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Arora AK, Vicente S, Engler K, Lessard D, Huerta E, Ishak J, Routy JP, Klein M, Kronfli N, Cox J, Lemire B, de Pokomandy A, Del Balso L, Sebastiani G, Vedel I, Quesnel-Vallée A, Lebouché B. Impact of social determinants of health on time to antiretroviral therapy initiation and HIV viral undetectability for migrants enrolled in a multidisciplinary HIV clinic with rapid, free, and onsite B/F/TAF: 'The ASAP study'. HIV Med 2024; 25:600-607. [PMID: 38213087 DOI: 10.1111/hiv.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Multidisciplinary care with free, rapid, and on-site bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) dispensation may improve health outcomes among migrants living with HIV. However, models for rapid B/F/TAF initiation are not well studied among migrants living with HIV, and an understanding of how social determinants of health (SDH) may affect HIV-related health outcomes for migrants enrolled in such care models is limited. METHODS Within a 96-week pilot feasibility prospective cohort study at a multidisciplinary HIV clinic, participants received free B/F/TAF rapidly after care linkage. The effects of SDH (i.e., birth region, sexual orientation, living status, education, employment, French proficiency, health coverage, use of a public health facility outside our clinic for free blood tests, and time in Canada) and other covariates (i.e., age, sex) on median time to antiretroviral therapy (ART) initiation and HIV viral undetectability from care linkage were calculated via survival analyses. RESULTS Thirty-five migrants were enrolled in this study. Median time to ART initiation and HIV undetectability was 5 days (range 0-50) and 57 days (range 5-365), respectively. Those who took significantly longer to initiate ART were aged <35 years, identified as heterosexual, had less than university-level education, or were unemployed. No factor was found to significantly affect time to undetectability. CONCLUSION Despite the provision of free B/F/TAF, several SDH were linked to delays in ART initiation. However, once initiated and engaged, migrants living with HIV reached HIV undetectability efficiently. Findings provide preliminary support for adopting this care model with migrants living with HIV and suggest that SDH should be considered when designing clinical interventions for more equitable outcomes.
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Affiliation(s)
- Anish K Arora
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Québec, Canada
| | - Serge Vicente
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Québec, Canada
| | - Kim Engler
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Québec, Canada
| | - David Lessard
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Québec, Canada
| | - Edmundo Huerta
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Québec, Canada
| | - Joel Ishak
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Québec, Canada
| | - Jean-Pierre Routy
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
| | - Marina Klein
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
| | - Joseph Cox
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, Québec, Canada
| | - Benoit Lemire
- Pharmacy Department, McGill University Health Centre, Montréal, Québec, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
| | - Lina Del Balso
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
| | - Giada Sebastiani
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada
| | - Amélie Quesnel-Vallée
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, Québec, Canada
- Department of Sociology, Faculty of Arts, McGill University, Montréal, Québec, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Québec, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
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Bu S, Royston L, Mabanga T, Berini CA, Tremblay C, Lebouché B, Cox J, Costiniuk CT, Durand M, Isnard S, Routy JP. Proteomics validate circulating GDF-15 as an independent biomarker for COVID-19 severity. Front Immunol 2024; 15:1377126. [PMID: 38686386 PMCID: PMC11057458 DOI: 10.3389/fimmu.2024.1377126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/25/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Growth differentiation factor 15 (GDF-15) was originally described as a stress-induced cytokine, and a biomarker of aging and cardiovascular diseases. We hypothesized that circulating GDF-15 would be associated with COVID-19 disease severity. Herein, we explored this hypothesis in a large cohort of COVID-19 patients. Methods Blood samples were collected from 926 COVID-19 adult patients and from 285 hospitalized controls from the Biobanque Québécoise de la COVID-19 (BQC19). COVID-19 severity was graded according to the WHO criteria. SOMAscan proteomics assay was performed on 50µL of plasma. ELISA were performed on 46 selected participants with left-over plasma to validate differences in plasma GDF-15 levels. Statistical analyses were conducted using GraphPad Prism 9.0 and SPSS. P values < 0.01 were considered significant. Results Proteomics showed that plasma GDF-15 levels were higher in COVID-19 patients compared to hospitalized controls. GDF-15 levels increased with COVID-19 severity. COVID-19 patients presenting with comorbidities including diabetes, cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease had higher GDF-15 levels. ELISA revealed significant elevation of GDF-15 until 30 days after hospitalization. Plasma GDF-15 elevation was correlated with older age. Moreover, GDF-15 levels correlated with pro-inflammatory cytokine interleukin-6 (IL-6) and inflammation marker C-reactive protein (CRP) as well as soluble levels of its putative receptor CD48. No association was established between anti-SARS-CoV-2 IgG levels and plasma GDF-15 levels. Conclusions This study confirms GDF-15 as a biomarker for COVID-19 severity. Clinical evaluation of GDF-15 levels could assist identification of persons at high-risk of progressing to severe disease, thus improving patient care.
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Affiliation(s)
- Simeng Bu
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Léna Royston
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Tsoarello Mabanga
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Carolina A. Berini
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Cécile Tremblay
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Bertrand Lebouché
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Cecilia T. Costiniuk
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Madeleine Durand
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Stephane Isnard
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Jean-Pierre Routy
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Division of Hematology, McGill University Health Centre, Montreal, QC, Canada
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Aslan A, Lessard D, Lebouché B, Bichard I, Loze B, Laussat E, Molina JM. Harm reduction and multidisciplinary consultations for gay, bisexual, and other men who have sex with men practising chemsex based in a French infectious disease unit: patients' characteristics and perceptions. Sex Health 2024; 21:SH23165. [PMID: 38467162 DOI: 10.1071/sh23165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Chemsex, a type of sexualised drug use, is expanding among gay, bisexual, and other men who have sex with men (GBMSM), with physical and mental health risks. Health-seeking behaviours of GBMSM practising chemsex is not clear. METHODS Harm reduction (HR) consultations for GBMSM engaging in chemsex and seeking comprehensive services including HR were offered in a Parisian infectious disease unit. From December 2021 to January 2022, HR consultation patients completed an online survey on their consumption, health, used services, and perspective on consultations. We generated descriptive statistics, and tested (χ 2 ) the relationship between reporting a specialised follow-up and perceived usefulness of intervention. RESULTS Of 172 patients, a total of 96 GBMSM (55.2%) completed the survey. Most ever consumed substance was 3-methylmethcathinone (3MMC; 92/96; 95.8%). Before consultations, about half consumed at least once a week (50/96; 52%), most reported negative impacts of chemsex on their social (60/96, 62.5%), professional (56/96, 58.3%), intimate (53/96; 55.21%), or sexual life (52/96; 54.17%). Also, more than two-thirds (n =57; 69.38%) had received a follow-up in specialised services: one-third had been followed in addictology (28/96, 29.2%) and/or psychotherapy (32/96, 33.3%), and one-fourth (24/96, 25.0%) had used emergency services. After consultations, three-quarters perceived the intervention as useful (n =74; 77.08%); we found no significant relationship with receiving a specialised follow-up; and most were satisfied with professionals' listening (90/96; 93.8%), and reported reduced risks (80/96; 83.3%). DISCUSSION Multidisciplinary HR, preventive, diagnostical, and therapeutic sexological and psychiatric interventions are greatly needed among GBMSM practising chemsex. HR interventions accessible in services already attended by GBMSM are a valuable option.
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Affiliation(s)
- Alexandre Aslan
- Unité des maladies infectieuses et tropicales, Hôpital Saint-Louis (Hopitaux de Paris - Assistance Publique de Paris), Paris, France
| | - David Lessard
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada; and Chronic and Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada; and Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Iris Bichard
- Unité des maladies infectieuses et tropicales, Hôpital Saint-Louis (Hopitaux de Paris - Assistance Publique de Paris), Paris, France
| | - Bénédicte Loze
- Unité des maladies infectieuses et tropicales, Hôpital Saint-Louis (Hopitaux de Paris - Assistance Publique de Paris), Paris, France
| | - Eleonore Laussat
- Unité des maladies infectieuses et tropicales, Hôpital Saint-Louis (Hopitaux de Paris - Assistance Publique de Paris), Paris, France
| | - Jean-Michel Molina
- Unité des maladies infectieuses et tropicales, Hôpital Saint-Louis (Hopitaux de Paris - Assistance Publique de Paris), Paris, France; and Université Paris Cité, Paris, France
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Bouabida K, Lebouché B, Pomey MP. The paradoxes of telehealth platforms: what did we learn from the use of telehealth platforms? Front Digit Health 2024; 6:1346039. [PMID: 38414713 PMCID: PMC10896980 DOI: 10.3389/fdgth.2024.1346039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/01/2024] [Indexed: 02/29/2024] Open
Abstract
This article is an overview and reflection of the findings of an evaluative study conducted on a program called "Techno-Covid Partnership" (TCP) implemented in April 2020 at the Centre Hospitalier de l'Université de Montréal (CHUM) in Montreal, Canada. In the context of the COVID-19 pandemic, the CHUM decided in April 2020 to implement telehealth, virtual care, and telemonitoring platforms and technologies to maintain access to care and reduce the risks of contamination and spread of COVID-19 as well as to protect users of health services and health professionals. Three technological platforms for telehealth and remote care and monitoring have been developed, implemented, and evaluated in real-time within the framework of the TCP program. A cross-sectional study was carried out in which a questionnaire was used and administered to users of telehealth platforms including patients and healthcare professionals. The methods and results of the study have been published previously published. In the completion of the two articles published in this context, in this paper, we briefly recall the context of the study and the method performed. The main focus of the paper is on presenting a critical overview and reflection on the major findings of our evaluation of the use of telehealth platforms from the point of view of patients and health professionals and discuss certain paradoxes i.e., the advantages, challenges, recommendations, and other perspectives that emerged in this study.
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Affiliation(s)
- Khayreddine Bouabida
- Centre de Recherche, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
- École de Santé Publique, Département de Gestion, D’évaluation et de Politique de Santé, Université de Montréal, Montreal, QC, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Marie-Pascale Pomey
- Centre de Recherche, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
- École de Santé Publique, Département de Gestion, D’évaluation et de Politique de Santé, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche, Hospital Center of the University of Montreal (CHUM), Montreal, QC, Canada
- Centre de Recherche, Centre of Excellence on Partnership with Patients and the Public, Montreal, QC, Canada
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Ma Y, Achiche S, Pomey MP, Paquette J, Adjtoutah N, Vicente S, Engler K, Laymouna M, Lessard D, Lemire B, Asselah J, Therrien R, Osmanlliu E, Zawati MH, Joly Y, Lebouché B. Adapting and Evaluating an AI-Based Chatbot Through Patient and Stakeholder Engagement to Provide Information for Different Health Conditions: Master Protocol for an Adaptive Platform Trial (the MARVIN Chatbots Study). JMIR Res Protoc 2024; 13:e54668. [PMID: 38349734 PMCID: PMC10900097 DOI: 10.2196/54668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI)-based chatbots could help address some of the challenges patients face in acquiring information essential to their self-health management, including unreliable sources and overburdened health care professionals. Research to ensure the proper design, implementation, and uptake of chatbots is imperative. Inclusive digital health research and responsible AI integration into health care require active and sustained patient and stakeholder engagement, yet corresponding activities and guidance are limited for this purpose. OBJECTIVE In response, this manuscript presents a master protocol for the development, testing, and implementation of a chatbot family in partnership with stakeholders. This protocol aims to help efficiently translate an initial chatbot intervention (MARVIN) to multiple health domains and populations. METHODS The MARVIN chatbots study has an adaptive platform trial design consisting of multiple parallel individual chatbot substudies with four common objectives: (1) co-construct a tailored AI chatbot for a specific health care setting, (2) assess its usability with a small sample of participants, (3) measure implementation outcomes (usability, acceptability, appropriateness, adoption, and fidelity) within a large sample, and (4) evaluate the impact of patient and stakeholder partnerships on chatbot development. For objective 1, a needs assessment will be conducted within the setting, involving four 2-hour focus groups with 5 participants each. Then, a co-construction design committee will be formed with patient partners, health care professionals, and researchers who will participate in 6 workshops for chatbot development, testing, and improvement. For objective 2, a total of 30 participants will interact with the prototype for 3 weeks and assess its usability through a survey and 3 focus groups. Positive usability outcomes will lead to the initiation of objective 3, whereby the public will be able to access the chatbot for a 12-month real-world implementation study using web-based questionnaires to measure usability, acceptability, and appropriateness for 150 participants and meta-use data to inform adoption and fidelity. After each objective, for objective 4, focus groups will be conducted with the design committee to better understand their perspectives on the engagement process. RESULTS From July 2022 to October 2023, this master protocol led to four substudies conducted at the McGill University Health Centre or the Centre hospitalier de l'Université de Montréal (both in Montreal, Quebec, Canada): (1) MARVIN for HIV (large-scale implementation expected in mid-2024), (2) MARVIN-Pharma for community pharmacists providing HIV care (usability study planned for mid-2024), (3) MARVINA for breast cancer, and (4) MARVIN-CHAMP for pediatric infectious conditions (both in preparation, with development to begin in early 2024). CONCLUSIONS This master protocol offers an approach to chatbot development in partnership with patients and health care professionals that includes a comprehensive assessment of implementation outcomes. It also contributes to best practice recommendations for patient and stakeholder engagement in digital health research. TRIAL REGISTRATION ClinicalTrials.gov NCT05789901; https://classic.clinicaltrials.gov/ct2/show/NCT05789901. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54668.
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Affiliation(s)
- Yuanchao Ma
- Department of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Sofiane Achiche
- Department of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
| | - Marie-Pascale Pomey
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre of Excellence on Partnership with Patients and the Public, Montreal, QC, Canada
| | - Jesseca Paquette
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Nesrine Adjtoutah
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Serge Vicente
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Mathematics and Statistics, University of Montreal, Montreal, QC, Canada
| | - Kim Engler
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Moustafa Laymouna
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - David Lessard
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Benoît Lemire
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Jamil Asselah
- Department of Medicine, Division of Medical Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Rachel Therrien
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Esli Osmanlliu
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Ma'n H Zawati
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Yann Joly
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
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Avallone F, Engler K, Cox J, Hickson F, Lebouché B. Interventions, Barriers, and Facilitators to Address the Sexual Problems of Gay, Bisexual and Other Men Who Have Sex with Men Living with HIV: A Rapid Scoping Review. AIDS Behav 2024; 28:450-472. [PMID: 38296920 DOI: 10.1007/s10461-023-04237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/02/2024]
Abstract
Sexual problems are common among gay, bisexual, and other men who have sex with men (GBM) after diagnosis with HIV. However, these are often overlooked in care and research, where sexual risk reduction and biomedical aspects of sexual health tend to dominate. We conducted a rapid scoping review to investigate which sexual problems of GBM living with HIV are addressed by interventions, and the barriers and facilitators to their implementation. Literature from high-income countries published in English since 2010 was reviewed. Medline, Embase, PsycInfo, and Scopus databases were searched on July 4, 2022. Targeted sexual problems were categorized according to the ten dimensions of Robinson's Sexual Health Model, and barriers and facilitators, according to the five domains of the Consolidated Framework for Implementation Research (CFIR). Interventions focused solely on the dimension of Sexual Health Care/Safer Sex were excluded. Relevant information was extracted from the qualifying documents with NVivo 12 software for content analysis. Fifty-two documents were included, referring to 37 interventions which mainly took place in the United States (n = 29/37; 78%), were group-based (n = 16; 41%), and used counselling techniques (n = 23; 62%; e.g., motivational interviewing, cognitive-behavioral therapy). Their settings were mostly primary care (n = 15; 40%) or community-based (n = 16; 43%). On average, interventions addressed three sexual health dimensions (SD = 2; range: 1-10). The most targeted dimension was Sexual Health Care/Safer Sex (n = 26; 70%), which concerned sexual risk reduction. Next, Challenges (n = 23; 62%), included substance use (n = 7; 19%), sexual compulsivity (n = 6; 16%), sexual abuse (n = 6; 16%), and intimate partner violence (n = 4; 11%). Third was Talking About Sex (n = 22; 59%) which mostly concerned HIV disclosure. About a third of interventions addressed Culture/Sexual identity (n = 14; 38%), Intimacy/Relationships (n = 12; 33%), and Positive sexuality (n = 11; 30%). Finally, few targeted Body Image (n = 4; 11%), Spirituality (n = 3; 8%), Sexual Anatomy Functioning (n = 2; 5%) or Masturbation/Fantasy (n = 1; 3%). Forty-one documents (79%) mentioned implementation barriers or facilitators, particularly about the characteristics of the interventions (41% and 78%, respectively; e.g., cost, excessive duration, acceptability, feasibility) and of the individuals involved (37% and 46%; e.g., perceived stigmatization, provider expertise). The other three CFIR dimensions were less common (5%-17%). The search strategy of this review may not have captured all eligible documents, due to its limit to English-language publications. Overall, most interventions incorporated a focus on Sexual Health Care/Safer Sex, at the expenses of other prevalent sexual problems among GBM living with HIV, such as intimate partner violence (Challenges), erectile dysfunction (Sexual Anatomy Functioning), and Body Image dissatisfaction. These findings suggest they could receive more attention within clinical care and at the community level. They also highlight the importance of cost-effective and acceptable interventions conducted in non-stigmatizing environments, where patients' needs can be met by providers who are adequately trained on sexuality-related topics.
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Affiliation(s)
- Francesco Avallone
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Kim Engler
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Joseph Cox
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada
- Department of Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Ford Hickson
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Bertrand Lebouché
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada.
- Department of Family Medicine, McGill University, Montreal, QC, Canada.
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
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Engler K, Avallone F, Cadri A, Lebouché B. Patient-reported outcome measures in adult HIV care: A rapid scoping review of targeted outcomes and instruments used. HIV Med 2024. [PMID: 38282323 DOI: 10.1111/hiv.13599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/20/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE There is international interest in the integration of patient-reported outcome measures (PROMs) into routine HIV care, but little work has synthesized the content of published initiatives. We conducted a rapid scoping review primarily to identify their selected patient-reported outcomes and respective instruments. METHODS Four databases were searched on 4 May 2022 (Medline, Embase, CINAHL and PsychINFO) for relevant English language documents published from 2005 onwards. Dual review of at least 20% of records, full texts and data extraction was performed. Outcomes and instruments were classified with an adapted 14-domain taxonomy. Instruments with evidence of validation were described. RESULTS Of 13 062 records generated for review, we retained a final sample of 94 documents, referring to 60 distinct initiatives led mostly in the USA (n = 29; 48% of initiatives), Europe (n = 16; 27%) and Africa (n = 9; 15%). The measured patient-reported outcome domains were: mental health (n = 42; 70%), substance use (n = 23; 38%), self-management (n = 16; 27%), symptoms (n = 12; 20%), sexual/reproductive health (n = 12; 20%), physical health (n = 9; 15%), treatment (n= 8; 13%), cognition (n = 7; 12%), quality of life (n = 7; 12%), violence/abuse (n = 6; 10%), stigma (n = 6; 10%), socioeconomic issues (n = 5; 8%), social support (n = 3; 5%) and body/facial appearance (n = 1; 2%). Initiatives measured 2.6 outcome domains, on average (range = 1-11). In total, 62 distinct validated PROMs were identified, with 53 initiatives (88%) employing at least one (M = 2.2). Overwhelmingly, the most used instrument was any version of the Patient Health Questionnaire to measure symptoms of depression, employed by over a third (26; 43%) of initiatives. CONCLUSION Published PROM initiatives in HIV care have spanned 19 countries and disproportionately target mental health and substance use.
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Affiliation(s)
- Kim Engler
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Francesco Avallone
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Abdul Cadri
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Avallone F, Engler K, Cox J, Hickson F, Lessard D, Bourdon J, Thomas R, Lebouché B. Conceptions of sexual health by gay men living with HIV in serodifferent couples in Montreal, Canada: results from a qualitative analysis. Sex Health 2024; 21:SH23164. [PMID: 38281508 DOI: 10.1071/sh23164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Gay, bisexual, and other men (GBM) who have sex with men living with HIV in serodifferent couples (one partner living with HIV, the other HIV-negative) may encounter unique sexual health challenges. This study aimed to explore their definition of sexual health that could improve service provision. METHODS We interviewed 10 gay-identified men living with HIV from 2017 to 2019 as part of CTNPT013, a study on the sexual health of HIV serodifferent GBM couples conducted at two HIV-specialised clinics in Montreal, Canada. Participants partook in semi-structured interviews on the meaning of sexual health. We performed a content analysis of interview transcripts, coding them according to the 10 dimensions of Robinson's Sexual Health Model. RESULTS Mean age of interviewees was 35.4years (s.d.,10.2; range, 20-53). Every dimension of Robinson's model was spontaneously evoked, except for body image and spirituality. All men indicated intimacy/relationships (e.g. sexual agreements) and sexual health care/safer sex (e.g. HIV management, risk behaviours) as relevant aspects of sexual health. Other dimensions included: positive sexuality (n =7), such as pleasure and enjoyment during sex; talking about sex (n =5), which mainly concerned HIV disclosure; sexual functioning (n =4); challenges to sexual health (n =3), including substance abuse; and culture/sexual identity (n =3). Two participants (n =2) cited masturbation/fantasy. CONCLUSIONS This study emphasises the multi-faceted nature of sexual health for gay men with HIV in serodifferent couples and the pivotal roles of relationships, HIV, risk management (e.g. via health care, knowledge), and positive sexual experiences. These dimensions could be considered in sexual health promotion interventions targeting this population.
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Affiliation(s)
- Francesco Avallone
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada; and Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Kim Engler
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Joseph Cox
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada; and Chronic Viral Illness Service, Royal Victoria Hospital, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada; and Department of Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Ford Hickson
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - David Lessard
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada; and Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; and Chronic Viral Illness Service, Royal Victoria Hospital, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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9
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Costiniuk CT, Singer J, Lee T, Galipeau Y, McCluskie PS, Arnold C, Langlois MA, Needham J, Jenabian MA, Burchell AN, Samji H, Chambers C, Walmsley S, Ostrowski M, Kovacs C, Tan DH, Harris M, Hull M, Brumme ZL, Lapointe HR, Brockman MA, Margolese S, Mandarino E, Samarani S, Vulesevic B, Lebouché B, Angel JB, Routy JP, Cooper CL, Anis AH. Antibody neutralization capacity after coronavirus disease 2019 vaccination in people with HIV in Canada. AIDS 2023; 37:F25-F35. [PMID: 37534695 PMCID: PMC10481923 DOI: 10.1097/qad.0000000000003680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/15/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES Many vaccines require higher/additional doses or adjuvants to provide adequate protection for people with HIV (PWH). Here, we compare coronavirus disease 2019 (COVID-19) vaccine-induced antibody neutralization capacity in PWH vs. HIV-negative individuals following two vaccine doses. DESIGN In Canadian prospective observational cohorts, including a multicentre study of PWH receiving at least two COVID-19 vaccinations (mRNA or ChAdOx1-S), and a parallel study of HIV-negative controls (Stop the Spread Ottawa Cohort), we measured vaccine-induced neutralization capacity 3 months post dose 2 (±1 month). METHODS COVID-19 neutralization efficiency was measured by calculating the half maximal inhibitory dilution (ID50) using a high-throughput protein-based neutralization assay for Ancestral (Wuhan), Delta and Omicron (BA.1) spike variants. Univariable and multivariable quantile regression were used to compare COVID-19-specific antibody neutralization capacity by HIV status. RESULTS Neutralization assays were performed on 256 PWH and 256 controls based on specimen availability at the timepoint of interest, having received two vaccines and known date of vaccination. There was a significant interaction between HIV status and previous COVID-19 infection status in median ID50. There were no differences in median ID50 for HIV+ vs. HIV-negative persons without past COVID-19 infection. For participants with past COVID-19 infection, median ICD50 was significantly higher in controls than in PWH for ancestral SARS-CoV-2 and Omicron variants, with a trend for the Delta variant in the same direction. CONCLUSION Vaccine-induced SARS-CoV-2 neutralization capacity was similar between PWH vs. HIV-negative persons without past COVID-19 infection, demonstrating favourable humoral-mediated immunogenicity. Both HIV+ and HIV-negative persons demonstrated hybrid immunity. TRIAL REGISTRATION clinicaltrials.gov NCT04894448.
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Affiliation(s)
- Cecilia T. Costiniuk
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital
- Infectious Diseases and Immunity in Global Health Research Program, Research Institute of McGill University Health Centre
- Department of Experimental Medicine, McGill University, Montreal, Québec
| | - Joel Singer
- School of Population and Public Health, University of British Columbia
- CIHR Canadian HIV Trials Network (CTN)
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia
| | - Terry Lee
- CIHR Canadian HIV Trials Network (CTN)
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia
| | - Yannick Galipeau
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario
| | - Pauline S. McCluskie
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario
| | - Corey Arnold
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario
| | - Marc-André Langlois
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario
| | - Judy Needham
- CIHR Canadian HIV Trials Network (CTN)
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia
| | - Mohammad-Ali Jenabian
- Department of Biological Sciences, Université du Québec à Montréal, Montreal, Québec
| | - Ann N. Burchell
- Department of Family and Community Medicine, St Michael's Hospital, Unity Health Toronto
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Hasina Samji
- Faculty of Health Sciences, Simon Fraser University, Burnaby
- British Columbia Centre for Disease Control, Vancouver, British Columbia
| | - Catharine Chambers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
- MAP Centre for Urban Health Solutions, St Michael's Hospital
| | - Sharon Walmsley
- Division of Infectious Diseases, Department of Medicine, University of Toronto
| | - Mario Ostrowski
- Clinical Sciences Division and Department of Immunology, University of Toronto, Li Ka Shing Knowledge Institute, St. Michael's Hospital
| | | | - Darrell H.S. Tan
- MAP Centre for Urban Health Solutions, St Michael's Hospital
- Division of Infectious Diseases, Department of Medicine, University of Toronto
- Institute of Public Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Marianne Harris
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver
| | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver
| | - Zabrina L. Brumme
- Faculty of Health Sciences, Simon Fraser University, Burnaby
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver
| | | | - Mark A. Brockman
- Faculty of Health Sciences, Simon Fraser University, Burnaby
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver
- Department of Molecular Biology and Biochemistry, Faculty of Science, Simon Fraser University, Burnaby, British Columbia
| | | | | | - Suzanne Samarani
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital
| | - Branka Vulesevic
- CIHR Canadian HIV Trials Network (CTN)
- Division of Infectious Diseases, Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario
| | - Bertrand Lebouché
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital
- Infectious Diseases and Immunity in Global Health Research Program, Research Institute of McGill University Health Centre
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials
| | - Jonathan B. Angel
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario
- Division of Infectious Diseases, Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario
| | - Jean-Pierre Routy
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital
- Infectious Diseases and Immunity in Global Health Research Program, Research Institute of McGill University Health Centre
- Division of Hematology, Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
| | - Curtis L. Cooper
- Division of Infectious Diseases, Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario
| | - Aslam H. Anis
- School of Population and Public Health, University of British Columbia
- CIHR Canadian HIV Trials Network (CTN)
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia
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10
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Mate KKV, Engler K, Lessard D, Lebouché B. Barriers to adherence to antiretroviral therapy: identifying priority areas for people with HIV and healthcare professionals. Int J STD AIDS 2023; 34:677-686. [PMID: 37113058 PMCID: PMC10467008 DOI: 10.1177/09564624231169329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 12/28/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Challenges to antiretroviral therapy adherence are well-known and continue to be a major hurdle in HIV care. The objective of this paper is to identify barriers to antiretroviral therapy (ART) adherence that are relevant to HIV care from the perspective of people living with HIV and healthcare and social service professionals. METHODS This study used an online survey design to collect information from the two groups. A total of 100 areas that covered six domains and 20 subdomains were administered to people living with HIV and care professionals in Canada and France. The survey asked participants to rate the importance of each area for HIV care on a four-point Likert scale. Any areas rated 3 or 4 were considered important and ranked. A Chi-square test was conducted for the difference between the groups, people living with HIV and professionals, and between women and men. RESULTS A response rate of 87% (58/66) in Canada and 65% (38/58) was achieved. 15 of 43 (35%) areas were endorsed as important barriers by both groups, across countries and sex-covering subdomains - drug cost coverage, challenging material circumstances, HIV stigma, and privacy concerns, affect, motivation, beliefs, acceptance of HIV, comorbidity, side effects, and demands and organisation of daily life. People living with HIV identified two, and care professionals identified nine, additional areas as important barriers to HIV care across different domains and subdomains. CONCLUSION The study identified some common and distinct barriers to ART from the perspective of the people living with HIV and care professionals.
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Affiliation(s)
- Kedar K. V. Mate
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC, Canada
| | - Kim Engler
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - David Lessard
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC, Canada
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11
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Cinque F, Saeed S, Kablawi D, Ramos Ballesteros L, Elgretli W, Moodie EEM, Price C, Monteith K, Cooper C, Walmsley SL, Pick N, Murray MCM, Cox J, Kronfli N, Costiniuk CT, de Pokomandy A, Routy JP, Lebouché B, Klein MB, Sebastiani G. Role of fatty liver in the epidemic of advanced chronic liver disease among people with HIV: protocol for the Canadian LIVEHIV multicentre prospective cohort. BMJ Open 2023; 13:e076547. [PMID: 37607785 PMCID: PMC10445396 DOI: 10.1136/bmjopen-2023-076547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Advanced chronic liver disease (ACLD) is a major cause of death for people with HIV (PWH). While viral hepatitis coinfections are largely responsible for this trend, metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging concern for PWH. We aimed to assess the contribution of MASLD to incident ACLD in PWH. METHODS AND ANALYSIS This multicentre prospective observational cohort study will enrol 968 consecutive HIV monoinfected patients from four Canadian sites, excluding subjects with alcohol abuse, liver disease other than MASLD, or ACLD at baseline. Participants will be followed annually for 4 years by clinical evaluation, questionnaires, laboratory testing and Fibroscan to measure liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). The primary outcome will be incidence of ACLD, defined as LSM>10 kPa, by MASLD status, defined as CAP≥285 dB/m with at least one metabolic abnormality, and to develop a score to classify PWH according to their risk of ACLD. Secondary outcomes will include health-related quality of life (HRQoL) and healthcare resource usage. Kaplan-Meier survival method and Cox proportional hazards regression will calculate the incidence and predictors of ACLD, respectively. Propensity score methods and marginal structural models will account for time-varying exposures. We will split the cohort into a training set (to develop the risk score) and a validation set (for validation of the score). HRQoL scores and healthcare resource usage will be compared by MASLD status using generalised linear mixed effects model. ETHICS AND DISSEMINATION This protocol has been approved by the ethics committees of all participating institutions. Written informed consent will be obtained from all study participants. The results of this study will be shared through scientific publications and public presentations to advocate for the inclusion of PWH in clinical trials of MASLD-targeted therapies and case-finding of ACLD in PWH.
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Affiliation(s)
- Felice Cinque
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sahar Saeed
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Dana Kablawi
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Luz Ramos Ballesteros
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Wesal Elgretli
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Colleen Price
- Canadian HIV/AIDS and Chronic Pain Society, Ottawa, Ontario, Canada
| | | | - Curtis Cooper
- Department of Medicine, Division of Infectious Diseases, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sharon L Walmsley
- Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Neora Pick
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Melanie C M Murray
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph Cox
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Nadine Kronfli
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Marina B Klein
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Giada Sebastiani
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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12
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Sebastiani G, Milic J, Kablawi D, Gioè C, Al Hinai AS, Lebouché B, Tsochatzis E, Finkel J, Ballesteros LR, Ramanakumar AV, Bhagani S, Benmassaoud A, Mazzola G, Cascio A, Guaraldi G. Fibroscan-Aspartate Aminotransferase Score Predicts Liver-Related Outcomes, but Not Extrahepatic Events, in a Multicenter Cohort of People With Human Immunodeficiency Virus. Clin Infect Dis 2023; 77:396-404. [PMID: 37013396 DOI: 10.1093/cid/ciad203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is frequent in people with human immunodeficiency virus (PWH). The Fibroscan-aspartate aminotransferase (FAST) score was developed to identify patients with nonalcoholic steatohepatitis (NASH) and significant fibrosis. We investigated prevalence of NASH with fibrosis and the value of FAST score in predicting clinical outcomes in PWH. METHODS Transient elastography (Fibroscan) was performed in PWH without viral hepatitis coinfection from 4 prospective cohorts. We used FAST >0.35 to diagnose NASH with fibrosis. Incidence and predictors of liver-related outcomes (hepatic decompensation, hepatocellular carcinoma) and extrahepatic events (cancer, cardiovascular disease) were evaluated through survival analysis. RESULTS Of the 1472 PWH included, 8% had FAST >0.35. Higher body mass index (adjusted odds ratio [aOR], 1.21 [95% confidence interval {CI}, 1.14-1.29]), hypertension (aOR, 2.24 [95% CI, 1.16-4.34]), longer time since HIV diagnosis (aOR, 1.82 [95% CI, 1.20-2.76]), and detectable HIV RNA (aOR, 2.22 [95% CI, 1.02-4.85]) were associated with FAST >0.35. A total of 882 patients were followed for a median of 3.8 years (interquartile range, 2.5-4.2 years). Overall, 2.9% and 11.1% developed liver-related and extrahepatic outcomes, respectively. Incidence of liver-related outcomes was higher in patients with FAST >0.35 versus FAST ≤0.35 (45.1 [95% CI, 26.2-77.7] vs 5.0 [95% CI, 2.9-8.6] per 1000 person-years). FAST >0.35 remained an independent predictor of liver-related outcomes (adjusted hazard ratio, 4.97 [95% CI, 1.97-12.51]). Conversely, FAST did not predict extrahepatic events. CONCLUSIONS A significant proportion of PWH may have NASH with significant liver fibrosis. FAST score predicts liver-related outcomes and can help management of this high-risk population.
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Affiliation(s)
- Giada Sebastiani
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Jovana Milic
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Dana Kablawi
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Claudia Gioè
- Infectious and Tropical Disease Unit, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone," Palermo, Italy
| | - Al Shaima Al Hinai
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University Health Centre, Montreal, Canada
| | - Emmanuel Tsochatzis
- Institute for Liver and Digestive Health, Division of Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Jemima Finkel
- Institute for Liver and Digestive Health, Division of Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Luz Ramos Ballesteros
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | | | - Sanjay Bhagani
- Institute for Liver and Digestive Health, Division of Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Amine Benmassaoud
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Giovanni Mazzola
- Infectious Diseases Unit, Sant'Elia Hospital, Caltanissetta, Italy
| | - Antonio Cascio
- Infectious and Tropical Disease Unit, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone," Palermo, Italy
- Department of Health Promotion Sciences and Mother and Child Care "Giuseppe D'Alessandro," University of Palermo, Italy
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
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13
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Mboumba Bouassa RS, Comeau E, Alexandrova Y, Pagliuzza A, Yero A, Samarani S, Needham J, Singer J, Lee T, Bobeuf F, Vertzagias C, Sebastiani G, Margolese S, Mandarino E, Klein MB, Lebouché B, Routy JP, Chomont N, Costiniuk CT, Jenabian MA. Effects of Oral Cannabinoids on Systemic Inflammation and Viral Reservoir Markers in People with HIV on Antiretroviral Therapy: Results of the CTN PT028 Pilot Clinical Trial. Cells 2023; 12:1811. [PMID: 37508476 PMCID: PMC10378564 DOI: 10.3390/cells12141811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Chronic HIV infection is characterized by persistent inflammation despite antiretroviral therapy (ART). Cannabinoids may help reduce systemic inflammation in people with HIV (PWH). To assess the effects of oral cannabinoids during HIV, ten PWH on ART were randomized (n = 5/group) to increasing doses of oral Δ9-tetrahydrocannabinol (THC): cannabidiol (CBD) combination (2.5:2.5-15:15 mg/day) capsules or CBD-only (200-800 mg/day) capsules for 12 weeks. Blood specimens were collected prospectively 7-21 days prior to treatment initiation and at weeks 0 to 14. Plasma cytokine levels were determined via Luminex and ELISA. Immune cell subsets were characterized by flow cytometry. HIV DNA/RNA were measured in circulating CD4 T-cells and sperm by ultra-sensitive qPCR. Results from both arms were combined for statistical analysis. Plasma levels of IFN-γ, IL-1β, sTNFRII, and REG-3α were significantly reduced at the end of treatment (p ˂ 0.05). A significant decrease in frequencies of PD1+ memory CD4 T-cells, CD73+ regulatory CD4 T-cells, and M-DC8+ intermediate monocytes was also observed (p ˂ 0.05), along with a transient decrease in CD28-CD57+ senescent CD4 and CD8 T-cells. Ki-67+ CD4 T-cells, CCR2+ non-classical monocytes, and myeloid dendritic cells increased over time (p ˂ 0.05). There were no significant changes in other inflammatory markers or HIV DNA/RNA levels. These findings can guide future large clinical trials investigating cannabinoid anti-inflammatory properties.
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Affiliation(s)
- Ralph-Sydney Mboumba Bouassa
- Department of Biological Sciences and CERMO-FC Research Centre, Université du Québec à Montréal, Montreal, QC H2X 3Y7, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Eve Comeau
- Department of Biological Sciences and CERMO-FC Research Centre, Université du Québec à Montréal, Montreal, QC H2X 3Y7, Canada
| | - Yulia Alexandrova
- Department of Biological Sciences and CERMO-FC Research Centre, Université du Québec à Montréal, Montreal, QC H2X 3Y7, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Amélie Pagliuzza
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Alexis Yero
- Department of Biological Sciences and CERMO-FC Research Centre, Université du Québec à Montréal, Montreal, QC H2X 3Y7, Canada
| | - Suzanne Samarani
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Judy Needham
- CIHR Canadian HIV Trials Network, Vancouver, BC V6Z 1Y6, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Joel Singer
- CIHR Canadian HIV Trials Network, Vancouver, BC V6Z 1Y6, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Terry Lee
- CIHR Canadian HIV Trials Network, Vancouver, BC V6Z 1Y6, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Florian Bobeuf
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Claude Vertzagias
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Giada Sebastiani
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Shari Margolese
- CIHR Canadian HIV Trials Network, Vancouver, BC V6Z 1Y6, Canada
| | | | - Marina B Klein
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Bertrand Lebouché
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3J1, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Jean-Pierre Routy
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Nicolas Chomont
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Cecilia T Costiniuk
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Mohammad-Ali Jenabian
- Department of Biological Sciences and CERMO-FC Research Centre, Université du Québec à Montréal, Montreal, QC H2X 3Y7, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, QC H3T 1J4, Canada
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Lanièce Delaunay C, Klein MB, Godin A, Cox J, Kronfli N, Lebouché B, Doyle C, Maheu-Giroux M. Public health interventions, priority populations, and the impact of COVID-19 disruptions on hepatitis C elimination among people who have injected drugs in Montreal (Canada): A modeling study. Int J Drug Policy 2023; 116:104026. [PMID: 37075626 PMCID: PMC10080278 DOI: 10.1016/j.drugpo.2023.104026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND In Montreal (Canada), high hepatitis C virus (HCV) seroincidence (21 per 100 person-years in 2017) persists among people who have injected drugs (PWID) despite relatively high testing rates and coverage of needle and syringe programs (NSP) and opioid agonist therapy (OAT). We assessed the potential of interventions to achieve HCV elimination (80% incidence reduction and 65% reduction in HCV-related mortality between 2015 and 2030) in the context of COVID-19 disruptions among all PWID and PWID living with HIV. METHODS Using a dynamic model of HCV-HIV co-transmission, we simulated increases in NSP (from 82% to 95%) and OAT (from 33% to 40%) coverage, HCV testing (every 6 months), or treatment rate (100 per 100 person-years) starting in 2022 among all PWID and PWID living with HIV. We also modeled treatment scale-up among active PWID only (i.e., people who report injecting in the past six months). We reduced intervention levels in 2020-2021 due to COVID-19-related disruptions. Outcomes included HCV incidence, prevalence, and mortality, and proportions of averted chronic HCV infections and deaths. RESULTS COVID-19-related disruptions could have caused temporary rebounds in HCV transmission. Further increasing NSP/OAT or HCV testing had little impact on incidence. Scaling-up treatment among all PWID achieved incidence and mortality targets among all PWID and PWID living with HIV. Focusing treatment on active PWID could achieve elimination, yet fewer projected deaths were averted (36% versus 48%). CONCLUSIONS HCV treatment scale-up among all PWID will be required to eliminate HCV in high-incidence and prevalence settings. Achieving elimination by 2030 will entail concerted efforts to restore and enhance pre-pandemic levels of HCV prevention and care.
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Affiliation(s)
- Charlotte Lanièce Delaunay
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina B Klein
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Arnaud Godin
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nadine Kronfli
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Carla Doyle
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
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15
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Royston L, Isnard S, Berini CA, Bu S, Lakatos PL, Bessissow T, Chomont N, Klein M, Lebouché B, de Pokomandy A, Kronfli N, Costiniuk CT, Thomas R, Tremblay C, Boivin G, Routy JP. Influence of letermovir treatment on gut inflammation in people living with HIV on antiretroviral therapy: protocol of the open-label controlled randomised CIAO study. BMJ Open 2023; 13:e067640. [PMID: 36690406 PMCID: PMC9872486 DOI: 10.1136/bmjopen-2022-067640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/08/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Chronic cytomegalovirus (CMV) infection is very frequent in people living with HIV (PLWH). High anti-CMV IgG titres, which may be linked to transient CMV replication, have been associated with earlier mortality, CD8 T-cell expansion, lower CD4/CD8 ratio and increased T-cell senescence. We previously showed that anti-CMV IgG titres correlated with gut permeability in PLWH on antiretroviral therapy (ART), which was associated with microbial translocation, systemic inflammation and non-infectious/non-AIDS comorbidities. Letermovir, a novel anti-CMV drug with a good safety profile, was recently approved for anti-CMV prophylaxis in allogeneic haematopoietic stem cell transplant recipients. A drastic and selective reduction of both low-grade replication and clinically significant CMV infections, combined with an improved immune reconstitution have been reported. In vitro, letermovir prevented CMV-induced epithelial disruption in intestinal tissues. Based on these findings, we aim to assess whether letermovir could inhibit CMV subclinical replication in CMV-seropositive PLWH receiving ART and, in turn, decrease CMV-associated gut damage and inflammation. METHOD AND ANALYSIS We will conduct a multi-centre, open-label, randomised, controlled clinical trial, including a total of 60 CMV-seropositive ART-treated PLWH for at least 3 years, with a viral load <50 copies/mL and CD4+ count >400 cells/µL. Forty participants will be randomised to receive letermovir for 14 weeks and 20 participants will receive standard of care (ART) alone. Plasma, pheripheral blood mononuclear cells (PBMCs), and stool samples will be collected. Colon biopsies will be collected in an optional substudy. We will assess the effect of letermovir on gut damage, microbial translocation, inflammation and HIV reservoir size. ETHICS AND DISSEMINATION The study was approved by Health Canada and the Research Ethics Boards of the McGill University Health Centre (MUHC-REB, protocol number: MP37-2022-8295). Results will be made available through publications in open access peer-reviewed journals and through the CIHR/CTN website. TRIAL REGISTRATION NUMBER NCT05362916.
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Affiliation(s)
- Léna Royston
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Canadian HIV Trials Network, Canadian Institutes of Health Research, Vancouver, BC, Canada
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Isnard
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Canadian HIV Trials Network, Canadian Institutes of Health Research, Vancouver, BC, Canada
| | - Carolina A Berini
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- CONICET, Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina
| | - Simeng Bu
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - Nicolas Chomont
- Department de Microbiologie, Maladies Infectieuses et Immunologie, Centre de Recherche du Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
| | - Marina Klein
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Canadian HIV Trials Network, Canadian Institutes of Health Research, Vancouver, BC, Canada
| | - Bertrand Lebouché
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Alexandra de Pokomandy
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Nadine Kronfli
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Cecilia T Costiniuk
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Canadian HIV Trials Network, Canadian Institutes of Health Research, Vancouver, BC, Canada
| | | | - Cécile Tremblay
- Department de Microbiologie, Maladies Infectieuses et Immunologie, Centre de Recherche du Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
| | - Guy Boivin
- Division of Pediatrics, Faculty of Medicine, Laval University, Quebec city, QC, Canada
| | - Jean-Pierre Routy
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Division of Hematology, McGill University Health Centre, Montreal, QC, Canada
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16
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Lessard D, Lebouché B, Morneau A, Bilodeau M, Rosenes R, Sanders J, Chomont N, Keeler P, Dubé K, Margolese S, Jenabian MA, Power C, Routy JP, Angel JB, Cohen ÉA, Costiniuk CT. Donating One's Body to HIV Cure Research Through Canadian Medical Assistance in Dying: A Case Study. Curr HIV Res 2023; 21:264-267. [PMID: 37670698 DOI: 10.2174/1570162x21666230904150923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/26/2023] [Accepted: 08/02/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Finding a cure for HIV is challenged by persisting reservoirs, the mapping of which necessitates invasive procedures. Inviting people with HIV (PWHIV) at the end of life to donate body specimens post-mortem through research autopsies is a novel approach, raising ethical concerns. OBJECTIVE This case study aims to explore the motivations, barriers, and facilitators of a terminally-ill Canadian PWHIV who requested medical assistance in dying (MAID) and expressed interest in donating his body for HIV cure research. CASE PRESENTATION An in-depth 3-hour and semi-structured interview was conducted with the participant. The interview transcription was thematically coded to identify motivations and perceived barriers and facilitators to participate in end-of-life HIV cure research. Our analysis identified six themes. Two themes expressed motivations: Collaboration in progress in health and science, seeing cure research as collaboration with professionals; and Opportunity to learn more, mostly about science and health. One theme expressed a barrier: Losing interest in or identification with long-term care research matters, especially those related to the management of long-term care. Three themes expressed by facilitators: Receiving information from professionals one trusts and knows, especially clinical and research teams; Perceiving research procedures as simple, useful, and embedded in care, perceiving clinical, educational, and interpersonal benefits that surpass costs of participation; and Perceiving research as one last way to contribute, that is, feeling useful or give back. CONCLUSION Several circumstances facilitated the patient's participation: being a single man, having time to participate, having no strong religious belief, and valuing clear, direct communication. His motivations to participate in HIV cure research were altruistic, and also an experience of working with clinical and research teams. Finally, this perspective highlights HIV cure research participant candidates' need for education about research procedures.
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Affiliation(s)
- David Lessard
- Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre (MUHC), Montreal, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, Canada
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre (MUHC), Montreal, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, Canada
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - André Morneau
- Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre (MUHC), Montreal, Canada
| | | | - Ron Rosenes
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Justin Sanders
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Nicolas Chomont
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Canada
| | - Patrick Keeler
- Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre (MUHC), Montreal, Canada
| | - Karine Dubé
- University of California San Diego School of Medicine, Division of Infectious Diseases and Global Public Health, San Diego, USA
| | - Shari Margolese
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Mohammad Ali Jenabian
- Département des Sciences Biologiques, Université du Québec à Montréal, Montreal, Canada
| | - Christopher Power
- Department of Medicine, Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre (MUHC), Montreal, Canada
| | - Jonathan B Angel
- Ottawa Hospital Research Institute and Division of Infectious Disease, The Ottawa Hospital, Ottawa, Canada
| | - Éric A Cohen
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Canada
- Institut de Recherche Clinique de Montréal, Montreal, Canada
| | - Cecilia T Costiniuk
- Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre (MUHC), Montreal, Canada
- Department of Medicine, Division of Infectious Diseases and Department of Microbiology and Immunology, McGill University, Montreal, Canada
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17
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Yang M, Daftary A, Mendelsohn JB, Ryan M, Bullock S, Bisaillon L, Bourne A, Lebouché B, Thompson T, Calzavara L. "Live a normal life": Constructions of resilience among people in mixed HIV status relationships in Canada. PLoS One 2023; 18:e0281301. [PMID: 36888619 PMCID: PMC9994671 DOI: 10.1371/journal.pone.0281301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/20/2023] [Indexed: 03/09/2023] Open
Abstract
Positive Plus One is a mixed-methods study of long-term mixed HIV-serostatus relationships in Canada (2016-19). Qualitative interviews with 51 participants (10 women, 41 men, including 27 HIV-positive and 24 HIV-negative partners) were analyzed using inductive thematic analysis to examine notions of relationship resilience in the context of emerging HIV social campaigns. Relationship resilience meant finding ways to build and enact life as a normal couple, that is, a couple not noticeably affected by HIV, linked to the partner with HIV maintaining viral suppression and achieving "undetectable = untransmittable" (U = U). Regardless of serostatus, participants with material resources, social networks, and specialized care were better able to construct resilience for HIV-related challenges within their relationships. Compared to heterosexual couples and those facing socioeconomic adversity, gay and bisexual couples were easier able to disclose, and access capital, networks and resources supporting resilience. We conclude that important pathways of constructing, shaping, and maintaining resilience were influenced by the timing of HIV diagnosis in the relationship, access to HIV-related information and services, disclosure, stigma and social acceptance.
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Affiliation(s)
- Minhui Yang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Amrita Daftary
- School of Global Health, and Dahdaleh Institute of Global Health Research, York University, Toronto, Canada
| | - Joshua B. Mendelsohn
- College of Health Professions, Pace University, New York, New York, United States of America
| | - Molly Ryan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sandra Bullock
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- * E-mail:
| | - Laura Bisaillon
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Bertrand Lebouché
- Faculty of Medicine, Division of Infectious Diseases and Chronic Viral Illness, and the Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada
| | - Tamara Thompson
- Faculty of Health Sciences, Douglas College, Coquitlam, Canada
| | - Liviana Calzavara
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Mate KKV, Lebouché B, Brouillette MJ, Fellows LK, Mayo NE. Development of a Prototype for a Bilingual Patient-Reported Outcome Measure of the Important Health Aspects of Quality of Life in People Living with HIV: The Preference Based HIV Index (PB-HIV). J Pers Med 2022; 12:jpm12122080. [PMID: 36556300 PMCID: PMC9781994 DOI: 10.3390/jpm12122080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: The aim of this project was to develop a short, HIV-specific, health-related quality of life measure with a scoring system based on patient preferences for the different dimensions of the Preference-Based HIV Index (PB-HIV). (2) Methods: This study is a cross-sectional analysis of data from the Canadian Positive Brain Health Now cohort (n = 854; mean age 53 years). Items from the standardized measures were mapped to the areas from the Patient-Generated Index and formed the domains. A Rasch analysis was used to identify the best performing item to represent each dimension. Each item was then regressed on self-rated health (scored 0 to 100) and the regression parameters were used as scaling weights to form an index score for the prototype measure. (3) Results: Seven independent dimensions with three declarative statements ordered as response options formed the PB-HIV Index (pain, fatigue, memory/concentration, sleep, physical appearance/body image, depression, motivation). Regression parameters from a multivariable model yielded a measure with a scoring range from 0 (worst health) to 100 (perfect health). (4) Conclusions: Preference-based measures are optimal, as the total score reflects gains in some dimensions balanced against losses in others. The PB-HIV Index is the first HIV-specific preference-based measure.
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Affiliation(s)
- Kedar K. V. Mate
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3S 1Z1, Canada
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S5, Canada
- Correspondence:
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3S 1Z1, Canada
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S5, Canada
| | - Marie-Josée Brouillette
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S5, Canada
- Department of Psychiatry, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Lesley K. Fellows
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - Nancy E. Mayo
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S5, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada
- Divisions of Clinical Epidemiology, Geriatrics, Experimental Medicine, Department of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3J1, Canada
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Mboumba Bouassa RS, Needham J, Nohynek D, Singer J, Lee T, Bobeuf F, Samarani S, Del Balso L, Paisible N, Vertzagias C, Sebastiani G, Margolese S, Mandarino E, Klein M, Lebouché B, Cox J, Brouillette MJ, Routy JP, Szabo J, Thomas R, Huchet E, Vigano A, Jenabian MA, Costiniuk CT. Safety and Tolerability of Oral Cannabinoids in People Living with HIV on Long-Term ART: A Randomized, Open-Label, Interventional Pilot Clinical Trial (CTNPT 028). Biomedicines 2022; 10:biomedicines10123168. [PMID: 36551926 PMCID: PMC9775551 DOI: 10.3390/biomedicines10123168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND With anti-inflammatory properties, cannabinoids may be a potential strategy to reduce immune activation in people living with HIV (PLWH) but more information on their safety and tolerability is needed. METHODS We conducted an open-label interventional pilot study at the McGill University Health Centre in Montreal, Canada. PLWH were randomized to oral Δ9-tetrahydrocannabinol (THC): cannabidiol (CBD) combination (THC 2.5 mg/CBD 2.5 mg) or CBD-only capsules (CBD 200 mg). Individuals titrated doses as tolerated to a maximum daily dose THC 15 mg/CBD 15 mg or 800 mg CBD, respectively, for 12 weeks. The primary outcome was the percentage of participants without any significant toxicity based on the WHO toxicity scale (Grades 0-2 scores). RESULTS Out of ten individuals, eight completed the study. Two from the CBD-only arm were withdrawn for safety concerns: phlebotomy aggravating pre-existing anemia and severe hepatitis on 800 mg CBD with newly discovered pancreatic adenocarcinoma, respectively. Seven did not have any significant toxicity. Cannabinoids did not alter hematology/biochemistry profiles. CD4 count, CD4/CD8 ratio, and HIV suppression remained stable. Most adverse effects were mild-moderate. CONCLUSIONS In PLWH, cannabinoids seem generally safe and well-tolerated, though larger studies are needed. Screening for occult liver pathology should be performed and hepatic enzymes monitored, especially with high CBD doses.
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Affiliation(s)
- Ralph-Sydney Mboumba Bouassa
- Department of Biological Sciences and CERMO-FC Research Centre, Université du Québec à Montréal, Montreal, QC H2X 3Y7, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Judy Needham
- CIHR Canadian HIV Trials Network, Vancouver, BC V6Z 1Y6, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Dana Nohynek
- CIHR Canadian HIV Trials Network, Vancouver, BC V6Z 1Y6, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Joel Singer
- CIHR Canadian HIV Trials Network, Vancouver, BC V6Z 1Y6, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Terry Lee
- CIHR Canadian HIV Trials Network, Vancouver, BC V6Z 1Y6, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Florian Bobeuf
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Suzanne Samarani
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Lina Del Balso
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Natalie Paisible
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Claude Vertzagias
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Giada Sebastiani
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Shari Margolese
- CIHR Canadian HIV Trials Network, Vancouver, BC V6Z 1Y6, Canada
| | | | - Marina Klein
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Bertrand Lebouché
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Family Medicine, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, QC H4A 3J1, Canada
| | - Joseph Cox
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Marie-Josée Brouillette
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Psychiatry, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Jean-Pierre Routy
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Hematology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Jason Szabo
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Family Medicine, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Clinique Médical L’Actuel, Montreal, QC H2L 4P9, Canada
| | - Réjean Thomas
- Clinique Médical L’Actuel, Montreal, QC H2L 4P9, Canada
| | | | - Antonio Vigano
- Medical Cannabis Program in Oncology, Cedars Cancer Center, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada
- Centre for Cannabis Research, McGill University, Montreal, QC H3A 0G4, Canada
| | - Mohammad-Ali Jenabian
- Department of Biological Sciences and CERMO-FC Research Centre, Université du Québec à Montréal, Montreal, QC H2X 3Y7, Canada
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Cecilia T Costiniuk
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illnesses Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Centre for Cannabis Research, McGill University, Montreal, QC H3A 0G4, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, QC H3A 0G4, Canada
- Correspondence: ; Tel.: +1-514-934-1934 (ext. 76195); Fax: +1-514-843-2209
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20
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Bouabida K, Lebouché B, Pomey MP. Telehealth and COVID-19 Pandemic: An Overview of the Telehealth Use, Advantages, Challenges, and Opportunities during COVID-19 Pandemic. Healthcare (Basel) 2022; 10:2293. [PMID: 36421617 PMCID: PMC9690761 DOI: 10.3390/healthcare10112293] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 07/25/2023] Open
Abstract
The use of telehealth and digital health platforms has increased during the COVID-19 pandemic due to the implementation of physical distancing measures and restrictions. To address the pandemic threat, telehealth was promptly and extensively developed, implemented, and used to maintain continuity of care offered through multi-purpose technology platforms considered as virtual healthcare facilities. The aim of this paper is to define telehealth and discuss some aspects of its utilization, role, and impact, but also opportunities and future implications particularly during the COVID-19 pandemic. In order to support our reflection and consolidate our viewpoints, numerous bibliographical sources and relevant literature were identified through an electronic keyword search of four databases (PubMed, Web of Science, Google Scholar, and ResearchGate). In this paper, we consider that telehealth to be a very interesting approach which can be effective and affordable for health systems aiming to facilitate access to care, maintain quality and safety of care, and engage patients and health professionals and users of health services. However, we also believe that telehealth faces many challenges, such as the issue of lack of human contact in care, confidentiality, and data security, also accessibility and training in the use of platforms for telehealth. Despite the many challenges it faces, we believe telehealth has enormous potential for strengthening and improving healthcare services. In this paper, we also call for and encourage further studies to build a solid and broad understanding of telehealth challenges with its short-term and long-term clinical, organizational, socio-economic, and ethical impacts.
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Affiliation(s)
- Khayreddine Bouabida
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
- École de Santé Publique, Département de Gestion, D’évaluation et de Politique de Santé, Université de Montréal, Montreal, QC H3N 1X9, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3A 0G4, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3J1, Canada
- Chronic Viral Illness Service, Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Marie-Pascale Pomey
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
- École de Santé Publique, Département de Gestion, D’évaluation et de Politique de Santé, Université de Montréal, Montreal, QC H3N 1X9, Canada
- Hospital Center of the University of Montreal (CHUM), Montreal, QC H2X 0C1, Canada
- Centre of Excellence on Partnership with Patients and the Public, Montreal, QC H2X 0A9, Canada
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21
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Sebastiani G, Paisible N, Costiniuk C, Cox J, Kablawi D, Klein MB, Kronfli N, Routy JP, Falutz J, Lebouché B, Guaraldi G. The Relationship between Visceral Adiposity and Nonalcoholic Fatty Liver Disease Diagnosed by Controlled Attenuation Parameter in People with HIV: A Pilot Study. Diagnostics (Basel) 2022; 12:diagnostics12112590. [PMID: 36359434 PMCID: PMC9689790 DOI: 10.3390/diagnostics12112590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Fat alterations are frequent in people with HIV (PWH) and predict worse cardiometabolic outcomes. Visceral adipose tissue (VAT) is associated with ectopic fat accumulation in the liver. We aimed to investigate nonalcoholic fatty liver disease (NAFLD) diagnosed by controlled attenuation parameter (CAP) as a potential marker of visceral adiposity in PWH. Methods: We conducted a prospective pilot study of HIV mono-infected patients undergoing metabolic characterization and paired CAP measured by transient elastography with dual-energy X-ray absorptiometry (DEXA) scan. NAFLD was defined as CAP ≥ 285 dB/m, in absence of alcohol abuse. Excess visceral adiposity was defined as VAT > 1.32 Kg. Pairwise correlation, area under the curve (AUC) and logistic regression analysis were employed to study the association between VAT and CAP. Results: Thirty patients were included, of whom 50% had NAFLD. CAP was correlated with VAT (r = 0.650, p < 0.001) measured by DEXA scan. After adjusting for duration of HIV infection, body mass index and waist circumference, CAP remained the only independent predictor of excess VAT (adjusted odds ratio 1.05, 95% confidence interval [CI] 1.01−1.10). The AUC analysis determined CAP had excellent performance to diagnose excess VAT (AUC 0.92, 95% CI 0.81−1.00), higher than BMI and waist circumference. The optimized CAP cut-off to diagnose excess VAT was 266 dB/m, with a sensitivity of 88.3% and a specificity of 84.6%. Conclusions: NAFLD diagnosed by CAP is associated with VAT in PWH independently of anthropometric measures of obesity. CAP may be a potential diagnostic marker of visceral adiposity in the practice of HIV medicine.
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Affiliation(s)
- Giada Sebastiani
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H4A3J1, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A3J1, Canada
- Correspondence: ; Tel.: +1-514-843-1616
| | - Nathalie Paisible
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A3J1, Canada
| | - Cecilia Costiniuk
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A3J1, Canada
| | - Joseph Cox
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A3J1, Canada
| | - Dana Kablawi
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H4A3J1, Canada
| | - Marina B. Klein
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A3J1, Canada
| | - Nadine Kronfli
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A3J1, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A3J1, Canada
| | - Julian Falutz
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A3J1, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A3J1, Canada
- Department of Family Medicine, McGill University, Montreal, QC H4A3J1, Canada
| | - Giovanni Guaraldi
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41100 Modena, Italy
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena, 41100 Modena, Italy
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22
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Linthwaite B, Kronfli N, Lessard D, Engler K, Ruppenthal L, Bourbonnière E, Obas N, Brown M, Lebouché B, Cox J. Implementation of Lost & Found, An Intervention to Reengage Patients Out of HIV Care: A Convergent Explanatory Sequential Mixed-Methods Analysis. AIDS Behav 2022; 27:1531-1547. [PMID: 36271984 PMCID: PMC10130100 DOI: 10.1007/s10461-022-03888-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/29/2022]
Abstract
Being out of HIV care (OOC) is associated with increased morbidity and mortality. We assessed implementation of Lost & Found, a clinic-based intervention to reengage OOC patients. OOC patients were identified using a nurse-validated, real-time OOC list within the electronic medical records (EMR) system. Nurses called OOC patients. Implementation occurred at the McGill University Health Centre from April 2018 to 2019. Results from questionnaires to nurses showed elevated scores for implementation outcomes throughout, but with lower, more variable scores during pre-implementation to month 3 [e.g., adoption subscales (scale: 1-5): range from pre-implementation to month 3, 3.7-4.9; thereafter, 4.2-4.9]. Qualitative results from focus groups with nurses were consistent with observed quantitative trends. Barriers concerning the EMR and nursing staff shortages explained reductions in fidelity. Strategies for overcoming barriers to implementation were crucial in early months of implementation. Intervention compatibility, information systems support, as well as nurses' team processes, knowledge, and skills facilitated implementation.
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Affiliation(s)
- Blake Linthwaite
- Research Institute of the McGill University Health Centre (RI-MUHC), 2155 Guy Street, 5th Floor, Montreal, QC, H3H 2R9, Canada
| | - Nadine Kronfli
- Research Institute of the McGill University Health Centre (RI-MUHC), 2155 Guy Street, 5th Floor, Montreal, QC, H3H 2R9, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, QC, Canada
| | - David Lessard
- Research Institute of the McGill University Health Centre (RI-MUHC), 2155 Guy Street, 5th Floor, Montreal, QC, H3H 2R9, Canada
| | - Kim Engler
- Research Institute of the McGill University Health Centre (RI-MUHC), 2155 Guy Street, 5th Floor, Montreal, QC, H3H 2R9, Canada
| | - Luciana Ruppenthal
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, QC, Canada
| | - Emilie Bourbonnière
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, QC, Canada
| | - Nancy Obas
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, QC, Canada
| | - Melodie Brown
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, QC, Canada
| | - Bertrand Lebouché
- Research Institute of the McGill University Health Centre (RI-MUHC), 2155 Guy Street, 5th Floor, Montreal, QC, H3H 2R9, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Centre (RI-MUHC), 2155 Guy Street, 5th Floor, Montreal, QC, H3H 2R9, Canada.
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, QC, Canada.
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada.
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23
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Romanchuk K, Linthwaite B, Cox J, Park H, Dussault C, Basta NE, Varsaneux O, Worthington J, Lebouché B, MacDonald SE, Ismail SJ, Kronfli N. Determinants of SARS-CoV-2 vaccine willingness among people incarcerated in 3 Canadian federal prisons: a cross-sectional study. CMAJ Open 2022; 10:E922-E929. [PMID: 36280247 PMCID: PMC9640165 DOI: 10.9778/cmajo.20210248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Maximizing uptake of SARS-CoV-2 vaccines among people in prison is essential in mitigating future outbreaks. We aimed to determine factors associated with willingness to receive SARS-CoV-2 vaccination before vaccine availability. METHODS We chose 3 Canadian federal prisons based on their low uptake of influenza vaccines in 2019-2020. Participants completed a self-administered questionnaire on knowledge, attitude and beliefs toward vaccines. The primary outcome was participant willingness to receive a SARS-CoV-2 vaccine, measured using a 5-point Likert scale to the question, "If a safe and effective COVID-19 vaccine becomes available in prison, how likely are you to get vaccinated?" We calculated the association of independent variables (age, ethnicity, chronic health conditions, 2019-2020 influenza vaccine uptake and prison security level), identified a priori, with vaccine willingness using logistic regression and crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS We recruited 240 participants from Mar. 31 to Apr. 19, 2021 (median age 46 years; 19.2% female, 25.8% Indigenous). Of these, 178 (74.2%) were very willing to receive a SARS-CoV-2 vaccine. Participants who received the 2019-2020 influenza vaccine (adjusted OR 5.20, 95% CI 2.43-12.00) had higher odds of vaccine willingness than those who did not; those who self-identified as Indigenous (adjusted OR 0.27, 95% CI 0.11-0.60) and in medium- or maximum-security prisons (adjusted OR 0.36, 95% CI 0.12-0.92) had lower odds of vaccine willingness than those who identified as white or those in minimum-security prisons, respectively. INTERPRETATION Most participants were very willing to receive vaccination against SARS-CoV-2 before vaccine roll-out. Vaccine promotion campaigns should target groups with low vaccine willingness (i.e., those who have declined influenza vaccine, identify as Indigenous or reside in high-security prisons).
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Affiliation(s)
- Kathryn Romanchuk
- Centre for Outcomes Research and Evaluation (Romanchuk, Linthwaite, Cox, Park, Dussault, Lebouché, Kronfli), Research Institute of the McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Cox, Basta, Kronfli), School of Population and Global Health, McGill University; Department of Medicine (Cox, Lebouché, Kronfli), Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, Que.; Correctional Service Canada (Varsaneux, Worthington), Ottawa, Ont.; Department of Family Medicine (Lebouché), McGill University, Montréal, Que.; Faculty of Nursing (MacDonald), University of Alberta; School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Division of Immunization Programs and Pandemic Preparedness (Ismail), Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada and Metro City Medical Clinic, Ottawa, Ont
| | - Blake Linthwaite
- Centre for Outcomes Research and Evaluation (Romanchuk, Linthwaite, Cox, Park, Dussault, Lebouché, Kronfli), Research Institute of the McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Cox, Basta, Kronfli), School of Population and Global Health, McGill University; Department of Medicine (Cox, Lebouché, Kronfli), Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, Que.; Correctional Service Canada (Varsaneux, Worthington), Ottawa, Ont.; Department of Family Medicine (Lebouché), McGill University, Montréal, Que.; Faculty of Nursing (MacDonald), University of Alberta; School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Division of Immunization Programs and Pandemic Preparedness (Ismail), Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada and Metro City Medical Clinic, Ottawa, Ont
| | - Joseph Cox
- Centre for Outcomes Research and Evaluation (Romanchuk, Linthwaite, Cox, Park, Dussault, Lebouché, Kronfli), Research Institute of the McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Cox, Basta, Kronfli), School of Population and Global Health, McGill University; Department of Medicine (Cox, Lebouché, Kronfli), Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, Que.; Correctional Service Canada (Varsaneux, Worthington), Ottawa, Ont.; Department of Family Medicine (Lebouché), McGill University, Montréal, Que.; Faculty of Nursing (MacDonald), University of Alberta; School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Division of Immunization Programs and Pandemic Preparedness (Ismail), Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada and Metro City Medical Clinic, Ottawa, Ont
| | - Hyejin Park
- Centre for Outcomes Research and Evaluation (Romanchuk, Linthwaite, Cox, Park, Dussault, Lebouché, Kronfli), Research Institute of the McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Cox, Basta, Kronfli), School of Population and Global Health, McGill University; Department of Medicine (Cox, Lebouché, Kronfli), Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, Que.; Correctional Service Canada (Varsaneux, Worthington), Ottawa, Ont.; Department of Family Medicine (Lebouché), McGill University, Montréal, Que.; Faculty of Nursing (MacDonald), University of Alberta; School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Division of Immunization Programs and Pandemic Preparedness (Ismail), Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada and Metro City Medical Clinic, Ottawa, Ont
| | - Camille Dussault
- Centre for Outcomes Research and Evaluation (Romanchuk, Linthwaite, Cox, Park, Dussault, Lebouché, Kronfli), Research Institute of the McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Cox, Basta, Kronfli), School of Population and Global Health, McGill University; Department of Medicine (Cox, Lebouché, Kronfli), Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, Que.; Correctional Service Canada (Varsaneux, Worthington), Ottawa, Ont.; Department of Family Medicine (Lebouché), McGill University, Montréal, Que.; Faculty of Nursing (MacDonald), University of Alberta; School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Division of Immunization Programs and Pandemic Preparedness (Ismail), Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada and Metro City Medical Clinic, Ottawa, Ont
| | - Nicole E Basta
- Centre for Outcomes Research and Evaluation (Romanchuk, Linthwaite, Cox, Park, Dussault, Lebouché, Kronfli), Research Institute of the McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Cox, Basta, Kronfli), School of Population and Global Health, McGill University; Department of Medicine (Cox, Lebouché, Kronfli), Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, Que.; Correctional Service Canada (Varsaneux, Worthington), Ottawa, Ont.; Department of Family Medicine (Lebouché), McGill University, Montréal, Que.; Faculty of Nursing (MacDonald), University of Alberta; School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Division of Immunization Programs and Pandemic Preparedness (Ismail), Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada and Metro City Medical Clinic, Ottawa, Ont
| | - Olivia Varsaneux
- Centre for Outcomes Research and Evaluation (Romanchuk, Linthwaite, Cox, Park, Dussault, Lebouché, Kronfli), Research Institute of the McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Cox, Basta, Kronfli), School of Population and Global Health, McGill University; Department of Medicine (Cox, Lebouché, Kronfli), Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, Que.; Correctional Service Canada (Varsaneux, Worthington), Ottawa, Ont.; Department of Family Medicine (Lebouché), McGill University, Montréal, Que.; Faculty of Nursing (MacDonald), University of Alberta; School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Division of Immunization Programs and Pandemic Preparedness (Ismail), Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada and Metro City Medical Clinic, Ottawa, Ont
| | - James Worthington
- Centre for Outcomes Research and Evaluation (Romanchuk, Linthwaite, Cox, Park, Dussault, Lebouché, Kronfli), Research Institute of the McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Cox, Basta, Kronfli), School of Population and Global Health, McGill University; Department of Medicine (Cox, Lebouché, Kronfli), Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, Que.; Correctional Service Canada (Varsaneux, Worthington), Ottawa, Ont.; Department of Family Medicine (Lebouché), McGill University, Montréal, Que.; Faculty of Nursing (MacDonald), University of Alberta; School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Division of Immunization Programs and Pandemic Preparedness (Ismail), Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada and Metro City Medical Clinic, Ottawa, Ont
| | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation (Romanchuk, Linthwaite, Cox, Park, Dussault, Lebouché, Kronfli), Research Institute of the McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Cox, Basta, Kronfli), School of Population and Global Health, McGill University; Department of Medicine (Cox, Lebouché, Kronfli), Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, Que.; Correctional Service Canada (Varsaneux, Worthington), Ottawa, Ont.; Department of Family Medicine (Lebouché), McGill University, Montréal, Que.; Faculty of Nursing (MacDonald), University of Alberta; School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Division of Immunization Programs and Pandemic Preparedness (Ismail), Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada and Metro City Medical Clinic, Ottawa, Ont
| | - Shannon E MacDonald
- Centre for Outcomes Research and Evaluation (Romanchuk, Linthwaite, Cox, Park, Dussault, Lebouché, Kronfli), Research Institute of the McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Cox, Basta, Kronfli), School of Population and Global Health, McGill University; Department of Medicine (Cox, Lebouché, Kronfli), Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, Que.; Correctional Service Canada (Varsaneux, Worthington), Ottawa, Ont.; Department of Family Medicine (Lebouché), McGill University, Montréal, Que.; Faculty of Nursing (MacDonald), University of Alberta; School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Division of Immunization Programs and Pandemic Preparedness (Ismail), Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada and Metro City Medical Clinic, Ottawa, Ont
| | - Shainoor J Ismail
- Centre for Outcomes Research and Evaluation (Romanchuk, Linthwaite, Cox, Park, Dussault, Lebouché, Kronfli), Research Institute of the McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Cox, Basta, Kronfli), School of Population and Global Health, McGill University; Department of Medicine (Cox, Lebouché, Kronfli), Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, Que.; Correctional Service Canada (Varsaneux, Worthington), Ottawa, Ont.; Department of Family Medicine (Lebouché), McGill University, Montréal, Que.; Faculty of Nursing (MacDonald), University of Alberta; School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Division of Immunization Programs and Pandemic Preparedness (Ismail), Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada and Metro City Medical Clinic, Ottawa, Ont
| | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation (Romanchuk, Linthwaite, Cox, Park, Dussault, Lebouché, Kronfli), Research Institute of the McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health (Cox, Basta, Kronfli), School of Population and Global Health, McGill University; Department of Medicine (Cox, Lebouché, Kronfli), Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, Que.; Correctional Service Canada (Varsaneux, Worthington), Ottawa, Ont.; Department of Family Medicine (Lebouché), McGill University, Montréal, Que.; Faculty of Nursing (MacDonald), University of Alberta; School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Division of Immunization Programs and Pandemic Preparedness (Ismail), Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada and Metro City Medical Clinic, Ottawa, Ont.
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Marcellin A, Martel-Laferrière V, Genest AG, Lebouché B, Marcotte S. Differences in Antiretroviral Adherence Behaviors, Treatment Success, and Eligibility for Long-Acting Injectable Treatment between Patients Who Acquired HIV in Childhood vs. Those Who Acquired It in Adolescence/Early Adulthood. J Pers Med 2022; 12:jpm12091390. [PMID: 36143175 PMCID: PMC9503311 DOI: 10.3390/jpm12091390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/08/2022] [Accepted: 08/21/2022] [Indexed: 12/02/2022] Open
Abstract
This study investigates the impact of the age at which HIV was acquired on adherence. There was no difference in adherence between patients who acquired HIV in childhood vs. those who acquired it in adolescence/early adulthood (83% vs. 90%; p = 0.24), but achievement of virological/immunological efficacy (78.8% vs. 93.5%, p = 0.02) was less likely in patients who had acquired HIV in childhood. On the basis of resistance, patients who acquired HIV in adolescence/early adulthood tended to be more eligible for cabotegravir/rilpivirine treatment (90.3% vs. 80.3%; p = 0.11).
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Affiliation(s)
- Anthony Marcellin
- Faculty of Pharmacy, Aix-Marseille University, 13284 Marseille, France
- Correspondence: (A.M.); (V.M.-L.); (B.L.); (S.M.)
| | - Valérie Martel-Laferrière
- Division of Microbiology and Infectious Diseases and Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC H2X0C1, Canada
- Correspondence: (A.M.); (V.M.-L.); (B.L.); (S.M.)
| | - Anne-Geneviève Genest
- Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre, Greenfield Park, QC J4V2H1, Canada
| | - Bertrand Lebouché
- McGill University Health Centre (MUHC), Montréal, QC H4A3J1, Canada
- Correspondence: (A.M.); (V.M.-L.); (B.L.); (S.M.)
| | - Suzanne Marcotte
- Department of Pharmacy, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC H2X0C1, Canada
- Correspondence: (A.M.); (V.M.-L.); (B.L.); (S.M.)
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25
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Lessard D, Engler K, Ma Y, Rodriguez Cruz A, Vicente S, Kronfli N, Barkati S, Brouillette MJ, Cox J, Kildea J, Hijal T, Pomey MP, Bartlett SJ, Asselah J, Lebouché B. Remote Follow-up of Self-isolating Patients With COVID-19 Using a Patient Portal: Protocol for a Mixed Methods Pilot Study (Opal-COVID Study). JMIR Res Protoc 2022; 11:e35760. [PMID: 35820054 PMCID: PMC9390833 DOI: 10.2196/35760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/28/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background People with COVID-19 are instructed to self-isolate at home. During self-isolation, they may experience anxiety and insufficient care. Patient portals can allow patients to self-monitor and remotely share their health status with health care professionals, but little data are available on their feasibility. Objective This paper presents the protocol of the Opal-COVID Study. Its objectives are to assess the implementation of the Opal patient portal for distance monitoring of self-isolating patients with COVID-19, identify influences on the intervention’s implementation, and describe service and patient outcomes of this intervention. Methods This mixed methods pilot study aims to recruit 50 patient participants with COVID-19 tested at the McGill University Health Centre (Montreal, Canada) for 14 days of follow-up. With access to an existing patient portal through a smartphone app, patients will complete a daily self-assessment of symptoms, vital signs, and mental health monitored by a nurse, and receive teleconsultations as needed. Study questionnaires will be administered to collect data on sociodemographic characteristics, medical background, implementation outcomes (acceptability, usability, and respondent burden), and patient satisfaction. Coordinator logbook entries will inform on feasibility outcomes, namely, on recruitment, retention, and fidelity, as well as on the frequency and nature of contacts with health care professionals. The statistical analyses for objectives 1 (implementation outcomes), 3 (service outcomes), and 4 (patient outcomes) will evaluate the effects of time and sociodemographic characteristics on the outcomes. For objectives 1 (implementation outcomes) and 4 (patient outcomes), the statistical analyses will also examine the attainment of predefined success thresholds. As for the qualitative analyses, for objective 2 (influences on implementation), semistructured qualitative interviews will be conducted with 4 groups of stakeholders (ie, patient participants, health care professionals, technology developers, and study administrators) and submitted for content analysis, guided by the Consolidated Framework for Implementation Research to help identify barriers to and facilitators of implementation. For objective 3 (service outcomes), reasons for contacting health care professionals through Opal will also be submitted for content analysis. Results Between December 2020 and March 2021, a total of 51 patient participants were recruited. Qualitative interviews were conducted with 39 stakeholders from April to September 2021. Delays were experienced owing to measures taken at the McGill University Health Centre to address COVID-19. The quantitative and qualitative analyses began in May 2022. As of June 2022, a total of 2 manuscripts (on the implementation and the patient outcomes) were being prepared, and 3 conference presentations had been given on the study’s methods. Conclusions This protocol is designed to generate multidisciplinary knowledge on the implementation of a patient portal–based COVID-19 care intervention and will lead to a comprehensive understanding of feasibility, stakeholder experience, and influences on implementation that may prove useful for scaling up similar interventions. Trial Registration ClinicalTrials.gov NCT04978233; https://clinicaltrials.gov/ct2/show/NCT04978233 International Registered Report Identifier (IRRID) DERR1-10.2196/35760
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Affiliation(s)
- David Lessard
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research & Evaluation, Montreal, QC, Canada.,See Acknowledgments, .,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Kim Engler
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research & Evaluation, Montreal, QC, Canada.,See Acknowledgments,
| | - Yuanchao Ma
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research & Evaluation, Montreal, QC, Canada.,See Acknowledgments, .,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Department of Mechanical Engineering, École Polytechnique de Montréal, Montreal, QC, Canada
| | - Adriana Rodriguez Cruz
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research & Evaluation, Montreal, QC, Canada.,See Acknowledgments, .,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Serge Vicente
- See Acknowledgments, .,Department of Mathematics and Statistics, Université de Montréal, Montreal, QC, Canada
| | | | - Nadine Kronfli
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research & Evaluation, Montreal, QC, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Sapha Barkati
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Marie-Josée Brouillette
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Department of Psychiatry Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Joseph Cox
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, QC, Canada
| | - Tarek Hijal
- Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Susan J Bartlett
- Department of Medicine, Divisions of Experimental Medicine, Clinical Epidemiology, Respiratory Medicine, and Rheumatology, McGill University, Montreal, QC, Canada
| | - Jamil Asselah
- Department of Medicine, Division of Medical Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Bertrand Lebouché
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research & Evaluation, Montreal, QC, Canada.,See Acknowledgments, .,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.,Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
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26
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Aqib A, Lebouché B, Engler K, Schuster T. Feasibility of a Platform Trial Design for the Development of Mobile Health Applications: A Review. Telemed J E Health 2022; 29:501-509. [PMID: 35951018 DOI: 10.1089/tmj.2021.0620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: A novel adaptive trial design called platform trials (PTs) may offer an effective, efficient, and unbiased approach to evaluate different developer versions of mobile health (m-health) apps. However, the feasibility of their use for this purpose is yet to be explored. Objective: This literature review aims to explore the reported challenges associated with the adaptive PT design to assess its feasibility for the development of m-health apps. Methods: A descriptive literature review using two databases (MEDLINE and Embase) was conducted. Documents published in English between 1947 and September 20, 2020, were eligible for inclusion. Results: The titles and abstracts of 758 records were screened after which 179 full-text articles were assessed for eligibility. A total of 41 articles were included in the synthesis, all published after the year 2000. The synthesis yielded eight distinct categories of challenging issues with PTs relevant to their application in m-health app development, along with potential solutions. These categories are ethical issues (e.g., related to informed consent, equipoise, justice) (with 19 articles contributing content), biases (7 articles), temporal drift (4 articles), miscellaneous statistical issues (3 articles), logistical issues (e.g., cost and human resources, frequent amendments; 6 articles), sample size and power conflict (2 articles), generalizability of the results (2 articles), and operational challenges (1 article). Conclusion: Although PT designs are relatively new, they have promising feasibility for the seamless evaluation of interventions that undergo continuous development, including m-health apps; however, various challenges may hinder their successful implementation.
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Affiliation(s)
- Asma Aqib
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.,Department of Internal Medicine, University of Alabama, Montgomery, Alabama, USA
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, Canada.,Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada
| | - Kim Engler
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, Canada
| | - Tibor Schuster
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
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27
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Lessard D, Dubé K, Bilodeau M, Keeler P, Margolese S, Rosenes R, Sinyavskaya L, Durand M, Benko E, Kovacs C, Guerlotté C, Tharao W, Arnold K, Masching R, Taylor D, Sousa J, Ostrowski M, Taylor J, Kaytes A, Smith D, Gianella S, Chomont N, Angel JB, Routy JP, Cohen ÉA, Lebouché B, Costiniuk CT. Willingness of Older Canadians with HIV to Participate in HIV Cure Research Near and After the End of Life: A Mixed-Method Study. AIDS Res Hum Retroviruses 2022; 38:670-682. [PMID: 35778845 PMCID: PMC9483839 DOI: 10.1089/aid.2022.0006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
HIV cure research requires interrogating latent HIV reservoirs in deep tissues, which necessitates autopsies to avoid risks to participants. An HIV autopsy biobank would facilitate this research, but such research raises ethical issues and requires participant engagement. This study explores the willingness to participate in HIV cure research at the end of life. Participants include Canadians with HIV [people with HIV (PWHIV)] aged 55 years or older. Following a mixed-method study design, all participants completed a phone or online survey, and a subset of participants participated in in-depth phone or videoconference interviews. We produced descriptive statistics of quantitative data and a thematic analysis of qualitative data. Barriers and facilitators were categorized under domains of the Theoretical Domains Framework. From April 2020 to August 2021, 37 participants completed the survey (mean age = 69.9 years old; mean duration of HIV infection = 28.5 years), including 15 interviewed participants. About three quarters of participants indicated being willing to participate in hypothetical medical studies toward the end of life (n = 30; 81.1%), in HIV biobanking (n = 30; 81.1%), and in a research autopsy (n = 28; 75.7%) to advance HIV cure research, mainly for altruistic benefits. The main perceived risks had to do with physical pain and confidentiality. Barriers and facilitators were distributed across five domains: social/professional role and identity, environmental context and resources, social influences, beliefs about consequences, and capabilities. Participants wanted more information about study objectives and procedures, possible accommodations with their last will, and rationale for studies or financial interests funding studies. Our results indicate that older PWHIV would be willing to participate in HIV cure research toward the end of life, HIV biobanking, and research autopsy. However, a dialogue should be initiated to inform participants thoroughly about HIV cure studies, address concerns, and accommodate their needs and preferences. Additional work is required, likely through increased community engagement, to address educational needs.
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Affiliation(s)
- David Lessard
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, Canada
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Karine Dubé
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Shari Margolese
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Ron Rosenes
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Liliya Sinyavskaya
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Madeleine Durand
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | | | - Charlotte Guerlotté
- COCQ-Sida, Montreal, Canada
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Wangari Tharao
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
- Women's Health in Women's Hands, Canada and African and Black Diaspora Global Network on HIV and AIDS, Toronto, Canada
- African and Caribbean Council on HIV/AIDS in Ontario, Toronto, Canada
| | - Keresa Arnold
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
- African and Caribbean Council on HIV/AIDS in Ontario, Toronto, Canada
| | - Renée Masching
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
- Canadian Aboriginal AIDS Network, Dartmouth, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
| | - Darien Taylor
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - José Sousa
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Mario Ostrowski
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
| | - Jeff Taylor
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Andy Kaytes
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Davey Smith
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Sara Gianella
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Nicolas Chomont
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal and Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Canada
| | - Jonathan B. Angel
- Ottawa Hospital Research Institute and Division of Infectious Disease, The Ottawa Hospital, Ottawa, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
| | - Éric A. Cohen
- Institut de Recherche Clinique de Montréal, Montreal, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, Canada
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Cecilia T. Costiniuk
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
- Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Canada
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28
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Ortiz-Paredes D, Amoako A, Ekmekjian T, Engler K, Lebouché B, Klein MB. Interventions to Improve Uptake of Direct-Acting Antivirals for Hepatitis C Virus in Priority Populations: A Systematic Review. Front Public Health 2022; 10:877585. [PMID: 35812487 PMCID: PMC9263261 DOI: 10.3389/fpubh.2022.877585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background & Objective Access to Hepatitis C (HCV) care remains suboptimal. This systematic review sought to identify existing interventions designed to improve direct-acting antiviral (DAA) uptake among HCV infected women, people who inject drugs (PWID), men who have sex with men (MSM), and Indigenous peoples. Methods Studies published in high- and middle-income countries were retrieved from eight electronic databases and gray literature (e.g., articles, research reports, theses, abstracts) were screened by two independent reviewers. Identified interventions were summarized using textual narrative synthesis. Results After screening 3,139 records, 39 studies were included (11 controlled comparative studies; 36 from high-income countries). Three groups of interventions were identified: interventions involving patients; providers; or the healthcare system. Interventions directed to patients included care co-ordination, accelerated DAA initiation, and patient education. Interventions involving providers included provider education, telemedicine, multidisciplinary teams, and general practitioner-led care. System-based interventions comprised DAA universal access policies and offering HCV services in four settings (primary care, secondary care, tertiary care, and community settings). Most studies (30/39) described complex interventions, i.e., those with two or more strategies combined. Most interventions (37/39) were tailored to, or studied among, PWID. Only one study described an intervention that was aimed at women. Conclusions Combining multiple interventions is a common approach for supporting DAA initiation. Three main research gaps were identified, specifically, a lack of: (1) controlled trials estimating the individual or combined effects of interventions on DAA uptake; (2) studies in middle-income countries; and (3) interventions tailored to women, MSM, and Indigenous people.
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Affiliation(s)
- David Ortiz-Paredes
- Center for Outcome Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Afia Amoako
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Taline Ekmekjian
- Medical Libraries, McGill University Health Center, Montreal, QC, Canada
| | - Kim Engler
- Center for Outcome Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Bertrand Lebouché
- Center for Outcome Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Glen site, McGill University Health Center, Montreal, QC, Canada
| | - Marina B. Klein
- Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Glen site, McGill University Health Center, Montreal, QC, Canada
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
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29
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Almomen A, Cox J, Lebouché B, Cheng MP, Frenette C, Routy JP, Costiniuk CT. Short Communication: Ongoing Impact of the Social Determinants of Health During the Second and Third Waves of the COVID-19 Pandemic in People Living with HIV Receiving Care in a Montreal-Based Tertiary Care Center. AIDS Res Hum Retroviruses 2022; 38:359-362. [PMID: 35172609 DOI: 10.1089/aid.2021.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We performed retrospective chart reviews and described the clinical characteristics, exposure risks, and disease severity of people living with HIV (PLWH) attending the Chronic Viral Illness Service (CVIS) in Montreal, Canada, who developed coronavirus disease 2019 (COVID-19) during September 2020-August 2021, coinciding with the second and third waves of the pandemic. A total of 61 PLWH with a positive COVID-19 polymerase chain reaction were identified, giving a COVID-19 prevalence of 5%. The most common exposure risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during waves two and three was having a family member/close contact with COVID-19 (36%). Similar to what we observed during the first wave, PLWH who acquired COVID-19 during waves two and three of the pandemic often worked or lived in long-term care residences or health care settings, putting them at risk. Five people (8%) were asymptomatic. Nearly all persons had mild disease on initial presentation and most had a full recovery. Two individuals were admitted to hospital with COVID-19, whereas three individuals acquired COVID-19 nosocomially. No individuals died due to COVID-19. Two individuals developed symptoms associated with long COVID-19 syndrome. Findings highlight the ongoing impact of the social determinants of health during the second and third waves of the pandemic in PLWH.
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Affiliation(s)
- Abdulaziz Almomen
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
| | - Joseph Cox
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
| | - Bertrand Lebouché
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
| | - Matthew P. Cheng
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
| | - Charles Frenette
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
| | - Jean-Pierre Routy
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
| | - Cecilia T. Costiniuk
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
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Xi M, Bullock S, Mendelsohn JB, Iveniuk J, Moravan V, Burchell AN, Tan DHS, Daftary A, Thompson T, Lebouché B, Bisaillon L, Myers T, Calzavara L. A national recruitment strategy for HIV-serodiscordant partners living in Canada for the Positive Plus One study: a mixed-methods study. BMC Public Health 2022; 22:832. [PMID: 35473617 PMCID: PMC9040331 DOI: 10.1186/s12889-022-13153-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background With the recent shift in focus to addressing HIV risk within relationships and couple-based interventions to prevent HIV transmission, successful recruitment of individuals involved in HIV-serodiscordant relationships is crucial. This paper evaluates methods used by the Positive Plus One (PP1) study to recruit and collect data on a diverse national sample of dyads and individuals involved in current or past HIV-serodiscordant relationships, discusses the strengths and limitations of the recruitment approach, and makes recommendations to inform the interpretation of study results and the design of future studies. Methods PP1 used a multi-pronged approach to recruit adults involved in a current or past HIV-serodiscordant relationship in Canada from 2016 to 2018 to complete a survey and an interview. Upon survey completion, index (first recruited) partners were invited to recruit their primary current HIV-serodiscordant partner. We investigated participant enrollment by recruitment source, participant-, relationship-, and dyad-level sociodemographic characteristics, missing data, and correlates of participation for individuals recruited by their partners. Results We recruited 613 participants (355 HIV-positive; 258 HIV-negative) across 10 Canadian provinces, including 153 complete dyads and 307 individuals who participated alone, and representing 460 HIV-serodiscordant relationships. Among those in current relationships, HIV-positive participants were more likely than HIV-negative participants to learn of the study through an ASO staff member (36% v. 20%, p < 0.001), ASO listserv/newsletter (12% v. 5%, p = 0.007), or physician/staff at a clinic (20% v. 11%, p = 0.006). HIV-negative participants involved in current relationships were more likely than HIV-positive participants to learn of the study through their partner (46% v. 8%, p < 0.001). Seventy-eight percent of index participants invited their primary HIV-serodiscordant partner to participate, and 40% were successful. Successful recruitment of primary partners was associated with longer relationship duration, higher relationship satisfaction, and a virally suppressed HIV-positive partner. Conclusions Our findings provide important new information on and support the use of a multi-pronged approach to recruit HIV-positive and HIV-negative individuals involved in HIV-serodiscordant relationships in Canada. More creative strategies are needed to help index partners recruit their partner in relationships with lower satisfaction and shorter duration and further minimize the risk of “happy couple” bias.
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Affiliation(s)
- Min Xi
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Sandra Bullock
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
| | | | - James Iveniuk
- Academic Research Centers, NORC at the University of Chicago, Chicago, IL, 60637, USA
| | | | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, M5B 1W8, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1V7, Canada
| | - Darrell H S Tan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, M5B 1W8, Canada.,Division of Infectious Diseases, St Michael's Hospital, Unity Health Toronto, Toronto, ON, M5B 1W8, Canada
| | - Amrita Daftary
- School of Global Health and Dahdaleh Institute for Global Health Research, York University, Toronto, ON, M3J 1P3, Canada
| | - Tamara Thompson
- Faculty of Health Sciences, Douglas College, Coquitlam, BC, V3B 7X3, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, H3S 1Z1, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre Montreal, Montreal, QC, H4A 3J1, Canada.,Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, H4A 35S, Canada
| | - Laura Bisaillon
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, M1C 1A4, Canada
| | - Ted Myers
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Liviana Calzavara
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
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Mendelsohn JB, Calzavara L, Bullock S, Iveniuk J, Tan DHS, Burchell AN, Bourne A, Lebouché B, Daftary A, Moravan V, Loutfy M, Conway B. Disclosure of HIV-serodiscordant relationships and association with viral suppression: results from the Positive Plus One study. AIDS Care 2022; 35:1037-1044. [PMID: 35416092 DOI: 10.1080/09540121.2021.2019669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Little is known about the effects of disclosure of HIV-serodiscordant relationships on clinical outcomes. We aimed to evaluate the effect of relationship disclosure on HIV viral suppression, and hypothesized that disclosure by HIV-positive and HIV-negative partners would be associated with viral suppression in the HIV-positive partner. METHODS We conducted a Canadian national online and telephone-administered survey of HIV-positive and HIV-negative partners in serodiscordant relationships. The primary outcome was self-reported viral suppression. Multivariable analyses were undertaken using Firth logistic regression. RESULTS We recruited 540 participants in current serodiscordant relationships (n = 228 HIV-negative; n = 312 HIV-positive). Similar proportions of HIV-positive and HIV-negative partners disclosed their relationship to healthcare professionals (82% v. 76%, p = 0.13). Among HIV-positive partners, disclosure of the relationship to healthcare professionals increased the odds of viral suppression (aOR = 4.7; CI: 2.13, 10.51) after adjusting for age, education, and relationship turmoil due to HIV. Increasing age (aOR = 1.28; 95% CI = 1.07, 1.55) and education (aOR = 2.43; 95% CI = 1.15, 5.26) were also associated with viral suppression. Among HIV-negative partners, relationship disclosure was not associated with viral suppression and HIV-negative heterosexual men were less likely to report that their HIV-positive partners were virally suppressed (aOR = 0.24; CI: 0.09, 0.61). CONCLUSIONS Disclosure of HIV-serodiscordant status by HIV-positive participants to healthcare professionals was associated with increased odds of viral suppression. Similar effects were not evident among HIV-negative participants. Future work should explore factors that empower relationship disclosure and incorporate them into supportive services for HIV-serodiscordant relationships.
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Affiliation(s)
| | - Liviana Calzavara
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sandra Bullock
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - James Iveniuk
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Darrell H S Tan
- Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, Latrobe University, Melbourne, Australia.,Kirby Institute, University of New South Wales, Kensington, Australia
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Canada.,Infectious Diseases and Immunity in Global Health Program, Centre for Outcomes Research and Evaluation, Montreal, Canada
| | - Amrita Daftary
- Dahdaleh Institute of Global Health Research, York University, Toronto, Canada.,Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Canada
| | | | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, Canada
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Lessard D, Ortiz-Paredes D, Park H, Varsaneux O, Worthington J, Basta NE, MacDonald SE, Lebouché B, Cox J, Ismail SJ, Kronfli N. Barriers and facilitators to COVID-19 vaccine acceptability among people incarcerated in Canadian federal prisons: A qualitative study. Vaccine X 2022; 10:100150. [PMID: 35243324 PMCID: PMC8883835 DOI: 10.1016/j.jvacx.2022.100150] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/24/2022] [Accepted: 02/16/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Canadian correctional institutions have been prioritized for COVID-19 vaccination given the multiple outbreaks that have occurred since the start of the pandemic. Given historically low vaccine uptake, we aimed to explore barriers and facilitators to COVID-19 vaccination acceptability among people incarcerated in federal prisons. METHODS Three federal prisons in Quebec, Ontario, and British Columbia (Canada) were chosen based on previously low influenza vaccine uptake among those incarcerated. Using a qualitative design, semi-structured interviews were conducted with a diverse sample (gender, age, and ethnicity) of incarcerated people. An inductive-deductive analysis of audio-recorded interview transcripts was conducted to identify and categorize barriers and facilitators within the Theoretical Domains Framework (TDF). RESULTS From March 22-29, 2021, a total of 15 participants (n = 5 per site; n = 5 women; median age = 43 years) were interviewed, including five First Nations people and six people from other minority groups. Eleven (73%) expressed a desire to receive a COVID-19 vaccine, including two who previously refused influenza vaccination. We identified five thematic barriers across three TDF domains: social influences (receiving strict recommendations, believing in conspiracies to harm), beliefs about consequences (believing that infection control measures will not be fully lifted, concerns with vaccine-related side effects), and knowledge (lack of vaccine-specific information), and eight thematic facilitators across five TDF domains: environmental context and resources (perceiving correctional employees as sources of outbreaks, perceiving challenges to prevention measures), social influences (receiving recommendations from trusted individuals), beliefs about consequences (seeking individual and collective protection, believing in a collective "return to normal", believing in individual privileges), knowledge (reassurance about vaccine outcomes), and emotions (having experienced COVID-19-related stress). CONCLUSIONS Lack of information and misinformation were important barriers to COVID-19 vaccine acceptability among people incarcerated in Canadian federal prisons. This suggests that educational interventions, delivered by trusted health care providers, may improve COVID-19 vaccine uptake going forward.
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Affiliation(s)
- David Lessard
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Canada.,Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trial in HIV, Research Institute of the McGill University Health Centre, Canada
| | - David Ortiz-Paredes
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Canada
| | - Hyejin Park
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Canada
| | | | | | - Nicole E Basta
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Canada.,School of Public Health, University of Alberta, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Canada.,Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trial in HIV, Research Institute of the McGill University Health Centre, Canada.,Department of Family Medicine, McGill University, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Canada
| | - Joseph Cox
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Canada
| | - Shainoor J Ismail
- Division of Immunization Programs and Pandemic Preparedness, Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada and Metro City Medical Clinic, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Canada
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Ryan M, Mendelsohn JB, Daftary A, Yang M, Bullock S, Lebouché B, Calzavara L. Dual pharmaceutical citizenship: Exploring biomedicalization in the daily lives of mixed HIV-serostatus couples in Canada. Soc Sci Med 2022; 298:114863. [PMID: 35279477 DOI: 10.1016/j.socscimed.2022.114863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 01/30/2022] [Accepted: 02/22/2022] [Indexed: 10/19/2022]
Abstract
Positive Plus One is the first large-scale mixed methods study of mixed HIV serostatus couples in Canada. We aimed to understand how biomedicalization i.e., a social process of commodification and expansion of the jurisdiction of medicine over health, influenced the everyday relationships of these couples. We completed 51 semi-structured interviews among a purposive sample of HIV-positive (n = 27) and HIV-negative (n = 24) partners in current or past mixed-serostatus relationships. Participants were recruited after completing an online survey where they consented to be re-contacted for qualitative interviews. Participants represented a diversity of sexual orientations, gender identities, and other sociodemographic characteristics. Drawing on inductive thematic analysis to identify patterns within couples, across serostatus and sexual orientations, we argue that everyday lives of mixed-serostatus couples were shaped by biomedical knowledge and enacted through routine adherence to obtain and maintain viral load undetectability. Our findings illustrated the importance of learning biomedical knowledge for mixed-serostatus couples in this study, the empowering influence of undetectable = untransmittable (UU) discourse, and its role in rendering HIV mundane through routine ART adherence. We introduce the concept of 'dual pharmaceutical citizenship' to underscore a process by which particular biopolitical and biomedical expectations are fulfilled in mixed-serostatus relationships. These findings have implications for people who do not readily accept or have access to biomedical knowledge, particularly when treatment-as-prevention frames a "right" and "wrong" approach to HIV management. Future studies should focus on couples where at least one partner does not readily accept or have access to biomedical knowledge.
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Affiliation(s)
- Molly Ryan
- Dalla Lana School of Public Health, University of Toronto, Canada
| | | | - Amrita Daftary
- Dahdaleh Institute of Global Health Research, York University, Canada; Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, South Africa
| | - Minhui Yang
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Sandra Bullock
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Canada; Department of Family Medicine, McGill University, Canada; Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, McGill University, Canada
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Engler K, Vicente S, Mate KKV, Lessard D, Ahmed S, Lebouché B. Content validation of a new measure of patient-reported barriers to antiretroviral therapy adherence, the I-Score: results from a Delphi study. J Patient Rep Outcomes 2022; 6:28. [PMID: 35347496 PMCID: PMC8960494 DOI: 10.1186/s41687-022-00435-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/10/2022] [Indexed: 11/12/2022] Open
Abstract
Background Over a third of people living with HIV (PLHIV) have suboptimal adherence to antiretroviral therapy (ART). Measures of barriers to ART adherence often lack comprehensiveness. To help manage ART adherence barriers in HIV care, we are developing a new patient-reported outcome measure (PROM) of these barriers (the I-Score). Methods We assessed the content validity of 100 items (distinct barriers) to retain only those most relevant to both PLHIV and HIV health/social service providers. A web-based Delphi was conducted in Canada and France, collecting data from December 2018 to October 2019. Items were evaluated on relevance (the combined rated importance and actionability for HIV care of items among both PLHIV and providers); comprehensibility (rated item clarity); comprehensiveness (examined against our conceptual framework); cross-cultural equivalence (based on comparisons by questionnaire language (English, French) and country of residence). Pearson’s chi-square tests were used for comparisons by language, country, gender, and stakeholder group (PLHIV, providers). Results Panelists included 40 PLHIV and 57 providers (66% response rate). Thirty-one items were retained based on consensus thresholds for relevance (minimum: 50% for PLHIV, 60% for providers) and showed good comprehensibility and comprehensiveness, when compared to our conceptual framework (representation of: 6/6 domains, 15/20 subdomains). No significant difference in relevance based on language or country was found among retained items, suggestive of cross-cultural equivalence. Among all 100 items, only 6 significant differences on relevance were observed for gender. For 62 items, the relevance ratings of PLHIV and providers differed significantly, with providers showing greater endorsement of all items but one. Discussion The Delphi led to a much-needed item reduction. Remaining items highlight the panel’s multidimensional priorities for the PROM on ART adherence barriers, with few, if any, differences by language, country, and gender. While the analyses may lack generalizability and power, the sample size is considered adequate for a PROM validation study. Conclusion Retained items showed good content validity. The different patterns of item endorsement observed underscore the utility of engaging multiple stakeholder groups in PROM development for use in clinical practice. The greater endorsement of items by providers versus patients merits further investigation, including the implications of such differentials for measure development. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00435-0.
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Affiliation(s)
- Kim Engler
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd, Montreal, QC, H4A 3S5, Canada.
| | - Serge Vicente
- Department of Mathematics and Statistics, University of Montreal, Montreal, QC, Canada
| | - Kedar K V Mate
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd, Montreal, QC, H4A 3S5, Canada
| | - David Lessard
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd, Montreal, QC, H4A 3S5, Canada
| | - Sara Ahmed
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd, Montreal, QC, H4A 3S5, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montreal, QC, Canada
| | - Bertrand Lebouché
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd, Montreal, QC, H4A 3S5, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
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Ortiz-Paredes D, Varsaneux O, Worthington J, Park H, MacDonald SE, Basta NE, Lebouché B, Cox J, Ismail SJ, Kronfli N. Reasons for COVID-19 vaccine refusal among people incarcerated in Canadian federal prisons. PLoS One 2022; 17:e0264145. [PMID: 35263350 PMCID: PMC8906611 DOI: 10.1371/journal.pone.0264145] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Vaccine uptake rates have been historically low in correctional settings. To better understand vaccine hesitancy in these high-risk settings, we explored reasons for COVID-19 vaccine refusal among people in federal prisons. METHODS Three maximum security all-male federal prisons in British Columbia, Alberta, and Ontario (Canada) were chosen, representing prisons with the highest proportions of COVID-19 vaccine refusal. Using a qualitative descriptive design and purposive sampling, individual semi-structured interviews were conducted with incarcerated people who had previously refused at least one COVID-19 vaccine until data saturation was achieved. An inductive-deductive thematic analysis of audio-recorded interview transcripts was conducted using the Conceptual Model of Vaccine Hesitancy. RESULTS Between May 19-July 8, 2021, 14 participants were interviewed (median age: 30 years; n = 7 Indigenous, n = 4 visible minority, n = 3 White). Individual-, interpersonal-, and system-level factors were identified. Three were particularly relevant to the correctional setting: 1) Risk perception: participants perceived that they were at lower risk of COVID-19 due to restricted visits and interactions; 2) Health care services in prison: participants reported feeling "punished" and stigmatized due to strict COVID-19 restrictions, and failed to identify personal benefits of vaccination due to the lack of incentives; 3) Universal distrust: participants expressed distrust in prison employees, including health care providers. INTERPRETATION Reasons for vaccine refusal among people in prison are multifaceted. Educational interventions could seek to address COVID-19 risk misconceptions in prison settings. However, impact may be limited if trust is not fostered and if incentives are not considered in vaccine promotion.
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Affiliation(s)
- David Ortiz-Paredes
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Hyejin Park
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Shannon E. MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nicole E. Basta
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Shainoor J. Ismail
- Division of Immunization Programs and Pandemic Preparedness, Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
- Metro City Medical Clinic, Edmonton, Alberta, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- * E-mail:
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Linthwaite B, Kronfli N, Marbaniang I, Ruppenthal L, Lessard D, Engler K, Lebouché B, Cox J. Increased reengagement of out-of-care HIV patients using Lost & Found, a clinic-based intervention. AIDS 2022; 36:551-560. [PMID: 34897240 PMCID: PMC8876436 DOI: 10.1097/qad.0000000000003147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 11/30/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Negative health outcomes associated with being out of HIV care (OOC) warrant reengagement strategies. We aimed to assess effectiveness of Lost & Found, a clinic-based intervention to identify and reengage OOC patients. METHODS Developed and delivered using implementation science, Lost & Found consists of two core elements: identification, operationalized through nurse validation of a real-time list of possible OOC patients; and contact, via nurse-led phone calls. It was implemented over a 12-month period (2018-2019) at the Chronic Viral Illness Service, McGill University Health Centre (CVIS-MUHC) during a type-II implementation-effectiveness hybrid pilot study. Descriptive outcomes of interest were identification as possibly OOC, OOC confirmation, contact, and successful reengagement. We present results from a pre-post analysis comparing overall reengagement to the year prior, using robust Poisson regression controlled for sex, age, and Canadian birth. Time to reengagement is reported using a Cox proportional hazards model. RESULTS Over half (56%; 1312 of 2354) of CVIS-MUHC patients were identified as possibly OOC. Among these, 44% (n = 578) were followed elsewhere, 19% (n = 249) engaged in care, 3% (n = 33) deceased, 2% (n = 29) otherwise not followed, and 32% (n = 423) OOC. Of OOC patients contacted (85%; 359/423), 250 (70%) reengaged and 40 (11%) had upcoming appointments; the remainder were unreachable, declined care, or missed given appointments. Pre-post results indicate people who received Lost & Found were 1.18 [95% confidence interval (CI) 1.02-1.36] times more likely to reengage, and reengaged a median 55 days (95% CI 14-98) sooner. CONCLUSION Lost & Found may be a viable clinic-based reengagement intervention for OOC patients. More robust evaluations are needed.
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Affiliation(s)
- Blake Linthwaite
- Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Nadine Kronfli
- Research Institute of the McGill University Health Centre (RI-MUHC)
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
| | - Ivan Marbaniang
- Department of Epidemiology, Biostatistics, and Occupational Health
| | - Luciana Ruppenthal
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
| | - David Lessard
- Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Kim Engler
- Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Bertrand Lebouché
- Research Institute of the McGill University Health Centre (RI-MUHC)
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Centre (RI-MUHC)
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
- Department of Epidemiology, Biostatistics, and Occupational Health
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Iveniuk J, Calzavara L, Bullock S, Mendelsohn J, Burchell A, Bisaillon L, Daftary A, Lebouché B, Masching R, Thompson T. Social capital and HIV-serodiscordance: Disparities in access to personal and professional resources for HIV-positive and HIV-negative partners. SSM Popul Health 2022; 17:101056. [PMID: 35342785 PMCID: PMC8943292 DOI: 10.1016/j.ssmph.2022.101056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/08/2023] Open
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Gelhorn H, Garris C, Arthurs E, Spinelli F, Cutts K, Chua GN, Collacott H, Lebouché B, Lowman E, Rice H, Heidenreich S. Patient and Physician Preferences for Regimen Attributes for the Treatment of HIV in the United States and Canada. J Pers Med 2022; 12:jpm12030334. [PMID: 35330334 PMCID: PMC8948790 DOI: 10.3390/jpm12030334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 02/18/2022] [Indexed: 11/24/2022] Open
Abstract
A long-acting injectable (LAI) antiretroviral therapy (ART) regimen is now available as a treatment option for virologically suppressed adults with HIV-1. This study assessed preference for a LAI regimen using an online survey of virally suppressed people living with HIV (PLWH) and physicians treating HIV in the US and Canada. Preference was elicited in a discrete choice experiment (DCE) with three choice options (switch to a LAI regimen, switch to another daily oral ART regimen, or stay on their current daily oral ART regimen) and four treatment attributes. A total of 553 PLWH and 450 physicians completed the survey. From the DCE results, 59% of PLWH were predicted to prefer a LAI over an alternative oral ART or staying on their current oral treatment, and 55–66% of physicians were predicted to recommend LAI for PLWH, depending on the treatment challenge scenario presented. PLWH indicated LAI would remove daily reminders of HIV (75%) and reduce feelings of being stigmatized (68%). A majority of PLWH and physicians preferred a LAI over oral ART to overcome treatment challenges such as daily pill burden and adherence. These benefits of LAI ART along with preferences of PLWH and physicians can help to inform ART choice.
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Affiliation(s)
| | - Cindy Garris
- US Health Outcomes, ViiV Healthcare, Research Triangle Park, NC 27709, USA
- Correspondence:
| | - Erin Arthurs
- GlaxoSmithKline, Mississauga, ON L5N 6L4, Canada;
| | - Frank Spinelli
- North American Medical Affairs, ViiV Healthcare, Research Triangle Park, NC 27709, USA;
| | | | - Gin Nie Chua
- Evidera, London W6 8BJ, UK; (G.N.C.); (H.C.); (S.H.)
| | | | - Bertrand Lebouché
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H3H 2R9, Canada;
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC H3S 1Z1, Canada
| | - Erik Lowman
- Midland Medical Center, Oakland Park, FL 33334, USA;
| | - Howard Rice
- Rice Medical Group, Mountain View, CA 94040, USA;
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Chu D, Lessard D, Laymouna MA, Engler K, Schuster T, Ma Y, Kronfli N, Routy JP, Hijal T, Lacombe K, Sheehan N, Rougier H, Lebouché B. Understanding the Risks and Benefits of a Patient Portal Configured for HIV Care: Patient and Healthcare Professional Perspectives. J Pers Med 2022; 12:jpm12020314. [PMID: 35207803 PMCID: PMC8880024 DOI: 10.3390/jpm12020314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/28/2022] [Accepted: 02/15/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Like other chronic viral illnesses, HIV infection necessitates consistent self-management and adherence to care and treatment, which in turn relies on optimal collaboration between patients and healthcare professionals (HCPs), including physicians, nurses, pharmacists, and clinical care coordinators. By providing people living with HIV (PLHIV) with access to their personal health information, educational material, and a communication channel with HCPs, a tailored patient portal could support their engagement in care. Our team intends to implement a patient portal in HIV-specialized clinics in Canada and France. We sought to understand the perceived risks and benefits among PLHIV and HCPs of patient portal use in HIV clinical care. Methods: This qualitative study recruited PLHIV and HIV-specialized HCPs, through maximum variation sampling and purposeful sampling, respectively. Semi-structured focus group discussions (FGDs) were held separately with PLHIV and HCPs between August 2019 and January 2020. FGDs were recorded, transcribed, coded using NVivo 12 software, and analyzed using content analysis. Results: A total of twenty-eight PLHIV participated in four FGDs, and thirty-one HCPs participated in six FGDs. PLHIV included eighteen men, nine women, and one person identifying as other; while, HCPs included ten men, twenty women, and one person identifying as other. A multi-disciplinary team of HCPs were included, involving physicians, nurses, pharmacists, social workers, and clinical coordinators. Participants identified five potential risks: (1) breach of confidentiality, (2) stress or uncertainty, (3) contribution to the digital divide, (4) dehumanization of care, and (5) increase in HCPs’ workload. They also highlighted four main benefits of using a patient portal: (1) improvement in HIV self-management, (2) facilitation of patient visits, (3) responsiveness to patient preferences, and (4) fulfillment of current or evolving patient needs. Conclusion: PLHIV and HCPs identified both risks and benefits of using a patient portal in HIV care. By engaging stakeholders and understanding their perspectives, the configuration of a patient portal can be optimized for end-users and concerns may be mitigated during its implementation.
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Affiliation(s)
- Dominic Chu
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (M.A.L.); (T.S.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC H4A 3J1, Canada; (D.L.); (K.E.); (Y.M.)
| | - David Lessard
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC H4A 3J1, Canada; (D.L.); (K.E.); (Y.M.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Department of Medicine, Division of Infectious Diseases and Chronic and Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (J.-P.R.); (N.S.)
| | - Moustafa A. Laymouna
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (M.A.L.); (T.S.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC H4A 3J1, Canada; (D.L.); (K.E.); (Y.M.)
| | - Kim Engler
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC H4A 3J1, Canada; (D.L.); (K.E.); (Y.M.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Department of Medicine, Division of Infectious Diseases and Chronic and Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (J.-P.R.); (N.S.)
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (M.A.L.); (T.S.)
| | - Yuanchao Ma
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC H4A 3J1, Canada; (D.L.); (K.E.); (Y.M.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Department of Medicine, Division of Infectious Diseases and Chronic and Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (J.-P.R.); (N.S.)
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, QC H3C 3A7, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Department of Medicine, Division of Infectious Diseases and Chronic and Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (J.-P.R.); (N.S.)
| | - Jean-Pierre Routy
- Department of Medicine, Division of Infectious Diseases and Chronic and Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (J.-P.R.); (N.S.)
| | - Tarek Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Karine Lacombe
- Faculté de Médecine, Sorbonne Université, Inserm IPLESP, Hôpital St Antoine, APHP, 75012 Paris, France;
| | - Nancy Sheehan
- Department of Medicine, Division of Infectious Diseases and Chronic and Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (J.-P.R.); (N.S.)
- Faculté de Pharmacie, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Hayette Rougier
- IMEA, Institut de Médecine et d’Épidémiologie Appliquée, F75018 Paris, France;
| | - Bertrand Lebouché
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (M.A.L.); (T.S.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC H4A 3J1, Canada; (D.L.); (K.E.); (Y.M.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Department of Medicine, Division of Infectious Diseases and Chronic and Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (J.-P.R.); (N.S.)
- Correspondence: ; Tel.: +1-514-843-2090
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Ortiz-Paredes D, Amoako A, Lessard D, Engler K, Lebouché B, Klein MB. Potential interventions to support HCV treatment uptake among HIV co-infected people in Canada: Perceptions of patients and health care providers. CanLivJ 2022; 5:14-30. [DOI: 10.3138/canlivj-2021-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 08/28/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND: Increasing direct-acting antiviral (DAA) treatment uptake is key to eliminating HCV infection as a public health threat in Canada. People living with human immunodeficiency virus (HIV) and hepatitis C (HCV) co-infection face barriers to HCV treatment initiation. We sought to identify interventions that could support HCV treatment initiation based on patient and HCV care provider perspectives. METHODS: Eleven people living with HIV with a history of HCV infection and 12 HCV care providers were recruited for this qualitative descriptive study. Participants created ranked-ordered lists of potential interventions during nominal groups ( n = 4) and individual interviews ( n = 6). Following the nominal group technique, transcripts and intervention lists underwent thematic analysis and ranking scores were merged to create consolidated and prioritized lists from patient and provider perspectives. RESULTS: Patient participants identified a total of eight interventions. The highest-ranked interventions were multidisciplinary clinics, HCV awareness campaigns and patient education, nurse- or pharmacist-led care, peer involvement, and more and better-prepared health professionals. Provider participants identified 11 interventions. The highest-ranked were mobile outreach, DAA initiation at pharmacies, a simplified process of DAA prescription, integration of primary and specialist care, and patient-centred approaches. CONCLUSION: Participants proposed alternatives to hospital-based specialist HCV care, which require increasing capacity for nurses, pharmacists, primary care providers, and peers to have more direct roles in HCV treatment provision. They also identified the need for structural changes and educational initiatives. In addition to optimizing HCV care, these interventions might result in broader benefits for the health of HIV–HCV co-infected people.
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Affiliation(s)
- David Ortiz-Paredes
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Afia Amoako
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - David Lessard
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Kim Engler
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Glen site, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina B Klein
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Glen site, McGill University Health Centre, Montreal, Quebec, Canada
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Isnard S, Fombuena B, Ouyang J, Royston L, Lin J, Bu S, Sheehan N, Lakatos PL, Bessissow T, Chomont N, Klein M, Lebouché B, Costiniuk CT, Routy B, Marette A, Routy JP. Camu Camu effects on microbial translocation and systemic immune activation in ART-treated people living with HIV: protocol of the single-arm non-randomised Camu Camu prebiotic pilot study (CIHR/CTN PT032). BMJ Open 2022; 12:e053081. [PMID: 35039291 PMCID: PMC8765027 DOI: 10.1136/bmjopen-2021-053081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 12/12/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Despite the success of antiretroviral therapy (ART) in transforming HIV disease into a chronic infection, people living with HIV (PLWH) remain at risk for various non-AIDS inflammatory comorbidities. Risk of non-AIDS comorbidities is associated with gut dysbiosis, epithelial gut damage and subsequent microbial translocation, and increased activation of both circulating CD4+ and CD8+ T-cells. Therefore, in addition to ART, novel gut microbiota-modulating therapies could aid in reducing inflammation and immune activation, gut damage, and microbial translocation. Among various gut-modulation strategies under investigation, the Amazonian fruit Camu Camu (CC) presents itself as a prebiotic candidate based on its anti-inflammatory and antioxidant properties in animal models and tobacco smokers. METHOD AND ANALYSIS A total of 22 PLWH on ART for more than 2 years, with a viral load <50 copies/mL, a CD4 +count >200 and a CD4+/CD8 +ratio <1 (suggesting increased inflammation and risk for non-AIDS comorbidities), will be recruited in a single arm, non-randomised, interventional pilot trial. We will assess tolerance and effect of supplementation with CC in ART-treated PLWH on reducing gut damage, microbial translocation, inflammation and HIV latent reservoir by various assays. ETHICS AND DISSEMINATION The Canadian Institutes of Health Research (CIHR)/Canadian HIV Trials Network (CTN) pilot trial protocol CTNPT032 was approved by the Natural and Non-prescription Health Products Directorate of Health Canada and the research ethics board of the McGill university Health Centre committee (number 2020-5903). Results will be made available as free access through publications in peer-reviewed journals and through the CIHR/CTN website. TRIAL REGISTRATION NUMBER NCT04058392.
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Affiliation(s)
- Stéphane Isnard
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Canadian HIV Trials Network, Canadian Institutes for Health Research, Vancouver, British Columbia, Canada
| | - Brandon Fombuena
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jing Ouyang
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Chongqing Public Health Medical Center, Chongqing, People's Republic of China
| | - Léna Royston
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Canadian HIV Trials Network, Canadian Institutes for Health Research, Vancouver, British Columbia, Canada
| | - John Lin
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Simeng Bu
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nancy Sheehan
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Peter L Lakatos
- Division of Gastroentrology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Talat Bessissow
- Division of Gastroentrology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicolas Chomont
- Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marina Klein
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Cecilia T Costiniuk
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bertrand Routy
- Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - André Marette
- Insitute of Nutrition and Functional food, Laval University, Quebec City, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Cardiology Axis of the Quebec Heart and Lung Institute, Laval University, Quebec city, Quebec, Canada
| | - Jean-Pierre Routy
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Hematology, McGill University Health Centre, Montreal, Quebec, Canada
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Bhambra N, Gold MS, Naumova D, Abdelhamid K, Lessard D, Lebouché B. Assessing needs for linguistic interpretation in hospital settings: A retrospective analysis of ad hoc interpreter requests. The Journal of Medicine Access 2022; 6:27550834221105215. [PMID: 36204521 PMCID: PMC9413498 DOI: 10.1177/27550834221105215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022]
Abstract
Background: In Canada, healthcare professionals often rely on ad hoc interpreters, who
are untrained volunteers recruited via intercom hospital announcements to
interpret for patients with language barriers. This study analyzed the
frequency of ad hoc interpreter requests via intercom announcements to
estimate hospital interpretation needs. Methods: A retrospective cohort analysis from intercom requests for medical
interpretation collected from five hospitals of the McGill University Health
Center. Requests included date, time, language requested, hospital location,
and extension for who placed the request. Results: A total of 1265 intercom requests were placed for 48 languages, with the top
five languages being Mandarin (17.8%), Punjabi (10.1%), Inuktitut (9.8%),
Arabic (7.3%), and Cantonese (6.4%). Almost 69.8% of requests were made
during working hours, 13.2% on workday evenings, and 14.8% on weekends.
Requests came from urgent care (42.3%), outpatient (29.5%), and inpatient
(23.3%) settings. Conclusion: This is the first published study that measures interpretation needs via
intercom requests. We propose that our method can be replicated to inform
implementation of professional medical interpretation services. We conclude
that linguistic interpretation needs are significant in the Montreal area,
and likely in Canada in general and pose a barrier to effective medical
care.
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Affiliation(s)
- Nishaant Bhambra
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Morgan Spencer Gold
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Darya Naumova
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Kenzy Abdelhamid
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - David Lessard
- Centre of Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre (MUHC), Montreal, QC, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC, Canada
| | - Bertrand Lebouché
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre of Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre (MUHC), Montreal, QC, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
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Klein MB, Young J, Ortiz-Paredes D, Wang S, Walmsley S, Wong A, Martel-Laferrière V, Pick N, Conway B, Angel J, Baril JG, Fraser C, Lebouché B, Tan DHS, Sandre R, Trottier S, Peiris H, Jayaraman J, Singer J. Virological Outcomes After Switching to Abacavir/Lamivudine/Dolutegravir Combined with Adherence Support in People Living with HIV with Poor Adherence: A Phase IV, Multicentre Randomized Prospective Open Label Study (TriiADD-CTN 286). Patient Prefer Adherence 2022; 16:3267-3281. [PMID: 36536672 PMCID: PMC9759014 DOI: 10.2147/ppa.s379065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Many people living with HIV struggle to consistently adhere to antiretroviral therapy, fail to achieve long-term virologic control and remain at risk for HIV-related disease progression, development of resistance and may transmit HIV infection to others. OBJECTIVE To determine if switching from current multi-tablet (curART) to single-tablet antiretroviral therapy (abacavir/lamivudine/dolutegravir; ABC/3TC/DTG), both combined with individualized adherence support, would improve HIV suppression in non-adherent vulnerable populations. METHODS TriiADD was an investigator-initiated randomized, multicentre, open label study. HIV+ adults with documented non-adherence on curART were randomized in a 1:1 ratio to immediately switch to ABC/3TC/DTG or to continue curART. Both arms received adherence support. The primary outcome was the proportion of participants in each arm with HIV RNA < 50 copies/mL 24 weeks after randomization. RESULTS In total, 50 people were screened and 27 randomized from 11 sites across Canada before the trial was stopped early due to slow recruitment. Participants were predominantly from ethnocultural communities, Indigenous people and/or had a history of injection drug use. The proportion achieving HIV RNA < 50 copies/mL at week 24 was 4/12 (33%) in the curART arm vs 7/13 (54%) in the ABC/3TC/DTG arm; median Bayesian risk difference, 5% (95% CrI, -17 to 28%) higher for those randomized to ABC/3TC/DTG. We encountered difficulties with recruitment of participants without prior drug resistance, retention despite intensive support, reliably measuring adherence and in overcoming entrenched adherence barriers. CONCLUSION Results of our trial are consistent with a slight improvement in viral suppression in a vulnerable population when a single tablet regimen is combined with patient-level adherence support. Beyond treatment simplicity and tolerability, tailored interventions addressing stigma and social determinants of health are still needed. The numerous challenges we encountered illustrate how randomised trials may not be the best approach for assessing adherence interventions in vulnerable populations.
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Affiliation(s)
- Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
- Correspondence: Marina B Klein, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Boulevard, D02.4110, Montréal, H4A 3J1, Canada, Tel +1-514-843-2090, Fax +1-514-843-2092, Email
| | - Jim Young
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - David Ortiz-Paredes
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Shouao Wang
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Sharon Walmsley
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
- University Health Network, University of Toronto, Toronto, Canada
| | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, Canada
| | - Valérie Martel-Laferrière
- Department of Microbiology and Infectious Diseases, Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - Neora Pick
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, Canada
| | | | - Jean-Guy Baril
- Clinique de Médecine Urbaine du Quartier Latin, Montreal, Canada
| | - Chris Fraser
- Cool Aid Community Health Centre, Victoria, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Darrell H S Tan
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Roger Sandre
- HAVEN Program, Health Sciences North, Sudbury, Canada
| | - Sylvie Trottier
- Centre de Recherche du CHU de Québec, Department of Microbiology, Infectiology and Immunology, Université Laval, Quebec, Canada
| | - Hansi Peiris
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Jayamarx Jayaraman
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
| | - Joel Singer
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
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Engler K, Vicente S, Ma Y, Hijal T, Cox J, Ahmed S, Klein M, Achiche S, Pant Pai N, de Pokomandy A, Lacombe K, Lebouché B. Implementation of an electronic patient-reported measure of barriers to antiretroviral therapy adherence with the Opal patient portal: Protocol for a mixed method type 3 hybrid pilot study at a large Montreal HIV clinic. PLoS One 2021; 16:e0261006. [PMID: 34969046 PMCID: PMC8717992 DOI: 10.1371/journal.pone.0261006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) remains problematic. Regular monitoring of its barriers is clinically recommended, however, patient-provider communication around adherence is often inadequate. Our team thus decided to develop a new electronically administered patient-reported outcome measure (PROM) of barriers to ART adherence (the I-Score) to systematically capture this data for physician consideration in routine HIV care. To prepare for a controlled definitive trial to test the I-Score intervention, a pilot study was designed. Its primary objectives are to evaluate patient and physician perceptions of the I-Score intervention and its implementation strategy. METHODS This one-arm, 6-month study will adopt a mixed method type 3 implementation-effectiveness hybrid design and be conducted at the Chronic Viral Illness Service of the McGill University Health Centre (Montreal, Canada). Four HIV physicians and 32 of their HIV patients with known or suspected adherence problems will participate. The intervention will involve having patients complete the I-Score through a smartphone application (Opal), before meeting with their physician. Both patients and physicians will have access to the I-Score results, for consideration during the clinic visits at Times 1, 2 (3 months), and 3 (6 months). The implementation strategy will focus on stakeholder involvement, education, and training; promoting the intervention's adaptability; and hiring an Application Manager to facilitate implementation. Implementation, patient, and service outcomes will be collected (Times 1-2-3). The primary outcome is the intervention's acceptability to patients and physicians. Qualitative data obtained, in part, through physician focus groups (Times 2-3) and patient interviews (Times 2-3) will help evaluate the implementation strategy and inform any methodological adaptations. DISCUSSION This study will help plan a definitive trial to test the efficacy of the I-Score intervention. It will generate needed data on electronic PROM interventions in routine HIV care that will help improve understanding of conditions for their successful implementation. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04702412; https://clinicaltrials.gov/.
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Affiliation(s)
- Kim Engler
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Serge Vicente
- Department of Mathematics and Statistics, University of Montreal, Montreal, Quebec, Canada
| | - Yuanchao Ma
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Tarek Hijal
- Department of Radiation Oncology, Cedars Cancer Center, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Division of Infectious Disease, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Sara Ahmed
- School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Marina Klein
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Infectious Disease, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sofiane Achiche
- Department of Mechanical Engineering, École Polytechnique de Montréal, Montreal, Quebec, Canada
| | - Nitika Pant Pai
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Alexandra de Pokomandy
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Infectious Disease, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Karine Lacombe
- Sorbonne Université, Inserm IPLESP, Hôpital St Antoine, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - Bertrand Lebouché
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Infectious Disease, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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Ortiz-Paredes D, Amoako A, Lessard D, Engler K, Lebouché B, Klein MB. Barriers and facilitators related to HCV treatment uptake among HIV coinfected populations in Canada: Patients and treatment provider perceptions. CanLivJ 2021; 5:124-143. [DOI: 10.3138/canlivj-2021-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/03/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND: Direct-acting antiviral (DAA) uptake is challenging across HIV-hepatitis C (HCV) coinfected populations. This study sought to identify barriers and facilitators related to DAA uptake in priority populations in Canada. METHODS: This qualitative descriptive study included 11 people living with HIV with a history of HCV and 15 HCV care providers. Participants were part of either nominal groups (n = 4) or individual interviews (n = 6) in which they identified and ranked barriers and facilitators to DAA uptake. Consolidated lists of barriers and facilitators were identified thematically. RESULTS: Patient participants highly ranked the following barriers: competing priorities and needs (i.e., social instability and mental health), delays in care, lack of adherence, and polypharmacy. Provider participant top barriers were the following: competing priorities and needs (i.e., social chaos), delays in care (e.g., systemic barriers, difficulties engaging patients, lack of trained HCV providers), and HCV-related stigma. Patient participants identified having a strong network of health care providers, family, and friends, possessing intrinsic motivation, and DAAs being a simple and tolerable oral treatment as important facilitators. Provider participant top-ranked facilitators were having resources to identify hard-to-reach populations (e.g., patient navigation, outreach), holistic care and addiction management, provider HCV education, and a strong network of interprofessional collaboration. CONCLUSION: The barriers to DAA initiation addressed by patients and providers overlapped, with some nuances. Multidisciplinary care fostering a strong supportive network and intrinsically motivated patients along with HCV education emerged as key facilitators. This study provides insights for developing potential strategies to improve DAA uptake among HIV-HCV coinfected people in Canada.
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Affiliation(s)
- David Ortiz-Paredes
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Afia Amoako
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - David Lessard
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Kim Engler
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Bertrand Lebouché
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Glen site, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina B. Klein
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Glen site, McGill University Health Centre, Montreal, Quebec, Canada
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46
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Bouabida K, Malas K, Talbot A, Desrosiers MÈ, Lavoie F, Lebouché B, Taguemout M, Rafie E, Lessard D, Pomey MP. Remote Patient Monitoring Program for COVID-19 Patients Following Hospital Discharge: A Cross-Sectional Study. Front Digit Health 2021; 3:721044. [PMID: 34859244 PMCID: PMC8630581 DOI: 10.3389/fdgth.2021.721044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The COVID-19 pandemic created an urgent need to act to reduce the spread of the virus and alleviate congestion from healthcare services, protect healthcare providers, and help them maintain satisfactory quality and safety of care. Remote COVID-19 monitoring platforms emerged as potential solutions. Objective: The purpose of this study was to evaluate the capacity and contribution of two different platforms used to remotely monitor patients with COVID-19 to maintain quality, safety, and patient engagement in care, as well as their acceptability, usefulness, and user-friendliness from the user's perspective. The first platform is focused on telecare phone calls (Telecare-Covid), and the second is a telemonitoring app (CareSimple-Covid). Methods: We performed a cross-sectional study. The data were collected through a phone survey from May to August 2020. Data were analyzed using descriptive statistics and t-test analysis. Participants' responses and comments on open-ended questions were analyzed using content analysis to identify certain issues and challenges and potential avenues for improving the platforms. Results: Fifty one patients participated in the study. Eighteen participants used the CareSimple-Covid platform and 33 participants used the Telecare-Covid platform. Overall, the satisfaction rate for quality and safety of care for the two platforms was 80%. Over 88% of the users on each platform considered the platforms' services to be engaging, useful, user-friendly, and appropriate to their needs. The survey identified a few significant differences in users' perceptions of each platform: empathy toward users and the quality and safety of the care received were rated significantly higher on the CareSimple-Covid platform than on the Telecare-Covid platform. Users appreciated four aspects of these telehealth approaches: (1) the ease of access to services and the availability of care team members; (2) the user-friendliness of the platforms; (3) the continuity of care provided, and (4) the wide range of services delivered. Users identified some technical limitations and raised certain issues, such as the importance of maintaining human contact, data security, and confidentiality. Improvement suggestions include promoting access to connected devices; enhancing communications between institutions, healthcare users, and the public on confidentiality and personal data protection standards; and integrating a participatory approach to telehealth platform development and deployment efforts. Conclusion: This study provides preliminary evidence that the two remote monitoring platforms are well-received by users, with very few significant differences between them concerning users' experiences and views. This type of program could be considered for use in a post-pandemic era and for other post-hospitalization clienteles. To maximize efficiency, the areas for improvement and the issues identified should be addressed with a patient-centered approach.
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Affiliation(s)
- Khayreddine Bouabida
- University of Montreal Hospital Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, QC, Canada.,École de Santé publique, Département de Gestion, Université de Montréal, Montreal, QC, Canada
| | - Kathy Malas
- Excutive Office, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada.,Département de Recherche, Montreal Cancer Institute, University of Montreal Hospital Centre (CRCHUM), Montreal, QC, Canada.,Innovation Axis, Research Center of the CHUM, Montreal, QC, Canada
| | - Annie Talbot
- Innovation Axis, Research Center of the CHUM, Montreal, QC, Canada.,Network Coordination Department, CHUM, Montreal, QC, Canada
| | - Marie-Ève Desrosiers
- Innovation Axis, Research Center of the CHUM, Montreal, QC, Canada.,Network Coordination Department, CHUM, Montreal, QC, Canada
| | - Frédéric Lavoie
- Innovation Axis, Research Center of the CHUM, Montreal, QC, Canada.,Network Coordination Department, CHUM, Montreal, QC, Canada
| | - Bertrand Lebouché
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in Human Immunodeficiency Virus (HIV), Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada
| | - Melissa Taguemout
- Innovation Axis, Research Center of the CHUM, Montreal, QC, Canada.,State-of-the-Art Technology and Methods, Montreal, QC, Canada
| | - Edmond Rafie
- Innovation Axis, Research Center of the CHUM, Montreal, QC, Canada.,State-of-the-Art Technology and Methods, Montreal, QC, Canada
| | - David Lessard
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in Human Immunodeficiency Virus (HIV), Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada
| | - Marie-Pascale Pomey
- Département de Recherche, Montreal Cancer Institute, University of Montreal Hospital Centre (CRCHUM), Montreal, QC, Canada.,State-of-the-Art Technology and Methods, Montreal, QC, Canada.,Center of Excellence of Patient Partnership and the Public, Montreal, QC, Canada.,Department of Health Management, Evaluation, and Policy, School of Public Health, Université de Montréal, Montreal, QC, Canada
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47
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Ji X, Chow E, Abdelhamid K, Naumova D, Mate KKV, Bergeron A, Lebouché B. Utility of mobile technology in medical interpretation: A literature review of current practices. Patient Educ Couns 2021; 104:2137-2145. [PMID: 33653659 DOI: 10.1016/j.pec.2021.02.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/16/2020] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Language barriers limit healthcare access. However, professional interpretation usage is infrequent due to high cost and poor interpreter availability. Healthcare-oriented mobile applications are becoming more accepted and may help alleviate this burden. This literature review aims to better understand the utility of mobile technology in healthcare interpretation. Specifically, the objective of this review is to synthesize the feasibility, outcome, and challenges of implementing technological medical interpretation services. PATIENT INVOLVEMENT No patients were involved for this review. METHODS In December 2019, MEDLINE (Ovid) was systematically searched according to PRISMA guidelines. All articles discussing the utility of technology in healthcare interpretation encounters were included. RESULTS Two major themes emerged: 1) comparing video and phone interpretation with in-person interpretation and 2) assessing direct translation software in healthcare settings. Phone and video interpretation help reduce overall patient wait-times. Both patients and clinicians preferred in-person or video interpretation over interpretation by phone. Chief benefits of using direct translation software include immediate access, low costs, and sustainability. Several studies discussed potential translation inaccuracies and the importance of having professional interpreters in medico-legal discussions. CONCLUSION Mobile applications may be used to facilitate access to medical interpreters with high clinician and patient satisfaction. Direct in-app translations facilitate access but risk inaccuracies with important medico-legal considerations. PRACTICAL VALUE Mobile applications are available at low costs and can improve access to interpreters though video and phone calls. Mobile software can also provide direct translation and facilitate clinical care. Clinicians should prioritize face-to-face encounters with professional medical interpreters, whenever possible. In a time of social distancing amidst the current COVID-19 pandemic, there is crucial value in elucidating the best telehealth interpretation practices.
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Affiliation(s)
- Xinyu Ji
- Faculty of Medicine, McGill University, Montreal, Canada.
| | - Ellen Chow
- Faculty of Medicine, McGill University, Montreal, Canada
| | | | - Darya Naumova
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Kedar K V Mate
- Center of Outcomes Research and Evaluation, McGill University Health Centre-Research, Montreal, Canada; Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Canada; Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, Canada.
| | - Amy Bergeron
- Medical Libraries, McGill University Health Centre, Montreal, Canada.
| | - Bertrand Lebouché
- Faculty of Medicine, McGill University, Montreal, Canada; Center of Outcomes Research and Evaluation, McGill University Health Centre-Research, Montreal, Canada; Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Canada; Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, Canada; Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada.
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48
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Lessard D, Vicente S, Keeler P, Lebouché B. A patient’s narrative of engaging HIV care: Lessons learned to harness resources and improve access to care. Patient Experience Journal 2021. [DOI: 10.35680/2372-0247.1566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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49
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Arora AK, Ortiz-Paredes D, Engler K, Lessard D, Mate KK, Rodriguez-Cruz A, Kronfli N, Vedel I, Cox J, Quesnel-Vallée A, Lebouché B. Barriers and Facilitators Affecting the HIV Care Cascade for Migrant People Living with HIV in Organization for Economic Co-Operation and Development Countries: A Systematic Mixed Studies Review. AIDS Patient Care STDS 2021; 35:288-307. [PMID: 34375137 PMCID: PMC8380795 DOI: 10.1089/apc.2021.0079] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Migrants in countries affiliated with the Organization for Economic Co-operation and Development (OECD) have a higher risk of acquiring HIV, experience delayed HIV diagnosis, and have variable levels of engagement with HIV care and treatment when compared to native-born populations. A systematic mixed studies review was conducted to generate a multilevel understanding of the barriers and facilitators affecting HIV Care Cascade steps for migrant people living with HIV (MLWH) in OECD countries. Medline, Embase, Scopus, CINAHL, and the Cochrane Library were searched on March 25, 2020. Screening, critical appraisal, and analysis were conducted independently by two authors. We used qualitative content analysis and the five-level Socio-Ecological Model (i.e., individual, interpersonal, organizational, community, and policy) to categorize barriers and facilitators. Fifty-nine studies from 17 OECD countries were included. MLWH faced similar barriers and facilitators regardless of their host country, ethnic and geographic origins, or legal status. Most barriers and facilitators were associated with the individual and organizational levels and centered around retention in HIV care and treatment. Adapting clinical environments to better address MLWH's competing needs via multidisciplinary models would address retention issues across OECD countries.
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Affiliation(s)
- Anish K. Arora
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - David Ortiz-Paredes
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Kim Engler
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - David Lessard
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - Kedar K.V. Mate
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - Adriana Rodriguez-Cruz
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
| | - Joseph Cox
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
| | - Amélie Quesnel-Vallée
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Department of Sociology, Faculty of Arts, McGill University, Montréal, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada
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50
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Ramendra R, Isnard S, Lin J, Fombuena B, Ouyang J, Mehraj V, Zhang Y, Finkelman M, Costiniuk C, Lebouché B, Chartrand-Lefebvre C, Durand M, Tremblay C, Ancuta P, Boivin G, Routy JP. Cytomegalovirus Seropositivity Is Associated With Increased Microbial Translocation in People Living With Human Immunodeficiency Virus and Uninfected Controls. Clin Infect Dis 2021; 71:1438-1446. [PMID: 31608409 PMCID: PMC7486843 DOI: 10.1093/cid/ciz1001] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/07/2019] [Indexed: 12/11/2022] Open
Abstract
Background Cytomegalovirus (CMV) seropositivity and anti-CMV immunoglobulin G (IgG) levels are associated with adverse health outcomes in elderly populations. Among people living with human immunodeficiency virus (PLWH), CMV seropositivity has been associated with persistent CD8 T-cell elevation and increased risk of developing non-AIDS comorbidities despite long-term antiretroviral therapy (ART). Herein, we investigated whether CMV seropositivity and elevation of anti-CMV IgG levels were associated with increased epithelial gut damage, microbial translocation, and systemic inflammation. Methods A total of 150 PLWH (79 ART-naive and 71 ART-treated) were compared to 26 without human immunodeficiency virus (HIV) infection (uninfected controls). Plasma markers of HIV disease progression, epithelial gut damage, microbial translocation, nonspecific B-cell activation, anti-CMV and anti–Epstein-Barr virus (EBV) IgG levels, and proinflammatory cytokines were measured. Results CMV seropositivity and elevated anti-CMV IgG levels were associated with markers of epithelial gut damage, microbial translocation, and inflammation in PLWH and participants without HIV infection. In contrast, total nonspecific IgG, immunoglobulin M, immunoglobulin A, and anti-EBV IgG levels were not associated with these markers. CMV seropositivity was associated with markers of epithelial gut damage, microbial translocation, and inflammation independent of sociodemographic and behavioral characteristics of the study population. Conclusions CMV-seropositive people with and without HIV had increased epithelial gut damage, microbial translocation, and inflammation. Furthermore, anti-CMV IgG levels were independently associated with increased epithelial gut damage and microbial translocation. CMV coinfection may partially explain persistent gut damage, microbial translocation, and inflammation in ART-treated PLWH.
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Affiliation(s)
- Rayoun Ramendra
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.,Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Stéphane Isnard
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.,Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - John Lin
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.,Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Brandon Fombuena
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.,Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Jing Ouyang
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.,Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.,Chongqing Public Health Medical Center, Chongqing, China
| | - Vikram Mehraj
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.,Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Yonglong Zhang
- Associates of Cape Cod Inc, Falmouth, Massachusetts, USA
| | | | - Cecilia Costiniuk
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.,Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.,Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Carl Chartrand-Lefebvre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Madeleine Durand
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Cécile Tremblay
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Petronela Ancuta
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Guy Boivin
- Department of Microbiology-Immunology and Infectious Diseases, Laval University, Quebec City, Quebec, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.,Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.,Division of Hematology, McGill University Health Centre, Montreal, Quebec, Canada
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