Effectiveness of an HIV care model integrated into addiction care based on medication-assisted treatment for HIV-positive people who use drugs

Introduction: Men who have sex with men (MSM) are one of the key populations driving HIV/AIDS epidemic globally. To date, MSM is the only population in Ukraine where the prevalence and incidence of HIV is increasing. As HIV-positive MSM might feel uncomfortable to report homosexual intercourses as a possible mode of transmission (MoT) of HIV, they prefer being registered as patients with heterosexual or non-defined MoT. This study aimed to calculate the proportion of misclassified MoT among HIV-positive MSM registered in Lviv oblast, Ukraine, during 2014-2018. Methodology: Cross-sectional study with 127 HIV-positive MSM patients from Lviv region for the period of 2014-2018. Results: Out of 127 HIV-positive MSM included in the study, 110 (86.6%) were from urban areas. In addition, 52 patients (40.9%) were diagnosed with stage 1 HIV, 16 (12.6%) – stage 2, 19 (15%) – stage 3, and 36 (28.3%) – stage 4. CD4 count < 200 cells/μL was found in 35 (27.6%) patients. Mean time from registration to antiretroviral therapy initiation was 80 days. During the first visit to medical doctor out of those 48 patients who had previously reported “other modes” of HIV transmission, 33 patients (68.7%) disclosed homosexual MoT of HIV. The remaining 15 (31.3%) patients disclosed their homosexual MoT of HIV later – during their regular follow-up visits to the doctor. Conclusion: Special measures are needed to improve the reporting of homosexual MoT which can potentially strengthen the HIV care among MSM.

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Implementing a Low-threshold Audio-only Telehealth Model for Medication-assisted Treatment of Opioid Use Disorder at a Community-based Non-profit Organization in Washington, D.C.

10.21203/rs.3.rs-915722/v1 ◽

2021 ◽

Author(s):

Ellis Jaewon Yeo ◽

Hannah Kralles ◽

David Sternberg ◽

Dana McCullough ◽

Ajetha Nadanasabesan ◽

...

Keyword(s):

Patient Characteristics ◽

The United States ◽

Opioid Use Disorder ◽

Retention Rates ◽

People Who Use Drugs ◽

Opioid Use ◽

Treatment Access ◽

Community Based ◽

Medication Assisted Treatment ◽

Low Threshold

Abstract BackgroundThe COVID-19 pandemic has had especially devastating effects on people who use drugs. Due to pandemic protocols in the United States, medication-assisted treatment (MAT) regulations became more flexible, permitting our community-based nonprofit organization to transition its low-threshold MAT clinic to an audio-only telehealth model of care in 2020. Case PresentationThis case study describes our transition from a low-threshold community-based in-person MAT clinic to an audio-only telehealth model. We extracted data from electronic health records to describe patient characteristics and to calculate treatment retention rates. We measure the success of our intervention relative to published retention rates, both overall as well as for in-person and telehealth care. ConclusionsLow-threshold medication-assisted treatment in the care of people with opioid use disorder is essential to increasing treatment access and continuity. We found that an audio-only telehealth model was viable. Although we had decreased retention rates following the transition to an audio-only telehealth model, our rates remained excellent compared to published values for in-person MAT care. We call for advocacy and regulations to support continued use of telehealth services throughout and beyond the COVID-19 pandemic.

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Costs and Cost-Effectiveness of the Patient-Centered HIV Care Model: A Collaboration Between Community-Based Pharmacists and Primary Medical Providers

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0000000000002458 ◽

2020 ◽

Vol 85 (3) ◽

pp. e48-e54 ◽

Cited By ~ 1

Author(s):

Ram K. Shrestha ◽

Jon C. Schommer ◽

Michael S. Taitel ◽

Oscar W. Garza ◽

Nasima M. Camp ◽

...

Keyword(s):

Cost Effectiveness ◽

Hiv Care ◽

Medical Providers ◽

Care Model ◽

Patient Centered ◽

Community Based

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Intimate Partner Violence Among Women Accessing HIV-Care Services at Tertiary Hospitals in Ogun State, Nigeria: Implications for Policy and Practice

Journal of Interpersonal Violence ◽

10.1177/0886260520909189 ◽

2020 ◽

pp. 088626052090918

Author(s):

Olumide Abiodun ◽

Kolawole Sodeinde ◽

Fikayo Bamidele ◽

Yejide Ojinni ◽

John Adekeye ◽

...

Keyword(s):

Intimate Partner Violence ◽

Partner Violence ◽

Smoking Status ◽

Intimate Partner ◽

Hiv Care ◽

Hiv Positive ◽

Current Smoking Status ◽

Ogun State ◽

Hiv Positive Women ◽

Tertiary Hospitals

Intimate partner violence is both a predisposing factor for and sequelae of HIV infection. It is more likely for HIV-positive women to experience intimate partner violence compared with HIV-negative women. Previous researches have described the other risk factors for intimate partner violence. This cross-sectional study identified the correlates of intimate partner violence among HIV-positive women accessing HIV-care. We interviewed 458 women accessing HIV-care at the three tertiary hospitals in Ogun State, Nigeria. Trained research assistants conducted 10-min structured interviews with validated questionnaires. We carried out descriptive, bivariate, and regression analyses. We used the backward elimination technique to build a model to predict the experience of intimate partner violence (IPV) within the preceding 12 months. We set the level of significance at .05. A total of 23 (5.02%) participants reported IPV within the preceding 12 months, while the prevalence of lifetime intimate partner violence was 24.02%. Younger age, the experience of IPV in previous relationships, and having multiple sex partners were related to the experience of IPV within the preceding 12 months ( p < .05). Also, the partners’ age, alcohol intake, and current smoking status were associated with the experience of IPV within the preceding 12 months ( p < .05). After regression analysis, participants’ age (adjusted odds ratio [AOR] = 0.892, 95% confidence interval [CI] = [0.831, 0.957]), experience of IPV in previous relationship (AOR = 12.841, 95% CI = [4.303, 38.318]), and partners’ current smoking status (AOR = 4.874, 95% CI = [1.252, 18.969]) retained association with the experience of IPV within the preceding 12 months. IPV among HIV-positive women accessing HIV-care occurs in a complicated, context-specific way. Routine HIV strategies and services should include interventions that involve men and address gender power imbalances. For effectiveness, specific interventions must consider women’s’ specific context and characteristics.

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Impact of Age and Prior Care on Barriers to Engagement in HIV Care for HIV Positive Women of Color

Journal of Adolescent Health ◽

10.1016/j.jadohealth.2013.10.063 ◽

2014 ◽

Vol 54 (2) ◽

pp. S24-S25

Author(s):

Jeffrey M. Birnbaum ◽

Elizabeth A. Eastwood ◽

Jennifer E. Lee

Keyword(s):

Women Of Color ◽

Hiv Care ◽

Hiv Positive ◽

Hiv Positive Women ◽

Engagement In Hiv Care

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Integrated care experiences and out-of-pocket expenditures: a cross-sectional survey of adults receiving treatment for HIV and hypertension in Malawi

BMJ Open ◽

10.1136/bmjopen-2019-032652 ◽

2020 ◽

Vol 10 (2) ◽

pp. e032652

Author(s):

Corrina Moucheraud ◽

Matthew Hing ◽

Juliet Seleman ◽

Khumbo Phiri ◽

Florence Chibwana ◽

...

Keyword(s):

Integrated Care ◽

Antihypertensive Medication ◽

Cost Of Care ◽

Hiv Care ◽

Hiv Positive ◽

Care Seeking ◽

Cross Sectional Survey ◽

Antihypertensive Medications ◽

Cross Sectional ◽

Medication Costs

ObjectivesAs HIV-positive individuals’ life expectancy extends, there is an urgent need to manage other chronic conditions during HIV care. We assessed the care-seeking experiences and costs of adults receiving treatment for both HIV and hypertension in Malawi.Design, setting and participantsA cross-sectional survey was conducted with HIV-positive adults with hypertension at a health facility in Lilongwe that offers free HIV care and free hypertension screening, with antihypertensives available for purchase (n=199). Questions included locations and costs of all medication refills and preferences for these refill locations. Respondents were classified as using ‘integrated care’ if they refilled HIV and antihypertensive medications simultaneously. Data were collected between June and December 2017.ResultsOnly half of respondents reported using the integrated care offered at the study site. Among individuals using different locations for antihypertensive medication refills, the most frequent locations were drug stores and public sector health facilities which were commonly selected due to greater convenience and lower medication costs. Although the number of antihypertensive medications was equivalent between the integrated and non-integrated care groups, the annual total cost of care differed substantially (approximately US$21 in integrated care vs US$90 for non-integrated care)—mainly attributable to differences in other visit costs for non-integrated care (transportation, lost wages, childcare). One-third of those in the non-integrated care group reported no expenditure for antihypertensive medication, and six people in each group reported no annual hypertension care-seeking costs at all.ConclusionsIndividuals using integrated care saw efficiencies because, although they were more likely to pay for antihypertensive medications, they did not incur additional costs. These results suggest that preferences and experiences must be better understood to design effective policies and programmes for integrated care among adults on antiretroviral therapy.

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Formative research to inform the development of a peer-led HIV self-testing intervention to improve HIV testing uptake and linkage to HIV care among adolescents, young people and adult men in Kasensero fishing community, Rakai, Uganda: a qualitative study

BMC Public Health ◽

10.1186/s12889-020-09714-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Joseph K. B. Matovu ◽

Aminah Nambuusi ◽

Scovia Nakabirye ◽

Rhoda K. Wanyenze ◽

David Serwadda

Keyword(s):

Young People ◽

Hiv Testing ◽

Hiv Care ◽

Hiv Positive ◽

Fishing Community ◽

Adult Men ◽

Self Testing ◽

Testing Uptake ◽

Hiv Testing Services ◽

Linkage To Hiv Care

Abstract Background Despite efforts to improve HIV testing and linkage to HIV care among adolescents, young people and adult men, uptake rates remain below global targets. We conducted formative research to generate data necessary to inform the design of a peer-led HIV self-testing (HIVST) intervention intended to improve HIV testing uptake and linkage to HIV care in Kasensero fishing community in rural Uganda. Methods This qualitative study was conducted in three study communities in Kasensero fishing community in Rakai district, Uganda, in May 2019. Six single-sex focus group discussions (FGDs) comprising 7–8 participants were conducted with adolescents and young people (15–24 years) and adult men (25+ years). We collected data on people’s perceptions about peer-led HIVST; potential acceptability of a peer-led HIVST intervention and suggestions on how to improve linkage to HIV care after a positive HIVST result. Peer-led HIVST was defined as an approach where trained lay people distribute HIVST kits to other people in the community. FGDs were audio-recorded with permission from the participants, transcribed verbatim and analysed manually following a thematic framework approach. Results Forty-seven participants (31 men and 16 women) participated in the FGDs. Across communities and age-groups, most participants mentioned that peer-led HIVST would be generally acceptable to people in the fishing community but people will need support in performing the test due to fear of performing the test wrongly or failing to cope with HIV-positive results. Most participants felt that peer-led HIVST would bring HIV testing services closer to the community “because [the peer-leader] could be my immediate neighbour”, making it easier for people to obtain the kits at any time of their convenience. To improve linkage to HIV care, participants felt that the use of peer-leaders to deliver the initial ART dose to self-tested HIV-positive individuals would be more preferable to the use of community-based ART groups or home-based ART initiation. Conclusion Our study shows that peer-led HIVST is potentially acceptable in the fishing community. These findings suggest that this approach can improve uptake of HIV testing and linkage to HIV care services among populations that are usually missed through conventional HIV testing services.

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