scholarly journals 763. Correlates of Antiretroviral Therapy Initiation Among Newly Diagnosed Older People with HIV in Ukraine

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S427-S427
Author(s):  
Amy J Allen ◽  
Oleksandr Zeziulin ◽  
Julia Rozanova ◽  
Taylor Litz ◽  
Irina Zaviryukha ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Older People ◽  
Opportunistic Infection ◽  
Retrospective Chart Review ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Newly Diagnosed ◽  
Art Initiation ◽  
Increased Risk ◽  
The Impact

Abstract Background Ukraine has a high burden of HIV, with only 52% of people living with HIV receiving Antiretroviral Therapy (ART) despite test and treat policies and free medications. An underrecognized but significantly increasing proportion of older people with HIV (OPWH) contribute 15% of new HIV diagnoses and demonstrate increased mortality compared to the age-matched general population. To assess the impact of age on HIV treatment outcomes, we examined correlates of ART initiation among newly diagnosed HIV patients in Ukraine. Methods A retrospective chart review was conducted of 400 patients newly diagnosed with HIV between July 1, 2017- Dec 1, 2018 in Odessa, Ukraine. OPWH were defined as those ≥50 years old at the time of diagnosis, while ART initiation was defined as prescription and dispensing of medication. Outcomes were censored 6 months from diagnosis. Demographic, clinical characteristics, and ART outcomes were examined and multivariable logistic regression models were used to estimate correlates of ART initiation with adjusted odds ratios at 95% confidence intervals. Results Of the 400 included patients, 198 (49.5%) were < 50 years old and 202 (50.5%) were ≥ 50 years old at the time of diagnosis. Patients ≥50 years old were more likely to have a lower CD4 count (median 148 (IQR 60-316) vs 295 (IQR 111-478), p=0.001). Correlates of ART initiation included age less than 50 and history of opportunistic infection within 12 months of diagnosis. After controlling for opportunistic infection history, OPWH were 51% less likely to receive ART than those < 50 years old at the time of diagnosis (AOR 0.496, CI 0.301-0.816, p=0.006). Conclusion OPWH exhibit an ART gap associated with advanced disease at presentation compared to younger individuals newly diagnosed with HIV. This is the first clinical data examining OPWH in Ukraine. Interventions to improve linkage to care for OPWH are urgently needed in a population already at increased risk for HIV related mortality. The results of this study emphasize the need for further studies to examine patient and systemic causes of decreased ART initiation among Ukrainian OPWH. Disclosures All Authors: No reported disclosures

scholarly journals Antiretroviral therapy among patients with HIV in Almaty, Kazakhstan: the implication for HIV-associated tuberculosis control

2020 ◽  
Vol 14 (11.1) ◽  
pp. 128S-132S
Author(s):  
Alfiya Denebayeva ◽  
Arpine Abrahamyan ◽  
Aelita Sargsyan ◽  
Karine Kentenyants ◽  
Ainur Zhandybayeva ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Treatment Guideline ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Preventive Strategy ◽  
Hiv Diagnosis ◽  
Art Initiation ◽  
Living With Hiv ◽  
And Control ◽  
The Impact

Introduction: Antiretroviral therapy (ART) is an effective preventive strategy against tuberculosis (TB) in people living with HIV (PLWH). In Kazakhstan, according to the revised HIV treatment guideline (2017), ART should be initiated immediately after HIV diagnosis established, regardless of CD4+ count. Aim: To evaluate the impact of early initiation of ART on TB infection in PLWH registered in the Center of Prevention and Control of AIDS, Almaty, Kazakhstan, between 2008 and 2018. Methodology: A retrospective cohort study was conducted using the data of 4,053 patients from electronic HIV case management system (2008-2018) (EHCMS). Results: The study revealed low rates (12.6%) of rapid ART (≤ 1 month after HIV diagnosis). Patients in the rapid ART initiation group were less likely to develop TB compared with those who started treatment >1 month after the HIV detection (odds ratio 1.6; 95% confidence interval [1.1, 2.2]; p = 0.00799). Interestingly, the risk for developing TB among patients receiving ART ≥ 1 month after HIV diagnosis was significantly higher compared with those not taking any treatment. The latter was explained by several confounding not addressed during the analysis, since ART was prescribed to patients with primarily deeper immunodeficiency, while the patients not receiving ART were less immunocompromised. Conclusion: Despite the recently changed HIV treatment guideline in Kazakhstan, ART is still initiated based on the disease severity. In 2018, the initiation of ART during the first month after HIV diagnosis increased by 50%. However, it is necessary to reduce the time to initiation of ART for all patients.

scholarly journals 764. Correlates of Lost to Follow-up Among Newly Diagnosed Older People with HIV in Ukraine

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S427-S428
Author(s):  
Amy J Allen ◽  
Oleksandr Zeziulin ◽  
Oleksandr Postnov ◽  
Julia Rozanova ◽  
Taylor Litz ◽  
...  
Keyword(s):  
Older People ◽  
Retrospective Chart Review ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Newly Diagnosed ◽  
Loss To Follow Up ◽  
Increased Risk ◽  
Lost To Follow Up ◽  
The City

Abstract Background Ukraine has the second largest HIV epidemic in Eastern Europe and Central Asia. Older People with HIV (OPWH) are at increased risk of poor outcomes compared to younger patients. We examined the prevalence and correlates of loss to follow-up (LTFU) among newly diagnosed patients in Ukraine. Methods Retrospective chart review was conducted of 400 patients newly diagnosed with HIV July 1, 2017 - Dec 1, 2018. Data was collected from clinics in the city of Odessa and surrounding regions. OPWH were ≥50 years old at diagnosis and LTFU was defined as no contact with the HIV clinic for 90 days. Demographic, clinical characteristics, and follow-up outcomes were examined, and multivariate logistic regression was used to estimate the adjusted odds ratios at 95% confidence intervals. Results Of the 400 people living with HIV, median age was 50 (IQR35-55), 196 (49%) were women, and 177 (44%) had CD4< 200cell/mm3 at diagnosis. Overall, 65 (16.5%) were LTFU from diagnosis and 54/65 (83%) were lost after their first appointment at the HIV clinic. Among those lost to follow-up, 49 (75%) were ≥50 at the time of diagnosis. Multivariate analysis showed LTFU was associated with age >50years (aOR 3.6, CI 1.8-7.3, p=0.001), lack of ART prescription (aOR 16.4, CI 8.5-31.8, p= 0.001), and living outside the city of Odessa (aOR 2.9, CI 1.5-5.7, p=0.002). Figure 1 shows the breakdown of lost to follow-up for OPWH. Figure 1. Retainment in HIV Care for OPWH compared to those <50 years old. Conclusion LTFU among OPWH is significantly greater than younger people with HIV, and associated with lack of ART and living in nonurban settings. OPWH may benefit from differentiated HIV service delivery to reduce loss to follow up and interventions tailored to improving HIV outcomes for OPWH in resource-limited settings are urgently needed. Disclosures All Authors: No reported disclosures

scholarly journals A Cascade of Interventions to Promote Adherence to Antiretroviral Therapy in African Countries

2020 ◽  
Vol 17 (5) ◽  
pp. 529-546 ◽  
Author(s):  
Rebecca Jopling ◽  
Primrose Nyamayaro ◽  
Lena S Andersen ◽  
Ashraf Kagee ◽  
Jessica E Haberer ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Point Of Care ◽  
Cost Effective ◽  
Economic Incentives ◽  
Hiv Care ◽  
People Living With Hiv ◽  
African Countries ◽  
Treatment Cascade ◽  
Art Initiation ◽  
Increased Risk

Abstract Purpose of Review We reviewed interventions to improve uptake and adherence to antiretroviral therapy (ART) in African countries in the Treat All era. Recent Findings ART initiation can be improved by facilitated rapid receipt of first prescription, including community-based linkage and point-of-care strategies, integration of HIV care into antenatal care and peer support for adolescents. For people living with HIV (PLHIV) on ART, scheduled SMS reminders, ongoing intensive counselling for those with viral non-suppression and economic incentives for the most deprived show promise. Adherence clubs should be promoted, being no less effective than facility-based care for stable patients. Tracing those lost to follow-up should be targeted to those who can be seen face-to-face by a peer worker. Summary Investment is needed to promote linkage to initiating ART and for differentiated approaches to counselling for youth and for those with identified suboptimal adherence. More evidence from within Africa is needed on cost-effective strategies to identify and support PLHIV at an increased risk of non-adherence across the treatment cascade.

scholarly journals 335. Antiretroviral Therapy Anchor-based Trends in Body Mass Index following Treatment Initiation among Military Personnel with HIV

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S177-S178 ◽  
Author(s):  
David Kline ◽  
Colton Daniels ◽  
Xiaohe Xu ◽  
Thankam Sunil ◽  
Anuradha Ganesan ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Gain ◽  
Antiretroviral Therapy ◽  
African Americans ◽  
Body Mass ◽  
People Living With Hiv ◽  
Art Initiation ◽  
Increased Risk ◽  
Baseline Bmi

Abstract Background Weight gain and obesity in people living with HIV have been associated with increased risk for non-AIDS-related comorbidities, and integrase strand transfer inhibitor (INSTI)-based regimens may lead to comparatively more weight gain than other regimens. We evaluated body mass index (BMI) following antiretroviral therapy (ART) initiation among participants in the US Military HIV Natural History Study (NHS). Methods Of 961 NHS participants started on initial ART between 2006–2017, 496 men who had available baseline BMI data and were virally suppressed (< 200 c/mL) at 1 and 2 years of follow-up were included (Tables 1 and 2). ART was categorized by anchor class to include INSTIs, non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs). Linear growth-curve modeling was used to predict BMI changes from ART initiation through 2 years of follow-up in participants stratified by baseline BMI (< 25 vs. ≥25 kg/m2) at ART start and anchor drug class. Demographic and HIV-related characteristics were analyzed as independent variables. Results Overall, the predicted BMI increased over 2 years regardless of baseline BMI (Table 3). There was a trend toward decreased BMI on ART for those with BMI ≥ 25 treated with a non-INSTI regimen (−0.63, P = 0.079). In participants with BMI < 25, all regimens were associated with overall gains in BMI except for those with high viral load (>100,000 c/mL) started on PI regimens (−1.61, P = 0.013). For those with BMI ≥ 25, only INSTI- and PI-based regimens were significantly associated with increased BMI (INSTI 0.54, P = 0.000; NNRTI 0.11, P = 0.174; PI 0.39, P = 0.006). Observed BMI increases for INSTI and PI regimens were also associated with increased time from HIV diagnosis to ART initiation (INSTI 0.35, P = 0.003; PI 0.44, P = 0.037). African Americans with BMI ≥ 25 on INSTIs had the greatest predicted gains in BMI (1.84, P = 0.007). Conclusion In our cohort of young military members with HIV infection, those with baseline BMI < 25 experienced BMI gains across all ART classes. Among those with baseline BMI ≥ 25, African Americans on INSTI regimens had the greatest BMI gains. Further studies are needed to determine whether NNRTI regimens should be considered in certain individuals at risk for INSTI-associated weight gain. Disclosures All authors: No reported disclosures.

scholarly journals “Moving Forward with Life”: Acceptability of a Brief Alcohol Reduction Intervention for People Receiving Antiretroviral Therapy in South Africa

2020 ◽  
Vol 17 (16) ◽  
pp. 5706
Author(s):  
Bronwyn Myers ◽  
Charles D. H. Parry ◽  
Neo K. Morojele ◽  
Sebenzile Nkosi ◽  
Paul A. Shuper ◽  
...  
Keyword(s):  
South Africa ◽  
Antiretroviral Therapy ◽  
Problem Solving ◽  
Alcohol Consumption ◽  
Controlled Trial ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Problem Solving Therapy ◽  
The Impact ◽  
Alcohol Reduction

Background: In South Africa, interventions are needed to address the impact of hazardous drinking on antiretroviral therapy among people living with HIV (PLWH). Participant feedback about these interventions can identify ways to enhance their acceptability. We interviewed participants in a randomized controlled trial of a brief motivational interviewing and problem-solving therapy (MI-PST) intervention about their perceptions of this alcohol-reduction intervention. Methods: The trial was conducted in HIV treatment clinics operating from six hospitals in the Tshwane region of South Africa. We conducted qualitative in-depth interviews with a random selection of participants. Twenty-four participants were interviewed after the final intervention session and 25 at the six-month follow up. Results: Participants believed that it was acceptable to offer PLWH, an alcohol reduction intervention during HIV treatment. They described how the MI-PST intervention had helped them reduce their alcohol consumption. Intervention components providing information on the health benefits of reduced consumption and building problem-solving and coping skills were perceived as most beneficial. Despite these perceived benefits, participants suggested minor modifications to the dosage, content, and delivery of the intervention for greater acceptability and impact. Conclusions: Findings highlight the acceptability and usefulness of this MI-PST intervention for facilitating reductions in alcohol consumption among PLWH.

scholarly journals Impact of Combined Antiretroviral Therapy on Metabolic Syndrome Components in Adult People Living with HIV: A Literature Review

Viruses ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 122
Author(s):  
Mariusz Sapuła ◽  
Magdalena Suchacz ◽  
Andrzej Załęski ◽  
Alicja Wiercińska-Drapało
Keyword(s):  
Metabolic Syndrome ◽  
Antiretroviral Therapy ◽  
Plasma Lipid ◽  
Hiv Treatment ◽  
New Drugs ◽  
People Living With Hiv ◽  
The Metabolic Syndrome ◽  
Major Interest ◽  
Living With Hiv ◽  
The Impact

The development of metabolic derangements as a result of HIV treatment has been an important area of research since the introduction of zidovudine in the 1980’s. Antiretroviral therapy has intensely evolved in the last three decades, with new drugs gradually incorporated into everyday clinical practice. With the life expectancy of people living with HIV rapidly approaching that of their HIV-negative counterparts, the influence of these antiretrovirals on the development of the components of the metabolic syndrome remains of major interest to clinicians and their patients. In this review, we aimed to discuss the impact of cART on components of the metabolic syndrome, i.e., weight, plasma lipid levels, plasma glucose levels, and blood pressure, describing the influence of cART classes and of individual antiretrovirals. We also aimed to outline the limitations of the research conducted to date and the remaining knowledge gaps in this area.

scholarly journals Prevalence, beliefs and impact of drug-drug interactions between antiretroviral therapy and illicit drugs among people living with HIV in Spain

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260334
Author(s):  
Vanessa Castro-Granell ◽  
Noé Garin ◽  
Ángeles Jaén ◽  
Santiago Cenoz ◽  
María José Galindo ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Drug Use ◽  
Illicit Drugs ◽  
Significant Proportion ◽  
People Living With Hiv ◽  
Close Monitoring ◽  
Cross Sectional Survey ◽  
Increased Risk ◽  
Living With Hiv ◽  
The Impact

Drug use implies important challenges related to HIV management, particularly due to an increased risk of potential interactions between antiretroviral therapy (ART) and illicit drugs (pDDIs). This study analyses the prevalence and severity of pDDIs among people living with HIV (PLHIV). It also explores their awareness of pDDIs and their beliefs about the toxicity that they may cause, as well as the impact of pDDIs on selected health variables. We conducted an on-line cross-sectional survey across 33 Spanish hospitals and NGOs to collect demographics and clinical data. pDDIs were checked against the Interaction Checker developed by Liverpool University. The sample of the present study was composed of 694 PLHIV who used illicit drugs. They represented 49.5% of the 1,401 PLHIV that participated in the survey. After excluding 38 participants due to lack of information on their ART or illicit drug use, 335 (51.1%) participants consuming drugs presented with some potentially significant pDDIs between their ART and illicit drugs, with a mean of 2.1±1.7 (1–10) pDDIs per patient. The drugs most frequently involved in pDDIs were cocaine, cannabis, MDMA and nitrates ("poppers"). The prevalence of pDDIs across ART regimens was: protease inhibitors (41.7%); integrase inhibitor-boosted regimens (32.1%), and non-nucleoside reverse transcriptase inhibitors (26.3%). An awareness of pDDIs and beliefs about their potential toxicity correlated positively with intentional non-adherence (p<0.0001). Participants with pDDIs exhibited a higher prevalence of intentional non-adherence (2.19±1.04 vs. 1.93±0.94; p = 0.001). The presence of pDDIs was not associated with poorer results in the clinical variables analysed. A significant proportion of PLHIV who use drugs experience pDDIs, thereby requiring close monitoring. pDDIs should be considered in the clinical management of HIV patients. Adequate information about pDDIs and indicators about how to manage ART when PLHIV use drugs could improve ART non-adherence.

scholarly journals “Moving forward with life’: Perceived acceptability and benefits of a brief alcohol-focused intervention for people receiving antiretroviral therapy in South Africa.

2020 ◽  
Author(s):  
Bronwyn Myers ◽  
Charles Parry ◽  
Neo Morojele ◽  
Sebenzile Nkosi ◽  
Paul Shuper ◽  
...  
Keyword(s):  
South Africa ◽  
Antiretroviral Therapy ◽  
Controlled Trial ◽  
Hiv Treatment ◽  
Hazardous Drinking ◽  
People Living With Hiv ◽  
Problem Solving Therapy ◽  
Middle Income ◽  
Intervention Session ◽  
The Impact

Abstract Background: In South Africa, like other low-and middle-income countries, interventions are needed to address the impact of hazardous drinking on adherence to antiretroviral therapy among people living with HIV (PLWH). Participant feedback about these interventions can identify ways to enhance their acceptability and potential impact. As part of a randomized controlled trial of a brief motivational interviewing and problem-solving therapy (MI-PST) intervention among PLWH who report hazardous drinking, we interviewed participants about their perceptions of this alcohol-reduction intervention.Methods: The trial was conducted in HIV treatment clinics operating from 6 hospitals in the Tshwane region of South Africa. In the trial, 305 participants were randomly assigned to the intervention comprising four modules of MI-PST delivered over two sessions. We conducted qualitative in-depth interviews of participants’ views about the acceptability and usefulness of the intervention for facilitating behaviour change on completion of the last intervention session and at the six-month study end-point. Twenty-four participants were interviewed after the final intervention session and 25 at the six-month follow up. Data were analysed using the framework approach. Results: Three themes emerged from the interviews that reflect participants’ perceptions of the acceptability and usefulness of this intervention. The first theme describes participants’ perceptions of the acceptability of screening and brief alcohol-focused interventions for PLWH. The second theme describes participants’ views of the usefulness of the intervention for reducing alcohol use and addressing life stressors. The third theme reflects participants’ views on how the intervention could be modified for greater reach and impact.Conclusion: Findings suggest that participants considered this intervention to be acceptable and useful for facilitating reductions in alcohol consumption. This study is the first to describe how PLWH applied the skills taught in the MI-PST intervention to manage and cope with daily problems instead of drinking heavily.

scholarly journals Timely initiation of HIV antiretroviral therapy in Haiti 2004–2018: a retrospective cohort study

2021 ◽  
Vol 45 ◽  
pp. 1
Author(s):  
Nancy Puttkammer ◽  
Canada Parrish ◽  
Yrvel Desir ◽  
Nathaelf Hyppolite ◽  
Nadjy Joseph ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
People Living With Hiv ◽  
Newly Diagnosed ◽  
Timely Initiation ◽  
Art Initiation ◽  
Hiv Antiretroviral Therapy ◽  
Living With Hiv

Objective. To describe trends in timing of ART initiation for newly diagnosed people living with HIV before and after Haiti adopted its Test and Start policy for universal HIV antiretroviral therapy (ART) in July 2016, and to explore predictors of timely ART initiation for both newly and previously diagnosed people living with HIV following Test and Start adoption. Methods. This retrospective cohort study explored timing of ART initiation among 147 900 patients diagnosed with HIV at 94 ART clinics in 2004–2018 using secondary electronic medical record data. The study used survival analysis methods to assess time trends and risk factors for ART initiation. Results. Timely uptake of ART expanded with Test and Start, such that same-day ART initiation rates increased from 3.7% to 45.0%. However, only 11.0% of previously diagnosed patients initiated ART after Test and Start. In adjusted analyses among newly diagnosed people living with HIV, factors negatively associated with timely ART initiation included being a pediatric patient aged 0–14 years (HR = 0.23, p < 0.001), being male (HR = 0.92, p = 0.03), being 50+ years (HR = 0.87, p = 0.03), being underweight (HR = 0.79, p < 0.001), and having WHO stage 3 (HR = 0.73, p < 0.001) or stage 4 disease (HR = 0.49, p < 0.001). Variation in timely ART initiation by geographic department and health facility was observed. Conclusions. Haiti has made substantial progress in scaling up Test and Start, but further work is needed to enroll previously diagnosed patients and to ensure rapid ART in key patient subgroups. Further research is needed on facility and geographic factors and on strategies for improving timely ART initiation among vulnerable subgroups.

scholarly journals Incidence and predictors of attrition among patients receiving ART in eastern Zimbabwe before, and after the introduction of universal ‘treat-all’ policies: A competing risk analysis

2021 ◽  
Vol 1 (10) ◽  
pp. e0000006
Author(s):  
Malebogo Tlhajoane ◽  
Freedom Dzamatira ◽  
Noah Kadzura ◽  
Constance Nyamukapa ◽  
Jeffrey W. Eaton ◽  
...  
Keyword(s):  
Retention In Care ◽  
Incidence Rates ◽  
Hiv Treatment ◽  
Competing Risk ◽  
Hiv Diagnosis ◽  
Art Initiation ◽  
Increased Risk ◽  
Adherence Counselling ◽  
Treat All ◽  
The Impact

As HIV treatment is expanded, attention is focused on minimizing attrition from care. We evaluated the impact of treat-all policies on the incidence and determinants of attrition amongst clients receiving ART in eastern Zimbabwe. Data were retrospectively collected from the medical records of adult patients (aged≥18 years) enrolled into care from July 2015 to June 2016—pre-treat-all era, and July 2016 to June 2017—treat-all era, selected from 12 purposively sampled health facilities. Attrition was defined as an absence from care >90 days following ART initiation. Survival-time methods were used to derive incidence rates (IRs), and competing risk regression used in bivariate and multivariable modelling. In total, 829 patients had newly initiated ART and were included in the analysis (pre-treat-all 30.6%; treat-all 69.4%). Incidence of attrition (per 1000 person-days) increased between the two time periods (pre-treat-all IR = 1.18 (95%CI: 0.90–1.56) versus treat-all period IR = 1.62 (95%CI: 1.37–1.91)). In crude analysis, patients at increased risk of attrition were those enrolled into care during the treat-all period, <34 years of age, WHO stage I at enrolment, and had initiated ART on the same day as HIV diagnosis. After accounting for mediating clinical characteristics, the difference in attrition between the pre-treat-all, and treat-all periods ceased to be statistically significant. In a full multivariable model, attrition was significantly higher amongst same-day ART initiates (aSHR = 1.47, 95%CI:1.05–2.06). Implementation of treat-all policies was associated with an increased incidence of ART attrition, driven largely by ART initiation on the same day as HIV diagnosis which increased significantly in the treat all period. Differentiated adherence counselling for patients at increased risk of attrition, and improved access to clinical monitoring may improve retention in care.

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