Predictive factors of facilitating linkage to care for HIV-positive detainees in ICE Health Service Corps-staffed facilities

2020 ◽  
Author(s):  
Alexandra M Mishreki ◽  
Nicole J Boardman ◽  
Stephanie K Brodine ◽  
Mingan Yang ◽  
Edith R Lederman
Keyword(s):  
Univariate Analysis ◽  
Linkage To Care ◽  
Hiv Care ◽  
Hiv Positive ◽  
Training And Education ◽  
Intensive Training ◽  
Related Data ◽  
Health Related ◽  
Limited Health ◽  
The Impact

Abstract Background Persons in ICE detention represent a population about whom limited health-related data is available in the literature. Since ICE detention is generally brief, facilitating linkage to care (FLC) for detainees with chronic diseases, including HIV-positive detainees, is challenging, yet critical to encourage continued treatment beyond custody. Between 2015 and 2017, IHSC-staffed facilities implemented intensive training related to HIV care and FLC and increased clinical oversight and consultations. This study examined the impact of these changes in relation to FLC. Methods Demographic and clinical data for detainees with known HIV-positive diagnoses at IHSC-staffed facilities entering custody in 2015 and 2017 were obtained via electronic health record. Univariate analysis and multiple logistic regressions were performed to identify factors that may increase FLC. Results After adjusting for year of entry into custody, detainees who received an infectious disease (ID) consultation had significantly higher odds (2.4, P < 0.001) of receiving FLC resources compared to those who did not receive an ID consultation. Between 2015 and 2017, the proportion of HIV-positive detainees receiving FLC resources increased from 29 to 62%. Conclusions ID consultations significantly improved FLC for HIV-positive detainees. Continued provider training and education is essential to continue improving the rate of FLC for HIV-positive ICE detainees.

scholarly journals 962. Linkage to Care Outcomes among Known HIV-Positive Patients at a High Prevalence Urban Hospital Emergency Department

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S511-S511
Author(s):  
Alexander W Sudyn ◽  
Jeffrey M Paer ◽  
Swetha Kodali ◽  
Samuel Maldonado ◽  
Amesika Nyaku ◽  
...  
Keyword(s):  
Hiv Risk ◽  
Hiv Transmission ◽  
Univariate Analysis ◽  
Linkage To Care ◽  
Retrospective Chart Review ◽  
Retention In Care ◽  
Patient Navigator ◽  
Urban Hospital ◽  
Opt Out ◽  
The Impact

Abstract Background Retention in care of persons with HIV (PWH) is essential for achieving viral suppression and decreasing community transmission. CDC estimates that the 23% of known PWH not retained in care account for 43% of all new transmissions. This study seeks to describe the impact of an opt-out ED screening with navigator-assisted linkage to care (LTC) protocol for out of care PWH. Methods An IRB-approved retrospective chart review was conducted among PWH (prior positive) inadvertently retested in the ED between 2015 and 2018. Univariate and multivariate logistic regression was used to identify factors associated with LTC with patient navigator (PN) support. Factors with p ≤ 0.1 were included in the multivariate analysis as were age and sex at birth. Patients who died were excluded from statistical analyses. Results Among 464 patients who tested positive, 338 (73%) were known positive with 120 (35%) of those out of care at the time of screening. Mean age for this group was 47 (SD 11.9); 57% male, 81% non-Hispanic black, 10% Hispanic, and 6% non-Hispanic white. Fifty-five (46%) patients were successfully LTC, 54 (45%) referred to the state for linkage, and 11 (9%) died. A total of 109 patients were included in the analysis. Univariate analysis was performed for age (F(1, 107) = 0.98, p = 0.324) and female sex at birth (OR = 1.42 [95% CI 0.66, 3.05], p = 0.373) as well as Hispanic race (OR = 3.33 [95% CI 0.84, 13.04], p = 0.085), heterosexual HIV risk (OR = 2.76 [95% CI 1.27, 5.99], p = 0.011), IDU (OR = 0.49 [95% CI 0.21, 1.11], p = 0.088), and other SUD (OR = 0.42 [95% CI 0.19, 0.94], p = 0.035). Only heterosexual HIV risk (OR = 3.01 [95% CI 1.23, 7.32], p = 0.015) maintained significance in the final multivariate model. Conclusion Opt-out ED screening revealed >30% of known positive PWH were out of care at the time of testing; of whom nearly 50% were LTC with PN support. It is possible that persons reporting heterosexual HIV risk may feel less stigmatized and therefore are more likely to LTC. Similarly, the association with SUD, albeit non-significant, may reflect underrepresentation of individuals with SUD in remission among patient navigators. Future opt-out ED screening protocols should build upon diverse care teams to further engage patients with SUD and those at risk for non-heterosexual HIV transmission. Disclosures All Authors: No reported disclosures

scholarly journals 1310. The Impact of Recent Incarceration on Post-Release HIV Linkage to Care and Risk-Taking Behaviors in the Setting of Enhanced Linkage to Care Policies in Florida

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S472-S473
Author(s):  
Greg Matthew E Teo ◽  
Suraj Nagaraj ◽  
Nisha Sunku ◽  
Sadaf Aslam ◽  
Rahul Mhaskar ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Behaviors ◽  
Barriers To Care ◽  
Linkage To Care ◽  
The United States ◽  
Self Report ◽  
Hiv Care ◽  
High Risk Behaviors ◽  
Persons Living With Hiv ◽  
The Impact

Abstract Background The United States has the largest incarcerated population in the world with 6.61 million adults in 2016.1 While incarceration is a known risk factor for difficulties in linkage to care2–3 and adverse health outcomes4–6, little is published on post-release incarcerated persons living with HIV (PLWH) in Florida. Methods Data were acquired from the Florida Cohort, an ongoing, longitudinal, cross-sectional study of PLWH recruited across HIV clinics in the state of Florida, from 2014 to 2018. Chi-square and multiple regression analyses correlated recent incarceration (within last 12 months) with demographics, HIV care adherence, perceived barriers to care, and self-reported high-risk behaviors. Results Of 936 participants, 6.4% (n = 60) reported recent incarceration within the last 12 months. Those recently incarcerated were more likely to report missing at least one appointment in the last 6 months (46.7% vs. 22.2%; P < 0.0001), to have an excessively long travel time ( >60 minutes) to a HIV provider (34.5% vs. 16.6%, P = 0.002; OR 2.66 [95% CI: 1.20–5.92]), and to lack reliable transportation (70% vs. 47.5%, P = 0.0007; OR 1.70 [95% CI: 0.82–3.52]) Those not recently incarcerated reported having completed a high school education (OR: 0.69 [95% CI: 0.5–0.97]) and stated they “never missed an appointment” (OR: 0.42 [95% CI: 0.22–0.81]). Recently incarcerated PLWH also had higher occurrence of high-risk behaviors such as receiving (40.4% vs. 8.7%; P = 0.001) or providing (30.4% vs. 10.4%; P = 0.000) money or drugs for sex, having used IV drugs (15% vs. 4%; P = 0.001), and not using condoms during exchange of drugs for sex (OR: 9.43 [95% CI: 3.78–23.52]). Conclusion Recently incarcerated PLWH continue to have significant geographical and logistical barriers to care and self-report more high-risk behaviors than nonincarcerated peers. Enhanced case management and telehealth services may be useful in linkage to care when PLWH transition from correctional to community healthcare systems in the Florida setting. Disclosures All authors: No reported disclosures.

scholarly journals Finding, treating and retaining persons with HIV in a high HIV prevalence and high treatment coverage country: Results from the Botswana Combination Prevention Project

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250211
Author(s):  
Pamela Bachanas ◽  
Mary Grace Alwano ◽  
Refeletswe Lebelonyane ◽  
Lisa Block ◽  
Stephanie Behel ◽  
...  
Keyword(s):  
Service Delivery ◽  
Hiv Care ◽  
Hiv Positive ◽  
Treatment Coverage ◽  
Combination Prevention ◽  
Persons Living With Hiv ◽  
Universal Test And Treat ◽  
Prevention Project ◽  
The Impact

Introduction The scale-up of Universal Test and Treat has resulted in reductions in HIV morbidity, mortality and incidence. However, healthcare system and personal challenges have impacted the levels of treatment coverage achieved. We implemented interventions to improve linkage to care, retention, viral load (VL) coverage and service delivery, and describe the HIV care cascade over the course of the Botswana Combination Prevention Project (BCPP) study. Methods BCPP was designed to evaluate the impact of prevention interventions on HIV incidence in 30 communities in Botswana. We followed a longitudinal cohort of newly identified and known HIV-positive persons not on antiretroviral therapy (ART) identified through community-based testing activities through BCPP and referred with appointments to local HIV clinics in 15 intervention communities. Those who did not keep the first or follow-up appointments were tracked and traced through phone and home contacts. Improvements to service delivery models in the intervention clinics were also implemented. Results A total of 3,657 newly identified or HIV-positive persons not on ART were identified and referred to their local HIV clinic; 90% (3,282/3,657) linked to care and of those, 93% (3,066/3,282) initiated treatment. Near the end of the study, 221 persons remained >90 days late for appointments or missing. Tracing efforts identified 54/3,066 (2%) persons who initiated treatment but died, and 106/3,066 (3%) persons were located and returned to treatment. At study end, 61/3,066 (2%) persons remained missing and were never reached. Overall, 2,951 (98%) persons living with HIV (PLHIV) who initiated treatment were still alive, retained in care and still receiving ART out of the 3,001 persons alive at the end of the study. Of those on ART, 2,854 (97%) had current VL results and 2,784 (98%) of those were virally suppressed at study end. Conclusions This study achieved high rates of linkage, treatment initiation, retention and VL coverage and suppression in a cohort of newly identified and known PLHIV not on ART. Tracking and tracing interventions effectively identified those persons who needed more resource intensive follow-up. The interventions implemented to improve service delivery and data quality may have also contributed to high linkage and retention rates. Clinical trial number: NCT01965470.

scholarly journals Factors Associated with Uptake of Contraceptives among HIV Positive Women on Dolutegravir based Anti-Retroviral Treatment at Health Centres of Kampala Capital City Authority.  A cross sectional study in Uganda.

2021 ◽  
Author(s):  
Leah Mbabazi ◽  
Mariah Sarah Nabaggala ◽  
Suzanne Kiwanuka ◽  
Juliet Kiguli ◽  
Stephen Okoboi ◽  
...  
Keyword(s):  
Family Planning ◽  
World Health ◽  
Hiv Care ◽  
Hiv Positive ◽  
Modern Contraceptive ◽  
Cross Sectional ◽  
Factors Associated ◽  
Hiv Positive Women ◽  
The Impact ◽  
Contraceptive Uptake

Abstract Background In May 2018, the World Health Organisation issued a teratogenicity alert for HIV positive women using dolutegravir (DTG) and emphasised increased integration of sexual and reproductive services into HIV care to meet contraceptive needs of HIV positive women. However, there are scarce data on the impact of this guidance on contraceptive uptake. Objective To investigate the uptake of contraceptives and the factors affecting the uptake of contraceptive services among the HIV positive women of reproductive age who use DTG.Methods A cross-sectional survey was conducted from April 2019 to July 2019, in five government clinics in central Uganda where DTG was offered as the preferred first-line antiretroviral treatment (ART) regimen. We randomly selected 359 non-pregnant women aged 15-49 years using DTG-based regimens. We used interviewer administered questionnaires to collect data on demographics, contraceptive use, social and health system factors. We defined contraceptive uptake as the proportion of women using any method of contraception divided by the total number of women on DTG during the review period. We described patients’ characteristics using descriptive statistics. Factors associated with contraceptive uptake were investigated using Poisson regression at multivariable analysis (STATA 14).Results Of the 359 participants, the mean age was 37(SD=6.8), half 50.7% had attained primary level of education and average monthly income <100,000Ushs. The overall level of Contraceptive uptake was 38.4%, modern contraceptive uptake was 37.6% and 96.4% of the participants had knowledge of contraceptives. The most utilised method was the injectable at 58.4% followed by condoms 15%, IUD 10.7%, pills 6.4%, implants 5.4%, and least used was sterilization at 0.7%. Predictor factors that increased likelihood of contraceptive uptake were; religion of others category AIRR=1.53(95% CI: 1.01, 2.29) and parity 3-4 children AIRR=1.48(95% CI: 1.14, 1.92). Reduced rates were observed for age 40-49 years AIRR=0.45(95% CI: 0.21, 0.94), unemployment AIRR 0.63(95% CI: 0.42, 0.94), not discussing FP with partner AIRR=0.39(95% CI: 0.29, 0.52) and not receiving FP counselling AIRR=2.86 (95% CI: 0.12, 0.73). Non-significant variables were facility, education level, marital status, sexual activity, experienced side effects of FP and knowledge on both contraceptives and DTG.Conclusion This study shows a low-level uptake of contraceptives and injectable was the most used method. It also indicated that FP counselling and partner discussion on FP increased contraceptive uptake. Therefore, more strategies should be put in place to increase male involvement in family planning programs and scale up the integration of family planning services into HIV care and management programs.

scholarly journals Factors Associated with Uptake of Contraceptives Among HIV Positive Women on Dolutegravir Based Anti-Retroviral Treatment - A Crossectional Survey in Urban Uganda.

2021 ◽  
Author(s):  
Leah Mbabazi ◽  
Mariah Sarah Nabaggala ◽  
Suzanne Kiwanuka ◽  
Juliet Kiguli ◽  
Eva Laker ◽  
...  
Keyword(s):  
Family Planning ◽  
Intrauterine Device ◽  
Reproductive Age ◽  
Hiv Care ◽  
Hiv Positive ◽  
Factors Associated ◽  
Hiv Positive Women ◽  
Family Planning Counseling ◽  
The Impact ◽  
Contraceptive Uptake

Abstract Background In May 2018, following the preliminary results of a study in Botswana that reported congenital anomalies in babies born to HIV-positive women taking dolutegravir drug, the WHO issued a teratogenicity alert. However, there are scarce data on the impact of this guidance on contraceptive uptake among women taking dolutegravir. We assessed the uptake of contraceptives in HIV-positive women of reproductive age on dolutegravir regimens. Methods We conducted a cross-sectional survey from April 2019 to July 2019 in five government health facilities in central Uganda, where dolutegravir-based regimens were offered as the preferred first-line antiretroviral treatment. We randomly selected 359 non-pregnant women aged 15-49 years taking dolutegravir-based regimens and interviewed them using semi-structured interviewer-administered questionnaires. We collected data on demographics, contraceptive use, individual, social, and health system factors. We described patients’ characteristics using descriptive statistics and assessed factors associated with contraceptive uptake using a modified Poisson regression model. Results A total of 359 women were included in the study. The mean age was 37 years (standard deviation=6.8) and overall contraceptive uptake was 38.4%. The most utilized method was injectable method at 58.4% followed by condoms (15%), intrauterine device (10.7%), pills (6.4%), implants (5.4%), and sterilization (0.7%) Predictors for contraceptive uptake were parity of 3-4 children (Adjusted Prevalence Ratio (APR) =1.48, 95% confidence interval (CI): 1.14, 1.92). There was reduced uptake in the age range of 40-49 years (APR=0.45, CI: 0.21-0.94), unemployed (APR: 0.6, CI: 0.42- 0.94), women not discussing family planning with their partner (APR=0.39, CI: 0.29-0.52) and not receiving family planning counseling (APR= 0.56, CI: 0.34-0.92). Conclusion We observed a low-level uptake of contraceptives, with injectables as the most used method. Family planning counseling and partner discussion on family planning were associated with contraceptive uptake among the women who used dolutegravir based regimens. There is a need for more strategies to integrate FP services and increase male involvement in HIV care programs.

scholarly journals Same-Day CD4 Testing to Improve Uptake of HIV Care and Treatment in South Africa: Point-of-Care Is Not Enough

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Bruce A. Larson ◽  
Kathryn Schnippel ◽  
Alana Brennan ◽  
Lawrence Long ◽  
Thembi Xulu ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Testing ◽  
Point Of Care ◽  
Linkage To Care ◽  
Retention In Care ◽  
Baseline Period ◽  
Hiv Care ◽  
Hiv Positive ◽  
Care And Treatment ◽  
Cd4 Testing

Background. We evaluated whether a pilot program providing point-of-care (POC), but not rapid, CD4 testing (BD FACSCount) immediately after testing HIV-positive improved retention in care.Methods. We conducted a retrospective record review at the Themba Lethu Clinic in Johannesburg, South Africa. We compared all walk-in patients testing HIV-positive during February, July 2010 (pilot POC period) to patients testing positive during January 2008–February 2009 (baseline period). The outcome for those with a≤250cells/mm3when testing HIV-positive was initiating ART<16weeks after HIV testing.Results. 771 patients had CD4 results from the day of HIV testing (421 pilots, 350 baselines). ART initiation within 16 weeks was 49% in the pilot period and 46% in the baseline period. While all 421 patients during the pilot period should have been offered the POC test, patient records indicate that only 73% of them were actually offered it, and among these patients only 63% accepted the offer.Conclusions. Offering CD4 testing using a point-of-care, but not rapid, technology and without other health system changes had minor impacts on the uptake of HIV care and treatment. Point-of-care technologies alone may not be enough to improve linkage to care and treatment after HIV testing.

The role of health-related data in promoting the security of health care in armed conflict and other emergencies

2013 ◽  
Vol 95 (889) ◽  
pp. 61-71 ◽  
Author(s):  
Robin Coupland
Keyword(s):  
Health Care ◽  
Armed Conflict ◽  
Critical Role ◽  
International Committee ◽  
Health Care Facilities ◽  
Health Care Personnel ◽  
Related Data ◽  
Health Related ◽  
The Many ◽  
The Impact

AbstractHealth-related data provide the basis of policy in many domains. By using a methodology specifically designed to gather data about any form of violence and its impact, violence affecting health-care personnel, health-care facilities, and the wounded and sick in these facilities can be quantified on an objective basis. The impact of this form of violence and its accompanying insecurity goes beyond those directly affected to the many who are ultimately denied health care. Reliable data about both the violence affecting health-care personnel and facilities and the ‘knock-on’ effects of this violence on the health of many others have a critical role to play in influencing the policies of all stakeholders, including governments, in favour of greater security of effective and impartial health care in armed conflict and other emergencies. The International Committee of the Red Cross has undertaken a study that attempts to understand on a global basis the nature and impact of the many different kinds of violence affecting health care.

scholarly journals How Follow-Up Counselling Increases Linkage to Care Among HIV-Positive Persons Identified Through Home-Based HIV Counselling and Testing: A Qualitative Study in Uganda

SAGE Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 215824401990016
Author(s):  
Dominic Bukenya ◽  
Janet Seeley ◽  
Grace Tumwekwase ◽  
Elizabeth Kabunga ◽  
Eugene Ruzagira
Keyword(s):  
Qualitative Study ◽  
Partner Violence ◽  
Linkage To Care ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Positive ◽  
Accurate Information ◽  
Home Based ◽  
Linkage To Hiv Care

We investigated how follow-up counselling had increased linkage to HIV care in a trial of referral to care and follow-up counseling, compared to referral to care only, for participants diagnosed as HIV-positive through home-based HIV counseling and testing. We carried out a cross-sectional qualitative study. Using random stratified sampling, we selected 43 trial participants (26 [60%] in the intervention arm). Sample stratification was by sex, distance to an ART facility, linkage, and nonlinkage to HIV care. Twenty-six in-depth interviews were conducted with participants in the intervention arm: 17 people who had linked to HIV care and 9 who had not linked after 6 months of follow-up. Home-based follow-up counseling helped to overcome worries resulting from an HIV-positive test result. In addition, the counseling offered an opportunity to address questions on HIV treatment side effects, share experiences of intimate partner violence or threats, and general problems linking to care. The counselling encouraged early linkage to HIV care and use of biomedical medicines, discouraging alternative medicine usage. Home-based follow-up counseling also helped to promote HIV sero-status disclosure, facilitating linkage to, retention in and adherence to HIV care and treatment. This study successfully demonstrated that home-based follow-up counselling increased linkage to care through encouragement to seek care, provision of accurate information about HIV care services and supporting the person living with HIV to disclose and manage stigma.

scholarly journals Undetectable equals untransmittable (U = U): awareness and associations with health outcomes among people living with HIV in 25 countries

2020 ◽  
pp. sextrans-2020-054551 ◽  
Author(s):  
Chinyere Okoli ◽  
Nicolas Van de Velde ◽  
Bruce Richman ◽  
Brent Allan ◽  
Erika Castellanos ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Standard Of Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Missed Opportunities ◽  
Suboptimal Adherence ◽  
Health Related ◽  
Living With Hiv ◽  
The Impact

Objectives‘Undetectable equals Untransmittable’ (U=U) is an empowering message that may enable people living with HIV (PLHIV) to reach and maintain undetectability. We estimated the percentage of PLHIV who ever discussed U=U with their main HIV care provider, and measured associations with health-related outcomes. Secondarily, we evaluated whether the impact of the U=U message varied between those who heard it from their healthcare provider (HCP) vs from elsewhere.MethodsData were from the 25-country 2019 Positive Perspectives Survey of PLHIV on treatment (n=2389). PLHIV were classified as having discussed U=U with their HCP if they indicated that their HCP had ever told them about U=U. Those who had not discussed U=U with their HCP but were nonetheless aware that ‘My HIV medication prevents me from passing on HIV to others’ were classified as being made aware of U=U from non-HCP sources. Multivariable logistic regression was used to measure associations between exposure to U=U messages and health outcomes.ResultsOverall, 66.5% reported ever discussing U=U with their HCP, from 38.0% (South Korea) to 87.3% (Switzerland). Prevalence was lowest among heterosexual men (57.6%) and PLHIV in Asia (51.3%). Compared with those unaware of U=U, those reporting U=U discussions with their HCP had lower odds of suboptimal adherence (AOR=0.59, 95% CI 0.44 to 0.78) and higher odds of self-reported viral suppression (AOR=2.34, 95% CI 1.72 to 3.20), optimal sexual health (AOR=1.48, 95% CI 1.14 to 1.92) and reporting they ‘always shared’ their HIV status (AOR=2.99, 95% CI 1.42 to 6.28). While exposure to U=U information from non-HCP sources was beneficial too, the observed associations were attenuated relative to those seen with reported discussions with HCPs.ConclusionHCP discussion of U=U with PLHIV was associated with favourable health outcomes. However, missed opportunities exist since a third of PLHIV reported not having any U=U discussion with their HCP. U=U discussions with PLHIV should be considered as a standard of care in clinical guidelines.

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