Factors associated with poor linkage to HIV care and related barriers among men who have sex with men

In an era of antiretroviral therapy (ART) for all HIV-1-infected patients, our primary aim was to describe prevalence and characteristics of patients disengaged from care at an urban ambulatory HIV clinic. We conducted a nested case–control study. All patients who disengaged from care (defined as being lost to follow-up for at least one year) from 2007 to 2014 inclusive were identified. Cases were matched to controls in a 1:4 ratio. A total of 1250 cases were included; 250/2289 (10.9%) of patients attending our HIV clinic disengaged from 2007 to 2014. One hundred and twenty-six (50.4%) were heterosexual, 81 (32.4%) were men who have sex with men and 40 (16%) were intravenous drug users. On univariate analysis only, patients with heterosexual risk were more likely to disengage from care (50.4% vs. 33.7%, p: <0.001). Those who disengaged were younger, mean age of 39 (p: <0.001). A higher proportion of patients who disengaged from care was not receiving ART and did not have a suppressed HIV-1 viral load (p: <0.001). On multivariable analysis, Irish patients were less likely to disengage from HIV care (odds ratio: 0.567, p: 0.002). Factors associated with non-retention in HIV care have been identified. A semi-structured interview of those patients who re-engaged will take place to further examine reasons for disengagement from care.

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Social–ecological factors associated with HIV infection among men who have sex with men in Jamaica

International Journal of STD & AIDS ◽

10.1177/0956462417717652 ◽

2017 ◽

Vol 29 (1) ◽

pp. 80-88 ◽

Cited By ~ 5

Author(s):

Carmen H Logie ◽

Kathleen S Kenny ◽

Ashley Lacombe-Duncan ◽

Kandasi Levermore ◽

Nicolette Jones ◽

...

Keyword(s):

Hiv Infection ◽

Hiv Care ◽

Structural Factors ◽

Multivariable Model ◽

Transmitted Infection ◽

Cross Sectional ◽

Study Objective ◽

Sexual Stigma ◽

Factors Associated ◽

Sex With Men

In Jamaica, where homosexuality is criminalized, scant research has examined associations between sexual stigma and HIV infection. The study objective was to examine correlates of HIV infection among men who have sex with men (MSM) in Jamaica. We conducted a cross-sectional tablet-based survey with MSM in Jamaica using chain referral sampling. We assessed socio-demographic, individual, social, and structural factors associated with HIV infection. A logit-link model, fit using backwards-stepwise regression, was used to estimate a final multivariable model. Among 498 participants (median age: 24, interquartile range: 22–28), 67 (13.5%) were HIV-positive. In the multivariable model, HIV infection was associated with increased odds of socio-demographic (older age, odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.00–1.10]; residing in Kingston versus Ocho Rios [OR: 6.99, 95% CI 2.54–19.26]), individual (poor/fair versus excellent/good self-rated health [OR: 4.55, 95% CI: 1.81–11.42], sexually transmitted infection [STI] history [OR: 3.67, 95% CI: 1.61–8.38]), and structural (enacted sexual stigma [OR: 1.08, 95% CI: 1.01–1.15], having a health care provider [OR: 2.23, 95% CI: 1.06–4.66]) factors. This is among the first studies to demonstrate associations between sexual stigma and HIV infection in Jamaica. Findings underscore the need to integrate STI testing in the HIV care continuum and to address stigma and regional differences among MSM in Jamaica.

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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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Factors associated with linkage to care for HIV patients in Tajikistan

International Journal of STD & AIDS ◽

10.1177/0956462418779658 ◽

2018 ◽

Vol 29 (12) ◽

pp. 1183-1189 ◽

Cited By ~ 2

Author(s):

Arash Alaei ◽

Nisheet Nautiyal ◽

Kathryn Mishkin ◽

D Saifuddin Karimov ◽

Dilshod Saidi ◽

...

Keyword(s):

Logistic Regression ◽

Injection Drug Users ◽

Drug Users ◽

Linkage To Care ◽

Capital City ◽

Hiv Care ◽

Multivariable Logistic Regression Model ◽

Cross Sectional ◽

Factors Associated ◽

Linkage To Hiv Care

There is a growing human immunodeficiency virus (HIV) epidemic in Tajikistan. This paper presents factors associated with linkage to HIV care among people aged 15 years and older in Tajikistan. This retrospective cross-sectional study used the Tajikistan Ministry of Health HIV registry data from patients diagnosed with HIV at age 15 years or older from 2000 to 2016. Chi squared tests and logistic regression models tested factors associated with linkage to care. A multivariable logistic regression model examined effect modifications. While linkage to care had an overall increase from 2000 to 2016, the odds of linkage were lower among certain sub-groups including among people in Dushanbe, men, people engaging in sex work, injection drug users, and older people. Regional differences exist with linkage to care, occurring least frequently in Dushanbe. While access to care and quality of care have increased significantly over time, findings suggest that linkage to care is low, especially in the capital city where many services are provided. Evaluation focusing on acceptability of HIV services should be undertaken to understand why certain people do not link with services. Additional research about the types of barriers to linking with HIV care is needed to increase linkage to HIV care.

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Autonomy-Supportive Healthcare Climate and HIV-Related Stigma Predict Linkage to HIV Care in Men Who Have Sex With Men in Ghana, West Africa

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958220978113 ◽

2021 ◽

Vol 20 ◽

pp. 232595822097811

Author(s):

Lily Y. Gu ◽

Nanhua Zhang ◽

Kenneth H. Mayer ◽

James M. McMahon ◽

Soohyun Nam ◽

...

Keyword(s):

Gender Nonconformity ◽

Hiv Stigma ◽

Hiv Care ◽

Sex Behavior ◽

Related Stigma ◽

And Gender ◽

Sex With Men ◽

Linkage To Hiv Care ◽

Living With Hiv ◽

The Impact

In Ghana, the HIV prevalence among MSM is more than 10 times greater than the general population of adults, and rates of engagement in HIV medical care are low among MSM diagnosed with HIV. Using structured surveys, we investigated the impact of HIV-related stigma, same-sex behavior stigma, and gender nonconformity stigma on linkage to HIV care (LTC) in MSM ( N = 225) living with HIV in Ghana. Autonomy-supportive healthcare climate ( OR = 1.63, p < .01), vicarious HIV stigma ( OR = 2.73, p < .01), and age ( OR = 1.06, p < .004) predicted LTC. Conversely, felt normative HIV stigma negatively predicted LTC ( OR = 0.65, p < .05). Finally, we identified regional disparities, with MSM from Takoradi being 4 times and 5 times more likely to be LTC compared to Kumasi and Accra, respectively. Our findings highlight the nuanced roles of stigmas in shaping the HIV care continuum among MSM living with HIV, while revealing potential gaps in current measures of HIV-related stigma.

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Factors associated with poor linkage to HIV care among index clients and sex partners receiving HIV assisted partner services (aPS) in Kenya

Sexually Transmitted Diseases ◽

10.1097/olq.0000000000001222 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Beatrice Wamuti ◽

Marielle G. Contesse ◽

Peter Maingi ◽

Paul Macharia ◽

Felix Abuna ◽

...

Keyword(s):

Hiv Care ◽

Sex Partners ◽

Factors Associated ◽

Linkage To Hiv Care

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Factors associated with HIV testing among men who have sex with men in Western Kenya: a cross-sectional study

International Journal of STD & AIDS ◽

10.1177/0956462416638967 ◽

2016 ◽

Vol 28 (2) ◽

pp. 179-187 ◽

Cited By ~ 6

Author(s):

Sylvia Shangani ◽

Violet Naanyu ◽

Ann Mwangi ◽

Heleen Vermandere ◽

Ethan Mereish ◽

...

Keyword(s):

Confidence Interval ◽

Hiv Testing ◽

Odds Ratio ◽

Social Stigma ◽

Hiv Care ◽

Western Kenya ◽

Lower Odds ◽

Factors Associated ◽

The Past ◽

Sex With Men

HIV diagnosis is an important step in the HIV cascade of prevention and treatment. However, men who have sex with men in low- and middle-income countries have limited access to HIV care services. We examined factors associated with prior HIV testing among men who have sex with men in western Kenya. We recruited 95 men who have sex with men aged 18 years and older, and who reported at least one sexual contact with a man in the past 6 months; however, this analysis is restricted to 89 participants who completed questions on HIV testing. Logistic regression model was used to determine factors associated with HIV testing in the past one year. Results indicate that 23 (26%) had not been tested in the past 12 months. Bivariate analyses demonstrated that condomless anal sex (odds ratio = 3.29, 95% confidence interval = 1.18–9.17) and comfort with healthcare providers (odds ratio = 1.15, 95 % CI = 1.05–1.26) were associated with higher odds of HIV testing in the past 12 months. Experiencing social stigma was associated with lower odds of HIV testing in the last 12 months (odds ratio = 0.91, 95% confidence interval = 0.84–0.94). In multivariable models, social stigma remained significantly associated with lower odds of HIV testing in the last 12 months odds ratio = 0.90, 95% confidence interval = 0.82–0.99) after inclusion of sexual risk and individual level variables. Development of men who have sex with men–sensitive HIV-testing services, addressing stigma, and training healthcare workers to provide culturally sensitive services may assist in effectively engaging men who have sex with men in the HIV treatment cascade.

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