scholarly journals HIV Care Prioritization using Phylogenetic Branch Length

2019 ◽  
Author(s):  
Niema Moshiri ◽  
Davey M. Smith ◽  
Siavash Mirarab
Keyword(s):  
Public Health ◽  
Public Health Intervention ◽  
Branch Length ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Terminal Branch ◽  
Simple Strategy ◽  
Subtype B ◽  
Public Health Officials ◽  
Living With Hiv

AbstractIn HIV epidemics, the structure of the transmission network can be dictated by just a few individuals. Public health intervention, such as ensuring people living with HIV adhere to antiretroviral therapy (ART) and are continually virally-suppressed, can help control the spread of the virus. However, such intervention requires utilizing the limited public health resource allocations. As a result, the ability to determine which individuals are most at-risk of transmitting HIV could allow public health officials to focus their limited resources on these individuals. Molecular epidemiology suggests an approach: prioritizing people living with HIV based on patterns of transmission inferred from their sampled viral sequences. In this paper, we introduce ProACT (Prioritization using AnCesTral edge lengths), a phylogenetic approach for prioritizing individuals living with HIV. ProACT uses a simple idea: ordering individuals by their terminal branch length in the phylogeny of their virus. In simulations and also on a dataset of HIV-1 subtype B pol sequences obtained in San Diego, we show that this simple strategy improves the effectiveness of prioritization compared to state-of-the-art methods that rely on monitoring the growth of transmission clusters defined based on genetic distance.

“HIV Stops with Me”

2017 ◽  
Author(s):  
Trevor Hoppe
Keyword(s):  
Public Health ◽  
Hiv Prevention ◽  
Condom Use ◽  
Communicable Disease ◽  
People Living With Hiv ◽  
Public Health Officials ◽  
Living With Hiv ◽  
Policy Shifts ◽  
New Strategies ◽  
Health Experts

When the CDC announced its new priorities for HIV prevention in 2003, many public health advocates were alarmed—where were the condoms? This announcement came on the heels of a growing sentiment among public health experts that declining rates of condom use required new strategies for keeping the epidemic in check. This chapter tells the story of how a series of CDC policy shifts over the next decade worked to “repolarize” the very notion of HIV prevention away from targeting HIV-negative people and toward targeting people living with HIV. By framing people living with HIV as individually responsibility for preventing new infections, public health officials contributed to the notion that people with a communicable disease are responsible for their illness and, as such, blameworthy for its continued spread.

scholarly journals SEPIA: Simulation-based Evaluation of Prioritization Algorithms

2021 ◽  
Author(s):  
Kimberly Almaraz ◽  
Tyler Jang ◽  
McKenna Lewis ◽  
Titan Ngo ◽  
Miranda Song ◽  
...  
Keyword(s):  
Public Health ◽  
Molecular Data ◽  
People Living With Hiv ◽  
Cluster Growth ◽  
Contact Networks ◽  
Simulation Based ◽  
Public Health Officials ◽  
Living With Hiv ◽  
Growth Approach ◽  
Better Than

Abstract Background: The ability to prioritize people living with HIV by risk of future transmissions could aid public health officials in optimizing epidemiological intervention. While methods exist to perform such prioritization based on molecular data, their effectiveness and accuracy are poorly understood, and it is unclear how one can directly compare the accuracy of different methods. We introduce SEPIA (Simulation-based Evaluation of PrIoritization Algorithms), a novel simulation-based framework for determining the effectiveness of prioritization algorithms. Under several metrics of effectiveness that we propose, we utilize various properties of the simulated contact networks and transmission histories to compare existing prioritization approaches: one phylogenetic (ProACT) and one distance-based (growth of HIV-TRACE transmission clusters). Results: Using all metrics of effectiveness that we propose, ProACT consistently slightly outperformed the transmission cluster growth approach. However, both methods consistently performed just marginally better than random, suggesting that there is significant room for improvement in prioritization tools. Conclusion: We hope that, by providing ways to quantify the effectiveness of prioritization methods in simulation, SEPIA will aid researchers in developing novel tools for prioritizing people living with HIV by risk offuture transmissions.

scholarly journals SEPIA: Simulation-based Evaluation of Prioritization Algorithms

2020 ◽  
Author(s):  
Kimberly Almaraz ◽  
Tyler Jang ◽  
McKenna Lewis ◽  
Titan Ngo ◽  
Miranda Song ◽  
...  
Keyword(s):  
Public Health ◽  
Molecular Data ◽  
People Living With Hiv ◽  
Cluster Growth ◽  
Contact Networks ◽  
Simulation Based ◽  
Public Health Officials ◽  
Living With Hiv ◽  
Growth Approach ◽  
Better Than

AbstractBackgroundThe ability to prioritize people living with HIV by risk of future transmissions could aid public health officials in optimizing epidemiological intervention. While methods exist to perform such prioritization based on molecular data, their effectiveness and accuracy are poorly understood, and it is unclear how one can directly compare the accuracy of different methods. We introduce SEPIA (Simulation-based Evaluation of PrIoritization Algorithms), a novel simulation-based framework for determining the effectiveness of prioritization algorithms. Under several metrics of effectiveness that we propose, we utilize various properties of the simulated contact networks and transmission histories to compare existing prioritization approaches: one phylogenetic (ProACT) and one distance-based (growth of HIV-TRACE transmission clusters).ResultsUsing all metrics of effectiveness that we propose, ProACT consistently slightly outperformed the transmission cluster growth approach. However, both methods consistently performed just marginally better than random, suggesting that there is significant room for improvement in prioritization tools.ConclusionWe hope that, by providing ways to quantify the effectiveness of prioritization methods in simulation, SEPIA will aid researchers in developing novel tools for prioritizing people living with HIV by risk of future transmissions.

scholarly journals HIV Viral Suppression among People Living with HIV on Antiretroviral Therapy in Haut-Katanga and Kinshasa Provinces of Democratic Republic of Congo

Healthcare ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 69
Author(s):  
Gulzar H. Shah ◽  
Lievain Maluantesa ◽  
Gina D. Etheredge ◽  
Kristie C. Waterfield ◽  
Osaremhen Ikhile ◽  
...  
Keyword(s):  
Public Health ◽  
Antiretroviral Therapy ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Clinical Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
National Guidelines ◽  
Republic Of Congo ◽  
Living With Hiv

Human immunodeficiency virus (HIV) infections and less-than-optimal care of people living with HIV (PLHIV) continue to challenge public health and clinical care organizations in the communities that are most impacted by HIV. In the era of evidence-based public health, it is imperative to monitor viral load (VL) in PLHIV according to global and national guidelines and assess the factors associated with variation in VL levels. Purpose: This study had two objectives—(a) to describe the levels of HIV VL in persons on antiretroviral therapy (ART), and (b) to analyze the significance of variation in VL by patients’ demographic and clinical characteristics, outcomes of HIV care, and geographic characteristics of HIV care facilities. Methods: The study population for this quantitative study was 49,460 PLHIV in the Democratic Republic of Congo (DRC) receiving ART from 241 CDC-funded HIV/AIDS clinics in the Haut-Katanga and Kinshasa provinces of the DRC. Analysis of variance (ANOVA) was performed, including Tamhane’s T2 test for pairwise comparisons using de-identified data on all patients enrolled in the system by the time the data were extracted for this study by the HIV programs in May 2019. Results: The VL was undetectable (<40 copies/mL) for 56.4% of the patients and 24.7% had VL between 40 copies/mL and less than 1000 copies per mL, indicating that overall, 81% had VL < 1000 and were virologically suppressed. The remaining 19% had a VL of 1000 copies/mL or higher. The mean VL was significantly (p < 0.001) higher for males than for females (32,446 copies/mL vs. 20,786, respectively), persons <15 years of age compared to persons of ages ≥ 15 years at the time of starting ART (45,753 vs. 21,457, respectively), patients who died (125,086 vs. 22,090), those who were lost to follow-up (LTFU) (69,882 vs. 20,018), those with tuberculosis (TB) co-infection (64,383 vs. 24,090), and those who received care from urban clinics (mean VL = 25,236) compared to rural (mean VL = 3291) or semi-rural (mean VL = 26,180) clinics compared to urban. WHO clinical stages and duration on ART were not statistically significant at p ≤ 0.05 in this cohort. Conclusions: The VL was >1000 copies/mL for 19% of PLHIV receiving ART, indicating that these CDC-funded clinics and programs in the Haut-Katanga and Kinshasa provinces of DRC have more work to do. Strategically designed innovations in services are desirable, with customized approaches targeting PLHIV who are younger, male, those LTFU, with HIV/TB co-infection, and those receiving care from urban clinics.

Enhanced Telehealth Case Management Plus Emergency Financial Assistance for Homeless-Experienced People Living With HIV During the COVID-19 Pandemic

2021 ◽  
pp. e1-e4
Author(s):  
Jennifer K. Brody ◽  
Serena Rajabiun ◽  
H. Joslyn Strupp Allen ◽  
Travis Baggett
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Care ◽  
Case Management ◽  
Financial Assistance ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Management Intervention ◽  
Case Management Intervention ◽  
Living With Hiv

Boston Health Care for the Homeless Program, in Boston, Massachusetts, implemented an intensive telehealth case management intervention combined with emergency financial assistance for 270 homeless-experienced people living with HIV (PLWH) to reduce COVID-19 transmission and promote HIV care retention during Boston’s first pandemic peak (March 16–May 31, 2020). Our telehealth model successfully maintained prepandemic case management and primary care contact levels, highlighting the importance of such programs in supporting the care engagement of homeless-experienced PLWH and addressing the dual COVID-19 and HIV epidemics. (Am J Public Health. Published online ahead of print March 18, 2021: e1–e4. https://doi.org/10.2105/AJPH.2020.306152 )

scholarly journals SEPIA: simulation-based evaluation of prioritization algorithms

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kimberly Almaraz ◽  
Tyler Jang ◽  
McKenna Lewis ◽  
Titan Ngo ◽  
Miranda Song ◽  
...  
Keyword(s):  
Public Health ◽  
Molecular Data ◽  
People Living With Hiv ◽  
Cluster Growth ◽  
Risk Prioritization ◽  
Simulation Based ◽  
Public Health Officials ◽  
Living With Hiv ◽  
Growth Approach ◽  
Better Than

Abstract Background The ability to prioritize people living with HIV (PLWH) by risk of future transmissions could aid public health officials in optimizing epidemiological intervention. While methods exist to perform such prioritization based on molecular data, their effectiveness and accuracy are poorly understood, and it is unclear how one can directly compare the accuracy of different methods. We introduce SEPIA (Simulation-based Evaluation of PrIoritization Algorithms), a novel simulation-based framework for determining the effectiveness of prioritization algorithms. SEPIA expands upon prior related work by defining novel metrics of effectiveness with which to compare prioritization techniques, as well as by creating a simulation-based tool with which to perform such effectiveness comparisons. Under several metrics of effectiveness that we propose, we compare two existing prioritization approaches: one phylogenetic (ProACT) and one distance-based (growth of HIV-TRACE transmission clusters). Results Using all proposed metrics, ProACT consistently slightly outperformed the transmission cluster growth approach. However, both methods consistently performed just marginally better than random, suggesting that there is significant room for improvement in prioritization tools. Conclusion We hope that, by providing ways to quantify the effectiveness of prioritization methods in simulation, SEPIA will aid researchers in developing novel risk prioritization tools for PLWH.

Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study (Preprint)

2019 ◽  
Author(s):  
Jenevieve Opoku ◽  
Rupali K Doshi ◽  
Amanda D Castel ◽  
Ian Sorensen ◽  
Michael Horberg ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hiv Care ◽  
Disease Stage ◽  
People Living With Hiv ◽  
Hiv Disease ◽  
Persons Living With Hiv ◽  
Living With Hiv

BACKGROUND HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. OBJECTIVE The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). METHODS Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. RESULTS There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, <i>P</i>&lt;.001) but more likely to be black (82.3% vs 69.5%, <i>P</i>&lt;.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, <i>P</i>&lt;.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, <i>P</i>&lt;.001), have a CD4 &lt;200 cells/µL in 2017 (6.2% vs 4.6%, <i>P</i>&lt;.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, <i>P</i>&lt;.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). CONCLUSIONS These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

Depressive Symptoms, Gender, Disclosure, and HIV Care Stage Among People Living with HIV in Cameroon

2021 ◽  
Author(s):  
Angela M. Parcesepe ◽  
Molly Remch ◽  
Anastase Dzudie ◽  
Rogers Ajeh ◽  
Denis Nash ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Living With Hiv

scholarly journals The Utilisation of Payment Models Across the HIV Continuum of Care: Systematic Review of Evidence

2021 ◽  
Author(s):  
Tiago Rua ◽  
Daniela Brandão ◽  
Vanessa Nicolau ◽  
Ana Escoval
Keyword(s):  
Positive Impact ◽  
Cost Effective ◽  
Relative Magnitude ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Continuum Of Care ◽  
Clinical Conditions ◽  
Study Designs ◽  
Living With Hiv ◽  
Payment Models

AbstractThe increasing chronicity and multimorbidities associated with people living with HIV have posed important challenges to health systems across the world. In this context, payment models hold the potential to improve care across a spectrum of clinical conditions. This study aims to systematically review the evidence of HIV performance-based payments models. Literature searches were conducted in March 2020 using multiple databases and manual searches of relevant papers. Papers were limited to any study design that considers the real-world utilisation of performance-based payment models applied to the HIV domain. A total of 23 full-text papers were included. Due to the heterogeneity of study designs, the multiple types of interventions and its implementation across distinct areas of HIV care, direct comparisons between studies were deemed unsuitable. Most evidence focused on healthcare users (83%), seeking to directly affect patients' behaviour based on principles of behavioural economics. Despite the variability between interventions, the implementation of performance-based payment models led to either a neutral or positive impact throughout the HIV care continuum. Moreover, this improvement was likely to be cost-effective or, at least, did not compromise the healthcare system’s financial sustainability. However, more research is needed to assess the durability of incentives and its appropriate relative magnitude.

scholarly journals Consequences of COVID-19 crisis for persons with HIV: the impact of social determinants of health

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kristie C. Waterfield ◽  
Gulzar H. Shah ◽  
Gina D. Etheredge ◽  
Osaremhen Ikhile
Keyword(s):  
Public Health ◽  
Health Care ◽  
Clinical Care ◽  
Hiv Infections ◽  
People Living With Hiv ◽  
Negative Consequences ◽  
Persons Who Inject Drugs ◽  
Persons Living With Hiv ◽  
Living With Hiv ◽  
The Impact

Abstract Background With the indiscriminate spread of COVID-19 globally, many populations are experiencing negative consequences such as job loss, food insecurity, and inability to manage existing medical conditions and maintain preventive measures such as social distancing and personal preventative equipment. Some of the most disadvantaged in the COVID-19 era are people living with HIV/AIDS and other autoimmune diseases. Discussion As the number of new HIV infections decrease globally, many subpopulations remain at high risk of infection due to lack of or limited access to prevention services, as well as clinical care and treatment. For persons living with HIV or at higher risk of contracting HIV, including persons who inject drugs or men that have sex with men, the risk of COVID-19 infection increases if they have certain comorbidities, are older than 60 years of age, and are homeless, orphaned, or vulnerable children. The risk of COVID-19 is also more significant for those that live in Low- and Middle-Income Countries, rural, and/or poverty-stricken areas. An additional concern for those living the HIV is the double stigma that may arise if they also test positive for COVID-19. As public health and health care workers try to tackle the needs of the populations that they serve, they are beginning to realize the need for a change in the infrastructure that will include more efficient partnerships between public health, health care, and HIV programs. Conclusion Persons living with HIV that also have other underlying comorbidities are a great disadvantage from the negative consequences of COVID-19. For those that may test positive for both HIV and COVID-19, the increased psychosocial burdens stemming from stress and isolation, as well as, experiencing additional barriers that inhibit access to care, may cause them to become more disenfranchised. Thus, it becomes very important during the current pandemic for these challenges and barriers to be addressed so that these persons living with HIV can maintain continuity of care, as well as, their social and mental support systems.

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