P6254Care cascade of hypertension in people living with HIV

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Nascimento Costa ◽  
M B Bairronuevo ◽  
F Val ◽  
A R E Macedo ◽  
N C Vegas ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
National Guidelines ◽  
Early Screening ◽  
Tertiary Care Centre ◽  
Hiv Primary Care ◽  
Cascade Of Care ◽  
Steep Decline ◽  
Living With Hiv

Abstract Background Life expectancy of people living with HIV (PLHIV) has been increasing since the advent of antiretroviral therapy. However, prevalence of non-communicable diseases (NCD) and associated deaths has followed the same trend. From these NCDs, those of cardiovascular origin have become the most prevalent among PLHIV. Purpose In this study we delineate a cascade of care for hypertension screening, diagnosis, treatment, drug adherence and control in PLHIV. Methods Male and female patients diagnosed with HIV above 40 years of age attending to an outpatient clinic of a reference tertiary care centre for infectious diseases were cross-sectionally screened for hypertension through blood pressure (BP) measurement during outpatient consultation. Results A total of 298 subject were enrolled. Of these, 107 (35.9%) presented elevated BP consistent with hypertension according to national guidelines. Of these, only 36 (33.6%) were aware of the diagnosis, 19 (17.7%) were on regular cardiological follow-up, 17 (15.8%) were under treatment and 11 (10.2%) responded to be adherent to BP lowering medication. Care Cascade HIV_HTN Conclusions Steep decline was revealed in several steps of the cascade of care, especially regarding the awareness level. Integrative methods for NCD and HIV care are urgently needed. Early screening of hypertension, diagnosis, treatment, adherence and ongoing BP control should be equal targets in HIV care. Finally, there is an urgent need to encourage HIV primary care and infectious disease health professionals to early screen for cardiovascular outcomes. Acknowledgement/Funding Fundação de Amparo à Pesquisa do Estado do Amazonas – FAPEAM

scholarly journals Quality of life among people living with HIV/AIDS in tertiary care centre of Himachal Pradesh

2020 ◽  
Vol 7 (12) ◽  
pp. 5144
Author(s):  
Sunita . ◽  
D. S. Dhadwal ◽  
Anmol Gupta ◽  
Anjali Mahajan ◽  
Deepesh Barall
Keyword(s):  
Quality Of Life ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
World Health ◽  
Value Systems ◽  
People Living With Hiv ◽  
Tertiary Care Centre ◽  
Living With Hiv ◽  
Hiv Aids

Background: The world health organization (WHO) has defined quality of life as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. The objective of study was to assess the quality of life among people living with HIV/AIDS by comparison of mean scores of their quality of life in physical, psychological, social and environmental domain.Methods: This cross-sectional study was conducted among PLWHA on ART during 2016-17. Data were collected using WHOQOLHIV‑BREF scale and mean±SD of score was calculated. The difference in mean scores of various domains were analysed using ANOVA test. All variables with p<0.2 on univariate analysis were included in multivariate linear regression model.Results: The total score of QOL was 61.71±9.43. The scores of QOL was highest in physical and lowest in environmental domains with 69.55±12.27 and 57.14±10.61 respectively. 71.25% patients rated their QOL good and only 10% were dissatisfied with their health. Currently ill status was the most associated factor under all except social domain. Males with higher education or living with their spouse had significantly better QOL scores.Conclusions: Being a male, educated, employed in the government sector, belonging to general caste category and living with their married spouse were the factors for their better QOL in comparison to their counterparts. Along with ART, other factors should be taken into consideration to improve QOL of PLWHA.

Does polypharmacy affect treatment outcomes of people living with HIV starting antiretroviral therapy?

2020 ◽  
Vol 31 (12) ◽  
pp. 1195-1201
Author(s):  
Thana Khawcharoenporn ◽  
Vitsaroot Tanslaruk
Keyword(s):  
Adverse Effects ◽  
Drug Interactions ◽  
Treatment Outcomes ◽  
Tertiary Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Team Approach ◽  
Care Clinic ◽  
Living With Hiv

Polypharmacy poses risks associated with drug-drug interactions, increased adverse effects, pill burden, poor compliance and unfavorable treatment outcomes. Whether polypharmacy affects treatment outcomes among people living with HIV (PLHIV) is largely unknown. A prospective study was conducted among PLHIV followed-up at a tertiary-care clinic of an academic medical center during January 2012 to December 2017. The clinic provided comprehensive HIV care with multidisciplinary team approach focusing on treatment adherence. Polypharmacy was defined as concurrent use of 5 or more non-antiretroviral (ARV) drugs for at least one year. Of the 248 PLHIV included, 23 (9%) received polypharmacy. PLHIV with polypharmacy were older (median age 45 vs. 36 years), were more likely to have underlying diseases (65% vs. 18%) and had lower median initial CD4 counts (40 vs. 214 cells/mm3). The rates of virologic suppression at 12 months after ARV therapy were 96% and 92% in polypharmacy and non-polypharmacy groups, respectively (P = 0.70), while the median CD4 cell count increase was higher among the non-polypharmacy group at 12 months (207 vs. 403 cells/mm3; P < 0.001). There were no differences in rates of adverse effects and experienced drug-drug interactions. Hospitalization due to HIV-related diseases within 12 months after ARV initiation [adjusted odds ratio (aOR) 11.63, P = 0.004] and lower 3-item score for ARV adherence (aOR 0.49, P = 0.01) were independently associated with failure of virologic suppression at 12 months. These findings suggest that polypharmacy did not affect the virological outcomes among our PLHIV. Patients with the characteristics associated with virological failure should be closely monitored.

scholarly journals HIV Viral Suppression among People Living with HIV on Antiretroviral Therapy in Haut-Katanga and Kinshasa Provinces of Democratic Republic of Congo

Healthcare ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 69
Author(s):  
Gulzar H. Shah ◽  
Lievain Maluantesa ◽  
Gina D. Etheredge ◽  
Kristie C. Waterfield ◽  
Osaremhen Ikhile ◽  
...  
Keyword(s):  
Public Health ◽  
Antiretroviral Therapy ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Clinical Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
National Guidelines ◽  
Republic Of Congo ◽  
Living With Hiv

Human immunodeficiency virus (HIV) infections and less-than-optimal care of people living with HIV (PLHIV) continue to challenge public health and clinical care organizations in the communities that are most impacted by HIV. In the era of evidence-based public health, it is imperative to monitor viral load (VL) in PLHIV according to global and national guidelines and assess the factors associated with variation in VL levels. Purpose: This study had two objectives—(a) to describe the levels of HIV VL in persons on antiretroviral therapy (ART), and (b) to analyze the significance of variation in VL by patients’ demographic and clinical characteristics, outcomes of HIV care, and geographic characteristics of HIV care facilities. Methods: The study population for this quantitative study was 49,460 PLHIV in the Democratic Republic of Congo (DRC) receiving ART from 241 CDC-funded HIV/AIDS clinics in the Haut-Katanga and Kinshasa provinces of the DRC. Analysis of variance (ANOVA) was performed, including Tamhane’s T2 test for pairwise comparisons using de-identified data on all patients enrolled in the system by the time the data were extracted for this study by the HIV programs in May 2019. Results: The VL was undetectable (<40 copies/mL) for 56.4% of the patients and 24.7% had VL between 40 copies/mL and less than 1000 copies per mL, indicating that overall, 81% had VL < 1000 and were virologically suppressed. The remaining 19% had a VL of 1000 copies/mL or higher. The mean VL was significantly (p < 0.001) higher for males than for females (32,446 copies/mL vs. 20,786, respectively), persons <15 years of age compared to persons of ages ≥ 15 years at the time of starting ART (45,753 vs. 21,457, respectively), patients who died (125,086 vs. 22,090), those who were lost to follow-up (LTFU) (69,882 vs. 20,018), those with tuberculosis (TB) co-infection (64,383 vs. 24,090), and those who received care from urban clinics (mean VL = 25,236) compared to rural (mean VL = 3291) or semi-rural (mean VL = 26,180) clinics compared to urban. WHO clinical stages and duration on ART were not statistically significant at p ≤ 0.05 in this cohort. Conclusions: The VL was >1000 copies/mL for 19% of PLHIV receiving ART, indicating that these CDC-funded clinics and programs in the Haut-Katanga and Kinshasa provinces of DRC have more work to do. Strategically designed innovations in services are desirable, with customized approaches targeting PLHIV who are younger, male, those LTFU, with HIV/TB co-infection, and those receiving care from urban clinics.

scholarly journals Disparities between HIV patient subgroups in Oman: An analysis of the 2019 cascade of care

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254474
Author(s):  
A. Elgalib ◽  
S. Shah ◽  
A. Al-Wahaibi ◽  
Z. Al-Habsi ◽  
M. Al-Fouri ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Risk Factor ◽  
Hiv Risk ◽  
Viral Suppression ◽  
Linkage To Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Cascade Of Care ◽  
Living With Hiv ◽  
Patient Subgroups

Background The HIV cascade of care is a framework for monitoring HIV care, identifying gaps and informing appropriate interventions. This study aimed to describe the cascade of care in Oman in 2019 and highlight disparities at the sub-population level. Methods We used the UNAIDS Spectrum modelling software to estimate the number of people living with HIV. A national HIV surveillance database was used to identify Omani people (≥13 years old) diagnosed with HIV from 1984 through December 2019. We calculated the cascade indicators as of 31 December 2019 stratified by sex, age, HIV risk factor, residence, and region of HIV care. We also performed multivariate logistic regression to determine the predictors of attrition at linkage, retention, on ART, and viral suppression. Results As of December 2019, the estimated number of people living with HIV in Oman was 2440. Out of the estimated number of people living with HIV, 69% were diagnosed, 66% were linked to care, 61% were retained in care, 60% were on ART, and 55% were virally suppressed. Of the 1673 diagnosed individuals, 96% were linked to care, 88% were retained in care, 87% were on ART, and 81% were virally suppressed. People who received HIV care outside Muscat had the largest attrition (11% loss) in the transition from linkage (97%) to retention (86%). Similarly, people aged 13–24 years had the largest attrition (13% loss) from “on ART” (88%) to viral suppression (75%). Logistic regression showed that both not reporting a specific HIV risk factor and receipt of HIV care outside Muscat independently predicted attrition at each cascade stage from linkage to care through viral suppression. Conclusions Our findings identified substantial disparities across various subpopulations along the cascade of care in Oman. This analysis will be invaluable in informing future interventions targeting patient subgroups who are at the highest risk of attrition.

scholarly journals Prevalence of Overweight And Obesity And Associated Factors Among People Living With Hiv Attending A Tertiary Care Clinic In Uganda

2022 ◽  
Author(s):  
Esther Alice Nalugga ◽  
Eva Laker ◽  
Maria Sarah Nabaggala ◽  
Ahmed Ddungu ◽  
Charles Batte ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Overweight And Obesity ◽  
Noncommunicable Disease ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Care Clinic ◽  
Factors Associated ◽  
Living With Hiv

Abstract Background: Overweight and obesity are significantly increasing among people living with HIV (PLWH), contributing to the risk of major adverse cardio-metabolic events. However, little is known on its prevalence among PLWH in sub-Saharan Africa. In this study, we report the prevalence and factors associated with overweight and obesity among PLWH in a large tertiary HIV clinic in Kampala, Uganda. Methods: A cross-sectional, retrospective review of electronic database of all PLWH that attended the Adult Infectious Diseases Institute clinic between November 2018 and April 2019 was conducted. Demographic, body mass index (BMI) [kg/m2] and clinical variables were extracted. Based on BMI, nutritional status was classified as undernutrition (< 18.5kg/m2), normal (≥18.5 < 25kg/m2), overweight (≥25 < 30kg/m2) and obesity (≥ 30kg/m2). Poisson regression analysis was performed to determine factors associated with overweight and obesity.Results: Overall, 7,818 participants were included in the analysis, 64% (n=4,976) were female, with a median age of 44 years (interquartile range (IQR): 36 — 51) and a median BMI of 24.2 (IQR: 21.2 — 28.1). The prevalence of overweight and obesity combined was 46% (55% female versus 30% male), obesity 18.2% (24.6% female versus 7.1% male) and overweight 27.8% (30.4% female versus 22.9% male). Factors associated with overweight and obesity were: Female sex (adjusted prevalence ratio [aPR]: 1. 8, 95%CI:1.69 — 1.87), age category 25—59 years (aPR: 1.9, 95%CI: 1.63 — 2.24) and ≥ 60 years (aPR: 1.8, 95%CI:1.49 — 2.12); duration on antiretroviral therapy (ART) for 6—10 years (aPR: 1.1, 95%CI:1.08 — 1.18), CD4 count ≥500 (aPR:1.3, 95%CI:1.21 — 1.30) and having at least one noncommunicable disease (NCD) (aPR: 1.1, 95%CI:1.07 — 1.18). Conclusions: There is a high burden of overweight and obesity among PLWH in Uganda. Nutrition and weight management programs particularly targeting high risk groups such as female and persons with underlying NCDs should be integrated into HIV care.

Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study (Preprint)

2019 ◽  
Author(s):  
Jenevieve Opoku ◽  
Rupali K Doshi ◽  
Amanda D Castel ◽  
Ian Sorensen ◽  
Michael Horberg ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hiv Care ◽  
Disease Stage ◽  
People Living With Hiv ◽  
Hiv Disease ◽  
Persons Living With Hiv ◽  
Living With Hiv

BACKGROUND HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. OBJECTIVE The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). METHODS Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. RESULTS There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, <i>P</i>&lt;.001) but more likely to be black (82.3% vs 69.5%, <i>P</i>&lt;.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, <i>P</i>&lt;.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, <i>P</i>&lt;.001), have a CD4 &lt;200 cells/µL in 2017 (6.2% vs 4.6%, <i>P</i>&lt;.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, <i>P</i>&lt;.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). CONCLUSIONS These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

Depressive Symptoms, Gender, Disclosure, and HIV Care Stage Among People Living with HIV in Cameroon

2021 ◽  
Author(s):  
Angela M. Parcesepe ◽  
Molly Remch ◽  
Anastase Dzudie ◽  
Rogers Ajeh ◽  
Denis Nash ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Living With Hiv

scholarly journals The Utilisation of Payment Models Across the HIV Continuum of Care: Systematic Review of Evidence

2021 ◽  
Author(s):  
Tiago Rua ◽  
Daniela Brandão ◽  
Vanessa Nicolau ◽  
Ana Escoval
Keyword(s):  
Positive Impact ◽  
Cost Effective ◽  
Relative Magnitude ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Continuum Of Care ◽  
Clinical Conditions ◽  
Study Designs ◽  
Living With Hiv ◽  
Payment Models

AbstractThe increasing chronicity and multimorbidities associated with people living with HIV have posed important challenges to health systems across the world. In this context, payment models hold the potential to improve care across a spectrum of clinical conditions. This study aims to systematically review the evidence of HIV performance-based payments models. Literature searches were conducted in March 2020 using multiple databases and manual searches of relevant papers. Papers were limited to any study design that considers the real-world utilisation of performance-based payment models applied to the HIV domain. A total of 23 full-text papers were included. Due to the heterogeneity of study designs, the multiple types of interventions and its implementation across distinct areas of HIV care, direct comparisons between studies were deemed unsuitable. Most evidence focused on healthcare users (83%), seeking to directly affect patients' behaviour based on principles of behavioural economics. Despite the variability between interventions, the implementation of performance-based payment models led to either a neutral or positive impact throughout the HIV care continuum. Moreover, this improvement was likely to be cost-effective or, at least, did not compromise the healthcare system’s financial sustainability. However, more research is needed to assess the durability of incentives and its appropriate relative magnitude.

scholarly journals Free access to antiretroviral treatment and protection against the risk of catastrophic health expenditure in people living with HIV: evidence from Cameroon

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marwân-al-Qays Bousmah ◽  
Marie Libérée Nishimwe ◽  
Christopher Kuaban ◽  
Sylvie Boyer
Keyword(s):  
Socioeconomic Status ◽  
Health Expenditure ◽  
Antiretroviral Treatment ◽  
Catastrophic Health Expenditure ◽  
Hiv Care ◽  
Free Access ◽  
People Living With Hiv ◽  
Art Policy ◽  
Living With Hiv ◽  
The Impact

Abstract Background To foster access to care and reduce the burden of health expenditures on people living with HIV (PLHIV), several sub-Saharan African countries, including Cameroon, have adopted a policy of removing HIV-related fees, especially for antiretroviral treatment (ART). We investigate the impact of Cameroon’s free antiretroviral treatment (ART) policy, enacted in May 2007, on catastrophic health expenditure (CHE) risk according to socioeconomic status, in PLHIV enrolled in the country’s treatment access program. Methods Based on primary data from two cross-sectional surveys of PLHIV outpatients in 2006–2007 and 2014 (i.e., before and after the policy’s implementation, respectively), we used inverse propensity score weighting to reduce covariate imbalances between participants in both surveys, combined with probit regressions of CHE incidence. The analysis included participants treated with ART in one of the 11 HIV services common to both surveys (n = 1275). Results The free ART policy was associated with a significantly lower risk of CHE only in the poorest PLHIV while no significant effect was found in lower-middle or upper socioeconomic status PLHIV. Unexpectedly, the risk of CHE was higher in those with middle socioeconomic status after the policy’s implementation. Conclusions Our findings suggest that Cameroon’s free ART policy is pro-poor. As it only benefitted PLHIV with the lowest socioeconomic status, increased comprehensive HIV care coverage is needed to substantially reduce the risk of CHE and the associated risk of impoverishment for all PLHIV.

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