scholarly journals HIV Care Continuum among Postpartum Women Living with HIV in Atlanta

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Christina M. Meade ◽  
Martina Badell ◽  
Stephanie Hackett ◽  
C. Christina Mehta ◽  
Lisa B. Haddad ◽  
...  
Keyword(s):  
Primary Care ◽  
Viral Suppression ◽  
Retention In Care ◽  
Hiv Care ◽  
Women Living With Hiv ◽  
Care Visit ◽  
Retention In Hiv Care ◽  
Hiv Primary Care ◽  
Living With Hiv

Introduction. While increased healthcare engagement and antiretroviral therapy (ART) adherence occurs during pregnancy, women living with HIV (WLWH) are often lost to follow-up after delivery. We sought to evaluate postpartum retention in care and viral suppression and to identify associated factors among WLWH in a large public hospital in Atlanta, Georgia. Methods. Data from the time of entry into prenatal care until 24 months postpartum were collected by chart review from WLWH who delivered with ≥20 weeks gestational age from 2011 to 2016. Primary outcomes were retention in HIV care (two HIV care visits or viral load measurements >90 days apart) and viral suppression (<200 copies/mL) at 12 and 24 months postpartum. Obstetric and contraception data were also collected. Results. Among 207 women, 80% attended an HIV primary care visit in a mean 124 days after delivery. At 12 and 24 months, respectively, 47% and 34% of women were retained in care and 41% and 30% of women were virally suppressed. Attending an HIV care visit within 90 days postpartum was associated with retention in care at 12 months (aOR 3.66, 95%CI 1.72-7.77) and 24 months (aOR 4.71, 95%CI 2.00-11.10) postpartum. Receiving ART at pregnancy diagnosis (aOR 2.29, 95%CI 1.11-4.74), viral suppression at delivery (aOR 3.44, 95%CI 1.39-8.50), and attending an HIV care visit within 90 days postpartum (aOR 2.40, 95%CI 1.12-5.16) were associated with 12-month viral suppression, and older age (aOR 1.09, 95% CI 1.01-1.18) was associated with 24-month viral suppression. Conclusions. Long-term retention in HIV care and viral suppression are low in this population of postpartum WLWH. Prompt transition to HIV care in the postpartum period was the strongest predictor of optimal HIV outcomes. Efforts supporting women during the postpartum transition from obstetric to HIV primary care may improve long-term HIV outcomes in women.

scholarly journals Identifying patterns of retention in care and viral suppression using latent class analysis among women living with HIV in Florida 2015–2017

AIDS Care ◽  
2020 ◽  
Vol 33 (1) ◽  
pp. 131-135
Author(s):  
Rahel Dawit ◽  
Diana M. Sheehan ◽  
Semiu O. Gbadamosi ◽  
Kristopher P. Fennie ◽  
Tan Li ◽  
...  
Keyword(s):  
Latent Class Analysis ◽  
Viral Suppression ◽  
Latent Class ◽  
Retention In Care ◽  
Class Analysis ◽  
Women Living With Hiv ◽  
Living With Hiv

scholarly journals 1322. A Mobile Technology-Based Intervention Improves HIV Care Continuum for Young People Living with HIV

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S478-S478
Author(s):  
Ping Du ◽  
John Zurlo ◽  
Tarek Eshak ◽  
Tonya Crook ◽  
Cynthia Whitener
Keyword(s):  
Mobile Technology ◽  
Viral Suppression ◽  
Retention In Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Hiv Viral Suppression ◽  
Study Participants ◽  
Living With Hiv

Abstract Background Young people living with HIV (YPLWH) have lower rates of retention in care and HIV viral suppression. Multiple barriers exist to engage YPLWH in care. As nearly all YPLWH use their mobile phones to access health information and to communicate with other people, we implemented a mobile technology-based intervention with the goal to improve HIV care continuum in YPLWH. Methods YPLWH were eligible for this study if they were: (1) aged 18–34 years; (2) newly diagnosed with HIV; (3) having a history of being out of care; or (4) not virally suppressed. We recruited YPLWH during January 2017-May 2018 and followed them every 6 months. We developed a HIPAA-compliant mobile application, “OPT-In For Life,” and let participants use this app to manage their HIV care. The app integrated multiple features that enabled users to communicate with the HIV treatment team via a secure messaging function, to access laboratory results and HIV prevention resources, and to set up appointment or medication reminders. We obtained participants’ demographics, app-usage data, and medical records to evaluate if this mobile technology-based intervention would improve HIV care continuum among YPLWH. We used a quasi-experiment study design to compare the rates of retention in care and HIV viral suppression every 6 months between study participants and YPLWH who were eligible but not enrolled in the study. Results 92 YPLWH participated in this study (70% male, 56% Hispanics or Blacks, 54% retained in care, and 66% virally suppressed at baseline). On average study participants used the app 1–2 times/week to discuss various health issues and supportive services with HIV providers, to access HIV-related health information, and to manage their HIV care. At the 6-month evaluation, compared with 88 eligible YPLWH who were not enrolled in this intervention, study participants had increased rates of retention in care (baseline-to-6-month between participants and nonparticipants: 54%–84% vs. 26%–25%) and HIV viral suppression (66%–80% vs. 56%–60%). Conclusion Our study demonstrates using a HIPAA-compliant mobile app as an effective intervention to engage YPLWH in care. This intervention can be adapted by other HIV programs to improve HIV care continuum for YPLWH or broader HIV populations. Disclosures All authors: No reported disclosures.

scholarly journals Individual and neighborhood predictors of retention in care and viral suppression among Florida youth (aged 13–24) living with HIV in 2015

2019 ◽  
Vol 30 (11) ◽  
pp. 1095-1104
Author(s):  
Merhawi T Gebrezgi ◽  
Diana M Sheehan ◽  
Daniel E Mauck ◽  
Kristopher P Fennie ◽  
Gladys E Ibanez ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Age Groups ◽  
Retention In Care ◽  
Population Based ◽  
Hiv Care ◽  
Foreign Born ◽  
Perinatal Hiv ◽  
Retention In Hiv Care ◽  
Older Youth ◽  
Sex With Men

Youth aged 13‒24 are less likely to be retained in HIV care and be virally suppressed than older age groups. This study aimed to assess predictors of retention in HIV care and viral suppression among a population-based cohort of youth (N = 2872) diagnosed with HIV between 1993 and 2014 in Florida. We used generalized estimating equations to estimate prevalence ratios (PRs). Retention in care was defined as evidence of engagement in care (at least one laboratory test, physician visit, or antiretroviral therapy prescription refill), two or more times, at least three months apart during 2015. Viral suppression was defined as having evidence of a viral load <200 copies/ml among those in care during 2015. Among the 2872 youth, 65.4% were retained in care, and among those in care, 65.0% were virally suppressed. Older youth (18‒24 years old) and non-Hispanic Blacks (NHBs) were less likely to be retained in care, whereas those men who have sex with men, perinatal HIV transmission, living in low socioeconomic neighborhoods, and those diagnosed with AIDS before 2016 were more likely to be retained in care. Those diagnosed with AIDS before 2016 and NHBs were less likely to be virally suppressed, whereas those men who have sex with men and foreign-born persons were more likely to be virally suppressed. Results suggest the need for targeted retention and viral suppression interventions for NHB youth and older youth (18‒24 years-age).

scholarly journals Low Birthweight, Retention in HIV Care, and Adherence to ART Among Postpartum Women Living with HIV in Ghana

2018 ◽  
Vol 23 (2) ◽  
pp. 433-444 ◽  
Author(s):  
Kwame S. Sakyi ◽  
Margaret Y. Lartey ◽  
Julie A. Dension ◽  
Caitlin E. Kennedy ◽  
Luke C. Mullany ◽  
...  
Keyword(s):  
Low Birthweight ◽  
Hiv Care ◽  
Postpartum Women ◽  
Women Living With Hiv ◽  
Retention In Hiv Care ◽  
Living With Hiv

scholarly journals Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi

2020 ◽  
Author(s):  
Melissa A. Stockton ◽  
Bradley N. Gaynes ◽  
Mina C. Hosseinipour ◽  
Audrey E. Pettifor ◽  
Joanna Maselko ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Load Testing ◽  
Art Initiation ◽  
Retention In Hiv Care ◽  
Hiv Care Engagement ◽  
Care Outcomes ◽  
Sub Saharan ◽  
Living With Hiv

Abstract As in other sub-Saharan countries, the burden of depression is high among people living with HIV in Malawi. However, the association between depression at ART initiation and two critical outcomes—retention in HIV care and viral suppression—is not well understood. Prior to the launch of an integrated depression treatment program, adult patients were screened for depression at ART initiation at two clinics in Lilongwe, Malawi. We compared retention in HIV care and viral suppression at 6 months between patients with and without depression at ART initiation using tabular comparison and regression models. The prevalence of depression among this population of adults newly initiating ART was 27%. Those with depression had similar HIV care outcomes at 6 months to those without depression. Retention metrics were generally poor for those with and without depression. However, among those completing viral load testing, nearly all achieved viral suppression. Depression at ART initiation was not associated with either retention or viral suppression. Further investigation of the relationship between depression and HIV is needed to understand the ways depression impacts the different aspects of HIV care engagement.

scholarly journals Perceived Barriers to HIV Care and Viral Suppression Comparing Newly Diagnosed Women Living with HIV in Rural Uganda with and without a History of Intimate Partner Violence

2021 ◽  
pp. 088626052110282
Author(s):  
Ijeoma Nwabuzor Ogbonnaya ◽  
Elizabeth Reed ◽  
Rhoda K. Wanyenze ◽  
Jennifer A. Wagman ◽  
Jay G. Silverman ◽  
...  
Keyword(s):  
Intimate Partner Violence ◽  
Partner Violence ◽  
Viral Suppression ◽  
Intimate Partner ◽  
Hiv Care ◽  
Newly Diagnosed ◽  
Women Living With Hiv ◽  
History Of ◽  
To Come ◽  
Living With Hiv

Intimate partner violence (IPV) is associated with poor HIV care linkage and retention, medication adherence, and viral suppression. However, limited knowledge exists regarding potential mechanisms linking IPV to these outcomes. We aimed to (a) identify the top barriers to accessing HIV care experienced by women living with HIV (WLHIV) who report a history of IPV and have suppressed viral load (VL) versus unsuppressed VL and (b) understand how these barriers influence VL, comparing WLHIV with a history of IPV to WLHIV without a history of IPV. Study data come from newly diagnosed WLHIV in rural Uganda participating in the standard-of-care control arm of a randomized trial ( n = 152). Descriptive results ranking mean scores from highest to lowest showed that, among women with a history of IPV, irrespective of viral suppression status, paying for transportation to come to clinic, having to wait at the clinic for long periods of time, and finding a clinic within reasonable travel distance were the top three barriers to accessing HIV care. WLHIV with a history of IPV were significantly more likely to have unsuppressed VL versus suppressed VL if they reported higher levels of difficulty finding a clinic within reasonable travel distance (RRR = 1.7, 95% CI [1.1–2.7]), getting permission to take time off from work (RRR = 1.5, 95% CI [1.0–2.9]), and finding time to come to the clinic for an appointment (RRR = 1.6, 95% CI [1.0–2.6]). The same relationships were not present among WLHIV without a history of IPV, suggesting these barriers and their effect on VL may be uniquely related to IPV. Interventions should address IPV and HIV care continuum outcomes in tandem, targeting barriers to accessing HIV care likely associated with IPV. Additional research is necessary to better understand how IPV relates to HIV care barriers and VL.

scholarly journals The FANMI (“my FAMILY” in Creole) study to evaluate community-based cohort care for adolescent and young women living with HIV in Haiti: protocol for a randomized controlled trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Grace Seo ◽  
Joseph Marie Bajo Joseph ◽  
Nancy Confident ◽  
Esther Jean ◽  
Bianca Louis ◽  
...  
Keyword(s):  
Risk Behaviors ◽  
Adolescent Girls ◽  
Young Women ◽  
Controlled Trial ◽  
Retention In Care ◽  
Hiv Care ◽  
Community Based ◽  
Randomized Controlled ◽  
Women Living With Hiv ◽  
Living With Hiv

Abstract Background Adolescent girls and young women living with HIV in resource-limited settings have the poorest health outcomes of any age group, due in part to poor retention in care. Differentiated models of HIV care that target the specific challenges of young people living with HIV are urgently needed. Methods The FANMI study is an unblinded randomized controlled trial designed to evaluate the efficacy of an adolescent-specific model of HIV care in Port-au-Prince, Haiti. The FANMI intervention places newly young women living with HIV who are not currently on ART or on ART ≤ 3 months, in cohorts of 5–10 peers to receive monthly group HIV care in a community location. In contrast, participants in the standard care arm receive routine HIV care and individual counseling each month in GHESKIO’s Adolescent Clinic. A total of 160 participants ages 16–23 years old are being randomized on a 1:1 basis. The primary outcome is retention in HIV care defined as being alive and in care at 12 months after enrollment. Secondary outcomes include viral suppression at 12 months, sexual risk behaviors, acceptability of the FANMI intervention, and health care utilization and costs. Discussion The FANMI study evaluates a novel community-based cohort model of HIV care aimed at improving retention in care and reducing risk behaviors for HIV transmission among adolescent girls and young women living with HIV. Specifically, the FANMI model of care addresses social isolation by placing participants in cohorts of 5–10 peers to provide intensified peer support and makes HIV health management a group norm; reduces stigma and improves convenience by providing care in a community setting; and integrates clinical care and social support by the same providers to streamline care and promote long-term patient-provider relationships. If shown to be effective, the FANMI intervention may serve as a model of HIV care for improving retention among hard-to-reach adolescents and young adults in Haiti and could be adapted for other high-risk groups globally. Trial registration Identifier: NCT03286504, Registered September 18, 2017.

scholarly journals Protocol for a prospective evaluation of postpartum engagement in HIV care among women living with HIV in South Africa

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e035465 ◽  
Author(s):  
Christina Psaros ◽  
Amelia M Stanton ◽  
C Andres Bedoya ◽  
Nzwakie Mosery ◽  
Shannon Evans ◽  
...  
Keyword(s):  
South Africa ◽  
Pregnant Women ◽  
Qualitative Interviews ◽  
Retention In Care ◽  
Well Being ◽  
Hiv Care ◽  
Research Committee ◽  
Human Research ◽  
Women Living With Hiv ◽  
Living With Hiv

IntroductionKwaZulu-Natal (KZN), South Africa (SA) has the highest prevalence of pregnant women living with HIV in the world. Pregnancy and the postpartum period offer opportunities to engage women in HIV care, to prevent perinatal transmission and to optimise maternal and infant well-being. However, research suggests that remaining engaged in HIV care during this time can be challenging.Methods and analysisWe are conducting a 5-year prospective cohort study among pregnant women living with HIV in KZN to estimate the rates and factors associated with attrition from HIV care during this critical period. To determine who is most likely to fall out of care, we are examining a range of relevant variables informed by a socioecological model of HIV care, including individual, relational, community and healthcare system variables. We are enrolling 18–45-year-old women, at 28 weeks or more of pregnancy, who are living with HIV and currently taking antiretroviral therapies. Participants complete quantitative assessments at baseline (pregnancy) and at 6, 12, 18 and 24 months postpartum. A subset of women and their partners are invited to complete qualitative interviews to further explore their experiences in HIV care. The main study outcomes are suppressed HIV RNA and retention in care at each study assessment. Our understanding of the factors that drive postpartum attrition from HIV care will ultimately inform the development of interventions to facilitate continued engagement in postpartum HIV care.Ethics and disseminationThis protocol has been approved by the Human Research Ethics Committee (Medical) at The University of the Witwatersrand (Johannesburg, SA) and the Partners Human Research Committee at Partners HealthCare (Boston, Massachusetts, USA). Site support and approval were obtained from the District Hospital and the KZN Provincial Department of Health. Results will be disseminated through peer-reviewed manuscripts, reports and both local and international presentations (Ethics Registration #170 212).

scholarly journals Building HIV Workforce Capacity Through a Residency Pathway: Outcomes and Challenges

2018 ◽  
Vol 5 (12) ◽  
Author(s):  
Jehan Z Budak ◽  
Kathleen Volkman ◽  
Brian R Wood ◽  
Shireesha Dhanireddy
Keyword(s):  
Primary Care ◽  
Training Programs ◽  
People Living With Hiv ◽  
Physician Shortage ◽  
Long Term Outcomes ◽  
Primary Care Career ◽  
Hiv Primary Care ◽  
Workforce Capacity ◽  
Living With Hiv

Abstract To help address the impending HIV physician shortage, we launched an HIV Medicine Pathway within our Internal Medicine Residency in 2008. Between 2015 and 2017, surveys showed a decrease in the number of graduates providing primary care for people living with HIV. We suggest evaluation of long-term outcomes from similar training programs and stronger support for HIV primary care career development.

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