scholarly journals The Impact of ART on the Economic Outcomes of People Living with HIV/AIDS

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Annet Nannungi ◽  
Glenn Wagner ◽  
Bonnie Ghosh-Dastidar
Keyword(s):  
Multivariate Analysis ◽  
Physical Health ◽  
Economic Outcomes ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Work Status ◽  
People Living With Hiv ◽  
Health Functioning ◽  
The Impact ◽  
Over Time

Background. Clinical benefits of ART are well documented, but less is known about its effects on economic outcomes such as work status and income in sub-Saharan Africa.Methods. Data were examined from 482 adult clients entering HIV care (257 starting ART; 225 not yet eligible for ART) in Kampala, Uganda. Self-reported data on work status and income were assessed at baseline, months 6 and 12. Multivariate analysis examined the effects of ART over time, controlling for change in physical health functioning and baseline covariates.Results. Fewer ART patients worked at baseline compared to non-ART patients (25.5% versus 34.2%); 48.8% of those not working at baseline were now working at month 6, and 50% at month 12, with similar improvement in both the ART and non-ART groups. However, multivariate analysis revealed that the ART group experienced greater improvement over time. Average weekly income did not differ between the groups at baseline nor change significantly over time, among those who were working; being male gender and having any secondary education were predictive of higher income.Conclusions. ART was associated with greater improvement in work status, even after controlling for change in physical health functioning, suggesting other factors associated with ART may influence work.

scholarly journals 1683. Empathy Scale Validation Among Expectant Seroconcordant Couples Enrolled in HIV Care and Treatment in Zambézia Province, Mozambique

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S616-S616
Author(s):  
Daniel Sack ◽  
Caroline DeSchacht ◽  
Graves Erin ◽  
Kipp Aaron ◽  
Ezequiel Barreto ◽  
...  
Keyword(s):  
Cognitive Empathy ◽  
Hiv Care ◽  
Reactivity Index ◽  
Individual Treatment ◽  
People Living With Hiv ◽  
Median Baseline ◽  
Care And Treatment ◽  
Living With Hiv ◽  
The Impact ◽  
Over Time

Abstract Background Among patients enrolled in HIV care and treatment in rural Mozambique, 30% abandon treatment within a year. A cluster randomized controlled trial assessing the impact of couple-based vs. individual treatment for concordant couples on viral suppression (the HoPS+ trial) hypothesizes that harnessing family support will improve patient outcomes. Individuals with high levels of empathy will likely provide greater social support for treatment retention and adherence. This study validates a locally tailored version of the interpersonal reactivity index (IRI)—cognitive empathy (CE) and affective empathy (AE)—among expectant parents living with HIV in Zambézia province, Mozambique. Methods Using baseline data from 558 participants from the HOPS+ trial, we used a maximum likelihood exploratory factor analysis with a promax oblique rotation to assess the culturally relevant questions from the IRI. We examined discriminant and construct validity through analysis of subscale relationships by sex, age, education, and depression and intra-person reliability over time with an interclass correlation model (n = 119). Results Our participants live in 6 districts and receive health care at 24 health facilities. The median age was 25 (IQR: 22 to 30), 50% were female, and 44% were single. Participants had a median of 5 years of formal education (IQR: 2–7). Half of them report their occupation as “farmer” and 17% screened positive for depression. On a scale of 0–4, the median baseline CE score was 2.6 (IQR: 1.9–3.2) and the median baseline AE score was 1.9 (IQR: 1–2.6). Males (2.6 vs. 2.4, P < 0.01), participants who finished primary school (2.7 vs. 2.5, P < 0.01), and older participants (2.6 vs. 2.5, P = 0.04) had higher CE scores, while depressed participants had higher AE scores (2.3 vs. 1.8, P < 0.01). We found moderate stability over time (CE ICC: 0.63, AE ICC: 0.54) in a subset of 119 study participants. Conclusion While depression is associated with 12.5% higher AE scores, older participants, males, and those high levels of education had higher scores on the CS scale. This preliminary work will inform future work on the HoPS+ trial and guide future interventions aimed at increasing retention in and adherence to treatment in people living with HIV. Disclosures All authors: No reported disclosures.

scholarly journals The CombinADO study to assess the impact of a combination intervention strategy on viral suppression, antiretroviral therapy adherence, and retention in HIV care among adolescents and young people living with HIV: protocol for a cluster-randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Phepo Mogoba ◽  
Maia Lesosky ◽  
Allison Zerbe ◽  
Joana Falcao ◽  
Claude Ann Mellins ◽  
...  
Keyword(s):  
Mental Health ◽  
Support Groups ◽  
Viral Suppression ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Retention In Hiv Care ◽  
Cluster Randomized ◽  
Living With Hiv ◽  
The Impact

Abstract Background Adolescents and youth living with HIV (AYAHIV) have worse HIV outcomes than other age groups, particularly in sub-Saharan Africa (SSA). AYAHIV in SSA face formidable health system, interpersonal- and individual-level barriers to retention in HIV care, uptake of ART, and achievement of viral suppression (VS), underscoring an urgent need for multi-component interventions to address these challenges. This cluster-randomized control trial (cRCT) aims to evaluate the effectiveness and monitor implementation of a community-informed multi-component intervention (“CombinADO strategy”) addressing individual-, facility-, and community-level factors to improve health outcomes for AYAHIV. Methods This trial will be conducted in 12 clinics in Nampula Province, Northern Mozambique. All clinics will implement an optimized standard of care (control) including (1) billboards/posters and radio shows, (2) healthcare worker (HCW) training, (3) one-stop adolescent and youth-friendly services, (4) information/motivation walls, (5) pill containers, and (6) tools to be used by HCW during clinical visits. The CombinADO strategy (intervention) will be superadded to control conditions at 6 randomly selected clinics. It will include five additional components: (1) peer support, (2) informational/motivational video, (3) support groups for AYAHIV caregivers, (4) AYAHIV support groups, and (5) mental health screening and linkage to adolescent-focused mental health support. The study conditions will be in place for 12 months; all AYAHIV (ages 10–24 years, on ART) seeking care in the participating sites will be exposed to either the control or intervention condition based on the clinic they attend. The primary outcome is VS (viral load < 50 copies/mL) at 12 months among AYAHIV attending participating clinics. Secondary outcomes include ART adherence (self-reported and TDF levels) and retention in care (engagement in the preceding 90 days). Uptake, feasibility, acceptability, and fidelity of the CombinADO strategy during implementation will be measured. Trial outcomes will be assessed in AYAHIV, caregivers, healthcare workers, and key informants. Statistical analyses will be conducted and reported in line with CONSORT guidelines for cRCTs. Discussion The CombinADO study will provide evidence on effectiveness and inform implementation of a novel community-informed multi-component intervention to improve retention, adherence, and VS among AYAHIV. If found effective, results will strengthen the rationale for scale up in SSA. Trial registration ClinicalTrials.gov NCT04930367. Registered on 18 June 2021

scholarly journals Free access to antiretroviral treatment and protection against the risk of catastrophic health expenditure in people living with HIV: evidence from Cameroon

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marwân-al-Qays Bousmah ◽  
Marie Libérée Nishimwe ◽  
Christopher Kuaban ◽  
Sylvie Boyer
Keyword(s):  
Socioeconomic Status ◽  
Health Expenditure ◽  
Antiretroviral Treatment ◽  
Catastrophic Health Expenditure ◽  
Hiv Care ◽  
Free Access ◽  
People Living With Hiv ◽  
Art Policy ◽  
Living With Hiv ◽  
The Impact

Abstract Background To foster access to care and reduce the burden of health expenditures on people living with HIV (PLHIV), several sub-Saharan African countries, including Cameroon, have adopted a policy of removing HIV-related fees, especially for antiretroviral treatment (ART). We investigate the impact of Cameroon’s free antiretroviral treatment (ART) policy, enacted in May 2007, on catastrophic health expenditure (CHE) risk according to socioeconomic status, in PLHIV enrolled in the country’s treatment access program. Methods Based on primary data from two cross-sectional surveys of PLHIV outpatients in 2006–2007 and 2014 (i.e., before and after the policy’s implementation, respectively), we used inverse propensity score weighting to reduce covariate imbalances between participants in both surveys, combined with probit regressions of CHE incidence. The analysis included participants treated with ART in one of the 11 HIV services common to both surveys (n = 1275). Results The free ART policy was associated with a significantly lower risk of CHE only in the poorest PLHIV while no significant effect was found in lower-middle or upper socioeconomic status PLHIV. Unexpectedly, the risk of CHE was higher in those with middle socioeconomic status after the policy’s implementation. Conclusions Our findings suggest that Cameroon’s free ART policy is pro-poor. As it only benefitted PLHIV with the lowest socioeconomic status, increased comprehensive HIV care coverage is needed to substantially reduce the risk of CHE and the associated risk of impoverishment for all PLHIV.

scholarly journals Aging, Health, and Quality of Life for Older People Living With HIV in Sub-Saharan Africa: A Review and Proposed Conceptual Framework

2017 ◽  
Vol 31 (1) ◽  
pp. 109-138 ◽  
Author(s):  
Mark J. Siedner
Keyword(s):  
Quality Of Life ◽  
Conceptual Framework ◽  
Care Delivery ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv ◽  
The Impact

Objective: The number of people living with HIV (PLWH) over 50 years old in sub-Saharan Africa is predicted to triple in the coming decades, to 6-10 million. Yet, there is a paucity of data on the determinants of health and quality of life for older PLWH in the region. Methods: A review was undertaken to describe the impact of HIV infection on aging for PLWH in sub-Saharan Africa. Results: We (a) summarize the pathophysiology and epidemiology of aging with HIV in resource-rich settings, and (b) describe how these relationships might differ in sub-Saharan Africa, (c) propose a conceptual framework to describe determinants of quality of life for older PLWH, and (d) suggest priority research areas needed to ensure long-term gains in quality of life for PLWH in the region. Conclusions: Differences in traditional, lifestyle, and envirnomental risk factors, as well as unique features of HIV epidemiology and care delivery appear to substantially alter the contribution of HIV to aging in sub-Saharan Africa. Meanwhile, unique preferences and conceptualizations of quality of life will require novel measurement and intervention tools. An expanded research and public health infrastructure is needed to ensure that gains made in HIV prevention and treamtent are translated into long-term benefits in this region.

HIV/AIDS

2020 ◽  
pp. 901-933
Author(s):  
Sarah Fidler ◽  
Timothy E.A. Peto ◽  
Philip Goulder ◽  
Christopher P. Conlon
Keyword(s):  
Large Scale ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
African Countries ◽  
Global Pandemic ◽  
The People ◽  
Reduce Life Expectancy ◽  
Sub Saharan ◽  
Living With Hiv ◽  
The Impact

Since its discovery in 1983, the human immunodeficiency virus (HIV) has been associated with a global pandemic that has affected more than 78 million people and caused more than 39 million deaths. Globally, 36.9 million (34.3–41.4 million) people were living with HIV at the end of 2013. An estimated 0.8% of adults aged 15–49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults living with HIV and accounting for nearly 71% of the people living with HIV worldwide. The impact of HIV in some African countries has been sufficient to reverse population growth and reduce life expectancy into the mid-30s, although HIV incidence has declined in some of these high-prevalence countries. However, there are large-scale HIV epidemics elsewhere (e.g. India, the Russian Federation, and Eastern Europe).

scholarly journals Systematic identification and referral of smokers attending HIV ambulatory care highlights the failure of current service provision in an at-risk population

2019 ◽  
Vol 6 (1) ◽  
pp. e000395
Author(s):  
James Brown ◽  
Christianna Kyriacou ◽  
Elisha Pickett ◽  
Kelly Edwards ◽  
Hemal Joshi ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Smoking Status ◽  
Healthcare Services ◽  
Lifestyle Changes ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Smoking Cessation Services ◽  
Living With Hiv ◽  
Systematic Identification ◽  
The Impact

IntroductionPeople living with HIV (PLWH) are more likely to smoke than the general population and are at greater risk of smoking-related illness. Healthcare services need to address this burden of preventable disease.MethodsWe evaluated the impact of a brief intervention that asked service users about smoking when they attended for ambulatory HIV care in London, UK, and offered referral to smoking cessation.ResultsOverall, 1548 HIV-positive individuals were asked about their smoking status over a 12-month period. Of this group, 385 (25%) reported that they were current smokers, 372 (97%) were offered referral to smoking cessation services and 154 (40%) accepted this. We established an outcome of referral for 114 (74%) individuals. A total of 36 (10% of smokers) attended stop smoking clinics and 16 (4%) individuals were recorded as having quit smoking.DiscussionThe simple intervention of asking PLWH about tobacco smoking and offering referral to smoking cessation services rapidly identified current smokers, 40% of whom accepted referral to smoking cessation services. This highlights the importance of promoting behaviour and lifestyle changes with every contact with health services. However, a large proportion of those referred were either not seen in local services or the outcome of referral could not be ascertained. If the risk of smoking-related morbidity among PLWH is to be reduced, more sustainable referral pathways and ways of improving uptake of smoking cessation services must be developed.

Uptake and trends in ordering of funded hepatitis B immunisation for priority populations in Victoria, Australia, 2013–2014

Sexual Health ◽  
2017 ◽  
Vol 14 (2) ◽  
pp. 188
Author(s):  
Jennifer H. MacLachlan ◽  
Benjamin C. Cowie
Keyword(s):  
At Risk ◽  
Hepatitis B ◽  
Risk Groups ◽  
Hepatitis B Vaccine ◽  
People Living With Hiv ◽  
Department Of Health ◽  
Priority Populations ◽  
Living With Hiv ◽  
The Impact ◽  
Over Time

Background The Department of Health and Human Services in Victoria provides funded hepatitis B vaccine to many priority groups at risk of acquiring infection. We aimed to determine the uptake of vaccine ordering for at-risk groups over time, to assess any trends and identify any gaps in prevention of hepatitis B for those at risk. Methods: Routinely collected administrative data regarding the indication for vaccine ordered by practitioners were analysed for the period June 2013 to December 2014. Number of doses and courses distributed was determined and compared with the estimated size of the priority populations. Results: During the 18-month period assessed, 20 498 doses of funded hepatitis B vaccine were ordered, equating to ~5700 complete courses, with the overall number of orders per quarter increasing between 2013 and 2014. The most common indication was being a household or sexual contact of people living with hepatitis B (2803 courses, 49.2% of the total), equating to approximately one course per new chronic hepatitis B notification. The remaining doses were largely distributed to people living with HIV (648 courses, 11.4%), people living with hepatitis C (621 courses, 10.9%), and people who inject drugs (594 courses, 10.4%). Conclusions: This analysis demonstrates that access to hepatitis B immunisation among priority populations appears to have increased in Victoria during 2013–14, however it could still be improved. Continued assessment of these data over time will be important to measure the impact of interventions on increasing the reach of the funded vaccine program.

Health and Voting in Young Adulthood

2017 ◽  
Vol 49 (3) ◽  
pp. 1163-1186 ◽  
Author(s):  
Christopher Ojeda ◽  
Julianna Pacheco
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Young Adulthood ◽  
Well Being ◽  
Lower Probability ◽  
Self Rated Health ◽  
Physical Limitations ◽  
The Impact ◽  
Over Time

Do changes in health lead to changes in the probability of voting? Using two longitudinal datasets, this article looks at the impact of three measures of health – physical health, mental health and overall well-being – on voting trajectories in young adulthood. The results show that self-rated health is associated with a lower probability of voting in one’s first election, depression is related to a decline in turnout over time and physical limitations are unrelated to voting. Some familial resources from childhood are also found to condition when the health–participation effect manifests.

A Longitudinal Analysis of Efficacy Expectations and Exercise in Older Adults

2004 ◽  
Vol 18 (4) ◽  
pp. 331-344 ◽  
Author(s):  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
Physical Health ◽  
Self Efficacy ◽  
Outcome Expectations ◽  
Analysis Of Covariance ◽  
Regular Exercise ◽  
Significant Difference ◽  
Efficacy Expectations ◽  
The Impact ◽  
Over Time

The purpose of this study was to consider the longitudinal changes in self-efficacy and outcome expectations for exercise and the impact of these variables on maintaining regular exercise over a 4-year period in a group of older adults living in a continuing care retirement community. There were 78 individuals who completed all four surveys. The participants had at least a high school education, and the majority were Caucasian (99%), female (83%) and either widowed or never married (80%). The mean age of the participants was 84.4 ± 5.1 years. Based on repeated measure analysis of covariance, controlling for mental and physical health, there was not a statistically significant difference in self-efficacy expectations (F = 2.0, p > .05) or outcome expectations (F = 2.2, p > .05) over time. There was a statistically significant decrease in exercise over time (F = 9.9, p < .05). Using path analysis it was demonstrated that self-efficacy expectations, outcome expectations, and physical health directly and indirectly influenced maintenance of regular exercise. Age, gender, and mental health had a limited and inconsistent influence on maintenance of exercise. Future research and clinical work should focus on developing and testing interventions that strengthen both self-efficacy and positive outcome expectations in older adults to facilitate maintenance of exercise behavior over time.

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