Impact of pre-diagnosis awareness of HIV-related stigma and dispositional coping on linkage to HIV care among newly diagnosed HIV+ Peruvian patients

Abstract Background Migrants represent an increasing proportion of people living with HIV in many developed countries. We aimed to describe the HIV care cascade and baseline genotypic resistance for newly diagnosed asylum seekers referred to the McGill University Health Centre (MUHC) in Montreal, Quebec, Canada. Methods We conducted a retrospective cohort study of patients linked to the MUHC from June 1, 2017 to October 31, 2018. We calculated the median time (days; interquartile range (IQR)) from: 1) entry into Canada to immigration medical examination (IME) (i.e. HIV screening); 2) IME to patient notification of diagnosis; 3) notification to linkage to HIV care (defined as a CD4 or viral load (VL) measure); 4) linkage to HIV care to combination antiretroviral therapy (cART) prescription; and 5) cART prescription to viral suppression (defined as a VL < 20 copies/mL). We reviewed baseline genotypes and interpreted mutations using the Stanford University HIV Drug Resistance Database. We calculated the proportion with full resistance to > 1 antiretroviral. Results Overall, 43% (60/139) of asylum seekers were newly diagnosed in Canada. Among these, 62% were late presenters (CD4 < 350 cells/μl), 22% presented with advanced HIV (CD4 < 200 cells/μl), and 25% with high-level viremia (VL > 100,000 copies/ml). Median time from entry to IME: 27 days [IQR:13;55]; IME to notification: 28 days [IQR:21;49]; notification to linkage: 6 days [IQR:2;19]; linkage to cART prescription: 11 days [IQR:6;17]; and cART to viral suppression: 42 days [IQR:31;88]; 45% were linked to HIV care within 30 days. One-fifth (21%) had baseline resistance to at least one antiretroviral agent; the K103 N/S mutation was the most common mutation. Conclusions While the majority of newly diagnosed asylum seekers were late presenters, only 45% were linked to care within 30 days. Once linked, care and viral suppression were rapid. Delays in screening and linkage to care present increased risk for onward transmission, and in the context of 21% baseline resistance, consideration of point-of-care testing and immediate referral at IME screening should be made.

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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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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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Poor rates of linkage to HIV care and uptake of treatment after home-based HIV testing among newly diagnosed 15-to-49 year-old men and women in a high HIV prevalence setting in South Africa

AIDS Care ◽

10.1080/09540121.2020.1719025 ◽

2020 ◽

Vol 33 (1) ◽

pp. 70-79 ◽

Cited By ~ 2

Author(s):

Brendan Maughan-Brown ◽

Sean Beckett ◽

Ayesha B. M. Kharsany ◽

Cherie Cawood ◽

David Khanyile ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Hiv Prevalence ◽

Hiv Care ◽

Newly Diagnosed ◽

Men And Women ◽

Home Based ◽

Linkage To Hiv Care ◽

Old Men

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What can viral suppression indicators tell us? Monitoring progress towards improvement in HIV care for those newly diagnosed in Queensland, Australia

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2020.09.760 ◽

2020 ◽

Vol 101 ◽

pp. 290-291

Author(s):

E. Kerr ◽

J. Malo ◽

E. Field ◽

D. Si ◽

R. Ware ◽

...

Keyword(s):

Viral Suppression ◽

Hiv Care ◽

Newly Diagnosed ◽

Monitoring Progress

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HIV-related stigma in the UK then and now: to what extent are we on track to eliminate stigma? A qualitative investigation

BMC Public Health ◽

10.1186/s12889-021-11000-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Barbara Hedge ◽

Karrish Devan ◽

Jose Catalan ◽

Anna Cheshire ◽

Damien Ridge

Keyword(s):

Antiretroviral Treatment ◽

Hiv Transmission ◽

Minority Groups ◽

Physical Violence ◽

Hiv Care ◽

People Living With Hiv ◽

Structured Interviews ◽

Health And Social Care ◽

Related Stigma ◽

Engagement In Hiv Care

Abstract Background The introduction of effective antiretroviral treatment in the late 1990s led to the perception that HIV was a chronic but manageable condition. Nevertheless, stigma remains one of the major hurdles for people living with HIV (PLWH) to accessing healthcare and biomedical preventions. Thus, Fast Track Cities has set a target of zero HIV discrimination by 2030 as part of its strategy to end HIV transmission. Methods Fifty-three participants from the United Kingdom, including PLWH (n = 21, 40%), health and social care workers (n = 24, 45%), and charity workers and activists (n = 13, 25%), were recruited. Semi-structured interviews investigated stigma and discrimination, focusing on both before and after the widespread use of effective antiretroviral treatment in the late 1990s. Data were analysed using a thematic approach. Results Before effective antiretroviral treatment narratives were shaped by two main themes: 1) the media’s role in influencing public opinion and contributing to misunderstandings of HIV transmission; and 2) personal experiences of HIV-related stigma, which for PLWH included incidents of physical violence and aggression, as well as fears of their HIV status being publicised. Contemporary narratives on stigma experiences were organised around four themes: 1) discrimination in healthcare settings; 2) stigma amongst men who have sex with men (MSM); 3) stigma towards African and Afro-Caribbean PLWH; and 4) the limits of change in public HIV-related knowledge and attitudes. Contemporary narratives indicated a reduction in enacted stigma, but continued anticipation of discrimination and self-reported shame, particularly in MSM and African and Afro-Caribbean PLWH. Conclusion The nature of stigma against those with HIV has evolved. The intersection of PLWH and minority groups (e.g. MSM and African and Afro-Caribbean persons) may enhance anticipatory and internalised stigma, with some suggestion that this may contribute to reduced engagement in HIV care and prevention services. Our findings indicate the need for further research in this area, as well as proactive interventions with community groups to enhance knowledge of HIV.

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Who Is Not Linking to HIV Care in Tennessee — the Benefits of an Intersectional Approach

Journal of Racial and Ethnic Health Disparities ◽

10.1007/s40615-021-01023-6 ◽

2021 ◽

Author(s):

Leslie J. Pierce ◽

Peter Rebeiro ◽

Meredith Brantley ◽

Errol L. Fields ◽

Cathy A. Jenkins ◽

...

Keyword(s):

Black Males ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Hiv Care ◽

Older Individuals ◽

Hiv Diagnosis ◽

Race And Gender ◽

Targeted Interventions ◽

And Gender ◽

Linkage To Hiv Care

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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1311. Ryan White HIV Care Continuum Model Doubled the Rate of Community HIV Viral Suppression for Newly Diagnosed Patients: A 10-Year Review

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1174 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S473-S473

Author(s):

Christina Rizk ◽

Alice Zhao ◽

Janet Miceli ◽

Portia Shea ◽

Merceditas Villanueva ◽

...

Keyword(s):

Viral Suppression ◽

Linkage To Care ◽

Hiv Care ◽

Hiv Care Continuum ◽

Newly Diagnosed ◽

New Haven ◽

Care Continuum ◽

Art Initiation ◽

Ryan White ◽

Hiv Viral Suppression

Abstract Background It is estimated that 1,295 per 100,000 are people living with HIV (PLWH) in New Haven, which is the second highest rate of HIV prevalence in Connecticut. Since 2009, New Haven has established the Ryan White (RW) HIV Care Continuum. The main goals of HIV care are early linkage to care, ART initiation, and HIV viral suppression. This study is designed to understand the trends and outcomes in newly diagnosed PLWH in New Haven County. Methods This study is a retrospective medical record review of all newly diagnosed RW eligible PLWH from January 1, 2009 to December 31, 2018. The data were collected in REDCap database and included demographics, HIV risk factor, presence of mental health and/or substance abuse disorder, date of diagnosis, date of initial visit, and ART initiation. Health outcomes such as AIDS at diagnosis and rate of viral suppression were evaluated. The data were then analyzed to show the trends over 10 years. Results From January 1, 2009 to December 31, 2018 there were 420 newly diagnosed RW PLWH. Sixty-seven percent of those were male, 56% were non-white, 47% self-identified as Men who have Sex with Men (MSM), and 41% were heterosexual. Twenty-nine percent had AIDS-defining condition at the time of the diagnosis. Thirty-four percent of the 420 patients had a mental health and/or substance use disorder; 53% of those were MSM and 51% were non-white. Over the 10-year period, it was noted that the duration between date of HIV diagnosis and linkage to care as well as ART initiation decreased. This decline was associated with a substantial increase in viral suppression. The average time between the dates of HIV diagnosis and initial visit decreased from 269 days in 2009 to 13 days in 2018. Moreover, the average time between the dates of diagnosis and ART initiation dropped from 308 days in 2009 to 15 days in 2018. The 1-year HIV viral suppression rate subsequently doubled from 44% in 2009 to 87% in 2018 (P < 0.01). Conclusion The Ryan White HIV Care Continuum Model with emphasis on early linkage to care and ART initiation can have a significant impact on HIV viral suppression at a community level for newly diagnosed patients. Another important observation in this study was the alarming high rate of AIDS at diagnosis, which highlights the need for universal HIV testing, and early diagnosis. Disclosures All authors: No reported disclosures.

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