. Overall, 112 (45.2%) patients obtained a sputum Xpert result, 66 (46.5%) in the prepandemic and 46 (43.4%) in the pandemic period; P-value = 0.629. The TB prevalence of 46/246 (18.7%) was similar in the prepandemic 28/140 (20.0%) and pandemic 18/106 (17.0%) population; P-value = 0.548. The 8-week all-cause mortality was 62/246 (25.2%), with no difference in cumulative survival when stratifying for the pandemic period; log-rank P-value = 0.412. CONCLUSION The study highlighted a large gap in the access to TB investigation and high early mortality among hospitalized PWH, irrespective of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Johanna Åhsberg
- Department of Infectious diseases, Odense University Hospital, Odense, Denmark; International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark; Mycobacterial Centre for Research Southern Denmark MyCRESD, Odense University Hospital, Odense, Denmark; Department of Clinical research, University of Southern Denmark, Odense, Denmark.
| | - Stephanie Bjerrum
- Department of Infectious diseases, Odense University Hospital, Odense, Denmark; Mycobacterial Centre for Research Southern Denmark MyCRESD, Odense University Hospital, Odense, Denmark; Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Yaw Adusi-Poku
- National Tuberculosis Control Programme, Ghana Health Service, Accra, Ghana
| | - Peter Puplampu
- Department of Medicine & Therapeutics, Medical school, College of Health sciences, University of Ghana, Accra, Ghana
| | - Åse Bengård Andersen
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ernest Kenu
- Department of Epidemiology and Disease control, University of Ghana, Accra, Ghana
| | - Margaret Lartey
- Department of Medicine & Therapeutics, Medical school, College of Health sciences, University of Ghana, Accra, Ghana
| | - Isik Somuncu Johansen
- Department of Infectious diseases, Odense University Hospital, Odense, Denmark; Mycobacterial Centre for Research Southern Denmark MyCRESD, Odense University Hospital, Odense, Denmark; Department of Clinical research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
9
|
Lesko CR, Keruly JC, Moore RD, Shen NM, Pytell JD, Lau B, Fojo AT, Mehta SH, Kipke M, Baum MK, Shoptaw S, Gorbach PM, Mustanski B, Javanbakht M, Siminski S, Chander G. COVID-19 and the HIV continuum in people living with HIV enrolled in Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO) cohorts. Drug Alcohol Depend 2022; 241:109355. [PMID: 35331581 PMCID: PMC8837482 DOI: 10.1016/j.drugalcdep.2022.109355] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND The COVID-19 pandemic disrupted the normal delivery of HIV care, altered social support networks, and caused economic insecurity. People with HIV (PWH) are vulnerable to such disruptions, particularly if they have a history of substance use. We describe engagement in care and adherence to antiretroviral therapy (ART) for PWH during the pandemic. METHODS From May 2020 to February 2021, 773 PWH enrolled in 6 existing cohorts completed 1495 surveys about substance use and engagement in HIV care during the COVID-19 pandemic. We described the prevalence and correlates of having missed a visit with an HIV provider in the past month and having missed a dose of ART in the past week. RESULTS Thirteen percent of people missed an HIV visit in the past month. Missing a visit was associated with unstable housing, food insecurity, anxiety, low resiliency, disruptions to mental health care, and substance use including cigarette smoking, hazardous alcohol use, cocaine, and cannabis use. Nineteen percent of people reported missing at least one dose of ART in the week prior to their survey. Missing a dose of ART was associated with being a man, low resiliency, disruptions to mental health care, cigarette smoking, hazardous alcohol use, cocaine, and cannabis use, and experiencing disruptions to substance use treatment. CONCLUSIONS Social determinants of health, substance use, and disruptions to mental health and substance use treatment were associated with poorer engagement in HIV care. Close attention to continuity of care during times of social disruption is especially critical for PWH.
Collapse
Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.
| | - Jeanne C Keruly
- Division of Infectious Diseases, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Richard D Moore
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Nicola M Shen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Jarratt D Pytell
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Anthony T Fojo
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Michele Kipke
- University of Southern California, Children's Hospital Los Angeles, CHL 4650 W. Sunset Blvd., Los Angeles, CA 90027, USA
| | - Marianna K Baum
- Department of Dietetics and Nutrition, Roger Stempel College of Public Health, Florida International University, 11200 SW 8 Street, AHC-5, 326, Miami, FL 33199, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California Los Angeles, 10880 Wilshire Boulevard, Los Angeles, CA 90024, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University, 625 N. Michigan Ave, Chicago, IL 60611, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Suzanne Siminski
- Frontier Science Foundation, 4033 Maple Road, Amherst, NY 14226, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| |
Collapse
|
10
|
Shah SA, Rosenberg M, Ahmad D, Ahmad S, Safian N, Shobugawa Y. Prevalence and determinants of unmet needs for hypertension care among the older population in Selangor: cross-sectional study. Health Res Policy Syst 2022; 20:127. [PMID: 36443790 PMCID: PMC9706828 DOI: 10.1186/s12961-022-00915-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hypertension is a major cause of morbidity and mortality worldwide. Although multiple studies have assessed the prevalence of hypertension among older people, no study has examined the unmet need for hypertension care among older people in Malaysia. This study uses the hypertension care cascade to identify the prevalence of unmet needs for hypertension care and their determinants among the older population in Selangor. METHODS This is a cross-sectional study involving a total of 1204 participants recruited from different areas in Selangor. A face-to-face interview was conducted using the Bahasa Malaysia version of the Japan Gerontological Evaluation Study questionnaire. The inclusion criteria were Malaysians aged ≥ 60 years who could converse in Bahasa Malaysia. RESULTS Among the 637 participants with hypertension, 18% (117) had not been previously screened but were found to have BP ≥ 140/90 mmHg, 21% (136) were undiagnosed, 3% (17) were untreated, 42% (267) were treated with antihypertensive medication but still had high blood pressure, and 16% (100) had hypertension that was controlled with medication. The hypertension care cascade demonstrates that 18% (117) of those with hypertension had never been screened for hypertension; 26% (136/520) of those who were screened never received a diagnosis; 4% (17/384) of those who were diagnosed did not receive treatment; and 73% (267/367) of those who were treated did not reach the threshold for control. The prevalence of total unmet needs was 84% (537/637). Statistically significant determinants of having any unmet need for hypertension care were smoking status and medical history, with adjusted odds ratios and 95% confidence intervals (CIs) in the multivariate analysis of 0.5 (95% CI: 0.3-0.9) for being a smoker, 2.8 (95% CI: 1.1-6.9) for having a history of stroke and 1.6 (95% CI: 1.0-2.5) for having a history of diabetes mellitus. CONCLUSIONS The prevalence of unmet need for hypertension care among the older population in Selangor is 84% (537/637), which is alarmingly high. This study highlights where and how much of the loss of care for hypertension happens in the care cascade and provides insight into the efforts required to improve effective service coverage to manage the increasing burden of hypertension associated with population ageing.
Collapse
Affiliation(s)
- Shamsul Azhar Shah
- grid.412113.40000 0004 1937 1557Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Megumi Rosenberg
- Centre for Health Development, World Health Organization, Kobe, Japan
| | - Dzulfitree Ahmad
- grid.412113.40000 0004 1937 1557Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Saharudin Ahmad
- grid.412113.40000 0004 1937 1557Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nazarudin Safian
- grid.412113.40000 0004 1937 1557Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Yugo Shobugawa
- grid.260975.f0000 0001 0671 5144Department of Active Ageing, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| |
Collapse
|
11
|
Saha R, Miller AP, Parriott A, Horvath H, Kahn JG, Malekinejad M. Viral blood-borne infections testing and linkage to care cascade among persons who experience homelessness in the United States: a systematic review and meta-analysis. BMC Public Health 2022; 22:1421. [PMID: 35883158 PMCID: PMC9327172 DOI: 10.1186/s12889-022-13786-6] [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: 08/06/2021] [Accepted: 07/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background Persons who experience homelessness remain at increased risk for three viral blood-borne infections: human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). We assessed the yield of testing and linkage to care programs targeting this population for these infections in the United States (US). Methods We searched PubMed, Embase, Web of Science, and Cochrane Central for peer-reviewed articles through August 27, 2020. Additionally, we searched the grey literature. Two individuals independently reviewed all relevant studies to check for eligibility and extracted data for each step in the care cascade. We used random-effects model to generate weighted pooled proportions to assess yield at each step. Cumulative proportions were calculated as products of adjacent-step pooled proportions. We quantitatively synthesized data from the studies that focused on non-drug injecting individuals. Results We identified 24 studies published between 1996–2019 conducted in 19 US states. Seventeen studies screened for HIV, 12 for HCV, and two screened for HBV. For HIV, 72% of approached were recruited, 64% had valid results, 4% tested positive, 2% were given results, and 1% were referred and attended follow-up. Of positives, 25% were referred to treatment and started care. For HCV, 69% of approached were recruited, 63% had valid results, 16% tested positive, 14% were given results, and 3% attended follow-up. Of positives, 30% were referred for treatment and 19% started care. The yield at each care cascade step differs widely by recruitment strategy (for example, for HIV: 71.6% recruited of reached under service-based with zero yield under healthcare facility-based and outreach). Conclusions A very large proportion of this population reached for HIV and HCV care were lost in the follow-up steps and never received treatment. Future programs should examine drop-out reasons and intervene to reduce health disparities in this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13786-6.
Collapse
Affiliation(s)
- Ria Saha
- Senior Public Health Intelligence Analyst, Medway Council, London, UK
| | - Amanda P Miller
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA.,Fielding School of Public Health, University of California, Los Angeles, Los Angeles, USA
| | - Andrea Parriott
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, USA.,California Department of Public Health, Sacramento, CA, USA
| | - Hacsi Horvath
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - James G Kahn
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Mohsen Malekinejad
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA. .,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
| |
Collapse
|
12
|
Peters MA, Noonan CM, Rao KD, Edward A, Alonge OO. Evidence for an expanded hypertension care cascade in low- and middle-income countries: a scoping review. BMC Health Serv Res 2022; 22:827. [PMID: 35761254 PMCID: PMC9235242 DOI: 10.1186/s12913-022-08190-0] [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: 12/22/2021] [Accepted: 06/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background With nearly 90% of annual hypertension-related deaths occurring in low- and middle-income countries (LMICs), there is an urgent need to measure the coverage of health services that effectively manage hypertension. However, there is little agreement on how to define effective coverage and the existing hypertension care cascade (hypertension prevalence, percent aware, percent treated, and percent controlled) does not account for the quality of care received by patients. This study reviews definitions of effective coverage and service quality for hypertension management services and proposes an expanded hypertension care cascade to improve measurement of health systems performance. Methods A systematic scoping review of literature published in six electronic databases between January 2000 and October 2020 identified studies that defined effective coverage of hypertension management services or integrated dimensions of service quality into population-based estimates of hypertension management in LMICs. Findings informed an expanded hypertension care cascade from which quality-adjusted service coverage can be calculated to approximate effective coverage. Results The review identified 18 relevant studies, including 6 that defined effective coverage for hypertension management services and 12 that reported a measure of service quality in a population-based study. Based on commonly reported barriers to hypertension management, new steps on the proposed expanded care cascade include (i) population screened, (ii) population linked to quality care, and (iii) population adhering to prescribed treatment. Conclusion There is little consensus on the definition of effective coverage of hypertension management services, and most studies do not describe the quality of hypertension management services provided to populations. Incorporating aspects of service quality to the hypertension care cascade allows for the calculation of quality-adjusted coverage of relevant services, enabling an appropriate measurement of health systems performance through effective coverage. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08190-0.
Collapse
Affiliation(s)
- Michael A Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Caitlin M Noonan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Krishna D Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Anbrasi Edward
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Olakunle O Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| |
Collapse
|
13
|
Jacka BP, Bazerman LB, Dickerson C, Moody M, Martin J, Patry E, Cady T, Compere H, Boudreau M, Beckwith CG. Feasibility of hepatitis C virus testing and linkage in community supervision offices: Great potential but persistent challenges. Int J Drug Policy 2022; 103:103668. [PMID: 35367903 PMCID: PMC9070602 DOI: 10.1016/j.drugpo.2022.103668] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persons involved with the justice system have an elevated risk of hepatitis C virus (HCV) yet remain marginalized from treatment. Efforts to eliminate HCV will require targeted interventions within the justice system effective at providing diagnosis and treatment. METHODS We implemented a novel HCV screening and treatment intervention for persons under community supervision in Rhode Island, USA during April 2018--March 2020. Participants received rapid point-of-care HCV antibody testing onsite and referral to community laboratory and treatment services as indicated. We assessed the HCV care cascade to identify areas for improvement. RESULTS Overall, 483 individuals were screened for HCV antibody; 85 (18%) were positive. A minority of participants with positive HCV antibody tests (n=25/85, 29%) presented to community laboratories for confirmatory testing. Among participants that received HCV viral load results and linked to a treatment provider (n=12), four initiated treatment, three had record of completing treatment, and two were confirmed to have achieved cure. CONCLUSION Linkage to HCV viral load testing and treatment was challenging in this community supervision population, with substantial loss to follow-up at each step of the HCV cascade. Community supervision remains an important venue for case identification but substantial barriers to accessing HCV treatment exist. Innovative HCV diagnosis and treatment strategies are needed for community supervision populations.
Collapse
Affiliation(s)
- Brendan P Jacka
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Laurie B Bazerman
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Collin Dickerson
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Marc Moody
- Rhode Island Department of Corrections, Pawtucket, Rhode Island, USA
| | - Johanna Martin
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Emily Patry
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Treniece Cady
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Hacheming Compere
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Matthew Boudreau
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA
| | - Curt G Beckwith
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA; The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| |
Collapse
|
14
|
Choi J, Park J, Lee D, Shim JH, Kim KM, Lim YS, Lee HC, Chung YH. The Korean Hepatitis C Virus Care Cascade in a Tertiary Institution: Current Status and Changes in Testing, Link to Care, and Treatment. Gut Liver 2022; 16:964-975. [PMID: 35354688 DOI: 10.5009/gnl210416] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/16/2021] [Accepted: 01/04/2022] [Indexed: 11/04/2022] Open
Abstract
Background/Aims The care cascade for hepatitis C virus (HCV) infection is impeded by multiple barriers, including suboptimal anti-HCV testing, link to care, and diagnosis. We explored the changes in the care cascade of HCV for the past 20 years and its current status in a large cohort from a tertiary referral center. Methods We analyzed 1,144,468 patients who had anti-HCV testing between January 2001 and June 2020. Metrics related to the care cascade of HCV infection and the long-term prognosis of patients were explored. Results The seroprevalence of anti-HCV positivity was 1.8%, with a recent decreasing trend. In all, 69.9% of anti-HCV positive patients performed HCV RNA testing, with a 65.7% positivity. Patients who did not have HCV RNA testing were older and more likely to have a non-hepatocellular carcinoma malignancy, normal alanine aminotransferase level, and good liver function. Linkage times for HCV RNA testing from the anti-HCV positivity and for antiviral treatment from HCV diagnosis decreased, notably after 2015, when highly efficacious oral antiviral treatment was introduced to Korea. The average treatment uptake rate was 35.4%, which increased to 38.9% after 2015. Of the 5,302 patients analyzed for long-term prognosis, the annual incidences of hepatocellular carcinoma were 1.02 or 2.14 per 100 person-years in patients with or without a sustained virological response, respectively. Conclusions The care cascade of HCV infection has been suboptimal for the past 20 years, despite the recent changes. More effort should be made to increase HCV RNA testing and treatment uptake.
Collapse
Affiliation(s)
- Jonggi Choi
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jina Park
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Danbi Lee
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju Hyun Shim
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kang Mo Kim
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Han Chu Lee
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hwa Chung
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Marshall AD, Rance J, Grebely J, Treloar C. 'Not just one box that you tick off' - Deconstructing the hepatitis C care cascade in the interferon-free direct acting antiviral era from the client perspective. Int J Drug Policy 2022; 102:103610. [PMID: 35151085 DOI: 10.1016/j.drugpo.2022.103610] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To achieve hepatitis C viral (HCV) elimination targets set by the World Health Organisation, pillars of the HCV care cascade are often referenced to track progress. The aim of this qualitative study was to explore the limitations of the care cascade framework through the real-world accounts of 'HCV journeys' among people who inject drugs (PWID), with particular attention to the intersection of PWID agency and structural determinants in the healthcare system. METHODS An in-depth analysis was conducted on five case studies to better understand participant experiences 'behind the cascade pillars'. The five case studies were drawn from the ETHOS Engage cohort as exemplars of the real-world complexities of people's HCV cascade journeys. Inclusion criteria for the qualitative study were participant has voluntarily signed the informed consent form, aged ≥18 years, HCV antibody positive by self-report, clients of selected sites participating in the ETHOS Engage cohort, and sufficiently proficient in English to participate in an interview. Thirty-four semi-structured interviews were conducted with participants who had received or had not received HCV treatment to identify barriers and facilitators to HCV care. RESULTS Participants 'housed' at the 'HCV RNA diagnosed pillar' (n = 2; Will; Julie) reported withholding their HCV serostatus in certain healthcare settings for fear that disclosure would lead to discriminatory decision-making from their treating physician. among participants who had completed treatment (n = 3; Corey; John; Nora) two reported still being unsure of their HCV status >6 months post-treatment. Ongoing feelings of frustration and shame were expressed in this 'post-cure care pillar' due to a perceived lack of quality care from clinic services and continued uneasiness when discussing drug use and reinfection while receiving opioid agonist treatment (OAT). Both case 'categories' described often tenuous therapeutic relationships with their physicians and recommended task-shifting to nurses and trusted case workers for ongoing care. CONCLUSION The care cascade provides a linear, two dimensional snapshot of clinical targets. Our findings illuminate structural barriers not visible behind its 'static' pillars, presenting insights into experiences among PWID otherwise dismissed as 'disengaged' or 'lost to follow-up'.
Collapse
Affiliation(s)
- A D Marshall
- The Kirby Institute, UNSW Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Australia.
| | - J Rance
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - J Grebely
- The Kirby Institute, UNSW Sydney, Australia
| | - C Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
| |
Collapse
|
16
|
Huang JF, Hsieh MY, Wei YJ, Hung JY, Huang HT, Huang CI, Yeh ML, Huang CF, Jang TY, Hsu PY, Liang PC, Dai CY, Lin ZY, Yu ML, Chuang WL. Towards a safe hospital: hepatitis C in-hospital micro-elimination program (HCV-HELP study). Hepatol Int 2021; 16:59-67. [PMID: 34850326 PMCID: PMC8631565 DOI: 10.1007/s12072-021-10275-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022]
Abstract
Question Is hepatitis C virus (HCV) micro-elimination achievable at the hospital level with the structured strategies? Findings The multidirectional program included the HCV reflex test for hospital personnel, outpatient surveillance, a call-back system, and surveillance of cancer patients prior to chemotherapy. Through the plans of the study, 97.8% of the HCV-viremic patients successfully received linkage-to-treat. The results of each strategy sufficiently met the 2030 elimination goal by the World Health Organization (WHO). Meaning HCV micro-elimination is achievable at the hospital level based on patient safety, staff occupational safety and infection control. Background and aims Scarce data are available on in-hospital hepatitis C virus (HCV) micro-elimination strategies. This pilot study was prospectively conducted to assess the outcomes of HCV in-hospital micro-elimination program (HCV-HELP) in a single center in Taiwan. Methods The study included the HCV reflex test for plans A (hospital personnel), B (outpatient surveillance), C (a call-back system for anti-HCV+ patients), and D (surveillance of cancer patients prior to chemotherapy). The primary outcome measurement was that > 80% of eligible patients were enrolled in linkage-to-treat; the secondary outcome measurement was the surveillance efficacy. Results We recruited 930, 6072, 2376 and 233 participants into plans A, B, C, and D, respectively, from Oct 2020 to May 2021. The anti-HCV-seropositivity prevalences were 0.22% for plan A, 4.3% for B, and 3.9% for D. Two staff members were identified as HCV-viremic in plan A; these staff members successfully achieved a sustained virological response (SVR). We identified 39, 95 and 2 HCV-viremic patients in plans B, C, and D, respectively. Of these 138 HCV-viremic patients, 135 (97.8%) received direct-acting antiviral therapy, and 134 achieved SVR. Two 4-month phases were stratified to compare efficacies in the liver clinic. In the late phase, the adjusted number of HCV-viremic patients was 4.36/10,000 outpatient visits (90/200,689), which was 3.18-fold higher than that of the early phase (1.37/10,000 outpatient visits [30/212,658], odds ratio 3.18; 95% confidence interval 2.10–4.81, p < 0.0001). Conclusion HCV micro-elimination is achievable at the hospital level as per the structured HCV-HELP study.
Collapse
Affiliation(s)
- Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou Road, Kaohsiung, 807 Taiwan
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yen Hsieh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou Road, Kaohsiung, 807 Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ju Wei
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou Road, Kaohsiung, 807 Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jen-Yu Hung
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsuan-Ti Huang
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-I Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou Road, Kaohsiung, 807 Taiwan
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou Road, Kaohsiung, 807 Taiwan
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou Road, Kaohsiung, 807 Taiwan
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tyng-Yuan Jang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou Road, Kaohsiung, 807 Taiwan
| | - Po-Yao Hsu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou Road, Kaohsiung, 807 Taiwan
| | - Po-Cheng Liang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou Road, Kaohsiung, 807 Taiwan
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou Road, Kaohsiung, 807 Taiwan
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zu-Yau Lin
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou Road, Kaohsiung, 807 Taiwan
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou Road, Kaohsiung, 807 Taiwan
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou Road, Kaohsiung, 807 Taiwan
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
17
|
Moitra E, Chan PA, Molina PE, Ernst F, Ferguson TF, Mimiaga MJ, Herman DS, Stein MD. HIV Engage-A randomized controlled efficacy trial of an acceptance-based behavioral therapy intervention to improve retention in care for HIV treatment naïve patients: Study protocol. Contemp Clin Trials 2021; 108:106514. [PMID: 34302986 PMCID: PMC8453091 DOI: 10.1016/j.cct.2021.106514] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/20/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION People with HIV (PWH) who are not consistently retained in medical care, particularly when they are first diagnosed, are at risk for: delayed antiretroviral therapy (ART) initiation, suboptimal ART adherence, unsuppressed viremia, and mortality. Suboptimal retention means effective ART cannot be leveraged to prevent onward HIV transmission. To address this, we developed and previously pilot tested the HIV Engage intervention-a novel behavioral approach to enhance retention in HIV care using acceptance-based behavioral therapy (ABBT)-and established feasibility and acceptability of this approach. In the current study, we investigate the efficacy of ABBT compared to an attention-matched control condition in a full-scale randomized controlled efficacy trial. METHODS Two hundred seventy HIV care naïve patients from geographically diverse clinics will be recruited and equally randomized to receive (a) the HIV Engage intervention, consisting of two 20-30 min ABBT sessions delivered in-person or remotely, or (b) an attention-matched HIV education control condition. Primary outcomes are number of HIV care appointments kept and HIV viral load suppression. Secondary outcomes are higher self-reported ART adherence, HIV status disclosure, increased social support, and reductions in perceived HIV stigma. Hypothesized mediators include acceptance of one's HIV diagnosis and willingness to disclose serostatus. We will also assess for epidemiologically-linked moderators of the treatment effect. CONCLUSIONS ABBT represents a novel, potentially promising approach to enhance retention in ongoing HIV care among treatment naïve PWH. This study will contribute significant actionable data establishing the impact, mediational mechanisms, and effect modifiers of ABBT.
Collapse
Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Philip A Chan
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Patricia E Molina
- Department of Physiology, School of Medicine, Louisiana State University - Health Sciences Center, New Orleans, LA, USA
| | - Frances Ernst
- Department of Psychiatry, School of Medicine, Louisiana State University - Health Sciences Center, New Orleans, LA, USA
| | - Tekeda F Ferguson
- Department of Physiology, School of Medicine, Louisiana State University - Health Sciences Center, New Orleans, LA, USA; Department of Epidemiology, School of Public Health, Louisiana State University - Health Sciences Center, New Orleans, LA, USA
| | - Matthew J Mimiaga
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Debra S Herman
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA
| | - Michael D Stein
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, RI, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
18
|
Busschots D, Bielen R, Koc ÖM, Heyens L, Dercon E, Verrando R, Janssens F, Van den Bergh L, Van Lint P, Bruckers L, Nevens F, Robaeys G. On-site testing and case management to improve hepatitis C care in drug users: a prospective, longitudinal, multicenter study in the DAA era. BMC Public Health 2021; 21:1574. [PMID: 34416867 PMCID: PMC8379886 DOI: 10.1186/s12889-021-11608-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/02/2020] [Accepted: 08/08/2021] [Indexed: 01/15/2023] Open
Abstract
Background Screening and treatment of hepatitis C virus (HCV) infection in people who use drugs (PWUD) remains insufficient. Reducing the burden of HCV infection in PWUD requires interventions focusing on the different steps of the HCV care cascade. Methods We performed a prospective, multicenter study, evaluating the impact of an HCV care model on the HCV care cascade among PWUD attending an addiction care center in Belgium between 2015 and 2018. Interventions within the care model consisted of pre-test counseling, on-site HCV screening and case management services. A multiple logistic regression model was performed to identify the independent factors influencing the outcomes. Results During the study period, 441 PWUD were registered at the addiction care center, 90% (395/441) were contacted, 88% (349/395) were screened for HCV infection. PWUD were more likely to be screened if they had ever injected drugs (p < .001; AOR 6.411 95% CI 3.464–11.864). In 45% (157/349), the HCV antibody (Ab) test was positive, and in 27% (94/349) HCV RNA was positive. Within the Belgian reimbursement criteria (fibrosis stage ≥ F2), 44% (41/94) were treated. Specialist evaluation at the hospital was lower for PWUD receiving decentralized opioid agonist therapy (p = .005; AOR 0.430 95% CI 0.005–0.380), PWUD with unstable housing in the past 6 months before inclusion (p = .015; AOR 0.035 95% CI 0.002–0.517) or if they were recently incarcerated (p = .001; AOR 0.010 95% CI 0.001–0.164). Conclusions This HCV care model demonstrated high screening, linkage to care, and treatment initiation among PWUD in Belgium. Using the cascade of care to guide interventions is easy and necessary to monitor results. This population needs guidance, not only for screening and treatment initiation but also for the long-term follow-up since one in six had cirrhosis and could develop hepatocellular carcinoma. Further interventions are necessary to increase linkage to care and treatment initiation. Universal access to direct-acting antiviral therapy from 2019 will contribute to achieving HCV elimination in the PWUD population. Trial registration Clinical trial registration details: www.clinicaltrials.gov (NCT03106194). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11608-9.
Collapse
Affiliation(s)
- Dana Busschots
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium. .,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.
| | - Rob Bielen
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium
| | - Özgür M Koc
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.,Medical Microbiology, School of NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Leen Heyens
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.,Medical Microbiology, School of NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Filip Janssens
- Department of Gastroenterology, Jessa Hospital, Hasselt, Belgium
| | - Luc Van den Bergh
- Department of Gastroenterology, Sint-Trudo Hospital, Sint-Truiden, Belgium
| | - Peter Van Lint
- Department of Gastroenterology, AZ Vesalius, Tongeren, Belgium
| | - Liesbeth Bruckers
- Faculty of Science, Center for statistics, Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Geert Robaeys
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Diepenbeek, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| |
Collapse
|
19
|
Khandpur S, Bhardwaj M, Awasthi A, Newtonraj A, Purty AJ, Khanna T, Abraham G, Tiwari S. Association of kidney functions with a cascade of care for diabetes and hypertension in two geographically distinct Indian cohorts. Diabetes Res Clin Pract 2021; 176:108861. [PMID: 34022251 DOI: 10.1016/j.diabres.2021.108861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/16/2021] [Accepted: 05/08/2021] [Indexed: 11/27/2022]
Abstract
AIM Type 2 diabetes (T2DM) and hypertension (HTN) are the main modifiable risk factors of chronic kidney disease (CKD), among the known traditional and non-traditional risk factors. METHODS We determined the prevalence and care-cascade of these modifiable CKD-risk factors and their association with socioeconomic status in adjoining Lucknow and Puducherry cities of India. RESULTS 439 participants reported no CKD were recruited. Serum analysis revealed an Estimated Glomerular Filtration Rate (eGFR) ≥ 90 ml/min/1.73 m2 in 60.36% of the population. Of them, 55.85% had HTN and/or T2DM as CKD-risk factors; however, less than half of this population was unaware of their CKD-risk status. Awareness and treatment were significantly higher in Puducherry and were associated with literacy, occupation, and residence place. Although the CKD-risk population was about two times higher in Puducherry than Lucknow, the populations with mild-low eGFR were comparable in the two regions. Moreover, in Lucknow, mild-low eGFR and low awareness were more prevalent among the younger participants (<30 years), relative to Puducherry. CONCLUSIONS Despite a higher prevalence of CKD-risk factors in Puducherry, populations with mild-low eGFR were comparable to Lucknow. More heightened awareness and better care cascade for CKD-risk factors in Puducherry may prevent or delay eGFR reduction.
Collapse
Affiliation(s)
- Sukhanshi Khandpur
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Mansi Bhardwaj
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ashish Awasthi
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram 122002, India
| | - Ariarathinam Newtonraj
- Department of Community Medicine, Pondicherry Institute of Medical Sciences (A Unit of Madras Medical Mission), Kalapet, Puducherry 605014, India
| | - Anil J Purty
- Department of Community Medicine, Pondicherry Institute of Medical Sciences (A Unit of Madras Medical Mission), Kalapet, Puducherry 605014, India
| | - Tripti Khanna
- Indian Council of Medical Research, Ramalingaswami Bhawan, New Delhi, India
| | - Georgi Abraham
- Department of Community Medicine, Pondicherry Institute of Medical Sciences (A Unit of Madras Medical Mission), Kalapet, Puducherry 605014, India
| | - Swasti Tiwari
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
| |
Collapse
|
20
|
Huang SH, Lee CY, Tsai CS, Tsai MS, Liu CE, Hsu WT, Chen HA, Liu WD, Yang CJ, Sun HY, Ko WC, Lu PL, Lee YT, Hung CC. Screening for Cryptococcal Antigenemia and Burden of Cryptococcosis at the Time of HIV Diagnosis: A Retrospective Multicenter Study. Infect Dis Ther 2021; 10:1363-1377. [PMID: 34057690 PMCID: PMC8322196 DOI: 10.1007/s40121-021-00451-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [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: 02/28/2021] [Accepted: 04/22/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction Screening for cryptococcal antigen (CrAg) is recommended for people living with HIV (PLWH) who present with low CD4 lymphocyte counts. Real-world experience is important to identify gaps between the guidelines and clinical practice. We investigated the trends of CrAg testing and prevalence of cryptococcal antigenemia among PLWH at the time of HIV diagnosis and the related mortality in Taiwan from 2009 to 2018. Methods Medical records of newly diagnosed PLWH seeking care at six medical centers around Taiwan between 2009 and 2018 were reviewed. The annual trends of PLWH who had CrAg testing and cryptococcal antigenemia were examined by Cochran-Armitage test. Among PLWH with CD4 < 200 cells/µl, timing of CrAg testing was analyzed for association with 12-month all-cause mortality in Kaplan-Meier plots and in a Cox proportional hazards model after adjustments. Results Among 5372 included PLWH, 1150 (21.4%) presented with baseline CD4 < 100 cells/µl, and this proportion had decreased during the study period [from 108 (29.3%) in 2009 to 93 (22.3%) in 2018 (P = 0.039)]. The overall prevalence of cryptococcal antigenemia was 7.8% among PLWH with CD4 < 100 cells/µl, which remained stable during the 10-year study period (P = 0.356) and was 2.6% among PLWH with CD4 100–199 cells/µl. The uptake of CrAg testing had increased from 65.7% in 2009 to 78.0% in 2018 (P = 0.002) among PLWH with CD4 < 100 cells/µl. Late CrAg testing, defined by 14 days or later after HIV diagnosis, was associated with increased risk of 12-month mortality compared to early CrAg testing (adjusted hazard ratio 2.028, 95% CI 1.109–3.708). Conclusions Burden of cryptococcosis remained high among PLWH with low CD4 lymphocyte counts in Taiwan. Uptake of CrAg screening among late HIV presenters was still suboptimal and delayed. Late CrAg testing was associated with a higher mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00451-5.
Collapse
Affiliation(s)
- Sung-Hsi Huang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.,Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Yuan Lee
- Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chin-Shiang Tsai
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Mao-Song Tsai
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Eng Liu
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Wei-Ting Hsu
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu, Yun-Lin County, Taiwan
| | - Hong-An Chen
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wang-Da Liu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, Taiwan.,Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Chia-Jui Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Ti Lee
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chien-Ching Hung
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan. .,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, Taiwan. .,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. .,China Medical University, Taichung, Taiwan.
| | | |
Collapse
|
21
|
Benzekri NA, Sambou JF, Ndong S, Diallo MB, Tamba IT, Faye D, Sall I, Diatta JP, Faye K, Cisse O, Sall F, Guèye NFN, Ndour CT, Sow PS, Malomar JJ, Hawes SE, Seydi M, Gottlieb GS. The impact of food insecurity on HIV outcomes in Senegal, West Africa: a prospective longitudinal study. BMC Public Health 2021; 21:451. [PMID: 33676463 PMCID: PMC7936446 DOI: 10.1186/s12889-021-10444-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/16/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Understanding the impact of food insecurity on HIV outcomes is critical for the development and implementation of effective, evidence-based interventions to address food insecurity and improve the HIV care cascade. We conducted a prospective, longitudinal study to determine the impact of food insecurity on HIV outcomes in Senegal, West Africa. Methods HIV-infected individuals presenting for care and initiation of ART through the Senegalese National AIDS program in Dakar and Ziguinchor were eligible for enrollment. Data were collected using interviews, clinical evaluations, laboratory analyses, and chart review at enrollment, month 6, and month 12. Logistic regression was used to determine the association between food insecurity and HIV outcomes. Results Among the 207 participants in this study, 70% were female and the median age was 37 years. The majority (69%) were food insecure at enrollment, 29% were severely food insecure, and 38% were undernourished. Nearly a third (32%) had no formal education, 23% practiced agriculture, and 40% owned livestock. The median daily food expenditure per person was $0.58. The median round trip transportation time to clinic was 90 min (IQR 30–240). The median cost of transportation to clinic was $1.74. At month 12, 69% were food insecure, 23% were severely food insecure, and 14% were undernourished. At month 12, 43% had not disclosed their HIV status; food insecurity was associated with non-disclosure of HIV-status due to fear of stigmatization and feelings of shame. Severe food insecurity was a strong predictor of loss to follow-up (OR 3.13 [1.08–9.06]) and persistent severe food insecurity was associated with virologic failure (OR 5.14 [1.01–26.29]) and poor adherence to ART 8.00 [1.11–57.57]. Poor nutritional status was associated with poor immunologic recovery (OR 4.24 [1.56–11.47]), virologic failure (OR 3.39 [1.13–10.21]), and death (OR 3.35 [1.40–8.03]). Conclusion Severity and duration of food insecurity are important factors in understanding the relationship between food insecurity and HIV outcomes. Our findings highlight the importance of nutritional status, socioeconomic opportunity, and self-stigmatization in the complex pathway between food insecurity and HIV outcomes. Interdisciplinary, multisectoral efforts are needed to develop and implement effective interventions to address food insecurity among people living with HIV. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10444-1.
Collapse
Affiliation(s)
- Noelle A Benzekri
- Department of Medicine, University of Washington, Box 358061, 750 Republican St., Seattle, WA, 98109-4725, USA.
| | | | - Sanou Ndong
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Mouhamadou Baïla Diallo
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | | | | | | | - Khadim Faye
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | - Fatima Sall
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Ndèye Fatou Ngom Guèye
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Cheikh T Ndour
- Division de Lutte contre le Sida et les IST, Ministère de la Santé et de l'Action Sociale, Dakar, Senegal
| | - Papa Salif Sow
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Moussa Seydi
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Geoffrey S Gottlieb
- Department of Medicine, University of Washington, Box 358061, 750 Republican St., Seattle, WA, 98109-4725, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
22
|
Abstract
Hepatitis C (HCV) care cascades have been described in diverse clinical settings, patient populations and countries, highlighting the steps in HCV care where improvements can be made and resources allocated. However, more research is needed to examine barriers to HCV treatment in rural, underserved populations and in Federally Qualified Health Centers (FQHCs). As part of a quality improvement (QI) project, this study aimed to describe and evaluate the HCV treatment cascade in an FQHC serving a large rural patient population in the Western United States. Standardized chart abstraction was utilized to aggregate data regarding patient demographics, the percentage of patients achieving each step in the treatment cascade, and relevant patient (i.e., viral load) and service variables (i.e., whether and when patients received treatment or medication). 389 patients were identified as having HCV and 86% were aware of their diagnosis. Fifty-five percent had their infection confirmed via viral load, 21% were staged for liver disease, 24% received a prescription for treatment, and 19% achieved cure. Compared to national data, the current regional sample had greater rates of diagnosis awareness and access to care, as well as sustained virologic response (SVR), but lower rates of viral load confirmation. Current findings suggest that rural patients living with HCV who receive care at FQHCs struggle to navigate the treatment cascade and achieve a cure, particularly with regard to infection confirmation, liver staging, and prescription. However, compared to national estimates, patients had greater rates of diagnosis awareness/treatment access and SVR.
Collapse
Affiliation(s)
- David M Hachey
- Department of Family Medicine, Idaho State University, 921 S. 8th Ave. Stop, Pocatello, ID, 83209, USA.
| | - John T Holmes
- Department of Family Medicine, Idaho State University, 921 S. 8th Ave. Stop, Pocatello, ID, 83209, USA
| | | |
Collapse
|
23
|
Haghighat R, Toska E, Bungane N, Cluver L. The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study. BMC Infect Dis 2021; 21:60. [PMID: 33435861 PMCID: PMC7805141 DOI: 10.1186/s12879-020-05742-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [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: 02/12/2020] [Accepted: 12/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. METHODS All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014-2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. RESULTS Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14-5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06-1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29-4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04-11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06-1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12-2.58], p=0.013) were more likely to be fully viral suppressed. CONCLUSIONS Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring.
Collapse
Affiliation(s)
- Roxanna Haghighat
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, Oxford, OX1 3DW, UK.
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.,Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Nontuthuzelo Bungane
- Department of Nursing Science, Faculty of Health Sciences, University of Fort Hare, Alice, South Africa
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, Oxford, OX1 3DW, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
24
|
Huang CF, Wu PF, Yeh ML, Huang CI, Liang PC, Hsu CT, Hsu PY, Liu HY, Huang YC, Lin ZY, Chen SC, Huang JF, Dai CY, Chuang WL, Yu ML. Scaling up the in-hospital hepatitis C virus care cascade in Taiwan. Clin Mol Hepatol 2020; 27:136-143. [PMID: 33317253 PMCID: PMC7820217 DOI: 10.3350/cmh.2020.0150] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/AIMS Obstacles exist in facilitating hepatitis C virus (HCV) care cascade. To increase timely and accurate diagnosis, disease awareness and accessibility, in-hospital HCV reflex testing followed by automatic appointments and a late call-back strategy (R.N.A. model) was applied. We aimed to compare the HCV treatment rate of patients treated with this strategy compared to those without. METHODS One hundred and twenty-five anti-HCV seropositive patients who adopted the R.N.A. model in 2020 and another 1,396 controls treated in 2019 were enrolled to compare the gaps in accurate HCV RNA diagnosis to final treatment allocation. RESULTS The HCV RNA testing rate was significantly higher in patients who received reflex testing than in those without reflex testing (100% vs. 84.8%, P<0.001). When patients were stratified according to the referring outpatient department, a significant improvement in the HCV RNA testing rate was particularly noted in patients from non-hepatology departments (100% vs. 23.3%, P<0.001). The treatment rate in HCV RNA seropositive patients was 83% (83/100) after the adoption of the R.N.A. model, among whom 96.1% and 73.9% of patients were from the hepatology and non-hepatology departments, respectively. Compared to subjects without R.N.A. model application, a significant improvement in the treatment rate was observed for patients from non-hepatology departments (73.9% vs. 27.8%, P=0.001). The application of the R.N.A. model significantly increased the in-hospital HCV treatment uptake from 6.4% to 73.9% for patients from non-hepatology departments (P<0.001). CONCLUSION The care cascade increased the treatment uptake and set up a model for enhancing in-hospital HCV elimination.
Collapse
Affiliation(s)
- Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Occupational Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pey-Fang Wu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-I Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Cheng Liang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Ting Hsu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Yao Hsu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Yin Liu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Chou Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zu-Yau Lin
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shinn-Cherng Chen
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Occupational Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan.,College of Biological Science and Technology, National Chiao Tung University, Hsin-Chu, Taiwan
| |
Collapse
|
25
|
Chan J, Kaba F, Schwartz J, Bocour A, Akiyama MJ, Rosner Z, Winters A, Yang P, MacDonald R. The hepatitis C virus care cascade in the New York City jail system during the direct acting antiviral treatment era, 2014-2017. EClinicalMedicine 2020; 27:100567. [PMID: 33150329 PMCID: PMC7599312 DOI: 10.1016/j.eclinm.2020.100567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/13/2020] [Accepted: 09/11/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND High patient turnover presents challenges and opportunity to provide hepatitis C virus (HCV) care in US jails (remand facilities). This study describes the HCV care cascade in the New York City (NYC) jail system during the direct-acting antiviral (DAA) treatment era. METHODS Patients admitted to the NYC jail system from January 2014 through December 2017 were included in this retrospective cohort analysis. We describe rates of screening, diagnosis, linkage to jail-based care, and treatment among the overall cohort, and among subgroups with long jail stays (≥120 days) or frequent stays (≥10 admissions). The study protocol was approved by a third-party institutional review board (BRANY, Lake Success, NY). FINDINGS Among the 121,371 patients in our analysis, HCV screening was performed in 40,219 (33%), 4665 (12%) of whom were viremic, 1813 (39%) seen by an HCV clinician in jail, and 248 (5% of viremic patients) started on treatment in jail. Having a long stay (adjusted risk ratio [aRR] 8·11, 95% confidence interval [CI] 6·98, 9·42) or frequent stays (aRR 1·51, 95% CI 1·04, 2·18) were significantly associated with being seen by an HCV clinician. Patients with long stays had a higher rate of treatment (14% of viremic patients). Sustained virologic response at 12 weeks was achieved in 147/164 (90%) of patients with available virologic data. INTERPRETATION Jail health systems can reach large numbers of HCV-infected individuals. The high burden of HCV argues for universal screening in jail settings. Length of stay was strongly associated with being seen by an HCV clinician in jail. Treatment is feasible among those with longer lengths of stay. FUNDING None.
Collapse
Affiliation(s)
- Justin Chan
- Correctional Health Services, NYC Health + Hospitals, 55 Water Street, 18th floor, New York, NY 10041, United States
- Corresponding authors.
| | - Fatos Kaba
- Correctional Health Services, NYC Health + Hospitals, 55 Water Street, 18th floor, New York, NY 10041, United States
| | - Jessie Schwartz
- Bureau of Communicable Diseases, Viral Hepatitis Program, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, United States
| | - Angelica Bocour
- Bureau of Communicable Diseases, Viral Hepatitis Program, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, United States
| | - Matthew J Akiyama
- Montefiore Medical Center, Albert Einstein College of Medicine, 1621 Eastchester Road, Bronx, NY 10461, United States
| | - Zachary Rosner
- Correctional Health Services, NYC Health + Hospitals, 55 Water Street, 18th floor, New York, NY 10041, United States
| | - Ann Winters
- Bureau of Communicable Diseases, Viral Hepatitis Program, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, United States
| | - Patricia Yang
- Correctional Health Services, NYC Health + Hospitals, 55 Water Street, 18th floor, New York, NY 10041, United States
| | - Ross MacDonald
- Correctional Health Services, NYC Health + Hospitals, 55 Water Street, 18th floor, New York, NY 10041, United States
- Corresponding authors.
| |
Collapse
|
26
|
Passi-Solar Á, Margozzini P, Mindell JS, Ruiz M, Valencia-Hernandez CA, Scholes S. Hypertension care cascade in Chile: a serial cross-sectional study of national health surveys 2003-2010-2017. BMC Public Health 2020; 20:1397. [PMID: 32928176 PMCID: PMC7490861 DOI: 10.1186/s12889-020-09483-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/18/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background Trend data on hypertension prevalence and attainment indicators at each step of the care cascade (awareness, treatment, control) are required in Chile. This study aims to quantify trends (2003–2017) in prevalence and in the proportion of individuals with hypertension attaining each step of the care cascade among adults aged 17 years or older, and to assess the impact of lowering the blood pressure (BP) thresholds used to define elevated BP on these indicators. Methods We used data from 2003, 2010, and 2017 Chilean national health surveys. Each year we assessed levels of (1) mean systolic (SBP) and diastolic (DBP) blood pressure, (2) hypertension prevalence (BP ≥ 140/90 mmHg or use of antihypertensive treatment), and (3) awareness, treatment, and control. Logistic regression on pooled data was used to assess trends in binary outcomes; linear regression was used to assess trends in continuous SBP and DBP. We compared levels of hypertension prevalence using two sources to ascertain antihypertensive treatment (self-reported versus medicine inventory). The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines were used to re-define hypertension using lower thresholds (BP ≥ 130/80 mmHg). Results Hypertension prevalence was 34.0, 32.0 and 30.8% in 2003, 2010 and 2017, respectively. Levels of treated- and controlled-hypertension were significantly higher in 2017 than in 2003 (65% versus 41% for treatment, P < 0.001; 34% versus 14% for control, P < 0.001), while levels of awareness were stable (66% versus 59%, P = 0.130). Awareness, treatment, and control levels were higher among females in 2003, 2010, and 2017 (P < 0.001). Mean SBP and DBP decreased over the 15-year period, except for SBP among females on treatment. Adopting the 2017 ACC/AHA guidelines would increase hypertension prevalence by 17 and 55% in absolute and relative terms, respectively. Conclusions Chile has experienced a positive population-wide lowering in blood pressure distribution which may be explained partly by a significant rise in levels of treated- and controlled-hypertension since 2003. Lowering the thresholds used to define elevated BP would substantially increase the financial public health challenge of further improving attainment levels at each step of the care cascade. Innovative and collaborative strategies are needed to improve hypertension management, especially among males.
Collapse
Affiliation(s)
- Álvaro Passi-Solar
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.,Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, CP 88330077, Santiago, Chile
| | - Paula Margozzini
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, CP 88330077, Santiago, Chile.
| | - Jennifer S Mindell
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Milagros Ruiz
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Carlos A Valencia-Hernandez
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Shaun Scholes
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| |
Collapse
|
27
|
Tsay CJ, Lim JK. Assessing the Effectiveness of Strategies in US Birth Cohort Screening for Hepatitis C Infection. J Clin Transl Hepatol 2020; 8:25-41. [PMID: 32274343 PMCID: PMC7132023 DOI: 10.14218/jcth.2019.00059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/04/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022] Open
Abstract
Chronic hepatitis C infection in the USA is a highly morbid condition and current guidelines recommend one-time screening among the birth cohort (1945-1965). Understanding strategies to optimize screening can help inform future hepatitis C virus (HCV) screening guidelines. A focused literature search was performed using PubMed and manual abstract review from major hepatology conferences over the past 2 years. The search strategy involved using Medical Subject Headings terms for hepatitis C, screening, birth cohort, baby boomers, and 1945-1965. The review was limited to data from the USA. A total of 327 articles were identified and 36 abstracts were included, with studies published between 2012-2019. Strategies including clinician education, electronic medical record alerts, reflex HCV RNA testing, point-of-care testing, multisite (outpatient, inpatient, emergency department, endoscopy suite) initiatives, direct patient solicitation, and utilization of non-physician providers have increased HCV screening rates. However, broad implementation remains less than optimal. Barriers include lack of patient acceptance to screening and engagement in the HCV care cascade. The Veterans Affairs Healthcare System has achieved higher birth cohort screening rates through an integrated approach requiring high-level engagement by leadership and institutional commitment. Multiple strategies for increasing birth cohort screening have been successful, but overall rates of HCV screening remain low. These strategies can inform public health efforts to implement emerging national recommendations for expansion of HCV screening to all U.S. adults age 18 or older.
Collapse
Affiliation(s)
- Cynthia J. Tsay
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Joseph K. Lim
- Yale Liver Center, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
28
|
Prenissl J, Jaacks LM, Mohan V, Manne-Goehler J, Davies JI, Awasthi A, Bischops AC, Atun R, Bärnighausen T, Vollmer S, Geldsetzer P. Variation in health system performance for managing diabetes among states in India: a cross-sectional study of individuals aged 15 to 49 years. BMC Med 2019; 17:92. [PMID: 31084606 PMCID: PMC6515628 DOI: 10.1186/s12916-019-1325-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/15/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Understanding where adults with diabetes in India are lost in the diabetes care cascade is essential for the design of targeted health interventions and to monitor progress in health system performance for managing diabetes over time. This study aimed to determine (i) the proportion of adults with diabetes in India who have reached each step of the care cascade and (ii) the variation of these cascade indicators among states and socio-demographic groups. METHODS We used data from a population-based household survey carried out in 2015 and 2016 among women and men aged 15-49 years in all states of India. Diabetes was defined as a random blood glucose (RBG) ≥ 200 mg/dL or reporting to have diabetes. The care cascade-constructed among those with diabetes-consisted of the proportion who (i) reported having diabetes ("aware"), (ii) had sought treatment ("treated"), and (iii) had sought treatment and had a RBG < 200 mg/dL ("controlled"). The care cascade was disaggregated by state, rural-urban location, age, sex, household wealth quintile, education, and marital status. RESULTS This analysis included 729,829 participants. Among those with diabetes (19,453 participants), 52.5% (95% CI, 50.6-54.4%) were "aware", 40.5% (95% CI, 38.6-42.3%) "treated", and 24.8% (95% CI, 23.1-26.4%) "controlled". Living in a rural area, male sex, less household wealth, and lower education were associated with worse care cascade indicators. Adults with untreated diabetes constituted the highest percentage of the adult population (irrespective of diabetes status) aged 15 to 49 years in Goa (4.2%; 95% CI, 3.2-5.2%) and Tamil Nadu (3.8%; 95% CI, 3.4-4.1%). The highest absolute number of adults with untreated diabetes lived in Tamil Nadu (1,670,035; 95% CI, 1,519,130-1,812,278) and Uttar Pradesh (1,506,638; 95% CI, 1,419,466-1,589,832). CONCLUSIONS There are large losses to diabetes care at each step of the care cascade in India, with the greatest loss occurring at the awareness stage. While health system performance for managing diabetes varies greatly among India's states, improvements are particularly needed for rural areas, those with less household wealth and education, and men. Although such improvements will likely have the greatest benefits for population health in Goa and Tamil Nadu, large states with a low diabetes prevalence but a high absolute number of adults with untreated diabetes, such as Uttar Pradesh, should not be neglected.
Collapse
Affiliation(s)
- Jonas Prenissl
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany. .,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Public Health Foundation of India, New Delhi, Delhi NCR, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Jennifer Manne-Goehler
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine I Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Johannesburg, Gauteng, South Africa.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ashish Awasthi
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Anne Christine Bischops
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
29
|
Liu WD, Tsai WC, Hsu WT, Shih MC, Chen MY, Sun HY, Hsieh SM, Sheng WH, Chuang YC, Cheng A, Lin KY, Huang YS, Huang SH, Huang YC, Chen GJ, Wu PY, Hung CC, Chang SC. Impact of initiation of combination antiretroviral therapy according to the WHO recommendations on the survival of HIV-positive patients in Taiwan. J Microbiol Immunol Infect 2020; 53:936-45. [PMID: 31105037 DOI: 10.1016/j.jmii.2019.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/05/2019] [Accepted: 03/25/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND/PURPOSE Early initiation of antiretroviral therapy (ART) reduces the risks for serious infections and mortality. We aimed to assess the outcomes of initiating ART among HIV-positive Taiwanese according to the CD4 cut-off values by the WHO recommendations. METHODS We reviewed medical records of patients with newly diagnosed HIV infection between 2004 and 2015 and 3 groups of patients were defined according to the timing of ART initiation based on CD4 count recommended by WHO: Group 1 between 2004 and 2009; Group 2 between 2010 and 2012; and Group 3 between 2013 and 2015. The primary outcome was all-cause mortality. All patients were followed until 2 years after the last patient was included in each group. RESULTS Of 2022 patients included, the mortality rate was 18.28, 14.01, and 9.10 deaths per 1000 person-years of follow-up (PYFU) in Groups 1, 2, and 3, respectively. In multivariable Cox regression analysis, factors associated with mortality were age (per 1-year increase, adjusted hazard ratio [AHR], 1.06; 95% CI, 1.05-1.08), presence of AIDS-defining disease at HIV diagnosis (AHR, 4.81; 95% CI, 2.99-7.74), solid-organ malignancy (AHR, 3.10; 95% CI, 1.86-5.18), and initiation of ART (AHR, 0.09; 95% CI, 0.05-0.16). By competing risk regression model for non-AIDS-related death, the AHR for Group 3 versus Group 1 was 0.27 (95% CI, 0.09-0.80). CONCLUSIONS While continued efforts are needed to improve early diagnosis and linkage to care, initiation of cART improved survival among HIV-positive patients in Taiwan according to the increasing CD4 cut-off values that were recommended by the WHO.
Collapse
|
30
|
Green D, Kharono B, Tordoff DM, Akullian A, Bershteyn A, Morrison M, Garnett G, Duerr A, Drain P. Demographic and risk group heterogeneity across the UNAIDS 90-90-90 targets: a systematic review and meta-analysis protocol. Syst Rev 2019; 8:110. [PMID: 31060607 PMCID: PMC6501385 DOI: 10.1186/s13643-019-1024-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 04/12/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite policies for universal HIV testing and treatment (UTT) regardless of CD4 count, there are still 1.8 million new HIV infections and 1 million AIDS-related deaths annually. The UNAIDS 90-90-90 goals target suppression of HIV viral load in 73% of all HIV-infected people worldwide by 2030. However, achieving these targets may not lead to expected reductions in HIV incidence if the remaining 27% (persons with unsuppressed viral load) are the drivers of HIV transmission through high-risk behaviors. We aim to conduct a systematic review and meta-analysis to understand the demographics, mobility, geographic distribution, and risk profile of adults who are not virologically suppressed in sub-Saharan Africa in the era of UTT. METHODS We will review the published and grey literature for study sources that contain data on demographic and behavioral strata of virologically suppressed and unsuppressed populations since 2014. We will search PubMed and Embase using four sets of search terms tailored to identify characteristics associated with virological suppression (or lack thereof) and each of the individual 90-90-90 goals. Record screening and data abstraction will be done independently and in duplicate. We will use random effects meta-regression analyses to estimate the distribution of demographic and risk features among groups not virologically suppressed and for each individual 90-90-90 goal. DISCUSSION The results of our review will help elucidate factors associated with failure to achieve virological suppression in sub-Saharan Africa, as well as factors associated with failure to achieve each of the 90-90-90 goals. These data will help quantify the population-level effects of current HIV treatment interventions to improve strategies for maximizing virological suppression and ending the HIV epidemic. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018089505 .
Collapse
Affiliation(s)
- Dylan Green
- Departments of Epidemiology and Global Health, University of Washington, 1959 NE Pacific St, Seattle, 98195 Washington USA
- Strategic Analysis, Research & Training (START) Center, University of Washington, 1510 San Juan Rd NE, 3rd floor, Seattle, Washington 98195 USA
| | - Brenda Kharono
- Departments of Epidemiology and Global Health, University of Washington, 1959 NE Pacific St, Seattle, 98195 Washington USA
- Strategic Analysis, Research & Training (START) Center, University of Washington, 1510 San Juan Rd NE, 3rd floor, Seattle, Washington 98195 USA
| | - Diana M. Tordoff
- Departments of Epidemiology and Global Health, University of Washington, 1959 NE Pacific St, Seattle, 98195 Washington USA
- Strategic Analysis, Research & Training (START) Center, University of Washington, 1510 San Juan Rd NE, 3rd floor, Seattle, Washington 98195 USA
| | - Adam Akullian
- Departments of Epidemiology and Global Health, University of Washington, 1959 NE Pacific St, Seattle, 98195 Washington USA
- Institute for Disease Modeling, 3150 139th Ave SE, Building IV, Bellevue, 98005 Washington USA
| | - Anna Bershteyn
- Institute for Disease Modeling, 3150 139th Ave SE, Building IV, Bellevue, 98005 Washington USA
| | - Michelle Morrison
- Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, 98109 Washington USA
| | - Geoff Garnett
- Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, 98109 Washington USA
| | - Ann Duerr
- Departments of Epidemiology and Global Health, University of Washington, 1959 NE Pacific St, Seattle, 98195 Washington USA
- Strategic Analysis, Research & Training (START) Center, University of Washington, 1510 San Juan Rd NE, 3rd floor, Seattle, Washington 98195 USA
- HIV Vaccine Trials Network, Vaccine and Infectious Disease and Public Health Science Divisions, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, 98109 Washington USA
| | - Paul Drain
- Departments of Epidemiology and Global Health, University of Washington, 1959 NE Pacific St, Seattle, 98195 Washington USA
- Strategic Analysis, Research & Training (START) Center, University of Washington, 1510 San Juan Rd NE, 3rd floor, Seattle, Washington 98195 USA
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, 1959 NE Pacific St, Seattle, 98195 Washington USA
| |
Collapse
|
31
|
Ahmed S, Autrey J, Katz IT, Fox MP, Rosen S, Onoya D, Bärnighausen T, Mayer KH, Bor J. Why do people living with HIV not initiate treatment? A systematic review of qualitative evidence from low- and middle-income countries. Soc Sci Med 2018; 213:72-84. [PMID: 30059900 DOI: 10.1016/j.socscimed.2018.05.048] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 05/15/2018] [Accepted: 05/25/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many people living with HIV (PLWH) who are eligible for antiretroviral therapy (ART) do not initiate treatment, leading to excess morbidity, mortality, and viral transmission. As countries move to treat all PLWH at diagnosis, it is critical to understand reasons for non-initiation. METHODS We conducted a systematic review of the qualitative literature on reasons for ART non-initiation in low- and middle-income countries. We screened 1376 titles, 680 abstracts, and 154 full-text reports of English-language qualitative studies published January 2000-April 2017; 20 met criteria for inclusion. Our analysis involved three steps. First, we used a "thematic synthesis" approach, identifying supply-side (facility) and demand-side (patient) factors commonly cited across different studies and organizing these factors into themes. Second, we conducted a theoretical mapping exercise, developing an explanatory model for patients' decision-making process to start (or not to start) ART, based on inductive analysis of evidence reviewed. Third, we used this explanatory model to identify opportunities to intervene to increase ART uptake. RESULTS Demand-side factors implicated in decisions not to start ART included feeling healthy, low social support, gender norms, HIV stigma, and difficulties translating intentions into actions. Supply-side factors included high care-seeking costs, concerns about confidentiality, low-quality health services, recommended lifestyle changes, and incomplete knowledge of treatment benefits. Developing an explanatory model, which we labeled the Transdisciplinary Model of Health Decision-Making, we posited that contextual factors determine the costs and benefits of ART; patients perceive this context (through cognitive and emotional appraisals) and form an intention whether or not to start; and these intentions may (or may not) be translated into actions. Interventions can target each of these three stages. CONCLUSIONS Reasons for not starting ART included consistent themes across studies. Future interventions could: (1) provide information on the large health and prevention benefits of ART and the low side effects of current regimens; (2) reduce stigma at the patient and community levels and increase confidentiality where stigma persists; (3) remove lifestyle requirements and support patients in integrating ART into their lives; and (4) alleviate economic burdens of ART. Interventions addressing reasons for non-initiation will be critical to the success of HIV "treat all" strategies.
Collapse
|
32
|
Clement ME, Collins LF, Wilder JM, Mugavero M, Barker T, Naggie S. Hepatitis C Virus Elimination in the Human Immunodeficiency Virus-Coinfected Population: Leveraging the Existing Human Immunodeficiency Virus Infrastructure. Infect Dis Clin North Am 2018; 32:407-423. [PMID: 29778263 PMCID: PMC6592269 DOI: 10.1016/j.idc.2018.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The objective of this review is to consider how existing human immunodeficiency virus (HIV) infrastructure may be leveraged to inform and improve hepatitis C virus (HCV) treatment efforts in the HIV-HCV coinfected population. Current gaps in HCV care relevant to the care continuum are reviewed. Successes in HIV treatment are then applied to the HCV treatment model for coinfected patients. Finally, the authors give examples of HCV treatment strategies for coinfected patients in both domestic and international settings.
Collapse
Affiliation(s)
- Meredith E Clement
- Division of Infectious Diseases, Duke University Medical Center, 315 Trent Drive, Hanes House, Room 181, DUMC Box 102359, Durham, NC 27710, USA
| | - Lauren F Collins
- Department of Medicine, Emory School of Medicine, 49 Jesse Hill Drive Southeast, Atlanta, GA 30303, USA
| | - Julius M Wilder
- Duke Division of Gastroenterology, Box 90120, Durham, NC 27708-0120, USA; Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA
| | - Michael Mugavero
- Division of Infectious Diseases, University of Alabama Birmingham, Community Care Building, 908 20th Street South, Birmingham, AL 35294, USA
| | - Taryn Barker
- Clinton Health Access Initiative, 383 Dorchester Avenue, Boston, MA 02127, USA
| | - Susanna Naggie
- Division of Infectious Diseases, Duke University Medical Center, 315 Trent Drive, Hanes House, Room 181, DUMC Box 102359, Durham, NC 27710, USA; Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA.
| |
Collapse
|
33
|
Ren XL, Wu ZY, Mi GD, McGoogan JM, Rou KM, Zhao Y, Zhang N. HIV care-seeking behaviour after HIV self-testing among men who have sex with men in Beijing, China: a cross-sectional study. Infect Dis Poverty 2017; 6:112. [PMID: 28655340 PMCID: PMC5488343 DOI: 10.1186/s40249-017-0326-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 05/17/2017] [Accepted: 06/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) has become the group with the fastest growing HIV epidemic in China. Since many Chinese MSM are conducting HIV self-testing, we aimed to determine the rate of HIV care seeking after self-testing, examine characteristics of "seekers" compared to "non-seekers," and explore factors associated with HIV care-seeking behaviour. METHODS A cross-sectional study design was used and an online survey was conducted in Beijing, China in 2016, among users of a popular Chinese gay networking smart phone application. Chi-square test was used to compare characteristics of those who sought HIV care ("seekers") and those who did not ("non-seekers"). Univariate and multivariate logistic regression analyses were conducted to assess factors associated with HIV care seeking. RESULTS Among 21,785 screened, 2383 participants (10.9%) were included in the study. A total of 380 participants (15.9%) reported seeking HIV care after HIV self-testing while 2003 (84.1%) did not. Lack of knowledge of the "window period" (adjusted odds ratio [AOR] = 0.68, 95% confidence interval [95% CI] = 0.47-0.97, P = 0.04) was associated with reduced odds of seeking HIV care, while lower monthly income (AOR = 1.29, 95% CI = 1.03-1.62, P = 0.03) and obtaining HIV self-testing kits from health facilities (AOR = 2.40, 95% CI = 1.81-3.17, P < 0.001), and non-governmental organizations (AOR = 2.44, 95% CI = 1.79-3.34, P < 0.001) was associated with increased odds of seeking HIV care. Among those who sought HIV care, a large majority (92.4%) had non-reactive HIV self-testing results. Only 29 out of 265 with reactive, uncertain, or unknown results sought HIV care. CONCLUSIONS We found a very low rate of HIV care seeking among our sample of urban Chinese MSM. The observation that most with reactive, uncertain, or unknown results did not seek HIV care is a cause for concern. These people should be paid more attention and helped to enter the care cascade. Our findings highlight that interventions aimed at improving linkage to care after HIV self-testing are urgently needed. However, further study is required to inform the design and implementation of future interventions aiming to encourage HIV care-seeking behaviour.
Collapse
Affiliation(s)
- Xian-Long Ren
- Division of Prevention Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Zun-You Wu
- Division of Prevention Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China.
| | - Guo-Dong Mi
- Office of the Director, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Jennifer M McGoogan
- Division of Prevention Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Ke-Ming Rou
- Division of Prevention Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Yan Zhao
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Nanci Zhang
- Division of Prevention Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| |
Collapse
|
34
|
Bendavid E, Stauffer D, Remera E, Nsanzimana S, Kanters S, Mills EJ. Mortality along the continuum of HIV care in Rwanda: a model-based analysis. BMC Infect Dis 2016; 16:728. [PMID: 27905895 DOI: 10.1186/s12879-016-2052-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 11/21/2016] [Indexed: 11/22/2022] Open
Abstract
Background HIV is the leading cause of death among adults in sub-Saharan Africa. However, mortality along the HIV care continuum is poorly described. We combine demographic, epidemiologic, and health services data to estimate where are people with HIV dying along Rwanda’s care continuum. Methods We calibrated an age-structured HIV disease and transmission stochastic simulation model to the epidemic in Rwanda. We estimate mortality among HIV-infected individuals in the following states: untested, tested without establishing care in an antiretroviral therapy (ART) program (unlinked), in care before initiating ART (pre-ART), lost to follow-up (LTFU) following ART initiation, and retained in active ART care. We estimated mortality among people living with HIV in Rwanda through 2025 under current conditions, and with improvements to the HIV care continuum. Results In 2014, the greatest portion of deaths occurred among those untested (35.4%), followed by those on ART (34.1%), reflecting the large increase in the population on ART. Deaths among those LTFU made up 11.8% of all deaths among HIV-infected individuals in 2014, and in the base case this portion increased to 18.8% in 2025, while the contribution to mortality declined among those untested, unlinked, and in pre-ART. In our model only combined improvements to multiple aspects of the HIV care continuum were projected to reduce the total number of deaths among those with HIV, estimated at 8177 in 2014, rising to 10,659 in the base case, and declining to 5,691 with combined improvements in 2025. Conclusion Mortality among those untested for HIV contributes a declining portion of deaths among HIV-infected individuals in Rwanda, but the portion of deaths among those LTFU is expected to increase the most over the next decade. Combined improvements to the HIV care continuum might be needed to reduce the number of deaths among those with HIV. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2052-7) contains supplementary material, which is available to authorized users.
Collapse
|
35
|
Labhardt ND, Ringera I, Lejone TI, Masethothi P, Thaanyane T, Kamele M, Gupta RS, Thin K, Cerutti B, Klimkait T, Fritz C, Glass TR. Same day ART initiation versus clinic-based pre-ART assessment and counselling for individuals newly tested HIV-positive during community-based HIV testing in rural Lesotho - a randomized controlled trial (CASCADE trial). BMC Public Health 2016; 16:329. [PMID: 27080120 PMCID: PMC4832467 DOI: 10.1186/s12889-016-2972-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 03/04/2016] [Accepted: 03/19/2016] [Indexed: 12/30/2022] Open
Abstract
Background Achievement of the UNAIDS 90-90-90 targets in Sub-Sahara Africa is challenged by a weak care-cascade with poor linkage to care and retention in care. Community-based HIV testing and counselling (HTC) is widely used in African countries. However, rates of linkage to care and initiation of antiretroviral therapy (ART) in individuals who tested HIV-positive are often very low. A frequently cited reason for non-linkage to care is the time-consuming pre-ART assessment often requiring several clinic visits before ART-initiation. Methods This two-armed open-label randomized controlled trial compares in individuals tested HIV-positive during community-based HTC the proposition of same-day community-based ART-initiation to the standard of care pre-ART assessment at the clinic. Home-based HTC campaigns will be conducted in catchment areas of six clinics in rural Lesotho. Households where at least one individual tested HIV positive will be randomized. In the standard of care group individuals receive post-test counselling and referral to the nearest clinic for pre-ART assessment and counselling. Once they have started ART the follow-up schedule foresees monthly clinic visits. Individuals randomized to the intervention group receive on the spot point-of-care pre-ART assessment and adherence counselling with the proposition to start ART that same day. Once they have started ART, follow-up clinic visits will be less frequent. First primary outcome is linkage to care (individual presents at the clinic at least once within 3 months after the HIV test). The second primary outcome is viral suppression 12 months after enrolment in the study. We plan to enrol a minimum of 260 households with 1:1 allocation and parallel assignment into both arms. Discussion This trial will show if in individuals tested HIV-positive during community-based HTC campaigns the proposition of same-day ART initiation in the community, combined with less frequent follow-up visits at the clinic could be a pragmatic approach to improve the care cascade in similar settings. Trial registration NCT02692027, registered February 21, 2016
Collapse
Affiliation(s)
- Niklaus Daniel Labhardt
- Clinical Research Unit, Medical Services and Diagnostics, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Isaac Ringera
- SolidarMed, Swiss Organization for Health in Africa, Premium House #224, Kingsway, P.O.Box 0254, Maseru West, 105, Lesotho
| | - Thabo Ishmael Lejone
- SolidarMed, Swiss Organization for Health in Africa, Premium House #224, Kingsway, P.O.Box 0254, Maseru West, 105, Lesotho
| | - Phofu Masethothi
- SolidarMed, Swiss Organization for Health in Africa, Premium House #224, Kingsway, P.O.Box 0254, Maseru West, 105, Lesotho
| | - T'sepang Thaanyane
- SolidarMed, Swiss Organization for Health in Africa, Premium House #224, Kingsway, P.O.Box 0254, Maseru West, 105, Lesotho
| | - Mashaete Kamele
- SolidarMed, Swiss Organization for Health in Africa, Premium House #224, Kingsway, P.O.Box 0254, Maseru West, 105, Lesotho
| | - Ravi Shankar Gupta
- District Health Management Team Butha-Buthe, Ministry of Health of Lesotho, Butha-Buthe, Lesotho
| | - Kyaw Thin
- Research Coordination Unit, Room Number 326, Ministry of Health of Lesotho, Maseru, Lesotho
| | - Bernard Cerutti
- Faculty of Medicine, UDREM, University of Geneva, 1 Rue Michel Servet, 1211, Geneva, Switzerland
| | - Thomas Klimkait
- Department of Biomedicine - Petersplatz, Molecular Virology, University of Basel, Basel, Switzerland
| | - Christiane Fritz
- SolidarMed, Swiss Organization for Health in Africa, Premium House #224, Kingsway, P.O.Box 0254, Maseru West, 105, Lesotho
| | - Tracy Renée Glass
- Clinical Research Unit, Medical Services and Diagnostics, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Biostatistics Department, Epidemiology and Public Health Unit, Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box 4002, Basel, Switzerland
| |
Collapse
|