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Collins LF, Koester KA, McNulty MC, Montgomery ET, Johnson MO, Neilands TB, Dilworth SE, Sauceda JA, Dance K, Erguera X, Diaz Tsuzuki M, Gutierrez JI, Christopoulos KA, Colasanti JA. Patient Attitudes Toward Self- or Partner-, Friend-, or Family-Administered Long-acting Injectable Antiretroviral Therapy: A Mixed-Methods Study Across 3 Urban Human Immunodeficiency Virus Clinics. Open Forum Infect Dis 2024; 11:ofae265. [PMID: 38854389 PMCID: PMC11161893 DOI: 10.1093/ofid/ofae265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Background Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) offers a novel drug delivery option for persons with human immunodeficiency virus (PWH) but requires administration every 4 or 8 weeks by a medical professional. Methods To facilitate LAI antiretroviral therapy (ART) scale-up, we evaluated patient interest in alternative administration approaches via a mixed-methods, serial cross-sectional study across 3 US HIV clinics. We surveyed PWH (December 2021 to May 2022) on appeal of self- or partner/friend/family-administered LAI-CAB/RPV; multivariable ordinal logistic regression explored associated characteristics. To contextualize survey results, we thematically analyzed semi-structured interview data collected from PWH (August 2020 to July 2021) on attitudes toward out-of-clinic LAI-ART administration. Results Among 370 surveyed PWH (median age, 46 years; 26% cisgender female, 59% Black, 56% sexual minority, 34% housing instability), self-administering LAI-CAB/RPV appealed to 67%. PWH who were White (adjusted odds ratio [aOR], 3.30 [95% confidence interval {CI}, 1.42-7.64]), stably housed (aOR, 2.16 [95% CI, 1.30-3.59]), or gay/bisexual (aOR, 1.81 [1.14-2.89]) were more likely to endorse self-administration. Fewer PWH (60%) reported partner/friend/family administration as appealing; adjusted models revealed similar sociodemographic preferences for this outcome. In 72 interviews, PWH noted that acceptability of out-of-clinic LAI-ART administration was qualified by convenience, prior injection experience, and potential fear of self-inflicted pain, dependence on others, and/or HIV disclosure. Conclusions In a multisite sample of PWH, self- and, to a lesser extent, partner/friend/family-administration of LAI-CAB/RPV appealed to most; however, was less appealing among populations more impacted by health disparities. Innovative LAI-ART delivery options could free up in-clinic resources to focus scale-up among marginalized populations.
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Affiliation(s)
- Lauren F Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
| | - Kimberly A Koester
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Moira C McNulty
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Elizabeth T Montgomery
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
- Women’s Global Health Imperative, RTI International, Berkeley, California, USA
| | - Mallory O Johnson
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Samantha E Dilworth
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - John A Sauceda
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Kaylin Dance
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
| | - Xavier Erguera
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Public Health, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Manami Diaz Tsuzuki
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - José I Gutierrez
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Katerina A Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Public Health, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
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Barth SK, Saulters KJ, Balba GP, Monroe AK, Horberg MA, Kumar PN, Greenberg AE, Castel AD. Mixed Methods Analysis of Telehealth Experience, Satisfaction, and Quality of Care During the COVID Pandemic Among Persons with HIV in Washington, DC. AIDS Behav 2024; 28:912-923. [PMID: 37872460 PMCID: PMC10923106 DOI: 10.1007/s10461-023-04198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/25/2023]
Abstract
The purpose of this study is to describe telehealth experiences and quality of HIV care provided to an urban population of people with HIV (PWH) in Washington, DC. We used self-reported survey data from a cohort of PWH in the DC Cohort longitudinal study linked to medical records (October 26, 2020-December 31, 2021). Analyses followed a mixed-methods approach, including prevalence estimates and multivariable logistic regression of telehealth use by demographic and HIV characteristics. We measured primary motivation, modes of engagement, and telehealth satisfaction. Qualitative responses to open-ended questions were coded using collaborative coding. A framework developed by the National Quality Forum (NQF) was applied to the results. Among 978 participants, 69% reported using telehealth for HIV care during the pandemic. High school graduates were less likely to use telehealth compared to those with college education (aOR 0.69, 95% CI 0.48, 0.98). PWH with > 1 co-morbid condition were more likely to use telehealth compared to those without (aOR 1.42, 95% CI 1.02, 1.95). The majority reported satisfaction with telehealth (81%). Qualitative analysis of telehealth satisfaction found that most responses were related to access to care and technology, effectiveness, and patient experience. PWH using telehealth during the pandemic were satisfied with their experience though use differed demographically. Telehealth was used effectively to overcome barriers to care engagement, including transportation, costs, and time. As we transition away from the emergency pandemic responses, it will be important to determine how this technology can be used in the future in an equitable manner to further strengthen HIV care engagement.
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Affiliation(s)
- Shannon K Barth
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA.
| | - Kacie J Saulters
- Department of Internal Medicine, University of Maryland Capital Region Health, Largo, MD, USA
| | - Gayle P Balba
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Anne K Monroe
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - Princy N Kumar
- Georgetown University School of Medicine, Washington, DC, USA
| | - Alan E Greenberg
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
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Qiao S, Zhang J, Li Z, Olatosi B, Weissman S, Li X. The Impacts of HIV-Related Service Interruptions During the COVID-19 Pandemic: Protocol of a Mixed Methodology Longitudinal Study. AIDS Behav 2023:10.1007/s10461-023-04138-5. [PMID: 37526786 DOI: 10.1007/s10461-023-04138-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
The global COVID-19 pandemic has imposed unprecedented pressure on health systems and has interrupted public health efforts for other major health conditions, including HIV. It is critical to comprehensively understand how the pandemic has affected the delivery and utilization of HIV-related services and what are the effective strategies that may mitigate the negative impacts of COVID-19 and resultant interruptions. The current study thus aims to comprehensively investigate HIV service interruptions during the pandemic following a socioecological model, to assess their impacts on various outcomes of the HIV prevention and treatment cascade and to identify resilience resources for buffering impacts of interruptions on HIV treatment cascade outcomes. We will assess HIV service interruptions in South Carolina (SC) since 2020 using operational report data from Ryan White HIV clinics and HIV service utilization data (including telehealth use) based on statewide electronic health records (EHR) and cellphone-based place visitation data. We will further explore how HIV service interruptions affect HIV prevention and treatment cascade outcomes at appropriate geospatial units based on the integration of multi-type, multi-source datasets (e.g., EHR, geospatial data). Finally, we will identify institutional-, community-, and structural-level factors (e.g., resilience resources) that may mitigate the adverse impacts of HIV service interruptions based on the triangulation of quantitative (i.e., EHR data, geospatial data, online survey data) and qualitative (i.e., in-depth interviews with clinic leaders, healthcare providers, people living with HIV, and HIV clinic operational reports) data regarding health system infrastructure, social capital, and organizational preparedness. Our proposed research can lead to a better understanding of complicated HIV service interruptions in SC and resilience factors that can mitigate the negative effects of such interruptions on various HIV treatment cascade outcomes. The multilevel resilience resources identified through data triangulation will assist SC health departments and communities in developing strategic plans in response to this evolving pandemic and other future public health emergencies (e.g., monkeypox, disasters caused by climate change). The research findings can also inform public health policymaking and the practices of other Deep South states with similar sociocultural contexts in developing resilient healthcare systems and communities and advancing epidemic preparedness.
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Affiliation(s)
- Shan Qiao
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, The University of South Carolina, Columbia, SC, USA.
- South Carolina SmartState Center of Health Quality, Columbia, USA.
| | - Jiajia Zhang
- South Carolina SmartState Center of Health Quality, Columbia, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, The University of South Carolina, Columbia, SC, USA
| | - Zhenlong Li
- South Carolina SmartState Center of Health Quality, Columbia, USA
- Geoinformation and Big Data Research Laboratory, Department of Geography, Colleague of Arts and Sciences, The University of South Carolina, Columbia, SC, USA
| | - Bankole Olatosi
- South Carolina SmartState Center of Health Quality, Columbia, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, The University of South Carolina, Columbia, SC, USA
| | - Sharon Weissman
- South Carolina SmartState Center of Health Quality, Columbia, USA
- Department of Internal Medicine, School of Medicine Columbia, The University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, The University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center of Health Quality, Columbia, USA
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Kim JYH, Barth SK, Monroe AK, Ahsan S, Kovacic J, Senn S, Castel AD. The impact of COVID-19 on the HIV continuum of care: challenges, innovations, and opportunities. Expert Rev Anti Infect Ther 2023; 21:831-846. [PMID: 37470436 DOI: 10.1080/14787210.2023.2239503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION In February 2019, the United States (US) launched the Ending the HIV Epidemic (EHE) initiative with emphasis on improving the various steps of the Human Immunodeficiency Virus (HIV) prevention and care continuum. However, in March 2020, the Coronavirus Disease 2019 (COVID-19) pandemic was declared, curtailing efforts to end the epidemic in the US. AREAS COVERED To describe the impact of the pandemic on EHE in the US, the authors performed a comprehensive literature review focusing on outcomes at each step of the HIV care continuum. Simultaneously, they identified examples of pandemic-era innovations that may help EHE. EXPERT OPINION Numerous studies demonstrated pandemic-related disruptions across the care continuum as well as the impact on preexisting barriers to care among People with HIV (PWH) at higher risk for poor outcomes. As the pandemic progressed, innovative approaches to delivering healthcare and providing essential services emerged, including widespread use of telemedicine, expansion of home-based care, self-collected sexually transmitted infection (STI) and HIV testing, and co-located testing for COVID-19 and HIV/STIs. While the COVID-19 pandemic initially hindered achieving EHE in the US, the ability to be agile, flexible, and creative led to innovation in HIV care delivery that may ultimately assist in meeting EHE goals as we transition into the post-pandemic era.
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Affiliation(s)
- Jenny Yeon Hee Kim
- Department of Global Health, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 4th Floor, Washington, DC, 20052, USA
| | - Shannon K Barth
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Anne K Monroe
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Sarah Ahsan
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Janja Kovacic
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Siena Senn
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
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Zakumumpa H, Kwiringira J, Katureebe C, Spicer N. Understanding Uganda's early adoption of novel differentiated HIV treatment services: a qualitative exploration of drivers of policy uptake. BMC Health Serv Res 2023; 23:343. [PMID: 37020290 PMCID: PMC10075495 DOI: 10.1186/s12913-023-09313-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Although differentiated service delivery (DSD) for HIV treatment was endorsed by the WHO in its landmark 2016 guidelines to lessen patients' need to frequently visit clinics and hence to reduce unnecessary burdens on health systems, uptake has been uneven globally. This paper is prompted by the HIV Policy Lab's annual report of 2022 which reveals substantial variations in programmatic uptake of differentiated HIV treatment services across the globe. We use Uganda as a case study of an 'early adopter' to explore the drivers of programmatic uptake of novel differentiated HIV treatment services. METHODS We conducted a qualitative case-study in Uganda. In-depth interviews were held with national-level HIV program managers (n = 18), district health team members (n = 24), HIV clinic managers (n = 36) and five focus groups with recipients of HIV care (60 participants) supplemented with documentary reviews. Our thematic analysis of the qualitative data was guided by the Consolidated Framework for Implementation Research (CFIR)'s five domains (inner context, outer setting, individuals, process of implementation). RESULTS Our analysis reveals that drivers of Uganda's 'early adoption' of DSD include: having a decades-old HIV treatment intervention implementation history; receiving substantial external donor support in policy uptake; the imperatives of having a high HIV burden; accelerated uptake of select DSD models owing to Covid-19 'lockdown' restrictions; and Uganda's participation in clinical trials underpinning WHO guidance on DSD. The identified processes of implementation entailed policy adoption of DSD (such as the role of local Technical Working Groups in domesticating global guidelines, disseminating national DSD implementation guidelines) and implementation strategies (high-level health ministry buy-in, protracted patient engagement to enhance model uptake, devising metrics for measuring DSD uptake progress) for promoting programmatic adoption. CONCLUSION Our analysis suggests early adoption derives from Uganda's decades-old HIV intervention implementation experience, the imperative of having a high HIV burden which prompted innovations in HIV treatment delivery as well as outer context factors such as receiving substantial external assistance in policy uptake. Our case study of Uganda offers implementation research lessons on pragmatic strategies for promoting programmatic uptake of differentiated treatment HIV services in other countries with a high HIV burden.
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Affiliation(s)
- Henry Zakumumpa
- School of Public Health, Makerere University, Kampala, Uganda.
| | | | - Cordelia Katureebe
- Ministry of Health, AIDS Control Program, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Spicer
- London School of Hygiene and Tropical Medicine, London, UK
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Frey E, Johnston CD, Siegler EL. Treatment Regimens and Care Models for Older Patients Living with HIV: Are We Doing Enough? HIV AIDS (Auckl) 2023; 15:191-208. [PMID: 37153650 PMCID: PMC10155713 DOI: 10.2147/hiv.s311613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023] Open
Abstract
With improved access to antiretroviral therapy throughout the world, people are aging with HIV, and a large portion of the global population of people with HIV (PWH) is now age 50 or older. Older PWH experience more comorbidities, aging-related syndromes, mental health challenges, and difficulties accessing fundamental needs than the population of older adults without HIV. As a result, ensuring that older PWH are receiving comprehensive healthcare can often be overwhelming for both PWH and the providers. Although there is a growing literature addressing the needs of this population, gaps remain in care delivery and research. In this paper, we suggest seven key components to any healthcare program designed to address the needs of older people with HIV: management of HIV, comorbidity screening and treatment, primary care coordination and planning, attention to aging related-syndromes, optimization of functional status, support of behavioral health, and improved access to basic needs and services. We review many of the difficulties and controversies related to the implementation of these components, which include the absence of screening guidelines for this population and the challenges of care integration, and we suggest key next steps.
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Affiliation(s)
- Emily Frey
- Department of Medicine, Weill Cornell/New York Presbyterian Hospital, New York, NY, USA
- Correspondence: Emily Frey, Department of Medicine, Weill Cornell Medicine, 505 East 70th Street, New York, NY, 10021, USA, Tel +1 212 746 4749, Fax +1 212 746 4609, Email
| | - Carrie D Johnston
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Eugenia L Siegler
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
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Kumbhakar RG, Budak JZ, Tao Y, Beste J, Lake E, Navabi N, Mose E, Barker G, Lee J, Hara K, Khosropour C, Dhanireddy S, Dombrowski JC. The Impact of a Walk-in Human Immunodeficiency Virus Care Model for People Who Are Incompletely Engaged in Care: The Moderate Needs (MOD) Clinic. Open Forum Infect Dis 2023; 10:ofac670. [PMID: 36628059 PMCID: PMC9825197 DOI: 10.1093/ofid/ofac670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Background The Moderate Needs (MOD) Clinic in Seattle, Washington provides walk-in primary care for people with human immunodeficiency virus (HIV) who are incompletely engaged in standard care. Methods We evaluated HIV outcomes among patients enrolled in the MOD Clinic (within group analysis) and, separately, among MOD patients versus patients who were MOD-eligible but did not enroll (comparison group analysis) during January 1, 2018-September 30, 2021. The primary outcome was viral suppression ([VS] viral load <200 copies/mL); secondary outcomes care engagement (≥2 visits ≥60 days apart) and sustained VS (≥2 consecutive suppressed viral loads ≥60 days apart). In the within group analysis, we examined outcomes at time of MOD enrollment versus 12 months postenrollment. In the comparison group analysis, we examined outcomes at the time of MOD eligibility versus 12 months posteligibility. Both analyses used modified Poisson regression. Results Most patients in MOD (N = 213) were unstably housed (52%) and had psychiatric comorbidities (86%) or hazardous substance use (81%). Among patients enrolled ≥12 months (N = 164), VS did not increase significantly from baseline to postenrollment (63% to 71%, P = .11), but care engagement and sustained VS both improved (37% to 86%, P < .001 and 20% to 53%, P < .001, respectively) from pre-enrollment to 12 months postenrollment. In the comparison group analysis, VS worsened in nonenrolled patients (N = 517) from baseline to 12 months posteligibility (82% to 75%, P < .001). Patients in the MOD Clinic who met criteria for the comparison group analysis (N = 68) were more likely than nonenrolled patients to be engaged in care at 12 months posteligibility (relative risk, 1.29; 95% confidence interval, 1.03-1.63). Conclusions The MOD Clinic enrollment was associated with improved engagement in care. This model adds to the spectrum of differentiated HIV care services.
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Affiliation(s)
- Raaka G Kumbhakar
- Correspondence: Raaka G. Kumbhakar, MD, Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 325 9th Ave., Box 358061, Seattle, WA 98104 (). Julia C. Dombrowski, MD, MPH, 325 9th Ave., Box 359777, Seattle, WA 98104 ()
| | - Jehan Z Budak
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Yuan Tao
- Harborview Medical Center, Seattle, Washington, USA
| | - Jason Beste
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Eve Lake
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Nazlee Navabi
- Present Affiliation: Wise Patient Internal Medicine, Seattle, Washington, USA
| | - Eric Mose
- Harborview Medical Center, Seattle, Washington, USA
| | - Gwen Barker
- Harborview Medical Center, Seattle, Washington, USA
| | - Ji Lee
- Harborview Medical Center, Seattle, Washington, USA
- School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Katie Hara
- Present Affiliation: Bailey-Boushay House, Seattle, Washington, USA
| | | | - Shireesha Dhanireddy
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Julia C Dombrowski
- Correspondence: Raaka G. Kumbhakar, MD, Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 325 9th Ave., Box 358061, Seattle, WA 98104 (). Julia C. Dombrowski, MD, MPH, 325 9th Ave., Box 359777, Seattle, WA 98104 ()
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Devlin SA, Garcia M, Fujimoto K, Hallmark C, McNeese M, Schneider J, McNulty MC. "Everything…Fell Apart Once COVID-19 Hit"-Leveraging the COVID-19 Response to Strengthen Public Health Activities toward Ending the HIV Epidemic: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15247. [PMID: 36429970 PMCID: PMC9690919 DOI: 10.3390/ijerph192215247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/08/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
COVID-19 caused widespread disruption of activities for Ending the HIV Epidemic (EHE). In this study we assessed public health perspectives on leveraging the COVID-19 response to advance the goals of EHE. We conducted a qualitative study with 33 public health partners in the Midwestern and Southern United States from October 2020 to February 2022. Participants were asked how the strategies developed for COVID-19 could be applied to the HIV epidemic. Interviews were recorded, transcribed, and examined using rapid qualitative analysis. Four themes emerged: (1) Rebuilding teams and adapting culture for success in EHE activities; (2) Recognizing and modernizing the role of disease intervention specialists (DIS); (3) Enhanced community awareness of the public health role in disease response and prevention; and (4) Leveraging COVID-19 data systems and infrastructure for EHE activities. The COVID-19 pandemic called attention to the dearth of public health funding and outdated information technology (IT) infrastructure used for HIV activities. It also led to greater public health knowledge, including increased familiarity with partner services and molecular epidemiology of HIV, and opportunities to develop new data systems for surveillance that can be applied to efforts for EHE.
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Affiliation(s)
- Samantha A. Devlin
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
- Chicago Center for HIV Elimination, Chicago, IL 60637, USA
| | - Moctezuma Garcia
- School of Social Work, San José State University, San Jose, CA 95112, USA
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Camden Hallmark
- Division of Disease Prevention and Control, Houston Health Department, Houston, TX 77054, USA
| | - Marlene McNeese
- Division of Disease Prevention and Control, Houston Health Department, Houston, TX 77054, USA
| | - John Schneider
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
- Chicago Center for HIV Elimination, Chicago, IL 60637, USA
| | - Moira C. McNulty
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
- Chicago Center for HIV Elimination, Chicago, IL 60637, USA
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The Management of HIV Care Services in Central and Eastern Europe: Data from the Euroguidelines in Central and Eastern Europe Network Group. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137595. [PMID: 35805250 PMCID: PMC9265352 DOI: 10.3390/ijerph19137595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/19/2022] [Accepted: 06/19/2022] [Indexed: 12/18/2022]
Abstract
Introduction: The COVID-19 pandemic has been challenging time for medical care, especially in the field of infectious diseases (ID), but it has also provided an opportunity to introduce new solutions in HIV management. Here, we investigated the changes in HIV service provision across Central and Eastern European (CEE) countries before and after the COVID-19 outbreak. Methods: The Euroguidelines in Central and Eastern Europe Network Group consists of experts in the field of ID from 24 countries within the CEE region. Between 11 September and 29 September 2021, the group produced an on-line survey, consisting of 32 questions on models of care among HIV clinics before and after the SARS-CoV-2 outbreak. Results: Twenty-three HIV centers from 19 countries (79.2% of all countries invited) participated in the survey. In 69.5% of the countries, there were more than four HIV centers, in three countries there were four centers (21%), and in four countries there was only one HIV center in each country. HIV care was based in ID hospitals plus out-patient clinics (52%), was centralized in big cities (52%), and was publicly financed (96%). Integrated services were available in 21 clinics (91%) with access to specialists other than ID, including psychologists in 71.5% of the centers, psychiatrists in 43%, gynecologists in 47.5%, dermatologists in 52.5%, and social workers in 62% of all clinics. Patient-centered care was provided in 17 centers (74%), allowing consultations and tests to be planned for the same day. Telehealth tools were used in 11 centers (47%) before the COVID-19 pandemic outbreak, and in 18 (78%) after (p = 0.36), but were represented mostly by consultations over the telephone or via e-mail. After the COVID-19 outbreak, telehealth was introduced as a new medical tool in nine centers (39%). In five centers (28%), no new services or tools were introduced. Conclusions: As a consequence of the COVID-19 pandemic, tools such as telehealth have become popularized in CEE countries, challenging the traditional approach to HIV care. These implications need to be further evaluated in order to ascertain the best adaptations, especially for HIV medicine.
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Santos GM, Hong C, Wilson N, Nutor JJ, Harris O, Garner A, Holloway I, Ayala G, Howell S. Persistent disparities in COVID-19-associated impacts on HIV prevention and care among a global sample of sexual and gender minority individuals. Glob Public Health 2022; 17:827-842. [PMID: 35435149 PMCID: PMC10953730 DOI: 10.1080/17441692.2022.2063362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/24/2022] [Indexed: 02/06/2023]
Abstract
As COVID-19 continues to persist, there is a need to examine its impact among sexual and gender minority individuals, especially those with intersecting vulnerabilities. We conducted a cross-sectional survey with a global sample of sexual and gender minority individuals (n = 21,795) from October 25, 2020 to November 19, 2020, through a social networking app. We characterised the HIV prevention and HIV treatment impacts of COVID-19 and the COVID-19 mitigation response and examined whether subgroups of our study population are disproportionately impacted by COVID-19. Many sexual and gender minority individuals reported interruptions to HIV prevention and HIV care and treatment services. These consequences were significantly greater among people living with HIV, racial/ethnic minorities, immigrants, individuals with a history of sex work, and socio-economically disadvantaged groups. These findings highlight the urgent need to mitigate the negative impacts of COVID-19 among sexual and gender minority individuals.
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Affiliation(s)
- Glenn-Milo Santos
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Chenglin Hong
- Department of Social Welfare, University of California Los Angeles, Los Angeles, CA, USA
| | - Natalie Wilson
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Orlando Harris
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | | | - Ian Holloway
- Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, CA, USA
| | - George Ayala
- Alameda County Public Health Department, San Leandro, CA, USA
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11
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Fisher KA, Patel SV, Mehta N, Stewart A, Medley A, Dokubo EK, Shang JD, Wright J, Rodas J, Balachandra S, Kitenge F, Mpingulu M, García MC, Bonilla L, Quaye S, Melchior M, Banchongphanith K, Phokhasawad K, Nkanaunena K, Maida A, Couto A, Mizela J, Ibrahim J, Charles OO, Malamba SS, Musoni C, Bolo A, Bunga S, Lolekha R, Kiatchanon W, Bhatia R, Nguyen C, Aberle-Grasse J. Lessons Learned from Programmatic Gains in HIV Service Delivery During the COVID-19 Pandemic — 41 PEPFAR-Supported Countries, 2020. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:447-452. [PMID: 35324881 PMCID: PMC8956337 DOI: 10.15585/mmwr.mm7112a2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Trepka MJ, Ward MK, Ladner RA, Sheehan DM, Li T, Ibarra C, Gbadamosi SO, Ibañez GE, Jean-Gilles M. HIV Care Access During the COVID-19 Pandemic as Perceived by Racial/Ethnic Minority Groups Served by the Ryan White Program, Miami-Dade County, Florida. J Int Assoc Provid AIDS Care 2022; 21:23259582221084536. [PMID: 35243926 PMCID: PMC8899832 DOI: 10.1177/23259582221084536] [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] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/21/2021] [Accepted: 02/11/2022] [Indexed: 11/29/2022] Open
Abstract
The Ryan White Program (RWP) in Miami-Dade County, Florida made several modifications to keep HIV care accessible during the COVID-19 Pandemic, including expanding telehealth services, increasing access to HIV medications, and waiving required lab tests for service recertification. We assessed ease of access to medical providers, medical case managers, and antiretroviral medications during the COVID-19 Pandemic among 298 Non-Hispanic Black, Hispanic, and Haitian people with HIV (PWH) served by the RWP Part A, Miami-Dade County, Florida using a telephone-administered survey between October 2020 and January 2021. Overall, most clients reported similar or better access compared to before the Pandemic. Use of videocalls to communicate with HIV medical providers varied by race/ethnicity: Hispanics (49.6%), Non-Hispanic Blacks (37.7%), and Haitian clients (16.0%). Results suggest the modifications helped maintain access to care during an unprecedented health crisis. Permanently adopting many of these modifications should be considered to continue to facilitate access to care.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL USA
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
| | - Melissa K. Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL USA
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
| | | | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL USA
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Cynthia Ibarra
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL USA
| | - Semiu O. Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL USA
| | - Gladys E. Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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13
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McGinnis KA, Skanderson M, Justice AC, Akgün KM, Tate JP, King JT, Rentsch CT, Marconi VC, Hsieh E, Ruser C, Kidwai-Khan F, Yousefzadeh R, Erdos J, Park LS. HIV care using differentiated service delivery during the COVID-19 pandemic: a nationwide cohort study in the US Department of Veterans Affairs. J Int AIDS Soc 2021; 24 Suppl 6:e25810. [PMID: 34713585 PMCID: PMC8554215 DOI: 10.1002/jia2.25810] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction The Department of Veterans Affairs (VA) is the largest provider of HIV care in the United States. Changes in healthcare delivery became necessary with the COVID‐19 pandemic. We compared HIV healthcare delivery during the first year of the COVID‐19 pandemic to a prior similar calendar period. Methods We included 27,674 people with HIV (PWH) enrolled in the Veterans Aging Cohort Study prior to 1 March 2019, with ≥1 healthcare encounter from 1 March 2019 to 29 February 2020 (2019) and/or 1 March 2020 to 28 February 2021 (2020). We counted monthly general medicine/infectious disease (GM/ID) clinic visits and HIV‐1 RNA viral load (VL) tests. We determined the percentage with ≥1 clinic visit (in‐person vs. telephone/video [virtual]) and ≥1 VL test (detectable vs. suppressed) for 2019 and 2020. Using pharmacy records, we summarized antiretroviral (ARV) medication refill length (<90 vs. ≥90 days) and monthly ARV coverage. Results Most patients had ≥1 GM/ID visit in 2019 (96%) and 2020 (95%). For 2019, 27% of visits were virtual compared to 64% in 2020. In 2019, 82% had VL measured compared to 74% in 2020. Of those with VL measured, 92% and 91% had suppressed VL in 2019 and 2020. ARV refills for ≥90 days increased from 39% in 2019 to 51% in 2020. ARV coverage was similar for all months of 2019 and 2020 ranging from 76% to 80% except for March 2019 (72%). Women were less likely than men to be on ARVs or to have a VL test in both years. Conclusions During the COVID‐19 pandemic, the VA increased the use of virtual visits and longer ARV refills, while maintaining a high percentage of patients with suppressed VL among those with VL measured. Despite decreased in‐person services during the pandemic, access to ARVs was not disrupted. More follow‐up time is needed to determine whether overall health was impacted by the use of differentiated service delivery and to evaluate whether a long‐term shift to increased virtual healthcare could be beneficial, particularly for PWH in rural areas or with transportation barriers. Programmes to increase ARV use and VL testing for women are needed.
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Affiliation(s)
- Kathleen A McGinnis
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA
| | - Melissa Skanderson
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA
| | - Amy C Justice
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kathleen M Akgün
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Janet P Tate
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joseph T King
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher T Rentsch
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Vincent C Marconi
- Emory University School of Medicine, Rollins School of Public Health, and the Atlanta VA Medical Center, Atlanta, Georgia, USA
| | - Evelyn Hsieh
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher Ruser
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farah Kidwai-Khan
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Roozbeh Yousefzadeh
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joseph Erdos
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lesley S Park
- Stanford Center for Population Health Sciences, Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, California, USA
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14
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Mpofu M, Moyo T, Gilbert M, Dikobe W, Nishimoto L, Katiko G, Batuka J, Satti H, Qambayot M, Mahler H, Kitso L, Marqusee H, Bateganya M. Distribution of antiretroviral therapy through private pharmacies and postal courier services during COVID-19 in Botswana: acceptability and reach of two out-of-facility individual differentiated service delivery models. J Int AIDS Soc 2021; 24 Suppl 6:e25814. [PMID: 34713589 PMCID: PMC8554222 DOI: 10.1002/jia2.25814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/19/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The advent of COVID-19 has put pressure on health systems as they implement measures to reduce the risk of transmission to people living with HIV (PLHIV) and healthcare workers. For two out-of-facility individual differentiated service delivery (DSD) models, we assessed acceptability of antiretroviral therapy (ART) distribution through private pharmacies and reach of home delivery of ART through courier services during the COVID-19 pandemic in Botswana. METHODS From 24 July to 24 August 2020, we conducted exit interviews with PLHIV receiving ART from 10 high-volume public facilities in Gaborone, and mapped and conducted an online survey with private pharmacies to assess willingness and capacity to dispense ART to PLHIV enrolled in the Botswana national ART program. We piloted ART home delivery from September 2020 to January 2021 in Gaborone and Kweneng East districts for PLHIV accessing ART at two Tebelopele Wellness Clinics. We used cascade analysis to measure the enrolment and eventual reach (percentage of those reached amongst those who are eligible) of ART home delivery. RESULTS Sixty-one PLHIV and 42 private pharmacies participated. Of the PLHIV interviewed, 37 (61%) indicated willingness to access ART from private pharmacies and pay BWP50 (∼US$4) per refill for a maximum of two refills per year. All private pharmacies surveyed were willing to provide ART, and 26 (62%) would charge a dispensing fee (range = BWP50-100; ∼US$4-8) per refill. All pharmacies operated 12 h/day, 6 days/week and on public holidays. In the home delivery pilot, 650 PLHIV were due for refills, 69.5% (n = 452) of whom were eligible for home delivery. Of these, 361 were successfully offered home delivery and 303 enrolled (enrolment = 83.9%: female = 87.2%, male = 77.8%, p = 0.013). A total of 276 deliveries were made, a reach of 61%. CONCLUSIONS Providing ART through private pharmacies and home delivery was acceptable in Botswana during COVID-19. Surveyed pharmacies were willing and able to dispense ART to PLHIV attending public sector facilities for free or for a nominal fee. Additionally, using courier services for ART home delivery is a novel and viable model in countries with a reliable courier service like Botswana and should be scaled up, particularly in urban areas.
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15
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Davis AJ, Greene M, Siegler E, Fitch KV, Schmalzle SA, Krain A, Vera JH, Boffito M, Falutz J, Erlandson KM. Strengths and Challenges of Various Models of Geriatric Consultation for Older Adults Living with HIV. Clin Infect Dis 2021; 74:1101-1106. [PMID: 34358303 DOI: 10.1093/cid/ciab682] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Indexed: 11/12/2022] Open
Abstract
As care of persons living with HIV (PWH) has transitioned from management of opportunistic infections to management of conditions associated with older age, new models of geriatric consultation are needed. The authors, who represent nine different clinics across North America and the United Kingdom, provided their insights on models of geriatric consultation for older individuals living with HIV. Three models of geriatric consultation are delineated: outpatient referral/consultation, combined HIV/geriatric multidisciplinary clinic, and dually-trained providers within one clinical setting. A patient-centered approach and the utilization of expertise across disciplines were universally identified as strengths. Logistical barriers and the reluctance of older PWH to see a geriatric care provider were identified as barriers to implementing these models. Although the optimal model of geriatric consultation depends on a region's resources, there is value in augmenting the training of infectious disease providers to include principles of geriatric care.
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Affiliation(s)
- Amelia J Davis
- University of Colorado - Anschutz Medical Campus; School of Medicine; Aurora, CO, USA
| | - Meredith Greene
- Department of Medicine, Division of Geriatrics; University of California, San Francisco; San Francisco, CA, USA
| | - Eugenia Siegler
- Division of Geriatrics and Palliative Medicine; Weill Cornell Medical College; New York, NY, USA
| | - Kathleen V Fitch
- Metabolism Unit; Massachusetts General Hospital and Harvard Medical School; Boston, MA, USA
| | - Sarah A Schmalzle
- Division of Infectious Disease; University of Maryland School of Medicine; Baltimore, MD, USA
| | - Alysa Krain
- Perelman School of Medicine, University of Pennsylvania; Philadelphia, PA, USA
| | - Jaime H Vera
- Department of Global Health and Infection; Brighton and Sussex Medical School;UK
| | - Marta Boffito
- Department of HIV Medicine; Chelsea and Westminster Hospital; London, UK
| | | | - Kristine M Erlandson
- Department of Medicine; University of Colorado - Anschutz Medical Campus; Aurora, CO, USA
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16
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Zakumumpa H, Tumwine C, Milliam K, Spicer N. Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda. BMC Health Serv Res 2021; 21:692. [PMID: 34256756 PMCID: PMC8276217 DOI: 10.1186/s12913-021-06607-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/04/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The notion of health-system resilience has received little empirical attention in the current literature on the Covid-19 response. We set out to explore health-system resilience at the sub-national level in Uganda with regard to strategies for dispensing antiretrovirals during Covid-19 lockdown. METHODS We conducted a qualitative case-study of eight districts purposively selected from Eastern and Western Uganda. Between June and September 2020, we conducted qualitative interviews with district health team leaders (n = 9), ART clinic managers (n = 36), representatives of PEPFAR implementing organizations (n = 6).In addition, six focus group discussions were held with recipients of HIV care (48 participants). Qualitative data were analyzed using thematic approach. RESULTS Five broad strategies for distributing antiretrovirals during 'lockdown' emerged in our analysis: accelerating home-based delivery of antiretrovirals,; extending multi-month dispensing from three to six months for stable patients; leveraging the Community Drug Distribution Points (CDDPs) model for ART refill pick-ups at outreach sites in the community; increasing reliance on health information systems, including geospatial technologies, to support ART refill distribution in unmapped rural settings. District health teams reported leveraging Covid-19 outbreak response funding to deliver ART refills to homesteads in rural communities. CONCLUSION While Covid-19 'lockdown' restrictions undoubtedly impeded access to facility-based HIV services, they revived interest by providers and demand by patients for community-based ART delivery models in case-study districts in Uganda.
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Affiliation(s)
- Henry Zakumumpa
- Makerere University, School of Public Health, Kampala, Uganda.
| | | | - Kiconco Milliam
- Department of Sociology, Kyambogo University, Kampala, Uganda
| | - Neil Spicer
- London School of Hygiene and Tropical Medicine, London, UK
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Severe coronavirus disease 2019 in a patient with HIV-2 infection. AIDS 2021; 35:1151-1152. [PMID: 33946091 DOI: 10.1097/qad.0000000000002835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Budak JZ, Scott JD, Dhanireddy S, Wood BR. The Impact of COVID-19 on HIV Care Provided via Telemedicine—Past, Present, and Future. Curr HIV/AIDS Rep 2021. [DOI: https://doi.org.10.1007/s11904-021-00543-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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19
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Budak JZ, Scott JD, Dhanireddy S, Wood BR. The Impact of COVID-19 on HIV Care Provided via Telemedicine—Past, Present, and Future. Curr HIV/AIDS Rep 2021. [DOI: https:/doi.org.10.1007/s11904-021-00543-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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20
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Budak JZ, Scott JD, Dhanireddy S, Wood BR. The Impact of COVID-19 on HIV Care Provided via Telemedicine-Past, Present, and Future. Curr HIV/AIDS Rep 2021; 18:98-104. [PMID: 33616811 PMCID: PMC7898490 DOI: 10.1007/s11904-021-00543-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 01/10/2023]
Abstract
Purpose of Review This review summarizes HIV care delivered via telemedicine before and during the COVID-19 pandemic and highlights areas of study to inform optimal usage of telemedicine in HIV clinical practice in the future. Recent Findings To address barriers to care created by the COVID-19 pandemic, regulatory agencies and payors waived longstanding restrictions, which enabled rapid expansion of telemedicine across the country. Preliminary data show that providers and persons with HIV (PWH) view telemedicine favorably. Some data suggest telemedicine has facilitated retention in care, but other studies have found increasing numbers of PWH lost to follow-up and worsened virologic suppression rates despite offering video and/or telephone visits. Summary The COVID-19 pandemic has exacerbated gaps in the HIV care continuum. To help mitigate the impact, most clinics have adopted new virtual care options and are now evaluating usage, impact, and concerns. Further research into the effects of telemedicine on HIV care and continued work towards universal access are needed.
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Affiliation(s)
- Jehan Z Budak
- Division of Allergy and Infectious Diseases, University of Washington, MS 359930, 325 9th Avenue, Seattle, WA, 98104, USA.
| | - John D Scott
- Division of Allergy and Infectious Diseases, University of Washington, MS 359930, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Shireesha Dhanireddy
- Division of Allergy and Infectious Diseases, University of Washington, MS 359930, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Brian R Wood
- Division of Allergy and Infectious Diseases, University of Washington, MS 359930, 325 9th Avenue, Seattle, WA, 98104, USA
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