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Bazazi AR, Thomas M, Vittinghoff E, Walkup J, Hermida R, Arnold EA, Cournos F, Crystal S, Dawson L, Dahiya P, Alonso-Fraire P, Dilley J, Olfson M, Mangurian C. Schizophrenia and Retention in HIV Care Among Adults Insured Through Medicaid in the United States: A Population-Based Retrospective Cohort Study. J Acquir Immune Defic Syndr 2025; 99:20-30. [PMID: 39847446 DOI: 10.1097/qai.0000000000003606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 12/18/2024] [Indexed: 01/24/2025]
Abstract
BACKGROUND People with schizophrenia spectrum disorders are at elevated risk of HIV, and people with both HIV and schizophrenia are at elevated risk of death compared with individuals with either diagnosis alone. Limited research has assessed the HIV care cascade, and in particular retention in care, among people with HIV (PWH) and schizophrenia in the United States. METHODS This population-based retrospective cohort study used Medicaid claims data to compare retention in HIV care between PWH with schizophrenia (n = 38,217) and matched controls without schizophrenia (n = 29,455) from 2001 to 2012. The primary outcome of annual retention in HIV care was at least 2 tests for CD4 + T-cell count or HIV viral load at least 90 days apart per year. Unadjusted and covariate-adjusted differences in period prevalence of retention among cases and controls were estimated. FINDINGS Annual retention in HIV care was 29.9% (95% CI: 29.4 to 30.4%) among people with schizophrenia and 38.5% (95% CI: 37.9 to 39.1%) among controls, representing 8.5% (95% CI: 9.3 to 7.7) lower retention in unadjusted and 9.0% (95% CI: 9.9 to 8.2) lower retention in adjusted estimates for people with HIV and schizophrenia. This disparity varied across states. Over time, retention increased and the disparity between people with and without schizophrenia diminished. INTERPRETATION PWH in the United States insured through Medicaid and diagnosed with schizophrenia experience lower retention in HIV care than controls. Suboptimal retention likely drives disparities in HIV-related morbidity and mortality for PWH with schizophrenia, and targeted individual and structural interventions are merited to improve the health of this population.
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Affiliation(s)
- Alexander R Bazazi
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California-San Francisco, School of Medicine, San Francisco, CA
| | - Marilyn Thomas
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California-San Francisco, School of Medicine, San Francisco, CA
- Department of Epidemiology & Biostatistics, University of California-San Francisco, San Francisco, CA
| | - Eric Vittinghoff
- Department of Epidemiology & Biostatistics, University of California-San Francisco, San Francisco, CA
| | - James Walkup
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ
| | - Richard Hermida
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ
| | - Emily A Arnold
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA
| | - Francine Cournos
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ
| | | | - Priya Dahiya
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California-San Francisco, School of Medicine, San Francisco, CA
| | - Paola Alonso-Fraire
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California-San Francisco, School of Medicine, San Francisco, CA
| | - James Dilley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California-San Francisco, School of Medicine, San Francisco, CA
| | - Mark Olfson
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California-San Francisco, School of Medicine, San Francisco, CA
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA; and
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA
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Ijaiya M, Troncoso E, Mutloatse M, Ifeanyi D, Obasa B, Emerenini F, De Voux L, Mnguni T, Parrott S, Okwor E, Dare B, Ogundare O, Atuma E, Strachan M, Fayorsey R, Curran K. Use of machine learning in predicting continuity of HIV treatment in selected Nigerian States. PLOS GLOBAL PUBLIC HEALTH 2025; 5:e0004497. [PMID: 40273279 PMCID: PMC12021289 DOI: 10.1371/journal.pgph.0004497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/20/2025] [Indexed: 04/26/2025]
Abstract
Nigeria, with the second-largest HIV epidemic globally, faces challenges in achieving its HIV epidemic control goals by 2030, with interruptions in treatment (IIT) a significant challenge. Machine learning (ML) models can help HIV programs implement targeted interventions to improve the quality of care, develop effective early interventions, and provide insights into optimal resource allocation and program sustainability. This paper aims to identify predictors and measure the performance of models used to predict the risk of IIT among People Living with HIV (PLHIV) on antiretroviral therapy (ART). We trained multiple supervised ML algorithms on de-identified client-level electronic medical records data from a cohort of PLHIV across four Nigerian states. Merged demographic, clinic, pharmacy, and laboratory data were included as potential predictor variables in multiple models. The study analyzed data from 41,394 PLHIV, with 266,520 observations receiving treatment across four Nigerian states. The overall IIT rate was 33.7%, ranging from 17.7% in Cross River State to 42.4% in Niger State. The AdaBoost model demonstrated the best performance, with a sensitivity of 69.2%, specificity of 82.3%, F1 score of 0.678, and PR-AUC and ROC-AUC values of 0.563 and 0.843, respectively. Key predictors included PLHIV prior behavior, visit history, and geographic factors, while demographic features played a lesser role. This study highlights the utility of ML, particularly the AdaBoost model, in stratifying PLHIV by the risk of IIT. By leveraging ML, HIV programs can implement data-driven, targeted interventions to improve care continuity. However, further research is needed to address data biases and contextual challenges in resource-constrained settings.
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Affiliation(s)
- Mukhtar Ijaiya
- Jhpiego - an Affiliate of Johns Hopkins University, Wuye District, Abuja, Federal Capital Territory, Nigeria
| | - Erica Troncoso
- Jhpiego - an Affiliate of Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Duruanyanwu Ifeanyi
- Jhpiego - an Affiliate of Johns Hopkins University, Wuye District, Abuja, Federal Capital Territory, Nigeria
| | - Benjamin Obasa
- Jhpiego - an Affiliate of Johns Hopkins University, Wuye District, Abuja, Federal Capital Territory, Nigeria
| | - Franklin Emerenini
- ICAP at Columbia University (Nigeria Country Office), Jabi, Abuja, Federal Capital Territory, Nigeria
| | | | | | | | - Ejike Okwor
- Jhpiego - an Affiliate of Johns Hopkins University, Wuye District, Abuja, Federal Capital Territory, Nigeria
| | - Babafemi Dare
- Jhpiego - an Affiliate of Johns Hopkins University, Wuye District, Abuja, Federal Capital Territory, Nigeria
| | - Oluwayemisi Ogundare
- Jhpiego - an Affiliate of Johns Hopkins University, Wuye District, Abuja, Federal Capital Territory, Nigeria
| | - Emmanuel Atuma
- Jhpiego - an Affiliate of Johns Hopkins University, Wuye District, Abuja, Federal Capital Territory, Nigeria
| | - Molly Strachan
- Jhpiego - an Affiliate of Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ruby Fayorsey
- ICAP at Columbia University, New York City, New York, United States of America
| | - Kelly Curran
- Jhpiego - an Affiliate of Johns Hopkins University, Baltimore, Maryland, United States of America
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Sanders TN, Roed AKH, Missel M, Berg SK, Nielsen SD, Olesen ML, Kirk O. Barriers to Retention in Care among Adults with HIV in Developed Countries: An Integrative Review. AIDS Behav 2025:10.1007/s10461-025-04685-z. [PMID: 40185958 DOI: 10.1007/s10461-025-04685-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2025] [Indexed: 04/07/2025]
Abstract
Focusing on factors hindering viral suppression is essential for improving the health outcomes of people with Human Immunodeficiency Virus (HIV) and working towards ending the HIV/AIDS epidemic. The aim of this integrative review is to create an overview of barriers to retention in care among adults with HIV living in developed countries. Based on a systematic literature search across EMBASE, PubMed, Scopus, CINAHL, and PsycInfo, 4,089 studies of various methodology were identified. A total of 52 studies met the inclusion criteria. Quality assessment was performed using the Mixed Method Appraisal Tool. Based on thematic analysis, the following five main themes were identified as most common barriers to retention in care: financial challenges, logistical challenges, stigma, mental health problems, and substance use. The integrative review highlights that various factors can hinder retention in care and underscores that strategies to promote retention in care should be person-centered and targeted the individual person's barriers to retention in care.
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Affiliation(s)
- Tea Nynne Sanders
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Anna Katrine Haslund Roed
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Malene Missel
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Heart and Lung Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Linnet Olesen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Interdiciplinary Research Unit for Womens, Childrens and Families Health Dept. 94A-2-2/Department of Gynaecology, Fertility and Births, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ole Kirk
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Ross JL, Rupasinghe D, Chanyachukul T, Crabtree Ramírez B, Murenzi G, Kwobah E, Mureithi F, Minga A, Marbaniang I, Perazzo H, Parcesepe A, Goodrich S, Chimbetete C, Mensah E, Maruri F, Thi Hoai Nguyen D, López‐Iñiguez A, Lancaster K, Byakwaga H, Tlali M, Plaisy MK, Nimkar S, Moreira R, Anastos K, Semeere A, Wandeler G, Jaquet A, Sohn A, the Sentinel Research Network of the International epidemiology Databases to Evaluate AIDS. Comorbidities and HIV-related factors associated with mental health symptoms and unhealthy substance use among older adults living with HIV in low- and middle-income countries: a cross-sectional study. J Int AIDS Soc 2025; 28:e26434. [PMID: 40045453 PMCID: PMC11882396 DOI: 10.1002/jia2.26434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 02/26/2025] [Indexed: 03/09/2025] Open
Abstract
INTRODUCTION People with HIV (PWH) are vulnerable to mental health and substance use disorders (MSDs), but the extent to which these are associated with other non-communicable diseases in ageing PWH populations remains poorly documented. We assessed comorbidities associated with symptoms of MSD among PWH ≥40 years in the Sentinel Research Network (SRN) of the International epidemiology Database to Evaluate AIDS (IeDEA). METHODS Baseline data collected between June 2020 and September 2022, from 10 HIV clinics in Asia, Latin America and Africa contributing to the SRN, were analysed. Symptoms of MSDs and comorbidities were assessed using standardized questionnaires, anthropometric and laboratory tests, including weight, height, blood pressure, glucose, lipids, chronic viral hepatitis and liver transient elastography. HIV viral load, CD4 count and additional routine clinical data were accessed from participant interview or medical records. HIV and non-HIV clinical associations of mental illness symptoms and unhealthy substance use were analysed using logistic regression. Mental illness symptoms were defined as moderate-to-severe depressive symptoms (PHQ-9 score >9), moderate-to-severe anxiety symptoms (GAD-7 >9) or probable post-traumatic stress disorder (PCL-5 >32). Unhealthy substance use was defined as ASSIST score >3, or AUDIT ≥7 for women (≥8 for men). RESULTS Of 2614 participants assessed at baseline study visits, 57% were female, median age was 50 years, median CD4 was 548 cells/mm3 and 86% had HIV viral load <1000 copies/ml. Overall, 19% had mental illness symptoms, 15% unhealthy substance use, 49% BMI >25 kg/m2, 38% hypertension, 15% type 2 diabetes, 35% dyslipidaemia, 34% liver disease and 23% history of tuberculosis. BMI >25 and dyslipidaemia were found in 54% and 40% of those with mental illness symptoms compared to 49% and 34% of those without. Mental illness symptoms were not significantly associated with the clinical factors assessed. Unhealthy substance use was more likely among those with dyslipidaemia (OR 1.55, CI 1.16-2.09, p = 0.003), and less likely in those with BMI >25 (OR 0.48, CI 0.30-0.77, p = 0.009). CONCLUSIONS Improved integration of MSD and comorbidity services in HIV clinical settings, and further research on the association between MSD and comorbidities, and care integration among older PWH in low-middle-income countries, are required.
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Affiliation(s)
- Jeremy L. Ross
- TREAT Asia/amfAR – The Foundation for AIDS ResearchBangkokThailand
| | | | | | - Brenda Crabtree Ramírez
- Departamento de InfectologíaInstituto Nacional de Ciencias Médicas y NutriciónMéxico CityMéxico
| | - Gad Murenzi
- Research for Development (RD Rwanda)KigaliRwanda
| | | | - Fiona Mureithi
- Infectious Disease Research in Zambia (CIDRZ)LusakaZambia
| | - Albert Minga
- The HIV care clinic of the National Blood Transfusion CentreBlood Bank Medical CentreAbidjanCôte d'Ivoire
| | - Ivan Marbaniang
- BJ Government Medical College‐JHU Clinical Research SitePuneIndia
| | - Hugo Perazzo
- Instituto Nacional de Infectologia Evandro Chagas (INI)Fundação Oswaldo Cruz (FIOCRUZ)Rio de JaneiroBrazil
| | - Angela Parcesepe
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Suzanne Goodrich
- Division of Infectious DiseasesIndiana University School of MedicineIndianapolisIndianaUSA
| | | | | | - Fernanda Maruri
- Division of Infectious DiseasesDepartment of Medicine, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | | | - Alvaro López‐Iñiguez
- Departamento de InfectologíaInstituto Nacional de Ciencias Médicas y NutriciónMéxico CityMéxico
| | - Kathryn Lancaster
- Division of Public Health SciencesWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | | | - Mpho Tlali
- Centre for Infectious Disease Epidemiology & Research, School of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - Marie K. Plaisy
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271University of Bordeaux, Bordeaux Population Health CentreBordeauxFrance
| | - Smita Nimkar
- BJ Government Medical College‐JHU Clinical Research SitePuneIndia
| | - Rodrigo Moreira
- Instituto Nacional de Infectologia Evandro Chagas (INI)Fundação Oswaldo Cruz (FIOCRUZ)Rio de JaneiroBrazil
| | - Kathryn Anastos
- Montefiore Medical CenterAlbert Einstein College of MedicineNew YorkNew YorkUSA
| | | | - Gilles Wandeler
- Department of Infectious DiseasesBern University Hospital, University of BernBernSwitzerland
| | - Antoine Jaquet
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271University of Bordeaux, Bordeaux Population Health CentreBordeauxFrance
| | - Annette Sohn
- TREAT Asia/amfAR – The Foundation for AIDS ResearchBangkokThailand
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Cordie A, Mohamed R, Hatem A, Essam M, Shaltout SW, El Garhy N, Al Sehemy L, Sherif M, Awad RA, Abdelraouf MI, Al-Sharif AM, Ramadan A, Hassany S, El Khateeb E, Sayed AM, Masoud ZWZ, Hamza RS, Tamim HH, Eldin Hamdy MS, Esmat G, Karam-Allah Ramadan H. Retention in care among people living with human immunodeficiency virus (HIV) in a low-resource setting. Int J STD AIDS 2025; 36:275-282. [PMID: 39655701 DOI: 10.1177/09564624241306152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2025]
Abstract
BACKGROUND This study aimed to evaluate the retention in care among a cohort of Egyptian people living with HIV (PLWHIV). METHOD The study was conducted on PLWHIV attending Kasr Alainy HIV and Viral Hepatitis Centre, Cairo, Egypt, from January 1, 2019, to March 31, 2023. PLWHIV were considered not retained in care if there was no documented clinical visit or HIV viral load (VL) or CD4 count test for more than 6 months from their last recorded visit or test. Multivariable logistic regression analysis was used to test factors associated with retention in care. RESULTS After excluding those who died and were referred, 369 PLWHIV were included in the analysis, and retention in care was observed in 325 (88%). The majority were males (81.8%) with a median age of 34 [29-41] years. Undetectable VL (OR: 3.555; 95% CI: 1.49-8.47), hepatitis B vaccination (OR: 2.835; 95% CI: 1.07-7.48), CD4 test availability (OR: 2.604; 95% CI: 1.02-6.64), receiving dolutegravir based antiretroviral therapy (OR: 2.429; 95% CI: 1.06-5.537), and longer duration of know HIV infection (OR: 1.025; 95% CI: 1.01- 1.04) were correlated with retention in care. Surprisingly, higher education levels were negatively correlated with retention in care (OR: 0.195, 95%: CI: 0.071-0.533), suggesting the need for further research to explore this relationship. CONCLUSION These results are invaluable for developing targeted interventions and informing health policies to improve retention in HIV care in Egypt. Enhancing access to VL and CD4 testing, promoting VL suppression, and focusing on specific groups at risk of dropping out of care are essential strategies.
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Affiliation(s)
- Ahmed Cordie
- Endemic Medicine Department, Cairo University, Cairo, Egypt
- Kasr Al-Aini HIV and Viral Hepatitis Fighting Group, Cairo University Hospitals, Cairo University, Cairo, Egypt
| | - Rahma Mohamed
- Endemic Medicine Department, Cairo University, Cairo, Egypt
- Kasr Al-Aini HIV and Viral Hepatitis Fighting Group, Cairo University Hospitals, Cairo University, Cairo, Egypt
| | - Ammar Hatem
- Endemic Medicine Department, Cairo University, Cairo, Egypt
| | - Mahmoud Essam
- Endemic Medicine Department, Cairo University, Cairo, Egypt
| | | | | | | | - Mirella Sherif
- Endemic Medicine Department, Cairo University, Cairo, Egypt
| | | | | | | | - Ahmed Ramadan
- Department of Chemical & Biotechnology Engineering, Sherbrooke, Faculty of Engineering, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Sahar Hassany
- Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt
| | - Engy El Khateeb
- Department of Clinical and Chemical Pathology, Cairo University, Cairo, Egypt
| | - Amal M Sayed
- Department of Clinical and Chemical Pathology, Cairo University, Cairo, Egypt
| | | | - Rania Soliman Hamza
- Department of Clinical and Chemical Pathology, Cairo University, Cairo, Egypt
| | - Hend Hamed Tamim
- Department of Clinical and Chemical Pathology, Cairo University, Cairo, Egypt
| | | | - Gamal Esmat
- Endemic Medicine Department, Cairo University, Cairo, Egypt
- Badr University in Cairo, Research Center, Badr City, Cairo, Egypt
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Chidrawar S, Sane S, Mamulwar M, Bembalkar S, Thakur R, Bhatnagar T, Tripathy SP, Marinaik SB, Sahu D, Biswas S, Datta S, Sabde Y, Tiwari R, Khismatrao D, Kushwaha BS, Puri AK, Das C, Godbole SV. Effect of antiretroviral therapy on retention of people living with HIV in India (2012-2017): a retrospective, cohort study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2025; 34:100552. [PMID: 40092666 PMCID: PMC11907478 DOI: 10.1016/j.lansea.2025.100552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 10/30/2024] [Accepted: 02/06/2025] [Indexed: 03/19/2025]
Abstract
Background India's free antiretroviral therapy (ART) programme was initiated in 2004. People living with HIV who were registered with ART centres (ARTC) were initiated on ART based on the CD4 count cutoffs as per prevailing guidelines. The others with higher counts remained on six-monthly follow up. We estimated retention rates among people living with HIV receiving ART in the programme and their determinants during 2012-2017. Methods In this retrospective cohort study, the records of people living with HIV aged ≥15 years, registered between April 2012 and March 2017 (reference period) in 81 of 396 ARTC across 33 Indian states were reviewed. 'People living with HIV not on ART' were defined as all those who were registered but not eligible for ART initiation or not started ART through the reference period. 'People living with HIV on ART' were those who were already on ART or initiated on ART as per prevailing guidelines. Relevant data from the clinic records were extracted and analysed for 'Not on ART' and 'On ART' groups separately using life-table method, Cox proportional hazards model to estimate retention probability and potential determinants. Findings Of 154,154 registered people living with HIV, 82.3% received ART ('on ART') during 2012-2017. Proportion retained was lower among 'not on ART' vs 'on ART' people living with HIV and was statistically significant (71.1% vs 88.9%, p < 0.001). Five-year retention probability was 57% for 'not on ART' and 81% for 'on-ART' people living with HIV (p < 0.001). The incidence of cases who were lost to follow up was 12.9 and 4.3/100 person-years among 'not on ART' & 'on ART' people living with HIV, respectively. Determinants of becoming lost to follow up (Adjusted HR, 95% CI) included 'being in not on ART' (Adjusted HR: 2.95, 95% CI: 2.85-3.05) 'being male' (1.08, 1.05-1.11); 'having CD4 count 351-500 cells/mm3' at registration (1.21, 1.16-1.26); and 'having tuberculosis' (1.15, 1.10-1.19). Interpretation New programmatic strategies for improving retention of people living with HIV in care may benefit by focussing on males, younger ages (15-29 years), CD4 counts during registration, history of or new TB diagnoses and early intervention within the first year. Funding This study was supported with NOA# SAMS/NACP/IE-ART/NARI/2017/09 dated March 27, 2017, awarded by Strategic Alliance Management Services Pvt. Ltd. (SAMS) with funding support from the Global Fund.
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Affiliation(s)
- Shweta Chidrawar
- ICMR-National Institute of Translational Virology and AIDS Research, Pune, India
| | - Suvarna Sane
- ICMR-National Institute of Translational Virology and AIDS Research, Pune, India
| | - Megha Mamulwar
- ICMR-National Institute of Translational Virology and AIDS Research, Pune, India
| | - Shilpa Bembalkar
- ICMR-National Institute of Translational Virology and AIDS Research, Pune, India
| | - Rachna Thakur
- ICMR-National Institute of Translational Virology and AIDS Research, Pune, India
| | | | | | | | - Damodar Sahu
- ICMR-National Institute for Research in Digital Health and Data Science, New Delhi, India
| | - Subrata Biswas
- ICMR-National Institute for Research in Bacterial Infections, Kolkata, India
| | - Shanta Datta
- ICMR-National Institute for Research in Bacterial Infections, Kolkata, India
| | - Yogesh Sabde
- ICMR-National Institute for Research in Environmental Health, Bhopal, India
| | - Rajnarayan Tiwari
- ICMR-National Institute for Research in Environmental Health, Bhopal, India
| | - Deepak Khismatrao
- ICMR-National Institute of Translational Virology and AIDS Research, Pune, India
| | | | | | - Chinmoyee Das
- National AIDS Control Organization, New Delhi, India
| | - Sheela V Godbole
- ICMR-National Institute of Translational Virology and AIDS Research, Pune, India
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7
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Richterman A, Dorvil N, Rivera V, Bang H, Severe P, Lavoile K, Pierre S, Apollon A, Dumond E, Pierre Louis Forestal G, Rouzier V, Joseph P, Cremieux PY, Pape JW, Koenig SP. Predictors of Clinical Outcomes Among People With Human Immunodeficiency Virus and Tuberculosis Symptoms After Rapid Treatment Initiation in Haiti. Open Forum Infect Dis 2025; 12:ofaf031. [PMID: 39906320 PMCID: PMC11793062 DOI: 10.1093/ofid/ofaf031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 01/17/2025] [Indexed: 02/06/2025] Open
Abstract
Background Few studies have evaluated baseline predictors of clinical outcomes among people with human immunodeficiency virus (HIV) starting antiretroviral therapy (ART) in the modern era of rapid ART initiation. Methods We conducted a secondary analysis of a previously reported open-label randomized controlled trial of 2 rapid treatment initiation strategies for people with treatment-naive HIV and tuberculosis symptoms at a large urban clinic in Haiti. We used logistic regression models to assess associations between baseline characteristics and (1) retention in care at 48 weeks, (2) HIV viral load suppression at 48 weeks (among participants who underwent viral load testing), and (3) all-cause mortality. For the viral load suppression outcome, we used inverse probability weighting to account for potential selection bias resulting from exclusion of participants who did not undergo viral load testing. Results A total of 500 participants were enrolled in the study from November 2017 to January 2020. Tuberculosis was diagnosed in 88 participants (18%), and ART was started in 494 (99%). After multivariable adjustment, less than secondary school education (adjusted odds ratio [AOR] 0.21 [95% confidence interval (CI), .10-.46]) was significantly associated with a reduced odds of retention in care. Dolutegravir initiation (AOR, 2.57 [95% CI, 1.22-5.43]), age (1.42 per 10-year increase [1.01-1.99]), and tuberculosis diagnosis (3.92 [1.36-11.28]) were significantly associated with increased odds of retention. Age (AOR, 1.36 [95% CI, 1.05-1.75]) and dolutegravir initiation (1.75 [1.07-2.85]) were positively associated with viral suppression, and tuberculosis diagnosis (0.50 [.28-.89) was negatively associated with viral suppression, with similar findings after incorporation of inverse probability weights. Higher CD4 cell count at enrollment was significantly associated with a lower odds of mortality (unadjusted odds ratio, 0.69 [95% CI, .55-.87]), and anemia was associated with a significantly greater odds of mortality (4.86 [1.71-13.81]). Conclusions We identified sociodemographic, treatment-related, clinical, and laboratory-based predictors of clinical outcomes. These characteristics may serve as markers of subpopulations that could benefit from additional interventions to support treatment success after rapid treatment initiation.
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Affiliation(s)
- Aaron Richterman
- Department of Medicine (Infectious Diseases), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nancy Dorvil
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa Rivera
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Heejung Bang
- Davis School of Medicine, University of California, Davis, California, USA
| | - Patrice Severe
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Kerylyne Lavoile
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Samuel Pierre
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Emelyne Dumond
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Patrice Joseph
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Jean W Pape
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Serena P Koenig
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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8
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Storholm ED, Siconolfi DE, Campbell CK, Pollack LM, Kegeles SM, Rebchook GM, Tebbetts S, Vincent W. Structural Inequities, Syndemics, and Resilience: The Critical Role of Social Support in Overcoming Barriers and Empowering Engagement in HIV Care for Young Black Sexual-Minority Men in the US South. J Racial Ethn Health Disparities 2025; 12:250-261. [PMID: 38095825 DOI: 10.1007/s40615-023-01869-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/12/2023] [Accepted: 11/12/2023] [Indexed: 01/19/2024]
Abstract
Young Black sexual minority men (YBSMM) living in the US South are among those most disproportionately impacted by HIV in the USA. This health inequity is, in part, due to lower rates of sustained engagement in the HIV care continuum, resulting in a lower prevalence of viral suppression and higher overall community-level viral load. Social, structural, and economic inequities have previously been linked with poorer HIV care engagement among YBSMM. HIV-related social support, individual-level resilience, and healthcare empowerment have been shown to be independently associated with improved HIV care engagement. The current study sought to assess the relative contribution of individual, structural, and economic factors on engagement in HIV care and to elucidate the potentially mediating role of healthcare empowerment. Data from 224 YBSMM with HIV in the US South indicated that greater levels of socioeconomic distress, intimate partner violence, and depressive symptoms were associated with lower levels of engagement in HIV care, while greater levels of individual-level resilience and healthcare empowerment were associated with higher levels of HIV care engagement. Importantly, healthcare empowerment mediated the association between resilience and engagement in HIV care and the association between social support and engagement in HIV care. Findings emphasize the critical role that HIV-related social support plays in fostering resilience and overcoming syndemic factors to promote empowerment and engagement in HIV care for YBSMM in the USA.
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Affiliation(s)
- Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA.
- RAND Corporation, Santa Monica, CA, USA.
| | | | - Chadwick K Campbell
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Lance M Pollack
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, San Francisco, CA, USA
| | - Susan M Kegeles
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, San Francisco, CA, USA
| | - Greg M Rebchook
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, San Francisco, CA, USA
| | - Scott Tebbetts
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, San Francisco, CA, USA
| | - Wilson Vincent
- Department of Psychology, Temple University, Philadelphia, CA, USA
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9
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Gasik RE, Smith EA, Skeen SJ, Tokarz S, Clum G, Felker-Kantor E, Theall KP. Using Geographic Momentary Assessment to Explore Spatial Environment Influences on Wellbeing in People With HIV. AIDS Behav 2025; 29:342-355. [PMID: 39465467 PMCID: PMC11739190 DOI: 10.1007/s10461-024-04527-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2024] [Indexed: 10/29/2024]
Abstract
Place-based socio-economic and racial inequities contribute to health disparities among people with HIV (PWH). We used geographic ecological momentary assessment (GEMA) methodologies to explore the interplay between psychosocial outcomes in daily diaries and community spatial measures among PWH in New Orleans. PWH (N = 69) were recruited from a clinic-based cohort study. Micro-longitudinal data were collected via smartphone-based daily diaries and geospatial tracking over 14 days. First, correlations were run between diary derived outcomes (e.g., feeling safe in current location, stress), and spatial measures (e.g., violent crime, alcohol outlets, and vacant lots) within a half-mile buffer around each diary point to understand the real time associations between mood and space. Next, we fit multilevel models, controlling for between-person effects, to assess within-person associations between accumulative spatial daily violence exposure (50m, 100m and 200m buffers), and measures of daily mood and coping. Violent crime, alcohol outlets and vacant lots were inversely correlated with feeling safe and positively correlated with perceived ease of obtaining drugs. Vacant lots were positively associated with stress and inversely correlated with positive mood. Within individuals, higher daily accumulated violence exposure was associated with increased rumination at the 50m buffer level, decreased trust in oneself and others at the 100m buffer, and decreased ratio of positive/negative mood at all buffers. Our results emphasize the intricate interplay between mental wellness, coping mechanisms, and spatial measures in PWH. Future research and interventions for PWH should consider how spatial factors may influence PWH in terms of mental health and care engagement.
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Affiliation(s)
- Rayna E Gasik
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
| | - Ethan A Smith
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Simone J Skeen
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Psychology, Hunter College, City University of New York, New York, NY, USA
| | - Stephanie Tokarz
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Gretchen Clum
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Erica Felker-Kantor
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Katherine P Theall
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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10
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Creasy SL, Egan JE, Krier S, Townsend J, Ward J, Hawk M, Kay ES. "Let me hear what you're needing": exploring how HIV providers conceptualize patient-provider interactions with people with HIV who use drugs using a harm reduction framework. Ther Adv Infect Dis 2025; 12:20499361251323721. [PMID: 40017794 PMCID: PMC11866378 DOI: 10.1177/20499361251323721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 02/11/2025] [Indexed: 03/01/2025] Open
Abstract
Background In addition to structural interventions such as syringe services and naloxone distribution, harm reduction (HR) is also a relational approach to care encompassing principles such as patient autonomy and pragmatism that can be implemented in healthcare teams to improve outcomes for people with HIV (PWH) who use drugs. Evidence suggests that using a relational HR framework to operationalize care for PWH who use drugs may improve the patient-provider relationship, thus positively impacting HIV outcomes. We previously found that negative attitudes toward people who use drugs are negatively associated with acceptance of HR; however, little is known about how HIV providers conceptualize the patient-provider relationship with PWH who use drugs. Objectives The aim of this study was to describe the ways healthcare workers (HCWs) characterize interactions with PWH who use drugs and if these characterizations reflect relational HR or missed opportunities to improve the patient-provider relationship. Design We used a qualitative descriptive design to characterize HCWs' descriptions of their interactions with PWH who use drugs. Methods We interviewed providers (n = 23) working at three HIV clinics in the United States to assess their interactions with patients. Providers included anyone who had worked at their respective clinic for ⩾1 year and who had face-to-face contact with patients (e.g., front desk staff, nurses, physicians, and social workers). Data were coded thematically via Dedoose. Results We discovered that HCWs characterize positive patient-provider interactions that both reflect HR principles and may not align with the principles of HR. Examples include when patients appear comfortable with and trusting of their provider, when patients feel heard by their provider, and when providers feel they are responsive to patient needs. However, other HCWs described positive interactions as counter to relational HR. Conclusion HCW descriptions of positive interactions in line with relational HR in their conceptualization of patient-provider interactions with PWH who use drugs have the potential to guide efforts in increasing the acceptability of HR in HIV care. Given evidence showing HR improves outcomes for those who use substances, findings suggest missed opportunities to incorporate relational HR into the patient-provider relationship in HIV primary care settings. Registration NCT05404750.
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Affiliation(s)
- Stephanie L. Creasy
- University of Pittsburgh, 130 De Soto St, 6th Floor, Pittsburgh, PA 15261, USA
| | - James E. Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Sarah Krier
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Jessica Townsend
- Department of Acute, Chronic, and Continuing Care at the University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Jessica Ward
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Mary Hawk
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Emma Sophia Kay
- Department of Acute, Chronic, and Continuing Care at the University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
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11
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Villanueva MS, Wheeler DP, Applin S, Hodge TW, Zack B, Rebeiro PF. Continuous care engagement in clinical practice: perspectives on selected current strategies for people with HIV in the United States. Expert Rev Anti Infect Ther 2024; 22:1043-1053. [PMID: 39417530 DOI: 10.1080/14787210.2024.2412988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 10/02/2024] [Indexed: 10/19/2024]
Abstract
INTRODUCTION Modern antiretroviral therapy is associated with reduced rates of HIV-related morbidity and mortality. HIV viral suppression and retention in care are critically important outcomes requiring successful continuous patient engagement. However, barriers to such engagement are complex and require innovative solutions. AREAS COVERED A multistakeholder group of experts comprising clinicians and service delivery researchers assembled to clarify what constitutes engagement in HIV care and identify overarching themes that inform strategies in this field. This article captures this expert opinion and adds relevant literature on selected current best practices. EXPERT OPINION The multistakeholder group felt strongly that a better understanding of the facilitators of continuous care engagement was critical. Unlike 'retention in care,' 'engagement in care' for an individual is nuanced, flexible, evolves and requires ongoing communication between patients, providers, and other key stakeholders. The following approaches highlight care engagement strategies at different stakeholder levels: 1) patient-level: personalized care and incentivization; 2) clinic-level: wraparound, co-localized, patient-centered low-barrier care, a diverse multidisciplinary team, patient support networks, and expanded use of telemedicine; 3) healthcare system-level: utilization of external partnerships. We propose a series of diverse and complementary approaches based on a more nuanced understanding of the qualitative aspects of engagement in care.
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Affiliation(s)
| | | | | | - Theo W Hodge
- Infectious Diseases, Washington Health Institute, Washington, DC, USA
| | | | - Peter F Rebeiro
- Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA
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Pokhrel D, Lang SG, Elder H, John B, Roosevelt KA, Klevens M, Randall LM, DeMaria A. Predictors of HIV Care Outcomes among Recently Out-of-Care Individuals in The Massachusetts Cooperative Re-engagement Controlled Trial Cohort. AIDS Behav 2024; 28:3883-3892. [PMID: 39172186 DOI: 10.1007/s10461-024-04457-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/23/2024]
Abstract
A cohort of individuals in care for HIV infection who were identified as being recently out-of-care (OOC) was recruited for a trial using a data-to-care approach and an intervention to facilitate re-engagement and retention in care. This allowed for analysis of demographic and clinical characteristics correlated with recently being OOC, re-engagement, and successful retention in care and viral suppression. Recently OOC persons with HIV infection (PWH) were identified for enrollment in the Cooperative Re-engagement Controlled Trial (CoRECT). CoRECT employed a data-to-care strategy, using both clinical and surveillance data, and an active public health re-engagement intervention. We estimated relative risks (RRs), unadjusted and with multivariate log binomial regression models, to analyze associations between sociodemographic and clinical predictors of being OOC, re-engagement, retention in care, and viral suppression. Of the 630 OOC PWH enrolled in CoRECT, most were male (72.7%) and over 30 years old (91.3%). Almost 40.0% were Black non-Hispanic, 29.7% were non-US born, and 41.6% were men who have sex with men (MSM). Possible predictors of re-engagement, retention in care, and viral suppression included younger age, Hispanic race/ethnicity, birth in a US dependency, AIDS status, and HIV exposure mode. Viral suppression status within 1-year pre-enrollment was significantly associated with all outcomes: re-engagement (aRR 1.28), retention (aRR 1.72), viral suppression (aRR 1.81), and durable viral suppression (aRR 3.30). Findings elucidate factors associated with care engagement and continuity for recently OOC PWH which can be used to inform targeted re-engagement activities for priority populations and guide future data-to-care interventions.
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Affiliation(s)
- Dinesh Pokhrel
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA.
| | - Simona G Lang
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - Heather Elder
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - Betsey John
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - Kathleen A Roosevelt
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - Monina Klevens
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - Liisa M Randall
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - Alfred DeMaria
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
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13
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West NS, Ddaaki W, Murray SM, Nakyanjo N, Isabirye D, Nakubulwa R, Nalugoda F, Surkan PJ, Hutton HE, Kennedy CE. "Someone who hates themself doesn't come for their drugs": Experiences of mental health along the HIV care continuum in South-Central, Uganda. PLoS One 2024; 19:e0290809. [PMID: 39388435 PMCID: PMC11466431 DOI: 10.1371/journal.pone.0290809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/04/2024] [Indexed: 10/12/2024] Open
Abstract
INTRODUCTION Poor mental health occurs more frequently among people living with HIV. Understanding what mental health problems occur and at what point during the continuum of HIV care is critical to ensure these problems are identified and appropriately addressed. We explored how mental health is experienced along the HIV care continuum in Rakai, Uganda. METHODS We conducted qualitative semi-structured in-depth interviews with 20 adults living with HIV and 10 health workers from March to December 2020. Interviews followed a timeline approach. Responses were analyzed using content analysis. RESULTS At the time of HIV diagnosis, nearly all participants described a range of strong emotions, including shock, fear and intense worry. Most participants described continued fear and intense worry leading up to, and at the time of, ART initiation. However, they said these emotions often subside after ART is initiated and viral suppression is achieved. Across interviews and at multiple points of the continuum, participants discussed how fear and worry led individuals to be "thinking too much" or be in "deep thoughts" and experience self-hatred. Individuals who stopped taking ART were thought to have more severe mental health problems ("madness", psychosis, suicidality). Participants were divided about the mental health of persons who returned to care after disengagement. CONCLUSION In this setting, mental health problems experienced by people living with HIV are dynamic across the care continuum. With expanded HIV testing campaigns and Universal Test and Treat policies, targeted interventions for psychosocial support at the time of testing and ART initiation remain critical.
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Affiliation(s)
- Nora S. West
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, United States of America
| | | | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | | | | | - Pamela J. Surkan
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Heidi E. Hutton
- Division of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Caitlin E. Kennedy
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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14
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Dinh DA, Tan Y, Saeed S. Disengagement from Care Among People Co-Infected with HIV and HCV: A Scoping Review. AIDS Behav 2024; 28:3381-3403. [PMID: 38992228 DOI: 10.1007/s10461-024-04436-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/13/2024]
Abstract
Disengagement from care among people with HIV (PWH) and hepatitis C (HCV) increases the risks of adverse health outcomes and poses significant barriers to achieving global HIV and HCV elimination goals. In accordance with the Joanna Briggs Institute framework, a scoping review was conducted to synthesize and highlight existing gaps in the literature on (dis)engagement in care among PWH and HCV. We searched for original studies on (dis)engagement in care among PWH and HCV in high-income countries using eight electronic databases from inception to May 2023. Our search yielded 4462 non-duplicated records, which were scoped to 27 studies. Definitions of (dis)engagement in care were diverse, with considerable heterogeneity in how retention was operationalized and temporally measured. Studies identified predictors of (dis)engagement to be related to drug and substance use (n = 5 articles), clinical factors (n = 5), social and welfare (n = 4), and demographic characteristics (n = 2). When engagement in care was treated as an exposure, it was associated with HCV treatment initiation (n = 3), achieving sustained virological response (n = 2), and maintaining HIV viral suppression (n = 1). Interventions to improve care engagement among PWH and HCV were limited to five studies using cash incentives (n = 1) and individual case management (n = 4). (Dis)engagement in care is a dynamic process influenced by shifting priorities that may 'tip the balance' towards or away from regularly interacting with healthcare professionals. However, inconsistent definitions render cross-study comparisons and meta-analyses virtually impossible. Further research needs to establish a standardized definition to identify patients at high risk of disengagement and develop interventions that leverage the nested HIV/HCV care cascades to retain and recover patients lost from care.
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Affiliation(s)
- Duy A Dinh
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Yvonne Tan
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Sahar Saeed
- Department of Public Health Sciences, Queen's University, 203 Carruthers Hall 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada.
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15
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Salazar J, Lisha NE, Neilands TB, Ludwig-Barron N, Johnson MO, Cachay ER, Napravnik S, Crane HM, Moore RD, Fredericksen RJ, Mayer KH, Christopoulos KA, Sauceda JA. The HIV Index Is Associated With Retention in Care Among Latinx Persons Living With HIV in the CFAR Network of Integrated Clinical Systems Cohort. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:261-271. [PMID: 39189958 DOI: 10.1521/aeap.2024.36.4.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
The HIV Index is a validated self-report scale of engagement in HIV care previously correlated with future retention and virologic suppression. However, its performance in a monoethnic Latinx population has not been studied. We evaluated the HIV Index among Latinx persons living with HIV in the Centers for AIDS Research Network of Integrated Clinical Systems cohort and performed multivariable logistic regression to estimate its association with primary outcomes of suboptimal retention (not keeping 100% of HIV clinic appointments) and virologic suppression (HIV viral load <200 copies/mL). The mean Index score was 4.5 (standard deviation 0.6) in both analytic samples, indicative of feeling well-engaged. Higher Index scores were associated with lower odds of suboptimal retention (OR = 0.12, 95% CI [0.03, 0.54], p = .005), however, there was no association between Index score and virologic suppression. The HIV Index is useful for assessing engagement and retention among Latinx PLWH in routine care.
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Affiliation(s)
- Jorge Salazar
- University of California, San Francisco, San Francisco, California
| | - Nadra E Lisha
- University of California, San Francisco, San Francisco, California
| | | | | | | | | | - Sonia Napravnik
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | | | | | - John A Sauceda
- University of California, San Francisco, San Francisco, California
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16
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Richterman A, Dorvil N, Rivera V, Bang H, Severe P, Lavoile K, Pierre S, Apollon A, Dumond E, Pierre Louis Forestal G, Rouzier V, Joseph P, Cremieux PY, Pape JW, Koenig SP. Predictors of Clinical Outcomes among People with HIV and Tuberculosis Symptoms after Rapid Treatment Initiation in Haiti. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.19.24309189. [PMID: 38946994 PMCID: PMC11213038 DOI: 10.1101/2024.06.19.24309189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Introduction Few studies have evaluated baseline predictors of clinical outcomes among people with HIV starting antiretroviral therapy (ART) in the modern era of rapid ART initiation. Methods We conducted a secondary analysis of a randomized controlled trial of two rapid treatment initiation strategies for people with treatment-naïve HIV and tuberculosis symptoms at an urban clinic in Haiti. We used logistic regression models to assess associations between baseline characteristics and (1) retention in care at 48 weeks, (2) HIV viral load suppression at 48 weeks (among participants who underwent viral load testing), and (3) all-cause mortality. Results 500 participants were enrolled in the study 11/2017-1/2020. Eighty-eight (18%) participants were diagnosed with tuberculosis, and ART was started in 494 (99%). After adjustment, less than secondary education (adjusted odds ratio [AOR] 0.21, 95% CI 0.10-0.46), dolutegravir initiation (AOR 2.57, 95% CI 1.22-5.43), age (AOR 1.42 per 10-year increase, 95% CI 1.01-1.99), and tuberculosis diagnosis (AOR 3.92, 95% CI 1.36-11.28) were significantly associated with retention. Age (AOR 1.36, 95% CI 1.05-1.75), dolutegravir initiation (AOR 1.75, 95% CI 1.07-2.85), and tuberculosis diagnosis (AOR 0.50, 95% CI 0.28-0.89) were associated with viral suppression. Higher CD4 cell count at enrollment (unadjusted odds ratio [OR] 0.69, 95% CI 0.55-0.87) and anemia (OR 4.86, 95% CI 1.71-13.81) were associated with mortality. Conclusions We identified sociodemographic, treatment-related, clinical, and laboratory-based predictors of clinical outcomes. These characteristics may serve as markers of sub-populations that could benefit from additional interventions to support treatment success after rapid treatment initiation.
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Affiliation(s)
- Aaron Richterman
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Nancy Dorvil
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa Rivera
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Heejung Bang
- University of California, Davis School of Medicine, Davis, California, United States of America
| | - Patrice Severe
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Kerylyne Lavoile
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Samuel Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Emelyne Dumond
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Weill Cornell Medical College, New York, New York, United States of America
| | - Patrice Joseph
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Jean W Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Weill Cornell Medical College, New York, New York, United States of America
| | - Serena P Koenig
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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17
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Trepka MJ, Gong Z, Ward MK, Fennie KP, Sheehan DM, Jean-Gilles M, Devieux J, Ibañez GE, Gwanzura T, Nawfal ES, Gray A, Beach MC, Ladner R, Yoo C. Using Causal Bayesian Networks to Assess the Role of Patient-Centered Care and Psychosocial Factors on Durable HIV Viral Suppression. AIDS Behav 2024; 28:2113-2130. [PMID: 38573473 PMCID: PMC11161314 DOI: 10.1007/s10461-024-04310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/05/2024]
Abstract
We assessed the role of patient-centered care on durable viral suppression (i.e., all viral load test results < 200 copies per ml during 2019) by conducting a retrospective cohort study of clients medically case managed by the Miami-Dade County Ryan White Program (RWP). Summary measures of patient-centered care practices of RWP-affiliated providers were obtained from a survey of 1352 clients. Bayesian network models analyzed the complex relationship between psychosocial and patient-centered care factors. Of 5037 clients, 4135 (82.1%) had durable viral suppression. Household income was the factor most strongly associated with durable viral suppression. Further, mean healthcare relationship score and mean "provider knows patient as a person" score were both associated with durable viral suppression. Healthcare relationship score moderated the association between low household income and lack of durable viral suppression. Although patient-centered care supports patient HIV care success, wrap around support is also needed for people with unmet psychosocial needs.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA.
- Research Center for Minority Institutions, Florida International University, Miami, FL, USA.
| | - Zhenghua Gong
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Melissa K Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, Miami, FL, USA
| | | | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, Miami, FL, USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Jessie Devieux
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Tendai Gwanzura
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Ekpereka S Nawfal
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Aaliyah Gray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
| | | | - Robert Ladner
- Behavioral Science Research Corporation, Coral Gables, FL, USA
| | - Changwon Yoo
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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18
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Eshak TB, Hobkirk AL, Whitener CJ, Conyers LM, Hwang W, Sznajder KK. Syndemic of Substance Abuse, Depression, and Type 2 Diabetes and Their Association with Retention in Care Among People Living with HIV. AIDS Behav 2024; 28:1612-1620. [PMID: 38281250 DOI: 10.1007/s10461-024-04275-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
Substance abuse (SA), depression, and type 2 diabetes (DM2) often co-occur among people living with HIV (PLHIV). Guided by a syndemic framework, this cross-sectional retrospective study examined the cumulative and interaction effects of SA, depression, and DM2 on retention in HIV care (RIC) among 621 PLHIV receiving medical care in central Pennsylvania. We performed logistic regression analysis to test the associations between SA, depression, and DM2 and RIC. To test the "syndemic" model, we assessed additive and multiplicative interactions. In an unadjusted model, a dose-response pattern between the syndemic index (total number of health conditions) and RIC was detected (OR for 1 syndemic factor vs. none: 1.01, 95% CI: 0.69-1.47; 2 syndemic factors: 1.59, 0.89-2.84; 3 syndemic factors: 1.62, 0.44-5.94), but no group reached statistical significance. Interactions on both additive and multiplicative scales were not significant, demonstrating no syndemic effect of SA, depression, and DM2 on RIC among our study sample. Our findings highlight that comorbid conditions may, in some populations, facilitate RIC rather than act as barriers, which may be due to higher levels of engagement with medical care.
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Affiliation(s)
- Tarek B Eshak
- Department of Public Health, College of Health Professions, Slippery Rock University, Slippery Rock, PA, USA.
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Health, Penn State University, Hershey, PA, USA
| | - Cynthia J Whitener
- Department of Medicine, Penn State University, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Liza M Conyers
- Department of Educational Psychology, Counseling, and Special Education, Penn State University, University Park, PA, USA
| | - Wenke Hwang
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, PA, USA
| | - Kristin K Sznajder
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, PA, USA
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19
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Stewart B, Byrne M, Levy M, Horberg MA, Monroe AK, Castel AD. The Association of Mental Health and Substance Use With Retention in HIV Care Among Black Women in Washington, District of Columbia. Womens Health Issues 2024; 34:250-256. [PMID: 38184379 PMCID: PMC11116077 DOI: 10.1016/j.whi.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Black women with HIV are impacted by mental health and substance use disorders alongside barriers to care. The impact of these disorders on retention in care, a crucial step of the HIV care continuum, has not been well-studied. We examined the association between these disorders and retention in care over a 2-year period. METHODS Data from January 1, 2011, to June 30, 2019, were obtained from the DC Cohort, an observational HIV study in Washington, District of Columbia. We examined the associations between mental health (i.e., mood-related or trauma-related) or substance use disorders, separately, on not being retained in HIV care over a 2-year interval post-enrollment among non-Hispanic Black women with HIV. Multivariate logistic regression with adjusted odds ratios (aORs) for sociodemographic and clinical variables was used to quantify the association of 1) having a confirmed mental health or substance use disorder and 2) not being retained in care. RESULTS Among the 2,181 women in this analysis, 690 (31.64%) were not retained in care. The prevalence of a mood-related disorder (39.84%) was higher compared with a substance use (16.19%) or trauma-related disorder (7.75%). Age per a 10-year increase (aOR 0.87; confidence interval [CI] 0.80, 0.94) and a mood-related disorder diagnosis (aOR 0.72; CI: 0.59, 0.88) were inversely associated with not being retained in care. CONCLUSION Mood-related disorders were prevalent among Black women with HIV in Washington, District of Columbia, but were not associated with worse retention in care. Future studies should examine key facilitators for Black women with HIV and coexisting mood-related disorders and how they impact retention in care.
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Affiliation(s)
- Bianca Stewart
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia.
| | - Morgan Byrne
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | | | - Michael A Horberg
- Mid-Atlantic Permanente Medical Group, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | - Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
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Humphries D, Marotta P, Hu Y, Wang V, Gross G, Rucker D, Jones J, Alam F, Brown T, Carter CR, Spiegelman D. St. Louis Enhancing Engagement and Retention in HIV/AIDS Care (STEER): a participatory intersectional needs assessment for intervention and implementation planning. RESEARCH SQUARE 2024:rs.3.rs-4225131. [PMID: 38746123 PMCID: PMC11092814 DOI: 10.21203/rs.3.rs-4225131/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background Missouri is one of seven priority states identified by the Ending the HIV Epidemic Initiative, and St. Louis contains almost half of the people living with HIV (PLWH) in Missouri. As St. Louis has a marked history of structural racism and economic inequities, we utilized the Intersectionality Based Policy Analysis (IBPA) framework to guide a participatory needs assessment for planning and program development. Methods The planning team included researchers, the lead implementer from our community partner, and two community representatives, and had biweekly 60-90 minute meetings for 18 months. The planning team discussed and approved all research materials, reviewed and interpreted results, and made decisions about outreach, recruitment, conduct of the needs assessment and development of the planned intervention. The needs assessment integrated information from existing data, (1) interviews with (a) PLWH (n=12), (b) community leaders (n=5), (c) clinical leaders (n=4), and (d) community health workers (CHWs) (n=3) and (e) CHW supervisors (n=3) who participated in a Boston University-led demonstration project on CHWs in the context of HIV and (2) focus groups (2 FG, 12 participants) with front line health workers such as peer specialists, health coaches and outreach workers. A rapid qualitative analysis approach was used for all interviews and focus groups. Results The IBPA was used to guide team discussions of team values, definition and framing of the problem, questions and topics in the key informant interviews, and implementation strategies. Applying the IBPA framework contributed to a focus on intersectional drivers of inequities in HIV services. The effective management of HIV faces significant challenges from high provider turnover, insufficient integration of CHWs into care teams, and organizational limitations in tailoring treatment plans. Increasing use of CHWs for HIV treatment and prevention also faces challenges. People living with HIV (PLWH) encounter multiple barriers such as stigma, lack of social support, co-morbidities, medication side effects and difficulties in meeting basic needs. Conclusions Addressing intersectional drivers of health inequities may require multi-level, structural approaches. We see the IBPA as a valuable tool for participatory planning while integrating community engagement principles in program and implementation design for improving HIV outcomes.
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Affiliation(s)
| | - Phillip Marotta
- Washington University In St Louis: Washington University in St Louis
| | | | | | - Greg Gross
- Washington University In St Louis: Washington University in St Louis
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Krankowska D, Flanczewski S, Gajek-Flanczewska W, Sapuła M, Cybula A, Wiercińska-Drapało A. Comparison between patients who interrupted ART and those with late HIV diagnosis. AIDS Care 2024; 36:374-381. [PMID: 37584430 DOI: 10.1080/09540121.2023.2237711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 07/12/2023] [Indexed: 08/17/2023]
Abstract
Early diagnosis of human immunodeficiency virus (HIV) and retention in care are cornerstones of better prognosis of people living with HIV (PLWH). The purpose of this study was to compare patients who discontinued antiretroviral treatment (ART) with those who were diagnosed late with HIV. In this retrospective analysis of PLWH under the care of one of the Infectious Diseases Clinics in Poland between 2020 and 2021, two sub-analyses were carried out. One comparing patients who relinked to care after treatment interruption ("Group A") with those who had late HIV diagnosis ("Group B"), another comparing group A to those who were adherent to ART ("Group C"). 215 patients were included in this study (Group A = 47, Group B = 53, Group C = 115). Those who discontinued ART more often used actively drugs (p = 0.001) in comparison to those with late HIV diagnosis. In both bivariate and multivariable analysis migrants were more often diagnosed late with HIV than interrupted ART (p = 0.004 and 0.015, respectively). In the second analysis, in the multivariable analysis female sex was not associated with treatment interruption, whereas active drug usage was. People using drugs have a higher risk of ART interruption. Migrants are more at risk of late HIV diagnosis. Adequate interventions should be made towards both groups.
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Affiliation(s)
- Dagny Krankowska
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
- Hospital for Infectious Diseases, Warsaw, Poland
| | - Sebastian Flanczewski
- Student's Scientific Society, Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Poland
| | - Wiktoria Gajek-Flanczewska
- Student's Scientific Society, Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Poland
| | - Mariusz Sapuła
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
- Hospital for Infectious Diseases, Warsaw, Poland
| | - Aneta Cybula
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
- Hospital for Infectious Diseases, Warsaw, Poland
| | - Alicja Wiercińska-Drapało
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
- Hospital for Infectious Diseases, Warsaw, Poland
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22
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Ballesty KL, Newton-John TRO, Hennessy RM, Alperstein DM, Begley K, Bulsara SM. 'What doesn't kill you. . .': A qualitative analysis of factors impacting the quality of life of people living with HIV. J Health Psychol 2024; 30:13591053241235091. [PMID: 38411113 PMCID: PMC11686924 DOI: 10.1177/13591053241235091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
Despite viral suppression, people living with HIV (PLHIV) report lower quality of life (QoL) than the general population, negatively impacting treatment adherence and wellbeing. This qualitative study explored factors influencing QoL of PLHIV. Participants completed a QoL questionnaire, with cut-off scores used to allocate participants into Low-Moderate QoL (n = 11) or High-Very High QoL (n = 10) focus groups. Thematic analysis indicated convergence across factors perceived to impact QoL, with some notable discrepancies. Socioeconomic stability, social connection and support, maintaining good health, adaptive attitudes and reduced impact of stigma were perceived to improve QoL, while obstacles to connection, ageing and poor HIV literacy in the general population were perceived to worsen QoL in both groups. The Low-Moderate QoL group alone identified socioeconomic stressors and ongoing burden of negative life experiences worsened their QoL. Results are presented in the context of local and global HIV health strategies, with implications for clinical management noted.
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Affiliation(s)
| | | | | | | | | | - Shiraze M Bulsara
- University of Technology Sydney (UTS), Australia
- The Albion Centre, Australia
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23
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Hastings C, French M, McClelland A, Mykhalovskiy E, Adam B, Bisaillon L, Bogosavljevic K, Gagnon M, Greene S, Guta A, Hindmarch S, Kaida A, Kilty J, Massaquoi N, Namaste V, O'Byrne P, Orsini M, Patterson S, Sanders C, Symington A, Wilson C. Criminal Code reform of HIV non-disclosure is urgently needed: Social science perspectives on the harms of HIV criminalization in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:8-14. [PMID: 38087186 PMCID: PMC10868573 DOI: 10.17269/s41997-023-00843-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/16/2023] [Indexed: 02/09/2024]
Abstract
The criminalization of HIV non-disclosure represents a significant issue of concern among people living with HIV, those working across the HIV sector, public health practitioners, and health and human rights advocates around the world. Recently, the government of Canada began a review of the criminal law regarding HIV non-disclosure and invited feedback from the public about potential reforms to the Criminal Code. In light of this public consultation, this commentary examines social science research from Canadian scholars that documents the intersecting damaging effects of HIV criminalization. Canadian social scientists and other researchers have shown that HIV criminalization is applied in uneven and discriminatory ways, impedes HIV prevention efforts, perpetuates HIV stigma, and has a damaging impact on the daily lives of people living with HIV. We argue that there is an urgent need for reforms that will significantly restrict how the criminal law is applied to HIV non-disclosure.
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Affiliation(s)
- Colin Hastings
- Department of Sociology and Legal Studies, University of Waterloo, Kitchener-Waterloo, ON, Canada.
| | - Martin French
- Department of Sociology and Anthropology, Concordia University, Montreal, QC, Canada
| | - Alexander McClelland
- Institute of Criminology and Criminal Justice, Carleton University, Ottawa, ON, Canada
| | | | - Barry Adam
- Department of Sociology, University of Windsor, Windsor, ON, Canada
| | - Laura Bisaillon
- Department of Health and Society, University of Toronto, Toronto, ON, Canada
| | | | - Marilou Gagnon
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, ON, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, ON, Canada
| | - Suzanne Hindmarch
- Department of Political Science, University of New Brunswick, Fredericton, NB, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Jennifer Kilty
- Department of Criminology, University of Ottawa, Ottawa, ON, Canada
| | - Notisha Massaquoi
- Department of Health and Society, University of Toronto, Toronto, ON, Canada
| | - Viviane Namaste
- Simone de Beauvoir Institute & Women's Studies, Concordia University, Montreal, QC, Canada
| | | | - Michael Orsini
- Institute of Feminist and Gender Studies and the School of Political Studies, University of Ottawa, Ottawa, ON, Canada
| | - Sophie Patterson
- Faculty of Health & Medicine, Lancaster University, Lancaster, England
| | - Chris Sanders
- Department of Sociology, Lakehead University, Thunder Bay, ON, Canada
| | | | - Ciann Wilson
- Department of Psychology, Wilfrid Laurier University, Kitchener-Waterloo, ON, Canada
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Raberahona M, Rakotomalala R, Andriananja V, Andriamamonjisoa J, Rakotomijoro E, Andrianasolo RL, Rakotoarivelo RA, Randria MJDD. A retrospective cohort analysis of people living with HIV/AIDS enrolled in HIV care at a reference center in Antananarivo, Madagascar. Front Public Health 2024; 11:1329194. [PMID: 38288430 PMCID: PMC10822960 DOI: 10.3389/fpubh.2023.1329194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/22/2023] [Indexed: 01/31/2024] Open
Abstract
Background The impact of the "Treat all" policy on the individual and in terms of public health is closely related to early diagnosis and retention in care. Patient-level data are scarce in Madagascar. In this study, we aimed to describe the profile of a cohort of newly diagnosed people living with HIV/AIDS (PLHIV), identify their outcomes, and assess factors associated with attrition from care and advanced HIV disease (AHD) at presentation. Methods We conducted a retrospective cohort study of PLHIV aged ≥15 years newly diagnosed at the University Hospital Joseph Raseta Befelatanana Antananarivo from 1 January 2010 to 31 December 2016. Results A total of 490 PLHIV were included in the cohort analysis. In total, 67.1% were male. The median age (interquartile range) at enrollment in care was 29 years (24-38). Overall, 36.1% of PLHIV were diagnosed with AHD at baseline. The proportion of patients with WHO stage IV at baseline increased significantly from 3.3% in 2010 to 31% in 2016 (p = 0.001 for trend). The probability of retention in care after the diagnosis at 12 months, 24 months, and 36 months was 71.8%, 65.5%, and 61.3%, respectively. Age ≥ 40 years (aHR: 1.55; 95% CI: 1.05-2.29; p = 0.026), low level of education (aHR:1.62; 95% CI: 1.11-2.36; p = 0,013), unspecified level of education (aHR:2.18; 95% CI: 1.37-3.47; p = 0.001) and unemployment (aHR:1.52; 95% CI: 1.07-2.16; p = 0.019) were independently associated with attrition from care. Factors associated with AHD at baseline were age ≥ 40 (aOR: 2.77; 95% CI: 1.38-5.57, p = 0.004), unspecified level of education (aOR: 3.80; 95% CI: 1.58-9.16, p = 0.003) and presence of clinical symptoms at baseline (aOR: 23.81; 95% CI: 10.7-52.98; p < 0.001). Sex workers were independently less likely to have an AHD at presentation (aOR: 0.23; 95% CI: 0.05-0.96, p = 0.044). Conclusion Sociodemographic determinants influenced retention in care more than clinical factors. The presence of clinical symptoms and sociodemographic determinants were the main factors associated with AHD at baseline.
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Affiliation(s)
- Mihaja Raberahona
- Department of Infectious Diseases, University Hospital Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
- Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | - Rado Rakotomalala
- Department of Infectious Diseases, University Hospital Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - Volatiana Andriananja
- Department of Infectious Diseases, University Hospital Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - Johary Andriamamonjisoa
- Department of Infectious Diseases, University Hospital Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - Etienne Rakotomijoro
- Department of Infectious Diseases, University Hospital Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | | | - Rivonirina Andry Rakotoarivelo
- Department of Infectious Diseases, Faculty of Medicine, University Hospital Tambohobe Fianarantsoa, University of Fianarantsoa, Fianarantsoa, Madagascar
| | - Mamy Jean de Dieu Randria
- Department of Infectious Diseases, University Hospital Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
- Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
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25
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Ojiambo KO, Nakku J, Wangi RN, Segawa I, Ndagire R, Nangendo J, Katahoire A, Semitala F. Socio-demographic and clinical characteristics associated with retention in care among adults living with HIV and severe mental illness and reasons for loss to follow-up in Uganda: a mixed-methods study. BMJ Open 2023; 13:e073623. [PMID: 37899147 PMCID: PMC10619097 DOI: 10.1136/bmjopen-2023-073623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE This study aimed to determine the socio-demographic and clinical characteristics associated with retention in care and reasons for loss to follow-up (LTFU) among people living with HIV (PLWH) with a known diagnosis of severe mental illness (SMI). DESIGN We conducted a parallel convergent mixed-methods study. The quantitative study was used to determine the proportion and factors associated with retention in care among PLWH and SMI. The qualitative study explored reasons for LTFU. SETTING This study was conducted at two the HIV clinics of two tertiary hospitals in Uganda. PARTICIPANTS We reviewed records of 608 PLWH who started antiretroviral therapy (ART) and included participants who had a documented diagnosis of SMI. OUTCOMES The primary outcome was retention in care. Age, gender, religion, tuberculosis (TB) status, WHO clinical stage, functional status, cluster of differentiation 4 (CD4) cell count, viral load and SMI diagnosis were among the predictor variables. RESULTS We collected data from 328 participants. Retention at 6 months was 43.3% compared with 35.7% at 12 months. Having an unsuppressed viral load (≥1000 copies/mL) (adjusted incidence risk ratio (IRR)=1.54, 95% CI: 1.17 to 2.03), being 36 years and below (adjusted IRR=0.94, 95% CI: 0.94 to 0.95), initial presentation at outpatient department (adjusted IRR=0.74, 95% CI: 0.57 to 0.96), having TB signs and symptoms (adjusted IRR=0.98 95% CI: 0.97 to 0.99) and being in lower WHO stages (I and II) (adjusted IRR=1.08, 95% CI: 1.02 to 1.14) at ART initiation were significantly associated with retention in care at 6 and 12 months. Inadequate social support, long waiting hours at the clinic, perceived stigma and discrimination, competing life activities, low socioeconomic status and poor adherence to psychiatric medication were barriers to retention in care. CONCLUSION Twelve-month retention in care remains low at 35.7% far below the 90% WHO target. There is a need to design and implement targeted interventions to address barriers to retention in care among PLWH and SMI.
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Affiliation(s)
- Kevin Ouma Ojiambo
- Clinical Epidemiology Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Africa Center for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - Rachel Nante Wangi
- Clinical Epidemiology Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ivan Segawa
- Clinical Epidemiology Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Regina Ndagire
- Clinical Epidemiology Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joanita Nangendo
- Clinical Epidemiology Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Anne Katahoire
- Child Health and Development Centre (CHDC), Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred Semitala
- Department of Medicine, School of medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Mulago Immune Suppression Syndrome Clinic, Mulago National Referral Hospital, Kampala, Uganda
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Skeen SJ, Tokarz S, Gasik RE, Solano CM, Smith EA, Sagoe MB, Hudson LV, Steele K, Theall KP, Clum GA. A Trauma-Informed, Geospatially Aware, Just-in-Time Adaptive mHealth Intervention to Support Effective Coping Skills Among People Living With HIV in New Orleans: Development and Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47151. [PMID: 37874637 PMCID: PMC10630874 DOI: 10.2196/47151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/27/2023] [Accepted: 09/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND In 2020, Greater New Orleans, Louisiana, was home to 7048 people living with HIV-1083 per 100,000 residents, 2.85 times the US national rate. With Louisiana routinely ranked last in indexes of health equity, violent crime rates in Orleans Parish quintupling national averages, and in-care New Orleans people living with HIV surviving twice the US average of adverse childhood experiences, accessible, trauma-focused, evidence-based interventions (EBIs) for violence-affected people living with HIV are urgently needed. OBJECTIVE To meet this need, we adapted Living in the Face of Trauma, a well-established EBI tailored for people living with HIV, into NOLA GEM, a just-in-time adaptive mobile health (mHealth) intervention. This study aimed to culturally tailor and refine the NOLA GEM app and assess its acceptability; feasibility; and preliminary efficacy on care engagement, medication adherence, viral suppression, and mental well-being among in-care people living with HIV in Greater New Orleans. METHODS The development of NOLA GEM entailed identifying real-time tailoring variables via a geographic ecological momentary assessment (GEMA) study (n=49; aim 1) and place-based and user-centered tailoring, responsive to the unique cultural contexts of HIV survivorship in New Orleans, via formative interviews (n=12; aim 2). The iOS- and Android-enabled NOLA GEM app leverages twice-daily GEMA prompts to offer just-in-time, in-app recommendations for effective coping skills practice and app-delivered Living in the Face of Trauma session content. For aim 3, the pilot trial will enroll an analytic sample of 60 New Orleans people living with HIV individually randomized to parallel NOLA GEM (intervention) or GEMA-alone (control) arms at a 1:1 allocation for a 21-day period. Acceptability and feasibility will be assessed via enrollment, attrition, active daily use through paradata metrics, and prevalidated usability measures. At the postassessment time point, primary end points will be assessed via a range of well-validated, domain-specific scales. Care engagement and viral suppression will be assessed via past missed appointments and self-reported viral load at 30 and 90 days, respectively, and through well-demonstrated adherence self-efficacy measures. RESULTS Aims 1 and 2 have been achieved, NOLA GEM is in Beta, and all aim-3 methods have been reviewed and approved by the institutional review board of Tulane University. Recruitment was launched in July 2023, with a target date for follow-up assessment completion in December 2023. CONCLUSIONS By leveraging user-centered development and embracing principles that elevate the lived expertise of New Orleans people living with HIV, mHealth-adapted EBIs can reflect community wisdom on posttraumatic resilience. Sustainable adoption of the NOLA GEM app and a promising early efficacy profile will support the feasibility of a future fully powered clinical trial and potential translation to new underserved settings in service of holistic survivorship and well-being of people living with HIV. TRIAL REGISTRATION ClinicalTrials.gov NCT05784714; https://clinicaltrials.gov/ct2/show/NCT05784714. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47151.
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Affiliation(s)
- Simone J Skeen
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
- Center for Community-Engaged Artificial Intelligence, Tulane University, New Orleans, LA, United States
- Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Stephanie Tokarz
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Rayna E Gasik
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Chelsea McGettigan Solano
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Ethan A Smith
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Momi Binaifer Sagoe
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Lauryn V Hudson
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Kara Steele
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Katherine P Theall
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Gretchen A Clum
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
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Ndagire R, Wangi RN, Ojiambo KO, Nangendo J, Nakku J, Muyinda H, Semitala FC. HIV viral load suppression among people with mental disorders at two urban HIV clinics in Uganda: a parallel convergent mixed methods study using the social ecological model. AIDS Res Ther 2023; 20:68. [PMID: 37726822 PMCID: PMC10510257 DOI: 10.1186/s12981-023-00567-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Uganda adopted and implemented the Universal Test and Treat (UTT) guidelines in 2017, which require HIV-infected persons to be initiated on antiretroviral therapy (ART) at any CD4 + cell count, and to be routinely monitored for viral load to assess response to ART. However, there is paucity of data on viral load suppression (VLS) among people living with HIV (PLHIV) with mental disorders. We conducted a parallel convergent mixed methods study to determine HIV VLS among people with a mental disorder and explored the socio-cultural determinants of VLS at Butabika hospital and Mulago (ISS) HIV Clinics in Uganda. METHODS We conducted a retrospective medical records review; seven key informant interviews (KII) among purposively selected healthcare providers and 12 in-depth interviews (IDI) among clinically stable PLHIV with a mental disorder. Data was collected on demographics, mental disorder, ART, viral load status, social support, stigma, and disclosure of HIV status. Quantitative data was analysed using descriptive statistics and modified Poisson regression, while Inductive thematic analysis was used for the qualitative data. RESULTS Of the 240 PLHIV with a mental disorder who were enrolled, 161 (67.1%) were female with mean age 38.9 (± 11.2) years. Overall, 88.8% (95% Cl: 84.0 - 92.2%) achieved VLS. Age (aPR = 1.00, 95%Cl = 1.00-1.00), male gender (aPR = 0.90, 95%Cl = 0.82-0.98), divorced (aPR = 0.88, 95%Cl = 0.82-0.94), widowed (aPR = 0.84, 95%Cl = 0.83-0.86), baseline CD4 count < 200 (aPR = 0.89, 95%Cl = 0.85-0.94), psychotic mental disorders (aPR = 1.11; 95%CI = 1.08-1.13) and fair (85-94%) ART adherence level (aPR = 0.69, 95%Cl = 0.55-0.87) and TDF/3TC/DTG (aPR = 0.92; 95%CI = 0.91-0.94) were associated with HIV VLS. Social support from family members, knowledge of impact of negative thoughts on VLS, fear of breaking up with partners and compassionate healthcare providers positively influenced VLS. Stigma and discrimination from the community, self-perceived stigma hindering social relations, socio-economic challenges and psychiatric drug stock-outs negatively affected VLS. CONCLUSION AND RECOMMENDATIONS HIV VLS among PLHIV with mental disorders at institutions that provide integrated HIV and mental health care is still below the UNAIDS 95% target. Health promotion messaging focusing on benefits of VLS and countering stigma to create a safe environment; and active involvement of family members in care could improve HIV treatment outcomes for PLHIV with mental disorders.
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Affiliation(s)
- Regina Ndagire
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda.
- Clarke International University, Kampala, Uganda.
| | - Rachel Nante Wangi
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Kevin Ouma Ojiambo
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joanita Nangendo
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Mental Referral Hospital, Kampala, Uganda
| | | | - Fred C Semitala
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University Joint AIDS Program (MJAP), Makerere University, Kampala, Uganda
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Dombrowski JC, Ramchandani MS, Golden MR. Implementation of Low-Barrier Human Immunodeficiency Virus Care: Lessons Learned From the Max Clinic in Seattle. Clin Infect Dis 2023; 77:252-257. [PMID: 37021670 PMCID: PMC10371304 DOI: 10.1093/cid/ciad202] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/20/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
Low-barrier care (LBC) for people with human immunodeficiency virus (HIV) is a differentiated service delivery strategy to engage people in HIV treatment who are not well-engaged in conventionally organized HIV medical care. The LBC approach is flexible, but experience suggests that the intervention has distinct core components. This review summarizes our experience implementing one model of LBC, the Max Clinic in Seattle; describes the core components of the intervention; and presents a framework for implementing low-barrier HIV care with the goal of providing a practical guide for clinical and public health leaders seeking to implement a new LBC program. A systematic approach to addressing key factors during LBC implementation can support practitioners to design an LBC approach that fits the local context while maintaining essential elements of the intervention.
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Affiliation(s)
- Julia C Dombrowski
- Department of Medicine, University of Washington, Seattle, Washington, USA
- HIV/STD Program, Public Health–Seattle & King County, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Meena S Ramchandani
- Department of Medicine, University of Washington, Seattle, Washington, USA
- HIV/STD Program, Public Health–Seattle & King County, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- Department of Medicine, University of Washington, Seattle, Washington, USA
- HIV/STD Program, Public Health–Seattle & King County, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Center for AIDS and STD, University of Washington, Seattle, Washington, USA
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Irvine MK, Abdelqader F, Levin B, Thomas J, Avoundjian T, Peterson M, Zimba R, Braunstein SL, Robertson MM, Nash D. Study protocol for data to suppression (D2S): a cluster-randomised, stepped-wedge effectiveness trial of a reporting and capacity-building intervention to improve HIV viral suppression in housing and behavioural health programmes in New York City. BMJ Open 2023; 13:e076716. [PMID: 37451738 PMCID: PMC10351323 DOI: 10.1136/bmjopen-2023-076716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION With progress in the 'diagnose', 'link' and 'retain' stages of the HIV care continuum, viral suppression (VS) gains increasingly hinge on antiretroviral adherence among people with HIV (PWH) retained in care. The Centers for Disease Control and Prevention estimate that unsuppressed viral load among PWH in care accounts for 20% of onward transmission. HIV intervention strategies include 'data to care' (D2C)-using surveillance to identify out-of-care PWH for follow-up. However, most D2C efforts target care linkage, not antiretroviral adherence, and limit client-level data sharing to medical (versus support-service) providers. Drawing on lessons learnt in D2C and successful local pilots, we designed a 'data-to-suppression' intervention that offers HIV support-service programmes surveillance-based reports listing their virally unsuppressed clients and capacity-building assistance for quality-improvement activities. We aimed to scale and test the intervention in agencies delivering Ryan White HIV/AIDS Programme-funded behavioural health and housing services. METHODS AND ANALYSIS To estimate intervention effects, this study applies a cross-sectional, stepped-wedge design to the intervention's rollout to 27 agencies randomised within matched pairs to early or delayed implementation. Data from three 12-month periods (pre-implementation, partial implementation and full implementation) will be examined to assess intervention effects on timely VS (within 6 months of a report listing the client as needing follow-up for VS). Based on projected enrolment (n=1619) and a pre-implementation outcome probability of 0.40-0.45, the detectable effect size with 80% power is an OR of 2.12 (relative risk: 1.41-1.46). ETHICS AND DISSEMINATION This study was approved by the New York City Department of Health and Mental Hygiene's institutional review board (protocol: 21-036) with a waiver of informed consent. Findings will be disseminated via publications, conferences and meetings including provider-agency representatives. TRIAL REGISTRATION NUMBER NCT05140421.
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Affiliation(s)
- Mary K Irvine
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Faisal Abdelqader
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Jacinthe Thomas
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Tigran Avoundjian
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Meghan Peterson
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health, City University of New York, New York City, New York, USA
| | - Sarah L Braunstein
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - McKaylee M Robertson
- Institute for Implementation Science in Population Health, City University of New York, New York City, New York, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York City, New York, USA
- Department of Epidemiology and Biostatistics, City University of New York, New York City, New York, USA
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Collins CB, Higa D, Taylor J, Wright C, Murray KH, Pitasi M, Greene Y, Lyles C, Edwards A, Andia J, Stallworth J, Alvarez J. Prioritization of Evidence-Based and Evidence-Informed Interventions for Retention in Medical Care for Persons with HIV. AIDS Behav 2023; 27:2285-2297. [PMID: 36580166 PMCID: PMC10225340 DOI: 10.1007/s10461-022-03958-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/30/2022]
Abstract
Up to 50% of those diagnosed with HIV in the U.S. are not retained in medical care. Care retention provides opportunity to monitor benefits of HIV therapy and enable viral suppression. To increase retention, there is a need to prioritize best practices appropriate for translation and dissemination for real-world implementation. Eighteen interventions from CDC's Compendium of Evidence-Based Interventions were scored using the RE-AIM framework to determine those most suitable for dissemination. A CDC Division of HIV Prevention workgroup developed a RE-AIM scale with emphasis on the Implementation and Maintenance dimensions and less emphasis on the Efficacy dimension since all 18 interventions were already identified as evidence-based or evidence-informed. Raters referenced primary efficacy publications and scores were averaged for a ranked RE-AIM score for interventions. Of 18 interventions, four included care linkage and 7 included viral suppression outcomes. Interventions received between 20.6 and 35.3 points (45 maximum). Scores were converted into a percentage of the total possible with ranges between 45.8 and 78.4%. Top four interventions were ARTAS (78.4%); Routine Screening for HIV (RUSH) (73.2%); Optn4Life (67.4%) and Virology Fast Track (65.9%). All four scored high on Implementation and Maintenance dimensions. Select items within the scale were applicable to health equity, covering topics such as reaching under-served focus populations and acceptability to that population. Navigation-enhanced Case Management (NAV) scored highest on the health equity subscale. RE-AIM prioritization scores will inform dissemination and translation efforts, help clinical staff select feasible interventions for implementation, and support sustainability for those interventions.
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Affiliation(s)
- Charles B Collins
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA.
| | - Darrel Higa
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Jocelyn Taylor
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Carolyn Wright
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Kimberly H Murray
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Marc Pitasi
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Yvonne Greene
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Cynthia Lyles
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Arlene Edwards
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Jonny Andia
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - JoAna Stallworth
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
| | - Jorge Alvarez
- Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA
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Crockett KB, Schember CO, Bian A, Rebeiro PF, Keruly J, Mayer K, Mathews C, Moore RD, Crane H, Geng E, Napravnik S, Shepherd BE, Mugavero MJ, Turan B, Pettit AC. Relationships Between Patient Race and Residential Race Context With Missed Human Immunodeficiency Virus Care Visits in the United States, 2010-2015. Clin Infect Dis 2023; 76:2163-2170. [PMID: 36757336 PMCID: PMC10273374 DOI: 10.1093/cid/ciad069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/30/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Racial inequities exist in retention in human immunodeficiency virus (HIV) care and multilevel analyses are needed to contextualize and address these differences. Leveraging data from a multisite clinical cohort of people with HIV (PWH), we assessed the relationships between patient race and residential characteristics with missed HIV care visits. METHODS Medical record and patient-reported outcome (PRO; including mental health and substance-use measures) data were drawn from 7 participating Center for AIDS Research Network of Integrated Clinical Systems (CNICS) sites including N = 20 807 PWH from January 2010 through December 2015. Generalized estimating equations were used to account for nesting within individuals and within census tracts in multivariable models assessing the relationship between race and missed HIV care visits, controlling for individual demographic and health characteristics and census tract characteristics. RESULTS Black PWH resided in more disadvantaged census tracts, on average. Black PWH residing in census tracts with higher proportion of Black residents were more likely to miss an HIV care visit. Non-Black PWH were less likely to miss a visit regardless of where they lived. These relationships were attenuated when PRO data were included. CONCLUSIONS Residential racial segregation and disadvantage may create inequities between Black PWH and non-Black PWH in retention in HIV care. Multilevel approaches are needed to retain PWH in HIV care, accounting for community, healthcare setting, and individual needs and resources.
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Affiliation(s)
- Kaylee B Crockett
- Department of Family and Community Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Cassandra O Schember
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter F Rebeiro
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeanne Keruly
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher Mathews
- School of Medicine, University of California San Diego, San Diego, California, USA
| | - Richard D Moore
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Heidi Crane
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Elvin Geng
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Sonia Napravnik
- Division of Infectious Disease, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Bryan E Shepherd
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - April C Pettit
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Ndagire R, Wangi RN, Ojiambo KO, Nangendo J, Nakku J, Muyinda H, Semitala FC. HIV viral load suppression among people with mental disorders at two urban HIV Clinics in Uganda: a parallel convergent mixed methods study using the Social Ecological Model. RESEARCH SQUARE 2023:rs.3.rs-2897447. [PMID: 37214962 PMCID: PMC10197750 DOI: 10.21203/rs.3.rs-2897447/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background Uganda adopted and implemented the Universal Test and Treat (UTT) guidelines in 2017, which require HIV-infected persons to be initiated on antiretroviral therapy (ART) at any CD4 + cell count, and to be routinely monitored for viral load to assess response to ART. However, there is paucity of data on viral load suppression (VLS) among people living with HIV (PLHIV) with mental disorders. We conducted a parallel convergent mixed methods study to determine HIV VLS among people with a mental disorder and explored the socio-cultural determinants of VLS at Butabika hospital and Mulago (ISS) HIV Clinics in Uganda. Methods We conducted a retrospective medical records review; seven key informant interviews (KII) among purposively selected healthcare providers and 12 in-depth interviews (IDI) among clinically stable PLHIV with a mental disorder. Data was collected on demographics, mental disorder, ART, viral load status, social support, stigma, and disclosure of HIV status. Quantitative data was analysed using descriptive statistics and modified Poisson regression, while Inductive thematic analysis was used for the qualitative data. Results Of the 240 PLHIV with a mental disorder who were enrolled, 161 (67.1%) were female with mean age 38.9 (± 11.2) years. Overall, 88.8% (95% Cl: 84.0% - 92.2%) achieved VLS. Age (aPR = 1.01, 95%Cl = 1.00-1.01), male gender (aPR = 0.95, 95%Cl = 0.95-0.95), divorced (aPR = 0.89, 95%Cl = 0.87-0.91), widowed (aPR = 0.84, 95%Cl = 0.79-0.90), baseline CD4 count < 200 (aPR = 0.89, 95%Cl = 0.82-0.95), and fair (85-94%) ART adherence level (aPR = 0.68, (95%Cl = 0.54-0.87) were associated with HIV VLS. Social support from family members, knowledge of impact of negative thoughts on VLS, fear of breaking up with partners and compassionate healthcare providers positively influenced VLS. Stigma and discrimination from the community, self-perceived stigma hindering social relations, socio-economic challenges and psychiatric drug stock-outs negatively affected VLS. Conclusion and recommendations HIV VLS among PLHIV with mental disorders at institutions that provide integrated HIV and mental health care is still below the UNAIDS 95% target. Health promotion messaging focusing on benefits of VLS and countering stigma to create a safe environment; and active involvement of family members in care could improve HIV treatment outcomes for PLHIV with mental disorders.
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Affiliation(s)
- Regina Ndagire
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University
| | - Rachel Nante Wangi
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University
| | - Kevin Ouma Ojiambo
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University
| | - Joanita Nangendo
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University
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Ma J, Jin Y, Jiao K, Wang Y, Gao L, Li X, Ma W. Antiretroviral treatment interruption and resumption within 16 weeks among HIV-positive adults in Jinan, China: a retrospective cohort study. Front Public Health 2023; 11:1137132. [PMID: 37228714 PMCID: PMC10203161 DOI: 10.3389/fpubh.2023.1137132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/10/2023] [Indexed: 05/27/2023] Open
Abstract
Background Treatment interruption has been found to increase the risk of opportunistic infections and death among HIV-positive adults, posing a challenge to fully realizing antiretroviral therapy (ART). However, it has been observed that short-term interruption (<16 weeks) was not associated with significant increases in adverse clinical events. There remains a dearth of evidence concerning the interruption and resumption of ART after short-term discontinuation in China. Methods HIV-positive adults who initiated ART in Jinan between 2004 and 2020 were included in this study. We defined ART interruption as more than 30 consecutive days off ART and used Cox regression to identify predictors of interruption. ART resumption was defined as a return to ART care within 16 weeks following discontinuation, and logistic regression was used to identify barriers. Results A total of 2,506 participants were eligible. Most of them were male [2,382 (95%)] and homosexual [2,109 (84%)], with a median age of 31 (IQR: 26-40) years old. Of all participants, 312 (12.5%) experienced a treatment interruption, and the incidence rate of interruption was 3.2 (95% CI: 2.8-3.6) per 100 person-years. A higher risk of discontinuation was observed among unemployed individuals [adjusted hazard ratio (aHR): 1.45, 95% CI: 1.14-1.85], with a lower education level (aHR: 1.39, 95% CI: 1.06-1.82), those with delayed ART initiation (aHR: 1.43, 95% CI: 1.10-1.85), receiving Alafenamide Fumarate Tablets at ART initiation (aHR: 5.19, 95% CI: 3.29-8.21). About half of the interrupters resumed ART within 16 weeks, and participants who delayed ART initiation, missed the last CD4 test before the interruption and received the "LPV/r+NRTIs" regimen before the interruption were more likely to discontinue treatment for the long term. Conclusion Antiretroviral treatment interruption remains relatively prevalent among HIV-positive adults in Jinan, China, and assessing socioeconomic status at treatment initiation will help address this issue. While almost half of the interrupters returned to care within 16 weeks, further focused measures are necessary to reduce long-term interruptions and maximize the resumption of care as soon as possible to avoid adverse clinical events.
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Affiliation(s)
- Jing Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yan Jin
- Institution for Acquired Immunodeficiency Syndrome (AIDS)/Sexually Transmitted Diseases (STD) Control and Prevention, Jinan Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Kedi Jiao
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yao Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Lijie Gao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xinrui Li
- Institution for Acquired Immunodeficiency Syndrome (AIDS)/Sexually Transmitted Diseases (STD) Control and Prevention, Jinan Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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O'Brien KK, Ibáñez-Carrasco F, Carusone SC, Bayoumi AM, Tang A, McDuff K, Jiancaro T, Da Silva G, Torres B, Loutfy MR, Islam S, Lindsay J, Price C, Zobeiry M, Pandovski Z, Illic I, Ahluwalia P, Brown DA, Avery L, Solomon P. Piloting an online telecoaching community-based exercise intervention with adults living with HIV: protocol for a mixed-methods implementation science study. BMJ Open 2023; 13:e067703. [PMID: 36997255 PMCID: PMC10069544 DOI: 10.1136/bmjopen-2022-067703] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Our aim is to evaluate the implementation of an online telecoaching community-based exercise (CBE) intervention with the goal of reducing disability and enhancing physical activity and health among adults living with HIV. METHODS AND ANALYSIS We will conduct a prospective longitudinal mixed-methods two-phased intervention study to pilot the implementation of an online CBE intervention with ~30 adults (≥18 years) living with HIV who consider themselves safe to participate in exercise. In the intervention phase (0-6 months), participants will take part in an online CBE intervention involving thrice weekly exercise (aerobic, resistance, balance and flexibility), with supervised biweekly personal training sessions with a fitness instructor, YMCA membership providing access to online exercise classes, wireless physical activity monitor to track physical activity and monthly online educational sessions on topics related to HIV, physical activity and health. In the follow-up phase (6-12 months), participants will be encouraged to continue independent exercise thrice weekly. Quantitative assessment: Bimonthly, we will assess cardiopulmonary fitness, strength, weight, body composition and flexibility, followed by administering self-reported questionnaires to assess disability, contextual factor outcomes (mastery, engagement in care, stigma, social support), implementation factors (cost, feasibility, technology), health status and self-reported physical activity. We will conduct a segmented regression analyses to describe the change in level and trend between the intervention and follow-up phases. Qualitative assessment: We will conduct online interviews with a subsample of ~10 participants and 5 CBE stakeholders at baseline (month 0), postintervention (month 6) and end of follow-up (month 12) to explore experiences, impact and implementation factors for online CBE. Interviews will be audiorecorded and analysed using content analytical techniques. ETHICS AND DISSEMINATION Protocol approved by the University of Toronto Research Ethics Board (Protocol # 40410). Knowledge translation will occur in the form of presentations and publications in open-access peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05006391.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | | | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Ontario, Canada
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kiera McDuff
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tizneem Jiancaro
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George Da Silva
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brittany Torres
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mona R Loutfy
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Shaz Islam
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Joanne Lindsay
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Colleen Price
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Ottawa, Ontario, Canada
| | - Mehdi Zobeiry
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Zoran Pandovski
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Ivan Illic
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | | | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa Avery
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Biostatistics Department, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Feldman MB, Tran TT, Boucher LM, Abdelqader F, Raker AR, Hile SJ. A process and impact evaluation of a peer-led HIV self-management program. EVALUATION AND PROGRAM PLANNING 2023; 96:102175. [PMID: 36459775 DOI: 10.1016/j.evalprogplan.2022.102175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 01/24/2022] [Accepted: 10/22/2022] [Indexed: 06/17/2023]
Abstract
There is evidence that people with HIV (PWH) receive health-related benefits from having peer support and learning self-management skills. This evaluation assessed the effect of The Positive Life Workshop (TPLW)-a 7-session peer-led HIV self-management program-on psychosocial and HIV treatment outcomes. The overall sample included 1360 PWH who completed TPLW during 3/2015-2/2019. Surveys were administered before and after the program, and three months following program completion. Analyses examined changes in outcomes from pre-test to both post-test and 3-month follow-up using non-parametric tests. Subgroup analyses were conducted for 406 participants with ≥ 1 characteristic of the priority population for TPLW (i.e., recent HIV diagnosis, not taking antiretroviral therapy (ART), suboptimal ART adherence, unsuppressed viral load). In the overall sample, there were statistically significant improvements in HIV-related knowledge, social support, patient self-advocacy, and confidence in self-management between pre-test and post-test/3-month follow-up assessment. Analyses for the priority population showed significant increases from pre-test to 3-month follow-up in the proportion of participants who were ≥ 90 % adherent to ART (59-83 %, p < 0.01) and virally suppressed (42 % to 66 %, p < 0.01). The findings suggest the importance of ensuring HIV self-management interventions reach vulnerable populations of PWH who struggle with initiating and maintaining HIV-related health-promoting behaviors.
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Affiliation(s)
- Matthew B Feldman
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States.
| | - Trang T Tran
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
| | - Lisa M Boucher
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent Ottawa, Ontario K1G 5Z3, Canada; C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario K1N 5C8, Canada
| | - Faisal Abdelqader
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
| | - Amanda R Raker
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
| | - Stephen J Hile
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
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Kumbhakar RG, Budak JZ, Tao Y, Beste J, Lake E, Navabi N, Mose E, Barker G, Lee J, Hara K, Khosropour C, Dhanireddy S, Dombrowski JC. The Impact of a Walk-in Human Immunodeficiency Virus Care Model for People Who Are Incompletely Engaged in Care: The Moderate Needs (MOD) Clinic. Open Forum Infect Dis 2023; 10:ofac670. [PMID: 36628059 PMCID: PMC9825197 DOI: 10.1093/ofid/ofac670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Background The Moderate Needs (MOD) Clinic in Seattle, Washington provides walk-in primary care for people with human immunodeficiency virus (HIV) who are incompletely engaged in standard care. Methods We evaluated HIV outcomes among patients enrolled in the MOD Clinic (within group analysis) and, separately, among MOD patients versus patients who were MOD-eligible but did not enroll (comparison group analysis) during January 1, 2018-September 30, 2021. The primary outcome was viral suppression ([VS] viral load <200 copies/mL); secondary outcomes care engagement (≥2 visits ≥60 days apart) and sustained VS (≥2 consecutive suppressed viral loads ≥60 days apart). In the within group analysis, we examined outcomes at time of MOD enrollment versus 12 months postenrollment. In the comparison group analysis, we examined outcomes at the time of MOD eligibility versus 12 months posteligibility. Both analyses used modified Poisson regression. Results Most patients in MOD (N = 213) were unstably housed (52%) and had psychiatric comorbidities (86%) or hazardous substance use (81%). Among patients enrolled ≥12 months (N = 164), VS did not increase significantly from baseline to postenrollment (63% to 71%, P = .11), but care engagement and sustained VS both improved (37% to 86%, P < .001 and 20% to 53%, P < .001, respectively) from pre-enrollment to 12 months postenrollment. In the comparison group analysis, VS worsened in nonenrolled patients (N = 517) from baseline to 12 months posteligibility (82% to 75%, P < .001). Patients in the MOD Clinic who met criteria for the comparison group analysis (N = 68) were more likely than nonenrolled patients to be engaged in care at 12 months posteligibility (relative risk, 1.29; 95% confidence interval, 1.03-1.63). Conclusions The MOD Clinic enrollment was associated with improved engagement in care. This model adds to the spectrum of differentiated HIV care services.
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Affiliation(s)
- Raaka G Kumbhakar
- Correspondence: Raaka G. Kumbhakar, MD, Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 325 9th Ave., Box 358061, Seattle, WA 98104 (). Julia C. Dombrowski, MD, MPH, 325 9th Ave., Box 359777, Seattle, WA 98104 ()
| | - Jehan Z Budak
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Yuan Tao
- Harborview Medical Center, Seattle, Washington, USA
| | - Jason Beste
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Eve Lake
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Nazlee Navabi
- Present Affiliation: Wise Patient Internal Medicine, Seattle, Washington, USA
| | - Eric Mose
- Harborview Medical Center, Seattle, Washington, USA
| | - Gwen Barker
- Harborview Medical Center, Seattle, Washington, USA
| | - Ji Lee
- Harborview Medical Center, Seattle, Washington, USA
- School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Katie Hara
- Present Affiliation: Bailey-Boushay House, Seattle, Washington, USA
| | | | - Shireesha Dhanireddy
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Julia C Dombrowski
- Correspondence: Raaka G. Kumbhakar, MD, Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 325 9th Ave., Box 358061, Seattle, WA 98104 (). Julia C. Dombrowski, MD, MPH, 325 9th Ave., Box 359777, Seattle, WA 98104 ()
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Dombrowski JC, Halliday S, Tsui JI, Rao D, Sherr K, Ramchandani MS, Emerson R, Fleming M, Wood T, Chwastiak L. Adaptation of the collaborative care model to integrate behavioral health care into a low-barrier HIV clinic. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231167105. [PMID: 37790178 PMCID: PMC10123894 DOI: 10.1177/26334895231167105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background The collaborative care management (CoCM) model is an evidence-based intervention for integrating behavioral health care into nonpsychiatric settings. CoCM has been extensively studied in primary care clinics, but implementation in nonconventional clinics, such as those tailored to provide care for high-need, complex patients, has not been well described. Method We adapted CoCM for a low-barrier HIV clinic that provides walk-in medical care for a patient population with high levels of mental illness, substance use, and housing instability. The Exploration, Preparation, Implementation, and Sustainment model guided implementation activities and support through the phases of implementing CoCM. The Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions guided our documentation of adaptations to process-of-care elements and structural elements of CoCM. We used a multicomponent strategy to implement the adapted CoCM model. In this article, we describe our experience through the first 6 months of implementation. Results The key contextual factors necessitating adaptation of the CoCM model were the clinic team structure, lack of scheduled appointments, high complexity of the patient population, and time constraints with competing priorities for patient care, all of which required substantial flexibility in the model. The process-of-care elements were adapted to improve the fit of the intervention with the context, but the core structural elements of CoCM were maintained. Conclusions The CoCM model can be adapted for a setting that requires more flexibility than the usual primary care clinic while maintaining the core elements of the intervention.
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Affiliation(s)
- Julia C. Dombrowski
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Scott Halliday
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Judith I. Tsui
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Kenneth Sherr
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Industrial & Systems Engineering, University of Washington, Seattle, WA, USA
| | - Meena S. Ramchandani
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Ramona Emerson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Mark Fleming
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Teagan Wood
- Department of Social Work, Harborview Medical Center, Seattle, WA, USA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Traynor SM, Schmidt RD, Gooden LK, Matheson T, Haynes L, Rodriguez A, Mugavero M, Jacobs P, Mandler R, Del Rio C, Carrico AW, Horigian VE, Metsch LR, Feaster DJ. Differential Effects of Patient Navigation across Latent Profiles of Barriers to Care among People Living with HIV and Comorbid Conditions. J Clin Med 2022; 12:114. [PMID: 36614917 PMCID: PMC9820894 DOI: 10.3390/jcm12010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/29/2022] [Accepted: 12/10/2022] [Indexed: 12/28/2022] Open
Abstract
Engaging people living with HIV who report substance use (PLWH-SU) in care is essential to HIV medical management and prevention of new HIV infections. Factors associated with poor engagement in HIV care include a combination of syndemic psychosocial factors, mental and physical comorbidities, and structural barriers to healthcare utilization. Patient navigation (PN) is designed to reduce barriers to care, but its effectiveness among PLWH-SU remains unclear. We analyzed data from NIDA Clinical Trials Network's CTN-0049, a three-arm randomized controlled trial testing the effect of a 6-month PN with and without contingency management (CM), on engagement in HIV care and viral suppression among PLWH-SU (n = 801). Latent profile analysis was used to identify subgroups of individuals' experiences to 23 barriers to care. The effects of PN on engagement in care and viral suppression were compared across latent profiles. Three latent profiles of barriers to care were identified. The results revealed that PN interventions are likely to be most effective for PLWH-SU with fewer, less severe healthcare barriers. Special attention should be given to individuals with a history of abuse, intimate partner violence, and discrimination, as they may be less likely to benefit from PN alone and require additional interventions.
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Affiliation(s)
- Sharleen M. Traynor
- Clinical Trials Research Associate Program, Durham Technical Community College, Durham, NC 27703, USA
| | - Renae D. Schmidt
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Lauren K. Gooden
- Sociomedical Sciences Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Tim Matheson
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA 94102, USA
| | - Louise Haynes
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Allan Rodriguez
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Michael Mugavero
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Blvd # 229, Birmingham, AL 35233, USA
| | - Petra Jacobs
- Center for Clinical Trials Network, National Institute on Drug Abuse, Rockville, MD 20892, USA
| | - Raul Mandler
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA
| | - Carlos Del Rio
- Division of Infectious Diseases, Emory University, Atlanta, GA 30322, USA
| | - Adam W. Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Viviana E. Horigian
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Lisa R. Metsch
- Sociomedical Sciences Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
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Ross JL, Jiamsakul A, Avihingsanon A, Lee MP, Ditangco R, Choi JY, Rajasuriar R, Gatechompol S, Chan I, Melgar MIE, Kim JH, Chong ML, Sohn AH, Law M. Prevalence and Risks of Depression and Substance Use Among Adults Living with HIV in the Asia-Pacific Region. AIDS Behav 2022; 26:3862-3877. [PMID: 35668223 PMCID: PMC9170121 DOI: 10.1007/s10461-022-03714-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/01/2022]
Abstract
Despite the mental health and substance use burden among people living with HIV (PLHIV) in the Asia-Pacific, data on their associations with HIV clinical outcomes are limited. This cross-sectional study of PLHIV at five sites assessed depression and substance use using PHQ-9 and ASSIST. Among 864 participants, 88% were male, median age was 39 years, 97% were on ART, 67% had an HIV viral load available and < 1000 copies/mL, 19% had moderate-to-severe depressive symptoms, and 80% had ever used at least one substance. Younger age, lower income, and suboptimal ART adherence were associated with moderate-to-severe depressive symptoms. Moderate-to-high risk substance use, found in 62% of users, was associated with younger age, being male, previous stressors, and suboptimal adherence. Our findings highlight the need for improved access to mental health and substance use services in HIV clinical settings.
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Affiliation(s)
- Jeremy L Ross
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand.
| | | | | | - Man Po Lee
- Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong SAR, China
| | - Rossana Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | - Iris Chan
- Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong SAR, China
| | - Maria Isabel Echanis Melgar
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
- Ateneo de Manila University, Quezon City, Philippines
| | - Jung Ho Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Annette H Sohn
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, Australia
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López JD, Qiao Q, Presti RM, Hammer RA, Foraker RE. The impact of neighborhood socioeconomic status on retention in care and viral suppression among people living with HIV. AIDS Care 2022; 34:1383-1389. [PMID: 35164602 DOI: 10.1080/09540121.2022.2040724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Our study combined publicly available neighborhood socioeconomic status (nSES) data from the U.S. Census and clinical data to investigate the relationships between nSES, retention in care (RIC) and viral suppression (VS). Data from 2275 patients were extracted from 2009 to 2015 from a midwestern infectious diseases clinic. RIC was defined as patients who kept ≥ 3 visits and VS as an average viral load <200 copies/mL during their index year of study. Logistic regression models provided estimates for neighborhood-level and patient-level variables. In multivariable models, patients living in zip codes with low disability rates (1.50, 1.30-1.70), who wereolder (1.02, 1.01-1.03), and receiving antiretroviral therapy (ART; 3.81, 3.56-4.05) were more likely to have RIC, while those who were unemployed (0.72, 0.45-0.98) and self-reported as BIPOC (0.79, 0.64-0.97) were less likely to have RIC. None of the nSES variables were significantly associated with VS in multivariable models, yet older age (1.05, 1.04-1.05) and self-reported as BIPOC (1.68, 1.36-2.09) were modestly associated with VS, and receiving ART (6.14, 5.86-6.42) was a strong predictor of VS. In multivariable models, nSES variables were independently predictive more than of patient-level variables, for RIC but not VS.
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Affiliation(s)
- Julia D López
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO, USA
| | - Qisha Qiao
- Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Rachel M Presti
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO, USA
| | - Rachel A Hammer
- Department of Plant and Microbial Biology, North Carolina State University, Raleigh, NC, USA
| | - Randi E Foraker
- Department of Internal Medicine, Institute for Informatics, Washington University School of Medicine, Saint Louis, MO, USA
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O'Brien KK, Solomon P, Carusone SC, Erlandson KM, Bergin C, Bayoumi AM, Hanna SE, Harding R, Brown DA, Vera JH, Boffito M, Murray C, Aubry R, O'Shea N, St Clair-Sullivan N, Boyd M, Swinton M, Torres B, Davis AM. Assessing the sensibility and utility of a short-form version of the HIV Disability Questionnaire in clinical practice settings in Canada, Ireland and the USA: a mixed methods study. BMJ Open 2022; 12:e062008. [PMID: 36175103 PMCID: PMC10098270 DOI: 10.1136/bmjopen-2022-062008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The Short-Form HIV Disability Questionnaire (SF-HDQ) was developed to measure the presence, severity and episodic nature of health challenges across six domains. Our aim was to assess the sensibility, utility and implementation of the SF-HDQ in clinical practice. DESIGN Mixed methods study design involving semistructured interviews and questionnaire administration. PARTICIPANTS We recruited adults living with HIV and HIV clinicians in Canada, Ireland and the USA. METHODS We electronically administered the SF-HDQ followed by a Sensibility Questionnaire (face and content validity, ease of usage, format) and conducted semistructured interviews to explore the utility and implementation of the SF-HDQ in clinical practice. The threshold for sensibility was a median score of >5/7 (adults living with HIV) and>4/7 (HIV clinicians) for ≥80% of items. Qualitative interview data were analysed using directed content analysis. RESULTS Median sensibility scores were >5 (adults living with HIV; n=29) and >4 (HIV clinicians; n=16) for 18/19 (95%) items. Interview data indicated that the SF-HDQ represents the health-related challenges of living with HIV and other concurrent health conditions; captures the daily episodic nature of HIV; and is easy to use. Clinical utility included measuring health challenges and change over time, guiding referral to specialists and services, setting goals, facilitating communication and fostering a multidisciplinary approach to care. Considerations for implementation included flexible, person-centred approaches to administration, and communicating scores based on personal preferences. CONCLUSIONS The SF-HDQ possesses sensibility and utility for use in clinical settings with adults living with HIV and HIV clinicians in three countries.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Instiute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Casey House, Toronto, Ontario, Canada
| | | | - Colm Bergin
- Department of Genitourinary and Infectious Diseases (GUIDE) Clinic, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Steven E Hanna
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Rachel Aubry
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Noreen O'Shea
- Department of Genitourinary and Infectious Diseases (GUIDE) Clinic, St James's Hospital, Dublin, Ireland
| | | | - Mallory Boyd
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marilyn Swinton
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Brittany Torres
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Aileen M Davis
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Kay ES, Creasy S, Batey DS, Coulter R, Egan JE, Fisk S, Friedman MR, Kinsky S, Krier S, Noble V, Turan B, Turan JM, Yu L, Hawk M. Impact of harm reduction care in HIV clinical settings on stigma and health outcomes for people with HIV who use drugs: study protocol for a mixed-methods, multisite, observational study. BMJ Open 2022; 12:e067219. [PMID: 36113946 PMCID: PMC9486355 DOI: 10.1136/bmjopen-2022-067219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/26/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Our previous pilot work suggests relational harm reduction strengthens relationships between people with HIV (PWH) who use drugs and their healthcare providers and improves HIV health outcomes. However, there is limited research examining ways that structural (eg, strategies like syringe service programmes) and/or relational (patient-provider relationship) harm reduction approaches in HIV clinical settings can mitigate experiences of stigma, affect patient-provider relationships and improve outcomes for PWH who use drugs. Our mixed methods, multisite, observational study aims to fill this knowledge gap and develop an intervention to operationalise harm reduction care for PWH who use drugs in HIV clinical settings. METHODS AND ANALYSIS Aim 1 will explore the relationship between healthcare providers' stigmatising attitudes towards working with PWH who use drugs and providers' acceptance and practice of structural and relational harm reduction through surveys (n=125) and interviews (n=20) with providers. Aim 2 will explore the interplay between patient-perceived harm reduction, intersectional stigma and clinical outcomes related to HIV, hepatitis C (if applicable) and substance use-related outcomes through surveys (n=500) and focus groups (k=6, total n=36) with PWH who use drugs. We will also psychometrically evaluate a 25-item scale we previously developed to assess relational harm reduction, the Patient Assessment of Provider Harm Reduction Scale. Aim 3 will use human-centred design approaches to develop and pretest an intervention to operationalise harm reduction care for PWH who use drugs in HIV clinical settings. ETHICS AND DISSEMINATION This study was approved via expedited review by the University of Pittsburgh Institutional Review Board (STUDY21090002). Study findings will be presented in peer-reviewed journals and public health conferences as well as shared with patient participants, community advisory boards and harm reduction organisations. TRIAL REGISTRATION NUMBER NCT05404750.
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Affiliation(s)
- Emma Sophia Kay
- Magic City Research Institute, Birmingham AIDS Outreach, Birmingham, Alabama, USA
| | - Stephanie Creasy
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - D Scott Batey
- Department of Social Work, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert Coulter
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stuart Fisk
- Center for Inclusion Health, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Mackey Reuel Friedman
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Sarah Krier
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Victor Noble
- Center for Inclusion Health, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Bulent Turan
- Department of Psychology, Koc Universitesi, Istanbul, Turkey
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lan Yu
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary Hawk
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Lewis MA, Harshbarger C, Bann C, Marconi VC, Somboonwit C, Piazza MD, Swaminathan S, Burrus O, Galindo C, Borkowf CB, Marks G, Karns S, Zulkiewicz B, Ortiz A, Abdallah I, Garner BR, Courtenay-Quirk C. Effectiveness of an Interactive, Highly Tailored "Video Doctor" Intervention to Suppress Viral Load and Retain Patients With HIV in Clinical Care: A Randomized Clinical Trial. J Acquir Immune Defic Syndr 2022; 91:58-67. [PMID: 35972854 PMCID: PMC9377499 DOI: 10.1097/qai.0000000000003045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND To determine whether Positive Health Check, a highly tailored video doctor intervention, can improve viral suppression and retention in care. SETTING Four clinics that deliver HIV primary care. METHODS A hybrid type 1 effectiveness-implementation randomized trial design was used to test study hypotheses. Participants (N = 799) who were not virally suppressed, were new to care, or had fallen out of care were randomly assigned to receive Positive Health Check or the standard of care alone. The primary endpoint was viral load suppression, and the secondary endpoint was retention in care, both assessed at 12 months, using an intention-to-treat approach. A priori subgroup analyses based on sex assigned at birth and race were examined as well. RESULTS There were no statistically significant differences between Positive Health Check (N = 397) and standard of care (N = 402) for either endpoint. However, statistically significant group differences were identified from a priori subgroup analyses. Male participants receiving Positive Health Check were more likely to achieve suppression at 12 months than male participants receiving standard of care adjusted risk ratio [aRR] [95% confidence interval (CI)] = 1.14 (1.00 to 1.29), P = 0.046}. For retention in care, there was a statistically significant lower risk for a 6-month visit gap in the Positive Health Check arm for the youngest participants, 18-29 years old [aRR (95% CI) = 0.55 (0.33 to 0.92), P = 0.024] and the oldest participants, 60-81 years old [aRR (95% CI) = 0.49 (0.30 to 0.81), P = 0.006]. CONCLUSIONS Positive Health Check may help male participants with HIV achieve viral suppression, and younger and older patients consistently attend HIV care. REGISTRY NAME Positive Health Check Evaluation Trial. Trial ID: 1U18PS004967-01. URL: https://clinicaltrials.gov/ct2/show/NCT03292913.
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Affiliation(s)
| | - Camilla Harshbarger
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Vincent C. Marconi
- Division of Infectious Diseases, Emory University School of Medicine, Emory Vaccine Center, and Rollins School of Public Health, Atlanta, Georgia; VA Medical Center, Decatur, GA
| | | | | | | | | | - Carla Galindo
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Craig B. Borkowf
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gary Marks
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | | | - Cari Courtenay-Quirk
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Samba BO, Lewis-Kulzer J, Odhiambo F, Juma E, Mulwa E, Kadima J, Bukusi EA, Cohen CR. Exploring Estimates and Reasons for Lost to Follow-Up Among People Living With HIV on Antiretroviral Therapy in Kisumu County, Kenya. J Acquir Immune Defic Syndr 2022; 90:146-153. [PMID: 35213856 PMCID: PMC9203903 DOI: 10.1097/qai.0000000000002942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND A better understanding why people living with HIV (PLHIV) become lost to follow-up (LTFU) and determining who is LTFU in a program setting is needed to attain HIV epidemic control. SETTING This retrospective cross-sectional study used an evidence-sampling approach to select health facilities and LTFU patients from a large HIV program supporting 61 health facilities in Kisumu County, Kenya. METHODS Eligible PLHIV included adults 18 years and older with at least 1 clinic visit between September 1, 2016, and August 31, 2018, and were LTFU (no clinical contact for ≥90 days after their last expected clinic visit). From March to June 2019, demographic and clinical variables were collected from a sample of LTFU patient files at 12 health facilities. Patient care status and retention outcomes were determined through program tracing. RESULTS Of 787 LTFU patients selected and traced, 36% were male, median age was 30.5 years (interquartile range: 24.6-38.0), and 78% had their vital status confirmed with 560 (92%) alive and 52 (8%) deceased. Among 499 (89.0%) with a retention outcome, 233 (46.7%) had stopped care while 266 (53.3%) had self-transferred to another facility. Among those who had stopped care, psychosocial reasons were most common {65.2% [95% confidence interval (CI): 58.9 to 71.1]} followed by structural reasons [29.6% (95% CI: 24.1 to 35.8)] and clinic-based reasons [3.0% (95% CI: 1.4 to 6.2)]. CONCLUSION We found that more than half of patients LTFU were receiving HIV care elsewhere, leading to a higher overall patient retention rate than routinely reported. Similar strategies could be considered to improve the accuracy of reporting retention in HIV care.
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Affiliation(s)
- Benard O Samba
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Jayne Lewis-Kulzer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA; and
| | - Francesca Odhiambo
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Eric Juma
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Edwin Mulwa
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Julie Kadima
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Elizabeth A Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA; and
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45
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Galaviz KI, Shah NS, Gutierrez M, Collins LF, Lahiri CD, Moran CA, Szabo B, Sumitani J, Rhodes J, Marconi VC, Nguyen ML, Cantos VD, Armstrong WS, Colasanti JA. Patient Experiences with Telemedicine for HIV Care During the First COVID-19 Wave in Atlanta, Georgia. AIDS Res Hum Retroviruses 2022; 38:415-420. [PMID: 34693726 PMCID: PMC9206466 DOI: 10.1089/aid.2021.0109] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We explored experiences with telemedicine among persons with HIV (PWH) during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. A convenience sample of adults (>18 years) receiving care in an urban clinic in Atlanta were invited to participate. Patients completed a structured survey that assessed the usefulness, quality, satisfaction, and concerns with telemedicine services (telephone calls) received during the first wave of the COVID-19 pandemic (March-May 2020). Demographic, plasma HIV-1 RNA, and CD4+ T cell count data were obtained through medical chart abstraction. Bootstrapped t-tests and chi-square tests were used to examine differences in patient experiences by age, sex, and race. Of 406 PWH contacted, 101 completed the survey (median age 55 years, 84% men, 77% Black, 98% virally suppressed, median CD4 count 572 cells/μL). The main HIV care disruptions experienced were delays in follow-up visits (40%), difficulty getting viral load measured (35%), and difficulty accessing antiretroviral therapy (21%). Participant ratings for quality (median score 6.5/7), usefulness (median score 6.0/7), and satisfaction (median score 6.3/7) with telemedicine were high. However, 28% of patients expressed concerns about providers' ability to examine them and about the lack of laboratory tests. More women had concerns about providers' ability to examine them (92% vs. 50%, p = .005) and about the safety of their personal information (69% vs. 23%, p = .002) compared with men. No age or race differences were observed. Although PWH are generally satisfied with telephone-based telemedicine, concerns with its use were notable, particularly among women. Future HIV telemedicine models should address these.
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Affiliation(s)
- Karla I. Galaviz
- Indiana University School of Public Health, Bloomington, Indiana, USA
| | - N. Sarita Shah
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Mariana Gutierrez
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Lauren F. Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Cecile D. Lahiri
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Caitlin A. Moran
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | | | | | - Jeselyn Rhodes
- Emory University, Office of Information Technology, IT Data Solutions, Atlanta, Georgia, USA
| | - Vincent C. Marconi
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Minh Ly Nguyen
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Valeria D. Cantos
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Wendy S. Armstrong
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Jonathan A. Colasanti
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
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Higa DH, Crepaz N, Mullins MM, Adegbite-Johnson A, Gunn JKL, Denard C, Mizuno Y. Strategies to improve HIV care outcomes for people with HIV who are out of care. AIDS 2022; 36:853-862. [PMID: 35025818 PMCID: PMC10167711 DOI: 10.1097/qad.0000000000003172] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of five intervention strategies: patient navigation, appointment help/alerts, psychosocial support, transportation/appointment accompaniment, and data-to-care on HIV care outcomes among persons with HIV (PWH) who are out of care (OOC). DESIGN A systematic review with meta-analysis. METHODS We searched CDC's Prevention Research Synthesis (PRS) Project's cumulative HIV database to identify intervention studies conducted in the U.S., published between 2000 and 2020 that included comparisons between groups or prepost, and reported at least one relevant outcome (i.e. re-engagement or retention in HIV care, and viral suppression). Effect sizes were meta-analyzed using random-effect models to assess intervention effectiveness. RESULTS Thirty-nine studies reporting on 42 unique interventions met the inclusion criteria. Overall, intervention strategies are effective in improving re-engagement in care [odds ratio (OR) = 1.79;95% confidence interval (95% CI): 1.36-2.36, k = 14], retention in care (OR = 2.01; 95% CI: 1.64-2.64, k = 22), and viral suppression (OR = 2.50;95% CI: 1.87-3.34, k = 27). Patient navigation, appointment help/alerts, psychosocial support, and transportation/appointment accompaniment improved all three HIV care outcomes. Data-to-care improved re-engagement and retention but had insufficient evidence for viral suppression. CONCLUSION Several strategies are effective for improving HIV care outcomes among PWH who are OOC. More work is still needed for consistent definitions of OOC and HIV care outcomes, better reporting of intervention and cost data, and identifying how best to implement and scale-up effective strategies to engage and retain OOC PWH in care and reach the ending the HIV epidemic goals.
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Affiliation(s)
- Darrel H Higa
- Division of HIV Prevention, Centers for Disease Control and Prevention
| | - Nicole Crepaz
- Division of HIV Prevention, Centers for Disease Control and Prevention
| | - Mary M Mullins
- Division of HIV Prevention, Centers for Disease Control and Prevention
| | | | - Jayleen K L Gunn
- Division of HIV Prevention, Centers for Disease Control and Prevention
- U.S. Public Health Service
| | | | - Yuko Mizuno
- Division of HIV Prevention, Centers for Disease Control and Prevention
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Baseline and Process Factors of Anti-Retroviral Therapy That Predict Loss to Follow-up Among People Living with HIV/AIDS in China: A Retrospective Cohort Study. AIDS Behav 2022; 26:1126-1137. [PMID: 34698955 DOI: 10.1007/s10461-021-03466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
We explored the predictors and predictive models of loss to follow-up (LTFU) during the first year of anti-retroviral therapy (ART). LTFU was defined as the failure to visit the clinic for antiretroviral drugs for ≥ 90 days after the last missed scheduled visit. Based on the electronic medical records of 5953 patients who were HIV positive and began ART between 2016 and 2019 in China, the LTFU rate was 7.24 (95% confidence interval 6.49-7.97) per 100 person-years during the first year of ART. ART baseline factors were associated with LTFU, but were non-optimal predictors. A model including ART process-related factors such as follow-up behaviors and physical health status had an area under the receiver operating characteristic curve of 73.4% for predicting LTFU. Therefore, the medical records of follow-up visits can be used to identify patients with a high risk of LTFU and allow interventions to be implemented proactively.
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48
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Linthwaite B, Kronfli N, Marbaniang I, Ruppenthal L, Lessard D, Engler K, Lebouché B, Cox J. Increased reengagement of out-of-care HIV patients using Lost & Found, a clinic-based intervention. AIDS 2022; 36:551-560. [PMID: 34897240 PMCID: PMC8876436 DOI: 10.1097/qad.0000000000003147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 11/30/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Negative health outcomes associated with being out of HIV care (OOC) warrant reengagement strategies. We aimed to assess effectiveness of Lost & Found, a clinic-based intervention to identify and reengage OOC patients. METHODS Developed and delivered using implementation science, Lost & Found consists of two core elements: identification, operationalized through nurse validation of a real-time list of possible OOC patients; and contact, via nurse-led phone calls. It was implemented over a 12-month period (2018-2019) at the Chronic Viral Illness Service, McGill University Health Centre (CVIS-MUHC) during a type-II implementation-effectiveness hybrid pilot study. Descriptive outcomes of interest were identification as possibly OOC, OOC confirmation, contact, and successful reengagement. We present results from a pre-post analysis comparing overall reengagement to the year prior, using robust Poisson regression controlled for sex, age, and Canadian birth. Time to reengagement is reported using a Cox proportional hazards model. RESULTS Over half (56%; 1312 of 2354) of CVIS-MUHC patients were identified as possibly OOC. Among these, 44% (n = 578) were followed elsewhere, 19% (n = 249) engaged in care, 3% (n = 33) deceased, 2% (n = 29) otherwise not followed, and 32% (n = 423) OOC. Of OOC patients contacted (85%; 359/423), 250 (70%) reengaged and 40 (11%) had upcoming appointments; the remainder were unreachable, declined care, or missed given appointments. Pre-post results indicate people who received Lost & Found were 1.18 [95% confidence interval (CI) 1.02-1.36] times more likely to reengage, and reengaged a median 55 days (95% CI 14-98) sooner. CONCLUSION Lost & Found may be a viable clinic-based reengagement intervention for OOC patients. More robust evaluations are needed.
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Affiliation(s)
- Blake Linthwaite
- Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Nadine Kronfli
- Research Institute of the McGill University Health Centre (RI-MUHC)
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
| | - Ivan Marbaniang
- Department of Epidemiology, Biostatistics, and Occupational Health
| | - Luciana Ruppenthal
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
| | - David Lessard
- Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Kim Engler
- Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Bertrand Lebouché
- Research Institute of the McGill University Health Centre (RI-MUHC)
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Centre (RI-MUHC)
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
- Department of Epidemiology, Biostatistics, and Occupational Health
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49
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Laher AE. Improving outcomes after hospitalisation in people with HIV. Lancet HIV 2022; 9:e140-e141. [PMID: 35245504 DOI: 10.1016/s2352-3018(22)00007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Abdullah E Laher
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa.
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50
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Friedman EE, Devlin SA, Gilson SF, Ridgway JP. Age and Racial Disparities in Telehealth Use Among People with HIV During the COVID-19 Pandemic. AIDS Behav 2022; 26:2686-2691. [PMID: 35133528 PMCID: PMC9256787 DOI: 10.1007/s10461-022-03607-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 12/04/2022]
Abstract
The COVID-19 pandemic resulted in widespread telehealth expansion. To determine telehealth uptake and potential sociodemographic differences in utilization among people with HIV (PwH), we examined HIV care appointments at the University of Chicago Medicine, an urban tertiary hospital. Visits between March 15th and September 9th for 2019 and 2020 were categorized as in-person, telehealth, and within telehealth, video, and phone. Differences in visit types were modeled using logistic regression to examine associations with demographics, insurance type, and HIV risk transmission category. Telehealth appointments were more likely for those aged 46–60 versus those 31–45 [46–60; AOR 1.89 95% CI (1.14, 3.15)]. Black race and participants of other races were less likely to use telehealth compared to whites [Black: AOR 0.33 95% CI (0.16, 0.64), other: AOR 0.10 95% CI (0.02, 0.34)]. Future studies should continue to examine potential disparities in telehealth use among PwH, including age and racial differences.
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