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Groves AK, Stankard P, Bowler SL, Jamil MS, Gebrekristos LT, Smith PD, Quinn C, Ba NS, Chidarikire T, Nguyen VTT, Baggaley R, Johnson C. A systematic review and meta-analysis of the evidence for community-based HIV testing on men's engagement in the HIV care cascade. Int J STD AIDS 2022; 33:1090-1105. [PMID: 35786140 PMCID: PMC9660288 DOI: 10.1177/09564624221111277] [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: 02/22/2022] [Revised: 05/29/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Men with HIV are less likely than women to know their status, be on antiretroviral therapy, and be virally suppressed. This review examined men's community-based HIV testing services (CB-HTS) outcomes. DESIGN Systematic review and meta-analysis. METHODS We searched seven databases and conference abstracts through July 2018. We estimated pooled proportions and/or risk ratios (for meta-analyses) for each outcome using random effects models. RESULTS 188 studies met inclusion criteria. Common testing models included targeted outreach (e.g. mobile testing), home-based testing, and testing at stand-alone community sites. Across 25 studies reporting uptake, 81% (CI: 75-86%) of men offered testing accepted it. Uptake was higher among men reached through CB-HTS than facility-based HTS (RR = 1.39; CI: 1.13-1.71). Over 69% (CI: 64-71%) of those tested through CB-HTS were men, across 184 studies. Across studies reporting new HIV-positivity among men (n = 18), 96% were newly diagnosed (CI: 77-100%). Across studies reporting linkage to HIV care (n = 8), 70% (CI: 36-103%) of men were linked to care. Across 57 studies reporting sex-disaggregated data for CB-HTS conducted among key populations, men's uptake was high (80%; CI: 70-88%) and nearly all were newly diagnosed and linked to care (95%; CI: 94-100%; and 94%; CI: 88-100%, respectively). CONCLUSION CB-HTS is an important strategy for reaching undiagnosed men with HIV from the general population and key population groups, particularly using targeted outreach models. When compared to facility-based HIV testing services, men tested through CB-HTS are more likely to uptake testing, and nearly all men who tested positive through CB-HTS were newly diagnosed. Linkage to care may be a challenge following CB-HTS, and greater efforts and research are needed to effectively implement testing strategies that facilitate rapid ART initiation and linkage to prevention services.
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Affiliation(s)
- Allison K Groves
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - Sarah L Bowler
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Muhammad S Jamil
- Department of HIV/AIDS, World Health
Organization, Geneva, Switzerland
| | | | - Patrick D Smith
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Caitlin Quinn
- Department of HIV/AIDS, World Health
Organization, Geneva, Switzerland
| | - Ndoungou Salla Ba
- Department of HIV/AIDS, World Health
Organization, Geneva, Switzerland
| | - Thato Chidarikire
- HIV Prevention Programmes, National Department of
Health, Johannesburg, South Africa
| | | | - Rachel Baggaley
- Department of HIV/AIDS, World Health
Organization, Geneva, Switzerland
| | - Cheryl Johnson
- Department of HIV/AIDS, World Health
Organization, Geneva, Switzerland
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Lin XX, Meng SY, Ke WJ, Zhang XH, Wang LY, Liao YY, Liu H, Zhao PZ, Liang CM, Chen HR, Long HY, Yang B, Yang LG. Community engagement on-site rapid test for chlamydia and gonorrhea among men who have sex with men: a pioneering study in Guangzhou, China. BMC Public Health 2022; 22:1036. [PMID: 35606713 PMCID: PMC9128213 DOI: 10.1186/s12889-022-13460-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 05/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are prevalent among men who have sex with men (MSM) in China. However, compared to syphilis and HIV, the testing rate for chlamydia and gonorrhea remains low. The purpose of this pilot study was to evaluate the feasibility for conducting rapid nucleic acid test for chlamydia and gonorrhea in MSM community-based organizations (CBO). Method We recruited our participants through an MSM CBO where free HV and syphilis testing were routinely provided. We collected data including social-demographic background, sexual history, chlamydia and gonorrhea testing history, and reasons for accepting this on-site rapid testing. Urine and/or anorectal swab samples were collected and tested for chlamydia and gonorrhea on-site and the testing results were delivered in about 1.5 h. Positive cases received on-site free treatment. Results From August 2020 to October 2020, 634 MSM visited the CBO for syphilis and HIV testing and 158 (158/634, 24.9%) accepted the on-site chlamydia and gonorrhea rapid test, 135 were finally enrolled. The positive rate fo chlamydia was 16.3% (22/135) and 3.0% (4/135) for gonorrhea, respectively. Only 19.3% participants had previously undergone chlamydia and gonorrhea testing and 68.9% (93/135) participants reported that they had heard of gonorrhea, 47.4% (64/135) had heard of chlamydia. The main reason for testing was “free for charge” (66.2%), followed by “convenient, ‘shorter waiting time” (45.2%) and “had high-risk sexual behavior recently” (16.3%). Conclusions This pilot study showed that the chlamydia and gonorrhea infection rate remains high among MSM, while the testing rate was low. On-site rapid testing is feasible and potentially preferred by MSM.
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Affiliation(s)
- Xiao-Xin Lin
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Si-Yan Meng
- UNC Project China, University of North Carolina at Chapel Hill, Guangzhou, China
| | - Wu-Jian Ke
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Xiao-Hui Zhang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Liu-Yuan Wang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Yu-Ying Liao
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Han Liu
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Pei-Zhen Zhao
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Chun-Mei Liang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Hui-Ru Chen
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Hai-Ying Long
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Bin Yang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.
| | - Li-Gang Yang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.
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Munck HNM, Qvist T, Helleberg M, Kaye PS, Pichon F, Cowan S. At-Risk Groups of Men Who Have Sex With Men Can Be Reached Through Community-Based HIV Testing in Denmark. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:439-449. [PMID: 34369829 DOI: 10.1521/aeap.2021.33.5.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study evaluates whether the community-based HIV testing clinic Checkpoint could reach at-risk groups of men who have sex with men (MSM) and link patients to care. A prospective observational study of all Checkpoint visits during 2013-2016 and a retrospective registry study of all MSM diagnosed with HIV in Denmark during the same period were conducted. One percent of the 9,074 tests in Checkpoint were HIV-positive, accounting for 19% of all new HIV diagnoses among MSM in Denmark. Checkpoint testers reported frequent condomless anal sex. Two percent of migrant Checkpoint testers were HIV-positive compared to 1 % among Danish MSM. HIV-positive MSM identified through Checkpoint were significantly younger, more of them were migrant, and a smaller proportion were late testers compared to those testing through the conventional health care system. Checkpoint reaches at-risk populations of MSM and links patients successfully to care.
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Affiliation(s)
| | - Tavs Qvist
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Susan Cowan
- Department of Sexually Transmitted Infections and Blood-Borne Viruses, Statens Serum Institut, Copenhagen, Denmark
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Hernando V, Cuevas MT, Pérez-Olmeda MT, Tasias M, Vera M, Jaen A, Mena A, Jarrin I, Diaz A. Recent infections among newly diagnosed cases of HIV infection in Spain, 2015-2016. National estimates using cohort data. Infect Dis (Lond) 2021; 53:440-449. [PMID: 33685324 DOI: 10.1080/23744235.2021.1893377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND To estimate the prevalence of recent infection (RI) among people newly diagnosed with HIV in Spain using a representative sample collected by the AIDS Research Network cohort (CoRIS) during 2015-2016. METHODS Stratified sampling of CoRIS data was used with proportional allocation by mode of transmission of new HIV diagnoses notified to National Surveillance System. Samples used were from patients in the CoRIS cohort with available stored plasma collected within 6 months after diagnosis. Weighted methods were used to estimate the prevalence of RI and multivariate logistic regression models were used to determine associated factors. RESULTS Of the 669 individuals included, 55.1% were men who had sex with men (MSM), 24.6% were heterosexual, and 20.3% were non-MSM non-heterosexual. The weighted prevalence of RI was 11.8% (95% Confidence interval [CI] 9.4-14.8%) overall, 15.5% (12.2-19.4%) among MSM, 6.3% (3.9-10.0%) among heterosexual, and 8.6% (3.2-20.9%) in non-MSM non-heterosexual persons. Factors associated with prevalence of RI were: MSM (OR 2.05; 95% CI 1.02-4.14) vs. heterosexual, being Spanish (OR 2.92; 1.36-6.26) or European (OR 3.42; 1.28-9.13) vs. Latin American, having a secondary or higher education level (OR 3.08; 0.95-1.00) vs. primary, and having a CD4 count of 350-499 (OR 3.26; 1.46-7.30) or >500 (OR 6.26; 2.92-13.39) vs. <350 cells/mm3. CONCLUSIONS In the absence of direct data from surveillance systems, the use of cohort data is a very valuable option for identifying the prevalence of RI at national level. This is the first nationwide study carried out in Spain to determine the prevalence of RI using an avidity assay.
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Affiliation(s)
- Victoria Hernando
- Centro Nacional de Epidemiologia, Institute of Health Carlos III, Madrid, Spain
| | - Maria Teresa Cuevas
- Centro Nacional de Microbiologia, Institute of Health Carlos III, Madrid, Spain
| | | | - Maria Tasias
- Department of Internal Medicine, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | - Mar Vera
- Instituto de Investigación Sanitaria San Carlos (IdISSC), Centro Sanitario Sandoval, Madrid, Spain
| | - Angels Jaen
- Department of Internal Medicine, Hospital Universitari Mutua Terraasa, Terrassa, Spain
| | - Alvaro Mena
- Department of Internal Medicine, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Inma Jarrin
- Centro Nacional de Epidemiologia, Institute of Health Carlos III, Madrid, Spain
| | - Asunción Diaz
- Centro Nacional de Epidemiologia, Institute of Health Carlos III, Madrid, Spain
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- Centro Nacional de Epidemiologia, Institute of Health Carlos III, Madrid, Spain
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Lorente N, Sherriff N, Panochenko O, Marcus U, Dutarte M, Kuske M, Aussó S, Huber J, Krone M, Schink SB, Cawley C, Casabona J, Folch C. The Role of Community Health Workers Within the Continuum of Services for HIV, Viral Hepatitis, and Other STIs Amongst Men Who Have Sex with Men in Europe. J Community Health 2020; 46:545-556. [PMID: 32737744 PMCID: PMC7393028 DOI: 10.1007/s10900-020-00900-1] [Citation(s) in RCA: 4] [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] [Indexed: 11/26/2022]
Abstract
Little is known about Community Health Workers (CHWs) who work in non-clinical settings to provide sexual health support around HIV, viral hepatitis, and other sexually transmitted infections (STIs) to men who have sex with men (MSM) in Europe and neighbouring countries. This article describes for the first time, who CHWs are, and how they contribute to the continuum of services for HIV, viral hepatitis, and other STIs amongst MSM. The first European Community Health Worker Online Survey (ECHOES) developed in the framework of the EU-funded ESTICOM project (www.esticom.eu), was available in 16 languages (October 2017-January 2018). Amongst the 1035 persons aged 18 and older reporting CHW activities in the previous 12 months, 28.2% were women, 30.7% were volunteers, 59.2% were men self-defining as gay/homosexual, bisexual or queer (‘peer CHWs’), and most CHWs worked/volunteered in private not-for-profit organisations (86.4%). CHWs involvement in the continuum of services for HIV, viral hepatitis and other STIs was as follows: primary prevention (88.6%), consultation and counselling (58.0%), testing provision (50.6%), linkage to care (49.8%), and treatment and support activities (51.3%). CHWs were also involved in cross-cutting activities such as developing interventions, advocacy, and engaging in research (46.3%). CHWs as a public health workforce contribute to all steps of the continuum of services for HIV, viral hepatitis, and other STIs amongst MSM in Europe. National governments should recognise and support CHWs better in order to make their activities more visible and sustainable, and increase their impact on the continuum of services.
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Affiliation(s)
- Nicolas Lorente
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, 08916, Badalona (Barcelona), Spain.
- Institut Investigació Germans Trias I Pujol (IGTP), 08916, Badalona (Barcelona), Spain.
- Centre D'Estudis Epidemiològics Sobre Les ITS I Sida de Catalunya (CEEISCAT), Fundació Institut D'Investigació en Ciències de La Salut Germans Trias I Pujol (IGTP), Edifici Muntanya, Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Barcelona, Spain.
| | - Nigel Sherriff
- School of Health Sciences, and Centre for Transforming Sexuality & Gender, University of Brighton, Brighton, BN1 9PH, UK
| | | | | | - Maria Dutarte
- European AIDS Treatment Group (EATG), 1000, Brussels, Belgium
- European Patients' Forum (EPF), 1040, Brussels, Belgium
| | | | - Susanna Aussó
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, 08916, Badalona (Barcelona), Spain
- Institut Investigació Germans Trias I Pujol (IGTP), 08916, Badalona (Barcelona), Spain
| | - Jörg Huber
- School of Health Sciences, and Centre for Transforming Sexuality & Gender, University of Brighton, Brighton, BN1 9PH, UK
| | | | | | | | - Jordi Casabona
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, 08916, Badalona (Barcelona), Spain
- Institut Investigació Germans Trias I Pujol (IGTP), 08916, Badalona (Barcelona), Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Departament de Pediatria, Obstetrícia i Ginecologia i de Medicina Preventiva, Universitat Autònoma de Barcelona, 08916, Badalona (Barcelona), Spain
| | - Cinta Folch
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, 08916, Badalona (Barcelona), Spain
- Institut Investigació Germans Trias I Pujol (IGTP), 08916, Badalona (Barcelona), Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), 28029, Madrid, Spain
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6
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Croxford S, Tavoschi L, Sullivan AK, Combs L, Raben D, Delpech V, Jakobsen SF, Amato‐Gauci AJ, Desai S. HIV testing strategies outside of health care settings in the European Union (EU)/European Economic Area (EEA): a systematic review to inform European Centre for Disease Prevention and Control guidance. HIV Med 2020; 21:142-162. [PMID: 31682060 PMCID: PMC7065225 DOI: 10.1111/hiv.12807] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 09/05/2019] [Accepted: 09/16/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES In recent years, new technologies and new approaches to scale up HIV testing have emerged. The objective of this paper was to synthesize the body of recent evidence on strategies aimed at increasing the uptake and coverage of HIV testing outside of health care settings in the European Union (EU)/European Economic Area (EEA). METHODS Systematic searches to identify studies describing effective HIV testing interventions and barriers to testing were run in five databases (2010-2017) with no language restrictions; the grey literature was searched for similar unpublished studies (2014-2017). Study selection, data extraction and critical appraisal were performed by two independent reviewers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Eighty studies on HIV testing in non-health care settings were identified, the majority set in Northern Europe. Testing was implemented in 65 studies, with men who have sex with men the risk group most often targeted. Testing coverage and positivity/reactivity rates varied widely by setting and population group. However, testing in community and outreach settings was effective at reaching people who had never previously been tested and acceptability of HIV testing, particularly rapid testing, outside of health care settings was found to be high. Other interventions aimed to increase HIV testing identified were: campaigns (n = 8), communication technologies (n = 2), education (n = 3) and community networking (n = 1). CONCLUSIONS This review has identified several strategies with potential to achieve high HIV testing coverage outside of health care settings. However, the geographical spread of studies was limited, and few intervention studies reported before and after data, making it difficult to evaluate the impact of interventions on test coverage.
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Affiliation(s)
- S Croxford
- National Infection ServicePublic Health EnglandLondonUK
| | - L Tavoschi
- European Centre for Disease Prevention and ControlStockholmSweden
- University of PisaPisaItaly
| | - AK Sullivan
- National Infection ServicePublic Health EnglandLondonUK
- Directorate of HIV and Sexual HealthChelsea and Westminster Hospital NHS Foundation TrustLondonUK
| | - L Combs
- CHIPRigshospitalet ‐ University of CopenhagenCopenhagenDenmark
| | - D Raben
- CHIPRigshospitalet ‐ University of CopenhagenCopenhagenDenmark
| | - V Delpech
- National Infection ServicePublic Health EnglandLondonUK
| | - SF Jakobsen
- CHIPRigshospitalet ‐ University of CopenhagenCopenhagenDenmark
| | - AJ Amato‐Gauci
- European Centre for Disease Prevention and ControlStockholmSweden
| | - S Desai
- National Infection ServicePublic Health EnglandLondonUK
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Hidayat R, Marguari D, Hairunisa N, Suparno H, Magnani R. Community HIV Screening Among MSM in Three Indonesian Cities. Curr HIV Res 2020; 17:65-71. [PMID: 30907323 DOI: 10.2174/1570162x17666190321115419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/12/2019] [Accepted: 03/17/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Indonesia lags behind its peers with regard to ART coverage of PLHIV. Insufficient HIV testing among MSM and other key affected populations remains a barrier to increasing ART coverage. OBJECTIVE This report presents the results of the first government-endorsed implementation research study of a community screening approach to increasing the rate of HIV testing among MSM in three cities. METHODS All new MSM outreach contacts meeting eligibility criteria during March-June 2017 were included in the study. HIV testing at a government health facility, which is required to qualify for government-supported ART, was advised for all new contacts. Men refusing formal testing were offered an HIV screening test in a community setting using a saliva-based rapid test and advised to get a confirmatory test at a health facility. All outreach contacts and testing activities were recorded on individual client records. RESULTS Of 1,149 eligible MSM, 27% were willing to be referred to receive HIV testing at a health facility, among which 83% were confirmed to have been tested. Of the 838 study subjects refusing health facility testing, 38% accepted community screening. The screening positivity rate was 14.8%. Only 38% of men with reactive screening tests received a confirmatory test at a health facility, along with 8% of those with non-reactive tests. CONCLUSION While community screening resulted in more MSM knowing their HIV status, reluctance to avail government health facility-based services, or indeed to be tested at all, must be addressed if community screening is to accelerate progress in getting HIV-positive MSM onto treatment.
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Affiliation(s)
| | | | - Nany Hairunisa
- Yayasan Spiritia, Jakarta, Indonesia.,Faculty of Medicine, Trisakti University, Jakarta, Indonesia
| | - Heru Suparno
- Health Research Center, University of Indonesia, Jakarta, Indonesia
| | - Robert Magnani
- AIDS Research Center, Atma Jaya Catholic University, Jakarta, Indonesia
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8
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Refugio ON, Roberts C, West R, Klausner JD. Sexually transmissible infection control programs for men who have sex with men - what will they look like in 2020? Sex Health 2019; 14:126-132. [PMID: 27444895 DOI: 10.1071/sh16038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/02/2016] [Indexed: 01/20/2023]
Abstract
The resurgence of sexually transmissible infections among men who have sex with men is a concern for sexual health. Traditional strategies have relied on the promotion of condom use, regular testing, treatment, and partner management. Future sexually transmissible infection control programs must combine current prevention methods with novel approaches that target the providers, patients, and mechanisms of health care delivery.
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Affiliation(s)
- Oliver N Refugio
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Chelsea Roberts
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Richard West
- Directorate of Sexual Health and HIV, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Jeffrey D Klausner
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
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9
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Platteau T, van Lankveld J, Apers L, Fransen K, Rockstroh J, Florence E. HIV testing for key populations in Europe: A decade of technological innovation and patient empowerment complement the role of health care professionals. HIV Med 2019; 19 Suppl 1:71-76. [PMID: 29488698 DOI: 10.1111/hiv.12601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES With persisting high numbers of new HIV diagnoses in Europe, HIV testing remains an important aspect of HIV prevention. The traditional centralized and medicalized HIV testing approach has been complemented with newly developed and evaluated non-traditional approaches. Two important factors guided this process: technological innovation and empowerment of the patient. METHODS We present a matrix to develop an HIV testing approach, and elaborate on three commonly used ones: community based testing, self-testing, and self-sampling. Despite non-traditional HIV testing approaches, barriers for testing remain. A potential disadvantage for users is the risk for false-reactive test results. As users receive an orientation test result, a reactive result should be confirmed. Another issue is the window phase, which is longer for some orientation tests compared to a traditional, laboratory-based test. RESULTS Future implementation of non-traditional HIV testing approaches will depend on legal frameworks throughout Europe. Community testing centers may additionally improve empowerment of key populations by expanding their portfolio to testing and treatment for sexually transmitted infections. Community engagement and ownership may imply a shrinking role for health care providers, but they remain crucial actors for personalized information, counselling and referral to specialized HIV-care for many people. CONCLUSIONS A highly effective HIV testing strategy to reduce undiagnosed people living with HIV in Europe is needed. Any approach, chosen according to the principles outlined in this paper, should reach the right people, diagnose them in the most accurate way, and optimize linkage to care.
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Affiliation(s)
- T Platteau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - J van Lankveld
- Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
| | - L Apers
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - K Fransen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - J Rockstroh
- Department of Medicine, University of Bonn, Bonn, Germany
| | - E Florence
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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10
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Meulbroek M, Pujol F, Pérez F, Dalmau-Bueno A, Taboada H, Marazzi G, Carrillo A, Cabas A, Gata A, Aldabó E, Roldán B, Coll P, Añez F, Pantaleón J, Mochales M, Gómez V, Marín O, Mir JF, Decoca J, Saz J. BCN Checkpoint: same-day confirmation of reactive HIV rapid test with Point Of Care HIV-RNA accelerates linkage to care and reduces anxiety. HIV Med 2019; 19 Suppl 1:63-65. [PMID: 29488706 DOI: 10.1111/hiv.12595] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND The introduction in 2006 of the rapid HIV test by BCN Checkpoint in a non-clinical setting has been a successful step forwards in the uptake of testing. Nevertheless, HIV serostatus should be reported as HIV positive only when a reactive result has been tested again using a different assay (WHO guidelines 2015). The standard confirmation test has been the Western Blot (WB) test. However confirmation results take around 7 days to come back. AIMS This study explores the possibility of Point of Care PCR testing for a same-day confirmation. MATERIALS AND METHODS Between March 2015 and September 2016 a POC PCR test (Xpert® HIV-1 Qual) was performed in parallel to the Western Blot test after a reactive HIV rapid test (Alere Determine™ HIV-1/2 Ag/Ab Combo and Alere™ HIV Combo). HIV confirmed positive cases received emotional support by peers, were informed and prepared for treatment initiation and rapidly linked to HIV clinic. RESULTS During the study period 11 455 tests were performed to 7163 clients. A total of 249 reactive rapid HIV tests were found. For analysis a total of 33 cases were excluded due to the lack of PCR and/or WB test. Results of comparison of the 216 cases showed 194 concordant positive confirmations and 14 concordant negative results. In three cases PCR was positive and WB negative. In five cases PCR was negative and WB positive. CONCLUSION The POC PCR assay is easy to use and feasible in a community-based center. Reducing time for confirmation to 90 min has been possible in 91.2% (197/216) of cases with positive PCR result. In cases of a negative PCR result an additional test (WB, Elisa or PCR quantitative) was needed to distinguish false positive results (6.5%) from viral load results below level of detection (2.3%). Clients expressed satisfaction with same-day confirmation and less anxiety.
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Affiliation(s)
- M Meulbroek
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - F Pujol
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - F Pérez
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - A Dalmau-Bueno
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - H Taboada
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - G Marazzi
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - A Carrillo
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - A Cabas
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - A Gata
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - E Aldabó
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - B Roldán
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - P Coll
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - F Añez
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - J Pantaleón
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - M Mochales
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - V Gómez
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - O Marín
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - J F Mir
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - J Decoca
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - J Saz
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
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11
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Rüütel K, Kallavus K, Tomera I. Monitoring anonymous HIV testing in Estonia from 2005 to 2015. HIV Med 2019; 19 Suppl 1:16-20. [PMID: 29488697 DOI: 10.1111/hiv.12587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In Estonia, a network of anonymous and free of charge HIV testing sites has been operating since 1988. Services are provided by health care organizations and financed by the National Institute for Health Development from the state budget. The objective of this analysis was to assess anonymous HIV testing in Estonia from 2005 to 2015. METHODS We used data collected from the National Institute for Health Development's annual reports, Health Board and Estonian Health Insurance Fund. RESULTS In Estonia, more than 200 000 HIV-tests are performed annually, and of these approximately 5-6% are within anonymous HIV testing sites. The percentage tested with rapid tests in anonymous testing sites has increased from 15% in 2010 to 53% in 2015. Furthermore, up to 65% of all newly diagnosed HIV-cases have been detected in these sites. The proportion of HIV-positive tests has decreased from 3.8% to 0.5% in anonymous testing sites and from 0.3% to 0.1% in general health care. Simultaneously, the cost of detecting one new HIV case has increased almost six times. CONCLUSIONS This analysis reveals that anonymous HIV testing services are well accepted by the general population as well as vulnerable populations. The positivity rate among those tested in anonymous testing sites remains higher than among all people tested, showing that the sites reach more of those who are at higher risk of HIV. In the light of decreasing positivity rate, more attention should be paid to people with higher HIV risk and increasing access to testing in community based settings.
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Affiliation(s)
- K Rüütel
- National Institute for Health Development, Tallinn, Estonia
| | - K Kallavus
- National Institute for Health Development, Tallinn, Estonia
| | - I Tomera
- National Institute for Health Development, Tallinn, Estonia
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12
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Factors associated with poor linkage to HIV care and related barriers among men who have sex with men. Enferm Infecc Microbiol Clin 2019; 37:521-524. [PMID: 30948138 DOI: 10.1016/j.eimc.2018.12.014] [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: 07/18/2018] [Revised: 12/07/2018] [Accepted: 12/15/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We assessed poor linkage to HIV care in a sample of HIV positive men who have sex with men (MSM) diagnosed in Spain. METHODS From 2012 to 2013 we recruited a sample of MSM mainly through gay-dating websites. Poor linkage to care was defined as receiving the first CD4 count >3 months after HIV diagnosis. We performed a logistic regression analysis to estimate factors associated with poor linkage to care and analyzed the underlying reasons. RESULTS Some 9.4% self-reported poor linkage to care. Those diagnosed in clinical settings other than sexual health clinics or in non-clinical settings presented increased odds of poor linkage to care. The most common reason was being assigned an appointment for first CD4 count >3 months after initial HIV diagnosis. CONCLUSION Poor linkage to care was very low, but for further improvements fast-track referral pathways should be created, especially in contexts outside sexual health clinics.
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13
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Guillén Y, Noguera-Julian M, Rivera J, Casadellà M, Zevin AS, Rocafort M, Parera M, Rodríguez C, Arumí M, Carrillo J, Mothe B, Estany C, Coll J, Bravo I, Herrero C, Saz J, Sirera G, Torrella A, Navarro J, Crespo M, Negredo E, Brander C, Blanco J, Calle ML, Klatt NR, Clotet B, Paredes R. Low nadir CD4+ T-cell counts predict gut dysbiosis in HIV-1 infection. Mucosal Immunol 2019; 12:232-246. [PMID: 30171206 DOI: 10.1038/s41385-018-0083-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/03/2018] [Accepted: 08/08/2018] [Indexed: 02/04/2023]
Abstract
Human immunodeficiency virus (HIV)-1 infection causes severe gut and systemic immune damage, but its effects on the gut microbiome remain unclear. Previous shotgun metagenomic studies in HIV-negative subjects linked low-microbial gene counts (LGC) to gut dysbiosis in diseases featuring intestinal inflammation. Using a similar approach in 156 subjects with different HIV-1 phenotypes, we found a strong, independent, dose-effect association between nadir CD4+ T-cell counts and LGC. As in other diseases involving intestinal inflammation, the gut microbiomes of subjects with LGC were enriched in gram-negative Bacteroides, acetogenic bacteria and Proteobacteria, which are able to metabolize reactive oxygen and nitrogen species; and were depleted in oxygen-sensitive methanogenic archaea and sulfate-reducing bacteria. Interestingly, subjects with LGC also showed increased butyrate levels in direct fecal measurements, consistent with enrichment in Roseburia intestinalis despite reductions in other butyrate producers. The microbiomes of subjects with LGC were also enriched in bacterial virulence factors, as well as in genes associated with beta-lactam, lincosamide, tetracycline, and macrolide resistance. Thus, low nadir CD4+ T-cell counts, rather than HIV-1 serostatus per se, predict the presence of gut dysbiosis in HIV-1 infected subjects. Such dysbiosis does not display obvious HIV-specific features; instead, it shares many similarities with other diseases featuring gut inflammation.
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Affiliation(s)
- Yolanda Guillén
- irsiCaixa AIDS Research Institute, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain.,Universitat Autònoma de Barcelona, Bellaterra, 08193, Catalonia, Spain
| | - Marc Noguera-Julian
- irsiCaixa AIDS Research Institute, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain.,Universitat Autònoma de Barcelona, Bellaterra, 08193, Catalonia, Spain.,Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, Vic, 08500, Catalonia, Spain
| | - Javier Rivera
- irsiCaixa AIDS Research Institute, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain.,Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, Vic, 08500, Catalonia, Spain
| | - Maria Casadellà
- irsiCaixa AIDS Research Institute, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain.,Universitat Autònoma de Barcelona, Bellaterra, 08193, Catalonia, Spain
| | - Alexander S Zevin
- University of Washington, 3018 Western Avenue, Seattle, WA, 98121, USA
| | - Muntsa Rocafort
- irsiCaixa AIDS Research Institute, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain.,Universitat Autònoma de Barcelona, Bellaterra, 08193, Catalonia, Spain
| | - Mariona Parera
- irsiCaixa AIDS Research Institute, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain
| | - Cristina Rodríguez
- irsiCaixa AIDS Research Institute, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain
| | - Marçal Arumí
- irsiCaixa AIDS Research Institute, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain
| | - Jorge Carrillo
- irsiCaixa AIDS Research Institute, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain.,Universitat Autònoma de Barcelona, Bellaterra, 08193, Catalonia, Spain
| | - Beatriz Mothe
- irsiCaixa AIDS Research Institute, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain.,Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, Vic, 08500, Catalonia, Spain.,Infectious Diseases Service & Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain
| | - Carla Estany
- Infectious Diseases Service & Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain
| | - Josep Coll
- irsiCaixa AIDS Research Institute, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain.,Infectious Diseases Service & Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain
| | - Isabel Bravo
- Infectious Diseases Service & Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain
| | - Cristina Herrero
- Infectious Diseases Service & Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain
| | - Jorge Saz
- BCN Checkpoint, Carrer del Comte Borrell, 164, Barcelona, 08015, Catalonia, Spain
| | - Guillem Sirera
- Infectious Diseases Service & Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain
| | - Ariadna Torrella
- Infectious Diseases Unit, Hospital Universitari Vall d'Hebrón, Passeig de la Vall d'Hebrón, 119-129, Barcelona, 08035, Catalonia, Spain
| | - Jordi Navarro
- Universitat Autònoma de Barcelona, Bellaterra, 08193, Catalonia, Spain.,Infectious Diseases Unit, Hospital Universitari Vall d'Hebrón, Passeig de la Vall d'Hebrón, 119-129, Barcelona, 08035, Catalonia, Spain
| | - Manuel Crespo
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario, Vigo. IIS Galicia Sur, Estrada de Clara Campoamor, 341, Vigo, 36312, Pontevedra, Spain
| | - Eugènia Negredo
- Universitat Autònoma de Barcelona, Bellaterra, 08193, Catalonia, Spain.,Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, Vic, 08500, Catalonia, Spain.,Infectious Diseases Service & Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain
| | - Christian Brander
- irsiCaixa AIDS Research Institute, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain.,Universitat Autònoma de Barcelona, Bellaterra, 08193, Catalonia, Spain.,Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, Vic, 08500, Catalonia, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluís Companys 23, Barcelona, 08010, Catalonia, Spain
| | - Julià Blanco
- irsiCaixa AIDS Research Institute, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain.,Universitat Autònoma de Barcelona, Bellaterra, 08193, Catalonia, Spain.,Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, Vic, 08500, Catalonia, Spain
| | - Maria Luz Calle
- Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, Vic, 08500, Catalonia, Spain
| | - Nichole R Klatt
- University of Washington, 3018 Western Avenue, Seattle, WA, 98121, USA
| | - Bonaventura Clotet
- irsiCaixa AIDS Research Institute, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain.,Universitat Autònoma de Barcelona, Bellaterra, 08193, Catalonia, Spain.,Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, Vic, 08500, Catalonia, Spain.,Infectious Diseases Service & Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain
| | - Roger Paredes
- irsiCaixa AIDS Research Institute, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain. .,Universitat Autònoma de Barcelona, Bellaterra, 08193, Catalonia, Spain. .,Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, Vic, 08500, Catalonia, Spain. .,Infectious Diseases Service & Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, Badalona, 08916, Catalonia, Spain.
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14
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Campbell CK, Lippman SA, Moss N, Lightfoot M. Strategies to Increase HIV Testing Among MSM: A Synthesis of the Literature. AIDS Behav 2018; 22:2387-2412. [PMID: 29550941 DOI: 10.1007/s10461-018-2083-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
More than 30 years into the HIV epidemic, men who have sex with men (MSM) continue to be disproportionately impacted. It is estimated that worldwide nearly half of MSM infected with HIV are unaware of their status, making HIV testing along with early linkage to care crucial to HIV prevention efforts. However, there remain significant barriers to HIV testing among MSM, due largely to complex issues of layered stigma that deter MSM from accessing traditional, clinic-based testing. We conducted a review and synthesis of the literature on strategies to increase uptake of HIV testing among MSM. We found that social network-based strategies, community-based testing, HIV self-testing, and modifications to the traditional clinic-based model can effectively reach a subset of MSM, but success was often context-specific and there are significant gaps in evidence. We provide recommendations for increasing HIV testing rates and status awareness among MSM.
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Affiliation(s)
- Chadwick K Campbell
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF Mail Code 0886, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA.
| | - Sheri A Lippman
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF Mail Code 0886, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
| | - Nicholas Moss
- Division of Communicable Disease Control & Prevention, Alameda County Public Health Department, Oakland, CA, USA
| | - Marguerita Lightfoot
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF Mail Code 0886, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
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15
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Croxford S, Yin Z, Burns F, Copas A, Town K, Desai S, Skingsley A, Delpech V. Linkage to HIV care following diagnosis in the WHO European Region: A systematic review and meta-analysis, 2006-2017. PLoS One 2018; 13:e0192403. [PMID: 29451875 PMCID: PMC5815583 DOI: 10.1371/journal.pone.0192403] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/22/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Timely linkage to care after HIV diagnosis is crucial as delayed access can result in poor patient outcomes. The aim of this systematic review was to synthesise the evidence to achieve a better understanding of what proportion of patients are linked to care and what factors impact linkage. METHODS Systematic searches were run in six databases up to the end of February 2017. The grey literature was also reviewed. Inclusion criteria were: sample size ≥50 people (aged ≥15), from the WHO European Region, published 2006-2017 and in English. Linkage to care was defined as a patient seen for HIV care after diagnosis. Study selection, data extraction and quality assurance were performed by two independent reviewers. Random-effects meta-analysis was carried out to summarise linkage to care within three months of diagnosis. RESULTS Twenty-four studies were included; 22 presented linkage to care data and seven examined factors for linkage. Linkage among 89,006 people in 19 countries was captured. Meta-analysis, restricted to 12 studies and measuring prompt linkage within three months, gave a pooled estimate of 85% (95% CI: 75%-93%). Prompt linkage was higher in studies including only people in care (94%; 95% CI: 91%-97%) than in those of all new diagnoses (71%; 95% CI: 50%-87%). Heterogeneity was high across and within strata (>99%). Factors associated with delaying or not linking to care included: acquiring HIV through heterosexual contact/injecting drug use, younger age at diagnosis, lower levels of education, feeling well at diagnosis and diagnosis outside an STI clinic. CONCLUSION Overall, linkage to care was high, though estimates were lower in studies with a high proportion of people who inject drugs. The high heterogeneity between studies made it challenging to synthesise findings. Studies should adopt a standardised definition with a three month cut-off to measure prompt linkage to care to ensure comparability.
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Affiliation(s)
- Sara Croxford
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- Centre for Population Research in Sexual Health and HIV, Institute of Global Health, University College London, London, United Kingdom
| | - Zheng Yin
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
| | - Fiona Burns
- Centre for Population Research in Sexual Health and HIV, Institute of Global Health, University College London, London, United Kingdom
- Royal Free London NHS Foundation Trust, London United Kingdom
| | - Andrew Copas
- Centre for Population Research in Sexual Health and HIV, Institute of Global Health, University College London, London, United Kingdom
| | - Katy Town
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- Centre for Population Research in Sexual Health and HIV, Institute of Global Health, University College London, London, United Kingdom
| | - Sarika Desai
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
| | - Andrew Skingsley
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
| | - Valerie Delpech
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
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16
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Perelman J, Rosado R, Ferro A, Aguiar P. Linkage to HIV care and its determinants in the late HAART era: a systematic review and meta-analysis. AIDS Care 2017; 30:672-687. [PMID: 29258350 DOI: 10.1080/09540121.2017.1417537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Poor engagement into HIV care limits the effectiveness of highly active antiretroviral therapies (HAART) to improve survival and reduce transmission. The design of effective interventions to enhance linkage to care is dependent on evidence about rates of entry into HIV care. This is a systematic review and meta-analysis on linkage measurement and its determinants in the late era of HAART (post-2003), in high-income countries. We searched the PubMed and Web of Science databases, restricting our sample to the late HAART era (post-2003) until February 2016, and to high-income countries. We retained only studies that produced quantified outcomes. We rejected the studies with a high risk of bias, and followed a standard meta-analytic approach. Because there was a high heterogeneity ( I 2 > 90%), the aggregated findings were based on a random-effects model. A total of 43 studies were identified, all of them following a cohort of patients newly diagnosed until referred to specialized care. For a one-month period, the meta-proportion was 71.1% (IC95%: 61.0%-81.2). For a three-month duration, the meta-proportion of linkage to care was 77.0% (IC95%: 75.0%-79.0). For a one-year period, the meta-proportion was 76.3% (IC95%: 54.2%-98.4%). The proportions were lower when lab tests were used as referral indicator, with a pooled meta-proportion of 76.7% (IC95%: 73.0%-80.4), in comparison to a value of 80.8% (IC95%: 68.7%-92.9) for consultations. Being black or male were the most commonly observed determinants of delayed entry into care. Young people, injecting drug users, people with low socioeconomic status, or at a less advanced stage of disease also experienced lower proportions of timely linkage. Timely engagement into care is below 80% and specific sub-groups are particularly at risk of late entry. These findings confirm earlier evidence that linkage to care remains low, and that efforts should focus on vulnerable populations.
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Affiliation(s)
- Julian Perelman
- a Escola Nacional de Saude Publica , Universidade NOVA de Lisboa , Lisbon , Portugal.,b Centro de Investigacao em Saude Publica , Escola Nacional de Saude Publica , Lisbon , Portugal
| | - Ricardo Rosado
- a Escola Nacional de Saude Publica , Universidade NOVA de Lisboa , Lisbon , Portugal
| | - Adriana Ferro
- a Escola Nacional de Saude Publica , Universidade NOVA de Lisboa , Lisbon , Portugal
| | - Pedro Aguiar
- a Escola Nacional de Saude Publica , Universidade NOVA de Lisboa , Lisbon , Portugal.,b Centro de Investigacao em Saude Publica , Escola Nacional de Saude Publica , Lisbon , Portugal
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17
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HIV Rapid Testing Programs in Non-Clinical Settings have the Potential to Constitute a Major Diagnostic Option for MSM in Spain. AIDS Behav 2017; 21:525-533. [PMID: 27807791 DOI: 10.1007/s10461-016-1597-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We analyze the impact of HIV rapid testing (RT) programs in non-clinical settings (NCS) by evaluating their contribution to new diagnoses reported to the Spanish HIV Surveillance System (SINIVIH) from 2007 to 2012. We estimate the proportion of new diagnoses reported to SINIVIH attributable to them and the maximum annual contribution (MAC). Of 95.575 rapid tests conducted, 2061 were reactive; 1582 in men who have sex with men (MSM). The contribution of RT in NCS increased from 3.4% in 2007 to 11.0% in 2012 (8.1%-16.6% in MSM). RT programs contributed 25.3% of the new diagnoses reported in Catalonia (MAC:30.6%), 15% in the Canary Islands (MAC:16.2%) and 13.7% in the Basque Country (MAC:21.0%). Among MSM, contribution was of 45.2% in Catalonia (MAC:60.7%), 20.2% in the Canary Islands (MAC:21.3%) and 16.6% in the Basque country (MAC:20.9%). Especially among MSM, RT in NCS contributed a large proportion of the new HIV cases diagnosed in regions with a very high HIV incidence.
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18
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Perelman J, Rosado R, Amri O, Morel S, Rojas Castro D, Chanos S, Cigan B, Lobnik M, Fuertes R, Pichon F, Kaye PS, Agustí C, Fernàndez-López L, Lorente N, Casabona J. Economic evaluation of HIV testing for men who have sex with men in community-based organizations - results from six European cities. AIDS Care 2016; 29:985-989. [PMID: 28027661 DOI: 10.1080/09540121.2016.1271392] [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: 10/20/2022]
Abstract
The non-decreasing incidence of HIV among men who have sex with men (MSM) has motivated the emergence of Community Based Voluntary Counselling and Testing (CBVCT) services specifically addressed to MSM. The CBVCT services are characterized by facilitated access and linkage to care, a staff largely constituted by voluntary peers, and private not-for-profit structures outside the formal health system institutions. Encouraging results have been measured about their effectiveness, but these favourable results may have been obtained at high costs, questioning the opportunity to expand the experience. We performed an economic evaluation of HIV testing for MSM at CBVCT services, and compared them across six European cities. We collected retrospective data for six CBVCT services from six cities (Copenhagen, Paris, Lyon, Athens, Lisbon, and Ljubljana), for the year 2014, on the number of HIV tests and HIV reactive tests, and on all expenditures to perform the testing activities. The total costs of CBVCTs varied from 54,390€ per year (Ljubljana) to 245,803€ per year (Athens). The cost per HIV test varied from to 41€ (Athens) to 113€ (Ljubljana). The cost per HIV reactive test varied from 1966€ (Athens) to 9065€ (Ljubljana). Our results show that the benefits of CBVCT services are obtained at an acceptable cost, in comparison with the literature (values, mostly from the USA, range from 1600$ to 16,985$ per HIV reactive test in clinical and non-clinical settings). This result was transversal to several European cities, highlighting that there is a common CBVCT model, the cost of which is comparable regardless of the epidemiological context and prices. The CBVCT services represent an effective and "worth it" experience, to be continued and expanded in future public health strategies towards HIV.
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Affiliation(s)
- Julian Perelman
- a Escola Nacional de Saúde Pública , Universidade NOVA de Lisboa , Lisbon , Portugal.,b Centro de Investigação em Saúde Pública , Lisbon , Portugal
| | - Ricardo Rosado
- a Escola Nacional de Saúde Pública , Universidade NOVA de Lisboa , Lisbon , Portugal
| | | | | | | | | | - Bojan Cigan
- e Drustvo informacijski center Legebitra , Ljubljana , Slovenia
| | - Miha Lobnik
- e Drustvo informacijski center Legebitra , Ljubljana , Slovenia
| | | | | | | | - Cristina Agustí
- h Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT) , Departament de Salut, Generalitat de Catalunya , Badalona , Spain.,i Hospital Germans trias i Pujol , Barcelona , Spain.,j The Institute for Health Science Research Germans Trias i Pujol (IGTP) , Badalona , Spain.,k CIBER Epidemiología y Salud Pública (CIBERESP) , Madrid , Spain
| | - Laura Fernàndez-López
- h Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT) , Departament de Salut, Generalitat de Catalunya , Badalona , Spain.,i Hospital Germans trias i Pujol , Barcelona , Spain.,j The Institute for Health Science Research Germans Trias i Pujol (IGTP) , Badalona , Spain.,k CIBER Epidemiología y Salud Pública (CIBERESP) , Madrid , Spain
| | - Nicolas Lorente
- h Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT) , Departament de Salut, Generalitat de Catalunya , Badalona , Spain.,i Hospital Germans trias i Pujol , Barcelona , Spain.,j The Institute for Health Science Research Germans Trias i Pujol (IGTP) , Badalona , Spain
| | - Jordi Casabona
- h Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT) , Departament de Salut, Generalitat de Catalunya , Badalona , Spain.,i Hospital Germans trias i Pujol , Barcelona , Spain.,j The Institute for Health Science Research Germans Trias i Pujol (IGTP) , Badalona , Spain.,k CIBER Epidemiología y Salud Pública (CIBERESP) , Madrid , Spain
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Lorente N, Fernàndez-López L, Fuertes R, Rojas Castro D, Pichon F, Cigan B, Chanos S, Meireles P, Lucas R, Morel S, Slaaen Kaye P, Agustí C, Klavs I, Platteau T, Casabona J. COBA-Cohort: a prospective cohort of HIV-negative men who have sex with men, attending community-based HIV testing services in five European countries (a study protocol). BMJ Open 2016; 6:e011314. [PMID: 27412103 PMCID: PMC4947773 DOI: 10.1136/bmjopen-2016-011314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Community-based voluntary counselling and testing (CBVCT) services for men who have sex with men (MSM) can reach those most-at-risk and provide an environment for gay men that is likely to be non-stigmatising. Longitudinal data on the behaviour of HIV-negative MSM are scarce in Europe. The aim of this protocol, developed during the Euro HIV Early Diagnosis And Treatment (EDAT) project, is to implement a multicentre community-based cohort of HIV-negative MSM attending 15 CBVCT services in 5 European countries. RESEARCH OBJECTIVES (1) To describe the patterns of CBVCT use, (2) to estimate HIV incidence, and to identify determinants of (3) HIV seroconversion and (4) HIV and/or sexually transmitted infection (STI) test-seeking behaviour. METHODS AND ANALYSIS All MSM aged 18 years or over and who had a negative HIV test result are invited to participate in the COmmunity-BAsed Cohort (COBA-Cohort). Study enrolment started in February 2015, and is due to continue for at least 12 months at each study site. Follow-up frequency depends on the testing recommendations in each country (at least 1 test per year). Sociodemographic data are collected at baseline; baseline and follow-up questionnaires both gather data on attitudes and perceptions, discrimination, HIV/STI testing history, sexual behaviour, condom use, and pre- and post-exposure prophylaxis. Descriptive, exploratory and multivariate analyses will be performed to address the main research objectives of this study, using appropriate statistical tests and models. These analyses will be performed on the whole cohort data and stratified by study site or country. ETHICS AND DISSEMINATION The study was approved by the Public Health authorities of each country where the study is being implemented. Findings from the COBA-Cohort study will be summarised in a report to the European Commission, and in leaflets to be distributed to study participants. Articles and conference abstracts will be submitted to peer-reviewed journals and conferences.
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Affiliation(s)
- Nicolas Lorente
- Centre for Epidemiological Studies on HIV/STI of Catalonia (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain
- The Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Laura Fernàndez-López
- Centre for Epidemiological Studies on HIV/STI of Catalonia (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain
- The Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Daniela Rojas Castro
- AIDES (MIRE-Mission Innovation Recherche Expérimentation), Pantin, France
- Groupe de Recherche en Psychologie Sociale (GRePS) EA4163, Université de Lyon 2, Bron, France
| | | | | | | | - Paula Meireles
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Raquel Lucas
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Stéphane Morel
- AIDES (MIRE-Mission Innovation Recherche Expérimentation), Pantin, France
| | | | - Cristina Agustí
- Centre for Epidemiological Studies on HIV/STI of Catalonia (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain
- The Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Irena Klavs
- National Institute of Public Health, Ljubljana, Slovenia
| | - Tom Platteau
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Jordi Casabona
- Centre for Epidemiological Studies on HIV/STI of Catalonia (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain
- The Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine, Univ Autonoma Barcelona, Badalona, Spain
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Lessard D, Lebouché B, Engler K, Thomas R. An analysis of socio-demographic and behavioural factors among immigrant MSM in Montreal from an HIV-testing site sample. CANADIAN JOURNAL OF HUMAN SEXUALITY 2016. [DOI: 10.3138/cjhs.251-a4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Little Canadian research exists on immigrant men who have sex with men (MSM), who are internationally reported to use rapid HIV-testing sites. Our objective was to describe immigrant MSM in a sample of clients at an HIV testing site. From July 2012 to November 2013, clients at Actuel sur Rue (AsR), a Montreal-based HIV rapid-testing site, provided data for a staff- and a self-administered questionnaire. We compared immigrant and non-immigrant MSM's socio-demographics and risk practices. Among immigrants, we analyzed these variables by country of origin. We conducted regression analyses examining how immigrant status and socio-demographics were associated with risk practices. During the study, 1353 MSM visited AsR and 407 (30%) were immigrants, mostly from Europe, Latin America/Caribbean, and Africa/Middle-East. The same proportion (2%) of immigrant and non-immigrant MSM received a positive rapid HIV test result. Relative to non-immigrant MSM, significantly more immigrant MSM reported a post-secondary degree, a lower income, and being unemployed. Fewer reported receiving an HIV-positive/unknown-status partner's sperm/blood in their mouth, ever having unprotected sex with an HIV-positive partner, and ever selling sex. In comparisons between MSM immigrants by origin, fewer Asian and African/Middle-Eastern MSM reported ever testing for HIV. In the regression analyses, immigrant status was not independently associated with sexual risk. MSM who earned less, were unemployed, or had a high school degree or less were more likely to have sold sex. Socio-demographics like employment, education and income were associated with reported sexual risk in MSM clients, but not immigrant status alone.
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Affiliation(s)
- David Lessard
- Department of Family Medicine, McGill University, Montreal, QC
- Research Institute of the McGill University Health Centre, Montreal, QC
- Chronic Viral Illness Service, Department of Infectious Disease, Glen Site of the McGill University Health Centre, Montreal, QC
| | - Bertrand Lebouché
- Department of Family Medicine, McGill University, Montreal, QC
- Research Institute of the McGill University Health Centre, Montreal, QC
- Chronic Viral Illness Service, Department of Infectious Disease, Glen Site of the McGill University Health Centre, Montreal, QC
| | - Kim Engler
- Research Institute of the McGill University Health Centre, Montreal, QC
- Chronic Viral Illness Service, Department of Infectious Disease, Glen Site of the McGill University Health Centre, Montreal, QC
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Noguera-Julian M, Rocafort M, Guillén Y, Rivera J, Casadellà M, Nowak P, Hildebrand F, Zeller G, Parera M, Bellido R, Rodríguez C, Carrillo J, Mothe B, Coll J, Bravo I, Estany C, Herrero C, Saz J, Sirera G, Torrela A, Navarro J, Crespo M, Brander C, Negredo E, Blanco J, Guarner F, Calle ML, Bork P, Sönnerborg A, Clotet B, Paredes R. Gut Microbiota Linked to Sexual Preference and HIV Infection. EBioMedicine 2016; 5:135-46. [PMID: 27077120 PMCID: PMC4816837 DOI: 10.1016/j.ebiom.2016.01.032] [Citation(s) in RCA: 268] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/12/2016] [Accepted: 01/27/2016] [Indexed: 12/22/2022] Open
Abstract
The precise effects of HIV-1 on the gut microbiome are unclear. Initial cross-sectional studies provided contradictory associations between microbial richness and HIV serostatus and suggested shifts from Bacteroides to Prevotella predominance following HIV-1 infection, which have not been found in animal models or in studies matched for HIV-1 transmission groups. In two independent cohorts of HIV-1-infected subjects and HIV-1-negative controls in Barcelona (n = 156) and Stockholm (n = 84), men who have sex with men (MSM) predominantly belonged to the Prevotella-rich enterotype whereas most non-MSM subjects were enriched in Bacteroides, independently of HIV-1 status, and with only a limited contribution of diet effects. Moreover, MSM had a significantly richer and more diverse fecal microbiota than non-MSM individuals. After stratifying for sexual orientation, there was no solid evidence of an HIV-specific dysbiosis. However, HIV-1 infection remained consistently associated with reduced bacterial richness, the lowest bacterial richness being observed in subjects with a virological-immune discordant response to antiretroviral therapy. Our findings indicate that HIV gut microbiome studies must control for HIV risk factors and suggest interventions on gut bacterial richness as possible novel avenues to improve HIV-1-associated immune dysfunction. The fecal microbiota of gay men in Europe is systematically richer and has a distinct composition. HIV-1 infection is independently associated with reduced gut bacterial richness, more so in immune discordant subjects. Interventions to increase gut bacterial richness might offer novel avenues to improve HIV-1-associated immune dysfunction.
The human intestinal microbiota is essential for human health and well-being and is driven by genetic, lifestyle and environmental factors. Here, we show in two independent cohorts of HIV-1-infected subjects and HIV-1-negative controls in Europe that gay men often have a distinct composition of the human fecal microbiota, with increased microbial richness and diversity and enrichment in the Prevotella enterotype. This is independent of HIV-1 status, and with only a limited contribution of diet effects. After accounting for sexual orientation, however, HIV-1 infection remains associated to reduced bacterial richness, more so in subjects with suboptimal CD4 + T-cell count recovery under antiretroviral therapy. Future studies should evaluate if interventions to increase gut bacterial richness could improve HIV-associated immune dysfunction.
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Affiliation(s)
- Marc Noguera-Julian
- IrsiCaixa AIDS Research Institute, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain; Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, 08500 Vic, Catalonia, Spain; Universitat Autònoma de Barcelona, 08193 Bellaterra, Catalonia, Spain
| | - Muntsa Rocafort
- IrsiCaixa AIDS Research Institute, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain; Universitat Autònoma de Barcelona, 08193 Bellaterra, Catalonia, Spain
| | - Yolanda Guillén
- IrsiCaixa AIDS Research Institute, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain; Universitat Autònoma de Barcelona, 08193 Bellaterra, Catalonia, Spain
| | - Javier Rivera
- IrsiCaixa AIDS Research Institute, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain; Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, 08500 Vic, Catalonia, Spain
| | - Maria Casadellà
- IrsiCaixa AIDS Research Institute, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain; Universitat Autònoma de Barcelona, 08193 Bellaterra, Catalonia, Spain
| | - Piotr Nowak
- Department of Medicine, Unit of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Huddinge 141, 86, Stockholm, Sweden
| | - Falk Hildebrand
- Structural and Computational Biology, European Molecular Biology Laboratory, Meyerhofstrasse 1, 69117 Heidelberg, Germany
| | - Georg Zeller
- Structural and Computational Biology, European Molecular Biology Laboratory, Meyerhofstrasse 1, 69117 Heidelberg, Germany
| | - Mariona Parera
- IrsiCaixa AIDS Research Institute, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain
| | - Rocío Bellido
- IrsiCaixa AIDS Research Institute, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain
| | - Cristina Rodríguez
- IrsiCaixa AIDS Research Institute, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain
| | - Jorge Carrillo
- IrsiCaixa AIDS Research Institute, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain; Universitat Autònoma de Barcelona, 08193 Bellaterra, Catalonia, Spain; ISGLOBAL, Carrer Rosselló, 132, 08036 Barcelona, Catalonia, Spain
| | - Beatriz Mothe
- IrsiCaixa AIDS Research Institute, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain; Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, 08500 Vic, Catalonia, Spain; Universitat Autònoma de Barcelona, 08193 Bellaterra, Catalonia, Spain; HIV Unit & Lluita Contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain
| | - Josep Coll
- IrsiCaixa AIDS Research Institute, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain; HIV Unit & Lluita Contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain
| | - Isabel Bravo
- HIV Unit & Lluita Contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain
| | - Carla Estany
- HIV Unit & Lluita Contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain
| | - Cristina Herrero
- HIV Unit & Lluita Contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain
| | - Jorge Saz
- BCN Checkpoint, Carrer del Comte Borrell, 164, 08015 Barcelona, Catalonia, Spain
| | - Guillem Sirera
- HIV Unit & Lluita Contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain
| | - Ariadna Torrela
- Infectious Diseases Unit, Hospital Universitari Vall d'Hebrón, Passeig de la Vall d'Hebrón, 119-129, 08035 Barcelona, Catalonia, Spain
| | - Jordi Navarro
- Infectious Diseases Unit, Hospital Universitari Vall d'Hebrón, Passeig de la Vall d'Hebrón, 119-129, 08035 Barcelona, Catalonia, Spain
| | - Manel Crespo
- Infectious Diseases Unit, Hospital Universitari Vall d'Hebrón, Passeig de la Vall d'Hebrón, 119-129, 08035 Barcelona, Catalonia, Spain
| | - Christian Brander
- IrsiCaixa AIDS Research Institute, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain; Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, 08500 Vic, Catalonia, Spain; Universitat Autònoma de Barcelona, 08193 Bellaterra, Catalonia, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Catalonia, Spain
| | - Eugènia Negredo
- Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, 08500 Vic, Catalonia, Spain; Universitat Autònoma de Barcelona, 08193 Bellaterra, Catalonia, Spain; HIV Unit & Lluita Contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain
| | - Julià Blanco
- IrsiCaixa AIDS Research Institute, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain; Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, 08500 Vic, Catalonia, Spain; Universitat Autònoma de Barcelona, 08193 Bellaterra, Catalonia, Spain
| | - Francisco Guarner
- Digestive Diseases Department, Vall d'Hebrón Institute of Research, Hospital Universitari Vall d'Hebrón, Passeig de la Vall d'Hebrón, 119-129, 08035 Barcelona, Catalonia, Spain
| | - Maria Luz Calle
- Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, 08500 Vic, Catalonia, Spain
| | - Peer Bork
- Structural and Computational Biology, European Molecular Biology Laboratory, Meyerhofstrasse 1, 69117 Heidelberg, Germany; Max-Delbrück-Centre for Molecular Medicine, Robert-Rössle-Str. 10, 13092 Berlin, Germany; Molecular Medicine Partnership Unit, EMBL, Meyerhofstrasse 1, 69117 Heidelberg, Germany
| | - Anders Sönnerborg
- Department of Medicine, Unit of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Huddinge 141, 86, Stockholm, Sweden
| | - Bonaventura Clotet
- IrsiCaixa AIDS Research Institute, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain; Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, 08500 Vic, Catalonia, Spain; Universitat Autònoma de Barcelona, 08193 Bellaterra, Catalonia, Spain; HIV Unit & Lluita Contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain
| | - Roger Paredes
- IrsiCaixa AIDS Research Institute, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain; Universitat de Vic-Universitat Central de Catalunya, C. Sagrada Família 7, 08500 Vic, Catalonia, Spain; Universitat Autònoma de Barcelona, 08193 Bellaterra, Catalonia, Spain; HIV Unit & Lluita Contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet s/n, 08916 Badalona, Catalonia, Spain
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IAPAC Guidelines for Optimizing the HIV Care Continuum for Adults and Adolescents. J Int Assoc Provid AIDS Care 2015; 14 Suppl 1:S3-S34. [PMID: 26527218 DOI: 10.1177/2325957415613442] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND An estimated 50% of people living with HIV (PLHIV) globally are unaware of their status. Among those who know their HIV status, many do not receive antiretroviral therapy (ART) in a timely manner, fail to remain engaged in care, or do not achieve sustained viral suppression. Barriers across the HIV care continuum prevent PLHIV from achieving the therapeutic and preventive effects of ART. METHODS A systematic literature search was conducted, and 6132 articles, including randomized controlled trials, observational studies with or without comparators, cross-sectional studies, and descriptive documents, met the inclusion criteria. Of these, 1047 articles were used to generate 36 recommendations to optimize the HIV care continuum for adults and adolescents. RECOMMENDATIONS Recommendations are provided for interventions to optimize the HIV care environment; increase HIV testing and linkage to care, treatment coverage, retention in care, and viral suppression; and monitor the HIV care continuum.
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Engler K, Rollet K, Lessard D, Thomas R, Lebouché B. Ability of a rapid HIV testing site to attract and test vulnerable populations: a cross-sectional study on Actuel sur Rue. Int J STD AIDS 2015; 27:973-7. [PMID: 26384948 DOI: 10.1177/0956462415602420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/01/2015] [Indexed: 11/16/2022]
Abstract
Quebec's HIV epidemic persists, particularly among men who have sex with men (MSM) and in Montreal. Increasing access to HIV testing is necessary and community-based rapid testing offers one strategy. This paper examines the clienteles and activities of a rapid HIV testing site in Montreal, the pilot project Actuel sur Rue. Comparative analyses were conducted with 1357 MSM, 147 heterosexual men and 64 women who visited Actuel sur Rue between July 2012 and November 2013 on socio-demographics, health, drug use, sexual practices/infection and HIV testing/prevention. Significant group differences were observed in each category. Actuel sur Rue received 1901 clients, conducted 1417 rapid HIV tests and tested 77 never-tested individuals. Rapid testing produced a high reactive rate (2%). Only 1/28 of those with reactive tests had no previous HIV testing, and 36% had used post-exposure prophylaxis, suggesting missed opportunities for prevention. Findings highlight diverse client vulnerability profiles and the relevance of checkpoints and further prevention efforts.
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Affiliation(s)
- Kim Engler
- Chronic Viral Illness Service, McGill University Health Centre, Canada Research Institute, McGill University Health Centre, Canada
| | - Kathleen Rollet
- Chronic Viral Illness Service, McGill University Health Centre, Canada Research Institute, McGill University Health Centre, Canada
| | - David Lessard
- Chronic Viral Illness Service, McGill University Health Centre, Canada Department of Family Medicine, McGill University, Canada
| | | | - Bertrand Lebouché
- Chronic Viral Illness Service, McGill University Health Centre, Canada Research Institute, McGill University Health Centre, Canada Department of Family Medicine, McGill University, Canada
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Platteau T, Fransen K, Apers L, Kenyon C, Albers L, Vermoesen T, Loos J, Florence E. Swab2know: An HIV-Testing Strategy Using Oral Fluid Samples and Online Communication of Test Results for Men Who Have Sex With Men in Belgium. J Med Internet Res 2015; 17:e213. [PMID: 26330138 PMCID: PMC4642797 DOI: 10.2196/jmir.4384] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 11/26/2022] Open
Abstract
Background As HIV remains a public health concern, increased testing among those at risk for HIV acquisition is important. Men who have sex with men (MSM) are the most important group for targeted HIV testing in Europe. Several new strategies have been developed and implemented to increase HIV-testing uptake in this group, among them the Swab2know project. Objective In this project, we aim to assess the acceptability and feasibility of outreach and online HIV testing using oral fluid samples as well as Web-based delivery of test results. Methods Sample collection happened between December 2012 and April 2014 via outreach and online sampling among MSM. Test results were communicated through a secured website. HIV tests were executed in the laboratory. Each reactive sample needed to be confirmed using state-of-the-art confirmation procedures on a blood sample. Close follow-up of participants who did not pick up their results, and those with reactive results, was included in the protocol. Participants were asked to provide feedback on the methodology using a short survey. Results During 17 months, 1071 tests were conducted on samples collected from 898 men. Over half of the samples (553/1071, 51.63%) were collected during 23 outreach sessions. During an 8-month period, 430 samples out of 1071 (40.15%) were collected from online sampling. Additionally, 88 samples out of 1071 (8.22%) were collected by two partner organizations during face-to-face consultations with MSM and male sex workers. Results of 983 out of 1071 tests (91.78%) had been collected from the website. The pickup rate was higher among participants who ordered their kit online (421/430, 97.9%) compared to those participating during outreach activities (559/641, 87.2%; P<.001). MSM participating during outreach activities versus online participants were more likely to have never been tested before (17.3% vs 10.0%; P=.001) and reported more sexual partners in the 6 months prior to participation in the project (mean 7.18 vs 3.23; P<.001). A total of 20 participants out of 898 (2.2%) were confirmed HIV positive and were linked to care. Out of 1071 tests, 28 (2.61%) with a weak reactive result could not be confirmed, and were thereby classified as false reactive results.
Most of the 388 participants who completed posttest surveys (388/983, 39.5%) were very positive about their experience. The vast majority (371/388, 95.6%) were very satisfied, while 17 out of 388 (4.4%) reported mixed feelings. Conclusions Despite a high yield and a considerable number of false reactive results, satisfaction was high among participants. The project helped us to reach the target population, both in numbers of tests executed and in newly diagnosed HIV infections. Further optimization should be considered in the accuracy of the test, the functionalities of the website (including an online counseling tool), and in studying the cost effectiveness of the methodology.
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Affiliation(s)
- Tom Platteau
- Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium.
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Fernández-Balbuena S, Belza MJ, Zulaica D, Martinez JL, Marcos H, Rifá B, Arrillaga A, de la Fuente L, Hoyos J. Widening the Access to HIV Testing: The Contribution of Three In-Pharmacy Testing Programmes in Spain. PLoS One 2015; 10:e0134631. [PMID: 26247367 PMCID: PMC4527698 DOI: 10.1371/journal.pone.0134631] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/11/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Spain has implemented several in-pharmacy HIV testing programmes performed by pharmacists as part of their everyday routine. We aim to assess the feasibility and the main outcomes of three programmes implemented in three Spanish regions with different sociological profiles and also different epidemiology for HIV. METHODS The characteristics of the 24151 people tested between 2009 and 2013 at 74 urban pharmacies are studied. We compare the main outcomes of the programmes with those of each Regional HIV Surveillance System (RHSS) assessing the contribution to the total new diagnosis in each region and if priority groups are being reached. RESULTS 45.7% were heterosexual men (MSW), 14.4% men who have sex with men (MSM), and 27% women. The 35% were younger than 30 and 9.6% foreigners. The 52% were previously untested, and women were the most likely to be untested. The three programmes altogether diagnosed 226 people, resulting in a global prevalence of 0.9% (95%CI: 0.8-1.1); 3.4% in MSM (95%CI: 2.8-4.0). The prevalence among Spaniards was 0.8% (0.7-1.0) vs. 2.2 (1.6-2.9) among foreigners. The percentages of MSM diagnosed by all three programmes were higher than the one reported by their respective RHSS. Thirty four percent of the reactive MSM and the 71.4% of the reactive MSW did not have a previous HIV test although big testing history differences were observed across the programmes. Altogether, these services contributed with the 10.6% of all HIV diagnoses in these regions. CONCLUSIONS In-pharmacy HIV testing programmes are a valuable testing option, having been able to uncover 1 out of 10 the new diagnoses reported in each region. They showed a good capacity of reaching and diagnosing previously untested populations, not only a priority population such as MSM but also heterosexual population who are more affected by delayed diagnosis. They seem to be particularly suitable for regions without large cities and specific HIV diagnostic services.
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Affiliation(s)
- Sonia Fernández-Balbuena
- National School of Health, Carlos III Health Institute, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
| | - María José Belza
- National School of Health, Carlos III Health Institute, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
| | - Daniel Zulaica
- Plan for prevention and control of AIDS and STIs, Basque health service, San Sebastian, Spain
| | - Jose Luis Martinez
- Section of surveillance, prevention and control of STIs and HIV, Office of surveillance and response to public health emergencies, Public health agency of Catalonia, Department of health of the regional government of Catalonia, Barcelona, Spain
| | - Henar Marcos
- Epidemiological Surveillance Service, Public Health Directorate, Regional Ministry of Health of Castilla and León, Valladolid, Spain
| | - Benet Rifá
- Section of surveillance, prevention and control of STIs and HIV, Office of surveillance and response to public health emergencies, Public health agency of Catalonia, Department of health of the regional government of Catalonia, Barcelona, Spain
| | - Arantxa Arrillaga
- Plan for prevention and control of AIDS and STIs, Basque health service, San Sebastian, Spain
| | - Luis de la Fuente
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
- National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain
| | - Juan Hoyos
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
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Lebouché B, Engler K, Machouf N, Lessard D, Thomas R. Predictors of interest in taking pre-exposure prophylaxis among men who have sex with men who used a rapid HIV-testing site in Montreal (Actuel sur Rue). HIV Med 2015; 17:152-8. [PMID: 26177691 DOI: 10.1111/hiv.12286] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The effective use of pre-exposure prophylaxis (PrEP) as an HIV prevention strategy depends on its uptake by individuals at high risk of infection. Few Canadian data are available on interest in PrEP among men who have sex with men (MSM). This study aimed to identify predictors of interest in PrEP among MSM clients of a rapid HIV-testing site in Montreal's gay village (Actuel sur Rue). METHODS Data were collected using a self-administered and a community agent-administered questionnaire. Among men reporting at least one male sexual partner and visiting the site between July 2012 and November 2013, we aimed to identify sociodemographic, sexual and temporal predictors of interest in taking effective PrEP with logistic regression analyses (univariate and multivariable). RESULTS Over half (55%; n = 653) of the sample of 1179 MSM were interested in PrEP. Among the 14 variables considered in the univariate analyses, only (younger) age, (greater) number of sexual partners (in the past 3 months), being part of a serodiscordant couple (in the past 12 months), ever combining sex with drugs and temporal events were associated with interest in PrEP at P < 0.20 and were included in the multivariable analyses. In the multivariable model, only being part of a serodiscordant couple [adjusted odds ratio (aOR) 2.56; 95% confidence interval (CI) 1.44-4.58], having > 10 partners (aOR 1.73; 95% CI 1.17-2.55) and responding after the publication of Quebec's interim PrEP guidelines (aOR 1.82; 95% CI 1.22-2.71) proved significant. CONCLUSIONS In this assessment of predictors of PrEP interest among Canadian MSM, partnering issues and the arrival of PrEP guidelines in Quebec (10 July 2013) were most closely linked to PrEP interest.
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Affiliation(s)
- B Lebouché
- Family Medicine, McGill University, Montreal, QC, Canada.,Chronic Viral Illness Service, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - K Engler
- Chronic Viral Illness Service, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - N Machouf
- Clinique médicale l'Actuel, Montreal, QC, Canada
| | - D Lessard
- Family Medicine, McGill University, Montreal, QC, Canada
| | - R Thomas
- Clinique médicale l'Actuel, Montreal, QC, Canada
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27
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Ferrer L, Loureiro E, Meulbroek M, Folch C, Perez F, Esteve A, Saz J, Taboada H, Pujol F, Casabona J. High HIV incidence among men who have sex with men attending a community-based voluntary counselling and testing service in Barcelona, Spain: results from the ITACA cohort. Sex Transm Infect 2015; 92:70-5. [PMID: 26136507 DOI: 10.1136/sextrans-2015-052042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 06/13/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify the HIV incidence and its associated factors (AFs) of the ITACA, a community-based cohort of HIV-negative men who have sex with men (MSM) established in Barcelona, Spain from 2008 to 2011. METHODS Participants were men aged 18 years or older, having a negative HIV test result at baseline and agreeing to participate. Bio-behavioural data were collected by peers in each visit. HIV incidence rates using person-time measures and 95% CIs were calculated. Cox logistic regression models were used to identify AFs to seroconversion. RESULTS Over the period, 3544 participants with at least one follow-up visit or those who had a first visit no longer than a year prior to the date of data censoring were included in the analysis contributing 3567.09 person-year (p-y) and 85 MSM seroconverted for an overall HIV incidence of 2.4 per 100 p-y (95% CI 1.9 to 2.9) ranging from 1.21/100 (2009) to 3.1/100 p-y (2011). Independent AF included: foreign origin, having more than five HIV tests at baseline, reporting in the preceding 6 months the following: condomless anal sex with the last steady partner of unknown serostatus, more than 10 casual partners, condomless anal sex with casual partner, self-reported gonorrhoea and entered in the cohort in 2010 or 2011. CONCLUSIONS The ITACA cohort revealed a high and increasing HIV incidence among MSM, especially important among foreign-born men. The findings underscore the need to implement multilevel interventions for MSM taking into account different types of partners, cultural origins and the exposure to other sexually transmitted infections.
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Affiliation(s)
- Laia Ferrer
- Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain Institut d'Investigacio Germans Trias i Pujol (IGTP), Badalona, Spain CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | - Eva Loureiro
- Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain Institut d'Investigacio Germans Trias i Pujol (IGTP), Badalona, Spain CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | | | - Cinta Folch
- Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain Institut d'Investigacio Germans Trias i Pujol (IGTP), Badalona, Spain CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universitat Autònoma de Barcelona (UAB), Bellaterra (Cerdanyola), Spain
| | - Felix Perez
- Projecte dels Noms-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - Anna Esteve
- Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain Institut d'Investigacio Germans Trias i Pujol (IGTP), Badalona, Spain CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universitat Autònoma de Barcelona (UAB), Bellaterra (Cerdanyola), Spain
| | - Jorge Saz
- Projecte dels Noms-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - Hector Taboada
- Projecte dels Noms-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - Ferran Pujol
- Projecte dels Noms-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - Jordi Casabona
- Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain Institut d'Investigacio Germans Trias i Pujol (IGTP), Badalona, Spain CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universitat Autònoma de Barcelona (UAB), Bellaterra (Cerdanyola), Spain
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28
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Meireles P, Lucas R, Martins A, Carvalho AC, Fuertes R, Brito J, Campos MJ, Mendão L, Barros H. The Lisbon Cohort of men who have sex with men. BMJ Open 2015; 5:e007220. [PMID: 25967995 PMCID: PMC4431135 DOI: 10.1136/bmjopen-2014-007220] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Newly diagnosed HIV infections among men who have sex with men (MSM) are rising in many European countries. Surveillance tools must be tailored to the current state of the epidemic, and include decentralised prospective monitoring of HIV incidence and behavioural changes in key populations. In this scenario, an open prospective cohort study was assembled--The Lisbon Cohort of MSM--aiming to dynamically monitor the frequency of disease and its predictors. PARTICIPANTS The Lisbon Cohort of MSM is an ongoing observational prospective study conducted at a community-based voluntary HIV counselling and testing centre in Lisbon, Portugal (CheckpointLX). Men testing negative for HIV, aged 18 or over and reporting having had sex with men are invited to follow-up visits every 6 months. At each evaluation, a face-to-face interview using a structured questionnaire is conducted, and HIV and syphilis rapid tests are performed by trained peer counsellors. From April 2011 to February 2014, 3106 MSM were eligible to the cohort of whom 923 (29.7%) did not participate. The remaining 2183 (70.3%) MSM were enrolled and 804 had at least one follow-up evaluation, for a total of 893 person-years of observation. FUTURE PLANS The study findings will be disseminated in peer-reviewed journals and presented at national and international conferences. The follow-up of this cohort of HIV-negative MSM will be a valuable tool for monitoring HIV incidence in a setting where limited prospective information existed. Moreover, it will allow for a deeper analytical approach to the study of population time trends and individual changes in risk factors that currently shape the HIV epidemic among MSM.
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Affiliation(s)
- Paula Meireles
- EPIUnit—Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Raquel Lucas
- EPIUnit—Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Ana Martins
- EPIUnit—Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Ana Cláudia Carvalho
- EPIUnit—Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Ricardo Fuertes
- Grupo Português de Activistas sobre Tratamentos VIH/SIDA (GAT), Lisboa, Portugal
| | - João Brito
- Grupo Português de Activistas sobre Tratamentos VIH/SIDA (GAT), Lisboa, Portugal
| | - Maria José Campos
- Grupo Português de Activistas sobre Tratamentos VIH/SIDA (GAT), Lisboa, Portugal
| | - Luís Mendão
- Grupo Português de Activistas sobre Tratamentos VIH/SIDA (GAT), Lisboa, Portugal
| | - Henrique Barros
- EPIUnit—Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
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Diaz A, del Romero J, Rodriguez C, Alastrue I, Belda J, Bru FJ, Cámara MM, Junquera ML, Sanz I, Viloria LJ, Gil L, Martínez E, Gual F, Landa MC, Pueyo I, Ureña JM, Martínez B, Varela JA, Polo A, Azpiri MA, Diez M. Effects of region of birth, educational level and age on late presentation among men who have sex with men newly diagnosed with HIV in a network of STI/HIV counselling and testing clinics in Spain. ACTA ACUST UNITED AC 2015; 20. [PMID: 25884148 DOI: 10.2807/1560-7917.es2015.20.14.21088] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This paper analyses late presentation (LP) of HIV infection, and its determinants, among men who have sex with men (MSM) in Spain, newly diagnosed with HIV (2003-2011) in 15 sexually transmitted infection/HIV counselling and testing clinics. LP was defined as <350 CD4 cells/µL or AIDS. In total, 3,081 MSM were included (2,499 having CD4/AIDS); overall LP was 25.3%. LP was higher in men older than 34 years, those not previously HIV-tested (adjusted odds ratio (aOR):3.1; 95% confidence intervals (CI):2.3-4.2) , and those tested > 12 months before diagnosis (12-24 months (aOR:1.4; 95% CI:1.0-2.0); > 24 months (aOR:2.2; 95% CI:1.7-3.0)). LP was less likely in MSM reporting a known HIV-infected partner as infection source or symptoms compatible with acute retroviral syndrome. 'Region of birth' interacted with 'educational level' and 'steady partner as infection source': only African and Latin-American MSM with low educational level were more likely to present late; Latin-American men attributing their infection to steady partner, but no other MSM, had LP more frequently. In Spain, HIV testing among MSM should be promoted, especially those > 34 years old and migrants with low educational level. The current recommendation that MSM be tested at least once a year is appropriate.
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Affiliation(s)
- A Diaz
- area de Vigilancia del VIH y comportamientos de riesgo, Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain
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30
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Belza MJ, Hoyos J, Fernández-Balbuena S, Diaz A, Bravo MJ, de la Fuente L. Assessment of an outreach street-based HIV rapid testing programme as a strategy to promote early diagnosis: a comparison with two surveillance systems in Spain, 2008-2011. ACTA ACUST UNITED AC 2015; 20. [PMID: 25884149 DOI: 10.2807/1560-7917.es2015.20.14.21089] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We assess the added value of a multisite, street-based HIV rapid testing programme by comparing its results to pre-existing services and assessing its potential to reduce ongoing transmission. Between 2008 and 2011, 8,923 individuals underwent testing. We compare outcomes with those of a network of 20 sexually transmitted infections (STI)/HIV clinics (EPI-VIH) and the Spanish National HIV Surveillance System (SNHSS); evaluate whether good visibility prompts testing and assess whether it reaches under-tested populations. 89.2% of the new infections were in men who have sex with men (MSM) vs 78.0% in EPI-VIH and 56.0% in SNHSS. 83.6% of the MSM were linked to care and 20.9% had <350 CD4 HIV prevalence was substantially lower than in EPI-VIH. 56.5% of the HIV-positive MSM tested because they happened to see the programme, 18.4% were previously untested and 26.3% had their last test ≥2 years ago. The programme provided linkage to care and early diagnosis mainly to MSM but attendees presented a lower HIV prevalence than EPI-VIH. From a cost perspective it would benefit from being implemented in locations highly frequented by MSM. Conversely, its good visibility led to reduced periods of undiagnosed infection in a high proportion of MSM who were not testing with the recommended frequency.
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Affiliation(s)
- M J Belza
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
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31
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Garcia de Olalla P, Molas E, Barberà MJ, Martín S, Arellano E, Gosch M, Saladie P, Carbonell T, Knobel H, Diez E, Caylà JA. Effectiveness of a pilot partner notification program for new HIV cases in Barcelona, Spain. PLoS One 2015; 10:e0121536. [PMID: 25849451 PMCID: PMC4388637 DOI: 10.1371/journal.pone.0121536] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/03/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND An estimated 30% of HIV cases in the European Union are not aware of their serological status. This study aimed to assess the effectiveness of a pilot HIV partner notification program. METHODS HIV cases diagnosed between January 2012 and June 2013 at two healthcare settings in Barcelona were invited to participate in a prospective survey. We identified process and outcome measures to evaluate this partner notification program, including the number of partners identified per interviewed index case, the proportion of partners tested for HIV as a result of the partner notification, and the proportion of new HIV diagnoses among their sex or needle-sharing partners. RESULTS Of the 125 index cases contacted, 108 (86.4%) agreed to provide information about partners. A total of 199 sexual partners were identified (1.8 partners per interviewed index case). HIV outcome was already known for 58 partners (70.7% were known to be HIV-positive), 141 partners were tested as result of partner notification, and 26 were newly diagnosed with HIV. The case-finding effectiveness of the program was 18.4%. CONCLUSION This pilot program provides evidence of the effectiveness of a partner notification program implemented in healthcare settings. This active partner notification program was feasible, acceptable to the user, and identified a high proportion of HIV-infected patients previously unaware of their status.
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Affiliation(s)
- Patricia Garcia de Olalla
- EpidemiologyService,Agència de Salut Pública de Barcelona, Barcelona, Spain
- Biomedical Research Consortium of the Epidemiology and Public Health Network (CIBERESP), Barcelona, Spain
- * E-mail:
| | - Ema Molas
- EpidemiologyService,Agència de Salut Pública de Barcelona, Barcelona, Spain
- Internal Medicine-InfectiousDiseases,University Hospital del Mar, Barcelona, Spain
| | - María Jesús Barberà
- Sexually Transmitted Infections Unit, University Hospital Valld’Hebron, Barcelona, Spain
| | - Silvia Martín
- Preventive Interventions and Programs Service,Agència de SalutPública de Barcelona, Barcelona, Spain
| | - Encarnació Arellano
- Sexually Transmitted Infections Unit, University Hospital Valld’Hebron, Barcelona, Spain
| | - Mercè Gosch
- Sexually Transmitted Infections Unit, University Hospital Valld’Hebron, Barcelona, Spain
| | - Pilar Saladie
- Sexually Transmitted Infections Unit, University Hospital Valld’Hebron, Barcelona, Spain
| | - Teresa Carbonell
- Internal Medicine-InfectiousDiseases,University Hospital del Mar, Barcelona, Spain
| | - Hernando Knobel
- Internal Medicine-InfectiousDiseases,University Hospital del Mar, Barcelona, Spain
| | - Elia Diez
- Preventive Interventions and Programs Service,Agència de SalutPública de Barcelona, Barcelona, Spain
- Biomedical Research Consortium of the Epidemiology and Public Health Network (CIBERESP), Barcelona, Spain
| | - Joan A Caylà
- EpidemiologyService,Agència de Salut Pública de Barcelona, Barcelona, Spain
- Biomedical Research Consortium of the Epidemiology and Public Health Network (CIBERESP), Barcelona, Spain
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32
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Diez M, Bleda MJ, Varela JR, Ordonana J, Azpiri MA, Vall M, Santos C, Viloria L, de Armas C, Urena JM, Trullen J, Pueyo I, Martinez B, Puerta T, Vera M, Sanz I, Junquera ML, Landa MC, Martinez E, Camara MM, Belda J, Bru FJ, Diaz A. Trends in HIV testing, prevalence among first-time testers, and incidence in most-at-risk populations in Spain: the EPI-VIH Study, 2000 to 2009. ACTA ACUST UNITED AC 2014; 19:20971. [PMID: 25443036 DOI: 10.2807/1560-7917.es2014.19.47.20971] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
During 2000 to 2009, data on people undergoing HIV testing and on those newly diagnosed with HIV were collected in a network of 20 Spanish clinics specialising in sexually transmitted infections and/or HIV testing and counselling. The number of tests performed, overall and disaggregated by different variables, was obtained. HIV prevalence among first-time testers and HIV incidence among repeat testers were calculated. To evaluate trends, joinpoint regression models were fitted. In total, 236,939 HIV tests were performed for 165,745 individuals. Overall HIV prevalence among persons seeking HIV testing was 2.5% (95% CI: 2.4 to 2.6). Prevalence was highest in male sex workers who had sex with other men (19.0% (95% CI: 16.7 to 21.4)) and was lowest in female sex workers (0.8% (95% CI: 0.7 to 0.9)). Significant trends in prevalence were observed in men who have sex with men (MSM) (increasing) and heterosexual individuals (decreasing). The incidence analysis included 30,679 persons, 64,104 person-years (py) of follow-up and 642 seroconversions. The overall incidence rate (IR) was 1.0/100 py (95% CI: 0.9/100 to 1.1/100). Incidence was significantly higher in men and transgender females than in women (1.8/100 py (95% CI: 1.6 to 1.9), 1.2/100 py (95% CI: 0.5 to 2.8) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively) and increased with age until 35–39 years. IRs in MSM and people who inject drugs were significantly greater than in heterosexual individuals (2.5/100 py (95% CI: 2.3 to 2.7), 1.6/100 py (95% CI: 1.1 to 2.2) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively), and an upward trend was observed in MSM. Our results call for HIV prevention to be reinforced in MSM and transgender women in Spain.
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Affiliation(s)
- M Diez
- Plan Nacional sobre el sida, Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, Spain
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33
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Fernández-Balbuena S, Belza MJ, Urdaneta E, Esteso R, Rosales-Statkus ME, de la Fuente L. Serving the underserved: an HIV testing program for populations reluctant to attend conventional settings. Int J Public Health 2014; 60:121-6. [PMID: 25224831 DOI: 10.1007/s00038-014-0606-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/18/2014] [Accepted: 09/08/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES We assess the contribution of a rapid-HIV testing program run by Médicos del Mundo and oriented to vulnerable populations reluctant to attend conventional settings. METHODS We compare the program outcomes with a network of 20 HIV/STI clinics (EPIVIH) and the Spanish National Surveillance System (SNHSS). RESULTS 33.3% of the new diagnoses were women (8.6% EPIVIH and 17.7% SNHSS). Transsexuals were 6.9% (1.9% EPIVIH), female sex workers 23.6% (2.0% EPIVIH) and 19.4% Sub-Saharan Africans (3.8% EPIVIH and 7.8% SNHSS). HIV prevalence in men was slightly higher than in the EPIVIH and almost twice among women. CONCLUSIONS This program is contributing substantially to the promotion of HIV diagnosis in female sex workers, sub-Saharan Africans and transsexuals, which are less present at clinical settings.
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Affiliation(s)
- Sonia Fernández-Balbuena
- National Epidemiology Centre, Carlos III Health Institute C/Sinesio Delgado 6, 28029, Madrid, Spain,
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Ankiersztejn-Bartczak M, Firląg-Burkacka E, Czeszko-Paprocka H, Kubicka J, Cybula A, Horban A, Kowalska JD. Factors responsible for incomplete linkage to care after HIV diagnosis: preliminary results from the Test and Keep in Care (TAK) project. HIV Med 2014; 16:88-94. [PMID: 25123958 DOI: 10.1111/hiv.12175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Linkage to care after HIV diagnosis remains underinvestigated in Europe, yet delays in linkage to care are an important obstacle to controlling the HIV epidemic. The Test and Keep in Care (TAK) project aims to determine the prevalence of HIV-positive persons who are lost or late to care and factors associated with this. METHODS Data from community-based voluntary counselling and testing that occurred in 2010-2011 were linked with data from HIV clinics using unique test numbers. Persons not registered in HIV clinics were considered lost to care (LTC). For statistical analysis, nonparametric tests were used for comparison, and a multivariable logistic regression model was developed that included all variables with P<0.1 from the univariable models. RESULTS A total of 110 persons were diagnosed as HIV-positive: 91% lived in central Poland, 5% were female and 71% were men who have sex with men (MSM). Forty-seven (42%) persons were LTC, seven of whom did not collect their enzyme-linked immunosorbent assay (ELISA) test result. Of those who registered, 75% registered within 1 month from HIV diagnosis, and 54% were late presenters. LTC individuals were more likely to have heterosexual or bisexual orientation, to have >20 sexual partners, to not be in a relationship with an HIV-positive partner, to not use condoms, and to be taking their first HIV test. In a logistic regression model, after adjusting for these factors, using condoms in a stable relationship decreased the odds of LTC by 72% (odds ratio 0.28; confidence interval 0.11-0.67). CONCLUSIONS Integration into care after HIV diagnosis requires improvement. Our results suggest that broadening awareness and counselling about sexual risks may have a positive impact.
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Abstract
HIV infection in Western Europe is mainly concentrated among men who have sex with men, heterosexuals who acquired HIV from sub-Saharan African countries, and in people who inject drugs. The rate of newly diagnosed cases of HIV has remained roughly stable since 2004 whereas the number of people living with HIV has slowly increased due to new infections and the success of antiretroviral therapy in prolonging life. An ageing population is gradually emerging that will require additional care. There are large differences across countries in HIV testing rates, proportions of people who present to care with low CD4+ cell counts, accessibility to treatment and care, and rates of retention once in care. Improved collection of HIV surveillance data will benefit countries and help to understand their epidemic better. However, social inequalities experienced by people with HIV still remain in some regions and urgently need to be addressed.
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Affiliation(s)
- Fumiyo Nakagawa
- Research Department of Infection and Population Health, UCL Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | - Andrew N. Phillips
- Research Department of Infection and Population Health, UCL Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | - Jens D. Lundgren
- Copenhagen HIV Programme (CHIP), Department of Infectious Disease (8632), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
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36
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Brennan A, Browne JP, Horgan M. A systematic review of health service interventions to improve linkage with or retention in HIV care. AIDS Care 2013; 26:804-12. [DOI: 10.1080/09540121.2013.869536] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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