scholarly journals Outcomes along the HIV continuum of care for Men who have Sex with Men in Haiti

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
W Dunbar ◽  
N Sohler ◽  
Y Coppieters
Keyword(s):  
Viral Suppression ◽  
Continuum Of Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Care Clinic ◽  
Effective Interventions ◽  
Sex With Men ◽  
Living With Hiv

Abstract Background The HIV epidemic in Haiti continues, with an estimated 160,000 people living with HIV at the end of 2018. Although HIV prevalence in the general population is estimated to be 2.0%, certain groups are at a higher risk of HIV infection. The prevalence of HIV among men who have sex with men (MSM) is estimated to be 12.9%. As previous data have found gaps in HIV care for this population, we explored the steps in the continuum of care to determine outcomes at each step. Methods We used an observational retrospective cohort study design to follow up MSM diagnosed with HIV in the largest HIV care clinic in Port-au-Prince, Haiti. Estimates were calculated of proportions of participants reached, tested, linked to care, commencing treatment, adherent to treatment, and who achieved virologic suppression. We identified factors associated with loss to follow-up at each step using multivariable analysis. Results Data were collected between January 1, 2015, and December 31, 2018. 5009 MSM were reached for prevention services. Of those reached, 2499 (49.8%, 95% CI 48.5-51.3) were tested for HIV, 222 (8.8%, 95% CI 7.8-10.0) had a positive test result for HIV, and 172 (77,47%, 95% CI 71.4-82.8) were linked to HIV care. Among participants who started care, 54 (44.6 95% CI 24.5-38.9) were retained and 98 (78.4%, 95% CI 49.2-64.5) achieve a suppressed viral load. Fifty-nine (44.8%, 95% CI 27.2-41.9) were lost to follow-up. Participants who had been younger, with lower educational and economic level were significantly less likely to achieve retention and viral suppression (p = 0.001). Conclusions HIV cascade data among MSM in Haiti show very poor rates of retention in treatment although those retained had good virologic outcome. Characteristics associated with LTFU suggest an urgent need to develop and implement effective interventions to support patients in achieving retention and viral suppression among MSM living with HIV. Key messages Poor HIV outcomes for men who have sex with men in Haiti. Effective interventions to improve HIV outcomes for men who have sex with men in Haiti are urgently needed.

scholarly journals 1313. Complementary Effects of Medical Follow-up and Virologic Suppression for Reincarcerated Inmates Living with HIV

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S474-S474
Author(s):  
Melissa E Badowski ◽  
R Kane Stafford ◽  
Brian W Drummond ◽  
Thomas D Chiampas ◽  
Sarah M Michienzi ◽  
...  
Keyword(s):  
Hiv Care ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Management Support ◽  
Chi Square ◽  
History Of ◽  
Secondary Endpoints ◽  
Living With Hiv ◽  
Hiv 1

Abstract Background Although prison presents an opportunity to achieve virologic suppression (VS) among people living with HIV, continued success is not guaranteed upon release. Methods A retrospective cohort study was performed in reincarcerated Illinois prisoners from January 1, 2016 to July 31, 2018. Patients were included if they were age ≥18 years, carried a diagnosis of HIV/AIDS, on antiretroviral therapy (ART) at the time of release, and had CD4 and HIV-1 RNA labs drawn within 6 months of release and reincarceration. Potential subjects were excluded if reincarcerated within 30 days due to a technical violation and not receiving ART at the time of prison release. Primary and secondary endpoints were percent of patients achieving VS upon reincarceration and percent of patients following at an HIV clinic while released. Statistical analysis included descriptive statistics, chi-square, and paired t-tests. Results Among 505 patients released during the study period, 95 patients were reincarcerated and 80 were included (Figure 1). Demographic information can be found in Table 1. Fifty-one patients (64%) reported follow-up at an HIV clinic while released, whereas 29 (36%) did not. Patients who had VS at the time of prison release were more likely to make their follow-up appointment (90%) compared with those who did not (69%) (P < 0.001). In addition, patients making their follow-up appointment were also more likely to have VS at the time of reincarceration (86% vs. 10%, P < 0.001). Recidivist patients adherent to ART were less likely to experience decreases in mean CD4 count (P = 0.03) (Table 2). Subjects reporting a history of substance use were more likely not to re-engage in post-release HIV care (P = 0.001), but no difference was noted in patients with a documented psychiatric history (P = 0.2). Conclusion Patients failing to meet VS at the time of prison release should be targeted for more intensive re-entry medical and case management support to ensure adherence to follow-up and maintenance of immunologic function. Disclosures All authors: No reported disclosures.

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 Association Between Patient Portal Access and Viral Suppression Among People Living with HIV in a Large Southeastern Clinical Cohort

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S40-S40
Author(s):  
Sarah Scott ◽  
Cathy Jenkins ◽  
Peter Rebeiro ◽  
Megan Turner ◽  
Sally Bebawy ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Sexual Contact ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Patient Portal ◽  
Adjusted Relative Risk ◽  
Care Clinic ◽  
Sociodemographic Disparities ◽  
Living With Hiv ◽  
Research Grant

Abstract Background Viral suppression (VS) among people living with HIV (PLWH), the goal of the HIV care continuum, leads to improved patient outcomes and decreased HIV transmission. Patient portals are online tools that enable patient interaction with healthcare systems and may increase patient engagement and improve health outcomes. We examined whether portal access was associated with VS among PLWH. Methods We conducted an observational cohort study among PLWH aged ≥18 years who had ≥1 HIV healthcare provider visit at the Vanderbilt Comprehensive Care Clinic (Nashville, Tennessee) from January 1, 2011–December 31, 2015. Patient portal access was defined as being registered for a portal account at any point in the year prior. VS was defined as having ≥1 viral load (VL) measured and the last VL ≤200 copies/ml within a given year. The adjusted relative risk (aRR) of VS was estimated with modified Poisson regression and robust standard errors for multiple outcomes per individual. Models were adjusted for all covariates in the Figure and for year since first kept appointment. Missing data were multiply imputed. Results The study population included 4,237 PLWH; median age was 43 years (IQR 33–50), 78% were male, 41% were black, and 60% reported male–male sexual contact (MSM). Of the 57% who had portal access during the study period, median age was 42 years (IQR 31–49), 86% were male, 30% were black, and 75% were MSM. In adjusted analysis, portal access was independently associated with improved VS (aRR = 1.19, 95% CI 1.16–1.21 vs. no portal access) (Figure). Increasing age and sexual contact (vs. injection drug use) remained associated with improved VS; black race (vs. white race), lower socioeconomic status, and higher baseline VL remained associated with poor VS after accounting for portal access (Figure). Conclusion Portal access was independently associated with improved VS, although sociodemographic disparities in VS persisted. Additionally, there were sociodemographic disparities in patient portal access. There may be important unmeasured confounders such as health literacy and educational attainment. Additional prospective studies are needed to determine whether patient portal access leads to improved VS among PLWH. Disclosures P. Rebeiro, NIH: Grant Investigator, Research grant; G. Jackson, Vanderbilt Center for Effective Health Communication: Grant Investigator, Research grant; Agency for Healthcare Research and Quality: Grant Investigator, Research grant; American Medical Informatics Association: Board Member, Research support; A. Pettit, NIH/NIAID - K08AI104352: Grant Investigator, Research grant

Dose Response Effects of Digital HIV Care Navigation on Mental Health and Viral Suppression among Young People Living with HIV (Preprint)

2021 ◽  
Author(s):  
Sean Arayasirikul ◽  
Caitlin M Turner ◽  
Dillon Trujillo ◽  
Jarett Maycott ◽  
Erin C Wilson
Keyword(s):  
Mental Health ◽  
Viral Load ◽  
Young People ◽  
Text Messaging ◽  
Viral Suppression ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Social Inequities ◽  
Sex With Men ◽  
Living With Hiv

BACKGROUND The HIV epidemic has revealed considerable disparities in health among sexual and gender minorities of color within the Unites States, disproportionately affecting men who have sex with men (MSM) and trans women. Social inequities further disadvantage those with intersectional identities through homophobia, anti-trans discrimination, and racism, shaping not only those at-risk for HIV infection, but also HIV prevention and care outcomes. Digital interventions have great potential to address barriers and improve HIV care among MSM and trans women; however, efficacy of digital HIV care interventions vary and need further examination. OBJECTIVE This study assessed 12-month efficacy of a 6-month digital HIV care navigation intervention among young people living with HIV (YPLWH) in San Francisco We examined dose-response relationships between intervention exposure (e.g. text messaging) and viral suppression and mental health. Health electronic navigation (eNavigation or eNav) is a 6-month, text message-based, digital HIV care navigation intervention, in which YPLWH are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. METHODS This study had a single-arm, prospective, pre-post design. Eligibility criteria for the study included: identifying as a man who has sex with men or a trans woman; being between the ages of 18 and 34 years; and being newly diagnosed with HIV or not being engaged/retained in HIV care or having a detectable viral load. We assessed and analyzed sociodemographic, intervention exposure, and HIV care and mental health outcome data for participants who completed the 6-month Health eNav intervention. We assessed all outcomes using generalized estimating equations (GEE) to account for within-subjects correlation, and marginal effects of texting engagement on all outcomes were calculated over the entire 12-month study period. Finally, we specified an interaction between texting engagement and time to evaluate the effects of texting engagement on outcomes. RESULTS Over the entire 12-month study period showed that every one-text increase in engagement was associated with an increased odds of undetectable viral load (adjusted odds ratio, aOR = 1.01, 95% CI = 1.00 – 1.02, p = 0.03). We found that mean negative mental health experiences decreased significantly at 12 months compared to baseline for every one-text increase in engagement (coefficient on interaction term: 0.97, 95%CI = 0.96-0.99, p < 0.01). CONCLUSIONS Digital care navigation interventions like Health eNavigation may be a critical component in the health delivery service system as the digital safety net for those whose social vulnerability is exacerbated in times of crisis, disasters, or global pandemics due to multiple social inequities. We found that increased engagement in a digital HIV care navigation intervention helped to improve viral suppression and mental health – intersecting, co-morbid conditions – 6-months after the intervention concluded. Digital care navigation may be a promising, effective, sustainable, and scalable intervention. INTERNATIONAL REGISTERED REPORT RR2-10.2196/16406

scholarly journals Clinical situation of Venezuelan migrants living with HIV in a hospital in Lima, Peru

2021 ◽  
pp. 095646242110240
Author(s):  
Genesis S Huerta-Vera ◽  
Manuel A Amarista ◽  
Fernando A Mejía ◽  
Ana B Graña ◽  
Elsa V Gonzalez-Lagos ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Clinical Situation ◽  
Cross Sectional Study ◽  
People Living With Hiv ◽  
Sectional Study ◽  
Cross Sectional ◽  
Epidemiological Trends ◽  
Clinical Conditions ◽  
Living With Hiv

Due to a huge crisis extensive to health services many Venezuelan people living with HIV (PLWH) had migrated abroad, including Peru where favorable laws were in place until June 2019. We describe the health status and epidemiological trends of PLWH from Venezuela at an HIV program in Lima. We analyzed baseline and follow-up data of all Venezuelan PLWH enrolled in our HIV program from January 2017 to December 2019. A cross-sectional study in a subsample served to describe ARV adherence and context of migration. Between 2017-2019 our HIV Program registered 398 Venezuelan PLWH, representing 20% of the 2018 annual enrollments; numbers decreased since mid-2019. The median age was 30 years (IQR 26;37) and 90.5% were men. Between 2017 and 2019, the proportion with diagnosis in Peru increased from 14.3% to 60.9%; of AIDS stage at entry, from 8.8% to 27.2%. By December 2019, 182/250 (72.8%) were still in care, and 43 (10.8%) had not started ART. Viral suppression evaluated in 195, was achieved in 71.8%. From 2017 to 2019, migrant PLWH arrived in worsened clinical conditions, with increasing diagnosis in Peru; the flow of migrant PLWH entering care diminished with less favorable laws. Viral suppression rates were suboptimal.

scholarly journals Psychosocial Determinants of HIV Stigma among Men Who Have Sex with Men in San Francisco, California

2021 ◽  
Vol 18 (15) ◽  
pp. 8031
Author(s):  
Dharma N. Bhatta ◽  
Jennifer Hecht ◽  
Shelley N. Facente
Keyword(s):  
Mental Health ◽  
San Francisco ◽  
Age Groups ◽  
Hiv Stigma ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Adjusted Risk ◽  
Sex With Men ◽  
Living With Hiv

Background: Stigma and discrimination are major challenges faced by people living with HIV (PLWH), and stigma continues to be prevalent among PLWH. We conducted a cross-sectional study of 584 men who have sex with men (MSM) living with HIV between July 2018 and December 2020, designed to better understand which demographic and behavioral characteristics of MSM living with HIV in San Francisco, California are associated with experience of stigma, so that programs and initiatives can be tailored appropriately to minimize HIV stigma’s impacts. Methods: This analysis was conducted with data from San Francisco AIDS Foundation (SFAF) encompassing services from multiple different locations in San Francisco. Data about the level of HIV-related stigma experienced were collected through a single question incorporated into programmatic data collection forms at SFAF as part of the client record stored in SFAF’s electronic health record. We performed linear regression to determine the associations between self-reported experiences of HIV stigma and other characteristics among MSM living with HIV. Results: HIV stigma was low overall among MSM living with HIV who are actively engaged in HIV care in San Francisco; however, it was significantly higher for the age groups of 13–29 years (adjusted risk difference (ARD): 0.251, 95% CI: 0.012, 0.489) and 30–49 years (ARD: 0.205, 95% CI: 0.042, 0.367) when compared to the age group of 50 years and older, as well as people who were homeless (ARD: 0.844, 95% CI: 0.120, 1.568), unstably housed (ARD: 0.326, 95% CI: 0.109, 0.543) and/or having mental health concerns (ARD: 0.309, 95% CI: 0.075, 0.544), controlling for race, injection history, and viral load. Conclusions: These findings highlight an opportunity to develop culturally, socially, and racially appropriate interventions to reduce HIV stigma among MSM living with HIV, particularly for younger men and those struggling with housing stability and/or mental health.

scholarly journals 1325. Inpatient Initiation of ART Improves Short-Term Mortality in People Living with HIV

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S479-S479
Author(s):  
Jamie Campbell ◽  
Christopher Polk ◽  
Danya Roshdy ◽  
Michael Leonard
Keyword(s):  
Hospice Care ◽  
Intervention Group ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Short Term ◽  
Patient Admissions ◽  
Short Term Mortality ◽  
Living With Hiv ◽  
The Impact

Abstract Background Treatment of HIV is recommended as soon as possible and early initiation of combined antiretroviral therapy (cART) is associated with improved engagement in care; however, treatment with cART is often deferred in hospitalized patients despite being correlated with improved outcomes. We implemented an institutional intervention to ensure all people living with HIV (PLwH) were on cART during hospitalization to improve patient outcomes. Methods We prospectively identified all PLwH hospitalized at our institution and had ID physicians and pharmacists ensure they were on appropriate cART and linked to outpatient care. We retrospectively collected clinical and lab data to assess the impact of our intervention on inpatient mortality, 30-day mortality, 30-day readmission rate, and frequency of outpatient follow-up. Patients were excluded from analysis if they were admitted for hospice care. Results We identified 389 patient admissions in 275 unique patients, of which 304 admissions were already on cART at admission. After ID physician assessment, 37 of the 85 not on cART at admission were initiated on therapy. We assessed the impact of this intervention on short-term outcomes as listed in Table 1. Despite the intervention group having similar immunologic and virologic baseline characteristics to those not initiated on cART, their inpatient and 30-day mortality was similar to those already on cART. Readmission rates also decreased in the intervention group. Thirteen of 24 patients in the intervention group who could be tracked for long-term follow-up within our system achieved virologic suppression by 90 days after hospital discharge. Conclusion Inpatient treatment with cART during hospitalization improves short-term mortality outcomes. This study also demonstrates the value of inpatient cART treatment as most patients achieved virologic suppression at subsequent outpatient follow-up. Disclosures All authors: No reported disclosures.

scholarly journals 1322. A Mobile Technology-Based Intervention Improves HIV Care Continuum for Young People Living with HIV

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S478-S478
Author(s):  
Ping Du ◽  
John Zurlo ◽  
Tarek Eshak ◽  
Tonya Crook ◽  
Cynthia Whitener
Keyword(s):  
Mobile Technology ◽  
Viral Suppression ◽  
Retention In Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Hiv Viral Suppression ◽  
Study Participants ◽  
Living With Hiv

Abstract Background Young people living with HIV (YPLWH) have lower rates of retention in care and HIV viral suppression. Multiple barriers exist to engage YPLWH in care. As nearly all YPLWH use their mobile phones to access health information and to communicate with other people, we implemented a mobile technology-based intervention with the goal to improve HIV care continuum in YPLWH. Methods YPLWH were eligible for this study if they were: (1) aged 18–34 years; (2) newly diagnosed with HIV; (3) having a history of being out of care; or (4) not virally suppressed. We recruited YPLWH during January 2017-May 2018 and followed them every 6 months. We developed a HIPAA-compliant mobile application, “OPT-In For Life,” and let participants use this app to manage their HIV care. The app integrated multiple features that enabled users to communicate with the HIV treatment team via a secure messaging function, to access laboratory results and HIV prevention resources, and to set up appointment or medication reminders. We obtained participants’ demographics, app-usage data, and medical records to evaluate if this mobile technology-based intervention would improve HIV care continuum among YPLWH. We used a quasi-experiment study design to compare the rates of retention in care and HIV viral suppression every 6 months between study participants and YPLWH who were eligible but not enrolled in the study. Results 92 YPLWH participated in this study (70% male, 56% Hispanics or Blacks, 54% retained in care, and 66% virally suppressed at baseline). On average study participants used the app 1–2 times/week to discuss various health issues and supportive services with HIV providers, to access HIV-related health information, and to manage their HIV care. At the 6-month evaluation, compared with 88 eligible YPLWH who were not enrolled in this intervention, study participants had increased rates of retention in care (baseline-to-6-month between participants and nonparticipants: 54%–84% vs. 26%–25%) and HIV viral suppression (66%–80% vs. 56%–60%). Conclusion Our study demonstrates using a HIPAA-compliant mobile app as an effective intervention to engage YPLWH in care. This intervention can be adapted by other HIV programs to improve HIV care continuum for YPLWH or broader HIV populations. Disclosures All authors: No reported disclosures.

A retrospective evaluation of highly active antiretroviral therapy simplification in patients with end-stage renal disease receiving hemodialysis

2021 ◽  
pp. 095646242110119
Author(s):  
Ashley Otto ◽  
Patricia Pecora Fulco
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Viral Suppression ◽  
Hiv Care ◽  
Fixed Dose ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Once Daily ◽  
Stage Renal Disease ◽  
End Stage

Antiretroviral (ARV) therapy in people living with HIV (PLWH) and end-stage renal disease (ESRD) on hemodialysis (HD) is complicated, requiring renally adjusted nucleoside reverse transcriptase inhibitors (NRTIs) and daily administration of non-renally eliminated agents. Recent data in PLWH with ESRD on HD demonstrate maintenance of viral suppression (82% with viral loads (VLs) <50 copies/mL) and favorable safety/tolerability profiles after ARV simplification with a fixed dose combination single tablet [elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF)]. Extrapolation of these data to all F/TAF formulations would allow ARV simplification to most PLWH with ESRD receiving HD. The objective of this retrospective study was to identify if ARV-experienced PLWH with ESRD on HD receiving renally adjusted NRTIs may be simplified to once daily ARV formulations without adverse effects while maintaining viral suppression. This single-center retrospective analysis assessed virologic control (3–12 months) and ARV tolerability post-regimen simplification (primarily NRTI once-daily dose adjustment) in PLWH with ESRD on thrice weekly HD receiving human immunodeficiency virus (HIV) care in an ambulatory clinic. Seventeen PLWH with ESRD on HD were included after documented ARV simplification. At 12 months, 12 patients (71%) remained undetectable (HIV VL <50 copies/mL) with two additional maintaining viral suppression (<200 copies/mL). One patient remained undetectable at month eight but became non-adherent with viral rebound. Two patients did not complete the 6- and 12-month evaluation after documented nonadherence ( N = 1) and an adverse effect (pruritus) ( N = 1). At 12 months, virologic suppression and tolerability resulted after a simplified ARV regimen including once daily F/TAF was initiated in PLWH with ESRD on thrice weekly HD with a reduction in pill burden.

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