scholarly journals How community ART delivery may improve HIV treatment outcomes: Qualitative inquiry into mechanisms of effect in a randomized trial of community‐based ART initiation, monitoring and re‐supply (DO ART) in South Africa and Uganda

2021 ◽  
Vol 24 (10) ◽  
Author(s):  
Hannah N. Gilbert ◽  
Monique A. Wyatt ◽  
Emily E. Pisarski ◽  
Stephen Asiimwe ◽  
Heidi Rooyen ◽  
...  
Keyword(s):  
South Africa ◽  
Treatment Outcomes ◽  
Hiv Treatment ◽  
Qualitative Inquiry ◽  
Community Based ◽  
Community Art ◽  
Art Initiation ◽  
Community Based Art ◽  
Hiv Treatment Outcomes ◽  
Art Delivery

scholarly journals The association between social capital and HIV treatment outcomes in South Africa

PLoS ONE ◽  
2017 ◽  
Vol 12 (11) ◽  
pp. e0184140 ◽  
Author(s):  
Grace Musanse Mukoswa ◽  
Salome Charalambous ◽  
Gill Nelson
Keyword(s):  
South Africa ◽  
Social Capital ◽  
Treatment Outcomes ◽  
Hiv Treatment ◽  
Hiv Treatment Outcomes

scholarly journals Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa?

AIDS Care ◽  
2016 ◽  
Vol 28 (sup2) ◽  
pp. 73-82 ◽  
Author(s):  
L. D. Cluver ◽  
E. Toska ◽  
F. M. Orkin ◽  
F. Meinck ◽  
R. Hodes ◽  
...  
Keyword(s):  
South Africa ◽  
Treatment Outcomes ◽  
Social Protection ◽  
Hiv Treatment ◽  
Art Adherence ◽  
Adolescent Art ◽  
Hiv Treatment Outcomes

Tenofovir stock shortages have limited impact on clinic- and patient-level HIV treatment outcomes in public sector clinics in South Africa

2016 ◽  
Vol 22 (2) ◽  
pp. 241-251 ◽  
Author(s):  
Alana T. Brennan ◽  
Jacob Bor ◽  
Mary-Ann Davies ◽  
Francesca Conradie ◽  
Mhairi Maskew ◽  
...  
Keyword(s):  
South Africa ◽  
Public Sector ◽  
Treatment Outcomes ◽  
Hiv Treatment ◽  
Limited Impact ◽  
Patient Level ◽  
Hiv Treatment Outcomes

scholarly journals Effects of community-based antiretroviral therapy initiation models on HIV treatment outcomes: A systematic review and meta-analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (5) ◽  
pp. e1003646
Author(s):  
Ingrid Eshun-Wilson ◽  
Ajibola A. Awotiwon ◽  
Ashley Germann ◽  
Sophia A. Amankwaa ◽  
Nathan Ford ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Facility ◽  
Viral Suppression ◽  
Meta Analysis ◽  
Community Setting ◽  
Standard Of Care ◽  
Hiv Treatment ◽  
Community Based ◽  
Community Art ◽  
Art Initiation

Background Antiretroviral therapy (ART) initiation in the community and outside of a traditional health facility has the potential to improve linkage to ART, decongest health facilities, and minimize structural barriers to attending HIV services among people living with HIV (PLWH). We conducted a systematic review and meta-analysis to determine the effect of offering ART initiation in the community on HIV treatment outcomes. Methods and findings We searched databases between 1 January 2013 and 22 February 2021 to identify randomized controlled trials (RCTs) and observational studies that compared offering ART initiation in a community setting to offering ART initiation in a traditional health facility or alternative community setting. We assessed risk of bias, reporting of implementation outcomes, and real-world relevance and used Mantel–Haenszel methods to generate pooled risk ratios (RRs) and risk differences (RDs) with 95% confidence intervals. We evaluated heterogeneity qualitatively and quantitatively and used GRADE to evaluate overall evidence certainty. Searches yielded 4,035 records, resulting in 8 included studies—4 RCTs and 4 observational studies—conducted in Lesotho, South Africa, Nigeria, Uganda, Malawi, Tanzania, and Haiti—a total of 11,196 PLWH. Five studies were conducted in general HIV populations, 2 in key populations, and 1 in adolescents. Community ART initiation strategies included community-based HIV testing coupled with ART initiation at home or at community venues; 5 studies maintained ART refills in the community, and 4 provided refills at the health facility. All studies were pragmatic, but in most cases provided additional resources. Few studies reported on implementation outcomes. All studies showed higher ART uptake in community initiation arms compared to facility initiation and refill arms (standard of care) (RR 1.73, 95% CI 1.22 to 2.45; RD 30%, 95% CI 10% to 50%; 5 studies). Retention (RR 1.43, 95% CI 1.32 to 1.54; RD 19%, 95% CI 11% to 28%; 4 studies) and viral suppression (RR 1.31, 95% CI 1.15 to 1.49; RD 15%, 95% CI 10% to 21%; 3 studies) at 12 months were also higher in the community-based ART initiation arms. Improved uptake, retention, and viral suppression with community ART initiation were seen across population subgroups—including men, adolescents, and key populations. One study reported no difference in retention and viral suppression at 2 years. There were limited data on adherence and mortality. Social harms and adverse events appeared to be minimal and similar between community care and standard of care. One study compared ART refill strategies following community ART initiation (community versus facility refills), and found no difference in viral suppression (RD −7%, 95% CI −19% to 6%) or retention at 12 months (RD −12%, 95% CI −23% to 0.3%). This systematic review was limited by there being overall few studies for inclusion, poor-quality observational data, and short-term outcomes. Conclusions Based on data from a limited set of studies, community ART initiation appears to result in higher ART uptake, retention, and viral suppression at 1 year compared to facility-based ART initiation. Implementation on a wider scale necessitates broader exploration of costs, logistics, and acceptability by providers and PLWH to ensure that these effects are reproducible when delivered at scale, in different contexts, and over time.

scholarly journals 369. Association Between Depression and HIV Treatment Outcomes in a US Military Population with HIV Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S193-S194
Author(s):  
Brandon Carney ◽  
Colton Daniels ◽  
Xiaohe Xu ◽  
Thankam Sunil ◽  
Anuradha Ganesan ◽  
...  
Keyword(s):  
Mental Health ◽  
Treatment Outcomes ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Art Initiation ◽  
Us Military ◽  
History Of ◽  
Hiv Treatment Outcomes ◽  
History Of Depression

Abstract Background Depression is common among HIV-infected individuals and may contribute to suboptimal adherence to antiretroviral therapy (ART) and reduced rates of viral load (VL) suppression. We evaluated longitudinal HIV treatment outcomes in US Military HIV Natural History Study (NHS) participants with or without a diagnosis depression. Methods Male NHS participants with available ICD-9 data for mental health diagnoses and self-reported adherence (SRA) were included (n = 549). Groups were defined as having a history of depression (n = 188, 34.2%), classified as major depressive disorder and/or anxiety disorder, or no history of depression (n = 361, 65.8%). Delay in ART initiation was defined as the time from HIV diagnosis to ART start greater than the group mean (4.91 ± 4.69 years). SRA was defined as taking ≥95% of ART doses and continuous ART was defined as longitudinal ART use with gaps < 30 days. Continuous VL suppression was defined as maintaining VLs < 200 c/mL on ART. Logistic regression analysis was performed comparing variables for those with and without a coded diagnosis of depression. Results Participants had a mean age of 33 (±8.36) years at HIV diagnosis, and similar proportions were Caucasian (44.3%) or African American (40.8%). At ART initiation, the mean CD4 count was 370 (±154 cells/μL) and 362 (±163 cells/μL) for those with and without a history of depression, respectively. Overall, older participants at HIV diagnosis had greater odds of having high SRA (OR 1.07, 95% CI 1.03–1.11), and compared with Caucasians, African Americans had lower odds of having high SRA (OR 0.43, 95% CI 0.25–0.75; table). Participants with a history of depression had greater odds of experiencing delayed ART initiation (OR 2.12, 95% CI 1.11–4.05). However, they also had greater odds of remaining on continuous ART (OR 1.38, 95% CI 0.95–2.02) during follow-up compared with those without a history of depression. Conclusion Although HIV-infected individuals with depression were more likely to experience delays in ART initiation, there were no observed differences in SRA or VL suppression. Continued efforts to identify and aggressively manage mental health disorders are important to success along the HIV care continuum. Disclosures All authors: No reported disclosures.

scholarly journals Computational models as predictors of HIV treatment outcomes for the Phidisa cohort in South Africa

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Andrew Revell ◽  
Paul Khabo ◽  
Lotty Ledwaba ◽  
Sean Emery ◽  
Dechao Wang ◽  
...  
Keyword(s):  
South Africa ◽  
Treatment Outcomes ◽  
Computational Models ◽  
Hiv Treatment ◽  
Hiv Treatment Outcomes

scholarly journals Longitudinal assessment of associations between food insecurity, antiretroviral adherence and HIV treatment outcomes in rural Uganda

AIDS ◽  
2014 ◽  
Vol 28 (1) ◽  
pp. 115-120 ◽  
Author(s):  
Sheri D. Weiser ◽  
Kartika Palar ◽  
Edward A. Frongillo ◽  
Alexander C. Tsai ◽  
Elias Kumbakumba ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Treatment Outcomes ◽  
Hiv Treatment ◽  
Longitudinal Assessment ◽  
Antiretroviral Adherence ◽  
Hiv Treatment Outcomes
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