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Loeb TA, Solomon SS, Gunaratne MP, Srikrishnan AK, Vasudevan CK, Khan RT, Anand S, Jayaseelan B, Kumar MS, Celentano DD, Lucas GM, Mehta SH, McFall AM. People who inject drugs and men who have sex with men living with HIV in India experience low probability of viral rebound and high levels of persistent viremia during the first 12 months of antiretroviral therapy. AIDS Care 2025:1-12. [PMID: 40155358 DOI: 10.1080/09540121.2025.2484635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 03/19/2025] [Indexed: 04/01/2025]
Abstract
People who inject drugs (PWID) and men who have sex with men (MSM) in India are disproportionately affected by HIV and experience challenges achieving sustained viral suppression. We evaluated probabilities of suppression over time and characteristics associated with persistent viremia and viral rebound among MSM and PWID living with HIV (PLHIV) using 12 months of data collected between 2017-2019 from a cluster-randomized trial across 16 cities in India. To assessprobabilities of suppression, we fit logistic transition models with generalized estimating equations. To assess correlates of persistent viremia and viral rebound, we fit multivariable multilevel logistic regression models. Of 750 PWID, 88% were male and 14% completed high school. Of 850 MSM, 29% completed high school and 54% were married. 46% of PWID and 67% of MSM maintained viral suppression once achieved. Probabilities of viral rebound decreased over time. The probability of newly achieving suppression decreased, from 33%-12% after six months among PWID and 60%-13% among MSM. Among PWID, correlates of persistent viremia included lower education, employment, homelessness, and active injection. Among MSM, hazardous alcohol use was associated with viremia and viral rebound. Treatment engagement and support efforts need to be intensified to encourage PLHIV to achieve life-long suppression.
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Affiliation(s)
- Talia A Loeb
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sunil S Solomon
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mihili P Gunaratne
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A K Srikrishnan
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - C K Vasudevan
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Rifa T Khan
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | | | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gregory M Lucas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Brunner P, Brunner K, Kübler D. The Cost-Effectiveness of HIV/STI Prevention in High-Income Countries with Concentrated Epidemic Settings: A Scoping Review. AIDS Behav 2022; 26:2279-2298. [PMID: 35034238 PMCID: PMC9163023 DOI: 10.1007/s10461-022-03583-y] [Citation(s) in RCA: 2] [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] [Accepted: 01/08/2022] [Indexed: 11/27/2022]
Abstract
The purpose of this scoping review is to establish the state of the art on economic evaluations in the field of HIV/STI prevention in high-income countries with concentrated epidemic settings and to assess what we know about the cost-effectiveness of different measures. We reviewed economic evaluations of HIV/STI prevention measures published in the Web of Science and Cost-Effectiveness Registry databases. We included a total of 157 studies focusing on structural, behavioural, and biomedical interventions, covering a variety of contexts, target populations and approaches. The majority of studies are based on mathematical modelling and demonstrate that the preventive measures under scrutiny are cost-effective. Interventions targeted at high-risk populations yield the most favourable results. The generalisability and transferability of the study results are limited due to the heterogeneity of the populations, settings and methods involved. Furthermore, the results depend heavily on modelling assumptions. Since evidence is unequally distributed, we discuss implications for future research.
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Affiliation(s)
- Palmo Brunner
- Department of Political Science, University of Zurich, Affolternstrasse 56, 8050, Zurich, Switzerland
| | - Karma Brunner
- Department of Political Science, University of Zurich, Affolternstrasse 56, 8050, Zurich, Switzerland
| | - Daniel Kübler
- Department of Political Science, University of Zurich, Affolternstrasse 56, 8050, Zurich, Switzerland.
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Emerson C, Meline J, Linn A, Wallace J, Kapella BK, Venkatesan M, Steketee R. End Malaria Faster: Taking Lifesaving Tools Beyond “Access” to “Reach” All People in Need. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-22-00118. [PMID: 35487558 PMCID: PMC9053156 DOI: 10.9745/ghsp-d-22-00118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022]
Abstract
To “reach the unreached” with preventive and curative malaria services, we must know which individuals and communities remain unreached and then bring tailored services from the clinic to the community and home.
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Affiliation(s)
- Courtney Emerson
- U.S. President's Malaria Initiative, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Jed Meline
- U.S. President's Malaria Initiative, United States Agency for International Development, Washington, DC, USA
| | - Anne Linn
- U.S. President's Malaria Initiative, United States Agency for International Development, Washington, DC, USA
| | - Julie Wallace
- U.S. President's Malaria Initiative, United States Agency for International Development, Washington, DC, USA
| | - Bryan K Kapella
- U.S. President's Malaria Initiative, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Meera Venkatesan
- U.S. President's Malaria Initiative, United States Agency for International Development, Washington, DC, USA
| | - Richard Steketee
- U.S. President's Malaria Initiative, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Caponi M, Burgess C, Leatherwood A, Molano LF. Demographic characteristics associated with the use of HIV pre-exposure prophylaxis (PrEP) in an urban, community health center. Prev Med Rep 2019; 15:100889. [PMID: 31194089 PMCID: PMC6551550 DOI: 10.1016/j.pmedr.2019.100889] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/26/2019] [Accepted: 05/12/2019] [Indexed: 11/16/2022] Open
Abstract
Individuals who are at high risk of contracting HIV should have equitable access to preventive measures, such as pre-exposure prophylaxis (PrEP). We conducted a retrospective data extract from the electronic medical records of federally-qualified health centers in New York City from 2016 to 2018. Descriptive statistics are presented, stratified by those who have been prescribed PrEP and those who have not. We created a variable called "ever-female" which includes individuals assigned female at birth or who have ever identified as female. A chi-square test was performed to determine the statistical significance between variables as p < .05. A total of 9659 patients met inclusion criteria for the study. Patients who were prescribed PrEP were significantly associated with being white and never-female, with 38.2% of those prescribed PrEP identifying as white and 83.8% of those prescribed PrEP categorized as never-female. Patients of trans experience were 9.6% of the PrEP cohort and 1.5% of the never PrEP cohort (p < .001). Patients identifying as Black/African American made up 19.8% of patients prescribed PrEP and 49.8% of those never prescribed PrEP (p < .001). Patients with the lowest reported income composed 48.4% of those prescribed PrEP compared to 69.3% of patients who were never prescribed PrEP (p < .001). These findings indicate that key demographic categories may not be accessing PrEP as much as would be expected for their level of risk. Barriers to access of PrEP for women and other at-risk, under-represented populations should be further studied.
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Affiliation(s)
- Mitchell Caponi
- Community Healthcare Network, New York, NY, United States of America
| | - Carolyne Burgess
- Community Healthcare Network, New York, NY, United States of America
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Hassan S, Cooke A, Saleem H, Mushi D, Mbwambo J, Lambdin BH. Evaluating the Integrated Methadone and Anti-Retroviral Therapy Strategy in Tanzania Using the RE-AIM Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050728. [PMID: 30823440 PMCID: PMC6427450 DOI: 10.3390/ijerph16050728] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/14/2019] [Accepted: 02/22/2019] [Indexed: 01/03/2023]
Abstract
There are an estimated 50,000 people who inject drugs in Tanzania, with an HIV prevalence in this population of 42%. The Integrated Methadone and Anti-Retroviral Therapy (IMAT) strategy was developed to integrate HIV services into an opioid treatment program (OTP) in sub-Saharan Africa and increase anti-retroviral therapy (ART) initiation rates. In this paper, we evaluate the IMAT strategy using an implementation science framework to inform future care integration efforts in the region. IMAT centralized HIV services into an OTP clinic in Dar Es Salaam, Tanzania: HIV diagnosis, ART initiation, monitoring and follow up. A mixed-methods, concurrent design, was used for evaluation: quantitative programmatic data and semi-structured interviews with providers and clients addressed 4 out of 5 components of the RE-AIM framework: reach, effectiveness, adoption, implementation. Results showed high reach: 98% of HIV-positive clients received HIV services; effectiveness: 90-day ART initiation rate doubled, from 41% pre-IMAT to 87% post-IMAT (p < 0.001); proportion of HIV-positive eligible clients on ART increased from 71% pre-IMAT to 98% post-IMAT (p < 0.001). There was high adoption and implementation protocol fidelity. Qualitative results informed barriers and facilitators of RE-AIM components. In conclusion, we successfully integrated HIV care into an OTP clinic in sub-Saharan Africa with increased rates of ART initiation. The IMAT strategy represents an effective care integration model to improve HIV care delivery for OTP clients.
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Affiliation(s)
- Saria Hassan
- Yale School of Medicine, Yale University, New Haven, CT 06511, USA.
| | - Alexis Cooke
- San Francisco Department of Psychiatry, University of California, San Francisco, CA 94118, USA.
| | - Haneefa Saleem
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Dorothy Mushi
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar-Es-Salaam 11000, Tanzania.
| | - Jessie Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar-Es-Salaam 11000, Tanzania.
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Transmission dynamics among participants initiating antiretroviral therapy upon diagnosis of early acute HIV-1 infection in Thailand. AIDS 2018; 32:2373-2381. [PMID: 30096068 DOI: 10.1097/qad.0000000000001956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess transmission characteristics in a predominantly MSM cohort initiating antiretroviral therapy (ART) immediately following diagnosis of acute HIV-1infection (AHI). METHODS A longitudinal study (2009-2017) was performed in participants with AHI (n = 439) attending a single clinic in Bangkok. Plasma samples obtained prior to ART were used to obtain HIV-1 pol sequences and combined with clinical and epidemiologic data to assess transmission dynamics (cluster formation and size) using phylogenetic analysis. Clusters were estimated using maximum likelihood, genetic distance of 1.5% and visual inspection. The potential transmitter(s) in a cluster was determined using time to viral suppression and interview data. RESULTS The cohort was predominantly MSM (93%) and infected with HIV-1 CRF01_AE (87%). Medians (ranges) for age and viral load prior to ART were 26 (18-70) years and 5.9 (2.5-8.2) log10 HIV-1 RNA copies/ml. Median time from history of HIV-1 exposure to diagnosis was 19 (3-61) days. Viral suppression was observed in 388 of 412 (94%) participants at a median time of 12 weeks following ART. Twenty-six clusters with median cluster size of 2 (2-5) representing 62 of 439 (14%) participants were observed. Younger age was associated with cluster formation: median 28 versus 30 years for unique infections (P = 0.01). A potential transmitter was identified in 11 of 26 (42%) clusters. CONCLUSION Despite high rates of viral suppression following diagnosis and treatment of AHI within a cohort of young Thai MSM, HIV-1 transmission continued, reflecting the need to expand awareness and treatment access to the entire MSM population.
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Associations of criminal justice and substance use treatment involvement with HIV/HCV testing and the HIV treatment cascade among people who use drugs in Oakland, California. Addict Sci Clin Pract 2017; 12:13. [PMID: 28610602 PMCID: PMC5470222 DOI: 10.1186/s13722-017-0078-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background People who smoke crack cocaine and people who inject drugs are at-risk for criminal justice involvement as well as HIV and HCV infection. Compared to criminal justice involvement, substance use treatment (SUT) can be cost-effective in reducing drug use and its associated health and social costs. We conducted a cross-sectional study of people who smoke crack cocaine and people who inject drugs to examine the association between incarceration, community supervision and substance use treatment with HIV/HCV testing, components of the HIV treatment cascade, social and physical vulnerability and risk behavior. Methods Targeted sampling methods were used to recruit people who smoke crack cocaine and people who inject drugs (N = 2072) in Oakland, California from 2011 to 2013. Poisson regression models were used to estimate adjusted prevalence ratios between study exposures and outcomes. Results The overall HIV prevalence was 3.3% (95% CI 2.6–4.1). People previously experiencing incarceration were 21% (p < 0.001) and 32% (p = 0.001), respectively, more likely to report HIV and HCV testing; and were not more likely to report receiving HIV care or initiating ART. People previously experiencing community supervision were 17% (p = 0.001) and 15% (p = 0.009), respectively, more likely to report HIV and HCV testing; and were not more likely to report receiving HIV care or initiating ART. People with a history of SUT were 15% (p < 0.001) and 23% (p < 0.001), respectively, more likely to report receiving HIV and HCV testing, 67% (p = 0.016) more likely to report HIV care, and 92% (p = 0.012) more likely to report HIV treatment initiation. People previously experiencing incarceration or community supervision were also more likely to report homelessness, trouble meeting basic needs and risk behavior. Conclusions People with a history of substance use treatment reported higher levels of HCV and HIV testing and greater access to HIV care and treatment among HIV-positive individuals. People with a history of incarceration or community supervision reported higher levels of HCV and HIV testing, but not greater access to HIV care or treatment among HIV-positive individuals., Substance use treatment programs that are integrated with other services for HIV and HCV will be critical to simultaneously address the underlying reasons drug-involved people engage in drug-related offenses and improve access to essential medical services.
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Jiang R, Lee I, Lee TA, Pickard AS. The societal cost of heroin use disorder in the United States. PLoS One 2017; 12:e0177323. [PMID: 28557994 PMCID: PMC5448739 DOI: 10.1371/journal.pone.0177323] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/25/2017] [Indexed: 02/07/2023] Open
Abstract
Objective Heroin use in the United States has reached epidemic proportions. The objective of this paper is to estimate the annual societal cost of heroin use disorder in the United States in 2015 US dollars. Methods An analytic model was created that included incarceration and crime; treatment for heroin use disorder; chronic infectious diseases (HIV, Hepatitis B, Hepatitis C, and Tuberculosis) and their treatments; treatment of neonatal abstinence syndrome; lost productivity; and death by heroin overdose. Results Using literature-based estimates to populate the model, the cost of heroin use disorder was estimated to be $51.2 billion in 2015 US dollars ($50,799 per heroin user). One-way sensitivity analyses showed that overall cost estimates were sensitive to the number of heroin users, cost of HCV treatment, and cost of incarcerating heroin users. Conclusion The annual cost of heroin use disorder to society in the United States emphasizes the need for sustained investment in healthcare and non-healthcare related strategies that reduce the likelihood of abuse and provide care and support for users to overcome the disorder.
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Affiliation(s)
- Ruixuan Jiang
- Center for Pharmacoepidemiology and Pharmacoeconomics Research and Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, College of Pharmacy, Chicago, IL, United States of America
| | - Inyoung Lee
- Center for Pharmacoepidemiology and Pharmacoeconomics Research and Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, College of Pharmacy, Chicago, IL, United States of America
| | - Todd A. Lee
- Center for Pharmacoepidemiology and Pharmacoeconomics Research and Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, College of Pharmacy, Chicago, IL, United States of America
| | - A. Simon Pickard
- Center for Pharmacoepidemiology and Pharmacoeconomics Research and Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, College of Pharmacy, Chicago, IL, United States of America
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- * E-mail:
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Mutch AJ, Lui CW, Dean J, Mao L, Lemoire J, Debattista J, Howard C, Whittaker A, Fitzgerald L. Increasing HIV testing among hard-to-reach groups: examination of RAPID, a community-based testing service in Queensland, Australia. BMC Health Serv Res 2017; 17:310. [PMID: 28454592 PMCID: PMC5410036 DOI: 10.1186/s12913-017-2249-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 04/19/2017] [Indexed: 01/18/2023] Open
Abstract
Background The success of ‘treatment as prevention’ (TasP) to control HIV relies on the uptake of testing across priority population groups. Innovative strategies including; rapid HIV testing (RHT) in community and outreach settings, engaging peer service providers, and not requiring disclosure of sexual history have been designed to increase access. This paper reports on the implementation of ‘RAPID’, a community-based testing program in Queensland, Australia that employs these strategies to increase access to testing. Methods Service data, including client registration forms and a satisfaction survey from all clients attending RAPID between August 2014 and July 2015 were analysed. Results In 2014/2015 1,199 people attended RAPID to receive a free HIV test. The majority were urban-based gay men. 17.1% were first-time testers and 20.1% of participants were not eligible to access Medicare, Australia’s universal health care scheme. Conclusions RAPID’s evidence-based strategies appear to facilitate access to HIV testing, particularly among those who have never tested before; however the implications for the ongoing treatment and care of people ineligible for Medicare, who test positive to HIV warrants careful consideration. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2249-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allyson J Mutch
- The School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
| | - Chi-Wai Lui
- The School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Judith Dean
- The School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Limin Mao
- Centre for Social Research in Health (CSRH), University of New South Wales, NSW, Australia
| | - Jime Lemoire
- Queensland Positive People, Brisbane, Queensland, Australia
| | - Joseph Debattista
- Metro North Public Health Unit, Queensland Health, Brisbane, Queensland, Australia
| | - Chris Howard
- Queensland Positive People, Brisbane, Queensland, Australia
| | - Andrea Whittaker
- School of Social Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lisa Fitzgerald
- The School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Kerrigan D, Barrington C, Donastorg Y, Perez M, Galai N. Abriendo Puertas: Feasibility and Effectiveness a Multi-Level Intervention to Improve HIV Outcomes Among Female Sex Workers Living with HIV in the Dominican Republic. AIDS Behav 2016; 20:1919-27. [PMID: 27016102 DOI: 10.1007/s10461-016-1376-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Female sex workers (FSW) are disproportionately affected by HIV. Yet, few interventions address the needs of FSW living with HIV. We developed a multi-level intervention, Abriendo Puertas (Opening Doors), and assessed its feasibility and effectiveness among a cohort of 250 FSW living with HIV in the Dominican Republic. We conducted socio-behavioral surveys and sexually transmitted infection and viral load testing at baseline and 10-month follow-up. We assessed changes in protected sex and adherence to antiretroviral therapy (ART) with logistic regression using generalized estimating equations. Significant pre-post intervention changes were documented for adherence (72-89 %; p < 0.001) and protected sex (71-81 %; p < 0.002). Higher intervention exposure was significantly associated with changes in adherence (AOR 2.42; 95 % CI 1.23-4.51) and protected sex (AOR 1.76; 95 % CI 1.09-2.84). Illicit drug use was negatively associated with both ART adherence and protected sex. Abriendo Puertas is feasible and effective in improving behavioral HIV outcomes in FSW living with HIV.
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Affiliation(s)
- Deanna Kerrigan
- The Johns Hopkins Bloomberg School of Public Health, 624 N Broadway HH 257, Baltimore, MD, 21205, USA.
| | - Clare Barrington
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Yeycy Donastorg
- Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Noya Galai
- The Johns Hopkins Bloomberg School of Public Health, 624 N Broadway HH 257, Baltimore, MD, 21205, USA
- Department of Statistics, The University of Haifa, Mt Carmel, Israel
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Moore CB, Ciaraldi E. Quality of Care and Service Expansion for HIV Care and Treatment. Curr HIV/AIDS Rep 2016; 12:223-30. [PMID: 25855339 DOI: 10.1007/s11904-015-0263-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The last two decades have seen exceptional development of antiretroviral treatment programs throughout the world. Over 14 million persons are accessing antiretroviral treatment (ART) treatment as of early 2015, and life expectancy has risen markedly in the most-affected populations. However, large patient numbers threaten to overwhelm already over-burdened health care systems and retention in care remains suboptimal. Developing innovative strategies to alleviate these burdens and retain patients in care remains a challenge. Furthermore, despite this expansion, large populations of HIV-infected persons remain undiagnosed and are unwilling or unable to access care and treatment programs. Marginalized and high-risk populations are particularly in danger of remaining outside of care and are also disproportionately affected by HIV. To reverse the trend and "fast track" our way out of the epidemic, ambitious treatment targets are required, and a concerted effort has to be made to engage these populations into care, initiate ART, and attain viral suppression.
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Saleem HT, Mushi D, Hassan S, Bruce RD, Cooke A, Mbwambo J, Lambdin BH. "Can't you initiate me here?": Challenges to timely initiation on antiretroviral therapy among methadone clients in Dar es Salaam, Tanzania. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 30:59-65. [PMID: 26831364 DOI: 10.1016/j.drugpo.2015.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/11/2015] [Accepted: 12/10/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite dramatic improvement in antiretroviral therapy (ART) access globally, people living with HIV who inject drugs continue to face barriers that limit their access to treatment. This paper explores barriers and facilitators to ART initiation among clients attending a methadone clinic in Dar es Salaam, Tanzania. METHODS We interviewed 12 providers and 20 clients living with HIV at the Muhimbili National Hospital methadone clinic between January and February 2015. We purposively sampled clients based on sex and ART status and providers based on job function. To analyze interview transcripts, we adopted a content analysis approach. RESULTS Participants identified several factors that hindered timely ART initiation for clients at the methadone clinic. These included delays in CD4 testing and receiving CD4 test results; off-site HIV clinics; stigma operating at the individual, social and institutional levels; insufficient knowledge of the benefits of early ART initiation among clients; treatment breakdown at the clinic level possibly due to limited staff; and initiating ART only once one feels physically ill. Participants perceived social support as a buffer against stigma and facilitator of HIV treatment. Some clients also reported that persistent monitoring and follow-up on their HIV care and treatment by methadone clinic providers led them to initiate ART. CONCLUSION Health system factors, stigma and limited social support pose challenges for methadone clients living with HIV to initiate ART. Our findings suggest that on-site point-of-care CD4 testing, a peer support system, and trained HIV treatment specialists who are able to counsel HIV-positive clients and initiate them on ART at the methadone clinic could help reduce barriers to timely ART initiation for methadone clients.
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Affiliation(s)
- Haneefa T Saleem
- Pangaea Global AIDS, 436, 14th Street, Suite 920, Oakland, CA 94612, United States.
| | - Dorothy Mushi
- Muhimbili University of Health and Allied Sciences, Department of Psychiatry, P.O. Box 65293, Dar es Salaam, Tanzania
| | - Saria Hassan
- Pangaea Global AIDS, 436, 14th Street, Suite 920, Oakland, CA 94612, United States
| | - R Douglas Bruce
- Pangaea Global AIDS, 436, 14th Street, Suite 920, Oakland, CA 94612, United States; Cornell Scott-Hill Health Center, 428 Columbus Avenue, New Haven, CT 06519, United States; Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States
| | - Alexis Cooke
- University of California, Los Angeles, Fielding School of Public Health, Department of Community Health Sciences, United States
| | - Jessie Mbwambo
- Muhimbili University of Health and Allied Sciences, Department of Psychiatry, P.O. Box 65293, Dar es Salaam, Tanzania
| | - Barrot H Lambdin
- RTI International, 351 California Street, Suite 500, San Francisco, CA 94104, United States; University of California San Francisco, San Francisco, CA, United States; University of Washington, Seattle, WA, United States
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Service integration: opportunities to expand access to antiretroviral therapy for people who inject drugs in Tanzania. J Int AIDS Soc 2015. [PMID: 26202669 PMCID: PMC4511823 DOI: 10.7448/ias.18.1.19936] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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