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Medeiros P, Koebel J, Yu A, Kazemi M, Nicholson V, Frank P, Persad Y, O'Brien N, Bertozzi B, Smith S, Ndung'u M, Fraleigh A, Gagnier B, Cardinal C, Webster K, Sanchez M, Lee M, Lacombe-Duncan A, Logie CH, Gormley R, de Pokomandy A, Kaida A, Loutfy MR. Experiences and resultant care gaps among women with HIV in Canada: concept mapping the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) findings. BMJ Open 2024; 14:e078833. [PMID: 38569698 DOI: 10.1136/bmjopen-2023-078833] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVES The community-based, longitudinal, Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) explored the experiences of women with HIV in Canada over the past decade. CHIWOS' high-impact publications document significant gaps in the provision of healthcare to women with HIV. We used concept mapping to analyse and present a summary of CHIWOS findings on women's experiences navigating these gaps. DESIGN Concept mapping procedures were performed in two steps between June 2019 and March 2021. First, two reviewers (AY and PM) independently reviewed CHIWOS manuscripts and conference abstracts written before 1 August 2019 to identify main themes and generate individual concept maps. Next, the preliminary results were presented to national experts, including women with HIV, to consolidate findings into visuals summarising the experiences and care gaps of women with HIV in CHIWOS. SETTING British Columbia, Ontario and Quebec, Canada. PARTICIPANTS A total of 18 individual CHIWOS team members participated in this study including six lead investigators of CHIWOS and 12 community researchers. RESULTS Overall, a total of 60 peer-reviewed manuscripts and conference abstracts met the inclusion criteria. Using concept mapping, themes were generated and structured through online meetings. In total, six composite concept maps were co-developed: quality of life, HIV care, psychosocial and mental health, sexual health, reproductive health, and trans women's health. Two summary diagrams were created encompassing the concept map themes, one for all women and one specific to trans women with HIV. Through our analysis, resilience, social support, positive healthy actions and women-centred HIV care were highlighted as strengths leading to well-being for women with HIV. CONCLUSIONS Concept mapping resulted in a composite summary of 60 peer-reviewed CHIWOS publications. This activity allows for priority setting to optimise care and well-being for women with HIV.
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Affiliation(s)
- Priscilla Medeiros
- Women's College Hospital, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Jill Koebel
- Women's College Hospital, Toronto, Ontario, Canada
| | - Amy Yu
- Women's College Hospital, Toronto, Ontario, Canada
| | - Mina Kazemi
- Women's College Hospital, Toronto, Ontario, Canada
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Peggy Frank
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Nadia O'Brien
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Mary Ndung'u
- Women's College Hospital, Toronto, Ontario, Canada
| | | | | | - Claudette Cardinal
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - A Lacombe-Duncan
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Mona R Loutfy
- Medicine, University of Toronto, Toronto, Ontario, Canada
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O'Brien KK, Ibáñez-Carrasco F, Carusone SC, Bayoumi AM, Tang A, McDuff K, Jiancaro T, Da Silva G, Torres B, Loutfy MR, Islam S, Lindsay J, Price C, Zobeiry M, Pandovski Z, Illic I, Ahluwalia P, Brown DA, Avery L, Solomon P. Piloting an online telecoaching community-based exercise intervention with adults living with HIV: protocol for a mixed-methods implementation science study. BMJ Open 2023; 13:e067703. [PMID: 36997255 PMCID: PMC10069544 DOI: 10.1136/bmjopen-2022-067703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Our aim is to evaluate the implementation of an online telecoaching community-based exercise (CBE) intervention with the goal of reducing disability and enhancing physical activity and health among adults living with HIV. METHODS AND ANALYSIS We will conduct a prospective longitudinal mixed-methods two-phased intervention study to pilot the implementation of an online CBE intervention with ~30 adults (≥18 years) living with HIV who consider themselves safe to participate in exercise. In the intervention phase (0-6 months), participants will take part in an online CBE intervention involving thrice weekly exercise (aerobic, resistance, balance and flexibility), with supervised biweekly personal training sessions with a fitness instructor, YMCA membership providing access to online exercise classes, wireless physical activity monitor to track physical activity and monthly online educational sessions on topics related to HIV, physical activity and health. In the follow-up phase (6-12 months), participants will be encouraged to continue independent exercise thrice weekly. Quantitative assessment: Bimonthly, we will assess cardiopulmonary fitness, strength, weight, body composition and flexibility, followed by administering self-reported questionnaires to assess disability, contextual factor outcomes (mastery, engagement in care, stigma, social support), implementation factors (cost, feasibility, technology), health status and self-reported physical activity. We will conduct a segmented regression analyses to describe the change in level and trend between the intervention and follow-up phases. Qualitative assessment: We will conduct online interviews with a subsample of ~10 participants and 5 CBE stakeholders at baseline (month 0), postintervention (month 6) and end of follow-up (month 12) to explore experiences, impact and implementation factors for online CBE. Interviews will be audiorecorded and analysed using content analytical techniques. ETHICS AND DISSEMINATION Protocol approved by the University of Toronto Research Ethics Board (Protocol # 40410). Knowledge translation will occur in the form of presentations and publications in open-access peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05006391.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | | | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Ontario, Canada
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kiera McDuff
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tizneem Jiancaro
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George Da Silva
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brittany Torres
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mona R Loutfy
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Shaz Islam
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Joanne Lindsay
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Colleen Price
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Ottawa, Ontario, Canada
| | - Mehdi Zobeiry
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Zoran Pandovski
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Ivan Illic
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | | | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa Avery
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Biostatistics Department, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Burchell AN, Raboud J, Donelle J, Loutfy MR, Rourke SB, Rogers T, Rosenes R, Liddy C, Kendall CE. Cause-specific mortality among HIV-infected people in Ontario, 1995-2014: a population-based retrospective cohort study. CMAJ Open 2019; 7:E1-E7. [PMID: 30622108 PMCID: PMC6350837 DOI: 10.9778/cmajo.20180159] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Risk factors for cause-specific mortality have not been widely studied among people with HIV infection. Our objectives were to estimate rates of and risk factors for all-cause and cause-specific mortality from 1995 to 2014 among HIV-infected people in Ontario. METHODS We conducted a population-based retrospective cohort study using provincial health databases of people with HIV infection who were aged 16 years or more, were residents of Ontario between 1995 and 2014, and had HIV infection according to a previously validated algorithm. We used International Classification of Diseases codes to classify the underlying cause of death and estimated age-adjusted mortality rates per 100 person-years for 1995 to 2014. We used descriptive statistics to characterize the cohort at baseline and calculated adjusted mortality rate ratios (RRs) using generalized estimating equations. RESULTS Among 23 043 people, the all-cause mortality rate declined from 6.69 to 1.53 per 100 person-years over the study period, and the rate of death from HIV/AIDS declined from 4.75 to 0.46 per 100 person-years. Concomitantly, the proportions of deaths due to cancer, cardiovascular disease and other noncommunicable diseases rose; however, rates remained constant or declined. Compared to males, females had higher mortality due to cardiovascular disease (adjusted RR 1.36, 95% confidence interval [CI] 1.04-1.77), noncommunicable causes (adjusted RR 1.75, 95% CI 1.39-2.20) and, by 2010-2014, any cause (adjusted RR 1.19, 95% CI 1.02-1.38). Residing in a low-income neighbourhood was associated with increased risk for most causes, including HIV/AIDS (adjusted RR in 2010-2014 1.86, 95% CI 1.49-2.31). Rural residence was associated with increased mortality due to malignant disease (adjusted RR 1.60, 95% CI 1.10-2.34) and noncommunicable disease (adjusted RR 1.86, 95% CI 1.25-2.77). Being an immigrant was associated with lower risk of death from all causes. INTERPRETATION Over the study period, death was increasingly due to common chronic conditions rather than to HIV infection itself. Care should incorporate the prevention and management of these conditions, especially among females and those residing in rural and low-income areas.
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Affiliation(s)
- Ann N Burchell
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Janet Raboud
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Jessy Donelle
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Mona R Loutfy
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Sean B Rourke
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Tim Rogers
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Ron Rosenes
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Clare Liddy
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Claire E Kendall
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont.
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Barré‐Sinoussi F, Abdool Karim SS, Albert J, Bekker L, Beyrer C, Cahn P, Calmy A, Grinsztejn B, Grulich A, Kamarulzaman A, Kumarasamy N, Loutfy MR, El Filali KM, Mboup S, Montaner JSG, Munderi P, Pokrovsky V, Vandamme A, Young B, Godfrey‐Faussett P. Expert consensus statement on the science of HIV in the context of criminal law. J Int AIDS Soc 2018; 21:e25161. [PMID: 30044059 PMCID: PMC6058263 DOI: 10.1002/jia2.25161] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Globally, prosecutions for non-disclosure, exposure or transmission of HIV frequently relate to sexual activity, biting, or spitting. This includes instances in which no harm was intended, HIV transmission did not occur, and HIV transmission was extremely unlikely or not possible. This suggests prosecutions are not always guided by the best available scientific and medical evidence. DISCUSSION Twenty scientists from regions across the world developed this Expert Consensus Statement to address the use of HIV science by the criminal justice system. A detailed analysis of the best available scientific and medical research data on HIV transmission, treatment effectiveness and forensic phylogenetic evidence was performed and described so it may be better understood in criminal law contexts. Description of the possibility of HIV transmission was limited to acts most often at issue in criminal cases. The possibility of HIV transmission during a single, specific act was positioned along a continuum of risk, noting that the possibility of HIV transmission varies according to a range of intersecting factors including viral load, condom use, and other risk reduction practices. Current evidence suggests the possibility of HIV transmission during a single episode of sex, biting or spitting ranges from no possibility to low possibility. Further research considered the positive health impact of modern antiretroviral therapies that have improved the life expectancy of most people living with HIV to a point similar to their HIV-negative counterparts, transforming HIV infection into a chronic, manageable health condition. Lastly, consideration of the use of scientific evidence in court found that phylogenetic analysis alone cannot prove beyond reasonable doubt that one person infected another although it can be used to exonerate a defendant. CONCLUSIONS The application of up-to-date scientific evidence in criminal cases has the potential to limit unjust prosecutions and convictions. The authors recommend that caution be exercised when considering prosecution, and encourage governments and those working in legal and judicial systems to pay close attention to the significant advances in HIV science that have occurred over the last three decades to ensure current scientific knowledge informs application of the law in cases related to HIV.
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Affiliation(s)
| | - Salim S Abdool Karim
- Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
- Centre for the AIDS Program of Research in South AfricaUniversity of KwaZulu‐NatalDurbanSouth Africa
- Weill Medical CollegeCornell UniversityNew YorkNYUSA
| | - Jan Albert
- Department of Microbiology, Tumor and Cell BiologyKarolinska InstitutetStockholmSweden
| | - Linda‐Gail Bekker
- Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
| | - Chris Beyrer
- Department of EpidemiologyCenter for AIDS Research and Center for Public Health and Human RightsJohn Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Pedro Cahn
- Infectious Diseases UnitJuan A. Fernandez Hospital Buenos AiresCABAArgentina
- Buenos Aires University Medical SchoolBuenos AiresArgentina
- Fundación HuéspedBuenos AiresArgentina
| | - Alexandra Calmy
- Infectious DiseasesGeneva University HospitalGenevaSwitzerland
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas‐FiocruzFiocruz, Rio de JaneiroBrazil
| | - Andrew Grulich
- Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
| | | | | | - Mona R Loutfy
- Women's College Research InstituteTorontoCanada
- Women's College HospitalTorontoCanada
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Kamal M El Filali
- Infectious Diseases UnitIbn Rochd Universtiy HospitalCasablancaMorocco
| | - Souleymane Mboup
- Institut de Recherche en Santéde Surveillance Epidemiologique et de FormationsDakarSenegal
| | - Julio SG Montaner
- Faculty of MedicineUniversity of British ColumbiaVancouverCanada
- BC Centre for Excellence in HIV/AIDSVancouverCanada
| | - Paula Munderi
- International Association of Providers of AIDS CareKampalaUganda
| | - Vadim Pokrovsky
- Russian Peoples’ Friendship University (RUDN‐ University)MoscowRussian Federation
- Central Research Institute of EpidemiologyFederal Service on Customers’ Rights Protection and Human Well‐being SurveillanceMoscowRussian Federation
| | - Anne‐Mieke Vandamme
- KU LeuvenDepartment of Microbiology and ImmunologyRega Institute for Medical Research, Clinical and Epidemiological VirologyLeuvenBelgium
- Center for Global Health and Tropical MedicineUnidade de MicrobiologiaInstituto de Higiene e Medicina TropicalUniversidade Nova de LisboaLisbonPortugal
| | - Benjamin Young
- International Association of Providers of AIDS CareWashingtonDCUSA
| | - Peter Godfrey‐Faussett
- UNAIDSGenevaSwitzerland
- Department of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonEngland
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Logie CH, Wang Y, Lacombe-Duncan A, Wagner AC, Kaida A, Conway T, Webster K, de Pokomandy A, Loutfy MR. HIV-related stigma, racial discrimination, and gender discrimination: Pathways to physical and mental health-related quality of life among a national cohort of women living with HIV. Prev Med 2018; 107:36-44. [PMID: 29277410 DOI: 10.1016/j.ypmed.2017.12.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/02/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
Social inequities compromise health-related quality of life (HR-QoL) among women living with HIV (WLWH). Little is known about health impacts of intersecting stigma based on HIV status, race and gender among WLWH or potential mechanisms to promote HR-QoL. We tested pathways from multiple types of stigma (HIV-related, racial, gender) to physical and mental HR-QoL utilizing baseline survey data from a national cohort of WLWH in Canada (2013-2015). Structural equation modeling was conducted using maximum likelihood estimation methods to test the direct effects of HIV-related stigma, racial discrimination, and gender discrimination on HR-QoL and indirect effects via social support and economic insecurity, adjusting for socio-demographic factors. Among 1425 WLWH (median age: 43years [IQR=35-50]), HIV-related stigma and gender discrimination had significant direct effects on mental HR-QoL. Social support mediated the relationship between HIV-related stigma and mental HR-QoL, accounting for 22.7% of the effect. Social support accounted for 41.4% of the effect of gender discrimination on mental HR-QoL. Economic insecurity accounted for 14.3% of the effect of HIV-related stigma, and 42.4% of the effect of racial discrimination, on physical HR-QoL. Fit indices suggest good model fit (χ2[1]=3.319, p=0.069; CFI=0.998; RMSEA=0.042 (90% CI: 0-0.069); SRMR=0.004). Findings reveal complex relationships between intersecting stigma and HR-QoL. Strategies that address intersecting stigma and economic insecurity among WLWH may prevent the harmful impacts of HIV-related stigma and gender discrimination on physical HR-QoL. Increasing social support may mitigate the impacts of stigma on mental health. Findings can inform multi-level interventions to promote health and wellbeing among WLWH.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada; Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada.
| | - Ying Wang
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada.
| | - Ashley Lacombe-Duncan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada.
| | - Anne C Wagner
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada.
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Tracey Conway
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, Montreal, QC H3S 1Z1, Canada; Chronic Viral Illness Service, McGill University Health Centre, 3801 University Street, Montreal, QC H3A 2B4, Canada.
| | - Mona R Loutfy
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada; Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
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Logie CH, Ahmed U, Tharao W, Loutfy MR. A Structural Equation Model of Factors Contributing to Quality of Life Among African and Caribbean Women Living with HIV in Ontario, Canada. AIDS Res Hum Retroviruses 2017; 33:290-297. [PMID: 27750027 DOI: 10.1089/aid.2016.0013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 01/26/2023] Open
Abstract
African and Caribbean Black (ACB) women in Canada are disproportionately impacted by new HIV infections. ACB women's HIV vulnerability is shaped by contexts of stigma and discrimination. HIV-related stigma compromises quality of life (QOL) among women living with HIV (WLWH), yet scant research has examined concomitant effects of racial discrimination and HIV-related stigma on QOL. We used data from a cross-sectional survey with ACB WLWH in Ontario (n = 173) to test a conceptual model of pathways between HIV-related stigma, racial discrimination, depression, social support, and QOL. We conducted structural equation modeling using maximum likelihood estimation to test the model. In independent models, HIV-related stigma was associated with lower QOL, and depression partially mediated the association between HIV-related stigma and QOL. In the simultaneous model, HIV-related stigma had significant direct effects on depression, social support, and an indirect effect on QOL. When social support was added as a mediator, the direct effect between HIV-related stigma and QOL was no longer significant, suggesting mediation. Racial discrimination had significant direct effects on HIV-related stigma, depression, and social support and an indirect effect on QOL. QOL was associated with higher social support and lower depression scores. The model fit the data well: χ2 = 203.266, degrees of freedom (DF): 112, p < .0001; Comparative Fit Index (CFI): 0.929, Tucker-Lewis Index (TLI): 0.912, Root-Mean Square Error of Approximation (RMSEA): 0.071. We found racial discrimination was associated with increased HIV-related stigma, and HIV-related stigma and racial discrimination compromised QOL. Findings suggest the need for multilevel interventions to reduce stigma and discrimination, address depression, and build social support to improve QOL among ACB WLWH.
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Affiliation(s)
- Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Uzma Ahmed
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Wangari Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto, Canada
| | - Mona R. Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
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Loutfy MR, Margolese S, Money DM, Gysler M, Hamilton S, Yudin MH. Lignes directrices canadiennes en matière de planification de la grossesse en présence du VIH. J Obstet Gynaecol Can 2017; 38:S59-S78. [PMID: 28063568 DOI: 10.1016/j.jogc.2016.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Logie CH, Kennedy VL, Tharao W, Ahmed U, Loutfy MR. Engagement in and continuity of HIV care among African and Caribbean Black women living with HIV in Ontario, Canada. Int J STD AIDS 2016; 28:969-974. [PMID: 27956646 DOI: 10.1177/0956462416683626] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/17/2022]
Abstract
Engagement in care is a key component of the HIV care cascade, yet there are knowledge gaps regarding how to assess HIV care engagement. This study aimed to develop a tool to assess HIV care engagement and to assess associations between HIV care engagement and quality of life (QOL) among African, Caribbean and Black (ACB) women living with HIV (WLWH). We conducted a cross-sectional survey with ACB WLWH across Ontario, Canada. We developed the 'HIV Engagement in and Continuity of Care Scale' (HECCS). We conducted exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to test the scale's factor structure. We conducted structural equation modeling (SEM) with maximum likelihood estimation to examine the associations between the HECCS and QOL. EFA yielded four factors: access to care, care by doctor/health professionals, control of HIV care, and appointment timekeeping. The CFA of the HECCS demonstrated good model fit: χ2 (DF: 1; n = 173) = 1.175, p = 0.278; CFI: 0.998; Tucker-Lewis Index (TLI): 0.990; RMSEA: 0.032. The HECCS was associated with increased QOL. The model fit the data well: χ2 (DF: 31, n = 173) = 51.19, p = 0.013; CFI = 0.955; TLI = 0.934; RMSEA = 0.062. Engagement in and continuity of care is multifaceted. We recommend interventions to promote the institutional capacity to better engage ACB WLWH in HIV care.
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Affiliation(s)
- Carmen H Logie
- 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.,2 Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Victoria L Kennedy
- 2 Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | | | - Uzma Ahmed
- 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Mona R Loutfy
- 2 Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,4 Department of Medicine, University of Toronto, Toronto, ON, Canada.,5 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Logie CH, Jenkinson JIR, Earnshaw V, Tharao W, Loutfy MR. A Structural Equation Model of HIV-Related Stigma, Racial Discrimination, Housing Insecurity and Wellbeing among African and Caribbean Black Women Living with HIV in Ontario, Canada. PLoS One 2016; 11:e0162826. [PMID: 27669510 PMCID: PMC5036880 DOI: 10.1371/journal.pone.0162826] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 08/29/2016] [Indexed: 01/15/2023] Open
Abstract
African and Caribbean Black women in Canada have new HIV infection rates 7 times higher than their white counterparts. This overrepresentation is situated in structural contexts of inequities that result in social, economic and health disparities among African and Caribbean Black populations. Economic insecurity is a distal driver of HIV vulnerability, reducing access to HIV testing, prevention and care. Less is known about how economic insecurity indicators, such as housing security, continue to influence the lives of women living with HIV following HIV-positive diagnoses. The aim of this study was to test a conceptual model of the pathways linking HIV-related stigma, racial discrimination, housing insecurity, and wellbeing (depression, social support, self-rated health). We implemented a cross-sectional survey with African and Caribbean Black women living with HIV in 5 Ontario cities, and included 157 participants with complete data in the analyses. We conducted structural equation modeling using maximum likelihood estimation to evaluate the hypothesized conceptual model. One-fifth (22.5%; n = 39) of participants reported housing insecurity. As hypothesized, racial discrimination had significant direct effects on: HIV-related stigma, depression and social support, and an indirect effect on self-rated health via HIV-related stigma. HIV-related stigma and housing insecurity had direct effects on depression and social support, and HIV-related stigma had a direct effect on self-rated health. The model fit the data well: χ2 (45, n = 154) = 54.28, p = 0.387; CFI = 0.997; TLI = 0.996; RMSEA = 0.016. Findings highlight the need to address housing insecurity and intersecting forms of stigma and discrimination among African and Caribbean Black women living with HIV. Understanding the complex relationships between housing insecurity, HIV-related stigma, racial discrimination, and wellbeing can inform multi-level interventions to reduce stigma and enhance health.
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Affiliation(s)
- Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Jesse I. R. Jenkinson
- Dalla Lana School of Public Health, Social and Behavioural Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Valerie Earnshaw
- Human Development and Family Studies, University of Delaware, Newark, Delaware, United States
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Ontario, Canada
| | - Mona R. Loutfy
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
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Abstract
HIV-related stigma is associated with many psychological challenges; however, minimal research has explored how perceived HIV-related stigma intersects with psychosocial issues that mothers living with HIV may experience including depression, perceived stress and social isolation. The present study aims to describe the correlates and predictors of HIV-related stigma in a cohort of women living with HIV (WLWH) from across Ontario, Canada during pregnancy and early postpartum. From March 2011 to December 2012, WLWH ≥ 18 years (n = 77) completed a study instrument measuring independent variables including sociodemographic characteristics, perceived stress, depression symptoms, social isolation, social support and perceived racism in the third trimester and 3, 6 and 12 months postpartum. Multivariable linear regression was employed to explore the relationship between HIV-related stigma and multiple independent variables. HIV-related stigma generally increased from pregnancy to postpartum; however, there were no significant differences in HIV-related stigma across all study time points. In multivariable regression, depression symptoms and perceived racism were significant predictors of overall HIV-related stigma from pregnancy to postpartum. The present analysis contributes to our understanding of HIV-related stigma throughout the pregnancy-motherhood trajectory for WLWH including the interactional relationship between HIV-related stigma and other psychosocial variables, most notably, depression and racism.
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Affiliation(s)
- Allyson Ion
- a School of Social Work , McMaster University , Hamilton , Ontario , Canada
| | - Anne C Wagner
- b Department of Psychology , Ryerson University , Toronto , Ontario , Canada
| | - Saara Greene
- a School of Social Work , McMaster University , Hamilton , Ontario , Canada
| | - Mona R Loutfy
- c Women's College Research Institute, Women's College Hospital , Toronto , Ontario , Canada.,d Department of Medicine , University of Toronto , Toronto , Ontario , Canada
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Remis RS, Liu J, Loutfy MR, Tharao W, Rebbapragada A, Huibner S, Kesler M, Halpenny R, Grennan T, Brunetta J, Smith G, Reko T, Kaul R. Prevalence of Sexually Transmitted Viral and Bacterial Infections in HIV-Positive and HIV-Negative Men Who Have Sex with Men in Toronto. PLoS One 2016; 11:e0158090. [PMID: 27391265 PMCID: PMC4938580 DOI: 10.1371/journal.pone.0158090] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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: 07/13/2015] [Accepted: 06/12/2016] [Indexed: 01/28/2023] Open
Abstract
Background Hepatitis B (HBV), hepatitis C (HCV) and other sexually transmitted infections (STIs) have been associated with HIV transmission risk and disease progression among gay men and other men who have sex with men (MSM), but the frequency and distribution of STIs in this community in Canada has not been extensively studied. Methods We recruited MSM living with and without HIV from a large primary care clinic in Toronto. Participants completed a detailed socio-behavioural questionnaire using ACASI and provided blood for syphilis, HIV, HBV and HCV, herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), and human cytomegalovirus (CMV) serology, urine for chlamydia and gonorrhea, and a self-collected anal swab for human papillomavirus (HPV) molecular diagnostics. Prevalences were expressed as a proportion and compared using chi-square. Results 442 MSM were recruited, 294 living with HIV and 148 without. Active syphilis (11.0% vs. 3.4%), ever HBV (49.4% vs. 19.1%), HCV (10.4% vs. 3.4%), HSV-2 (55.9% vs. 38.2%), CMV (98.3% vs. 80.3%) and high-risk (HR) anal HPV (67.6% vs. 51.7%) infections were significantly more common in men living with HIV. Chlamydia and gonorrhea were infrequent in both groups. Regardless of HIV infection status, age and number of lifetime male sexual partners were associated with HBV infection and lifetime injection drug use with HCV infection. Conclusions Syphilis and viral infections, including HBV, HCV, HSV-2, CMV, and HR-HPV, were common in this clinic-based population of MSM in Toronto and more frequent among MSM living with HIV. This argues for the implementation of routine screening, vaccine-based prevention, and education programs in this high-risk population.
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Affiliation(s)
- Robert S. Remis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Juan Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mona R. Loutfy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Ontario, Canada
| | - Anuradha Rebbapragada
- Public Health Laboratory–Toronto Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Sanja Huibner
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Maya Kesler
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Troy Grennan
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Graham Smith
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Tatjana Reko
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Rupert Kaul
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Ng R, Kendall CE, Burchell AN, Bayoumi AM, Loutfy MR, Raboud J, Glazier RH, Rourke S, Antoniou T. Emergency department use by people with HIV in Ontario: a population-based cohort study. CMAJ Open 2016; 4:E240-8. [PMID: 27398370 PMCID: PMC4933601 DOI: 10.9778/cmajo.20150087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Emergency department use may reflect poor access to primary care. Our objective was to compare rates and causes of emergency department use between adults living with and without HIV. METHODS We conducted a population-based study involving Ontario residents living with and without HIV between Apr. 1, 2011, and Mar. 31, 2012. We frequency matched adults with HIV to 4 HIV-negative people by age, sex and census division, and used random-effects negative binomial regression to compare rates of emergency department use. We classified visits as low urgency or high urgency, and also examined visits for ambulatory care sensitive conditions. Hospital admission following an emergency department visit was a secondary outcome. RESULTS We identified 14 534 people with HIV and 58 136 HIV-negative individuals. Rates of emergency department use were higher among people with HIV (67.3 v. 31.2 visits per 100 person-years; adjusted rate ratio 1.58, 95% confidence interval [CI] 1.51-1.65). Similar results were observed for low-urgency visits. With the exception of hypertension, visit rates for ambulatory care sensitive conditions were higher among people with HIV. People with HIV were also more likely than HIV-negative individuals to be admitted to hospital following an emergency department visit (adjusted odds ratio 1.55, 95% CI 1.43-1.69). INTERPRETATION Compared with HIV-negative individuals, people with HIV had high rates of emergency department use, including potentially avoidable visits. These findings strongly support the need for comprehensive care for people with HIV.
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Affiliation(s)
- Ryan Ng
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Claire E Kendall
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Ann N Burchell
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Ahmed M Bayoumi
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Mona R Loutfy
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Janet Raboud
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Richard H Glazier
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Sean Rourke
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
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Greene S, Ion A, Kwaramba G, Smith S, Loutfy MR. "Why are you pregnant? What were you thinking?": How women navigate experiences of HIV-related stigma in medical settings during pregnancy and birth. Soc Work Health Care 2015; 55:161-179. [PMID: 26684355 DOI: 10.1080/00981389.2015.1081665] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Having children is a growing reality for women living with HIV in Canada. It is imperative to understand and respond to women's unique experiences and psychosocial challenges during pregnancy and as mothers including HIV-related stigma. This qualitative study used a narrative methodological approach to understand women's experiences of HIV-related stigma as they navigate health services in pregnancy (n = 66) and early postpartum (n = 64). Narratives of women living with HIV expose the spaces where stigmatizing practices emerge as women seek perinatal care and support, as well as highlight the relationship between HIV-related stigma and disclosure, and the impact this has on women's pregnancy and birthing experiences.
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Affiliation(s)
- Saara Greene
- a School of Social Work , McMaster University , Hamilton , Ontario , Canada
| | - Allyson Ion
- a School of Social Work , McMaster University , Hamilton , Ontario , Canada
| | - Gladys Kwaramba
- c School of Social Work , McMaster University , Hamilton , Ontario , Canada
| | - Stephanie Smith
- c School of Social Work , McMaster University , Hamilton , Ontario , Canada
| | - Mona R Loutfy
- b Women's College Research Institute, Women's College Hospital , University of Toronto , Toronto, Ontario , Canada
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Margolick JB, Apuzzo L, Singer J, Wong H, Lee T, Gallant JE, El-Helou P, Loutfy MR, Rachlis A, Fraser C, Kasper K, Tremblay C, Tossonian H, Conway B. A Randomized Trial of Time-Limited Antiretroviral Therapy in Acute/Early HIV Infection. PLoS One 2015; 10:e0143259. [PMID: 26600459 PMCID: PMC4658016 DOI: 10.1371/journal.pone.0143259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/28/2015] [Accepted: 11/01/2015] [Indexed: 01/23/2023] Open
Abstract
Background It has been proposed that initiation of antiretroviral treatment (ART) very soon after establishment of HIV infection may be beneficial by improving host control of HIV replication and delaying disease progression. Methods People with documented HIV infection of less than 12 months’ duration in Baltimore MD and seven Canadian sites were randomized to either a) observation and deferred ART, or b) immediate treatment with ART for 12 months. All subjects not receiving ART were followed quarterly and permanent ART was initiated according to contemporaneous treatment guidelines. The endpoint of the trial was total ART-free time from study entry until initiation of permanent ART. Results One hundred thirteen people were randomized, 56 to the observation arm and 57 to the immediate treatment arm. Twenty-three had acute (<2 months) infection and 90 early (2–12 months) infection. Of those randomized to the immediate treatment arm, 37 completed 12 months of ART according to protocol, 9 declined to stop ART after 12 months, and 11 were nonadherent to the protocol or lost to follow-up. Comparing those in the observation arm to either those who completed 12 months of ART or all 56 who were randomized to immediate ART, there was no significant difference between the arms in treatment-free interval after study entry, which was about 18 months in both arms. Conclusions This study did not find a benefit from administration of a brief, time-limited (12-month) course of ART in acute or early HIV infection. Trial Registration ClinicalTrials.gov NCT00106171
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Affiliation(s)
- Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Linda Apuzzo
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Joel Singer
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Hubert Wong
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Terry Lee
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Joel E. Gallant
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | | | | | - Anita Rachlis
- Sunnybrook Health Sciences, Toronto, Ontario, Canada
| | | | - Kenneth Kasper
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cécile Tremblay
- Centre de recherché du Centre Hospitalier de l’ Université de Montréal, Montréal, Quebec, Canada
| | - Harout Tossonian
- Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada
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Tulloch TG, Rotondi NK, Ing S, Myers T, Calzavara LM, Loutfy MR, Hart TA. Retrospective reports of developmental stressors, syndemics, and their association with sexual risk outcomes among gay men. Arch Sex Behav 2015; 44:1879-89. [PMID: 26089251 PMCID: PMC4559573 DOI: 10.1007/s10508-015-0479-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/28/2014] [Accepted: 01/07/2015] [Indexed: 05/04/2023]
Abstract
Gay and bisexual men (GBM) continue to have a disproportionately higher HIV incidence than any other group in Canada and the United States. This study examined how multiple co-occurring psychosocial problems, also known as a syndemic, contribute to high-risk sexual behavior among GBM. It also examined the impact of early life adversity on high-risk sexual behavior as mediated by syndemic severity. A sample of 239 GBM completed self-report questionnaires at baseline and 6-month follow-up. Syndemic variables included depression, polysubstance use, and intimate partner violence. Early life adversity variables measured retrospectively included physical and verbal bullying by peers and physical and sexual abuse by adults. A Cochran-Armitage trend test revealed a proportionate increase between number of syndemic problems and engagement in high-risk sex (p < .0001), thereby supporting syndemic theory. All early life adversity variables were positively correlated with number of syndemic problems. A bootstrap mediation analysis revealed indirect effects of two types of early life adversity on high-risk sex via syndemic severity: verbal bullying by peers and physical abuse by adults. There was also an overall effect of physical bullying by peers on high-risk sexual behavior, but no specific direct or indirect effects were observed. Consistent with syndemic theory, results provide evidence that certain types of early life adversity impact high-risk sex later in life via syndemic problems. Behavioral interventions to reduce sexual risk among GBM should address anti-gay discrimination experienced before adulthood as well as adult psychological problems.
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Affiliation(s)
- Tyler G. Tulloch
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
| | - Nooshin K. Rotondi
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
- Present Address: Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
| | - Stanley Ing
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
| | - Ted Myers
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | | | - Mona R. Loutfy
- Department of Medicine, University of Toronto, Toronto, ON Canada
| | - Trevor A. Hart
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
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16
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Ng R, Macdonald EM, Yudin MH, Bayoumi AM, Loutfy MR, Raboud J, Masinde KI, Tharao WE, Brophy J, Glazier RH, Antoniou T. Maternal placental syndromes among women living with HIV in Ontario: a population-based study. CMAJ Open 2015; 3:E360-5. [PMID: 26770960 PMCID: PMC4701653 DOI: 10.9778/cmajo.20140112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Maternal placental syndromes are associated with adverse fetal outcomes and maternal cardiovascular disease. However, whether HIV infection increases the risk of maternal placental syndromes is unknown. Our objective was to compare the risk of maternal placental syndromes between women living with and without HIV infection in Ontario. METHODS We conducted a population-based study using health administrative data from Ontario. We identified all pregnancies resulting in a live birth between Apr. 1, 2002, and Mar. 31, 2011; we identified women living with HIV using a validated case-finding algorithm. Our primary composite outcome was maternal placental syndromes, defined as a diagnosis of preeclampsia, eclampsia, placental abruption or placental infarction. We used generalized estimating equations with a logit link function to derive adjusted odds ratios (AORs) and 95% confidence intervals (CI) for the association between HIV infection and maternal placental syndromes. RESULTS Data from 1 132 871 pregnancies were available for analysis; 634 (0.06%) of the pregnancies were in women living with HIV. After multivariable adjustment, we found no difference in the risk of maternal placental syndromes between women living with HIV and those without HIV infection (5.8% v. 5.6%; AOR 0.85 [95% CI 0.59-1.21]). An increased risk of maternal placental syndromes was associated with pre-existing diabetes (AOR 1.47 [95% CI 1.39-1.54]), pre-existing hypertension (AOR 4.28 [95% CI 4.15-4.42]) and chronic kidney disease (AOR 1.83 [95% CI 1.61-2.08]). INTERPRETATION Women with HIV are not at increased risk of maternal placental syndromes. Our results underscore the importance of optimizing the management of comorbid illness associated with maternal placental syndromes during the prenatal period for all women, irrespective of HIV status.
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Affiliation(s)
- Ryan Ng
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Erin M Macdonald
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Mark H Yudin
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Ahmed M Bayoumi
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Mona R Loutfy
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Janet Raboud
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Khatundi-Irene Masinde
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Wangari E Tharao
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Jason Brophy
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Richard H Glazier
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences (Ng, Macdonald, Loutfy, Raboud, Glazier, Antoniou); Li Ka Shing Knowledge Institute (Yudin, Antoniou, Bayoumi), St. Michael's Hospital; Centre for Research on Inner City Health (Yudin, Bayoumi), St. Michael's Hospital; Department of Obstetrics and Gynecology (Yudin), St. Michael's Hospital and University of Toronto; Department of Medicine (Loutfy, Bayoumi), University of Toronto; Women's College Research Institute (Loutfy, Masinde), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Dalla Lana School of Public Health (Raboud), University of Toronto; Women's Health in Women's Hands Community Health Centre (Tharao), Toronto, Ont.; Children's Hospital of Eastern Ontario and University of Ottawa (Brophy), Ottawa, Ont.; Department of Family and Community Medicine (Glazier, Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont
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17
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Macdonald EM, Ng R, Bayoumi AM, Raboud J, Brophy J, Masinde KI, Tharao WE, Yudin MH, Loutfy MR, Glazier RH, Antoniou T. Adverse Neonatal Outcomes Among Women Living With HIV: A Population-Based Study. J Obstet Gynaecol Can 2015; 37:302-309. [PMID: 26001682 DOI: 10.1016/s1701-2163(15)30279-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 10/22/2022]
Abstract
BACKGROUND There have been few population-based studies describing the risk of adverse neonatal outcomes among women living with HIV in Canada. Accordingly, we compared the risk of preterm birth (PTB), low birth weight (LBW) and small for gestational age births among Ontario women aged 18 to 49 years living with and without HIV infection. METHODS We conducted a population-based study using Ontario health administrative data. Generalized estimating equations with a logit link function were used to derive adjusted odds ratios (aORs) and 95% confidence intervals for the association of HIV infection with adverse neonatal outcomes. RESULTS Between 2002-2003 and 2010-2011, a total of 1 113 874 singleton live births were available for analysis, of which 615 (0.06%) were to women living with HIV. The proportion of singleton births that were SGA (14.6% vs. 10.3%; P < 0.001), PTB (14.6% vs. 6.3%; P < 0.001), and LBW (12.5% vs. 4.6%; P < 0.001) were higher among women living with HIV than among women without HIV. Following multivariable adjustment, the risks of PTB (aOR 1.76; 95% CI 1.38 to 2.24), SGA (aOR 1.43; 95% CI 1.12 to 1.81), and LBW (aOR 1.90; 95% CI 1.47 to 2.45) were higher for women living with HIV than for women without HIV. CONCLUSION Women with HIV are at higher risk of adverse neonatal outcomes than HIV-negative women. Further research is required to develop preconception and prenatal interventions that could reduce the excess burden of poor pregnancy outcomes among women living with HIV.
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Affiliation(s)
| | - Ryan Ng
- Institute for Clinical Evaluative Sciences, Toronto ON
| | - Ahmed M Bayoumi
- Institute for Clinical Evaluative Sciences, Toronto ON; Li Ka Shing Knowledge institute, Toronto ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto ON; Department of Medicine, University of Toronto, Toronto ON; Centre for Research on inner City Health, St. Michael's Hospital, Toronto ON
| | - Janet Raboud
- Institute for Clinical Evaluative Sciences, Toronto ON; Toronto General Research institute, University Health Network, Toronto ON; Dalla Lana School of Public Health, University of Toronto, Toronto ON
| | - Jason Brophy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa ON
| | | | - Wangari E Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto ON
| | - Mark H Yudin
- Li Ka Shing Knowledge institute, Toronto ON; Centre for Research on inner City Health, St. Michael's Hospital, Toronto ON; Department of Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto ON
| | - Mona R Loutfy
- Institute for Clinical Evaluative Sciences, Toronto ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto ON; Department of Medicine, University of Toronto, Toronto ON; Women's College Research institute, Women's College Hospital, Toronto ON
| | - Richard H Glazier
- Institute for Clinical Evaluative Sciences, Toronto ON; Li Ka Shing Knowledge institute, Toronto ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto ON; Centre for Research on inner City Health, St. Michael's Hospital, Toronto ON; Dalla Lana School of Public Health, University of Toronto, Toronto ON; Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto ON
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences, Toronto ON; Li Ka Shing Knowledge institute, Toronto ON; Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto ON; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON
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18
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Jaworsky D, Benoit A, Raboud J, O'Brien-Teengs D, Blitz S, Rourke SB, Burchell AN, Loutfy MR. Comparison of coping strategies and supports between aboriginal and non-aboriginal people living with HIV in Ontario. AIDS Care 2015; 28:63-9. [PMID: 26279181 DOI: 10.1080/09540121.2015.1061634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 10/23/2022]
Abstract
Complex historical and cultural factors have contributed to the HIV epidemic among Aboriginal populations in Canada. This study assesses social supports, adaptive and maladaptive coping mechanisms, stress, and mastery of Canadian-born Aboriginal and Canadian-born Caucasian people living with HIV in Ontario and posits that coping and social support are important micro- and meso-level factors associated with the epidemic. This cross-sectional analysis included questionnaire data collected from 2007 to 2011 at HIV clinics in Toronto. Categorical and continuous variables were compared using chi-square and Wilcoxon rank sum tests, respectively. Correlates of social support and coping were determined using univariate and multivariable linear regression. The analysis included 70 Aboriginal and 665 Caucasian participants. Aboriginal participants had lower levels of employment, education, and annual household income. Aboriginal participants reported more overall (7 vs. 4, p = 0.0003), ongoing (4 vs. 2, p = 0.0004), and early childhood (2 vs. 1, p = 0.02) stressors. Maladaptive coping, adaptive coping, and mastery scores were similar between Aboriginal and Caucasian participants. In multivariable analysis, injection drug use and lower education levels were significant correlates of higher maladaptive coping and lower overall support scores. Despite numerous socioeconomic challenges and personal stressors, Aboriginal people living with HIV who are accessing care exhibited comparable coping and mastery scores to Canadian-born Caucasian people living with HIV, suggesting remarkable strengths within Aboriginal people living with HIV and their communities.
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Affiliation(s)
- Denise Jaworsky
- a Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Anita Benoit
- b Women and HIV Research Program , Women's College Research Institute , Toronto , Ontario , Canada
| | - Janet Raboud
- c Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.,d Toronto General Research Institute , University Health Network, Toronto General Hospital , Toronto , Ontario , Canada
| | - Doe O'Brien-Teengs
- e Lakehead University , Thunder Bay , Ontario , Canada.,f Mushkego Cree, Weenusk First Nation , Thunder Bay , Ontario , Canada
| | - Sandra Blitz
- g University Health Network, Toronto General Hospital , Toronto , Canada
| | - Sean B Rourke
- h Ontario HIV Treatment Network , Toronto , Canada.,i Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada.,j Department of Psychiatry , University of Toronto , Toronto , Ontario , Canada
| | - Ann N Burchell
- c Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.,h Ontario HIV Treatment Network , Toronto , Canada
| | - Mona R Loutfy
- b Women and HIV Research Program , Women's College Research Institute , Toronto , Ontario , Canada.,c Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.,k Faculty of Medicine , University of Toronto , Toronto , Canada
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19
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Patterson S, Cescon A, Samji H, Chan K, Zhang W, Raboud J, Burchell AN, Cooper C, Klein MB, Rourke SB, Loutfy MR, Machouf N, Montaner JSG, Tsoukas C, Hogg RS. Life expectancy of HIV-positive individuals on combination antiretroviral therapy in Canada. BMC Infect Dis 2015; 15:274. [PMID: 26183704 PMCID: PMC4504463 DOI: 10.1186/s12879-015-0969-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [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: 08/27/2014] [Accepted: 05/29/2015] [Indexed: 02/01/2023] Open
Abstract
Background We sought to evaluate life expectancy and mortality of HIV-positive individuals initiating combination antiretroviral therapy (ART) across Canada, and to consider the potential error introduced by participant loss to follow-up (LTFU). Methods Our study used data from the Canadian Observational Cohort (CANOC) collaboration, including HIV-positive individuals aged ≥18 years who initiated ART on or after January 1, 2000. The CANOC collaboration collates data from eight sites in British Columbia, Ontario, and Quebec. We computed abridged life-tables and remaining life expectancies at age 20 and compared outcomes by calendar period and patient characteristics at treatment initiation. To correct for potential underreporting of mortality due to participant LTFU, we conservatively estimated 30 % mortality among participants lost to follow-up. Results 9997 individuals contributed 49,589 person-years and 830 deaths for a crude mortality rate of 16.7 [standard error (SE) 0.6] per 1000 person-years. When assigning death to 30 % of participants lost to follow-up, we estimated 1170 deaths and a mortality rate of 23.6 [SE 0.7] per 1000 person-years. The crude overall life expectancy at age 20 was 45.2 [SE 0.7] and 37.5 [SE 0.6] years after adjusting for LTFU. In the LTFU-adjusted analysis, lower life expectancy at age 20 was observed for women compared to men (32.4 [SE 1.1] vs. 39.2 [SE 0.7] years), for participants with injection drug use (IDU) history compared to those without IDU history (23.9 [SE 1.0] vs. 52.3 [SE 0.8] years), for participants reporting Aboriginal ancestry compared to those with no Aboriginal ancestry (17.7 [SE 1.5] vs. 51.2 [SE 1.0] years), and for participants with CD4 count <350 cells/μL compared to CD4 count ≥350 cells/μL at treatment initiation (36.3 [SE 0.7] vs. 43.5 [SE 1.3] years). Life expectancy at age 20 in the calendar period 2000–2003 was lower than in periods 2004–2007 and 2008–2012 in the LTFU-adjusted analyses (30.8 [SE 0.9] vs. 38.6 [SE 1.0] and 54.2 [SE 1.4]). Conclusions Life expectancy and mortality for HIV-positive individuals receiving ART differ by calendar period and patient characteristics at treatment initiation. Failure to consider LTFU may result in underestimation of mortality rates and overestimation of life expectancy. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0969-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sophie Patterson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada. .,Faculty of Health Sciences, BLU 9512, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Angela Cescon
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada. .,Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
| | - Hasina Samji
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
| | - Keith Chan
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
| | - Wendy Zhang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Division of Infectious Diseases, University Health Network, Toronto, Canada.
| | | | - Curtis Cooper
- The Ottawa Hospital Division of Infectious Diseases, University of Ottawa, Ottawa, Canada.
| | - Marina B Klein
- Faculty of Medicine, McGill University, Montreal, Canada. .,The Montreal Chest Institute, McGill University Health Centre, Montreal, Canada.
| | | | - Mona R Loutfy
- Faculty of Medicine, University of Toronto, Toronto, Canada. .,Maple Leaf Medical Clinic, Toronto, Canada. .,Women's College Research Institute, Toronto, Canada.
| | | | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada. .,Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - Chris Tsoukas
- Faculty of Medicine, McGill University, Montreal, Canada.
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada. .,Faculty of Health Sciences, BLU 9512, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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20
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Ng R, Macdonald EM, Loutfy MR, Yudin MH, Raboud J, Masinde KI, Bayoumi AM, Tharao WE, Brophy J, Glazier RH, Antoniou T. Adequacy of prenatal care among women living with human immunodeficiency virus: a population-based study. BMC Public Health 2015; 15:514. [PMID: 26058544 PMCID: PMC4462120 DOI: 10.1186/s12889-015-1842-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 08/12/2014] [Accepted: 05/14/2015] [Indexed: 11/10/2022] Open
Abstract
Background Prenatal care reduces perinatal morbidity. However, there are no population-based studies examining the adequacy of prenatal care among women living with HIV. Accordingly, we compared the prevalence of adequate prenatal care among women living with and without HIV infection in Ontario, Canada. Methods Using administrative data in a universal single-payer setting, we determined the proportions of women initiating care in the first trimester and receiving adequate prenatal care according to the Revised-Graduated Prenatal Care Utilization Index . We also determined the proportion of women with HIV receiving adequate prenatal care by immigration status. We used generalized estimating equations with a logit link function to derive adjusted odds ratios (aORs) and 95 % confidence intervals (CI) for all analyses. Results Between April 1, 2002 and March 31, 2011, a total of 1,132,135 pregnancies were available for analysis, of which 634 (0.06 %) were among women living with HIV. Following multivariable adjustment, women living with HIV were less likely to receive adequate prenatal care (36.1 % versus 43.3 %; aOR 0.74, 95 % CI 0.62 to 0.88) or initiate prenatal care in the first trimester (50.8 % versus 70.0 %; aOR 0.51, 95 % CI 0.43 to 0.60) than women without HIV. Among women with HIV, recent (i.e. ≤ 5 years) immigrants from Africa and the Caribbean were less likely to receive adequate prenatal care (25.5 % versus 38.5 %; adjusted odds ratio 0.51; 95 % CI, 0.32 to 0.81) than Canadian-born women. Conclusion Despite universal health care, disparities exist in the receipt of adequate prenatal care between women living with and without HIV. Interventions are required to ensure that women with HIV receive timely and adequate prenatal care. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1842-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ryan Ng
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | - Erin M Macdonald
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | - Mona R Loutfy
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,Department of Medicine, University of Toronto, Toronto, Ontario, Canada. .,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
| | - Mark H Yudin
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. .,Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada. .,Department of Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
| | - Janet Raboud
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. .,Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | | | - Ahmed M Bayoumi
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,Department of Medicine, University of Toronto, Toronto, Ontario, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. .,Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Wangari E Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto, Ontario, Canada.
| | - Jason Brophy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada.
| | - Richard H Glazier
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. .,Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. .,Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. .,Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
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Loutfy MR, Antoniou T, Shen S, Diong C, Vlaicu M, Halpenny R, Kovacs C, Fletcher D, Raboud JM. Virologic and Immunologic Impact and Durability of Enfuvirtide-Based Antiretroviral Therapy in HIV-Infected Treatment-Experienced Patients in a Clinical Setting. HIV Clinical Trials 2015; 8:36-44. [PMID: 17434847 DOI: 10.1310/hct0801-36] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of enfuvirtide-based therapy in treatment-experienced patients in a clinical setting. METHOD Retrospective study of treatment-experienced patients receiving enfuvirtide-based therapy for a minimum of 2 months. Endpoints included virologic suppression, virologic rebound, immunologic response, and adverse events. RESULTS Sixty-four patients were eligible for inclusion in the analysis. Median baseline viral load and CD4+ count were 4.7 log10 copies/mL (interquartile range [IQR], 4.0-5.2) and 150 cells/mm3 (IQR, 60-250), respectively. At month 12, viral load declined by a median of 2.53 log10 copies/mL (IQR, 0.97-3.12). The unadjusted median time to virologic suppression was 7.7 months (95% CI 4.1-10.4 months). Baseline viral load and number of protease inhibitors in the current regimen were significantly associated with virologic suppression following multivariate analysis (hazard ratio [HR] 0.45, 95% CI 0.31-0.63, p < .0001, and HR 0.51, 95% CI 0.27-0.94, p = .03, respectively). Among the 42 patients who attained sustained virologic suppression, 10 experienced virologic rebound during a median follow-up of 13.3 months (IQR, 7.0-19.1). Injection site reactions were reported in 33 (52%) patients, resulting in treatment discontinuation in nine patients. CONCLUSION Enfuvirtide-based therapy provides durable antiretroviral activity for treatment-experienced patients in a clinical setting.
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Affiliation(s)
- M R Loutfy
- Department of Medicine, University of Toronto, Toronto, Ontario Maple Leaf Medical Clinical, Toronto, Ontario, Canada.
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Loutfy MR, Ackad N, Antoniou T, Baril JG, Conway B, de Wet J, Trottier B, Kovacs CM, Thompson W, Martel AY, Trottier S, Rouleau D, Shafran SD, Rachlis A, Fraser C, Smaill F, Walmsley SL, Tseng AL, Sampalis JS. Randomized Controlled Trial of Once-Daily Tenofovir, Lamivudine, and Lopinavir/Ritonavir Versus Remaining on the Same Regimen in Virologically Suppressed HIV-Infected Patients on Their First PI-Containing HAART Regimen. HIV Clinical Trials 2015; 8:259-68. [DOI: 10.1310/hct0805-259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Raboud J, Blitz S, Walmsley S, Thompson C, Rourke SB, Loutfy MR. Effect of Gender and Calendar Year on Time to and Duration of Virologic Suppression Among Antiretroviral-Naïve HIV-Infected Individuals Initiating Combination Antiretroviral Therapy. HIV Clinical Trials 2015; 11:340-50. [DOI: 10.1310/hct1106-340] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Papp E, Mohammadi H, Loutfy MR, Yudin MH, Murphy KE, Walmsley SL, Shah R, MacGillivray J, Silverman M, Serghides L. HIV protease inhibitor use during pregnancy is associated with decreased progesterone levels, suggesting a potential mechanism contributing to fetal growth restriction. J Infect Dis 2015; 211:10-8. [PMID: 25030058 PMCID: PMC4264589 DOI: 10.1093/infdis/jiu393] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [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: 02/02/2014] [Accepted: 05/09/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Protease inhibitor (PI)-based combination antiretroviral therapy (cART) is administered during pregnancy to prevent perinatal human immunodeficiency virus (HIV) transmission. However, PI use has been associated with adverse birth outcomes, including preterm delivery and small-for-gestational-age (SGA) births. The mechanisms underlying these outcomes are unknown. We hypothesized that PIs contribute to these adverse events by altering progesterone levels. METHODS PI effects on trophoblast progesterone production were assessed in vitro. A mouse pregnancy model was used to assess the impact of PI-based cART on pregnancy outcomes and progesterone levels in vivo. Progesterone levels were assessed in plasma specimens from 27 HIV-infected and 17 HIV-uninfected pregnant women. RESULTS PIs (ritonavir, lopinavir, and atazanavir) but not nucleoside reverse transcriptase inhibitors (NRTIs) or nonnucleoside reverse transcriptase inhibitors reduced trophoblast progesterone production in vitro. In pregnant mice, PI-based cART but not dual-NRTI therapy was associated with significantly lower progesterone levels that directly correlated with fetal weight. Progesterone supplementation resulted in a significant improvement in fetal weight. We observed lower progesterone levels and smaller infants in HIV-infected women receiving PI-based cART, compared with the control group. In HIV-infected women, progesterone levels correlated significantly with birth weight percentile. CONCLUSIONS Our data suggest that PI use in pregnancy may lead to lower progesterone levels that could contribute to adverse birth outcomes.
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Affiliation(s)
- Eszter Papp
- Toronto General Research Institute, University Health Network
| | | | - Mona R. Loutfy
- Women's College Research Institute, Women's College Hospital
- University of Toronto
| | | | | | - Sharon L. Walmsley
- Toronto General Research Institute, University Health Network
- University of Toronto
| | | | | | - Michael Silverman
- University of Toronto
- Lakeridge Health, Rouge Valley Hospital, Ajax, Canada
| | - Lena Serghides
- Toronto General Research Institute, University Health Network
- Women's College Research Institute, Women's College Hospital
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Loutfy MR, V LK, Mohammed S, Wu W, Muchenje M, Masinde K, Salam K, Soje L, Gregorovich S, Tharao W. Recruitment of HIV-Positive Women in Research: Discussing Barriers, Facilitators, and Research Personnel's Knowledge. Open AIDS J 2014; 8:58-65. [PMID: 25624955 PMCID: PMC4302460 DOI: 10.2174/1874613601408010058] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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] [Received: 10/05/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 11/22/2022] Open
Abstract
Background : Women have historically been under-represented in HIV research, partly due to ineffective recruitment strategies. Objective : To improve the existing understanding of recruitment for HIV-positive women based on a province-wide cross-sectional study. Methods : A survey was emailed to all site coordinators who recruited participants in a study involving 490 HIV-positive women living in Ontario, Canada. The survey consisted of questions regarding the important recruitment barriers and successes. Quantitative data were then contextualized within extensive knowledge from research personnel and team members. Results : Completed surveys were received from (89%) site coordinators (34/38) and 98% (31/34) were women. The highest ranked recruitment barriers identified were: sensitivity of the research topic (59%), time/availability constraints (59%), language barriers (53%), HIV disclosure/stigma issues (47%), lack of trust of research personnel (41%), fear of research (41%) and inaccessibility to child care and transportation (41%). The respondents felt that the most important personal attributes for recruitment were research personnel who were respectful (97%), skilled (91%), flexible (88%) and empathetic (88%) and had good communication skills (88%). The most successful recruitment strategies identified were: developing a strong rapport (88%) that was facilitated by an empathetic relationship (100%), acknowledging the sensitive nature of the research topic (94%), providing cash financial compensation (88%), and developing recruitment strategies unique to women (88%). Conclusion : There are differences in the approaches needed for the recruitment of HIV-positive women in research. For successful recruitment of HIV-positive women, a strong rapport between the research personnel and study participants is important. This rapport is facilitated by having study personnel who are respectful, trustworthy, empathetic, and flexible. Population-specific recruitment strategies are important to ensure adequate recruitment of minority groups in research with greater gender consideration for women requiring specific attention.
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Affiliation(s)
- Mona R Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada ; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Logan Kennedy V
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Saira Mohammed
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Wei Wu
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Marvelous Muchenje
- Women's Health in Women's Hands Community Health Centre, Toronto, Ontario, Canada
| | - Khatundi Masinde
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Khaled Salam
- AIDS Committee of Ottawa, Ottawa, Ontario, Canada
| | - Lena Soje
- Black Coalition for AIDS Prevention, Toronto, Ontario, Canada
| | | | - Wangari Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto, Ontario, Canada
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Logie CH, Navia D, Loutfy MR. Correlates of a lifetime history of sexually transmitted infections among women who have sex with women in Toronto, Canada: results from a cross-sectional internet-based survey. Sex Transm Infect 2014; 91:278-83. [PMID: 25477474 DOI: 10.1136/sextrans-2014-051745] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 06/24/2014] [Accepted: 11/12/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Structural drivers of sexually transmitted infections (STI) among women who have sex with women (WSW) have been underexplored. The study objective was to understand sociodemographic, individual, structural, and sexual health factors associated with a lifetime history of STI among WSW. METHODS A cross-sectional survey was conducted in 2012 to engage a peer-driven recruitment sample of WSW in Toronto, Canada. Data were collected among a convenience sample of 466 WSW using an online structured interview. RESULTS Approximately one-fifth (n=89, 19.1%) of participants reported an STI diagnosis history. Participants identifying as bisexual were more likely, and lesbians less likely, to report an STI history than those identifying as queer. In multivariate logistic regression analyses adjusted for sociodemographic variables, STI history was associated with intrapersonal (STI knowledge, HIV/STI risk perceptions), interpersonal (male sex partners in past 3 months, number of lifetime sexual partners) and structural (sexual stigma, history of forced sex, belief healthcare provider (HCP) uncomfortable addressing sexual orientation) factors as well as sexual healthcare uptake (ever had STI/HIV test, STI/Pap test in past 2 years). Gender-non-conforming participants were less likely to report an STI history. CONCLUSIONS This research is among the first to examine intrapersonal, interpersonal and structural factors correlated with an STI history among WSW. Findings highlight the importance of STI prevention strategies for WSW to be tailored to sexual identity, with particular attention to bisexual women's needs. Interventions should connect to sexual healthcare, address sexual stigma and train HCP to better meet the needs of WSW.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniela Navia
- Department of Anthropology, University of Calgary, Calgary, Alberta, Canada
| | - Mona R Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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Wagner AC, Ivanova EL, Hart TA, Loutfy MR. Examining the Traits-Desires-Intentions-Behavior (TDIB) model for fertility planning in women living with HIV in Ontario, Canada. AIDS Patient Care STDS 2014; 28:594-601. [PMID: 25291213 DOI: 10.1089/apc.2014.0075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objective of this study was to determine the predictors of fertility behavior (i.e., trying to become pregnant) in a large representative sample of women living with HIV of reproductive age in Ontario, Canada. The Traits-Desires-Intentions-Behavior model was used to examine the key predictors of reproductive decision making and behavior. A total of 320 women living with HIV were included in the current analysis. The women living with HIV were between the ages of 18 and 52 (mean=37.23, SD=7.53), 56.4% had at least one child living in the home, over 40% identified as being of African ethnicity, and the average time since HIV diagnosis was 10.49 years (SD=5.71). In hierarchical multilevel analysis, perceived family support for trying to become pregnant, living in a large metropolitan city (i.e., Toronto), women's fertility desires, and fertility intentions were associated with fertility behavior (χ(2)9=59.97, p<0.001). As only 10.6% of participants reported engaging in fertility-related behavior, while 57.5% intended a pregnancy in the future, identifying barriers to fertility and discrepancies between intentions and behaviors can support policy programs and assist health care providers to better facilitate the fertility goals of women living with HIV.
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Affiliation(s)
- Anne C. Wagner
- Department of Psychology, Ryerson University, Toronto, Canada
| | | | - Trevor A. Hart
- Department of Psychology, Ryerson University, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mona R. Loutfy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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Samji H, Taha TE, Moore D, Burchell AN, Cescon A, Cooper C, Raboud JM, Klein MB, Loutfy MR, Machouf N, Tsoukas CM, Montaner JSG, Hogg RS. Predictors of unstructured antiretroviral treatment interruption and resumption among HIV-positive individuals in Canada. HIV Med 2014; 16:76-87. [PMID: 25174373 DOI: 10.1111/hiv.12173] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Sustained optimal use of combination antiretroviral therapy (cART) has been shown to decrease morbidity, mortality and HIV transmission. However, incomplete adherence and treatment interruption (TI) remain challenges to the full realization of the promise of cART. We estimated trends and predictors of treatment interruption and resumption among individuals in the Canadian Observational Cohort (CANOC) collaboration. METHODS cART-naïve individuals ≥ 18 years of age who initiated cART between 2000 and 2011 were included in the study. We defined TIs as ≥ 90 consecutive days off cART. We used descriptive analyses to study TI trends over time and Cox regression to identify factors predicting time to first TI and time to treatment resumption after a first TI. RESULTS A total of 7633 participants were eligible for inclusion in the study, of whom 1860 (24.5%) experienced a TI. The prevalence of TI in the first calendar year of cART decreased by half over the study period. Our analyses highlighted a higher risk of TI among women [adjusted hazard ratio (aHR) 1.59; 95% confidence interval (CI) 1.33-1.92], younger individuals (aHR 1.27; 95% CI 1.15-1.37 per decade increase), earlier treatment initiators (CD4 count ≥ 350 vs. <200 cells/μL: aHR 1.46; 95% CI 1.17-1.81), Aboriginal participants (aHR 1.67; 95% CI 1.27-2.20), injecting drug users (aHR 1.43; 95% CI 1.09-1.89) and users of zidovudine vs. tenofovir in the initial cART regimen (aHR 2.47; 95% CI 1.92-3.20). Conversely, factors predicting treatment resumption were male sex, older age, and a CD4 cell count <200 cells/μL at cART initiation. CONCLUSIONS Despite significant improvements in cART since its advent, our results demonstrate that TIs remain relatively prevalent. Strategies to support continuous HIV treatment are needed to maximize the benefits of cART.
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Affiliation(s)
- H Samji
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
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Yang H, Pidgorna A, Loutfy MR, Shuen P. Effects of interruptions of controlled-rate freezing on the viability of umbilical cord blood stem cells. Transfusion 2014; 55:70-8. [DOI: 10.1111/trf.12774] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/20/2014] [Accepted: 05/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Hongyou Yang
- Progenics Cord Blood Cryobank; Women's College Research Institute; Women's College Hospital; University of Toronto; North York General Hospital; Toronto Ontario Canada
| | - Alla Pidgorna
- Progenics Cord Blood Cryobank; Women's College Research Institute; Women's College Hospital; University of Toronto; North York General Hospital; Toronto Ontario Canada
| | - Mona R. Loutfy
- Progenics Cord Blood Cryobank; Women's College Research Institute; Women's College Hospital; University of Toronto; North York General Hospital; Toronto Ontario Canada
| | - Paul Shuen
- Progenics Cord Blood Cryobank; Women's College Research Institute; Women's College Hospital; University of Toronto; North York General Hospital; Toronto Ontario Canada
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Aljassem K, Raboud JM, Hart TA, Benoit A, Su D, Margolese SL, Rourke SB, Rueda S, Burchell A, Cairney J, Shuper P, Loutfy MR. Gender Differences in Severity and Correlates of Depression Symptoms in People Living with HIV in Ontario, Canada. ACTA ACUST UNITED AC 2014; 15:23-35. [DOI: 10.1177/2325957414536228] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigates the differences in severity and correlates of depression symptoms among 1069 men and 267 women living with HIV in Ontario, Canada, who completed the 20-item Center for Epidemiologic Studies Depression Scale (CES-D). Women had higher CES-D scores than that of men (median [interquartile range]: 13 [5-26] versus 9 [3-20], P = .0004). More women had total CES-D scores >15 (mild-moderate depression; 44% versus 33%, P = .002) and >21 (severe depression; 31% versus 23%, P = .003). Unlike men, at age 40, women’s scores increased yearly (0.4 per increased year, P = .005). The distribution of scores differed by gender: There was no difference in the 10th percentile of depression scores, 0 (95% confidence interval [CI]: 1.0-1.0) but the 75th percentile of depression scores for women was 6 (95% CI: 2.0-10.0) points higher than that of men. Important gender differences exist in depression symptoms and in correlates of symptoms in people living with HIV.
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Affiliation(s)
- Kinda Aljassem
- Department of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Janet M. Raboud
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Trevor A. Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Ryerson University, Toronto Ontario, Canada
| | - Anita Benoit
- Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - DeSheng Su
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Shari L. Margolese
- Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Sean B. Rourke
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Department of Psychiatry, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Sergio Rueda
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Department of Psychiatry, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Ann Burchell
- Department of Psychology, Ryerson University, Toronto Ontario, Canada
| | - John Cairney
- Department of Family Medicine and Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Paul Shuper
- Department of Psychology, University of Toronto, Toronto, Canada
| | - Mona R. Loutfy
- Department of Medicine, University of Toronto, Toronto, Ontario Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Logie CH, Navia D, Rwigema MJ, Tharao W, Este D, Loutfy MR. A group-based HIV and sexually transmitted infections prevention intervention for lesbian, bisexual, queer and other women who have sex with women in Calgary and Toronto, Canada: study protocol for a non-randomised cohort pilot study. BMJ Open 2014; 4:e005190. [PMID: 24760356 PMCID: PMC4010811 DOI: 10.1136/bmjopen-2014-005190] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 03/27/2014] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The limited research that exists suggests that lesbian, bisexual queer (LBQ) and other women who have sex with women are at similar risk for sexually transmitted infections (STI) as heterosexual women. However, scant research has evaluated HIV and STI prevention strategies for LBQ women. The authors present the rationale and study protocol for developing and pilot testing a psychoeducational group-based HIV and STI prevention intervention with LBQ women in Calgary and Toronto, Canada. METHODS AND ANALYSIS This is a multicentre non-randomised cohort pilot study. The target population is LBQ women in Calgary and Toronto, Canada. The authors aim to recruit 40 participants using purposive peer-driven recruitment methods. Participants will conduct a pretest followed by a 2-day group programme of six 2 h sessions addressing stigma, STI and HIV prevention, healthy relationships, safer sex self-efficacy, self-worth, social support and LBQ community engagement. Participants will conduct a post-test directly following the intervention and 6 weeks after the intervention. The primary outcome is safer sex practices; our prespecified index of clinically significant change is an effect size of 0.50. Secondary outcomes include: safer sex self-efficacy, STI testing frequency, STI knowledge, resilient coping, social support, sexual stigma, access to care, depression and self-esteem. We will conduct mixed-effects regression to calculate mean outcome pre-post test score change. ETHICS AND DISSEMINATION Research ethics approval was attained from the Office of Research Ethics (REB: 29291), University of Toronto, Toronto, Ontario, Canada. Trial results will be published according to the Transparent Reporting of Evaluations with Non-randomised Designs (TREND) statement, regardless of the outcomes. TRIAL REGISTRATION NUMBER This study is registered at http://clinicaltrials.gov, registration number NCT02067845.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Daniela Navia
- Faculty of Arts, University of Calgary, Calgary, Canada
| | - Marie-Jolie Rwigema
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Wangari Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto, Canada
| | - David Este
- Faculty of Social Work, University of Calgary, Calgary, Canada
| | - Mona R Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
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Antoniou T, Zagorski B, Macdonald EM, Bayoumi AM, Raboud J, Brophy J, Masinde KI, Tharao WE, Yudin MH, Ng R, Loutfy MR, Glazier RH. Trends in live birth rates and adverse neonatal outcomes among HIV-positive women in Ontario, Canada, 2002-2009: a descriptive population-based study. Int J STD AIDS 2014; 25:960-6. [PMID: 24648318 DOI: 10.1177/0956462414526861] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 11/16/2022]
Abstract
To characterise trends in live birth rates, adverse neonatal outcomes and socio-demographic characteristics of pregnant women with diagnosed HIV between the ages of 18 and 49 in Ontario, Canada from 1 April 2002 to 31 March 2010, we conducted a population-based study. Utilising linked administrative healthcare databases we used generalised estimating equations to characterise secular trends and examine the association between live births and socio-demographic characteristics, including age, region of birth and neighbourhood income quintile. Between 2002/2003 and 2009/2010, there were 551 live births during 15,610 person-years of follow-up. The proportion of HIV-positive mothers originally from Africa or the Caribbean increased from 26.7% to 51.6% over the study period. The risk of pre-term (risk ratio 2.13, 95% confidence interval 1.74 to 2.61) and small for gestational age births (risk ratio 1.53, 95% confidence interval 1.20 to 1.94) was higher in women with HIV compared with provincial estimates for these outcomes. Women with HIV have rates of pre-term and small for gestational age births that exceed provincial estimates for these outcomes. Further research is required to identify factors mediating these disparities that are amenable to pre-natal risk reduction initiatives.
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Affiliation(s)
- Tony Antoniou
- Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Canada The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Brandon Zagorski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Ahmed M Bayoumi
- The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada Institute for Clinical Evaluative Sciences, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada Department of Medicine, University of Toronto, Toronto, Canada Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON Canada
| | - Janet Raboud
- Institute for Clinical Evaluative Sciences, Toronto, Canada Toronto General Research Institute, University Health Network, Toronto, ON Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Jason Brophy
- Children's Hospital of Eastern Ontario, Ottawa, ON Canada
| | | | | | - Mark H Yudin
- The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON Canada Department of Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto, ON Canada
| | - Ryan Ng
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Mona R Loutfy
- Institute for Clinical Evaluative Sciences, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada Department of Medicine, University of Toronto, Toronto, Canada Women's College Research Institute, Women's College Hospital, Toronto, ON Canada
| | - Richard H Glazier
- Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Canada The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada Institute for Clinical Evaluative Sciences, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
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Logie CH, Daniel C, Newman PA, Weaver J, Loutfy MR. A psycho-educational HIV/STI prevention intervention for internally displaced women in Leogane, Haiti: results from a non-randomized cohort pilot study. PLoS One 2014; 9:e89836. [PMID: 24587068 PMCID: PMC3938530 DOI: 10.1371/journal.pone.0089836] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 01/25/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little evidence exists regarding efficacious HIV and sexually transmitted infections (STI) prevention interventions with internally displaced populations. Internally displaced women are at elevated risk for HIV/STI due to limited access to health services, heightened poverty and social network breakdown. The FASY (Famn an Aksyon Pou Sante' Yo) (Women Taking Action For Their Health) study examined the effectiveness of a peer health worker (PHW) delivered psycho-educational HIV/STI pilot study with internally displaced women in Leogane, Haiti. METHOD This was a non-randomized cohort pilot study. Participants completed a computer-assisted pre-test programmed on Android tablet PCs followed by an HIV/STI educational video-based session and a 6-week psycho-educational group program of weekly meetings. Participants completed a post-test upon completion of group sessions. The primary outcome was HIV knowledge; our pre-specified index of clinically significant change was an effect size of 0.30. Secondary outcomes included: STI knowledge, condom use, social support, resilient coping, depression and relationship control. We used mixed-effects regression to calculate mean outcome pre-post score change. This study was registered (clinicaltrials.gov, NCT01492829). RESULTS Between January 1-April 30, 2012 we assigned 200 participants to the study. The majority of participants (n = 176, 88%) completed the study and were followed up at 8 weeks, finishing April 30, 2012. Adjusted for socio-demographic characteristics, HIV knowledge (β = 4.81; 95% CI 4.36-5.26), STI knowledge (β = 0.84; 95% CI 0.70-0.99), condom use (AOR = 4.05, 95% CI 1.86-8.83), and depression (β = -0.63, 95% CI -0.88--0.39) scores showed statistically significant change post-intervention (p<0.05). CONCLUSIONS This pilot study evaluated a PHW psycho-educational HIV/STI prevention intervention among internally displaced women in post-earthquake Haiti. Pilot studies are an important approach to understand feasibility and scientific impacts of HIV prevention strategies in disaster contexts. Study results may inform HIV prevention interventions among internally displaced women in Haiti and can be tested for applicability with internally displaced women globally. ClinicalTrials.gov: Identifier NCT01492829, URL: http://clinicaltrials.gov/ct2/show/NCT01492829?term=logie&rank=1.
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Affiliation(s)
- Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Women's College Research Institute, University of Toronto, Toronto, Canada
| | - CarolAnn Daniel
- Faculty of Social Work, Adelphi University, New York, United States of America
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - James Weaver
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Mona R. Loutfy
- Women's College Research Institute, University of Toronto, Toronto, Canada
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Abstract
In 2003, an outbreak of a novel respiratory virus exploded from mainland China into an international issue, catching the world by surprise. The ensuing challenges to hospital and public health workers rose to a level never before seen in healthcare, in part due to the unknown nature of the disease, the fear of the human-to-human transmission and the significant media involvement. A new coronavirus was identified as the causative agent and named the severe acute respiratory syndrome-associated virus. A number of antiviral and anti-inflammatory treatment strategies were explored during the epidemic, with varying success. Following the epidemic, in vitro antiviral analyses of numerous compounds have been conducted. This review summarizes treatment agents assessed during and after the 2003 severe acute respiratory syndrome outbreak, with the aim of guiding future decision makers should the virus return.
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Affiliation(s)
- Stephen Chihrin
- University of Western Ontario , Faculty of Medicine, London, Ontario, Canada
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Antoniou T, Loutfy MR, Brunetta J, Smith G, Halpenny R, la Porte C. Pharmacokinetics of raltegravir in the semen of HIV-infected men. Antivir Ther 2014; 19:607-11. [DOI: 10.3851/imp2750] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
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Palmer AK, Cescon A, Chan K, Cooper C, Raboud JM, Miller CL, Burchell AN, Klein MB, Machouf N, Montaner JSG, Tsoukas C, Hogg RS, Loutfy MR. Factors Associated with Late Initiation of Highly Active Antiretroviral Therapy among Young HIV-Positive Men and Women Aged 18 to 29 Years in Canada. ACTA ACUST UNITED AC 2013; 13:56-62. [DOI: 10.1177/2325957413510606] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Initiating highly active antiretroviral therapy (HAART) with low CD4 counts or AIDS-defining illnesses (ADIs) increases risk of treatment failure and death. We examined factors associated with late initiation among 18- to 29-year-olds within the Canadian Observational Cohort (CANOC) collaboration, a multi-site study of HIV-positive persons who initiated HAART after 2000. Late initiation was defined as beginning HAART with a CD4 count <200 cells/mm3 and/or having a baseline ADI. Multivariable logistic regression was used to identify independent correlates of late initiation. In total, 1026 individuals (422 from British Columbia, 400 from Ontario, and 204 from Quebec) met our age criteria. At HAART initiation, median age was 27 years (interquartile range, 24, 28 years). A total of 412 individuals (40%) identified as late initiators. Late initiation was associated with female gender, age >25 years at initiation, initiating treatment in earlier years, and having higher baseline viral load. The high number of young adults in our cohort starting HAART late indicates important target populations for specialized services, increased testing, and linkages to care.
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Affiliation(s)
- Alexis K. Palmer
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Angela Cescon
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Keith Chan
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Curtis Cooper
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Janet M. Raboud
- University of Toronto, Toronto, ON, Canada
- Division of Infectious Diseases, University Health Network, Toronto, ON, Canada
| | - Caroline L. Miller
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Marina B. Klein
- Faculty of Medicine, McGill University, Montreal, QC, Canada
- The Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Nima Machouf
- Clinique Medicale l’Actuel, Montreal, QC, Canada
| | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chris Tsoukas
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Mona R. Loutfy
- University of Toronto, Toronto, ON, Canada
- Maple Leaf Medical Clinic, Toronto, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
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Benoit AC, Light L, Burchell AN, Gardner S, Rourke SB, Wobeser W, Loutfy MR. Demographic and clinical factors correlating with high levels of psychological distress in HIV-positive women living in Ontario, Canada. AIDS Care 2013; 26:694-701. [PMID: 24215281 DOI: 10.1080/09540121.2013.855301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The concept of psychological distress includes a range of emotional states with symptoms of depression and anxiety and has yet to be reported in HIV-positive women living in Ontario, Canada, who are known to live with contributing factors. This study aimed to determine the prevalence, severity, and correlates of psychological distress among women accessing HIV care participating in the Ontario HIV Treatment Network Cohort Study using the Kessler Psychological Distress Scale (K10). The K10 is a 10-item, five-level response scale. K10 values range from 10 to 50 with values less than or equal to 19 categorized as not clinically significant, scores between 20 and 24 as moderate levels, 25-29 as high, and 30-50 as very high psychological distress. Correlates of psychological distress were assessed using the Pearson's chi-square test and univariate and multivariate logistic regression analysis. Moderate, high, and very high levels of psychological distress were experienced by 16.9, 10.4, and 15.1% of the 337 women in our cohort, respectively, with 57.6% reporting none. Psychological distress levels greater than 19, correlated with being unemployed (vs. employed/student/retired; AOR = 0.33, 95% CI: 0.13-0.83), living in a household without their child/children (AOR = 2.45, 95% CI: 1.33-4.52), CD4 counts < 200 cells/mm(3) (AOR = 2.07, 95% CI: 0.89-4.80), and to a lesser degree an education of some college or less (vs. completed college or higher; AOR=1.71, 95% CI: 0.99-2.95). Age and ethnicity, a priori variables of interest, did not correlate with psychological distress. Findings suggest that socioeconomic factors which shape the demography of women living with HIV in Ontario, low CD4 counts, and losing the opportunity to care for their child/children has a significant relationship with psychological distress. Approaches to manage psychological distress should address and make considerations for the lived experiences of women since they can act as potential barriers to improving psychological well-being.
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Affiliation(s)
- Anita C Benoit
- a Department of Medicine , Women's College Research Institute, Women's College Hospital , Toronto , ON , Canada
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Kennedy VL, Serghides L, Raboud JM, Su D, Blitz S, Hart TA, Walmsley SL, Angel JB, Smaill FM, Ralph ED, Tharao WE, Loutfy MR. The importance of motherhood in HIV-positive women of reproductive age in Ontario, Canada. AIDS Care 2013; 26:777-84. [DOI: 10.1080/09540121.2013.855295] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- V. Logan Kennedy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Lena Serghides
- Sandra Rotman Centre for Global Health, Toronto General Research Institute, University Health Network, Toronto, Canada
| | - Janet M. Raboud
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - DeSheng Su
- University Health Network, Toronto, Ontario, Canada
| | - Sandra Blitz
- University Health Network, Toronto, Ontario, Canada
| | - Trevor A. Hart
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Sharon L. Walmsley
- University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan B. Angel
- Ottawa Health Research Institute and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Fiona M. Smaill
- McMaster University Medical Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Edward D. Ralph
- Infectious Diseases Care Program, St. Joseph's Health Care, London, Ontario, Canada
| | | | - Mona R. Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ndumbi P, Gillis J, Raboud J, Cooper C, Hogg RS, Montaner JSG, Burchell AN, Loutfy MR, Machouf N, Klein MB, Tsoukas C. Characteristics and determinants of T-cell phenotype normalization in HIV-1-infected individuals receiving long-term antiretroviral therapy. HIV Med 2013; 15:153-64. [DOI: 10.1111/hiv.12096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2013] [Indexed: 01/05/2023]
Affiliation(s)
- P Ndumbi
- McGill University Health Centre; Montreal Canada
| | - J Gillis
- Toronto General Research Institute; University Health Network; Toronto Canada
| | - J Raboud
- Toronto General Research Institute; University Health Network; Toronto Canada
- University of Toronto; Toronto Canada
| | - C Cooper
- The Ottawa Hospital Research Institute; University of Ottawa; Ottawa Canada
| | - RS Hogg
- Simon Fraser University; Burnaby Canada
- British Columbia Centre for Excellence in HIV/AIDS; Vancouver Canada
| | - JSG Montaner
- British Columbia Centre for Excellence in HIV/AIDS; Vancouver Canada
- Department of Medicine; University of British Columbia; Vancouver Canada
| | - AN Burchell
- Ontario HIV Treatment Network; Toronto Canada
- Dalla Lana School of Public Health; University of Toronto; Toronto Canada
| | - MR Loutfy
- University of Toronto; Toronto Canada
- Women's Health Research Institute; Toronto Canada
- Maple Leaf Medical Clinic; Toronto Canada
| | - N Machouf
- Clinique Médicale l'Actuel; Montreal Canada
| | - MB Klein
- Division of Infectious Diseases and Chronic Viral Illness Service; McGill University Health Centre; Montreal Canada
| | - C Tsoukas
- McGill University Health Centre; Montreal Canada
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Leung V, Gillis J, Raboud J, Cooper C, Hogg RS, Loutfy MR, Machouf N, Montaner JSG, Rourke SB, Tsoukas C, Klein MB. Predictors of CD4:CD8 ratio normalization and its effect on health outcomes in the era of combination antiretroviral therapy. PLoS One 2013; 8:e77665. [PMID: 24204912 PMCID: PMC3813720 DOI: 10.1371/journal.pone.0077665] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [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: 06/12/2013] [Accepted: 09/04/2013] [Indexed: 12/22/2022] Open
Abstract
Background HIV leads to CD4:CD8 ratio inversion as immune dysregulation progresses. We examined the predictors of CD4:CD8 normalization after combination antiretroviral therapy (cART) and determined whether normalization is associated with reduced progression to AIDS-defining illnesses (ADI) and death. Methods A Canadian cohort of HIV-positive adults with CD4:CD8<1.2 prior to starting cART from 2000–2010 were analyzed. Predictors of (1) reaching a CD4:CD8 ≥1.2 on two separate follow-up visits >30 days apart, and (2) ADI and death from all causes were assessed using adjusted proportional hazards models. Results 4206 patients were studied for a median of 2.77 years and 306 (7.2%) normalized their CD4:CD8 ratio. Factors associated with achieving a normal CD4:CD8 ratio were: baseline CD4+ T-cells >350 cells/mm3, baseline CD8+ T-cells <500 cells/mm3, time-updated HIV RNA suppression, and not reporting sex with other men as a risk factor. There were 213 ADIs and 214 deaths in 13476 person-years of follow-up. Achieving a normal CD4:CD8 ratio was not associated with time to ADI/death. Conclusions In our study, few individuals normalized their CD4:CD8 ratios within the first few years of initiating modern cART. This large study showed no additional short-term predictive value of the CD4:CD8 ratio for clinical outcomes after accounting for other risk factors including age and HIV RNA.
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Affiliation(s)
- Victor Leung
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Jennifer Gillis
- Toronto General Research Institute, University Health Network, Toronto, Canada
| | - Janet Raboud
- Toronto General Research Institute, University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Curtis Cooper
- University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert S. Hogg
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- * E-mail:
| | - Mona R. Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Maple Leaf Medical Clinic, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Chris Tsoukas
- Department of Medicine, McGill University, Montreal, Canada
- McGill University Health Centre, Montreal, Canada
| | - Marina B. Klein
- Department of Medicine, McGill University, Montreal, Canada
- McGill University Health Centre, Montreal, Canada
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Abstract
The impact of antiretroviral therapy (ART) on the natural history of HIV-1 infection has resulted in dramatic reductions in disease-associated morbidity and mortality. Additionally, the epidemiology of HIV-1 infection worldwide is changing, as women now represent a substantial proportion of infected adults. As more highly effective and tolerable antiretroviral regimens become available, and as the prevention of mother-to-child transmission becomes an attainable goal in the management of HIV-infected individuals, more and more HIV-positive women are choosing to become pregnant and have children. Consequently, it is important to consider the efficacy and safety of antiretroviral agents in pregnancy. Protease inhibitors are a common class of medication used in the treatment of HIV-1 infection and are increasingly being used in pregnancy. However, several studies have raised concerns regarding pharmacokinetic alterations in pregnancy, particularly in the third trimester, which results in suboptimal drug concentrations and a theoretically higher risk of virologic failure and perinatal transmission. Drug level reductions have been observed with each individual protease inhibitor and dose adjustments in pregnancy are suggested for certain agents. Furthermore, studies have also raised concerns regarding the safety of protease inhibitors in pregnancy, particularly as they may increase the risk of pre-term birth and metabolic disturbances. Overall, protease inhibitors are safe and effective for the treatment of HIV-infected pregnant women. Specifically, ritonavir-boosted lopinavir- and atazanavir-based regimens are preferred in pregnancy, while ritonavir-boosted darunavir- and saquinavir-based therapies are reasonable alternatives. This paper reviews the use of protease inhibitors in pregnancy, focusing on pharmacokinetic and safety considerations, and outlines the recommendations for use of this class of medication in the HIV-1-infected pregnant woman.
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Affiliation(s)
- Nisha Andany
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Loutfy MR, Blitz S, Zhang Y, Hart TA, Walmsley SL, Smaill FM, Rachlis AR, Yudin MH, Angel JB, Ralph ED, Tharao W, Raboud JM. Self-Reported Preconception Care of HIV-Positive Women of Reproductive Potential: A Retrospective Study. J Int Assoc Provid AIDS Care 2013; 13:424-33. [PMID: 23918921 DOI: 10.1177/2325957413494238] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 11/15/2022] Open
Abstract
OBJECTIVES We determined the proportion and correlates of self-reported pregnancy planning discussions (that is preconception counseling) that HIV-positive women reported to their family physicians (FPs), HIV specialists, and obstetrician/gynecologists (OB/Gyns). METHODS In a cross-sectional substudy, HIV-positive women of reproductive potential were asked whether their care providers discussed pregnancy planning. Logistic regression was used to calculate odds ratios for the correlates of preconception counseling. RESULTS A total of 431 eligible participants (median age 38, interquartile range = 32-43) reported having discussion with a physician (92% FP, 96% HIV specialists, and 45% OB/Gyns). In all, 34%, 41%, and 38% had their pregnancy planning discussion with FP, HIV specialist, and Ob/Gyns, respectively; 51% overall. In the multivariable model, significant correlates of preconception counseling were age (P = .02), marital status (P < .01), number of years living in Canada (P < .001), and age of youngest child (P < .01). CONCLUSIONS Preconception care in our cohort was suboptimal. We recommend that counseling on healthy preconception should be part of routine HIV care.
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Affiliation(s)
- Mona R Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Sandra Blitz
- Toronto General Research Institute, Toronto, Ontario, Canada
| | - Yimeng Zhang
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Trevor A Hart
- Ryerson University, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Sharon L Walmsley
- Faculty of Medicine, University of Toronto, Ontario, Canada Toronto General Research Institute, Toronto, Ontario, Canada
| | | | - Anita R Rachlis
- Faculty of Medicine, University of Toronto, Ontario, Canada Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark H Yudin
- Faculty of Medicine, University of Toronto, Ontario, Canada St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Jonathan B Angel
- Ottawa Health Research Institute and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Edward D Ralph
- Infectious Diseases Care Program, St Joseph's Health Care, London, Ontario, Canada
| | - Wangari Tharao
- Women's Health in Women's Hands, Toronto, Ontario, Canada
| | - Janet M Raboud
- Toronto General Research Institute, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Antoniou T, Gillis J, Loutfy MR, Cooper C, Hogg RS, Klein MB, Machouf N, Montaner JSG, Rourke SB, Tsoukas C, Raboud JM. Impact of the Data Collection on Adverse Events of Anti-HIV Drugs Cohort Study on Abacavir Prescription among Treatment-Naive, HIV-Infected Patients in Canada. ACTA ACUST UNITED AC 2013; 13:153-9. [DOI: 10.1177/2325957413495565] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To evaluate the trends in abacavir (ABC) prescription among antiretroviral (ARV) medication-naive individuals following the presentation of the Data Collection on Adverse Events of Anti-HIV Drugs (DAD) cohort study. Methods: We conducted a retrospective cohort study of ARV medication-naive individuals in the Canadian Observational Cohort (CANOC). Results: Between January 1, 2000, and February 28, 2010, a total of 7280 ARV medication-naive patients were included in CANOC. We observed a significant change in the proportion of new ABC prescriptions immediately following the release of DAD (−11%; 95% confidence interval [CI]: −20% to −2.4%) and in the months following the presentation of these data (−0.66% per month; 95% CI: −1.2% to −0.073%). A post-DAD presentation decrease in the odds of being prescribed ABC versus tenofovir (TDF) was observed (adjusted odds ratio, 0.72 per year, 95% CI: 0.54-0.97). Conclusions: Presentation of the DAD was associated with a significant decrease in ABC use among ARV medication-naive, HIV-positive patients initiating therapy.
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Affiliation(s)
- Tony Antoniou
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Keenan Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Gillis
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Mona R. Loutfy
- University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinical, Toronto, Ontario, Canada
- Women’s College Hospital Research Institute, Toronto, Ontario, Canada
| | - Curtis Cooper
- Division of Infectious Diseases, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Marina B. Klein
- The Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Nima Machouf
- Clinique Medicale l’Actuel, Montreal, Quebec, Canada
| | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia
- Department of Medicine, University of British Columbia, British Columbia, Canada
| | - Sean B. Rourke
- Keenan Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Chris Tsoukas
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Janet M. Raboud
- University of Toronto, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
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Eron JJ, Cooper DA, Steigbigel RT, Clotet B, Gatell JM, Kumar PN, Rockstroh JK, Schechter M, Markowitz M, Yeni P, Loutfy MR, Lazzarin A, Lennox JL, Strohmaier KM, Wan H, Barnard RJO, Nguyen BYT, Teppler H. Efficacy and safety of raltegravir for treatment of HIV for 5 years in the BENCHMRK studies: final results of two randomised, placebo-controlled trials. Lancet Infect Dis 2013; 13:587-96. [PMID: 23664333 DOI: 10.1016/s1473-3099(13)70093-8] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Two randomised, placebo-controlled trials-BENCHMRK-1 and BENCHMRK-2-investigated the efficacy and safety of raltegravir, an HIV-1 integrase strand-transfer inhibitor. We report final results of BENCHMRK-1 and BENCHMRK-2 combined at 3 years (the end of the double-blind phase) and 5 years (the end of the study). METHODS Integrase-inhibitor-naive patients with HIV resistant to three classes of drug and who were failing antiretroviral therapy were enrolled. Patients were randomly assigned (2:1) to raltegravir 400 mg twice daily or placebo, both with optimised background treatment. Patients and investigators were masked to treatment allocation until week 156, after which all patients were offered open-label raltegravir until week 240. The primary endpoint was previously assessed at 16 weeks. We assessed long-term efficacy with endpoints of the proportion of patients with an HIV viral load of less than 50 copies per mL and less than 400 copies per mL, and mean change in CD4 cell count, at weeks 156 and 240. FINDINGS 1012 patients were screened for inclusion. 462 were treated with raltegravir and 237 with placebo. At week 156, 51% in the raltegravir group versus 22% in the placebo group (non-completer classed as failure) had viral loads of less than 50 copies per mL, and 54% versus 23% had viral loads of less than 400 copies per mL. Mean CD4 cell count increase (analysed by an observed failure approach) was 164 cells per μL versus 63 cells per μL. After week 156, 251 patients (54%) from the raltegravir group and 47 (20%) from the placebo group entered the open-label raltergravir phase; 221 (47%) versus 44 (19%) completed the entire study. At week 240, viral load was less than 50 copies per mL in 193 (42%) of all patients initially assigned to raltegravir and less than 400 copies per mL in 210 (45%); mean CD4 cell count increased by 183 cells per μL. Virological failure occurred in 166 raltegravir recipients (36%) during the double-blind phase and in 17 of all patients (6%) during the open-label phase. The most common drug-related adverse events at 5 years in both groups were nausea, headache, and diarrhoea, and occurred in similar proportions in each group. Laboratory test results were similar in both treatment groups and showed little change after year 2. INTERPRETATION Raltegravir has a favourable long-term efficacy and safety profile in integrase-inhibitor-naive patients with triple-class resistant HIV in whom antiretroviral therapy is failing. Raltegravir is an alternative for treatment-experienced patients, particularly those with few treatment options. FUNDING Merck Sharp & Dohme.
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Raboud J, Su D, Burchell AN, Gardner S, Walmsley S, Bayoumi AM, Blitz S, Cooper C, Salit I, Cohen J, Rourke SB, Loutfy MR. Representativeness of an HIV cohort of the sites from which it is recruiting: results from the Ontario HIV Treatment Network (OHTN) cohort study. BMC Med Res Methodol 2013; 13:31. [PMID: 23496868 PMCID: PMC3608156 DOI: 10.1186/1471-2288-13-31] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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: 03/13/2012] [Accepted: 02/27/2013] [Indexed: 11/17/2022] Open
Abstract
Background Participation bias is a well-known phenomenon in epidemiologic research, where individuals consenting to research studies differ from individuals who are not able or willing to participate. These dissimilarities may limit the generalizability of results of research studies. Quantification of the participation bias is essential for the interpretation of research findings. Methods The Ontario HIV Treatment Network Cohort Study (OCS) is an ongoing open cohort study of HIV positive individuals receiving care at one of 11 sites in Ontario. OCS participants from 4 sites were compared to non-participants (those who declined or were not approached) at those sites with regard to gender, age, HIV risk factor, CD4 count and viral load (VL). Generalized logit regression models were used to identify predictors of declining to participate or not being approached to participate. Results Compared to participants (P) in the OCS, individuals who declined to participate (D) and those who were not approached (NA) were slightly younger (D:45, NA:44 vs P:46), less likely to be male (D: 71%, NA:75% vs P:88%), less likely to be Caucasian (D:41%, NA:57% vs P:72%) and less likely to be Canadian-born (D: 39%, NA: 52% vs P: 69%). Patients who were not approached to participate were less likely to have VL < 50 copies/mL than other patients (D: 75%, NA: 62%, P: 74%) and had lower CD4 counts than OCS participants (D: 450 cells/mm3, NA: 420 cells/mm3, P: 480 cells/mm3). Conclusions Significant demographic and clinical differences were found between OCS participants and non-participants. Extrapolation of research findings to other populations should be undertaken cautiously.
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Affiliation(s)
- Janet Raboud
- Toronto General Research Institute, University Health Network, Room 13EN226, 200 Elizabeth St., Toronto, Ontario M5G 2C4, Canada.
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Loutfy MR, Wu W, Letchumanan M, Bondy L, Antoniou T, Margolese S, Zhang Y, Rueda S, McGee F, Peck R, Binder L, Allard P, Rourke SB, Rochon PA. Systematic review of HIV transmission between heterosexual serodiscordant couples where the HIV-positive partner is fully suppressed on antiretroviral therapy. PLoS One 2013; 8:e55747. [PMID: 23418455 PMCID: PMC3572113 DOI: 10.1371/journal.pone.0055747] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [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: 06/19/2012] [Accepted: 12/31/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The risk of sexual HIV transmission in serodiscordant couples when the HIV-positive partner has full virologic suppression on combination antiretroviral therapy (cART) is debated. This study aims to systematically review observational studies and randomized controlled trials (RCTs), evaluating rates of sexual HIV transmission between heterosexual serodiscordant couples when the HIV-positive partner has full suppression on cART. METHODS AND FINDINGS We searched major bibliographic databases to November 2012 for relevant observational studies and RCTs without language restrictions. Conference proceedings, key journals and bibliographies were also searched. Studies reporting HIV transmission rates, cART histories and viral loads of the HIV-positive partners were included. Two reviewers extracted methodologic characteristics and outcomes. Of 20,252 citations, 3 studies met all eligibility criteria with confirmed full virologic suppression in the HIV-positive partner. We included 3 additional studies (2 cohort studies, 1 RCT) that did not confirm viral suppression in the HIV-positive partner at transmission in a secondary meta-analysis. Methodologic quality was reasonable. The rate of transmission in the 3 studies confirming virologic suppression was 0 per 100 person-years (95% CI = 0-0.05), with low heterogeneity (I(2) = 0%). When we included the 3 studies that did not confirm virologic suppression, the rate of transmission was 0.14 per 100 person-years (95%CI = 0.04-0.31) (I(2) = 0%). In a sensitivity analysis including all 6 studies, the rate of transmission was 0 per 100 person-years (95%CI = 0-0.01) after omitting all transmissions with known detectable or unconfirmed viral loads, as full suppression in these cases was unlikely. Limitations included lack of data on same-sex couples, type of sexual intercourse (vaginal vs. anal), direction of HIV transmission, exact viral load at the time of transmission, sexually transmitted infections (STI) rates, and extent of condom use. CONCLUSIONS Our findings suggest minimal risk of sexual HIV transmission for heterosexual serodiscordant couples when the HIV-positive partner has full viral suppression on cART with caveats regarding information on sexual intercourse type, STIs, and condom use. These findings have implications when counseling heterosexual serodiscordant couples on sexual and reproductive health. More research is needed to explore HIV transmission risk between same-sex couples.
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Affiliation(s)
- Mona R Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada.
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Abstract
OBJECTIVE Four main clinical issues need to be considered for HIV-positive individuals and couples with respect to pregnancy planning and counselling: (1) pre-conceptional health; (2) transmission from mother to infant, which has been significantly reduced by combined antiretroviral therapy; (3) transmission between partners during conception, which requires different prevention and treatment strategies depending on the status and needs of those involved; and (4) management of infertility issues. The objective of the Canadian HIV Pregnancy Planning Guidelines is to provide clinical information and recommendations for health care providers to assist HIV-positive individuals and couples with their fertility and pregnancy planning decisions. These guidelines are evidence- and community-based and flexible, and they take into account diverse and intersecting local/population needs and the social determinants of health. OUTCOMES Intended outcomes are (1) reduction of risk of vertical transmission and horizontal transmission of HIV, (2) improvement of maternal and infant health outcomes in the presence of HIV, (3) reduction of the stigma associated with pregnancy and HIV, and (4) increased access to pregnancy planning and fertility services. EVIDENCE PubMed and Medline were searched for articles published in English or French to December 20, 2010, using the following terms: "HIV" and "pregnancy" or "pregnancy planning" or "fertility" or "reproduction" or "infertility" or "parenthood" or "insemination" or "artificial insemination" or "sperm washing" or "IVF" or "ICSI" or "IUI." Other search terms included "HIV" and 'horizontal transmission" or "sexual transmission" or "serodiscordant." The following conference databases were also searched: Conference on Retroviruses and Opportunistic Infections, International AIDS Conference, International AIDS Society, Interscience Conference on Antimicrobial Agents and Chemotherapy, the Canadian Association of HIV/AIDS Research, and the Ontario HIV Treatment Network Research Conference. Finally, a hand search of key journals and conferences was performed, and references of retrieved articles were reviewed for additional citations. Subsequently, abstracts were categorized according to their primary topic (based on an outline of the guidelines) into table format with the following headings: author, title, study purpose, participants, results and general comments. Finally, experts in the field were consulted for their opinions as to whether any articles were missed. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table) and through use of the Appraisal of Guidelines Research and Evaluation instrument for the development of clinical guidelines. SPONSORS The Society of Obstetricians and Gynecologists of Canada, Women and HIV Research Program, Women's College Research Institute, Women's College Hospital, University of Toronto, Abbott Laboratories Canada, the Ontario HIV Treatment Network, the Canadian Institutes of Health Research, and the Canadian HIV Trials Network.
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Yudin MH, Money DM, Cheung MC, Loutfy MR. Physician attitudes regarding pregnancy, fertility care, and assisted reproductive technologies for HIV-infected individuals and couples. HIV Clin Trials 2013. [PMID: 23195674 DOI: 10.1310/hct1306-357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Family and pregnancy planning are important for HIV-infected individuals and couples. There is a paucity of data regarding physician attitudes with respect to reproduction in this population, but some evidence suggests that attitudes can influence the information, advice, and services they will provide. OBJECTIVE To determine physician attitudes toward pregnancy, fertility care, and access to assisted reproductive technologies for HIV-infected individuals, and to determine whether attitudes differed based on specific physician characteristics. METHODS A survey was sent electronically to obstetrician/gynecologists and infectious disease specialists in Canada. Items were grouped into 5 key domains: physician demographics, physician attitudes toward pregnancy and adoption, physician attitudes toward fertility care, physician attitudes toward assisted reproductive technology, and challenges for an HIV-infected population. Attitudes were determined based on answers to individual questions and also for each domain. Univariate and logistic regression analyses were used to determine the influence of specific physician characteristics on attitudes. RESULTS Completed surveys were received from 165 physicians. Most had positive attitudes regarding pregnancy or adoption (89%), fertility care (72%), and assisted reproductive technology (79%). In multivariate analyses, having cared for HIV-infected patients was significantly associated with having a positive attitude toward fertility care or assisted reproductive technology. CONCLUSIONS In this national survey of Canadian physicians, most had positive attitudes toward pregnancy, adoption, fertility care, and use of assisted reproductive technology among HIV-infected persons. Physicians who had cared for HIV-infected individuals in the past were more likely to have positive attitudes than those who had not.
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Affiliation(s)
- Mark H Yudin
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada.
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Loutfy MR, Logie CH, Zhang Y, Blitz SL, Margolese SL, Tharao WE, Rourke SB, Rueda S, Raboud JM. Gender and ethnicity differences in HIV-related stigma experienced by people living with HIV in Ontario, Canada. PLoS One 2012; 7:e48168. [PMID: 23300514 PMCID: PMC3531426 DOI: 10.1371/journal.pone.0048168] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 09/20/2012] [Indexed: 11/18/2022] Open
Abstract
This study aimed to understand gender and ethnicity differences in HIV-related stigma experienced by 1026 HIV-positive individuals living in Ontario, Canada that were enrolled in the OHTN Cohort Study. Total and subscale HIV-related stigma scores were measured using the revised HIV-related Stigma Scale. Correlates of total stigma scores were assessed in univariate and multivariate linear regression. Women had significantly higher total and subscale stigma scores than men (total, median = 56.0 vs. 48.0, p<0.0001). Among men and women, Black individuals had the highest, Aboriginal and Asian/Latin-American/Unspecified people intermediate, and White individuals the lowest total stigma scores. The gender-ethnicity interaction term was significant in multivariate analysis: Black women and Asian/Latin-American/Unspecified men reported the highest HIV-related stigma scores. Gender and ethnicity differences in HIV-related stigma were identified in our cohort. Findings suggest differing approaches may be required to address HIV-related stigma based on gender and ethnicity; and such strategies should challenge racist and sexist stereotypes.
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Affiliation(s)
- Mona R Loutfy
- Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
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Antoniou T, Zagorski B, Loutfy MR, Strike C, Glazier RH. Socio-economic- and sex-related disparities in rates of hospital admission among patients with HIV infection in Ontario: a population-based study. Open Med 2012; 6:e146-54. [PMID: 23687530 PMCID: PMC3654511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/09/2012] [Accepted: 08/27/2012] [Indexed: 12/03/2022]
Abstract
BACKGROUND Among people living with HIV infection in the era of combination antiretroviral therapy (cART), admission to hospital may indicate inadequate community-based care. As such, population-based assessments of the utilization of inpatient services represent a necessary component of evaluating the quality of HIV-related care. METHODS We used a validated algorithm to search Ontario's administrative health care databases for all persons living with HIV infection aged 18 years or older between 1992/93 and 2008/09. We then conducted a population-based study using time-series and longitudinal analyses to first quantify the immediate effect of cART on hospital admission rates and then analyze recent trends (for 2002/03 to 2008/09) in rates of total and HIV-related admissions. RESULTS The introduction of cART in 1996/97 was associated with more pronounced reductions in the rate of hospital admissions among men than among women (for total admissions, -89.9 v. -60.5 per 1000 persons living with HIV infection, p = 0.003; for HIV-related admissions, -56.9 v. -36.3 per 1000 persons living with HIV infection, p < 0.001). Between 2002/03 and 2008/09, higher rates of total hospital admissions were associated with female sex (adjusted relative rate [RR] 1.15, 95% confidence interval [CI] 1.05-1.27) and low socio-economic status (adjusted RR 1.21, 95% CI 1.14-1.29). Higher rates of HIV-related hospital admission were associated with low socio-economic status (adjusted RR 1.30, 95% CI 1.17-1.45). Recent immigrants had lower rates of both total admissions (adjusted RR 0.70, 95% CI 0.61-0.80) and HIV-related admissions (adjusted RR 0.77, 95% CI 0.61-0.96). INTERPRETATION We observed important socio-economic- and sex-related disparities in rates of hospital admission among people with HIV living in Ontario, Canada.
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