Neighborhood Social Capital in Relation to Late HIV Diagnosis, Linkage to HIV Care, and HIV Care Engagement

Abstract Introduction Guided by an intersectional approach, we assessed the association between social categories (individual and combined) on time to linkage to HIV care in Tennessee. Methods Tennessee residents diagnosed with HIV from 2012-2016 were included in the analysis (n=3750). Linkage was defined by the first CD4 or HIV RNA test date after HIV diagnosis. We used Cox proportional hazards models to assess the association of time to linkage with individual-level variables. We modeled interactions between race, age, gender, and HIV acquisition risk factor (RF), to understand how these variables jointly influence linkage to care. Results Age, race, and gender/RF weAima A. Ahonkhaire strong individual (p < 0.001 for each) and joint predictors of time to linkage to HIV care (p < 0.001 for interaction). Older individuals were more likely to link to care (aHR comparing 40 vs. 30 years, 1.20, 95%CI 1.11-1.29). Blacks were less likely to link to care than Whites (aHR= 0.73, 95% CI: 0.67-0.79). Men who have sex with men (MSM) (aHR = 1.18, 95%CI: 1.03-1.34) and heterosexually active females (females) (aHR = 1.32, 95%CI: 1.14-1.53) were more likely to link to care than heterosexually active males. The three-way interaction between age, race, and gender/RF showed that Black males overall and young, heterosexually active Black males in particular were least likely to establish care. Conclusions Racial disparities persist in establishing HIV care in Tennessee, but data highlighting the combined influence of age, race, gender, and sexual orientation suggest that heterosexually active Black males should be an important focus of targeted interventions for linkage to HIV care.

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Repeat Western Blot Testing After Receiving an HIV Diagnosis and Its Association with Engagement in Care

The Open AIDS Journal ◽

10.2174/1874613601206010196 ◽

2012 ◽

Vol 6 (1) ◽

pp. 196-204 ◽

Cited By ~ 3

Author(s):

Wayne A Duffus ◽

Kristina W Kintziger ◽

James D Heffelfinger ◽

Kevin P Delaney ◽

Terri Stephens ◽

...

Keyword(s):

South Carolina ◽

Western Blot ◽

Surveillance System ◽

Linear Models ◽

Hiv Care ◽

Hiv Diagnosis ◽

Confirmatory Testing ◽

Hiv Care Engagement ◽

Western Blot Testing ◽

Hiv Aids

Objectives: To examine the prevalence of and factors associated with potentially unnecessary repeat confirmatory testing after initial HIV diagnosis and the relationship of repeat testing to medical care engagement. Design: South Carolina HIV/AIDS surveillance data for 12,504 individuals who were newly diagnosed with HIV infection between January 1997 and December 2008 were used for this analysis. State law requires that all positive Western blot [WB] results be reported regardless of frequency. Methods: HIV-infected persons, diagnosed from 1997-2008 and followed through 2009, with repeat positive WB results were compared to those who did not have repeat positive WB results. We defined repeat positive testing as documentation of one or more positive WB obtained ≥90 days following initial WB confirmatory result. HIV care engagement for the period from 2007-2009 was assessed by documentation of CD4+ T-cell/viral load reports to the South Carolina HIV/AIDS surveillance system during each six-month period of a calendar year for those individuals diagnosed prior to the assessment period and still alive at the end. Relative risk [RR] with 95% confidence intervals [CI] and multivariable general linear models were used to assess if any covariates of interest were independently associated with repeat positive confirmatory testing. Results:A total of 4,237 [34%] of 12,504 HIV-infected individuals had results of repeat positive WB testing reported to the surveillance system during 1997-2008. Persons who had repeat positive WB testing were more likely than persons who did not have repeat WB testing to have progressed to AIDS >1 year following diagnosis [RR: 1.70; 95% CI: 1.61, 1.80] and to be consistently in care [RR: 1.35; 95% CI: 1.24, 1.47] or have sporadic care [RR: 1.80; 95% CI: 1.68, 1.94]. Discussion:Having repeat positive WB tests may be a marker of engaging HIV care. However, given the limited resources available for care, it is important that healthcare reform policy and clinical recommendations promote improvements in communications about previous test results.

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Individual, Community, and Structural Factors Associated With Linkage to HIV Care Among People Diagnosed with HIV in Tennessee

10.21203/rs.3.rs-74852/v1 ◽

2020 ◽

Author(s):

Aima A Ahonkhai ◽

Peter Rebeiro ◽

Cathy Jenkins ◽

Michael Rickles ◽

Mekeila Cook ◽

...

Keyword(s):

Linkage To Care ◽

Hiv Care ◽

County Level ◽

Structural Factors ◽

Hiv Diagnosis ◽

Factors Associated ◽

Sex Risk ◽

Heterosexual Sex ◽

The Individual ◽

Linkage To Hiv Care

Abstract Background We assessed trends and identified individual- and county-level factors associated with linkage to HIV care in Tennessee (TN). Methods TN residents diagnosed with HIV from 2012–2016 were included in the analysis (n = 3,750). Linkage was defined by the first CD4 or HIV RNA test date at or after HIV diagnosis. We used modified Poisson regression to estimate probability of 30-day linkage to care at the individual- and county-levels. Results Both MSM (aRR 1.16, 95%CI 1.01–1.32) and women who reported heterosexual sex risk factors (aRR 1.28, 95%CI 1.11–1.48) were more likely to link to care within 30-days than heterosexual males. Non-Hispanic Black individuals had poorer linkage than White individuals (aRR 0.77, 95%CI 0.72–0.83). County-level mentally unhealthy days were negatively associated with linkage (aRR 0.59, 95%CI 0.40–0.88). Conclusions Disparities persist at both individual and county levels and may warrant structural interventions to address racism and mental health needs.

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HIV Diagnosis, Linkage to HIV Care, and HIV Risk Behaviors Among Newly Diagnosed HIV-Positive Female Sex Workers in Kigali, Rwanda

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0b013e3182170fd3 ◽

2011 ◽

Vol 57 (4) ◽

pp. e70-e76 ◽

Cited By ~ 21

Author(s):

Sarah L Braunstein ◽

Marie-Michèle Umulisa ◽

Nienke J Veldhuijzen ◽

Evelyne Kestelyn ◽

Chantal M Ingabire ◽

...

Keyword(s):

Risk Behaviors ◽

Hiv Risk ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Risk Behaviors ◽

Hiv Care ◽

Hiv Positive ◽

Newly Diagnosed ◽

Hiv Diagnosis ◽

Linkage To Hiv Care

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Patterns of engagement in HIV care during pregnancy and breastfeeding: findings from a cohort study in North-Eastern South Africa

BMC Public Health ◽

10.1186/s12889-021-11742-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

David Etoori ◽

Brian Rice ◽

Georges Reniers ◽

Francesc Xavier Gomez-Olive ◽

Jenny Renju ◽

...

Keyword(s):

Hiv Testing ◽

Cox Regression ◽

Sub Saharan Africa ◽

Hiv Care ◽

Hiv Diagnosis ◽

Factors Associated ◽

Art Initiation ◽

Risk Period ◽

Hiv Care Engagement ◽

Engagement In Hiv Care

Abstract Background Eliminating mother-to-child transmission of HIV (MTCT) in sub-Saharan Africa is hindered by limited understanding of HIV-testing and HIV-care engagement among pregnant and breastfeeding women. Methods We investigated HIV-testing and HIV-care engagement during pregnancy and breastfeeding from 2014 to 2018 in the Agincourt Health and Demographic Surveillance System (HDSS). We linked HIV patient clinic records to HDSS pregnancy data. We modelled time to a first recorded HIV-diagnosis following conception, and time to antiretroviral therapy (ART) initiation following diagnosis using Kaplan-Meier methods. We performed sequence and cluster analyses for all pregnancies linked to HIV-related clinic data to categorise MTCT risk period engagement patterns and identified factors associated with different engagement patterns using logistic regression. We determined factors associated with ART resumption for women who were lost to follow-up (LTFU) using Cox regression. Results Since 2014, 15% of 10,735 pregnancies were recorded as occurring to previously (51%) or newly (49%) HIV-diagnosed women. New diagnoses increased until 2016 and then declined. We identified four MTCT risk period engagement patterns (i) early ART/stable care (51.9%), (ii) early ART/unstable care (34.1%), (iii) late ART initiators (7.6%), and (iv) postnatal seroconversion/early, stable ART (6.4%). Year of delivery, mother’s age, marital status, and baseline CD4 were associated with these patterns. A new pregnancy increased the likelihood of treatment resumption following LTFU. Conclusion Almost half of all pregnant women did not have optimal ART coverage during the MTCT risk period. Programmes need to focus on improving retention, and leveraging new pregnancies to re-engage HIV-positive women on ART.

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Patient Characteristics and Determinants of CD4 at Diagnosis of HIV in Mexico from 2008 to 2017: A 10-Year Population-Based Study

10.21203/rs.3.rs-104632/v1 ◽

2020 ◽

Author(s):

Amilcar Azamar Alonso ◽

Sergio A Bautista-Arredondo ◽

Fiona Smaill ◽

Lawrence Mbuagbaw ◽

Andrew P Costa ◽

...

Keyword(s):

Early Diagnosis ◽

Major Change ◽

Population Based ◽

Health Facilities ◽

Late Diagnosis ◽

Cd4 Count ◽

Hiv Care ◽

Hiv Diagnosis ◽

Late Hiv Diagnosis ◽

The Impact

Abstract Background: Worldwide, around 37.9 million people are living with HIV, of which 220,000 live in Mexico. In 2007-2012 the Mexican government launched the National HIV program and there was a major change in HIV policies implemented in 2013-2018, when efforts focused on prevention, increase in early diagnosis and timely treatment. Thus, the objectives of this study were to identify the determinants of late HIV diagnosis (i.e. CD4 count less than 200 cells/mm3) in Mexico from 2008 to 2017 and to evaluate the impact of the 2013-2017 National HIV program. Methods: Using patient level data from the SALVAR database, which includes 64% of the population receiving HIV care in Mexico, an adjusted logistic model was conducted. Main study outcomes were HIV late diagnosis which was defined as CD4 count less than 200 cells/mm3 at diagnosis. Results: the study included 106,830 individuals newly diagnosed with HIV and treated in Mexican public health facilities between 2008 and 2017 (mean age: 33 years old, 80% male). HIV late diagnosis decreased from 45% to 43% (P <0.001) between 2008-2012 and 2013-2017 (i.e. before and after the implementation of the 2013-2017 policy). Multivariable logistic regressions indicated that being diagnosed between 2013-2017 (odds ratio [OR]= 0.96 [95% Confidence interval [CI]: [0.93, 0.98]) or in health facilities specialized in HIV (OR=0.64 [95% CI: 0.60, 0.69]) was associated with early diagnosis. Being male, older than 29 years old, diagnosed in Central East, the South region of Mexico or in high-marginalized locality increased the odds of a late diagnosis.Conclusions: The results of this study indicate that the 2013-2017 National HIV program in Mexico has been marginally successful in decreasing the proportion of individuals with late HIV diagnosis in Mexico.

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Impact and barriers of an HIV rapid test program implementation at an oncological referral center in Mexico

International Journal of STD & AIDS ◽

10.1177/0956462418762235 ◽

2018 ◽

Vol 29 (9) ◽

pp. 884-889 ◽

Cited By ~ 1

Author(s):

Martin-Onraet Alexandra ◽

Perez-Jimenez Carolina ◽

Gonzalez-Rodriguez Andrea ◽

Volkow-Fernandez Patricia

Keyword(s):

Scale Up ◽

Rapid Test ◽

Hiv Prevalence ◽

Care Staff ◽

Hiv Care ◽

Health Staff ◽

Test Program ◽

Hiv Diagnosis ◽

Rapid Tests ◽

Linkage To Hiv Care

The aim of this study was to evaluate the implementation of human immunodeficiency virus (HIV) screening with rapid tests in an oncologic center in Mexico City, report the HIV prevalence, and describe contacts screening and linkage to HIV care while identifying barriers to the performance of the program. In 2014, an HIV rapid test program was implemented in four departments of the hospital “Instituto Nacional de Cancerología”. From 2014 to 2016, 3032 HIV rapid tests were performed in the hospital. The overall HIV prevalence was 0.8%, with the highest prevalence in the Hematology Department (2.4%). In the Gynecology Department, prevalence was 0.05%. Only 25 and 22 tests were performed in the lung cancer and germ cell tumor clinic, respectively, with one positive test. The health staff not offering the test was the main limitation to the full implementation of the program in those departments. The contacts screening led to three positive cases. The acceptance of the test was 99%. Patients who tested positive were seen by an infectious diseases physician on the same day the test was performed. Rapid HIV tests are a useful tool to expand HIV diagnosis in patients with cancer and to establish a rapid linkage to HIV care. Staff education needs to be improved to raise awareness of the health staff for a successful scale up of the program.

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Patient characteristics and determinants of CD4 at diagnosis of HIV in Mexico from 2008 to 2017: a 10-year population-based study

AIDS Research and Therapy ◽

10.1186/s12981-021-00409-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Amilcar Azamar-Alonso ◽

Sergio A. Bautista-Arredondo ◽

Fiona Smaill ◽

Lawrence Mbuagbaw ◽

Andrew P. Costa ◽

...

Keyword(s):

Early Diagnosis ◽

Major Change ◽

Population Based ◽

Health Facilities ◽

Late Diagnosis ◽

Cd4 Count ◽

Hiv Care ◽

Hiv Diagnosis ◽

Late Hiv Diagnosis ◽

The Impact

Abstract Background In 2007–2012 the Mexican government launched the National HIV program and there was a major change in HIV policies implemented in 2013–2018, when efforts focused on prevention, increase in early diagnosis and timely treatment. Still, late HIV diagnosis is a major concern in Mexico due to its association with the development of AIDS development and mortality. Thus, the objectives of this study were to identify the determinants of late HIV diagnosis (i.e. CD4 count less than 200 cells/mm3) in Mexico from 2008 to 2017 and to evaluate the impact of the 2013–2017 National HIV program. Methods Using patient level data from the SALVAR database, which includes 64% of the population receiving HIV care in Mexico, an adjusted logistic model was conducted. Main study outcomes were HIV late diagnosis which was defined as CD4 count less than 200 cells/mm3 at diagnosis. Results The study included 106,830 individuals newly diagnosed with HIV and treated in Mexican public health facilities between 2008 and 2017 (mean age: 33 years old, 80% male). HIV late diagnosis decreased from 45 to 43% (P < 0.001) between 2008 and 2012 and 2013–2017 (i.e. before and after the implementation of the 2013–2017 policy). Multivariable logistic regressions indicated that being diagnosed between 2013 and 2017 (odds ratio [OR] = 0.96 [95% Confidence interval [CI] [0.93, 0.98]) or in health facilities specialized in HIV care (OR = 0.64 [95% CI 0.60, 0.69]) was associated with early diagnosis. Being male, older than 29 years old, diagnosed in Central East, the South region of Mexico or in high-marginalized locality increased the odds of a late diagnosis. Conclusions The results of this study indicate that the 2013–2017 National HIV program in Mexico has been marginally successful in decreasing the proportion of individuals with late HIV diagnosis in Mexico. We identified several predictors of late diagnosis which could help establishing health policies. The main determinants for late diagnosis were being male, older than 29 years old, and being diagnosed in a Hospital or National Institute.

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