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Lessard D, Lebouché B, Morneau A, Bilodeau M, Rosenes R, Sanders J, Chomont N, Keeler P, Dubé K, Margolese S, Jenabian MA, Power C, Routy JP, Angel JB, Cohen ÉA, Costiniuk CT. Donating One's Body to HIV Cure Research Through Canadian Medical Assistance in Dying: A Case Study. Curr HIV Res 2023; 21:264-267. [PMID: 37670698 DOI: 10.2174/1570162x21666230904150923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/26/2023] [Accepted: 08/02/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Finding a cure for HIV is challenged by persisting reservoirs, the mapping of which necessitates invasive procedures. Inviting people with HIV (PWHIV) at the end of life to donate body specimens post-mortem through research autopsies is a novel approach, raising ethical concerns. OBJECTIVE This case study aims to explore the motivations, barriers, and facilitators of a terminally-ill Canadian PWHIV who requested medical assistance in dying (MAID) and expressed interest in donating his body for HIV cure research. CASE PRESENTATION An in-depth 3-hour and semi-structured interview was conducted with the participant. The interview transcription was thematically coded to identify motivations and perceived barriers and facilitators to participate in end-of-life HIV cure research. Our analysis identified six themes. Two themes expressed motivations: Collaboration in progress in health and science, seeing cure research as collaboration with professionals; and Opportunity to learn more, mostly about science and health. One theme expressed a barrier: Losing interest in or identification with long-term care research matters, especially those related to the management of long-term care. Three themes expressed by facilitators: Receiving information from professionals one trusts and knows, especially clinical and research teams; Perceiving research procedures as simple, useful, and embedded in care, perceiving clinical, educational, and interpersonal benefits that surpass costs of participation; and Perceiving research as one last way to contribute, that is, feeling useful or give back. CONCLUSION Several circumstances facilitated the patient's participation: being a single man, having time to participate, having no strong religious belief, and valuing clear, direct communication. His motivations to participate in HIV cure research were altruistic, and also an experience of working with clinical and research teams. Finally, this perspective highlights HIV cure research participant candidates' need for education about research procedures.
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Affiliation(s)
- David Lessard
- Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre (MUHC), Montreal, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, Canada
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre (MUHC), Montreal, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, Canada
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - André Morneau
- Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre (MUHC), Montreal, Canada
| | | | - Ron Rosenes
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Justin Sanders
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Nicolas Chomont
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Canada
| | - Patrick Keeler
- Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre (MUHC), Montreal, Canada
| | - Karine Dubé
- University of California San Diego School of Medicine, Division of Infectious Diseases and Global Public Health, San Diego, USA
| | - Shari Margolese
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Mohammad Ali Jenabian
- Département des Sciences Biologiques, Université du Québec à Montréal, Montreal, Canada
| | - Christopher Power
- Department of Medicine, Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre (MUHC), Montreal, Canada
| | - Jonathan B Angel
- Ottawa Hospital Research Institute and Division of Infectious Disease, The Ottawa Hospital, Ottawa, Canada
| | - Éric A Cohen
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Canada
- Institut de Recherche Clinique de Montréal, Montreal, Canada
| | - Cecilia T Costiniuk
- Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre (MUHC), Montreal, Canada
- Department of Medicine, Division of Infectious Diseases and Department of Microbiology and Immunology, McGill University, Montreal, Canada
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2
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Gillis JL, Grennan T, Grewal R, Ogilvie G, Gaspar M, Grace D, Lofters A, Raboud JM, Saarela O, MacPherson P, Rosenes R, Salit IE, Burchell AN, Burchell A, Rueda S, Arbess G, Cohen J, Cooper C, Lavoie E, Crouzat F, Andany N, Walmsley S, Silverman M, Sandre R, Tharao W, Gauvin H, Smaill F. Influence of previous experience with and beliefs regarding anal cancer screening on willingness to be screened among men living with HIV. BMC Public Health 2022; 22:2444. [PMID: 36577960 PMCID: PMC9795733 DOI: 10.1186/s12889-022-14471-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 10/26/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Implementation of anal cancer screening requires the procedure to be acceptable to the target population. Our objective was to assess the beliefs of men living with HIV regarding anal cancer screening and identify factors associated with their willingness to participate in screening. METHODS We developed a cross-sectional questionnaire using the Theory of Planned Behavior to examine beliefs regarding prevention of human papillomavirus (HPV)-related diseases, administered to men living with HIV in 2016-2017 in a multi-site HIV clinical cohort. Correspondence analysis was used to examine the interrelationships between men's beliefs and willingness to undergo anal cancer screening. We used multivariable proportional odds models to identify factors associated with increasing willingness. Results were reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS Among 1677 male participants, the vast majority (90%) would be willing to undergo screening by "anal Pap test"; willingness clustered with positive beliefs (e.g. confident they can get screened; disagree that they will feel pain) in the correspondence analysis. Higher self-perceived risk for anal cancer and positive beliefs regarding screening were associated with higher willingness to be screened. Gay, bisexual and other men who have sex with men had higher willingness (aOR = 1.62; 95% CI: 1.15, 2.29) than heterosexual men. Racialized men reported lower willingness (aOR = 0.68; 95% CI: 0.54, 0.89) than white men. CONCLUSIONS Men generally had positive beliefs and were willing to undergo screening, though there were differences by sexual orientation and racial identity. Tailored community-led initiatives could focus on men's understanding of their risk and expectations of anal cancer screening to facilitate participation.
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Affiliation(s)
- Jennifer L. Gillis
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario Canada ,grid.415502.7MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada
| | - Troy Grennan
- grid.418246.d0000 0001 0352 641XBritish Columbia Centre for Disease Control, Vancouver, British Columbia Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, British Columbia Canada
| | - Ramandip Grewal
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.415502.7MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada
| | - Gina Ogilvie
- grid.418246.d0000 0001 0352 641XBritish Columbia Centre for Disease Control, Vancouver, British Columbia Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, British Columbia Canada
| | - Mark Gaspar
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Daniel Grace
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Aisha Lofters
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.415502.7MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada ,grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario Canada
| | - Janet M. Raboud
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario Canada
| | - Olli Saarela
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Paul MacPherson
- grid.412687.e0000 0000 9606 5108The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario Canada ,grid.28046.380000 0001 2182 2255Department of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Ron Rosenes
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario Canada
| | - Irving E. Salit
- grid.231844.80000 0004 0474 0428Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario Canada
| | - Ann N. Burchell
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.415502.7MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
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Lessard D, Dubé K, Bilodeau M, Keeler P, Margolese S, Rosenes R, Sinyavskaya L, Durand M, Benko E, Kovacs C, Guerlotté C, Tharao W, Arnold K, Masching R, Taylor D, Sousa J, Ostrowski M, Taylor J, Kaytes A, Smith D, Gianella S, Chomont N, Angel JB, Routy JP, Cohen ÉA, Lebouché B, Costiniuk CT. Willingness of Older Canadians with HIV to Participate in HIV Cure Research Near and After the End of Life: A Mixed-Method Study. AIDS Res Hum Retroviruses 2022; 38:670-682. [PMID: 35778845 PMCID: PMC9483839 DOI: 10.1089/aid.2022.0006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
HIV cure research requires interrogating latent HIV reservoirs in deep tissues, which necessitates autopsies to avoid risks to participants. An HIV autopsy biobank would facilitate this research, but such research raises ethical issues and requires participant engagement. This study explores the willingness to participate in HIV cure research at the end of life. Participants include Canadians with HIV [people with HIV (PWHIV)] aged 55 years or older. Following a mixed-method study design, all participants completed a phone or online survey, and a subset of participants participated in in-depth phone or videoconference interviews. We produced descriptive statistics of quantitative data and a thematic analysis of qualitative data. Barriers and facilitators were categorized under domains of the Theoretical Domains Framework. From April 2020 to August 2021, 37 participants completed the survey (mean age = 69.9 years old; mean duration of HIV infection = 28.5 years), including 15 interviewed participants. About three quarters of participants indicated being willing to participate in hypothetical medical studies toward the end of life (n = 30; 81.1%), in HIV biobanking (n = 30; 81.1%), and in a research autopsy (n = 28; 75.7%) to advance HIV cure research, mainly for altruistic benefits. The main perceived risks had to do with physical pain and confidentiality. Barriers and facilitators were distributed across five domains: social/professional role and identity, environmental context and resources, social influences, beliefs about consequences, and capabilities. Participants wanted more information about study objectives and procedures, possible accommodations with their last will, and rationale for studies or financial interests funding studies. Our results indicate that older PWHIV would be willing to participate in HIV cure research toward the end of life, HIV biobanking, and research autopsy. However, a dialogue should be initiated to inform participants thoroughly about HIV cure studies, address concerns, and accommodate their needs and preferences. Additional work is required, likely through increased community engagement, to address educational needs.
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Affiliation(s)
- David Lessard
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, Canada
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Karine Dubé
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Shari Margolese
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Ron Rosenes
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Liliya Sinyavskaya
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Madeleine Durand
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | | | - Charlotte Guerlotté
- COCQ-Sida, Montreal, Canada
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Wangari Tharao
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
- Women's Health in Women's Hands, Canada and African and Black Diaspora Global Network on HIV and AIDS, Toronto, Canada
- African and Caribbean Council on HIV/AIDS in Ontario, Toronto, Canada
| | - Keresa Arnold
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
- African and Caribbean Council on HIV/AIDS in Ontario, Toronto, Canada
| | - Renée Masching
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
- Canadian Aboriginal AIDS Network, Dartmouth, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
| | - Darien Taylor
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - José Sousa
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Mario Ostrowski
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
| | - Jeff Taylor
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Andy Kaytes
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Davey Smith
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Sara Gianella
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Nicolas Chomont
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal and Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Canada
| | - Jonathan B. Angel
- Ottawa Hospital Research Institute and Division of Infectious Disease, The Ottawa Hospital, Ottawa, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
| | - Éric A. Cohen
- Institut de Recherche Clinique de Montréal, Montreal, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, Canada
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Cecilia T. Costiniuk
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
- Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Canada
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Wobeser WL, McBane JE, Balfour L, Conway B, Gill MJ, Huff H, Kilby DLP, Fergusson DA, Mallick R, Mills EJ, Muldoon KA, Rachlis A, Ralph ED, Rosenes R, Singer J, Singhal N, Tan D, Tremblay N, Vo D, Walmsley SL, Cameron DW. A randomized control trial of high-dose micronutrient-antioxidant supplementation in healthy persons with untreated HIV infection. PLoS One 2022; 17:e0270590. [PMID: 35834528 PMCID: PMC9282469 DOI: 10.1371/journal.pone.0270590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Although micronutrient and antioxidant supplementation are widely used by persons with human immunodeficiency virus (HIV), a therapeutic role beyond recommended daily allowances (RDA) remains unproven. An oral high-dose micronutrient and antioxidant supplement (Treatment) was compared to an RDA supplement (Control) for time to progressive immunodeficiency or initiation of antiretroviral therapy (ART) in people living with HIV (PLWH). Methods This study was a randomized, double-blind, placebo-controlled multicenter clinical trial. PLWH were recruited from Canadian HIV Trials Network sites, and followed quarterly for two years. Eligible participants were asymptomatic, antiretroviral treatment (ART)-naïve, HIV-seropositive adults with a CD4 T lymphocyte count (CD4 count) between 375–750 cells/μL. Participants were randomly allocated 1:1 to receive Treatment or Control supplements. The primary outcome was a composite of time-to-first of confirmed CD4 count below 350 cells/μL, initiation of ART, AIDS-defining illness or death. Primary analysis was by intention-to-treat. Secondary outcomes included CD4 count trajectory from baseline to ART initiation or two years. A Data and Safety Monitoring Board reviewed the study for safety, recruitment and protocol adherence every six months. Results Of 171 enrolled participants: 66 (38.6%) experienced a primary outcome: 27 reached a CD4 count below 350 cells/μL, and 57 started ART. There was no significant difference in time-to-first outcome between groups (Hazard Ratio = 1.05; 95%CI: 0.65, 1.70), or in time to any component outcome. Using intent-to-treat censoring, mean annualized rates of CD4 count decline were -42.703 cells/μL and -79.763 cells/μL for Treatment and Control groups, with no statistical difference in the mean change between groups (-37.06 cells/μL/52 weeks, 95%CI: (-93.59, 19.47); p = 0.1993). Accrual was stopped at 171 of the 212 intended participants after an interim analysis for futility, although participant follow-up was completed. Conclusions In ART-naïve PLWH, high-dose antioxidant, micronutrient supplementation compared to RDA supplementation had no significant effect on disease progression or ART initiation. Clinical trial registration ClinicalTrials.gov Identifier: NCT00798772.
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Affiliation(s)
- Wendy L. Wobeser
- Department of Biomedical and Molecular Sciences and Public Health, Queen’s University, Kingston, Ontario, Canada
| | - Joanne E. McBane
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Louise Balfour
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Brian Conway
- Vancouver Infectious Disease Clinic, Vancouver, British Columbia, Canada
| | - M. John Gill
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Harold Huff
- Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Donald L. P. Kilby
- Faculty of Health Services, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A. Fergusson
- Clinical Epidemiology Program (CEP), University of Ottawa at The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - Ranjeeta Mallick
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Edward J. Mills
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Global Evaluative Sciences, Vancouver, British Columbia, Canada
| | - Katherine A. Muldoon
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Obstetrics and Maternal Investigations Research Group, The Ottawa Hospital, Ottawa, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anita Rachlis
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Edward D. Ralph
- Division of Infectious Diseases, Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Ron Rosenes
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
| | - Joel Singer
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neera Singhal
- Global Evaluative Sciences, Vancouver, British Columbia, Canada
| | - Darrell Tan
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- La Ka Shing Knowledge Institute, St. Michael’s, Toronto, Ontario, Canada
| | - Nancy Tremblay
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dong Vo
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sharon L. Walmsley
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - D. William Cameron
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program (CEP), University of Ottawa at The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
- * E-mail:
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Malazogu F, Rousseau RK, Shivappa N, Huibner S, Walmsley SL, Kovacs CM, Benko E, Reinhard RJ, Rosenes R, Hebert JR, Kaul R. The Dietary Inflammatory Index Is Not Associated With Gut Permeability or Biomarkers of Systemic Inflammation in HIV Immunologic Non-responders. Front Nutr 2021; 8:736816. [PMID: 34881278 PMCID: PMC8646029 DOI: 10.3389/fnut.2021.736816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Immunologic non-responders (INRs) are a subset of individuals living with HIV who have suboptimal blood CD4+ T cell recovery despite effective antiretroviral therapy (ART). They are at an increased risk of serious non-AIDS co-morbidities and death, and demonstrate enhanced systemic immune activation. In other populations diet has been correlated with markers of systemic inflammation through the Diet Inflammatory Index (DII), but this association has not been studied in persons living with HIV (PLWH). Blood was collected from 28 INR PLWH with a blood CD4+ T cell count <350/μL despite ≥2 years of effective ART. Participants completed a Canadian Diet History Questionnaire, and their responses were used to calculate the DII. Plasma inflammatory markers (IFNγ, TNF, IL-6, sVCAM, D-dimer, sCD14 and CRP) were assayed by ELISA, cellular immune activation (HLA-DR and CD38 on CD4+ and CD8+ T cells) was quantified using flow cytometry, and small bowel permeability assessed by calculation of the urine LacMan ratio after drinking a mix of lactulose and mannitol. Participants were a median age of 57 years, had been on effective ART for 15 years, and the median DII was -1.91 (range of -3.78 to +2.23). No correlation was observed between DII and plasma markers of inflammation, levels of T cell activation, gut permeability, or the biomarker of bacterial translocation sCD14. Self-reported alcohol intake, a potential confounder of the relationship between diet and inflammatory biomarkers, was also not associated with systemic inflammation or gut permeability. Our findings suggest that other mechanisms, rather than diet, are likely to be the major driver of systemic inflammation in INR individuals.
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Affiliation(s)
- Fat Malazogu
- Departments of Medicine and Immunology, University of Toronto, Toronto, ON, Canada
| | - Rodney K Rousseau
- Departments of Medicine and Immunology, University of Toronto, Toronto, ON, Canada
| | - Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, United States.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Nutrition, Connecting Health Innovations Limited Liability Corporation (LLC), Columbia, SC, United States
| | - Sanja Huibner
- Departments of Medicine and Immunology, University of Toronto, Toronto, ON, Canada
| | - Sharon L Walmsley
- Departments of Medicine and Immunology, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Colin M Kovacs
- Departments of Medicine and Immunology, University of Toronto, Toronto, ON, Canada.,Maple Leaf Medical Clinic, Toronto, ON, Canada
| | - Erika Benko
- Maple Leaf Medical Clinic, Toronto, ON, Canada
| | | | | | - James R Hebert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, United States.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Nutrition, Connecting Health Innovations Limited Liability Corporation (LLC), Columbia, SC, United States
| | - Rupert Kaul
- Departments of Medicine and Immunology, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada
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6
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Rousseau RK, Walmsley SL, Lee T, Rosenes R, Reinhard RJ, Malazogu F, Benko E, Huibner S, Kovacs CM, Singer J, Kim CJ, Kaul R. A randomized, blinded, placebo-controlled trial of De Simone formulation probiotic during HIV-associated suboptimal CD4+ T cell recovery. J Acquir Immune Defic Syndr 2021; 89:199-207. [PMID: 34693932 DOI: 10.1097/qai.0000000000002840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess whether probiotic supplementation may reduce disease-linked systemic immune activation in people living with HIV with the immunologic non-responder (INR) phenotype. DESIGN Phase 2b, randomized, double-blind, placebo-controlled pilot trial. METHODS HIV-positive individuals with blood CD4+ T cell counts <350/mm3 despite viral suppression were randomized 2:1 to receive De Simone Formulation Probiotic (DSFP; "Visbiome" commercially) or placebo for 48 weeks; target enrolment was 36 patients. The primary endpoint was change in blood CD8+ T cell co-expression of HLA-DR and CD38 ("CD8 activation"). Secondary endpoints included biomarkers of inflammation, immune reconstitution, bacterial translocation, and gut permeability. Adjusted linear regression and linear mixed methods regression evaluated the differences between study arms from baseline to week 48. Study monitoring was done by the CIHR Canadian HIV Trials Network Data Safety Monitoring Committee. RESULTS Nineteen patients received DSFP, while 10 received placebo. One probiotic-arm patient withdrew early. Blood CD8 activation increased 0.82 percentage points (pp) in the probiotic arm (95% confidence interval [CI];-1.23,2.87;) and decreased by 2.06pp in the placebo arm (-4.81,0.70; between arms p=0.097). CD4+ T cell activation (%HLA-DR+) decreased in the placebo arm (-3.79pp [-7.32,-0.26]) but increased in the probiotic arm (1.64 [-0.98,4.26]; between arms p=0.018). No differences were observed in plasma or urine biomarkers of inflammation or microbial translocation. CONCLUSIONS Blood immune activation markers in INR individuals on effective ART were not reduced by supplementation with DSFP; CD4+ T cell activation may have been increased.
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Affiliation(s)
- Rodney K Rousseau
- University of Toronto, Departments of Immunology, Medicine, and Internal Medicine, Toronto, Canada University Health Network, Toronto General Hospital Immunodeficiency Clinic, Toronto, Canada Toronto General Hospital Research Institute, Toronto, Canada CIHR Canadian HIV Trials Network, Vancouver, Canada Centre for Health Evaluation & Outcomes Sciences, Vancouver, Canada Community Health Advocate and Consultant (Independent), Toronto, Canada Public/Global Health Consultant (Independent), San Francisco, USA Maple Leaf Medical Clinic, Toronto, Canada
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7
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Gillis JL, Grennan T, Grewal R, Ogilvie G, Gaspar M, Grace D, Lofters A, Raboud JM, Saarela O, MacPherson P, Rosenes R, Salit IE, Burchell AN. Low human papillomavirus (HPV) knowledge related to low risk perception among men living with HIV: Implications for HPV-associated disease prevention. Prev Med 2020; 141:106274. [PMID: 33022315 DOI: 10.1016/j.ypmed.2020.106274] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 12/14/2022]
Abstract
Human papillomavirus (HPV)-associated anal cancer is orders of magnitude higher among men living with HIV than the general male population. Our objective was to examine factors associated with HPV awareness and self-perceived risk for HPV-associated anal cancer among men living with HIV, which may influence uptake of cancer prevention strategies. A cross-sectional questionnaire on HPV was administered from 2016 to 2017 to 1677 men in a multisite, HIV clinical cohort in Ontario, Canada. We used logistic regression and proportional odds models to identify factors associated with being familiar with HPV and increasing self-perceived risk for anal cancer, respectively. We used correspondence analysis to examine associations of specific HPV-related knowledge with self-perceived risk. Only 52% were familiar with HPV, and 72% felt they had no or low risk for anal cancer. Familiarity with HPV was more common among men who have sex with men than heterosexual men (58% vs. 21%). Older men were less likely to be familiar with HPV (adjusted odds ratio [aOR] per 10 years = 0.77; 95% confidence interval [CI]: 0.69, 0.85). Familiarity with HPV was associated with increasing self-perceived risk (aOR = 2.39; 95% CI: 1.87, 3.04). After accounting for differences in HPV awareness and sexual orientation, racialized men had lower self-perceived risk (aOR = 0.68; 95% CI: 0.52, 0.88). In the correspondence analysis, risk-focused HPV-related knowledge (e.g., knowing smoking increases risk) was associated with highest risk perception. Efforts are needed to improve HPV-related health literacy in this population. Our findings suggest specific HPV-related knowledge may differentially influence self-perceived risk for anal cancer.
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Affiliation(s)
- Jennifer L Gillis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ramandip Grewal
- 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, Unity Health Toronto, Toronto, Ontario, Canada
| | - Gina Ogilvie
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aisha Lofters
- 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, Unity Health Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Janet M Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Paul MacPherson
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; The School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ron Rosenes
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Irving E Salit
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ann N Burchell
- 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, Unity Health Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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8
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Chelico L, King A, Ticknor J, McDonald M, Rosenes R, Mercredi J, Saddleback J, Bailey G, King M. Perspectives of Saskatchewan researchers and community members on HIV-1 strains circulating in Saskatchewan. AIDS 2020; 34:1987-1989. [PMID: 32132362 PMCID: PMC7575011 DOI: 10.1097/qad.0000000000002515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 01/30/2020] [Accepted: 02/15/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | - Alexandra King
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | | | - Michael McDonald
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
| | - Ron Rosenes
- Community Health Advocate and Researcher, Toronto, Ontario
| | | | | | - Geri Bailey
- Saskatoon Tribal Council Health & Family Services Inc
| | - Malcolm King
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Rachlis B, Nam S, Rosenes R, Santoni T, Peck R, Betts A, Kendall C, Yoong D, Sharp A, Gauvin H, Goddard L, Owino M, Rourke SB, Antoniou T. Using concept mapping to explore the challenges associated with affording and accessing medications among people living with HIV in Ontario, Canada. AIDS Care 2020; 33:827-832. [PMID: 32490685 DOI: 10.1080/09540121.2020.1770182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Antiretroviral medications are expensive, and people living with HIV often experience challenges accessing and paying for medication due to various obstacles. We used concept mapping to explore the challenges people living with HIV in Ontario, Canada, face when accessing medication. In brainstorming, 68 participants generated 447 statements in response to the focus prompt "Some people living with HIV have trouble getting and paying for prescription drugs because … ". These were consolidated into 77 statements, which were sorted (n = 30) and rated (n = 32) on importance and commonality. A ten-cluster concept map consisting of individual- and health system-related clusters was generated. Clusters included: (1) Stigma, (2) Medication-Related Issues, (3) Individual Challenges, (4) Basic Needs, (5) Immigration, (6) Coverage, (7) Trillium Drug Program, (8) Access to Services, (9) System-Level Issues and (10) Access to Professional Services. Statements in Coverage and Basic Needs were rated most important and common although there was variability by Ontario residence and drug coverage mechanisms. Strategies to address challenges were generated in Interpretation (n = 25 participants). Given that continuous access to antiretroviral therapy is necessary to fully realize treatment benefits, policies and interventions that address these challenges are needed.
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Affiliation(s)
- Beth Rachlis
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Seungwon Nam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Ron Rosenes
- Canadian HIV/AIDS Legal Network, Toronto, Canada
| | | | - Ryan Peck
- HIV & AIDS Legal Clinic Ontario (HALCO), Toronto, Canada
| | - Adrian Betts
- The AIDS Committee of Durham Region, Oshawa, Canada
| | - Claire Kendall
- Bruyère Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Deborah Yoong
- Department of Pharmacy, St. Michael's Hospital, Toronto, Canada
| | | | | | | | - Maureen Owino
- Committee for Accessible AIDS Treatment (CAAT), Toronto, Canada
| | - Sean B Rourke
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Tony Antoniou
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada
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- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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10
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Gaspar M, Rosenes R, Burchell AN, Grennan T, Salit I, Grace D. Diagnosing uncertainty: The challenges of implementing medical screening programs for minority sub-populations in Canada. Soc Sci Med 2019; 244:112643. [PMID: 31698281 DOI: 10.1016/j.socscimed.2019.112643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 12/29/2022]
Abstract
The social science literature on medical screening has documented a notable disjuncture between the promises of population-based screening programs and the complex realities of their rollout in everyday practice. We contribute to this scholarship by examining how healthcare providers confront numerous uncertainties associated with the implementation of anal cancer screening programs in Canada given the absence of standardized national evidence-based guidelines. The data was derived from in-depth interviews conducted with 13 physicians and 2 clinical researchers about anal cancer screening for gay, bisexual and other men who have sex with men living with HIV, the minority sub-population at the highest risk for HPV-associated anal cancer. Despite having unknown utility and low specificity, an initial anal Pap test was used to triage patients into anal dysplasia clinics for high-resolution anoscopy. This process led to technological scepticism toward the Pap's accuracy, diagnostic ambiguity related to the interpretation of the cytology results and increased patient anxiety regarding abnormal results. Physicians navigated a tension between wanting to avoid exposing their patients to additional uncertainties caused by screening and pre-cancer treatment and wanting to ensure that their patients did not develop anal cancer under their care. A high number of abnormal anal Pap results paradoxically reintroduced some of the capacity issues that the Pap was meant to resolve, as the existing dysplasia clinics were incapable of seeing all patients with abnormal results. We define this sequence as the epistemic-capacity paradox, a dynamic whereby seeking evidence to improve healthcare capacity simultaneously produces evidence that introduces capacity challenges and generates additional uncertainty. The epistemic-capacity paradox demonstrates the limitations of evidence-based medicine frameworks at determining best practices in the context of rarer health conditions affecting minority sub-populations, where smaller population numbers and limited institutional support pose systemic challenges to the acquisition of sufficient evidence.
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Affiliation(s)
- Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Ron Rosenes
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Irving Salit
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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11
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Grace D, Gaspar M, Rosenes R, Grewal R, Burchell AN, Grennan T, Salit IE. Economic barriers, evidentiary gaps, and ethical conundrums: a qualitative study of physicians' challenges recommending HPV vaccination to older gay, bisexual, and other men who have sex with men. Int J Equity Health 2019; 18:159. [PMID: 31623613 PMCID: PMC6798383 DOI: 10.1186/s12939-019-1067-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 07/15/2019] [Accepted: 09/30/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The human papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide. Gay, bisexual, and other men who have sex with men (GBM), and GBM living with HIV in particular, are disproportionately impacted by HPV-associated cancers. The HPV vaccine, given early enough in life, may markedly reduce the likelihood of such cancers. In Canada, most provincial insurance programs only cover HPV vaccination for GBM up to the age of 26. Our objective was to understand physicians' everyday experiences and challenges in recommending HPV vaccination to older GBM patients. METHODS As part of the HPV Screening and Vaccine Evaluation (HPV-SAVE) Study, we conducted semi-structured interviews with 25 HIV-positive GBM patients who had received anal cancer screening and 15 service providers, including 13 physicians, who had arranged for anal cancer screening in the Canadian provinces of Ontario and British Columbia. In this analysis, we draw upon the 13 physician interviews, which were coded following Grounded Theory. RESULTS Physicians strongly supported the HPV vaccine for all GBM and considered it to be important for the management of HIV-related care. However, the overall support for HPV vaccination among physicians did not translate into consistent recommendation practices. There were two overarching factors that limited the strength/frequency of physicians' vaccine recommendation practices. First, cost/insurance coverage for some older patients impacted if and how the HPV vaccine was discussed. Second, physicians had diverse perspectives on both the prevention and therapeutic benefits of vaccinating older GBM and the reality that national guidelines are incongruent with publicly funded vaccine programs for vaccinating patients over 26 years old. These two interrelated factors have co-produced an apparent economic-evidentiary conundrum for many physicians regarding how and for whom to offer HPV vaccination. CONCLUSION Economic barriers coupled with evidentiary and guideline gaps have created clinical practice challenges for physicians and has resulted in different messages being communicated to some older GBM patients about how important HPV vaccination is for their health.
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Affiliation(s)
- Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada
| | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada
| | - Ron Rosenes
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4 Canada
| | - Ramandip Grewal
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, 30 Bond St, Toronto, ON M5B 1W8 Canada
| | - Ann N. Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, 30 Bond St, Toronto, ON M5B 1W8 Canada
| | - Troy Grennan
- BC Centre for Disease Control, 655 West 12th Ave., Vancouver, BC V5Z 4R4 Canada
| | - Irving E. Salit
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4 Canada
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12
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Kendall CE, Porter JE, Shoemaker ES, Seoyeon Kang R, Fitzgerald M, Keely E, Afkham A, Crowe L, MacPherson P, Rosenes R, Lundrigan P, Bibeau C, Liddy C. Evolving Toward Shared HIV Care Using the Champlain BASE eConsult Service. MDM Policy Pract 2019; 4:2381468319868216. [PMID: 31453365 PMCID: PMC6699006 DOI: 10.1177/2381468319868216] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/17/2019] [Indexed: 11/28/2022] Open
Abstract
Background. Electronic consultation (eConsultation) is a potential
strategy to improve access to specialist expertise and facilitate collaborative
care models. The Champlain BASE eConsult service allows for asynchronous
communication between primary care providers (PCP) and specialists on a secure,
web-based system. HIV experts accessible include HIV physician specialists, HIV
pharmacists, and social workers with expertise in HIV. Objective.
This study aims to describe the use, value, and utility of this eConsultation
service in the care of people living with HIV and to characterize the common
question types and clinical topics asked by PCPs. Methods. We
analyzed the data from eConsults sent to the HIV specialty group in Ontario’s
Champlain Local Health Integration Network between February 2015 and December
2017. Usage data and close-out survey responses were analyzed using descriptive
statistics, eConsults were classified using a predefined list of validated
taxonomy, and a thematic analysis was performed on the consultation logs to
identify common clinical themes. Results. Among the 46 eConsults,
the most common question type related to drug treatment (58.7%,
n = 27) and management (19.6%, n = 9). The
main clinical themes involved the care of significant complexities in people
living with HIV, such as comorbidities and drug interactions, and suggestions of
coordinated patient care. As well, eConsult was used for advice regarding
pre-exposure prophylaxis for HIV-negative patients at risk of HIV infection.
PCPs highly valued the eConsult service (average rating 4.8/5).
Conclusion. Overall, this study demonstrates that eConsult
provides an efficient and valuable service to PCPs caring for patients living
with or at risk for HIV by improving access to HIV specialists and facilitating
the delivery of team-based comprehensive care.
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Affiliation(s)
- Claire E Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Janessa E Porter
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Esther S Shoemaker
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Rachel Seoyeon Kang
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Michael Fitzgerald
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amir Afkham
- Champlain Local Health Integration Network, Ottawa, Ontario, Canada
| | - Lois Crowe
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Paul MacPherson
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ron Rosenes
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Philip Lundrigan
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Christine Bibeau
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
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Shoemaker ES, Becker ML, Liddy CE, McClarty LM, Asghari S, Hurd J, Rourke SB, Shaw SY, Bibeau C, Rosenes R, Lundrigan P, Crowe L, Ireland L, Loeppky C, Kendall CE. Creating Clinical Cohorts: Challenges Encountered in Two Canadian Provinces. Healthc Policy 2019; 15:10-18. [PMID: 31629452 PMCID: PMC7008696 DOI: 10.12927/hcpol.2019.25942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
In 2013, the Living with HIV (LHIV) Innovation team established clinical cohorts of people living with HIV in Manitoba and Newfoundland and Labrador, and they linked the data to provincial health administrative databases. Access to these data enabled researchers to conduct studies across provincial borders; contribute to a national dialogue on HIV health system performance; and give recommendations for evidence-based healthcare, health policy and public health. However, research funding is episodic; maintaining cohorts requires stable funding. We support the establishment of a cross-jurisdictional approach to facilitate streamlined data collection and linkage without interruption and to allow for meaningful analysis in order to inform national policies.
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Affiliation(s)
- Esther S Shoemaker
- Bruyère Research Institute, University of Ottawa, Ottawa Hospital Research Institute, Institute of Clinical and Evaluative Sciences, Ottawa, ON
| | - Marissa L Becker
- Centre for Global Public Health, University of Manitoba, Winnipeg, MB
| | - Clare E Liddy
- Bruyère Research Institute, Department of Family Medicine, University of Ottawa, Ottawa, ON
| | - Leigh M McClarty
- Centre for Global Public Health, University of Manitoba, Winnipeg, MB
| | - Shabnam Asghari
- Department of Family Medicine, Centre for Rural Health Studies, Memorial University of Newfoundland, St. John's, NL
| | - Jillian Hurd
- Department of Family Medicine, Centre for Rural Health Studies, Memorial University of Newfoundland, St. John's, NL
| | - Sean B Rourke
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Department of Psychiatry, University of Toronto Toronto, ON
| | - Souradet Y Shaw
- Centre for Global Public Health, University of Manitoba, Winnipeg, MB
| | - Christine Bibeau
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON
| | - Ron Rosenes
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON
| | - Philip Lundrigan
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON
| | - Lois Crowe
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON
| | | | - Carla Loeppky
- Manitoba Health, Seniors and Active Living, Government of Manitoba, Winnipeg, MB
| | - Claire E Kendall
- Bruyère Research Institute, University of Ottawa, Institute of Clinical and Evaluative Sciences, Li Ka Shing Knowledge Institute, Ottawa, ON
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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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15
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Grace D, Gaspar M, Paquette R, Rosenes R, Burchell AN, Grennan T, Salit IE. HIV-positive gay men's knowledge and perceptions of Human Papillomavirus (HPV) and HPV vaccination: A qualitative study. PLoS One 2018; 13:e0207953. [PMID: 30496221 PMCID: PMC6264470 DOI: 10.1371/journal.pone.0207953] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 08/29/2018] [Accepted: 11/08/2018] [Indexed: 11/22/2022] Open
Abstract
The human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. Gay, bisexual, and other men who have sex with men (GBM) living with HIV are disproportionately impacted by HPV-associated anal cancer, with rates about 100-fold that of the general population. Fortunately, HPV vaccination has proven efficacy in preventing both anogenital warts (condyloma) in males and anal pre-cancers (anal intraepithelial neoplasia; AIN) in GBM up to the age of 26. We conducted in-depth, semi-structured interviews with 25 HIV-positive gay men in Toronto to gain an understanding of their knowledge and experiences related to HPV and the HPV vaccine. These participants were part of The HPV Screening and Vaccine Evaluation (HPV-SAVE) Study, and received invitations to have anal cancer screening from their primary care doctors. Interviews were analyzed following a Grounded Theory Approach. Most participants had not received the HPV vaccine. Men described a lack of prior knowledge of the health consequences of HPV for GBM living with HIV and financial barriers to vaccine access. Participants did not articulate concerns about vaccine safety. Men frequently reported initial beliefs that HPV was predominantly-or exclusively-a risk for females or young girls, and thus they had not considered the vaccine to be necessary. Some participants remained uncertain if the current availability of the vaccine, and their newly acquired knowledge of its importance, was "too little, too late" because of their age and/or HPV exposure. Improving access and uptake of HPV vaccination requires addressing both financial barriers to access as well as increasing HPV health literacy levels, particularly by reframing the long-standing gendered associations of HPV. Physicians should provide clear, tailored messages regarding HPV vaccination.
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Affiliation(s)
- Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Ron Rosenes
- Canadian HIV/AIDS Legal Network, Toronto, Canada
| | | | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, Canada
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16
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Kendall CE, Raboud J, Donelle J, Loutfy M, Rourke SB, Kroch A, Liddy C, Rosenes R, Burchell AN. Lost but not forgotten: A population-based study of mortality and care trajectories among people living with HIV who are lost to follow-up in Ontario, Canada. HIV Med 2018; 20:88-98. [PMID: 30474908 PMCID: PMC9292000 DOI: 10.1111/hiv.12682] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2018] [Indexed: 11/27/2022]
Abstract
Objectives Selection as a consequence of volunteer participation in, and loss to follow‐up from, cohort studies may bias estimates of mortality and other health outcomes. To quantify this potential, we estimated mortality and health service use among people living with HIV (PLWH) who were lost to cohort follow‐up (LTCFU) from a volunteer clinical HIV‐infected cohort, and compared these to mortality and health service use in active cohort participants and non‐cohort‐participants living with HIV in Ontario, Canada. Methods We analysed population‐based provincial health databases from 1995 to 2014, identifying PLWH ≥ 18 years old; these included data from participants in the Ontario HIV Treatment Network Cohort Study (OCS), a volunteer, multi‐site clinical HIV‐infected cohort. We calculated all‐cause mortality, hospitalization and emergency department (ED) visit rates per 100 person‐years (PY) and estimated hazard ratios (HRs) of mortality, adjusting for age, sex, income, rurality, and immigration status. Results Among 23 043 PLWH, 5568 were OCS participants. Compared with nonparticipants, participants were younger and less likely to be female, to be an immigrant and to reside in a major urban centre, and had lower comorbidity. Mortality among active participants, participants LTCFU and nonparticipants was 2.52, 3.30 and 2.20 per 100 PY, respectively. After adjustment for covariates, mortality risk was elevated among participants LTCFU compared with active participants (HR 2.26; 95% confidence interval 1.91, 2.68). Age‐adjusted hospitalization rates and ED visit rates were highest among participants LTCFU. Conclusions Mortality risk and use of health care resources were lower among active cohort participants. Our findings may inform health outcome estimates based on volunteer cohorts, as well as quantitative bias adjustment to correct for such biases.
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Affiliation(s)
- C E Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.,ICES, Toronto, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - J Raboud
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - J Donelle
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Loutfy
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Maple Leaf Medical Clinic, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - S B Rourke
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - A Kroch
- Ontario HIV Treatment Network, Toronto, ON, Canada.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - C Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - R Rosenes
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | | | - A N Burchell
- ICES, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Kendall CE, Shoemaker ES, Boucher L, Rolfe DE, Crowe L, Becker M, Asghari S, Rourke SB, Rosenes R, Bibeau C, Lundrigan P, Liddy C. The organizational attributes of HIV care delivery models in Canada: A cross-sectional study. PLoS One 2018; 13:e0199395. [PMID: 29924865 PMCID: PMC6010295 DOI: 10.1371/journal.pone.0199395] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/06/2018] [Indexed: 11/25/2022] Open
Abstract
HIV treatment in Canada has rapidly progressed with the advent of new drug therapies and approaches to care. With this evolution, there is increasing interest in Canada in understanding the current delivery of HIV care, specifically where care is delivered, how, and by whom, to inform the design of care models required to meet the evolving needs of the population. We conducted a cross-sectional survey of Canadian care settings identified as delivering HIV care between June 2015 and January 2016. Given known potential differences in delivery approaches, we stratified settings as primary care or specialist settings, and described their structure, geographic location, populations served, health human resources, technological resources, and available clinical services. We received responses from 22 of 43 contacted care settings located in seven Canadian provinces (51.2% response rate). The total number of patients and HIV patients served by the participating settings was 38,060 and 17,678, respectively (mean number of HIV patients in primary care settings = 1,005, mean number of HIV patients in specialist care settings = 562). Settings were urban for 20 of the 22 (90.9%) clinics and 14 (63.6%) were entirely HIV focused. Primary care settings were more likely to offer preventative services (e.g., cervical smear, needle exchange, IUD insertion, chronic disease self-management program) than specialist settings. The study illustrates diversity in Canadian HIV care settings. All settings were team based, but primary care settings offered a broader range of preventative services and comprehensive access to mental health services, including addictions and peer support.
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Affiliation(s)
- Claire E. Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institute of Clinical and Evaluative Sciences, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Esther Susanna Shoemaker
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institute of Clinical and Evaluative Sciences, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lisa Boucher
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Lois Crowe
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Marissa Becker
- Departments of Medicine, Medical Microbiology and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shabnam Asghari
- Department of Family Medicine, Centre for Rural Health Studies, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Sean B. Rourke
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ron Rosenes
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Christine Bibeau
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Philip Lundrigan
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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18
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Kendall CE, Shoemaker ES, Crowe L, MacPherson P, Becker ML, Levreault E, Boucher LM, Rosenes R, Bibeau C, Lundrigan P, Liddy CE. Patient activation among people living with HIV: a cross-sectional comparative analysis with people living with diabetes mellitus. AIDS Care 2018; 30:1444-1451. [PMID: 29792355 DOI: 10.1080/09540121.2018.1469723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/16/2022]
Abstract
Standardized self-management supports are an integral part of care delivery for many chronic conditions. We used the validated Patient Activation Measure (PAM®) to assess level of engagement for self-management from a sample of 165 people living with HIV (PLWH) and 163 people with diabetes. We conducted multivariable logistic regression to assess associations between demographics and PAM® scores. PLWH had high levels of activation that were no different from those of people with diabetes (mean score = 67.2, SD = 14.2 versus 65.0, SD = 14.9, p = 0.183). After adjusting for patient characteristics, only being on disability compared to being employed or a student was associated with being less activated (AOR = 0.276, 95%CI = 0.103-0.742). Our findings highlight the potential for the implementation of existing standardized chronic disease self-management programs to enhance the care delivery for PLWH, with people on disability as potential target populations.
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Affiliation(s)
- Claire E Kendall
- a C.T. Lamont Primary Health Care Research Centre , Bruyère Research Institute , Ottawa , ON , Canada.,e Department of Medicine , University of Ottawa , Ottawa , ON , Canada.,f Institute of Clinical and Evaluative Sciences , Toronto , ON , Canada.,g Li Ka Shing Knowledge Institute , St. Michael's Hospital , Toronto , ON , Canada
| | - Esther S Shoemaker
- a C.T. Lamont Primary Health Care Research Centre , Bruyère Research Institute , Ottawa , ON , Canada.,e Department of Medicine , University of Ottawa , Ottawa , ON , Canada.,f Institute of Clinical and Evaluative Sciences , Toronto , ON , Canada
| | - Lois Crowe
- a C.T. Lamont Primary Health Care Research Centre , Bruyère Research Institute , Ottawa , ON , Canada
| | - Paul MacPherson
- b Chronic Disease Program , Ottawa Hospital Research Institute , Ottawa , ON , Canada
| | - Marissa L Becker
- c Departments of Medicine, Medical Microbiology and Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| | - Eleni Levreault
- d Faculty of Medicine , University of Ottawa , Ottawa , ON , Canada
| | - Lisa M Boucher
- a C.T. Lamont Primary Health Care Research Centre , Bruyère Research Institute , Ottawa , ON , Canada.,e Department of Medicine , University of Ottawa , Ottawa , ON , Canada
| | - Ron Rosenes
- a C.T. Lamont Primary Health Care Research Centre , Bruyère Research Institute , Ottawa , ON , Canada
| | - Christine Bibeau
- a C.T. Lamont Primary Health Care Research Centre , Bruyère Research Institute , Ottawa , ON , Canada
| | - Philip Lundrigan
- a C.T. Lamont Primary Health Care Research Centre , Bruyère Research Institute , Ottawa , ON , Canada
| | - Clare E Liddy
- a C.T. Lamont Primary Health Care Research Centre , Bruyère Research Institute , Ottawa , ON , Canada.,e Department of Medicine , University of Ottawa , Ottawa , ON , Canada
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Asghari S, Hurd J, Marshall Z, Maybank A, Hesselbarth L, Hurley O, Farrell A, Kendall CE, Rourke SB, Becker M, Johnston S, Lundrigan P, Rosenes R, Bibeau C, Liddy C. Challenges with access to healthcare from the perspective of patients living with HIV: a scoping review & framework synthesis. AIDS Care 2018; 30:963-972. [PMID: 29397762 DOI: 10.1080/09540121.2018.1435848] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Accessing healthcare can be difficult but the barriers multiply for people living with HIV (PLHIV). To improve access and the health of PLHIV, we must consider their perspectives and use them to inform standard practice. A better understanding of the current literature related to healthcare access from the perspective of PLHIV, can help to identify evidence gaps and highlight research priorities and opportunities. To identify relevant peer-reviewed publications, search strategies were employed. Electronic and grey literature databases were explored. Articles were screened based on their title and abstract and those that met the screening criteria, were reviewed in full. Data analysis was conducted using a collaborative approach that included knowledge user consultation. Initial concepts were extracted, summarized and through framework synthesis, developed into emerging and final themes. From 20,678 articles, 326 articles met the initial screening criteria and 64 were reviewed in full. The final themes identified, in order of most to least frequent were: Acceptability, Availability, Accessibility, Affordability, Other Barriers, Communication, Satisfaction, Accommodation, Preferences and Equity in Access. The most frequently discussed concepts related to negative interactions with staff, followed by long wait times, limited household resources or inability to pay fees, and fear of one's serostatus being disclosed. Knowledge users were in agreement with the categorization of initial concepts and final themes; however, some gaps in the literature were identified. Specific changes are critical to improving access to healthcare for PLHIV. These include improving availability by ensuring staff and healthcare professionals have proper training, cultivating acceptability and reducing stigma through improving HIV awareness, increasing accessibility through increased HIV information for PLHIV and improved dissemination of this information to increase patient knowledge and health awareness. Finally, ensuring proper protocols are implemented and followed to guarantee patient confidentiality and overall satisfaction with healthcare services are recommended.
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Affiliation(s)
- Shabnam Asghari
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Jillian Hurd
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Zack Marshall
- b School of Social Work , McGill University , Montreal , QC , Canada
| | - Allison Maybank
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Lydia Hesselbarth
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Oliver Hurley
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Alison Farrell
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Claire E Kendall
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
| | - Sean B Rourke
- d Li Ka Shing Knowledge Institute , St. Michael's Hospital , Toronto , ON , Canada
| | - Marissa Becker
- e Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada
| | - Sharon Johnston
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
| | - Phil Lundrigan
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
| | - Ron Rosenes
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
| | - Christine Bibeau
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
| | - Clare Liddy
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
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20
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Kendall CE, Shoemaker ES, Crowe L, Rosenes R, Lundrigan P, Bibeau C, Asghari S, Becker M, Rourke SB, Marshall Z, Liddy C. Engagement of people with lived experience in primary care research: Living with HIV Innovation Team Community Scholar Program. Can Fam Physician 2017; 63:730-731. [PMID: 28904041 PMCID: PMC5597020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Claire E Kendall
- Clinician Investigator in the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute in Ottawa, Ont, and Associate Professor in the Department of Family Medicine at the University of Ottawa and in the Clinical Epidemiology program at the Ottawa Hospital Research Institute
| | - Esther Susanna Shoemaker
- Research Associate in the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute
| | - Lois Crowe
- Research Manager, in the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute
| | - Ron Rosenes
- Community Scholar in the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute
| | - Philip Lundrigan
- Community Scholar in the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute
| | - Christine Bibeau
- Community Scholar in the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute
| | - Shabnam Asghari
- Assistant Professor in the Department of Family Medicine in the Centre for Rural Health Studies at Memorial University of Newfoundland in St John's
| | - Marissa Becker
- Associate Professor in the Departments of Medicine, Medical Microbiology, and Community Health Sciences at the University of Manitoba in Winnipeg
| | - Sean B Rourke
- Scientific and Executive Director of the Ontario HIV Treatment Network, a clinical neuropsychologist and scientist in the Centre for Urban Health Solutions at the Li Ka Shing Knowledge Institute of St Michael's Hospital, and Professor in the Department of Psychiatry at the University of Toronto in Ontario
| | - Zack Marshall
- Assistant Professor in the Department of Social Development Studies and the School of Social Work at Renison University College at the University of Waterloo in Ontario
| | - Clare Liddy
- Clinician Investigator in the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute and Associate Professor in the Department of Family Medicine at the University of Ottawa
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21
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Kendall CE, Walmsley S, Lau C, Jembere N, Burchell AN, Loutfy M, Raboud J, Rosenes R, Rourke SB, Antoniou T. A cross-sectional population-based study of breast cancer screening among women with HIV in Ontario, Canada. CMAJ Open 2017; 5:E673-E681. [PMID: 28855308 PMCID: PMC5621963 DOI: 10.9778/cmajo.20170038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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 As women with HIV live longer, the need for age-appropriate breast cancer screening will increase. We compared rates of screening mammography among women with and without HIV. METHODS We used administrative health databases to identify all women in Ontario, Canada, who were eligible for screening mammography (aged 50 to 74 yr and no history of breast cancer) as of Apr. 1, 2011. We used multivariable log-binomial regression to compare the 2-year period prevalence of screening mammography in 2011 to 2013 among women with and without HIV and to examine the correlates of screening among women with HIV. RESULTS We identified 1 447 015 screen-eligible women, among whom 623 (0.04%) were women with HIV. Women with HIV were less likely to undergo screening than women without HIV (50.1% v. 63.4%, p < 0.001). Following multivariable adjustment, HIV-positive status was associated with significantly lower odds of undergoing mammography (adjusted prevalence ratio [PR] 0.83, 95% confidence interval [CI] 0.77-0.89). Compared with women with HIV receiving regular care from both a family physician and an HIV specialist, women with HIV receiving neither kind of care (adjusted PR 0.64, 95% CI 0.50-0.83) or predominantly specialist care (adjusted PR 0.77; 95% CI 0.60 to 0.97) were less likely to undergo screening mammography. INTERPRETATION Women with HIV are less likely to undergo breast cancer screening mammography than women without HIV. Addressing this disparity requires optimizing care delivery to ensure adequate provision of comprehensive primary care to people with HIV.
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Affiliation(s)
- Claire E Kendall
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Sharon Walmsley
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Cindy Lau
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Nathaniel Jembere
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Ann N Burchell
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Mona Loutfy
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Janet Raboud
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Ron Rosenes
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Sean B Rourke
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Tony Antoniou
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
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Kim CJ, Walmsley SL, Raboud JM, Kovacs C, Coburn B, Rousseau R, Reinhard R, Rosenes R, Kaul R. Can Probiotics Reduce Inflammation and Enhance Gut Immune Health in People Living with HIV: Study Designs for the Probiotic Visbiome for Inflammation and Translocation (PROOV IT) Pilot Trials. HIV Clin Trials 2016; 17:147-57. [PMID: 27267710 DOI: 10.1080/15284336.2016.1184827] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Despite substantial improvements in HIV outcomes with combination antiretroviral therapy (cART), morbidity and mortality remain above population norms. The gut mucosal immune system is not completely restored by cART, and the resultant microbial translocation may contribute to chronic inflammation, inadequate CD4 T-cell recovery, and increased rates of serious non-AIDS events. Since the microbial environment surrounding a CD4 T cell may influence its development and function, we hypothesize that probiotics provided during cART might reduce inflammation and improve gut immune health in HIV-positive treatment-naïve individuals (PROOV IT I) and individuals with suboptimal CD4 recovery on cART (PROOV IT II). METHODS These prospective, double-blinded, randomized, placebo-controlled, multicenter pilot studies will assess the impact of the probiotic Visbiome at 900 billion bacteria daily. Forty HIV positive cART-naïve men will be randomized in the PROOV IT I study, coincident with antiretroviral initiation, and be followed for 24 weeks. In PROOV IT II, 36 men on cART, but with a CD4 T-cell count below 350 cells/mm(3) will be followed for 48 weeks. The primary outcome for both studies is the comparison of blood CD8 T-cell immune activation. Secondary analyses will include comparison of blood inflammatory biomarkers, microbial translocation, blood and gut immunology and HIV levels, the bacterial community composition, diet, intestinal permeability, and the safety, adherence and tolerability of the study product. DISCUSSION These studies will evaluate the ability of probiotics as a safe and tolerable therapeutic intervention to reduce systemic immune activation and to accelerate gut immune restoration in people living with HIV.
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Affiliation(s)
- Connie J Kim
- a Toronto General Research Institute , University Health Network , Toronto , Canada
| | - Sharon L Walmsley
- a Toronto General Research Institute , University Health Network , Toronto , Canada.,c Department of Immunology, Dalla Lana School of Public Health, and Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Canada
| | - Janet M Raboud
- a Toronto General Research Institute , University Health Network , Toronto , Canada.,c Department of Immunology, Dalla Lana School of Public Health, and Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Canada
| | | | - Bryan Coburn
- a Toronto General Research Institute , University Health Network , Toronto , Canada.,c Department of Immunology, Dalla Lana School of Public Health, and Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Canada
| | - Rodney Rousseau
- c Department of Immunology, Dalla Lana School of Public Health, and Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Canada
| | | | - Ron Rosenes
- e Community Health Advocate and Consultant , Toronto , ON , Canada
| | - Rupert Kaul
- a Toronto General Research Institute , University Health Network , Toronto , Canada.,c Department of Immunology, Dalla Lana School of Public Health, and Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Canada
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23
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Balfour L, Spaans JN, Fergusson D, Huff H, Mills EJ, la Porte CJ, Walmsley S, Singhal N, Rosenes R, Tremblay N, Gill MJ, Loemba H, Conway B, Rachlis A, Ralph E, Loutfy M, Mallick R, Moorhouse R, William Cameron D. Micronutrient deficiency and treatment adherence in a randomized controlled trial of micronutrient supplementation in ART-naïve persons with HIV. PLoS One 2014; 9:e85607. [PMID: 24465617 PMCID: PMC3897458 DOI: 10.1371/journal.pone.0085607] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 12/02/2013] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The MAINTAIN study is an on-going RCT comparing high-dose micronutrient and anti-oxidant supplementation versus recommended daily allowance (RDA) vitamins in slowing HIV immune deficiency progression in ART-naïve people with HIV infection. OBJECTIVE We planned analysis of the first 127 participants to determine the baseline prevalence of serum micronutrient deficiencies and correlates, as well as tolerance and adherence to study interventions. METHODS Participants receive eight capsules twice daily of 1) high-dose or 2) RDA supplements for two years and are followed-up quarterly for measures of immune deficiency progression, safety and tolerability. Regression analysis was used to identify correlates of micronutrient levels at baseline. Adherence was measured by residual pill count, self-report using the General Treatment Scale (GTS) and short-term recall HIV Adherence Treatment Scale (HATS). RESULTS Prior micronutrient supplementation (within 30 days) was 27% at screening and 10% of study population, and was not correlated with baseline micronutrient levels. Low levels were frequent for carotene (24%<1 nmol/L), vitamin D (24%<40 nmol/L) and serum folate (20%<15 nmol/L). The proportion with B12 deficiency (<133 pmol/L) was 2.4%. Lower baseline levels of B12 correlated lower baseline CD4 count (r = 0.21, p = 0.02) with a 21 pmol/L reduction in B12 per 100 cells/µL CD4. Vitamin D levels were higher in men (p<0.001). After a median follow-up of 1.63 years, there were 19 (15%) early withdrawals from the study treatment. Mean treatment adherence using pill count was 88%. Subjective adherence by the GTS was 81% and was moderately but significantly correlated with pill count (r = 0.29, p<0.001). Adherence based on short-term recall (HATS) was >80% in 75% of participants. CONCLUSION Micronutrient levels in asymptomatic HIV+ persons are in keeping with population norms, but micronutrient deficiencies are frequent. Adherence levels are high, and will permit a valid evaluation of treatment effects. TRIAL REGISTRATION ClinicalTrials.gov NCT00798772.
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Affiliation(s)
- Louise Balfour
- CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Ottawa at the Ottawa Hospital, Ottawa, Ontario, Canada
| | - Johanna N. Spaans
- CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Clinical Epidemiology Program, University of Ottawa at The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, University of Ottawa at The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - Harold Huff
- Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Edward J. Mills
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Charles J. la Porte
- Division of Infectious Diseases, Department of Medicine, University of Ottawa at the Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, University of Ottawa at The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - Sharon Walmsley
- CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Neera Singhal
- CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Clinical Epidemiology Program, University of Ottawa at The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - Ron Rosenes
- CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
| | - Nancy Tremblay
- CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Ottawa at the Ottawa Hospital, Ottawa, Ontario, Canada
| | - M. John Gill
- CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Hugues Loemba
- CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Department of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Conway
- CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anita Rachlis
- CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Edward Ralph
- CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Mona Loutfy
- CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ranjeeta Mallick
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rika Moorhouse
- Clinical Epidemiology Program, University of Ottawa at The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - D. William Cameron
- CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Ottawa at the Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, University of Ottawa at The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
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Zipursky AR, Gogolishvili D, Rueda S, Brunetta J, Carvalhal A, McCombe JA, Gill MJ, Rachlis A, Rosenes R, Arbess G, Marcotte T, Rourke SB. Evaluation of brief screening tools for neurocognitive impairment in HIV/AIDS: a systematic review of the literature. AIDS 2013; 27:2385-401. [PMID: 23751261 PMCID: PMC3814629 DOI: 10.1097/qad.0b013e328363bf56] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [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: 04/05/2013] [Revised: 05/29/2013] [Accepted: 05/29/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE(S) To systematically review literature on brief screening tools used to detect and differentiate between normal cognition and neurocognitive impairment and HIV-associated neurocognitive disorders (HANDs) in adult populations of persons with HIV. DESIGN A formal systematic review. METHODS We searched six electronic databases in 2011 and contacted experts to identify relevant studies published through May 2012. We selected empirical studies that focused on evaluating brief screening tools (<20 min) for neurocognitive impairment in persons with HIV. Two reviewers independently reviewed retrieved literature for potential relevance and methodological quality. Meta-analyses were completed on screening tools that had sufficient data. RESULTS Fifty-one studies met inclusion criteria; we focused on 31 studies that compared brief screening tools with reference tests. Within these 31 studies, 39 tools were evaluated and 67% used a comprehensive neuropsychological battery as a reference. The majority of these studies evaluated HIV-associated dementia (HAD). Meta-analyses demonstrated that the HIV Dementia Scale (HDS) has poor pooled sensitivity (0.48) and the International HIV Dementia Scale (IHDS) has moderate pooled sensitivity (0.62) in detecting a range of cognitive impairment. Five newer screening tools had relatively good sensitivities (>0.70); however, none of the tools differentiated HAND conditions well enough to suggest broader use. There were significant methodological shortcomings noted in most studies. CONCLUSION HDS and IHDS perform well to screen for HAD but poorly for milder HAND conditions. Further investigation, with improved methodology, is required to understand the utility of newer screening tools for HAND; further tools may need to be developed for milder HAND conditions.
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Affiliation(s)
- Amy R Zipursky
- aOntario HIV Treatment Network bUniversity of Toronto cMaple Leaf Clinic, Toronto, Ontario dSt. Michael's Hospital, Toronto, Ontario eSouthern Alberta HIV Clinic and University of Alberta, Edmonton, Alberta fSunnybrook Hospital, Toronto, Ontario, Canada gUniversity of California, San Diego, La Jolla, California, USA
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25
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Vasquez C, Lioznov D, Nikolaenko S, Yatsishin S, Lesnikova D, Cox D, Pankovich J, Rosenes R, Wobeser W, Cooper, on behalf of the St. Peters C. Gender disparities in HIV risk behavior and access to health care in St. Petersburg, Russia. AIDS Patient Care STDS 2013; 27:304-10. [PMID: 23651108 DOI: 10.1089/apc.2013.0019] [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: 01/15/2023] Open
Abstract
Over 40,000 HIV-infected individuals live in St Petersburg, Russia. Population characteristics and barriers to care are largely undefined. 152 consecutive patients receiving HIV care at two sites completed a questionnaire in Spring 2011. Rates of chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infection, alcohol use, and rates of antiretroviral uptake were similar by gender. Males reported a higher history of injection drug use (80.3% vs. 48.7%; p<0.01) and tuberculosis infection (18.8% vs. 1.6%; p<0.01). Females were more likely to have had a child (63.3% vs. 31.5%; p<0.01) and be currently raising that child within their residence (49.3% vs. 15.3%; p<0.01). Unprotected sex (60.5% vs. 17.8%; p<0.01) and a history of sexually transmitted infection (37.7% vs. 20.3%; p=0.03) were more common in females. Females utilized social services more frequently (34.2% vs. 11.9%; p<0.01). There is a heavy burden of concurrent infectious disease, substance use and abuse, mental health illness, and need for social service support in this population. Important differences exist between genders in service uptake and utilization. Further evaluation of these differences may help inform the allocation of limited resources in this high HIV prevalence region of Russia.
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Affiliation(s)
| | | | | | - Sergey Yatsishin
- St. Petersburg Branch of Russian Red Cross, St. Petersburg, Russia
| | - Darya Lesnikova
- St. Petersburg Branch of Russian Red Cross, St. Petersburg, Russia
| | - David Cox
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Jim Pankovich
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Ron Rosenes
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
- CTN Community Advisory Committee, Toronto, Ontario, Canada
| | - Wendy Wobeser
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
- Queen's University, Kingston, Ontario, Canada
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26
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Loutfy MR, Brunetta J, Kovacs C, Diong C, Gamble M, Antoniou T, Smith G, Halpenny R, Rosenes R, Raboud JM. Four-year follow-up of polyalkylimide gel use for the treatment of HIV-associated lipoatrophy. HIV Clin Trials 2012; 12:323-32. [PMID: 22189151 DOI: 10.1310/hct1206-323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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
PURPOSE To evaluate polyalkylamide gel (PAIG) use in treating HIV-associated facial lipoatrophy (FLA) 4 years after its injection in an open-label, randomized controlled trial (RCT). METHODS Five patients were treated with PAIG in a pilot study, and 31 patients were subsequently enrolled in the RCT of immediate or delayed (12 weeks later) PAIG injections. Endpoints included proportion of participants with complications; changes in FLA severity score (FLSS); and quality of life (QoL), depression, anxiety, and satisfaction scores. Infections were classified as "confirmed" if purulent material was extracted and/or an organism cultured. Infections were classified as "possible" if only clinical signs were present without purulent discharge or microbiologic confirmation. RESULTS Year 4 results were available for 5 pilot and 27 full-scale study participants. Delayed complications included 5 confirmed infections (15.6%), 3 possible infections (9.4%), nodules (25%), and bleeding (3%). No significant changes were observed between years 2 to 4 in patient-graded FLSS, QoL, depression, and anxiety scores. Whereas 94% of participants were satisfied with their overall treatment, only 69% were satisfied with PAIG treatment specifically. CONCLUSION Even though PAIG treatment was associated with delayed complications including high rates of infection and nodules, most patients were satisfied with the treatment.
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Affiliation(s)
- Mona R Loutfy
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada.
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27
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Andany N, Raboud JM, Walmsley S, Diong C, Rourke SB, Rueda S, Rachlis A, Wobeser W, Macarthur RD, Binder L, Rosenes R, Loutfy MR. Ethnicity and gender differences in lipodystrophy of HIV-positive individuals taking antiretroviral therapy in Ontario, Canada. HIV Clin Trials 2011; 12:89-103. [PMID: 21498152 DOI: 10.1310/hct1202-89] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This study assessed ethnicity and gender differences in prevalence, type, and severity of antiretroviral-associated lipodystrophy in HIV-positive individuals in Ontario. METHODS This was a cross-sectional analysis of the Ontario Cohort Study (OCS), a prospective study of HIV-positive patients in Ontario. Lipodystrophy was defined as at least 1 major or 2 minor self-reported changes of peripheral lipoatrophy and/or central lipohypertrophy. Prevalence, type, and severity were compared by ethnicity (Black, White, or Other) and gender. Univariate and multivariate logistic regression analyses identified predictors of lipodystrophy. RESULTS Data were available for 778 participants (659 men, 119 women). There were 517 Whites, 121 Blacks, and 140 patients of Other ethnicities. In univariate analyses, Whites reported more peripheral lipoatrophy (P = .004) and abdominal lipohypertrophy (P = .04); these ethnic differences were observed in males (P = .05 and P = .03, respectively) but not females. Males reported more peripheral lipoatrophy (P = .01), whereas females had more central lipohypertrophy (P < .0001) and mixed fat redistribution (P < .0001). Multivariable regression analyses revealed Black women to be most vulnerable to lipodystrophy (P = .02), particularly lipohypertrophy (P < .0001). CONCLUSIONS Ethnicity and gender are important factors influencing lipodystrophy. Combining lipoatrophy and lipohypertrophy into a single entity is not appropriate. Black women were most vulnerable to lipohypertrophy, which has important implications for antiretroviral therapy roll-out in Africa.
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Affiliation(s)
- Nisha Andany
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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