Late HIV diagnosis and missed opportunities for testing: piloting a standardised, multi-source review process

Late diagnosis of human immunodeficiency virus (HIV) (CD4 < 350) remains common in the UK and missed opportunities (MOs) for testing are often evident. National guidelines recommend HIV clinics conduct look-back reviews in all patients presenting late; however, a standardised methodology is not available and reviews are not routinely performed. This multi-centre audit reviewed all new, late HIV diagnoses across three centres in North East England. A standardised review process (incorporating a shared regional pathology system and summary care records) was used to identify MOs. Of 45 late diagnoses reviewed (median age 45 years, 76% male, median CD4 cell count 134), 28 (62%) had one or more MO, with a median of 18 months from MO to presentation. Sixty-two per cent of MOs occurred in primary care and most (82%) consisted of indicator conditions. At HIV presentation, 27 (60%) suffered moderate harm, 16 (36%) presented with acquired immune deficiency syndrome (AIDS) and 10 (22%) suffered severe harm, including 3 (7%) who died. Despite challenges in eliciting full medical records, the comprehensive review process described, which incorporates two regional electronic records, was more effective than previous methodologies and identified more MOs. Many people present with late HIV infection or AIDS and increased efforts are needed to improve testing.

Download Full-text

Getting the right message: a content analysis and application of the health literacy INDEX tool to online HIV resources in Australia

Health Education Research ◽

10.1093/her/cyaa042 ◽

2020 ◽

Author(s):

Corie Gray ◽

Gemma Crawford ◽

Roanna Lobo ◽

Bruce Maycock

Keyword(s):

Content Analysis ◽

Health Literacy ◽

Hiv Prevention ◽

Immune Deficiency Syndrome ◽

Deficiency Syndrome ◽

Average Score ◽

People Living With Hiv ◽

Literacy Assessment ◽

Hiv Knowledge ◽

Missed Opportunities

Abstract Health literacy is considered by some as a determinant of health. Research suggests that different levels of health literacy may be associated with human immunodeficiency virus (HIV) knowledge and behaviour, including willingness to test. This study assessed the health literacy demands of existing Australia HIV prevention resources available online using a health literacy assessment and content analysis. Two reviewers assessed 66 resources using the Health Literacy INDEX. Sixty-one (92%) scored below 50%, with an average score of 35.5%. A coding frame was developed to conduct a content analysis of the resources excluding videos, multiple webpages and booklets (n = 52). We coded for six categories of knowledge: HIV knowledge (100% of resources), transmission (96%), acquired immune deficiency syndrome (AIDS) knowledge (88%), testing (87%), consequence of infection (85%) and prevention (77%). We found that resources required a reading grade above grade 8, and very few resources considered audience appropriateness. There were missed opportunities to encourage HIV prevention or testing. Some resources used incorrect language to refer towards people living with HIV, and transmission and prevention messages were often inconsistent. Guidelines for developing HIV prevention resources are warranted to improve health literacy, accessibility and appropriateness of resources and ensure consistent messages and framing of HIV risk.

Download Full-text

Factors Associated with Knowledge, Attitudes, and Prevention towards HIV/AIDS among Adults 15–49 Years in Mizoram, North East India: A Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19010440 ◽

2021 ◽

Vol 19 (1) ◽

pp. 440

Author(s):

Lucy Ngaihbanglovi Pachuau ◽

Caterina Tannous ◽

Kingsley Emwinyore Agho

Keyword(s):

Rural Areas ◽

Immune Deficiency Syndrome ◽

Educational Interventions ◽

Deficiency Syndrome ◽

Public Health Issue ◽

Cross Sectional ◽

Factors Associated ◽

North East India ◽

North East ◽

Hiv Aids

Despite a campaign of effective educational interventions targeting knowledge, attitudes, and prevention, Human Immunodeficiency-Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) continues to be a significant public health issue in India, with Mizoram reporting the highest HIV/AIDS cases in 2018–2019. In this study, we extracted Mizoram state from the National Family Health Survey Fourth Series (NFHS-4) 2015–2016 datasets and investigated factors associated with respondents’ knowledge, attitudes, and prevention towards HIV/AIDS. The sample included 3555 adults aged 15–49 years residing in Mizoram, North-east India. Respondents who reported having ever heard of HIV/AIDS was 98%. Multivariate analysis indicated that the probability of having inadequate knowledge of HIV/AIDS was higher among those with no schooling, who were illiterate, of non-Christian faiths, belonging to backward tribes or caste, from poor households, and those who lived in rural areas, not exposed to media. The odds of mother-to-child transmission (PMTCT) of HIV/AIDS transmission was high among females (AOR = 3.12, 95% CI 2.34–4.16), respondents aged 35–39 years (AOR = 1.74, 95% CI 1.05–2.87) and those belonging to other backward class. The HIV/AIDS knowledge of respondents was found to be encouraging as the majority (98%) were considered to have a good level of understanding of the condition. An educational intervention to reduce the number of adults 15–49 years infected with HIV/AIDS in Mizoram should target those from low socioeconomic groups, those from non-Christian religions, and those from other backward classes.

Download Full-text

Mortality and its Predictors among children on Antiretroviral treatment in Ethiopia: A systematic review and Meta –analysis

10.21203/rs.3.rs-28687/v1 ◽

2020 ◽

Author(s):

Yared Asmare Aynalem ◽

Hilina Ketema ◽

Tadesse Yirga Akalu ◽

Alemayehu Gonie ◽

Getnet Dessie ◽

...

Keyword(s):

Immune Deficiency ◽

Nutritional Status ◽

Subgroup Analysis ◽

Immune Deficiency Syndrome ◽

Acquired Immune Deficiency Syndrome ◽

Deficiency Syndrome ◽

Preventive Therapy ◽

Cd4 Cell Count ◽

Cd4 Cell ◽

Acquired Immune Deficiency

Abstract Background: It is well known that antiretroviral therapy (ART) decrease the progress of acquired immune deficiency syndrome (AIDS) related morbidity and mortality and helps the progress towards achieving the United Nations Program on HIV/ AIDS(UNAIDS) treatment goals. Despite this, mortality in Ethiopia becomes public health concern, and variance is observed across studies. With this gap, there is no pooled estimate. Thus, the goal of this study was to assess the pooled mortality and its predictors among antiretroviral treated HIV/AIDS patients.Methods: PubMed, Scopus and Google Scholar databases were used to search articles. The quality of studies was assessed using the Newcastle Ottawa quality assessment scale. The funnel plot and Egger's test were performed to confirm the presence of publication bias. Heterogeneity across studies was evaluated using the I2 statistic. The pooled incidence rate and its predictors were estimated using a weighted inverse variance random-effects model. Subgroup analysis and sensitivity analysis were also performed. Results: In this review, 12 studies with the cohort size of 4,935 were included. The overall incidence of mortality rate was 6.02 (95% CI: 3.7, 8.2) per 100 person-years. A higher incidence of mortality was observed (12.51% (95%CI: 0.32, 24.7)) in south nation nationality and Peoples (SNNP) on subgroup analysis. Being advanced world health organization(WHO) clinical stage (AHR:5.34( 95% CI: 3.1,9.2.6)), lower CD4 cell count (AHR :2.46 (95 %CI: 1.8, 3.2)), anemia (AHR :2.76 (95% CI: 1.9,3.9)), and nutritional status (AHR :1.9 (95%CI: 1.3, 2.6)) were major predictors of mortality. In contrast, cotrimoxazole preventive therapy (CPT) (AHR: 0.34, (95% CI 0.05, 0.63)) reduced mortality.Conclusions: In Ethiopia, the incidence of mortality was high. Lower CD4 cell count, anemia, WHO clinical staging (III/IV), and undernutrition were the contributing factors. But cotrimoxazole preventive therapy had a high effect on mortality reduction. Therefore, an earlier management would be started before advancing signs of acquired immune deficiency syndrome (AIDS) regardless of WHO staging, CD4 cell level, and nutritional status.

Download Full-text

HIV – lessons from a late diagnosis

Acute Medicine Journal ◽

10.52964/amja.0613 ◽

2016 ◽

Vol 15 (2) ◽

pp. 84-87

Author(s):

Xin Hui S. Chan ◽

◽

Barbara L. Onen ◽

Mansoor M. Raza ◽

Dushyant Mital ◽

...

Keyword(s):

Hiv Testing ◽

Hiv Diagnosis ◽

Septic Complications ◽

Routine Testing ◽

Late Hiv Diagnosis ◽

Hiv Test ◽

High Prevalence ◽

Wide Experience ◽

Routine Hiv Testing ◽

The Uk

Late HIV diagnosis is the most important predictor of HIV-related morbidity and mortality in the UK and often results from missed testing opportunities during earlier contact with health services. The HPA now recommends routine HIV testing be commissioned as a priority for all general medical admissions in high prevalence areas, such as Milton Keynes. We present the case of a patient admitted to our Medical Admissions Unit (MAU) managed initially for presumed septic complications of metastatic disease who was later found to have terminal HIV disease. In keeping with UK-wide experience which we review, a local audit following this case found MAU HIV test coverage increased after routine testing but not after staff education alone, and resulted in implementation of routine HIV testing in our MAU.

Download Full-text

The psychiatry of HIV infection

Advances in Psychiatric Treatment ◽

10.1192/apt.3.1.17 ◽

1997 ◽

Vol 3 (1) ◽

pp. 17-24

Author(s):

José Catalan

Keyword(s):

Immune Deficiency Syndrome ◽

Deficiency Syndrome ◽

Psychological Consequences ◽

Geographical Pattern ◽

The Past ◽

Immunodeficiency Virus ◽

Global Nature ◽

The Uk ◽

Acquired Immune Deficiency ◽

Hiv 1

In 1981 the condition that was later to be known as the acquired immune deficiency syndrome (AIDS) was described, and in 1983 its causative agent, the human immunodeficiency virus 1 (HIV-1), was isolated. The past 15 years have led to a growing awareness of the global nature of the epidemic and, in parallel with it, to the recognition of its medical, socioeconomic and psychological consequences. In the UK, almost 12 000 AIDS cases have been reported since 1982, and more than 25 000 cases of HIV-1 infection have been identified since 1984. Most cases of AIDS and HIV-1 have been in the Thames Regions, and it is expected that this geographical pattern will continue until the end of the decade.

Download Full-text

Effect of aerobic exercise training on cardiovascular parameters and CD4 cell count of people living with human immunodeficiency virus/acquired immune deficiency syndrome: A randomized controlled trial

Nigerian Journal of Clinical Practice ◽

10.4103/1119-3077.141414 ◽

2014 ◽

Vol 17 (5) ◽

pp. 543 ◽

Cited By ~ 21

Author(s):

S Lamina ◽

UA Ezugwu ◽

MJ Nwankwo ◽

AA Amaeze ◽

CI Ezema ◽

...

Keyword(s):

Controlled Trial ◽

Immune Deficiency Syndrome ◽

Acquired Immune Deficiency Syndrome ◽

Deficiency Syndrome ◽

Aerobic Exercise Training ◽

Cd4 Cell Count ◽

Randomized Controlled ◽

Immunodeficiency Virus ◽

Cd4 Cell ◽

Acquired Immune Deficiency

Download Full-text

New Onset of Kaposi Sarcoma in a Human Immunodeficiency Virus-1-Infected Homosexual Man, Despite Early Antiretroviral Treatment, Sustained Viral Suppression, and Immune Restoration

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu005 ◽

2014 ◽

Vol 1 (1) ◽

Cited By ~ 4

Author(s):

Amrei von Braun ◽

Dominique L. Braun ◽

Jivko Kamarachev ◽

Huldrych F. Günthard

Keyword(s):

Human Immunodeficiency Virus ◽

Antiretroviral Treatment ◽

Kaposi Sarcoma ◽

Immune Deficiency Syndrome ◽

Deficiency Syndrome ◽

Cd4 Cell Count ◽

Sustained Viral Suppression ◽

Immunodeficiency Virus ◽

Cd4 Cell ◽

New Onset

Abstract This is a rare case of new onset Kaposi sarcoma in a man infected with human immunodeficiency virus (HIV) and receiving antiretroviral treatment since primary HIV infection, with normal CD4+ cell count and suppressed viral load. The presentation questions the general understanding of Kaposi sarcoma as an acquired immune deficiency syndrome-defining disease occurring predominantly in severely immunocompromised patients infected with HIV.

Download Full-text

Haemophilia, Blood Products and HIV Infection

Scottish Medical Journal ◽

10.1177/003693308703200404 ◽

1987 ◽

Vol 32 (4) ◽

pp. 109-111 ◽

Cited By ~ 5

Author(s):

Gordon D.O. Lowe

Keyword(s):

Hiv Infection ◽

Immune Deficiency Syndrome ◽

Risk Groups ◽

Deficiency Syndrome ◽

Clotting Factor ◽

Blood Products ◽

Immunodeficiency Virus ◽

The Usa ◽

The Uk ◽

Clotting Factor Concentrates

Between 1979 and 1984, many haemophiliacs in the UK were exposed to the human immunodeficiency virus (HIV) by transfusion of blood products, in particular clotting factor concentrates, especially those imported from the USA. In the UK 1025 haemophiliacs are HIV-antibody-positive, of whom 75 are in Scotland. Thirty-one UK haemophiliacs have developed the Acquired Immune Deficiency Syndrome (AIDS), of whom 23 have died. The clinical progress of HIV infection appears similar in haemophiliacs and in other risk groups, except that Kaposi's sarcoma is rare. There is evidence that transfusion of blood products is immunosuppressive in the absence of HIV antibody. Blood donor selection and heat treatment of clotting factor concentrates were introduced from 1985, and so far these measures appear to have largely prevented new HIV infection in haemophiliacs. Meanwhile a tragic toll of iatrogenic disease and death continues to increase.

Download Full-text