How to use sequence analysis for life course epidemiology? An example on HIV-positive Sub-Saharan migrants in France

2018 ◽  
Vol 72 (6) ◽  
pp. 507-512
Author(s):  
Anne Gosselin ◽  
Annabel Desgrées du Loû ◽  
Eva Lelièvre
Keyword(s):  
Sequence Analysis ◽  
Life Course ◽  
Social Epidemiology ◽  
Cox Model ◽  
Hiv Care ◽  
Event History ◽  
Hiv Diagnosis ◽  
Life Course Epidemiology ◽  
Paris Region ◽  
Sub Saharan

BackgroundLife course epidemiology is now an established field in social epidemiology; in sociodemography, the quantitative analysis of biographies recently experienced significant trend from event history analysis to sequence analysis. The purpose of this article is to introduce and adapt this methodology to a social epidemiology question, taking the example of the impact of HIV diagnosis on Sub-Saharan migrants’ residential trajectories in the Paris region.MethodsThe sample consists of 640 migrants born in Sub-Saharan Africa receiving HIV care. They were interviewed in healthcare facilities in the Paris region within the PARCOURS project, conducted from 2012 to 2013, using life event history calendars, which recorded year by year their health, family and residential histories. We introduce a two-step methodological approach consisting of (1) sequence analysis by optimal matching to build a typology of migrants’ residential pathways before and after diagnosis, and (2) a Cox model of the probability to experience changes in the residential situation.ResultsThe seven-clusters typology shows that for a majority, the HIV diagnosis did not entail changes in residential situation. However 30% of the migrants experienced a change in their residential situation at time of diagnosis. The Cox model analysis reveals that this residential change was in fact moving in with one’s partner (HR 2.99, P<0.000) rather than network rejection.ConclusionThis original combination of sequence analysis and Cox models is a powerful process that could be applied to other themes and constitutes a new approach in the life course epidemiology toolbox.Trial registration numberNCT02566148.

scholarly journals Effect of Female Sex Work Targeted Community-based Interventions Along the HIV Treatment Cascade in Sub-Saharan Africa: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Lydia Atuhaire ◽  
Olatunji Adetokunboh ◽  
Constance Shumba ◽  
Peter S Nyasulu
Keyword(s):  
Hiv Testing ◽  
Meta Analysis ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Community Based Interventions ◽  
Community Based ◽  
Hiv Services ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Sub Saharan

Abstract Background: Female Sex Workers are extremely vulnerable and highly susceptibility to being infected with human immunodeficiency virus. As a result, community based targeted interventions have been recommended as one of the models of care to improve access to HIV services and continued engagement in care. However little is known about the specific community intervention packages that have optimal effect on FSWs access and retention in HIV care. This paper synthesized evidence on the effectiveness of community-based interventions that provided HIV services to FSWs across all stages of HIV care cascade.Methods: We defined the 5 steps that make up the HIV care cascade and categorized them as outcomes, namely HIV testing, HIV diagnosis, linkage to care, ART use and viral suppression. We conducted a systematic search of randomized controlled trials, cohort and cross sectional studies done in sub-Saharan African countries and published from 2004 to 2020. We reviewed studies with data on the implementation of community interventions for any of the HIV care cascade stage. The data were analyzed using random effects meta-analysis where possible and for the rest of the studies, data were synthesized using summary statistics. Results: The significant impact of the community interventions was observed on HIV testing, HIV diagnosis and ART use. However, for HIV testing and ART use, the improvement was not sustained for the entire period of implementation. There were minimal interventions that had impact on HIV diagnosis, with only one community service delivery model showing significance. Generally, the interventions that had reasonable impact are those that implemented targeted and comprehensive package of HIV services provided at one location, and with unique strategies specific to each cascade stage.Conclusions: The effect of community-based interventions varies across the different stages of HIV care cascade with impact observed in specific strategies with features unique to each cascade stage. Moreover, positive effects of these strategies were short term and with small-scale implementation. As such, the information on long-term treatment outcomes, and the extent to which FSWs remain engaged in care is sparse. There is need to conduct a further research to deepen the assessment of the effectiveness of community-based interventions on HIV care cascade for FSWs. This will enhance identification of evidence based optimal interventions that will guide effective allocation of scarce resources for strategies that would have a significant impact on HIV service delivery.Systematic review registration: PROSPERO CRD42020157623.

Social and structural factors and engagement in HIV care of sub-Saharan African migrants diagnosed with HIV in the Paris region

AIDS Care ◽  
2019 ◽  
Vol 31 (7) ◽  
pp. 897-907
Author(s):  
Nicolas Vignier ◽  
Annabel Desgrees Du Lou ◽  
Julie Pannetier ◽  
Andrainolo Ravalihasy ◽  
Anne Gosselin ◽  
...  
Keyword(s):  
Hiv Care ◽  
Structural Factors ◽  
African Migrants ◽  
Paris Region ◽  
Sub Saharan ◽  
Engagement In Hiv Care

Cervical screening uptake and abnormalities among women attending sexual health clinics for HIV care

Sexual Health ◽  
2014 ◽  
Vol 11 (3) ◽  
pp. 288
Author(s):  
Donna M. Tilley ◽  
Catherine C. O'Connor ◽  
Sunil Adusumilli ◽  
Maggie Smith ◽  
Clara Marin-Zapata ◽  
...  
Keyword(s):  
Health Services ◽  
Sexual Health ◽  
Cervical Screening ◽  
Pap Test ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Screening Uptake ◽  
Sub Saharan ◽  
Sexual Health Clinics

The aim of this study was to describe cervical screening uptake and assess correlates of screen-detected abnormalities in women attending sexual health services for HIV care. Of 156 women, 115 had documentation of a Pap test at least once in 3 years and 9.6% had an annual Pap test performed. Pap abnormalities were associated with younger age, being born in Sub-Saharan Africa, more recent arrival in Australia, lower CD4 count, detectable viral load, shorter time on antiretroviral therapy and more recent HIV diagnosis. Women accessing sexual health services for HIV care, especially those from culturally and linguistically diverse backgrounds, appear to be substantially under-screened and efforts to optimise screening are needed.

scholarly journals Age-dependent inequalities in HIV/STI burden and care receipt among men and transgender persons who have sex with men in Nairobi

2021 ◽  
Author(s):  
Adrian Smith ◽  
Elizabeth Fearon ◽  
Rhoda Kibuti ◽  
Erastus Irungu ◽  
Mary Kungu ◽  
...  
Keyword(s):  
Viral Load ◽  
Self Report ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
African Countries ◽  
Hiv Viral Load ◽  
Transgender Persons ◽  
Sub Saharan ◽  
Sex With Men

Background Gay, bisexual and other men who have sex with men (GBMSM) and transgender persons (TP) bear high burdens of HIV and other sexually transmitted infections (STIs) in sub-Saharan Africa, yet evidence of HIV care coverage for these groups is sparse from the region despite prevailing stigma and discrimination towards these groups. Methods 618 GBMSM/TP were recruited in Nairobi between May to December 2017 using respondent-driven sampling. Participants reported recent sexual behaviour, HIV testing and care receipt, and symptoms of STIs. Participants tested for HIV using Kenyan testing algorithms and GeneXpert methods, syphilis, viral hepatitis and ano-genital gonorrhoea and chlamydia. We assessed associations with HIV status and detectable HIV viral load using multivariable robust Poisson regression models. Findings 26.4% (286/618) were HIV positive of whom 76.5% were status aware, 65.3% were on ART, and 47.4% were virally suppressed (<50 copies/ml). Participants 18-22 years old were less likely to be status aware, be receiving ART or to have achieved viral suppression. Mean log viral load was 3.14 log higher in 18-22 year olds compared to older participants. Bacterial STIs were frequently detected at both urethral and rectal sites and a majority of infections at both sites were asymptomatic by self-report (rectal 82.2%, urethral 90.8%). Interpretation Engagement in the HIV diagnosis and care cascade among GBMSM/TP in Kenya is markedly better than in most sub-Saharan African countries. However it falls short of achievements among the general population in the country and cascades achieved in GBMSM in high income settings. Young men and transgender persons who have sex with men are least well served by the current configuration of adult key population services, and programmes should identify and address the sexual, social and developmental needs of adolescent and young key populations

scholarly journals Low levels of frailty in HIV-positive older adults on antiretroviral therapy in northern Tanzania

2021 ◽  
Author(s):  
Clare Bristow ◽  
Grace George ◽  
Grace Hillsmith ◽  
Emma Rainey ◽  
Sarah Urasa ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
High Standard ◽  
Female Gender ◽  
Screening Tools ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Diagnostic Tools ◽  
Clinical Frailty Scale ◽  
Frailty Phenotype ◽  
Sub Saharan

Abstract There are over 3 million people in sub-Saharan Africa (SSA) aged 50 and over living with HIV. HIV and combined antiretroviral therapy (cART) exposure may accelerate the ageing in this population, and thus increase the prevalence of premature frailty. There is a paucity of data on the prevalence of frailty in an older HIV + population in SSA and screening and diagnostic tools to identify frailty in SSA. Patients aged ≥ 50 were recruited from a free Government HIV clinic in Tanzania. Frailty assessments were completed, using 3 diagnostic and screening tools: the Fried frailty phenotype (FFP), Clinical Frailty Scale (CFS) and Brief Frailty Instrument for Tanzania (B-FIT 2). The 145 patients recruited had a mean CD4 + of 494.84 cells/µL, 99.3% were receiving cART and 72.6% were virally suppressed. The prevalence of frailty by FFP was 2.758%. FFP frailty was significantly associated with female gender (p = 0.006), marital status (p = 0.007) and age (p = 0.038). Weight loss was the most common FFP domain failure. The prevalence of frailty using the B-FIT 2 and the CFS was 0.68%. The B-FIT 2 correlated with BMI (r = − 0.467, p = 0.0001) and CD4 count in females (r = − 0.244, p = 0.02). There is an absence of frailty in this population, as compared to other clinical studies. This may be due to the high standard of HIV care at this Government clinic. Undernutrition may be an important contributor to frailty. It is unclear which tool is most accurate for detecting the prevalence of frailty in this setting as levels of correlation are low.

Sign in / Sign up

Export Citation Format

Share Document