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Kowalska JD, Wójcik G, Rutkowski J, Antonyak S, Siewaszewicz E. Rapid antiretroviral treatment start seems as vital and cost-effective strategy in Central and Eastern Europe. PRZEGLAD EPIDEMIOLOGICZNY 2022; 76:304-313. [PMID: 36520041 DOI: 10.32394/pe.76.29] [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: 06/17/2023]
Abstract
BACKGROUND It is essential to deliver specialist human immunodeficiency virus (HIV) care with maximum effectiveness, but also minimum time delay. Therefore, we aimed to determine whether rapid linkage to care defined as starting combined antiretroviral therapy (cART) on the day of the first visit at the HIV clinic is a costeffective approach. METHODS In the analysis, Markov's lifetime model presented in our previous study was implemented. The inputs used in the model were updated in the terms of costs, life expectancy, and patient characteristics. For the analysis we used information from the previous model about the additional costs of treatment and qualityadjusted life years (QALYs) lost in the life horizon for people newly infected with HIV. The number of newly infected persons was estimated based on available data. RESULTS Input data was available for 344 men having sex with men (MSM) who registered in the HIV specialist care between 2016 and 2017. The estimated QALY loss due to lack of rapid treatment initiation, where the viral load is not (was) taken into account, equals 0·018 (0·022), 0·039 (0·047), 0·131 (0·158) respectively in low, medium and high risk transmission groups. Rapid cART initiation was dominant regardless of the chosen scenarios. CONCLUSIONS Cost-effectiveness analysis considering the HIV transmission indicates that the rapid initiation of HIV treatment is a cost-effective and potentially cost-saving approach to improve HIV care and reduce HIV transmission in Central and Eastern Europe.
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Affiliation(s)
- Justyna D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- HIV Out-Patients Clinic, Hospital for Infectious Diseases in Warsaw, Warsaw, Poland
| | | | | | - Svitlana Antonyak
- HIV Department of Clinic of the Gromashevsky Institute of Epidemiology and Infectious Diseases, Kiev, Ukraine
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Gasbarrini N, Dubravić D, Combs L, Dišković A, Ankiersztejn-Bartczak M, Colaiaco F, Wawer I, Wysocki P, Rosińska M, Marzec-Boguslawska A, Collins B, Simões D, Jakobsen ML, Raben D. Increasing integrated testing in community settings through interventions for change, including the Spring European Testing Week. BMC Infect Dis 2021; 21:874. [PMID: 34517819 PMCID: PMC8438814 DOI: 10.1186/s12879-021-06555-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maximising access to testing by targeting more than one infection is effective in identifying new infections in settings or populations. Within the EU funded Joint Action INTEGRATE, this paper examined the feasibility and impact of expanding integrated testing for HIV, hepatitis C (HCV), chlamydia, gonorrhoea and/or syphilis in four community-based pilots through targeted interventions in Croatia, Italy and Poland and the Spring European Testing Week since community settings are key in detecting new infections and reaching key populations. METHODS Pilots led by local INTEGRATE partners prioritised testing for other infections or key populations. The Croatian pilot expanded testing for men who have sex with men to syphilis, chlamydia and gonorrhoea. Italian partners implemented a HIV and HCV testing/information event at a migrant centre. A second Italian pilot tested migrants for HIV and HCV through outreach and a low-threshold service for people who use drugs. Polish partners tested for HIV, HCV and syphilis among people who inject drugs in unstable housing via a mobile van. Pilots monitored the number of individuals tested for each infection and reactive results. The pilot Spring European Testing Week from 18 to 25 May 2018 was an INTEGRATE-driven initiative to create more testing awareness and opportunities throughout Europe. RESULTS The Croatian pilot found a high prevalence for each syphilis, chlamydia and gonorrhoea respectively, 2.1%, 12.4% and 6.7%. The Italian migrant centre pilot found low proportions who were previously tested for HIV (24%) or HCV (11%) and the second Italian pilot found an HCV prevalence of 6.2%, with low proportions previously tested for HIV (33%) or HCV (31%). The Polish pilot found rates of being previously tested for HIV, HCV and syphilis at 39%, 37%, and 38%, respectively. Results from the Spring European Testing Week pilot showed it was acceptable with increased integrated testing, from 50% in 2018 to 71% in 2019 in participants. CONCLUSIONS Results show that integrated testing is feasible and effective in community settings, in reaching key populations and minimising missed testing opportunities, and the pilots made feasible because of the European collaboration and funding. For sustainability and expansion of integrated community testing across Europe, local government investment in legislation, financial and structural support are crucial.
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Affiliation(s)
| | - Davor Dubravić
- Croatian Association for HIV and Viral Hepatitis (HUHIV), Zagreb, Croatia
| | - Lauren Combs
- CHIP, Centre of Excellence for Health, Immunity and Infections,, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Arian Dišković
- Croatian Association for HIV and Viral Hepatitis (HUHIV), Zagreb, Croatia
| | | | | | - Iwona Wawer
- National AIDS Centre, Agency of the Ministry of Health, Warsaw, Poland
| | - Piotr Wysocki
- National AIDS Centre, Agency of the Ministry of Health, Warsaw, Poland
| | - Magdalena Rosińska
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | | | - Ben Collins
- ReShape/International HIV Partnerships, London, UK
| | - Daniel Simões
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Marie Louise Jakobsen
- CHIP, Centre of Excellence for Health, Immunity and Infections,, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Dorthe Raben
- CHIP, Centre of Excellence for Health, Immunity and Infections,, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
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Jabłonowska E, Szetela B, Bielecki M, Horban A, Bociąga-Jasik M, Mularska E, Hlebowicz M, Olczak A, Parczewski M, Grzeszczuk A, Bielec D, Cybula A, Kocbach-Przudzik A, Ankiersztejn-Bartczak M, Kowalska JD. Acquired immune deficiency syndrome (AIDS) and late presentation in Poland - data from Test and Keep in Care (TAK) Polska project. HIV Med 2021; 22:387-396. [PMID: 33410278 DOI: 10.1111/hiv.13041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/17/2020] [Accepted: 11/26/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Late presentation (LP) at HIV diagnosis is associated with worse prognosis and an increase in the number of new infections. We analyse the proportion of patients diagnosed late and factors related to LP in Poland in 2016-2017. METHODS Data were obtained from 13 out of 17 HIV centres in Poland from 2016 and 2017, including date of diagnosis, age, sex, transmission route, anti-hepatitis C virus (anti-HCV), Venereal Diseases Research Laboratory (VDRL) antibodies, AIDS diagnosis, baseline HIV viral load and CD4 count. RESULTS Out of 1522 patients, 88.9% were male with median age of 33.6 years. Men who have sex with men (MSM) comprised 69.4% of all new infections, heterosexual route of transmission (HTX) 18.2% and injecting drug use (IDU) 4.7%. Late presenters comprised 44.8% of the study group. Factors associated with LP were female sex [odds ratio (OR) = 1.5, 95% confidence interval (95% CI): 1.09-2.08], older age (OR = 1.59, 95% CI: 1.42-1.79 per decade), route of transmission (HTX: OR = 1.96, 95% CI: 1.50-2.56; IDU: OR = 3.17, 95% CI: 1.92-5.37), positive HCV results (OR = 1.90, 95% CI: 1.23-2.95) and syphilis diagnosis (OR = 2.06, 95% CI: 2.29-3.31). Adjusting for these factors, the only independent factors associated with LP were age (OR = 1.52, 95% CI: 1.35-1.71) and route of transmission (HTX: OR = 1.73, 95% CI: 1.23-2.44; IDU: OR = 2.24, 95% CI: 1.25-4.10). CONCLUSIONS Late presentation in Poland follows European trends. A total of 44.8% of all newly diagnosed patients in Poland continue to present late or at the AIDS stage. Independent factors associated with LP/AIDS were older age, IDU and HTX. Patients from these groups should be targeted to improve early diagnosis and medical care.
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Affiliation(s)
- E Jabłonowska
- Department of Infectious Diseases and Hepatology, Medical University of Lodz, Lodz, Poland
| | - B Szetela
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiencies, Wroclaw Medical University, Wroclaw, Poland
| | - M Bielecki
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warszawa, Poland
| | - A Horban
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - M Bociąga-Jasik
- Department of Infectious Diseases, Jagiellonian University Medical College, Cracow, Poland
| | - E Mularska
- Outpatient Clinic for AIDS Diagnostics and Therapy Specialistic Hospital, Chorzow, Poland
| | - M Hlebowicz
- Department of Infectious Diseases, Gdansk Medical University, Gdansk, Poland
| | - A Olczak
- Faculty of Medicine, Department of Infectious Diseases and Hepatology Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - M Parczewski
- Department of Infectious and Tropical Diseases and Immune Deficiency, Pomeranian Medical University, Szczecin, Poland
| | - A Grzeszczuk
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Bialystok, Poland
| | - D Bielec
- Department of Infectious Diseases, Medical University in Lublin, Lublin, Poland
| | - A Cybula
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
| | - A Kocbach-Przudzik
- Clinical Division of Infectious Diseases, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | | | - J D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
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Raben D, Sullivan AK, Mocroft A, Kutsyna G, Hadžiosmanović V, Vassilenko A, Chkhartisvili N, Mitsura V, Pedersen C, Anderson J, Begovac J, Bak Dragsted U, Bertisch B, Grzeszczuk A, Minton J, Necsoi VC, Kitchen M, Ajana F, Sokhan A, Comi L, Farazmand P, Pesut D, De Wit S, Gatell JM, Gazzard B, d’Arminio Monforte A, Rockstroh JK, Yazdanpanah Y, Champenois K, Jakobsen ML, Lundgren JD. Improving the evidence for indicator condition guided HIV testing in Europe: Results from the HIDES II Study - 2012 - 2015. PLoS One 2019; 14:e0220108. [PMID: 31408476 PMCID: PMC6692030 DOI: 10.1371/journal.pone.0220108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 07/09/2019] [Indexed: 12/03/2022] Open
Abstract
Background It is cost-effective to perform an HIV test in people with specific indicator conditions (IC) with an undiagnosed HIV prevalence of at least 0.1%. Our aim was to determine the HIV prevalence for 14 different conditions across 20 European countries. Methods Individuals aged 18–65 years presenting for care with one of 14 ICs between January 2012 and June 2014 were included and routinely offered an HIV test. Logistic regression assessed factors associated with testing HIV positive. Patients presenting with infectious mononucleosis-like syndrome (IMS) were recruited up until September 2015. Results Of 10,877 patients presenting with an IC and included in the analysis, 303 tested positive (2.8%; 95% CI 2.5–3.1%). People presenting with an IC in Southern and Eastern Europe were more likely to test HIV positive as were people presenting with IMS, lymphadenopathy and leukocytopenia/ thrombocytopenia. One third of people diagnosed with HIV after presenting with IMS reported a negative HIV test in the preceding 12 months. Of patients newly diagnosed with HIV where data was available, 92.6% were promptly linked to care; of these 10.4% were reported lost to follow up or dead 12 months after diagnosis. Conclusion The study showed that 10 conditions had HIV prevalences > 0.1%. These 10 ICs should be adopted into HIV testing and IC specialty guidelines. As IMS presentation can mimic acute HIV sero-conversion and has the highest positivity rate, this IC in particular affords opportunities for earlier diagnosis and public health benefit.
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Affiliation(s)
- Dorthe Raben
- Centre for Health & Infectious Disease Research, Rigshospitalet, Copenhagen, Denmark
| | - Ann Kathleen Sullivan
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, England, United Kingdom
| | - Amanda Mocroft
- University College London, London, England, United Kingdom
| | | | - Vesna Hadžiosmanović
- Clinical Center University of Sarajevo, Infectious Diseases Clinic, Sarajevo, Bosnia
| | | | | | | | | | - Jane Anderson
- Homerton University Hospital, London, England, United Kingdom
| | - Josip Begovac
- University Hospital of Infectious Diseases, Zagreb, Croatia
| | | | | | | | - Jane Minton
- St James’s University Hospital, Leeds, England, United Kingdom
| | | | | | - Faiza Ajana
- Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Anton Sokhan
- Kharkiv National Medical University, Kharkiv, Ukraine
| | - Laura Comi
- Ospedale di Bergamo, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Dragica Pesut
- University of Belgrade School of Medicine, Clinical Centre of Serbia, Belgrade, Serbia
| | - Stephane De Wit
- Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - José Maria Gatell
- Hospital Clinic de Barcelona/IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Brian Gazzard
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, England, United Kingdom
| | | | | | - Yazdan Yazdanpanah
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Hôpital Bichat, Paris, France
| | | | - Marie Louise Jakobsen
- Centre for Health & Infectious Disease Research, Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| | - Jens Dilling Lundgren
- Centre for Health & Infectious Disease Research, Rigshospitalet, Copenhagen, Denmark
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Siwak E, Horban A, Witak-Jędra M, Cielniak I, Firląg-Burkacka E, Leszczyszyn-Pynka M, Witor A, Muller K, Bociąga-Jasik M, Kalinowska-Nowak A, Gąsiorowski J, Szetela B, Jabłonowska E, Wójcik-Cichy K, Jankowska J, Lemańska M, Olczak A, Grąbczewska E, Grzeszczuk A, Rogalska-Plonska M, Suchacz M, Mikuła T, Łojewski W, Bielec D, Kocbach P, Błudzin W, Parczewski M. Long-term trends in HIV care entry: over 15 years of clinical experience from Poland. HIV Med 2019; 20:581-590. [PMID: 31250958 DOI: 10.1111/hiv.12762] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Delay in HIV diagnosis and consequently late care entry with low CD4 counts remain a major challenge for the control of the HIV/AIDS epidemic. The aim of this study was to analyse the evolution of characteristics of the HIV epidemic in Poland. METHODS Cross-sectional data were collected for 3972 HIV-infected patients followed up in 14 of 17 Polish HIV treatment centres in the years 2000-2015. Clinical data were analysed and factors associated with late presentation (baseline CD4 count < 350 cells/μL or history of AIDS-defining illness) and advanced HIV disease (baseline CD4 count < 200 cells/μL or history of AIDS) were identified. RESULTS The majority (57.6%) of patients entered care late, while 35.6% presented with advanced HIV disease. The odds of being linked to care late or with advanced HIV disease increased consistently across age categories, increasing from 2.55 [95% confidence interval (CI) 1.46-4.47] for late presentation and 3.13 (95% CI 1.49-6.58) for advanced disease for the 21-30-year-old category to 5.2 (95% CI 1.94-14.04) and 8.15 (95% CI 2.88-23.01), respectively, for individuals > 60 years of age. Increased risks of late entry and advanced HIV disease were also observed for injecting drug users [adjusted odds ratio (aOR) 1.74 (95% CI 1.16-2.60) and 1.55 (95% CI 1.05-2.30), respectively], with lower aOR associated with the men who have sex with men transmission route [aOR 0.3 (95% CI 0.31-0.59) and 0.39 (95% CI 0.29-0.53), respectively]. The frequencies of cases in which patients were linked to care late and with advanced HIV disease decreased over time from 67.6% (2000) to 53.5% (2015) (P < 0.0001) and from 43.5% (2000) to 28.4% (2015) (P = 0.001), respectively. CONCLUSIONS Despite improvements over time, most patients diagnosed with HIV infection entered care late, with a third presenting with advanced HIV disease. Late care entry remains common among people who inject drugs and heterosexual groups.
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Affiliation(s)
- E Siwak
- Hospital for Infectious Diseases, HIV Out-Patient's Clinic, Warsaw, Poland
| | - A Horban
- Hospital for Infectious Diseases, HIV Out-Patient's Clinic, Warsaw, Poland.,Department for Adults Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - M Witak-Jędra
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University, Szczecin, Poland
| | - I Cielniak
- Hospital for Infectious Diseases, HIV Out-Patient's Clinic, Warsaw, Poland
| | - E Firląg-Burkacka
- Hospital for Infectious Diseases, HIV Out-Patient's Clinic, Warsaw, Poland
| | - M Leszczyszyn-Pynka
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University, Szczecin, Poland
| | - A Witor
- Regional Hospital, Out-Patient's Clinic for Immune Deficiency, Chorzów, Poland
| | - K Muller
- Regional Hospital, Out-Patient's Clinic for Immune Deficiency, Chorzów, Poland
| | - M Bociąga-Jasik
- Department of Infectious Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - A Kalinowska-Nowak
- Department of Infectious Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - J Gąsiorowski
- Department of Infectious Diseases, Hepatology and Acquired Immune Deficiencies, Wroclaw Medical University, Wrocław, Poland
| | - B Szetela
- Department of Infectious Diseases, Hepatology and Acquired Immune Deficiencies, Wroclaw Medical University, Wrocław, Poland
| | - E Jabłonowska
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, Łódź, Poland
| | - K Wójcik-Cichy
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, Łódź, Poland
| | - J Jankowska
- Pomeranian Center of Infectious Diseases and Tuberculosis in Gdańsk, HIV Outpatient Clinic, Gdańsk, Poland
| | - M Lemańska
- Pomeranian Center of Infectious Diseases and Tuberculosis in Gdańsk, HIV Outpatient Clinic, Gdańsk, Poland
| | - A Olczak
- Department of Infectious Diseases and Hepatology, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - E Grąbczewska
- Department of Infectious Diseases and Hepatology, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - A Grzeszczuk
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland
| | - M Rogalska-Plonska
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland
| | - M Suchacz
- Department of Infectious and Tropical Diseases and Hepatology, Medical University in Warsaw, Warsaw, Poland
| | - T Mikuła
- Department of Infectious and Tropical Diseases and Hepatology, Medical University in Warsaw, Warsaw, Poland
| | - W Łojewski
- Department of Infectious Diseases, Regional Hospital in Zielona Góra, Zielona Góra, Poland
| | - D Bielec
- Department of Infectious Diseases, Medical University in Lublin, Lublin, Poland
| | - P Kocbach
- Clinical Ward of Infectious Diseases, Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - W Błudzin
- Department of Infectious Diseases, Regional Hospital in Opole, Opole, Poland
| | - M Parczewski
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University, Szczecin, Poland
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Kowalska JD, Ankiersztejn-Bartczak M, Shepherd L, Mocroft A. Cascade of care and factors associated with virological suppression among HIV-positive persons linked to care in the Test and Keep in Care (TAK) project. Infection 2018; 46:533-540. [PMID: 29785614 PMCID: PMC6096934 DOI: 10.1007/s15010-018-1154-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/17/2018] [Indexed: 12/03/2022]
Abstract
Introduction Early treatment remains the most effective HIV prevention strategy; poor linkage to care after HIV diagnosis may compromise this benefit. We sought to better understand patient characteristics and their association with virological suppression (VS) following cART initiation. Methods The TAK project collects pre-linkage to care and clinical data on patients diagnosed with HIV in voluntary testing facilities in central Poland. Data collected for persons diagnosed in 2010–2013 were linked with HIV clinic records. Individuals linked to care who commenced cART were followed from until the earliest of first VS (HIV RNA < 50 copies/ml), last visit, death or 6 January 2016. Cox-proportional hazard models were used to identify factors associated with first viral suppression. Results 232 persons were HIV positive, 144 (62%, 95% CI 55, 68%) linked to care, 116 (81% of those linked to care, 95% CI 73, 87%) started cART during follow up, of which 113 (97%, 95% CI 93, 99%) achieved VS. Non-PI based regimen (for integrase inhibitors aHR: 5.03: 1.90, 13.32) and HLA B5701-positive (aHR: 3.97: 1.33, 11.85) were associated with higher chance of VS. Unknown syphilis status (aHR: 0.27: 0.13, 0.57) and higher HIV RNA (aHR a tenfold increase: 0.56: 0.42, 0.75) remained associated with lower chance of VS. Conclusions Although a low proportion of persons were linked to care, almost all those linked to care started cART and achieved rapid VS. The high rates of VS were irrespective of prior HIV-associated risk behaviours. Linkage to care remains the highest priority in prevention strategies in central Poland.
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Affiliation(s)
- Justyna D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Ul. Wolska 37, 01-201, Warsaw, Poland. .,Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland.
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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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Kowalska JD, Wójcik G, Rutkowski J, Ankiersztejn-Bartczak M, Siewaszewicz E. Modelling the cost-effectiveness of HIV care shows a clear benefit when transmission risk is considered in the calculations - A message for Central and Eastern Europe. PLoS One 2017; 12:e0186131. [PMID: 29131849 PMCID: PMC5683634 DOI: 10.1371/journal.pone.0186131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 09/26/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV epidemic remains a major global health issue. Data from cost-effectiveness analyses base on CD4+ count and morbidity in patients with symptomatic and asymptomatic HIV infection. The approach adopted in these analyses includes many other factors, previously not investigated. Additionally, we evaluate the impact of sexual HIV transmission due to delayed cART on the cost-effectiveness of care. METHODS A lifetime Markov model (1-month cycle) was developed to estimate the cost per quality adjusted life years (QALY) for a 1- and 3-year delay in starting cART (as compared to starting immediately at linkage to care) lifetime costs, clinical outcomes and cost-effectiveness. Patients were categorized into having asymptomatic HIV, AIDS, Hodgkin's Lymphoma, and non-AIDS defining condition. Mortality rates and utility values were obtained from published literature. The number of new infected persons was estimated on the basis of sexual orientation, the number of sexual partners per year, the number of sex acts per month, frequency of condom use and use of cART. For the input Test and Keep in Care (TAK) project cohort data were used. Costs of care, cART and potential life-years lost were based on estimated total costs and the difference in expected QALY gained between an HIV-positive and an average person in Polish population. Costs were based on real expenditures of the Ministry of Health, National Health Fund, available studies and experts' opinion. Costs and effects were discounted at rates of 5% and 3.5%, respectively. RESULTS Input data were available for 141 patients form TAK cohort. The estimated number of new HIV infections in low, medium and high risk transmission groups were 0.28, 0.61, 2.07 with 1 and 0.82, 1.80, 6.11 with a 3-year delay, respectively. This reflected QALY loss due to cART delay of 0.52, 1.13, 3.84 and 2.02, 4.43, 15.03 for a 1- and 3-year delay, respectively. If additional costs of treatment and potential life-years lost due to new HIV infections were not taken into account, initiating cART immediately at linkage to care was not cost-saving irrespective of cART delay. Otherwise, when additional costs and QALY lost due to new HIV infections were included, immediate cART initiation was cost-saving regardless of the chosen scenarios. CONCLUSIONS If new HIV infections are not taken into account, then starting cART immediately does not dominate comparing to delaying cART. When taking into account HIV transmission in cost-effectiveness analysis, immediate initiation of HIV treatment is a profitable decision from the public payer's perspective.
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Affiliation(s)
- Justyna D. Kowalska
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- HIV Out-Patients Clinic, Hospital for Infectious Diseases in Warsaw, Warsaw, Poland
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Kowalska JD, Shepherd L, Ankiersztejn-Bartczak M, Cybula A, Czeszko-Paprocka H, Firląg-Burkacka E, Mocroft A, Horban A. Poor Linkage to Care Despite Significant Improvement in Access to Early cART in Central Poland - Data from Test and Keep in Care (TAK) Project. PLoS One 2016; 11:e0162739. [PMID: 27711159 PMCID: PMC5053409 DOI: 10.1371/journal.pone.0162739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 08/26/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The main objective of the TAK project is investigating barriers in accessing HIV care after HIV-diagnosis at the CBVCTs of central Poland. Here we describe factors associated with and changes over time in linkage to care and access to cART. METHOD Data collected in 2010-2013 in CBVCTs were linked with HIV clinics records using unique identifiers. Individuals were followed from the day of CBVCTs visit until first clinical visit or 4/06/2014. Cox-proportional hazard models were used to identify factors associated with being linked to care and starting cART. RESULTS In total 232 persons were diagnosed HIV-positive and 144 (62.1% 95%CI: 55.5-68.3) persons were linked to care. There was no change over time in linkage to care (p = 0.48), while time to starting cART decreased (p = 0.02). Multivariate factors associated with a lower rate of linkage to care were hetero/bisexual sexual orientation, lower education, not having an HIV-positive partner and not using condoms in a stable relationship. Multivariate factors associated with starting cART were lower education, recent year of linked to care, and first HIV RNA and CD4 cell count. CONCLUSIONS Benefits of linkage to care, measured by access to early treatment, steadily improved in recent years. However at least 1 in 3 persons aware of their HIV status in central Poland remained outside professional healthcare. Persons at higher risk of remaining outside care, thus target population for future interventions, are bi/heterosexuals and those with lower levels of education.
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Affiliation(s)
- Justyna D. Kowalska
- Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland
- Medical University of Warsaw, Department for Adult's Infectious Diseases, Warsaw, Poland
- * E-mail:
| | - Leah Shepherd
- Department of Infection and Population Health, University College London, London, United Kingdom
| | | | - Aneta Cybula
- Medical University of Warsaw, Department of Infectious and Tropical Diseases and Hepatology, Warsaw, Poland
| | | | | | - Amanda Mocroft
- Department of Infection and Population Health, University College London, London, United Kingdom
| | - Andrzej Horban
- Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland
- Medical University of Warsaw, Department for Adult's Infectious Diseases, Warsaw, Poland
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Kowalska JD, Oprea C, de Witt S, Pozniak A, Gökengin D, Youle M, Lundgren JD, Horban A. Euroguidelines in Central and Eastern Europe (ECEE) conference and the Warsaw Declaration - a comprehensive meeting report. HIV Med 2016; 18:370-375. [PMID: 27553526 DOI: 10.1111/hiv.12436] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective of this paper is to summarize the outcomes of the Euroguidelines in Central and Eastern Europe (ECEE) conference held in Warsaw in February 2016. The main aim of this conference was to facilitate a discussion on European AIDS Clinical Society (EACS) guidelines implementation across the region and neighbouring countries and to present the current obstacles in benchmarking HIV care in Europe. METHODS During a 2-day meeting, there were country-based presentations using a predefined template so as to make the data comparable and focus the discussion. Areas covered were country epidemiology, surveillance, national strategy for treatment and prevention, standards of care, access to care and treatment availability. Each participant filled in a questionnaire investigating HIV guidelines usage per country. RESULTS In total, 16 Central and Eastern Europe (CEE) and neighbouring countries were represented at the conference: Albania, Armenia, Belarus, Croatia, Czech Republic, Estonia, Georgia, Hungary, Lithuania, Moldova, Poland, Romania, Russia, Serbia, Slovakia and Turkey. EACS guidelines version 7.1 were used in 14 (87%) countries. In 11 (69%) countries, national guidelines were available, of which eight had been recently updated. Half of the countries declared that they use World Health Organization (WHO) and Department of Health and Human Services (DHHS) guidelines, over one-third the European Centre for Disease Prevention and Control (ECDC) HIV testing guidelines and one in five the International Antiviral Society-USA (IAS-USA) Panel guidelines from 2012. CONCLUSIONS Participants declared their will to promote the widespread use of EACS guidelines for HIV infection in the CEE region and neighbouring countries by signing the Warsaw Declaration. They also emphasized the need to increase publishing of data from national cohorts in that region.
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Affiliation(s)
- J D Kowalska
- Hospital for Infectious Diseases in Warsaw, Medical University of Warsaw, Warsaw, Poland
| | - C Oprea
- Victor Babes Clinical Hospital for Infectious Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,European AIDS Clinical Society, Brussels, Belgium
| | - S de Witt
- European AIDS Clinical Society, Brussels, Belgium.,Infectious Diseases Department, Saint Pierre University Hospital Brussels, Brussels, Belgium
| | - A Pozniak
- European AIDS Clinical Society, Brussels, Belgium.,Chelsea and Westminster Hospital, London, UK
| | - D Gökengin
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - M Youle
- European AIDS Clinical Society, Brussels, Belgium.,HIV Clinical Research, Royal Free Hospital, London, UK
| | - J D Lundgren
- European AIDS Clinical Society, Brussels, Belgium.,Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Centre for Health and Infectious Disease Research (CHIP), Copenhagen, Denmark
| | - A Horban
- Hospital for Infectious Diseases in Warsaw, Medical University of Warsaw, Warsaw, Poland.,European AIDS Clinical Society, Brussels, Belgium
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