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Taggart T, Ritchwood TD, Nyhan K, Ransome Y. Messaging matters: achieving equity in the HIV response through public health communication. Lancet HIV 2021; 8:e376-e386. [PMID: 34087098 DOI: 10.1016/s2352-3018(21)00078-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/27/2022]
Abstract
Public health messages shape how the world understands the HIV epidemic. Considerable inequalities remain in HIV care continuum indicators by subpopulation and geography (eg, highest infection and mortality burden among men who have sex with men and people who live in sub-Saharan Africa). Health equity-focused approaches are necessary in this next decade to close gaps in the HIV epidemic. Between 1981 and 1989, HIV messages triggered fear and victim blaming, and highlighted behaviours of a few marginalised groups as deviant. Between 1990 and 1999, messages signalled that HIV was a growing challenge for the world and required multisector approaches that addressed structural drivers of inequality. Between 2000 and 2009, messages highlighted universal testing, while advances in HIV testing made these messages easier for individuals to respond to than in previous decades. Currently, messages signal that ending HIV is possible, people can live productive lives with HIV, and transmission to people without HIV can be eliminated. Public health messaging about the HIV epidemic has evolved substantially over the past 40 years. Future HIV messaging should be driven by health equity principles that include an increased representation of key populations in message design and dissemination, transparency of funding, and communicating any impact that campaigns have had on closing health inequalities.
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Affiliation(s)
- Tamara Taggart
- Department of Prevention and Community Health, George Washington University, Milken Institute School of Public Health, Washington, DC, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
| | - Tiarney D Ritchwood
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Kate Nyhan
- Harvey Cushing-John Hay Whitney Medical Library, Yale University, New Haven, CT USA
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Chanto S, Kiertiburanakul S. Causes of Hospitalization and Death among Newly Diagnosed HIV-Infected Adults in Thailand. J Int Assoc Provid AIDS Care 2021; 19:2325958220919266. [PMID: 32336194 PMCID: PMC7235965 DOI: 10.1177/2325958220919266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
More than half of newly diagnosed HIV-infected patients enter to care with a low CD4 count. A retrospective cohort study was conducted among newly diagnosed HIV-infected adults who were hospitalized. Of 148 patients, median (interquartile range [IQR]) age was 39.3 (30.5-47.1) years and 114 (77%) patients were male. Baseline median (IQR) CD4 count was 79 (24-218) cells/mm3. The median (IQR) length of hospital stay was 8 (4-16) days. Half of the patients were hospitalized with AIDS-defining illness (ADI). Common opportunistic infections were Pneumocystis jirovecii pneumonia (20.3%) and tuberculosis (18.9%). CD4 count was statistically significantly associated with hospitalization with ADI (odds ratio: 0.85, per 10 cells/mm3 increased; 95% confidence interval: 0.80-0.90). The mortality was 5.4%. In conclusion, half of newly diagnosed Thai HIV-infected patients were hospitalized with ADI. Early detection of HIV infection leading to early antiretroviral therapy initiation and prevention of serious complications is essential.
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Affiliation(s)
- Sukonthip Chanto
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasisopin Kiertiburanakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Figueroa–Agudelo FN, Cabrera–Garcia HB, Zapata–Cárdenas A, Donado–Gómez JH. Características sociodemográficas y clínicas de pacientes con diagnóstico nuevo de VIH. INFECTIO 2019. [DOI: 10.22354/in.v23i3.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: caracterizar de forma sociodemográfica y clínica pacientes con diagnóstico nuevo de VIH, que fueron hospitalizados en una Clínica Universitaria de alta complejidad entre el año 2010 – 2016.Materiales y métodos: se realizó un estudio observacional, descriptico, de corte transversal por medio de revisión de historias clínicas, que incluyo pacientes ≥14 años, a quienes se les diagnosticó VIH durante la hospitalización y tuvieran al menos un conteo de linfocitos CD4.Resultados: la mediana para la edad fue 41 años (RIC 31 – 51), el 85,1% eran hombres. Los principales síntomas al ingreso fueron generales/sistémicos (70,2%). 99 pacientes (61,5%) tenían infecciones oportunistas siendo tuberculosis la más frecuente (34,3%). La mediana para el conteo de CD4 fue 88 células/mm3 RIC (27 – 327) y el 77% se clasificó como SIDA. 29 pacientes murieron (18%) encontrando como posible factor de riesgo tener conteo de CD4 <200 células/mm3, no pertenecer al régimen contributivo, ingresar con síntomas respiratorios, tener diagnóstico de neumonía, criterios de falla multiorgánica o necesidad de UCI/UCE.Conclusión: para nuestro caso la mayoría de pacientes con diagnóstico nuevo de VIH se encontraban en estados avanzados de inmunosupresión con alta carga de enfermedades definitorias de SIDA. Es importante fortalecer las políticas de salud pública para diagnosticar más temprano la infección por VIH.
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Gangcuangco LMA, Sawada I, Tsuchiya N, Do CD, Pham TTT, Rojanawiwat A, Alejandria M, Leyritana K, Yokomaku Y, Pathipvanich P, Ariyoshi K. Regional Differences in the Prevalence of Major Opportunistic Infections among Antiretroviral-Naïve Human Immunodeficiency Virus Patients in Japan, Northern Thailand, Northern Vietnam, and the Philippines. Am J Trop Med Hyg 2017; 97:49-56. [PMID: 28719295 PMCID: PMC5508895 DOI: 10.4269/ajtmh.16-0783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/22/2017] [Indexed: 11/07/2022] Open
Abstract
To identify regional differences in the distribution of opportunistic infections (OIs) among human immunodeficiency virus (HIV)-infected patients in Asia, the medical records of antiretroviral therapy (ART)-naïve patients who attended the following tertiary hospitals from 2003 to 2011 were reviewed: Nagoya Medical Center (NMC, Nagoya, Japan), Lampang Hospital (LPH, Lampang, northern Thailand), Bach Mai Hospital (BMH, Hanoi, northern Vietnam), and Philippine General Hospital (PGH, Manila, Philippines). Logistic regression analyses were performed to identify associations between country of origin and risk of major OIs. In total, 1,505 patients were included: NMC, N = 365; LPH, N = 442; BMH, N = 384; and PGH, N = 314. The median age was 32 years, and 73.3% of all patients were male. The median CD4 count was 200 cells/μL. Most patients at NMC and PGH were men who have sex with men. Injection drug users were most common at BMH (35.7%). Mycobacterium tuberculosis (TB) was most common at PGH (N = 75) but was rare at NMC (N = 4). Pneumocystis pneumonia (PCP) prevalence was highest at NMC (N = 74) and lowest at BMH (N = 13). Multivariable logistic regression showed increased odds of TB at PGH (adjusted odds ratio [aOR] = 42.2, 95% confidence interval [CI] = 14.6-122.1), BMH (aOR = 12.6, CI = 3.9-40.3), and LPH (aOR = 6.6, CI = 2.1-21.1) but decreased odds of PCP at BMH (aOR = 0.1, CI = 0.04-0.2) and LPH (aOR = 0.2, CI = 0.1-0.4) compared with those at NMC. The cryptococcosis risk was increased at LPH (aOR = 6.2, CI = 0.9-41.0) compared with that at NMC. Cytomegalovirus (CMV) retinitis prevalences were similar in all countries. OI prevalence remained high among ART-naïve patients in our cohort. The risks of TB, PCP, and cryptococcosis, but not CMV retinitis, differed between countries. Improved early HIV detection is warranted.
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Affiliation(s)
- Louie Mar A. Gangcuangco
- Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
- Bridgeport Hospital-Yale New Haven Health, Bridgeport, Connecticut
| | - Ikumi Sawada
- Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Naho Tsuchiya
- Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | | | | | | | - Marissa Alejandria
- Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Katerina Leyritana
- Philippine General Hospital, University of the Philippines, Manila, Philippines
| | | | | | - Koya Ariyoshi
- Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
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Kim MJ, Chang HH, Kim SI, Kim YJ, Park DW, Kang C, Kee MK, Choi JY, Kim SM, Choi BY, Kim WJ, Kim JM, Choi JY, Choi YH, Lee JS, Kim SW. Trend of CD4+ Cell Counts at Diagnosis and Initiation of Highly Active Antiretroviral Therapy (HAART): Korea HIV/AIDS Cohort Study, 1992-2015. Infect Chemother 2017; 49:101-108. [PMID: 28608664 PMCID: PMC5500264 DOI: 10.3947/ic.2017.49.2.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/17/2017] [Indexed: 12/23/2022] Open
Abstract
Background CD4+ cell counts reflect immunologic status of human immunodeficiency virus (HIV) patients. Recommended CD4+ cell counts for the initiation of highly active antiretroviral therapy (HAART) has increased over the past several years in various HIV treatment guidelines. We investigated the trend of CD4+ cell counts at diagnosis and treatment start using data from the Korea HIV/acquired immune deficiency syndrome (AIDS) Cohort Study. Materials and Methods The Korea HIV/AIDS Cohort Study started in 2006 and enrolled HIV patients from 21 tertiary and secondary hospitals in South Korea. The data for CD4+ cell counts at diagnosis and HAART initiation from these HIV patients were analyzed by three-year time intervals and presented by number of CD4+ cells (≤100, 101-200, 201-350, 351-500 and >500 cells/mm3). The HIV-RNA titer at diagnosis and HAART initiation were presented by 3-year intervals by groups ≤50,000, 50,001-100,000, 100,001-200,000, 200,001-1,000,000, and >1,000,000 copies/mL. Results Median values of CD4+ cell count and HIV-RNA titer at initial HIV diagnosis were 247 cells/mm3 and 394,955 copies/mL, respectively. At time of initiating HAART, median values of CD4+ cell count and HIV-RNA were 181 cells/mm3 and 83,500 copies/mL, respectively. Patients with low CD4+ cell count (CD4+ cell count ≤200 cells/mm3) at diagnosis (31-51%) and initiation of HAART accounted for the largest proportion (30-65%) over the three-year time intervals. This proportion increased until 2010-2012. Conclusion CD4+ cell count at initiation of HAART was found to be very low, and the increase in late initiation of HAART in recent years is of concern. We think that this increase is primarily due to an increasing proportion of late presenters. We recommend early detection of HIV patients and earlier start of HAART in order to treat and prevent spread of HIV infection.
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Affiliation(s)
- Min Jung Kim
- Department of Internal Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Ha Chang
- Department of Internal Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Il Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn Jeong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chun Kang
- Division of AIDS, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Mee Kyung Kee
- Division of AIDS, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Ju Yeon Choi
- Division of AIDS, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Soo Min Kim
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Bo Youl Choi
- Institute for Health and Society, Hanyang University, Seoul, Korea.,Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Woo Joo Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - June Myung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea
| | - Jin Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Shin Woo Kim
- Department of Internal Medicine, Kyungpook National University, Daegu, Korea.
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Chaiyasin N, Sungkanuparph S. Rate of CD4 Decline and Factors Associated with Rapid CD4 Decline in Asymptomatic HIV-Infected Patients. J Int Assoc Provid AIDS Care 2015; 15:3-6. [PMID: 26567226 DOI: 10.1177/2325957415616493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The accurate marker to assess the risk of disease progression in HIV disease is CD4 count. CD4 decline to <200 cells/mm3 prompts the patients to have risk of opportunistic infections. A retrospective cohort study was conducted in asymptomatic HIV-infected patients who had CD4 count>200 cell/mm3, were antiretroviral naive, and had ≥1-year follow-up. Eighty patients, with mean age of 36.4 (standard deviation [SD]=9.1) years and 58.8% females, were analyzed. The mean (SD) baseline CD4 count was 423 (119) cells/mm3. During the median (IQR) time of 29.0 (14.1-49.6) months, 26.3% had CD4 declined to <200 cells/mm3. From Cox proportional hazard model, only baseline CD4 count<350 cells/mm3 was significantly associated with rapid decline in CD4 count (HR 4.208; 95%CI, 1.428-12.397; P=.009). Age, gender, comorbid disease, risk of HIV infection, duration of HIV diagnosis, and body weight were not associated with rapid CD4 decline. This indicates that asymptomatic patients with CD4 count<350 cells/mm3 are at priority for antiretroviral therapy in resource-limited settings.
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Affiliation(s)
- Natdanai Chaiyasin
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Somnuek Sungkanuparph
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Mingbunjerdsuk P, Asdamongkol N, Sungkanuparph S. Factors Associated with Immunological Discordance in HIV-Infected Patients Receiving Antiretroviral Therapy with Complete Viral Suppression in a Resource-Limited Setting. Jpn J Infect Dis 2015; 68:301-4. [PMID: 25720640 DOI: 10.7883/yoken.jjid.2014.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
"Immunological discordance," i.e., immunological failure despite complete viral suppression in human immunodeficiency virus (HIV)-infected patients receiving antiretroviral therapy (ART), is associated with increased risk of AIDS or death. To evaluate risk factors for immunological discordance in a resource-limited setting in which patients usually present late with low CD4 cell counts, we conducted a case-control study among HIV-infected patients receiving ART and having undetectable HIV RNA. The study included patients with immunological discordance (cases), which was defined as CD4 cell count < 30% above baseline and absolute CD4 cell count < 200 cells/mm(3) at the first 12 months of undetectable HIV RNA (<50 copies/mL). Patients without immunological discordance were included as controls. Of 142 patients (44 cases; 98 controls), the mean age was 38.6 ± 9.4 years and 67.6% were men; 65.5% had history of opportunistic infections. In multivariate analysis, only baseline CD4 cell count < 100 cells/mm(3) (odd ratio [OR], 2.53; 95% confidence interval [CI], 1.04-6.14; P = 0.040) and history of lost to follow-up (OR, 11.04; 95% CI, 2.87-42.46; P < 0.001) were significantly associated with immunological discordance. Early initiation of ART and intervention to improve regular clinic visit compliance and adherence to ART are crucial to prevent immunological discordance among HIV-infected patients.
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Ouédraogo DD, Sawadogo LM, Sagna Y, Sawadogo AB, Diallo I, Hema A, Poda A, Drabo YJ. Risk Factors for Early Mortality on Antiretroviral Treatment of Elderly People Infected with HIV in Burkina Faso. J Int Assoc Provid AIDS Care 2014; 14:553-9. [PMID: 25294855 DOI: 10.1177/2325957414553841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Age is a key determinant of mortality due to diseases including HIV infection. METHODS A retrospective and descriptive cohort study used a computerized database to compare HIV-infected patients diagnosed in late adulthood to a group of patients diagnosed before their 49 years of age, without matching the characteristics of HIV infection. The study included patients who visited the day hospital (outpatient clinic) of the Sanou Souro Teaching Hospital of Bobo-Dioulasso, in Burkina Faso, from January 2007 to December 2011. Older adults were defined as those aged 50 years and more. RESULTS Participants in the study consisted of 2572 patients (265 older adults and 2307 young patients living with HIV. Based on Markov chain method, 32.1% of the older adults living with HIV were found to be seroconvert at 50 years or older. The median follow-up time on antiretroviral treatment (ART) was 32.7 months (range 0.03-65.4 months). Two hundred and ninety-five (11.5%) patients died, including 21.1% of older adults and 10.4% of young (P < .01). World Health Organization stage 3 or 4 and the lowest CD4 count reached <200 cells/mm(3) were the factors associated with early mortality of older adults on ART. CONCLUSION Mortality rate of older adult patients living with HIV in Burkina Faso is high. Early diagnosis, early treatment, and primary prevention of HIV infection in the older adults are the main keys that could help reduce such mortality.
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Affiliation(s)
- Dieu-Donné Ouédraogo
- Internal Medicine Department, Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Lynda Magali Sawadogo
- Internal Medicine Department, Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Yempabou Sagna
- Internal Medicine Department, Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Adrien B Sawadogo
- Infectious Department, Sanou Souro Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - Ismael Diallo
- Internal Medicine Department, Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Arsène Hema
- Infectious Department, Sanou Souro Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - Armel Poda
- Infectious Department, Sanou Souro Teaching Hospital, Bobo-Dioulasso, Burkina Faso
| | - Youssouf Joseph Drabo
- Internal Medicine Department, Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso
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Kiertiburanakul S, Boettiger D, Lee MP, Omar SF, Tanuma J, Ng OT, Durier N, Phanuphak P, Ditangco R, Chaiwarith R, Kantipong P, Lee CK, Mustafa M, Saphonn V, Ratanasuwan W, Merati TP, Kumarasamy N, Wong WW, Zhang F, Pham TT, Pujari S, Choi JY, Yunihastuti E, Sungkanuparph S. Trends of CD4 cell count levels at the initiation of antiretroviral therapy over time and factors associated with late initiation of antiretroviral therapy among Asian HIV-positive patients. J Int AIDS Soc 2014; 17:18804. [PMID: 24598459 PMCID: PMC3944639 DOI: 10.7448/ias.17.1.18804] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 01/06/2014] [Accepted: 02/12/2014] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Although antiretroviral therapy (ART) has been rapidly scaled up in Asia, most HIV-positive patients in the region still present with late-stage HIV disease. We aimed to determine trends of pre-ART CD4 levels over time in Asian HIV-positive patients and to determine factors associated with late ART initiation. METHODS Data from two regional cohort observational databases were analyzed for trends in median CD4 cell counts at ART initiation and the proportion of late ART initiation (CD4 cell counts <200 cells/mm(3) or prior AIDS diagnosis). Predictors for late ART initiation and mortality were determined. RESULTS A total of 2737 HIV-positive ART-naïve patients from 22 sites in 13 Asian countries and territories were eligible. The overall median (IQR) CD4 cell count at ART initiation was 150 (46-241) cells/mm(3). Median CD4 cell counts at ART initiation increased over time, from a low point of 115 cells/mm(3) in 2008 to a peak of 302 cells/mm(3) after 2011 (p for trend 0.002). The proportion of patients with late ART initiation significantly decreased over time from 79.1% before 2007 to 36.3% after 2011 (p for trend <0.001). Factors associated with late ART initiation were year of ART initiation (e.g. 2010 vs. before 2007; OR 0.40, 95% CI 0.27-0.59; p<0.001), sex (male vs. female; OR 1.51, 95% CI 1.18-1.93; p=0.001) and HIV exposure risk (heterosexual vs. homosexual; OR 1.66, 95% CI 1.24-2.23; p=0.001 and intravenous drug use vs. homosexual; OR 3.03, 95% CI 1.77-5.21; p<0.001). Factors associated with mortality after ART initiation were late ART initiation (HR 2.13, 95% CI 1.19-3.79; p=0.010), sex (male vs. female; HR 2.12, 95% CI 1.31-3.43; p=0.002), age (≥51 vs. ≤30 years; HR 3.91, 95% CI 2.18-7.04; p<0.001) and hepatitis C serostatus (positive vs. negative; HR 2.48, 95% CI 1.-4.36; p=0.035). CONCLUSIONS Median CD4 cell count at ART initiation among Asian patients significantly increases over time but the proportion of patients with late ART initiation is still significant. ART initiation at higher CD4 cell counts remains a challenge. Strategic interventions to increase earlier diagnosis of HIV infection and prompt more rapid linkage to ART must be implemented.
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Affiliation(s)
| | - David Boettiger
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Man Po Lee
- Queen Elizabeth Hospital, Hong Kong, China SAR
| | | | - Junko Tanuma
- National Center for Global Health and Medicine, Toyama Shinjuku-ku, Tokyo, Japan
| | | | - Nicolas Durier
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | | | | | - Romanee Chaiwarith
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | - Vonthanak Saphonn
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - Winai Ratanasuwan
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Wing Wai Wong
- Taipei Veterans General Hospital and AIDS Prevention and Research Centre, National Yang-Ming University, Taipei, Taiwan
| | | | | | | | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Evy Yunihastuti
- Working Group on AIDS Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Lahuerta M, Ue F, Hoffman S, Elul B, Kulkarni SG, Wu Y, Nuwagaba-Biribonwoha H, Remien RH, El Sadr W, Nash D. The problem of late ART initiation in Sub-Saharan Africa: a transient aspect of scale-up or a long-term phenomenon? J Health Care Poor Underserved 2013; 24:359-83. [PMID: 23377739 DOI: 10.1353/hpu.2013.0014] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Efforts to scale-up HIV care and treatment have been successful at initiating large numbers of patients onto antiretroviral therapy (ART), although persistent challenges remain to optimizing scale-up effectiveness in both resource-rich and resource-limited settings. Among the most important are very high rates of ART initiation in the advanced stages of HIV disease, which in turn drive morbidity, mortality, and onward transmission of HIV. With a focus on sub-Saharan Africa, this review article presents a conceptual framework for a broader discussion of the persistent problem of late ART initiation, including a need for more focus on the upstream precursors (late HIV diagnosis and late enrollment into HIV care) and their determinants. Without additional research and identification of multilevel interventions that successfully promote earlier initiation of ART, the problem of late ART initiation will persist, significantly undermining the long-term impact of HIV care scale-up on reducing mortality and controlling the HIV epidemic.
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Affiliation(s)
- Maria Lahuerta
- ICAP-Columbia University, Mailman School of Public Health, New York, NY 10032, USA.
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11
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Tiéno H, Guira O, Sagna Y, Diendéré EA, Diallo I, Bognounou R, Zoungrana L, Zida S, Nikiéma P, Drabo YJ. Characteristics and Follow-up of Newly Managed HIV-Infected Patients in the National Referral Center in Ouagadougou, Burkina Faso. ACTA ACUST UNITED AC 2013; 14:40-5. [DOI: 10.1177/2325957412470722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: In sub-Saharan countries, HIV testing and treatment facilities are available, especially at subsidized rates for the past few years. Methods: A prospective and descriptive review was conducted at Yalgado Ouédraogo Teaching Hospital Internal Medicine department in Ouagadougou, using personal case report forms, between June 2009 and August 2010 in all newly diagnosed adults with positive HIV antibody. Results: The study participants consisted of 191 patients at a median age of 37 years (range, 18-65 years) and sex ratio (men/women): 0.66. In all, 110 (57.6%) patients were symptomatic. Fourteen patients were lost to follow-up. Of the 177 patients, 144 had CD4 count <350 cells/mm3 and all have been treated. At the ninth month, weight gain and immune restoration were significant ( P < .01); only 79 of the 144 patients had viral load measurement, and 76 of the 79 were undetectable. Mortality rate of treated patients was 6.25%. Conclusion: Laboratory tests and highly active antiretroviral therapy make the management of patients easier, but a majority of them still presented late and were still lost to follow-up. Nevertheless, we have excellent treatment success.
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Affiliation(s)
- Hervé Tiéno
- Service de Médecine Interne, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Oumar Guira
- Service de Médecine Interne, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Yempabou Sagna
- Service de Médecine Interne, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Eric Arnaud Diendéré
- Service de Médecine Interne, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Ismael Diallo
- Service de Médecine Interne, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Réné Bognounou
- Service de Médecine Interne, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Lassane Zoungrana
- Service de Médecine Interne, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Seidou Zida
- Service de Médecine Interne, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Péré Nikiéma
- Service de Médecine Interne, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Youssouf Joseph Drabo
- Service de Médecine Interne, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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12
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Rithpho P, Grimes DE, Grimes RM, Senaratana W. Known to Be Positive But Not in Care: A Pilot Study From Thailand. ACTA ACUST UNITED AC 2009; 8:202-7. [DOI: 10.1177/1545109709336221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was designed to describe persons with HIV/ AIDS (PWHAs) in Thailand who have not disclosed their HIV status to the government HIV clinics to receive medical care. Objectives were to (1) demonstrate a way to access these persons, and (2) describe their characteristics, HIV status, reasons for nondisclosure, and problems related to their self-care. Two nongovernmental organizations (NGOs) serving the nonmedical needs of PWHAs were used. In all, 22 PWHAs participated. Approximately 80% have known their HIV status for more than 1 year and 30% for more than 5 years. Almost 60% currently used recreational drugs. Reasons for not disclosing their HIV status included that they were still healthy (81.8%) and worried about stigma (77.3%). Two thirds will disclose when a serious problem occurs. This study demonstrates that this population can be accessed and studied through NGOs and that this population differs slightly from PWHAs in Thailand studied at initiation of medical care.
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Affiliation(s)
| | - Deanna E. Grimes
- School of Nursing, University of Texas Health Science Center at Houston, Texas,
| | - Richard M. Grimes
- Medical School, University of Texas Health Science Center at Houston, Texas
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