scholarly journals 1303. Impact of Pharmacy Type on HIV Viral Suppression at a University-Based HIV Clinic in the Midwest

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S470-S470
Author(s):  
Josh Havens ◽  
Moses New-Aaron ◽  
Yangyang Gao ◽  
Qingfeng He ◽  
Fadul Nada ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Viral Suppression ◽  
Binary Logistic Regression ◽  
Mail Order ◽  
Hiv Viral Load ◽  
Regimen Adherence ◽  
Chi Squared ◽  
Hiv Viral Suppression ◽  
Mail Order Pharmacy ◽  
The Impact

Abstract Background People with HIV (PWH) utilize various pharmacy types beyond the traditional local pharmacy including mail order and specialty pharmacies. Some pharmacies often provide additional adherence services such as refill reminders, expedited delivery, and adherence packaging. Limited data are available describing the relationship between pharmacy type and HIV viral suppression (VS). We evaluated the impact of pharmacy type on VS. Methods We conducted a single-center, retrospective cohort study of PWH (≥19 years) receiving care at a Midwestern HIV clinic between January 1, 2018, and December 31, 2018, with at least 1 HIV RNA reading during the study period. We collected sociodemographic information, ART regimen, adherence (PDC—percentage of days covered), and clinical characteristics. Patients were stratified by pharmacy type: local (traditional pharmacy without adherence services), local specialty (traditional pharmacy with adherence services and same-day, couriered delivery), and mail order (mail order pharmacy with or without adherence services). Pearson Chi-squared tests and binary logistic regression were used to examine the effect of pharmacy type on VS (HIV viral load ≤50 copies/mL). Results A total of 1014 patients met study criteria; 164 (16%) utilized a local, 720 (71%) local specialty, and 130 (13%) mail order. VS rates were similar between pharmacy types: local (91%), semi-specialty local (88%), and mail order (96%). After adjusting for sociodemographic characteristics, ART regimen, ART adherence and other clinical characteristics, there was no association between pharmacy type and VS when comparing local and mail to local specialty pharmacy types (local—aOR: 0.98, 95% CI, 0.46–2.12; mail—aOR: 1.65, 95% CI, 0.46–6.0). Factors found to be negatively associated with VS were single marital status (aOR: 0.49; 95% CI, 0.24–0.95), current or historical opportunistic infection (aOR: 0.51; 95% CI, 0.26–0.99), and usage of a multiclass or dual ART regimen (aOR: 0.40; 95% CI, 0.16–0.98). Conclusion Despite additional services offered by some pharmacies, no differences were observed in HIV VS between pharmacy types. Disclosures All authors: No reported disclosures.

scholarly journals Characteristics of visits and predictors of admission from a paediatric emergency room in Saudi Arabia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammad H. Al-Qahtani ◽  
Abdullah A. Yousef ◽  
Bassam H. Awary ◽  
Waleed H. Albuali ◽  
Mohammed A. Al Ghamdi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Binary Logistic Regression ◽  
Total Sample ◽  
Age Group ◽  
Chi Squared ◽  
Improper Use ◽  
Level Shifts ◽  
The Impact

Abstract Background The Emergency Repartment (ER) is one of the most used areas in healthcare institutions. Problems with over utilisation and overcrowding have been reported worldwide. This study aims at examining the characteristics of paediatric ER visits, the rate of hospital admissions and its associated predictors at King Fahd Hospital of the University in the Eastern Province of Saudi Arabia. Methods This is a retrospective, medical record-based study. Variables included gender, age group, nationality, complaints, Triage level, shifts and seasons. Descriptive statistics were reported as frequencies/percentages. P-values were obtained through a Chi-Squared test while unadjusted and adjusted odds ratios were estimated by binary logistic regression, where admission was considered as the outcome. Results The total number of paediatric patients included was 46,374, and only 2.5% were admitted. Males comprised 55.4% while females comprised 44.6%. The most common age group were toddlers, and 92.4% of the total sample were Saudis. The most common complaint was fever (26.9%) followed by respiratory symptoms (24.9%). Only 7 patients (0.02%) were classified as triage I (Resuscitation), and most were triage IV (Less urgent) (71.0%). Most visits occurred during the winter months. Adjusted ORs showed that neonates had higher odds of admission (OR = 3.85, 95%CI = 2.57–5.76). Moreover, those presenting with haematological conditions showed an OR of 65.49 (95%CI = 47.85–89.64), followed by endocrine conditions showing an OR of 34.89 (95%CI = 23.65–51.47). Triage I had a very high odds of admission (OR = 19.02, 95%CI = 2.70–133.76), whereas triage V was associated with a very low odds of admission (OR = 0.30, 95%CI = 0.23–0.38). Conclusions A low rate of hospital admission was found in comparison with other rates worldwide. This was mostly attributed to an alarmingly high number of non-urgent ER visits. This further emphasises the problem with improper use of ER services, as these cases should be more appropriately directed towards primary healthcare centres. Further studies to examine the impact of prioritising patients in the ER based on the identified predictors of hospital admission, in addition to the standard triage system, are suggested.

Viral suppression and mortality among HIV infected adults initiated Anti-Retroviral Therapy at Temeke Regional hospital: Programmatic achievements and Opportunities for improvement

2020 ◽  
Vol 31 (1) ◽  
pp. 66-82
Author(s):  
Tumaini J. Nagu ◽  
Erhad D. Bilaro
Keyword(s):  
Viral Suppression ◽  
Real Life ◽  
Dar Es Salaam ◽  
Attrition Rate ◽  
Sub Saharan Africa ◽  
Careful Examination ◽  
Hiv Viral Load ◽  
Public Health Importance ◽  
Implementation Challenges ◽  
Hiv Viral Suppression

Background: Despite the fact that HIV disease has greater impact in the Sub-Saharan Africa (SSA) region, treatment outcomes are scarcely reported at implementation level. Programmatic data present real life implementation challenges of public health importance which should inform policies. This study was conducted to describe mortality, viral suppression and document challenges at secondary facility HIV clinic in Temeke, Dar es Salaam Tanzania.Methods: Hospital-based retrospective cohort study was conducted among HIV patients initiated on ART between May and November 2016 at Temeke Hospital, Dar es Salaam, Tanzania. Data was collected from HIV database between May and November 2017. Mortality was reported as proportion while viral suppression was defined as HIV-RNA below 50 copies per ml.Results: A total of 747 PLHIV were eligible and were included in the study. Out of these, forty (5.4) patients died. Good adherence to Antiretroviral therapy was seen in 70% of PLHV only. Of the 419 participants with HIV viral load measurements, viral suppression was achieved in 318 (75.9%) patients. Viral suppression is more likely for patients with CD4+ T lymphocyte count greater than 200 cells/μL. There was high attrition rate from the clinic, more than one-third 35.2% of those initiated ART were still attending the clinic at one year.Conclusion: HIV viral suppression and adherence to ART at Temeke HIV CTC are still sub-optimal. Good tracking, enhanced adherence as well as early diagnosis and treatment might improve viral suppression at one year. High attrition from the clinic may need careful examination. Keywords: Viral suppression, HIV, SSA, treatment failure, AIDS, Tanzania

scholarly journals Impact of Abstinence and of Reducing Illicit Drug Use Without Abstinence on Human Immunodeficiency Virus Viral Load

2019 ◽  
Vol 70 (5) ◽  
pp. 867-874 ◽  
Author(s):  
Robin M Nance ◽  
Maria Esther Perez Trejo ◽  
Bridget M Whitney ◽  
Joseph A C Delaney ◽  
Fredrick L Altice ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Substance Use ◽  
Viral Load ◽  
Drug Use ◽  
Viral Suppression ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Hiv Viral Load ◽  
Immunodeficiency Virus ◽  
The Impact

Abstract Background Substance use is common among people living with human immunodeficiency virus (PLWH) and a barrier to achieving viral suppression. Among PLWH who report illicit drug use, we evaluated associations between HIV viral load (VL) and reduced use of illicit opioids, methamphetamine/crystal, cocaine/crack, and marijuana, regardless of whether or not abstinence was achieved. Methods This was a longitudinal cohort study of PLWH from 7 HIV clinics or 4 clinical studies. We used joint longitudinal and survival models to examine the impact of decreasing drug use and of abstinence for each drug on viral suppression. We repeated analyses using linear mixed models to examine associations between change in frequency of drug use and VL. Results The number of PLWH who were using each drug at baseline ranged from n = 568 (illicit opioids) to n = 4272 (marijuana). Abstinence was associated with higher odds of viral suppression (odds ratio [OR], 1.4–2.2) and lower relative VL (ranging from 21% to 42% by drug) for all 4 drug categories. Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with VL suppression (OR, 2.2, 1.6, respectively). Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with lower relative VL (47%, 38%, respectively). Conclusions Abstinence was associated with viral suppression. In addition, reducing use of illicit opioids or methamphetamine/crystal, even without abstinence, was also associated with viral suppression. Our findings highlight the impact of reducing substance use, even when abstinence is not achieved, and the potential benefits of medications, behavioral interventions, and harm-reduction interventions.

scholarly journals Impact of Availability of Telehealth Programs on Documented HIV Viral Suppression: A Cluster-Randomized Program Evaluation in the Veterans Health Administration

2019 ◽  
Vol 6 (6) ◽  
Author(s):  
Michael E Ohl ◽  
Kelly Richardson ◽  
Maria C Rodriguez-Barradas ◽  
Roger Bedimo ◽  
Vincent Marconi ◽  
...  
Keyword(s):  
Primary Care ◽  
Viral Suppression ◽  
Veterans Health ◽  
Health Administration ◽  
Primary Care Clinics ◽  
Intention To Treat ◽  
Service Areas ◽  
Hiv Viral Suppression ◽  
Cluster Randomized ◽  
The Impact

Abstract Background Telehealth may improve care for people with HIV who live far from HIV specialty clinics. We conducted a cluster-randomized evaluation to determine the impact of availability of HIV telehealth programs on documented viral suppression in Veterans Administration clinics. Methods In 2015–2016, people who previously traveled to HIV specialty clinics were offered telehealth visits in nearby primary care clinics. Patients were cluster-randomized to immediate telehealth availability (n = 925 patients in service areas of 13 primary care clinics offering telehealth) or availability 1 year later (n = 745 patients in 12 clinics). Measures during the evaluation year included telehealth use among patients in areas where telehealth was available and documented HIV viral suppression (viral load performed and <200 copies/mL). Impact of telehealth availability was determined using intention-to-treat (ITT) analyses that compared outcomes for patients in areas where telehealth was available with outcomes for patients where telehealth was not available, regardless of telehealth use. Complier average causal effects (CACEs) compared outcomes for telehealth users with outcomes for control patients with equal propensity to use telehealth, when available. Results Overall, 120 (13.0%) patients utilized telehealth when it was available. Availability of telehealth programs led to small improvements in viral suppression in ITT analyses (78.3% vs 74.1%; relative risk [RR], 1.06; 95% confidence interval [CI], 1.01 to 1.11) and large improvements among telehealth users in CACE analyses (91.5% vs 80.0%; RR, 1.14; 95% CI, 1.01 to 1.30). Conclusions Availability of telehealth programs improved documented viral suppression. HIV clinics should offer telehealth visits for patients facing travel burdens.

scholarly journals Impact of Pharmacy Type on HIV Viral Suppression: A Retrospective Cross-Sectional Cohort Study

2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Joshua P Havens ◽  
Harlan Sayles ◽  
Nada Fadul ◽  
Sara H Bares
Keyword(s):  
Cohort Study ◽  
Protease Inhibitor ◽  
Retrospective Cohort ◽  
Viral Suppression ◽  
Poverty Level ◽  
Cross Sectional ◽  
Illicit Substance ◽  
Hiv Viral Suppression ◽  
Delivery Services ◽  
The Impact

Abstract Background People with HIV (PWH) use various pharmacy types beyond traditional local pharmacies. Some specialized pharmacies offer additive adherence services such as refill reminders, expedited delivery, and adherence packaging. Methods This single-center, retrospective cohort study evaluated the impact of pharmacy type on the gain or loss of HIV viral suppression (VS; HIV RNA ≤50 copies/mL). Patients (≥19 years) were categorized by VS and pharmacy type: HIV-specialized (additive adherence/delivery services) vs traditional (without adherence/delivery services). Fisher exact tests examined the effect of pharmacy type on differences in VS between years, and logistic regression models identified possible predictors of gaining or losing VS. Results During 2017–2018, no differences were observed for the gain or loss of VS across pharmacy types (VS gain vs continued viremia, P = .393; VS loss vs continued VS, P = .064). Predictors for the gain of VS included antiretroviral therapy adherence as percentage of days covered (PDC; adjusted odds ratio [aOR], 1.05; P < .001) and Federal Poverty Level 100%–138% (FPL; aOR, 0.17; P = .032). Predictors for the loss of VS included use of protease inhibitor (aOR, 2.85; P = .013), ≥1 other illicit substance including tobacco (aOR, 2.96; P = .024), PDC (aOR, 0.95; P < .001), FPL 139%–200% (aOR, 0.09; P = .031), and CD4 >200 cells/ccm (aOR, 0.19; P = .013). Conclusions The gain or loss of VS among PWH in this retrospective cohort was not impacted by pharmacy transitions within the 2-year study period. However, PDC, FPL, illicit substance use, protease inhibitor use, and CD4 >200 cells/ccm were identified as factors associated with changes in VS.

scholarly journals Impact of mail order pharmacy use and travel time to pharmacy on viral suppression among people living with HIV

AIDS Care ◽  
2020 ◽  
Vol 32 (11) ◽  
pp. 1372-1378
Author(s):  
Jessica P. Ridgway ◽  
Eleanor E. Friedman ◽  
Justine Choe ◽  
Cynthia T. Nguyen ◽  
Todd Schuble ◽  
...  
Keyword(s):  
Travel Time ◽  
Viral Suppression ◽  
People Living With Hiv ◽  
Mail Order ◽  
Mail Order Pharmacy ◽  
Living With Hiv

The risk of depression among racially diverse people living with HIV: the impact of HIV viral suppression

AIDS Care ◽  
2020 ◽  
pp. 1-9
Author(s):  
Mamta K. Jain ◽  
Xilong Li ◽  
Beverley Adams-Huet ◽  
Yordanos M. Tiruneh ◽  
Amneris E. Luque ◽  
...  
Keyword(s):  
Viral Suppression ◽  
People Living With Hiv ◽  
Racially Diverse ◽  
Hiv Viral Suppression ◽  
Living With Hiv ◽  
The Impact

scholarly journals The Impact of COVID-19 on Staff Working Practices in UK Horseracing

Animals ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 2003
Author(s):  
Emma Davies ◽  
Will McConn-Palfreyman ◽  
Jane M. Williams ◽  
Geoff P. Lovell
Keyword(s):  
Working Conditions ◽  
Online Survey ◽  
Health And Safety ◽  
Binary Logistic Regression ◽  
Job Security ◽  
Employee Support ◽  
Chi Squared ◽  
Working Practices ◽  
The Impact ◽  
Tests For Independence

Due to COVID-19, horseracing was required to cease all activity in March 2020; however, little is known about the pandemic’s impact on staff working practices. This study investigated the impact of COVID-19 on staff working practices during the initial lockdown phases. An online survey about working conditions during lockdown was answered by 287 participants. Chi-squared tests for independence and binary logistic regression (BLR) analysis was undertaken. A total of 53.7% (n = 154) of staff were working during lockdown. Pandemic-specific workplace changes were reported as effective by 87.8% (n = 115) of staff. Flat grooms reported workplace changes as less effective (χ2 (52, n = 131) = 92.996, p < 0.001). A total of 67.2% (n = 193) of staff were positive about job security. Trainers and grooms were significantly less likely to report jobs as secure (χ2 (52, n = 287) = 75.653, p < 0.05). The findings suggest that most of the racing industry positively received changes made by their employers to tackle the pandemic, and for staff still working during lockdown, their health and safety was prioritised. Continued development of employee support structures to promote job security and workforce stability is advised, which will minimise the disruption of staff changes on the care and welfare of the horses.

scholarly journals 1904. Impact of Mail Order Pharmacy Use on Viral Suppression Among HIV-Infected Patients

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S547-S547 ◽  
Author(s):  
Justine Choe ◽  
Cynthia Nguyen ◽  
Natasha N Pettit ◽  
Jessica P Ridgway
Keyword(s):  
Viral Suppression ◽  
Mail Order ◽  
Mail Order Pharmacy
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