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Quan NK, Taylor-Robinson AW. Vietnam's Evolving Healthcare System: Notable Successes and Significant Challenges. Cureus 2023; 15:e40414. [PMID: 37456482 PMCID: PMC10348075 DOI: 10.7759/cureus.40414] [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: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
From regional and rural grassroots to a nationwide level, Vietnam has established a four-tiered hierarchical healthcare system, comprising national, provincial, district, and commune healthcare centers. Over the last three decades, alongside increasing provision of universal health insurance coverage and cutting healthcare expenditure, the country has demonstrated its dedication to preventative medicine and health promotion. Recent investment in research, development, and production has led to "homegrown" vaccines for SARS-CoV-2 now undergoing clinical trial. Nevertheless, despite substantial progress in improving health outcomes for the entire population, the healthcare sector experiences significant challenges. The current public system is paper-based, requires digitalization, and lacks information technology support. In common with many other countries, there is a vast disparity in the distribution of healthcare professionals between cities and rural areas, as well as between private and public sectors. Consequently, public healthcare in remote locations is particularly underserved. Moreover, ongoing underfunding caused by high out-of-pocket expenses for the average salary, as well as stigmatization of sensitive health issues by a largely conservative populace, demand a well-articulated and culturally sensitive approach. As the level of smartphone ownership and internet coverage are both comparatively high for Southeast Asia, the introduction of telemedicine, mobile health applications, and other digital health solutions may be both practicable and beneficial. Importantly, in order to develop healthcare facilities and reduce patient direct payments, the key issue of funding must be addressed. In order to overcome disease-related stigma, a locally tailored program of community education, awareness, and engagement is required. In summary, in several ways, Vietnam provides a role model for developing healthcare systems in low- and middle-income countries. There are undoubted hurdles to overcome, but the country continues to construct a healthcare system that is accessible and affordable for the majority.
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Affiliation(s)
- Nguyen K Quan
- Epidemiology and Public Health, College of Health Sciences, VinUniversity, Hanoi, VNM
| | - Andrew W Taylor-Robinson
- Epidemiology and Public Health, College of Health Sciences, VinUniversity, Hanoi, VNM
- Epidemiology and Public Health, Center for Global Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
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Giang HT, Duc NQ, Khue PM, Quillet C, Oanh KTH, Thanh NTT, Vallo R, Feelemyer J, Vinh VH, Rapoud D, Michel L, Laureillard D, Moles JP, Jarlais DD, Nagot N, Huong DT. Gender Differences in HIV, HCV risk and Prevention Needs Among People who Inject drug in Vietnam. AIDS Behav 2022; 27:1989-1997. [PMID: 36441408 PMCID: PMC10149475 DOI: 10.1007/s10461-022-03932-x] [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: 11/12/2022] [Indexed: 11/30/2022]
Abstract
We examined gender differences among people who inject drug (PWID) in Hai Phong, Vietnam in term of blood-borne infections, risk behaviors, and access to care. Using respondent-driven-sampling surveys, we recruited 3146 PWID from 2016 to 2018. Inclusion criteria included a positive urine test for heroin and recent injection marks. There were 155 female PWID (4,9%), including 82 at RDS-2016, 32 at RDS-2017 and 38 at RDS-2018. The age mean was 36.3 ± 7.2 years. The majority of female PWID had less than high school education (90.9%) and were unemployed (51.3%). There was no difference in the proportion of HIV and HCV positive by gender. However, women had several significant differences in risk behaviors than men in multivariable logistic regression. Being a woman was independently associated with being unemployed, being a sex worker, having unstable housing, having uses drugs for less than 5 years, more use of methamphetamine, having a partner who ever injected drugs, and less access to methadone treatment. Interventions targeting female PWID are needed, possibly through community organizations and peer educators.
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Affiliation(s)
- Hoang Thi Giang
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam.
| | - Nguyen Quang Duc
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam
| | - Pham Minh Khue
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam
| | - Catherine Quillet
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | | | | | - Roselyne Vallo
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | | | - Vu Hai Vinh
- Dept of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Delphine Rapoud
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | - Laurent Michel
- Pierre Nicole Center, CESP/Inserm 1018, French Red Cross, Paris, France
| | - Didier Laureillard
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Nîmes, France
| | - Jean Pierre Moles
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | | | - Nicolas Nagot
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | - Duong Thi Huong
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam
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Coomes D, Green D, Barnabas R, Sharma M, Barr-DiChiara M, Jamil MS, Baggaley R, Owiredu MN, Macdonald V, Nguyen VTT, Vo SH, Taylor M, Wi T, Johnson C, Drake AL. Cost-effectiveness of implementing HIV and HIV/syphilis dual testing among key populations in Viet Nam: a modelling analysis. BMJ Open 2022; 12:e056887. [PMID: 35953255 PMCID: PMC9379490 DOI: 10.1136/bmjopen-2021-056887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Key populations, including sex workers, men who have sex with men, and people who inject drugs, have a high risk of HIV and sexually transmitted infections. We assessed the health and economic impacts of different HIV and syphilis testing strategies among three key populations in Viet Nam using a dual HIV/syphilis rapid diagnostic test (RDT). SETTING We used the spectrum AIDS impact model to simulate the HIV epidemic in Viet Nam and evaluated five testing scenarios among key populations. We used a 15-year time horizon and a provider perspective for costs. PARTICIPANTS We simulate the entire population of Viet Nam in the model. INTERVENTIONS We modelled five testing scenarios among key populations: (1) annual testing with an HIV RDT, (2) annual testing with a dual RDT, (3) biannual testing using dual RDT and HIV RDT, (4) biannual testing using HIV RDT and (5) biannual testing using dual RDT. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome is incremental cost-effectiveness ratios. Secondary outcomes include HIV and syphilis cases. RESULTS Annual testing using a dual HIV/syphilis RDT was cost-effective (US$10 per disability-adjusted life year (DALY)) and averted 3206 HIV cases and treated 27 727 syphilis cases compared with baseline over 15 years. Biannual testing using one dual test and one HIV RDT (US$1166 per DALY), or two dual tests (US$5672 per DALY) both averted an additional 875 HIV cases, although only the former scenario was cost-effective. Annual or biannual HIV testing using HIV RDTs and separate syphilis tests were more costly and less effective than using one or two dual RDTs. CONCLUSIONS Annual HIV and syphilis testing using dual RDT among key populations is cost-effective in Vietnam and similar settings to reach global reduction goals for HIV and syphilis.
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Affiliation(s)
- David Coomes
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Dylan Green
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Ruanne Barnabas
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Magdalena Barr-DiChiara
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S Jamil
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - R Baggaley
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Morkor Newman Owiredu
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Virginia Macdonald
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | - Son Hai Vo
- Viet Nam Authority for HIV/AIDS Prevention and Control, Government of Viet Nam Ministry of Health, Hanoi, Viet Nam
| | - Melanie Taylor
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Teodora Wi
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl Johnson
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Alison L Drake
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
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Pollack TM, Duong HT, Nhat Vinh DT, Phuong DT, Thuy DH, Nhung VTT, Uyen NK, Linh VT, Van Truong N, Le Ai KA, Ninh NT, Nguyen A, Canh HD, Cosimi LA. A pretest-posttest design to assess the effectiveness of an intervention to reduce HIV-related stigma and discrimination in healthcare settings in Vietnam. J Int AIDS Soc 2022; 25 Suppl 1:e25932. [PMID: 35818864 PMCID: PMC9274370 DOI: 10.1002/jia2.25932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/03/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Stigma and discrimination are important barriers to HIV epidemic control. We implemented a multi‐pronged facility‐level intervention to reduce stigma and discrimination at health facilities across three high‐burden provinces. Key components of the intervention included measurement of stigma, data review and use, participatory training of healthcare workers (HCWs), and engagement of people living with HIV and key populations in all stigma reduction activities. Methods From July 2018 to July 2019, we assessed HIV‐related stigma and discrimination among patients and HCWs at 10 facilities at baseline and 9 months following an intervention. A repeated measures design was used to assess the change in stigma and discrimination among HCWs and a repeated cross‐sectional design assessed the change in stigma and discrimination experienced by PLHIV. HCWs at target facilities were invited at random and PLHIV were recruited when presenting for care during the two assessment periods. McNemar's test was used to compare paired proportions among HCWs, and chi‐square test was used to compare proportions among PLHIV. Mixed models were used to compare outcomes before and after the intervention. Results Semi‐structured interviews were conducted with 649 and 652 PLHIV prior to and following the intervention, respectively. At baseline, over the previous 12 months, 21% reported experiencing discrimination, 16% reported self‐stigma, 14% reported HIV disclosure without consent and 7% had received discriminatory reproductive health advice. Nine months after the intervention, there was a decrease in reported stigma and discrimination across all domains to 15%, 11%, 7% and 3.5%, respectively (all p‐values <0.05). Among HCWs, 672 completed the pre‐ and post‐intervention assessment. At baseline, 81% reported fear of HIV infection, 69% reported using unnecessary precautions when caring for PLHIV, 44% reported having observed other staff discriminate against PLHIV, 54% reported negative attitudes towards PLHIV and 41% felt uncomfortable working with colleagues living with HIV. The proportions decreased after the intervention to 52%, 34%, 32%, 35% and 24%, respectively (all p‐values <0.05). Conclusions A multi‐pronged facility‐level intervention was successful at reducing healthcare‐associated HIV‐related stigma in Vietnam. The findings support the scale‐up of this intervention in Vietnam and highlight key components potentially applicable in other settings.
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Affiliation(s)
- Todd M Pollack
- Partnership for Health Advancement in Vietnam, Hanoi, Vietnam.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Baylor College of Medicine, Houston, Texas, USA
| | - Hao Thi Duong
- Partnership for Health Advancement in Vietnam, Hanoi, Vietnam.,Baylor College of Medicine, Houston, Texas, USA
| | | | - Do Thi Phuong
- Partnership for Health Advancement in Vietnam, Hanoi, Vietnam
| | - Do Huu Thuy
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | | | | | - Vuong The Linh
- Binh Duong Center for Disease Control, Binh Duong, Vietnam
| | | | - Kim Anh Le Ai
- Thai Nguyen Center for Disease Control, Thai Nguyen, Vietnam
| | | | - Asia Nguyen
- Division of Global HIV and TB, Center for Global Health, United States Centers for Disease Control and Prevention Vietnam, Hanoi, Vietnam
| | - Hoang Dinh Canh
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Lisa A Cosimi
- Partnership for Health Advancement in Vietnam, Hanoi, Vietnam.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Brown PCM, Thuy DTT, Edsall A, Hang NT, Mai PP, Hoffman K, Bart G, Korthuis PT, Giang LM. Familial support in integrated treatment with antiretroviral therapy and medications for opioid use disorder in Vietnam: A qualitative study. Subst Abus 2022; 43:1004-1010. [PMID: 35435799 PMCID: PMC9678077 DOI: 10.1080/08897077.2022.2060435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Patients report that familial support can facilitate initiation and maintenance of antiretroviral therapy (ART) and medications for opioid use disorder (MOUD). However, providing such support can create pressure and additional burdens for families of people with opioid use disorder (OUD) and HIV. We examined perspectives of people with HIV receiving treatment for OUD in Vietnam and their family members. Methods: Between 2015 and 2018, we conducted face-to-face qualitative interviews with 44 patients and 30 of their family members in Hanoi, Vietnam. Participants were people living with HIV and OUD enrolled in the BRAVO study comparing HIV clinic-based buprenorphine with referral to methadone treatment at 4 HIV clinics and their immediate family members (spouses or parents). Interviews were professionally transcribed, coded in Vietnamese, and analyzed using a semantic, inductive approach to qualitative thematic analysis. Results: Family members of people with OUD and HIV in Vietnam reported financially and emotionally supporting MOUD initiation and maintenance as well as actively participating in treatment. Family members described the burdens of supporting patients during opioid use, including financial costs and secondary stigma. Conclusions: Describing the role of family support in the lives of people living with OUD and HIV in the context of Vietnam enriches our understanding of their experiences and will support future treatment efforts targeting the family unit.
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Affiliation(s)
| | | | - Andrew Edsall
- Oregon Health & Science University School of Medicine
| | | | | | - Kim Hoffman
- Portland State University-Oregon Health & Science University School of Public Health, Portland, OR
| | - Gavin Bart
- University of Minnesota Medical School and Hennepin Healthcare
| | - P. Todd Korthuis
- Oregon Health & Science University School of Medicine,Portland State University-Oregon Health & Science University School of Public Health, Portland, OR
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Dat VQ, Lyss S, Dung NTH, Hung LM, Pals SL, Anh HTV, Kinh NV, Bateganya M. Prevalence of Advanced HIV Disease, Cryptococcal Antigenemia, and Suboptimal Clinical Outcomes Among Those Enrolled in Care in Vietnam. J Acquir Immune Defic Syndr 2021; 88:487-496. [PMID: 34446679 PMCID: PMC8575167 DOI: 10.1097/qai.0000000000002786] [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: 06/13/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND People living with advanced HIV disease are at high risk of morbidity and mortality. We assessed the prevalence of cryptococcal antigenemia (CrAg) and clinical outcomes among patients newly presenting with CD4 ≤100 cells/μL in Vietnam. SETTING Twenty-two public HIV clinics in Vietnam. METHODS During August 2015-March 2017, antiretroviral therapy (ART)-naïve adults presenting for care with CD4 ≤100 cells/μL were screened for CrAg. Those who consented to study enrollment were followed up for up to 12 months and assessed for clinical outcomes. RESULTS Of 3504 patients with CD4 results, 1354 (38.6%) had CD4 ≤100 cells/μL, of whom 1177 (86.9%) enrolled in the study. The median age was 35 years (interquartile range 30-40); 872 (74.1%) of them were men, and 892 (75.8%) had CD4 <50 cells/μL. Thirty-six patients (3.1%) were CrAg-positive. Overall, 1151 (97.8%) including all who were CrAg-positive initiated ART. Of 881 patients (76.5%) followed up for ≥12 months, 623 (70.7%) were still alive and on ART at 12 months, 54 (6.1%) had transferred to nonstudy clinics, 86 (9.8%) were lost to follow-up, and 104 (11.8%) had died. Among all 1177 study participants, 143 (12.1%) died, most of them (123, 86.0%) before or within 6 months of enrollment. Twenty-seven patients (18.9%) died of pulmonary tuberculosis, 23 (16.1%) died of extrapulmonary tuberculosis, 8 (5.6%) died of Talaromyces marneffei infection, and 6 (4.2%) died of opioid overdose. Eight deaths (5.8%) occurred among the 36 CrAg-positive individuals. CONCLUSIONS Late presentation for HIV care was common. The high mortality after entry in care calls for strengthening of the management of advanced HIV disease.
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Affiliation(s)
- Vu Quoc Dat
- Department of Infectious Diseases, National Hospital for Tropical Diseases (NHTD), Hanoi, Vietnam
- Intensive Care Unit, Hanoi Medical University, Hanoi, Vietnam
| | - Sheryl Lyss
- U.S. Centers for Disease Control and Prevention (CDC), Hanoi, Vietnam
- Dr. Lyss Iis now with the Division of HIV/AIDS Prevention, U.S Centers for Disease Control & Prevention (CDC), Atlanta, GA
| | - Nguyen Thi Hoai Dung
- Department of Infectious Diseases, National Hospital for Tropical Diseases (NHTD), Hanoi, Vietnam
| | - Le Manh Hung
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Sherri L. Pals
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Division of Global HIV &TB (DGHT), U.S Centers for Disease Control & Prevention (CDC), Atlanta, GA; and
| | - Ho Thi Van Anh
- U.S. Centers for Disease Control and Prevention (CDC), Hanoi, Vietnam
| | - Nguyen Van Kinh
- Department of Infectious Diseases, National Hospital for Tropical Diseases (NHTD), Hanoi, Vietnam
| | - Moses Bateganya
- Division of Global HIV &TB (DGHT), U.S Centers for Disease Control & Prevention (CDC), Atlanta, GA; and
- FHI 360, Durham, NC
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Heath K, Levi J, Hill A. The Joint United Nations Programme on HIV/AIDS 95-95-95 targets: worldwide clinical and cost benefits of generic manufacture. AIDS 2021; 35:S197-S203. [PMID: 34115649 DOI: 10.1097/qad.0000000000002983] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Joint United Nations Programme on HIV/AIDS aims for HIV testing, treatment and viral suppression rates to be 95%--95%--95% by 2025. Patented drug prices remain a barrier to HIV treatment. Generic alternatives are being produced and exported from countries without patent barriers at a fraction of the cost. METHODS We collated export records of active pharmaceutical ingredient for HIV drugs to estimate the minimum costs of production. Using epidemiological data describing national HIV epidemics, we calculated the cost to treat 164 countries at 95%--95%-95%. Using weighted log-linear regression models, we estimated the mother-to-child transmissions (MTCTs), HIV-related deaths and new HIV infections preventable every year by increased treatment. FINDINGS We estimated that TDF/3TC/DTG could be produced for $59 per person per year. At this price, the 164 countries in our analysis could be treated at 95%--95%--95% for $2 billion a year, preventing 66 308 MTCTs, 241 811 HIV-related deaths and 631 398 new HIV infections every year. In comparison, global expenditure on HIV pharmaceuticals in 2019 was $28 billion. INTERPRETATION At $2 billion/year, the 164 countries in our analysis could be treated for the price of 4 weeks of current global sales. Global access to generic alternatives could reduce expenditure and improve clinical outcomes.
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Affiliation(s)
| | - Jacob Levi
- Accident and Emergency Medicine, Homerton Row, Clapton, London
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
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LEVINTOW SN, PENCE BW, POWERS KA, BRESKIN A, SRIPAIPAN T, HA TV, CHU VA, QUAN VM, LATKIN CA, GO VF. Depression, antiretroviral therapy initiation, and HIV viral suppression among people who inject drugs in Vietnam. J Affect Disord 2021; 281:208-215. [PMID: 33333474 PMCID: PMC7855445 DOI: 10.1016/j.jad.2020.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/23/2020] [Accepted: 12/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The burden of depression is high among people who inject drugs (PWID) and may contribute to the spread of HIV through poor treatment engagement and persistent viremia. We estimated the effects of depression on antiretroviral therapy (ART) initiation and viral suppression among PWID living with HIV. METHODS Longitudinal data were collected from 455 PWID living with HIV in Vietnam during 2009-2013. We estimated the 6- and 12-month cumulative incidence of ART initiation and viral suppression, accounting for time-varying confounding, competing events, and missing data. The cumulative incidence difference (CID) contrasted the incidence of each outcome had participants always vs. never experienced severe depressive symptoms across study visits to date. RESULTS Severe depressive symptoms decreased the cumulative incidence of ART initiation, with CID values comparing always vs. never having severe depressive symptoms of -7.5 percentage points (95% CI: -17.2, 2.2) at 6 months and -7.1 (95% CI: -17.9, 3.7) at 12 months. There was no appreciable difference in the cumulative incidence of viral suppression at 6 months (CID = 0.3, 95% CI: -11.3, 11.9) or 12 months (CID = 2.0, 95% CI: -21.8, 25.8). LIMITATIONS Discrepancies between the ART initiation and viral suppression outcomes could be due to under-reporting of ART use and missing data on viral load. CONCLUSIONS Future work probing the seemingly antagonistic effect of depression on treatment uptake - but not viral suppression - will inform the design of interventions promoting HIV clinical outcomes and reducing onward transmission among PWID.
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Affiliation(s)
- Sara N. LEVINTOW
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC, USA
| | - Brian W. PENCE
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC, USA
| | - Kimberly A. POWERS
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC, USA
| | | | - Teerada SRIPAIPAN
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC, USA
| | - Tran Viet HA
- UNC Project Vietnam, University of North Carolina, Hanoi, Vietnam
| | - Viet Anh CHU
- UNC Project Vietnam, University of North Carolina, Hanoi, Vietnam
| | - Vu Minh QUAN
- Centers for Disease Control and Prevention, Atlanta GA, USA
| | - Carl A. LATKIN
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Vivian F. GO
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC, USA
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Chau LB, Hoa DM. Newly diagnosed HIV individuals: Barriers to timely entrance into care after adopting treat all policy. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1836724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Le Bao Chau
- Health Management Training Institute, Hanoi University of Public Health (HUPH), Hanoi, Vietnam
| | - Do Mai Hoa
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
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Schutte C, Forsythe S, Mdala JF, Zieman B, Linder R, Vu L. The short-term effects of the implementation of the "Treat All" guidelines on ART service delivery costs in Namibia. PLoS One 2020; 15:e0228135. [PMID: 31986182 PMCID: PMC6984719 DOI: 10.1371/journal.pone.0228135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 01/08/2020] [Indexed: 11/19/2022] Open
Abstract
The introduction of “Treat All” (TA) has been promoted to increase the effectiveness of HIV/AIDS treatment by having patients initiate antiretroviral therapy at an earlier stage of their illness. The impact of introducing TA on the unit cost of treatment has been less clear. The following study evaluated how costs changed after Namibia’s introduction of TA in April 2017. A two-year analysis assessed the costs of antiretroviral therapy (ART) during the 12 months before TA (Phase I–April 1, 2016 to March 31, 2017) and the 12 months following (Phase II–April 1, 2017 to March 31, 2018). The analysis involved interviewing staff at ten facilities throughout Namibia, collecting data on resources utilized in the treatment of ART patients and analyzing how costs changed before and after the introduction of TA. An analysis of treatment costs indicated that the unit cost of treatment declined from USD360 per patient per year in Phase I to USD301 per patient per year in Phase II, a reduction of 16%. This decline in unit costs was driven by 3 factors: 1) shifts in antiretroviral (ARV) regimens that resulted in lower costs for drugs and consumables, 2) negotiated reductions in the cost of viral load tests and 3) declines in personnel costs. It is unlikely that the first two of these factors were significantly influenced by the introduction of TA. It is unclear if TA might have had an influence on personnel costs. The reduction in personnel costs may have either represented a positive development (fewer personnel costs associated with increased numbers of healthier patients and fewer visits required) or alternatively may reflect constraints in Namibia’s staffing. Prior to this study, it was expected that the introduction of TA would lead to a significant increase in the number of ART patients. However, there was less than a 4% increase in the number of adult patients at the 10 studied facilities. From a financial point of view, TA did not significantly increase the resources required in the ten sampled facilities, either by raising unit costs or significantly increasing the number of ART patients.
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Affiliation(s)
| | - Steven Forsythe
- Avenir Health, Glastonbury, Fountain Hills, AZ, United States of America
- * E-mail:
| | | | - Brady Zieman
- Population Council, Washington, DC, United States of America
| | - Rachael Linder
- Avenir Health, Glastonbury, Fountain Hills, AZ, United States of America
| | - Lung Vu
- Population Council, Washington, DC, United States of America
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Tran BX, Dang AK, Vu GT, Tran TT, Latkin CA, Ho CSH, Ho RCM. Patient satisfaction with HIV services in Vietnam: Status, service models and association with treatment outcome. PLoS One 2019; 14:e0223723. [PMID: 31703089 PMCID: PMC6839840 DOI: 10.1371/journal.pone.0223723] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/26/2019] [Indexed: 01/13/2023] Open
Abstract
This study assessed the satisfaction of patients receiving antiretroviral treatment (ART) in Vietnam and its multilevel predictors. Cross-sectional data were collected from January to September 2013 in eight outpatient clinics in Hanoi and Nam Dinh provinces. Patient satisfaction was evaluated using the Satisfaction with HIV/AIDS Treatment Interview Scale. Multivariable Tobit regression was utilized to measure the associations between these factors and satisfaction with treatment services. Generalized Mixed-effect Regression model was used to estimate the effect of satisfaction with the quality of service on the change between the initial and the latest CD4 cell count. Among 1133 patients, most of them were completely satisfied with the 10 domains measured (65.5% to 82.5%). "Service quality and convenience" domain which was attributed by the waiting time and administrative procedure had the lowest score of complete satisfaction. Compared to central clinics, provincial clinics were negatively associated with the overall satisfaction (Coef = -0.58; 95%CI = -0.95; -0.21). Patients rating higher score in "Consultation, explanation, and guidance of health care workers", "Responsiveness of health care workers to patients' questions and requests" and "Perceived overall satisfaction with the quality of service" were related to improvement in immunological treatment outcomes. Our results revealed the high level of satisfaction among ART patients towards HIV care and treatment services, and this had a high correlation to treatment outcomes. Interventions should focus on reducing administrative procedures, providing sufficient guidance and comprehensive services which integrate physical with psychological care for improving the health outcome of the ART program.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Anh Kim Dang
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Tung Thanh Tran
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger C. M. Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
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Factors Associated with Improved HIV/AIDS Treatment Outcomes: Comparing two Major ART Service Delivery Models in Vietnam. AIDS Behav 2019; 23:2840-2848. [PMID: 31236748 DOI: 10.1007/s10461-019-02571-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A mixed design approach was performed to assess the CD4 count levels over time and their associated factors among 362 HIV patients on ART from clinics with HIV testing and counseling (ART-HTC) services and those with general healthcare (ART-GH) services. Longitudinal CD4 count data were retrospectively collected from medical records. Sociodemographic, clinical, alcohol use and smoking characteristics were obtained via face-to-face interviews. Multivariate mixed effect linear regression was utilized to determine the association. We found that HIV patients at ART-GH clinics were more likely to achieve higher CD4 counts over time compared to patients at ART-HTC clinics. Additionally, having an increase in CD4 counts was found to be associated with having longer duration of ART and higher baseline CD4 levels. Cigarette smoking and hazardous alcohol use, however, were not associated with CD4 count improvement. Our findings suggest that combining HTC and GH services might provide a synergistic benefit in ART treatment outcomes through an improved access to comprehensive HIV healthcare services for HIV patients on therapy.
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Changes in Substance Abuse and HIV Risk Behaviors over 12-Month Methadone Maintenance Treatment among Vietnamese Patients in Mountainous Provinces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132422. [PMID: 31288440 PMCID: PMC6651144 DOI: 10.3390/ijerph16132422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/21/2019] [Accepted: 07/04/2019] [Indexed: 11/16/2022]
Abstract
Methadone maintenance treatment (MMT) programs have been used worldwide to reduce the number of drug users and for HIV prevention; however, evidence of their effectiveness in mountainous areas is limited. This study aimed to identify changes in substance abuse and sexual practices among MMT patients after treatment in three Vietnamese mountainous provinces. A survey on risk behaviors was conducted among 300 drug users in six MMT clinics prior to and following one year of MMT. Cramér's effect size of changes was extrapolated to justify the magnitude of the intervention's effectiveness. A generalized estimation equation was used to find the factors associated with respondents' substance use and sexual risk behavior. While drug-related risk behaviors were significantly reduced, alcohol and sex-related behaviors remained risk factors for HIV in this group. Additionally, condom use was common among participants at both time points, but not among those having sex with sex workers. Socio-economic characteristics of ethnic, education, occupation, as well as drug use history influenced the possibility of engaging in drug use and/or sexual risk behavior following treatment. Further emphasis on managing these among MMT patients is required, potentially by providing integrated services including smoking and drinking counseling and condom use promotion in accordance with MMT.
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Nguyen TMT, Tran BX, Fleming M, Pham MD, Nguyen LT, Nguyen ALT, Le HT, Nguyen TH, Hoang VH, Le XTT, Vuong QH, Ho MT, Dam VN, Vuong TT, Nguyen V, Nguyen HLT, Do HP, Doan PL, Nguyen HH, Latkin CA, Ho CSH, Ho RCM. HIV knowledge and risk behaviors among drug users in three Vietnamese mountainous provinces. Subst Abuse Treat Prev Policy 2019; 14:3. [PMID: 30646945 PMCID: PMC6334422 DOI: 10.1186/s13011-019-0191-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/03/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Globally, people who inject drugs are highly vulnerable to HIV transmission. Methadone maintenance treatment (MMT) programs are one of the most cost-effective mechanisms to substitute opioid use and improve the quality of life of patients. Since the coverage of MMT is still limited and even for those patients who are treated, improving their knowledge on HIV and maintaining healthy behaviors are key to maximizing the outcomes of HIV harm reduction programs. This study examined the knowledge on HIV, perceived risk and HIV testing among drug users accessing methadone maintenance services in three Vietnamese mountainous areas. METHODS A cross-sectional study of 300 people enrolling for MMT services in three provinces in Vietnam was conducted. The factors associated with the knowledge, attitudes, and practices of respondents about HIV/AIDS were exploited using multivariable logistic model. RESULTS Of the 300-people surveyed, 99% knew of HIV and 60.6% were identified as having good knowledge. While 75.2% identified that injecting drugs was a risk factor for HIV, 52.2% thought they were not at risk of HIV mainly as they did not share needles. 92.6% had undergone HIV testing with 17.4% being positive, a number which was significantly lower than Vietnam's national average for people who inject drugs. Age, ethnicity and education were associated with knowledge of HIV while ART treatment was linked to self-assessed HIV status. CONCLUSIONS This study sheds new light on the knowledge attitudes and practices of people who inject drugs, particularly males in mountainous areas of Vietnam regarding HIV prevention. Overall, knowledge was good with most conducting safe practices towards transmission. Enhanced education and targeting of minority groups could help in increasing the numbers receiving MMT and HIV services.
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Affiliation(s)
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
- Vietnam Young Physician Association, Hanoi, Vietnam
| | | | - Manh Duc Pham
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Long Thanh Nguyen
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | | | - Huong Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Thang Huu Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Van Hai Hoang
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Xuan Thanh Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Quan Hoang Vuong
- Centre for Interdisciplinary Social Research, Phenikaa University, Hanoi, Vietnam
- Université Libre de Bruxelles, B-1050 Brussels, Belgium
| | - Manh Tung Ho
- Institute of Philosophy, Vietnam Academy of Social Sciences, Hanoi, Vietnam
| | | | | | - Vu Nguyen
- Department of Neurosurgery Spine-Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
| | | | - Huyen Phuc Do
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh city, Vietnam
| | - Phuong Linh Doan
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh city, Vietnam
| | - Hai Hong Nguyen
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh city, Vietnam
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Singapore
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15
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Nguyen TMT, Tran BX, Fleming M, Pham MD, Nguyen LT, Le HT, Nguyen ALT, Le HT, Nguyen TH, Hoang VH, Le XTT, Vuong QH, Ho MT, Dam VN, Vuong TT, Do HN, Nguyen V, Nguyen HLT, Do HP, Doan PL, Nguyen HH, Latkin CA, Ho CS, Ho RC. Methadone Maintenance Treatment Reduces the Vulnerability of Drug Users on HIV/AIDS in Vietnamese Remote Settings: Assessing the Changes in HIV Knowledge, Perceived Risk, and Testing Uptake after a 12-Month Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2567. [PMID: 30453555 PMCID: PMC6265999 DOI: 10.3390/ijerph15112567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/02/2018] [Accepted: 11/12/2018] [Indexed: 11/25/2022]
Abstract
Methadone Maintenance Treatment (MMT) program has been considered a medium through which human immunodeficiency virus (HIV) risks assessment and prevention on drug use/HIV-infected population can be effectively conducted. Studies concerning the implementation of such idea on patients in remote, under-developed areas, however, have been limited. Having the clinics established in three mountainous provinces of Vietnam, this study aimed to evaluate the changes in knowledge of HIV, perceived risk, and HIV testing uptake of the patients. A longitudinal study was conducted at six MMT clinics in three provinces with a pre- and post-assessments among 300 patients. Outcomes of interest were compared between baseline and after 12 months. The magnitude of changes was extrapolated. The proportion of participants reporting that their HIV knowledge was not good fell by 4.4% (61.3% at the baseline vs. 56.8% at 12 months). The significant improvement seen was in the knowledge that needle sharing was a mode of transmission (82.7% vs. 89.6%). Nevertheless, the majority of participants reportedly considered mosquitoes/insect and eating with the HIV-infected patient were the route of transmission at both time points (84.7% vs. 89.1%, 92.2% vs. 93.3%, respectively). This study found a limited improvement in HIV knowledge and testing uptake among MMT patients following a 12-month period. It also highlighted some shortcomings in the knowledge, attitudes and practices (KAP) of these patients, in particular, incorrect identification of HIV transmission routes, among patients both at program initiation and follow-up. The findings lent support to the argument for enhancing education and counseling efforts at MMT clinics regarding HIV, as well as for improving access to preventive and health care services through the integration of MMT/HIV services.
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Affiliation(s)
- Tam Minh Thi Nguyen
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi 100000, Vietnam.
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Mercerdes Fleming
- School of Medicine and Medical Science, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland.
| | - Manh Duc Pham
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi 100000, Vietnam.
| | - Long Thanh Nguyen
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi 100000, Vietnam.
| | - Huong Thi Le
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi 100000, Vietnam.
| | | | - Huong Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Thang Huu Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Van Hai Hoang
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Xuan Thanh Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Quan Hoang Vuong
- Center for Interdisciplinary Social Research, Thanh Tay University, Hanoi 100000, Vietnam.
- Solvay Brussels School of Economics and Management, Centre Emile Bernheim, Université Libre de Bruxelles, B-1050 Brussels, Belgium.
| | - Manh Tung Ho
- Institute of Philosophy, Vietnam Academy of Social Sciences, Hanoi 100000, Vietnam.
| | - Van Nhue Dam
- Faculty of Graduate Studies, National Economics University, Hanoi 100000, Vietnam.
| | | | - Ha Ngoc Do
- Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam.
| | - Vu Nguyen
- Department of Neurosurgery Spine-Surgery, Hanoi Medical University Hospital, Hanoi 100000, Vietnam.
| | - Huong Lan Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Danang 550000, Vietnam.
| | - Huyen Phuc Do
- Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam.
| | - Phuong Linh Doan
- Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam.
| | - Hai Hong Nguyen
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi 100000, Vietnam.
- Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam.
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Cyrus Sh Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore.
| | - Roger Cm Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh 700000, Vietnam.
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Lancaster KE, Hoffman IF, Hanscom B, Ha TV, Dumchev K, Susami H, Rose S, Go VF, Reifeis SA, Mollan KR, Hudgens MG, Piwowar‐Manning EM, Richardson P, Dvoriak S, Djoerban Z, Kiriazova T, Zeziulin O, Djauzi S, Ahn CV, Latkin C, Metzger D, Burns DN, Sugarman J, Strathdee SA, Eshleman SH, Clarke W, Donnell D, Emel L, Sunner LE, McKinstry L, Sista N, Hamilton EL, Lucas JP, Duong BD, Van Vuong N, Sarasvita R, Miller WC. Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis. J Int AIDS Soc 2018; 21:e25195. [PMID: 30350406 PMCID: PMC6198168 DOI: 10.1002/jia2.25195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/26/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION People who inject drugs (PWID) experience high HIV incidence and face significant barriers to engagement in HIV care and substance use treatment. Strategies for HIV treatment as prevention and substance use treatment present unique challenges in PWID that may vary regionally. Understanding differences in the risk structure for HIV transmission and disease progression among PWID is essential in developing and effectively targeting intervention strategies of HIV treatment as prevention. METHODS We present a baseline analysis of HIV Prevention Trials Network (HPTN) 074, a two-arm, randomized controlled trial among PWID in Indonesia (n = 258), Ukraine (n = 457) and Vietnam (n = 439). HPTN 074 was designed to determine the feasibility, barriers and uptake of an integrated intervention combining health systems navigation and psychosocial counselling for the early engagement of antiretroviral therapy (ART) and substance use treatment for PWID living with HIV. Discordant PWID networks were enrolled, consisting of an HIV-positive index and their HIV-negative network injection partner(s). Among the enrolled cohort of 1154 participants (502 index participants and 652 network partners), we examine regional differences in the baseline risk structure, including sociodemographics, HIV and substance use treatment history, and injection and sexual risk behaviours. RESULTS The majority of participants were male (87%), with 82% of the enrolled females coming from Ukraine. The overall mean age was 34 (IQR: 30, 38). Most commonly injected substances included illegally manufactured methadone in Ukraine (84.2%), and heroin in Indonesia (81.8%) and Vietnam (99.5%). Injection network sizes varied by region: median number of people with whom participants self-reported injecting drugs was 3 (IQR: 2, 5) in Indonesia, 5 (IQR: 3, 10) in Ukraine and 3 (IQR: 2, 4) in Vietnam. Hazardous alcohol use, assessed using the Alcohol Use Disorders Identification Test - Alcohol Consumption Questions (AUDIT-C), was prominent in Ukraine (54.7%) and Vietnam (26.4%). Reported sexual risk behaviours in the past month, including having two or more sex partners and giving/receiving money or drugs in exchange for sex, were uncommon among all participants and regions. CONCLUSIONS While regional differences in risk structure exist, PWID particularly in Ukraine need immediate attention for risk reduction strategies. Substantial regional differences in risk structure will require flexible, tailored treatment as prevention interventions for distinct PWID populations.
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Affiliation(s)
- Kathryn E Lancaster
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
| | - Irving F Hoffman
- Division of Infectious DiseasesSchool of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Tran Viet Ha
- Department of Health BehaviorGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Hepa Susami
- University of Indonesia/Cipto Mangunkusumo HospitalJakartaIndonesia
| | | | - Vivian F Go
- Department of Health BehaviorGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Sarah A Reifeis
- Department of BiostatisticsGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
- Center for AIDS Research (CFAR)School of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Katie R Mollan
- Center for AIDS Research (CFAR)School of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Michael G Hudgens
- Department of BiostatisticsGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
- Center for AIDS Research (CFAR)School of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | | | | | - Sergii Dvoriak
- Ukrainian Institute on Public Health PolicyKyivUkraine
- Academy of Labor, Social Relations and TourismKyivUkraine
| | - Zubairi Djoerban
- University of Indonesia/Cipto Mangunkusumo HospitalJakartaIndonesia
| | | | | | | | | | - Carl Latkin
- Department of Health, Behavior, and SocietyJohns Hopkins UniversityBaltimoreMDUSA
| | - David Metzger
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - David N Burns
- Division of AIDSNational Institute of Allergy and Infectious DiseasesU.S. National Institutes of HealthBethesdaMDUSA
| | - Jeremy Sugarman
- Department of MedicineBerman Institute of BioethicsJohns Hopkins UniversityBaltimoreMDUSA
| | - Steffanie A Strathdee
- Department of MedicineSchool of MedicineUniversity of California San DiegoSan DiegoCAUSA
| | | | - William Clarke
- School of MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | | | | | | | | | | | | | | | - Bui D Duong
- Vietnam Authority of HIV/AIDS Control ‐ Ministry of HealthHanoiVietnam
| | | | | | - William C Miller
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
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Tran BX, Fleming M, Do HP, Nguyen LH, Latkin CA. Quality of life improvement, social stigma and antiretroviral treatment adherence: implications for long-term HIV/AIDS care. AIDS Care 2018; 30:1524-1531. [PMID: 30099885 DOI: 10.1080/09540121.2018.1510094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
By 2020, the Vietnamese government has committed to having 90% of patients receiving ART as well as 90% of those on ART having successful viral suppression. Factors that influence adherence to ART among patients are essential to allowing the adequate care. This study was conducted across 8 outpatient clinics in Hanoi and Nam Dinh province and included 1133 patients living with HIV. Socioeconomic factors such as marital status, education, employment as well as health-related quality of life improvements were investigated as potentially being associated with adherence rates of ART patients. Through multivariate logistic regression analysis with self-reported ART adherence and VAS scores, this study was able to identify marital status and employment as two factors associated with positive adherence scores. Similarly, health problems, stigmatization, and duration on ART were associated negatively with ART adherence. Knowing that these factors may be linked to adherence rates, they can be preemptively managed with patients to enhance adherence rates and achieve successful viral suppression.
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Affiliation(s)
- Bach Xuan Tran
- a Institute for Preventive Medicine and Public Health, Hanoi Medical University , Hanoi , Vietnam.,b Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA.,c Vietnam Young Physician Association , Hanoi , Vietnam
| | | | - Huyen Phuc Do
- e Institute for Global Health Innovations, Duy Tan University , Da Nang , Vietnam
| | - Long Hoang Nguyen
- f Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - Carl A Latkin
- b Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
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18
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Tran BX, Fleming M, Nguyen CT, Latkin CA. Financial mobilization for antiretroviral therapy program: multi-level predictors of willingness to pay among patients with HIV/AIDS in Vietnam. AIDS Care 2018; 30:1488-1497. [PMID: 30047280 DOI: 10.1080/09540121.2018.1503633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In Vietnam, significant progress has been made in increasing the number of patients receiving antiretroviral therapy (ART) in the last number of years. As this number increases and international aid and funding for HIV services declines, a greater proportion of ART funding will need to be provided by the government budget, health insurance or by the patients themselves. This study aims to evaluate the willingness of HIV patients to pay for ART. A cross-sectional study which included 1133 HIV-positive patients was conducted across 8 outpatient centers in Hanoi and Nam Binh in Northern Vietnam in 2013. Contingent valuation method was used to assess the willingness to pay (WTP) of patient for ART. Over 90% of the patients were willing to pay for ART for an average amount of 19.7 USD per month. Regression models showed that the willingness of patients to pay for ART was influenced by factors such as employment, income, quality of life and social factors. The amount patients were willing to pay was also associated with gender, living place and level of HIV service administration. By establishing these factors which influence the amount of WTP for ART, plans for the future can be effectively designed and patient groups at risk can be appropriately managed.
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Affiliation(s)
- Bach Xuan Tran
- a Department of Health Economics, Institute for Preventive Medicine and Public Health , Hanoi Medical University , Hanoi , Vietnam.,b Department of Health, Behavior and Society ,, Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Mercedes Fleming
- c School of Medicine and Medical Science , University College Dublin , Dublin , Ireland
| | - Cuong Tat Nguyen
- d Institute for Global Health Innovations, Duy Tan University , Danang , Vietnam
| | - Carl A Latkin
- b Department of Health, Behavior and Society ,, Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Nguyen HH, Bui DD, Dinh TTT, Pham LQ, Nguyen VTT, Tran TH, Pham TH, Nguyen SM, Suthar AB, Do NT, Ford N, Lo Y, Nguyen LH, Giang LM, Kato M. A prospective "test-and-treat" demonstration project among people who inject drugs in Vietnam. J Int AIDS Soc 2018; 21:e25151. [PMID: 29984473 PMCID: PMC6036396 DOI: 10.1002/jia2.25151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 05/15/2018] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Modelling suggests that early diagnosis and immediate antiretroviral therapy (ART) among key populations would have a substantial impact in reducing HIV transmission and mortality in Vietnam. An implementation research project of "test-and-treat" among people who inject drugs (PWID) was developed to inform effective roll-out of such interventions. METHODS "Test-and-treat" was offered to PWID in two high burden provinces, Thai Nguyen and Thanh Hoa. The interventions comprised the offer of biannual HIV testing and immediate ART, irrespective of CD4 count. PWID were enrolled between April 2014 and July 2015 and followed up for 12 months, and retention, HIV viral load (VL) and risk behaviours were assessed. Retention in care of this prospective cohort was compared with the retention among men enrolled in care in the preceding period (April 2012 to March 2013) at the same clinics when ART was initiated at CD4 cell count ≤350 cells/mm3 . RESULTS In total, 287 HIV positive PWID started immediate ART. The majority (98%) were men; median age was 34; and median (interquartile range) CD4 count was 199 (50 to 402) cells/mm3 . After 12 months, 238 participants (83%) were retained on ART, and 205 achieved viral suppression (<1000 copies/mL) (92% among those in whom VL was measured, 71% overall). Baseline CD4 count ≤100 cells/mm3 and history of imprisonment were associated with lower retention and viral suppression, while engagement in methadone maintenance was associated with higher retention. Retention in care was higher in the "test-and-treat" cohort (83%) compared with men enrolled in care in the preceding period (78%), primarily because lost-to-follow-up during pre-ART care was eliminated. No decline in consistent condom use and clean needle use was observed. CONCLUSIONS Early ART initiation resulted in successful treatment outcomes among PWID, with no observed increase in self-reported risk behaviours, suggesting feasibility and potential effectiveness of "test-and-treat" approach. The results also call for differentiated care for PWID, including promoting early diagnosis and engagement in methadone maintenance therapy while enhancing care for those with advanced HIV disease and history of imprisonment.
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Affiliation(s)
- Hai H Nguyen
- Viet Nam Authority of HIV/AIDS ControlMinistry of HealthHanoiVietnam
| | - Duong D Bui
- Viet Nam Authority of HIV/AIDS ControlMinistry of HealthHanoiVietnam
| | | | | | - Van TT Nguyen
- Vietnam Country OfficeWorld Health OrganizationHanoiVietnam
| | - Tram H Tran
- National Institute of Hygiene and EpidemiologyHanoiVietnam
| | - Thang H Pham
- National Institute of Hygiene and EpidemiologyHanoiVietnam
| | | | | | - Nhan T Do
- Viet Nam Authority of HIV/AIDS ControlMinistry of HealthHanoiVietnam
| | - Nathan Ford
- HIV DepartmentWorld Health OrganizationGenevaSwitzerland
| | - Ying‐Ru Lo
- Regional Office for the Western PacificWorld Health OrganizationManilaPhilippines
| | - Long Hoang Nguyen
- Viet Nam Authority of HIV/AIDS ControlMinistry of HealthHanoiVietnam
| | | | - Masaya Kato
- Vietnam Country OfficeWorld Health OrganizationHanoiVietnam
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Fox GJ, Nhung NV, Sy DN, Hoa NLP, Anh LTN, Anh NT, Hoa NB, Dung NH, Buu TN, Loi NT, Nhung LT, Hung NV, Lieu PT, Cuong NK, Cuong PD, Bestrashniy J, Britton WJ, Marks GB. Household-Contact Investigation for Detection of Tuberculosis in Vietnam. N Engl J Med 2018; 378:221-229. [PMID: 29342390 DOI: 10.1056/nejmoa1700209] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Active case finding is a top priority for the global control of tuberculosis, but robust evidence for its effectiveness in high-prevalence settings is lacking. We sought to evaluate the effectiveness of household-contact investigation, as compared with standard, passive measures alone, in Vietnam. METHODS We performed a cluster-randomized, controlled trial at clinics in 70 districts (local government areas with an average population of approximately 500,000 in urban areas and 100,000 in rural areas) in eight provinces of Vietnam. Health workers at each district clinic or hospital were assigned to perform either household-contact intervention plus standard passive case finding (intervention group) or passive case finding alone (control group). In the intervention districts, household contacts of patients with positive results for tuberculosis on sputum smear microscopy (smear-positive tuberculosis) were invited for clinical assessment and chest radiography at baseline and at 6, 12, and 24 months. The primary outcome was the cumulative incidence of registered cases of tuberculosis among household contacts of patients with tuberculosis during a 2-year period. RESULTS In 70 selected districts, we enrolled 25,707 household contacts of 10,964 patients who had smear-positive pulmonary tuberculosis. In the 36 districts that were included in the intervention group, 180 of 10,069 contacts were registered as having tuberculosis (1788 cases per 100,000 population), as compared with 110 of 15,638 contacts (703 per 100,000) in the control group (relative risk of the primary outcome in the intervention group, 2.5; 95% confidence interval [CI], 2.0 to 3.2; P<0.001); the relative risk of smear-positive disease among household contacts in the intervention group was 6.4 (95% CI, 4.5 to 9.0; P<0.001). CONCLUSIONS Household-contact investigation plus standard passive case finding was more effective than standard passive case finding alone for the detection of tuberculosis in a high-prevalence setting at 2 years. (Funded by the Australian National Health and Medical Research Council; ACT2 Australian New Zealand Clinical Trials Registry number, ACTRN12610000600044 .).
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Affiliation(s)
- Greg J Fox
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nguyen V Nhung
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Dinh N Sy
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nghiem L P Hoa
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Le T N Anh
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nguyen T Anh
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nguyen B Hoa
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nguyen H Dung
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Tran N Buu
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nguyen T Loi
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Le T Nhung
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nguyen V Hung
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Phan T Lieu
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Nguyen K Cuong
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Pham D Cuong
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Jessica Bestrashniy
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Warwick J Britton
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
| | - Guy B Marks
- From Sydney Medical School (G.J.F., N.T.A., W.J.B.) and the Centenary Institute of Cancer Medicine and Cell Biology (W.J.B.), University of Sydney, Camperdown, NSW, Woolcock Institute of Medical Research, Glebe, NSW (G.J.F., N.L.P.H., N.T.A., T.N.B., N.T.L., L.T.N., N.V.H., P.T.L., P.D.C., J.B., G.B.M.), and South Western Sydney Clinical School, University of New South Wales, Kensington (G.B.M.) - all in Australia; National Lung Hospital (N.V.N., D.N.S., L.T.N.A., N.B.H., N.K.C.) and Hanoi Medical University (N.V.N., N.K.C.), Hanoi, and Pham Ngoc Thach Hospital, Ho Chi Minh City (N.H.D.) - all in Vietnam; and the Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris (N.B.H.)
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Chawla S, Shringarpure K, Modi B, Sharma R, Rewari BB, Shah AN, Verma PB, Dongre AR, Kumar AMV. Why are HIV-infected people not started on antiretroviral therapy? A mixed-methods study from Gujarat, India. Public Health Action 2017; 7:183-192. [PMID: 29201653 DOI: 10.5588/pha.16.0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/24/2017] [Indexed: 12/20/2022] Open
Abstract
Setting: Five purposively selected antiretroviral therapy (ART) centres in Gujarat, India. Objectives: To assess the proportion of ART-eligible people living with the human immunodeficiency virus (PLHIV) who were not initiated on ART within 2 months of being recorded as eligible, to identify factors associated with non-initiation and to explore reasons from the provider's perspective. Design: We used a mixed-methods design (triangulation) of 1) a quantitative phase involving record reviews and cohort analysis (Poisson regression) of PLHIV registered during April 2014-March 2015, and 2) a qualitative phase involving one-to-one interviews with 25 providers. Results: Of 2079 ART-eligible PLHIV, 339 (16%) were not started on ART within 2 months. PLHIV with CD4 counts of <350 cells/μl and patients who were labourers, hospitalised, bedridden or registered with certain ART centres were more likely not to be initiated on ART. Qualitative results were categorised into two broad themes: government health system- and patient-related challenges, which validated and complemented the quantitative findings. Conclusion: Several patient subgroups at greater risk of ART non-initiation were identified, along with reasons for risk; this has important programme implications for achieving the UNAIDS 90-90-90 goal, and particularly the second 90 component of having 90% of diagnosed PLHIV start ART.
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Affiliation(s)
- S Chawla
- Gujarat State AIDS Control Society, Health and Family Welfare Department, Government of Gujarat, Ahmedabad, India
| | - K Shringarpure
- Department of Community Medicine, Government Medical College and SSG Hospital, Vadodara, India
| | - B Modi
- Department of Community Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College, Gandhinagar, India
| | - R Sharma
- Department of Community Medicine, GMERS Medical College, Sola, Ahmedabad, India
| | - B B Rewari
- World Health Organization India Country Office, New Delhi, India
| | - A N Shah
- Department of Medicine, BJ Medical College and Civil Hospital, Ahmedabad, India
| | - P B Verma
- Gujarat State AIDS Control Society, Health and Family Welfare Department, Government of Gujarat, Ahmedabad, India.,Department of Community Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College, Gandhinagar, India
| | - A R Dongre
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India.,The Union, Paris, France
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Pollack TM, Duong HT, Pham TT, Do CD, Colby D. Cigarette smoking is associated with high HIV viral load among adults presenting for antiretroviral therapy in Vietnam. PLoS One 2017; 12:e0173534. [PMID: 28267790 PMCID: PMC5340371 DOI: 10.1371/journal.pone.0173534] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/21/2017] [Indexed: 11/18/2022] Open
Abstract
High HIV viral load (VL >100,000 cp/ml) is associated with increased HIV transmission risk, faster progression to AIDS, and reduced response to some antiretroviral regimens. To better understand factors associated with high VL, we examined characteristics of patients presenting for treatment in Hanoi, Vietnam. We examined baseline data from the Viral Load Monitoring in Vietnam Study, a randomized controlled trial of routine VL monitoring in a population starting antiretroviral therapy (ART) at a clinic in Hanoi. Patients with prior treatment failure or ART resistance were excluded. Characteristics examined included demographics, clinical and laboratory data, and substance use. Logistic regression was used to calculate crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Out of 636 patients, 62.7% were male, 72.9% were ≥30 years old, and 28.3% had a history of drug injection. Median CD4 was 132 cells/mm3, and 34.9% were clinical stage IV. Active cigarette smoking was reported by 36.3% with 14.0% smoking >10 cigarettes per day. Alcohol consumption was reported by 20.1% with 6.1% having ≥5 drinks per event. Overall 53.0% had a VL >100,000 cp/ml. Male gender, low body weight, low CD4 count, prior TB, and cigarette smoking were associated with high VL. Those who smoked 1–10 cigarettes per day were more likely to have high VL (aOR = 1.99, 95% CI = 1.15–3.45), while the smaller number of patients who smoked >10 cigarettes per day had a non-significant trend toward higher VL (aOR = 1.41, 95% CI = 0.75–2.66). Alcohol consumption was not significantly associated with high VL. Tobacco use is increasingly recognized as a contributor to premature morbidity and mortality among HIV-infected patients. In our study, cigarette smoking in the last 30 days was associated with a 1.5 to 2-fold higher odds of having an HIV VL >100,000 cp/ml among patients presenting for ART. These findings provide further evidence of the negative effects of tobacco use among HIV-infected patients.
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Affiliation(s)
- Todd M. Pollack
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
- Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Hao T. Duong
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
| | - Thuy T. Pham
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
- Department of Infectious Diseases, Bach Mai hospital (BMH), Hanoi, Vietnam
| | - Cuong D. Do
- Department of Infectious Diseases, Bach Mai hospital (BMH), Hanoi, Vietnam
| | - Donn Colby
- Center for Applied Research on Men and Community Health (CARMAH), HCMC, Vietnam
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
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Pham LTT, Kitamura A, Do HM, Lai KA, Le NT, Nguyen VTT, Kato M. Retrospective analysis of antiretroviral therapy uptake and retention of male clients receiving methadone maintenance therapy in two provinces in Vietnam: potential synergy of the two therapies. Harm Reduct J 2017; 14:12. [PMID: 28212645 PMCID: PMC5316168 DOI: 10.1186/s12954-017-0133-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/13/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Vietnam has a concentrated HIV epidemic with injection drug use being the dominant mode of HIV transmission. Vietnam has rapidly expanded antiretroviral therapy (ART) and methadone maintenance therapy (MMT). This study aims to analyze ART uptake and retention among male clients receiving MMT in Vietnam in the early phase of the MMT program. METHODS The male clients (age ≥18) who were newly enrolled in care or started ART at two HIV clinics in Hanoi (2009 to 2011) and three HIV clinics in Can Tho (2010 to 2012) were included for the analysis. The CD4 lymphocyte count at HIV care enrollment and ART initiation and retention on ART were retrospectively analyzed. The values of those receiving MMT were compared with the values of two groups: those in whom injection drug use (IDU) status was documented, but were not receiving MMT, and all male clients not receiving MMT. To analyze retention, survival analysis with log rank test and Cox proportional hazard model was used. RESULTS During the study period, 663 adult men were newly enrolled in HIV care (237 had IDU status documented) and 456 initiated ART (167 had IDU status documented). Among those who initiated ART, 28 were receiving MMT. At care enrolment, those receiving MMT had a median CD4 count of 230 (IQR 57-308) cells/mm3, while men self-reporting IDU and not receiving MMT and all men not receiving MMT had a median CD4 count of 158 (IQR 50-370) cells/mm3 and 143 (IQR 35-366) cells/mm3, respectively. At ART initiation, men receiving MMT had significantly higher CD4 count with median at 203 (IQR 64-290) cells/mm3 than men self-reporting IDU and not receiving MMT (80, IQR 40-220, cells/mm3, p = 0.038) and all men not receiving MMT (76, IQR 20-199, cells/mm3, p = 0.009). Those receiving MMT had a significantly higher retention rate than those self-reporting IDU but not receiving MMT (hazard ratio = 0.18, p = 0.019) and men not receiving MMT (hazard ratio = 0.20, p = 0.041). CONCLUSIONS Our analysis suggests that men receiving MMT in Vietnam are achieving relatively early uptake and high retention rates on ART. The findings support potential benefits of integrating MMT and ART services in Vietnam.
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Affiliation(s)
- Linh Thi Thuy Pham
- Health Management Training Institute, Hanoi University of Public Health, Hanoi, Vietnam
| | - Akiko Kitamura
- Vietnam Country Office, World Health Organization, 304 Kim Ma, Hanoi, Vietnam
| | - Hoa Mai Do
- Health Management Training Institute, Hanoi University of Public Health, Hanoi, Vietnam
| | - Kim Anh Lai
- Can Tho Provincial AIDS Center, Can Tho, Vietnam
| | | | - Van Thi Thuy Nguyen
- Vietnam Country Office, World Health Organization, 304 Kim Ma, Hanoi, Vietnam
| | - Masaya Kato
- Vietnam Country Office, World Health Organization, 304 Kim Ma, Hanoi, Vietnam
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24
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Golin CE, Knight K, Carda-Auten J, Gould M, Groves J, L White B, Bradley-Bull S, Amola K, Fray N, Rosen DL, Mugavaro MJ, Pence BW, Flynn PM, Wohl D. Individuals motivated to participate in adherence, care and treatment (imPACT): development of a multi-component intervention to help HIV-infected recently incarcerated individuals link and adhere to HIV care. BMC Public Health 2016; 16:935. [PMID: 27596559 PMCID: PMC5011897 DOI: 10.1186/s12889-016-3511-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/13/2016] [Indexed: 11/28/2022] Open
Abstract
Background Policy-makers promote a seek, test, treat and retain (STTR) strategy to expand HIV testing, support linkage and engagement in care, and enhance the continuous use of antiretroviral therapy for those HIV-infected. This HIV prevention strategy is particularly appropriate in correctional settings where HIV screening and treatment are routinely available yet many HIV-infected individuals have difficulty sustaining sufficient linkage and engagement in care, disease management, and viral suppression after prison release. Methods/design Our research team developed Project imPACT (individuals motivated to Participate in Adherence, Care and Treatment), a multi-component approach for HIV-Infected recently incarcerated individuals that specifically targets their care linkage, retention, and medication adherence by addressing multiple barriers to care engagement after release. The ultimate goals of this intervention are to improve the health of HIV-infected individuals recently released from prison and reduce HIV transmission to their communities by maintaining viral suppression. This paper describes the intervention and technology development processes, based on best practices for intervention development and process evaluation. These processes included: 1) identifying the target population; 2) clarifying the theoretical basis for intervention design; 3) describing features of its foundational interventions; 4) conducting formative qualitative research; 5) integrating and adapting foundational interventions to create and refine intervention content based on target audience feedback. These stages along with the final intervention product are described in detail. The intervention is currently being evaluation and a two arm randomized, controlled trial in two US state prison systems. Discussion Based on a literature review, qualitative research, integration of proven interventions and behavioral theory, the final imPACT intervention focused on the transition period two to three months before and three months after prison release. It emphasized pre-release readiness, pre- and post-release supportive non-judgmental counseling, linking individuals to a HIV care clinic and technological supports through videos and text messages. This article provides a useful model for how researchers can develop, test, and refine multi-component interventions to address HIV care linkage, retention and adherence. Clinical trial registration NCT01629316, first registered 6-4-2012; last updated 6-9-2015.
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Affiliation(s)
- Carol E Golin
- School of Medicine and Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA. .,Department of Health Behavior, UNC-CH Gillings School of Global Public, CB 7440, 135 Dauer Road, Chapel Hill, NC, 27599, USA.
| | - Kevin Knight
- Institute of Behavioral Research, Texas Christian University, Fort Worth, USA
| | - Jessica Carda-Auten
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Michele Gould
- Institute of Behavioral Research, Texas Christian University, Fort Worth, USA
| | - Jennifer Groves
- Cecil G. Sheps Center, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Becky L White
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Steve Bradley-Bull
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kemi Amola
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Niasha Fray
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - David L Rosen
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | - Brian W Pence
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Patrick M Flynn
- Institute of Behavioral Research, Texas Christian University, Fort Worth, USA
| | - David Wohl
- School of Medicine, 321 S The University of North Carolina at Chapel Hill, Chapel Hill, USA
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25
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Auld AF, Shiraishi RW, Mbofana F, Couto A, Fetogang EB, El-Halabi S, Lebelonyane R, Pilatwe PT, Hamunime N, Okello V, Mutasa-Apollo T, Mugurungi O, Murungu J, Dzangare J, Kwesigabo G, Wabwire-Mangen F, Mulenga M, Hachizovu S, Ettiegne-Traore V, Mohamed F, Bashorun A, Nhan DT, Hai NH, Quang TH, Van Onacker JD, Francois K, Robin EG, Desforges G, Farahani M, Kamiru H, Nuwagaba-Biribonwoha H, Ehrenkranz P, Denison JA, Koole O, Tsui S, Torpey K, Mukadi YD, van Praag E, Menten J, Mastro TD, Hamilton CD, Abiri OO, Griswold M, Pierre E, Xavier C, Alfredo C, Jobarteh K, Letebele M, Agolory S, Baughman AL, Mutandi G, Preko P, Ryan C, Ao T, Gonese E, Herman-Roloff A, Ekra KA, Kouakou JS, Odafe S, Onotu D, Dalhatu I, Debem HH, Nguyen DB, Yen LN, Abdul-Quader AS, Pelletier V, Williams SG, Behel S, Bicego G, Swaminathan M, Dokubo EK, Adjorlolo-Johnson G, Marlink R, Lowrance D, Spira T, Colebunders R, Bangsberg D, Zee A, Kaplan J, Ellerbrock TV. Lower Levels of Antiretroviral Therapy Enrollment Among Men with HIV Compared with Women - 12 Countries, 2002-2013. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2015; 64:1281-6. [PMID: 26605861 DOI: 10.15585/mmwr.mm6446a2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Equitable access to antiretroviral therapy (ART) for men and women with human immunodeficiency virus (HIV) infection is a principle endorsed by most countries and funding bodies, including the U.S. President's Emergency Plan for AIDS (acquired immunodeficiency syndrome) Relief (PEPFAR) (1). To evaluate gender equity in ART access among adults (defined for this report as persons aged ≥15 years), 765,087 adult ART patient medical records from 12 countries in five geographic regions* were analyzed to estimate the ratio of women to men among new ART enrollees for each calendar year during 2002-2013. This annual ratio was compared with estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS)(†) of the ratio of HIV-infected adult women to men in the general population. In all 10 African countries and Haiti, the most recent estimates of the ratio of adult women to men among new ART enrollees significantly exceeded the UNAIDS estimates for the female-to-male ratio among HIV-infected adults by 23%-83%. In six African countries and Haiti, the ratio of women to men among new adult ART enrollees increased more sharply over time than the estimated UNAIDS female-to-male ratio among adults with HIV in the general population. Increased ART coverage among men is needed to decrease their morbidity and mortality and to reduce HIV incidence among their sexual partners. Reaching more men with HIV testing and linkage-to-care services and adoption of test-and-treat ART eligibility guidelines (i.e., regular testing of adults, and offering treatment to all infected persons with ART, regardless of CD4 cell test results) could reduce gender inequity in ART coverage.
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26
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Abstract
PURPOSE OF REVIEW People who inject drugs (PWID), sex workers, and MSM simultaneously bear a high burden of HIV and stigma and discrimination. The purpose of this review was to summarize recent information about the understanding of the HIV care cascade among PWID, sex workers, and MSM populations around the globe. RECENT FINDINGS A review of the published literature relating to the care cascade in these three key populations was conducted. Data on the care cascade among key populations are sparse, particularly for PWID and sex workers. In the 12 countries in which a study or report of the care cascade was available stratified by these populations, all three populations have care cascade outcomes that are far below the 90-90-90 target set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) for 2020. Culturally tailored interventions, including colocation of services and peer navigators, can improve care cascade outcomes among key populations. SUMMARY Key populations' care cascade outcomes must be included in international reporting metrics to expand cascade data for these groups. Improving care cascade outcomes in these key populations through culturally tailored interventions should be a priority in the coming years.
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Affiliation(s)
- Kathryn Risher
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth Mayer
- Harvard School of Medicine, Boston, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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