scholarly journals 369. Association Between Depression and HIV Treatment Outcomes in a US Military Population with HIV Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S193-S194
Author(s):  
Brandon Carney ◽  
Colton Daniels ◽  
Xiaohe Xu ◽  
Thankam Sunil ◽  
Anuradha Ganesan ◽  
...  
Keyword(s):  
Mental Health ◽  
Treatment Outcomes ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Art Initiation ◽  
Us Military ◽  
History Of ◽  
Hiv Treatment Outcomes ◽  
History Of Depression

Abstract Background Depression is common among HIV-infected individuals and may contribute to suboptimal adherence to antiretroviral therapy (ART) and reduced rates of viral load (VL) suppression. We evaluated longitudinal HIV treatment outcomes in US Military HIV Natural History Study (NHS) participants with or without a diagnosis depression. Methods Male NHS participants with available ICD-9 data for mental health diagnoses and self-reported adherence (SRA) were included (n = 549). Groups were defined as having a history of depression (n = 188, 34.2%), classified as major depressive disorder and/or anxiety disorder, or no history of depression (n = 361, 65.8%). Delay in ART initiation was defined as the time from HIV diagnosis to ART start greater than the group mean (4.91 ± 4.69 years). SRA was defined as taking ≥95% of ART doses and continuous ART was defined as longitudinal ART use with gaps < 30 days. Continuous VL suppression was defined as maintaining VLs < 200 c/mL on ART. Logistic regression analysis was performed comparing variables for those with and without a coded diagnosis of depression. Results Participants had a mean age of 33 (±8.36) years at HIV diagnosis, and similar proportions were Caucasian (44.3%) or African American (40.8%). At ART initiation, the mean CD4 count was 370 (±154 cells/μL) and 362 (±163 cells/μL) for those with and without a history of depression, respectively. Overall, older participants at HIV diagnosis had greater odds of having high SRA (OR 1.07, 95% CI 1.03–1.11), and compared with Caucasians, African Americans had lower odds of having high SRA (OR 0.43, 95% CI 0.25–0.75; table). Participants with a history of depression had greater odds of experiencing delayed ART initiation (OR 2.12, 95% CI 1.11–4.05). However, they also had greater odds of remaining on continuous ART (OR 1.38, 95% CI 0.95–2.02) during follow-up compared with those without a history of depression. Conclusion Although HIV-infected individuals with depression were more likely to experience delays in ART initiation, there were no observed differences in SRA or VL suppression. Continued efforts to identify and aggressively manage mental health disorders are important to success along the HIV care continuum. Disclosures All authors: No reported disclosures.

scholarly journals Association between Depression and HIV Treatment Outcomes in a US Military Population with HIV Infection

2020 ◽  
Author(s):  
Brandon Carney ◽  
Colton Daniel ◽  
Xiaohe Xu ◽  
Thankam Sunil ◽  
Anuradha Ganesan ◽  
...  
Keyword(s):  
Mental Health ◽  
Treatment Outcomes ◽  
Latent Class ◽  
Virologic Failure ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Lower Odds ◽  
Us Military ◽  
Hiv Treatment Outcomes

Abstract Background: Depression is common among HIV-infected individuals and may contribute to suboptimal adherence to antiretroviral therapy (ART) and subsequent inability to attain viral load (VL) suppression. We evaluated longitudinal HIV treatment outcomes in US Military HIV Natural History Study (NHS) participants with depression. Methods: Male NHS participants with available ICD-9 data for mental health diagnoses, Center for Epidemiological Studies Depression (CES-D) measures, and self-reported adherence (SRA) were included. ART use was defined as ART initiation between 2006-2010, with follow-up through 2015. SRA was defined as taking ³95% of ART doses and continuous ART was defined as longitudinal ART use with gaps <30 days. Continuous VL suppression was defined as maintaining VLs <200 c/mL on ART. To analyze the association between depression and HIV treatment outcomes, latent class analysis was used to create classes of depression trajectories: low depression (LD), recent onset depression (ROD) and high Depression (HD). Results: Participants had a mean age of 32 (±8.3) years at HIV diagnosis, and similar proportions were Caucasian (44.3%) or African American (40.8%). Overall, older participants at HIV diagnosis had greater odds of having 95% SRA (OR 1.06, 95% CI 1.02-1.12), and African Americans had lower odds (OR 0.41, 95% CI 0.22-0.76) compared to Caucasians (OR 1.49, 95% CI 0.52-4.28). However, there was no difference in SRA by depression trajectory. Participants with HD had a trend towards taking ART continuously (OR 1.75, 95% CI 0.99-3.09), and those with ROD had significantly higher odds of virologic failure (OR 0.58, 95% CI 0.38-0.91). Conclusions: Although there was no observed association between depression and SRA, participants with ROD had lower odds of attaining the HIV treatment goal of VL suppression. Continued efforts to identify and aggressively manage mental health disorders is important to success along the HIV care continuum.

scholarly journals Association between depression and HIV treatment outcomes in a US military population with HIV infection

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Brandon Carney ◽  
Colton Daniels ◽  
Xiaohe Xu ◽  
Thankam Sunil ◽  
Anuradha Ganesan ◽  
...  
Keyword(s):  
Mental Health ◽  
Treatment Outcomes ◽  
Latent Class ◽  
Virologic Failure ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Lower Odds ◽  
Us Military ◽  
Hiv Treatment Outcomes

Abstract Background Depression is common among HIV-infected individuals and may contribute to suboptimal adherence to antiretroviral therapy (ART) and subsequent inability to attain viral load (VL) suppression. We evaluated associations between depression, self-reported adherence, and longitudinal HIV treatment outcomes in US Military HIV Natural History Study (NHS) participants with and without depression. Methods Male NHS participants with available ICD-9 data for mental health diagnoses, Center for Epidemiological Studies Depression (CES-D) measures, and self-reported adherence (SRA) were included. ART use was defined as ART initiation between 2006 and 2010, with follow-up through 2015. SRA was defined as taking 95% of ART doses and continuous ART was defined as longitudinal ART use with gaps  < 30 days. Continuous VL suppression was defined as maintaining VLs  < 200 c/mL on ART. To analyse the association between depression and HIV treatment outcomes, latent class analysis was used to create classes of depression trajectories: low depression (LD), recent onset depression (ROD) and high Depression (HD). Results Participants had a mean age of 32 (± 8.3) years at HIV diagnosis, and similar proportions were Caucasian (44.3%) or African American (40.8%). Overall, older participants at HIV diagnosis had greater odds of having 95% self-reported adherence (OR 1.06, 95% CI 1.02–1.12), and African Americans had lower odds (OR 0.41, 95% CI 0.22–0.76) compared to Caucasians (OR 1.49, 95% CI 0.52–4.28). However, there was no difference in SRA by depression trajectory. Participants with HD had an increased odds of taking ART continuously (OR 1.75, 95% CI 0.99–3.09), and those with ROD had significantly higher odds of virologic failure (OR 0.58, 95% CI 0.38–0.91). Conclusions Although there was no observed association between depression and SRA, participants with ROD had lower odds of attaining the HIV treatment goal of VL suppression. Continued efforts to identify and aggressively manage mental health disorders is important to success along the HIV care continuum.

scholarly journals How early is too early? Challenges in ART initiation and engaging in HIV care under Treat All in Rwanda—A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251645
Author(s):  
Jonathan Ross ◽  
Charles Ingabire ◽  
Francine Umwiza ◽  
Josephine Gasana ◽  
Athanase Munyaneza ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Qualitative Interviews ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Hiv Diagnosis ◽  
Art Initiation ◽  
Treat All

Introduction HIV treatment guidelines recommend that all people living with HIV (PLWH) initiate antiretroviral therapy (ART) as soon as possible after diagnosis (Treat All). As Treat All is more widely implemented, an increasing proportion of PLWH are likely to initiate ART when they are asymptomatic, and they may view the relative benefits and risks of ART differently than those initiating at more advanced disease stages. To date, patient perspectives of initiating care under Treat All in sub-Saharan Africa have not been well described. Methods From September 2018 to March 2019, we conducted individual, semi-structured, qualitative interviews with 37 patients receiving HIV care in two health centers in Kigali, Rwanda. Data were analyzed using a mixed deductive and inductive thematic analysis approach to describe perceived barriers to, facilitators of and acceptability of initiating and adhering to ART rapidly under Treat All. Results Of 37 participants, 27 were women and the median age was 31 years. Participants described feeling traumatized and overwhelmed by their HIV diagnosis, resulting in difficulty accepting their HIV status. Most were prescribed ART soon after diagnosis, yet fear of lifelong medication and severe side effects in the immediate period after initiating ART led to challenges adhering to therapy. Moreover, because many PLWH initiated ART while healthy, taking medications and attending appointments were visible signals of HIV status and highly stigmatizing. Nonetheless, many participants expressed enthusiasm for Treat All as a program that improved health as well as health equity. Conclusion For newly-diagnosed PLWH in Rwanda, initiating ART rapidly under Treat All presents logistical and emotional challenges despite the perceived benefits. Our findings suggest that optimizing early engagement in HIV care under Treat All requires early and ongoing intervention to reduce trauma and stigma, and promote both individual and community benefits of ART.

HIV treatment outcomes among newcomers living with HIV in Manitoba, Canada

2021 ◽  
pp. e20200042
Author(s):  
Charity Maritim ◽  
Leigh McClarty ◽  
Stella Leung ◽  
Sharon Bruce ◽  
Gayle Restall ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Clinical Characteristics ◽  
Cohort Analysis ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Similar Proportion ◽  
People Living With Hiv ◽  
Persons Living With Hiv ◽  
Hiv Treatment Outcomes ◽  
Living With Hiv

Background: Despite the overrepresentation of immigrants and refugees (newcomers) in the HIV epidemic in Canada, research on their HIV treatment outcomes is limited. This study addressed this knowledge gap by describing treatment outcomes of newcomers in comparison with Canadian-born persons living with HIV in Manitoba. Methods: Clinical data from 1986 to 2017 were obtained from a cohort of people living with HIV and receiving care from the Manitoba HIV Program. Retrospective cohort analysis of secondary data was completed using univariate and multivariate statistics to compare differences in socio-demographic and clinical characteristics and treatment outcomes among newcomers, Canadian-born Indigenous persons, and Canadian-born non-Indigenous persons on entry into HIV care. Results: By end of 2017, 86 newcomers, 259 Canadian-born Indigenous persons, and 356 Canadian-born non-Indigenous persons were enrolled in the cohort. Newcomers were more likely than Canadian-born Indigenous and non-Indigenous cohort participants to be younger and female and have self-reported HIV risk exposure as heterosexual contact. Average CD4 counts at entry into care did not differ significantly between groups. A higher proportion of newcomers was also diagnosed with tuberculosis within 6 months of entry into care (21%), compared with 6% and 0.6% of Canadian-born Indigenous non-Indigenous persons, respectively. Newcomers and Canadian-born non-Indigenous persons had achieved viral load suppression (< 200 copies/mL) at a similar proportion (93%), compared with 82% of Canadian-born Indigenous participants ( p < 0.05). Conclusions: The distinct demographic and clinical characteristics of newcomers living with HIV requires a focused approach to facilitate earlier diagnosis, engagement, and support in care.

scholarly journals The Influence of Neighborhood Characteristics on HIV Treatment Outcomes Among Adults: A Scoping Review Protocol

2021 ◽  
Author(s):  
Linda Jepkoech Kimaru ◽  
Magdiel Habila ◽  
Namoonga Mantina ◽  
Purnima Madhivanan ◽  
Elizabeth Connick ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Scoping Review ◽  
Hiv Treatment ◽  
Community Level ◽  
Hiv Care ◽  
Neighborhood Characteristics ◽  
Hiv Interventions ◽  
Individual Behaviors ◽  
Hiv Treatment Outcomes ◽  
Living With Hiv

Abstract BackgroundThe HIV pandemic has caused enormous suffering and loss of life in the last forty years. Currently more than 34 million people have died as a result of HIV infection and over 37 million people are currently living with HIV. There have been tremendous global efforts to address the HIV pandemic and although significant progress has been made in treatment and prevention of HIV, many people living with HIV still do not have appropriate access to treatment and care. Current HIV interventions have focused more on individual factors than on community level factors. Community level factors influence individual behavior by enhancing or limiting access to- and utilization of HIV care. The objective of this scoping review is to assess and critically examine the association between neighborhood characteristics and outcomes of HIV treatment.Methods The following databases will be searched for studies published on and prior to May 31, 2021: PubMed, PsycINFO, CINAHL, and EMBASE. We will include published full text studies with both experimental and observational study designs that discussed neighborhood characteristics and HIV treatment outcomes. We will exclude abstracts only publications and studies reporting opinion. Data generated from the search will be managed using Mendeley 1.19.8. The review will be conducted using Arskey and Levac’s methodological framework for scoping reviews. A narrative synthesis will be conducted on the included studies. Discussion Sustainability of HIV interventions that focus on individual behaviors rely on the community level factors that influence those individual behaviors. This review will enhance the understanding of the impact of neighborhood characteristics on HIV treatment outcomes among adults, and possibly shed a light on potential points of intervention that will aid in improving ART initiation, ART adherence, and HIV viral load suppression.Scoping Review Registration: OSF 10.17605/OSF.IO/MD89T

scholarly journals Video-Based Intervention for Improving Maternal Retention and Adherence to HIV Treatment: Patient Perspectives and Experiences

2021 ◽  
Vol 18 (4) ◽  
pp. 1737
Author(s):  
Steven Masiano ◽  
Edwin Machine ◽  
Mtisunge Mphande ◽  
Christine Markham ◽  
Tapiwa Tembo ◽  
...  
Keyword(s):  
Positive Impact ◽  
Low Cost ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Structured Interviews ◽  
Convenience Sample ◽  
Long Term Conditions ◽  
Art Initiation ◽  
Retention In Hiv Care

VITAL Start is a video-based intervention aimed to improve maternal retention in HIV care and adherence to antiretroviral therapy (ART) in Malawi. We explored the experiences of pregnant women living with HIV (PWLHIV) not yet on ART who received VITAL Start before ART initiation to assess the intervention’s acceptability, feasibility, fidelity of delivery, and perceived impact. Between February and September 2019, we conducted semi-structured interviews with a convenience sample of 34 PWLHIV within one month of receiving VITAL Start. The participants reported that VITAL Start was acceptable and feasible and had good fidelity of delivery. They also reported that the video had a positive impact on their lives, encouraging them to disclose their HIV status to their sexual partners who, in turn, supported them to adhere to ART. The participants suggested using a similar intervention to provide health-related education/counseling to people with long term conditions. Our findings suggest that video-based interventions may be an acceptable, feasible approach to optimizing ART retention and adherence amongst PWLHIV, and they can be delivered with high fidelity. Further exploration of the utility of low cost, scalable, video-based interventions to address health counseling gaps in sub-Saharan Africa is warranted.

scholarly journals Gaps in the Continuum of HIV Care: Long Pretreatment Waiting Time between HIV Diagnosis and Antiretroviral Therapy Initiation Leads to Poor Treatment Adherence and Outcomes

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Shu Su ◽  
Shifu Li ◽  
Shunxiang Li ◽  
Liangmin Gao ◽  
Ying Cai ◽  
...  
Keyword(s):  
Treatment Adherence ◽  
Waiting Time ◽  
Cox Regression ◽  
Treatment Guidelines ◽  
Current Treatment ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Treatment Data ◽  
Poor Treatment

Background.Criteria for antiretroviral treatment (ART) were adjusted to enable early HIV treatment for people living HIV/AIDS (PLHIV) in China in recent years. This study aims to determine how pretreatment waiting time after HIV confirmation affects subsequent adherence and outcomes over the course of treatment.Methods.A retrospective observational cohort study was conducted using treatment data from PLHIV in Yuxi, China, between January 2004 and December 2015.Results.Of 1,663 participants, 348 were delayed testers and mostly initiated treatment within 28 days. In comparison, 1,315 were nondelayed testers and the median pretreatment waiting time was 599 days, but it significantly declined over the study period. Pretreatment CD4 T-cell count drop (every 100 cells/mm3) contributed slowly in CD4 recovery after treatment initiation (8% less,P<0.01) and increased the risk of poor treatment adherence by 15% (ARR = 1.15, 1.08–1.25). Every 100 days of extensive pretreatment waiting time increased rates of loss to follow-up by 20% (ARR = 1.20, 1.07–1.29) and mortality rate by 11% (ARR = 1.11, 1.06–1.21), based on multivariable Cox regression.Conclusion.Long pretreatment waiting time in PLHIV can lead to higher risk of poor treatment adherence and HIV-related mortality. Current treatment guidelines should be updated to provide ART promptly.

scholarly journals Understanding the interplay of individual and social–developmental factors in the progression of substance use and mental health from childhood to adulthood

2016 ◽  
Vol 28 (3) ◽  
pp. 721-741 ◽  
Author(s):  
Tiffany M. Jones ◽  
Karl G. Hill ◽  
Marina Epstein ◽  
Jungeun Olivia Lee ◽  
J. David Hawkins ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Social Environments ◽  
Developmental Factors ◽  
Substance Use Problems ◽  
History Of ◽  
Individual Functioning ◽  
Family History Of Depression ◽  
History Of Depression

AbstractThis study examines the interplay between individual and social–developmental factors in the development of positive functioning, substance use problems, and mental health problems. This interplay is nested within positive and negative developmental cascades that span childhood, adolescence, the transition to adulthood, and adulthood. Data are drawn from the Seattle Social Development Project, a gender-balanced, ethnically diverse community sample of 808 participants interviewed 12 times from ages 10 to 33. Path modeling showed short- and long-term cascading effects of positive social environments, family history of depression, and substance-using social environments throughout development. Positive family social environments set a template for future partner social environment interaction and had positive influences on proximal individual functioning, both in the next developmental period and long term. Family history of depression adversely affected mental health functioning throughout adulthood. Family substance use began a cascade of substance-specific social environments across development, which was the pathway through which increasing severity of substance use problems flowed. The model also indicated that adolescent, but not adult, individual functioning influenced selection into positive social environments, and significant cross-domain effects were found in which substance-using social environments affected subsequent mental health.

scholarly journals Longitudinal assessment of associations between food insecurity, antiretroviral adherence and HIV treatment outcomes in rural Uganda

AIDS ◽  
2014 ◽  
Vol 28 (1) ◽  
pp. 115-120 ◽  
Author(s):  
Sheri D. Weiser ◽  
Kartika Palar ◽  
Edward A. Frongillo ◽  
Alexander C. Tsai ◽  
Elias Kumbakumba ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Treatment Outcomes ◽  
Hiv Treatment ◽  
Longitudinal Assessment ◽  
Antiretroviral Adherence ◽  
Hiv Treatment Outcomes
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