Fundamentals of HIV Medicine 2017

2017 ◽  
Author(s):  
American Academy of HIV Medicine
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Transmission ◽  
Retention In Care ◽  
Hiv Care ◽  
Coordination Of Care ◽  
Accountable Care ◽  
Care Providers ◽  
Prevention Strategies ◽  
Economic Issues ◽  
Transmission Prevention

Fundamentals of HIV Medicine is the nation’s most frequently utilized HIV patient care and reference textbook. Authored by leading HIV care providers, researchers, and experts, the new 2017 edition provides a comprehensive review of all facets of the medical management of individuals with HIV. The following topics are discussed in the book: epidemiology and the spread of HIV, mechanisms of HIV transmission, transmission prevention strategies, immunology, HIV elimination strategies, linkage into care, retention in care and accountable care, complementary and alternative medicine approaches, coordination of care, antiretroviral therapy, antiretroviral therapy in special populations, comorbidities and complications, social and economic issues, and clinical research.

scholarly journals A Novel Combined Mother-Infant Clinic to Optimize Post-Partum Maternal Retention, Service Utilization, and Linkage to Services in HIV Care in Rural Rwanda

2017 ◽  
Vol 6 (1) ◽  
pp. 36 ◽  
Author(s):  
Guillaine Neza, BSc ◽  
Wilberforce Mwizerwa, BA ◽  
Jackline Odhiambo, BA ◽  
Bethany L. Hedt-Gauthier, PhD ◽  
Lisa R. Hirschhorn, MD, MPH ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Service Utilization ◽  
Hiv Transmission ◽  
Post Partum ◽  
Retention In Care ◽  
Hiv Care ◽  
Program Outcomes ◽  
Modern Contraception ◽  
Retention In Hiv Care ◽  
Mother To Child

Background and Objectives: Despite recent improvements in accessibility of services to prevent mother-to-child transmission of HIV, maternal retention in HIV care remains a challenge in the postpartum period. This study assessed service utilization, program retention, and linkage to routine services, as well as clinical outcomes for mothers and infants, following implementation of an integrated mother-infant clinic in rural Rwanda.Methods: We conducted a retrospective cohort study of all HIV-positive mothers and their infants enrolled in the integrated clinics in two rural districts between July 1, 2012, and June 30, 2013. At 18 months post-partum, data on mother-infant service utilization and program outcomes were reported.Results: Of the 185 mother-infant pairs in the clinics, 98.4% of mothers were on antiretroviral therapy (ART) and 30.3% used modern contraception at enrollment. At 18 months post-partum, 98.4% of mothers were retained and linked back to adult HIV program. All mothers were on ART and 72.0% on modern contraception. For infants, 93.0% completed follow-up. Two (1.1%) infants tested HIV positive.Conclusion and Global Health Implication: An integrated clinic was successfully implemented in rural Rwanda with high mother retention in care and low mother to child HIV transmission rates. This model of integration of services may contribute to improved mother-infant retention in care during post-partum period and should be considered as one approach to addressing this challenge in similar settings.Key words: HIV • Integrated Clinic • Combined Clinic • Antiretroviral Therapy • Post-partum Retention • Linkages • ART • PMTCT • Option B+ • AfricaCopyright © 2017 Neza Guillaine et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.affect economic and health promotion.

scholarly journals 1042. The Attitude of Patients With HIV about Telehealth for Their HIV Care

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S550-S551
Author(s):  
Dima Dandachi ◽  
Bich Dang ◽  
Thomas Giordano Giordano
Keyword(s):  
Hiv Transmission ◽  
Personal Information ◽  
Critical Role ◽  
Retention In Care ◽  
Hiv Care ◽  
Structural Factors ◽  
Personal Factors ◽  
Response Distribution ◽  
Related Factors ◽  
Clinic Visits

Abstract Background The world is facing a pandemic of SARS-CoV-2 that disrupted our healthcare system and the way we deliver healthcare. For people with HIV (PWH), the ability to be retained in care plays a critical role in improving health outcomes and in preventing HIV transmission. Several definitions exist for retention in care, but they are centered around outpatient clinic visits. It is now more important than ever to understand PWH’s attitudes about using telemedicine for HIV care instead of face-to face clinic visits. Methods We administered a one-time survey to PWH presenting to an outpatient HIV center in Houston, Texas, from February–June 2018. The survey items were used to assess PWH’s attitudes towards and concerns for telehealth and explanatory variables. Results 371 participants completed the survey; median age was 51, 36% were female, and 63% African-American. Overall, 57% of respondents were more likely to use telehealth for their HIV care if available, as compared to one-on-one in-person care, and 37% would use telehealth frequently or always as an alternative to clinic visits. Participants reported many benefits including ability to fit better their schedule, decreasing travel time, and privacy but expressed concerns about the ability to effective communication and examination and the safety of personal information. Factors associated with likelihood of using telehealth include personal factors (US-born, men who have sex with men, higher educational attainment, higher HIV-related stigma perception), HIV-related factors (long standing HIV), and structural factors (having difficulty attending clinic visits, not knowing about or not having the necessary technology). There was no association between participants with uncontrolled HIV, medication adherence, and likelihood of using telehealth. Survey items and response distribution Conclusion Telehealth programs for PWH can improve retention in care. A modification of the definition for retention in care, incorporating telehealth, should be considered. Availability and confidence using various telehealth technologies need to be addressed to increase acceptability and usage of telehealth among PWH. Disclosures All Authors: No reported disclosures

scholarly journals Do HIV Care Providers Appropriately Manage Hepatitis B in Coinfected Patients Treated with Antiretroviral Therapy?

2007 ◽  
Vol 44 (7) ◽  
pp. 996-1000 ◽  
Author(s):  
M. K. Jain ◽  
C. K. Opio ◽  
C. C. Osuagwu ◽  
R. Pillai ◽  
P. Keiser ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hepatitis B ◽  
Hiv Care ◽  
Care Providers

scholarly journals Barriers to Universal Prescribing of Antiretroviral Therapy by HIV Care Providers in the United States, 2013–2014

2017 ◽  
Vol 74 (5) ◽  
pp. 479-487 ◽  
Author(s):  
John Weiser ◽  
John T. Brooks ◽  
Jacek Skarbinski ◽  
Brady T. West ◽  
Christopher C. Duke ◽  
...  
Keyword(s):  
United States ◽  
Antiretroviral Therapy ◽  
The United States ◽  
Hiv Care ◽  
Care Providers

scholarly journals Delivery of HIV Antiretroviral Therapy Adherence Support Services by HIV Care Providers in the United States, 2013 to 2014

2017 ◽  
Vol 16 (6) ◽  
pp. 624-631 ◽  
Author(s):  
John Weiser ◽  
Linda Beer ◽  
John T. Brooks ◽  
Kathleen Irwin ◽  
Brady T. West ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Nurse Practitioners ◽  
Support Services ◽  
International Association ◽  
The United States ◽  
Hiv Care ◽  
Art Adherence ◽  
Care Providers ◽  
Adherence Support ◽  
Hiv Antiretroviral Therapy

Background: Little is known about clinicians’ adoption of recommendations of the International Association of Providers of AIDS Care and others for supporting adherence to antiretroviral therapy (ART). Methods: We surveyed a probability sample of US HIV care providers to estimate the percentage offering 3 ART adherence support services to most or all patients and assessed the characteristics of providers offering all 3 services (comprehensive support) to most or all patients. Results: Almost all providers (95.5%) discussed ART adherence at every visit, 60.1% offered advice about tools to increase adherence, 53.5% referred nonadherent patients for supportive services, and 42.8% provided comprehensive support. Nurse practitioners were more likely to offer comprehensive support as were providers who practiced at Ryan White HIV/AIDS Program-funded facilities, provided primary care, or started caring for HIV-infected patients within 10 years. Conclusion: Less than half of HIV care providers offered comprehensive ART adherence support. Certain subgroups may benefit from interventions to increase delivery of adherence support.

scholarly journals 1319. Events of Disengagement from HIV care and Subsequent Reengagement in a Kenyan Pastoralist Community: Frequency, Determinants, and Patient Views

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S476-S477
Author(s):  
Paul Otieno Yonga ◽  
Stephen Kiplimo Kalya ◽  
Lutgarde Lynen ◽  
Tom Decroo
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Transmission ◽  
Hospital Admissions ◽  
Hiv Care ◽  
Engagement In Care ◽  
Work Related ◽  
Medication Side ◽  
Competing Priorities ◽  
Lost To Follow Up

Abstract Background Regular follow-up HIV-infected patients on antiretroviral therapy (ART) is vital to ensure viral suppression, thus reducing HIV transmission, and HIV-related morbidity and mortality. However, some patients have been reported to have events of disengagement from care with subsequent re-engagement in care, though knowledge on the magnitude and determinants of this phenomenon, particularly in pastoralist communities is scarce. Methods A mixed-methods study was carried out among HIV-infected patients on antiretroviral therapy (ART) follow-up between January 2014 and June 2017 at the Baringo County Referral Hospital, Kabarnet, Kenya. Records on their clinic attendance and laboratory follow-up were extracted, and those noted to have a recent event of disengagement from care who later re-engaged in care, were then purposively sampled for in-depth interviews. Results 342 patient records were analyzed, of which 48% (166/342) of the patients were noted to be active at the end of the study period, with 63.3% (105/166) of them noted to have one or more events of disengagement from care. Female patients, patients with baseline CD4 counts ≥200 cells/mm3, and patients with a low WHO stage category (I and II) were more likely to return to care after an experience of disengagement from HIV care (P < 0.05). Eight interviewee transcripts showed the following reported reasons for disengagement in care: long distances, stigma, work-related problems, medication side effects, competing priorities, perceived recovery of the health status, medication fatigue, and not being informed of their clinic return dates. Motivators for re-engagement in care included hospital admissions, fear of getting sick like their spouse, and phone reminders. Conclusion A vast majority of patients currently active in care experienced multiple events of disengagement from care. Thus, early identification of those who disengage from care is recommended, before they become lost to follow-up. Disclosures All authors: No reported disclosures.

scholarly journals Estimating the HIV undiagnosed population in Catalonia, Spain: descriptive and comparative data analysis to identify differences in MSM stratified by migrant and Spanish-born population

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018533 ◽  
Author(s):  
Juliana Maria Reyes-Urueña ◽  
Colin N J Campbell ◽  
Núria Vives ◽  
Anna Esteve ◽  
Juan Ambrosioni ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Retention In Care ◽  
Hiv And Aids ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Undiagnosed Hiv ◽  
Sex With Men ◽  
Living With Hiv

ObjectiveUndiagnosed HIV continues to be a hindrance to efforts aimed at reducing incidence of HIV. The objective of this study was to provide an estimate of the HIV undiagnosed population in Catalonia and compare the HIV care cascade with this step included between high-risk populations.MethodsTo estimate HIV incidence, time between infection and diagnosis and the undiagnosed population stratified by CD4 count, we used the ECDC HIV Modelling Tool V.1.2.2. This model uses data on new HIV and AIDS diagnoses from the Catalan HIV/AIDS surveillance system from 2001 to 2013. Data used to estimate the proportion of people enrolled, on ART and virally suppressed in the HIV care cascade were derived from the PISCIS cohort.ResultsThe total number of people living with HIV (PLHIV) in Catalonia in 2013 was 34 729 (32 740 to 36 827), with 12.3% (11.8 to 18.1) of whom were undiagnosed. By 2013, there were 8458 (8101 to 9079) Spanish-born men who have sex with men (MSM) and 2538 (2334 to 2918) migrant MSM living with HIV in Catalonia. A greater proportion of migrant MSM than local MSM was undiagnosed (32% vs 22%). In the subsequent steps of the HIV care cascade, migrants MSM experience greater losses than the Spanish-born MSM: in retention in care (74% vs 55%), in the proportion on combination antiretroviral treatment (70% vs 50%) and virally suppressed (65% vs 46%).ConclusionsBy the end of 2013, there were an estimated 34 729 PLHIV in Catalonia, of whom 4271 were still undiagnosed. This study shows that the Catalan epidemic of HIV has continued to expand with the key group sustaining HIV transmission being MSM living with undiagnosed HIV.

scholarly journals Systemic Delays in the Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients in Houston, Texas

2018 ◽  
Vol 17 ◽  
pp. 232595821877404 ◽  
Author(s):  
Osaro Mgbere ◽  
Maria Rodriguez-Barradas ◽  
Karen Joan Vigil ◽  
Melanie McNeese ◽  
Fazal Tabassam ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Medical Care ◽  
Treatment Guidelines ◽  
Health Benefits ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Medical Decision ◽  
Care Providers ◽  
Harris County ◽  
Starting Point

Background: The current US HIV treatment guidelines support initiation of antiretroviral therapy (ART) for persons with HIV for personal health benefits and prevention of HIV transmission. However, high levels of adherence to ART are critical to maximize individual and public health benefits. We examined the nonclinical barriers to ART initiation for clinically eligible individuals and the provider- and patient-related factors associated with these barriers among HIV-infected patients in Houston/Harris County, Texas. Methods: We analyzed data obtained from a probability sample of HIV medical care providers (HMCPs) in 13 outpatient facilities in Houston/Harris County, Texas surveyed between June and September 2009. We used an inductive thematic approach to code HMCP responses to an open-ended question that asked the main reasons why providers may delay initiating ART for clinically eligible patients. Results: The reasons cited by providers for delaying ART for clinically eligible patients were adherence (42.5%; 95% confidence interval [CI]: 28.5-57.8), acceptance (30%; 95% CI: 18.1-45.4), and structural concerns (27.5%; 95% CI: 16.1-42.8), with significant variations ( P < .0001) noted across patients’ race/ethnicity and transmission category. HIV medical care providers with 6 to 10 years’ experience in HIV care and those providing medical care for more than 100 patients monthly were about 4 times (adjusted odds ratio [aOR]: 3.80; 95% CI: 1.20-5.92; P = .039) and 10 times (aOR: 10.36; 95% CI: 1.42-22.70; P = .019) more likely to state adherence and acceptance concerns, respectively, as reasons for delaying ART for clinically eligible patients. Conclusion: Our findings highlight the fact that clinical guidelines are only a starting point for medical decision-making process and that patients themselves play an important role. HMCP access to referrals for other medical issues, support services, and treatment education may help improve adherence and patient readiness for ART, thereby avoiding systemic delays.

scholarly journals Perinatal HIV Transmission Prevention: Challenges among Women Living with HIV in sub-Saharan Africa

2020 ◽  
Vol 9 (3) ◽  
pp. 354-359
Author(s):  
Elizabeth Armstrong-Mensah ◽  
Krystal Ruiz ◽  
Aminata Fofana ◽  
Victoria Hawley
Keyword(s):  
Antiretroviral Therapy ◽  
Sex Education ◽  
Hiv Transmission ◽  
Public Health Problem ◽  
Sub Saharan Africa ◽  
Creative Commons ◽  
Perinatal Hiv ◽  
Transmission Prevention ◽  
Sub Saharan ◽  
Hiv Transmission Prevention

About 86 percent of the estimated 160,000 children newly-infected with the human immunodeficiency virus (HIV) live in sub-Saharan Africa. Despite global efforts to reduce perinatal HIV transmission, this phenomenon continues to be a public health problem in sub-Saharan Africa. This paper discusses challenges associated with perinatal HIV transmission prevention in sub-Saharan Africa and offers strategies for the way forward. These strategies include safe sex education and behavioral change, increased access to integrated antenatal care, training of unskilled traditional birth attendants into formal delivery systems, access to antiretroviral therapy, and investing in virologic testing. Key words: • HIV • Perinatal • Antiretroviral Therapy • Mother to Child HIV Transmission • HIV Prevention • Sub-Saharan Africa   Copyright © 2020 Armstrong-Mensah, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

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