scholarly journals HIV TREATMENT OUTCOMES IN RURAL GEORGIA USING TELEMEDICINE

2020 ◽  
Author(s):  
Folake J. Lawal ◽  
Moshood O. Omotayo ◽  
Tae Jin Lee ◽  
Arni S.R. Srinivasan Rao ◽  
Jose A. Vazquez
Keyword(s):  
Healthcare Access ◽  
Retrospective Chart Review ◽  
Healthcare Services ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Remote Communities ◽  
Hiv Viral Load ◽  
Face To Face ◽  
Significant Difference ◽  
Hiv Treatment Outcomes

AbstractBackgroundThe dearth of specialized healthcare services contributes to the ongoing HIV epidemic. Telemedicine (TM) is a potential tool to improve HIV care, but little is known about its effectiveness when compared to traditional (face-to-face) (F2F) care in rural populations. The objective of this study is to examine the effectiveness of HIV care delivered through TM compared to F2F care.MethodsWe conducted a retrospective chart review of a subset of HIV patients who attended TM clinic in Dublin Georgia, and conventional F2F clinic in Augusta, Georgia between May 2017 to April 2018. All TM patients were matched to F2F patients based on gender, age, and race. HIV Viral Load (VL) and gain in CD4 counts were compared using T-test and Snedecor Statistics.Results385 patients were included in the analyses (F2F=200, TM=185). Mean CD4 in the TM group was higher (643.9 cells/mm3) than the F2F group (596.3 cells/mm3) (p< 0.001). There was no statistically significant difference in VL reduction and control. Thirty-eight of eighty-five patients with detectable VL achieved viral suppression during the study period (F2F = 24/54, TM =14/31), with a mean change of −3.34 × 104 and −1.24 × 104 respectively, p = 1.00. Mean VL was F2F = 416.8 cp/ml, TM = 713.4 cp/ml, p = 0.3.ConclusionTM was associated with outcome measures comparable to F2F. Increased access to specialty HIV care through TM can facilitate HIV control in communities with limited healthcare access in rural US. Rigorous prospective evaluation of TM for HIV care effectiveness is warranted.Article SummaryTelemedicine can be useful in improving access to specialist outpatient care for HIV and other chronic diseases, in remote communities with limited resources. Telemedicine can lead to similar outcomes when compared to traditional face-to-face outpatient consultations. This is especially true currently with COVID-19.

scholarly journals HIV Treatment Outcomes in Rural Georgia Using Telemedicine

2021 ◽  
Author(s):  
Folake J Lawal ◽  
Moshood O Omotayo ◽  
Tae Jin Lee ◽  
Arni S R Srinivasan Rao ◽  
Jose A Vazquez
Keyword(s):  
Healthcare Access ◽  
Retrospective Chart Review ◽  
Healthcare Services ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Viral Load ◽  
Face To Face ◽  
U Statistics ◽  
Significant Difference ◽  
Hiv Treatment Outcomes

Abstract Background The increasing shortage of specialized healthcare services contributes to the ongoing HIV epidemic. Telemedicine (TM) is a potential tool to improve HIV care, but little is known about its effectiveness when compared to traditional (face-to-face) (F2F) care in rural populations. The objective of this study is to compare the effectiveness of HIV care delivered through TM with F2F model. Methods We conducted a retrospective chart review of a subset of patients with HIV who attended TM clinic in Dublin, Georgia and F2F clinic in Augusta, Georgia between May 2017 to April 2018. All TM patients were matched to F2F patients based on gender, age, and race. HIV Viral Load (VL) and CD4 count gain were compared using T-test and Mann-Whitney U Statistics. Results 385 patients were included in the analyses (F2F=200, TM=185). Mean CD4 in the TM group was higher (643.9 cells/mm3) than F2F group (596.3 cells/mm3) (p&lt; 0.001). There was no statistically significant difference in VL reduction, control or mean VL (F2F = 416.8 cp/ml, TM = 713.4 cp/ml), (p = 0.30). Thirty-eight of eighty-five patients with detectable VL achieved viral suppression during the study period (F2F = 24/54, TM = 14/31), with a mean change of -3.34 x 10 4 and -1.24 x 10 4 respectively, p = 1.00. Conclusion TM was associated with outcome measures comparable to F2F. Increased access to specialty HIV care through TM can facilitate HIV control in communities with limited healthcare access in rural US. Rigorous prospective evaluation of TM for HIV care effectiveness is warranted.

scholarly journals 1010. Effective Management of HIV in Rural Georgia Using Telemedicine

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S533-S533
Author(s):  
Folake J Lawal ◽  
Arni S R Srinivasa Rao ◽  
Jose A Vazquez
Keyword(s):  
Rural Areas ◽  
Viral Suppression ◽  
Retrospective Chart Review ◽  
Cd4 Count ◽  
Hiv Care ◽  
Resistance Mutations ◽  
Remote Communities ◽  
Hiv Viral Load ◽  
Viral Control ◽  
Significant Difference

Abstract Background The increasing incidence of HIV and lack of care in rural areas contributes to the ongoing epidemic. The dearth of specialized health services within remote communities and access of this population to available services poses a challenge to HIV care. Telemedicine (TM) is a potential tool to improve HIV care in these remote communities, but little is known about its effectiveness when compared to traditional (face-to-face) (F2F) care. The objective of this study is to examine the effectiveness of HIV care delivered through TM, and compare to F2F care. Methods This is a retrospective chart review of all HIV positive patients who attended either the F2F clinic (Augusta, GA) or the TM clinic (Dublin, GA) between May 2017 to April 2018. Data extracted included demographics, CD4 count, HIV PCR, co-morbidities, dates of clinic attendance, HIV resistance mutations and ART changes. Viral suppression and gain in CD4 counts were compared. T-test was conducted to test differences in characteristics and outcomes between the two groups. Results 385 cases were included in the study (52.5% black, 82% females, F2F=200, TM=185). Mean CD4 count in the TM group was statistically higher (643.9 cells/mm3) than the F2F group (596.3 cells/mm3) (p&lt; 0.001). There was no statistically significant difference in mean HIV viral load (F2F= 416.8 cp/ml, TM=713.4 cp/ml, p=0.3) and rates of year-round viral control (F2F= 73% vs TM = 77% p= 0.54). 38 patients achieved viral suppression during the study period (F2F= 24, TM =14) with a mean change of -3.34 x 104 vs -1.24 x 104, respectively. The difference in mean change was not statistically significant by Snedacor’s W Statistics. This indicates there was no significant difference between the two populations in terms of mean viral suppression among patients who were otherwise not suppressed before the study period. Conclusion To achieve an HIV cure, HIV care is required to extend to rural areas of the country and the world. Through delivery of care using TM, trained specialists can target communities with little or no health care. Moreover, use of TM achieves target outcome measures comparable to F2F clinics. Increase in the use of TM will improve the access to specialty HIV care and help achieve control of HIV in rural communities. Disclosures All Authors: No reported disclosures

scholarly journals Policy implementation analysis on access to healthcare among undocumented immigrants in seven autonomous communities of Spain, 2012–2018

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e045626
Author(s):  
Megi Gogishvili ◽  
Sergio A Costa ◽  
Karen Flórez ◽  
Terry T Huang
Keyword(s):  
Policy Implementation ◽  
Undocumented Immigrants ◽  
Healthcare Services ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Undocumented Migrants ◽  
Royal Decree ◽  
La Mancha ◽  
Free Healthcare ◽  
Implementation Analysis

BackgroundIn 2012, the Government of Spain enacted Royal Decree-Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012 excluding undocumented immigrants from publicly funded healthcare services. We conducted a policy implementation analysis to describe and evaluate the legal and regulatory actions taken at the autonomous community (AC) level after enactment of 2012 RDL and RD and their impact on access to general healthcare and HIV services among undocumented immigrants.MethodsWe reviewed documents published by the governments of seven ACs (Andalucía, Aragón, Euskadi (Basque Country), Castilla-La Mancha, Galicia, Madrid, Valencia) from April 2012 to July 2018, describing circumstances under which undocumented immigrants would be able to access free healthcare services. We developed indicators according to the main systemic barriers presented in official documents to analyse access to free healthcare across the participating ACs. ACs were grouped under five access categories: high, medium-high, medium, medium-low and low.ResultsAndalucía provided the highest access to free healthcare for undocumented immigrants in both general care and HIV treatment. Medium-high access was provided by Euskadi and medium access by Aragón, Madrid and Valencia. Castilla-La Mancha provided medium-low access. Galicia had low access. Only Madrid and Galicia provided different and higher level of access to undocumented migrants in HIV care compared with general healthcare.ConclusionsImplementation of 2012 RDL and RD across the ACs varied significantly, in part due to the decentralisation of the Spanish healthcare system. The challenge of healthcare access among undocumented immigrants included persistent systemic restrictions, frequent and unclear rule changes, and the need to navigate differences across ACs of Spain.

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 Resilience-Focused HIV Care to Promote Psychological Well-Being During COVID-19 and Other Catastrophes

2021 ◽  
Vol 9 ◽  
Author(s):  
L. Lauren Brown ◽  
Erika G. Martin ◽  
Hannah K. Knudsen ◽  
Heather J. Gotham ◽  
Bryan R. Garner
Keyword(s):  
Systems Of Care ◽  
Well Being ◽  
Hiv Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Psychological Wellness ◽  
Multi Level ◽  
Definition Of ◽  
Hiv Continuum Of Care ◽  
Hiv Treatment Outcomes

The COVID-19 pandemic has adversely affected people with HIV due to disruptions in prevention and care services, economic impacts, and social isolation. These stressors have contributed to worse physical health, HIV treatment outcomes, and psychological wellness. Psychological sequelae associated with COVID-19 threaten the overall well-being of people with HIV and efforts to end the HIV epidemic. Resilience is a known mediator of health disparities and can improve psychological wellness and behavioral health outcomes along the HIV Continuum of Care. Though resilience is often organically developed in individuals as a result of overcoming adversity, it may be fostered through multi-level internal and external resourcing (at psychological, interpersonal, spiritual, and community/neighborhood levels). In this Perspective, resilience-focused HIV care is defined as a model of care in which providers promote optimum health for people with HIV by facilitating multi-level resourcing to buffer the effects of adversity and foster well-being. Adoption of resilience-focused HIV care may help providers better promote well-being among people living with HIV during this time of increased psychological stress and help prepare systems of care for future catastrophes. Informed by the literature, we constructed a set of core principles and considerations for successful adoption and sustainability of resilience-focused HIV care. Our definition of resilience-focused HIV care marks a novel contribution to the knowledge base and responds to the call for a multidimensional definition of resilience as part of HIV research.

scholarly journals The HIV Outpatient Study—25 Years of HIV Patient Care and Epidemiologic Research

2020 ◽  
Vol 7 (5) ◽  
Author(s):  
Kate Buchacz ◽  
Carl Armon ◽  
Frank J Palella ◽  
Richard M Novak ◽  
Jack Fuhrer ◽  
...  
Keyword(s):  
Opportunistic Infections ◽  
Clinical Epidemiology ◽  
Temporal Trends ◽  
The United States ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Noncommunicable Diseases ◽  
Primary Data ◽  
Hiv Viral Load ◽  
Outpatient Study

Abstract Background The clinical epidemiology of treated HIV infection in the United States has dramatically changed in the past 25 years. Few sources of longitudinal data exist for people with HIV (PWH) spanning that period. Cohort data enable investigating new exposure and disease associations and monitoring progress along the HIV care continuum. Methods We synthesized key published findings and conducted primary data analyses in the HIV Outpatient Study (HOPS), an open cohort of PWH seen at public and private HIV clinics since 1993. We assessed temporal trends in health outcomes (1993–2017) and mortality (1994–2017) for 10 566 HOPS participants. Results The HOPS contributed to characterizing new conditions (eg, lipodystrophy), demonstrated reduced mortality with earlier HIV treatment, uncovered associations between select antiretroviral agents and cardiovascular disease, and documented remarkable shifts in morbidity from AIDS opportunistic infections to chronic noncommunicable diseases. The median CD4 cell count of participants increased from 244 cells/mm3 to 640 cells/mm3 from 1993 to 2017. Mortality fell from 121 to 16 per 1000 person-years from 1994 to 2017 (P &lt; .001). In 2010, 83.7% of HOPS participants had a most recent HIV viral load &lt;200 copies/mL, compared with 92.2% in 2017. Conclusions Since 1993, the HOPS has been detecting emerging issues and challenges in HIV disease management. HOPS data can also be used for monitoring trends in infectious and chronic diseases, immunologic and viral suppression status, retention in care, and survival, thereby informing progress toward the Ending the HIV Epidemic initiative.

Incidence of Hepatotoxicity in Iranian Patients With HIV on Antiretroviral Therapies and Its Correlation with Virologic Response to HIV Treatment

2020 ◽  
Author(s):  
Tayebeh Hashempour ◽  
Javad Moayedi ◽  
Zahra Mousavi ◽  
Masoumeh Esmaeli ◽  
Azizeh Asadzadeh ◽  
...  
Keyword(s):  
Virologic Response ◽  
Hiv Treatment ◽  
Hiv Viral Load ◽  
Serum Alanine Aminotransferase ◽  
Severe Hepatotoxicity ◽  
Antiretroviral Therapies ◽  
Significant Difference ◽  
Periodic Monitoring ◽  
Iranian Patients ◽  
Alt Activity

Abstract Objective To investigate hepatotoxicity in Iranian patients with HIV to assess the association between virologic response to HIV treatment and serum alanine aminotransferase (ALT). Methods This study was conducted with 200 control patients, 75 patients with HIV naïve to antiretroviral therapy (ART), and 443 patients who received ARTs with virologic response (≤1000 copies/mL) or virologic treatment failure (&gt;1000 copies/mL). Serum ALT level and HIV viral load were determined in all patients. Results Patient ALT levels were significantly higher than those of control patients (45.1 ± 44.4 IU/L vs 23.8 ± 5.4 IU/L). Compared to patients who were ART-naïve, patients with ART experience had significantly higher ALT levels (38.2 ± 26.2 IU/L vs 46.3 ± 46.7 IU/L), and severe hepatotoxicity was only detected in those with ART experience (8 patients, 1.8%). Mean ALT had no significant difference between virologic response/failure groups. The ALT activity and HIV load had a negative correlation coefficient, but it was not significant. Conclusion Periodic monitoring for the possibility of hepatotoxicity is highly recommended in all patients with HIV, especially in those receiving ART treatment.

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 The Effect of Homelessness on the HIV Care Continuum in an Underserved Metropolitan Area of the South : Potential Implications for Ending the HIV Epidemic in America.

2020 ◽  
Author(s):  
Vladimir Berthaud ◽  
Livette Johnson ◽  
Ronda Jennings ◽  
Maxine Chandler-Auguste ◽  
Abosede Osijo ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Scientific Evidence ◽  
Hiv Treatment ◽  
Hiv Care ◽  
P Value ◽  
National Plan ◽  
Ryan White ◽  
Hiv Treatment Outcomes ◽  
Hiv Seropositive

Abstract A wealth of scientific evidence supports the effectiveness of HIV prophylaxis and treatment. Homelessness has become one of the strongest predictors of health status and viral suppression among vulnerable populations and can undermine the national plan to eliminate HIV by 2030. This retrospective observational study examined the extent in which homelessness affects HIV treatment in an underserved urban area of Middle Tennessee in 2014-2019. Among 692 HIV-seropositive patients, the proportion of homeless patients increased from 13.5% to 27.7%, thrice the national average for HIV-seropositive people (8.4%) and twice that of Ryan White patients nationwide (12.9%). Our findings suggest that homeless patients were half as likely to achieve viral suppression as compared to those who had a permanent/stable home [OR 0.48 (0.32-0.72), p-value <0.001]. The alarming rate of homelessness in this population raises serious concerns for long-term HIV treatment outcomes and the trajectory of the syndemic of homelessness and HIV.

Treating pediatric conjunctivitis without an exam: An evaluation of outcomes and antibiotic usage

2018 ◽  
Vol 26 (1-2) ◽  
pp. 73-78 ◽  
Author(s):  
Kristine S Penza ◽  
Martha A Murray ◽  
Jane F Myers ◽  
Julie Maxson ◽  
Joseph W Furst ◽  
...  
Keyword(s):  
Retrospective Chart Review ◽  
Phone Call ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Face To Face ◽  
Phone Calls ◽  
Significant Difference ◽  
Primary Care Office ◽  
Previous Encounter

Objective The objective of this research paper is to compare antibiotic treatment, follow-up rates, and types of follow-up encounters among eVisits, phone calls, and in-person encounters for pediatric conjunctivitis. Study design A retrospective chart review of pediatric patients evaluated for conjunctivitis between May 1, 2016 and May 1, 2017, was performed. A total of 101 eVisits, 202 in-person retail clinic visits, and 202 nurse phone calls for conjunctivitis were manually reviewed for outcomes. Exclusion criteria included previous encounter for conjunctivitis in the past 14 days, treatment with an oral antibiotic at the initial encounter, or patient outside Minnesota at the time of encounter. Comparison among the three encounter types with regard to follow-up rates, follow-up encounter type within 14 days of initial evaluation, and prescribing rates was performed. Results Patients completing non-face-to-face encounters were significantly more likely to have follow-up care (34.6% and 45.5%) than those who had a face-to-face visit at the retail clinic (7.4%), p ≤ 0.0001. Patients initially evaluated by eVisit were more likely to have follow-up at the retail clinic while patients initially evaluated by phone call were more likely to have follow-up in their primary care office. Treatment rates with antibiotics were significantly higher in phone call encounters (41.6%) than in eVisits (25.7%) or face-to-face encounters (19.8%), p < 0.0001. Conclusions Non-face-to-face visits have significantly higher rates of follow-up when compared to face-to-face encounters. Antibiotic prescribing is greater with phone call triage encounters; however, there was no significant difference in antibiotic prescribing rates between eVisits and face-to-face visits. Follow-up type varied according to site of initial encounter.

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